The Diagnostic Dragnet

Dr. Brad Sachs          

Winnie the Pooh has remained one of my favorite books ever since I was a child, and I enjoyed it even more when I read it to my children, and, more recently, to my grand-daughter. The tales are sweet and poignant, the wisdom embedded in the characters’ brilliantly innocent observations is timeless, and the patient, affectionate acceptance that reveals itself in their interactions with each other provides us with a tender and inspirational model for relatedness in its highest form.  (If you are able to find better words to live by than, “Some people care too much.  I think it’s called love,” be sure to let me know.)

So I have to confess that it troubled me when a patient whose child had been diagnosed with ADHD enthusiastically brought in some information she had found on-line that reduced each of the characters from Winnie the Pooh into exemplars of different versions of attention deficit disorder:  Winnie himself, for example, embodied “inattentiveness and distractibility”, Tigger embodied “impulsivity and hyperactivity”, Eeyore embodied “inattentiveness with dysphoria”, and so on.

I am not doubting, from a clinical perspective, the existence of neurologically-based attentional deficiencies, nor am I ignoring the likelihood that there are specific sub-types of these deficiencies (although I do believe that ADHD is frequently over-diagnosed and that there is a veritable epidemic of unnecessary psychopharmacological treatment—neurochemical nips and tucks—when it comes to addressing what are often quite normal childhood behaviors).  But how, exactly, had A.A. Milne’s lovely, ageless tales about a compellingly anthropomorphic teddy bear and his devoted friends been drained of their essential humanity and dwindled down into nothing more than a dingy, humdrum diagnostic manual?

What increasingly worries me when I listen to contemporary families struggle with academic and behavioral problems has to do with our growing inability to distinguish between psychological discomfort and a psychological disorder.  We have so narrowed the definition of what is normal that the slightest deviation from that highly restrictive norm is now framed as some sort of emotional disturbance, with a diagnostic classification all its own.

Mental illness does, indeed, exist, but as Aldous Huxley wryly noted decades ago, “Medical science has made such tremendous progress that there is hardly a healthy human left.”

What I have repeatedly seen as a result of the now ubiquitous medicalization of human behavior is that parents have gradually lost the sense that there is any value to discussing behavioral problems with their children.  After all, if these problems all have purely genetic and/or neurobiological roots, why bother?  For many of the mothers and fathers who consult with me, it appears to make no more sense to apply thought and consideration to the origin of their child’s problem behavior than it would for them to apply thought and consideration to the origin of a broken leg or the flu.

The result is that parents find it easy to abdicate any responsibility for addressing these matters since, after all, an “expert” has determined that their child has something immutably and irreversibly “wrong” with her.

I frequently hear this way of thinking in the choice of words used to describe children.  For example, going back to ADHD for a moment, many a parent has announced to me during an intake session that, “My child is ADHD,” rather than, “My child has ADHD.”  The difference is a significant one—the latter suggests that the child has a condition, the former suggests that that condition defines who s/he is.

With this context in mind, it should come as no surprise that numerous teachers have now begun to report to me that they have had students enter class and blithely announce that they should be excused from any schoolwork that day because they forgot to take their medication for ADHD.  In these situations, the reality that ADHD is a weakness or a vulnerability that can be compensated for, even without medication, has been banished from the realm of the possible.  The concept of summoning her resources and marshalling her strengths in the service of overcoming this weakness simply disappears.

What parents need to keep in mind when it comes to the majority of pediatric and adolescent mental health diagnoses is that it’s not that the child is unable to control her behavior but that the child finds it harder than she would like for her to control her behavior.  The distinction between these two realities is a profound one, and emphasizing the latter rather than the former exerts limitless positive impact on children’s self-respect and self-confidence.

I have seen the same kinds of passive, helpless parenting as a result of neuroscientific developments.  Because there is now evidence that the human brain is still maturing up until the age of 25, I have listened with astonishment as intelligent parents explain that there’s nothing much for them to do about their child’s disreputable behavior except to basically sit back and wait.

One parent reported to me, “I know that he’s gotten several speeding tickets already, and had one fairly serious car accident, but I’ve read that his frontal lobe hasn’t matured yet—after all, he’s only 19—so it doesn’t really make sense for me to punish him by not letting him drive our car.  I guess he’ll eventually figure this out.”   I was left scratching my head, wondering what irreversible tragedy awaited this young man, and his prospective victims, while everyone patiently waited for further myelination and synaptic pruning to take place in his prefrontal cortex.

