Archive for October, 2011
The Good Divorce
I NEVER wanted to get divorced. My parents’ split had been like an antipersonnel bomb, ripping everyone to pieces. So for 16 years, I stayed married.
But the relationship curdled over time, and, ultimately, it rotted into nothing. The contrast of these two endings always reminds me of that pithy old Robert Frost poem “Fire and Ice,” in which passion leads to detonation and dispassion to gelidity. In both cases, it’s over and terrible.
Frankly, hearing the word-sandwich of “good” and “divorce” — which I do with some frequency — makes me queasy. Bluntly, there is precious little upside to divorce. It is a horror, its effects on everyone are real and enduring, and in a parenting culture that sees skinned knees as spiritual gifts, it can seem as if we’re giving our children the big door prize of relentless psycho-economic distress. It is hard to feel as if one is a good, divorced parent. But one can try.
Weirdly, and mercifully, ending our marriage was not utterly devastating. My former husband and I were, and are, never going to have one of those California divorces, where the exes all sit around the Hockney-style pool drinking Chablis. Not our style. But we have concentrated not on our rancor but on our children. Like most divorced people our age we know.
“It could be that, because this group is marrying later in life, if at all — and mostly staying together — if they do get divorced, they do it very differently,” said Betsey Stevenson, an assistant professor at the Wharton School of Business who tracks marriage and divorce trends.
“Differently” may not sound like a radical move, but in the annals of American divorce, it actually is. First of all, “this group” (by and large, Generation X, born between 1965 and 1980) according to Dr. Stevenson’s research and census data, does a full recon to avoid divorce in advance, to the extent that nearly 60 percent of us now live with their future spouses before marrying. Almost 80 percent of us over all have made it a decade into marriage, a good indicator of marital longevity.
So it makes sense that if we do divorce, we do our due diligence there, too. Consider that just 30 years ago, only three states upheld joint custody; today, all do. Also consider that divorce mediation and collaborative divorce are on the rise, a result of parents’ wanting to spare children the horrors of the Kramer v. Kramer bloodbaths of their own childhoods. Survey the increasing legions of exes who continue to share homes, holidays, vacations to preserve a sense of family for the children.
Part of doing my due diligence includes keeping an eye on the newswire. I always read every study I can find on the impact of divorce in children, and they are all deeply upsetting. On a hopeful note, however, many conclude that if the parents maintain open, friendly relations, children do — in time — develop in as well-adjusted a way as anyone. Which gives me some feeling of faith, even as I am terrified that it is not true.
Then I read a report that squashed all that: Children of divorce score worse in math and social skills, and suffer from lower self-esteem than those from non-divorce households, period. Published in the June issue of American Sociological Review, the author, Hyun Sik Kim — a doctoral candidate at the University of Wisconsin, Madison — formulated this devastating conclusion: “After the divorce, students return to the same growth rate as their counterparts … But they remain behind their peers from intact families.”
It got worse. Mr. Kim attributed the setbacks to factors like fighting and potentially depressed parents, dividing time between parents, and financial hardship.
The blood dropped from my brain straight into my heart: My kids endured all those risk factors. There was no question that I became depressed and freaked out; the recessed and post-divorce money situation was rough. My girls’ father and I have joint custody, so they spend a week with him and a week with me; in other words, they shift households regularly. Again: all the risk factors.
As if on cue, our older child had had a very difficult third-grade year, two years ago, in which she was at the vortex of a mean-girl tornado. She’d always had an entrenched sense of justice, but when she perceived that a classmate had deeply violated her code, the propulsion of her hate-mongering was breathtaking. Her father and I were dumbfounded: “Heathers” — really?
Then, our younger one had reading and math problems. We couldn’t understand: She was so bright, so eager to learn, had such an allusive imagination. What was the problem?
We talked about it — again, a small but radical move. Indeed, our divorce, while heartbreaking, in many ways strengthened our core friendship. My parents’ fiery demise, like many of their peers,’ had meant that not only had they not talked about the problems my brother and I were having, but they “talked” only through their lawyers and eviscerated each other’s character in front of us.
I wonder sometimes: Do those marriages that suffered from a lack of heat while intact generally produce better divorced parents? “I think those of us who don’t feel any sense of jealousy or having been spurned have an easier time talking with each other about our children,” said a Brooklyn author and divorcing mother who asked that her name not be used. “We can rewrite the ‘divorce’ script.”
I tend to agree. It had unquestionably contributed to the ruin of our marriage that my former husband and I had been friends rather than devoted spouses, but in this case, there but for the grace of God went we. It was a no-brainer for my children’s dad and me to double up on strengthening the only risk factor that our children had not had to suffer: bickering, blaming ex-spouses.
We then hunkered down, talked candidly daily, shared observations about each child’s behavior and what we could do in our respective households to maintain a unified system. We met with the school psychologist to puzzle through the subtext of the queen-bee situation; we got extra help in reading and math for our younger child.
To our older daughter, we asked her to consider the possibility that she was angry and confused about all the really hard changes in her life, and that she might well be scapegoating her classmate as a way of channeling those powerful feelings. To our younger one, we practiced reading at the same time every day, at Mom’s and at Dad’s.
Gradually, the difficulties lifted. Our older daughter ultimately came around; without prompting, she apologized to her target in a thoughtful, responsible way, and was forgiven. We haven’t seen any repeat since.
Our younger child’s reading has blossomed; she even writes her own books now. Math is still hard. But we’re working on it. The teachers’ conferences and report cards have brought tears to our eyes: Everyone is working so hard.
