How the Diagnostic & Statistical Manual (DSM) Came to Be

Michael is a neatnick. This is not bad. He keeps everything in order, can find whatever he needs, feels free of debris, and thinks more clearly because of it. His wife, Marcie, is a bit more, shall we say, free. She is not bound by rules of where to put things, how to think, or when to do what. This may not be bad, either. She is an artist and has exhibited at major galleries across the nation. She does have a bit of challenge getting supper for the kids on time so Michael and Marcie have worked out that they would prepare it the night before and have it ready to pop into the oven the next day. Frequently, he will leave a piece of paper on the pan of food in the fridge saying something like, “put in oven at 5:30.” Michael finds his wife’s messiness a bit challenging but he fell in love with her free spirit, something that was not present in the house in which he grew up. He is proud of her national acclaim. And he doesn’t mind the income it brings in either. Marcie is delighted to have a husband that appreciates her creativity and who keeps some order in their lives. She grew up with one overburdened parent in the house and an absent one. She cannot remember family meals, so she was drawn to someone who represented stability and home. This is a healthy couple. They enjoy each other’s uniqueness. What’s bad about diagnostic labeling in your marriage Not every couple who is attracted to their opposite continues to appreciate...

What You Need to Know about Psychotherapy Approaches

On December 2, 2012, I spoke at a parenting conference to a pretty good-sized audience given that it was only a month after Hurricane Sandy devastated the area. After the panel of therapists was finished with small breakout sessions, a sampling of them met for a Q & A from the audience. I was one of them. The audience had some good questions. I was more interested in hearing how my fellow therapists were answering those questions than in giving my own answers. However, a question arose to which I could not resist responding. The questioner wanted to know how to decide which type of psychotherapy approach to use in therapy for his child. I explained that family therapy, as opposed to psychology, operates on the principle that people are not sick and don’t have “diseases.” Therefore, taking his child to a family therapist would have the advantage of not placing a stigma on the child or the family. Furthermore, I was ready to add that he and his wife would be given effective tools to use with their child. No sooner had the first words left my mouth then the moderator, a psychiatrist, cut me off. Standing at the podium and speaking with passion, he told the story of a person who went to family therapy without success because that person had an undiagnosed medical condition. “So,” he concluded, “it is better to go to a psychologist or medical professional.” Until that moment, I had no idea that other psychotherapists felt threatened by family therapists. Talk about a learning experience! It now seems to me that giving readers...

Playing Victim Is Emotional Abuse

There are people who don’t allow the feeling of compassion in. That may seem amazing to you: If someone else said they are hurt, how can you not feel badly about it? The answer is that they come from worlds away where tears don’t stir emotions; they are hardened – except, perhaps, to themselves. Interestingly, they feel their own pain but have never been able to leave themselves behind in their dealings with others. They play victim. That means they feel they have a license to strike out and hurt others. That’s emotional abuse. Here’s how it works: This is what people like this believe about their loved one when the loved one cries and says he or she is hurt: they must be manipulative. they are just too sensitive and they will react badly to anything. they are really hurt because of something else and it is convenient to blame me. –Anything to not look at themselves Evan and Alice A year ago, Evan thanked Alice for the lovely tie that she gave him for his birthday, but was not as enthusiastic as Alice would have expected. He explained that he really would have preferred a new golf club. Alice was taken aback by this as he knew that she objected to his devotion to golf at the expense of time spent on Sundays with the family. She didn’t say anything and hoped he would forget that he had mentioned it to her. Now, a year later, his birthday was coming and Alice didn’t know what to do. During the year, she had gently mentioned her objections on...

Are You A Know It All? – A Simple Test

“I swear,” he said to me, shaking his head, “she is so stupid—.” I cut him off quickly with, “Stupid? Is she stupid? Didn’t she graduate college?” “Well, yes,” he stammered, “but, please, how could someone do something like that?” “Okay,” I answered, “that’s a different question. To figure out what was in her head, we have to ask her, but before we do that, I’m still interested in your use of the word, ‘stupid.’ Is she or isn’t she stupid?” “No, she isn’t ordinarily stupid,” he concluded with a deep sigh, slinking into the cushions as if wishing he wouldn’t have to get out of them and start dealing with the mess in his life. When You Say “Is” You Sound Like A Know It All “You see,” I point out, “the problem is not so much with the word ‘stupid,’ as it is with the word, ‘is.’ For example, if you said, ‘She is acting as if she were stupid, which is really strange since I know she is smart,’ you’d have a whole different meaning, one which really expresses how you feel without sounding like you are a Mr. Know It All and you’re passing judgment on her. I’m not crazy about the word ‘stupid’ in any case, but the word ‘is’ makes it sound like you’ve come down from Heaven with The Answers. You don’t want to do that, I’m sure. It’s disrespectful.” As Peter looked at me, I could see a little ray of light in his eyes, the dawn of an awareness. “Is that why she has told me so many times, ‘You...

Hurricane Sandy Snags a Therapist

Yaaay! We moved into our new place – finally after three months – and that is why I am a day late posting my new blog entry. Here is the story I wrote last week that led up to Monday’s move… One of my grandsons is sitting three inches from me on the couch reading from his first grade reader. His mother, an excellent mother – not because she is my daughter, but because she really is – is listening and following intently, managing to not lose her focus while patting the head of the two-year old who wants a little attention, too. It’s an honor to be here, listening to the learning and soaking in the earnestness of these beautiful children doing their homework. An honor, and yet, now that we have finally, finally, after three months found an apartment, I will be so happy to leave and not wake up to my four-month old granddaughter crying desperately in the middle of the night. So I am posting my blog from my own experience of having been unexpectedly rendered homeless by Hurricane Sandy on October 29, 2012. It’s going to be a little different type of post because being a Marriage & Family Therapist does not render me immune from the cauldron that is a family. A cauldron under pressure. The first six weeks went really, really well. It was my son-in-law that phoned the day before the storm was to hit, insisting that we come stay with them for the duration. He knew my husband is handicapped and didn’t want him to be placed in danger should...

