THE BLAME GAME

Gregory awakened Sunday morning and his first thought through a pounding head was, “Damn, how much did I drink last night?” He looked over at the night table and there was a half empty bottle of bourbon. “I don’t even remember what I did last night,” he lamented.

Gregory was in pretty bad shape. His problem drinking was out of hand. His wife had left him and taken their two kids aged 9 and 12. His boss had warned him earlier in the week that if he didn’t shape up he would be fired. He was in and out of rehab and counseling but neither was going well. He was constantly being told by other patients and counselors that he needed to stop blaming others for his problems.

Gregory had a long list of those who were to blame for his ills, beginning with his parents, his brothers, a couple of emotionally-abusive high-school coaches, numerous unfair high-school and college teachers, his wife, a lineup of insensitive supervisors and bosses, and rebellious kids. The only one he overlooked was the Devil! Gregory’s pattern of coping with his difficulties was consistent: find others to blame.

But now, here he was lying in bed on that Sunday morning, and he finally said to himself, “I have to face up to the fact that no one is to blame for my misery but me. I am at fault.” Sounds like a breakthrough, doesn’t it? At last, Gregory is taking a look inside rather than outside. Well, yes, that’s a positive step, but there’s still a fundamental problem with his approach: he’s still hung up on blaming someone, in this case, himself.

Coping with life is not about assigning blame; it’s about moving forward. Self-blame for your problems, even when true, is not a step forward; it’s stagnation, forming a pity parade that stands still because you feel you have justified your destructive behavior by blaming someone. As long as you’re obsessed with the blame game, you will never move forward.

So, what does Gregory need to do? First of all, drop the self-pity and accept that no one is going to cushion the corners of his world for him. He needs to assess his current situation and focus on actions and thoughts he can take, things under his control, to improve his situation. Imagine if Gregory called his wife that Sunday morning and said, “Honey, I understand now. It’s all my fault, not yours or the kids’. It’s all on me.”

She would best reply, “Well good for you, Greg. But I’m not interested in who’s to blame for where we are. It really doesn’t matter at this point. I’m interested in seeing what you’re going to do about where we are! Give me some actions, some positive changes in how you behave that will help this family move forward.”

Next time you find yourself trying to cope by deciding it’s all your fault, face the fact that self-pity is not going to improve your life. You must decide how you are going to change your behavior to cope. Choosing the best actions will require a lot of honesty, commitment, hard work, communication with others, help from them, and facing  up to what you can and cannot control.

 

 

DEPRESSION PART III

It may be the dog days of August, but some people are already worrying about winter. Later sunrises and earlier sunsets are already upon us, and once late Fall kicks in, reduced sunlight becomes very noticeable. Some people develop SAD, an acronym for Seasonal Affective Disorder, or Seasonal Adjustment Disorder. This depression hits them in the winter when there is reduced sunlight. In fact, some professionals say SAD results from reduced sunlight, which causes biochemical imbalances in the brain.

A few victims treat SAD by sitting in front of a special lamp for an hour or so each day before sunrise and again after sunset. The idea is to extend the amount of time your brain is bathed in light each day, and thus maintain an appropriate biochemical balance to be blessed with a good mood. Others prefer to take anti-depressant medication to correct the presumed imbalance. Still another approach to SAD is in line with themes we try to develop in this blog. This approach focuses on personal empowerment, autonomous action, and taking control of your behavior during the winter months

There’s no doubt winter brings a special set of depression-inducing stressors. You’re cooped up in the house (quite a bit if you live in the North) and it’s tough to take those enjoyable strolls around the neighborhood after dinner. You exercise less and gain weight, which further depresses you. You’re more likely to get sick during the winter. You worry about road conditions when there’s ice and snow, and what to do with the kids if there are school delays and cancelations. And in the middle of it all are the dreaded holidays.

But, hey, maybe SAD need not be such a big deal, at least if you approach winter the right way. Why not use some coping techniques to reduce some of that down-in-the-dumps feeling? As always, you need to assess what you can and can’t control.

