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depression

Depression

Traumas as Social Interactions and Self Love

Malignant Self Love – Narcissism Revisited

Read “Traumas as Social Interactions” by Dr. Sam Vaknin, l (accessed August 12, 2015)

We react to serious mishaps, life altering setbacks, disasters, abuse, and death by going through the phases of grieving. Traumas are the complex outcomes of psychodynamic and biochemical processes. But the particulars of traumas depend heavily on the interaction between the victim and his social milieu.

It would seem that while the victim progresses from denial to helplessness, rage, depression and thence to acceptance of the traumatizing events – society demonstrates a diametrically opposed progression. This incompatibility, this mismatch of psychological phases is what leads to the formation and crystallization of trauma.

Self Love

Victim Phase I – DENIAL

The magnitude of such unfortunate events is often so overwhelming, their nature so alien, and their message so menacing – that denial sets in as a defense mechanism aimed at self-preservation. The victim denies that the event occurred, that he or she is being abused, that a loved one passed away.

Society Phase I – ACCEPTANCE, MOVING ON

The victim’s nearest (“Society”) – his colleagues, his employees, his clients, even his spouse, children, and friends – rarely experience the events with the same shattering intensity. They are likely to accept the bad news and move on. Even at their most considerate and emphatic, they are likely to lose patience with the victim’s state of mind. They tend to ignore the victim or chastise him, to mock, or to deride his feelings or behavior, to collude to repress the painful memories, or to trivialize them.

Summary Phase I

The mismatch between the victim’s reactive patterns and emotional needs and society’s matter-of-fact attitude hinders growth and healing.
The victim requires society’s help in avoiding a head-on confrontation with a reality he cannot digest. Instead, the society serves as a constant and mentally destabilizing reminder of the root of the victim’s unbearable agony (the Job syndrome).

Victim phase II – HELPLESSNESS

Denial gradually gives way to a sense of all-pervasive and humiliating failure, often accompanied by debilitating fatigue and
mental disintegration. These are among the classic symptoms of PTSD (Post Traumatic Stress Disorder).
These are the bitter results of the internalization and integration of the harsh realization that there is nothing one can do to alter the outcomes of a natural, or man-made, catastrophe. The horror in confronting one’s finiteness, meaninglessness, eligibility, and powerlessness – is overpowering.

Society Phase II – DEPRESSION

The more the members of society come to grips with the magnitude of the loss, or evil, or threat represented by the grief inducing events – the sadder they become. Depression is often little more than suppressed or self-directed anger. The anger, in this case, is belatedly caused by an identified or diffuse source of threat, or of evil, or loss. It is a higher level variant of the “fight or flight” reaction, tempered by the rational understanding that the “source” is often too abstract to tackle directly.

Summary Phase II

Thus, when the victim is most in need, terrified by his helplessness and adrift – society is immersed in depression and unable to provide a holding and supporting environment.
Growth and healing are again retarded by social interaction.
The victim’s innate sense of annulment is enhanced by the self-addressed anger (=depression) of those around him.

PHASE III

Both the victim and society react with RAGE to their predicaments. In an effort to Narcissistically reassert himself, the victim develops a grandiose sense of anger directed at paranoidly selected, unreal, diffuse, and abstract targets (=frustration sources).
By expressing aggression, the victim re-acquires mastery of the world and himself.

Members of society use rage to re-direct the cause of their depression (which is, as we said, self-directed anger) and to channel it safely. To ensure that this expressed aggression alleviates their depression – real targets must are selected and real punishments meted out. In this respect, “social rage” differs from the victim. The former is intended to sublimate aggression and channel it in a socially acceptable manner – the latter to reassert narcissistic self-love as an antidote to an all-devouring sense of helplessness.

In other words, society, by itself, being in a state of rage, positively enforces the narcissistic rage reactions of the grieving victim. This, in the long run, is counter-productive, inhibits personal growth, and prevents healing. It
also erodes the reality test of the victim and encourages self-delusions, paranoid ideation, and ideas of reference.

