June 6, 2015

By: Carol Maxym, Ph.D.

Seventy-one years.  Entire lifetimes.  June 6, 1944.  Does it matter anymore?  Even those who survived the day are mainly gone now.  Fewer and fewer to tell their stories.  The world has changed and the news is more about the Middle East or Ukraine or Africa.  Europe, it seems has settled.  Mainly.

So what does it matter 71 years later?  I’m sure you’ve seen the films of the Americans, the British, the Canadians, the Australians, the New Zealanders stepping out of those boats, moving towards the land.  Many, ever so many killed before they even made it there. But they kept on coming.  And they established themselves on the beaches.  They moved inland. I have never stopped being awed, truly awed by the courage of those young men. 

When they came home—those that did—people didn’t keep thanking them for their service.  I think the reason is because pretty much any able-bodied American served in the war.  No one had to try to assuage feelings of what?  Guilt?  Inadequacy?  No one had to hide behind bloviated gratitude.  No one had to hold forth about heroism because everyone accepted the heroism.  The women who worked in the factories were heroes, too.  There was a social contract that held people together.

So twice this weekend I watched teens in groups of adults hide in electronics, in phones, in video games, texts, instagrams.  And I ask myself:  If they are called upon, will they/would they be up to the task?  Can they come out of their own tiny (for it is tiny) world long enough to behold true heroism and imitate it in real life?  To know they must stand on the side of right? 

Could they rise to the occasion or have we so disadvantaged them—yes, disadvantaged them by entitlement, by rescue, by creating a child and teen centered world?  Have we kept them from knowing how to do what is right simply because it is right? 

Have we rescued a generation to the point they do not have the ability to be heroic?

Fewer and fewer remain to tell their stories of D-Day…and would anyone be listening?

The Brady Poll

By: Carol Maxym Ph.D

        

Lots and lots of talk about the “punishment” meted out to Patriots’ QB Tom Brady.  Lots and lots of opinions on whether the “punishment” is just, unjust, too terrible, not terrible enough.  

This morning’s TV news was conducting a poll on watchers’ opinion on the appropriateness of the “punishment.”  I just have to put the word into quotation marks because I can’t see how missing four games is a punishment for potentially lying, manipulating, and disappointing people who believed in him, teaching kids covertly if not overtly that winning is more important than honor… But then, that’s just my opinion.

And there’s the problem.  Opinions.  I am going to say something outlandish.  We have too many opinions these days.  Too many opinions based on very little or false data.  There is an opinion poll out every day on everything from punishments for Quarterbacks to Global Warming to favorite candidate.

Opinions, per se are a part of our democracy.  Well and good.  But shouldn’t one take the trouble to be well informed before forming an opinion?  Shouldn’t one need to be able to support one’s opinion beyond “I just feel that way”?

During the news broadcast I watched this morning, in the course of the reporting—maybe five minutes but probably only about three minutes—opinions changed and more people were saying that Brady’s “punishment” was unfair than at the beginning of the segment.  So, reporting from one reporter for a minute or so changed people’s opinions.

Here’s a question to consider:  If there had been an opinion poll about D-Day on June 1, 1944,, how many people would have thought it a good idea? 24 hours into it, what percentage of people would have thought it well planned or likely to succeed?  Fortunately, no data exists for those fantasy opinion polls because none were taken.

Things have changed.  A lot.  Now one is expected to have and say opinions about just about everything—with very little data to support those opinions.  We all know that we seek to hear the “facts” that we like, whether they be facts or not, and we form opinions based upon…well, other people’s opinions masquerading as facts but presented as truth.

So what does this have to do with raising kids?  A lot, I think, because kids growing up in a world where having an ill-informed or un-informed opinion begin to think that’s normal, ok, intelligent, expected.  Let’s take that a step further.  Kids are taught very little in school these days about the difference between fact and opinion.  My experience is that kids hardly know the difference.

So, what to think about?  Well, am I wrong or right or almost right or mainly wrong but sort of right?  How are you forming your opinion?  What opinions have your children expressed to you in the last day or two?  Are they supported by facts or just by wanting things to be so?  In school is your child being taught the difference between fact and opinion.  What do you think:  Is it more important for your child to learn the difference between fact and opinion or to learn about “self-esteem”?  Think about it.

ENOUGH!

