Blame, Guilt, and Family Dysfunction

public domain

 

When I discuss family dysfunction, the question of “who’s to blame”– the adult children or their parents – frequently arises. Emotions then tend to run wild. I believe this is the wrong question. The fact is that all family members are beans in the same soup, acting out patterns that have been building up for generations and are being passed down. The right question should always be, “How do we FIX this?”

The question of blame is often the subject of vehement defensive reactions by the community of parents in the US, who gripe about anyone who engages in“ parent blaming” and “parent bashing.” They want to believe that they have absolutely nothing to do with their children’s problems, which they like to think are all genetic or all caused by peer groups at school.

Many mental health practitioners have sided with these nonsensical ideas. I’ve written before about a time when, at a nearby child and adolescent psychiatric hospital, juvenile delinquency and even suicidal thoughts were blamed entirely on heavy metal music. That way, parental guilt could be assuaged so they would pay for their kids to get “treated” for listening to Judas Priest. Well, at least until their insurance ran out.

So are these folks saying that even physical and sexual abuse by parents has nothing to do with children’s insecurities? Or their acting out? Even here, the answer seems to be a sort of yes – people falsely opining that the incidence of this abuse is actually minimal and that almost all of these accusations of such are false. Really?

It is true that if a therapist makes a parent feel guilty, they are less likely to look critically at their own parenting practices or seek help, so therapists have to figure out a way around this paradox. My therapy model attempted to do just that with patients who were adult children facing this conundrum.

I have also written about the massive increase in recent years in parental guilt caused by cultural changes in gender roles. In reaction, this has led to an epidemic of so-called helicopter parenting. That this type of interaction is a major correlate of adolescent depression, which means probably with the rate of suicide as well, has been recently demonstrated in studies (for example: Wattanatchariya K, Narkpongphun A, Kawilapat S. The relationship between parental adverse childhood experiences and parenting behaviors. Acta Psych. 2024(243).  While correlation and causation are two different things, I believe on the basis of my wide clinical experience that in this case these studies are indeed about causation.

Another complication of parent guilt was described in the 2/27/24 column by advice columnist Carolyn Hax.  A mother described herself as being wracked with guilt because her teenage children suffered from anxiety and depression, despite her and her spouse loving them immeasurably and doing their best every day to support, listen to and nurture them. Ms. Hax of course tried to tell her that she did not screw up because “kids everywhere are having an extraordinarily difficult time right now” and that “depression and anxiety are way up, stress is up, mental health resources are strained, and schools are overburdened, underfunded and understaffed.”

My fear is that Ms. Hax’s advice for her to stop beating herself will fall on deaf ears. As I have described in previous posts, parental guilt has become more widespread, and parents often feed into the guilt of other parents – especially if the parents try to set limits with their kids instead of helicoptering. I can recall other families giving us a hard time when we wouldn’t give our kids away at college unlimited funds to do whatever they wanted.

Besides stopping parents from setting appropriate limits with their kids or disciplining them properly, another big problem is one that I have seen clinically but which is not described in the mental health literature: the kids see their parents feeling guilty all the time even when there is no obvious reason for it, and take this to mean that their parents need to feel guilty. They may therefore act like they are more impaired than they actually are so that the parents can continue to indulge this need. The fact that the guilt remains omnipresent in this situation confirms their beliefs!

In a column the very next day, Ms. Hax answered a letter in which a wife in an abusive relationship will not leave for fear of harming the kids.  The letter says “But I read so much about how kids thrive in stable families and are damaged by splits or divorces other than in highly abusive situations. My partner is not physically abusive but checks a lot of other boxes: yelling, vicious anger  name-calling, silent treatments.”

How anyone can possibly believe that subjecting kids to this sort of abuse is better for them than coping with their feelings about a parental divorce is beyond me. And kids are smart enough to wonder about that themselves. So how do they then interpret Mom’s refusal to leave? Perhaps mom is using the kids as some sort of excuse because deep down she thinks she needs or deserves her husband’s abuse? I know that sounds bizarre, but you would be surprised.