Victim Phase IV – DEPRESSION

As the consequences of narcissistic rage – both social and personal – grow more unacceptable, depression sets in. The victim internalizes his aggressive impulses. Self-directed anger is safer but is the cause of great sadness and even suicidal ideation. The victim’s depression is a way of conforming to social norms. It is also instrumental in ridding the victim of the unhealthy
residues of narcissistic regression. It is when the victim acknowledges the malignancy of his rage (and its anti-social nature) that he adopts a depressive stance.

Society Phase IV – HELPLESSNESS

People around the victim (“society”) also emerge from their phase of rage transformed. As they realize the futility of their anger,
they feel more and more helpless and devoid of options. They grasp their limitations and the irrelevance of their good intentions. They accept the inevitability of loss and evil and Kafkaesque agree to live under an ominous cloud of arbitrary judgment, meted out by impersonal powers.

Summary Phase IV

Again, the members of society are unable to help the victim to emerge from a self-destructive phase. His depression is enhanced by their apparent helplessness. Their introversion and inefficacy induce in the victim a feeling of nightmarish isolation and alienation. Healing and growth are once again retarded or even inhibited.

Victim Phase V – ACCEPTANCE AND MOVING ON

Depression – if pathologically protracted and in conjunction with other mental health problems – sometimes leads to suicide. But more often, it allows the victim to process mentally hurtful and potentially harmful material and paves the way to acceptance. Depression is a laboratory of the psyche. Withdrawal from social pressures enables the direct transformation of anger into other emotions, some of them otherwise socially unacceptable. The honest encounter between the victim and his (possible) death often becomes a cathartic and self-empowering inner dynamic. The victim emerges ready to move on.

Society Phase V – DENIAL

Society, on the other hand, having exhausted its reactive arsenal – resorts to denial. As memories fade and as the victim recovers and abandons his obsessive-compulsive dwelling on his pain – society feels morally justified to forget and forgive. This mood of historical revisionism, of moral leniency, of effusive forgiveness, of re-interpretation, and of a refusal to remember in detail – leads to a repression and denial of the painful events in society.

Summary Phase V

This final mismatch between the victim’s emotional needs and society’s reactions is less damaging to the victim. He is now more
resilient, stronger, more flexible, and more willing to forgive and forget. Society’s denial is really a denial of the victim. But, having
ridden himself of more primitive narcissistic defenses – the victim can do without society’s acceptance, approval, or look. Having endured the purgatory of grieving, he has now re-acquired his self, independent of society’s acknowledgment.

Women’s Strengths Aid in Addiction Recovery

Addiction Recovery – Women’s Strengths Aid

When we think about addiction, it’s all too common that we focus on the negative aspects of the story: the toll that it takes on Treatment for Womenfamily and friends, as well as the addict themselves. This is especially true when it comes to women who are addicts, because narratives about women are more likely to center on how their families are impacted by addiction. The other side of the story is a much more positive one: women tend to have particular strengths that mean they often move through the recovery process more easily than men.

According to academic evidence, women recover from addiction at higher rates than men. One of the primary reasons for this is a simple matter of biology: women progress more rapidly through the various stages of addiction. They hit “rock bottom” sooner than men, and as a result, they get into recovery programs sooner than men. That means women, as a group, experience less of the physical devastation wrought by addiction, and this helps to make the recovery process less physically demanding.

womens-eyeAnother important difference is also related to biological factors. Women are more than twice as likely as men to develop mood disorders such as depression and anxiety, partly because women go through a wide variety of hormonal changes throughout their lives. Mental health issues often underlie addiction, and getting treatment helps female addicts address their addiction.

Finally, there are the social strengths of women. Girls and women are encouraged much more so than boys and men to express emotion, to develop expressive relationships, and to allow themselves the luxury of accepting help when they’re in need. All of these factors together are enormously important in the recovery process, which means that women tend to have more tools for coping with recovery in general.