My former husband and I were not good spouses. But we admire and trust each other. We do not do anything perfectly. We are stressed, we struggle financially, we’re not great at masking our feelings on certain days. We know there are more problems ahead, a lifetime of them. We do not bicker; we talk about the kids every day. We don’t know what else to do. We love these children. Like every other parent we know.
http://www.nytimes.com/2011/10/30/fashion/the-good-divorce-cultural-studies.html?_r=2&pagewanted=all
Read Full Post | Make a Comment ( None so far )What You Can Do When He Is Angry
When your boyfriend is angry at you, make a special effort to remain calm. Take a few deep breaths, relax tension in your body, speak slowly, and keep your voice soft. Staying calm encourages him to calm down. Say “I’m sorry you’re upset.” Don’t act impatient, treat him as stupid or immature, nor make a fool of him in front of other people. If he yells at you or speaks loudly, point out what he needs to do in a positive, rather than negative, way. Don’t say “Stop yelling!” Say something like, “Let’s sit down and talk this over calmly.” Reassure him that you can both work together and find a solution when he calms down. If you have overcome worse problems in the past, say so.
Occasionally allow him to save face with excuses. Listen carefully, use good eye contact, and show your attention by saying “Oh,” “uh huh,” “hmm,” “I see,” etc. Occasionally rephrase or summarize his ideas to show you understand and to allow him to clarify feelings or issues, if necessary. Start with the simplest issues first in order to have some success in negotiating. Agree with him when you can, praise something good about him, and try to find and express positive feelings about him. Backing down on one of your minor points can help, but doing so regularly without him also compromising shows unassertiveness and allows him to take advantage of you.
A bad temper is a long-term habit. You may need to assert yourself again and again for months to change an explosive boyfriend. Use persistent repetition in making your needs and desires known, requests, demands, saying no, putting forth your opinion, complaining about treatment you don’t like, and refusing sex when you so desire. In a calm but firm way, keep insisting on your rights and the changes you need until he takes you seriously and agrees or compromises with you. A strong, clear, firm voice sounds very different from a weak, soft, pleading, or monotonous voice. Repeating won’t always work, but people often don’t get what they want simply because they give up too easily. Persistence proves how determined you are. Focus on the issue important to you. Don’t let him change the conversation and argue related issues.
Occasionally, you may need to repeat yourself more loudly, firmly, insistently, or even angrily to get what you want. Good rates of eye contact are more assertive than looking away or looking down too much. Use good, but not rigid, posture. Don’t laugh, use humor, or smile inappropriately when you need to defend your rights. Act serious.
Remember, polite requests and assertiveness work much better than anger. Your anger can lead to a vicious cycle of arguments, anger, and retaliation that contributes to your boyfriend’s problem behaviors. Emphasize more positive approaches such as increasing positive interactions, making contracts, and rewarding behaviors you like.
Read Full Post | Make a Comment ( None so far )violence in teenagers
It is the first time there has been an in-depth look at violence in the intimate relationships of disadvantaged teenagers who are not in mainstream education. Some of those who took part had been permanently excluded from school, were young offenders or teenage mothers.
The researchers interviewed 82 boys and girls aged 13-18 for the NSPCC-funded research entitled ‘Standing on my own two feet’. The research underlines the need to address the problem being highlighted by the Home Office’s teen violence campaign, launched this month.
Although the study does not claim to be representative of the UK population, it suggests levels of violence in teenage relationships may be much higher than previously assumed. More than half of the girls who supplied information in the study said they had been in a sexually violent relationship before they were 18 and over half of the girls reported that they had been a victim of physical violence in at least one of their intimate relationships. A quarter of boys who responded said they had dated physically aggressive partners.
Today’s research found that children from disadvantaged backgrounds were much more likely to experience abusive partner relationships than their better-off counterparts. The research ran parallel to a landmark study (2009)2 on violence in relationships among those in mainstream education.
Many of the young people who participated in the study appeared to accept violence as normal, although unwanted, aspect of being in a relationship. Some suffered black eyes, lost teeth or were head-butted.
Christine Barter, lead author and Senior Research Fellow from the University’s School for Policy Studies, said: “Tragically, control and violence seem to be so prevalent in these relationships that girls are unable to recognise its impact — it is an everyday happening. Many girls found it very difficult to see that their partner’s behaviour is abusive. The government and those working with young people need to recognise that teenage partner violence is an even more profound child welfare issue for disadvantaged young people. This will help professionals assess the possibility of partner violence and challenge young people’s beliefs that this abuse is a normal part of teenage relationships.”
Emma, who was interviewed for the study, told researchers how she had been forced into having sex ‘quite a few times’ when she was 13, “I’ve never shouted rape or anything. I’ve never been able to say that I’ve been raped but it’s not like I’ve given consent. In certain situations it has been pushed on me and it has been really horrible.”
Fourteen-year-old Jo said her boyfriend had, “only hit me in the face once. He used to push me down the stairs and stuff though.”
Even though half of all those taking part in the research had been assigned a social worker most did not reveal their partner’s violence. Many said that welfare professionals were not interested in this aspect of their lives.
Andrew Flanagan, Chief Executive of the NSPCC, said: “It’s appalling that violence in these relationships seems to be just part of daily life.
These findings underline how important it is for children to be educated about abusive behaviour and for them to feel able to seek help to prevent it happening. The NSPCC is making strides to educate children and young people on recognising abuse through our newly launched Schools Service. This knowledge empowers our youth to take action and get help.
“Only through awareness can we start to reduce abuse which damages so many young lives.”
Home Office Minister, Lynne Featherstone, said: “Although teenage romances can often be short lived, we know that sometimes, they can be just as intense and important as adult relationships. In extreme cases they can also fall foul of the same pitfalls and dangers. That’s why it is so important to ensure young people develop healthy relationships and know where to go for support when things go wrong.
“We need to challenge the attitudes and behaviours that foster an acceptance of abusive relationships by intervening as early as possible. Bringing the issue out in the open will help teenagers feel confident to challenge abusive behaviour when they experience it or see it.”
http://www.sciencedaily.com/releases/2011/09/110914081543.htm
Read Full Post | Make a Comment ( None so far )How To Help Your Child’s Brain Grow Up Strong
Babies may look helpless, but as soon as they come into the world, they’re able to do a number of important things. They can recognize faces and moving objects. They’re attracted to language. And from very early on, they can differentiate their mother from other humans.
