Mental Health Blogs

Archive for January, 2010

Some interesting news from this morning’s session of the murder trial of Rebecca Riley’s mother back in Massachusetts. The testimony is from child psychiatrist Kayoko Kifiju and concerns Rebecca’s older sibling, Kaitlynne.

“At the time, Kaitlynne Riley was 2 years old, and Carolyn Riley had turned to doctors because the girl was being aggressive toward her older brother, Kifuji testified.

“The psychiatrist said she met with the little girl for an hour, during which the girl talked about seeing ‘monsters’ and ‘ghosts’–but did not display any sign of excessive aggressive behavior. Yet, Kifuji testified, she diagnosed Kaitlynne Riley as having bipolar disorder and prescribed Depakote for treatment.

“‘I made a diagnosis of bipolar disorder on Kaitllynne Riley based on information I got and I put her on medication,’ Kufiji testified.

“Asked by Middleton whether she saw any sign that the 2-year-old was unduly aggressive, the doctor replied, ‘no.’”

Evidence-based medicine at work. Sarcasm aside, who diagnoses a kid so young who is not displaying outward signs of dysfunction based upon a one-hour appointment? If a 2-year-old seeing monsters and ghosts–meaning having an active imagination–is enough to get a kiddo diagnosed and medicated then we are in deep trouble as a society.

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“But I don’t want to be weak”, he said.

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We’ve been quibbling about a title for our book-to-be for over a year now. We’ve used a working title of Off the Couch: Three Psychiatrists Discuss Their Work. Clink and I like it, Roy hates it, our editor cringed and changed it to Off the Couch: How Psychiatry Works and How Psychiatrists Think. We’ve toyed with everything from Beyond the Couch, to Psychiatry Demystified, to Set the Couch on Fire. Then HappyOrganist suggested Behind the Couch in one of the comments. Behind the Couch— I like it, it has the whole behind the scenes connotation. Oddly enough, Roy liked it. Roy liked it. Wow. It’s the first title that all three of us have been able to live with. Editor says “we’ll see.” She obviously didn’t love it. So for the moment, our working title is : Behind the Couch: Three Psychiatrists Explain Their Work. Thank you HappyOrganist!
So I want to know: do you like this title? I know it’s a complicated question, there’s “do you like it” versus “would you buy it?” versus “would you pick it up in a bookstore” versus “Yuck!” So I’m just going to ask as a yes or no poll. Please vote and thanks for your input.

How do you like Behind the Couch as a book title?(poll)

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Listen to our latest podcast at mythreeshrinks.com or subscribe to our rss feed. Email us at mythreeshrinks at gmail.

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Okay, picture this: I’m sitting in front of my desktop computer. Swivel to the right and my laptop is there. On the desk in front of me is my cell phone on which I’m arranging a meeting via text message. My left shoulder cradles a phone against my left ear(my home line) where I’ve been on hold with Medicare for the last 10 minutes because I want to talk about details of the 27 page form that I need to fill out for my office change of address. My left hand holds a second phone (my fax line) to my right ear — I’m on hold for an insurance company where I’m hoping to talk to someone to help a patient get reimbursement even though I’m out-of-network. My right hand types this blog post. I may explode but I won’t have gone down without trying.

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Listen to our latest podcast at mythreeshrinks.com or subscribe to our rss feed. Email us at mythreeshrinks at gmail.

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A new study out in the American Journal of Obstetrics & Gynecology adds more fuel to the controversy around pregnancy and anti-depressants. In it, researchers report that among 3,000 pregnant women in Washington State those who took an SSRI anti-depressants during the second or third trimester had an almost five times higher risk of delivering a preterm baby. The study also found a higher risk among women taking benzodiazepines.

The new study joins other recent studies casting doubt on doctors’ longstanding claim that anti-depressants aren’t linked to birth complications and it sure makes you wonder how post-partum depression can be properly addressed without putting babies at risk.

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I see a lot of really good people. You could say that most of the people in my practice– no, make that all of them– are just great people. Not that some don’t have personality problems, or disorders that make them difficult to like, necessarily, or to be around, but if you get to know people, basically, they’re pretty lovable.

So it baffles, me, low self-esteem, even though it shouldn’t. A therapist like me will be working with a perfectly wonderful person, an individual that most people like, indeed rely upon, the go to guy, girl, and this person doesn’t feel he or she measures up. The person I see as kind, good, caring, unprejudiced, compares himself with other people and thinks, I’m so not as good.

