Sep 29

Need Deprivation that Causes Serious Problems in our Youth

Over the last few years, our community has suffered far too many losses.Credit: Jozef Polc via 123rf.com

 

I feel very much empathy for the family members. I am not even capable of comprehending what they have been through.

I’m afraid they were focused on thinking way too much about what they might have done wrong, what they might have done differently or what might have changed the outcome.

Friends, family members did the best they could in the circumstances they were faced with, I believe.

With that being said, it is far from me to blame anybody.

Furthermore, it’s also unrealistic to pull simplistic explanations about cause and effect.

 

On the other hand: if we really want to be sure to support our children and teenagers to reach their full potential with a reasonable emotional balance, we need to understand what they are facing.

When I was working in a Crisis Response Team, I worked with suicidal people on a daily basis. Oftentimes they admitted that they did not want to die. In reality, they hurt so deeply that they wanted to escape from the pain. Death seemed to be a form of relief.

Naturally, I have no way of knowing what was in the mind of our teenagers who took their own lives.

But one thing is obvious: they were suffering tremendously from something.

.Where does that pain originate from?

It is as simple as that:

 

When our needs are fulfilled, we are happy and content.

When our needs are not fulfilled, we are suffering.

 

NEEDS

Let me ponder about their needs for a bit.

 

There are some basic, biological needs including oxygen, food, water and sleep.

It is easy to understand that we need to breath, eat, drink and sleep.

Or is it? – I’ll get back to this question shortly..

 

In addition, there are our psychological needs of being loved, being heard, being appreciated, and being acknowledged.

 

According to Jeffrey Young, the founder of scheme therapy; there are 5 basic emotional needs of children that have to be fulfilled in order for them to be able to adapt in a healthy way to their environment.

 

1/ Need for secure attachment

2/ Need for autonomy and competence

3/ Need of free expression of their need and feelings

4/ Need of spontaneity and playfulness

5/ Need of boundaries and self-control

 

It is worth investigating how need fulfillment occurs in the families, and how we – as a society – support the individual families to fulfill the needs of their members.

 

BIOLOGICAL NEEDS

I skipped talking about how we feed (and how we nurture) our children and how we teach them to respect and take good care of their body. Although this is a very important part of our health, it is not my expertise. Currently, there are many areas of thought about these issues.

SLEEP

What I find deeply troublesome is that we all are very well aware that sleep deprivation is a form of torture. The media is quite open about the new researches that show teenagers require at least 9 hours of sleep. Furthermore, they are in “sleep phase delay”. In other words, they fall asleep typically 2 hours later than children and adults.

Many want to blame the electronics. However, that would not explain that research found the same delay in many mammalian species in the same time of their development. There is a vague explanation about the hormones.  There is a more precise explanation that for whatever reason, melatonin secretion begins about 2 hours later during the teen years than in adults and children. Furthermore, there is a relative disconnection between the light and the circadian rhythm regulator: suprachiasmatic nuclei.

Whatever the reason is, we know that they cannot fall asleep as early as we would like and this is not their “choice”. We know that they need more hours of sleep than adults need because of their rapid bodily, hormonal and mental development.

Therefore; what do we do?

We put our teenagers into the earliest possible school start time usually around 7:20am.

In comparison, we do not start elementary school children who are wide awake anyway at 6-7!

We begin with the teenagers that are complaining that they are moody, irritable, cannot focus, snooze during class, turn to drugs to eliminate malaise, and struggle with mood swings.

If you read the symptoms of sleep deprivation, you will find this same exact list.

 

In states where school administrators experimentally put teenagers in later school starts, – including Seattle – studies found higher admittance, less tardiness, improved grades and overall mental health.

 

It should be noted that the CIA uses sleep deprivation as an effective torture technique for detainees.

Many US school administration uses sleep deprivation as an effective torture technique for teenagers.

Reason? I haven’t heard a convincing reason yet.

 

BASIC CHILDHOOD EMOTIONAL NEEDS

1/  NEED FOR SECURE ATTACHMENT – OR EMOTIONAL SAFETY

We are born with an innate tendency to form bonds with our caregivers. At the end of the first year, we already have certain patterns of how we are attached to them.

Scary, isn’t it? The most important things are happening before a word can leave our mouth!

Attachment theorists found 4 distinctive patterns in how we behave with our care giver. Moreover, we take  this attitude into  our other relationships.

