Notes of a Psychology Watcher ---Steven J. Ceresnie, Ph.D. Psychologist
Essays and Opinions. Book Reviews. Noteworthy Articles. Humor. Quotations.
Saturday, December 17, 2022
Friday, December 2, 2022
On Human Nature
We will create a revolution in our understanding of human nature, when we can explain how the brain generates the mind. We have no idea how the brain can produce a directive, willful “I,” how self-consciousness flows from brain tissue, and how we can go from tangibles such as neurotransmitters and molecules to intangibles such as thoughts, moods, and perceptions. We don’t know how brain facts become mind facts. We do know that there is not a twisted thought for every twisted neuron.
Early in his career, Freud wrote a book about how the brain worked and was connected to the mind — but he abandoned his work because of the unbridgeable brain-mind discontinuity. He went on to propose his convenient “fictions” of id, ego, and superego.
For psychologists, this brain-mind gap creates obstructions to learning about human nature, leads to accumulating more information than knowledge, and keeps many clinicians trapped in denominational conflicts such as whether to assume a biological or psychodynamic orientation. It is not possible to imagine what the obliteration of the mind-brain problem will lead to in our conception of human nature. My hope is that we will come to a greater understanding of the role of freedom in a world we are not yet able to see.
Makes You Stop and Think
“The most beautiful experience we can have is the mysterious. It is the fundamental emotion which stands at the cradle of true art and true science.”
--- Albert Einstein
“The first principle is that you must not fool yourself --- and you are the easiest person to fool.”
--- Richard Feynman
“Every atom in your body except for hydrogen and helium was made in stars long ago and blown into space when those stars exploded --- much later to be tossed into the air and soil and oceans of Earth and eventually incorporated into your body.”
“I’ve always been struck by the fact that the number of neurons in our brain is about equal to the number of stars in a galaxy: one hundred billion.”
“If you traveled to the Sun on a high-speed train, say at two hundred miles per hour, it would take about fifty years to get there.”
--- Alan Lightman
“Man is equally incapable of seeing the nothingness from where he emerges and the infinity in which his is engulfed.”
--- Blaise Pascal
Thoughts on Human Nature*
We will create a revolution in our understanding of human nature, when we can explain how the brain generates the mind. We have no idea how the brain can produce a directive, willful “I,” how self-consciousness flows from brain tissue, and how we can go from tangibles such as neurotransmitters and molecules to intangibles such as thoughts, moods, and perceptions. We don’t know how brain facts become mind facts. There is not a twisted thought for every twisted neuron.
Early in his career, Freud wrote a book about how the brain worked and was connected to the mind — but he abandoned his work because of the unbridgeable brain-mind discontinuity. He went on to propose his convenient “fictions” of id, ego, and superego.
For psychologists, this brain-mind gap creates obstructions to learning about human nature, leads to accumulating more information than knowledge, and keeps many clinicians trapped in denominational conflicts such as whether to assume a biological, behavioral, psychodynamic or humanistic orientation.
It is not possible to imagine what the obliteration of the mind-brain problem will lead to in our conception of human nature.
My hope is that we will come to a greater understanding of the role of freedom in a world we are not yet able to see.
--- Steven Ceresnie
*McHugh, Paul R., Slavney, Phillip R. The Perspectives of Psychiatry. Baltimore: Johns Hopkins University Press. 1998, Second Edition.
On Medication for Attention-Deficit/Hyperactivity Disorder*
The idea of using medication to treat problems of behavior provokes deep feelings and equally strong opinions in many people --- despite that fact that medication for ADHD was first approved by the Federal Drug Administration in 1957, and there is much research support for the effectiveness of treating ADHD with medication. This is even more true when the symptoms are interpreted in moral terms: a pill for laziness? a pill to stop procrastination? a pill for messiness? It is difficult for most people to understand that ADHD is a neurophysiological disorder, not a sign of moral failure.
When parents refuse a carefully monitored trial of stimulant medication to treat their child with ADHD, I bite my lip when many parents don’t understand that medication may significantly reduce ADHD symptoms in their youngster and sometimes act like “glasses for the mind.”
I am frustrated and sad because I’ve witnessed hundreds of youngsters and adults benefit from ADHD medication --- treatment that can save a child from a life of such problems as depression, anxiety, substance abuse, school, work and relationship failures, and unrelenting, harsh self-criticism – and begin to push adults with ADHD back to a more normal path – at home and at work.
Along with a carefully monitored trial of medication, I stress the importance of medication AND psychotherapy. Over the years, I’ve learned to take my cues from parents, youngsters and adults about when they are ready for psychological treatment.
I urge parents who are hesitant to try their child on medication for ADHD to talk with parents about their experiences about their children taking medication, to consult pediatricians and child psychiatrists, and to talk with experienced teachers. I urge adults to consider attending a group for adults with ADHD.
