Thursday, January 25, 2018

Crimes in Plain Sight

There's a common thread in two front-page news stories. In California, parents hid their severely abused children in plain sight. In Michigan and elsewhere, a doctor sexually abused teenage girls right in front of witnesses. No one did anything.

Why don't people notice what is right in front of them? Here is a list of answers:

1. A lingering belief, left over from agrarian patriarchy, that children are the possessions of their parents, rather than individuals with human rights.

2. A belief in "maternal instinct," which is translated to mean all mothers love their children and know what's best for them.

3. A mistaken faith in designated authorities and a corresponding lack of confidence in one's own judgment.

4. A mobile and transient society that is overpopulated and overworked and encouraged to spend leisure time with electronic gadgets rather than with other people.

5. The American tradition of individualism, which in contemporary society has been termed the "right to privacy"-- although no such right actually exists in the Constitution.

6. A tolerance of "difference" that has gone well beyond notions of equal rights to mean tolerance of pathological behaviors.

All of the above reasons relate to the horror in California. One neighbor thought that the children's bizarre nighttime activity must be some sort of therapy for special needs children. The neighbor believed the children must have a disorder that he, as a layperson, couldn't possibly understand, and he ignored the most obvious possible cause of the children's malfunction--abuse. Why would we be surprised--we live in a society that has given dozens of different names to children's disorders that obfuscate the fact these disorders are cause by abuse or neglect. Examples include "Fetal Alcohol Syndrome," which is caused by maternal alcoholism, and "Oppositional Defiant Disorder," a fancy term for bad behavior in children that is caused by poor parenting or in some cases neglect or abuse.

Churchgoers, fellow students, college professors and neighbors didn't question why the family wasn't social, because we live in a society in which "entertainment" comes from glowing screens rather than human interaction.  More puzzlingly, some ignored the extreme thinness of the children and in one instance, the fact one child wolfed down food when it was available. But in a society in which we are encouraged to celebrate different "body types" (note the "Fat Acceptance" movement) and any and every kind of diet, no matter how unnatural, the witnesses probably felt uncomfortable asking questions. (How far are we from an Anorexia Acceptance movement? Not far). Even failure to obtain basic medical care for one's children, such as vaccines against fatal communicable diseases, is considered acceptable in many circles. Increasingly, we live in a society in which questioning another's behaviors or way of life is considered "intolerant," "judgmental" or even bigoted.

No one reported Dr. Nassar because he was a highly respected and credentialed doctor (Reason #3). But credentials and peer recognition do not guarantee good ethics. No one believed the children because many do not believe that children, including their own children, possess judgment (Reason #1). Despite the fact that many parents cater to their children's whims and treat them inappropriately as friends, a condescension toward children persists in our society. There used to be an old saying, "out of the mouths of babes" comes wisdom, but like so many old aphorisms that represented the distillation of thousands of years of knowledge, it has fallen by the wayside in favor of credentialism. More incredibly, no one questioned why a male doctor would choose to specialize in treating adolescent girls. Perhaps many were uncomfortable asking this question, believing it would imply some sort of "misandry" (a word with which I recently became acquainted, via the internet). The fear of being called a bigot has become paralyzing (#6).

I honestly don't believe it was lack of compassion nor laziness that kept people from noticing and reporting what was right under their noses. It was the messages of our society that teach people that  credentials trump common sense, that they shouldn't judge others' behavior, that parents know best and that no one actually doesn't love their children. None of these messages are true.

Thursday, January 18, 2018

Is the Mainstream Media a Good Source of Information on Mental Health?

It's all relative, I suppose, but my answer to the question above would be "no."

Over the past 10 years, maybe longer, I've read numerous erroneous articles in mainstream media  sources on health and mental health. One of the reasons I started this blog was to offer a professional's viewpoint on complex issues relating to mental health. With a professional degree and license, and experience in the field for what is now more than 26 years, I am an expert. Why don't mainstream media sources hire experts to report on health issues? Occasionally they do--for example, CNN  employed Sanjay Gupta, a surgeon, to do health-related reporting for a number of years. However, even a doctor isn't necessarily qualified to discuss every specialized area of healthcare.

Good reporters diligently seek out experts for commentary and quotes. However, without professional training, even an intelligent lay reporter, and the reporter's editors, may not be able to understand or evaluate sources of complex information. This is a problem many media outlets don't want to address, probably because paying staff who also have professional degrees might require a larger budget.

Here are some examples of inaccurate or incomplete mental health reporting in the mainstream media:

A couple of days ago, The New York Times published a news feature about disparities in opioid addiction treatment that appear to fall along racial and income lines. The reporter found that lower income and black and Hispanic patients tended to go to methadone programs, while higher income, white patients were more likely to see private doctors and receive suboxone treatment. The implication was that rich white people receive better treatment. However, a  careful reading of the entire article revealed that some patients preferred methadone and that methadone programs offer social services that private doctors prescribing suboxone usually don't. The main drawback of methadone programs, revealed by a close reading of the article, is that they often require daily or twice weekly visits, which is time-consuming. But the fact that a treatment is time-consuming does not mean that it is worse or less effective. It may mean the opposite. I wonder how many readers took the time to ponder this, and how many persons glanced at the headline and felt rage at what they assumed was racial injustice? This type of journalism fans the flames of division in our society.