“They really come equipped to learn about the world in a way that wasn’t appreciated until recently,” says neuroscientist Sandra Aamodt. “It took scientists a long time to realize that their brains are doing some very complicated things.”
Aamodt and fellow neuroscientist Sam Wang explain how the human brain develops from infancy to adolescence in their new book, Welcome to Your Child’s Brain. The two researchers also offer tips for parents to help their children eat their spinach, learn their ABCs and navigate elementary school.
Before all of those things, however, children have to learn how to talk. Babies can differentiate syllables and new sounds from very early on, but there are ways for parents to help their children develop their language skills faster and more efficiently.
“The most simple way is to talk to your baby and around your baby a lot,” says Aamodt. “And the other thing that parents can do is to respond when the baby speaks, even if the baby isn’t forming the words correctly or you don’t understand it. Just act like some communication has occurred — smile and give the baby a little pat — and that encourages the baby to continue to try to communicate.”
But because language is so social, says Wang, passive exposure to words really doesn’t help babies learn in any way.
“For instance, videos that are often shown to babies containing language are not nearly so effective,” he says. “In some cases, people try to teach babies language by showing them videos in a foreign language. It doesn’t work very well at all because these are not social ways of exposing a child to language.”
Parents should also realize that their children may reach certain intellectual milestones at different times — and that’s OK.
“Language is acquired quite well before the age of 6, but trying to force your children to read before the age of 4 is an effort that doesn’t work very well because the brain is not very well-equipped to tell the letter ‘b’ from the letter ‘d’ and so on,” says Wang. “[But] it’s something that older children can do without any effort at all.”
And children who grow up in bilingual households have a distinct advantage over their peers.
“Kids who learn two languages young are better able to learn abstract rules and to reverse rules that they’ve already learned,” says Aamodt. “They’re less likely to have difficulty choosing between conflicting possibilities when there are two possible responses that both present themselves. They’re also better at figuring out what other people are thinking, which is probably because they have to figure out which language to use every time they talk to somebody in order to communicate.”
Aamodt and Wang also emphasize the importance of teaching your children self-control from an early age.
“This is really critical because there are so many things parents want to do when they read parenting books,” he says. “They take steps to teach their children math or reading … but a big thing we can do for our children is to do the best to foster the development of self-control and willpower. Self-control and the ability to restrain impulses is associated with success at every age, whether it means being able to read at age 4, or being able to restrain impulses at a later age, or even what your peers think of you in high school. At all of these ages, willpower and self-control is a stronger predictor of academic success than IQ.”
When children are young, they can learn self-control by focusing on any fun activity — whether that means studying martial arts or playing with dolls and planning a make-believe tea party.
“It gives the child practice at planning and organizing a series of topics to achieve a desired goal,” says Aamodt. “When you’re planning a tea party, you can’t be acting like a fighter pilot. You have to be acting like a lady having a tea party. So pretending is one of the earliest types of exposure most kids get to planning and organizing their actions. And the more you practice that, the better you’re going to be at it.”
Making sure your child has fun while learning self-control is vitally important. Aamodt and Wang recommend, for instance, telling your child to pretend he or she is protecting a castle instead of just saying, “Stand still.”
“Taking advantage of a child’s natural sense of fun is a terrific way to instill these things,” says Wang. “This is not the kind of thing that works well if it’s forced. It can be something as easy as pretending to guard the castle or playing a take-turns game where you say, ‘I’m going to draw an ear on this piece of paper, and when you see an ear, then it’s your time to listen. And if you see a mouth on this other piece of paper, then it’s your time to talk.’ So all of these things can be done in very simple ways — in ways that are often fun — and the more fun it is, the more likely the child is to pay attention for a longer period of time. These things are fun, they don’t cost money, and anybody can do it.”
On rewards vs. punishment
Dr. Aamodt: “With a child, you’re not only concerned with getting a child to behave. You’re also concerned with building a good relationship with your child. You want your child to think of you as a wonderful person to be around. You also don’t want to teach our kids that the way we solve our interpersonal problems is with violence.”
Dr. Wang: “Negative reinforcement is often not very effective with deterring behavior. … negative reinforcement punishment tends to not be very general. So the child will avoid doing the specific thing that led to the punishment and not learn some broader rule. From a practical standpoint, negative reinforcement is not terribly effective.”
On time out
Dr. Wang: “One thing that’s similar between how children and nonhuman animals learn best is the phenomenon of timeout, which has entered the lexicon as a means of getting a child to avoid doing something later. It comes from technical literature from which the long phrase is ‘timeout and reinforcement,’ which is if the kid does something undesirable, you simply take the child, go to the corner, and just sit there. And you don’t say anything at all. You don’t have to be negative. You don’t have to mete out a punishment. You just have to say, ‘Sit there for 3 minutes, and when I come back, we’re done.’ And then you forget about it and move on. This works at all ages.”
On stress and pregnancy
Dr. Aamodt: “Stress is not good for babies. No ethics review board in the world would approve [an experiment] in which we deliberately damaged [pregnant women's] babies. But there are these so-called experiments of nature. One experiment that was done looked at women who had been evacuated from a hurricane in Louisiana when they were pregnant. What that study found was a substantially increased rate of autism in babies who had been in their fifth or sixth month of gestation at the time they fled the hurricane. The effect was stronger in cases where the hurricane was more dangerous.”
http://www.npr.org/2011/09/14/140340903/how-to-help-your-childs-brain-grow-up-strong
Read Full Post | Make a Comment ( None so far )Why are so many girls cutting themselves?