I used to give ADHD adults material to read – but when I inquired whether they found the material helpful, these adults would describe how they left the material in the backseat of their car, or a restaurant, or couldn’t find the articles among the stacks of papers on their desk.
Sometimes parents with an ADHD child or an adult with ADHD who initially refused to consider a trial of medication comes back to me – in several months, a year or longer and are now open to a trial of medication.
I evaluated a 10-year-old boy and recommend medication to treat his ADHD. His parents were not open to medication – “We know,” they say, “how the pharmaceutical companies are more concerned about profits than people. We are not going down that road.” These same parents report having dinner with their long-time couple friends, Bill and Jane. At the dinner, the mother of the son I evaluated, tells her friends that she went to a psychologist who had the nerve to recommend that her son take medication. To her surprise, Bill becomes angry, with veins popping out of his forehead, saying he recently started taking Adderall to treat his chronic, previously undiagnosed ADHD. In a loud voice, he described his anger at growing up with untreated ADHD --- and experiencing many of the side-effects of his parents’ refusal to allow him to take medication. Side-effects such as school failure, substance abuse, and years of relationship problems.
A thoughtful, sophisticated teacher came to me about her 10-year-old son’s
psychological difficulties. She said, “I heard an advertisement for a brain clinic on a Christian radio station. I went to their website and I was impressed by their research and testimonials of their patients.” She then took her son to this neighborhood brain mapping clinic -- at a fee of two-thousand dollars for ten treatments. When I asked her son about the treatments, he said:
The first time I had to repeat some numbers I read – they put these things on my head to get my brain waves to go through head phones and I get to listen to it. It was different brain waves every time – and sometimes it repeated. I fell asleep once and it helped me sleep better. I’m not worrying about sleeping. I listened to ocean noises and that helped me listen better.
When the brain clinic treatment did not work, the parents and the youngster experienced a successful trial of pharmacotherapy for ADHD.
Many years ago, there was a news report of an adolescent who was taking Ritalin who committed suicide. Now that’s a tragic outcome and important for all clinicians to pay attention to and learn from. By coincidence, a pediatrician called me shortly after this report of the adolescent suicide, to tell me he had just moved here and was taking referrals for youngsters suspected of having ADHD and learning disabilities. He moved here from the state where this adolescent killed himself and he knew the child psychiatrist who prescribed this youngster Ritalin. What did not come out in the news reports of this tragedy, he said, was that the adolescent’s stepfather was molesting him for years.
Parents of a youngster with ADHD decided to consult a medical doctor specializing in holistic medicine for treatment of their son to avoid pharmacotherapy. The doctor recommended a stringent diet – a diet, the parents said, was impossible to follow. The parents said there were so many food ingredients to avoid, there was not enough information on food labels to guarantee they were complying with the diet. After a try of the diet failed, to the parents’ shock, the doctor recommended treating their son with caffeine suppositories. The parents changed their opposition to medicine and treated their son with a successful trial of pharmacotherapy.
Here is a list of the changes in ADHD symptoms when medication treatment is effective:
· HYPERACTIVITY (trouble doing nothing): fidgetiness and restlessness decrease; patients are able to relax; then are able to stay at their desks or at the dinner table or at a movie or in church.
· INATTENTION-CONCENTRATION is greatly improved. It is not only that patients can concentrate better; they can concentrate when they want to. Distractibility diminishes. Attention to spousal conversations improve and frequently is quickly manifested in better marital relations.
· MOODINESS. Both highs and lows decrease as do feelings of boredom; mood is described as more stable.
· TEMPER. The threshold for outbursts is raised. Patients are less irritable and angry outbursts are less frequent, and less extreme.
· DISORGANZIATION-ORGANIZATIONAL ACTIVITIES. This is evident at school, running a household, and work. Patients may spontaneously establish orderly strategies.
· STRESS SENSITIVITY. Patients describe themselves as having their thin skin thickened, ability to take life problems in stride, feeling less hassled by daily existence.
· IMPULSIVITY. Patients report that they do not interrupt others while listening to them; they think before they talk; that they have become tolerant drivers and that they may stop impulse buying.
*Weiss, Margaret; Hechtman, Lily Trokenberg; Weiss, Gabrielle. ADHD in Adulthood: A Guide to Current Theory, Diagnosis, and Treatment. Baltimore: Johns Hopkins University Press, 2001.
Nurture and Nature
“Unfortunately, psychologists know much less about how the environment influences a person’s personality than is commonly assumed. People often talk as if the environmental effects had been well understood for decades, and the new discovery was that there were genetic effects too. In fact, nothing could be further from the truth. The area of environmental influences on personality is a morass of unsupported or poorly tested ideas, and, ironically, it is behavior geneticists who have brought the most progress to the field. The irony is that behavior genetics was founded in order to discover heritable influences on human behavior. The methods such studies use, however, also allow us to identify non-genetic influences, and say quite a lot about them.”
