I have a general practice in psychology. Many of my clients are expats and foreigners. Living in Sri Lanka now for sixteen years, being Dutch myself and married to my Sri Lankan wife Manjula I can relate to the issues that expats encounter. I work with adults (expat issues, marriage counselling, depression, anxiety, sexual problems, addictions, LGBTQ-related issues, trauma therapy, stress, personal development, giving meaning to your life, how to build self-esteem, choosing a profession and career advice, social issues, etc. etc.) and with children (teenager counselling, study related problems, personal and social issues, etc.).
Furthermore I give (onsite) individual coaching for CEO's, higher management, entrepreneurs and executives (confidential personal issues, leadership issues, career development, work stress, etc.).
I am affiliate psychologist with:
- the United States Embassy in Colombo for visiting American citizens, for Embassy staff members and I conduct psychological assessments of US citizens on behalf of the U.S. Social Security Administration.
- UNHCR Sri Lanka, for refugees until their resettlement abroad.
- Workplace Options (www.workplaceoptions.com) for their Sri Lankan clients. For them I provide Employee Assistance Program (EAP) services for employees and family members.
Confidentiality is most important to me. What is said in therapy is very private and it stays private. One of the methods I use is to work with feelings, behaviour and thoughts; in the present and in the past. The end result is a more balanced personality. In the first two articles from the list below I describe this method.
Other methods I use are for example:
- elements of short-term psychodynamic therapy
- elements of cognitive behaviour therapy
- elements of emotionally focused couple therapy
An interesting video about psychotherapy from the "School of Life" is "here".
Although I am not a big proponent of administering drugs for mental illnesses like depression and anxiety, in some cases it can be useful. Depression has everything to do with FEELING depressed. Since depression is about stuck emotions, it makes sense to treat it from that angle. Psychiatrists and other medical doctors are generally speaking not trained in conducting and understanding research. Psychologists on the other hand, have to undergo a stringent and extensive schooling regarding research (please read this article "here for typical differences between psychologists and psychiatrists). Not only plain statistics like multiple regression analysis but more about the art of how to set up proper research studies and how to read them. Research is difficult; you need to have an extremely critical mindset.
There exists no "chemical imbalance in the brain" and this and the "serotonin reuptake" story (people are encouraged to believe that depression is caused by a deficiency of serotonin as in the analogy with diabetes and insulin) are just clever marketing concoctions of the pharmaceutical industry, there is no scientific medical proof. Please read this article "here . In July 2022 an article in Nature (which cited a comprehensive study in the journal of Molecular Psychiatry in July 2022) by the British psychiatrists Joanna Moncrieff and Mark Horowitz, debunked the story that depression is the result of a disturbance of the serotonin balance in the brain.
We know for some twenty years that antidepressants do not outperform placebo (see for example www.joannamoncrieff.com. and Kirsch, 1998). On top of that antidepressants have a whole list of (possible) side-effects, of which weight gain and sexual dysfunctions (not a pleasant thing when you're already depressed) are the most common ones; for both genders for example reduced libido and delayed or blocked orgasm and for men difficulty in having an erection. For more information please read in the articles below. With extreme rare illnesses like bipolar depression (if correctly diagnosed!, please read this article "here ) and schizophrenia medication is paramount. As I always tell my clients, whenever they want to stop with medication it's very important to do this under medical supervision. The American psychiatrist Dr. Peter Breggin (his website is www.breggin.com.) writes critical articles about psychiatric drugs, shock therapy, and other topics.
On this website you will find the following published articles.
Articles in chronological order (please click)
Articles by category (please click)
The Psychologist From Holland Who Took A Closer Look At Sri Lanka. Published on January 10th 2010 in The Sunday Leader.
Feelings are stronger than the mind; Marcel de Roos: Eminent Dutch Psychologist promulgates fresh outlook in Sri Lanka. Published on May 9th 2010 (plus a reprint on June 2th 2010) in The Island.
Depression in Sri Lanka, taking pills or talking? Published on July 26th 2010 in The Island.
Making a decision the unconscious way. Published on August 8th 2010 in The Sunday Leader and in the March Issue 2013 of Lanka Woman.
Emotional abuse, the silencing enemy. Published on August 22th 2010 in The Sunday Leader and in the May Issue 2011 of Lanka Woman.
Homosexuality in Sri Lanka, taking pills or talking? Published on September 19th 2010 in The Sunday Leader and in the August Issue 2011 of Lanka Woman.
Depression in Sri Lanka, taking pills or talking? A psychotherapeutic answer. Published on September 5th 2010 in The Sunday Leader.
Addictions: a psychological way out. Published on October 3th 2010 in The Sunday Leader, and in the July Issue 2011 of Lanka Woman.
Child psychology: dealing with (exam) stress. Published on October 10th 2010 in The Sunday Leader and in the February Issue 2012 of Lanka Woman.
Anxiety disorders, a psychological approach. Published on November 7th 2010 in The Sunday Leader.
Child psychology: why is my daughter cutting herself? Published on November 14th 2010 in The Sunday Leader, and in the June Issue 2011 of Lanka Woman.
Anorexia, bulimia and binge eating disorders: a cry for (self)love? Published on November 21th 2010 in The Sunday Leader and in the October Issue 2011 of Lanka Woman.
Marriage, troubled waters and a possible bridge Published on December 12th 2010 in The Sunday Leader and in the January Issue 2012 of Lanka Woman.
Breast cancer and emotional support Published on December 19th 2010 in The Sunday Leader, and in the September Issue 2011 of Lanka Woman.
Child psychology: dealing with (cyber) bullying Published on December 26th 2010 in The Sunday Leader.
A helping hand in your hour of need. Published in Lanka Woman, December Issue 2010.
Antidepressants and the "chemical-imbalance" hoax. Published on January 9th 2011 in The Sunday Leader and on January 31th 2012 in The Daily Mirror.
Depression and how to deal with it - Part 1. Published in Lanka Woman, January Issue 2011.
Alcohol addiction and how to deal with it. Published on January 23th 2011 in The Sunday Leader.
Depression and how to deal with it - Part 2. Published in Lanka Woman, February Issue 2011.
Weight loss Published on March 13th 2011 in The Sunday Leader.
Depression and how to deal with it - Part 3 / 4. About anti-depressants Published in Lanka Woman, March/April Issue 2011.
Emotions in the Boardroom. Published on May 8th 2011 in The Sunday Leader and in the June 2013 Issue of Lanka Woman.
Emotions, revisited. Published on June 5th 2011 in The Sunday Leader.
"Nature versus nurture" and mental diseases. Published on July 24th 2011 in The Sunday Leader and in the December Issue 2011 of Lanka Woman.
Empty nest syndrome. Published in Lanka Woman, November Issue 2011.
Valium and other Benzodiazepines, failure drugs par excellence. Published on January 15th 2012 in The Sunday Leader and in the April Issue 2012 of Lanka Woman.
"Feelings are stronger than the mind". Published on January 21th 2012 in The Daily Mirror, on January 23th 2012 in The Daily News and in the March Issue of Lanka Woman 2012.
Psychotherapy/counselling in Sri Lanka. Published on February 14th 2012 in The Daily Mirror and in the May Issue 2012 of Lanka Woman.
Anger Management. Published in the June Issue 2012 of Lanka Woman.
Self-harm, a growing trend among the youth. Published on July 1th 2012 in The Sunday Observer
Post Traumatic Stress Disorder. Published in the July Issue 2012 of Lanka Woman.
Grieving is normal, it's not a mental illness. Published in the August Issue 2012 of Lanka Woman.
Teen love affairs can lead to depression and suicides. Published on September 2th 2012 in The Sunday Observer
Sexual Abuse by Parents. Published in the September Issue 2012 of Lanka Woman.
ADHD, psychiatric epidemic or hype? Published in the October Issue 2012 of Lanka Woman.
The "Chemical Imbalance" Myth. Published in the November Issue 2012 of Lanka Woman.
"Electroshock Treatment". Published in the December Issue 2012 of Lanka Woman.
Bipolar Madness. Published in the January Issue 2013 of Lanka Woman.
Psychological / Psychiatric Assessment. Published in the February Issue 2013 of Lanka Woman.
Tips for a fair fight with your spouse. Published in the April Issue 2013 of Lanka Woman.
Why antidepressants don't work. Published in the May Issue 2013 of Lanka Woman.
Divorcing with children. Published in the July Issue 2013 of Lanka Woman.
Emotional overeating. Published in the August Issue 2013 of Lanka Woman.
Depression, alleged genetic causes and the "medical model". Published in the September Issue 2013 of Lanka Woman.
They need someone to listen to. Published on September 22th 2013 in The Nation Sunday Print Edition.
Psychotherapy and Buddhism. Published in the October Issue 2013 of Lanka Woman.
The forgiveness trap. Published in the December Issue 2013 of Lanka Woman and on July 25th 2015 in The Nation Sunday Print Edition.
Bipolar Madness Revisited. Published in the December Issue 2013 of Lanka Woman.
Readers questions regarding depression. Published in the January Issue 2014 of Lanka Woman.
Cognitive behaviour therapy, does it really work? Published in the February Issue 2014 of Lanka Woman.
Abusive relationships. Published in the March Issue 2014 of Lanka Woman.
Facebook....... Published in the April Issue 2014 of Lanka Woman and in the January 4th 2015 in The Nation Free magazine.
Depression and how to really deal with it. Published in the May Issue 2014 of Lanka Woman.
ADHD, what is it again (and what not)? Published in the June Issue 2014 of Lanka Woman.
Succession in the family business. Published in the July Issue 2014 of Lanka Woman.
Withdrawal effects. Published in the August Issue 2014 of Lanka Woman.
Teen love affairs and depression. Published in the September Issue 2014 of Lanka Woman.
Positive psychology : old wine in new bottles. Published in the October Issue 2014 of Lanka Woman.
DSM(5): Bestseller with little psychiatric use. Published in the November Issue 2014 of Lanka Woman.
Anxiety, a lady clad in brightly red. Published on November 16th 2015 in The Nation Free magazine.
No right way or amount of time to grieve. Published in parts on November 23th and November 30th 2015 in The Nation Free magazine.
ADHD with adults: a lucrative new market. Published in the December Issue 2014 of Lanka Woman.
Don't allow drinks to drink you. Published in parts on December 7,December 14 and December 21 2014 in The Nation Free magazine.
Adverse effects of internet addiction. Published on December 28 2014 in The Nation Free magazine.
Shocking truths about shock treatment. Published in the January Issue 2015 of Lanka Woman and in May 17 2015 in The Nation Free magazine.
Peer pressure, robbed of opinion. Published in parts on January 11 and January 18 2015 in The Nation Free magazine.
Eating disorders. Published in parts on January 25, February 1, February 8 and February 15 2015 in The Nation Free magazine.
Psychological testing: Big business but little relevance. Published in the February Issue 2015 of Lanka Woman.
Good, bad stress. Published in parts on February 22 and February 29 2015 in The Nation Free magazine.
Psychological context of female sexual problems. Published in the March Issue 2015 of Lanka Woman.
Depression series. Published in parts on March 8, March 14, March 21, March 28,April 4, April 11 and April 18 2015 in The Nation Free magazine.
Q's and A's with Dr Marcel: The chemical imbalance myth, Bipolar depression and ADHD. Published in the April Issue 2015 of Lanka Woman.
An experiment in social obedience. Published in the May Issue 2015 of Lanka Woman.
Introverts versus extroverts. Published in parts on May 2 and May 9 2015 in The Nation Free magazine.
Manipulative, authoritarian upbringing and how to set yourself free. Published in the June Issue 2015 of Lanka Woman.
Sexuality series. Published in parts on May 23, May 30, June 6, June 13, June 20 and June 27 2015 in The Nation Free magazine.
Propagating ineffective medicine: Biased, selective writings and na ve, ill-informed writers. Published in the July Issue 2015 of Lanka Woman
Black box suicide warnings for antidepressants, the real story.
ADHD series. Published in parts on July 4, July 11 and July 18 2015 in The Nation Free magazine.
Good stress and bad stress. Published in the August Issue 2015 of Lanka Woman
Sex Education. Published in the September Issue 2015 of Lanka Woman
Eating disorders. Published in the October Issue 2015 of Lanka Woman
Conclusive new study: damaging effects of antidepressants (SSRI s) with children. Published in the November Issue 2015 of Lanka Woman
Johnson & Johnson: the illegal and fraudulent off-label marketing of Risperdal.
Introverts and extroverts. Published in the December Issue 2015 of Lanka Woman
Sexuality: Sexual orientation. Published in the January Issue 2016 of Lanka Woman
Do we need a diagnosis with mental health issues? Published in the February Issue 2016 of Lanka Woman
Narcissistic mothers. Published in the March Issue 2016 of Lanka Woman
Sexual abuse in Sri Lanka. Published in the April Issue 2016 of Lanka Woman
ADHD, psychiatric epidemic or hype? Published in the May Issue 2016 of Lanka Woman
Bipolar Madness, reprise. Published in the June Issue 2016 of Lanka Woman
Effectiveness of psychological interventions. Published in the July Issue 2016 of Lanka Woman
Male and female sexual fantasies. Published in the August Issue 2016 of Lanka Woman
"Top-teams". Published in the September Issue 2016 of Lanka Woman
Benefits of psychotherapy. Published in the October Issue 2016 of Lanka Woman
Sexuality: Foreplay. Published in the November Issue 2016 of Lanka Woman
Giving meaning to your life. Published in the December Issue 2016 of Lanka Woman
Burnout? The broader perspective. Published in the January Issue 2017 of Lanka Woman
The end of electroconvulsive treatment (ECT)? Published in the February Issue 2017 of Lanka Woman
There exists no such thing as a free lunch... Published in the March Issue 2017 of Lanka Woman
Bullying and how to stop it effectively. Published in the April Issue 2017 of Lanka Woman
Q s and A s with Dr Marcel: ECT, Alcohol and Anxiety. Published in the May Issue 2017 of Lanka Woman
ADHD, conclusions from important recent studies. Published in the June Issue 2017 of Lanka Woman
Depression, it's not in the brain..... Published in the July Issue 2017 of Lanka Woman
A plea for "unproductive" daydreaming. Published in the August Issue 2017 of Lanka Woman
Online therapy, pros and cons. Published in the September Issue 2017 of Lanka Woman
Why "choosing for happiness" doesn't work. Published in the October Issue 2017 of Lanka Woman
Narcissistic partners. Published in the November Issue 2017 of Lanka Woman
Differences between psychologists and psychiatrists. Published in the January Issue 2018 of Lanka Woman
Grossly exaggerated prevalence figures of bipolar depression. Published in the February Issue 2018 of Lanka Woman
Gender roles/issues in Sri Lanka. Published in the March Issue 2018 of Lanka Woman
Stop using depression tests as a diagnostic tool. Published in the April Issue 2018 of Lanka Woman
The State of Affairs , a new perspective on infidelity. Published in the May Issue 2018 of Lanka Woman
That unsurprising Cipriani antidepressants study, media headlines and FACTS. Published in the June Issue 2018 of Lanka Woman
Sexual abuse in girl schools in Sri Lanka. Published in the July Issue 2018 of Lanka Woman
Psychopaths: charming but utterly selfish and ruthless. Published in the August Issue 2018 of Lanka Woman
Advising versus the art of listening. Published in the September Issue 2018 of Lanka Woman
Corporal punishment as a child and subsequent anger issues as an adult. Published in the October Issue 2018 of Lanka Woman
Why the development of "antidepressant"- drugs is stagnating. Published in the November Issue 2018 of Lanka Woman
The nonsense of "Positive Psychology". Published in the December Issue 2018 of Lanka Woman
Vaginismus. Published in the January Issue 2019 of Lanka Woman
How to help a depressed loved one / friend. Published in the February Issue 2019 of Lanka Woman
"Borderliners". Published in the March Issue 2019 of Lanka Woman
The fallacy of cognitive behaviour therapy. Published in the April Issue 2019 of Lanka Woman
Stand by your man, but at what price? Published in the May Issue 2019 of Lanka Woman
Grieving. Published in the June Issue 2019 of Lanka Woman
"Forgiveness therapy", a critical assessment. Published in the July and August Issue 2019 of Lanka Woman
A tribute to Dr Irvin Yalom. Published in the September Issue 2019 of Lanka Woman
Existential Psychotherapy. Published in the October Issue 2019 of Lanka Woman
Suicide & nurses and doctors from hell. Published in the November Issue 2019 of Lanka Woman
Manipulations with antidepressants-research. Published in the December Issue 2019 of Lanka Woman
There exists no "evidence based therapies . Published in the January Issue 2020 of Lanka Woman
Why (short term) Psychodynamic Therapy is far superior to CBT. Published in the February Issue 2020 of Lanka Woman
Treatment of Eating disorders. Published in the March Issue 2020 of Lanka Woman
How to survive like a Stoic in times of corona-virus. Published in the June Issue 2020 of Lanka Woman
What makes a relationship / marriage work? Published in the July Issue 2020 of Lanka Woman
Sexual abuse in childhood. Published in the August Issue 2020 of Lanka Woman
Doing things the Sri Lankan way. Published in the September Issue 2020 of Lanka Woman
Regaining customer's trust. Published in the September Issue 2020 of TravTalkmiddleeast
Sexual abuse of boys. Published in the October Issue 2020 of Lanka Woman
How to deal with your Inner Critic. Published in the November Issue 2020 of Lanka Woman
Psychology and Assessment.Published in the December Issue 2020 of Lanka Woman
Some notes about gender differences. Published in the January Issue 2021 of Lanka Woman
How to find the correct psychologist for YOU. Published in the February Issue 2021 of Lanka Woman
What forms our identity? Published in the March Issue 2021 of Lanka Woman
Confidentiality and psychotherapy. Published in the April Issue 2021 of Lanka Woman
Phases of grief. Published in the May Issue 2021 of Lanka Woman
The double illusion of the DSM. Published in the June Issue 2021 of Lanka Woman
What is a Good Life . Published in the August Issue 2021 of Lanka Woman
Q s and A s with Dr Marcel: ADHD and The Secret Published in the September Issue 2021 of Lanka Woman
Gaming and other addictions: a psychological way out Published in the online magazine Ceylondigest and in the November Issue 2021 of Lanka Woman
Art and wellbeing.Published in the December Issue 2021 of Lanka Woman
The Secret and other nonsense about happiness . Published in the online magazine Ceylondigest
The serious drawbacks of cognitive behaviour therapy.Published in the January Issue 2022 of Lanka Woman
"ADHD"Published in the online magazine Ceylondigest
Transference and counter-transference.Published in the February Issue 2022 of Lanka Woman
The Clitoris.Published in the March Issue 2022 of Lanka Woman
"Love in a Times of Loneliness".Published in the April Issue 2022 of Lanka Woman
Psychological aspects of negotiating.Published in the May Issue 2022 of Lanka Woman
"Not good enough".Published in the June Issue 2022 of Lanka Woman
Lessons from Epicurus.Published in the July Issue 2022 of Lanka Woman
Cultivating your Inner Monster .Published in the August Issue 2022 of Lanka Woman
Borderliners , the real story.Published in the september Issue 2022 of Lanka Woman
The trouble with the DSM-5.Published in the online magazine Ceylondigest
Depression, the serotonin myth debunked.Published in the October Issue 2022 of Lanka Woman and in the online magazine Ceylondigest
Infidelity.Published in the November Issue 2022 of Lanka Woman
When your house becomes an empty nest.Published in the December Issue 2022 of Lanka Woman
Guilt-tripping and Gaslighting.Published in the January Issue 2023 of Lanka Woman
Trauma and the impact on your body.Published in the February Issue 2023 of Lanka Woman
The detrimental disorder labels of the DSM5.Published in the March Issue 2023 of Lanka Woman
The scourge of bullying.Published in the April Issue 2023 of Lanka Woman
DSM5, comorbidities and the emotional iceberg.Published in the May Issue 2023 of Lanka Woman
Some Nietzsche and a bit of Freud & Jung.Published in the June Issue 2023 of Lanka Woman
(Short term) Psychodynamic Psychotherapy.Published in the July Issue 2023 of Lanka Woman
EMDR, Promising New Method or Purple Hat Therapy?Published in the August Issue 2023 of Lanka Woman
Cognitive behaviour therapy, a critical reviewPublished in April Issue 2023 of the (online) Psychology Quarterly Magazine
Anorexia, a myriad of questions.Published in the September Issue 2023 of Lanka Woman
Narcissism, as a popular label and in a psychological pathological sense.Published in the October Issue 2023 of Lanka Woman
The law of attraction and other nonsense.Published in the November Issue 2023 of Lanka Woman
Brown & Lovely.Published in the December Issue 2023 of Lanka Woman
Mental disorders and genes: The trouble with twin studies.Published in the January Issue 2024 of Lanka Woman
Emotions and therapyPublished in the online magazine Ceylondigest
Tips for how to support a grieving personPublished in the February Issue 2024 of Lanka Woman
Borderliners and DBT: a questionable approach.Published in the March Issue 2024 of Lanka Woman
Anxiety: a lady clad in a bright red dress.Published in the April Issue 2024 of Lanka Woman
Bipolar depression: easily and often misdiagnosed.Published in the May Issue 2024 of Lanka Woman
The art of how NOT to advise.Published in the June Issue 2024 of Lanka Woman
Frans de Waal, a primatologist s view on sex and gender.Published in the July Issue 2024 of Lanka Woman
Trendy buzzwords: attachment styles.Published in the August Issue 2024 of Lanka Woman
Cognitive behaviour therapy: flawed, ineffective and overrated.Published in the September Issue 2024 of Lanka Woman
The brevity of life.Published in the October Issue 2024 of Lanka Woman
Treating traumas, not everyone's expertise.Published in the November Issue 2024 of Lanka Woman
The Psychologist From Holland Who Took A Closer Look At Sri Lanka. Published on January 10th 2010 in The Sunday Leader.
Feelings are stronger than the mind; Marcel de Roos: Eminent Dutch Psychologist promulgates fresh outlook in Sri Lanka. Published on May 9th 2010 (plus a reprint on June 2th 2010) in The Island.
Depression in Sri Lanka, taking pills or talking? A psychotherapeutic answer. Published on September 5th 2010 in The Sunday Leader.
Antidepressants and the "chemical-imbalance" hoax. Published on January 9th 2011 in The Sunday Leader and on January 31th 2012 in The Daily Mirror.
Why antidepressants don't work. Published in the May Issue 2013 of Lanka Woman.
Depression, alleged genetic causes and the "medical model". Published in the September Issue 2013 of Lanka Woman.
The "Chemical Imbalance" Myth. Published in the November Issue 2012 of Lanka Woman.
Teen love affairs and depression. Published in the September Issue 2014 of Lanka Woman.
Readers questions regarding depression. Published in the January Issue 2014 of Lanka Woman.
