A New Normal?

A recent issue of Mishpacha's Family First included the following:

1) a mother writing about her nine year old son who looks normal but behaves atrociously because of PDD (pervasive developmental disorder) which is on the autism spectrum

2) a woman writing about her bipolar condition

3) the ongoing "Family Diary" about a child who behaves terribly at home who, in this chapter, is put on Ritalin

4) a woman writing about her relationship with her ex-sisters-in-law following her divorce from their brother who suffered from paranoid schizophrenia

Is this the frum media's way of attempting to "remove the stigma" from mental illness? I think it's scaring the daylights out of us.

When Talk is Dangerous

Tehillim 73:15 אם אמרתי אספרה כמו הנה דור בניך בגדתי
"If I said, "I shall tell it as it is," behold I have made the generation of Your children into traitors."

Rashi: Said Asaph, “If I said in my heart to tell everything as it is, all that His people say about this, I would make them into traitors and wicked men."

Metzudas Dovid: If I say it the way it is, i.e. whatever it is that I think, then the talking will incite even those who are your children, i.e. those who believe in You, for when they hear what is thought, I will make them into traitors which is why I won't talk much.

I heard someone say, based on this verse, that the trend to discuss all our frum society's ills out in the open is the modern day version of "es iz shver tzu zayn a Yid" - it's hard to be a Jew.  How many Jews are being turned off to frum life when they hear about all the crises and social ills we are suffering from?

Back in the early 1900's, when shomer Shabbos Jews sighed over the hardships of being religious, they lost their children who were not interested in living a hard, religious life.  These days, why would someone want to belong to a society which has a shidduch crisis, tuition crisis, parnassa crisis, housing crisis, drop-outs, those who keep "half Shabbos," Kiddush clubs and alcoholism, drug addiction, mental illness, shalom bayis problems and molestation problems? Sounds quite unappealing!

Some editors and askanim pat themselves on the back for "breaking taboos" and (supposedly) dispelling stigmas by airing issues that used to be kept quiet.  Are we gaining or losing thereby, that is the question.  What would they say if they knew that just one person was turned off to Yiddishkeit because of this openness?

a related post

Is Wearing Black Our Problem?

I'm constantly reading news items about studies that were done, some of them silly, some of them interesting.  I'd like a study to be done in the frum world about the possible correlation or cause-effect relationship between the preponderance of wearing black and the seemingly astronomical rate of anxiety and depression, panic attacks and OCD behavior.

According to our frum publications that are doing their best to "remove the stigma from mental illness," as futile as that might be, just about everyone and their neighbor is on anti-anxiety or anti-depression meds or should be, and we are urged not to be ashamed but to seek help and get our meds so we can live happy lives. 

If you look at pictures taken many decades ago, even at the black and white pictures, you will see that men who were bnei Torah wore suits, shirts and hats of various colors.  In wedding pictures of today, there isn't much point in printing in color since both the men and women's side consist mainly of black anyway.  Toddlers on up are also dressed in black.  Goyim have noticed this recent phenomenon and are heard to ask whether wearing black is part of our religion.

Since we are affected by what we do, says the Sefer Ha'Chinuch, and we know we are affected by what we wear (ex. how we dress to do messy projects or exercise and how we dress for Shabbos or a simcha), the premise of my suggested study is that our society's move toward wearing black has a negative effect on our mental health.  Perhaps the first thing a therapist should suggest to a client is that they minimize wearing black.

It's not like this study can ever happen because we don't know the rates of mental illness and medication of frum people of previous decades.  And how could the hypothesis about color be proven?

On a positive note, I've been noticing more colors lately.  Still plenty of black, but colors are making a modest comeback.

Fake Medicine

Some tidbits from an article in The Atlantic called "The Real Problems With Psychiatry":

* Every doctor who knows anything, knows that there is no biochemical imbalance that causes depression.