I, personally, want to blame society, more-so than the family, the values of the greater culture, the world out there, television, advertising, the movies, movie stars, professional athletes. How can we compete, seriously, with the wealthy, the talented, the beautiful? Most of us equivocate about buying a new purse, new socks.

When I say most, I mean most.

So society knocks us down several notches. And then there are parents. It’s not cool to pick on parents anymore (so much else enters into the equation), but parenting matters when it comes to building self-esteem. Kids are vulnerable, look to parents as large people, giants, really, whose judgment means every thing. I told my son recently that I know that I still hope, want, approval from my parents, and feel that’s a good thing. It isn’t a primary motivation for my behavior, but it’s in there, deep inside. And they weren’t bad, to tell you the truth. They esteemed me plenty.

Not all of us are great at self-esteem building, even when we think we’re doing a great job. It’s a humbling job. In fact, we can be perfectly clueless when we have values. We really want our kids to learn these things, so we try hard to get our message across, and often it is and it is rejected. But sometimes we’re trying to inculcate a value that doesn’t need inculcating. Take humility. There’s a value that needs to be reconsidered.

Humility, I’ve humbly suggested on this blog before, can work against kids, not for them. It’s a good thing to understand that in the grand scheme of things, we’re very little, that it’s not about us. Our contributions are few, and our lives are short. We spend most of our lives becoming, changing, maturing, changing some more, and when we’re old enough to really understand the errors of our ways, it’s too late. When we get old and sick we lose the power to do anything about it, can no longer start all over again.

So we should be humble, really, because face it, we’re so limited.

But a person has to believe in himself. You have to believe in yourself, if you intend to ever accomplish anything. You can’t say, Why bother trying? Because if you don’t bother you’ll never know who you are. You’ll never recognize your own skills, your own value. What’s the worst thing that can happen? You fail. Aw. Get over it, get over yourself when that happens, no big deal. Brush it off, try something else. Life is long, or it might be.

It can feel huge, failure. Slows us down, is what it does, smashes the ego, forget about deflating the ego, these aren’t balloons. Unfortunately, not knowing that potential is immeasurable, failure slows most of us down, sometimes to a crawl, not a good crawl. So it has to be good to brush ourselves off, pick ourselves up, not look back. Learn from it and move on as fast as we can. Let’s not dwell here in our failure. The company is depressing.

Ball players know this. A professional football player can play ball with a dislocated shoulder. Not that that’s a good thing, but that these men do this is significant, illuminating, really. The human spirit dominates pain, can forget, can get over anything. (For $50,000 a game, I might consider this too, come to think of it.)

Probably the only good thing about humility, actually, and this is a very good thing, is that it tempers conceit. No one finds conceit attractive, indeed it’s pretty repulsive, a big ego, which is probably the reason some fiercely believe in beating a kid into humility. Not to argue with religious teaching, discuss this with your clergy-person, please, but you don’t want to miss the lesson that most of us will fall somewhere between narcissism and being a nobody. (Jewish joke, remind me to tell you one day).

Thus a little humility is a good thing, but beat the “I” out of a kid only if you want that kid to forever compare himself and come up short. Any beating will do, to facilitate low self-esteem. Just name your abuse of the day– emotional, verbal, physical, financial, sexual– they’ll all do the job.

The most clever method, of course, often innocent, too, is denying praise. Deny it. Deny this thing called praise. It is in your power, as a parent, to do so. You don’t want your kid to grow up with a “big head”, right?*

Never say, Great job. For sure don’t say, Brilliant! And those little pictures they make in nursery school? Be sure to say, oh, don’t worry, one day you’ll be better at this.

If your kid is upset about a ‘B’ be upset, too. Tell him he should have made an ‘A’. What an idiot, seriously, for getting a ‘B’. He could have done, should do better.

Parents who buy into this method of child rearing tell me that it gives the kid a bar, a standard to strive for, “You’ll do better next time, you’ll try harder, study more, workout more, practice more.” Not all of them will, however, do better, I mean. Sometimes you want to go with what you got and see it as good, doing your best with what you’ve got.

Thankfully, most kids are resilient. They know they’re strengths, and they resent, rightfully, a parent who withholds praise. It feels good, praise, doesn’t it? Who doesn’t love praise?