Black box suicide warnings for antidepressants, the real story.
Depression, it's not in the brain..... Published in the July Issue 2017 of Lanka Woman
Why "choosing for happiness" doesn't work. Published in the October Issue 2017 of Lanka Woman
Stop using depression tests as a diagnostic tool. Published in the April Issue 2018 of Lanka Woman
That unsurprising Cipriani antidepressants study, media headlines and FACTS. Published in the June Issue 2018 of Lanka Woman
Why the development of "antidepressant"- drugs is stagnating. Published in the November Issue 2018 of Lanka Woman
How to help a depressed loved one / friend.Published in the February Issue 2019 of Lanka Woman
The fallacy of cognitive behaviour therapy.Published in the April Issue 2019 of Lanka Woman
Suicide & nurses and doctors from hell.Published in the November Issue 2019 of Lanka Woman
Manipulations with antidepressants-research.Published in the December Issue 2019 of Lanka Woman
There exists no "evidence based therapies .Published in the January Issue 2020 of Lanka Woman
Why (short term) Psychodynamic Therapy is far superior to CBT.Published in the February Issue 2020 of Lanka Woman
How to deal with your Inner Critic.Published in the November Issue 2020 of Lanka Woman
The double illusion of the DSM.Published in the June Issue 2021 of Lanka Woman
The serious drawbacks of cognitive behaviour therapy.Published in the January Issue 2022 of Lanka Woman
Transference and counter-transference.Published in the February Issue 2022 of Lanka Woman
"Not good enough".Published in the June Issue 2022 of Lanka Woman
Depression, the serotonin myth debunked.Published in the October Issue 2022 of Lanka Woman and in the online magazine Ceylondigest
Trauma and the impact on your body.Published in the February Issue 2023 of Lanka Woman
(Short term) Psychodynamic Psychotherapy.Published in the July Issue 2023 of Lanka Woman
EMDR, Promising New Method or Purple Hat Therapy?Published in the August Issue 2023 of Lanka Woman
Cognitive behaviour therapy, a critical reviewPublished in April Issue 2023 of the (online) Psychology Quarterly Magazine
Mental disorders and genes: The trouble with twin studies.Published in the January Issue 2024 of Lanka Woman
Cognitive behaviour therapy: flawed, ineffective and overrated.Published in the September Issue 2024 of Lanka Woman
The brevity of life.Published in the October Issue 2024 of Lanka Woman
Treating traumas, not everyone's expertise.Published in the November Issue 2024 of Lanka Woman
"Nature versus nurture" and mental diseases. Published on July 24th 2011 in The Sunday Leader and in the December Issue 2011 of Lanka Woman.
Psychological / Psychiatric Assessment. Published in the February Issue 2013 of Lanka Woman.
ADHD, what is it again (and what not)? Published in the June Issue 2014 of Lanka Woman.
DSM(5): Bestseller with little psychiatric use. Published in the November Issue 2014 of Lanka Woman.
Depression, it's not in the brain..... Published in the July Issue 2017 of Lanka Woman
Differences between psychologists and psychiatrists. Published in the January Issue 2018 of Lanka Woman
Grossly exaggerated prevalence figures of bipolar depression. Published in the February Issue 2018 of Lanka Woman
Psychology and Assessment.Published in the December Issue 2020 of Lanka Woman
The double illusion of the DSM. Published in the June Issue 2021 of Lanka Woman
The trouble with the DSM-5.Published in the online magazine Ceylondigest
The detrimental disorder labels of the DSM5.Published in the Marchy Issue 2023 of Lanka Woman
DSM5, comorbidities and the emotional iceberg.Published in the May Issue 2023 of Lanka Woman
Emotional abuse, the silencing enemy. Published on August 22th 2010 in The Sunday Leader and in the May Issue 2011 of Lanka Woman.
Child psychology: dealing with (cyber) bullying Published on December 26th 2010 in The Sunday Leader.
Sexual abuse in Sri Lanka. Published in the April Issue 2016 of Lanka Woman
Sexual Abuse by Parents. Published in the September Issue 2012 of Lanka Woman.
The forgiveness trap. Published in the December Issue 2013 of Lanka Woman and on July 25th 2015 in The Nation Sunday Print Edition.
Self-harm, a growing trend among the youth. Published on July 1th 2012 in The Sunday Observer
Abusive relationships. Published in the March Issue 2014 of Lanka Woman.
Manipulative, authoritarian upbringing and how to set yourself free. Published in the June Issue 2015 of Lanka Woman.
Bullying and how to stop it effectively. Published in the April Issue 2017 of Lanka Woman.
Sexual abuse in girl schools in Sri Lanka. Published in the July Issue 2018 of Lanka Woman
Psychopaths: charming but utterly selfish and ruthless. Published in the August Issue 2018 of Lanka Woman
Corporal punishment as a child and subsequent anger issues as an adult. Published in the October Issue 2018 of Lanka Woman
Stand by your man, but at what price? Published in the May Issue 2019 of Lanka Woman
"Forgiveness therapy", a critical assessment. Published in the July and August Issue 2019 of Lanka Woman
Why (short term) Psychodynamic Therapy is far superior to CBT.Published in the February Issue 2020 of Lanka Woman
Sexual abuse in childhood.Published in the August Issue 2020 of Lanka Woman
Sexual abuse of boys.Published in the October Issue 2020 of Lanka Woman
Guilt-tripping and Gaslighting.Published in the January Issue 2023 of Lanka Woman
Trauma and the impact on your body.Published in the February Issue 2023 of Lanka Woman
The scourge of bullying.Published in the April Issue 2023 of Lanka Woman
Treating traumas, not everyone's expertise.Published in the November Issue 2024 of Lanka Woman
Psychological / Psychiatric Assessment. Published in the February Issue 2013 of Lanka Woman.
Bipolar Madness. Published in the January Issue 2013 of Lanka Woman.
Bipolar Madness Revisited. Published in the December Issue 2013 of Lanka Woman.
Bipolar Madness, reprise. Published in the June Issue 2016 of Lanka Woman
Grossly exaggerated prevalence figures of bipolar depression. Published in the February Issue 2018 of Lanka Woman
Mental disorders and genes: The trouble with twin studies.Published in the January Issue 2024 of Lanka Woman
Bipolar depression: easily and often misdiagnosed.Published in the May Issue 2024 of Lanka Woman
ADHD, psychiatric epidemic or hype? Published in the October Issue 2012 of Lanka Woman.
ADHD, what is it again (and what not)? Published in the June Issue 2014 of Lanka Woman.
ADHD with adults: a lucrative new market. Published in the December Issue 2014 of Lanka Woman.
ADHD, conclusions from important recent studies. Published in the June Issue 2017 of Lanka Woman
Why (short term) Psychodynamic Therapy is far superior to CBT.Published in the February Issue 2020 of Lanka Woman
Q s and A s with Dr Marcel: ADHD and The Secret Published in the September Issue 2021 of Lanka Woman
"ADHD" Published in the online magazine Ceylondigest
Mental disorders and genes: The trouble with twin studies.Published in the January Issue 2024 of Lanka Woman
"Borderliners".Published in the March Issue 2019 of Lanka Woman
Borderliners , the real story.Published in the september Issue 2022 of Lanka Woman
Trauma and the impact on your body.Published in the February Issue 2023 of Lanka Woman
(Short term) Psychodynamic Psychotherapy.Published in the July Issue 2023 of Lanka Woman
Borderliners and DBT: a questionable approach.Published in the March Issue 2024 of Lanka Woman
Treating traumas, not everyone's expertise.Published in the November Issue 2024 of Lanka Woman
Addictions: a psychological way out. Published on October 3th 2010 in The Sunday Leader, and in the July Issue 2011 of Lanka Woman.
Alcohol addiction and how to deal with it. Published on January 23th 2011 in The Sunday Leader.
Don't allow drinks to drink you. Published in parts on December 7,December 14 and December 21 2014 in The Nation Free magazine.
Adverse effects of internet addiction. Published on December 28 2014 in The Nation Free magazine.
Why (short term) Psychodynamic Therapy is far superior to CBT.Published in the February Issue 2020 of Lanka Woman
Gaming and other addictions: a psychological way out Published in the online magazine Ceylondigest and in the November Issue 2021 of Lanka Woman
Anorexia, a myriad of questions.Published in the September Issue 2023 of Lanka Woman
Dealing with (exam) stress. Published on October 10th 2010 in The Sunday Leader and in the February Issue 2012 of Lanka Woman.
Why is my daughter cutting herself? Published on November 14th 2010 in The Sunday Leader, and in the June Issue 2011 of Lanka Woman.
Dealing with (cyber) bullying Published on December 26th 2010 in The Sunday Leader.
Peer pressure, robbed of opinion. Published in parts on January 11 and January 18 2015 in The Nation Free magazine.
Bullying and how to stop it effectively. Published in the April Issue 2017 of Lanka Woman.
Sexual abuse in girl schools in Sri Lanka. Published in the July Issue 2018 of Lanka Woman
Corporal punishment as a child and subsequent anger issues as an adult. Published in the October Issue 2018 of Lanka Woman
Sexual abuse in childhood.Published in the August Issue 2020 of Lanka Woman
Sexual abuse of boys.Published in the October Issue 2020 of Lanka Woman
What forms our identity?Published in the March Issue 2021 of Lanka Woman
"Not good enough".Published in the June Issue 2022 of Lanka Woman
The scourge of bullying.Published in the April Issue 2023 of Lanka Woman
Brown & Lovely.Published in the December Issue 2023 of Lanka Woman
Trendy buzzwords: attachment styles.Published in the August Issue 2024 of Lanka Woman
Treating traumas, not everyone's expertise.Published in the November Issue 2024 of Lanka Woman
Eating disorders. Published in parts on January 25, February 1, February 8 and February 15 2015 in The Nation Free magazine.
Emotional overeating. Published in the August Issue 2013 of Lanka Woman.
Why (short term) Psychodynamic Therapy is far superior to CBT.Published in the February Issue 2020 of Lanka Woman
Treatment of Eating disorders.Published in the March Issue 2020 of Lanka Woman
(Short term) Psychodynamic Psychotherapy.PPublished in the November Issue 2024 of Lanka Womanublished in the July Issue 2023 of Lanka Woman
Anorexia, a myriad of questions.Published in the September Issue 2023 of Lanka Woman
Treating traumas, not everyone's expertise.Published in the November Issue 2024 of Lanka Woman
The forgiveness trap. Published in the December Issue 2013 of Lanka Woman and on July 25th 2015 in The Nation Sunday Print Edition.
"Forgiveness therapy", a critical assessment. Published in the July and August Issue 2019 of Lanka Woman
Marriage, troubled waters and a possible bridge Published on December 12th 2010 in The Sunday Leader and in the January Issue 2012 of Lanka Woman.
Tips for a fair fight with your spouse. Published in the April Issue 2013 of Lanka Woman.
Divorcing with children. Published in the July Issue 2013 of Lanka Woman.
Empty nest syndrome. Published in Lanka Woman, November Issue 2011.
The State of Affairs , a new perspective on infidelity. Published in the May Issue 2018 of Lanka Woman
Corporal punishment as a child and subsequent anger issues as an adult. Published in the October Issue 2018 of Lanka Woman
Stand by your man, but at what price? Published in the May Issue 2019 of Lanka Woman
Suicide & nurses and doctors from hell.Published in the November Issue 2019 of Lanka Woman
Why (short term) Psychodynamic Therapy is far superior to CBT.Published in the February Issue 2020 of Lanka Woman
What makes a relationship / marriage work?Published in the July Issue 2020 of Lanka Woman
How to survive like a Stoic in times of corona-virus.Published in the June Issue 2020 of Lanka Woman
How to find the correct psychologist for YOU.Published in the February Issue 2021 of Lanka Woman
Confidentiality and psychotherapy.Published in the April Issue 2021 of Lanka Woman
What is a Good Life .Published in the August Issue 2021 of Lanka Woman
Infidelity.Published in the November Issue 2022 of Lanka Woman
When your house becomes an empty nest.Published in the December Issue 2022 of Lanka Woman
Guilt-tripping and Gaslighting.Published in the January Issue 2023 of Lanka Woman
Trauma and the impact on your body.Published in the February Issue 2023 of Lanka Woman
The scourge of bullying.Published in the April Issue 2023 of Lanka Woman
Brown & Lovely.Published in the December Issue 2023 of Lanka Woman
Tips for how to support a grieving personPublished in the February Issue 2024 of Lanka Woman
Anxiety: a lady clad in a bright red dress.Published in the April Issue 2024 of Lanka Woman
Trendy buzzwords: attachment styles.Published in the August Issue 2024 of Lanka Woman
The brevity of life.Published in the October Issue 2024 of Lanka Woman
Treating traumas, not everyone's expertise.Published in the November Issue 2024 of Lanka Woman
Emotions in the Boardroom. Published on May 8th 2011 in The Sunday Leader and in the June 2013 Issue of Lanka Woman.
Emotions, revisited. Published on June 5th 2011 in The Sunday Leader.
Anger Management. Published in the June Issue 2012 of Lanka Woman.
Grieving is normal, it's not a mental illness. Published in the August Issue 2012 of Lanka Woman.
Post Traumatic Stress Disorder. Published in the July Issue 2012 of Lanka Woman.
Anxiety disorders, a psychological approach. Published on November 7th 2010 in The Sunday Leader.
Why "choosing for happiness" doesn't work. Published in the October Issue 2017 of Lanka Woman
Corporal punishment as a child and subsequent anger issues as an adult. Published in the October Issue 2018 of Lanka Woman
The fallacy of cognitive behaviour therapy.Published in the April Issue 2019 of Lanka Woman
Suicide & nurses and doctors from hell.Published in the November Issue 2019 of Lanka Woman
Why (short term) Psychodynamic Therapy is far superior to CBT.Published in the February Issue 2020 of Lanka Woman
How to survive like a Stoic in times of corona-virus.Published in the June Issue 2020 of Lanka Woman
How to deal with your Inner Critic.Published in the November Issue 2020 of Lanka Woman
Phases of grief.Published in the May Issue 2021 of Lanka Woman
The serious drawbacks of cognitive behaviour therapy.Published in the January Issue 2022 of Lanka Woman
Transference and counter-transference.Published in the February Issue 2022 of Lanka Woman
"Not good enough".Published in the June Issue 2022 of Lanka Woman
Cultivating your Inner Monster .Published in the August Issue 2022 of Lanka Woman
Guilt-tripping and Gaslighting.Published in the January Issue 2023 of Lanka Woman
Trauma and the impact on your body.Published in the February Issue 2023 of Lanka Woman
(Short term) Psychodynamic Psychotherapy.Published in the July Issue 2023 of Lanka Woman
EMDR, Promising New Method or Purple Hat Therapy?Published in the August Issue 2023 of Lanka Woman
Emotions and therapyPublished in the online magazine Ceylondigest
Tips for how to support a grieving personPublished in the February Issue 2024 of Lanka Woman
Anxiety: a lady clad in a bright red dress.Published in the April Issue 2024 of Lanka Woman
The art of how NOT to advise.Published in the June Issue 2024 of Lanka Woman
Trendy buzzwords: attachment styles.Published in the August Issue 2024 of Lanka Woman
Treating traumas, not everyone's expertise.Published in the November Issue 2024 of Lanka Woman
Positive psychology : old wine in new bottles. Published in the October Issue 2014 of Lanka Woman.
Effectiveness of psychological interventions. Published in the July Issue 2016 of Lanka Woman
Why "choosing for happiness" doesn't work. Published in the October Issue 2017 of Lanka Woman
The nonsense of "Positive Psychology". Published in the December Issue 2018 of Lanka Woman
Existential Psychotherapy.Published in the October Issue 2019 of Lanka Woman
Why (short term) Psychodynamic Therapy is far superior to CBT.Published in the February Issue 2020 of Lanka Woman
The Secret and other nonsense about happiness .Published in the online magazine Ceylondigest
The serious drawbacks of cognitive behaviour therapy.Published in the January Issue 2022 of Lanka Woman
A tribute to Dr Irvin Yalom.Published in the September Issue 2019 of Lanka Woman
Existential Psychotherapy.Published in the October Issue 2019 of Lanka Woman
What is a Good Life .Published in the August Issue 2021 of Lanka Woman
Lessons from Epicurus.Published in the July Issue 2022 of Lanka Woman
The brevity of life.Published in the October Issue 2024 of Lanka Woman
Narcissistic mothers. Published in the March Issue 2016 of Lanka Woman
Narcissistic partners. Published in the November Issue 2017 of Lanka Woman
Psychopaths: charming but utterly selfish and ruthless. Published in the August Issue 2018 of Lanka Woman
Narcissism, as a popular label and in a psychological pathological sense.Published in the October Issue 2023 of Lanka Woman
Sex Education. Published in the September Issue 2015 of Lanka Woman
Sexuality: Sexual orientation. Published in the January Issue 2016 of Lanka Woman
Homosexuality in Sri Lanka, taking pills or talking? Published on September 19th 2010 in The Sunday Leader and in the August Issue 2011 of Lanka Woman.
Psychological context of female sexual problems. Published in the March Issue 2015 of Lanka Woman.
Male and female sexual fantasies. Published in the August Issue 2016 of Lanka Woman
Sexuality: Foreplay. Published in the November Issue 2016 of Lanka Woman
Sexuality series. Published in parts on May 23, May 30, June 6, June 13, June 20 and June 27 2015 in The Nation Free magazine.
Gender roles/issues in Sri Lanka. Published in the March Issue 2018 of Lanka Woman
Vaginismus. Published in the January Issue 2019 of Lanka Woman
Stand by your man, but at what price? Published in the May Issue 2019 of Lanka Woman
Why (short term) Psychodynamic Therapy is far superior to CBT.Published in the February Issue 2020 of Lanka Woman
Some notes about gender differences.Published in the January Issue 2021 of Lanka Woman
The Clitoris.Published in the March Issue 2022 of Lanka Woman
"Love in a Times of Loneliness".Published in the April Issue 2022 of Lanka Woman
Frans de Waal, a primatologist s view on sex and gender.Published in the July Issue 2024 of Lanka Woman
Cognitive behaviour therapy, does it really work? Published in the February Issue 2014 of Lanka Woman.
Effectiveness of psychological interventions. Published in the July Issue 2016 of Lanka Woman
Benefits of psychotherapy. Published in the October Issue 2016 of Lanka Woman
The fallacy of cognitive behaviour therapy. Published in the April Issue 2019 of Lanka Woman
There exists no "evidence based therapies . Published in the January Issue 2020 of Lanka Woman
Why (short term) Psychodynamic Therapy is far superior to CBT.Published in the February Issue 2020 of Lanka Woman
The serious drawbacks of cognitive behaviour therapy.Published in the January Issue 2022 of Lanka Woman
Cognitive behaviour therapy, a critical reviewPublished in April Issue 2023 of the (online) Psychology Quarterly Magazine
Cognitive behaviour therapy: flawed, ineffective and overrated.Published in the September Issue 2024 of Lanka Woman
Treating traumas, not everyone's expertise.Published in the November Issue 2024 of Lanka Woman
Psychological / Psychiatric Assessment. Published in the February Issue 2013 of Lanka Woman.
Do we need a diagnosis with mental health issues? Published in the February Issue 2016 of Lanka Woman
Psychological testing: Big business but little relevance. Published in the February Issue 2015 of Lanka Woman.
"Nature versus nurture" and mental diseases. Published on July 24th 2011 in The Sunday Leader and in the December Issue 2011 of Lanka Woman.
DSM(5): Bestseller with little psychiatric use. Published in the November Issue 2014 of Lanka Woman.
Differences between psychologists and psychiatrists. Published in the January Issue 2018 of Lanka Woman
There exists no "evidence based therapies . Published in the January Issue 2020 of Lanka Woman
Why (short term) Psychodynamic Therapy is far superior to CBT.Published in the February Issue 2020 of Lanka Woman
Psychology and Assessment.Published in the December Issue 2020 of Lanka Woman
The double illusion of the DSM.Published in the June Issue 2021 of Lanka Woman
The serious drawbacks of cognitive behaviour therapy.Published in the January Issue 2022 of Lanka Woman
Making a decision the unconscious way. Published on August 8th 2010 in The Sunday Leader and in the March Issue 2013 of Lanka Woman.
Breast cancer and emotional support Published on December 19th 2010 in The Sunday Leader, and in the September Issue 2011 of Lanka Woman.
Weight loss Published on March 13th 2011 in The Sunday Leader.
Psychotherapy/counselling in Sri Lanka. Published on February 14th 2012 in The Daily Mirror and in the May Issue 2012 of Lanka Woman.
"Nature versus nurture" and mental diseases. Published on July 24th 2011 in The Sunday Leader and in the December Issue 2011 of Lanka Woman.
Cognitive behaviour therapy, does it really work? Published in the February Issue 2014 of Lanka Woman.
Q's and A's with Dr Marcel: The chemical imbalance myth, Bipolar depression and ADHD. Published in the April Issue 2015 of Lanka Woman.
An experiment in social obedience. Published in the May Issue 2015 of Lanka Woman.
Introverts versus extroverts. Published in parts on May 2 and May 9 2015 in The Nation Free magazine.
