Jung At Heart Archive March 2007

Count me as a fan

Two posts in one day? Have you gone mad, Cheryl?  -- We'll leave that issue for elsewhere.

So what would move me to make a second post today? Why a post from what has become a must read blog for me -- a post on this very lively issue of bi-polar illness in children. Here is what CP&P has to say, in part, today:

"A. Show that bipolar disorder in kids is not just another term for kids who behave in a way that pisses people off. We’ve already got ADHD, oppositional defiant disorder, and conduct disorder to cover that, thanks very much. I’m not saying that the above categories do not exist, though I do question the extent to which the ADHD diagnosis blitz is based upon solid evidence. Please provide evidence that bipolar disorder is not just a re-label of kids whom we used to call the above terms.

B. Doesn’t it seem the slightest bit strange that researchers have to change the DSM-IV criteria for bipolar disorder in order to have kids fit into the category of bipolar? Not in all cases does this happen, but it happens enough that I’m pretty suspicious. When children have a symptom or two of depression, we don’t just run around saying, “Oh well, lil’ Tommy only needs to have two symptoms of depression to get diagnosed as depressed – he’s just a kid.” What’s up with that? Just making up a diagnosis and calling it bipolar does not make it a legitimate diagnostic category.

C. How does labeling youth as bipolar lead to beneficial outcomes? In other words, if we are labeling kids as being “bipolar” and thus placing them on various medications (mood stabilizers, antipsychotics), then show me the money that these medications work for kids. Showing data over the long-term would be nice, by the way.

Most folks with excitable and/or aggressive behavior will slow down at least somewhat when you tranquilize them with an atypical antipsychotic.Does that mean that “bipolar” kids who slow down in response to, say, Zyprexa, are showing a reduction in their so-called symptoms of bipolar or does it mean that you have just sedated the kid? Or are sedation and a decrease in mania one and the same."

There's more -- please go and read it.

Mar 30, 2007 9:29 AM

There is hope...

Last night I was checking through the links to various and sundry articles from my Google Alerts. It's interesting to watch certain topics work their way through various media over time -- I think I saw the report of the efficacy of telephone therapy with depressed patients close to a month ago but it pops up still in some new outlet as the idea moves through various outlets. I work with a number of my patients on the telephone and have for several years -- yes, it does work. They could have just asked me.

Anyway, while following links last night, I ran across this interesting piece in the Swathmore College student newspaper. I am used to finding great enthusiasm for the brave new world of neuroscience and the like from younger people, especially since the mind-oriented approaches to psychology -- those of us who focus on meaning rather than symptom relief -- are decreasingly part of academic psychology. So it was refreshing to read Josh Cohen's article about his reaction to this research:

"Last week, researchers at New York University announced a breakthrough in neurophysiology: they have succeeded in deleting frightening experiences from the memories of rats. The researchers artificially created anxiety in the rats and then rearranged the rats’ brains so that there was no longer any experience of the “anxiety attack...Too often these sorts of scientific discoveries are appropriated by the cultural project of Happiness, which seizes the scientific truth (or description) as prescription for the human condition.

But when scientists describe anxiety as the misfiring of this or that neuron, they’re doing so retrospectively; they’re providing a what, even a how, and yet they can’t say anything about who did what to you and why. So the prescription sounds a lot like self-help, but with the backing of hard science: “You are the way you are.” This is why it’s so scary that one of the researchers, Greg Quirk, said with regards to his team’s findings: “This is the future of psychiatry.”

Then --

"I want battle scars, not surgery scars. I want beautiful losers, not fake winners. I want my worst memories. I don’t say this because life is suffering (though it is) or because you need to suffer to make art (though that is true, too). After all, romanticizing your life away is really not much of a life, either. The thing about the fundamentally scientific approach to human beings, though, is that it is completely anti-imagination."

Yes, some of that comes of the earnestness of a college sophomore still in the throes of discovering who he is and what life is about. But he strikes a note of deeper truth when he gets that suffering, to a degree, is in fact a part of life and is not without meaning. Jung teaches us that suffering cannot be escaped, or not without peril, and must be embraced and accepted as part of the human condition.

Josh will refine his thinking as he gets older but he is making a good start and it is encouraging to see among the young a voice that challenges the existing dogma about mental health.



Mar 30, 2007 8:16 AM

Researching Meaning

For all that I complain here about the dominance of cognitive behavioral therapy in the field today -- and I actually think it dominates research more than actual practice -- I admit that I do from time to time draw on techniques that I learned from the behavioral approach I learned back at the dawn of time when I was in training. But I am far more engaged by the therapeutic process of exploring and discovering meaning -- of symptoms, of dreams, and of life -- in the lives of those I work with and in my own life.

