I just read in Brock & Barnard’s Procedures in Marriage and Family Therapy about Wolin and colleagues’ research into rituals in alcoholic families. Apparently, the negative effects of an alcoholic parent were predicted better by the amount that family rituals were disrupted by the alcoholism than by the presence of alcoholism itself. For example, if the family continued to eat dinner together every night, continued with their bedtime rituals, etc, children remained about as well off as those in non-alcoholic households. But if the family rituals were destroyed, the children were much worse off, including much more likely to become alcoholic or marry an alcoholic themselves.

I haven’t read any of the original research, so I don’t know for sure if it is that these rituals actually provide resiliency or if the presence or lack of rituals served as a proxy measure for how bad the alcoholism was. It could also be a combination of the two. It does look like the family therapy literature considers that rituals promote resiliency in general, providing structure and comforting predictability for kids, and resulting in better outcomes. (I doubt they are bad for the adults, either.)  Something to think about, parents!

My favorite new term from my family therapy program is parataxic distortion, coined by the “American Freud” and one of the grandfathers of family therapy, Harry Stack Sullivan.

A parataxic distortion is when a current situation or person reminds you of something from your past, often without you knowing it, such that you behave to some degree as if you are in your past, dealing with that situation or person. Parataxic distortion is an umbrella term for confusions like Freud’s transference (client gets inappropriately emotional about therapist) and countertransference (therapist gets inappropriately emotional about client). It is also very much like to co-counseling’s “restimulation of distress.” Most likely every psychotherapeutic school has its own name for this phenomenon.

The idea is that there is a way in which your memories are categorical, not specific. That is, if your dad hit you when you were a kid, you not only attach fear and anger to your dad in your memory, you also attach it to a range of things, maybe bald men, short men, men in general, authority figures in general, certain kinds of places or rooms, etc.

Mostly, our memories are useful. This ability to generalize, for example, helps us avoid burning ourselves on hot stoves in general instead of having to painfully learn not to touch each hot stove. Neat trick!

But with a parataxic distortion, our unconscious memory keeps us from being able to understand and deal with situations as they are, in the present. It patterns your behavior. It limits your options. Usually without your knowing it, it makes your life more scary, sad, irritating, and ultimately isolated than it needs to be. Most therapeutic modalities have some version of this three-stage recipe for resolving parataxic distortions: 1) Form a trusting relationship with someone who has less distortion in the area you have trouble with. 2) Have a “corrective emotional experience,” where you basically re-experience your distortion-driven emotional pattern while demonstrably safe in this trusting relationship. 3) Have a “cognitive reappraisal,” meaning come to a new understanding of your behavior in light of current reality as it is. Go meta.

Easier said than done, of course, but well worth it!

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

I’m reading Froma Walsh’s Spiritual Resources in Family Therapy (1st edition) for my Wellness & Spirituality Throughout the Life Cycle class. Here’s a quote:

“Active congregational participation as well as prayer tend to become increasingly important over adulthood. Whereas only 35% of young adults aged 18-29 attend their place of worship weekly, 41% of persons aged 30-49, 46% of those  aged 50-64, and 56% of those over 65 attend weekly.”

That quote is from the 1999 edition of the book, and so those numbers are probably based on a survey conducted in the 1990s. The source is not cited, so I can’t be sure, so take this criticism with a grain of salt. I’m just using this example to point out something that happens a lot with the analysis of age-based research. That is, this presentation makes it sound as if humans attend church more and more as they get older, but these numbers say no such thing.

What these numbers say is that at the time of the survey, 35% of young adults say they are going to their place of worship weekly and that each age group above them at this time show more of that behavior. Each generation has its own characteristics. It may well be that this group of young adults is part of a less church-going generational cohort, which will stay more or less that way as they age. Imagine, for example, that such is the case and the next generation that comes along attends church more often. A survey at that time will show that place-of-worship attendance is relatively high in young adults, drops off in middle age, and then resurges in old age, and many will assume, based on that, that this is the “natural” progression of human church-going behavior.