The recently-released draft of the next edition of the DSM includes a new diagnosis: Non-Suicidal Self-Injury, or NSSI. You can read Tracy Alderman’s PT blog about the new diagnosis here, or read the proposed DSM-V criteria for NSSI here.
I remember my first psychiatry rotation, back in 1985 when I was a medical student at the University of Pennsylvania. A young woman was admitted to the psych ward. She had been cutting herself with razor blades. “Weird,” I breathed. “Weird,” the psychiatry resident agreed. The attending psychiatrist put her in the locked ward, on full suicide precautions. He explained to us that this behavior was a “cry for help.” That’s what many people thought back then. In ancient times.
Today we know better, or we think we do. Most of these girls and young women are not suicidal, and they don’t want anybody to find out. They don’t want to be discovered. That’s why they wear long sleeves, so nobody will see their wrists; or, more often nowadays, they cut themselves on the upper inner thigh, where nobody will look. Cutting themselves with razor blades, or burning themselves with matches, becomes compulsive, almost addictive for some of these girls. There is now evidence that for at least some of these girls, this behavior triggers a release of endogenous opiates. Cutting delivers a weird kind of disembodied rush. “I felt like I was up on the ceiling, watching myself do it,” another girl told me. “I was literally high.”
How common is it? Much more common than it used to be. Studies from the 1990′s suggested rates of 3% or lower. But more recent studies suggest that as many as one in five girls between 10 and 18 years of age are now cutting themselves with razor blades or burning themselves with matches, etc. For example, researchers at Yale University recently reported that 56% of the 10- to 14-year-old girls they interviewed reported engaging in NSSI at some point in their lifetime, including 36% in the past year. I know of no community survey of boys in any age group which approaches that kind of prevalence.
Which brings me to one of my problems with the proposed DSM-V criteria. There’s no mention of gender differences in the presentation of self-injury. Imagine a teenage boy who’s not doing well in life: he doesn’t have any friends, he’s not doing well in school, he spends most of his time playing first-person-shooter video games. Let’s suppose this teenage boy repeatedly hits the wall with his fist during arguments with his parents. This boy would meet all the proposed DSM-V criteria for NSSI.
Now Imagine a teenage girl who secretly cuts herself with a razor blade. She’s the golden girl: she’s pretty, she has lots of friends, she’s successful academically, she seems to be doing well. The growing prevalence of such girls among cutters is well-documented; see for example Adler and Adler (2007), who assert that these girls are exhibiting a “voluntarily chosen deviant behavior” rather than true psychopathology. I don’t agree with Adler and Adler, but that’s beside the point. Such a girl would also meet the proposed DSM-V criteria for exactly the same psychiatric diagnosis as the boy who broke a bone in his hand when he slammed his fist into a wall. But a “loser” boy who publicly slams his fist into a wall is experiencing an inner turmoil very different from the golden girl who secretly cuts herself with a razor blade. Lumping these two teenagers together, and pretending that they have the same problem, is not likely to be productive either clinically or nosologically.
Many researchers who study self-injury have minimized gender differences in their own data. For example, in one recent survey of young people 14 to 21 years of age (Nixon et al. 2008), researchers reported that 16.9% of those surveyed had engaged in self-injury. Read the abstract of that paper: you won’t find any mention of gender differences. But when you read the full text (available at no charge by clicking here), you find that 24.3% of girls were self-injuring, compared with 8.4% of the boys. You’ll find those data in Table I of the paper. The authors acknowledge the finding (in a single sentence) but they do not discuss it or try to understand it. Furthermore, this study — like most studies of NSSI - conflates the boy who publicly smashes the wall with his fist, with the girl who secretly cuts herself with a razor, in the same category — a blurring of reality which further masks the magnitude and significance of the underlying gender differences.
In my experience, boys who are deliberately hurting themselves usually fall in a narrow demographic. Bluntly, those boys tend to be the weirdos, the losers, the lonely outsiders. Not so for girls. The most popular girl, the pretty girl, the girl who seems to have it all together, may also be the girl at greatest risk for cutting herself.
The stereotype is that kids who cut themselves are depressed. While that stereotype is usually accurate for boys, it’s less reliably accurate for girls. Most boys who cut themselves are depressed, but many girls are not. Janis Whitlock and her colleagues at Cornell (Whitlock et al. 2008) found that college women injure themselves differently, and for different reasons, compared to college men. Cheng et al. (2010) recently developed a screening questionnaire to identify college students who were engaging in NSSI. They found that some of the best questions for screening the women were useless for screening the men, and vice versa. Other researchers have found that girls are more likely than boys to self-injure as a means of self-punishment, while boys are more likely to self-injure in the aftermath of a romantic break-up (Adler & Adler 2007; Rodham et al. 2004). But most research on NSSI overlooks these gender differences. Boys who are failing in every aspect of their life, who hit the wall during an argument, are lumped into the same category with girls who seem to be doing great, but who are cutting themselves in secret.
It’s risky to look at celebrity culture for any insights into the human condition, but in this case I think the stories of celebrities illustrate reasonably well what I’m hearing from young people, female and male, around the United States and Canada. Megan Fox told Rolling Stone that she had deliberately cut herself as a teenager. Angelina Jolie, Lindsay Lohan, Amy Winehouse, and the late Lady Diana Spencer, all have been identified as women who repeatedly and deliberately injured themselves. By contrast, the best-known male celebrity who cuts himself is Marilyn Manson. I think Mr. Manson would agree that he takes pride in being a weirdo. And he likes to cut himself – on stage.
In other words, the girls who are most successful at meeting gender-specific societal expectations appear to be just as likely as other females to be cutting themselves. Not so for boys. How come? The bottom line is that these pretty girls are searching for a sense of self that’s not about how they look, but about who they are. We reward them for how they look but we — i.e. American society — are much less interested in what’s going on inside. Self-cutting fills that need for some of these girls — just as anorexia does for others, and obsessive perfectionism does in others.