By: Carol Maxym, Ph.D.

ENOUGH!

Enough of the articles and news reports like this one, http://www.cbc.ca/news/world/lufthansa-not-required-to-report-lubitz-s-depression-company-says-1.3022632. 

....and this one,http://www.dailymail.co.uk/news/article-3026640/Lufthansa-did-not-tell-aviation-regulator-Germanwings-pilot-Andreas-Lubitz-previously-struggled-depression.html

I’ve refrained from commenting about the purported psychological basis to the tragic decision of a German Wings pilot.  And now I just can’t be silent any longer.  Enough!  Enough of this gabble about depression.  Three points are really clear:

1.    Depression was not what made the co-pilot make the decision he did to crash the plane into a mountainside.

2.    We will never, ever, ever know what made the co-pilot make the decision he made.

3.    There is absolutely no way ever to make certain that someone doesn't do something horrible and evil and cruel to other people again.

Therefore, let’s stop the nonsense speculation.  Let’s look at this frenzy of silliness masquerading as psychology, psychotherapy, psychiatry and see it for what it most certainly is.  Silliness.  Silliness that mainly just sounds like a pharm rep trying to sell his new pill to a psychiatrist, nurse practitioner or other person who can sell (ooops, prescribe) pills.  Silliness because it perverts the discussion of the human mind, the human spirit, human emotions into a pseudo crossword puzzle of pretend psychological knowledge and understanding.  This is NOT what psychology is about.

I mean why are we speculating about depression instead of evil ? 

The narrative seems to go sort of this way:  Andreas Lubitz once “had” depression and therefore somehow his depression had something to do with/was his motive for his decision to murder a plane load of innocent people.

However, we are also told that depression is “treatable,” and that we mustn’t stigmatize the mentally ill (are depressed people mentally ill or are they depressed?  At what point does “depression” become mental illness?  Ooops.  Mental refers to cognitive processes of the mind and depression is emotional—it’s a long standing verbal problem with trying to talk thoughtfully about these issues.

Then we get back to that one pesky [of 155 known] neurotransmitter (Serotonin) that somehow drives us all to smiley or frowny faces on a daily basis—or a disorder basis.. But I’m not clear about the stigmatizing of “mentally ill” people because they are just like us (with 14% of the population diagnosed as depressed and that supposedly is under-reported) they are certainly like many of us.  By the way, have you ever felt depressed? 

So then we must get to noticing that this looks like the worst epidemic of illness since the Spanish Flu outbreak in 1918-19 that killed more people than World War 1 and is the worst recorded epidemic in recorded history.  And if 14%+ of the population has depression and depression (though treatable but apparently not completely or not over a long period of time), then what about bus drivers, train engineers, taxi drivers, cooks, ship captains—other people in their cars who could act from their not fully treated depression and do something evil.  I mean, mustn’t we check to see that they never had or were treated for depression?  Or treated for evilness?  Because any one of these people could choose to do an act similar to Andreas Lubitz.  Maybe we need to screen everyone everyday, just to be very, very sure. 

Maybe we need to consider the possibility that his man was insane and/or evil.

What about the shooting at the movie theater in Aurora, Colorado?  Maybe he was depressed?  Now you know that sounds ridiculous because it is.  Why is that ridiculous but opining on and on about the possible, once-treated [but not successfully] depression of Andreas Lubitz makes sense?

I go back to my professor in graduate school who used to say, “Since no one claims to be a physicist because they know that gravity is why an apple falls from a tree, why does everyone think they understand psychology?  Listen, pilots:  I don’t tell you how to fly a plane; please stop talking pseudo-psychology.

Now all this muddle about depression and mental illness and stigmatization and treatable depression and once having taken medication…it really makes you want to think about it and notice how absurd we are [well, the media] as we try to understand that which will always and necessarily exceed the horizons of our imagination.

OpEd in Response to The Atlantic's "The Irrationality of AA" by Gabrielle Glaser

By: Robert Schmidt, M.A.

Published in The Atlantic today, http://www.theatlantic.com/features/archive/2015/03/the-irrationality-of-alcoholics-anonymous/386255/?utm_source=SFFB.

A few thoughts: 

1. Why does it matter whether or not addiction is a disease? Labeling it as such only serves to leverage payment (rightly so) from health insurance providers for treatment. 