As far as I know, Walsh is accurate in her analysis, based on information she is not giving. It’s a potential error to be aware of, though, and one often overlooked by researchers in psychology. I’ve noticed it often since reading Strauss & Howe’s Generations. They make the point really well, that we often think that increasing age causes people to become more or less something-or-other–more conservative, say–basing our reasoning on the generational cohorts that are currently alive, but it may just seem that way because of the quirks of our sample.

In order to know, we would need more information than this snapshot. We need multiple surveys conducted over quite a period of time, while different generational cohorts were alive, to get longitudinal information. Does each generation attend church more and more as it ages? Is the difference in church-going between a generation in its young years and that generation in old age greater or less than the difference between that generation and another generation entirely?

PsychCentral reported today on a study in Psychonomic Bulletin and Review that found, unexpectedly, that 2.5% of the participants in a study were fully capable of driving while talking on a cell phone. Apparently they were interested in finding out just how much cell-phone talking disrupted driving abilities, not whether anyone was capable of doing it. Their answer: It disrupts it a lot. Cell-phone talkers take 20% longer to hit the breaks on average, for example. But this 2.5% were unaffected. They called these people “supertaskers.”

Still, 2.5% is not a large percentage. I’ve heard that something like 90% of drivers consider themselves to be better drivers than average. I wonder how many people think they are in the top 2.5%?

Tomorrow, March 27, 2010, hundreds of millions of people on all seven continents will use no electricity between 8:30 and 9:30 pm, their time. “Earth Hour,”  is an annual “action against global warming” event that started in Australia, four years ago.

At first I thought it was silly–a drop in the bucket–but I’ve decided I’m going to do it. This is why:

1) I think it will be nice to turn everything off for an hour. I always love it when the power goes out. It’s relaxing.

2) I like that it is a global event. I like things that encourage people to think globally. Yes, this event could be a bit of an ego-stoker or guilt-assuager, but overall I imagine it stands to reduce ego-centrism in participants, a little less focused on ourselves, a little more focused on everything else.

3) There is good evidence in social psychology that token acts like this can be a gateway to real political action. People who participate may come to think of themselves as someone who takes action about global warming, like voting or spending money differently.

4) I think that global climate change may well be the biggest challenge humans face in the next several generations. The people I know who think the most about it are divided into two camps. One group prioritizes amelioration: If we act quickly and dramatically, we can keep things from getting out of control. The second prioritizes adaptation. These folks say that we’re just now experiencing the effects of the beginning of the industrial revolution, over a hundred years ago, and anything we do now may help our ancestors, should they come to exist, but not us. They say it’s time to start figuring out how at least some of us can survive the coming incredibly harsh conditions. There is a third group, of course, who are ideologically immune to the idea of catastrophic climate change. If they are right, hooray! I’ve yet to come across one who seemed knowledgeable about complex-system behavior, though. (Can anyone point me to one?)

While I’m on the topic of climate change, my favorite lectures on the subject are two of the Long Now Foundation’s Seminars About Long Term Thinking: John Baez’ “Zooming Out In Time” and Saul Griffith’s “Climate Change Recalculated.” They are worth checking out.

Here’s part 5 of the stuff I learned in my undergrad in psychology that I thought should have been headlines. If you missed them, here are part 1, part 2, part 3, & part 4. As always, if you are interested or skeptical, leave me a comment and I’ll give you my sources.

If You Punish Your Kids, Use the Mildest Effective Punishment: Do the mildest thing you can that stops the behavior you don’t want. The reason is that a punishment that is harsher than necessary takes the child’s initiative for stopping the behavior out of the picture. If you say “Hey, don’t do that,” and the child responds, they come to think that they didn’t really want to do that thing anyway, since such a mild rebuke got them to stop. Psychologists call these principles “insufficient punishment” and “self-persuasion.” These are research findings, not just speculation. If you sit on and beat your child to get them to stop doing something (as suggested by Mike & Debi Pearl), they will believe something more like “That activity was so great that I’ve only stopped because of that horrible punishment.” In other words, the form of the punishment affects the identity of the child–do they behave well because they think of themselves as well-behaved, or do they behave well only because they fear punishment?

You May Want Your Kids To Be Less Blindly Obedient Than Most People: One of the most famous psychological experiments of all time found that most people risked killing someone they barely knew, given an institutional setting and an authority telling them to do it. The Nazis were mostly not evil, just obedient, like most of us.