Benefits of psychotherapy. Published in the October Issue 2016 of Lanka Woman
Effectiveness of psychological interventions. Published in the July Issue 2016 of Lanka Woman
Q s and A s with Dr Marcel: ECT, Alcohol and Anxiety. Published in the May Issue 2017 of Lanka Woman
Online therapy, pros and cons. Published in the September Issue 2017 of Lanka Woman
Differences between psychologists and psychiatrists. Published in the January Issue 2018 of Lanka Woman
Psychopaths: charming but utterly selfish and ruthless. Published in the August Issue 2018 of Lanka Woman
Advising versus the art of listening. Published in the September Issue 2018 of Lanka Woman
The fallacy of cognitive behaviour therapy.Published in the April Issue 2019 of Lanka Woman
Stand by your man, but at what price? Published in the May Issue 2019 of Lanka Woman
Suicide & nurses and doctors from hell.Published in the November Issue 2019 of Lanka Woman
There exists no "evidence based therapies .Published in the January Issue 2020 of Lanka Woman
Why (short term) Psychodynamic Therapy is far superior to CBT.Published in the February Issue 2020 of Lanka Woman
How to survive like a Stoic in times of corona-virus.Published in the June Issue 2020 of Lanka Woman
Doing things the Sri Lankan way.Published in the September Issue 2020 of Lanka Woman
How to deal with your Inner Critic.Published in the November Issue 2020 of Lanka Woman
Some notes about gender differences.Published in the January Issue 2021 of Lanka Woman
How to find the correct psychologist for YOU.Published in the February Issue 2021 of Lanka Woman
What forms our identity?Published in the March Issue 2021 of Lanka Woman
Confidentiality and psychotherapy.Published in the April Issue 2021 of Lanka Woman
What is a Good Life .Published in the August Issue 2021 of Lanka Woman
Q s and A s with Dr Marcel: ADHD and The Secret Published in the September Issue 2021 of Lanka Woman
Transference and counter-transference.Published in the February Issue 2022 of Lanka Woman
"Love in a Times of Loneliness".Published in the April Issue 2022 of Lanka Woman
Psychological aspects of negotiating.Published in the May Issue 2022 of Lanka Woman
"Not good enough".Published in the June Issue 2022 of Lanka Woman
Lessons from Epicurus.Published in the July Issue 2022 of Lanka Woman
Cultivating your Inner Monster .Published in the August Issue 2022 of Lanka Woman
Infidelity.Published in the November Issue 2022 of Lanka Woman
The scourge of bullying.Published in the April Issue 2023 of Lanka Woman
Some Nietzsche and a bit of Freud & Jung.Published in the June Issue 2023 of Lanka Woman
EMDR, Promising New Method or Purple Hat Therapy?Published in the August Issue 2023 of Lanka Woman
Cognitive behaviour therapy, a critical reviewPublished in April Issue 2023 of the (online) Psychology Quarterly Magazine
Brown & Lovely.Published in the December Issue 2023 of Lanka Woman
Mental disorders and genes: The trouble with twin studies.Published in the January Issue 2024 of Lanka Woman
Tips for how to support a grieving personPublished in the February Issue 2024 of Lanka Woman
The art of how NOT to advise.Published in the June Issue 2024 of Lanka Woman
Treating traumas, not everyone's expertise.Published in the November Issue 2024 of Lanka Woman
Propagating ineffective medicine: Biased, selective writings and na ve, ill-informed writers. Published in the July Issue 2015 of Lanka Woman
Conclusive new study: damaging effects of antidepressants (SSRI s) with children. Published in the November Issue 2015 of Lanka Woman
Johnson & Johnson: the illegal and fraudulent off-label marketing of Risperdal.
Valium and other Benzodiazepines, failure drugs par excellence. Published on January 15th 2012 in The Sunday Leader and in the April Issue 2012 of Lanka Woman.
Withdrawal effects. Published in the August Issue 2014 of Lanka Woman.
There exists no such thing as a free lunch... Published in the March Issue 2017 of Lanka Woman
Grossly exaggerated prevalence figures of bipolar depression. Published in the February Issue 2018 of Lanka Woman
That unsurprising Cipriani antidepressants study, media headlines and FACTS. Published in the June Issue 2018 of Lanka Woman
Why the development of "antidepressant"- drugs is stagnating. Published in the December Issue 2018 of Lanka Woman
Manipulations with antidepressants-research.Published in the December Issue 2019 of Lanka Woman
There exists no "evidence based therapies .Published in the January Issue 2020 of Lanka Woman
Why (short term) Psychodynamic Therapy is far superior to CBT.Published in the February Issue 2020 of Lanka Woman
The double illusion of the DSM.Published in the June Issue 2021 of Lanka Woman
Art and wellbeing.Published in the December Issue 2021 of Lanka Woman
Depression, the serotonin myth debunked.Published in the October Issue 2022 of Lanka Woman and in the online magazine Ceylondigest
Emotions in the Boardroom. Published on May 8th 2011 in The Sunday Leader and in the June 2013 Issue of Lanka Woman.
Psychological testing: Big business but little relevance. Published in the February Issue 2015 of Lanka Woman.
Positive psychology : old wine in new bottles. Published in the October Issue 2014 of Lanka Woman.
"Top-teams". Published in the September Issue 2016 of Lanka Woman
Succession in the family business. Published in the July Issue 2014 of Lanka Woman.
Burnout? The broader perspective. Published in the January Issue 2017 of Lanka Woman
Anger Management. Published in the June Issue 2012 of Lanka Woman.
Good stress and bad stress. Published in the August Issue 2015 of Lanka Woman
Cognitive behaviour therapy, does it really work? Published in the February Issue 2014 of Lanka Woman.
DSM(5): Bestseller with little psychiatric use. Published in the November Issue 2014 of Lanka Woman.
Benefits of psychotherapy. Published in the October Issue 2016 of Lanka Woman
Effectiveness of psychological interventions. Published in the July Issue 2016 of Lanka Woman
Why "choosing for happiness" doesn't work. Published in the October Issue 2017 of Lanka Woman
Advising versus the art of listening. Published in the September Issue 2018 of Lanka Woman
The fallacy of cognitive behaviour therapy.Published in the April Issue 2019 of Lanka Woman
There exists no "evidence based therapies .Published in the January Issue 2020 of Lanka Woman
Why (short term) Psychodynamic Therapy is far superior to CBT.Published in the February Issue 2020 of Lanka Woman
Regaining customer's trust.Published in the September Issue 2020 of TravTalkmiddleeast
The serious drawbacks of cognitive behaviour therapy.Published in the January Issue 2022 of Lanka Woman
Psychological aspects of negotiating.Published in the May Issue 2022 of Lanka Woman
Cognitive behaviour therapy, a critical reviewPublished in April Issue 2023 of the (online) Psychology Quarterly Magazine
The art of how NOT to advise.Published in the June Issue 2024 of Lanka Woman
"Electroshock Treatment". Published in the December Issue 2012 of Lanka Woman.
Shocking truths about shock treatment. Published in the January Issue 2015 of Lanka Woman and in May 17 2015 in The Nation Free magazine.
The end of electroconvulsive treatment (ECT)? Published in the February Issue 2017 of Lanka Woman
Psychotherapy and Buddhism. Published in the October Issue 2013 of Lanka Woman.
Positive psychology : old wine in new bottles. Published in the October Issue 2014 of Lanka Woman.
Giving meaning to your life. Published in the December Issue 2016 of Lanka Woman
A plea for "unproductive" daydreaming. Published in the August Issue 2017 of Lanka Woman
Why "choosing for happiness" doesn't work. Published in the October Issue 2017 of Lanka Woman
The nonsense of "Positive Psychology". Published in the December Issue 2018 of Lanka Woman
Why (short term) Psychodynamic Therapy is far superior to CBT.Published in the February Issue 2020 of Lanka Woman
What is a Good Life .Published in the August Issue 2021 of Lanka Woman
Q s and A s with Dr Marcel: ADHD and The Secret Published in the September Issue 2021 of Lanka Woman
Art and wellbeing.Published in the December Issue 2021 of Lanka Woman
The Secret and other nonsense about happiness . Published in the online magazine Ceylondigest
Lessons from Epicurus.Published in the July Issue 2022 of Lanka Woman
Cultivating your Inner Monster .Published in the August Issue 2022 of Lanka Woman
Some Nietzsche and a bit of Freud & Jung.Published in the June Issue 2023 of Lanka Woman
The law of attraction and other nonsense.Published in the November Issue 2023 of Lanka Woman
The brevity of life.Published in the October Issue 2024 of Lanka Woman
Marcel de Roos, (PhD) a psychologist from Holland is preparing to settle down in Sri Lanka - leaving behind a 25 year old practice - Central Clinic - in Amsterdam. Dr. de Roos says that he has fallen in love with Sri Lanka and has moved his home to this country. As human emotions, feelings and the mind does not change from country to country, Psychologist de Roos says that his practice in Sri Lanka will help many Sri Lankans.
Having also been a counsellor for students at the University of Amsterdam in the past few years, Dr. de Roos helped them to cope with the stressful environment and issues such as depression, anxiety and loneliness.
Recently Dr. Marcel de Roos set up a company (Marcel de Roos Consultancy) in Holland dealing with assessment for higher management. Corporate firms not only want qualified staff but they want them to perform adequately in their own work environment. Besides interviewing them he devised a series of appropriate tests and let them perform tasks with the help of hired actors and colleague psychologists.
Speaking of his patients in Holland down the years, de Roos said "The patient population has been varied, but the majority consisted of women. Relationship issues, work related ones and depression were the most commonly asked questions."
"My practice was a general one so I treated all kinds of disorders. My patients came from all strata of society. I have a strong sense of justice so abuse in any form is something I abhor. Clients with a history of abuse may count on my help and I will do everything I can to empower them to overcome their ordeals," he said directing this help to victims of abuse and those who need his help in Sri Lanka.
Dr. Marcel de Roos went on to elaborate that he is appalled by the stories he has heard from female clients about what they have had to go through. "There seems to be a huge difference between role patterns in Holland and Sri Lanka. In Holland there is a strong sense of equality among women. A majority of them work (part time) and thus generate their own income. In the past 30 years the women's' lib movement has accomplished much. For instance equal rights at work, men taking an active part in the upbringing of children and much legislation," he said.
He went on to say that the strong bonds parents have with their children in Sri Lanka is notable. "The education system seems successful and drugs and alcohol are not promoted," observed de Roos.
But Dr. Marcel de Roos also went on to point out some disturbing facets. "Sri Lanka seems to be a very male oriented society where most women take second place. I have heard many tales about emotional, physical and sexual abuse. Behind the typical Sri Lankan smile a completely different world often seems to be hidden: women in Sri Lanka are prone to 'stand by their man' no matter what. When a woman has had enough and has the courage to speak out, chances are that she isn't taken seriously.
"What many women need here is support and understanding. Very often women take the blame. They feel guilty and feel it is their fault that they are abused and that their marriage is falling apart. The difference in the gender roles in Sri Lanka seems to play a dominant part in the lives of men and women from a very young age," observed the psychologist from Holland.
But Dr. Marcel de Roos went on to warn that contrary to what many people believe, emotional abuse is as serious and as harmful as physical or sexual abuse. "It is used to control, demean, harm or punish a woman. The forms may vary, but the end result is the same - a frightened woman who does everything to please her partner to be safe from harm," pointed out Dr. de Roos.
Dr. de Roos said that some tactics used by the abuser are to isolate a woman from her friends and family, criticize the woman constantly, act overly jealous and possessive, control her money, make all the decisions in the family, intimidate and harass - even making use of the children. 'Abused women should try to seek help and speak about their experiences. It is only then that her ordeal may end,' he advised.
He went on to observe that depression seems to be increasing among young people in Sri Lanka. "The many pressures they have to cope with might be a factor. I hope that I can make a contribution to alleviate the above mentioned issues in Sri Lanka," he said.
"Twenty five years ago when I started practicing, the emphasis in psychology was on trying to change the thoughts of clients. As a result of that their feelings would improve. As I got more experience I realised that it wasn't helping my clients in the long term. There seemed to be something missing. The feelings of depression or anxiety in many cases reappeared after a while. That's why my motto in psychology is 'feelings are stronger than the mind.' The inclusion of feelings and making them the focal point of counseling changed a lot for my clients," Dr. de Roos added.
"When people are feeling empty, depressed or burnt out, these are in many cases symptoms of an underlying conflict. Usually these symptoms stem from feelings from the past which are still too painful to be felt. When you succeed in making the connection, then those 'old' feelings (usually mixed with present ones) explain to you the cause of your present state. Finally you can start to feel the painful feelings from the past in full. At first with the help of a therapist, after a while by yourself. Each time when you are triggered in the present by a representative of an old feeling, the intensity of the painful feeling will diminish," said Dr. de Roos.
He went on to elaborate. "For instance when you are feeling depressed, it does not originate in the present but in your past. Focusing on your feelings can reveal the cause of your present state and can allow you to feel the deeper, underlying roots. The new approach is that you don't focus on the 'thought' side, but that you work with your feelings. Present plus past combined. It is a very down to earth method. It is aimed at giving the client powerful tools to do the work himself so that in time he does not have to rely on the therapist."
"Medication can have its benefits with severe traumas and phobias where the client is unable to cope with the deeper underlying issues. In my patient group, I prefer to work without medication and solve problems with therapy," said Dr. de Roos.
When asked: How do you like Sri Lanka, Dr. Marcel de Roos said, "Well on the surface, Sri Lanka is in many ways like a picture post card. The beauty of the island is often breathtaking and natural resources are plentiful. People who live in tropical countries seem to be warmer by nature and smile a lot more than in cold Northern Europe. I plan to stay here and work here for some years and it is certainly no punishment to do so," said this famous psychologist with a smile.
A huge fan of Sri Lankan food, Dr. de Roos now finds that he cannot live without the godamba rotis, koththu rotis, hoppers and hot curries. "So much so that if I have to visit Holland I now will have to take the curry and chilli powders with me. As a Sri Lankan, I now find that food in Holland is bland..." he said with a smile. And he truly has gone the whole hog, for not only has he fallen in love with Sri Lanka but says that he is also deeply in love with his Sri Lankan wife Jennifer, who seems to have entered his heart and mind in a big way.
Speaking of death and loss, Psychologist Dr. Marcel de Roos went on to say 'This month it's a year since the Editor of The Sunday Leader was killed. Many are still trying to cope with his death and the loss continues to evoke grief and sadness. From a professional point of view grief is a natural reaction to loss. It's the emotional suffering you feel when something or someone you love is taken away. There is no right way or right amount of time to grieve. It's a very personal experience. However it is possible to give some general advice. The most important is to try to get support from other people. Share your grief with your family or co-workers, don't grieve alone. It is also important to take care of yourself. Face your feelings and try to maintain good physical health. Be aware that grief doesn't turn into depression and don't hesitate to seek professional help when necessary.'
The link to the original article is here
'Feelings are stronger than the mind,' says the effervescent Psychologist from the Netherlands; Dr. Marcel de Roos. His interest in people, their general well being and the greater need to hear their problems out has prompted him to look at a broader angle in which one could bring succour to the sufferer.
Sri Lankans are yet to get used to the idea of seeing a psychologist/psychiatrist as many are of the notion that psychiatry is relegated to the wards of Angoda and if one suffers from psychological problems its best to suppress the matter or seek professional help in secret as 'the neighbors will think one has gone stark raving mad!'
The tide has to change if not society will consist of people who suffer in silence for fear of exposing their vulnerability. Depression, bipolar disorders, schizophrenia, sexual/mental/physical abuse, acute grief are rampant in our society but we fail to see further than our fellow Sri Lankan's face which is often wreathed with a smile. The sooner we accept the need for professional psychologists to assist those in need, do we pave the way for a society of wholesome albeit productive individuals.
Having therapy consists of nothing more than talking. It's venting your feelings, talking about your issues with the help of an understanding professional therapist. In due process the impact of the emotions will become less and patients will feel a sense of balance in their personal life. Much depends on the relationship between the patient and the therapist.
Dr. Marcel de Roos is like a breath of fresh air to the psychological sphere in our country which consists of a handful of psychiatrists/psychologists who try to change the way of thinking of the patient in the hope that by doing so the behaviour and feelings will change too (cognitive behavioural therapy). 'When I started my practice in Holland 25 years ago I noticed that the above mentioned form of therapy offered short term recourse and the depression or anxiety resurfaced in time. The inclusion of feelings in the therapy and making it the focal point of counseling (instead of the "thoughts") changed a lot for my clients, and forged the missing link,' added Dr. de Roos.
Elaborating on the above he stated that the cause of a patient's depression does not lie in the present but in his past. 'The depression is in many cases a symptom of an underlying conflict. Usually this symptom stems from feelings from the past which are still too painful to be felt. When you succeed in making the connection, then those 'old' feelings (usually mixed with present ones) explain to you the cause of your present state. Finally you can start to feel the painful feelings from the past in full; initially with the help of a therapist, thereafter by yourself. Each time when you are triggered in the present by a representative of an old feeling, the intensity of the painful feeling will diminish.' 'Medication can have its benefits with severe traumas and phobias in which the client is unable to cope with the deeper underlying issues. In my patient group, I prefer to work without medication and solve problems primarily through therapy,' said he.
'My practice in Sri Lanka involves dealing with individuals with a wide variety of questions and issues. Usually they are centered on problems like depression, stress, anxiety and sexual dysfunction etc. It could be personal or work related as well.
Since a few months ago the emphasis in my practice has shifted towards business people from the corporate world. They operate in a highly competitive environment where it doesn't pay to show one's emotions. Especially CEO's and higher management find it rewarding to talk in a safe setting about their personal issues. Generally speaking, the higher in hierarchy the lonelier it becomes. In management courses the focal point is usually on the analytical side and on control while well founded decision making requires balanced emotions too.
A general manager of a retail company came to my practice on recommendation of a friend of his whom I had coached for a few months. At first his question was to teach him better coping strategies with his stressful work situation but on the second appointment his underlying issues became apparent. A highly demanding father and a warmth lacking mother had made him the successful manager he was. From early schooldays on he had always strived to be outstanding in academics and in sports. He had received his personal satisfaction from those. His emotional side however had lagged behind his achievements and he became a bit lopsided. So far in his career he had managed when confronted with emotion packed decision making, to overrule that with his will power. In the past month however he had been forced to lay off a few dozen coworkers in dire straits which had touched him deeply on a personal level. This General Manager had never learned to vent his emotions and in subsequent years the pent up baggage had become intensified. After a series of talks he felt much more balanced and he could cope better with the demands in his work,' exemplified he.
The main reason which prompted this valuable individual to relocate to our isle is his stunning Sri Lankan spouse Jennifer who supports his endeavours in the field of psychology and wishes to see it accepted amongst society as a necessary antidote to silent killers.
The link to a copy of the original article is here and here
People sometimes say that they feel blue or depressed. It s not something to be alarmed about; everybody has his moods once in a while. Such feelings can occur after losing your job, a loss of somebody dear to you, a setback or apparently without a reason. Usually these feelings dissolve after a while but with some people they persist. Their whole existence seems to be coloured by it. They don t want to be involved in things, they have no energy or sense of joy and their outlook on life seems black. People who are in this mood for more than two weeks can be clinically depressed and should consult a doctor or a psychologist.
According to the World Health Organization (WHO), depression will be the second most important medical disease worldwide by the year 2020. Depression has a high lifetime prevalence (about 16%) and at its worst can lead to suicide.
In Sri Lanka depression is a leading disease. According to the WHO in 2006 almost 400,000 Sri Lankans experienced a serious mental disorder. In some areas depression was reported as high as a quarter of the population. Suicide rates in Sri Lanka are among the highest in the world according to a WHO report in 2008 (conservative estimate: 24 per 100,000).
Not every depression is the same. They vary from mild to severe, from a few to many symptoms. The intensity of the symptoms differs a lot too. Some well known and important forms of depression are:
- Major depression. The two main symptoms are that people have a depressed mood and have no interest in activities for at least two weeks for most of the time almost every day. Furthermore they must have at least three more symptoms out of seven (for instance weight change, sleeping problems, thinking about death or suicide).
- Bipolar depression. Some people have periods with depression as with manic periods which are coloured by much activity and energy (hence the name bipolar, two poles).
- Post natal depression. About 10 20% of the women after giving birth develop a depression.
There is still a lot of uncertainty about the causes of depression. A few theories have been developed which until now haven t been completely proven (they are partly hypothetical). Nowadays researchers agree that the origins of depression are multicausal: there are biological, genetic, psycho-social and personality aspects. Each of them can contribute in some form as a factor.
The most important question is of course to determine what the best strategy is to overcome a depression. When someone is suffering from a severe depression (with strong suicidal tendencies) it is clear that medication should play a major role, at least in the first stage of the therapy. In the case of mild or moderate depression psychotherapy should be the preferred method. With mild depression even jogging (three times a week) can help. There is an abundance of research that shows that with mild or moderate depression psychotherapy (or even taking a placebo drug!) has the same or better results than medication. This said, while many anti-depressives have an impressive list of side effects. Some of those are even worse than the ailment they are supposed to cure. In Sri Lanka psychology seems to be rather unknown. It is often confused with counselling, which is only a (limited) form of psychotherapy. A psychologist deals with the whole range of disorders and methods or therapies, not only counselling. Most people in Sri Lanka when faced with a depression almost automatically end up taking prescribed medicine. Psychologists are trained to try to discover the causes of depression and to help the patient to overcome and deal with it. Medication (while it can have its use in severe cases) only suppresses the emotions and doesn t solve anything. This is one of the reasons why having therapy with a psychologist usually takes time, it is not a quick and superficial fix.
The link to the original article is here
In Sri Lanka depression is a leading disease. According to the World Health Organization (WHO) in 2006 almost 400,000 Sri Lankans experienced a serious mental disorder. In some areas depression was reported as high as a quarter of the population. The WHO reported in 2008 that suicide rates in Sri Lanka are among the highest in the world (conservative estimate: 24 per 100,000). Depression will be the second most important medical disease worldwide by the year 2020. It has a high lifetime prevalence (about 16%) and at its worst can lead to suicide.
Some well known and important forms of depression are:
- Major depression. The two main symptoms are that people have a depressed mood and have no interest in activities for at least two weeks for most of the time almost every day. Furthermore they must have at least three more symptoms out of seven (for instance weight change, sleeping problems, thinking about death or suicide).
- Bipolar depression. Some people have periods with depression as with manic periods which are coloured by much activity and energy (hence the name bipolar, two poles).
- Post natal depression. About 10 20% of the women after giving birth develop a depression.
Not every depression is the same. They vary from mild to severe, from a few to many symptoms. The intensity of the symptoms differs a lot too. There is a still lot of uncertainty about the causes of depression. A few theories have been developed which until now haven t been completely proven (they are partly hypothetical). Nowadays researchers agree that the origins of depression are multicausal: there are biological, genetic, psycho-social and personality aspects. Each of them can contribute in some form as a factor.
The most important question is of course to determine what the best strategy is to overcome a depression. When someone is suffering from a severe depression (with strong suicidal tendencies) it is clear that medication should play a major role, at least in the first stage of the therapy. In the case of mild or moderate depression psychotherapy should be the preferred method. With mild depression even jogging (three times a week) can help. There is an abundance of research that shows that with mild or moderate depression psychotherapy (or even taking a placebo drug!) has the same or better results than medication. This said, while many anti-depressives have an impressive list of side effects. Some of those are even worse than the ailment they are supposed to cure. In Sri Lanka psychology seems to be rather unknown. It is often confused with counselling, which is only a (limited) form of psychotherapy. A psychologist deals with the whole range of disorders and methods or therapies, not only counselling. Most people in Sri Lanka when faced with a depression almost automatically end up taking prescribed medicine. Medication (while it can have its use in severe cases) only suppresses the emotions and doesn t solve anything. Psychologists are trained to try to discover the causes of depression and to help the patient to overcome and deal with it.
Apparently psychotherapy seems to consist only of talking. But in reality it is all about FEELINGS. Usually at the start of a therapy emotions which are suppressed can contribute hugely to the existing problems. Regularly (once or twice a week) venting your feelings and speaking about your issues with a professional psychologist in a safe setting can significantly alleviate your burden.
Feelings of depression are in many cases symptoms of an underlying conflict. Usually these symptoms stem from feelings from the past which are still too painful to be felt. When you succeed in making the connection, then those old feelings (usually mixed with present ones) explain to you the cause of your present state. Finally you can start to feel the painful feelings from the past in full. The intensity of these painful feelings will diminish each time when you are triggered in the present by a representative of that old feeling.