The use of the word “disease” should be a non-factor in the treatment of individuals who are tasked with creating unique personal narratives on their alcohol use in the evidence based psychological treatment models that Gabrielle Glaser correctly references here.  

Although, it is also clear that Glaser is a big supporter of the use of medication treatments for alcohol and substance use disorders, a topic which deserves consideration in long form on another day. 

2. Glaser argues that AA takes a cookie cutter approach, recommending complete abstinence for those who might be better served by “moderation” styled approaches.  However, there is another side to that coin... Yes, there is a danger that complete abstinence is an overreaction for some and that this approach is really meant for those on the “severe” end of the bell curve, but so is harm reduction! The whole idea of moderating one's use and limiting harms is based on the precedents set by the needle exchange programs and the legislating of prostitution in Amsterdam.  So, it is the same thing all over again: we are basing our treatment recommendations on evidence collected at the “severe” end of the spectrum, only this time we are taking the risk of under prescribing instead of over prescribing levels of abstinence.

3. To say that AA is unscientific is a lazy criticism. After having successfully met the standards of certain prescribed phases of scientific rigor, treatment approaches are labeled as “evidence based.” There are several factors that are considered in this process, including the efficacy of the treatment as well as the cost and the ease with which it can be dispersed. 

Efficacy is in interesting term which the Ms. Glaser uses several times: either incorrectly, or misleadingly. Treatment efficacy refers to either the statistical significance or (preferably) the statistical effect size of a treatment in a controlled setting. To be clear: efficacy studies are conducted in laboratories. So to say that there is no proven efficacy for AA is misleading because it cannot be conducted in a controlled setting. AA has long been implemented in the public sphere, so to bring it into a laboratory setting would be to alter it fundamentally. It is impossible to measure the efficacy of AA, because there is no way to design an experiment for it.

Scientific investigations of treatments outside of the lab (ie, real world applications of treatments) are known as “effectiveness studies.” This is an important distinction because in order for a treatment to be labeled with an “evidence based” endorsement it must first have been validated for efficacy and then for effectiveness.

This is important because of all the qualities that should be celebrated about AA (and there are many), perhaps the most heroic is the fact that AA is widely available and accessible: even to those who subsist on the lowest rungs of our socio-economic ladder. The value of that quality cannot be overstated. 

Note: I strongly believe that the average individual in our culture does not fully appreciate or even understand exactly how rigorous the scientific process actually is. Science moves at a much slower pace than most people think. And, when considering the science of psychology, we are talking about something that is so complex and difficult to control for that it has only really been in existence for about 60 years (give or take).

And, even that doesn't distinguish it from medicine very much. A prominent neurologist recently told me that 90% of the treatments he recommends for his patients are not evidence based: these are treatments like acupuncture, physical therapy, dieting etc… 

Glasser also references several studies comparing the long term outcomes of AA to evidence based treatments saying that AA's success rate is likely in the single digits. Three things to to keep in mind here: A) "success" is a loosely defined term, B) follow up's rarely go past six months, and C) outcome measurements are inevitably based on self reports, (ie. asking the alcoholics how much they have been drinking: ie, asking them to lie).

4. Glaser’s criticism of alcohol use disorder treatments as having been corrupted for years by the ubiquity of AA, fails to acknowledge the importance of that ubiquity. She is solely talking about the implementation of alcohol and substance use disorder treatment in centers and practices which actually collect money for their services. And undoubtedly, she has a strong argument in her call for quality assurance here. 

However; when one decides to use their finger to plug a hole in the dyke, there is always a good chance that a new leak may spring elsewhere. 

Does the promotion of medication treatments not serve to further empower the greedy pharmaceutical companies that make up so many of the top Fortune 500's already? The same companies that so mishandled the AIDS epidemic in the 80’s and 90’s that they are responsible for the deaths of tens of millions in Africa http://fireintheblood.com/ . The same pharmaceutical companies that produce Oxycontin, Percocet, Vicodin, and Xanax...

Does the promotion of evidence based psychological treatments such as CBT and Motivational Interviewing ensure that those techniques will be carried out with any more standardization than the current approach? 

I will tell you that it does not, because I have studied these techniques in depth and I have worked in centers which utilize them. In my experience it is just as easy for someone to say they are doing CBT and actually do nothing, as it is for them to say they are doing AA and do the same. 