Humans Can Be Conformist to the Point of Doubting Their Own Senses:

Each Ethical Decision You Make Affects Your Future Ethical Decisions and Your Identity: If you, say, decide to cheat on a test, you will be more likely to cheat on tests in the future, think of yourself as someone who cheats on tests, and form permissive attitudes about cheating. The opposite is true if you decide not to cheat on a test.

Complement Your Kids For the How Hard They Work, Not How Smart They Are: Getting attention for being smart tends to make kids want to appear smart, which makes them choose easier challenges and lighter competition; it’s the success that matters. Getting attention for hard work does the opposite. This means that these kids will end up smarter than the kids who got attention for being smart.

Teach Your Kids to Think About Intelligence as a Fluid Property: That is, teach them that they can become more intelligent by trying. The more they believe it, the more it will be true for them.

If Your Kids Read, Don’t Reward Them For Reading: They will be more likely to stop, if you do, because they will start to think of reading as something they do to be rewarded, not because they like it. If they don’t read, reward them for reading. This goes for other activities, too.

Psychology hit the actual headlines last week, with Sharon Begley’s “The Depressing News About Antidepressants” in Newsweek. The story is that, if you look at all the evidence, not just the “successful” trials, SSRIs like Prozac and Paxil do not work better than a placebo for mild and moderate depression. Begley also tells the story as if she’s sorry to break the news and spoil the placebo effect. Here’s my version of the headlines from this story:

Pharmaceutical Companies Have Known For At Least Ten Years That SSRIs Work No Better Than Placebos: At least, anyone there who understood statistics and paid any attention to their research.

The Idea That SSRIs Are Better Than Placebos Was Propagated By Publishing Only the “Successful” Trials: This, obviously, was quite unethical.

The FDA Almost Certainly Knew That SSRIs Were No Better Than Placebos, Too: They had all of the research. Perhaps they did not read it.

People Who Read Psych Journals Knew SSRIs Were No Better Than Placebos Two Years Ago: The news caused a stir in my undergrad psych lab in 2008.

We Do Not Know What Causes Depression: The idea that depression has to do with the neurotransmitter serotonin was based largely on the (incomplete) evidence that SSRIs (selective serotonin re-uptake inhibitors) cured depression. In fact, we have pretty limited knowledge of what goes on inside a living brain. In fact, we have no ethical way to measure how much serotonin or any other neurotransmitter is where inside anyone’s living brain, so when a doctor tells you something like, “You are depressed because you have overactive serotonin re-uptake mechanisms,” they are passing on speculation, not science.

If You Recovered From Mild to Moderate Depression While On An SSRI, It Was Probably Your Own Hope That Lifted You Out: The thing about placebos is that they work pretty well. If you benefited from the placebo effect, it was your own strength, your own hope, that made the difference. You overcame that challenge. I think that’s pretty cool.

While SSRIs Do Not Treat Depression Better Than Placebos, They Do Have Side Effects: Here’s a list from wikipedia: Decreased or absent libido, Impotence or reduced vaginal lubrication, Difficulty initiating or maintaining an erection or becoming aroused, Persistent genital arousal disorder despite absence of desire, Muted, delayed or absent orgasm (anorgasmia), Reduced or no experience of pleasure during orgasm (ejaculatory anhedonia), Premature ejaculation, Weakened penile, vaginal or clitoral sensitivity, Genital anesthesia, Loss or decreased response to sexual stimuli, Reduced semen volume, Priapism (persistent erectile state of the penis or clitoris)anhedonia, apathy, nausea/vomiting, drowsiness or somnolence, headache, bruxism (involuntarily clenching or grinding the teeth), extremely vivid and strange dreams, dizziness, fatigue, mydriasis (pupil dilation), urinary retention, changes in appetite, changes in sleep, weight loss/gain (measured by a change in bodyweight of 7 pounds), may result in a double risk of bone fractures and injuries, changes in sexual behaviour,increased feelings of depression and anxiety (which may sometimes provoke panic attacks), tremors (and other symptoms of Parkinsonism in vulnerable elderly patients), autonomic dysfunction including orthostatic hypotension, increased or reduced sweating, akathisia, liver or renal impairment, suicidal ideation (thoughts of suicide), photosensitivity (increased risk of sunburn), Paresthesia, Mania, hypomania, sexual dysfunction such as anorgasmia, erectile dysfunction, and diminished libido, a severe and even debilitating withdrawal syndrome, a slight increase in the risk of self-harm, suicidal ideation, and suicidality in children, neonatal complications such as neonatal abstinence syndrome (NAS) and persistent pulmonary hypertension, and platelet dysfunction.