The Relationship Between Negative Self-Talk and Grandiosity

Remember Kerry? We wrote about him a couple weeks ago. He and his brother-in-law had a flare-up because Kerry used some very sharp language to make his point. He felt entitled to “express” himself. His wife, Penny, was exhausted with a lifetime of this sort of thing. She used to quarrel with her husband and that certainly didn’t work. Then she tried to reason with him and learned, much to her surprise, that he could not apologize to her brother because he would feel it was “weak.” She disagreed; she told him that admitting mistakes is a sign of strength because it takes a strong person to do that. I asked how readers think that the story will end. Some people think that Kerry will never change. Here is my problem with that: You have to have tried everything—and I mean everything—before you can be sure that your conclusion is correct. Most people give up too easily. When You Criticize Your Child Kerry might possibly be able to change if he can heal from the original pain that caused him to become so adversarial and sharp-tongued. Kerry grew up with very critical parents. As he said, “They never had anything positive to say.” When that happens, the child is always on the lookout for criticism. He expects it. So, if the best defense is a good offense, then Kerry mastered the art. The problem, of course, is that it causes the very problem it was meant to avoid: attacks. Not only that, it certainly loses the good will of others. This is made worse because Kerry bears a painful...

One Surprising Reason People Don’t Apologize

Kerry got into it with his brother-in-law again. Somehow this happened with some, almost predictable, regularity about twice a year. Each time was painful for them and for the witnesses. Yet, it seemed doomed to repeat itself. And in that horrible cycle, Kerry would not apologize. Why not? It started innocently enough. Chuck was looking at the news headlines when he opened his email. “Boy,” he said, “there go the American apologists again. Why won’t they just be proud of who they are? Why are we always afraid to speak up? Why can’t we take some strong steps with people who put us down?” Kerry, his brother-in-law, happened to be passing through the kitchen at that moment. He and his wife, Penny, were visiting for a few days and Kerry came with suitcases full of opinions. “What gives you the right to spill American blood?” he retorted, his face growing red. “What do you want to do, inflame them more? Why, you’re just a murderer!” How Other People Perceive Our “Passion” About An Idea Chuck was shocked although he shouldn’t have been. This was Kerry’s modus operandi: If he disagreed with an opinion that someone expressed, he felt duty-bound to express his disagreement in the strongest possible terms. He always believed that strong terms got the message across. Chuck was offended. More than offended, he was perplexed. How in the world could his own wishing for fairness and truth in the media and in the eyes of the government rather than placating people ready to throw bombs at a moment’s notice be the equivalent of murder? It made no...

How to Explain Tragedy to Children

On September 11, 2001, I got a call from my daughter, concerned about a plane that seemed to have gone astray into the World Trade Center. Within a short while we all learned that the news was about a planned attack. The inexplicable. How do we explain this to our children? The news was frightening, tragic, disturbing, and traumatizing. Worst of all, I later heard that people, including young children, had witnessed the replay of the video on the news numerous times. That was a mistake. How Trauma Starts Research shows that, of the five senses, people are predominantly visual. For example, babies born visually handicapped, if not given special training, have a lower statistical probability of coping in life than those born deaf. The right hemisphere of the brain is available from birth to receive information and it includes receiving visual images. The left hemisphere kicks in at about 12 months and begins to learn how to explain in words the meanings gleaned from those visual images. Trauma is predominantly a visual problem although as any war veteran will tell you, the other senses most certainly are involved. Even without seeing the image of the planes going into the towers, humans will automatically create mental images to fit the words and those images can be traumatic. That is the essence of childhood nightmares, especially repeating nightmares: The child creates the images and is now afraid of them. The images carry some meaning for the child that he may or may not be able to explain. We are now faced with a new tragedy that took place in Connecticut...

What Is Missing In How We Treat Mental Illness

I’m angry. I am so angry that I need to get it out before I can reach out with love and tears to the families of murdered children. I am angry because I have been saying for years that our country is going about its handling of mental illness in the wrong way. I have just written an article at GoodTherapy.org on that very topic. The new Diagnostic and Statistical Manual of Mental Disorders will be coming out in the spring, DSM-5, and, as the reviewers for GoodTherapy said about my article: “They’ve had five versions, and nearly 20 years since the last one, to get Diagnostic and Statistical Manual of Mental Disorders right. And they’ve failed miserably.” Why Adam Lanza Killed If you are not up for reading a heavily-researched article on the history of the DSM and why it is junk, here is the synopsis: Labeling people with diagnoses and then pushing pills at them is NOT, I repeat NOT the answer to helping people with emotional difficulties. Adam Lanza did NOT kill people, including his own mother, because he had Asperger’s Syndrome. Like all the other mass murderers, he killed people because a. he was in terrible, unbearable pain b. he wanted the world to “know” the degree of pain he was in by giving us that same degree of pain. Adam Lanza needed something far more potent than pills. The pharmaceutical industry has been pushing pills and I have been patiently trying to explain why that is not the answer. In short, pills are incapable of taking away the degree of pain that some people,...
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