Of course we need to be just as concerned about girls who are NOT pretty, girls who do NOT meet society’s stereotyped notions of what girls should look like, and who are cutting themselves. But I think that ignoring gender differences in NSSI disadvantages many of those who are struggling with this issue — especially girls (both ‘pretty’ and not).
I’m bothered that so few people want to address the gender differences in NSSI - which I think are absolutely central to understanding why these young people are hurting themselves, and essential to intervening effectively with them. Marilyn Manson is not Megan Fox. Marilyn Manson’s issues are not Megan Fox’s issues. Interventions which might have helped Marilyn Manson stop cutting would be unlikely to benefit Megan Fox, and vice versa. Nevertheless — even people who really care about NSSI tend to overlook or deliberately understate gender issues here. The leading non-profit organization concerned with NSSI, “To Write Love On Her Arms,” asserts on their web site that self-injury “. . .has the same occurrence between males and females.” Not true.
Gender matters. Why are people so afraid to talk about it?
Mentally ill and behind bars
Melissa Clark sat wide-eyed and agitated in a visiting room at Cook County Jail’s Cermak Hospital, rocking her right leg so vigorously that her entire body shook.
Why can’t you bail me out? she repeatedly pleaded to her mother.
Carla Clark leaned forward, her forehead inches away from the partition that kept her from hugging her only daughter, and asked one question: If she bailed the 22-year-old out of jail, would the young woman take her antipsychotic medication?
In a rambling answer, Melissa said no. Street drugs, not medication, were what made her feel better.
Clark eyed her daughter wearily. “Then I can’t bail you out,” she said.
Melissa’s predicament tears at her mother. While jail is not an ideal place for a person needing psychiatric care, for now it might be the safest temporary option for Melissa, who has been diagnosed with bipolar disorder and schizophrenia.
In the past she has wandered the streets, committed petty crimes, overdosed on heroin and been assaulted by drug dealers. Arrested for robbery at a Whole Foods store in Chicago a year ago, she has been in jail ever since.
Soon a criminal court judge will have to decide: What do we do with Melissa?
It’s the kind of problem that faces families, judges, psychiatrists, law enforcement officials and mental health advocates across Illinois, and comes up frequently as people with mental illnesses spill into jails and prisons because of a dearth of community-based services.
Cook County Jail’s sizable mentally ill population has transformed the detention center into Illinois’ largest psychiatric facility.
About 20 percent of the jail’s 9,000 or so detainees have been diagnosed as having a mental illness. A larger, undetermined number don’t have a diagnosis but show symptoms of psychiatric illness, said Cook County Sheriff Tom Dart.
“It’s horribly sad on a million levels,” Dart said. “This is a person who’s here, not because they are quote-unquote criminal, but because they have an illness that manifests itself in doing certain acts and we are treating them like criminals.”
Incarcerating people for behavior caused by their mental illnesses is costly, inhumane and doesn’t make sense, mental health advocates say.
State budget cuts have made the situation worse, they say, and Dart has been considering a lawsuit against the state for allowing the jail to become a dumping ground for people with serious mental illnesses.
Melissa’s life began to spiral out of control during her teen years. She has cycled in and out of hospitals, jails and rehab facilities. Even though she comes from a middle-class family with resources, she is running out of options.
The family’s finances have been hit hard by medical, psychiatric and legal bills, lessening relatives’ ability to support Melissa. And because Melissa is an adult, she cannot be forced to participate in rehab programs or take her medications except in an emergency or under court order.
Carla Clark said jail time has been hell for her daughter, who is unable to fully understand why she is there. “I have helplessly watched her mental health deteriorate in this stressful environment,” Clark said.
Melissa is being evaluated by psychiatrists to determine if she is fit for trial, but the process has been agonizingly slow.
“For what she did, it shouldn’t take this long,” said her brother Brandon Clark. “The waiting period is unforgivable.”
The family also worries about where Melissa will go next.
In large part because of Medicaid and other funding cuts, the number of public and private psychiatric beds has plummeted over the years, and often there are waiting lists.
Even as Illinois hospitals have seen an influx of patients with mental illnesses and substance abuse problems seeking care, they have faced Medicaid cuts, inadequate private health insurance coverage and shortages of psychiatrists, especially in rural areas, said Danny Chun, a spokesman for the Illinois Hospital Association.
Hospital officials across the state “are deeply concerned and alarmed by the human consequences of delays in treatment, inadequate treatment, or no treatment at all for persons with serious mental illness or substance abuse problems,” said a hospital association white paper issued in May.
“Families have limited options available for needed services such as substance abuse treatment, medication, community outpatient and psychiatric care,” the association said. “Far too many families are waiting far too long, for far too few services.”
Outpatient programs run by community agencies also have undergone deep cuts.
“It’s so frustrating to know what to do and not be able to do it because of lack of money, especially because we know that investing in early prevention services is always going to be more cost-effective than the high-cost services,” said Lora Thomas, executive director of the Illinois chapter of the National Alliance on Mental Illness, an advocacy group. “If services are available in the community, we can avoid visits to the emergency room — by far, the most costly service — and institutionalization in jails, prisons and nursing homes, or homelessness.”
Terre Marshall, director of mental health at Cook County Jail, said homelessness keeps many mentally ill people from getting much needed medications and entitlements, such as Medicaid and Social Security disability income.
Left untreated, severely mentally ill people may engage in disruptive behaviors that can result in arrests for crimes that include loitering, disturbing the peace, drug possession, prostitution, retail theft and criminal trespass.
It can become a vicious cycle. Even though Melissa desperately wants to get out of jail, she already is resigned to come back because she can’t imagine not abusing drugs.
Almost all of Cook County Jail’s mentally ill detainees also have a substance abuse problem because they have been self-medicating with street drugs, said Dr. Jonathan Howard, jail psychiatrist.
