Book Review: The Origins of You by Vienna Pharaon

 

My “Unified Therapy” psychotherapy model, which I’ve been writing about since the publication of my first book in 1988, is meant to treat people who engage in repetitive self-destructive and self-defeating behavior, particularly in relationship contexts. You know, like people who marry one alcoholic or narcissist after another. While looking at their past is essential – in fact I look back three generations to find out why my patients, and their parents and grandparents, act the way they do – what’s even more important is what goes on in the present.

I found that people were acting out roles in their families to stabilize their parents, not for selfish reasons, and were suppressing who they really would want to be if left to their own devices. We all have a tendency to do this due to the effects of an evolutionary process called kin selection. We can choose to do otherwise, but if we do we become subject to terror when our families invalidate us.

Family roles are something modern day therapists pay almost no attention to, so when a book comes out that addresses dysfunctional behavior that dates back to family processes in childhood, I’m keen to read it. The Origins of You by therapist Vienna Pharaon is such a book. She looks at her clients' repetitive dysfunctional behavior in their relationships  as a way for them to feel safe because of earlier interactions with parents. She looks for ways that people do things like act like doormats in relationships – or go to opposite extremes and constantly try to dominate other people.

She addresses five needs from which these behaviors arise, which she says derive from what she calls “origin wounds.” She notes that her clients who had previous therapists often had not mentioned them. The needs which lead to these origin wounds are:

1.       I want to fell worthy.

2.     I want to belong

3.     I want to be prioritized.

4.     I want to trust

5.     I want to feel safe.

After review their childhood history, she uses a lot of popular techniques which are basically supposed to lead to behavior changes after insight into these wounds is achieved, and then has her clients monitor their behaviors for those which lead to conflicts, communication problems, and lack of boundaries. Then they talk about what changes need to be made.

The author claims a fair amount of success doing this, which I don’t doubt. She talks about emotionally abusive parents and a little about physically abusive ones, and domestic violence in the family. But not very much about severe physical abuse and neglect or child sexual abuse which families have refused to acknowledge. In my experience, clients like those who follow the recommendations here would be subject to massive invalidation by their families, which I found eventually and (almost always) undid any positive changes they had made from the type of therapy described in the book.

To her credit, the author does say that these problematic patterns are learned in the family and passed down to subsequent generations. And that the parents also have their own origin wounds, with which I totally agree.

But there are two issues that I (but almost no other therapists) have with her ideas. First, aren’t these people really aware at some level of what they are doing, even when they won’t admit it - even to themselves? Second, are they really protecting themselves, or are they altruistically sacrificing themselves for their parents?

On the first issue, the author does seem to come closer to my point of view in the text and with a couple of her clients. She mentions that a dysfunctional path “is easily recognizable, but sometimes hides in plain sight.” A client named Amir could clearly describe what he was doing but claimed to have no idea why. A long time ago I came to the conclusion that people are not stupid or blind about this, but acted as it they were. To understand what’s going on in my view, check out these posts on a groupthink process called willful blindness.

On the second issue, it’s hard to believe that clients are acting this way because they are protecting themselves, when the patterns are obviously bring them much pain. (There is one selfish motive mentioned above: the phenomenon of existential groundlessness). But as I have said, they are sacrificing their own needs to help maintain family stability.

Which also means that the process going on with the parents continues well into adulthood. The author seems to know this on some level but does not talk a lot about the response of their parents to new changes in the client’s behavior, so it’s hard to judge if she thinks this happens very often. Near the end of the book she does mention only briefly the risk that her clients maybe be “judged, shamed, rejected, or even disowned.”

In general, the author describes these patterns and how to conceptualize them very well, along with techniques which may lead to significant behavioral changes in some families where massive invalidation is far less likely that in those producing offspring with severe personality disorders. 

Pornography Addiction

Is pornography addiction a real condition? In the book I co-edited, Groupthink in Science, we have a chapter by Nicole Prause, a neuroscientist who has been very active in this debate (and is mentioned prominently in the book I’ll be talking abut). She makes what I consider an extremely good case that this “addiction” model is nonsensical. I agree.