--- Daniel Nettle
Golden Rules for Mental Health
“Be honest, realistic and loving with yourself and to those around you; assume a positive outlook and make brave, positive life choices, going against the grain when necessary; listen to your body and keep healthy and active; and do not tolerate persistent discontent, whatever its cause, even if it seems minor.”
--- Daniel Nettle
Preventing Problems is Hard to Do
Irving, a 90-year-old man has his son Michael buy him lottery tickets every week for thirty years.
Picking up the latest lottery ticket for his father, Michael sees that his father has won 10 million dollars.
Worried about how is father who has a bad heart would take the shock of winning 10 million dollars, Michael calls his father's doctor, tells him about his concerns, and the doctor agrees to call Irving under the pretense of repeating some medical tests, and then tell him about his winnings in the safety of his medical office.
Dr. Bloom thanks Irving for coming to his office to repeat some tests. Making conversation, Dr. Bloom asks Irving if he plays the lottery. Irving says his son has bought him lottery tickets for thirty years and he has never won anything. Dr. Bloom asks Irving what he would do if he won 10 million dollars in the lottery. Irving thinks for a moment and says, "You have been my doctor for many years. I would give you 5 million dollars.”
The doctor drops dead.
A Chaotic World
When Anna Freud was eighty-five, a depressed young man sent her a lament about the
chaotic state of the world, she sent him a succinct statement of her credo:
“I agree with you wholeheartedly that things are not as well as you would like them to
be. However, my feeling is that there is only one way to deal with it, namely to try and
be all right with oneself, and to create around one at least a small circle where matters
are arranged as one wants them to be.”
--- Anna Freud
An Early Career Psychologist: Myth or Malady?
Approaching three score and fifteen years, I have had the privilege of being invited into the private lives of many people in deep distress - that's what clinical psychologists do. But lately, I feel my mind and body are changing - my muscles are becoming more supple, my waistline is shrinking, my pectoral muscles are taking the shape of a younger man, and I stop at clothing stores to sample clothing worn by college students and young men. I have started listening to music that matches the tastes of younger, more macho males - I find pleasure in rap, heavy metal and alternative music genres.
On some nights, late in the evenings, I go up in our finished attic and try on the fashionable attire of young men and adjust my Spotify to play the latest rap tunes. There are other symptoms I experience but I'm embarrassed to make these public. I dare not tell my wife; I fear she would suggest I seek psychiatric help.
Yet psychiatric help, of which I'm most familiar, is not what I believe I need. Of course, I'm aware that at my chronological age any number of biological or psychological maladies may explain my unusual behaviors, not to mention denial of mental and physical deterioration, dementia or death.
Over the years, I have not been prone to denial, the most logical explanation for my behavior, and my physical health is good - although I do take blood pressure and cholesterol medications, not uncommon for gentleman my age.
Oh, I forgot to mention that I started reading many psychology articles and textbooks - I keep up with the literature and don't miss an opportunity to cruise the shelves of psychology texts in college book stores I visit across the country seeking out the current requirements for a Ph.D. in psychology. Not only do I read as much as I can, but I tell my wife about my cravings to collect these journals and textbooks - to my wife it appears I'm studying for exams. All of this reading can be traced to the many seminars I'm asked to present around the country; okay, that's not exactly the truth.
Bear with me as I briefly outline what I have come to think as my existential crises: I am an early career psychologist trapped inside a 74-year-old body. After all my years of immersing myself in the lives of others, I'm aware how easily our minds adopt beliefs, opinions, and facts used to justify our actions. As that astute philosopher David Hume reminds us, the intellect is a slave to our passions.
So as a scientist, skeptic and a life-long worshipper of reason, I set out to test my passion-driven beliefs examined under the light of intensive psychotherapy, peering into my unconscious, preconscious, conscious, defense mechanisms and neurotransmitters. To do this, I took a sabbatical from my work and committed myself to challenging my beliefs, or at least attempting to understand them, by subjecting myself to the psychotherapy by the best clinicians I could find who practiced psychoanalysis, cognitive behavioral therapy, pharmacotherapy, and various other approaches. I took carefully monitored trials of antidepressant and antipsychotic medications.
I am embarrassed but not surprised to report the early career psychologist continues to live and grow inside of me despite excellent psychotherapy and pharmacotherapy. Of course, I have not revealed my preoccupation to my wife or any of my friends or colleagues. In the old days - during my training as a psychologist- my behaviors were called a perversion.
So, I confine my early career psychologist behaviors in my attic in my home - three late evenings a week for two hours after my wife goes to sleep. I've given up on being cured. Over my own years of practice, I have learned that the word "cure" is not often applied to psychiatric maladies. Consequently, I have come to accept the advice of Sigmund Freud:
A man should not strive to eliminate his complexes, but to get into accord with them; they are legitimately what directs his conduct in the world.