A change last year in the way Illinois funds treatment programs has meant that people not enrolled in Medicaid are not always eligible for services that they need, some treatment providers said.
“It’s been a heartbreaking year because we have not been able to serve individuals that we would have been able to help in the past,” said Jill Valbuena, program director of the Thresholds Justice Program.
Melissa Clark was arrested after a skirmish with a security guard who caught her shoplifting food. She is one of an estimated 260,000 Illinoisans who have schizophrenia or bipolar disorder.
Before her illness took over, she was a cheerleader, a fan of ’60s rock, a ravenous reader of fiction and biographies, a good student who enjoyed drawing. A family photo shot several years ago shows a smiling Melissa with her blond hair cascading past her shoulders and her mother beaming at her side.
A far different woman recently appeared in front of a Cook County Criminal Court judge. At a hearing last month, she appeared sullen and disoriented in blue jail garb, her hands cuffed behind her back.
Melissa, who has been arrested about a dozen times, has been unable to care for herself or hold a job.
“She has no quality of life right now,” her mother said despairingly, after a recent jail visit. “She hasn’t had quality of life in a long time.”
After repeatedly fighting other detainees, she was transferred to the jail hospital.
Brandon Clark said it is heartbreaking to see his sister behind bars, especially since he feels that the prolonged incarceration is further eroding her mental health.
He and his mother would like to see Melissa transferred to a state psychiatric facility where she could get forced medication.
“It’s such a difficult thing to say that I want someone to force medications on my sister. But after trying everything for the last seven years, it’s the only option,” Brandon said. “Otherwise she’s going to die because she’s going to overdose, somebody is going to kill her, or she’s going to get hit by a car wandering around because she doesn’t know what’s going on.”
State-operated psychiatric beds are in short supply, however.
In the 1960s there were about 35,000, according to the hospital association. That number has dropped to about 730 beds for psychiatric patients who have not been charged with a crime and about 630 for people found unfit for trial or guilty but criminally insane.
The Clarks cling to hope that Melissa eventually will get the help she needs and will have a chance to live a relatively normal life. They attend her court hearings and regularly visit her in jail.
“I don’t care what happens to me,” said Carla Clark, who blows kisses to her daughter whenever she sees her. “I have to help my daughter.”
Jail officials, who see people like Melissa Clark all the time, say they are keenly aware of the personal tragedies, and the social costs.
“I always tell people,” Dart said, “‘How is it that we, as a society, think this is good?’”
http://www.chicagotribune.com/health/ct-met-mentally-ill-in-jail-20110915,0,94387,full.story
Read Full Post | Make a Comment ( None so far )the trip home seems shorter
In 1969, astronaut Alan Bean went to the moon as the lunar module pilot on Apollo 12. Although the trip going to the moon covered the same distance as the trip back, “returning from the moon seemed much shorter,” Bean says.
People will often feel a return trip took less time than the same outbound journey, even though it didn’t. In the case of Apollo 12, the trip back from the moon really did take somewhat less time. But the point remains that this so-called “return trip effect” is a very real psychological phenomenon, and now a new scientific study provides an explanation.
Niels van de Ven, a psychologist at Tilburg University in the Netherlands, says the conventional wisdom is the trip back seems shorter because it’s more familiar, so people recognize landmarks. “And that might help to increase the feeling of speed, of how fast you travel,” he says.
But that didn’t seem right to him. “When I take, for example, an airplane, I also have this feeling, and I don’t recognize anything on my way, of course. When I look out of the window, I don’t see something I recognize,” van de Ven says.
So he decided to do some experiments exploring that feeling. One involved people who were planning to ride their bikes to a fair. He asked each person to ride the same route to the fair. Then he split the participants into two groups. He asked the riders in one group to come home by the exact same route. For the other group, he mapped out a different route, but one that was the exact same length. If the familiarity explanation was right, only the group travelling home by the same route should feel that the trip home was shorter.
In the end, this return trip effect gives you a positive feeling once you get home, so I’m not sure whether you want it to go away.
When he did the experiment, he found the route didn’t matter. Both groups had the same feeling that the return trip was shorter.
Here’s what van de Ven thinks is going on: “Often we see that people are too optimistic when they start to travel,” he says. So when they finish the outbound trip, they feel like it took longer than they expected. That feeling of pessimism carries over to when they’re ready to return home. “So you start the return journey, and you think, ‘Wow, this is going to take a long time.’”
But just as initial optimism made the trip out feel longer than expected, this pessimism starting back makes the trip home feel shorter.
“It’s really all about your expectations — what you think coming in,” says Michael Roy, a psychologist at Elizabethtown College and a co-author with van de Ven on the article describing this effect in the journal Psychonomic Bulletin and Review.
Roy doubts all psychologists will agree with their conclusion that expectation is an important cause of the trip home effect. “But … we’re not saying this is the only cause. There are definitely likely other causes as well,” he says.
In fact, there are psychologists who agree with astronaut Bean that the trip home seems shorter because there’s less pressure to reach the intended target on time.
“When you have a destination you want to be there on time,” wrote Richard A. Block, a psychologist at Montana State University, in an email. “But when you go back home (return trip) it does not matter that much. Thus, when you are going there, your attention is more focused on the target and not distracted.” In this case, being distracted makes the trip seem shorter.
It’s true that the return home effect is just an illusion, and a better understanding of it might make it go away. But van de Ven says that might not be a good idea.
“In the end, this return trip effect gives you a positive feeling once you get home, so I’m not sure whether you want it to go away.”
http://www.npr.org/2011/09/05/140159009/why-the-trip-home-seems-to-go-by-faster
Read Full Post | Make a Comment ( None so far )Brain Responds To Cute Or Creepy
Animals have a special place in the human heart. Now, researchers are reporting that creatures great and small also have a special place in our heads.