In her book, The Pornography Wars, academic sociologist Dr. Kelsey Burke examines in fine detail both sides of this ongoing debate without clearly taking a position either way. She talks with a variety of academics and members of interest and church groups and gets them to open up considerably about their opinions. Clearly, a lot of the debate is based more on ideology than on science. On both sides! As we all know, sex is a subject that has created a huge disturbance in human culture, what with religion, gender issues, Victorian culture, and the like.

My own view is that sex negativity is still rampant in the United States, despite the fact that most people these days engage in relations prior to marriage. They often feel somewhat guilty about it afterwards. Interestingly, this has put radical feminists and religious fundamentalists on the same side of the pornography debate. What strange bedfellows indeed.

Now, to be extra clear, sex trafficking and being forced to participate in a porn film are issues that are completely legitimate. No one should be forced to do anything like this against their will. But in my mind, those issues are very different than the question of whether pornography per se is bad for anyone, and if so, who and in what way? Or the question of whether watching it compulsively in maladaptive ways is a “disease.”

I believe questions about addictions as true mental diseases should be limited to those substances, such as alcohol and opiates when used to excess, lead to tolerance and serious withdrawal symptoms. Just about anything can be used to excess and create negative consequences for the users and their associates. To me, most so-called “addictions” are nothing more than self-destructive behavior designed to have certain affects on family relationships and romantic partners.

I’d now like to list a few examples of the evidence for what I am saying here from the book in question. Research in this field, the author points out, depends on self-reports by subjects - which is not objective data, and which are highly dependent on the types of questions researchers ask and how they are phrased. There is, for example, a phenomenon called acquiescence, in which subjects’ responses are likely to go along with the values implied in the question - for example asking only about negative consequences but avoiding questions about positive benefits.

Lying about issues with moral implications is widely prevalent. Does anybody really believe that a female brought up in an evangelical religion will admit to secretly enjoying watching porn and having experienced no actual negative consequences from doing so outside of maybe feeling guilty? Additionally, it is obvious that people’s beliefs about porn influence the consequences they experience during and after watching it.

Another issue is correlation versus causation. Is watching porn bad for marriage, or does a bad marriage lead to more porn viewing? An interesting finding: Protestant men are more likely than any other, group, including atheists, to consider themselves addicted to porn. Yet they report watching less porn than the other groups. Several studies show that religious commitment is a better predictor of people believing  they are addicted than actual porn usage.

As I have discussed in several other posts, the fact that the brain’s connections are plastic and change all the time when exposed to environmental influences makes claims that neuroscience has “proved” that a porn “addicted” person has an organic disease incorrect. As Dr. Burke points out, nature and nurture and their interactions are what lead to most brains study results. And the boundaries between these things are “far from tidy.”

Another point: just because someone has a higher libido than someone else does not mean that they are sex addicts - they just want sex more often. Also, home porn may often be a cue for some other reward like masturbation. In a laboratory setting, contingencies like these aren’t in the cards.

Then there is a prominent Protestant theological teaching.  A quote from one of Billy Graham's recently posthumously-published newspaper columns sums it up concisely. He writes, “All people are sinners in need of a Savior.” What this means is clear from his sermons: prohibited but universal individualistic desires such as lust are evidence that we are all evil in the eyes of God and need to renounce our biological nature and follow what God – really the church – tells us to do. Or else. In the words of a woman at a church group’s conference on the harms created by porn addiction, "...after the Garden of Eden we’ve been running from God ever since.”

This also has led to perceptions about men versus women’s sexuality. Religion teaches us that sin was created by a woman’s curiosity when Eve bit into the apple. In the middle ages, women were actually considered the lustier of the two sexes due to the impurity associated with Eve’s curiosity. In the 1800’s during the industrial revolution and mass migration from family farms into cities, this changed into its opposite: women changed from Eve to Mary. Women were thought to want sex, not for itself, but only in order to insure the commitment of marriage. “Why buy the cow if you can get the milk for free?” was a question asked by confirmed virgins. Although men were thought to want sex way more than women, they were also perceived as being less in control of their behavior. Masculinity was defined as being in control, so if they “conquered” the natural sinfulness of a porn addiction, this was thought of as an accomplishment.