The attachment types are:

Secure – Insecure – Avoidant – Fearful

The regular pattern is more flexible than we originally thought, not to mention we might have more distinct attachment types to our different care givers. We can “re-learn” attachment if we have a good teacher, mentor, friend, or counselor.

It is very important to get positive, affirmative, inclusive feelings from the peers as they are the “new family” and the reference points for teenagers.

Being seen, being heard, being acknowledged, being heard, and being understood – not to mention being loved – are all essential to our emotional safety.

 

2/ NEED FOR AUTONOMY AND COMPETENCE

The level of autonomy is changing throughout the years. Every phase needs a different approach.

Babies do not have and do not need autonomy. In the first year, all we have to do is fulfill their dependency needs. When it is done, their autonomy begins to flourish in their toddlerhood.

The “terrible twos” are the times when the first opposition arises based on the autonomy need:

“NO means YES” – as one of my friends’ daughter interpreted her brother’s behavior. Actually “NO” means the vague realization that I am not you.

In the preschool and school years, developing competence requires freedom of exploration and encouragement rather than reward.

Forget about correction and criticism, it undermines the confidence of competence.

Independence comes with responsibilities. This is why the Montessori schools are developed to a higher level. According to their philosophy, they control the environment not the child. Children have more independence than in traditional schools, and take a larger portion of responsibility for their actions.

In the teenage years, there is another spurt in autonomy, the second phase of growing independence. This is the time when they wean from their family and turn toward their age group in interest, and in attachment as well.

Be reassured. Although it is not as obvious as before, the family support, acceptance and love is equally important and remains intact.

Do not worry about the “NO”-s. It’s not personal! (At least not always.) One of the assignments of this age is to establish a unique personality. It begins with: “I am not you.” (Meaning: I am looking for my own style, values, likes and dislikes.) Figuring out who they really are takes time. The “No! I am not you” phase is the necessary first step in this process.

The teenage autonomy phase brings another challenge which is the ongoing balance between the rights and responsibilities. Teens and parents have to participate in developing workable compromises.

Parents, who had controlling parenting style up until now might experience difficulties. Inevitably, we gradually lose control over our young adults. Trying to force control is not only useless, it backfires.

Whoever raised their kids with physical punishment might backfire and result in a slam to the face.

I prefer the democratic style from the very beginning, although it might take disproportionately more time than the authoritative style. Children who grew up accustomed to the cooperation and negotiation have an easy (easier) transition to adulthood.

 

3/ FREE EXPRESSION OF NEEDS AND FEELINGS

This is the area where the water gets murky because we operate largely from our unconscious level. We tend to unknowingly pass over what we were exposed as children.

In general, in our culture, boys are not supposed to express fear, sadness, pain and anxiety, but they are allowed to express anger. (No wonder we have so many angry birds.)

Girls are not supposed to express anger but they are allowed to show fear, anxiety and sadness.

Expressing positive feelings are rather welcomed for both genders, maybe less for boys than girls.

In healthy relationships, the expressing needs are fundamental for the functioning of the relationship. Our happiness is dependent on it. Expecting our partner to figure out what we need by using a manipulative expectation, “If you loved me you knew…” is unreasonable. We need to express our needs firmly, but calmly.

Unfortunately many of us were raised with restrictions that did not allow us to express our needs in order to “not to bother” others. In some families there is a kind of “reluctance” or negligence fulfilling others’ needs. Rejection of the expression might come in the form of mocking, labels, put downs, and belittling.

Learning how to communicate our needs and wants needs guidance and practice: What are they? How do we express them? How we can let them be fulfilled? Repressing them is the possible worst training we can give. That is the parents’ responsibility to teach their children to communicate about their needs and feelings.

 

4/ THE NEED OF SPONTANEITY AND PLAYFULNESS

We don’t even know what that is, do we?

Free play? – When?

Doing what we want? – Are you kidding me?

In middle/high school, they spend 35 hours per week, homework is about 11-20 hours per week – at least it was in highly capable classes – not counting practice time on the instruments and the other extracurricular activities like sports, volunteer work, school programs. They experience 46-55 work hours.

 

May I ask the policy makers how many hours per week you are working? 40? Really?

What’s the reason we push our children over our limit?

 

But it’s only the official policy.

On the side note: a myriad of studies proved that homework does not correlate with academic achievement.

Afterwards, the pressure from society comes as we did not realize they are overloaded already anyway.