A team led by researchers at Caltech has found individual brain cells that respond when a person sees an animal, but not when that person sees another person, a place, or an object.
The cells were found in the amygdala, an almond-shaped part of the brain involved in emotions, including fear. And they responded to any kind of animal, including spiders, dogs and rodents, says Christof Koch, a researcher at Caltech and the lead author of the study, published in Nature Neuroscience.
One reason present-day humans have these cells may be because some animals posed a threat to our ancestors, Koch says. Specialized cells could have helped the brain respond quickly to danger, he says.
Koch says he was reminded of how important a quick response can be during a recent run along a mountainous trail in Los Angeles.
“As I was about to step down I saw there was a rattlesnake,” he says. “By the time I realized it, by the time I felt fear, you say, oh my god there’s a snake, I had already automatically extended my legs, my stride was larger so I didn’t step on the snake.”
That’s a good example of why our brains pay special attention to animals. The new study, he says, helps explain how.
The ‘Peter Rabbit Cell,’ Programmed For Cuteness
The discovery came while Koch and other researchers were studying the brains of 41 people about to have surgery for severe epilepsy. To find the source of their seizures, doctors placed electrodes deep in the brain.
The researchers looked to see how cells in several parts of the brain responded to a variety of images. But it was only in the amygdala that they found cells firing specifically in response to animals, Koch says.
That makes sense, Koch says because the amygdala “seems to be specialized in alerting us to things that are emotionally important to us — either positive or because they’re scary.”
Long before we had [bridges or buildings], we had animals. And so if we didn’t pay attention to them then … that might not have been such a good idea
- Lynne Isbell, an anthropologist at the University of California, Davis
And animals are both, he says. Some want to eat us. Others could be our dinner. And, of course, some we just want to cuddle.
“We found in one patient a cell that I call the “Peter Rabbit cell” because it responded to three very cute images,” says Koch. “One was a rabbit, one was a white snow hare and the third one was a cute little mouse.”
The finding confirms earlier work suggesting that the human brain is particularly responsive to animals. Behavioral studies, for instance, have found that people pay more attention to animals and people than to things.
More Attention To Animals Than People?
In one experiment, scientists showed people a series of pictures in which a single element would change. The viewers were really good at keeping track of people and animals, says Joshua New of Barnard College in New York.
“Embed a tiny little person or a tiny little animal anywhere in the scene and they’ll notice it changing right away,” he says. On the other hand, people were really bad at noticing changes in things like buildings.
“We actually had other images where entire grain silos were appearing and disappearing and they would report that there was no change in the scene,” he says.
More recent research suggests that people actually pay as much attention to animals as they do to other people, New says.
And he says once a person has detected a living creature, their brain keeps monitoring it — probably because, unlike, say, a bridge or a building, a person or animal can suddenly turn from friendly to hostile.
It’s easy to think of reasons that the human brain would evolve to focus more attention on animals than bridges or buildings, says Lynne Isbell from the anthropology department at the University of California, Davis.
“Long before we had those things, we had animals,” she says. “And so if we didn’t pay attention to them then, you know, that might not have been such a good idea.”
That would have been especially true when it came to snakes, which early humans in Africa and Asia would have encountered frequently.
“Our ancestors who weren’t able to adjust to those sorts of things would have been bitten and probably would have died,” Isbell says.
http://www.npr.org/2011/09/01/140116969/human-brain-responds-to-animals-cute-or-creepy
Read Full Post | Make a Comment ( None so far )The Child-Focused Divorce
When Brian Sibley and Rachael Brownell sat down at their kitchen table to discuss getting a divorce, they agreed on one thing: They wanted to minimize the damage the split would do to their daughters.
Mr. Sibley and Ms. Brownell, who had been married for six years, each went through their own parents’ divorces at the age of 10 and had felt torn between two parents. The two agreed to spare the girls that experience by focusing on their needs.
They told the 4-year-old and the 7-year-old twins that they would all still be a family but that families don’t always live together. “We wanted to acknowledge this is a heartbreak, and this is not how we saw things going, but we still love you,” says Ms. Brownell, a 43-year-old author from Bellingham, Wash. She recalls feeling lonely and embarrassed and never discussing her parents’ divorce with them—feelings she didn’t want her own daughters to have to repeat.
“Children can absolutely thrive after a divorce, but it takes work” on the parents’ part, says Christy Buchanan, professor of psychology at Wake Forest University and co-author of “Adolescents After Divorce.”
The divorce of parents has been blamed for children’s behavior problems, poor grades in school and even trouble in their own romantic relationships as adults. One study says the intensity of conflict between parents is one of the best predictors of how kids will do after a divorce.
There is some good news: The divorce rate, which peaked around 1980, is at its lowest level since 1970. Still, some 1.1 million U.S. children, or 1.5%, lived with a parent who had divorced in the previous year, according to the Census Bureau’s Marital Events of Americans: 2009 survey.
Alicia Cashman, who is 45 and married, says she felt “profound sadness” when she was 13 and her parents told her they were divorcing. She and her three siblings stayed with their father, a professor at a local community college, because he had a flexible work schedule.
She was surprised to find she missed her parents’ arguments. “There was something warm about the fighting, compared with the silence,” she recalls. But soon she realized something important: Both parents were still in her life every day. Her mother moved half a mile away and kept a key to the family house, popping in to bring dinner, clean, monitor homework or make sure the kids were in bed. On holidays, she prepared big meals at the house for everyone, even her ex-husband.
“It was important to have both parents,” says Ms. Cashman, a merchandiser for a greeting-card company in Carlsbad, Calif.
Five years after their divorce, Ms. Cashman’s parents remarried each other, divorcing a second time after seven years. “Things can get better,” Ms. Cashman says. “There is always the possibility of reconnecting, as my parents continued to do throughout their relationship.”
