January 2011


One of the heads of my Couples & Family Therapy program, Jeff Todahl, is launching an exciting and inspiring campaign this coming Saturday. It’s called “90 by 30,” referring to his intention to reduce domestic violence and child maltreatment by 90% by the year 2030 in Eugene and Springfield.  He announced the launch at a domestic violence awareness event I helped put on with the University of Oregon Men’s Center last fall. [Here’s the video of his talk. It’s good.] As an expert on domestic violence and part of the Trauma Healing Project in Eugene, he has decided:

1) We know how to do it–all of the programs necessary have been invented and proven effective in various parts of the US.

2) It is feasible to bring all of those programs into one area and virtually eliminate domestic violence and child maltreatment here.

3) Doing so will be a huge step toward the elimination of domestic violence and child maltreatment nationally and globally.

4) The elimination of domestic violence and child maltreatment would shrink the 943-page Diagnostic and Statistical Manual of Mental Disorders to the size of a pamphlet. That is, it would mean a virtual elimination of mental health problems for humans.

If you are in Lane County and this sounds like an interesting project, join us for a panel presentation by Jeff and his collaborators February 5th, 2011, from 11am – 2pm at the University of Oregon. The event will be held in Room 220, HEDCO building, at 17th and Alder, Eugene, Oregon.

We don’t really know but the DSM estimates between 1 and 6% of children and many fewer adults have this experience. You are more likely to have this happen if you are related to someone who has had this happen, but we have no idea why. It usually just goes away in adolescence. If my parents had been the type to take their kids to mental health professionals, I almost certainly would have gotten this diagnosis as a kid. If so, and if my parents had been the drug-giving kind, I might have been prescribed a benzodiazepine (like Valium) for it. Generally, though, it can be treated by comforting your child when they wake up like this, until it goes away. If you think there might have been a triggering event for the condition, therapy might be helpful.

Here are the criteria, quoted word-for-word from the Diagnostic and Statistical Manual of Mental Disorders IV-TR, page 639:

Diagnostic criteria for 307.46 Sleep Terror Disorder

A. Recurrent episodes of abrupt awakening from sleep, usually occurring during the first third of the major sleep episode and beginning with a panicky scream.

B. Intense fear and signs of autonomic arousal, such as tachycardia, rapid breathing, and sweating, during each episode.

C. Relative unresponsiveness to efforts of others to comfort the person during the episode.

D. No detailed dream is recalled and there is amnesia for the episode.

E. The episodes cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

F. The disturbance is not due to  the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

 

In case you’re not up to date on the current American Psychological Association guidelines, they decided in their recent let’s-hit-the-college-kids-up-for-more-money new edition of their style guide (Don’t buy it, by the way. Go here instead.) that we now have to put two instead of one space after each period.

That’s why this email I got from Reanna is funny:

The two spaces after a period convention came about in reaction to the monospace fonts of typewriters (they’re so gappy that the extra space helped to differentiate the end of the sentence). Now all the fonts we use are proportional (except courier), and typesetters agree that two spaces is wrong.
“We would never accept teachers pushing other outmoded ideas on kids because that’s what was popular back when they were in school. The same should go for typing. So, kids, if your teachers force you to use two spaces, send them a link to this article. Use this as your subject line: “If you type two spaces after a period, you’re doing it wrong.”


Somebody tell the APA.

I attended a lecture today about addiction where the lecturer claimed that the American Medical Association requires that a phenomenon meet the following criteria to be considered a disease:

1) It must be progressive

2) It must manifest identifiable symptoms

3) It must occur chronically in affected individuals

4) It must be fatal if left untreated

That makes some things obvious diseases. Cancers, for example. There are many things that we consider diseases that do not fit these criteria, though. I believe that obesity, for example, is not officially considered a disease because it is not fatal. It’s correlated with many fatal conditions but isn’t fatal on its own. Most mental disorders fail to meet this criteria too. Anorexia is fatal if untreated, but anxiety disorders, dissociative disorders, ADHD, learning disorders, conduct disorders, psychotic disorders, and dissociative disorders and many others are not. There is a pretty good case to make for  alcoholism and some other addictions meeting these criteria. Disorders that are associated with suicidality, too, might qualify, like severe depression, and possibly “gender identity disorder,” though GID may not be progressive and so fail the first criteria.