In fact, although obviously I can’t say in this particular case on the basis of a letter to an advice columnist, there may even be an element of truth in this idea. The answer to what might be going on can often be obtained by a therapist using the Adlerian question: “What would be the downside of successfully getting out of this bad relationship?” A common answer: "My parents would blame me and tell me I should go back to him and be a better wife." I kid you not! Maybe because those parents themselves are in a similar relationship. If so, we’d have to find out whether this is indeed the case, and then ask the Adlerian question to the grandparents about why they continue their relationship.

When people feel guilty, it leads to defensiveness, which can lead to fight, flight or freeze reactions which cut off conversations about how to solve problems. Since the problems go back many generations, I have always suggested that we just put the blame on Adam and Eve, and be done with it.

 

 

 

 

 

The Pervasive Weaknesses of Psychotherapy Studies

A psychiatrist with Intense, bulging eyes by C. Josef, CC Attributions 4.0

 

In my last post, I mentioned that the research into both psychotherapy outcomes and personality disorders is extremely weak, and even that characterization may even be giving it too much credit. Extensive clinical experience has been dismissed as “anecdotal,” even when therapists see the same things over and over again and their observations are confirmed by many other therapists who actually look at the same phenomena.

The irony here is that almost ALL of the “research” data in these two areas is a collection of anecdotes, since they are entirely based on patient self-report or the experimenters’ personal observations – all of which are subject to significant bias. We cannot read minds and people act and lie a lot, and a lot of other influences on the “data” are extant and unknown to the researchers.

Most psychotherapy outcome studies are characterized by frequent patient drop-outs and by the fact that a significant portion of the study subjects do not respond to the treatment being offered. And outcome measures in these studies are typically the relief of symptoms, not changes in the patient’s abilities to love, work, and play successfully. And the subjects are rarely followed up for a significant period of time to see if any results that are attained last. A significant portion of the study “gains” are often lost after a year or so.

There are over 200 different models for understanding psychopathology and doing psychotherapy, although most are variations of the five major models: psychodynamic, cognitive, behavioral, affect focused, and family systems. Most therapists borrow techniques from schools other than the one they were trained  in.

When results from several different studies using different schools are compared, most tend to come out with about the same success rates. In the beginning of a movement to try to integrate the different schools, this was known jokingly as the Dodo Bird verdict (after a character in Alice in Wonderland) – all have won and all must have prizes. And when two schools are compared in a single study, the school of person who is the lead author of the study comes out the winner in 85% of them (an allegiance effect). Bias, anyone?

Even then, when a certain percentage of the study subjects did respond to the “inferior” treatment, we don’t know whether or not they would have done well in the “better” treatment. Or if those who did not respond to the “better” one would have responded to the other treatment.

Over the years I have posted critiques of the “research” and in this post will summarize a bunch more of the points I made. If there is a whole post about them, I’ll include a link to the original.

A big one I mentioned in the last post: when a school of therapy is evaluated, the individual interventions which comprise them (of which there are quite a few) usually are not, so we don’t know which of them worked and which of them did not or were even counterproductive. Responses to the individual interventions are important to know about because, despite the use of treatment manuals supposedly insuring that all therapists in a study using a specific school are doing the same things, this is not possible. Subjects all respond differently to a given intervention. Therapists have to pick and choose which intervention will be used next. Also differing - with significant impact - is the way the intervention is presented: phrasing, body language, tone of voice etc.

Another major study weakness: Those that try to apportion causation of psychological behavioral syndromes to genetic vs. environmental influences use studies of twins raised apart. This type of study routinely over-estimates genetic contributions by assuming parents treat all their children alike, which is way off. Furthermore, they are looking at the end result of gene and environmental interaction (phenotype, not genotype) without any way to know how much of a given finding to apportion to each of them.

Most psychotherapy outcome studies exclude patients with more than one disorder, although a high percentage of patients have co-morbid affective and anxiety disorders as well as more than one personality disorder. The therapy will of course look more effective if you include only the easiest patients.

In studies of psychiatric symptoms which may occur in response to stress, reactions are evaluated without any reference to what the actual stresses were to which the subjects were responding. 

Confusion between correlation and causation is illustrated in such studies as those that attempt to determine the causes or the results of drug abuse. For example: Does marijuana cause poor school performance or the other way around - or is there actually a third factor which leads to both of them?