In my opinion, the function that all this mythology serves is to show the negative effect of allowing yourself to express lust, so the people who are doing without get to feel more justified in giving freer sex up. Said one Christian who had “overcome” a porn “addiction,” quoted in the book, he was “…tired of not being the person that God made me to be.”

Well, what about those radical feminists? They are certainly not primarily evangelical Christians. Nonetheless, they have without realizing it accepted the Christian dogma while trying to frame it as something else. Both Evangelicals and radical feminists believe that men feel entitled to sex and women are both objectified and victimized. The radical feminists seem to implicitly accept the idea that women cannot want and enjoy sex as much as men, despite the fact that they can have multiple orgasms and men cannot.  The general sex negativity towards women's lust prevalent in both sexes  in our “patriarchal” society  was summed up nicely by Elise Loehnen: "Good women want to be seen as sensual, warm and inviting of sex, but not overtly interested."

Because of the prevalence of these gender attitudes and in order to sell more, porn does in fact  frequently show women being objectified by men. The feminists  use this to “prove” their point, ignoring that this occurs because of the cultural groupthink expectations of the audience. And there are plenty of women who somehow enjoy watching porn as much as men do even under these circumstances.

I am Interviewed on Two New Podcasts

 I'm interviewed on two new podcasts. 

The first describes my background and how I got interested in the family dynamics of self-destructive behavior (particularly borderline personality disorder) and its psychotherapy:

https://www.youtube.com/watch?v=XPQdl664QgM

In the second one, I talk about my self-help book, Coping with Critical, Demanding, and Dysfunctional Parents: Powerful Strategies to Help Adult Children Maintain Boundaries and Stay Sane:

https://www.youtube.com/watch?v=MLM6tvLe_Oo&list=PLOSSy_bIynJqUnE3ilzI9UR7J92aYeCI2&index=42

Medication for Symptoms of Borderline Personality Disorder

A recent review of the literature on the use of medications in cases of people with borderline personality (BPD) disorder (“Pharmacological Treatments for Borderline Personality Disorder: A Systematic Review and Meta-Analysis.”  CNS Drugs. 35(10):1053-1067, 2021 10) concluded that “Despite the common use of pharmacotherapies for patients with BPD, the available evidence does not support the efficacy of pharmacotherapies alone to reduce the severity of BPD.” Additionally, “Second-generation antipsychotics, anticonvulsants, and antidepressants were not able to consistently reduce the severity of BPD.”

Well, duh. This is hardly surprising in light of the fact that personality disorders are primarily disorders of relationships and their subsequent effect on the mental state of participants in problematic interactions. Last I checked, medications do not fix relationships.

So are medications not indicated at all for people with this relatively common disorder? Well that’s nonsense as well, because sufferers often have other co-existing anxiety and mood syndromes (comorbid disorders) for which meds are most useful. The most common one in this population is panic disorder. One study showed that 40% of these people experienced panic attacks, but I think it’s much higher than that, at least in the patients who came to a psychiatrist like me for psychotherapy. It’s also true that rage attacks—another symptom of the disorder—are physiologically identical to panic attacks. You know, fight or flight.

I found out relatively early on that self injurious behavior like self-cutting or burning or bulimia often occurred when a patient found themselves in a hopeless bind in their families in which they felt it was imperative to do something to “fix” the situation but they felt helpless to do so. I discovered this the hard way. 

A patient would call me, often late at night, asking me what to do about something when they knew very well that I did not yet know enough about their situation to make any suggestions which would actually be helpful. If I dared to offer most anything, they immediately would know that I was full of crap. Talk about a sense of helplessness. I later figured out the best response in this situation was to say, “You don’t have to do anything right now. From what you’ve told me, this crisis will soon pass and be replaced by another crisis in short order.” Patients found this comment had a calming effect.