One thing you can’t control is winter weather. How do you deal with that? The answer is, stay active. Is it possible that you might develop mood swings in the winter months because you change your routine and give in to the darkness and cold? All those worries about the dangers of bad-weather driving, flying home for the holidays, becoming snowbound in an airport, getting the flu, or a host of other self-imposed concerns just tie you up in knots, so you curl up on the couch and become more likely to avoid life.

Here’s our non-pharmaceutical take on SAD: the key to a good mood during the dark months is to maintain a steady “diet” of activity, just like during the summer months. You should schedule special events and activities that you’ll look forward to. Sure, you have to bundle up in January to take that walk, but doing so is better than sitting on your butt.

We know a serious outside walker who is also a serious winter hater! Still, she never lets the winter weather defeat her when it comes to walking outside. During the winter she bundles up in layers of sweat clothes, scarves, and windbreakers. Then, armed with her music device and earphones, out she goes. Her only concession to winter weather is the route she takes. If there is snow on the ground, many of her summer walking paths are just not accessible, so she changes the route accordingly. She always returns home about an hour later moaning and groaning about the evils of winter, but she is invigorated and feels good physically and mentally after these winter walks.

Perhaps the fundamental idea behind SAD is flawed. As winter approaches and the days get shorter, if you believe you are doomed to get depressed because of reduced sunlight, that’s your choice. But remember: darkness is not necessarily going to make you depressed; it’s what you do during the darkness that makes the difference. The winter months can be viewed as a challenging time to continue with those activities that give you pleasure and a sense of control in your life, not as a time to hibernate! What you do is under your control; the weather is not! We believe you will be much better “inoculated” against winter psychological dangers if you continue your regular exercise and other activity routines during the winter. Spit in winter’s face!

If you tend to get down in the dumps during those long winter months and want to purchase an expensive lamp to bathe your brain in artificial sunlight, fine; that’s up to you. If you want to take anti-depressant medication, well, that’s your choice, too. But you can also be open to that third alternative, and not be afraid to find new strategies to maintain your warm-weather activity routine. Plus, you can take on new things in spite of winter. Remember, the winter months bring special challenges to many people. Do things for others; get involved in charity projects during the holiday season; volunteer at a homeless shelter during the coldest time of the year. In general, do things, hit the road, get out there and be with people. And before you know it, you’ll be venturing outside to be bathed in that warm April sunshine!

 

MISCONCEPTIONS ABOUT DEPRESSION PART II

If you’re like most people, when you think of the word “depression,” your thinking is clouded by a lot of misconceptions, such as, “If I’m unhappy I’m depressed.” Depression is not the same as unhappiness. You have bad days and get down in the dumps. Who doesn’t? Maybe you have lost a loved one, been laid off, experienced a relationship breakup or a divorce. You feel pretty rotten, but in these cases of situational sadness, a change in circumstances or your perception of events can soothe emotional upheavals and lift your spirits. But if you get into a chronic, persistent habit of avoiding troublesome events instead of facing them, then you begin moving from sadness and unhappiness to learned helplessness and depression. Like all coping challenges, the key is the degree to which you get swept up in the avoidance pattern.

Confusing unhappiness with depression is not the only thing that can make evaluating depression difficult. For instance, you might get caught in a chronic pattern of actions that involve disengaging from life. Church and Brooks call this self-defeating pattern subtle suicide in their book of the same title, and they note how the condition can be confused with depression. Subtle suicide, however, is characterized by ambivalence, apathy and a “Who cares?” attitude toward life, and can be distinguished from chronic depressive disorder. Still, many people who show this ambivalence toward life are often misdiagnosed as depressed and prescribed anti-depressant medication, which doesn’t work well with subtle suicide.

Another misconception is believing your primary care physician is best equipped to diagnose and treat depression. Unfortunately, in the medical profession most diagnoses of “depression” are not made on the basis of formal psychological assessment, and informal diagnoses can lead to diagnostic errors and inappropriate treatments. For instance, anxiety, anger, and other emotions brought about by life circumstances can easily be confused with depression. A psychologist can distinguish these conditions from depression with appropriate diagnostic assessment.