Differences in brain area size and functioning between different groups on fMRI scans are automatically interpreted as abnormalities. In fact, most differences are due to normal neural plasticity in response to changes in the environment.

In studying  the nature of the relationship between parents and children, No one can  precisely measure the nature of the relationship. These relationships are not constants but vary across time and situational contexts. Parents might be good disciplinarians when it comes to providing children with adequate curfews, for example, but terrible at allowing them to stay up all hours of the night. Furthermore, the disciplinary practices certainly change over time as the children get older. Second, how does a study even attempt to measure the tone of parenting practices? Third, oftentimes studies are based on parent self report. If a mother were abusive or inconsistent, how likely do these authors think she would admit to it, even if she were very self-aware, which obviously many people are not.

In some Cognitive Behavioral Therapy outcome sudies, therapy  is at times compared with "treatment as usual" —letting subjects get whatever other treatments outside of the study treatment that they chose to have, allowing good therapists and bad therapists, and good therapies and bad therapies, to essentially cancel each other out. Even so, the sizes of treatment effects are only small to moderate.  “Response” just meant there was some significant improvement in symptoms, not that the symptoms of the disorders actually went away. Rates for actual remission from the disorders were even smaller. A considerable proportion of study patients do not sufficiently benefit from CBT.

In epidemiological research into environmental risk factors for various psychiatric disorders, most studies try to measure the effect of a single environmental exposure on a single outcome—something that rarely exists in the real world. Individuals are exposed to environmental elements as they accumulate over time, so that one single exposure usually means very little. Exposure also is “dynamic, interactive, and intertwined" with various other domains including those internal to individuals, what individuals do within various contexts, and the external environment itself—which is constantly changing. Last but not least, each individual attributes a different, and sometimes changing, psychological meaning to everything that happens to them.

The difference between “cannot” and “do not:” Study are often characterized by lack of attention to subject motivation, and ignorance of the concept of “false self.” In one study, high-psychopathy participants showed atypical, significantly reduced neural responses in the brain on an fMRI to negatively-toned pictures under passive viewing conditions. However, this effect seemed to disappear when the subjects were instructed to try to maximize their naturally occurring emotional reactions to these same pictures!

Researchers mistake a high index of suspicion for an “inability” to correctly read the mental states of others.

Studies show that changing a parent’s behavior towards BPD children can make those with BPD better—but seem to ignore the possibility that their behavior apparently helped cause the disorder in the first place.

When Children Kill Their Parents

According to CBS News, most offspring who kill their parents are adult children, meaning they are over 18 years of age. Over the 32-year period examined, the number of juvenile parricide offenders was substantially lower. On the average, juveniles killed 31 fathers and 18 mothers per year. The reverse is more common: according to FBI statistics, an average of about 450 children of all ages yearly are killed by their own parents. Parents were responsible for 61% of child murders under the age of five.

The fact that young children or older adult children kill their own parents seems to run counter to one of the themes of this blog: that a lot of behavior problems and self-destructive patterns are caused by the residue of kin selection, the tendency of people to put their kin and ethic group’s interests above their own, and in certain circumstances be willing to sacrifice themselves. Even die for them. If this is really the case, and I’ve been witnessing self sacrifice for decades in my psychotherapy patient population, how can we account for children killing parents?

I must admit I do not know for certain, since I have never had anyone who killed a parent in psychotherapy with me. However, based on my theory, I believe the main reason may have to do with another concept I’ve written about: Hatefulness as a gift of love. In some cases, parents hate themselves so much and think their children are so much better off without them - even if the child ends up in jail - that they act hatefully to such an extent that they kind of give off the message “kill me.” 

Another reason was illustrated in a case I am about to discuss: A parent who wants to murder a spouse may appear to be so selfish as to have their child take the rap for killing that person—thinking that the child would not have to go to jail due to being so young.

In almost all cases, kids who kill parents are victims of severe abuse, as in the cases to be discussed. But severe abuse alone is clearly not enough to induce a kid to do something like that, since the number of cases of severe child abuse massively exceeds the number of such killings. Most children who are abused do not even tell on their parents, let alone kill one of them. As little kids, they often think being beaten is normal, and worry more about their parents’ mental health than their own. So it has to be abuse plus something else. In one of the two cases to be discussed, it was a direct suggestion.