Depression often has a double diversion trick. In the first place it focuses our attention to our self instead of towards those who have done us harm. Secondly the attention is placed on the present instead of the past where the cause of the pain lies. This double diversion trick works very well: we endlessly wander in the maze of depressed feelings constantly further away from the entrance. People around us often try to convince us with well meant advice: that you have to think positively, that life and yourself isn t worthless, that the glass is half full instead of half empty, that you have to do things that you like, and so on. This won t help you at all! Feelings and thoughts of depression aren t cured by well meant positive advice and they keep devastating our lives. It means that all the attention we give towards our own functioning in the present is in vain. The only way out of this gruesome maze is that we consciously release our attention from our own functioning and start looking for the repressed functioning of others in the past.
In therapy you will learn to become familiar with your personal depression history . You will recognize the causes, the triggers in the present that link to the causes and you will learn to get yourself out of your depressed state. Moreover, you learn to do this by yourself so that you will become independent of the therapist.
To conclude, the advantages of psychotherapy compared with medication seem obvious. There are no side-effects, you empower yourself to get out of your depressed state by your own, you get insight into your emotions, it s not a quick superficial fix and you are not dependent (or even addicted!) on medication to feel well.
The link to the original article is here
Recently psychologists have turned their attention on the best way how to make a decision. Why doesn t thinking really help us in making complicated choices? We ponder and ponder at the best choice for buying a house or making an important career decision. Making endless lists on pros and cons and having sleepless nights. We place the conscious mind on a pedestal and regard it as the crowning glory of evolution. We think it distinguishes us from other animals, it makes us sensible and rational and regard it as the foundation of our brain. We look upon our unconscious brain as the little helper of the conscious.
Nowadays there is much research that suggests that our unconscious might rule our conscious brain (with a processing capacity as 200,000 times bigger than the conscious mind). In a laboratory test situation participants had to make a certain decision. MRI scanning revealed that it s not the conscious decision that comes first but the brain activity needed to prepare the action: the unconscious. There are numerous experiments which show the supremacy of the unconscious on our opinions, on our behaviour, on the first impression we have, and on taking decisions.
Take for example priming . With priming certain knowledge is activated, for example in the form of a quality or a stereotype, without realizing it. When in an experiment subjects read words like aggressive, violent and mean, they subsequently regard persons as more aggressive than when they hadn t read those words. In another experiment subjects who were primed with words like insolent , acted more insolent than when they were primed with the word polite .
However, the effects of priming are short termed. With first impressions it is about categorizing people in stereotypes: good-bad, man-woman, young-old, Western-Eastern. On this basis we activate our stereotypes, without knowing that we pigeon-hole people. There might be some connection with the history of our species: our ancestors benefited with a quick assessment whether somebody had bad intentions or not.
Recent studies have shown that decisions taken after an unconscious thought process are often of better quality than those which are taken after a conscious thought process. There are difficult and easy decisions. Most people don t fret about the purchase of a dvd or a coconut scraper. The choice will become more difficult when you have to buy a house (many variables), when you have to make a difficult management decision or when you want to start a different career.
The general consent was that one has to think well and conscious before the purchase or decision was made. Accurately weigh the pros and cons and a satisfying result is guaranteed. But the conscious mind cannot handle all the different factors needed for a complicated decision process. So it chooses two or three, usually the ones easiest to phrase. But these are not necessary the most important ones, so it is not certain that the optimum decision is made. The unconscious mind has a much greater capacity and it can process all the needed aspects. It's better to collect all the information and think about it carefully. After that look for some distraction; do something you enjoy and sleep over it for a few nights. Put yourself on a deadline and let your unconscious mind decide. This usually gives good results.
The link to the original article is here
When people talk about abuse they usually mean sexual or physical abuse. While it is true that these two forms are very serious, there is another form of abuse which is less known but at least as severe. Emotional abuse is a form of abuse where a person treats another in a psychologically harmful way. It is a silencing attack on the self-esteem of a human being: in the end the victim feels so small that there is no talk-back possible.
Forms of emotional abuse are: rejection, humiliation, terrorizing, isolation, neglecting. There are no visible marks such as bruises, scars or welts. Although all these forms are without physical or sexual contact they can do serious damage to one s self esteem. Words that belittle, shame, accuse, threat or criticize in an unfair manner cause emotional damage. Neglecting or the withholding of love as a way to punish brings emotional damage too.
Usually emotional abuse appears in situations where power plays a role, such as in abusive relationships, bullying, child abuse and in working situations. It is used to control, demean, harm or punish a person. In marriage some tactics used by the male abuser are to isolate his wife from her friends and family, criticize her constantly, act overly jealous and possessive, control her money and make all the decisions in the family, intimidate and harass - even making use of the children.
Victims of emotional abuse regularly behave in a typical way: withdrawal into their shell in the presence of the perpetrator, depression, feelings of shame and guilt, taking responsibility for the behaviour of the perpetrator, push themselves to the limit in order to try to prevent repetition of the abuse. Very likely consequences of emotional abuse are some serious disorders like chronic depression, anxiety, chronic fear and post-traumatic stress disorder. It affects the immune system and it can influence the physical and mental health for years. Usually victims have difficulties with feeling their emotions.
With emotional abuse the way to recovery lies in starting to FEEL again. it is about feeling your justified anger. When you are aware that you are a victim of emotional abuse the best way is to start talking with a professional psychologist. You will get acknowledgement (it IS horrible) and identification (I belong to this group). The American psychotherapist Susan Forward has written several books about emotional abuse (for instance Men Who Hate Women and the Women Who Love Them and Toxic Parents ). The Swiss psychotherapist Alice Miller has written extensively on feeling your justified anger. On her website www.alice-miller.com (especially the reader s mail section) there is a treasure of material. Her books and website are about all kinds of abuse and above all how to overcome them.
When you are abused you can have two responses: be overwhelmed, victimized and sad, and suffer the whole impact; or you can remember that you have your resources and use them. One of the resources is your sense of injustice, and it gives you access to your anger; when you get angry you stop feeling depressed. This feeling of justified rage leads you to appropriate actions. It gets you out of your fear, shame, guilt and other immobilizing emotions. It doesn t mean physically attacking the perpetrator but standing up for yourself.
The link to the original article is here
This ironical title refers to questions I once in a while have to answer in my psychology practice. Clients sometimes pretend to come to talk about a different matter and then the real issue is asked, or they call me by phone to preserve their anonymity. Clients have indeed asked me if there are pills to cure them from homosexuality. I have to explain to them that you are born with a heterosexual or homosexual nature; there is no treatment for it.
In Sri Lanka there seems to be a big taboo on homosexuality. It isn t seriously talked about and as a consequence it is often regarded as shameful or even immoral. This said, in many countries homosexuality is seen as a fact of life and even in some countries homosexuals lawfully have the right to marry. Although it is difficult to get an accurate percentage (there are many methodological obstacles) researchers agree that the world wide prevalence of self-identified homosexuality is roughly 4%.
Nowadays researchers focus on biological explanations regarding why individuals have a heterosexual, bisexual, gay or lesbian orientation. Those explanations are chiefly based on genetic factors and prenatal exposure to hormonal influences in the foetal brain.
It was a big turning point when in 1973 the American Psychiatric Association (APA) removed homosexuality as being a disorder from the DSM (Diagnostic and Statistical Manual of Mental Disorders). They stated that homosexuality per se implies no impairment in judgment, stability, reliability, or general social or vocational capabilities. There is now a large body of research evidence that indicates that being gay, lesbian or bisexual is compatible with normal mental health and social adjustment.
The APA stated in 2006: Currently, there is no scientific consensus about the specific factors that cause an individual to become heterosexual, homosexual, or bisexual including possible biological, psychological, or social effects of the parents sexual orientation. However, the available evidence indicates that the vast majority of lesbian and gay adults were raised by heterosexual parents and the vast majority of children raised by lesbian and gay parents eventually grow up to be heterosexual .
The Royal College of Psychiatrics stated in 2007: Despite almost a century of psychoanalytic and psychological speculation, there is no substantive evidence to support the suggestion that the nature of parenting or early childhood experiences play any role in the formation of a person s fundamental heterosexual or homosexual orientation. It would appear that sexual orientation is biological in nature, determined by a complex interplay of genetic factors and the early uterine environment. Sexual orientation is therefore not a choice .
Returning to the question raised in the title of this article (homosexuality in Sri Lanka, taking pills or talking?) it is obvious that awareness and being able to talk freely about one s sexual identity should be the preferred answer. On the internet there is an abundance of information but very often there is a need for personal contact. In Sri Lanka, there seems to be a long way to go in informing the general public about these matters. That means transforming it from a taboo topic to establishing organizations with local offices where Sri Lankans openly can get advice and support.
The link to the original article is here
Addictions are in many forms, for instance to gambling, chatting, internet games, sex, shopping, work, substances. With addiction to substances there is a physical and a mental component. Physically it means that the human body has been accustomed to this substance and has adapted itself to the use of it. When the administration of that substance stops this causes withdrawal symptoms. Usually there is a built up of tolerance which means that to get the same effect of the addictive substance one has to increase the quantity. Being mentally addicted means that you have the idea that you can t do anything without using the substance, that you can t perform without it. A special category is addiction to certain medications like sleeping tablets and anxiety-reducing drugs (the so called benzodiazepines such as diazepam, oxazepam and alprazolam). Often prescriptions are used for many years to maintain the addiction and it becomes very difficult to stop.
Addictions help us to stop feeling what we would feel without them. By administration ourselves with a shot of our favourite addiction we don t feel the pain of for example emptiness or loneliness. Generally speaking we don t feel our unfulfilled needs (from the past), we anaesthetic them. When the endogen opiates (beta-endorphins) can t help us adequately with dealing with painful emotions we can try exogenous opiates like drugs, alcohol or cigarettes. The physical addiction is relatively easy to stop, contrarily to the mental addiction because addictions work twofold. They suppress painful emotions and at the same time create the illusion that we can get what we need . The object of our craving is after all available in the present! It is this illusion that persistently stimulates each addiction. But this high is only temporary, the longing for our needs from the past to be fulfilled stays. But no addiction whatsoever can do that. People who are addicted very often have a history of structural abuse (physical, emotional or sexual). As a consequence an addictive personality is formed.
The approach to deal with addictions isn t an easy one. Willpower won t work ( what you resist persists ); you can achieve a lot with willpower but your Monster (your compulsory side, your addiction) is much stronger than yourself. A punish and reward system doesn t work well either. What usually does work is to find out what you REALLY crave for or are afraid of. It is crucial to find out how you tick and what you want to do with your life. When you are addicted you usually have lost contact with your body and feelings. You not only have a mind with compulsory thoughts but you have also feelings which can tell you a lot about yourself. You ll get insight into yourself, in your pros and cons, in your behaviour, in your emotions. Practically it means: stopping with the addiction (if necessary in phases); each time when the need comes up try to feel this emotion in your body (not your thoughts) and focus on it; and lastly try to accept the pain when you feel that you will never get what you needed in the past. To succeed in all this you ll need a dedicated and professional therapist.
The link to the original article is here
In Sri Lanka many children have to deal with stress. Every now and then the subject is raised and attempts are made to tackle the symptoms of stress. While this might give short term relief, in the long term nothing is changed. For Sri Lankans the strong bond between parents and children seem normal. Undoubtedly this has a positive impact on children: for example they feel safer, they can rely on their parents and they respect them. The flipside of the coin is that children might depend too long on their parents for their own decision making (like school or university options, choice of a profession, relationships and so on). In addition to this there seems to be a reluctance to talk about issues with your child; often many things are just not talked about (for instance emotional problems like depression, drugs and alcohol, sexual preferences, and so on). While it is done in all probability out of love and caring for the child, overprotective, too restrictive or high demanding parents can cause much stress.
As long as the child s grades at school are adequate there seems to be nothing wrong. But at school or university there usually is a fierce competition which is enhanced by the school or university system. Children might feel easily compelled to perform for their parent s sake which can cause stress. Also group mechanisms like bullying or being left out are factors that contribute. International research shows that one out of five exam candidates is suffering from extreme stress. It gives them the feeling that they will perform less than in a normal situation. At the exam they suffer from trembling hands and legs, are unable to remember things and sometimes have a complete black out. A little stress keeps us alert and can improve a performance while too much stress prevents this.
Some useful pointers (short term solutions) for dealing with stress at an exam are:
- Try to be conservative and reasonable about the demands you place on yourself
- Visualize that you will perform well at the exam. Start for example five or six days before the actual exam at the same time as the exam will take place. Make it as realistic as possible. Watch yourself entering the class room, sit behind your desk and start taking the exam.
- Relaxation exercises such as focusing on your breathing or progressive muscle relaxation (Jacobson).
- Try to study effectively and efficiently in the weeks before the exam.
- Despite all the preparations and practice you might get nervous before the exam. Medications like tranquilizers and beta blockers aren t useful solutions because they reduce your creativity. A herbal pill can work too and has no side-effects. Bring such a pill to the exam in case you need it. Usually when you do have such a pill with you, in all probability you will not use it.
When the stress seems structural it is time to look for long term solutions. One of these can be to try to link the feelings of the present stress with similar feelings in your past. In time this can give you the opportunity to achieve a more balanced emotional life. To do this you ll need the help of a professional psychologist.
The link to the original article is here
Anxiety is a feeling that occurs when there is fear of an imminent danger. When there is no real cause for this fear and the person experiences social or professional problems because of it, we speak of a disorder. In psychiatry, anxiety disorders have the highest prevalence among all diseases. Some well known anxiety disorders are:
- Generalized anxiety disorder. A long-lasting chronic anxiety which is difficult to control. The patient suffers from overly concern and fear where the frequency, intensity and duration of the worries are in no proportion to their real source. It is the most common anxiety disorder, especially with older people.
- Social anxiety disorder. People who suffer from this type of anxiety have a fear of speaking in public, going to parties, attending meetings and so on. As a result from the huge fear of rejection and criticism they can get isolated. There is no gender difference in the prevalence of social phobia.
- Obsessive compulsive disorder (OCD). The name of this disorder stems from obsessive thoughts and compulsive movements. The thoughts can t be controlled but the person is aware of them (unlike delusions). The movements (or rituals) are repetitive and are used to neutralize the anxiety which is incited by the obsessive thoughts. Examples are repetitive hand washing, aversion to odd numbers, opening a door a certain number of times before one enters a room.
- Agoraphobia. If you have this kind of fear, then you are likely to avoid crowded places such as city squares, shopping malls and movie theatres. Generally speaking agoraphobia is the fear to leave a safe and comfortable environment. In severe cases people might only feel safe at home.
For treatment the preferred method is psychotherapy. In some selected cases (like panic attacks) this can be combined with (short term!) medication. In Sri Lanka, possibly because of a lack of psychologists, as a rule medication seems to be the only available option. This said, while medication only suppresses the emotions and doesn t solve anything. Besides that, there is danger of dependency and possible side-effects. Psychotherapy looks for causes and real solutions; it is not a quick and superficial fix.
As always it is essential to see the patient in whole. Listen to his story, not only to the symptoms. Each person is different. In my professional experience, people with an anxiety disorder have reasons to feel anxious. Usually the fear is the expression of a complex hurtful past and often combined with depression. It is about FEELINGS of anxiety, and how to overcome them. In therapy the essence should be to look for the tale behind the anxiety. Each fear tells an enciphered but real story. You re suffering from your survival mechanism that points you to the wrong path by directing your attention to the present, instead of your past where the cause of the danger lies. In therapy you ll be learning to face your original feelings and the hurt that accompanies them. Anxiety is like a lady clad in brightly red. Don t send her away out of fear of the colour but try to listen to her story. Only then it is possible to find emotional balance.
The link to the original article is here
Self-harm or self-mutilation can consist of any form of trying to hurt oneself. For instance cutting, scratching, burning, banging or hitting. There are no exact figures of the prevalence of self-harm, but researchers estimate that between 1 and 5% of the population is engaged in it. Many people are successful in hiding their injuries out of shame and fear. Very often there is a lack of understanding from family and social workers. The latest research found a huge increase in self-harm with young people but no different gender rates. This said, it is known that men often engage in different forms of self-harm (predominantly hitting themselves) than women (predominantly cutting themselves).
Cutting is a form of self-harm which typically occurs with young women (teenagers). The reasons vary but usually it is an expression of unbearable feelings. When you feel so much emotional pain and you can t cope with that, then the transformation into physical pain is a way to make those feelings more manageable. Some teenagers with problems become agitated and aggressive or start drinking and smoking joints. Others, usually the more introvert types, try to convert the pain within by harming themselves. They bang their heads against the wall, pull out their hairs or start to cut themselves. Many people who harm themselves have had painful experiences in the past which gave them strong feelings of fear, pain, guilt, anger or helplessness. Simultaneously they felt that they couldn t talk about it to anybody or that they were misunderstood. These experiences could have been associated with violence, abuse (emotional, physical or sexual), neglect, humiliation or the loss of important persons. Because of this, a lack of self-esteem is formed and it becomes difficult to express their feelings, especially with others. Loneliness starts to creep in although there might be a wide circle of acquaintances. Usually the unresolved feelings of pain, distress or anger stay hidden behind a happy and seemingly unbothered exterior. The painful experiences might be over but still one has the feeling of living on a time bomb. When this becomes unbearable it can cause self-harm like cutting to relieve that pain.
When confronted with this kind of behaviour parents should try to listen to their child. Don t get scared, angry or just talk but really try to LISTEN. Parents might think one thing but for teenagers it might be something completely else. When your child trusts you enough she will open up and tell her story. If necessary, parents should look for psychological help.
When in therapy the whole personality should be taken into account and not only a symptom like cutting. It can take many months before the child takes herself more seriously, regains her self confidence and learns healthier coping mechanisms. Finding alternative methods of coping with the feelings of anxiety or stress or "numbness" is often a good start towards recovery. That can be exercising, painting or writing instead of hurting oneself. But the real change has to come from within. That means that the teenager understands that she has every reason to feel angry and hurt. That she starts to understand why she feels guilty, ashamed or powerless. That she can cry and feel her hurt and that the feeling of hurt will slowly ebb away. That she has the right to exist and be herself.
The link to the original article is here
Eating disorders are serious diseases. The physical and social consequences are huge and the longer the eating disorder exists the longer the way to recovery. An eating disorder is an extremely unhealthy obsession with food and weight. It is most likely to affect young adolescent women. Approximately 90% of all people with anorexia or bulimia are female. There are three main eating disorders:
- Anorexia (nervosa). Anorexia is a condition that goes beyond out-of-control dieting. A person with anorexia is determined to suppress her appetite. They are addicted to dieting, often accompanied by excessive exercising, and continue with it even when they look starved and skinny because of their distorted body image. They are in denial and try to hide their eating behaviour and the consequences, out of fear of pressure from others to gain weight.
- Bulimia (nervosa). Bulimia is characterized by out of control recurrent binge eating, followed by self-induced vomiting, purging or excessive exercising. These behaviours compensate the food intake and prevent weight gain. The period of binge eating is not related to intense hunger but more a response to issues as depression, stress or lack of self esteem. Unlike anorexia, people with bulimia don t starve themselves and usually maintain a more or less normal weight.
- Binge eating disorder (BED). Binge eating is the most common but least known eating disorder. People with BED typically suffer from rapid weight gain and out of control eating binges, but unlike bulimia they don t vomit, purge or exercise excessively. Usually underlying emotions play a role such as stress, hurt, anger or the need for comforting. Contrasting to anorexia and bulimia, BED is not a predominantly women s disease , although it is twice as common among women as among men.
The causes of eating disorders are diverse; there is no one single explanation. It is usually a combination of factors where the contribution of each factor can differ with each patient. Possible causes are our culture s idealization of thinness which can trigger constant dieting habits, family traits, traumatic events, psychological factors (low self esteem, emotional issues) and genetic predispositions.
Treatment of eating disorders is difficult and usually takes a long time. First step is to admit that you have a problem; this alone can be difficult because of the ingrained beliefs about weight, food and body image. Psychotherapy can only start when patients are in a reasonable physical condition. Severe undernourishment can be life threatening and causes dissociation from feelings. This is important because people with eating disorders use food to deal with uncomfortable or painful emotions. When in therapy the quality of the relationship between the therapist and patient is crucial, there has to be trust. A good therapist always focuses on the deeper psychological issues behind the outward eating behaviour. The essence is the confrontation with the original hurtful emotions which led to the eating disorder.
The link to the original article is here
In my psychology practice I give much so called marriage counselling. When couples want this kind of counselling it is convenient for them to look for a psychologist. A psychologist does counselling but is also trained to be aware of possible deeper lying issues which might be at play. In addition he is qualified to give different kinds of therapy on the spot so that the couple can stay with the same therapist.
The first years in a marriage are usually relatively cloudless. But after some time the initial feelings of bliss and happiness can become less or even disappear and the marriage can lose its glow. Nobody likes to go to marriage counselling. Many couples only chose a counsellor when there have been countless fights and they see no other way out than to bring in a third party. It s much better to look for help in an earlier phase and try to discuss matters with an objective counsellor. It s important that both spouses have a good feeling about this person; only then there is a chance that their marriage will improve.
In my professional experience, in Sri Lanka it are usually the women who want counselling, the men more often than not have to be convinced of its usefulness. This seems to be culturally defined because of the typical (Asian) gender roles. Generally speaking boys are raised like little princes and are geared for studies or vocational jobs. Girls usually have to apply themselves to the domestic chores and while they can do their studies, marriage seems to be the primary goal. As a consequence Sri Lanka appears to be a male dominated society where many women feel second best. Men often take their marriage, their role in it and their spouse for granted. This pattern predominantly occurs with the 35 plus generation; the younger age group seems to be more open to different views.
In brief, men and women are wired in a different way. The causes stem from nature and nurture. It is not surprising then that they often have trouble in understanding each other. In Sri Lanka this is enhanced because of the schooling system where most of the children attend boys or girls schools, so there is little opportunity to get familiar with the opposite sex in a natural way.
In counselling/therapy I often get questions like how to regain trust with each other after an affair, the empty nest syndrome, the relationship with in-laws, what does my wife/husband really wants, how to rekindle passion, how to deal with nagging and blaming each other, relationships at work, women who feel they try to please too much, etc, etc. Sometimes I feel that before couples get married, they should take a relationship test to determine whether they really make a good fit!
As I am Dutch (known for their common sense), here are some down to earth tips for preserving your marriage. Try to understand your spouse, what makes her/him tick. When you communicate try to practise the art of listening. Make an effort to talk about issues and express your feelings. Above all, affection, hugs and romantic gestures are what people usually want in a relationship. These are safe signals ; they signify that your spouse cares about you. Nowadays many people are very busy with work, children and housekeeping. Try to make time for each other for hugging, cosy nights at home, good conversations, eating out, taking a walk, (even cleaning the house together!), give a little present to your spouse, breakfast on bed, going to a concert, film or play, make a day trip or for a weekend. These little ways of giving attention do wonders in a marriage.