The reality of comorbidity in psychological dysfunctions can also present diagnostic problems. Comorbidity means the simultaneous presence of more than one pathology, such as when a client shows depression, but also anxiety attacks and post-traumatic stress disorder. If the diagnosis is depression, the other conditions are overlooked and the use of anti-depressants will likely not work. The client will be frustrated and the practitioner will begin trial-and-error applications of one medication after another.

Misconceptions also occur over the biochemical imbalance issue. Many psychiatrists believe that their client’s problem results from such an imbalance in the brain, and medication can restore balance. Other professionals say this type thinking is like saying a headache results from an aspirin deficit in the brain. Such controversy can be confusing to the client.

One thing we can say is that a lot of research has shown that psychiatric medications are generally no better than a placebo for low and moderate levels of depression, such as Persistent Depressive Disorder (PDD). This finding should not surprise you because there are no medications that will empower you, or that will develop an action plan for you to navigate the challenges of life and develop more satisfying and productive actions. In PDD, such things are crucially involved in dealing with the disorder. More severe conditions, however, like Major Depression and Bipolar Disorder do respond positively to medications. Once again, the accuracy of diagnosis plays an important role.

The bottom line is, be cautious and seek information from a variety of sources. If you feel you have a persistent, chronic problem with your mood that interrupts your daily activities, you should consult both a psychiatrist and a psychologist. This combination will provide you with a thorough psychological evaluation and diagnosis, decrease the risk of diagnostic errors, and help you work actively as a participant in developing a treatment plan that may include medications.

ABOUT DEPRESSION PART I

You have probably heard of Bipolar Disorder and Major Depression, but perhaps not Persistent Depressive Disorder (PDD). The symptoms in PDD tend to be quite subtle, compared to bipolar and major depression where symptoms are much more severe and dramatic. For instance, suicide attempts, psychiatric hospitalization, and the need for anti-depressant medication are much more common with major depression and bipolar disorder.

PDD is largely a cognitive condition, a way of perceiving and thinking about events in your life in a negative way. If you think negative thoughts, especially about yourself, you are going to feel pretty rotten – you are going to avoid challenges and become more likely to get depressed. Negative thoughts preclude positive actions, and without positive actions in your life you will never feel satisfied and productive. Imagine waking up feeling pretty good, but going through the day repeatedly telling yourself, “I’m incompetent; I’m going to fail; I can’t do anything worthwhile; I’m a disappointment to others; I’m such a klutz everyone feels sorry for me.” How do you think you will feel at the end of the day? Satisfied or kind of “down”?

If you feel you might suffer from depression but tend to write it off as just having some problems dealing with life, you could be one of the “silent sufferers” afflicted with PDD. You go to work or school, you care for your loved ones if necessary, and generally function in the normal range of activities. But you have this gnawing feeling that most people seem to enjoy life more than you do. You seem to have more than your share of pessimism, guilt, lack of interest, appetite fluctuations, low self-esteem, chronic fatigue, social withdrawal, and concentration difficulties. Whatever your particular profile, you have a chronic discontent with yourself, and your negative thinking has become a way of life. You can even learn to tolerate this depressive state and are not really convinced that you suffer from a psychological disorder.

The seeds of PDD are usually planted in childhood or adolescence, and result from poor development and guidance in developing social skills, optimistic thinking, and a belief that you can deal with challenges. The results are early beliefs that you are helpless, have a tendency to dwell on the negative, and experience a steady build-up of stress. These conditions often lead some folks to seek psychological help, and frequently the psychiatric diagnosis of depression results in a prescription for anti-depressant medication. Unfortunately, this medication, which can be effective with Major Depression and Bipolar Disorder, is usually ineffective for PDD. About the best that can be expected from the medication is a temporary “kick-start” to developing new thinking and action patterns with the help of psychological intervention.