* Our gut reaction is always "that was really sick. Those guys in Boston -- they were really sick." But how do we know? Unless you decide in advance that anybody who does anything heinous is sick. This society is very wary of using the term "evil."

* A depression diagnosis gives people an identity formed around having a disease that we know doesn't exist, and how that can divert resources from where they might be needed. Imagine how much less depression there would be if people weren't worried about tuition, health care, and retirement.

* The DSM is created by a group of committees. It's a bureaucratic process. In place of scientific findings, the DSM uses expert consensus to determine what mental disorders exist and how you can recognize them.

* You can't just ask for special services for a student who is awkward. You have to get special services for a student with autism. In court, mental illnesses come from the DSM. If you want insurance to pay for your therapy, you have to be diagnosed with a mental illness.

the article

Unlicensed Therapists

There was an interesting article in "Ami Living" (issue #62) about unlicensed advice-givers, whether they call themselves counselors, therapists, marital counselors, etc.  The author interviewed three men who have no degrees and yet offer advice.  To sum up:

pro licensing/anti unregulated counselors:
1) public protection - people have been hurt by self-declared practioners
2) the material studied for a degree plus the supervised training is invaluable
3) formal schooling plus a natural aptitude are a winning combination
4) the shtetl rav knew his limits

pro unregulated counselors:

1) there are awful licensed therapists, a degree is no guarantee of competence
2) a chush (instinct, talent) for advice giving cannot be learned in school; those who are professionally trained often lack common sense and a listening and sensitive heart and go "by the book".  Being able to give good eitzos (advice) is not something you learn in school.
3) formal schooling in which you must study ideas that are contrary to Torah is not an asset but a liability
4) they can be fine for most human relationship and personal problems
5) good for those who don't want to get involved in anything medical because of the stigma (even though psychologists and social workers are not in the medical profession)

What did people do before the field of mental health developed and became regulated? Of course there were always rabbis, rebbetzins, mashgichim, pastors, chaplains, and friends to turn to for advice.

The frum psychologist Dr Sorotzkin's answer to the question of what people did before psychology is the same as for antibiotics, "Some lived and some died."  I think that is true now too, though not in the way he means it, with many people "dying" with the lack of help or outright harm perpetrated by some professionals.

He believes that all things being equal, the chances are higher that a trained and licensed therapist will be better than one who isn't.  He thinks that licensed people are more likely to be effective and quicker to know what they can and cannot do.  Sounds reasonable but until it's proven (and how can it be proven?) it's an opinion.

A frum psychologist quoted in the article said that the rav and rebbe of yesteryear "were guided by a strong sense of morality, spirituality and plain old common sense."  He thinks that many of those trying to give advice today are lacking in all three.  He also thinks that the advisors of yesteryear were focused on the person who needed help as opposed to today where many are as interested in being advice-givers as they in helping.  "There is much less listening, much more advice-giving."

The professionals feel threatened by those who get referrals even though they did not  put in years and money into a degree.  When a social worker is quoted as saying, "A person should never do anything he is not qualified to do.  A dermatologist would not promote himself as a brain surgeon," I am not impressed.  What's the comparison? How is an counselor who gives advice comparable to one type of doctor who promotes himself as having another specialty?

This same individual is annoyed by congregational rabbis who counsel.  What bothers him is the case, for example, of a couple going to their rabbi for marriage counseling and not getting the desired result and concluding that counseling doesn't work without realizing it was the unqualified rabbi who was the problem.  This social worker apparently believes that anyone with a degree or license will give only excellent advice, which is wishful thinking. 

If only a study could be done in the frum world about the efficacy of frum unprofessional counseling versus professional counseling, but that seems impossible

As for money, it didn't come up in the interviews in the article.  A sidebar said that the mental health advisor (i.e. non-professional) rarely charges, volunteering the bulk of his work for the mitzva.

