Affirmative Distraction | City Journal (city-journal.org)

 

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

 Satire

An Early Career Psychologist: Myth or Malady?

 Steven J. Ceresnie, Ph.D.

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.

 After much consideration, I fear I have a yet undiscovered serious psychiatric disorder that in some way mimics those few men I see in my practice who tell me they feel they have a female genotype - a concept I use metaphorically - trapped inside their male phenotype. These men are convinced they are females and that the world has played a cruel trick on them. In fact, their fear of not living as females is stronger than their fear of death; some grand existential dilemma.

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.

 

1. 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.
2. 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.
3. 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.
4. 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.
5. 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

6. The more psychologically disturbed the parents, the more unreliable their history of their family and child.
7. 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.
8. 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.
9. 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.
10. 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?

11.  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.
12.  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.
13. 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

14. Every youngster must have a medical evaluation before you diagnose psychological disorders.
15. The more diagnoses the child has the more complicated the management of the problems.
16. 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.