PDD is primarily an avoidance issue, the sorts of things that we discuss in this blog. With PDD you have developed long-standing actions that allow you to avoid facing challenges and maintain your symptoms. You probably tend to avoid stressors, unfortunately the very stressors that helped cause and sustain your depression and other life problems; in other words, you avoid the very stressors that you must learn to confront. As a result, you are likely caught in a vicious cycle of action patterns that is difficult to exit, and unlikely to be affected by anti-depressant medications. Your depression is accompanied by actions that rob you of energy, motivation, and positive attitudes that are needed to break free of the avoidance vicious cycle. As a result, your depression probably creates problems in other areas, such as social interactions, concentration and focus, alcohol/drug issues, etc. Such co-existence of problems is known as co-morbidity and is not at all uncommon. So, do not despair. If you are willing to work you can learn to challenge and face your demons, and possibly without long-term medication use.

ROOTS OF CHILD ABUSE

In previous posts we noted that child abuse can be passed on from one generation to the next. Abuse your child and you have increased the likelihood that your child will abuse his/her child, and so one down the line. Note that we said “increased the likelihood” not “guaranteed.” So let’s look at some of the psychological factors involved in this perpetuation.

Also, please remember what we have said previously about an individual as a complex array of puzzle pieces. We may isolate and understand some of those pieces, but there will always be more pieces. We can never have a complete understanding of an individual. Yes, we can make some really good educated guesses about one’s psychological dynamics, but our understanding will always be incomplete. For instance, if you hear someone say, perhaps in a courtroom as an expert witness, “This man is no longer a danger to society. He can be paroled without concern,” red flags should go up in your head. No expert should make such a bold and absolute prediction.

OK, back to perpetuating the psychological seeds of child abuse. First of all, let’s note that if you are raised in a physically abusive environment, you are seeing an aggressive role model; that model is telling you, “Violence and aggression are the way to resolve conflicts, and are appropriate reactions when you are frustrated and angry.” The research is quite clear that a cold, rejecting early home life increases the odds of later adult dysfunctions, such as child abuse.

An early abusive environment will encourage you to mistrust the world. You will see others as unreliable, dangerous, and social interactions are to be avoided for your psychological well-being. You will hold grudges, which will perpetuate your inner anger. These reactions will give you great insecurity in social situations. The result could be extreme withdrawal and disengagement from interactions with others or lashing out to harm them. The precise pattern is one of those puzzle pieces that is hard to predict in advance.

As we noted in an earlier entry, whether you withdraw or lash out to deal with your anxieties and anger, you will have a hard time learning how to interpret social signals. Among other things, you will be confused about how to give and receive love. This confusion will add frustration and more anger to the mix, and you will be likely to take your anger out on the source of your confusion.

The very presence of a child will likely tap into the recesses of your mind and awaken the anxieties, confusion, and anger of your childhood when you were abused. You will put yourself in the place of the child in front of you, and you will react to the frustrating social signals in the way you experienced: Abuse.

We have not painted a very pretty picture, have we? Remember, however, the transition from abused to abuser need not be inevitable. Just being aware of all the possibilities raised above can help you introduce new pieces into the puzzle that is you, or the puzzle that is someone you’re trying to help. Our personalities are not static and unchanging as we grow; we are capable of taking charge of those things we can control, learning to face and accept (not blame) some uncomfortable truths about ourselves, finding values that coordinate with a social conscience, and behaving in more personally satisfying ways by reaching new levels of self-awareness and self-actualization.

PERPETUATING CHILD ABUSE

Last week we talked about child abuse and considered one hypothesis about possible dynamics involved in at least some cases. Let’s look at another dimension to the problem of child abuse.

Years ago I was talking with the Director of a daycare facility. This particular daycare was registered with the local Juvenile Court, and children who had been removed from a parent’s care for safety were often placed in the facility during the day. The Director was sharing some of her observations in her facility of toddler-age kids (around 2) who had been removed from physically-abusive homes.