In my first merry dance with graduate school, I had planned to do my dissertation on the development of a clinical measure to assess likelihood of suicide based on a pretty existential understanding of what underlies suicide. Maurice Farber, a social psychologist, had done some interesting research on factors involved in the differential rates of suicide in the three Scandinavian countries. He concluded that hope was the major factor and linked it to a variety of expressions. Working with him, we came up with a way to operationalizing hope in order to measure it. We saw it as sense of efficacy, future time perspective, and another that I can't remember now -- it has been almost 40 years since I gave much though to it. Well, I ended up leaving ABD and the study never got past the very early stages.

I was delighted today to read that others have been interested enough in how to measure meaning to have actually developed good research designs to do so. In an article in the Chicago Tribune,

" The developing field, called experimental existential psychology, or XXP, explores how people find meaning and purpose in their lives. A topic that was once the province of poets and philosophers can now be examined under the cold light of science, researchers say.

How people deal with existential concerns could help explain a broad spectrum of behavior, they believe, from political and religious leanings to altruism and the pursuit of riches to patriotism and terrorism."

""It's the psychology of the soul in the sense of looking at the deepest things we rely on in our lives," he said. "It is a sense of inner being that helps us function and feel secure in what's really a scary world.

"We all want a sense of continuance, a sense that we're more than just these temporary creatures on this dirt ball," Greenberg said. "We want to feel we're significant beings in a meaningful world."

It gives me hope when I read that there are still people out there wanting to look beyond behavior into what people feel and how they think about their lives and the meaning of life. Then I think that no doubt some drug company will come along and find a drug that tests just better than placebo and would be perfect for disorders of meaning of life, a category which would of course need to be developed in the next version of the DSM.
Mar 27, 2007 8:55 AM

Who decides?

I continue to be dismayed, angry, concerned -- choose any adjective in that family -- about the huge influence of pharmaceutical companies on mental health practice. Between the drug companies and the insurance companies -- and they travel hand in hand -- the whole field of mental health treatment has altered in ways that do not favor patients at all. If you too get exercised about this issue, I recommend following these bogs: Furious Seasons and Clinical Psychology & Psychiatry -- they both track this with passion and lots of documentation. As I read their posts and observe myself what is happening in this field, I start to feel helpless or at least that I am very far out of the mainstream. Most of the people I know outside of my field and my practice firmly believe that depression is due to a "chemical imbalance" that requires medication, perhaps for life. If they try therapy, it is usually for fairly short terms and then they say it doesn't help. It really  shouldn't surprise me -- billions of dollars have been spent to make them think that way.

Mental health and psychotherapy has become medicalized to far greater degree than I ever believed  would happen.

I think I will go find something cheerier to contemplate today -- like the melting snow.


Mar 25, 2007 4:53 PM

All you need is ... a new medication?

I was watching The View this morning -- I happen to think that some of the best discussion on television happens every day on this show. Anyway, there I was happily watching and then came the commercial -- you can see it here. All of the examples shown looked like good candidates for some work in therapy. But is that what the commercial is for? Of course not, silly. If you explore all of the links at the site, you will find that they do give a nod to psychotherapy, but the implication of the commercial is certainly that it is a change of medication that is needed. Because this commercial comes courtesy of Wyeth. And Wyeth is the manufacturer of Effexor.

I would so like to see some solid thinking and research about what is means that we have become so willing to believe that solutions are best found in medications. There is something in the intersection of the interests of pharmaceutical companies, health insurance companies and whatever this is that drives us to prefer thinking in terms of disease instead of responsibility or meaning that makes me very uneasy.

Mar 20, 2007 11:45 AM

Bipolar children, revisted

In the last couple of days, there has been another rash of posts here and there on the issue of bipolar illness in children -- I posted about this on 2/20/2007. There is something deeply troubling about the push to attach serious psychiatric diagnoses to children. What I find interesting in what I have read so far is an absence of curiosity about why the upswing in prevalence of this problem and very little, except from critics, about the tendency to label anything other than perfect behavior as pathological. Have we really become Lake Wobegone, where all the children are  above average -- and those who are not are on meds? Think about the memorable naughty children from children's lit -- would they now be slapped with a psychiatric diagnosis and medicated out of their naughtiness? *

Yesterday, Furious Season critiqued a piece by John McManamy in which he defends the practice of so-labeling kids. When I read this by McManamy:

"Then came the book that put the illness on the map. In Jan 2000, “The Bipolar Child” by Demitri Papolos MD and Janice Papolos hit the shelves and became a surprise best-seller. Almost instantly, parents started using the book to educate their child’s clinicians and educators...