“You have to volunteer!”

“You have to play sports!”

“You have to participate in church!”

“You have to have extra music lessons!”

 

At the end, the infinitely exhausted children have no time, no motivation and no practice to reflect things of their own. They are unable to figure out what they want for themselves let alone how to entertain themselves or structure their time when no authority tells them what to do. We deprive them the opportunity to learn how.

Spontaneity and playfulness has no time or place in their life.

 

By the way reflection: Goldie Hawn and Daniel Siegel initiation to bring mindfulness meditation to school produced very promising changes in school children’s mental health.

 

5/ THE NEED OF BOUNDARIES AND SELF-CONTROL

There are 3 categories usually used for parenting styles:

Authoritative, Laissez-Faire and Democratic.

 

In the authoritative style, the parent sets and enforces the rules regardless of the will and feelings of the children.

 

In the Laissez-Fair method, children are free to do whatever they like, regardless of the will and feelings of their surroundings.

 

In the democratic style, there are flexible rules and boundaries. Everybody’s request is considered, everybody’s will and feelings are taken care of.

 

Surprisingly, children who were raised without regulations or boundaries are not as happy as children raised by rules. Limitations, as well as predictability, help us to feel safe and secure.

 

They need to know what is expected of them. They need to be sure what to expect from their family members as well as from the wider environment.

Structure seems to be essential for mental health on many levels.

What we expose them to in structure, rhythm and discipline, they internalize and it becomes their inner structure, rhythm and self-discipline in their adulthood.

 

When I was a child, we had 45 minute lessons and 10-15 minute breaks. I mean breaks. Not passing times. We had to pay full attention to the work in the classroom. We were not allowed to use the bathroom, eat, or talk unless we were asked to. After each class, we had time to go to the restroom and talk with our friends. We had one long break to eat.

 

Let’s see the structure of a typical middle school, high school day today:

Typically they have 52-55 minute classes. In Middle school they have 4 (four!) minutes of “passing time”. In high school they have 7 (seven) minutes of passing time. During those minutes they have to:

 

1: go to their locker that is sometimes located in the opposite end  of the campus than where their classes are.

2: open-close locker, change gears according to the classes

3: get to the next classroom

 

If they are 1 (one!) minute late, they are deemed tardy.

What do you think fits into those 4 or 7 minutes? Bathroom? Talk? Give a break to the brain? No way.

 

What does this rushed rhythm set them up for? Not being able to focus on the next class; less and less as time goes by. Ask the teachers how they are doing by the time they reach the 5th, 6th period! It usually amounts to repeated requests to go to the bathroom, drinking and so on.

Of course! The natural rhythm of their body does not allow them to follow this unforgiving regime.

Is this rushing stress provoking? – Pretty much.

I asked the teachers about it.: They state that they can do it. Yes. I know. This is not the point.

Knowingly, purposefully causing them stress is my problem.

 

On the contrary: if the teacher did not fit into the 52-55 minutes timeframe, some of them keep their students longer; taking away further by 1-2 minutes from the 4 or 7 without any consequence. Is it not the deprivation of an incredible short rest time?

Some do not let them out for restroom break. Is it not deprivation of the need for secretion?

Sometimes teaching stretches into the lunch break. Is it not the deprivation of the need of being fed?

 

Not having the right structure to internalize harms their future sense of scheduling as well.

 

I know how much I rely on my elementary school rhythm.

I schedule a one hour long session with my clients, and a 15 minute break in between.

 

It serves multiple purposes. They do not bump each other in the doorway, it gives us the possibility to clarify insurance or other things to arrange, schedule another appointment and the like. But my main reason I need to have those extra minutes in between sessions is that

I need to process what I have heard. I need to reflect on it, I need to let it sink in order to turn it to helpful interaction whenever I need it.

This is not only necessary, this is doable.

 

PROGRESS REPORT:

Most of the areas in how we treat and school our children need thorough improvement.

 

            FULFILLING BIOLOGICAL NEEDS:

Healthier diet

More exercise

A lot more sleep – different school start schedule (See Seattle Bell Times.)

More resting – recuperation time

 

            FULFILLING PSYCHOLOGICAL NEEDS

1/ For secure attachment: acknowledgment, understanding, acceptance.

2/ Need for autonomy and competence: negotiation, cooperation, balance of rights and responsibilities, encouragement.

3/ Expression of needs and feelings: empathy, acceptance, raising awareness about our own needs and feelings.