So what medications can reduce the chances of self injurious behavior by lowering the frequency of panic attacks? Oddly, when I first started private practice way back in 1979, a psychoanalyst (of all people) told me the secret: a combination of an antidepressant drug called an MAO inhibitor (this was before there were any Prozac-like drugs, which also fill the bill) with a long acting benzodiazepine like Clonazepam. Prescribing these worked far more quickly for reducing or even stopping self injurious behavior episodes than months of dialectical behavior therapy, and was quite effective.

Naturally, I was criticized for prescribing this combination. With MAOI’s, the patient would have to avoid certain foods and drugs which interact with these medications and cause an attack of severe high blood pressure. (Luckily with the Prozac-like SSRI’s, this is no longer an issue). “You mean you trusted these people to keep to the diet?!? I was asked. My answer, “Yes I do if they tell me they will stick to the diet.” Yes, and if they told me that, lo and behold, they did! I had only one patient take a proscribed medication, ending up in the ER, and I took him off the MAOI immediately.

“And benzo’s can be abused!” was the next attack. Yes, so can pretty much anything. Once again, if the patient agreed to take the meds as prescribed, and I prescribed an adequate dose (patients who were given sub-therapeutic doses tended to raise the dose on their own), seemed not to abuse them. I received further confirmation of this belief when states started to produce a data base of prescriptions for drugs of abuse, and I saw that my patients were only rarely getting them from another doc (in which case I immediately tapered them off the drug). Luckily, with the exception of Xanax and in methadone treatment centers, there is no large street market offering my patients benzo’s.

So are there studies that prove this combination is effective in the way I say? Well I’ve been on the lookout for such studies for decades, and there literally aren’t any! The closest that come are those that study SSRI’s by themselves in this population without the necessary augmentation. They show some very small effects on self-injury, but nothing substantial. Oddly, I asked the guy who did most of these studies if he ever considered doing the add-on one, and he looked at me as if he didn’t understand what I was talking about. He later gave a talk on BPD and chemicals (neurotransmitters) that help brain cells communicate, and he discussed several of them. Except one —GABA—which is the most important one in anxiety and the target of benzo drugs.

Verrrrry interrrresssssting.

Book Review: Stolen by Elizabeth Gilpin

 

A startling and fascinating new book and an equally mesmerizing new Netflix documentary look at organizations which are designed to destroy people’s self actualization and their true selves in favor of a particularly monstrous form of groupthink. As the author of Stolen says, attendees were supposed to become like bees in a hive. Both of these groups twisted religion and psychotherapy to the point that they are almost unrecognizable.

One, the one described in the book, was even worse than the other, if that’s even possible, because it attacked and destroyed children: so called “schools” for “troubled” kids. At least the one described in the documentary was aimed at adults who were willing participants.

This post will be about the book, while the doc will be described in the next one. Stolen, was written by a woman who, when she was 15 years old, was a star high school athlete in two sports and an A student—but was nonetheless labeled as a disturbed troublemaker by her highly critical and often absent father and a hyper-religious mother who spent a lot of her time reading the Bible. Gilpin doesn’t describe any physical or sexual abuse in her home, but strongly implies that her parents, particularly her Dad, were verbally abusive and highly invalidating. Her Mom would support her privately but then always side with the Dad when the family was together.

She had started running away when she was only five, and later began partying with high school friends to avoid being home. She was also admittedly very angry and at times returned the father's verbal abuse, and she did dabble in alcohol and pot a few times. But the book doesn’t really describe in detail why she was so angry, although she did accuse her parents of never believing her. Oddly, the parents entirely discounted their own parenting as a factor in her behavior and never seem to wonder what made her like she was. At one point during her stay at the school, her father wrote a letter that said, “I’m glad that you’ve been able to accept that you’re ultimately to blame for your own anger.”

She was suddenly taken away by strangers in the middle of the night and sent to a “therapeutic” boarding school run by an organization called CEBU, which was anything but therapeutic. For the first three months, the teens were made to hike over and over again to a bunch of different campsites in the middle of the woods and were subject to physical abuse, such as being made to keep marching even after the group was attacked by a hive of bees and had multiple stings. They weren’t allowed to shower and were given crap to eat. They were monitored constantly and communication between the victims was highly restricted.