What is the current approach anyway? I have traveled the country visiting treatment centers and I have taken courses on the treatment of substance use disorders in multiple settings at the graduate and the undergraduate levels. It seems like everywhere I go my colleagues are speaking in the same voice as Glaser in this Atlantic article. I rarely hear professionals say that they are using AA or the 12 steps anymore. Mostly everyone is using “evidence based” treatments now, and mostly everyone who actually works in the field (unlike Ms. Glasser who is a journalist) is aware of the changing trends towards evidence based treatments and harm reduction. As a matter of fact, I doubt there is any one who would really argue against the need to be more scientific. 

Yet, we are still fighting an uphill battle. It would be naive to think that we only need to do X,Y, and Z in order to reduce the impact of alcohol and substance use on individuals and on our society. It is a gigantic problem because it is not simply solved. Let’s not be so reductionist about this and let’s make sure that before we go ahead and decide that AA (something that is widespread and free and already functioning well) is no good, let’s make sure we really mean it.  

The Help that Helps

By: Carol Maxym, Ph.D.

After four inquiries from prospective clients last week, each of whom had a long story of turmoil where the help hadn’t helped, I thought it time to address the issue of what really does help kids and families.  I get that that sounds arrogant; I really do.  Still when one hears of kids or young adults who are hospitalized again and again with little to no amelioration of their symptoms,  diagnosed with made-up disorders, prescribed medications for which the data supporting their efficacy is mainly MIA, it seems to me that the obvious next step is to remember the second most common finding in research regarding what works in psychotherapy.  

That finding?  

What hasn’t worked up till now won’t start working by doing more of the same. 

Simple.  Obvious.  Generally ignored. 

I do not take suicide or suicidal thoughts lightly.  Ever.  However, redefining hopelessness as depression or even the more ominous Clinical Depression and prescribing medications (whose side effects absolutely include suicidality and/or suicidal ideation) doesn’t seem to be very sensible.

The help that helps is very likely to be sensible.

When kids are hopeless, it is the reasons for those feelings which are important and require help, guidance, love, direction, understanding, boundaries, and hope from adults.  When kids are feeling “weird” (to quote Graham Moore who won an Academy Award on Sunday), it is the context of their lives which screams for scrutiny. 

Kids who can’t/don’t find meaning in life and who cannot or just aren’t seduced by lots and lots of  expensive designer stuff and  facebook friends they’ve never met, aren’t disordered.  They aren’t sick.  They aren’t anomalies.  Adolescence is a time of seeking, questioning, wondering, exploring.  When all that is pathologized, we leave kids in a worse place than before.  Holden Caulfield jumps to my mind.  And Young Werther.  David Copperfield (Dickens)…Oh, and Hamlet.  This is not a new problem; only our ways of helping kids to move through the problem is new—and apparently not that much better.

“Life is not as easy as walking through a field” (Pasternak) and yet we keep on walking.

The help that helps is very much based in understanding people—kids, young adults, and adults as well.  By understanding I mean accepting the human condition and that life isn’t a long series of smiley faces.  Understanding is connecting, empathizing, noticing context—and holding to moral and ethical standards.  Understanding is about meaning, the lifelong endeavor to find meaning.  The help that helps is about talking to the person in front of you with no thoughts at all about a “diagnosis.” 

In all the 500+ pages of the latest DSM, there is nothing about feeling weird or hopeless or wondering what is the meaning of life or this child’s life at this moment and beyond.

The help that helps must look beyond the prevailing template [paradigm] which has morphed and degraded the human experience into something that is as often as not a mischaracterized as a “disorder.”

Bipolarized Life

By Carol Maxym Ph.D.

This morning (well, and for much of the day) the news was filled with the story of the Jordanian pilot murdered—executed---cruelly, viciously, by ISIS.  A deed, I suppose, committed by those for whom shock value is equal to a man’s life.  I cannot pretend to understand what makes someone think that burning another man alive is a worthwhile deed.

But here’s something else I don’t really get and that is a part of our everyday lives.  I watched coverage of the murder–it was on for a good 6 or more minutes uninterrupted..  Then came commercials.  So, suddenly I hear soft clincky music and I learn about a medication for a made-up disease.  Then comes the sexy lady with the Viagra pitch.  Then come the kids dressed like adults throwing phones trying to sell me I have no idea what because I’ve muted them.  Then comes the car insurance…Then, back to the news.