4/ Spontaneity and Playfulness: less rigorous schedule, more free time, more “let go”, paying attention to the “big picture”: lessening the accumulated demands of the school, families and different organizations.

5/ Boundaries and Self-Control: modeling clear boundaries, respectful behavior toward others, manner, encouraging empathy.

 

 

By only using this approach, we will be able to ensure that the next generation will become healthier: physically, mentally and emotionally.

 

I’d be happy to help you or your teen!

 

Please contact me! 425.280.2643

Sound.Soul.Counseling@ProtonMail.com

Free Initial Consultation

Aug 04

Mukilteo Is Strong, But Healing From The Emotional Wound Is Slow

#MukilteoStrong

How Can We Support Each Other?

 

Mukilteo has been shaken by the fatal shooting that occurred on Saturday night. We are all devastated by losing three of our young people, and another injured. For the young man who pulled the trigger, he is facing life altering charges.

In such traumatic events, we witness very different reactions from people: some cry openly, others are looking for the comfort of their friends, some need to talk about it, some are withdrawn and others look numb. The pain can be manifested in very different forms at different times. There is no right or wrong way to process traumatic events.

Everybody grieves in an individual way. However some basic stages of grief can be recognized in almost everyone’s reaction.

GRIEF

Shock

– when we first learn about a traumatic event or great loss, we feel shocked. Initially, we might deny or try to deny. However, when reality hits our body and soul, we react with a strong stress response. We might cry, shake, experience insomnia or refuse to eat.

Anger

– almost unavoidable is the fact that we got angry towards the person who caused the damage. It could originate from the person who left us or anybody who was not able to prevent the tragedy. We can feel guilt and blame ourselves because we did not do something different.

Sorrow

– after the most intense feelings sidetrack, we begin to feel the weight of the loss. I do not consider it depression, because it is a completely normal reaction to losing something important. It has nothing to do with the mental illness. You cannot spare yourself from it. If you try, you might not get to the end of the grief.

Apathy

– after a longer period of intense negative feelings, the sting of the pain gradually dissipates and apathy takes over: feeling no pain, but not happiness as well. This is a kind of defense from the pain, but not the natural “base line”.

 Coming to term

– after many waves of anger, sorrow and apathy, feeling better, feeling worst most of the time, we can come to terms with what life threw at us.

 

I know! Some days after the shooting, it is unimaginable that we can ever come to terms with such an incomprehensible loss.

 

SUPPORT

What can we do to help each other and our children during this painful process?

Acknowledge the fact that we face difficult times.
Denial does not help to solve any problem.
Accept the different way of grieving.
Do not ignore, put down, reject, judge or ridicule whoever processes differently than you. Some are more expressive with their feelings, while others cannot show them at all. It is all fine.
Provide a safe place for processing, physically, mentally.
Let the stories out, let the feelings out, and let the tears out in an accepting, supportive environment. Knowing that the survivors are here for each other and accepting every feeling and thought can be the most important thing that we can give each other.
Movement heals.
Exercise breaks down the stress hormones. Take a walk, go for a swim or hit the gym, whatever works for you!
Nature has its calming effect on many of us.
If you are one of them, use it for your advantage: go to the beach, to a park or to the woods.
Music – listen to calming, soothing music.
People – Look for a connection with your support people. Don’t isolate yourself. Accept help.
Avoid alcohol and drugs.
Although it might ease the stress momentarily, it creates more problems in the long run. I addition, it elongates the grief by interfering with it.
Limit decisions for today’s needs.
Being deeply disturbed is not the time for making long term decisions.
Gradually return to your daily routine.
Making it through the days by focusing on your normal daily assignments brings back the normalcy faster. As hard as it is, it keeps you away from dangerous stress responses like reaching for alcohol or getting lost in extreme negative thoughts.

 

Mukilteo encountered one of its most devastating tragedies of our times, but the community already made its choice that you can see all around social media:

Stay strong, and choose love instead of hate.

 

 

I am more than happy to help!
First consultation is free.
We can talk further options then.
Call me!
+1 (425) 280-2643

 

Send an Email to me!
Sound.Soul.Counseling@ProtonMail.com

Jun 10

4 Components Adding Up To Raise (Or Not) Narcissistic Children

At the age of primer narcissism the child need to be the center of the care taker's universe.