Dr Papolos had the MD, but his wife Janice was the one who possessed perfect pitch in connecting to readers. To fully appreciate her contribution, one only has to sample the 100 reader reviews on Amazon, from which the following is representative:
"The first time I read this book after my 8-year-old son was finally diagnosed properly four years ago, I cried with relief that FINALLY what our family had been living with was right there in black and white … It brings peace to your chaos ... it helps give you control over this crazy situation. As we say in the Bipolar Parents support group, ‘RUN, don't walk - buy this book NOW!’"

I was surprised that there is so little critical attention paid to the fact that this may in significant part be driven by parental desire to have a label for their kids rather than by an actual disorder. This seems to have become commonplace in the last 15 years or so. And with it, skyrocketing numbers of kids labeled as ADHD, Oppositional Defiant Disorder and now Bipolar. The labels, attached at ever earlier ages, become self-fulfilling prophecy as problems become center stage and strengths are all but ignored. Where there used to be an attitude that most kids will outgrow the problems of childhood, if not on their own then with some guidance and discipline, today we seem to be eager to tag them as mentally ill, perhaps consigning them to a degree of perceived disability and illness for life. I find this deeply troubling.

I know that there are children with serious behavior problems. I also know that in many places and for many parents, medication rather than behavioral approaches are the first line approach rather than the last resort. I still think that in most of these cases, behavioral interventions, especially when made early, would succeed and leave both parents and children equipped with tools for dealing with problems in the future.

Could it be that as the pressure which parents feel to maximize their children's potential by enrolling them in sports, lessons of all kinds, concern about making it into the best schools and then colleges is far more about the parents' narcissism than it is about the needs and wants of the child? Twenty-five years ago, David Elkind sounded the alarm about stressing kids in his book, The Hurried Child -- what we are seeing today seems the outgrowth of what was already observable to Elkind in the early 80's, only now things are worse.

* Click here for a nice article reviewing the naughty children of children's literature.

Mar 20, 2007 8:52 AM

Divorce and widowhood

Last week a friend, who was widowed a couple of years or so ago made an observation that I have been thinking about. She observed that for her, divorce was harder than being widowed, because with divorce, the other goes on and in that sense there is no ending.

I think she is spot on though I haven't the experience of widowhood that she has. Is there ever a satisfactory resolution of the old business of a marriage that dies? I kind of doubt it. Even when the two work their way through all the hurt feelings and anger and negotiating and arrive at a settlement and then pretty much sever contact, some things linger on in the background and pop up from time to time. A memory of a good time or hearing something about him or her or seeing a flash of the other parent in your child. Or something comes to mind that you find yourself thinking she might like or that might prove to him you're right. The relationship goes on in a way, like an underground stream. Most of the time it stays below ground and rarely causes any problems but then, every once in a while there it is again -- and then it submerges again.

Nothing really earth-shatteringly important in this. I just found it interesting.

Mar 19, 2007 10:29 AM

Winter's last gasp?

Last night we got another big dump of snow which changed to rain late this morning. Ice is coming down the river into the harbor creating these odd patterns --

icemelt

Mar 17, 2007 1:48 PM

We Feel Fine

I love reading the Technology section of the NY Times. It appeals to my inner geek. Today, David Pogue had several interesting links to innovative web sites. This on, We Feel Fine, captivated enough to keep me there poking around for quite some time. Both the geek and the psychologist in me love it.

Mar 15, 2007 5:26 PM

Zimbardo speaks out

Phillip Zimbardo was a big name in psychology when I was in graduate school in the late 60's and early 70's. Long before we has social phobia, which of course requires medication, Zimbardo was studying shyness and developed behavioral treatment for it. But he is probably best known for the Stanford Prison Experiment, which revealed, much to everyone's discomfort and horror, how brutal and sadistic ordinary people could become when put in control of other human beings. In my day, this study was one way we attempted to understand the behavior of concentration camp guards.

But we have a far more contemporary situation for viewing what Zimbardo found and that is in our own treatment of detainees in the current so-called war on terrorism. and most notably the shame of Abu Ghraib.

In his final lecture before his retirement from Stanford last week, Zinbardo lambasted the current administration for its policies on detainee torture --

Philip Zimbardo said abuses committed by Army reservists at Iraq's Abu Ghraib prison were not isolated incidents by rogue soldiers. Rather, sadism was the inevitable result of U.S. government policies that condone brutality toward enemies, he said.

Individual military personnel -- those who stripped prisoners and leashed them like dogs -- are only as culpable as the people who created the overall environment in which the soldiers operated, Zimbardo told undergraduates enrolled in introductory psychology.

"Good American soldiers were corrupted by the bad barrel in which they, too, were imprisoned," said Zimbardo, 73. "Those barrels were designed, crafted, maintained and mismanaged by the bad barrel makers, from the top down in the military and civilian Bush administration."

He went on to say:

Decades later, Zimbardo applied his analysis to American soldiers at Abu Ghraib. He testified as an expert witness in the court martial of Staff Sgt. Ivan Frederick, the highest-ranking officer implicated in the scandal.