Medical Treatment that Kills

Rabbi Moshe Sherer a'h, was chairman of Agudath Israel of America.  There is a 600+ page biography about him out of which I read a few hundred pages.  He was a dynamic, driven person who could have made millions if he ran a company but devoted himself to the welfare of Klal Yisrael. 

How shocked I was to read that he contracted acute leukemia as a result of the chemotherapy he had taken for lymphoma (which happens in 8% of cases)! That medication is accompanied by unpleasant side effects, is one thing; that the medication causes a virulent disease when being applied to cure a virulent disease, is outrageous.  Similar to one of the side effects of antidepressants being suicidal thoughts.  May Hashem spare us such cures and keep us well.

Mind Over Heart

 

I recently completed a marathon book-reading.  I had a book out of the library that was due which I could not renew because it had a hold placed on it.  It's a book that I had out once before and did not read and could not renew and I didn't want to take it out a third time.  Instead, I started reading it and it had me engrossed for a few days.  It was a Holocaust memoir called The Seamstress.

Shortly after I finished it, I read yet another article about OCD in a frum magazine. This time, it was from the perspective of a woman with OCD.  She describes in excrutiating detail an insane day in her life.  I use insane literally.  Her behavior is that of a crazy person.

Coming right after the Holocaust book, the contrast between self-imposed, demented suffering and externally-inflicted anti-Semitic suffering was vast.  I will admit that the article elicited emotions from me that are probably not what the author and publisher had in mind.  I am sure the article was meant to evoke tremendous compassion on the sufferer, and yet, I felt outraged  that someone could bring such suffering upon themselves.

Of course that was followed by thoughts like - that's not nice, I'm not understanding that she is trapped, that she is miserable, that she deserves more compassion because she brought this upon herself, not less.  

And of course, those writing about mental health these days insist that these are illnesses just like physical illnesses and just as we do not choose to have tumors, we do not choose to suffer from mental illness.  The problem is, I am not convinced.

Coming on the heels of the Holocaust book in which the author was 44 pounds by war's end, doesn't help make me sympathetic to anorexic people either.  Self-imposed starvation with all the food around us?! But then again, I think, these are psychological problems and those enmeshed in unhealthy thinking don't think, "I will ruin my life by having these unhealthy thoughts."

And yet, the self-absorption at the root of so many of these problems is a modern-day luxury.  If the woman of the OCD article had to struggle to survive, had to use her wits to get food and remain alive, avoid beatings and various threats to her continued existence, she would not be fixated on imaginary threats to her well-being.

I came across a post online by a man who refers to his "selfish OCD" who writes:
OCD is a very selfish disorder, and I was always thinking about myself. It was all about me and my obsessions and the compulsive checking I needed to do to make myself feel better. My wife was an outgoing, caring, loving person with a great personality but my OCD was changing all that. We didn’t go out anymore because of all my obsessions, and my wife wasn’t a happy and laughing person anymore. Instead she was crying every day.
 

I was very selfish, and I was using her all the time for compulsive reassurance, trying to use her to get rid of my obsessions or to confirm that everything was fine and that I hadn’t done anything wrong or bad. I would ask her for reassurance over and over again and would push her so far as to make her put her hand on the Bible and swear that she was telling the truth. While I was seeking reassurance from her it was all about me. I didn’t care how she felt; I only wanted to get rid of the obsession. After she gave me the reassurance that I needed and everything was fine again, I would feel guilty about putting her under so much stress, but only for a short time. Soon I was doubting again and needed to ask her for reassurance again, and then it was all about me again, all about my obsessions and feelings. I didn’t care how she was feeling as long as I felt better.

 
... Even when my wife was sick it was all about my obsessive thoughts. I didn’t think about how my wife was feeling ...  The doctor told her that she had an infection in one of her glands and that she needed to have an operation. When my wife told me, I immediately started my checking methods. I had to be sure I hadn’t done something wrong that could have caused my wife to get ill. (I would do these same checking methods when I hear anyone I know is in the hospital. I need to make sure they are fine, and then I need to make sure that I am not responsible for making them ill.) Instead of worrying about how much pain my wife must have been in and how she must have felt about the operation, I was busy with my obsessive compulsive thoughts. 