They were then transferred to a high school which had various exercises that were designed after something we Californians were aware of in the sixties and seventies called the Synanon Games, a twisted version of AA. More on Synanon at the end of the post.

During these games the teens were subject to vicious verbal attacks from the people running the school, and also forced to attack one another in the same way. For the high crime of having engaged in a sex act, for example, the girls were called sluts and whores who were desperately seeking attention (because they were starved of it at home perhaps?). With the boys, however, the prevailing attitude was “boys will be boys.” 

Gilpin was still a virgin at the time, but was immediately told she was a liar when she said that. She was accused of being a drug addict and an alcoholic despite her limited behavior in this regard. If a student denied being an addict, they were immediately accused of being “in denial.”

If she told the truth, it never seemed to be bad enough for the counselors, so she began to just make stuff up. Clearly she wasn’t the only one of the teens who felt they had to do that. If the teens rebelled, they were punished severely. Once when she threw up she was forced to eat her own vomit. They were threatened with being transferred to an even worse facility, masquerading as a hospital, if they did not fall in line.

Clearly the program was an exercise in degradation designed to stamp out any semblance of individuality. Gilpin said that the more self hating she seemed, the more she was praised for “doing good work.” In reality, both her parents and the school were victim blaming, scapegoating her for her own abuse at their hands. One of her friends there later committed suicide.

Interestingly, even after she “graduated,” she did not tell her parents exactly what took place at the school. At least she did not write about doing so. She described herself as letting her anger with them take over, doing nothing but shouting at them about how f’d up they were for sending her to such an awful place. IMO, in doing this, she was actually providing her parents with justification for their having sent her there in the first place. Protecting them to an extent, just as I suspect she was doing by not describing in more detail in the book the way they had been treating her that made her want to run away so badly.

Synanon was initially a drug rehabilitation program founded by Charles E. Dederich in 1958 in Santa Monica, California. By the early 1960s, Synanon became an alternative community - later labeled a cult - centered on group truth-telling sessions that came to be known as the Synanon Game, a form of attack therapy. 

Attack therapy involves highly confrontational interaction between the patient and a therapist, or between the patient and fellow patients during group therapy, in which the patient may be verbally abused, denounced, or humiliated by the therapist or other members of the group. Attack therapy "attempts to tear down the patient's defenses by extreme verbal or physical measures."

Synanon ultimately became the Church of Synanon in the 1970s. Synanon disbanded in 1991 due to members being convicted of criminal activities (including attempted murder) and retroactive loss of its tax-free status with the Internal Revenue Service due to financial misdeeds, destruction of evidence, and terrorism. It has been called one of the “most dangerous and violent cults America had ever seen." Mel Wasserman, influenced by his Synanon experience, founded the CEDU's schools which used the confrontation model of Synanon. 

The CEDU model was widely influential on the development of parent-choice, private-pay residential programs. People originally inspired by their CEDU experience developed or strongly influenced a significant number of the schools in the therapeutic boarding school industry.

Book Review: Not to People Like Us by Susan Weitzman

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Oh well.

Why Fat Shaming is Counterproductive

 

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

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

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

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

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

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

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

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

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

More Stories from the Journal of Obvious Results

As I did on my posts of  November 30, 2011,   October 2, 2012, September 17, 2013,  June 3, 2014,  February 24, 2015,  December 15, 2015,  September 13, 2016 and March 15, 2017, it’s time once again to look over the highlights of the latest issue of one of my two favorite psychiatry journals, Duh! and No Sh*t, Sherlock. We'll take a look at the unsurprising findings published in the latest issue of the later. 

The journals honor the tradition of The Golden Fleece Award, an award given to public officials in the United States for their squandering of public money, its name sardonically derived from the actual Order of the Golden Fleece, a prestigious chivalric award created in the late-15th Century, and a play on the word fleece, as in charging excessively for goods or services. The late United States  Senator William  Proxmire  began to issue the Golden Fleece Award in 1975 in monthly press releases.

My comments are in bronze.