As one piece of evidence that the theory of self-sacrifice is correct even in these cases, one of the persons about to be discussed (Ms. Bailey) says herself in her book: “It is innate in us to want to protect the only thing we know, and even through abuse and neglect we still seek to protect the very ones who inflict such pain.”

Two cases  have been in the media lately: The first was featured on an A&E TV documentary called The Prison Confessions of Gypsy Rose Blanchard. When she was in her early twenties, she induced an angry and easily manipulated boy  to kill her own mother. Afterwards, she was imprisoned for almost 10 years before being paroled.,The actual killer is still in prison. 

The second is in a book called My Mother’s Soldier, written by a woman named Mary Elizabeth Bailey. When she was only 11 years old, her mother induced her to shoot and kill her highly abusive stepfather. In that case, she was afterwards whisked away to foster care while her mother went to jail, just as the mother must have suspected would happen.

Both of these women relate horrifying tales of severe abuse by parental figures, while Ms. Bailey was also severely neglected.

Blanchard was a victim of Munchausen by proxy, where her mother faked illnesses in her as well as disabilities in order to get money. People, including supposedly much of her mother’s family, didn’t think she was able to walk, since she was always in a wheelchair. She was subjected to surgeries and medications she did not need. Apparently mom was really good at faking this stuff in her with doctors, and the girl willingly went along with it. At one point mom insisted the girl had a fear of eating, and a stomach tube was surgically inserted in her. She was in the hospital for six months with it.

The two of them moved from place to place. The mother would not let her go to school  or have any friends, so they were each other’s only major relationship in life for years. The child felt so stymied that she recalled her first day in prison as a happy time. For the first time in her life - even in that environment - she felt “free.”

In the Bailey case, the murderous child had  been sexually abused by her grandfather – who of course denied it when interviewed and who theorized quickly that Mary was trying to shift the blame for the murder on to him. But how on earth had he brought up a daughter who would do such terrible things to her own daughter? By comparison, Mom made him look like an ideal parent.

Unlike with the grandfather, Bailey idealized her grandmother. This is understandable since Grandma was the only family member who treated her with love in one-to-interactions, and frequently took her under her care when the mother wanted to go out and party. On the other hand, grandma had also been the one who raised the incredibly irresponsible mother who had dropped out of school very early, ran wild, had sex somewhat indiscriminately with multiple partners even while married to an insecure, violent alcoholic (who probably was doing the same thing) who frequently beat her up. And Grandma often returned Mary to the mother’s abusive, neglectful care whenever the mother asked her to because of the mother's need for help  financing her life.

And she never called the police about any of the abuse. The only time she even threatened to do that was when the stepfather threatened her, and he responded by hitting her so hard on the side of the head that she had hearing damage. And yet still no call to the police.

Mary was generally ignored to the point where she was often given no food for days. Stepdad came into the picture after the girl had been raised for a time by the grandmother. (The fact that he was not a primary attachment figure originally might have made it easier for Mary to follow her mother’s instructions to shoot him). 

Stepdad beat her frequently, and the only things he had to say to her were names like “you little redheaded brat!” He had a job which took him away from the house for significant periods of time, but mom didn’t take care of her daughter either – she would go off to party at some nearby apartments. She rather openly had affairs even though she knew her husband was a violent alcoholic and would find out and beat her as well as the kids.

Pretty amazing stuff.

 

New Podcast, Part II. Family Dysfunction Effects Not "All in Your Head"

New podcast, Part II, discusses my family dysfunction model in more detail. Your problems with it are not "all in your head."

https://www.youtube.com/watch?v=pjG5LbV26ps

The Canceling of the American Psychotherapist

 

In my review of the book, The Coddling of the American Mind by Haidt and Lukianoff, I focused on a cultural shift on college campuses that has often led to an environment characterized by political correctness rather than free and open debate between opposing viewpoints. Groups have even turned on their own members for deviating ever so slightly from a “party line.” I discussed how this is one way that groupthink can manifest itself.