As I noted above, I am not downplaying the significance of careful diagnostic work-ups,  ignoring the painful reality of the serious mental illness that some individuals do suffer from, or dismissing the fact that psychotropic medication has relieved unnecessary suffering for many.  But when we earnestly find a way to reduce and pathologize so much of the essentially normal behavior that children display, we quickly lose both the motivation and the capacity to talk to them in meaningful ways about why they do what they do, and how they might make changes for the better.

The bottom line, from my vantage point, is that we need to shift the conversation away from “What is wrong with my child and how shall we go about fixing her?” to “What is my child trying to say, and how can I help her to say it?”

 

Check out our Find A Psychologist Referral Service to find a psychologist near you!

Dr. Brad Sachs is a family psychologist who lives and works in Columbia, Maryland, and the best-selling author of numerous books, including THE GOOD ENOUGH CHILD:  HOW TO HAVE AN IMPERFECT FAMILY AND BE PERFECTLY SATISFIED and WHEN NO ONE UNDERSTANDS:  LETTERS TO A YOUNG ADULT ON LIFE, LOSS, AND THE HARD ROAD TO ADULTHOOD.   He can be contacted atwww.drbradsachs.com.

 

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OCD – It is not what you think!

OCD – It is not what you think!

Most people see Obsessive-Compulsive Disorder much like popular TV shows depict – people with quirky habits, or a fear of germs with a lot of handwashing, or extreme attention to neatness and order. People with OCD are like Monk and the man in As Good As It Gets, and maybe a celebrity who has talked publically about their OCD, like Jessie Eisenberg and Howie Mandel and Cameron Diaz.  People often  joke a bit about themselves, saying things like “I’m a little OCD about my desk”   or “All graduate students are a little OCD, you have to be”.  Actually, people who have OCD and are struggling with unwanted thoughts and behaviors see nothing funny or helpful about their symptoms. And OCD can take forms that are not at all obvious.  Typically, people think that obsessions are thoughts or worries or preoccupations and compulsions are observable behavioral “habits” that are repetitive, nonsensical or irresistible.  In fact, most compulsions are unobservable mental activities . Although lock-checking and handwashing, avoiding things and trying to keep things a particular way are certainly are common, more common are hidden compulsions that may seem like coping skills or seeking reassurance or trying to talk rational sense into yourself.

In fact, obsessions and compulsions are not defined by the content – or what they are “about”—but more by their relationship with each other.   An obsession is a thought or image that intrudes unbidden and unwelcome into the mind, causes anxiety or fear or disgust,  and gets stuck and repeated. A compulsion is anything (like a ritual or a behavior or an avoidance or asking for reassurance or mentally checking a memory) that temporarily reduces the anxiety — but only temporarily.   Obsessions are the opposite of wishes – they are the opposite of what you value or want – so the content is often taboo – including sex, violence, perversity, suicide, mistake making. So gentle people have repetitive thoughts of causing harm to loved ones, and religious people have blasphemous thoughts that deeply upset them. What is so important to know is that the content of OCD is not an indication of hidden motives or unconscious wishes.  Obsessions grow and get stuck precisely by means of the energy expended in the attempts to get rid of them.  OCD can look like weird habits, but it can also look like an inability to make decisions, or excessive jealousy, or hypochondria or incessant doubts about one’s own sexuality or relationships or even intrusive worries that make little sense to the sufferer, about safety or morality or unanswerable questions about what the future might hold.

There is effective treatment for OCD – once it is identified – both medications and a very specialized form of CBT (cognitive behavioral therapy) called ERP (exposure and response prevention). But simply support and reassurance and conversation about the topic the OCD happens to have hooked itself to are generally not helpful.  Resources can be found through www.adaa.org or www.iocdf.org
Dr Dr.-Sally-Winston-2-webSally Winston is founder and co-director of the Anxiety and Stress Disorders Institute of Maryland. She is co-author,  with Dr Martin Seif, of What Every Therapist Needs To Know About Anxiety Disorders (Routledge, 2014). She can be reached at www.anxietyandstress.com

 

The Fun House Mirror

The Fun House Mirror

By Beth Sperber Richie, Ph.D.

Sometimes I feel I have the simplest job in the world. People come to me with such distorted pictures of themselves and my job is simply to straighten out the fun house mirror. I reflect women’s best selves back to them since they only see that distorted image.

