As my current patients know, I'm relocating to California next month.
I've always loved Northern California, and I have family there. I've been thinking about moving there for several years, and now is the time.
Tuesday, September 18, 2018
Sunday, May 27, 2018
Is Marijuana Safe?
I've long been suspicious about claims that marijuana is harmless. I was interested in this article in the Washington Post, by a neuroscientist. Any drug changes the body's chemistry.
Tuesday, May 15, 2018
College Students and Suicide
Recently The New York Times published an article about a growing controversy: As more college students commit suicide, parents are frustrated by medical and academic confidentiality laws that seemingly have prevented the colleges from contacting them about their children who are having mental health problems. What should be done about these situations?
When new patients come to my practice, I have them fill out a form that includes space to list an emergency contact. So far, no one has refused to name an emergency contact. I've only called an emergency contact once or twice in 16 years, but it is necessary for me to have this information, because someone's life could be at stake. Why don't colleges and universities do the same? I don't know. Perhaps their administrators believe psychiatric emergencies aren't their purview.
An emergency contact person is ideally someone who is willing to escort the person to an Emergency Room or stay with the person until the crisis is over.
In a genuine emergency, confidentiality laws don't apply. If someone in my practice tells me that he or she is planning on committing suicide, I ask to escort them to the Emergency Room, and if they refuse I would call 911. I do not need a confidentiality waiver to call 911, but, I have in fact never needed to call 911, because every time, the person has agreed to go to the hospital. A college counseling center should be staffed by licensed clinicians who are obligated to work with their patients the same way that I am.
What about situations in which a college student is deteriorating, but it's not yet an emergency? The student should be asked to take a leave of absence for a semester and engage in mental health treatment. Then the treating clinician should be asked to sign off on a form stating that the patient is not at risk, before the student can resume classes.
When new patients come to my practice, I have them fill out a form that includes space to list an emergency contact. So far, no one has refused to name an emergency contact. I've only called an emergency contact once or twice in 16 years, but it is necessary for me to have this information, because someone's life could be at stake. Why don't colleges and universities do the same? I don't know. Perhaps their administrators believe psychiatric emergencies aren't their purview.
An emergency contact person is ideally someone who is willing to escort the person to an Emergency Room or stay with the person until the crisis is over.
In a genuine emergency, confidentiality laws don't apply. If someone in my practice tells me that he or she is planning on committing suicide, I ask to escort them to the Emergency Room, and if they refuse I would call 911. I do not need a confidentiality waiver to call 911, but, I have in fact never needed to call 911, because every time, the person has agreed to go to the hospital. A college counseling center should be staffed by licensed clinicians who are obligated to work with their patients the same way that I am.
What about situations in which a college student is deteriorating, but it's not yet an emergency? The student should be asked to take a leave of absence for a semester and engage in mental health treatment. Then the treating clinician should be asked to sign off on a form stating that the patient is not at risk, before the student can resume classes.
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.
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.
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.
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.
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.
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.
Tuesday, October 31, 2017
Brainwashed!
Over the past year I had been experiencing the pervasive sense that large numbers of people in the US were going crazy. From neighbors, colleagues, patients and random persons on the internet I heard statements that sounded extreme in their despair, fear and rage. At times the statements entered the realm of clinical paranoia. I was told by left-of-center persons that America was full of Nazis, and by persons to the right that the "Left" was engaged in a purposeful campaign to destroy the Constitution and install a totalitarian regime. I blamed the media and our two main political parties for the incessant drumbeat of hysterical "news" stories, inflammatory language and demonization of others that fed this mass hysteria. But it turns out that the real story is even weirder: It was the Russians.
Why do people succumb to propaganda and why can't they see that they are being manipulated? There are many factors:
Conformism: Humans are social animals and want to "belong." If a group of people with whom someone wants to associate insists on a shared belief system, many people will adopt the beliefs even though those beliefs have no basis in fact. The strong need to "belong" will override logical thought processes.