Last term I read Metaframeworks, a book about Bruenlin, Schwartz, and Kune-Karrer’s integration of family therapy models. It’s a fun read, but don’t run out and buy it unless you are like me, very nerdy about family therapy and a sucker for good theoretical integrations.

Metaframeworks presents two models for how relationships can grow over time. The first is a model from the 80s, by a family theorist named Wynne. In it, people in relationships develop four capacities, in this sequence:

1) Attachment/cargiving: We have “affectional bonding” with each other.

2) Communicating: We have “communicational codes” in common.

3) Joint problem solving: We have the ability to work successfully together on complex tasks.

4) Mutuality: We have the ability to renegotiate the relationship.

Metaframeworks criticizes Wynne’s model as “epigenetic,” meaning that each stage is related to the next in the way that our genes are related to our bodies: Each stage is the source and foundation of the next. If their analysis of Wynne is correct, then Wynne thought that you can’t really communicate in a relationship until you have achieved “affectional bonding.”

The authors’ scheme is similar but more complex. It has six processes that happen in relationships, and the relationships between them are “recursive,” meaning the product of each process affects the other processes. They are ambiguous about the sense in which their processes are a developmental scheme. My best guess is that they mean that each of these processes can develop in relationships, and the better developed they are, the better off we are. They say a few things that hint at a stage model, that each stage flows from the previous, and that inadequate development of an earlier process constrains later ones. But they don’t use words like “earlier” or “later” and they are very clear that the processes are related in a web-like fashion. Very postmodern. Anyway, here are the processes:

1) Attraction: We feel drawn together.

2) Liking: We appreciate and value each other.

3) Nurturing: We create safety by exchanging care.

4) Coordinating meaning: We can agree on what it means when we do and say things.

5) Setting rules: The rules by which we operate are functional.

6) Metarules: We have ways of changing our rules when we need to.

It is interesting that both Wynne and Metaframeworks consider and then reject intimacy (where “each person comes to believe in and experience the relationship as completely safe”) as a highest stage or most complex process. Wynne, apparently, does so because it is “difficult to achieve.” Metaframeworks does so because that trust can be lost, and because some couples with functional relationships never get there.

I’m not convinced. I really value intimacy in my own relationships, and I think that if we stop short of intimacy, at “stable and successful,” in our close relationships, we are missing out. And why reject a developmental stage because it is difficult to achieve?

Heard said by an economist on NPR in 1998: “What I’m saying is this: What goes up must… pause before going up again.”

Heard said by an economist on NPR in 2010: “As they say on Wall Street: Flat is the new up.”

It is very important to be able to complain in your relationship. The sooner the better, in most cases, before it festers. There are more and less skillful ways to bring a complaint, of course, but do the best you can. If your complaint crosses the line into criticism, though, you are doing something that, according to John Gottman, is toxic to your relationship. Criticism is one of his “Four Horsemen of the Apocalypse” for relationships. Everyone does it, but the less the better, and some kind of repair is in order when you do.

Criticism is a negative, global statement, often about someone’s character or history. It brings out defensiveness (another of the Four Horsemen) because it is an attack. Any complaint can easily be turned into a criticism. Here are some of Gottman’s observations about how we do it:

Start a complaint with “You always…”

Start a complaint with “You never…”

Start a complaint with “The problem with you is…”

After a complaint, ask “How can you treat me this way?”

After a complaint, ask “Why would you do a thing like that?”

After a complaint, ask “What is wrong with you?”

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