Image courtesy of Sura Nualpradid by FreeDigitalPhotos.net

Narcissistic people can be very difficult to deal with:

they are self-absorbed, they focus on themselves, they might be hyper-arrogant, demanding, entitled and there is no way you could convince them to take responsibility for their action.

None of us dream to raise children who will then look through us or exploit us when they grow up.

Unfortunately this happens with many.

In his article: How Children Become Narcissist? Jesse Singal based on a new study tends to accept that parental overvaluation is rather the case than the lack of parental warmth.
If we contrast the social learning theory with the generalized psychoanalytic view of “warm” mother; it might be. Although still I doubt it.

I propose to narrow down the psychoanalytic concept of “empathetic mother” to a mother who fulfills the primary narcissistic needs. What exactly is that I go into the details below.
In this case for me the attitude is not either–or, but both.

What components are adding up developing a Narcissistic Personality?

 

1/ Genetics.

Narcissism is shown to have strong genetic background. This is what we cannot influence other than not choosing partner who shows the signs of Narcissism, and better to watch the family members as well. A Hungarian saying advises: “Look the mother, marry the daughter!”

 

2/ Intrauterine influences.

During embryonic development certain type of neurons are shaping in certain time bathing in a special mixture of hormones and neurotransmitters that basically regulate their later functioning. What happening is an incredibly sophisticated and orchestrated process shaped by millions of years of evolution. We don’t exactly know all of its components, nor can we influence it. The best bet we can get is to provide the least stressful and most healthy environment for the embryo/fetus to develop.

 

3/ Early Childhood: Primer Narcissism and Healthy Need Fulfillment

Psychoanalysts state that there is a state in child development at around age 2-4 what they call the primer narcissism. In this stage the child already developed a kind of independence from the mother or care giver, and begins to form his or her own ego. How she does it? Absorbing the significant other’s clues about him or her!

You recognize this phase: it is full of: “Watch me!” “Look at me!” Look how strong I am!” “I am smarter than you! “ “My father can beat up your father.” And so on.
Kohut and Kernberg suppose that the parental empathy in general is necessary to raise mentally strong and healthy children.

I suggest more specification. Parental empathy is important to realize that the child is in the normal, natural phase of healthy primer narcissism, and so s/he is in need of positive feed-back in double level:

Emotionally: parents need to fulfill the natural need for being seen, appreciated and valued.
The child needs to feel that s/he is the center of the caregiver’s universe.
S/he needs to feel loved – then s/he knows s/he’s loveable.
S/he needs to be seen – then s/he feels acknowledged.
S/he needs to feel appreciated – so s/he feels valuable.

Cognitively: parents need to provide the appropriate positive feed-back that can be “incorporated” (built in) by the child which serves as the nuclei of the self-esteem. It has to be genuine and true: reinforcing the real positive accomplishments of the child let it be anything from packing away the toys, being cooperative or making new friends.

Personally I am huge believer of the positive discipline, so I rather reward – mostly verbally – 10 good move of a child than criticize or correct 1.

Wherever the unfulfilled need: there is the injury. If the parents don’t fulfill the needs of the primer narcissism, the personality development gets stuck. They might chase in all of their life what they did not get in the appropriate stage: being in the middle of attention, getting the acknowledgement and appreciation.

 

4/ Later Childhood: Expectations and Social Learning

Need fulfilling does not have to go against reality.

All children makes enormous amount of positive actions if you observe them with open mind.

Whoever is not the best in counting is caring about their toys. Who is not careful with toys might be an excellent tree climber. Some may not be any of them, but can be easy-going and well mannered… It’s the parent’s job to find the positive traits of their child and reinforce it as often as they can.

While we might hunt for positive behavior or achievements, we do not have to over-praise ordinary actions or exaggerate them.

If your child brings a painting for you, it is more constructive to pay attention, ask about the details, the choice of the color, the meaning and why did s/he choose to paint exactly what s/he did, than evaluate him “little Van Gogh”.

(Does it require more time, attention from the parent’s part? Of course! You did not choose to have a child for convenience reasons, did you?)

Moreover growing out of babyhood we have to set up expectations and slowly, patiently but consequently make them fulfilled.

Many of those expectations are social expectations: not making advances in the expense of others. Not bragging. Not demanding more attention than the others. Not interrupting others. Not putting ourselves before or above others, and the like.

Establishing rules and expectations are also parental assignments that go parallel with need fulfillment.