There are days where I find it astonishing how twisted a self-image my clients can have. And then I step back and think about the times I am really hard on myself, or push myself to do things that are unreasonable and I should have said no to, and I think it’s not so surprising at all.

We live in a culture where there are huge societal pressures to be a particular way or do a particular thing. We are expected to take care of our families, be supportive of our spouses, work in a volunteer and/or paid capacity, coordinate our children’s lives, be friendly and patient and understanding and still look beautiful and be healthy and exercise, all in a 24-hour day. No wonder we sometimes get twisted up.

How do I help clients (and myself!) with this? The first thing I encourage folks to do is to outline their values and goals to try to figure out their end goal. Then we construct a path toward that goal. I reflect back to them any contradictions I see between their actions and thoughts, and the values they say they have. For example, some clients tell me that what they value most is time with their families –but their schedules reflect time running from one activity to the next with no opportunity for the family to gather as a whole. Or a client says she values her own physical and mental health but doesn’t make the time to exercise or is viciously self-critical in her thoughts.

And then I borrow a phrase from Albert Ellis, “Don’t ‘should’ on yourself.” We all have a list of “shoulds” in our heads. We spend lots of time looking at what should be happening in our lives, or how we should behave, what we should have said. Then we turn against ourselves and beat ourselves up for not having met those “shoulds.” Well, cut it out! Perhaps you should be exactly where you are, doing exactly what you are doing. Stop using against yourself what society or your family or culture says is how you should live your life.

Find a psychologist near your with MPA’s Find A Psychologist Referral Service or nationally through APA’s Psychologist Locator.

 

As seen on a Sussex Directories Inc site

Beth Sperber Richie, Ph.D. is a licensed psychologist and coach in private practice in the Washington, D.C. area.  Dr. Richie provides career counseling and psychotherapy to individuals, couples and groups.  Her specialties include working with adult survivors of trauma and sexual assault, cross-cultural counseling and women’s career development and achievement. She coaches individual clients to achieve the optimum integration of their career development and life goals, while attempting to maintain that integration in the many roles which make up her own life.

If I can help you stop “shoulding” on yourself, or help you craft a life more consistent with your values, give me a call at 301-523-8882 or send me an email at: Beth@MosaicLife.net.

 

 

The Pressures to Achieve: Helping Children Find the Balance Between Keeping Up and Running Themselves Ragged

The Pressures to Achieve: Helping Children Find the Balance Between Keeping Up and Running Themselves Ragged

Alison J. Bomba, Psy.D.

Today’s children are faced with a unique set of circumstances and pressures that are far different from those experienced by people growing up in previous generations. The pressure to “keep up” let alone “get ahead” feels much different than it used to. We live in a fast-paced society in which “keeping up with the Jones” seems next to impossible, and there is an incredible amount of pressure placed on children and teens to achieve at a very high rate.

Academically speaking, “on-grade level” no longer feels “good enough,” as many children feel they are failing if they don’t qualify for AP (Advanced Placement) or GT (Gifted and Talented) courses. Higher-level courses are being introduced at a much younger age, and a new standard has been created – the bar has been significantly raised. (High school freshman are being offered courses that used to be introduced at the college level.) The academic competition is steeper than ever, as students are now obtaining weighted GPA’s beyond a 4.0. In addition to feeling pressured to “keep up” academically, children are challenged to balance their schoolwork with multiple extracurricular activities, community service endeavors, and leadership roles, leaving little time to complete homework and study for exams….let alone obtain the 10 hours of sleep per night required for optimal brain functioning.

Students are also feeling a significant amount of pressure to excel athletically. The competitiveness surrounding middle and high school level sports is quite overwhelming as many parents find themselves questioning the intensity of the coaching at the middle school level and feeling pressures to hire personal trainers and enroll their children in multiple elitist camps in order to boost performance so that they (their children) don’t get lost in the shuffle. Child athletes are suffering from an increased rate of head injuries and are requiring more major surgeries (knee replacements, etc.) than ever before as a result of the increased competitiveness. All in all, it seems as if “good enough” is no longer “good enough.”

With all these pressures, how can parents, educators, and coaches help to ease the minds of children and teenagers growing up in the fast-paced society in which we live? How do we assist children in “finding the balance” between setting high goals and expectations for themselves while at the same time maintaining a healthy lifestyle?