Notes of a Psychology Watcher
Some Guiding Principles for the Assessment of
Psychological Disorders in Children and Adolescents
Steven J. Ceresnie, Ph.D.
- Take a developmental perspective. What is normal at age one year is abnormal at age five years. Remember that a child may be chronologically 10 years old, mentally 14 years old, emotionally seven years old, and physically 13 years old.
- Be aware of the pervasiveness of comorbidity in childhood psychological disorders. It is rare for a youngster – or an adult – to have one problem. With physical problems, children can have a broken leg, Crohn’s disease, and need glasses. The same is true for psychological disorders.
- During your interviews – with parents and youngsters, remain neutral. Your ability to manage transference and countertransference is crucial in forming a treatment alliance and obtaining accurate information. Don’t criticize or blame parents. Pay attention to your tone of voice and nonverbal behaviors. Stay humble – especially if you have not lived personally through the family stage of the child you are evaluating (e.g. if you have never been the parent of an adolescent) - listen and learn. It is difficult to listen your way into trouble.
- When you have enough information, do not be afraid to “label” a child. A label or diagnosis is helpful for communication, treatment, and prediction. Diagnosis is prognosis. When a child gets an accurate diagnostic label that leads to effective treatment, you may prevent the child and his family from experiencing years of doctor shopping, and intense emotional pain. You may help steer the child and the family into a more normal course of development.
- Evaluate the following categories:
A. Neurological: Disease/Disorder, e.g. autism, schizophrenia, attention-deficit/hyperactivity disorder, pervasive developmental disorder, or learning disabilities.
B. Constitutional factors
1.) Temperament, e.g. activity level; patterns of movement; regularity; distractibility; approach versus withdrawal; adaptability; persistence; intensity of reaction – positive or negative affect; sensitivity; quality of mood.
2.) Personality traits, e.g. openness, conscientiousness, extrovert, agreeable, neurotic
3.) Intellectual and academic resources
4.) Attachment behavior: ways of construing and behaving in close relationships
5.) Parental expectations: constructive vs. destructive
6.) Parenting styles: authoritarian, authoritative, permissive, neglectful
a. Parental warmth and responsiveness to the child
b. The family’s control of the child and the demands they place on the child.
7.) Peer relationships
8.) Life events
9.) Influences of school, community, and culture
NOTE: Development is a two-way street. Parents and children mold each other. Children are not blank slates, but share half of their parents’ genes. Be cautious drawing conclusions of what parents’ behaviors may “cause” a child’s behavior --- research traces correlation, not causality.
Babies control and bring up their families as much as they are controlled by them; in fact, the family brings up the baby by being brought up by him or her. --- Erik Erikson
- The more psychologically disturbed the parents, the more unreliable their history of their family and child.
- A common error in assessing children and adolescents is not to get teachers’ observations and information about peer relationships. It is useful to review a sample of the child’s report cards from early on to the present grade level, especially the teachers’ comments. A well-liked child with close chums is less vulnerable to future behavioral and emotional troubles.
- While observing and participating in play with children is important in uncovering preoccupations and possible symbolic meanings, using play techniques alone do not allow you to assess specific symptoms and to make a diagnosis. To make a diagnostic judgment based on symptoms, you need to develop specific questions geared to the child’s developmental stage. Tools such as the K-SADS are helpful semi-structured interviews that promote differential diagnoses.
- Psychological testing, especially assessing intellectual and academic resources, are important parts of an evaluation. For example, emotional disorders such as depression and anxiety can be secondary to psychological demoralization caused by Specific Learning Disorders, and/or neurological disorders such as Attention-Deficit/Hyperactivity Disorder, and/or family stress. If a child achieves at grade level, it does not mean that the child is performing near his intellectual abilities. Psychological testing allows you to uncover unknown intellectual resources of a youngster that can boost his morale and offer opportunities to enhance skills. A frequent outcome of intellectual assessment is to uncover a child’s significant strengths in nonverbal reasoning abilities.
- It is crucial to take a comprehensive family history to make a diagnosis of children’s problems. You can always improve the accuracy of your diagnosis if you know the details of the family history. To boost your diagnostic acumen, ask the youngsters’ parents questions in at least the following areas of the family history:
A. Who does your child take after? Don’t accept “She’s her own unique person.”
B. Ask about a family history of learning disabilities. Does anybody in the family have trouble with reading, spelling, math or writing, or was any family member in special classes? Be alert to family members who change jobs a lot, or have a history of underachievement at work. You will be surprised how many people have trouble with spelling.
C. Ask about a family history of hyperactivity, distractibility, and impulsivity. For hyperactivity, ask about family members who have trouble doing nothing, or are live wires, or frequently exercise. For distractibility, ask about people who have trouble filtering out external distractions, and have trouble with reading comprehension. For impulsivity, ask about people with firecracker tempers as opposed to people with slow-burn tempers, or brooding.