What about feelings?  What about the complete disruption of feelings?  The honest, authentic reaction to the vile, evil deed done by ISIS, then silly, manipulative, deceptive froth to make me buy stuff.  What does that do to feelings?

After the ads we return to more commentary, a bit of detail about the murder, and a few photos of the murdered pilot.  And feelings…once again justified outrage, disgust, horror.  And then, again, back to the manipulation, the manipulative music.  Murder.  Fluff.  Horror.  Silliness.  Whatever you may think of ads, compared to the reality of the execution by burning alive of the Jordanian pilot, it is fluff and silliness.  I am not saying we should grieve endlessly, but can’t we show some respect???

Is it really any wonder that kids (and adults) feel mood swings?  We are being programmed into constant, violent mood swings on a minute-by-minute basis.  How are we supposed to process those emotional swings? 

I think the answer is that mainly we don’t/can’t process that rapidity of mood change,  We don’t even exactly acknowledge them because they are a part of daily life.  It isn’t much different on the Internet.  Information stimulates this emotion then that one—horror to hope in 23 seconds or less. 

Honestly, I don’t think humans are really meant to be able to process emotions that way.  I don’t think that kids have a chance to be emotionally stable when they are being taken from hideous to cute in the blink of an eye.  And that is also true of lots of other parts of kids lives.  Think about it.

What to do?  Well, neither you nor I can change the world situation.  Nor can we change or influence the ads that come your way, your children’s way.  I think, however, being aware—acutely aware—is the key.  If you are aware of the way your emotions are being swung, tampered with, manipulated, it is much easier to avoid the swing.  Teaching your children about the swings and how not to become involved is a life lesson like teaching how to fish instead of giving a fish.

Happy Helicoptering

By Carol Maxym Ph.D.

Or, what do you get out of helicoptering?

I've just asked you a really hard question.  What do you get out of helicoptering?  Probably your first reaction will be to begin to list all the reasons why you must helicopter.  Slow down, please.  Read on and give yourself a chance to think it through in a different way.

Professional Mothering is the term I've coined to describe one of the main ways modern moms get caught in helicoptering  

In your job anticipating problems is a good thing.  Solving problems immediately is a very good thing.  Preventing problems adds real value to you as an employee or as a professional.  Having things well organized—another plus in the working world.  Tying up all the lose ends—another asset.  Rescuing your boss from a giant gaffe—big time good in the professional world.
Here’s the rub:  Doing all those things as a mother?  Yeah, no.  Not helpful.  Really.

There are so many “soccer moms” today who have a great education, many years of professional success before deciding to become moms.  Please don’t take this the wrong way, moms, but there are certainly ways, times when being a mom is very boring.  Very unstimulating.  You wonder what that great education was for.  I remember that very well from my days as a young mother.  Mothering just isn't always intellectually stimulating,  Mothering often isn't exciting.  Mothering rarely provides a sense of immediate success or reward—the kind that does occur in the work world.  Frankly, it’s seldom that anyone really thanks you (certainly not your toddler who cannot understand) or pays real and authentic tribute to what you do all day.

There is no respite from mothering.  You are on duty 24/7 for years and years.
So, mothers, let’s face it:  You look for something to do, something stimulating, something you can really sink your teeth into.  You are trying to bring into your mothering world the parts of your professional world that you really liked, that kept you stimulated.  Understandable.  The question is more if it is useful.

Helicoptering is one of the ways to feel busy, useful, important.  The more you helicopter, the more your child [appears to] needs you, so the more you have to do.  I mean, if he’s forgotten his lunch, well, you must take it to him.  Same goes for homework.  And what about the project for science?  Getting her ready for camp—certainly she can’t pack her own things.  She wouldn't know how.
Here’s the deal:  Your child will never learn how to be independent and highly functional if you helicopter.  As you child feels less than competent because he/she isn't as competent as you are (well, of course—you are an adult, you child is…well, a child), anxiety can take hold because your child cannot feel competent to do whatever the task, remember what needs to be remembered, take care of whatever needs to be taken care of.

So, I’ll be really blunt:  Helicoptering is selfish and it isn't good mothering (or fathering).

Think about it.