Human beings possess the quality of mo'ach shalit al halev--"the mind rules the heart." Unlike animals, who act on instinct, a person is capable of achieving full control over his thoughts and moods.  This fundamental principle needs to be taught very early on in life.  It requires constant reminders and is often not easy to act upon, but knowing that this is what constitutes our humanity and that we can control our emotions is step one.  It is often said, happiness is a choice, not a condition.  Likewise, unhappiness, anger, sad feelings are a choice.  We can and must exercise hesech ha'daas - diverting our minds from the unhealthy thoughts that occur to us.  It is our choice, and bechira is what being a human being is about.

Sybil Exposed

I did not read Sybil but I am reading Sybil Exposed.  Sybil was a book published in 1973 that went on to become a bestseller and a movie.  It was presented as the true story of a woman treated for multiple personality disorder who had been so horribly abused by her mother that she became a psychiatric case.  The book described grotesque rated R scenes that had the public enthralled.  Not surprisingly, huge numbers of people were diagnosed as having a multiple personality disorder after the book became a hit (like anorexia became a "fad diagnosis" in Hong Kong after it was marketed there, see my post "Crazy Like Us"  click here to read post

The lives of three women are intertwined: the patient, her doctor, and the author of Sybil.  The author of Sybil Exposed shows how the patient's illness wasn't an illness, how her treatment was a sham, and how the fictional story Sybil came to be written and presented as the truth. 

As much as the book is an expose of the book Sybil, it is an expose of the quackery of the psychiatric profession.  As anybody who has read previous posts (labels: psychiatry and mental illness) on this blog have seen, I am not impressed by the pseudo-medical specialty of psychiatry.  The so-called treatments given by the doctor in this case as well as her colleagues back in the 50's till the present day, are a horror.  Forget about "first do no harm."  That is far from their guiding principle.  When will the public finally figure out that the emperor has no clothes? That the psychiatric/mental health profession in cahoots with the drug companies are making us into a nation of drugged, incompetent, invalids?

Positive Psychology - An Oxymoron?

Two days ago there was a news item which said: Medication to treat mental health disorders is soaring among U.S. adults.  20% of all adults said they took at least one medication to treat a mental disorder. Among women, 25% said they took such medication and 20% said they were using an antidepressant.

The number of children under 10 taking antipsychotic medication, which is reserved for the most severe mental illnesses, doubled from 2001 to 2010.

In short, we are either getting crazier and sadder or the psychiatric and pharmaceutical companies are doing a great job convincing us that we are. 

The crying shame is that the voice of psychologists like Dr. Martin Seligman, the father of “positive psychology” who was called “the Freud of the 21^st century” by Newsweek, is drowned out by the doom peddlers.  Seligman shocked the world of psychology by focusing on what makes people mentally healthy instead of what makes them mentally ill.

Forbes had an article last week about the upcoming DSM V with an intro that said, "The new manual of mental disorders coins bizarre new psychological disorders, lowers the threshold for diagnosing old ones, and has some critics pulling their hair out."

We are a generation that wants to be victims, that wants to be able to blame our parents, our environment, our genes, our so-called chemical imbalance, anything but ourselves, for our problems.  If you as much as suggest that someone who has truly suffered at the hands of evil people can move past that and have a good life, you are vilified and accused of not understanding the depths of the person's trauma. 

In their sincerity to help molestation victims, they push those hapless individuals down and seek to keep them down.  I suspect it's because they believe that if the person goes on to lead a happy life, it demonstrates that what happened to them was not that egregious.  That's like saying that a Holocaust victim who was stripped of his dignity, who was robbed and beaten, who was a hairsbreadth away from death thousands of times and who lost his parents, spouse, children, extended family and community, could not go on to marry and live a good life.  But thousands did! And they are heroes of the spirit, particularly if they retained their faith and raised religious, upstanding children. 