D. Ask about a family history of trouble with the law: gamblers, con-artists, crooks, barroom brawlers.
E. Ask about a history of excessive use of alcohol and or drugs, including prescription drugs. Ask about family members who have been arrested for drunk driving or substance use.
F. Ask about a history of depression and bipolar disorder. For depression, use such terms as down in the dumps, sad, crying, miserable, and unhappy. Ask about feeling cranky, irritable or easily upset. Ask about whether there are times the adolescent’s energy level is very high or very low; whether during the high periods the adolescent spends a lot of money, takes on too many activities; is more sexual, seems strange or annoying to others; in the low periods if the adolescent needs to stay in bed more and feels hopeless and suicidal.
G. Ask about whether there are things the child feels compelled to do over and over again like touching, counting or checking even though she knows her behavior may not make sense. Ask about bothersome thoughts that won’t go away.
H. Ask about going on a diet and whether friends or family get worried. Ask about whether the youngster is afraid of gaining weight. Ask if the adolescent has times when they eat a large amount of food in a short time. Ask about the youngster’s exercise routine, or making themselves throw up.
a. Ask if the child feels that somebody is out to hurt or harm them; if the youngster ever felt people are talking about them behind their back; if the adolescent thinks somebody is spying on them; if the youngster’s eyes ever play tricks on them. Ask: Do you see people or visions that other people don’t see? Ask if their ears play tricks on them --- hearing voices that others don’t hear. Ask: Do these voices tell you what to do, or interfere with you daily life?
- Ask about worries such as being away from parents and worries about your parents getting hurt. Ask whether the youngster thinks he worries more than other kids.
- Ask the youngster about getting into fights, using a weapon, stealing things, lying about his actions, starting fires, and threatening people. Ask whether the adolescent feels he can get emotionally close to people.
- You should recommend to the child and her parents what they need, not just what you have to offer. For example, with experience, it will occur to you when to refer a youngster to consider pharmacotherapy.
As far as I’m concerned I have had great help from medical colleagues used to the administering of the modern drugs…In all of these cases the therapeutic use of drugs did not in any way interfere with the progress of the analysis, quite the contrary it helped the analysis to maintain itself during phases when otherwise the patient might have had to be hospitalized. --- Anna Freud
- Every youngster must have a medical evaluation before you diagnose psychological disorders.
- The more diagnoses the child has the more complicated the management of the problems.
- Don’t be afraid to get help from colleagues. We do not understand the etiology of any psychological disorder. Our diagnostic manual is akin to a birdwatcher’s field guide --- we can describe clusters of symptoms but do not understand why these symptoms go together.
As psychologists, we are about at the level of chemistry before Mendeleev began to fill in the periodic table of elements.
Much of our therapeutic efforts are based on rules of thumb that are difficult to prove, and these notions are vulnerable to crank ideas such as false memories of child sexual abuse and fights between theoretical factions within the field.
Not all psychological problems fit neatly into our diagnostic categories. These categories continue to evolve. Diagnosis deferred, or I don’t know is acceptable. Not all problems have ready solutions. When in doubt, tell the truth.
Saturday, June 25, 2022
Friday, June 17, 2022
"It is only shallow people who do not judge by appearances."
--- Oscar Wilde
Sunday, January 2, 2022
Powers, Ron. “No One Cares About Crazy People. The Chaos and Heartbreak of Mental Health in America.” New York: Hatchette Books, 2017.
Ron Powers promised his wife, Honoree Fleming, he would not write this book.
But ten years after his guitar prodigy son Kevin hanged himself in their basement a week before his twenty-first birthday in July 2005, after struggling with schizophrenia for three years; and then a few years later his older son Dean started experiencing the symptoms of schizophrenia and had a psychotic break --- Ron Powers changed his mind.
Powers started to reconsider his promise when he read the hateful words, “No One Cares About Crazy People,” in an email from Kelly Rindfleisch, who was Governor Scott Walker’s Deputy Chief of Staff in 2010 uncovered by the Milwaukee Journal Sentinel, mocking the horrible treatment of psychiatric patients in the Milwaukee County Mental Health Complex, he was shocked and angered. Patients treated for bipolar disorder and schizophrenia were starved, raped, impregnated, and walked around naked.
Powers hopes you will not enjoy his memoir and trenchant review of the history of mental health treatment in America. He wants you to be wounded by his book --- wounded enough to do something about the state of help for the severely mentally ill in America.
Born in Hannibal, Missouri, Mark Twain’s hometown, Powers’ works include “Mark Twain: A Life.” With James Bradley, he co-wrote the 2000 number one New York Times Bestseller “Flags of Our Fathers,” made into a movie by Clint Eastwood. Powers was the first television critic to win the Pulitzer Prize.
Powers’ writing tears at your guts with his vast knowledge of our treatment of severe mental maladies, his intimate understanding of schizophrenia, and his heart-wrenching story of his two sons.
