Nathen's Miraculous Escape

I don’t really have time to post. I’m busy reading sentences like, “There is ample clinical research methodology available presently, and such interactions can be reliably described, characterized, and codified in a relatively objective manner,” from page 412 of Textbook of Family and Couples Therapy, by Sholevar and Schwoeri.

There are several reasons that that sentence is an unpleasant read, but none of them are unusual in the books and articles I am reading. I think this kind of writing comes from a frustrated desire to have one’s field recognized as “real science.” Many important and useful ideas have been garbled by this desire.

What grabbed my attention here, though, was the use of the word “presently.” I read that and thought, can we really have a word that means both “soon” and “now”? Yes, we can, of course, but it’s a funny thing to do. When I was learning Mandarin by the Learnables method, where you just listen and look at pictures, I was unable to distinguish between the words for “on top of” and “underneath.” I made a big joke out of that. If you’re going to have a homonym in your language, don’t use it for two such closely related but different concepts! It would be like having the same word for up and down.

To a Mandarin speaker, though, the words for “on top of” and “underneath” sound quite different. “Presently” is even worse than a homonym for closely related but very different concepts. It’s the exact same word for them. Silly.

Every year I work at a summer camp for home- and unschooled teenagers, Not Back to School Camp. This will be my twelfth year–thirty some sessions. It is usually the highlight of my year. An NBTSC alumni, Allen Ellis, made this video about it in 2009. Maya posted it on her blog a couple of months ago, and I’m copying her. In moments like this I really wonder who it is that reads my blog. I suspect you are 97% my family and NBTSC friends, who have already seen this. Oh well. This is for the other 3%, whose names are mostly David, Ceri, and Emily.

The guy in the still shot that heads the video is my friend Blake Boles. Every time I see this shot I wonder if Allen asked his permission to use it like that. It’s a funny one.

Another unfortunately common situation I will have to assess for in the families I see (in addition to drug & alcohol abuse, domestic violence and many other things) is sexual or physical abuse. One of my texts (Patterson’s Essential Skills in Family Therapy: From the First Interview to Termination) estimates that 1 in 5 women and 1 in 9 men were sexually abused as kids. My other practicum text, Brock & Barnard’s Procedures in Marriage and Family Therapy, gives this list of indicators of abuse(p. 52):

The presence of an alcoholic parent

The family with poor mother-daughter connections/bonds

A mother who is very dependent either psychologically or physically as the result of illness or accident

A father who appears to be very controlling and possessive of his daughter(s)

An acting-out adolescent girl engaging in sexual promiscuity or suicidal gestures who is a frequent runaway or drug abuser

A child who appears to be very overresponsible and parentified in the family context

This is another DSM-IV-TR Mental Disorder diagnosis that is commonly given to children. The DSM says that its prevelence has been increasing for a few decades now and that up to 10% of kids, mostly boys in “urban settings”, have it. It’s a pretty serious label to give a kid. It’s linked with suicide, homicide, various criminal acts, and is thought of as a precursor to Antisocial Personality Disorder. Here are the criteria, quoted word-for-word from the DSM-IV-TR (pp. 98-99):

Diagnostic criteria for Conduct Disorder

A. A repetitive and persistent pattern of behavior in which the basioc rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months, with at least one criterion present in the past 6 months.

Aggression to people and animals

(1) often bullies, threatens, or intimidates others

(2) often initiates physical fights

(3) has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun)

(4) has been physically cruel to people

(5) has been physically cruel to animals

(6) has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery)

(7) has forced someone into sexual activity

Destruction of property

(8) has deliberately engaged in fire setting with the intention of causing serious damage

(9) has deliberately destroyed others’ property (other than by fire setting)

Deceitfulness or theft

(10) has broken into someone else’s house, building, or car

(11) often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others)

(12) has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery)

Serious violations of rules

(13) often stays out at night despite parental prohibitions, beginning before age 13 years

(14) has run away from home overnight at least twice while living in parental or parental surrogate (or once without returning for a lengthy period)

(15) is often truant from school, beginning before age 13 years

B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.

C. If the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.

Code based on age at onset:

312.81 Conduct Disorder, Childhood-Onset Type: onset of at least one criterion characteristic of Conduct Disorder prior to age 10 years

312.82 Conduct Disorder, Adolescent-Onset Type: absence of any criteria characteristic of Conduct Disorder prior to age 10 years

312.89 Donduct Disorder, Unspecified Onset: age at onset is not known

Specify severity:

Mild: few if any conduct problems in excess of those required to make the diagnosis and conduct problems cause only minor harm to others

Moderate: number of conduct problems and effect on other intermediate between “mild” and “severe”

Severe: many conduct problems in excess of those required in excess of those required to make the diagnosis or conduct problems cause considerable harm to others

Elizabeth Gilbert, in her book about marriage, Commitment, lays out her interpretation of a Rutgers report on divorce statistics. Here’s her list of things that correlate with divorce, in the order she mentions them. She lays them out with a lot more subtlety, humor, and personality, but read the book if you want that.