A  new book by Lukianoff and Schlot talks about how this situation has apparently gotten much worse, and has spread to other educational institutions and vocational venues such as journalism.

One of the most problematic ideas of groupthink on campuses has to do with the so-called Diversity, Equity and Inclusion (DEI) philosophy. Of course, diversity, equality (of opportunity, not of outcome), and inclusiveness are virtuous and wonderful things when applied to individuals with all of their family and historical influences and experiences. Unfortunately, this has now morphed into defining people entirely by their ethnic group. Members of groups are either ALL victims (ALL black people) or ALL oppressors because they may have benefitted in some  way from their “advantages” (ALL white people). 

Apparently except for Jews, who have been just about the most oppressed group for the longest time over history but also somehow counted some of the world's most successful people among their numbers. This obvious rebuttal to “Critical Theory” has been solved by some people by seeing Jews as White colonialists, while by others seeing them as Colored. Whichever is convenient. These people are still trying to figure out how to classify Asian Americans who aren’t white but who are who also more successful on average than other American groups.

This is in fact exactly the opposite of what Martin Luthor King preached! He spoke of judging people by the content of their character and not by the color of their skin.

But no matter. The primary reason that I am reviewing this book is because this type of thinking has now spread to psychotherapy teaching programs! Your problems all now seem to originate, not from your family or personality or genetics, but from the fact that you are either an oppressor or a victim, according to your group identity, and you need to admit it! As the authors say, “It’s not about your problems. You are the problem.”  

Everything wrong with people is seen through this lens. Therapists are now lecturing patients who have “incorrect” political views. “Multicultural and social justice counseling competencies” has even been endorsed by the American Counseling Association. The American Psychological Association is beginning to follow suit. They endorse, for instance, the idea that the repression of feelings of males typically seen in many cultures (who, say, won’t cry), often modeled by parents, is an example of traditional masculinity invariably being “toxic.”

The authors of the Cancelling book believe that these approaches are counterproductive. They can cause patients to see themselves only as helpless victims, and discourage people who are automatically assumed to be perpetrators from seeking help. How do these therapists reconcile themselves to the fact that, in 2020, 70% of completed suicides were “privileged” white males (according to the American Suicide Foundation).

When I first read the chapter about psychology programs I was a little unsure how common this was, since I hadn't heard about it. But then I saw an advertisement for a book for therapists in the Psychotherapy Networker magazine. It was called Decolonizing Therapy by a PsyD named Jennifer Mullan. I quote from the ad: "Ignoring collective global trauma makes delivering effective therapy impossible; not knowing how to interrogate privilege (as a therapist, client, or both), and shying away from understanding how we may be participating in oppression is irresponsible." 

Well, I do believe a therapist has to understand what each family may have experienced in this regard to understand certain shared intrapsychic conflicts that are seen within a given family - but each family is unique. And hopefully the therapist is not acting out blatantly racist attitudes. To assume all white therapists are doing this is what is irresponsible.

Anyone who disagrees in some graduate programs is in high danger of being “cancelled” by fellow students. One student said the environment was so mean that a student who lost a family member to COVID was afraid to tell anyone lest they be told that they were crying “white tears” and lectured about how people of color were the real victims of the pandemic!

Now of course it is true that many people have been severely traumatized  by racial or group experiences and that such trauma can lead to psychopathology, but that is not the same as saying that other factors might not be equally or even more important.

This is a perfect example of one key feature of Groupthink: either/or or black and white thinking. No context, no subtlety. I recently had a negative personal experience with that type of thinking with psychology interns I used to lecture to. This one didn’t involve oppressors vs. victims, but there was a certain similarity in its misclassification scheme. And it’s something brand new.

I used to lecture them about borderline personality disorder (BPD). The interns came from the University of Tennessee Health Science center and another group of interns from the Memphis VA. Now admittedly I did discuss some of my own, outside-the-mainstream ideas, but I also discussed other current psychotherapy paradigms and theories about the disorder. 

After I retired, I was still invited back every year to give the talk. Then suddenly the person in charge who called me to do this stopped calling. It took me two or three years to find out why, but I finally was able to corner her. First the VA, and then the UT interns said they no longer wanted lectures about doctor’s individual practice experiences (mine was over 35 years), but only from people who did literature reviews or active researchers! 