The link to the original article is here
The diagnosis breast cancer and the following treatment have major consequences for the patient and her family. The feelings you experience when you hear from your doctor that you have cancer are indescribable. Shock, disbelief, denial, anger, fear are just meagre words. These are normal reactions after hearing such a devastating diagnosis. During treatment many women experience serious impairment in physical, emotional, social and spiritual sense. But simultaneously the emphasis is on the disease and the medical treatments. There is no time to grieve and come to terms with your raw emotions.
For a lot of women the period after the treatment is felt as very difficult, almost like a black hole . They might miss the habitual medical consultations and the contact with the familiar specialist. People expect from you to get on with your life but most women have to deal with their traumatic emotions and need more time for that. Besides this, more often than not there are problems communicating about the disease with their husband, children, family and friends. How do you tell people that you have breast cancer? There might be fear for their reactions, or you don t want to burden them with it. But it has to be told! Because only then it becomes real and less threatening. The best way to deal with this is to follow your intuition. It all depends on your personality; you ll find a way to tell it which suits you best. To tell people that you have breast cancer and what it means for you is a therapeutic healthy way to cope with it. It can also deepen friendships and relationships.
Don t get frightened when your husband has a different reaction than you expected. There are perfect men who are loving, understanding and comforting. But there are also men who are different: in denial, selfish, cold. It could be just his way of trying to deal with the situation. Try to tell him how you feel and try to show your vulnerability. To talk about your and his feelings is the best way to accomplish a sense of togetherness. For your children, you are the world. It is almost impossible to tell them. The only way is to be very tender and careful, and above all very open and honest. Take plenty of time and give it much attention. Continue to talk with your child every day. Watch its reactions, listen and be protective. Notify the school so the teachers are aware of the situation and your child s possible reactions. For family and friends it has everything to do with the quality of the relationship you have with them. Again, follow your intuition. You chose the way how to tell it, it will depend on the particular person. With a close family member or friend you will sometimes find that at first you are comforting them. They can be so afraid to miss you and they can have trouble to see you suffering. Do comfort them but don t pretend be strong, remember it is you who is sick. With more distant relatives and friends you might decide not to tell or only to one person who can inform others. It s difficult to estimate how people will react. Some will turn out to be real friends and support you in a warm and significant way. Others will drop out. Don t blame yourself when they do, it s not your fault. They might be afraid of sickness or death. Try to use your energy in a positive way and enjoy the company of the people who are there for you. They are gold in this difficult part of your life and give you practical and mental support. You will never be alone with such friends, accept it as a gift.
After some time your life will become normal again. But it will never be as it was before. After the operation and treatments you have got a life back. It s different; you have been through much agony, pain and hurt. You have been touched by the realization that life has an ending. That makes that you experience life differently, perhaps more intense, worthwhile and conscious. You might even feel thankful to be able to continue your life, in a meaningful way and smelling, seeing, sensing, hearing and tasting more than ever before.
Breast cancer and the accompanying treatments can have a huge impact on intimacy and on your sex life. As a consequence women might have less liking for sex. The changes to the breast(s) or amputation play a significant role. For many women breasts are a part of their femininity. They are important for sex and intimacy with their husband. Having breast cancer causes it to be emotionally charged. There is a lot more to be said about this but that might be something for another column in the future.
It is paramount that there should be support groups and self help groups in Sri Lanka. Sadly, in this society breast cancer isn t a topic that is much talked about openly. On the internet there are groups but they are usually initiated by women from the West. What Sri Lanka needs are actual groups where women can meet and talk with each other (after the treatment phase) about their experiences.
The link to the original article is here
Bullying at school (children) or at the work place (adults) is a serious problem. It is a universal, non-cultural defined phenomenon. Research has shown that the prevalence and manifestation of bullying in the West and East is almost similar. It can be verbal, physical or electronic (this so called cyber bullying by computer or mobile phone has increased significantly). Men, children, and people with a lower education usually bully in a more physical manner. Women, adults and higher educated people usually use verbal forms which can be even more damaging.
With children bullying is poignant and distressing. When one speaks with a child that is bullied your heart sinks. The loneliness, the hurt, seeing a little human being in this state is heart-rending. For parents it s upsetting too because it is hard to find adequate help. International studies state that in primary schools one out of four children say that they are sometimes bullied (and 4% say that it happens several times a week). In secondary schools 7% of the students are bullied.
There is a difference between teasing and bullying. Some teachers and parents are not able to perceive that. With teasing both parties are more or less equal and it is usually in a one to one situation. The teasing is mutual and both sides are assertive enough to speak up for themselves. With bullying there is no equivalence or balance of power. The bullying is often not one to one but with a group against one (or a few). The victim can t defend himself/herself and is always targeted. Very often he/she can t or daren t hit back or give an effective talk back. Teasing stops after a while but bullying continues persistently.
With bullying one usually thinks of the bully and the victim. But each student in class has a role in this process. Some of them are the co-bully (wants to fit in, is usually insecure), the helper (takes a stand for the victim, is not afraid of the bully, is usually popular), the silent one (stays out, disapproves of the bullying but is too frightened to speak out), the sneaky one (approves the bullying but doesn t take part, is afraid to be bullied himself, calls in others to support the bullying).
The consequences of being bullied for some time can be severe. The victim doesn t know when the next harassment will come. He/she is often eight hours a day, five days a week busy with the mental preparation for the next attack. In the long term it can cause an inferiority complex, anxiety, chronic fear and insecurity, depression, loneliness, post-traumatic stress disorder and even suicide. It can influence the mental and physical health for years. At school it affects the group because of the threatening and unsafe atmosphere. Children are anxious and there is distrust; as a consequence they are less open and spontaneous. At home it affects the family (parents and siblings) of the victim too.
To stop bullying it is important that the child should speak to the parents or a (school) counsellor. As a parent you should take your child seriously. Give it support and understanding (and don t condemn by saying you should stand up for yourself ). Children find it difficult to tell that they are being bullied. Ask and try to listen, let your child tell its story. Discuss together with your child what he/she can do to get out of this situation and only take action after you have talked about it. Contacting the parents of the bully is a possibility but very often they take their own child s side. Talk with the teacher and ask what can be done at school. Don t blame the school but discuss the responsibilities of the school and try to find a solution with each other.
One solution is to teach (in a loving way) your child to be more assertive. Martial arts are a possibility but that is usually in a group with again the risk of bullying. A practical course to deal with bullying should contain three central themes: assertive body language, adequate reaction against bullying and self confidence. Children must learn to improve their posture, charisma, tone of voice and use of words, be able to say no and express their own opinion, to participate and work with each other. But above all a child should have an understanding and caring parent or counsellor. Such a person can teach the above mentioned qualities in the family or in a special group.
Cyber bullying is a new phenomenon. For parents the internet might be unknown territory, so it pays off to begin to learn about the digital world of your child. Start chatting, MSN, surfing, searching and downloading yourself. Install a good quality virus scanner and firewall. Read relevant literature about the internet, special filter software and what teenagers usually do there.
For children up to 13 you should put the computer in a visible place to enable you to monitor and help out when something happens. Talk with your child about the internet. Tell about your own experiences and ask your child what they do and enjoy most. When you know about the internet and you show interest, your child will confide in you when needed. Make an agreement with your child about the do s and don ts on the internet and place it next to the computer. Teach your child that it never gives personal information on the internet (use an alias and don t leave names, addresses, phone numbers and the like). Be there when your child joins a website. Check this site and see what it is all about.
When your child is the victim of cyber bullying here are some tips. Ignore hate mails. When you don t response the bully will stop. Block the sender of the mail or MSN. When something uncomfortable happens in a chat just leave it (or log in with a different nickname). Don t take it personal when somebody insults you. You probably don t know that person and when you do, remember that children often say something out of boredom. But when the bullying continues talk it over with your parent or teacher. Save all the material because it is evidence and it can be useful for solving the problem.
It is very important that your child talks about it and doesn t feel guilty. Cyber bullying is annoying but it can be stopped and in many instances the perpetrator can be traced.
The link to the original article is here
Dr. Marcel de Roos, a psychologist (PhD) from the Netherlands shares his thoughts on psychological dilemmas that most often than not get conveniently pushed under the carpet, in a conservative society which rarely extends its hand to support the sufferers except sympathize or shun them for their plight. In an informative Q and A he talks of the role of Sri Lankan women and their aching hearts which is camouflaged with warm smiles, gender differences, physiological disorders that get very little attention and how to deal with issues affecting women.
Q: Dr. de Roos, do tell our readers a bit about yourself and your family and why you decided to settle down here in Sri Lanka?
A: I m married to my Sri Lankan wife Jennifer and we have two sons who study abroad. We plan to stay here for many years to come. My reason for coming to Sri Lanka was of course to live with Jennifer. We chose Sri Lanka because of the food (I love the spicy food here!), the people (very friendly and open) and the climate (obvious!). In Sri Lanka psychology seems to be rather unknown. It is often confused with counseling, which is only a (limited) form of psychotherapy. A psychologist deals with the whole range of disorders and methods or therapies, not only counseling. In Holland I had a general practice where I treated all kinds of disorders in adults and children, from various social backgrounds. My patient population was varied, but the majority consisted of women. Relationship issues, work related ones, anxiety and depression were the most commonly asked questions.
Q: Whom does your practice cater to?
A: Here in Sri Lanka I have a general practice in psychology. I work with adults dealing with depression, stress, anxiety, social issues, etc and with children on issues like study related problems and social issues. About 2/3 of my patients are women.
Q: What can one expect when they come for a therapy session with you?
A: Having therapy consists of nothing more than talking. It's venting your feelings and talking about your issues with the help of an understanding professional therapist. With time, the impact of the emotions will become less and patients will feel a sense of balance in their personal life. Much of the success depends on the relationship between the patient and the therapist.
Q: When dealing with the subject of women, what are the most commonly discussed issues?
A: What I hear in my practice are in many cases relationship issues. They range from troubled marriages to abuse in any form, be it emotional, sexual or physical. Loneliness, depression, anxiety and traumatic past experiences are also what I commonly deal with. On the subject of children, I deal with issues like stress at schools, the inability to find their passion in studies, teenagers cutting themselves, problems with their parents, bullying and so on.
Q: You ve shown special interest in gender differences affecting women, how grave is the problem here in Sri Lanka? Physiologically how does it affect a woman s well- being?
A: On the surface Sri Lanka looks like a friendly place to be. The beauty of the island is often breathtaking and natural resources are plentiful. In tropical countries people come across as warmer by nature and smile a lot more than those living in cold Northern Europe. Behind the typical Sri Lankan smile a different world often seems to be hidden: the country appears to be a very male oriented society where most women take second place.
For example role patterns seem to be ingrained into children from a very young age on. Sons are often treated favourably and domestic chores are reserved for the daughters. Boys are groomed for a study or a vocational job while girls often are solely prepared for marriage. It s hard for women to get equal rights at work. There are few men who take an active part in the upbringing of children. All this can lead to feelings of stress, depression and anxiety.
From what I ve seen and heard so far, this attitude seems a normal way of life in Sri Lanka. The younger generation however, seem to be more open minded.
Q: Where do you think that the problem stems from?
A: I believe the problem is culturally defined. Not only in Sri Lanka, but in the whole of Asia this is an issue which is passed down from generation to generation.
Q: How should we try to change this pattern which has existed for years?
A: Education at schools is paramount. Also role models and the media can contribute. Awareness through articles in papers and magazines will make a huge difference. It will be a slow process though; cultural changes usually are slow.
Q: How should the women deal with these issues that affect their well being?
A: Awareness is crucial. Talk about it with friends. Try to learn from each other s experiences. And again, bringing it in the media can reach a greater public.
Q: How do you create awareness about these issues, apart from helping them through your therapy sessions?
A: In my own modest way I try to talk about this and other issues with women who visit my practice plus I write articles in a weekend paper.
Dr.de Roos requests LW readers to contribute to this topic and put forward their own experiences about other psychological matters affecting the general well being of society. Readers are welcome to send their questions to: marcel.deroos@yahoo.com
The use of antidepressants has increased enormously with the availability of modern medicine such as fluoxetine (Prozac) and paroxetine (Seroxat). They belong to the group of so called SSRIs (Selective Serotonin Reuptake Inhibitors). Especially the assumption (actively promoted by the pharmaceutical industry), that these modern antidepressants are safe and have less side-effects than the older generation drugs, have made doctors prescribe them generously.
For a relative small group of severe depressed patients, antidepressant (older and newer generation) drugs are a true blessing. Without them they could not have a more or less functional and regular life. But to be effective they have to be combined with psychotherapy. However, psychiatrists and general practitioners are busy people and as a consequence they usually lack the time. Besides this, adequately managing a patient with depression isn t easy and is time consuming.
For the majority of the patients with a depression theirs is a light or moderate one. There is an abundance of research evidence (see below) that for this large group of patients, placebo pills or psychotherapy does a better job when compared with antidepressants, and with no chance of possible (serious) side-effects. Nevertheless, for pharmaceutical industries their biggest sales are within this mild and moderate group of depressed patients.
The working of the SRRIs is based upon the theory that depressed people suffer from an inadequate amount of serotonin. This so-called neurotransmitter is used in the brain to transmit signals between neurons. SSRIs are said to work by preventing the reuptake of serotonin by the nerve cell that released it, thus forcing the serotonin to remain actively working. But there is no hard evidence to support this popular concept.
The basics are that in the 1950s scientists discovered that a drug called iproniazid seemed to help some people with depression. Simply formulated, this drug increases brain levels of serotonin. This correlation does not mean that there is proof that low levels of this neurotransmitter can cause depression. For more than 50 years this chemical-imbalance theory of depression is based upon this. Direct evidence doesn't exist. For instance when healthy people's serotonin levels are lowered, it does not change their mood. This is strange because the chemical-imbalance theory suggests this. There is even an effective antidepressant called tianeptine that LOWERS the level of serotonin. This raises the question why depression can equally be affected by drugs that increase levels of serotonin and by drugs that decrease it.
Research financed by pharmaceutical industries very often has a specific design that is tailor-made to give an effect. But that said effect is almost totally explainable by the design. The majority of studies to the effectiveness of antidepressants is financed by the manufacturers. In this research the focus is on small improvements within a specially selected group of depressed people.
The National Institutes of Mental Health (NIMH) in the USA in 2006 enabled a research on the effectiveness of antidepressants with real people who sought treatment with real psychiatrists and real general practitioners (American Journal of Psychiatry 2006; 163:28-40).The results were shocking: with 70% of the people treatment with antidepressants fails. The real world differs a lot from an experimental setting. From the patient s side there is impatience with results, fear of addiction, and experienced side-effects (in the 15 largest studies about antidepressants 59% of the users experienced side-effects). Managing a depression in an effective way from the point of view of a psychiatrist takes a lot of time and work. It s about assessing the improvement of the treatment, assessing the (different) medication, assessing the psychotherapy. It s not just writing out the same prescription in each control consultation (Lancet 2006; 367:2041).
Several other independent studies (which were also not financed by pharmaceuticals) about antidepressants give an equal distressing picture: (2008) N Engl J Med 358:252-260; (2008) PLoS Med 5:e45; (2010) JAMA 303:47-53. These studies for instance also include unpublished research where the outcome was not favourable for antidepressants. The researchers invoked the Freedom of Information Act to obtain access to the Food and Drug Administration database of studies used in the initial approval for the most popular antidepressants. It contains all of the data from initial trials. Meta-analyses about pharmaceutical financed research show that the effect of SSRI s in scientific experiments is not much different from placebo drugs. Other meta-analyses show that with mild or moderate depression there is no improvement, the only effect is with severe depression. But subsequent analysis showed that the apparent clinical effectiveness of the antidepressants among these most severely depressed patients reflected a decreased responsiveness to placebo rather than an increased responsiveness to antidepressants
SSRIs have been presented as better drugs than their predecessors. This has not been confirmed in research: they are no more effective than the older generation and have no less side-effects (although these effects differ slightly in incidence). The most common side-effects of SSRIs in the first two till four weeks are: dry mouth, nausea, anxiety, strange feelings, diarrhea, disturbed sleeping pattern.
Common longterm side-effects which affects the quality of life in a serious way are weight gain (usually in the range of 5 25 kg) and sexual dysfunctions (not a pleasant thing when you are already depressed). The latter consists of loss of sexual drive, failure to reach orgasm and erectile dysfunction. Difficulty in tolerating these (short and long-term) side-effects is the most common reason for discontinuing antidepressants.
There is a risk of addiction. About 30% of the patients who take SSRIs develop an addiction to the drug. It seems conceivable that the group of patients who formerly were addicted to tranquillizers (benzodiazepines like diazepam) are now addicted to SSRIs. This group typically consists of patients that doctors perceive as time consuming and difficult .
For all SSRIs the Food and Drug Administration in the USA requires a so called Black Box warning. It states that they double suicidal rates (from 2 in 1,000 to 4 in 1,000) in children and adolescents. For adults up to 25 there is an increased risk for suicidal behaviour and suicide. Doctors who do prescribe these pills to children need extra training (parents can also read the accompanying instructions for use). Children don t need pills but a good therapist who talks with them and monitors the family.
Poisoning by antidepressants happens regularly by means of excessive intake; either by accident or as a suicide attempt. Among children 50% of the deadly medication poisonings is caused by antidepressants. Usually it s about swallowing tablets without knowing what they are.
Less common possible side-effects are bone fractures, an increased risk of strokes and cardio-vascular death, an increased risk of suicide for adults (because the patient becomes more active but the mood improvement occurs later), serotonin syndrome (a potentially life-threatening adverse drug reaction), increased aggression.
The chemical-imbalance theory turns out to be just a marketing concept of the pharmaceutical industry; there is no scientific medical proof. For some unknown reason antidepressants can have an effect with patients who suffer from a severe depression; with a mild or moderate depression prescription of these drugs is of no use at all. Psychotherapy is the most effective treatment because it focuses on causes and not on symptoms. In Sri Lanka when one is depressed and visits a doctor one usually leaves the room with a prescription for antidepressants. Other possible solutions are rarely mentioned or not at all. Of course the safety of these drugs is relatively good when you take into account the number of patients that have taken them. But there is a quite large group of patients that DO have problems because of these drugs. It could be you or your child. If you have any doubts or are suffering from a mild or moderate depression you should be critical and think along with your doctor. Knowing Sri Lankan society this could turn out to prove difficult but ultimately it s your own responsibility for yourself and your family.
The link to the original article is here
An interesting link is here. It is an episode of the renowned CBS "60 minutes" program about the placebo effect of antidepressants. Another recent "60 minutes" link which refutes the "chemical imbalance" theory is: here.
A critical article in The New Yorker about antidepressants is here.
Dr. Peter Breggin (a well known American psychiatrist) talks about his views on "chemical imbalance" here, and about how psychiatric drugs really work here. His testimony at the Veterans Affairs Committee on "Antidepressant-Induced Suicide, Violence and Mania" is here. A paper of Dr. Peter Breggin on Psychiatric Drug Adverse Reactions (Side Effects) and Medication Spellbinding is here.
Dr. Marcel de Roos, continues his informative discussion on depression this month, enlightening LW readers about depression, why if affects twice as much women than men and the theories behind his growing phenomenon for which the exact causes are unknown.
Q: Dr. de Roos can you tell us something about the theories why women are more affected by depression than men?
A: There are predominantly three clusters of explanations: biological, social and psychological. A biological explanation is that mood swings are caused by hormones. Depression is linked with hormonal changes in the menstrual cycle, pregnancy, post natal period, miscarriage and menopause.
Social differences between women and men can partly explain this difference too. Generally speaking women have a lower social economical status than men. People with a lower status are prone to have a bigger chance to become depressed. Besides this, for women who work, the combination of work, doing the household and taking care of the children can cause a lot of stress.
Psychological explanations which contribute to the development of depression are for example that usually women are less assertive, feel habitually more guilty and they more often than not have a habit to please. Certain phases in life can cause depression too: when the children have moved out of the house or when women start to take care of the parents or in-laws. Abuse (sexual, physical or emotional) can cause feelings of worthlessness and ultimately depression.
Q: Why does depression have a negative effect on our general well- being?
A: Feelings of depression are in many cases symptoms of an underlying conflict. Usually these symptoms stem from feelings from the past which are still too painful to be felt. When you succeed in making the connection, then those old feelings (usually mixed with present ones) explain to you the cause of your present state. Finally you can start to feel the painful feelings from the past in full. The intensity of these painful feelings will diminish each time when you are triggered in the present by a representative of that old feeling.
Depression often has a double diversion trick. In the first place it focuses our attention to our self instead of towards those who have done us harm. Secondly the attention is placed on the present instead of the past where the cause of the pain lies. This double diversion trick works very well: we endlessly wander in the maze of depressed feelings constantly further away from the entrance. People around us often try to convince us with well meant advice: that you have to think positively, that life and yourself isn t worthless, that the glass is half full instead of half empty, that you have to do things that you like, and so on. This won t help you at all! Feelings and thoughts of depression aren t cured by well meant positive advice and they keep devastating our lives. It means that all the attention we give towards our own functioning in the present is in vain. The only way out of this gruesome maze is that we consciously release our attention from our own functioning and start looking for the repressed functioning of others in the past.
Q: How does treatment help a sufferer of depression?
A: Treatment of depression can be psychological, medical or a combination. In the case of mild or moderate depression psychotherapy should be the preferred method (medical research is very clear about this). With a severe depression a combination of medication and psychotherapy works best.
In therapy you will learn to become familiar with your personal depression history . You will recognize the causes, the triggers in the present that link to the causes and you will learn to get yourself out of your depressed state. Moreover, you learn to do this by yourself so that you will become independent of the therapist.
Dr.de Roos requests LW readers to contribute to this topic and put forward their own experiences about other psychological matters affecting the general well being of society. Readers are welcome to send their questions to: marcel.deroos@yahoo.com. For more information about Dr. de Roos please visit his website www.marcelderoos.com
Of all the drugs available in Sri Lanka alcohol is still the one most frequently used. It is socially accepted, easily available, comes in many forms and tastes and is affordable for most people. To many users its effects are seen as pleasant: it relaxes, inhibits and is usually stimulating.
Dependency on alcohol is a slow and gradual process. One has to go through several phases before one is addicted.
- Social drinking. A social drinker takes a glass of alcohol for social fun and because he/she likes it. Generally speaking the amounts of alcohol are not that high and drinking isn t a daily routine.
- Habitual drinking. Drinking occurs on most days of the week with a couple of glasses. For example at the end of the day after work to relax. The social context has disappeared and the only consumed drink is alcohol. In this phase the habitual drinker or his/her surroundings finds no problems with the regular use of alcohol.