About his two sons, Powers says, “There is no greater feeling of helplessness than to watch two beloved sons deteriorate before your eyes, not knowing what to do to bring them back.”
Powers tells us that both of his sons suffered from schizophrenia and anosognosia. The latter is an inability to understand or have insight into your mental illness. Despite hallucinations, delusions, paranoia, you think you are mentally healthy.
Anyone who reads the history of our treatment of the severely mentally ill in America will feel nauseous, sad and angry. For example, “Life” magazine ran a story in 1946 with horrid pictures of Pennsylvanias Philadelphia State Hospital at Byberry and Ohios Cleveland State Hospital. Movies such as “The Snake Pit,” in 1948 showed the hideous treatment of patients in mental hospitals.
Powers recounts the “good intentions” of President Kennedy’s 1963 legislation that sought to provide more humane care for patients in psychiatric institutions. This transfer of patients to the community was prompted by the discovery of “miracle” drugs like the anti-psychotic Thorazine, aimed to cure schizophrenia. An aim that worked like a powerful rifle that misses the target.
With the consensus of political liberals and conservatives – for different reasons, we went from a nationwide peak of around 560,000 beds in 1955, to about 35,000 today --- half of what we need. Without these beds, we have about one-third of the homeless consisting of the mentally ill; more psychiatric patients in prisons than in hospitals; the mentally ill clogging emergency rooms and warehoused in the nursing homes.
Powers reminds us how some psychiatrists --- Thomas Szasz, R.D. Laing, and cult leaders such as the science fiction writer L. Ron Hubbard, creator of Scientology, have poisoned the well of psychiatric treatments, claiming such nonsense that mental illness is a myth. Szasz’s widely read book “The Myth of Mental Illness” (1961) propelled the antipsychiatry movement. Szasz wrote:
“My argument was limited to the proposition that mental illness is a myth, whose function it is to disguise and thus render more palatable the bitter pill of moral conflicts in human relations.”
Powers tells how Szasz teamed up with L. Ron Hubbard of Scientology fame backed by millions of Scientology member dollars to create the Citizens Commission on Human Rights (CCHR) established in 1969 headquartered in Los Angeles, California. Its stated mission --- and CCHR continues to this day – is to “eradicate abuses committed under the guise of mental health and enact patient and consumer protection.” On the CCHR website, they write: PSYCHIATRY: AN INDUSTRY OF DEATH. Some protection.
There is some good news about progress in treating mental illness. For example, Congress has authorized 1.1 billion dollars to do an eight-state demonstration program . Mental Health Act introduced by our Democratic senator Debbie Stabenow which became law in 2014 and detailed criteria for treatment centers to become certified community behavioral health clinics. In 2016 Republican senator Roy Blunt of Missouri introduced a bill to add funding to 24 states to expand the demonstration program.
In 2008 the National Institute for Mental Health launched the Recovery after an Initial Schizophrenia Episode project. The NIMH just completed its first trials of the project in 2015 and finds much value in aggressive intervention for first-episode psychosis (1).
We have a long road to travel to bring the research and treatment of severe mental illness out from under the stigma of treatment and into the mainstream of competent care.
Perhaps the stigma and humiliation of mental illness will lessen as we discover the biological etiologies of psychiatric maladies and provide reliable and valid measures of illnesses of the mind.
(1) Satel, Sally & Torrey, E. Fuller Torrey. “A Prescription for Mental-Health Policy.” “National Affairs, Number 31, Spring 2017.
Saturday, January 1, 2022
BOOK REVIEW: Mankoff, Robert. “How About Never? Is Never Good For You? My Life in Cartoons.” New York: Henry Holt and Co. 2014.
Haec enim ridentur vel sola vel
maxime quae notant et designant
turpitudinem aliquam non turpiter.
An indecency decently put is the
Thing we laugh at hardest.
If you like to laugh – and think, this is the book for you.
Imagine two guys looking up at a big sign that says STOP AND THINK. One fellow says to the other: “Sorta makes you STOP AND THINK.” The reaction of these two fellows is exactly what the cartoons in The New Yorker Magazine make you do – cartoons that are better described as life drawings requiring you to think about life’s predicaments and ambiguities, facing the dangers and excitements of being alive.
Bob Mankoff, cartoon editor for The New Yorker (TNY), has written a memoir about his life in cartoons. The topics of TNY cartoons draw on humor from sex, love, death, parenting, marriage, family, cruelty, fear, jealousy, envy, hate, identity, character, conscience, desire, mourning and more --- the same topics that psychologists are up to their ears in.
Mankoff left psychology graduate school to seek his fortune in drawing cartoons. He started selling cartoons in 1977, and started working for TNY in 1980. He says he knows all about rejection, being booted out of psychology graduate school, and submitting thousands of cartoons to TNY before getting his first cartoon published.