Melissa Hilton

Kids and Mental Disorders – ADHD

Children and mental disorders – when is too soon for diagnosis?

I spend a decent chunk of my time cruising chat boards and reading journals, news, social media posts and such about mental disorders.  My own “specialties” are Bipolar Disorder, Adult ADHD, Autism Spectrum DisorderBorderline Personality Disorder, Anxiety Disorder, Depression, Abuse Disorders, OCD… nevermind – I really “specialize” in them all, because I know most Attention Deficit Hyperactivity Disorderof these disorders within my social circle, and I know them on a professional level.

Anyway, I was on a Facebook page the other day for ADHD. (attention deficit hyperactivity disorder)  A woman posted a question about how to manage a kid with ADHD who wakes up and wreaks havoc within the house while everyone is trying to get ready for school and work.  Naturally he was disagreeable, confrontational, oppositional, had “meltdowns” – and it was all exhausting.  (pretty typical behavior for a truly ADHD kid)  A therapist once told me that the ADHD brain doesn’t “wake up” right away and cause all this trouble partly because their brain is not actually engaged yet.  The mom was asking for advice.

Comments on the page gave some really good answers. Some of them are common. Like plan your morning before you go to bed (get out clothes, get backpack ready, make lunch), let the kid make some choices – blah blah blah, stuff we have all heard.

Others were less common, but possibly better advice. Advices like; give the kid an extra 30 minutes to “wake up” in silence, give the child an incentive to get dressed NOW – like playing Minecraft after he is dressed.  I handle mine with the “don’t talk to him yet” option – waiting about 20-30 minutes before making him get busy.  His siblings aren’t allowed to bug him during this time either.  He can wrap himself in a blanket, stare at the wall or whatever – just don’t go back to sleep.

One lady suggested that the kid should be woken to take his meds an hour before he has to be out of bed. Then let him go back to sleep so that his medicines are working by the time he actually gets up.  I found that last piece of advice to be very helpful. My husband with adult ADHD takes his meds about 4 am and gets up at 6, ready to go rather than rude, obnoxious and unhelpful.

Mental Disorders - ADHDWhat troubled me was a comment from a woman who didn’t actually give advice, but chimed in to complain about how hard her four-year-old was to manage.  She said that he had been diagnosed with ADHD and was on meds, but also said that he had bipolar disorder, and still was a screaming banshee in the morning.  This gives me pause for concern.

I certainly can’t do anything about this particular kid, and I don’t really know the exact circumstances but I find the dual diagnosis with bipolar disorder very troubling for a four-year-old child.  Certainly, kids can exhibit ADHD symptoms at 4, and some will benefit from treatment.  But the medications weren’t working, and I am not so sure about the bipolar disorder.

Traditionally, until a few years ago, no one was willing to consider bipolar disorder as a pediatric concern.  Still today, though bipolar disorder obviously exists in childhood – most of the major issues don’t come out until adolescence.

The Diagnostic and Statistical Manual of Mental Disorders does not recognize the bipolar disorder in children under the age of 13

The National Institutes of Mental Health does acknowledge that bipolar disorder in children MAY exist but also warns that many children are misdiagnosed when the main problem is ADHDNIMH recommends that these children be labeled with Mood Dysregulation Syndrome until such time as a diagnosis can be relied upon.

The main problem in diagnosing young children with any mental disorder is that symptoms in children are vastly different from those in adults.  To complicate matters, symptoms of various Cerebrum Lobesdisorders in children are similar to one another.

Symptoms such as irritability, excessive mood swings, meltdowns, oppositional behavior, trouble in school, social inadequacies, explosive behavior, frequent frustration, and hyperactivity, etc. can point to a number of disorders.  Frankly the child may be ADHD, Bipolar, Depressed, Autism Spectrum… or even have food intolerance.

Because of our family history (not just mine), I watch my children very carefully.  I do analyze everything that happens, and I know that all of them probably have a disorder of one type or another.  Two may have ADHD, one is likely bipolar and one has Asperger’s or mild ASD.  I have sought treatment for some issues – but with others, I hesitate to run to a physician – likely a pediatrician who just doesn’t really know.