- Problem drinking. A problem drinker drinks alcohol every day and needs the drink to feel good. It can be an escape from the daily tensions or problems, but actually it is a flight from reality. Because of the excessive alcohol intake chances are great that there will be physical, social and/or psychological problems. A special form is the so called binge drinking: episodic excessive drinking. This binge drinking can cause severe health risks. Most problem drinkers try to hide their drinking problem from the outside world. Withdrawal symptoms like trembling hands and anxiety start to occur. The tolerance for alcohol has built up which means that to get the same effect one has to increase the quantity.
- Alcoholism. In this last phase the user is addicted to alcohol. Basically his/her life is controlled by drinking. Very often drinking starts in the morning and is continued throughout the day. In this phase there is a severe physical and a psychological addiction. The withdrawal symptoms become intensified and there is a real craving for alcohol. The alcoholic starts to neglect him/herself. Long term alcohol abuse can cause a number of physical and psychological symptoms like cirrhosis of the liver, alcoholic dementia, Korsakoff syndrome, depression and so on.
Anxiety and depression disorders are the most prevalent psychological symptoms associated with alcohol. These symptoms typically initially worsen during alcohol withdrawal, but usually disappear with continued abstinence.
The most important element in the treatment of alcohol addiction is that the user learns to be responsible for his/her addiction. Usually this takes some time for the problem drinkers; for the alcoholics it takes a long time. The physical dependence can relatively easy be dealt with (the so called detox). The psychological dependence is much tougher to handle. In psychotherapy one learns the personal addiction history and to recognise the trigger moments in the present which can activate emotional issues from the past. Alternative options to deal with those emotional issues are discussed. Other important topics to enhance the quality of life are building up your self-esteem, how to cope with worrying, being able to deal with temptations and setting realistic personal goals. It is also important to change the lifestyle. Starting to exercise three times a week and eating a healthy diet are the basics. Ultimately it s about reinventing your life, giving meaning to your life and changing your outlook upon your life.
The link to the original article is here
Every human being has to cope with loss in his or her life. Grief is a natural reaction to loss; it s the emotional suffering you feel when something or someone you love is taken away. The passing away of a beloved person causes grief but also a broken marriage or friendship, declining health, the death of a pet or losing one s job are experiences where people feel sorrow.
Human grief is normal, it s NOT a mental illness such as proposed in the coming DSM V (Diagnostic and Statistical Manual of Mental Disorders, 5th edition), the influential bible of psychiatrists. Dr. Allen Frances, a renowned American psychiatrist who chaired the task force that wrote the current 4th edition of the DSM, is very concerned about this. He fears that the proposal would label a normal human emotion as a mental disorder and could bring on even wider pushing of so called mood-stabilizing pills with all the dire consequences. Dr. Allen Frances has a blog in The Huffington Post; the link is here
The process of grieving usually takes place in phases and can last for a long time. Sometimes this process seems to be stuck; one can t get over the loss. When grief turns into depression one shouldn t hesitate to seek professional help.
Everybody deals with loss and the accompanying pain in his or her own way. Influences on the process of grieving are the kind of relationship one had with the deceased, the way in which the person has died (suddenly or a after a long illness) and the age of the deceased and the next of kin.
Immediately after the death of the loved one you typically live in a kind of intoxicated state of mind. When that passes you start to realise the truth of the loss: you are angry and sad, confused and you want to go back to the time when everything seemed good and carefree. Usually you don t function well in this phase and the demise of the beloved is in your mind during the whole day.
After this follows a period that you are more capable to look back to what the person has meant to you, what the two of you have shared. Subsequently you gradually are able to give your attention to other people. Little by little you get on with your life and you realise that you slowly can enjoy beautiful and nice things.
During these three phases it is important that certain tasks are done. It s not about a sequence (in reality they will intermix with each other) but more about completion of these tasks.
- Accepting the reality of the loss; this knowledge has to be felt.
- Feeling the pain and the hurt.
- Adapting to a life where the deceased isn t there anymore.
- Transforming the emotional energy you had with the deceased into a memory in order to be able to continue with your life.
There is no right way or right amount of time to grieve. It s a very personal experience. To grieve has nothing to do with trying to forget or with closure. A deceased loved one will always have a place in your life. But at a certain moment you will be able to look back with compassion, love and without much hurt and be thankful that the person was part of your life. The interpersonal duration of grief varies a lot. Sometimes you ll experience a relapse. A sudden memory can make you momentary very sad. But it won t hinder you anymore in your daily functioning. It s important to know and accept that you need time to cope with your loss.
Some practical tips:
- Try to share your feelings with friends and family in a way that suits you. This is beneficial to yourself and it gives others the opportunity to support and help you.
- Although it is fine to express your feelings, you don t have to give in to every emotion. Sometimes it s good to cry or to be angry, sometimes it s good to seek distraction and focus on something else. It is only yourself who can feel what works for you, which way is helpful for you.
- It is also important to take care of yourself, try to maintain a good physical health.
- Try to sustain a regular life that gives you a sense of balance. Don t take important decisions until you feel stable enough.
- You could start to write letters or to a make collage book about the person. You can write down your feelings and thoughts, memories, paste pictures, poems or songs that you like, which have an association with the loved one.
- You could also talk with friends and family about who the person was, and bring back memories.
- During the period of grieving all kinds of physical complaints may occur, like eating and sleeping problems. When you decide to go to a medical doctor for these complaints, tell the doctor about your loss.
- Be careful with sleeping tablets and tranquilizers. These medicines can help to calm you down for a while but because of their suppressive effects they can disturb the grieving process. When you are mourning it hurts, and that pain cannot be taken away with medicine. Sleeping tablets and tranquillizers can be addictive so it s best to be cautious with these pills.
Dr. Marcel de Roos continues his revelations on key facts about depression, a deeper look at different kinds of depressions that plague people and the effectiveness of anti-depressants. All of us at some point in our lives claim to feel sad and blue, but how do we understand the gravity of our feelings of anxiousness and vulnerability, how do we analyze that this feeling is not just a passing mood that will vanish away in a day or two.
I found this interesting quote about depression which said If depression is creeping up and must be faced, learn something about the nature of the beast: You may escape without a mauling.
Here are some interesting facts that you might have not know about depression:
According to the World Health Organization (WHO), depression will be the second most important medical disease worldwide by the year 2020.
In Sri Lanka, depression is a leading (non communicable) disease. At its worst it can lead to suicide. According to the WHO in 2006 almost 400,000 Sri Lankan s experienced a serious mental disorder.
The reported suicide rate in Sri Lanka is high, according to the website of the Sri Lankan police service: in 2009 20 per 100,000 died of suicide. When considering women, in 2009 25% of all reported suicides had been caused by harassment from the husband and family disputes.
Women have a twice as much chance to be suffering from depression than men. Although the exact reasons are unknown, researchers attribute it to a combination of biological, social and psychological factors.
Q: How does someone know if one is suffering from depression? How do you identify depression from the usual feeling of sadness that plagues almost everybody once in a while?
A: People sometimes say that they feel blue or depressed. It s not something to be alarmed about; everybody has his or her moods once in a while. Such feelings can occur after losing your job, the loss of somebody dear to you or a setback of some sort. Usually, these feelings dissolve after a while but with some people they persist. Their whole existence seems to be coloured by it. They don t want to be involved in things, they have no energy or sense of joy and their outlook on life seems black. People who are in this mood for more than two weeks can be clinical depressed and should consult a doctor or a psychologist.
Q: Dr. de Roos are their different kinds of depression? Can you explain?
A: Yes. Not every depression is the same. They vary from mild to severe, from a few to many symptoms. The intensity of the symptoms differs a lot too. Some well known and important forms of depression are:
Major depression. The two main symptoms are that people have a depressed mood and have no interest in activities for at least two weeks for most of the time almost every day. Furthermore they must have at least three more symptoms out of seven (for instance weight change, sleeping problems, thinking about death or suicide).
Bipolar depression. Some people have periods with depression as with manic periods which are coloured by much activity and energy (hence the name bipolar, two poles).
Post natal depression. About 10 20% of the women develop a depression after child birth.
Q: What causes depression? How does one combat depression and its ill effects?
A: There is a still lot of uncertainty about the causes of depression. A few theories have been developed which until now haven t been completely proven (they are partly hypothetical). These days, researchers agree that the origins of depression are multicausal: there are biological, genetic, psycho-social and personality aspects. Each of them can contribute in some form as a factor.
The most important question is of course to determine what the best strategy is to overcome a depression. When someone is suffering from a severe depression (with strong suicidal tendencies) it is clear that medication should play a major role, at least in the first stage of the therapy. In the case of mild or moderate depression psychotherapy should be the preferred method. With mild depression even jogging (three times a week) can help. There is an abundance of research that shows that with mild or moderate depression psychotherapy (or even taking a placebo drug!) has the same or better results than medication.
Dr.de Roos requests LW readers to contribute to this topic and send their questions to: marcel.deroos@yahoo.com. Readers can also put forward their own experiences about other psychological issues. For more information about Dr. Marcel de Roos please visit his website www.marcelderoos.com or call him on 077-2310869.
The percentage of overweight people in Sri Lanka is a growing concern. Although there are no exact island-wide statistics available international data are alarming. According to a recent worldwide study in The Lancet more than half a billion men and women are clinically obese (one woman in seven and one man in 10). That s nearly twice as much dangerously overweight people than in 1980. For overweight people (a preliminary stage of obese) the results suggest that being overweight affects one in three (!) adults. Although the problem is most prevalent in the richer nations (the USA and in a lot of European states), many developing countries are catching up.
Research shows that being overweight or obese can dramatically increase the risk of developing heart disease, diabetes, cancer, dementia and other serious illnesses. Overweight can be determined in two ways: measuring if your weight fits with your length and the measurement of your waist. The latter is a good way to determine the amount of your body fat.
The causes of being overweight are basically eating too much and insufficient exercise. Heredity plays a minor role and being overweight seldom stems from a disease. When you eat more than your body needs, the nutrients are transformed into body fat. You are prone to become overweight:
when one or both parents were overweight;
when you were raised in a family with an unhealthy dietary pattern (many soda s, beers, oily snacks and sweets) and insufficient exercise (spending much time in the car, in front of the TV or computer);
when as a child you were comforted or rewarded with sweets;
when you have a tendency to eat away your emotional problems;
when you were raised in a dysfunctional family or when you were abused;
when you have the habit to start eating or drinking when faced with stress;
when you have quit smoking;
when your appetite increases because of the side-effects of certain medications (for instance anti-depressants);
when you have an underactive thyroid
The best way to start losing weight is the gradual way. Maintaining a strict diet is very difficult. Moreover, temporary reducing your food intake in a stringent way only has an effect in the short term (the yo-yo effect).
Most important is to try to find out WHY you overeat. It is about feelings, not about the thoughts. With many people emotions (from their past) play a significant role. It s essential that you should assess this and strive to acquire more balanced feelings. Spend sufficient time on this because it is vital. Exercising and dieting are relatively easy, but maintaining your weight demands a good insight into your reasons for overeating. This way you avoid the feared yo-yo effect and you maintain a healthy life style. Don t fall into the trap of trying to motivate yourself with willpower (it will last only for a limited period). Living healthy and maintaining a reduced weight should be a way of life instead of a rigid goal.
In order to lose weight it is particularly important to eat less; exercise is accommodating the process. One has to do a lot of physical activity to lose weight purely by that alone. Start the day with a good breakfast. Avoiding breakfast is not a good idea because your will feel hungry during the day and you will consume more calories with your other meals. Don t omit any other meal. Regular meals during the day help to keep the body alert and make the metabolism work, thus increasing the combustion. Food deprivation is one of the biggest mistakes in an attempt to lose weight, because it leads to a sharp drop in blood sugar which will to lead you to eat more. Eat healthy and varied food and reduce your fat, sugar and alcohol intake. When your body gets fewer calories than it consumes, its fatty tissue diminishes.
Choose a form of exercise which you like doing. Individual or in a group, indoor or outside, pick up a sport or go walking. Don t underestimate the daily opportunities like taking the stairs instead of the lift, walking short distances instead of taking the car and doing domestic chores. Physical exercise is good for you whether you are trying to lose weight or not. You will lose weight, you will sleep better at night, you will feel more energetic from it and it s beneficial for your heart and whole body.
Discover your personal emotional reasons for overeating, inform yourself thoroughly about the topic weight loss, develop your individual way of dealing with overeating, make a plan and create your new way of life.
The link to the original article is here
Dr. Marcel de Roos, continues his elaborative description on depression and how best one should deal with it successfully. This month s topic will focus on anti- depressants, its effectiveness and possible side-effects.
Q: What can you tell us about the modern anti-depressants?
A: The use of anti-depressants has increased enormously with the availability of modern medicine such as fluoxetine (Prozac) and paroxetine (Seroxat). Especially the assumption (actively promoted by the pharmaceutical industry), that these modern anti-depressants are safe and have less side-effects than the older generation drugs, have made doctors prescribe them generously.
For a relative small group of severe depressed patients, anti-depressant (older and newer generation) drugs are a true blessing. Without them they could not have a more or less functional and regular life. But to be effective they have to be combined with psychotherapy. However, psychiatrists and general practitioners are busy people and as a consequence they usually lack the time. Besides this, adequately managing a patient with depression isn t easy and is time consuming.
Q: What kind of research has been done on anti-depressants?
A: For the majority of the patients with a depression theirs is a light or moderate one. There is an abundance of hard research evidence (see below) that for this large group of patients, placebo pills or psychotherapy does a better job when compared with anti-depressants, and with no chance of possible (serious) side-effects. Nevertheless, for pharmaceutical industries their biggest sales are within this mild and moderate group of depressed patients.
Research about anti-depressants is usually financed by pharmaceutical industries. The designs of these studies are tailor-made to give an effect. But that said effect is almost totally explainable by the design. In this research the focus is on small improvements within a specially selected group of depressed people.
Several big independent studies (which were not financed by pharmaceuticals) about anti-depressants give completely other results. One study shows that in real life with 70% of the patients, treatment with anti-depressants fails. In another important study, the effect of these drugs was not much better from placebo drugs; the only effect was with severe depression.
There is no scientific proof that modern anti-depressants work as the pharmaceutical industry wants us to believe. The theory behind this biochemical mechanism (if it exists!) is incomplete and lacks direct evidence. Only with severe depressed patients for some reason the drugs seem to work.
Q: Are there any side effects of anti-depressants?
A: most anti-depressants (including the modern ones) have an impressive list of side effects. Some of those are even worse than the ailment they are supposed to cure. The most common side-effects in the first four weeks are: a dry mouth, nausea, anxiety, strange feelings, diarrhoea, a disturbed sleeping pattern. Common long term side-effects which affect the quality of life in a serious way are weight gain (usually in the range of 5 25 kg) and sexual dysfunctions (not a pleasant thing when you are already depressed). Difficulty in tolerating these (short and long-term) side-effects is the most common reason for discontinuing anti-depressants.
Other facts about anti-depressants:
In the USA a so called Black Box warning is required for anti-depressants. It states that anti-depressants double suicidal rates (from 2 in 1,000 to 4 in 1,000) in children and adolescents. For adults up to 25 there is an increased risk for suicidal behaviour and suicide. Doctors who do prescribe these pills to children need extra training. Children don t need pills but a good therapist who talks with them and monitors the family.
Among children 50% of the deadly medication poisonings is caused by anti-depressants. Usually it s about swallowing tablets without knowing what they are.
There is a risk of addiction. About 30% of the patients who take anti-depressants develop an addiction to the drug.
Less common possible side-effects are bone fractures, an increased risk of strokes and cardio-vascular death, an increased risk of suicide for adults, serotonin syndrome (a potentially life-threatening adverse drug reaction), increased aggression.
Q: To conclude: how effective are anti-depressants? What should we be aware of?
A: Anti-depressants are effective with patients who suffer from a severe depression; with a mild or moderate depression prescription of these drugs is of no use at all. Psychotherapy or psychotherapy combined with anti-depressants is the most effective treatment because it focuses on causes and not on symptoms. In Sri Lanka, when one is depressed and visits a doctor one usually leaves the doctors room with a prescription for anti-depressants. Other possible solutions are rarely mentioned or not at all. Of course the safety of these drugs is relatively good when you take into account the number of patients that have taken them. But there is quite a large group of patients that DO have problems because of these drugs. It could be you or your child. If you have any doubts or are suffering from a mild or moderate depression you should think critical and discuss your reservations with your doctor before taking any anti-depressants. Knowing Sri Lankan society this could turn out to prove difficult but ultimately it s your own responsibility for yourself and your family.
Dr.de Roos requests LW readers to contribute to this topic and send their questions to: marcel.deroos@yahoo.com. Readers can also put forward their own experiences about other psychological issues. For more information about Dr. Marcel de Roos please visit his website www.marcelderoos.com or call him on 077-2310869.
In my psychology practice I have coached many business people from the corporate world. They operate in a highly competitive environment where it doesn't pay to show one's emotions. Especially CEO s, entrepreneurs and higher management find it rewarding to talk in a private and professional setting about their personal issues. Generally speaking, the higher in hierarchy the lonelier it becomes. In management courses the focal point usually is on the analytical side and on control while well founded decision making requires balanced emotions too. Therefore, it is imperative that sound leadership should include knowledge about feelings and how to manage those.
Interest in leadership issues isn t something from recent years. In the late fourth century BC Plato wrote his book Republic . In a part of this book he described what he saw as the necessary qualities and training for a King-philosopher. He started something what we can call now a training centre for leadership (the curriculum was quite draconic and without any mentioning of emotions). Whether Plato was successful at this remains the question. When he tried to put his theory into practise in Syracuse (Sicily, Italy) as a teacher for the Tiran Dionysus, it nearly cost him his life.
Later on different thinkers wrote about different aspects of leadership. Machiavelli for instance wrote about acquiring and maintaining (political) power and Max Weber about organisations and leadership. But it wasn t until Freud that the new dimension human nature was added. Although nowadays many psychologists consider most of Freud s writings as anecdotal, it opened the door to the study of emotions.
In the past decades many books (usually based upon American business models) regarding leadership issues have been written. There are bookcases filled with studies about required positive qualities for leadership. Literature about leadership is controversial; there is an abundance of competing theories with no clear cut answers. The emphasis is on abstract theoretical concepts, while the subject of study, the leader, disappears in a haze.
Leadership is more than behaviour and thoughts; the complex psychological factors that form the personality of the leader are the key to his/her behaviour. That is why his/her inner world , i.e. his/her emotional make-up, is the driving force to success or failure in business. What happens with leaders when they have acquired power? Many leaders, who reach the top of their organisation, simply can t cope with the stress that leadership brings them.
Leadership is idiosyncratic and psychological factors play a significant role. Not only behaviour and cognition, but especially (deep) emotions can make or break a leader. As a consequence, efforts in trying to change sub-optimal performing leaders solely on the mind and behaviour level are doomed to fail in the long term. What is needed is individual coaching or therapy where emotions form the focal point.
Recently I heard about a CEO from a leading bank, who has the habit of publicly criticizing board members during a board meeting when they give a presentation. The comments are always negative, even on the smallest details. Of course this is killing for the board member concerned and very bad for morale. Why is this CEO doing this and why isn t he aware of what he is doing? Most probably this primitive behaviour pattern is based upon feelings of insecurity and a desire to dominate (there are of course underlying psychological explanations for this). When not corrected, then ultimately this will damage the organisation.
Another example of how emotions can thwart business people is the following. A General Manager of a retail company came to my practice on recommendation of a friend of his whom I had coached for a few months. His initial request was to teach him better coping strategies with his stressful work situation but on the second appointment his underlying issues became apparent. A highly demanding father and a warmth lacking mother had made him the successful manager he was. From early schooldays on he had always strived to be outstanding in academics and in sports. He had received his personal satisfaction from those. His emotional side however had lagged behind his achievements and he became a bit lopsided. So far in his career he had managed when confronted with emotion packed decision making, to overrule that with his will power. In the past months he had been forced to lay off a few dozen co-workers in dire straits which had touched him deeply on a personal level. This General Manager had never learned to vent his emotions and in subsequent years the pent up luggage had become intensified. After a series of talks he felt much more balanced and he could cope better with the demands in his work.
Business people in positions of CEO, higher management or as an entrepreneur live in a lonely, complex and stressful environment. They should realise that feelings are stronger than the mind and that they are prone to abnormal behaviour based upon their deeper emotions. A visit to a professional psychologist can be the start to form a more balanced personality.
The link to the original article is here
Many Sri Lankans have an almost ingrained denial of mental health issues. It s fine to hobble around with your broken leg in plaster and share this inconvenience with everybody who cares to listen. On the other hand it s almost a taboo to talk with a friend about your depressed child or about the relationship problems you have with your spouse. In addition, Sri Lankans have a tendency to medicalize psychological issues (they prefer taking pills) instead of talking about their feelings. The shame culture seems to be very strong.
Apparently there are reasons for this, because the gossip culture is very powerful too. When clients finally come to my psychology practice to talk about their issues, very often they say that they chose me because I am a foreign resident (Dutch, and married to my Sri Lankan wife Jennifer). They assume (which is true) that I don t gossip about my clients.
Outward appearances count: the husband has to earn well, the wife smiling and pleasant and the children must be well behaved and show good study results. To complete this fairy tale package, the house and car must be owned and regular holidays abroad should be included too.
Many families suffocate in this outward shell. In any marriage there are issues which need to be talked about: relationship problems (like a lack of affection/respect, conflicting personalities, sexual problems, unfaithfulness, communication problems, etc.), unhappy children (problems at school, anxiety, depression) and financial problems to name a few.
To top this, in South East Asian culture, much attention is placed upon mind and behaviour; emotions are usually disregarded. In reality, emotions (and instincts) are the driving forces in our lives. Evolutionary speaking, emotions are much older than our cognitive brain. We are often taken by surprise by instinctive reactions and emotional impulses. Although our thinking process is very quick and seems to be the powerful ruler, emotions are difficult to control from the neo cortex. It s one of the reasons why we sometimes feel driven without exactly knowing why. We can be filled with joy, overwhelmed by grief, engulfed with power or we can feel deeply depressed.
There seems to be a lot of misunderstanding about emotions and how to try to change unwanted behaviour and emotions. As a result, while attempting to change emotions people use here and now techniques which offers only short term recourse. Perspective ( the glass is half full instead of half empty ), positive thinking, concentrating on your strengths and positive points, and so forth. The problem with these techniques is that they are mind driven and focus on your behaviour whilst totally ignoring the uniqueness of the emotions. What is worse, they only concentrate on the present, while ignoring the influence of emotions from your past.