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

3/17/17. Because substance abuse is an indicator of being satisfied with your life. US Veterans With Substance Abuse Problems May Have Higher Risk Of Suicide Than Veterans Without Such Problems, Study Suggests. HealthDay  reported, “US veterans with substance abuse problems have a higher risk of suicide than veterans who don’t,” researchers found after examining data on “more than four million veterans.” The findings were published online March 16 in the journal Addiction.

5/24/17. Because having a potentially fatal illness is so exhilarating. Lung Cancer Diagnosis May Increase Suicide Risk, Study Suggests. HealthDay (5/23, Mille) reports that research suggests individuals “with lung cancer have a strikingly higher-than-normal risk of suicide.” Investigators looked at “data from over 3 million patients during a 40-year period.” The research indicated “that a lung cancer diagnosis raised the odds of suicide by over four times compared to people in the general population.” The findings were presented at the American Thoracic Society meeting.

5/30/17. Because most people adjust instantly when uprooted from their entire way of life by a bloody war. Syrian Refugee Children Living In The US Reported High Levels Of Anxiety, Small Study Suggests. MedPage Today (5/28, Visk) reported, “Syrian refugee children living in the US reported high levels of anxiety,” researchers found. Specifically, “based on self-reported test scores, more than half of children had a probable anxiety diagnosis, and more than 80% had probable separation anxiety,” the 59-child study revealed. The findings were presented during a poster session at the American Psychiatric Association’s annual meeting. Healio (5/26, Oldt) also covered the study.

8/17/17. Cheaters are prone to cheat? Will wonders never cease? Serial Infidelity Across Subsequent Relationships (Arch Sex Behav; ePub 2017 Aug 7; Knopp, et al ).  Prior infidelity emerged as an important risk factor for infidelity in next relationships, according to a recent study. Researchers addressed risk for serial infidelity by following adult participants (n=484) longitudinally through 2 mixed-gender romantic relationships. Participants reported their own extra-dyadic sexual involvement (ESI) (ie, having sexual relations with someone other than their partner) as well as both known and suspected ESI on the part of their partners in each romantic relationship.

9/6/17.  And I thought most elderly people who fall fall out of bed. For nursing home residents, mobility increases risk of fracture. Reuters (9/5, Rapaport) reports a new study published in The Journals of Gerontology: Series A found that for nursing home residents, “risk factors for fracture included the ability to walk independently, wandering the halls, dementia and diabetes.” The study was based on data from “419,668 nursing home residents, including 14,553 who experienced hip fractures.” Lead author Sarah Berry, MD, of the Institute for Aging Research and Harvard Medical School in Boston said, “Frail nursing home residents that are still mobile and independent have opportunity to fall.”

9/6/17. People prone to diseases get them more often than those who are not? Genetic variants linked to health problems appear less frequently in people who live longer, study indicates. Newsweek (9/5, Osborne) reports genetic research published in PLOS Biology used data from over 200,000 people to show humans “appear to be evolving to hit puberty later and those who start at an older age live longer.” Researchers also discovered that “genetic variants linked to heart disease, obesity and high cholesterol appear less frequently in people who live longer.”

9/8/17. Because major depression has a genetic component, and depressed mothers may have attachment issues or altered parental behavior, ya think? Children Whose Mothers Took Antidepressants During Pregnancy May Be At Increased Risk For Psychiatric Illnesses Themselves, Research Indicates. HealthDay (9/7, Preidt) reports, “Children whose mothers took antidepressants during pregnancy may be at increased risk for psychiatric disorders themselves,” researchers concluded after reviewing “data from more than 905,000 children born in Denmark between 1998 and 2012,” whose “health was followed for up to 16.5 years.” The findings were published online Sept. 6 in the BMJ. According to Medscape (9/7, Brooks), the authors of an accompanying editorial “say that reporting absolute risks, as the researchers do in this study, is important to facilitate communication between clinicians and pregnant women.”

9/8/17. Maybe cuz they’re the ones who are eating again? Young Women With Anorexia Nervosa Who Resume Menstruation By End Of Treatment May Experience Greater Improvement In Psychological, Physiological Well-Being Than Those Who Do Not, Small Study Suggests.