Our understanding of mental disorders is still evolving

I was personally diagnosed with the wrong disorder for over 15 years – and I was an adult.  How damaging would it have been if I had been labeled with a disorder that I did not have when I was only four years old?
The particular woman I described with the dual diagnosis child was beside herself.  Despite the fact that the four-year-old was receiving medical treatment for both disorders – it wasn’t working.  To me, this means that the treatment was with the wrong meds and for the wrong disorder(s).  In addition, her management skills weren’t the best.

As I said, I know that my children are likely to have disorders of their own but I don’t want to treat them for just any disorder.  I will want them to be treated for the right disease.  My advice to this parent, or any parent whose child had been put on medication that wasn’t working would be to seek a second opinion.

I am more emphatic about that advice if the doctor was willing to “add” a diagnosis to provide more medication; she should definitely seek another opinion.  Preferably the opinion of a pediatric Ritalin - ADHD Medicinepsychiatrist – or even a pediatric behavioral neurologist.  These specialists are few and far between, but it isn’t worth doing anything, but suffering through all the misery because the treatment isn’t working.

Medications are beneficial in the treatment of some types of mental disorders, but they do “change the brain”.  That is how they work – changing the brain can be harmful if you are changing it in the “wrong” directions.  Just seems like common sense.

Melissa Lind

Intermittent Explosive Disorder

Intermittent Explosive Disorder – More Than Just Anger

Intermittent Explosive Disorder (also called IED, that is appropriate as it can go off unexpectedly and cause significant damage)

Intermittent Hulk Explosive DisorderProbably everyone knows that teenage boy (or girl) who punched a hole through the wall.  Perhaps for some, this became a regular pattern of behavior during adolescence but most of those teenagers outgrew it.  In fact, at least one-quarter of teenage boys has done something dumb like punching a wall.

One boy I knew in high school even broke his hand by punching the roof of his car, and some boys were routinely doing stupid stuff.  Despite that, all of it was teenage angst and changes that can be attributed to the massive amounts of testosterone flowing through the male adolescent body – none of them had intermittent explosive disorder.

Intermittent Explosive Disorder is worse than punching a hole through a wall.

It typically is first identified in the early teens – but can be seen much earlier in some cases.    In order to be actually characterized as intermittent explosive disorder, an individual must have had three episodes of explosive behavior that is severely out of proportion to the stressor.

Intermittent Explosive Disorder HulkinsectThey must have broken or smashed something that is monetarily valuable (more than a few dollars), physically attacked or made explicit threats to attack someone with the intent of causing harm.  If these three episodes occur within the space of 12 months, the disorder is considered to be more severe.

Here is the catch.

How do you distinguish between IED, average – though extreme teenage behavior and other psychiatric conditions?  It turns out that IED is probably a diagnosis of “if nothing else fits” as other psychiatric disorders certainly overlap with similar symptoms – and you have to rule out the adolescent hormone issue.

Bipolar disorder may cause outbursts of extreme anger and agitation, Borderline personality disorder may cause outbreaks, ADHD patients can exhibit a severe lack of self-control, and drug abuse is always a potential cause.  Even though those diseases may cause IED-like events, a sustained behavior pattern is something to address.

Intermittent Explosive Disorder WarningA recent study reported by the National Institutes of Health shows that IED can actually affect up to 4 percent of adults and lead to an estimated 43 attacks over a lifespan.  The disorder may also increase that chance of depression, anxiety and substance abuse disorders.  People with IED have an obvious increased risk of legal trouble, financial difficulties, and divorce – that’s a no-brainer.

So the biggest problem for mental health professionals, like many other disorders, is to untangle all of the information leading in and out with a mix of behaviors and a mix of causes.  What came first – the chicken or the egg?  What came first – the drug abuse or the anger?  Which illness is more important – bipolar disorder or the IED?