Another misconception is the chemical imbalance theory concerning emotions. This is just a theory and an incomplete one at that. At present, emotions cannot be corrected with fine-tuned medications to bring on the desired specific effect in the brain. The state of the art medication for depression is a good example for this. For light and moderate depression placebo pills and psychotherapy do a better job than anti-depressants. Furthermore, the underlying theory for the working of anti-depressant pills is incomplete and lacks direct evidence. And lastly, the modern anti-depressants have a long list of (possible) serious side effects. For an extensive discussion about all this see my article anti-depressants and the chemical imbalance hoax on my website.
What does work is a combination of cognition, behaviour, emotions, influences from your past and the present. This blend will bring you balance in your life.
Twenty five years ago when I started practicing, the emphasis in psychology was on trying to change the thoughts of clients. The assumption was that as a result of this their feelings would improve. As I got more experienced I realized that it wasn't helping my clients in the long term. The feelings of depression or anxiety in many cases reappeared after a while. That's why my motto in psychology is feelings are stronger than the mind . The inclusion of feelings and making them the focal point of the therapy changed a lot for my clients.
When people are feeling empty, depressed or burnt out, these are in many cases symptoms of an underlying conflict. Usually these symptoms stem from feelings from the past which are still too painful to be felt. Secondly, it focuses our attention to our self instead of towards those who have done us harm in the past. When you succeed in making the connection, then those 'old' feelings (usually mixed with present ones) explain to you the cause of your present state. Then you can start to feel the painful feelings from the past in full. At first you practise it with the help of a therapist and later by yourself. After a while the intensity of the painful feeling will diminish.
Focusing on your feelings can reveal the real cause of your issues and can allow you to feel the deeper, underlying roots. The new approach is that you don't focus on the 'thought' side, but that you work with your feelings. Present plus past combined. It is a very down to earth method. It is aimed at giving the client powerful tools to do the work himself so that in time he does not have to rely on the therapist.
Apparently psychotherapy seems to consist only of talking. But in reality it is all about FEELINGS. Regularly (once or twice a week) venting your feelings and speaking about your issues with a professional psychologist in a safe setting can significantly alleviate your burden.
The link to the original article is here
Mental diseases and their causes have gone through many oscillations in the course of time. Nowadays for many people it seems a proven fact that genetic and biological factors ( nature ) and not environmental ones ( nurture ) are the main causes of mental illnesses. It s all about chemical imbalances . But this belief is only a few decades old. Throughout history there has been a constant pendulum swing between nature and nurture .
For example in the 19th century, European factory workers and their families showed a multitude of biological/psychological/social problems, with alcoholism as the most visible one. Alcoholism ran in families, tuberculosis was rife, and theft was common. The explanation at first seemed obvious: it was all about degeneration, consequences of a hereditary determination which generation by generation brings about a downward spiral ( nature ). Later on another explanation became dominant: the workers had a tough seven day working week, they were underpaid, had no education and had very large families which lived in miserable small houses with no sanitary facilities ( nurture ). When things are taken out of their (social economic) context then strange things can happen.
In the sixties and seventies of the last century the emphasis in the treatment of mental diseases was on the nurture side. Existing previous treatment with medication, electro shocks and isolation was seen as very nature orientated and became suspect. From now on the causes of the illness should be found with the parents and in society. Medication was out . Sexual liberation, encounter groups and sensitivity trainings were the buzz words. Movies like One flew over the cuckoo s nest by Milos Forman, Family life by Ken Loach and the book I never promised you a rose garden by Hannah Green became iconic of that period. Parents of schizophrenic children were much hurt by the general belief that the cause of schizophrenia lies with the parents (the cold mother and the infamous double bind communication Don t do what I say! ). A number of studies and experiments showed that psychiatrists could not distinguish between their patients and normal people.
As in any revolutionary period the reformers went too far and in the eighties the pendulum swung back in favour of nature. Human behaviour (and in particular mental disorders) from then on was seen as neurobiological based and genetic controlled. It also puts people into their comfort zone because the blame of the mental disease is not on the parents, the environment or the person himself. After all, it s just some neurotransmitter deficiency in the brain which can be replenished with little pills, which you have to take for the rest of your life.
This conviction is swallowed , because almost everybody is convinced that very important discoveries have been made in psychiatry, genetics and neurobiology. In concrete terms this means that there is a belief that the physical causes of ADHD, depression, schizophrenia, etc. are clear. There are some minor gaps, but the big picture is there, isn t it? In connection with this, the idea is that these discoveries have formed the basis for efficient pharmacologic treatments which directly influence the underlying biological processes of for example depression. We only have to monitor our chemical imbalances .
If only so! Chemical imbalance for example, is a marketing concept; there is no medical proof for it. The advertising boys know very well that with the increase of the frequency of a message, the more the supposedly truth of that message is accepted. It can be found on the internet, books and in the other media. Big Pharma (the pharmaceutical industries) has invested a lot in the present belief in the power of pills for mental diseases. The stakes are high and the profits are phenomenal. A huge marketing and research industry has been created for this purpose.
They conveniently forget that most pharmaceutical effects of medications nearly always have been the result of coincidental discoveries (for example anti psychotic drugs, anti depressives, anti smoking pills, Viagra, etc., etc.). Their specific working at a certain disorder is hardly known. The positive effects are overestimated and the side-effects are underestimated. The most expensive drugs receive the biggest promotion. Psycho pharmaceutical medications have no solid scientific base; there is no scientific proof for the neurobiological causes of psychiatric and psychological problems.
In 2002 the American Psychiatric Association, published a report (David Kupfer, et al: A Research Agenda for DSM-V) concerning the preparation of the fifth edition of the DSM (Diagnostic and Statistical Manual of Mental Disorders). They concluded that there are no positive conclusions for the assumed biological or genetic causes of the hundreds of DSM disorders. People with the same DSM diagnose are not homogeneous groups, and within these groups likewise treatments differ in effectiveness. Very often persons can be categorized with different labels. The fact that antidepressants are prescribed for a variety of disorders from the DSM signifies that the categorization is arbitrary. There is a lot more to tell about the DSM such as the (pharmaceutical) interest groups behind it, the changes in perspectives between the different editions, and so on. Despite the above shortcomings, the DSM is without doubt one of the greatest social scientific successes ever. The classifications of the DSM are worldwide used and embedded in the psychiatric/psychological practises.
ADHD (Attention Deficit Hyperactivity Disorder) is nothing more than a description of a number of behaviour symptoms. There is no scientific argumentation for choosing exactly these symptoms. The name ADHD suggests uniformity, but in reality it is a very heterogeneous group. There is no compelling evidence that there is either a genetic or an environmental cause. It is suggested that the cause lies in a complex interaction between genetic and environmental factors, which is not surprising given the doubtful existence of ADHD as a syndrome. Treatment with medication gives quicker results than psychological intervention but after a few years there is hardly any difference between the two forms; a combination seems preferable. But there are more and more indications that long term use of said medication causes growth deficiency. Many children are just agitated, attention seeking and ADHD (if it exists) is over-diagnosed and over-medicated.
For depression and schizophrenia there is also no proof for a genetic or neurobiological cause. Again scientists assume that the diseases are caused by a complex interaction between the biological and environmental factors.
At present, there is no discovery, no evidence that biologic or genetic abnormalities are reliable predictors for psychiatric disorders (American Psychiatric Association). The scientific knowledge about mental disorders is much less than expected and the pharmaceutical treatments much less effective than people think. In the past years there have been many publications, media broadcastings and lawsuits against Big Pharma, which could signify that the pendulum is slowly swinging back in favour of nurture .
The link to the original article is here
An interesting link is here. It's the website of an American psychiatrist, Dr. Peter Breggin who is known for his critical views on biopsychiatry.
One of his columns is here.
In my psychology practice I have treated a substantial number of people with so called PTSD (Post Traumatic Stress Disorder). PTSD is an anxiety disorder which is characterized by considerable stress symptoms that are of a physical and psychological nature.
A post traumatic stress disorder can develop when a trauma for some reason can t be dealt with. Examples are disasters (tsunami!), war experiences, rape, traffic accidents, etc. The person concerned has experienced the traumatic event(s) with intense fear, horror or helplessness. Coping with traumatic events is a long and difficult process and sometimes it s just too much for a person and his life becomes unbearable.
Sadly enough Sri Lanka with its recent history of civil war has a high percentage of persons suffering from this disorder. It is not exactly known why one individual can cope with a trauma and another can t. Possible explanations are the severity of the trauma, the psychological or physical resilience and the adaptability of the person involved.
The essential symptoms of PTSD are generally grouped into three clusters:
- A recurrent reliving of the traumatic event (flashbacks) in dreams, nightmares, obsessive thoughts. An excessive physical and psychological reaction on triggers which refer to the traumatic experience (for example pictures, videos).
- A tendency to withdraw from others and a systematic avoidance of everything that can be linked to the trauma. As a consequence there is social isolation and emotional numbness. This can result in concentration problems, memory troubles and hopelessness about the future.
- Increased emotional arousal resulting in sleep deprivation, irritability, easily startled or frightened, feelings of guilt or shame, over-usage of alcohol, medicine or drugs, and hearing and seeing things that aren t there.
After a traumatic experience it is normal that people feel tense, afraid and depressed. They might experience sleeping problems, an overactive mind, crying spells and are easily frightened. This doesn t mean that they have PTSD. But if these disturbing thoughts and feelings last longer than a month, if they are intense, or if you have the feeling that you can t get a grip on your life, then it is time to talk with a psychologist.
Treatment of PTSD can be individual or in a group. The prognosis is usually good; in 15 to 20 sessions a substantial improvement can be achieved. In order to try to optimize support from the home situation it is recommended that the partner takes part in the therapy too. With PTSD psychotherapists very often use a treatment called desensitization (or exposure ). This helps to reduce the symptoms, by encouraging you to remember the traumatic event in steps and express your feelings about it. It is very important that the traumatic experience and the accompanying (deep) emotions are being felt. The pace of the steps is always in sync with what the victim can handle. In this way, after a while the memories of the event become less frightening. Hypnotherapy and writing assignments can be effective too. Hypnosis induces a deep state of relaxation in which traumatic memories can be treated in a better way. Writing about a shocking event helps to vent the emotions and it gives structure too.
One of the aims of the therapy is to regain a sense of safety. That also means a renewed feeling of control over your own body and over your own life. A traumatic event changes your life; you will never be the same as before. As a rule one learns from it. Therefore it s important that awareness is given to how it has changed your self-image and your outlook on the world. Treatment of PTSD is possible but it is not easy and it involves total commitment from client and therapist.
Sri Lankan parents (especially mothers) seem much more concerned with the process of raising their children than their Western counterparts. Very often they have a very close and special bond with their offspring. Education in particular is seen as a vital matter; parents fret and worry and try to get the best out of their son or daughter.
And then the moment is there that the children leave the house. Either for studies overseas or they get married. Saying goodbye to a child that is forming its own family or is leaving the country is an emotional experience. The house that has represented a busy buzzing nest for years becomes empty. When the youngest child has left the parental nest many women experience emotions of emptiness, sadness or even depression; they suffer from the Empty Nest Syndrome. How to give meaning to your life after this?
For mothers, for twenty years or more, the biggest part of their lives was centred upon the care for the children and the house. All of a sudden this has ended. No more crumbs on the couch, no more sporting clothes in the laundry. Mothers can feel left out and can wrestle with questions like: What is left over from my job as a mother and woman? or Am I still useful?
The Empty Nest Syndrome is comparable with a grieving process, with two dominating emotions. The first is the physical loss of the children. You miss their natural presence, their stories at the dinner table and the contact. And also the absence of their friends and other people connected with them. You are much less involved in their lives and you have to learn to take your distance.
The second emotion is aimlessness or uselessness. It can be difficult to fill in the oceans of time which were previously devoted to the children; from driving them to sport events to helping out with their homework. The house becomes less dirty and the amount of laundry isn t what it used to be, so there is a lot of spare time. When you find it difficult to spend this time in a meaningful way, you can get depressed.
In some marriages the latent relationship problems materialize when the children have left the house. For many years the children were the dominant theme of conversation and now it can become clear that there are precious few other binding factors. Or tensions might pop up because the wife finally has spare time and wants to travel or engage in other activities with her spouse while the husband still has to work a full day.
The Empty Nest syndrome predominantly occurs with women who consider the care for the children as the most important task in their lives. When there is no job or not an inspiring one, the empty house can feel like a burden. Women with a strong bond with their children, who have difficulties to let go can be at risk too.
Very often the moving out of the children coincides with the menopause. Besides physical complaints like having hot flushes, sleeplessness and apathy, there is the undeniable silence of the house. The combination of mood swings caused by the menopause hormones and the emptiness of the house can lead to a serious depression.
The best way to prevent the Empty Nest Syndrome is to prepare yourself for the oncoming departure of your children. A (part time) job, hobbies or a study can provide you with a life outside the family. They can give you meaningful activities and social contacts. By going sometimes on a holiday without the children you get accustomed to a life with the two of you. Try to realize that from secondary school onwards your children become more and more self reliant; they don t need you that much anymore. It helps too to give it a moment s thought once in a while that someday your child will leave the house. Try to discuss your thoughts, feelings and future plans with your spouse. The period prior the departure usually is a very hectic time. Mothers help to furnish the new house or spend a lot of time in the preparations for the marriage. Try to build in moments of rest and reflection.
Many women, who continue to suffer from the empty nest, simply fill it in with a dog, or they take care of another s child. Others take a foster child or lodge students. When you don t want to fill up your house but you do want to fill in your time you can try to find a meaningful way to spend your time. Activities where you can help others are more satisfying than individual ones like sports. Good examples are taking care of family members, friends or neighbours in need or volunteer work in a home for the elderly. If you miss the contact with young people, you could start coaching a youth sports team.
Generally speaking, after one year since the children have left, most women have regained a balance in their lives. They have a pleasant daily routine, go on trips and spend time on their hobbies. Their most important task as a parent has been done and they are entitled to feel proud on what they have accomplished. The contact with the children is still there of course but it is a more mature relation. When the feelings of depression continue for longer than a year, then it s time to speak with a counsellor or a psychologist.
In non-Western countries like India and Sri Lanka Valium (or Diazepam) and its generic variants are cheap and easy available over (and under) the counter. Despite the fact that these drugs are considered as last choice medicine and only recommended for strict short-term usage, the widespread prescription by doctors continues. They belong to the so called group of benzodiazepines. These are psychoactive drugs all of which have five effects: promotion of sleep, relief of anxiety, muscle relaxation, anticonvulsant, and it impairs short term memory (e.g. before an operation). They are used to treat for instance insomnia and anxiety. For more information please read the so called Ashton Manual (see below).
Valium for example came available in the 1960 s and at first was considered as a big success. For instance many housewives took them in order to try to cope with a busy life raising children, household chores and a demanding husband. Which prompted The Rolling Stones to make an ironical song about it called Mother s little helper . But gradually long term usage (longer than two, three weeks) of benzodiazepines became associated with harmful consequences. This consisted of adverse psychological and physical adverse effects like depression, emotional blunting, memory impairment, tolerance, physical dependence and serious withdrawal effects. Especially Valium is considered to be one of the most dangerous drugs because of its easy availability, its high risk of addiction and its gruesome long-term withdrawal effects. There is also a serious questioning of the effectiveness of the drugs itself. In fact, nowadays the medical community considers the benzodiazepines as a huge pharmaceutical mistake because of the many adverse effects (see for example the recent meta literature analysis Benzodiazepines revisited - will we ever learn? in Addiction, 2011; 106: 2086-2109).
It usually starts with prescribed pills from the GP or from the specialist. The complaints are tensions or anxiety, a feeling of emptiness or having trouble falling asleep. The well-intentioned but ill-informed doctor typically prescribes anxiety-reducing drugs and sleeping pills. The recommended dose usually helps only for a couple of weeks and then the dosage has to be increased. But this doesn t solve the problems at home or at work which are the real cause of this situation. In the USA there are millions of people who take these tranquillizers for more than a year, and there are quite a number of people who take them longer than ten or even twenty years. They obtain them with a repeat prescription from the doctor or by ordering them on the internet.
The prolonged usage of Valium gets one into a sort of slumber condition. Because of the decreased concentration and liveliness users typically make a somewhat dazed impression. Well known effects of addiction to this medicine are loss of reality, isolation, dysfunctioning at work and in the family and impairment of the cognitive functions. The chronic usage of anxiety reducing medication and sleeping pills, in particular from the group of benzodiazepines, causes an extra problem. Usually there is a built up of tolerance which means that to get the same effect of the pills you have to increase the quantity. The body becomes addicted and craves for a higher dosage to get the sought after high . By increasing the dosage and by continuing the usage of the pills, the mental and physical dependency on these medications increases too. When one stops taking these tablets this dependence expresses itself by severe withdrawal symptoms, such as feelings of high anxiety or fear, depression or possible seizures. Just the sensation of these unpleasant feelings plus the awareness of the suppressed real problems are reasons enough to continue taking these pills.
The alarming scientific reports from independent researchers about the questionable effectiveness, the (serious) side-effects of these pills and possible long term negative effects on our brains are frantically denied by the drug companies. It is shocking to realize the extent of the power and the different ways of influencing that the pharmaceutical companies have. Although a bit bombastic, the following two documentaries "Making a Killing: The Untold Story of Psychotropic Drugging" here and "The Marketing of Madness" here give you a chilling account of what is really going on in the pharmaceutical business world. Another interesting link is here. It is an episode of the renowned CBS "60 minutes" program about the failure and dangers of antidepressants.
When long term users of Valium or other benzodiazepines want to stop they should do so by tapering it off and with the help of a medical doctor. But unfortunately many doctors are not aware of the various pitfalls. The following three websites give you adequate information:
- www.theroadback.org
- www.benzo.org.uk (with the so called Ashton Manual for information about tapering off)
- www.benzobuddies.org
The link to the original article is here
An interesting link is here
Many Sri Lankans have an almost ingrained denial of mental health issues. It s fine to hobble around with your broken leg in plaster and share this inconvenience with everybody who cares to listen. On the other hand it s almost a taboo to talk with a friend about your depressed child or about the relationship problems you have with your spouse. In addition, Sri Lankans have a tendency to medicalize psychological issues; they prefer taking pills instead of talking about their feelings. The shame culture seems to be very strong.
Apparently there are reasons for this, because the gossip culture is very powerful too. When clients finally come to my psychology practice to talk about their issues, very often they say that they chose me because I am a foreign resident (Dutch, and married to my Sri Lankan wife Jennifer). They assume (which is true) that I don t gossip about my clients.
In Sri Lanka outward appearances count: the husband has to earn well, the wife smiling and pleasant and the children must be well behaved and show good study results. To complete this fairy tale package, the house and car must be owned and regular holidays abroad should be included too.
Many families suffocate in this outward shell. In any marriage there are issues which need to be talked about: relationship problems (like a lack of affection/respect, conflicting personalities, sexual problems, unfaithfulness, communication problems, etc.), unhappy children (problems at school, anxiety, depression) and financial problems to name a few.
To top this, in South East Asian culture, much attention is placed upon mind and behaviour; emotions are usually disregarded. In reality, emotions (and instincts) are the driving forces in our lives. Evolutionary speaking, emotions are much older than our cognitive brain. We are often taken by surprise by instinctive reactions and emotional impulses. Although our thinking process is very quick and seems to be the powerful ruler, emotions are difficult to control from the neo cortex. It s one of the reasons why we sometimes feel driven without exactly knowing why. We can be filled with joy, overwhelmed by grief, engulfed with power or we can feel deeply depressed.
There seems to be a lot of misunderstanding about emotions and how to try to change unwanted behaviour and emotions. As a result, while attempting to change emotions people use here and now techniques which offers only short term recourse. Perspective ( the glass is half full instead of half empty ), positive thinking, concentrating on your strengths and positive points, and so forth. The problem with these techniques is that they are mind driven and focus on your behaviour whilst totally ignoring the uniqueness of the emotions. What is worse, they only concentrate on the present and disregard the influence of emotions from your past.
Another misconception is the so called chemical imbalance theory concerning emotions. This is just a marketing concept from the pharmaceutical industry; there is no scientific medical proof. At present, emotions cannot be corrected with fine-tuned medications to bring on the desired specific effect in the brain. The state of the art medication for depression is a good example for this. For light and moderate depression a placebo pill(!) and of course psychotherapy does a better job than anti-depressants. Only with a severe depression anti-depressants for some reason seem to have an influence on patients, but they should always be combined with psychotherapy. Psychotherapy deals with causes and not only with symptoms as these pills allegedly do. The underlying theory for the supposedly working of anti-depressant pills is incomplete and lacks direct evidence. And lastly, the modern anti-depressants have a long list of possible (serious) side effects. For an extensive discussion about all this see my article "anti-depressants and the chemical imbalance hoax on my website www.marcelderoos.com.
What does work is a combination of cognition, behaviour, emotions, influences from your past and the present. This blend will bring you balance in your life.
Twenty five years ago when I started practicing, the emphasis in psychology was on trying to change the thoughts of clients. The assumption was that as a result of this their feelings would improve. As I got more experienced I realized that it wasn't helping my clients in the long term. The feelings of depression or anxiety in many cases reappeared after a while. That's why my motto in psychology is feelings are stronger than the mind . The inclusion of feelings and making them the focal point of the therapy changed a lot for my clients.
When people are feeling empty, depressed or burnt out, these are in many cases symptoms of an underlying conflict. Usually these symptoms stem from feelings from the past which are still too painful to be felt. Secondly, it focuses our attention to our self instead of towards those who have done us harm in the past. When you succeed in making the connection, then those 'old' feelings (usually mixed with present ones) explain to you the cause of your present state. Then you can start to feel the painful feelings from the past in full. At first you practise it with the help of a therapist and later by yourself. After a while the intensity of the painful feeling will diminish.
Focusing on your feelings can reveal the real cause of your issues and can allow you to feel the deeper, underlying roots. The new approach is that you don't focus on the 'thought' side, but that you work with your feelings. Present plus past combined. It is a very down to earth method. It is aimed at giving the client powerful tools to do the work himself so that in time he does not have to rely on the therapist.
Apparently psychotherapy seems to consist only of talking. But in reality it is all about FEELINGS. Regularly (once or twice a week) venting your feelings and speaking about your issues with a professional psychologist in a safe setting can significantly alleviate your burden.
The link to the original article is here
When you are on a holiday and you want to book a hotel then the number of stars gives you information about the quality you expect. In the corporate world it s not uncommon to have a company ISO certified so customers can rely on for example a certain quality, reliablility or safety of the product. When you want to have psychotherapy or counselling there are no stars or ISO certification. As a new client you re in the dark about where to go, who is reliable and trustworthy. What are the criteria to define the quality of a counsellor or psychologist?