He became the cartoon editor in 1997, about 20 years after selling his first cartoon. As editor of the magazine, he evaluates more than 500 cartoons every week, selecting about 10 - 15 for each magazine issue
Mankoff is most famous for creating the cartoon bank, and for the following best-selling cartoon:
An executive is at his desk, on the phone, and looking at his calendar says, “No, Thursday’s out. How about never?” Is never good for you?”
His title of his memoir is taken from what might be the most popular cartoon in the history of TNY. Mankoff remembers how he got the idea for this cartoon. He was trying to get on the phone with a friend who he wanted to see. That friend kept saying, “Can we meet this time? Could we do it that time?” And finally Mankoff says to his so-called friend, “How about never? Is never good for you?”
Mankoff traces this snotty retort back to his Queens and Bronx New York Jewish background. The Chapter 1 title is: “I’m Not Arguing, I’m Jewish.” During childhood, whenever he complained to his mother he was bored, she told him to bang his head against the wall, Mankoff quips. She taught him boredom was a luxury.
He describes his never-boring cartoon editor job as evaluating humor, a much different process from enjoying humor. He gives an example of a cartoon with 10 possible captions --- and this is the format of the cartoon caption contest that runs every week in TNY. The readers submit captions to a cartoon on the page, and the winners of the caption contest are printed. His editing job consists of picking cartoons with the best captions.
To evaluate cartoons, Mankoff reports that he is faced with the paradox of choice, which automatically brings the interference of the judgment process, short-circuiting the laugh response. So instead of laughing at the cartoon, he has to judge it.
In analyzing humor, Mankoff comments about what comics call “the magic of three.” He says you need a sequence for surprise to make a narrative funny.
Here is an example of a cartoon with the element of triplets in humor --- a one, two, and then boom.
A woman is saying, “I started my vegetarianism for moral reasons, then for health concerns, and now it’s just to annoy people.”
The cartoons in TNY, show the very widespread humor taking place in New York, the circus of the world. Humor makes fun of what’s in the public mind.
Here are two examples of cartoons about same-sex marriage:
A couple is looking at TV, and the guy is saying, “Gays and lesbians are getting married. Haven’t they suffered enough?”
A couple is in bed, and the guy is saying to the woman, “What’s your opinion of some-sex marriage?”
Mankoff appreciates humor that is benign, not speaking truth to power, but humor directed back at the people who are reading the magazine.
He describes a theory of humor he calls, “Just the Right Amount of Wrong.” He says this view emphasizes that humor is different in different contexts. He says that the mother’s milk of humor is anything that’s embarrassing, guilt- or anxiety-filled. Mankoff has learned that humor comes in almost endless varieties: humor based on reality, observational humor, silliness, and playful incongruity or absurdity.
An example of an absurd cartoon is:
It’s a cowboy at a desk. The person sitting in front of him is a cow, and he’s reading his resume. And the cowboy is saying, “Very impressive. I’d like to find 5,000 more like you.”
One cartoon, apparently not for everybody’s taste, shows a rodent in a cage, and then another picture of a rodent who hung himself. The caption is: “Discouraging data on the antidepressant.” Mankoff tells about readers who send in letters saying they don’t like cartoons where animals suffer. Mankoff’s response: “We use anesthetic ink.” A wise-guy he is.
Some people are hypersensitive to humor, and some people have little or no humor. I make it a rule never to use humor with people I don’t like ---- it is hard to keep my unconscious slips from showing.
Mankoff notes there have been many cartoons in TNY about the Grim Reaper because humor is an important way we cope with death, anxiety, suffering and illness.
An example of Grim Reaper humor:
The Grim Reaper is taking away her husband, and the wife is at the apartment door, and she is saying, “Relax, Harry. Change is good.”
Cartoons about marriage are another staple of TNY cartoons. Mankoff mentions he is happily married to his third wife (the magic of three). He says humor is essential in our attempts to understand our partners and for our partners to understand us.
He cites a cartoon on marriage:
A man is talking to a woman in the living room and he says, “Believe me, Janet, I consider you an important part of our marriage.
Mankoff focuses on the links between creativity and humor. He mentions Arthur Koestler’s book, “The Act of Creation,” in which he connects humor, science and art.
Life without a sense of humor is life without any sense of proportion or perspective.
Where laughter stops, so does common sense.
As the psychologist William James noted, “Common sense and a sense of humor are the same thing, moving at different speeds. A sense of humor is just common sense, dancing.”
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Friday, December 31, 2021
Book Review: "Chatter. The Voice in Our Head, Why It Matters, and How to Harness It." by Ethan Kross. 2021.
Ethan Kross is an experimental psychologist and neuroscientist who specializes in emotion regulation. He is a professor of psychology and management at the University of Michigan and director of the Emotion and Self Control Laboratory, where he studies the science of the silent conversations or how we talk to ourselves.His book is divided into seven chapters and an appendix outlining the specific tools discussed in the book to reduce anxiety and offer hope.