  1. Help children keep their priorities in check! Assist them in identifying what’s important and help them to differentiate the essential from the unessential.
  1. Know when to say NO! With so many opportunities available, it is often difficult for children and teens to choose just one or two activities. Help them set healthy limits for themselves and assist them in continuously monitoring and assessing their abilities to successfully manage their schedules.
  1. Seek help when needed. If the stress of “keeping up” interferes with basic needs being met (sleep, physical or mental health, etc.) or completion of essential activities (schoolwork), seek support from educational staff, athletic coaches, school counselors, pediatricians, or mental health providers.

MPA’s Find A Psychologist Referral Service can help you find a psychologist near you!

AlisonBombaDr. Alison Bomba (formerly Dr. Alison Dunton) is a licensed psychologist who treats children, adolescents, and young adults in private practice in both Frederick and Ellicott City. She received her doctoral degree in clinical psychology from the American School of Professional Psychology at Argosy University in Washington, D.C. Dr. Bomba provides results-oriented, compassionate care and uses ethical, evidence-based practices to effectively treat various behavioral and psychiatric disorders. She works closely with schools, pediatricians, and other health professionals to provide comprehensive treatment and is also available to conduct classroom observations and attend school meetings as needed to assist parents in advocating for their children’s educational needs. www.drbomba.com

Blossoming hearts: How parents can make sense of adolescent romance

Brad Sachs, Ph.D.

“There is always some madness in love.  But there is also always some reason in madness.”
–Friedrich Nietzsche —

The adolescent journey is both an ancient and eternal one because this journey is ultimately what sustains the human race—only by differentiating from their families of origin and voyaging forth into the world to initiate the process of finding intimacy with a partner will our children arrive at the juncture in their lives when reproduction takes place, and the next generation begins to germinate and take its place in the world.

Watching our children begin their incipient pursuit of love can be a source of tremendous delight and pride, and stir pleasant memories of our own first, fumbling but exhilarating steps in the direction of the courtship that may have ultimately led to our children’s existence.  Of course, necessary as it is for teenagers to find and forge an enduring relationship with a loved one, the process of discovering and nurturing healthy intimacy is generally a long, and sometimes harrowing, one, often comprised of one or more relationships that do not appear to be quite as healthy and suitable as caring parents would like them to be.  With this in mind, it is helpful for  Continue reading “Blossoming hearts: How parents can make sense of adolescent romance”

A Recipe for Exhausted Parents

Jaclyn Halpern, Psy. D.
So often, parents walk into our offices with little hope left. They are exhausted and out of ideas. They’ve read every book, and tried every method. Yet, they still cannot understand why their children keep acting up. They ask questions like, “why can’t they just…?” and “why do they always…?” They want to know why their child is not responding to incentives and consequences. They don’t understand why their child keeps choosing to misbehave.

These parents, who are truly trying their hardest, are out of ideas and out of energy. They find themselves engaging in fights with their children, or attempting to reason with them when they are out of control. My advice to these parents is…stop. Take a moment to breathe and reassess the entire situation.

First and foremost, I recommend that parents  Continue reading “A Recipe for Exhausted Parents”

“Can We Talk?”

As I broach the topic of communication, I am reminded of the words from a popular 90’s R&B tune where the crooner is contemplating what he would say to an unnamed young lady that he is too shy to approach.  For those of you music trivia fanatics, I am referring to Tevin Campbell’s hit “Can we talk?” While the title of the song is somewhat misleading since the poor guy doesn’t actually talk to the girl, the refrain of the tune reminds us of a very basic purpose of verbal communication – to provide information.  The type of information can be varied, from factual to a more intimate sharing of feelings.

Effective communication is critical to all successful interpersonal relationships. Where there is effective communication, there is an exchange of information which promotes knowledge and understanding.  Marriages thrive when there is effective communication, as do families and organizations.  Individuals also benefit from being able to communicate their thoughts and feelings to others, particularly when coping with crises or traumatic events. Want to improve your communication skills? Consider the following T.I.P. (though this list is not exhaustive):

Talk openly and honestly. How else will those you are closest to be able to know your thoughts and feelings if you don’t provide them with this information?

Incorporate active listening skills. Listen intently and paraphrase what you heard to demonstrate to the other person that you actually heard what they said.

Practice effective communication daily.  As with anything else, practice makes perfect. Use these effective communication tips routinely until you get the hang of it.

To find a psychologist near you, please visit the Find A Psychologist section of our website.

Written by Renita Gabriel, Psy.D. Dr. Gabriel can be found at http://www.breakthroughspsycservices.com