Tag Archives: psychiatry

On the Capacity to be Alone In the Presence of Another…

I’ve written about this concept by DW Winnicott on past posts – ‘the capacity to be alone in the presence of another’ –  one that underlies many aspects of our developmental journey – our capacity for solitude, for good reading and attention, love in relationships, and self respect, inter alia…

   This excerpt is from a write up that details an interview with Adam Phillips on this topic. Both links are included below: 

PHILLIPS: That idea was one of Winnicott’s most radical, because what he was saying was that solitude was prior to the wish to transgress. That there’s something deeply important about the early experience of being in the presence of somebody without being impinged upon by their demands, and without them needing you to make a demand on them. And that this creates a space internally into which one can be absorbed. In order to be absorbed one has to feel sufficiently safe, as though there is some shield, or somebody guarding you against dangers such that you can “forget yourself ” and absorb yourself, in a book, say. Or, for the child, in a game. It must be one of the precursors of reading, I suppose. I think for Winnicott it would be the definition of a good relationship if, in the relationship, you would be free to be absorbed in something else.

http://www.brainpickings.org/index.php/2014/06/09/adam-phillips-paul-holdengraber-interview/

http://www.theparisreview.org/interviews/6286/the-art-of-nonfiction-no-7-adam-phillips

Enjoy.

 

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Trauma and Children

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Here’s a short article I wrote for the local paper…

Trauma and Children – Do we always recognize the effect on children and adolescents? 

Much of what we know about trauma and how it affects our children is based on the work of mental health professionals that have focused on adults, including the large amounts of research done on PTSD (post-traumatic stress disorder).  My early work with children that had experienced domestic violence in the home was during a time when very little was known about the effects or the proper treatment to help these children or their mothers.  However, new developmental research, mostly in the past two decades, have concentrated on children and adolescents that experience domestic violence in the home, school violence, physical and sexual abuse, emergency medical care, and car accidents.  The fear, the anxiety, and the sense of helplessness that accompanies such events often results in dramatic reactions and behavioral changes in the child.

The American Psychological Association (APA) defines ‘trauma’ as a threat of injury, death, or an event that is experienced by the child as threatening the physical integrity of self or other personcausing fear, terror, or helplessness.  The behavioral changes may include separation anxiety in the child, sadness or anger that was not observed prior to the event, sleep disturbances, or difficulties in the ability to focus or concentrate – often causing problems in the home or in school.  Oftentimes, because the family may be suffering, or because of cultural or ethic factors, parents may not be able to make sense of the behaviors or notice if the changes are slight and gradual. The children may not show immediate effects to the event, for example to a dog bite or a car crash. In the case of sexual abuse, the parents may not know right away of its occurrence – and so the signs or symptoms exhibited will not be understood by the parents.

Further, the responses of children and adolescents will vary, depending on the child’s age, their developmental level, and of course, previous exposure to the threat or traumatic experience.  That is, if the threat or event is chronic – as in domestic violence in the home – or is  acute, happening now – for example, a bad car crash.  Some estimates (from psychological studies) suggest that 2/3 of children up to age 16 have experienced or been exposed to trauma, or the threat of trauma.  Up to nearly 5 million children have been exposed to or experienced trauma – many from abuse, both sexual and physical – and violence in the home.

As the diagnostic criteria have recently been more adequately studied, we can understand the apparent increase in disorders of anxiety in children, including the increase in diagnoses of post-traumatic stress disorder. (PTSD is a sub-category of anxiety diagnosis).  Intrusive thoughts or memories related to the trauma will interfere with the child’s thinking, as well as their ability to focus.  As the experience is far outside the realm of normal experience, the child’s normal mechanisms for adapting to the environment or situation may fail him or her, leaving them feeling more vulnerable.  The child or the adolescent cannot make sense of the experience as it does not conform to their usual experience, and thus cannot adapt and master the thoughts and emotions that are occurring to them.

Different professionals will have different perspectives on what constitutes trauma, and how best to approach it therapeutically. There are not sufficient studies to support the effectiveness of any one therapeutic approach yet, though cognitive behavioral therapy is perhaps seen by many as the most effective. The need for what is referred to as ‘evidence based treatment’ continues – treatment that has been shown to be effective for children, adolescents, and adults – based on reliable and valid research.

What has been shown to be effective is that the quality of the therapeutic relationship is the key to success.  The safe, secure, and trusting relationship between the therapist and child, the parents, and the school personnel – all of whom can support the strengths and resources of the child or adolescent ­ needs to be fostered.  Coping skills must be identified and strengthened – and these can be supported through psychotherapy or counseling, individual help through tutoring (giving child individual attention), stress reduction exercises, such as mindfulness activities or meditation, and fostering leisure activities.

It is also important to establish and maintain the structure and routines of everyday life, with meals and school or extracurricular activities as good ways to provide the necessary structure.  Finally, it is important to engage the community, letting school or church personnel know of the event or experience, as well as others that have contact with the child, so that their child’s behavior is understood in the proper context by the teachers or counselors. These suggestions will help foster a support network for the child or adolescent – with trusted and safe adults.

More information on trauma is available through the American Psychiatric Association and the American Psychological Association.  Please also feel free to email me with questions or comments on the subject.