Much of the talk we say to ourselves is helpful. We plan for an interview; we think about what we want to say in a presentation; we rehearse our conversation with our mother-in-law before Thanksgiving Day dinner; we talk to ourselves about how to apologize to our spouse for our rude behavior and irritability.
Professor Kross, and other neuroscientists, have discovered that we are the authors of our life stories; our brain secretes interpretations of the world to help us create a coherent, sensible, explanation for events and our experiences.
Professor Kross estimates we spend about one-third to one-half of our waking hours talking to ourselves. He says people can think to themselves at a rate that is equal to speaking 4,000 words per-minute out loud.
Sometimes what we say to ourselves backfires. We may catastrophize problems; ruminate through redundant loops of irrational thinking; bombard ourselves with negative thoughts, sabotage our ability to think clearly, and gain access to reams of negative self-talk ---- called chatter.
This chatter can negatively affect our relationships, our work, and our physical health.
Effective psychological therapy helps us to acknowledge our feelings and experiences, helps us bear our feelings and experiences without distorting reality, and helps us put our feelings and experiences into perspective.
Through peer reviewed research, Professor Kross and his colleagues from all over the world, have identified methods or tools to expand our abilities to acknowledge, bear, and put into perspective our negative self-talk.
These are times that test our mental health. If you are not anxious now, there is something wrong with you: the uncertainty of the pandemic --- sickness, death, loss; isolation from family and friends; the closing of schools requiring remote learning, a process new to teachers and students, often interfering with a parents’ ability to earn a living and children getting a proper education this year. Economic uncertainty – Will I be able to find another job? Will my business survive? When will I get the vaccine against the Corona virus? Political polarization. I’m not used to staying home with my spouse and children for twenty-four hours a day. I thought marital relationships are for better or worse, but not for lunch. These are only a few of the burdens and stresses preoccupying millions of citizens.
My lawyer colleagues tell me filings for divorce have increased. Child protective service workers report an increase in domestic violence. Mental maladies such as depression, anxiety disorders, panic attacks, and the horrors of suicide have increased.
Professor Kross offers an array of techniques aimed to reduce stress and anxiety, and to help you put these challenges into perspective. Not all of these tools work for everybody, but you are likely to find some methods that work for you.
Someone said life is like climbing one mountain after another ---- the lifetime challenge is to enjoy mountain climbing.
An underlying theme of Professor Kross’ creative, eloquent work, is to change your thinking to steady your emotions - to promote more rational thinking, self-control, self-confidence, reduce emotional distress, and find ways to enjoy mountain climbing.
When he was a boy growing up, Professor Kross said whenever he faced a problem, his father would tell him, “to go inside,” to introspect, and a solution will occur to him. This fatherly advice, helped a lot.
Yet, when Professor Kross took his first psychology class, to his chagrin, he learned the complexities of introspection. He wanted to know more about how to study the benefits of introspection and self-talk.
In his book, Professor Kross takes us on a tour of tools generated from his lab and those of colleagues, that illuminate research-based methods to use introspection, to drop a bomb, so to speak, to stop self-talk gone crazy.
These tools, such as distance self-talk, coach us through problems --- talking to ourselves using our own name (not out loud), rather than the pronoun “I” to work through predicaments. Professor Kross has found examples of highly successful people – athletes, courageous young activists, and others who spontaneously make use of this seemingly simple technique.
Another tool is called temporal distancing or mental time travel --- taking our minds into the future, telling ourselves that this pandemic will end, we will see our friends and family, we will get back to a more normal life.
Professor Kross mentions some tools that many of us use that at first, we would not associate with reducing anxiety: cleaning our desk, organizing our clothes in the closet, cleaning the pots and pans. Controlling your outside environment helps us take charge of the internal chatter.
Another tool that may reduce the backfiring chatter in our mind, is the experience of awe ---- we look up at the stars in the sky and realize we are one of billions of planets – maybe our problems are not so overwhelming after all.
Research studies in Professor Kross’ lab tells us we benefit from emotional support when we share our internal chatter with understanding family or friends. But talking about our feelings may bring us closer to the listening friend, but unless we learn ways to broaden our perspective, to reframe our experiences, this venting of chatter may not help.
No matter how good we get at using the creative, research-based tools in this book, coping with inevitable predicaments, moral dilemmas, atrocities, tragedies, fear, rejection, betrayal and more, maintaining mental stability is an ongoing challenge and process through life.
Is it fair? No. Is it reality? Yes.
Should your mental maladies interfere with your daily life, these psychological tools are some of the building blocks of effective psychological therapy.
Psychological therapy and reducing your chatter will not enable a life of contentment. Contentment is for cows. Getting control of your negative chatter may help you start to enjoy mountain climbing.
Most psychological self-help books fit under the category of fiction. Dr. Kross’ book, “Chatter,” is that rare researched based psychology book that gets filed under nonfiction. Do yourself a favor, read this book. You will say to yourself, "thank you."