Moreover, in my experience as an addictions counselor, the 12-step program--an abstinence-based program that is free and has no side effects--has helped tens of thousands or maybe millions of people worldwide recover from addiction. The Times's article didn't mention these programs, and I wondered if the reporter thought that 12-step programs are only for alcoholics. The reporter interviewed MDs, but didn't appear to have interviewed non-medical addiction counselors. Did he even understand that such persons exist? Or perhaps he thought their opinions wouldn't be as credible as those of MDs?  I even wondered if the reporter was given a task by an editor to write about discrimination in treatment, and found the facts to fit the prescribed story.

Sometimes The New York Times has printed essays by a writer named Daphne Merkin. In one very long negative essay on psychotherapy, "My Life in Therapy,"  she revealed that she has been a patient in psychotherapy for decades. Ms. Merkin is not a mental health professional. She complained about the lack of efficacy of her treatment but also revealed that she had been confused about how to participate in treatment. If someone has been a patient for decades, this would indicate a chronic condition, and all mental health problems to some degree involve distorted perceptions. In addition, the fact that someone would have an important question about treatment but be unable or unwilling to voice and discuss it with their therapist might raise the possibility that there is something wrong with this person, and then there's the question of why someone would continue in treatment that is not helping her.  Why publish such an article, a lengthy first person diatribe from someone who has no expertise in the subject but some sort of personal grudge?  Curiously, the Times recently gave Ms. Merkin a platform to critique the "#MeToo"  movement, an assignment that should have been given to an established, credible feminist author. Apparently, as long as someone is a "writer" they are allowed to expound on any subject, regardless of whether the person has expertise, scholarship or judgment.

But the most most ridiculous example I can think of from The New York Times was an article  a few years ago about the lack of male psychotherapists. This is a serious issue, as some patients might do better with male therapists. But the writer Benedict Carey commented that one problem for a female therapist might be not understanding that her male patient's participation in a bar fight was just part of a fun night out. I've had many male patients, and one was stabbed in a bar fight. He almost died, and it wasn't a fun night out. Does anyone really enjoy being beaten up or stabbed? Surely, glee in violence cannot be the reason we need male psychotherapists.

I started this blog post with the intention of using examples from across the media, but the post has gotten long using just examples from The New York Times. Maybe the problem is even worse than I thought.

Thursday, January 4, 2018

Some Important Tips About Being in Psychotherapy

Over the past 30 years, the general public's understanding of psychotherapy has declined. This is because of the growing influence of health insurance companies and pharmaceutical companies, which prefer that people take psychiatric medications rather than going to psychotherapy. It's not uncommon for me to hear patients use the verbiage of pharmaceutical companies without realizing they are doing so. This societal change has caused problems for me and other therapists.

Here is a brief summary of some aspects of being in psychotherapy and how therapy works, that used to be common knowledge but are now mostly unknown among persons under 45:

1. You do not have to use normal social rituals with your therapist. You do not have to shake your therapist's hand, ask them "how are you?" or inquire whether they had a good time on their vacation. It's the one type of  relationship that's about you and not the other person, and this is part of why and how psychotherapy cures.

2 Your therapist wants to hear everything. I discussed this in a previous post. Your history of sexual abuse, your porn habit, your poor money management and bad credit--people go to therapy to talk about the things they can't talk about elsewhere--that's one of the reasons why therapists exist. If you tell lies to your therapist or avoid mentioning important information, your therapy will not be effective.

3. If your therapist confronts you on something you did or are doing in therapy, such as repeatedly showing up late, or behavior in the session, such as sexual provocativeness, the purpose is for the both of you to explore what the behavior means. You do not have to say "I'm sorry." Instead, you should ponder the meaning of your behavior and work with the therapist to understand it. Things that other people say that are meant as criticisms are meant by your therapist to prompt self-exploration. (On the other hand, if the dysfunctional behavior continues, the therapist has a right to stop working with you).

4. The reason for #3 above is that an important part of what's called "insight-oriented therapy" (also known as psychodynamic therapy or psychoanalytically-oriented therapy) is a discussion of the dynamic between the therapist and the patient. In longer-term therapy, particularly therapy that lasts more than two years, patients often undergo a regression and start re-enacting childhood behaviors with the therapist. This is a phenomenon known as "transference." In some cases it is very important for the therapist and patient to discuss the interaction between them and what it means, as behavior in the session may reflect long-standing behavioral patterns or relationships in early childhood.

Psychotherapy is about more than learning "coping strategies." A patient could research coping strategies on the internet. Ultimately psychotherapy is about personal growth through a specific type of dyadic relationship. Psychotherapy harnesses the human tendency to grow and develop through interaction with another person. When psychotherapy is effective it is a permanent cure--perhaps not a 100 percent cure, but a cure that does not go away when the therapy ends--unlike medication.

Your Privacy

This morning I read this story in The New York Times. Not to worry--because I'm old-fashioned (as well as verging on old) I don't keep patient records in a "cloud" or even on my computer. My records are written in pen-and-ink and are stored in a locked file cabinet in my apartment in a doorman building.