Displacement: Persons with histories of abuse or neglect in childhood deal with anxiety, anger and even outrage, but may be unable to connect those emotions with their childhood experiences due to wanting to protect the images of their family members. Instead, they direct their fear and outrage toward public figures or groups or imagined groups. It is emotionally convenient to fear and hate those you don't personally know.
Self-esteem: Many people revel in a belief in their own moral superiority. By aligning themselves with what they see as a virtuous or righteous position and condemning others who disagree, they feel better about themselves.
What can counter these dangerous tendencies? Here are some tips:
1. Learn history. The better educated and older people I know demonstrated less susceptibility to the propaganda, and not just because they don't use Twitter. It's that they (we) have seen it all before, and what we haven't seen personally we have read about. Propaganda and popular hysteria are nothing new. There have been waves of mass hysteria throughout history, often with atrocious, catastrophic or genocidal results.
2. Use logical analysis to assess claims made by groups, including established groups. It doesn't matter who made the argument or published the news story if it doesn't make sense.
3. Listen to your gut instincts. If something seems fishy, it probably is. If you can't put the pieces together, maybe it's because they don't fit. Ask yourself: Is something missing from the story? Does the story seem too bad or too good to be real?
4. Live a healthier lifestyle: Acknowledge your childhood traumas, build your self-esteem in healthy ways and seek friends who don't demand that you agree with their political beliefs. Talk to different types of people and listen to them.
Why do people succumb to propaganda and why can't they see that they are being manipulated? There are many factors:
Conformism: Humans are social animals and want to "belong." If a group of people with whom someone wants to associate insists on a shared belief system, many people will adopt the beliefs even though those beliefs have no basis in fact. The strong need to "belong" will override logical thought processes.
Displacement: Persons with histories of abuse or neglect in childhood deal with anxiety, anger and even outrage, but may be unable to connect those emotions with their childhood experiences due to wanting to protect the images of their family members. Instead, they direct their fear and outrage toward public figures or groups or imagined groups. It is emotionally convenient to fear and hate those you don't personally know.
Self-esteem: Many people revel in a belief in their own moral superiority. By aligning themselves with what they see as a virtuous or righteous position and condemning others who disagree, they feel better about themselves.
What can counter these dangerous tendencies? Here are some tips:
1. Learn history. The better educated and older people I know demonstrated less susceptibility to the propaganda, and not just because they don't use Twitter. It's that they (we) have seen it all before, and what we haven't seen personally we have read about. Propaganda and popular hysteria are nothing new. There have been waves of mass hysteria throughout history, often with atrocious, catastrophic or genocidal results.
2. Use logical analysis to assess claims made by groups, including established groups. It doesn't matter who made the argument or published the news story if it doesn't make sense.
3. Listen to your gut instincts. If something seems fishy, it probably is. If you can't put the pieces together, maybe it's because they don't fit. Ask yourself: Is something missing from the story? Does the story seem too bad or too good to be real?
4. Live a healthier lifestyle: Acknowledge your childhood traumas, build your self-esteem in healthy ways and seek friends who don't demand that you agree with their political beliefs. Talk to different types of people and listen to them.
Tuesday, October 17, 2017
Normalization of Pathological Behavior, Part One: Psychological Defense Mechanisms
Since the Harvey Weinstein revelations, I've been thinking about the normalization of pathological behavior. This is a common phenomenon in our society and in most societies.
This article in The New York Times summarizes the reasons why women often don't report sexual harassment--mainly, that they fear retaliation. There are other factors, however, that make people in general turn a blind eye to harmful and pathological behaviors. These include psychological defense mechanisms such as denial, rationalization and dissociation, effects of mass culture, and deliberate propaganda by vested interests that uses rhetorical tricks to minimize atrocities. I'll address psychological defense mechanisms today.