She said, “We often have a child who gets frustrated about something, angry over a toy, or any of a number of things, and starts crying. A lot of times one of the other kids shows some concern. I’ve seen them go to a crying kid and offer a toy, or ask, ‘What’s wrong?’ in a soothing way. Never, however….never have I seen a child from an abusive home behave in any sympathetic way toward another child. Right now we have two children from abused homes who have been placed with us by the courts. Just the other day, a child was pounding some blocks together and accidentally hit her finger. She was really crying and I noticed how many of our kids were looking over to see what was going on. Three or four actually came over and acted like they wanted to help the staff member who was comforting the child. The two abused kids? One was totally ignoring the commotion and going on with his playing; the other came over and shoved the crying child, shouting, ‘Shut up or I’ll beat you!’ I thought, my God, the kid is already a child abuser and he’s only 2!” Later she added, “You want to produce adult child abusers? Abuse them when they’re children!”

Years ago I was home one afternoon when I heard a crash against the front door and lots of yelling. I ran and opened the door and there was our 9-year old daughter, just home from school, and another girl I didn’t know, who ran when I opened the door. Our house was just a few yards from the school bus stop, and apparently the girl had chased our daughter right onto our porch and shoved her pretty good before I arrived.

Our daughter told me this girl regularly bullied her on the school bus, and this day decided to chase her. She said the girl lived just a block away and gave me her last name. “Oh, great,” I thought, “I’ve got to call this girl’s parents about this and complain.” I would rather navigate a mine field than confront parents I didn’t know. After all, some parents attack coaches who don’t play their kids enough! But then I looked at my panicky daughter……………

The girl’s last name and street was in the phone book, so I dialed the number (this was around 1979, guys!). I introduced myself and confirmed that this was the mother of the girl. I said, “Ma’am, your daughter just chased my daughter down the street to our house and attacked her right on our porch! We really need to do something about this”

“Well,” she said with clear anger in her tone, “my daughter just got home and told me how your daughter said I was a whore! What about that?” I thought, “Damn, this is going downhill in a hurry.”

“Ma’am, I promise you, I will talk to my daughter and guarantee that she will never say anything like that about you again. I apologize and understand why you’re upset. I would be, too.” [I know, you’re ready to barf but remember, if you want to soothe the wild beast, you need to play soft music.] “But, the fact is,” I continued, “We can’t have your daughter on our porch attacking our daughter. It’s not right.”

Pause. Silence. Was she loading the cannon for battle? Was she looking for her 6’6” 250lb husband to tell him to get the rifle out of the closet? My life was flashing before my eyes!

Finally, she calmly said, “You know something, I wish that last year I had done what you just did. Last year there was this older girl who bullied our daughter all the time, especially on the bus. I should have done what you did…..I should have called her mother and said we needed to do something. Instead, I just told our daughter to complain to the driver and sit as far from this girl as she could. I don’t believe it. Now she’s doing to your daughter what happened to her last year.”

For the next 5 minutes or so we commiserated about the impossible challenges facing parents. I made sure I showered her with understanding, still concerned she was married to the incredible hulk who would love to take me apart limb by limb. We worked out a good plan that presented consistent for the kids from their parents. I never talked to her again, and neither daughter ever again bothered the other again.

These two stories make the same point about child abuse: Being abused as a child will increase the odds that you will abuse children as an adult. How come? Just taking the first step in trying to answer that question will require some effort, so I’ll hold off until the next post.

DYNAMICS OF CHILD ABUSE

Child abuse can take many forms for many reasons. The boyfriend who puts out his cigarettes on his girlfriend’s child’s stomach, a child from another boyfriend, may have different psychological issues driving the action than the mother who regularly beats her two-year old, or than the young man who forces sexual acts on a 12-year old boy. All the actions are heinous, but we’re often frustrated in our efforts to understand and deal with child abusers because each case has unique features.