Until Your Medicated Kids Are Old, We Will Not Know What All of the Side Effects of Treatment by SSRIs Are: This is true for any new drug, and it’s worth considering. If your child is on Prozac or other new drug, they are essentially part of a massive experimental trial.

Pharmaceutical Companies Pay for Psychiatric Educations: Why would it surprise anyone that treatment equals drugs in this case?

Most Antidepressant Prescriptions Written by Health Care Providers With No Significant Psychiatric Training: GPs, OBGYNs, pediatricians, etc account for 80% of SSRI prescriptions.

Alexithymic describes someone who can’t talk about emotions. They also have trouble knowing when they or others are experiencing an emotion, and trouble distinguishing which emotion it is, if they do notice one. It is not a considered a clinical condition, but it can produce clinical conditions, like somatization, where people develop various body conditions instead of feeling emotions. It becomes a problem when somatizers insist on one medical test or procedure after another for a problem that will never yield to biological intervention. I read one estimate that 20% of money spent on medical services is for these kinds of concerns. (!)

There are social consequences, too, of course. If you can’t recognize that you’re in the grip of an emotion, you can be hard to understand and hard to deal with. It’s also hard for an alexithymic person to relate to others who are having emotions–it’s more difficult to take their perspectives and to have empathy.

It’s not a black-or-white condition, of course. Everyone is somewhere on the spectrum of emotional fluency. It’s not an intractable state, either. You can learn emotional fluency, and most people do, to some extent. It’s part self-awareness, part self-acceptance, and part vocabulary. It’s something you continue learning throughout life, given a supportive environment. Parents can stifle the learning curve in their children by how and when they give them attention. Somatizing children, for example, can come from parents who give them attention for physical pain but not emotional pain. Another problematic parenting technique, called “mystification” by psychologists, works to slow the emotional learning curve; when a child is angry, for example, a parent might say something like, “You’re not angry,” or “You shouldn’t be angry.” That kind of thing goes a long way to confuse people about emotions.

This is part 3 of a series of things I learned during my Bachelor’s degree in psychology that I thought should have been headlines in the mainstream news. If you missed them, here’s part 1 and part 2. Again, if you’re interested or skeptical, leave me a comment with a specific question and I’ll give you my references.

Egaz Moniz Was Given the Nobel Prize for Medicine in 1949 for Developing the Prefrontal Lobotomy: This “psychosurgery” involved slicing or scrambling the front part of the brain, and tended to produce more manageable behavior in “patients.”

40,000 Human Beings Were Lobotomized in the United States Between 1936 and 1977: These were men, women, and children with “illnesses” like schizophrenia, PTSD, depression, anxiety, homosexuality, criminal behavior, and being hard to manage.

Antipsychotic Thorazine Hailed as “Chemical Lobotomy”: Yes, this was meant as a compliment.

200,000,000 Prescriptions for Antidepressants in the US in 2007: That’s quite a few prescriptions.

80% of Antidepressant Prescriptions in the US Not Written by Psychiatrists: Consider that it may be a good idea to at least see a specialist in mental illness before taking psychotropic drugs or giving them to your kids.

Some Psychopharmaceuticals as Effective as Exercise in Treating Depression: But who wants to exercise when you’re depressed?

Sleep Deprivation the Most Effective Treatment For Depression, By Far: Never heard of this one? Maybe it’ll hit the news when someone figures out how to make money from sleep deprivation.

The World Health Organization Found That Schizophrenics Recover, But Only in Countries Without Easy Access to Psychopharmaceuticals: Schizophrenics can recover? Well, yes, it looks like they can. And yes, the WHO data shows a correlation, not necessarily causation, but an interesting correlation!

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