Let’s not forget, too, that peers at school can be harsh, and siblings merciless. I’m preaching to the choir, you all know this, when I talk about parenting. Anyone interested in being a good parent should be able to do a pretty good job; there are parenting classes at community centers, zillions of websites and blogs to read. If you let your kids carp on one another, beat on one another verbally, physically, sexually, the siblings will do damage. Nothing like brothers and sisters to humble a person.

So what have we got here? And do football players have low self-esteem?

I don’t know. But let’s review:

(a) there’s that comparison thing, looking around and seeing how small we are, how incredibly powerless, and how inferior to others in, well, so, so many things

(b) and there’s the social war our egos have to battle, growing up with people who beat on us, remind us how inferior we are (even if we’re not), how fat, how dumb. And remember, we’re supposed to take failure on the chin, especially as adults, for failure makes us feel like losers. Failure in adulthood can hurt us even more if our parents and siblings have already fertilized the field,

and finally,

(c) the praise-deficiency model, which suggests that we need praise, and without it some of us will never be quite sure of ourselves, won’t ever have a solid, I’m good enough feeling. Not that that’s always good, feeling good enough. It suits some of us well to feel we could always be better, try harder.

But you don’t want to be feeling bad, inferior, not all the time, not to the degree of pining and moping, depression. You just don’t. And praise is the antidote for this. It’s like water. A little every day, some form or another, and a person thrives.

Apparently there’s a movie, can’t remember the name, about enlightenment. (oh, someone just told me it’s the Celestine Prophesy by James Redfield). It’s sci-fi and the idea is that some people in society are enlightened, they get it, and others don’t, and those who do try to keep it to themselves. Apparently enlightenment is understanding that the only thing that really matters is kindness, being a good person, meeting people in a way that communicates acceptance and understanding.

I might be wrong about the message of the movie, because I didn’t see it, but that’s what I got out of my friend’s description. What it means to me is that enlightenment and self-esteem may actually be discrete variables. People who have all those qualities surely don’t feel enlightened, not if their self-esteem is low. Which means that one has nothing to do with the other, not necessarily.

Okay, so you already knew that. But I thought it was interesting.

therapydoc

*I am being facetious, here, tongue in cheek. Do not withhold praise thinking it a good parenting strategy, and do not abuse children, either.

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Thank you all so much for your input on my Intrusions post. I’m going to sit with the chapter and your comments and try to get it all put together. Soon. I hope.

So I want to talk about a weird social situation. I have to confabulate this one, you’ll bear with me and not get too involved with the details, because they aren’t real.

There’s this woman I know sort of vaguely. We’ve had a few conversations over the years, and she has always greeted me very warmly. We were never friends, but I like her, and like I said, the vibes between us were good. She called me at work one day and asked if I’d treat one of her family members. She’s not a friend— I said yes– but I did make the comment to Family Member that I knew Warm Woman and asked if this was a problem. It wasn’t. I saw the family member for a while, the treatment was successful and Family Member has left treatment with the understanding that my door remains open. Nothing that was said in the therapy changed my opinion of Warm Woman….Family Member cherishes her and didn’t reveal any skeletons in any closets.

Yesterday I went to a small event for a group I belong to. Warm Woman was there, seems she’s also a member of this group. She ignored me. I followed suit and did not approach her– seems as the relative of the patient, it’s her call. And I do know she’s been in treatment herself, and that she understands all about boundaries. It felt weird though. I wanted to say Hi, and I wanted to tell her to give my regards to Family Member who has not seen me for a while. I almost felt like I was in the room with my own uncomfortable patient, but Warm Woman was never my patient. I even wondered if I should drop out of the group, but I like going, and I joined, in part, at the request of someone else in the group, someone who has no idea this interaction is happening.

Just thought I’d share a day in the weird life of a shrink.

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Thanks for all the kind queries about my situation. I’m fine. I’ve simply been overwhelmed with work–volunteer basis, mind you–ever since co-authoring the marijuana law reform initiative for Washington State on January 11. My days have been 12 to 14 hours. That’s what it takes to begin the necessary organizational work on such a campaign. I cannot even begin to describe how much heavy lifting is involved.

I expect to be back to a more normal volume of posts fairly soon. I appreciate everyone’s understanding.

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Another possible way that Scapegoats make themselves targets is by expressing forbidden emotions within a relationship system.

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Another possible dynamic of a family system with a scapegoat role is that of perfection and blaming.

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