 

From the 4 components that support Narcissistic character traits, we cannot directly influence two: the genetic and the intrauterine effects.

But I am a firm believer that even with the worst genetic make-up and the most troublesome pregnancy, we as parents have the opportunity to counteract with the emergence of Narcissism with

A/ fulfilling the children healthy narcissistic need in their stage of primer narcissism
B/ guiding them, teaching them, training them tactfully the golden rules of social interactions.

 

More  about Personality Disorders

 

Sound.Soul.Counseling@ProtonMail.com

425.280.2643

First published in: YourTango.com

 

Apr 15

Personality Disorder Under The Lens

Personality DisorderPersonality Disorder – not label, not put down, but no excuse for bad behavior: what is it then?

 

Attaching a mental health diagnosis to each other has become fashionable lately. Recently, statements in the press stating Trump is a narcissist, the neighbor is borderline, and the boss is bipolar are pretty commonplace.

In defense of my likable clients who suffered a great deal, it drives me mad because they are using mental health diagnosis as put downs or labels. I deem this behavior as something profoundly inappropriate and outright mean.

To make matters worse, the assumptions are blatantly false. Donald Trump’s inappropriate behavior is caused by lack of respect and bad conscious choices, not his narcissistic personality disorder.

It is true the other way around as well. Mental health diagnosis is not an excuse for bad behavior. Personality disorders might cause huge challenges in someone’s capability to accommodate his or her environment, but they are not excuses for disrespect or meanness.

 

Personality Disorders

… are diagnostic categories in which the individual has a longstanding , stable, relatively fixed pattern of thoughts, feelings and actions that permeates his or her whole life , including work and personal relationships, that deviates significantly from the expectation of the culture.

It differs from psychosis in that the person’s connection to reality is intact; there are no hallucinations or delusions that are present.

It differs from “depression, “anxiety” and “PTSD” in the extensive nature of the characteristics. Near the personality disorder, the person might suffer from the symptoms of depression or anxiety.

 

Causes of Personality Disorders

Behind them we assume there is genetic disposition with epigenetics that certainly plays a significant role and environmental stressors; especially early childhood abuse or neglect are contributors.

In the case of Antisocial Personality Disorder, James Fallon in his book “The Psychopath Inside” ,proposed the “Three legged Stool” theory that says: “… (1) unusually low functioning of the orbital prefrontal cortex and anterior temporal lobe including the amygdala, (2) the high-risk variants of several genes, the most famous being the warrior gene, and (3) early childhood emotional, physical or sexual abuse.

 

Type of Personality Disorders

The present Diagnostic and Statistical Manual of Mental Disorders discriminates 10 personality disorders and groups them in 3 clusters:

Cluster A: the “odd, eccentric” (and its features shortly)

Paranoid Personality Disorder: fears that everybody is out to get them.
Schizoid Personality Disorder: social detachment, in emotional “desert”.
Schizotypal Personality Disorder: odd beliefs, limited social capacity.

 

Cluster B: the “dramatic, emotional, and erratic” (Features shortly)

Antisocial Personality Disorder: no regards to others rights, no remorse, no morals.
Borderline Personality Disorder: intense, unstable emotions, polarized worldview, impulsive behavior.
Narcissistic Personality Disorder: grandiose self, entitlement, self-love.
Histrionic Personality Disorder: excessive but shallow emotionality, attention seeking.

 

Cluster C: the “anxious, fearful”

Avoidant Personality Disorder: avoiding social situations in order to protect themselves from feelings of inadequacy.
Dependent Personality Disorder: strong need to be taken care of by other, great difficulty to stand up for themselves.
Obsessive-Compulsive Personality Disorder: preoccupied with rules, regulations or rituals in order to control their anxiety.

 

It seems like a well defined system. Professionals can categorize the illnesses quite well, right? – Wrong. The criteria are vague, and fall into continuum. The “Box” is not as well contoured as you might think.

 

Diagnosing Personality Disorders

The Diagnostic and Statistic Manual of Mental Disorders gives a list of vague characteristics that are more or less typical of anybody in certain phases or situation of their lives.

Let’s take the example of Narcissistic Personality Disorder according to the DSM –IV:

“A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
(1) has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)
(2) is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
(3) believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)
(4) requires excessive admiration
(5) has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations
(6) is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends
(7) lacks empathy: is unwilling to recognize or identify with the feelings and needs of others
(8) is often envious of others or believes that others are envious of him or her
(9) shows arrogant, haughty behaviors or attitudes”

Before freaking out by diagnosing yourself as Narcissistic, it should be noted that everybody likes to feel important, admired, having power, brilliance, ideal love or feel entitled, have unreasonable expectations and so on.