One of the biggest clues may be in examining (or better, paying attention to) behavior that occurs before puberty.  In other words: What came first – the behavior or puberty?  Clearly if the behavior started before puberty, there was and is an issue.  If the behavior begins during adolescence – you have to wait (and hope) to see if the behavior goes away once the hormones are settled.

IED is not a simple diagnosis.

It requires a careful examination of an entire psychiatric and behavioral history – and the “ruling out” of a lot of other disorders that may be to blame.  Unfortunately, in the end – unless an underlying cause can be found, there is no medicationAnger management and cognitive behavioral therapy are likely the only answer – minimization of harm, not very satisfactory if it was your car window that got smashed in a fit of rage.

Melissa Lind

Borderline Personality Disorder in the News

In the news (and movies): Borderline Personality Disorder

Borderline Personality Disorder (BPD) doesn’t get a lot of “press” or screen time.

We have all seen movies and news stories about people with bipolar disorder. (Girl Interrupted, Mad Love, Borderline Personality Disorder Newsand the unforgettable Who’s Afraid of Virginia Wolf, drug addiction) (Chris Farley, Philip Seymore Hoffman, and Anna Nicole Smith), and major depression (Robin Williams, Owen Wilson, and Princess Diana).  Many of these movies or real-life examples also show how mental disorders are intertwined.

Depression comes with alcoholism, bipolar disorder comes with drug addiction, bipolar disorder comes with a lot of issues – but not much attention gets paid to Borderline Personality Disorder.

Borderline Personality Disorder has a few issues:

  1. It is a personality disorder and not a psychiatric disorder that can be treated with medication
  2. It is hard to diagnose and can often be confused with other disorders
  3. Borderline patients may misrepresent their behavior to medical professionals
  4. Borderline patients are often “difficult” to be around
  5. Borderline personality disorder is not well known – make it not well known… and, for this reason, there is no reason to write a news story or make a movie about it.

“Good news”;

I put that in parentheses because the diagnosis is not great – but it is good that BPD is getting a bit of attention.  Two notable examples – one not so great and one which may or may not be great.

Not So Great;

The trial of Jodi Arias.  In 2008, Travis Alexander was brutally murdered.  He was stabbed over 20 times, shot, and photographed after his death.  The alleged perpetrator: his girlfriend, Jodi Arias.

The case has been pending for many years – one of the reasons may be the development of a clear understanding of why Arias acted the way that she did after the murder.  Reportedly, Arias was witnessed immediately after Alexander’s memorial (including explicit text messages sent for “flirting”), and she has been pegged as a possible borderline patient.  This is in addition to Alexander’s former friends that reported her stalking behavior, and her statements that the boyfriend was a pedophile and a domestic abuser.

Arias’ own friends and a court psychologist have reported erratic behavior, similar to that of BPD.  No verdict has been issued as of yet, and we may never know, but it does bring BPD into the news (not in a nice way but into the light, however).

In fact, some mental health professionals have expressed the belief that BPD patients may be more dangerous – both emotionally and physically – than most other mental disorders, some likening it to a form of sociopathy.

Possibly good news;

Borderline Personality Disorder in the NewsOn the movie front, Kristen Wiig (of Bridesmaids –and the new, all-female Ghostbusters) has starred in a”dramedy”. Dramedy is  a combination of a comedy and drama that is centered around a woman with BPD.   In Welcome to Me, the character, portrayed by Wiig, wins the lottery and uses part of the money to start a talk show.

Along the way, she skips out on treatment, quits taking her meds and ends up living in a casino.  No word on reviews for the show, but it has some big names including Joan Cusack and Tim Robbins. It is produced in part by Will Farrell, and even though it premiered at the Toronto International Film Festival, theater showings have not been announced.

If you know a BPD patient – imagine what he or she might do after winning the lottery.  BPD is hard to diagnose, hard to predict and even tougher to be around.

Whether the movie is any good, whether the trial comes to a just end…

Melissa Lind

Borderline Personality Disorder has gotten some attention!