"Positive Psychology" may seem like an oxymoron but it doesn't have to be.

cont. from previous post

The third section is about schizophrenia and why people diagnosed with this illness in developing nations (i.e. third world countries) have a better prognosis than those living in the most industrialized countries of the world.

What I found fascinating in this chapter is the following - it is believed by Westerners that if the people view mental illness like any other disease (and I've seen this line repeated time and again in frum articles and comments to articles) this will remove the stigma. After all, if mental illness is not the choice of the sufferer and does not come from supernatural forces, the sufferer is not to blame. It's simply a matter of faulty genes or some "imbalance" in the brain.

"Unfortunately, as mental health professionals and advocates for the mentally ill have been winning this rhetorical and conceptual battle, they've been simultaneously losing the war against stigma. Studies of attitudes in the US between the 1950's and 1996 have demonstrated that the perception of dangerousness surrounding the mentally ill has steadily increased over this time. It turns out that those who adopted the biomedical and genetic beliefs about mental illness were most often those who wanted less contact with the mentally ill or thought of them as dangerous and unpredictable."

Why is this so? "The problem, it appears, is that the biomedical or genetic narrative about an illness such as schizophrenia carries with it the subtle assumption that a brain made ill through biomedical or genetic abnormalities is more thoroughly broken and permanently abnormal compared to one made ill through life events."

The final section is called "The Mega-Marketing of Depression in Japan," which is about a huge drug company wanting to develop a new market for its products and how a marketing campaign was carefully planned and executed which introduced the Japanese to this illness and most importantly, to drugs to treat it.

It's pretty scary to read that this and other illnesses and the drugs to treat it are not coming from doctors without a monetary incentive but from a company whose only goal is to increase profits. The Ritalin producers are doing soooo very well, aren't they ... It's equally as scary to read how we are manipulated, and how our ideas about very important things are shaped by people hired to shape our ideas! And then we see these ideas regurgitated in our frum publications as though they are Torah Mi'Sinai ...

Crazy Like Us

I recently finished a very interesting book called "The Globalization of the American Psyche - Crazy Like Us" by Ethan Watters.  It tells how Americans have exported their understanding of mental illness and have imposed it on cultures with very different ways of relating to those illnesses.

The first section is about how anorexia was marketed in Hong Kong, yes, marketed.  To explain what this means - in late 1995, Princess Diana gave her famous interview confirming the rumors that she had suffered from bulimia for more than four years.  The newspapers covered this widely, of course, and bulimic behaviors spread like wildfire among adolescents.  Patients themselves often said that they tried vomiting etc. because they read or heard about it.  The chapter shows how similarly, anorexia barely existed and when it manifested, it was different than the American version, i.e. they weren't on a diet and were not interested in losing weight.

The problem is, the American DSM and Western medicine in general are highly respected in other parts of the world and so even when their patients do not fit American norms, they ignore that.

One of the important points that is made is that those who argue that increased incidence of a condition is due to its previously going unrecognized or underreported do not balance their assertion with the fact that when the media promotes a new disorder/condition/illness, people latch on to it and "discover" that they too are sick.  He has a fascinating part about the hysteria diagnosis in the late 19th century.  Do you know of anyone diagnosed with hysteria nowadays? No, because that condition with all its symptoms is no longer trendy.

The second section is about bringing PTSD to Sri Lanka after the tsunami.  Lots of well-meaning Westerners went there to help the natives avoid PTSD, completing ignoring the natives' culture and ways of dealing with traumatic events while foisting their mental illness ideas on them.  Amazingly, study after study published during the 1990's showed that early interventions were either ineffective or actually harmful!  "Early interventions sometimes appeared to be priming victims to experience certain symptoms."