A colleague once described some preliminary data from his research. Some participants were moms who had physically abused and neglected their child, and, through court rulings, had temporarily lost custody of the child and been ordered to attend counseling sessions. A second group of moms also had one child, but had “normal,” stable home lives. For both groups, the moms’ child was between 2 and 5.

Each mom was tested individually. They were first wired up to a polygraph to measure physiological signs of arousal (heart rate, respiration, palm sweating), and then they watched two videos. One showed an infant smiling while lying on a mattress; the other showed an infant crying loudly while lying on a mattress. After each video the moms were asked how they felt while watching it, and what they thought was going on with the infant.

When the non-abusive moms watched the smiling video, they showed no physiological arousal. They said the video was pleasant to watch; the infant was obviously happy and enjoying interacting with whomever was present. The abusive moms, however, showed elevated physiological arousal when watching the smiling tape. Their interpretations of what the infant was feeling, however, were somewhat mixed. They said things like, “I’m not sure what’s going on”; “The kid may be tricking the caregiver into giving it something sweet”; “It may be burping and causing its expression.”  These moms did not enjoy watching the tape and seemed unsure about what was going on.

When the non-abusive moms watched the crying video, they show increased physiological arousal. This tape was very unpleasant for them, and they all said words like, “He’s really upset about something. Probably hungry, or needs to be changed, or just needs to be held and cuddled and talked to.” The abusive moms? They also showed increased physiological arousal to the crying tape. However, they interpreted the crying as criticism directed at the caregiver. “This baby is really angry at whoever is taking care of him. He’s saying that she’s doing a lousy job.”

So, what’s going on here? The researchers hypothesized that the abusive moms were poor at reading social signals from the infant. A smile, a cry…..what do they mean? What do they tell me I need to do? Abusive moms, the psychologists believe, just can’t interpret social signals. For most of us, a smile usually means, “I’m happy and love you”; a frown or cry means, “I’m hurting and need you to care for me.” Unable to sort out this information in their daily interactions with their child, the abusive moms get frustrated, angry, and lash out physically at the helpless child. Plus, when the child acts irritated, the moms conclude he is irritated at them.

Where could this insensitivity to social cues come from? One possible cause is that the abusive moms were raised in abusive homes. In fact, nearly 40% of the moms in this study indicated their childhood home was physically abusive. Imagine being raised in a home where you’re spanked, hit, pushed, and yelled at on a regular basis, regardless of what you do; whether you reach out lovingly to parents, or show anger toward them, or try to avoid them, the result is the same: anger and rejection aimed at you.

Being raised in such a world would make social signals a mystery to you: “What do I have to do to give and receive support and affection?” Simply put, this childrearing pattern makes it difficult to learn how to give and receive love. Thus, in other settings, when someone reaches out, you don’t know how to react. And when you don’t know how to react to a signal, that signal becomes aversive, a threat that reminds you of your inadequacies. And so it is for our abusive moms: “Why are you smiling? What do you want from me? What am I supposed to do? Damn you!” The crying infant? “OK, I get it…I’m a lousy mother. Why do you have to remind me? Damn you!”

The lesson here about social signals has broad relevance for everyday interactions far beyond cases of child abuse. Most of us, for instance, are not threatened by social signals from others because we recognize them and know how to react. But what about the young man who ends relationships as soon as the girl begins to get serious? What’s his problem? Deep inside is he anxious about commitment because he never really learned how to give and receive love? Are such positive expressions toward others mysterious psychological threats that must be avoided? If you are a regular reader of this blog, you know precisely the negative coping consequences of avoidance.

One final word: problems deciphering social signals are in no way the explanation for all cases of child abuse. As we said at the beginning of this post, each case is different and unique. Think of trying to analyze human behavior as doing a challenging puzzle. You may have three people before you, each one a child abuser, but each one will have different pieces to their puzzle. Yes, some pieces will appear in all three puzzles, but for the most part, each puzzle will have pieces not found in the others. Sensitivity to social signals is such a puzzle piece; it may appear in many, but not all, cases of child abuse.