Your parents are divorced

You are alcoholic

You are mentally ill

You cheat on your spouse

You gamble compulsively

You are violent

You are younger than 25

You have not gone to college (especially the woman)

You have children

You lived with your spouse before marriage

You have different racial backgrounds

You are different ages

You have different religions

You have different ethnic backgrounds

You have different cultural backgrounds

You have different careers

You don’t know your neighbors

You don’t belong to social clubs

You don’t live near your families

You are not religious

The man does not do housework

My mom sent me this in response to my posting the diagnostic criteria for AD/HD yesterday. She’s not a health care professional, but she did raise five boys. Since I’m the oldest I got to see her do it. I also got to benefit from her love of nature (and sending us out into it), reading to her kids, being affectionate with her kids, making nutritious food, and her skepticism of TV and traditional schooling. And many, many other things, like her faith in her kids. The first thing they told us in my class on psychopathology was that we were not to diagnose ourselves, our friends, or family, so I won’t, but I suspect that all of us (except perhaps Ben) fit the diagnostic criteria for AD/HD for periods of our young lives. She wouldn’t even feed us sugar, much less amphetamines, so it’s not like it was a close call, but thanks, Mom, for not feeding us stimulants!

“Here is my humble prescription for hyperactivity in children (who, by the way, are usually boys): First, TAKE HIM OUT OF SCHOOL!! Live in, or move to, a rural area. (Or at least make sure there is a wild area, like woods or a meadow, nearby). Each day, after he has slept as late as he wants to, feed him a highly nutritious breakfast that contains no sugar, no additives, no colorings. Just whole foods. Then, send him outside to play in nature. Make sure he gets plenty of sun exposure. Make sure he has some of these things: trees to climb, grass to lie in, rocks to scramble on, water to swim or wade in, wildlife to watch, dirt to dig in, and bushes to hide in. (Create a beautiful outdoor environment for him if your outdoor area is naturally very stark.) Make sure he has plenty of water to drink. Let him roam freely. At lunchtime have him come in for another nutritious meal of whole foods. No sugar. Only water to drink. After a cuddle and as much attention as he wants from you, send him back outside to play in nature. Let him play as long as he wants. When he wants to come back inside, he can be read to or told stories, he can play or read quietly, or he can just rest while listening to soft classical music, or take a nap. No TV. No computers. No gameboys… no screens of any kind. Nothing with headphones. Then, back outside to play until the sun goes down. Back in for another nutritious meal, and then he is put in the bathtub. He plays in the bathtub for as long as he wants (an hour or more in very warm water is good). Then, he has a bedtime routine (thorough teeth brushing and flossing- you do it if necessary- and then jammies). After that he gets read to for a LONG TIME in bed…an hour or more is good… until he is sleepy. Make sure he has plenty of hugs and cuddles and kisses and loving words as he drifts off. Follow this prescription every day until his hyperactivity is cured. By the way, this routine could be of benefit to “normal” children, as well. It works for calming and soothing and centering and bringing color to their cheeks, and a more cheerful attitude in general. And, I’d go so far as to say, adults should try it, too… to cure whatever ails them.”

The DSM-IV-TR reports a prevalence of 3-7% for the famous AD/HD, depending, somewhat cryptically, on “the population sampled and the method of ascertainment” (p. 90). AD/HD is a shoe-in for medication in the minds of most mental health professionals. Children have been treated for this Disorder with stimulants since 1937. We still do not know for certain, however, what the effects are on adults who took stimulants as children. We do know that AD/HD tends to go away during adolescence.

Here are the diagnostic criteria, straight from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Note that criterion C is an attempt to make sure that the troublesome behavior is not just a reaction to one situation, like school–you shouldn’t be diagnosed AD/HD based on behavior that only happens at school, or just at home. That would be something else going on. Note also that, according to the “coding note” at the bottom that once you have this diagnosis, unless you have none of these symptoms, you will always be considered AD/HD “in partial remission.” One last note: I notice in reading literature referring to this Disorder that it is usually referred to as ADD/ADHD. I don’t know why this is, as there is no “Attention Deficit Disorder” in the DSM-IV-TR. Perhaps there was in earlier editions.

Diagnostic criteria for Attention-Deficit/Hyperactivity Disorder

A. Either (1) or (2):

(1) six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

Inattention

(a) often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities

(b) often has difficulty sustaining attention in tasks or play activities

(c) often does not seem to listen when spoken to directly

(d) often does not follow through on instructions and fails to finish school-work, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)

(e) often has difficulty organizing tasks and activities

(f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)

(g) often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)

(h) is often easily distracted by extraneous stimuli

(i) is often forgetful in daily activities

(2) six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with development level:

Hyperactivity

(a) often fidgets with hands or feet or squirms in seat

(b) often leaves seat in classroom or in other situations in which remaining seated is expected

(c) often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)

(d) often has difficulty playing or engaging in leisure activities quietly

(e) is often “on the go” or often acts as if “driven by a motor”

(f) often talks excessively

Impulsivity

(g) often blurts out answers before questions have been completed

(h) often has difficulty awaiting turn

(i) often interrupts or intrudes on others (e.g., butts into conversations or games)

B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.

C. Some impairment from the symptoms is present in two or more settings (e.g., at shool [or work] and at home).

D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.

E. The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

Code based on type:

314.01 Attention-Deficit/Hyperactivity Disorder, Combined Type: if both Criteria A1 and A2 are met for the past 6 months

314.00 Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type: if Criterion A1 is met but Criterion A2 is not met for the past 6 months

314.01 Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive-Impulsive Type: if Criterion A2 is met but Criterion A1 is not met for the past 6 months

Coding note: For individuals (especially adolescents and adults) who currently have symptoms that no longer meet full criteria, “In Partial Remission” should be specified.