Frederick received a maximum eight-year prison term for abusing and humiliating detainees. He was stripped of nine medals and 22 years of retirement pay.

Zimbardo -- who spent months interviewing Frederick and his friends and relatives, and poring over Frederick's work history and personal background -- argued that his sentence should be lessened.

Based on academic research, Zimbardo said, very few people could resist the situational pressures of Abu Ghraib -- particularly Army reservists, themselves subject to hazing and abuse by active duty soldiers.

"There's only one rung lower than reservists, and that's the detainees," Zimbardo said while flashing dozens of "trophy photos" of Iraqi prisoners in naked piles, being menaced by snarling German shepherds, covered in blood or with their eyes missing.

It seems a very good note on which to close an academic career.

Mar 14, 2007 9:06 AM

Self-disclosure, part 2

A reader emailed me with a question about therapist self-disclosure because she had become uncomfortable when her therapist disclosed a personal story from her life. Her question was about what to do, which of course, I could not say. I did suggest that she raise the issue with the therapist and see where they could take it.

I have been thinking about this today. I have had personal experience with therapists who disclosed nothing about themselves beyond indicating, by the wearing of a ring, that they were married. And I have had experience with therapists who revealed entirely too much about themselves. The blank slate therapist can seem cold, aloof and remote. The very disclosing therapist can seem to be making himself too much the focus of the work. So what is the right level? I come back again the importance of getting enough experience to develop a good feel for what is right, and for getting really good clinical supervision, especially around tricky issues like this.


Mar 13, 2007 7:30 PM

Panic & Psychoanalysis

I have come to expect that any study on the effectiveness of psychotherapy -- and there aren't many done these days when so much research is underwritten by drug companies but that is a rant for another day -- any study will involve some flavor of cognitive behavioral therapy. In fact, many young clinicians believe it is the only effective method. So I was quite pleased to find this today:

Psychoanalysis effective for panic disorder

"The findings from a clinical trial indicate that psychoanalytic therapy can be particularly effective for people suffering from panic disorder. Relaxation training is also helpful but it has a lower success rate."

I wish the study had compared results between psychodynamic therapy and cognitive behavioral therapy, because I suspect that they might well be equally effective over the 12 week course of therapy used. Still, the study reports 73% of the therapy group improved.

"With increasing concerns about side effects from medications commonly for panic disorder, "it is good news that patients can choose from more than one time-limited psychotherapy for treatment of panic," she [the investigator] added."

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Mar 12, 2007 2:04 PM

Jay Haley

I read last week that Jay Haley died recently. I never became involved in family therapy -- it always felt like too many people in the room to me. And I'm not sure that much of the techniques that Haley pioneered and advocated remain in use. In the late 60's and early 70's when I was in graduate school, Haley was a revolutionary voice, one I enjoyed reading. All these years later, I can't say really how his work influenced mine, but I still vividly remember reading The Power Tactics of Jesus Christ.


Mar 10, 2007 10:58 AM

Self Disclosure

I got an email Friday on the issue of therapist self-disclosure in psychotherapy. This is an interesting issue and certainly one every therapist must wrestle with and come to his or her own terms with. I remember the therapist I saw in college as a completely blank screen -- I knew nothing about him and frankly he learned very little about me. There was something quite sterile about the whole relationship, consistent with the strong classical psychoanalytic notions about what was and was not appropriate in those days. In the heyday of the encounter movement, which was coming along when I was in graduate school, quite the opposite obtained in which many therapists quite literally let it all hang out in activities like nude encounter groups.

No one has mandated anything like a clear set of rules or guidelines to govern self-disclosure. Those concerned with risk-management would counsel disclosing as little as possible. Those placing a premium on fostering a solid relationship would support a range of kinds of disclosure, always stopping short of confessional or inappropriately personal revelations.

But still, we must all grapple with the issue ourselves. My patients know I am married, that I have also been previously married and divorced, that I have adult children, that I myself have spent time in personal therapy. They know I like to read, I enjoy movies, that I lean toward Jungian analytical psychology as my theoretical base. Even the most rigorous defender of the so-called secure frame and therapeutic neutrality makes self-disclosures in a variety of ways -- accent, choice of office location and furnishings, style of dress, and so on. We can never be an entirely neutral presence in the life of an another. All we can do is strive to be aware of the reasons for any disclosure we do make and to do our best to keep our personal issues as little entangled with those of our patients as possible. But perfection is beyond our reach in this as in all endeavors. We will make mistakes. And when we do, acknowledging them becomes part of the therapeutic process.

I'm interested in how others, therapists and patients alike, experience this issue.

Mar 1, 2007 11:58 PM

© Cheryl Fuller, 2007. All  rights reserved.