We can place people on the continuum regarding these features. We consider it a personality disorder if it manifests itself in rigid and overwhelming emotional states or behaviors that interfere with the everyday functioning of the person.

This categorization raises other concerns as well. In order to diagnose Narcissistic Personality Disorder, the person needs to show at least 5 of these characteristics from this list. If another person shows another 5, is it the same illness? What if someone shows only 4? What if someone shows 3 from this list and 2 from let’s say the Borderline or the Antisocial Personality Disorder’s list? By the way, it’s quite common.

It is obvious that the category is not as unambiguous as people might think.

 

Treatment options

• Currently, there is no medication prescribed for personality disorder. However, pills can help to withstand the intense depression or anxiety bouts.

• Cognitive Behavior Therapies, as their names imply, are working on the conscious level and can achieve a lot by re-training the “Ego”. Famous among them is the Dialectic Behavior Therapy that manages stress syndromes, and teaches coping strategies for patients struggling with Borderline Personality Disorder. Furthermore, it has proven to lower the suicide rate among them.

• Long term – more often psychodynamic therapies are trying to unfold the unconscious connection in between the trauma/neglect they suffered and the present symptoms. Psychodynamic therapists believe that the symptoms are communications and unconscious attempts to resolve the issue and/or protect the person from the trauma they encountered. The therapy’s goal is multiplex: dealing with the trauma in the emotional level, bringing the unconscious associations into awareness, and modeling a healthy relationship with the therapist.

 

Prognosis varies…

1/ by person. No one can change somebody else but themselves. If the individual has the motivation, primarily by suffering enough, they might change. A real, severe personality disorder that had decades to develop needs more years of therapy to show some improvement.
2/ by severity. The more intense the symptoms, the bigger the challenge to change.
3/ by type of personality disorder.

Antisocial Personality does not react on psychotherapy because they do not have the interest/sensitivity for social clues that psychotherapy works with.

The Cluster A “odd type” disorders are quite stubborn, but at least they might have one trusting relationship with their therapist in the otherwise asocial “hostile” world.

Slow changes might be expected from the remaining types if every other condition including motivation, rapport with the therapist, and time for processing is in place.
4/ Occasionally, family members might suffer more from the symptoms than the client. They might benefit from consultations on what’s the most advantageous approach to handle the person suffering from personality disorder.

 

All in all:

personality disorders are deeply engrained, dysfunctional emotional, attitudinal and behavioral patterns of a person. Its emergence has a genetic and epigenetic background in interaction with the social environment. Its definition is somewhat vague, because of the different manifestations in different persons. Aiming for reasonable changes requires a huge dose of motivation as well as adequate time in committed therapy.

 

Need more help? Contact me at:

Sound.Soul.Counseling@ProtonMail.com

425.280.2643

First published in: YourTango.com

Photo courtesy of David Castillo Dominici from FreeDigitalPhotos.net.

Feb 26

4 Reasons Why ADHD Is Epidemic in America (but not in Europe)

ADHDConsidering ADHD our focus might be in the wrong place

 

Thanks to the challenge made by one professor of pediatrics, the ADHD argument received new momentum recently.

In his published opinion, “ADHD does disservice to children as a diagnosis,” Dimitri Christakis, of Seattle Children’s Hospital said he considers that the “attentional capacity” varies from individual to individual, situation to situation. Also, he found that the bell curve represents it better than a simple dichotomy of whether someone has ADHD or not.

He is not the first one to challenge the main stream medical model. In a 2012 article published by Psychology Today, Marilyn Wedge, PhD, argued that “French kids don’t have ADHD” and published her own book stating that ADHD has become an American epidemic.

Though it makes complete sense to look at ADHD as a spectrum, in and of itself does not explain the difference in prevalence between Europe and America.

Naturally I don’t want to hurt anybody’s feelings — especially not the children who are suffering from the disorder, or the parents who have tried everything before they reached for medication. This article does not reference them.

I am talking about children whose dysfunctional behavior is a reflection of the non-biological, mostly emotional imbalances in their environment.