Kevin Lee, a social worker in Dartmouth, Mass., runs support groups for children of divorce called the Banana Splits, one for kids in second and third grades, one for fourth and fifth grades. Each group meets for 90 minutes every other week for two 12-week sessions; high school kids who also are children of divorce help out. Children are referred from local schools and area therapists.
“Children come into the room and hear other kids talking and realize they are not alone,” Mr. Lee says.
Mary Ann Aronsohn, a Los Angeles marriage and family therapist, says parents should think of co-parenting as a business venture and treat their ex-spouse as they would a colleague or a client. Would you yell at a client, denigrate him to others or call him at home at all hours? Don’t do it to your ex, either.
Ms. Aronsohn suggests divorcing couples create a parenting plan, detailing not only child-custody arrangements but also how to make joint parenting decisions.
It may include a “short story” explaining to the children why the marriage ended—”We loved each other very much in the beginning and hoped we could make a life together that would last forever, but we were wrong. You had no fault in this. While we will have different households, we think we will do a better job at being parents”—and a “mission statement” describing how they hope to behave.
“This gives kids the freedom to love both parents,” Ms. Aronsohn says.
Some divorcing parents agree to maintain a child’s routine—foods, mealtimes, story time, bedtime—in each household. They may record minutes of meetings with their therapist so they won’t forget the things they have agreed on.
To minimize conflict, they communicate via email and address just one or two issues at a time. Family counselors remind parents not to take what a child says as the gospel truth.
Experts also advise divorcing parents to say nice things about each other. “It doesn’t cost anything to say, ‘Your dad has such a great sense of humor and your laugh is just like his and I love hearing it,’ ” Ms. Aronsohn says.
Tell children you hope they have a good time with daddy this weekend—it frees them up to enjoy themselves and feel less conflicted.
Don’t confide your anger or your grief to your child. Communicate directly with your ex, not through the kids. Don’t ask them to carry messages back and forth, even neutral ones, like, “Tell Mommy to pick you up at 6 p.m.” If the message makes Mom feel bad, the child will feel guilty. With small children, a notebook or log that travels back and forth with the child can help parents record and keep track of details.
Since their separation two years ago, Ms. Brownell and Mr. Sibley have worked together. During a weekend when their 6-year-old daughter was staying with Mr. Sibley, Ms. Brownell got a text from her ex saying a children’s parade in town was starting soon, and the little girl wanted to dress up as either a dinosaur or a ballerina.
Ms. Brownell rummaged through her house looking for the costumes, then rushed downtown. She found her ex and her daughter just as the parade was receding down the block. Both parents helped their daughter put on the dinosaur costume, then ran with her to catch up with the others. They walked in the parade, all three together. “You could see her little, sunny face lit up with joy,” says Ms. Brownell. “That was one of the best moments of my life.”
http://online.wsj.com/article/SB10001424053111904537404576552631228768332.html
Read Full Post | Make a Comment ( None so far )Advantages of Anger
We all know anger is bad… right? Generally, it’s unpleasant to feel and it often leads to undesirable outcomes. After all, when was the last time you lost your temper with your boss and was pleased with the outcome?
However, perhaps you can also think of times when anger wasn’t so bad. Perhaps, in some contexts, feeling angry was actually beneficial. This counterintuitive idea was pursued by researchers Matthijs Baas, Carsten De Dreu, and Bernard Nijstad in a series of studies recently published in The Journal of Experimental Social Psychology. They found that angry people were more likely to be creative – though this advantage didn’t last for long, as the taxing nature of anger eventually leveled out creativity. This study joins several recent lines of research exploring the relative upside to anger – the ways in which anger is not only less harmful than typically assumed, but may even be helpful (though perhaps in small doses).
In an initial study, the researchers found that feeling angry was indeed associated with brainstorming in a more unstructured manner, consistent with “creative” problem solving. In a second study, the researchers first elicited anger from the study participants (or sadness, or a non-emotional state) and then asked them to engage in a brainstorming session in which they generated ideas to preserve and improve the environment. In the beginning of this task, angry participants generated more ideas (by volume) and generated more original ideas (those thought of by less than 1 percent or less of the other participants), compared to the other sad or non-emotional participants. However, this benefit was only present in the beginning of the task, and eventually, the angry participants generated only as many ideas as the other participants.
These findings reported by Baas and colleagues make sense, given what we already know about anger. Though anger may be unpleasant to feel, it is associated with a variety of attributes that may facilitate creativity. First, anger is an energizing feeling, important for the sustained attention needed to solve problems creatively. Second, anger leads to more flexible, unstructured thought processes. This flexibility involves the use of broad and inclusive categories and the increased ability to find new connections between categories. People who feel angry (vs. sad, for example) are less likely to think in systematic ways, and are more likely to rely on broad, global cues when judging information. This kind of global processing tends to be associated with literally seeing the “bigger picture.”
These findings join the growing body of work showing that negative emotions, like anger, may have beneficial effects in our daily lives. This work, however, is usually accompanied by caveats – anger is not likely to be beneficial in any and all contexts. Rather, anger is likely to be beneficial only in certain situations, or for certain people. Supporting the situation-sensitive nature of the benefits of anger, research I was involved in found that angry people were more likely to perform better in a negotiation, but only when that negotiation was confrontational in nature. Indeed, in these studies, we found that in situations in which anger is likely to be useful – like a confrontational negotiation – participants actually wanted to feel angry and took steps to foster this emotion within themselves.
Supporting the person-sensitive nature of the benefits of anger, another paper recently published in Psychological Science reported that angry people were actually perceived as better leaders, but only when leading people who were less sensitive to conflict. This finding suggests that successful relationships may depend on the alignment between the emotional natures of the partners, even if this alignment involves the experience of anger. Overall, these lines of research demonstrate that anger isn’t all bad news. Rather, feeling angry may be downright beneficial, depending on what one is trying to achieve or whom one is trying to impress.
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