Rudy Oldeschulte, M.A., J.D. is a Del Rio psychotherapist, specializing in individual  psychotherapy and parent guidance.  He has served on the faculty of the University of  Arizona College of Medicine and the British Association of Psychotherapists. Post- graduate training and education was done in London and at the University of Michigan.

            Email address is: roldeschulte@gmail.com and his website is: www.rudyoldeschulte.com

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Why the long face? Sadness makes us seem nobler, more elegant, more adult. Which is pretty weird, when you think about it

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…[s]urely what people want is to be happy. Whole philosophies (I’m looking at you, utilitarianism) rest on the premise that more happiness is always and everywhere a good thing. There is a Global Happiness Index, measuring how happy people are (Denmark tops the league). Bhutan even has a Gross National Happiness Commission, with the power to review government policy decisions and allocate resources…

…It’s good to be happy sometimes, of course. Yet the strange truth is that we don’t wish to be happy all the time. If we did, more of us would be happy – it’s not as if we in the affluent West lack tools or means to gratify ourselves. Sometimes we are sad because we have cause, and sometimes we are sad because – consciously or unconsciously – we want to be. Perhaps there’s a sense in which emotional variety is better than monotony, even if the monotone is a happy one. But there’s more to it than that, I think. We value sadness in ways that make happiness look a bit simple-minded…

See link for entire article:

http://aeon.co/magazine/altered-states/any-fool-can-be-happy-sadness-takes-strengt

 

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A Mad World…A diagnosis of mental illness is more common than ever – did psychiatrists create the problem, or just recognise it?

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When a psychiatrist meets people at a party and reveals what he or she does for a living, two responses are typical. People either say, ‘I’d better be careful what I say around you,’ and then clam up, or they say, ‘I could talk to you for hours,’ and then launch into a litany of complaints and diagnostic questions, usually about one or another family member, in-law, co-worker, or other acquaintance. It seems that people are quick to acknowledge the ubiquity of those who might benefit from a psychiatrist’s attention, while expressing a deep reluctance ever to seek it out themselves…

…While a continuous view of mental illness probably reflects underlying reality, it inevitably results in grey areas where ‘caseness’ (whether someone does or does not have a mental disorder) must be decided based on judgment calls made by experienced clinicians. In psychiatry, those calls usually depend on whether a patient’s complaints are associated with significant distress or impaired functioning. Unlike medical disorders where morbidity is often determined by physical limitations or the threat of impending death, the distress and disruption of social functioning associated with mental illness can be fairly subjective. Even those on the softer, less severe end of the mental illness spectrum can experience considerable suffering and impairment. For example, someone with mild depression might not be on the verge of suicide, but could really be struggling with work due to anxiety and poor concentration. Many people might experience sub-clinical conditions that fall short of the threshold for a mental disorder, but still might benefit from intervention.

See link for interesting article on psychiatry…and bits about the importance of psychotherapeutic intervention…

http://aeon.co/magazine/being-human/have-psychiatrists-lost-perspective-on-mental-illness/

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Is Depression Just Bad Chemistry?

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“Much of the general public seems to have accepted the chemical imbalance hypothesis uncritically. For example, in a 2007 survey of 262 undergraduates, psychologist Christopher M. France of Cleveland State University and his colleagues found that 84.7 percent of participants found it “likely” that chemical imbalances cause depression. In reality, however, depression cannot be boiled down to an excess or deficit of any particular chemical or even a suite of chemicals. “Chemical imbalance is sort of last-century thinking. It’s much more complicated than that,” neuroscientist Joseph Coyle of Harvard Medical School was quoted as saying in a blog by National Public Radio’s Alix Spiegel.”

See link: http://www.scientificamerican.com/article/is-depression-just-bad-chemistry/

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The GEEL Question…treating the mentally ill…

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A fascinating article, well worth the read – looking at an alternative approach to our thinking about mental health and therapeutics…

“Half an hour on the slow train from Antwerp, surrounded by flat, sparsely populated farmlands, Geel (pronounced, roughly, ‘Hyale’) strikes the visitor as a quiet, tidy but otherwise unremarkable Belgian market town. Yet its story is unique. For more than 700 years its inhabitants have taken the mentally ill and disabled into their homes as guests or ‘boarders’. At times, these guests have numbered in the thousands, and arrived from all over Europe. There are several hundred in residence today, sharing their lives with their host families for years, decades or even a lifetime. One boarder recently celebrated 50 years in the Flemish town, arranging a surprise party at the family home. Friends and neighbours were joined by the mayor and a full brass band.”

See the link: 

http://aeon.co/magazine/living-together/the-town-where-the-mentally-ill-get-a-warm-welcome/?utm_source=Aeon+newsletter&utm_campaign=adfefb7e37-Weekly_Newsletter_January_10_20141_10_2014&utm_medium=email&utm_term=0_411a82e59d-adfefb7e37-64036721

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Introverts…

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     Those that tend toward introversion – often confused with shy individuals – face a number of difficulties (or challenges) each day.  Many can circumvent the issues, sometimes more easily than other times.  The following article addresses some of the more important considerations, especially as psychiatric entities attempt to pathologize introversion, shyness…One can certainly be pleased that this topic is being talked about more openly now…in the news, in professional journals…

http://www.huffingtonpost.com/2013/08/20/introverts-signs-am-i-introverted_n_3721431.html

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