 

As a European therapist, I see four factors that contribute to the American ADHD excessive occurrence:

 

1. Children are forced to sit and listen in a school setting instead of getting up and experiencing things first-hand

The makeup of our behavior dates back to the time when our ancestors lived their hunter and gatherer lifestyle. Children learned from the parents and relatives while they lead their everyday life together in groups.

The activity was variable, moving from task to task, while they had a chance to change some words with each other while moving around. The group had to synchronize its activity, but the way how children participated was rather free and self directed.

In today’s schools, children’s activity is not self directed, provides no chance to move around and requires long moments of focused attention with high levels of discipline. This was rarely necessary in ancient times.

Had I been chased through my five, six hours a day, class to class with four minutes breaks in between, like in U.S. middle schools, and had I been given sometimes two or more hours of homework on top of that, I surely would have a shortened attention span. I would fidget, and I bet I would burst out in heavy cursing, quite often without a crumb of ADHD.

Would you not?

In other words, the present day school expectations are unrealistic and not age appropriate in many cases.

 

2. There is less emphasis on structure and discipline

Growing up in Hungary and living in Germany for six years, I agree with Marilyn Wedge. In Europe, there is more emphasis on discipline, structure and compliance than in the U.S., although every culture differs from each other in certain aspects.

Limits, structure, routine, consequence — they are not equal with authoritative parenting style or rigidity, and far away from helicopter parenting.

In my case, it meant I had to be obedient with my parents and teachers. Had I not, there were consequences. There were rules I had to keep; there was a flexible, but steady, daily rhythm we were exposed to.

We had to wait while everybody sat down to the table and everybody finishes. There was very little TV time.

School had 45 minutes classes with 10 or 15 minutes in between. We had enough time to arrange everything in breaks, therefore we were not allowed to leave the classroom for the restroom, or eat or drink during class.

Being loud, bothering others was never allowed and we had to be polite. We even had to give our place to elderly people on the bus.

Naturally, the discipline what our parents provided translated into self-discipline as we grew up. That parental boundary setting doesn’t exist in America.

 

3. Over-diagnosing is commonplace

In Hungary, I was trained to give mental health diagnosis very carefully because of the possible devastating effects. We observed patients for two weeks in different group settings and in individual therapies. We did multiple tests with them.

After two weeks, the whole staff (psychiatrists, psychologists and nurses) would sit together, discuss their experiences and come up with a cautious diagnosis.

We would never diagnose teenagers with psychosis, only “teen age disturbances” knowing that this age is rather turbulent and it might resolve as they grow older. Psychosis manifests itself mostly in young adulthood, not earlier. There was no way to diagnose children with bipolar disorder or other psychosis, with the exception of (very rare) hebephrenic schizophrenia.

In the US, it is common to diagnose children with the most severe mental illnesses in comparison to what we consider as nonsense in Europe. I live with the suspicion that in many cases ADHD diagnosis goes out with the same ease.

It is convenient to think in the medical model. If we can put struggling children in one medical category, we can assume that the problem is solved.

Instead of coming up with an alternative (less medicated) solution — exhausting activities, exercises, structure, routine, reward, consequences, sufficient time for sleep — the child is given medication to keep them from bothering anyone without the need for re-evaluating the effectiveness of the system.

Problem solved? No. Symptom solved.

 

4. Medication is thought to be the only solution

The pills that we use to influence the brain contain serious chemicals — many of them terribly addictive. Until we know exactly how the brain functions differently in ADHD (which hasn’t happened yet), the treatment is mostly statistical trial and error. In some cases it makes the symptom disappear, but in many cases it does not.

I can accept it as the last resort when the behavior of the child is SO troublesome that it restricts his or her achievement or social life — but more often than not, this isn’t the case.

Do we face biologically based ADHD or an “undisciplined” child, perhaps with partially delayed development?

Whether or not we medicate the child, this is the most important way we can help them; by giving structure, limits, appropriate exercises, enough sleep, interesting activities, appropriate diet, predictable daily rhythm, lots of attention and patience together with ever present consistence.

I know — it’s an incredibly exhausting feat for parents.

But, sorry to deliver the bad news — no pill can replace it.

The unrealistic, age-inappropriate expectations in the public schools, the inconsistent socialization of small children, the dominance of the medical model in the culture and the pharmaceutical industry’s interest for profit are all contributors to the ADHD over-representation in America.

 

Published in Your Tango in January 2016

 

More about Parenting:

Considerate Parenting, Grounded Adults

Unconventional Parenting

 

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