Psychological defense mechanisms serve to ward off anxiety by distorting reality. In rationalization, the mind invents "reasons" why something happens that aren't really logical, but serve to distract from an unpleasant or frightening reality. In dissociation, consciousness is altered so that an experience isn't perceived at all in daily consciousness, but may be acted out unconsciously, or remembered while in an altered state (such as hypnosis). Denial is a phenomenon in which "the existence of unpleasant realities is disavowed; [it] refers to keeping out of conscious awareness any aspects of external reality that, if acknowledged, would produce anxiety" (Kaplan and Sadock, "Synopsis of Psychiatry," 2007 edition).
The mind resorts to defensive maneuvers in order to preserve physical health. Overwhelming stress can cause great damage to the body--altering hormones, damaging the immune system, interfering with sleep and worse. The survival instinct will undermine the mind's ability to accurately perceive reality in order to avoid the physically damaging effects of overwhelming fear.
People who have been victims of rape or other traumas not infrequently experience dissociation. Aspects of the trauma may be blocked from conscious awareness.
Sometimes trauma survivors invent "reasons" why the incident occurred (rationalization). As the general population is made aware of behavior such as Weinstein's, others may also engage in denial or rationalization. People don't want to believe that another human could be that horrible, and perhaps especially, when that human is the same gender as they are. It's too frightening.
The way to overcome denial, dissociation and rationalization is to speak about the crimes and traumas. Overwhelming evidence eventually destroys the use of distorting defense mechanisms, for most people.
This article in The New York Times summarizes the reasons why women often don't report sexual harassment--mainly, that they fear retaliation. There are other factors, however, that make people in general turn a blind eye to harmful and pathological behaviors. These include psychological defense mechanisms such as denial, rationalization and dissociation, effects of mass culture, and deliberate propaganda by vested interests that uses rhetorical tricks to minimize atrocities. I'll address psychological defense mechanisms today.
Psychological defense mechanisms serve to ward off anxiety by distorting reality. In rationalization, the mind invents "reasons" why something happens that aren't really logical, but serve to distract from an unpleasant or frightening reality. In dissociation, consciousness is altered so that an experience isn't perceived at all in daily consciousness, but may be acted out unconsciously, or remembered while in an altered state (such as hypnosis). Denial is a phenomenon in which "the existence of unpleasant realities is disavowed; [it] refers to keeping out of conscious awareness any aspects of external reality that, if acknowledged, would produce anxiety" (Kaplan and Sadock, "Synopsis of Psychiatry," 2007 edition).
The mind resorts to defensive maneuvers in order to preserve physical health. Overwhelming stress can cause great damage to the body--altering hormones, damaging the immune system, interfering with sleep and worse. The survival instinct will undermine the mind's ability to accurately perceive reality in order to avoid the physically damaging effects of overwhelming fear.
People who have been victims of rape or other traumas not infrequently experience dissociation. Aspects of the trauma may be blocked from conscious awareness.
Sometimes trauma survivors invent "reasons" why the incident occurred (rationalization). As the general population is made aware of behavior such as Weinstein's, others may also engage in denial or rationalization. People don't want to believe that another human could be that horrible, and perhaps especially, when that human is the same gender as they are. It's too frightening.
The way to overcome denial, dissociation and rationalization is to speak about the crimes and traumas. Overwhelming evidence eventually destroys the use of distorting defense mechanisms, for most people.
Wednesday, October 11, 2017
Raising Resilient Children
There have been a plethora of books and articles written in the past few years about the lack of "resilience" among members of "Generation Y" (people born from approximately 1985 to 2000), what has caused it and what to do about it. But now, the millenials are starting to have their own children. How can they avoid the mistakes of their parents? Here are some tips:
1. Have more than one child and make sure that siblings aren't more than 3 or 4 years apart in age. I know this might not be feasible for all parents, but it is worth mentioning, because the advantages of siblings outweigh the negatives, and the advantages are significant.
Although some studies in the past indicated that only children have higher achievement, some studies also found a greater incidence of drug addiction among only children.