Medscape (9/7, Davenport) reports, “Young women with anorexia nervosa (AN) who resume menstruation by the end of treatment experience greater improvement in both psychological and physiologic well-being than those who do not,” researchers found after studying 39 women with AN and 40 women with bulimia nervosa. The findings were presented at the European College of Neuropsychopharmacology Congress.

9/8/17.  Why would you need doctors for people to have healthcare? I just don’t understand. ACA Plans With Narrow Networks May Provide Less Access To Mental Healthcare, Study Indicates. Reuters (9/7, Rapaport) reports that according to a new study conducted by researchers at the University of Pennsylvania Perelman School of Medicine in Philadelphia, “narrow-network insurance plans created by the Affordable Care Act (ACA) offer only limited access to mental health care.” The article says these plans seem to have substituted lower costs for less access to mental healthcare.

9/11/17. Self destructive kids study less? High school students with poor grades more likely to have unhealthy behaviors, CDC study indicates. The Atlanta Journal-Constitution (9/8, Hart) reported, “There’s a link between unhealthy behavior and bad grades, according to a new study of high school students by the US Centers for Disease Control and Prevention.”  HealthDay (9/8, Preidt) reported the study suggests US high school students with poor grades are “much more likely to have unhealthy behaviors – including illegal drug use – than teens at the top of the class,” researchers concluded after “analyzing data from a 2015 government survey.” The findings were published in the CDC’s Morbidity and Mortality Weekly Report.

9/15/17. Because as we all know the incidence of health problems decreases with age. Risk For Health Anxiety May Be Increased In Older Adults, Study Suggests. MD Magazine (9/14, Warren) reports, “The risk for health anxiety...a disorder characterized by a preoccupation with physical health and/or somatic/body symptoms, is increased in older adults,” researchers found after assessing “538 primary care patients” ranging in age from 18 to 90. The findings were published online June 24 in the Journal of Anxiety Disorders.

9/29/17. They thought infectious disease occur spontaneously, I guess. Babies with older siblings may be at higher risk of hospitalization for influenza, researchers say. In “Well,” the New York Times (9/28, Bakalar, Subscription Publication) reports, “Having older brothers and sisters puts infants at higher risk for being hospitalized” for influenza, researchers concluded after studying “1,115 hospital admissions of children under two born in Scotland from 2007 to 2015.” The findings were published in the European Respiratory Journal.

10/2/17. Because listening to people talk about the voices in their heads is so relaxing. Caregivers of Individuals With Schizophrenia Experience High Levels of Distress, Study Finds. Psychological distress among family or friends who provide unpaid support to people with schizophrenia or schizoaffective disorder is much higher than the general population, reports a study published today in Psychiatric Services in Advance.

 

10/4/17. I didn’t know PTSD had anything to do with being traumatized. PTSD Particularly Common Among People Exposed To Mass Shootings, Studies Indicate. The AP (10/3, Tanner) reports that people who survived this week’s shootings in Las Vegas may be at risk for post-traumatic stress disorder (PTSD). Also at risk for “psychological fallout” are first responders, medical staff, eyewitnesses, and bystanders. Studies indicate “PTSD is particularly common among people exposed to mass shootings versus other types of trauma, with rates as high as 90 percent reported” by some researchers.

10/25/17. Because being abused as a child is good for your mental health. Young Adults Who Recall Being Maltreated May Have A Particularly Elevated Risk For Psychopathology, Researchers Say.   A study to be published in the January issue of the Journal of Psychiatric Research (10/24, Newbury, Arseneault, Moffitt, Caspi, Danese, Baldwin, Fisher) “explores the validity and utility of retrospective self-reports versus prospective informant-reports of childhood maltreatment.” Study data “were obtained from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally-representative birth cohort of 2,232 children followed to 18 years of age (with 93% retention).” Researchers evaluated “childhood maltreatment” through “prospective informant-reports from caregivers, researchers, and clinicians when children were aged 5, 7, 10 and 12,” and via “retrospective self-reports of maltreatment experiences occurring up to age 12, obtained at age 18 using the Childhood Trauma Questionnaire.” The study revealed that “young adults who recall being maltreated have a particularly elevated risk for psychopathology.”