This same type of thing was happening on my Psychology Today blog. One post I wrote was rejected because, they said, it was an opinion piece not based on research - when most of their posts are NOT research based. They just, for the first time in years, didn't like my opinion. So I stopped posting.

As readers of my blogs know, the literature in both psychotherapy and BPD is weak - and that's being generous. It is characterized by false assumptions, the fact that whole schools of therapy are evaluated but not the individual interventions which comprise them, the ignoring of many obvious impacting factors, and clinically-useless correlations between certain symptoms within one diagnoses or between two of them. People with a lot of clinical experiences in this area are a hell of a lot more knowledgeable than researchers. 

The interns even wanted solely literature-based reviews a about the treatment of transgendered patients, which has barely begun as a subject for any studies at all!

If a therapist is more interested in politics and your ethnic group than in you, drop them ASAP and find another therapist.

Perpetrators of Domestic Violence

 

A new article in the blog ACE’s (Adverse Childhood Experiences) Too High  describes some new and current programs that aim to help the perpetrators of domestic violence. Not its victims, its perpetrators.

 

Help the perpetrators of domestic violence and not just its victims? Whoever heard of such a thing? How can anyone care about them? Not a popular idea to be sure.  Perpetrators are traditionally shunted to the side as worthy only of blame, shame and punishment.

However, if we want to actually decrease the incidence of domestic violence, we have to address the behavior of everyone involved. In fact, initial data shows that these programs reduce the level of recidivism among arrested wife beaters.  These healing  programs, most developed in the last decade or so, show a zero to 8 percent re-arrest rate over months or years, instead of the traditional rates of 12% to 60%. 

And the whole domestic violence situation is often a lot more complicated than it seems.

Sorry, it's not “blaming the victim” to point out that, according to the National Domestic Violence Hotline, it takes a victim of domestic violence on average seven times before they leave an abusive relationship for good. So not like they have nothing to do with it at all. What message does their going back give to the perpetrator? He’s usually aware that this is a puzzle: Why does she want to be with someone who treats her like that? Furthermore, why does he want to be with someone who pisses him off so much? Often abusers have themselves been victims of child abuse as children, and/or observed such things as domestic violence or drug abuse by their parents. 

Of course this does NOT excuse the violence. Abusers already know that what they have done is wrong, so any attempt by someone to excuse their behavior seems to them to be disingenuous, and therefore they would not take it seriously.  However, understanding them is a mechanism that can be employed in helping them gain control and alter dysfunctional interactions with their spouses. 

The ACE's blog article also points to the following facts to justify treating the perpetrators:

·         Many women don’t want to leave but would prefer that someone just fix        their partners; 

·         Teens who engage in dating violence often flip from abuser to being              abused; 

·         It’s becoming harder to tell who’s the primary aggressor, because both           parties stewed in the same dysfunctional soup when they were growing          up, and  the couples do as well in their current relationship.                  

·         Family violence and intimate partner violence are more accurate terms          for domestic violence because violence occurs between or among parents        and adult children, siblings, members of generations in the same family,         extended family or in gay relationships; 

·         Abuse is also emotional and financial, something for which it’s                   difficult to make an arrest.            

 

Family violence is at the root of many problems in any community: over-crowded courtrooms and jails, burgeoning child welfare caseloads, increased youth violence and gun violence, increased healthcare costs and homelessness—a significant portion of what a community spends its tax dollars.

 

Healing-centered programs require that an abuser take responsibility for the actions that lead to his or her arrest.  One of the themes of this blog is the ongoing relationship between child adversity and dysfunctional relationships. To get to the bottom of the problems of any given couple, in my opinion this absolutely must be addressed for both parties as well as for their own relationship. 

 

Although the various patterns of the intergeneration transfer of dysfunctional patterns that I describe in my blog are not well understood in the field, some people teaching healing-centered batterer interventions course are steeped in the science of childhood adversity.

 

The rest of the ACE's blog post describes more details of several of these programs throughout the country. There would probably be more of such programs, but the risk of being cancelled if you show any empathy at all towards abusers is high. That hurts the victims of domestic violence just as much as it does the perpetrators.