People who grow up with siblings learn crucial skills of negotiating, sharing, advocating and taking turns, earlier and more consistently than only children do. More importantly, a sibling close in age is a "buddy" who provides peer identification, which is important for personality development. Only children often feel lonely because school friends and play dates aren't a substitute for a sibling, and worse, when the parental marriage is dysfunctional, an only child can become a parent's best friend, an unnatural situation that interferes with personality development and in the worst cases leads to incest.
Although I've heard stories of dysfunctional sibling relationships (including abuse), the majority of my patients who have siblings have benefitted from those relationships. Siblings too far apart in age often don't function as siblings, however, with the older sibling often taking on a quasi-parental role that may not be appropriate.
2. Allow your child to engage in unstructured, unsupervised play. It really is true that hovering parents interfere with a child's developing sense of autonomy. Let younger children play by themselves (or with siblings) in their rooms, and let older children play by themselves in the backyard, if you have one.
3. Send your child to sleep-away camp if you can afford it. Do this when your child is 11 or 12 years old. Sleep-away camp can be a way for only children to get some of the benefits that children with siblings get. A good sleep-away camp offers challenging outdoor activities that build confidence.
4. Remember that academic achievement alone doesn't guarantee success in life. The Unabomber went to Harvard. Prestigious academic degrees don't guarantee mental health or social functioning. I have found that many of my patients who are the children of immigrants were kept home after school to study, study, study. The end result is often anxiety disorders and worse. Just today I read an article in The New York Times about the skyrocketing rate of adolescent anxiety disorders, with one teen profiled taking 3 Advanced Placement classes as a high school junior. I don't understand why this is allowed by the school, much less by the parents.
5. Be a role model of mental health. The best way to be a good parent is to be a healthy parent. Parents with untreated depression or those who engage in substance abuse tend to have emotionally disturbed children. Nine times out of ten, when I worked with children, I found that there was either abuse or neglect or a parent had an untreated disorder.
1. Have more than one child and make sure that siblings aren't more than 3 or 4 years apart in age. I know this might not be feasible for all parents, but it is worth mentioning, because the advantages of siblings outweigh the negatives, and the advantages are significant.
Although some studies in the past indicated that only children have higher achievement, some studies also found a greater incidence of drug addiction among only children.
People who grow up with siblings learn crucial skills of negotiating, sharing, advocating and taking turns, earlier and more consistently than only children do. More importantly, a sibling close in age is a "buddy" who provides peer identification, which is important for personality development. Only children often feel lonely because school friends and play dates aren't a substitute for a sibling, and worse, when the parental marriage is dysfunctional, an only child can become a parent's best friend, an unnatural situation that interferes with personality development and in the worst cases leads to incest.
Although I've heard stories of dysfunctional sibling relationships (including abuse), the majority of my patients who have siblings have benefitted from those relationships. Siblings too far apart in age often don't function as siblings, however, with the older sibling often taking on a quasi-parental role that may not be appropriate.
2. Allow your child to engage in unstructured, unsupervised play. It really is true that hovering parents interfere with a child's developing sense of autonomy. Let younger children play by themselves (or with siblings) in their rooms, and let older children play by themselves in the backyard, if you have one.
3. Send your child to sleep-away camp if you can afford it. Do this when your child is 11 or 12 years old. Sleep-away camp can be a way for only children to get some of the benefits that children with siblings get. A good sleep-away camp offers challenging outdoor activities that build confidence.
4. Remember that academic achievement alone doesn't guarantee success in life. The Unabomber went to Harvard. Prestigious academic degrees don't guarantee mental health or social functioning. I have found that many of my patients who are the children of immigrants were kept home after school to study, study, study. The end result is often anxiety disorders and worse. Just today I read an article in The New York Times about the skyrocketing rate of adolescent anxiety disorders, with one teen profiled taking 3 Advanced Placement classes as a high school junior. I don't understand why this is allowed by the school, much less by the parents.
5. Be a role model of mental health. The best way to be a good parent is to be a healthy parent. Parents with untreated depression or those who engage in substance abuse tend to have emotionally disturbed children. Nine times out of ten, when I worked with children, I found that there was either abuse or neglect or a parent had an untreated disorder.
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