In Sri Lanka there are many institutions that offer counselling. From the outside it is usually hard to assess whether they maintain proper standards in training and practice. A professional code of conduct should be based upon four principles: responsibility, integrity, respect and professionalism. The comprehensive code itself can comprise up to a few dozen pages. Training and supervision should be mandatory and strictly monitored. However, a fancy code of conduct is easily written and training and supervision can be just paperwork.
It s important that a counsellor knows his limits. A person who has completed a part-time six months counselling course is something quite different than a university trained psychologist. Some say it s safer to choose the latter because of quality of the education. Others say that it is the quality of the personality of the counsellor that counts most. He should be emphatic, understanding, authentic and honest. In practice both factors contribute to the quality of counselling; it s cumulative. As a rule of the thumb, long-term, serious and complex illnesses like depression, schizophrenia, severe anxiety, etc. belong to the territory of a professional psychologist. The term counselling is better equipped for a short-term and focused advice about a client s (uncomplicated) issues.
When clients want to go into therapy or counselling they should pay attention to certain pointers. Try to obtain information from ex-clients of a counsellor; their experiences can give you valuable insights. Ask the therapist anything you want; it s your time and money. Ask about his qualifications, the methods he uses and his professional experience. Ask about his own experiences with problems and how he has dealt with them. Does he appreciate the immense significance of upbringing, or does he deny it? Lastly and most important, trust your own feelings with this person: are they negative or positive? Therapy is very personal and it involves human beings. So please be critical when choosing a psychologist or counsellor. You ought to have a feeling of trust and being at ease with this person.
Psychiatrists make use of the so called medical model where, in Sri Lanka typically after a very brief consultation, medications are prescribed in order to try to reduce symptoms of mental illnesses. The specific working of these medications is mostly unknown, many have (serious) side-effects and they are much less effective than people think. Psychologists and counsellors on the contrary focus on the causes and the whole story behind the symptoms. There are no side-effects and the client is not dependent on pills to feel well. In therapy the client learns to deal with his issues by himself and finds his emotional balance.
In Sri Lanka psychotherapy is still rather unknown. Many Sri Lankans are not aware that it can be extremely helpful for their mental wellbeing. In addition, they have a tendency to medicalize psychological issues (they prefer taking pills) instead of talking about their feelings. And lastly, people are still reluctant to seek support from a psychologist because it is considered shameful (you must be mad!). But regularly venting your feelings and speaking about your issues with a professional psychologist or counsellor in a safe setting can significantly alleviate your burden.
Anger management is the process of learning to recognize early signals that you are angry and to take action to handle the social situation in a positive and constructive manner. It doesn t mean that you should try to hold your anger or to suppress it. Anger is a normal human emotion and it is healthy when you are able to express it in an appropriately way.
Many people who suffer from anger attacks and aggressive behaviour have the feeling that they are helpless and that it s beyond their control. I became blank , I wasn t myself , I can t remember anything are much heard excuses. But prior to most anger attacks there are warning signals. Some people feel their head is getting warmer or tighter; others become fidgety or start to sweat.
We all feel angry once in a while and sometimes we say things that we regret later. This is a normal part of life and doesn t mean that we need help. But when your anger has a negative effect on your relations, if it makes you feel unhappy, or if it leads to violent or reckless behaviour, then a visit to a therapist makes sense.
You definitely need help when:
- you have strong issues with authorities,
- you often have the feeling that you choke with anger,
- you have lots of arguments with your partner, family or colleagues,
- you hit your partner or children,
- you show aggressive or angry behaviour whilst driving a car (road rage).
Anger management helps you to determine the triggers that make you flare up. It s about recognition of those triggers and subsequently acting upon those. This acting consists mainly of organizing a time out. Some examples are:
- Simply counting until 10,
- Leaving the situation when you feel the anger rising. Just leave with an excuse like a bathroom visit,
- Breathe consciously deeply in and out; try to direct your breathing lower towards your belly,
- Relax yourself in an active way (the so called progressive muscle relaxation) starting from the top of your head to your toes.
Try to avoid dealing with problems when you are already tired or frustrated. Exercising on a regular basis helps to prevent building up tension in your body in a healthy way. Look for physical activities like dancing, chopping wood and jogging as long as it s an activity that you enjoy. But the most important factor is to try to understand where your anger stems from. Usually this is a complex process and it takes time. A professional psychologist can help you with this. Aggressive people should learn to handle anger provoking situations differently.
Somebody who has been treated in a belittling or humiliating way (for example at school or by his parents) will probably overreact to teasing remarks. It s important to try to make an emotional link between the felt anger in the present and the anger from the past. Experiencing and feeling that old anger gives you insight and is the start of a more balanced emotional life. When you are an aggressive person and you want long-term solutions then you should look for professional help.
Electroconvulsive treatment (ECT) is the modern equivalent for what used to be called electroshock. With ECT a generalized seizure is produced by a brief exposure to an electrical stimulus. Up till today the specific working of ECT (if it works) is unknown and neither what the electrically stimulated seizure does to the brain. Usually ECT is given in a series of treatments (two or three times a week during one month). Although modern ECT is administered with anaesthesia and muscle relaxing medication, at the moment ECT is still the most controversial psychiatric treatment.
Application of ECT should be restricted to persons with a very severe depression and then only as a last resort, when other forms of treatment haven t given any improvement. In rare cases it can be used with other severe mental illnesses like acute mania and certain schizophrenic syndromes where there is no other choice.
Much of the controversy with ECT lies in questions about its effectiveness, the side effects, the objectivity of ECT specialists, and the climate created by the insurance companies to provide a quick fix instead of hospitalisation or psychotherapy.
There are patients who do report that after ECT their mood had been improved for a few weeks, but the prognosis for long term results is not good and patients need to go back on heavy medication (antidepressants). This rapid relapse, and in a significant amount of cases the permanent loss of memory and concentration, is a huge and disabling problem. Especially elderly people form a high risk group. Many people feel that they were insufficiently informed about these side effects.
Much research about ECT is done or funded by stakeholders. Independent research usually shows that the cost-benefit analysis of ECT is very poor. They conclude that the risk of damage caused by it cannot justify its continued use.
In my psychology practice I hear on regular base stories from Sri Lankans who have received ECT (locally or abroad) while alternatives were available. In cases of moderate depression or anxiety it was administered in a manner like: let s just try this out In Europe on the contrary, usage of ECT is more conservative: if nothing else works, then
The debate surrounding the use of ECT is constantly fired up by testimony from former patients, adverse scientific reports, unfavourable media coverage, and the unknown black box of ECT itself.
An interesting link is here
Maryam* was a beautiful girl, had a good academic record, shone in sports and came from a middle-class family. Loved by her friends and teachers, she was the star at school having won several accolades. But everyday, there were cuts on her arms and wounds that were visible even on her legs. Nobody knew what was going on but it was evident that she was cutting herself but she was hiding her problems without talking to anyone.
Self-injury is not a new trend in Sri Lanka and it still affects a considerable proportion of the population, at some point in their lives. While some get over it, there are many who suffer in silence and still continue to mutilate themselves.
In Sri Lanka, the condition of teenage cutting , self-mutilation, self-harm or self-injury is not properly understood. While a doctor might treat a teenager for a wound or an injury, there are signs that show if a wound has been accidental or intentional.
Many people have been successful in hiding their injuries so they cut themselves in places where it is not visible but what they should know is physical wounds might heal but mental scars will never fade. They also say it is accidental and do not know that there are ways of determining how a cut is made when it is self-made.
More often than not, a doctor might ask the teenager if they have depression or any other ailments, but since teenagers often consult a doctor with their parents, the injury will be treated and not followed up. Also, parents tend to influence doctors saying that teenagers have no problems but do not realise (or do not accept) that there might be issues beyond just the self-inflicted wound.
At present, Sri Lanka does not have the statistics with which to determine the number of self-injury cases. Even though we have specialised units dealing with abuse and teenage pregnancy, there is no such hospital dealing with self-injury especially pertaining to the youth.
However, an international expert, Dr. Marcel de Roos, a psychologist with a PhD from Holland has been doing research and treating such cases. Practising in Sri Lanka for three years now, Dr. de Roos said, I have successfully treated about 15 cases of teenage self-injury by not just giving them anti-depressant drugs but talking and counselling them.
The doctor said that self-harm or self-mutilation can consist of any form of trying to hurt oneself. I have seen cuts not only on the arms and wrists but also side cuts on the neck and thighs. There have been one or two cases on the belly as well, he said.
According to him, there are no exact figures of the prevalence of self-harm, but he sees it as a growing condition which is turning into a disease.
In Sri Lanka, the culture is such that nobody talks about it in the open and problems at home are supposed to be kept at home and not divulged to anybody.
If outsiders know about it, they don't interfere or because they don't want to get into trouble, said the doctor. He said that sorting out problems at home is good but more often than not, there have been cases of abuse, violence or pressure from family members which drives teenagers to turn to self-harm as a mode of escapism. There are teenagers with problems who turn to alternative forms of self-harm such as drinking alcohol and smoking because they use such habits to escape their problems.
Such experiences could have been associated with neglect, humiliation or the loss of loved ones and a lack of self-esteem is formed and it becomes difficult to express their feelings, especially with others.
Besides abuse, low self-esteem is also a problem which stems from past issues and gives the teenager equal amount of pain when they can't deal with the problem. Dr. de Roos said that there are teenagers who lead a good life at home with loving parents but if they are bullied in school or are in love with someone they cannot have, they might cut themselves because they think there is nobody to talk to or nobody will listen. Often they even hide their problems from their friends unless someone comes up to them and tries to talk to them.
For the teenager, when the emotional pain is too much to handle, they cut themselves because physical pain is easier to deal with than mental agony. They feel helpless or depressed which drives them to cut themselves, said Dr.de Roos. According to experts, there is distribution among the genders of teenagers who injure themselves. It is known that men often engage in different forms of self-harm (predominantly hitting themselves) than women (predominantly cutting themselves). Loneliness is also another reason why teenagers would cut themselves.
During adolescence, teenagers will want to shut themselves out from the rest of the world, talk less to their parents and try to be close to their friends. They think their friends are right and if led astray, it can have deadly consequences, he said.
The problem in Sri Lanka is that parents are not aware of this condition to determine what is going on. There are different levels of society where people have to be educated and find what is wrong and what is right. Often they are concerned about the well-being of their children, but they might not see the warning signs.
In helping their children, parents should talk and listen to their child. Parents might have a certain perception but for teenagers it might be something entirely different, he said. Dr. de Roos said that children should have trust in their parents and shouldn't treat their family members as the enemy but should be friends. He said, When your child trusts you enough, she will open up and tell her story. If necessary, parents should look for psychological help.
Dr. de Roos said that if counselling is needed, go to the right people because doctors might only tell the teenager to take pills to stop depression but this doesn't solve the problem. So it is best to tackle it from the root cause and tell the teenager that they can always talk about anything that is bothering them.
He said, Try to be there for your teenager and don't judge them if they come out with some startling revelations. Just take your child seriously and look for a way to help deal with the problem together.
In Sri Lanka, the pressure from parents as the teenager to perform academically is a big issue and also, during consultations, the parents sit in with the child.
I usually talk to the parents and with their permission, sit with the teenager and ask them personally what is going on and then the truth comes out, he said.
The teenager needs reassurance and this is more than just keeping blades, knives and scissors away from them. Adolescence is the most important time in a teenager's life and there will be obstacles so dealing with it, getting help and knowing.
Before practising in Sri Lanka, Dr.de Roos said he saw the same problem among models when he was in Holland. It is a difficult thing to see, beautiful girls with everything they could wish for, falling prey to self-injury because they aren't happy with themselves, he said.
Dr. de Roos said, When in therapy the whole personality should be taken into account and not only just the physical signs of cutting.
He said that therapy and recovery process can take a long time in a teenager to heal but finding alternative methods of coping with the feelings of anxiety or stress or numbness is often a good start.
Dabbling in other hobbies and stimulating the mind to do other things instead of wasting time on such negative emotions is good for the teenager.
Also channelling the energies into a sport such as tennis or going to the gym will help the teenager deal with the pain better instead of looking at hurting themselves. Dr. de Roos said, However, the real change has to come from within, which means that the teenager understands that she has every reason to feel angry and hurt.
That she starts to understand why she feels guilty, ashamed or powerless. That she can cry and feel her hurt and that the feeling of hurt will slowly ebb away.
That she has the right to exist and be herself. If you're a teenager, take heed and ensure that if you or a friend has a problem, deal with it the proper way.
We should be happy and love ourselves because we have been given a beautiful body and a lovely life so we should not waste or ruin it.
*Names changed to protect identities
Self-mutilation was a non-fatal expression of an attenuated death wish and thus coined the term partial suicide. In 1938, Karl Menninger refined his conceptual definitions of self-mutilation. His study on self-destructiveness differentiated between suicidal behaviours and self-mutilation. These are classified as follows:
* Neurotic - nail-biters, pickers, extreme hair removal and unnecessary cosmetic surgery.
* Religious - self-flagellants and others.
* Puberty rites - hymen removal, circumcision or clitoral alteration.
* Psychotic - eye or ear removal, genital self-mutilation and extreme amputation organic brain diseases which allow repetitive head-banging, hand-biting, finger-fracturing or eye removal.
* Conventional - nail-clipping, trimming of hair and shaving beards.
The link to the original article is here
In Sri Lanka parents very often have a strong and overbearing influence on their children. Children will feel safe because of this; they can rely on their parents and they will respect them. On the other hand, the influence might go too far. The child might feel uncertain about itself because it is unable to make decisions for itself.
Sri Lankan mothers and sons in particular have a special bond with each other. It is not uncommon that mothers feed their 25+ year old offspring by hand. Both parents quite often have a big say in which person the child has to marry and what study it must follow. While this is no doubt done with all the good intentions, it can cause emotional damage in the children.
Alice Miller, a well known Swiss psychotherapist (www.alice-miller.com), wrote in 1979 a famous book called The drama of the gifted child . It s about children from dominating (very often with corporal punishment) and manipulative parents, who have learned to anticipate what their parents want and expect from them, and act upon that. Then they were treated like good children, were acknowledged, and got positive commands, hugs and love. But when they tried to follow their own feelings or find their inner voice then that acknowledgement, positivism and love was denied by the parents. This rejection is without force and very subtle; the child is hardly aware of it.
The problem with these children is that haven t learned to think for themselves, don t know what they want for themselves and don t know where their personal boundaries are. For the outside world they are well behaved and show good study results; they are the perfect child. But later in life very often they will have difficulties in becoming an independent adult. Their parents are continuously in their minds with their values, their norms, their expectations. They avoid confrontations, are almost constantly in a state of feeling guilty. Very often they develop mechanisms to avoid painful feelings (anxiety, stress, sadness, etc.) with addictions (like alcohol, food, drugs, porn or internet). When they have children of their own, they tend to raise them according to the same rules as their parents: a vicious cycle.
In South East Asia children respect their parents very much. The kind of upbringing as mentioned above (including corporal punishment) in its less extreme form is not uncommon here. Although it brings about adults who are very much disciplined, they usually lack critical thinking, individuality and creativity.
When trying to free yourself from all this, it is important to look for a university educated professional psychologist. A counsellor lacks the essential knowledge and training to deal with all these issues. In therapy you will learn to understand how the pattern works and you will become familiar with your own personal history. With the right therapist you will have somebody who listens unconditionally and who will accept you as you are. The feeling of guilt will become less by understanding where it stems from and by accepting that emotion. It needs to be felt but after some time it will fade away.
You will also learn how to deal with dominant behaviour. React on it in a calm but strong way so that the people concerned learn that you don t accept that anymore. Don t be afraid, authoritarian people need an authoritarian approach, they get frightened, they recognize it and they back down. They will respect your opinion when you re clear and above all, show that you respect yourself.
Time and again people are shocked when they hear that there was a case of incest in their family or circle of friends without their knowledge. This can be partly explained because of the manipulation that adults use to keep it unnoticed. It can consist of making you feel guilty or you don t dare to refuse because then you re not his favourite anymore. Another explanation lies in the isolation of the child. Usually it is a kind of family secret that is maintained by blackmailing the other family members which evokes feelings like fear, dependency and guilt.
Sexual abuse means that someone is forced to undergo, perform or witness sexual acts without her/his consent. The victims are typically vulnerable because they are dependent or afraid of the perpetrator. Usually the mother feels dependent too; she is unable to free herself emotionally and economically from her husband. Sometimes it seems like that all family members fence themselves in from each other but also from the outside world. In most cases they learn in a subtle way how to maintain the secret and to stay loyal towards each other.
In the long term, sexual abuse can have serious emotional consequences for the victims:
- Problems in sexual relations (separating emotions from sexuality or feeling blocked in that sense)
- Depression
- Feeling emotionally frozen or rigid
- Loneliness, isolation
- Low self esteem
- Feeling guilty and ashamed.
Many incest victims felt betrayed in their childhood and teenage years because of the sexual abuse by their (step) father or brother and the mother who didn t protect them. As a result of this, in many cases women have a fear for intimacy which can cause huge problems in later relationships.
A sexual abused child can t develop a healthy feeling of self-worth. In effect, more often than not self destructive tendencies can occur like self mutilation. Especially when the mother or other family members don t believe her, trivialize her story or think it s a child s fantasy. To the child this feels as a total rejection of her whole personality.
Sexually abused women typically seek satisfaction in casual relationships where there are almost no feelings of affection or attachment. As soon as there is more than sexuality they usually break up. Incest victims have a significant higher chance of becoming a prostitute. Others enjoy having ways of controlling other people; this is clearly a reverse mirror of their own childhood.
There is no standard treatment for the consequences of sexual abuse. It depends on for example at what age the abuse started, how long it lasted, whether the perpetrator is a family member or somebody else, whether you have told your story before and weren t taken seriously, etc. In my psychology practice I have heard quite a lot about unprofessional treatments by some Sri Lankan counsellors and therapists. Best to forget about it, so many girls have experienced it here, forgive and forget . This is absurd, to say the least. Victims should come to terms with their ordeals. This means reliving the traumatic events in steps in a safe setting and expressing your feelings about it. In this way the impact of the memories becomes less and people feel more balanced.
Confrontation with the perpetrator and with the mother is a possibility but it is the choice of the victim to do so. It can help you to change the balance of power between you and your parents, build up a sense of self-worth and to deal with your feelings of anger, fear and insecurity. On the other hand there can be reasons not to confront. It might be too much in an emotional sense for the victim, there might be fear of losing the family, or the father might be very sick or old.
Treatment of sexual abuse is not something that anybody can do. Because of the severity of the trauma and the complexity of it, it is recommended that therapy should only be given by professional psychologists.
The Sunday Observer spoke to Dr. Marcel de Roos, a psychologist with a PhD from Holland who has been practising in Sri Lanka for three years. He explained why teenage depression can lead to a disturbing trend of love affairs related to suicides and murders.
Q: Why is there a growing number of cases of depression among teenagers and young adults in Sri Lanka?
A: It seems that they have to cope with a lot of pressure. In Sri Lanka much emphasis is placed upon education. It's not uncommon that children have a lot of tuition hours next to their regular school hours. The schooling system itself is geared upon achievements too. Getting high marks, participating in extracurricular activities, trying to get into the best schools, it's all very competitive.
Too much competition or not being able to accomplish your high standards can cause depression. Parents play a role in this too because in many cases they promote the said high standards.
It is not only in schooling that high standards are placed. In relationships there is also a yearning for the "ideal" partner. It's in the culture, brought about by parents and enhanced by taking concepts as palm reading and horoscopes very seriously. When for some reason the relationship isn't as "fantastic" as the young adult had perceived it at the start, it can cause depression.
Another factor is that in Sri Lanka there is no tradition of talking about one's issues. On the contrary, there is a strong pervading notion that problems should be kept within the family. This also can cause depression.
The above factors have been for a long time prevalent in Sri Lankan society. Why depression amongst teenagers and young adults seems to be more than before could be attributed to a number of reasons:
- better recognition amongst the public. The internet, newspapers and other media give more information than before.
- better recognition in the health sector.
- inability to fulfill their dreams, for example forced to stay in the country for economic reasons and not go abroad. Or reading on the internet about possibilities and opportunities and not be able to achieve those.
Q: How come depression, anger, pain and sorrow is linked to love affairs gone awry?
A: Love affairs, especially in Sri Lanka (and in more Asian countries) are seen as very special. Much effort, energy, hopes and dreams are connected with them. Usually, Sri Lankan young people don't have much "relationship experience" before they get involved into "the" ultimate one.
As a consequence, when they go through a relationship breakup, the pain is very deep and can easily transform into depression.
In Sri Lanka, this is enhanced because of the schooling system where most of the children attend boys or girls schools, so there is little opportunity to get familiar with the opposite sex in a natural way.
Q: Why do teenagers and young adults look to suicide as a form of escaping the depression and rejection by their lovers without solving it or moving on?
A: Probably because of the lack of a "talk" culture here. Problems, if they are talked about, are kept within the family. It is not done to talk with friends about your personal issues. When there is no safety valve to relieve the pressure by talking about it, then suicide seems to be a realistic option.
In the end, life seems to be a black tunnel with taking your life as the only possibility. This can be aggravated by feelings of shame or guilt associated with the breaking up.
Q: How come teenagers and young adults take it upon themselves to murder their own loved ones and commit suicide themselves in the process?
A: Apart from mental illnesses, there can be all kinds of strong emotions leading to the conviction that this is the only "way out".
Q: In what way can parents identify and tackle depression and love affair problems with their children?
A: There are a few tell tale signals regarding depression. The two main symptoms are that people have a depressed mood and have no interest in activities for at least two weeks for most of the time almost every day.
Furthermore they must have at least three more symptoms out of seven (for instance weight change, sleeping problems, thinking about death or suicide). The best way for parents to tackle depression with their child is to talk with it.
When your child trusts you enough the story will come out. Be aware that depression has NOTHING to do with the so called "chemical imbalance" in the brain. There is no medical scientific proof for this; it is just a marketing concept from the pharmaceutical industry. Talking and venting your feelings about your moods is the best way.
Q: There is a significant number of teen depression cases especially in love affairs that often goes unreported due to misconception or plain ignorance. Why is this so?
A: Perhaps the cause lies in the fact that parents don't take it that serious. "Oh it's just a broken love affair, is that all?". Or that parents simply don't know what to do, or feel ashamed to talk about it.
Q: How can we educate the youth on combating depression and help them?
A: By informing them through the media. But information alone isn't enough. The existing culture with regard to parents being open-minded and talking with their children in Sri Lanka has to change. But changing a culture isn't an easy thing to do and it takes considerable time.
Q: What sort of trend do you see with modern love affairs and emotions relating to them?
A: Amongst the better educated, more affluent and assertive younger generation Sri Lankans modern love affairs are more accepted. Still, on the emotional side there is a void. Rationally they can think things over, but emotional factors like the way they were brought up or cultural factors play a big role. In my psychology practice I have to deal often with this dichotomy of emotional versus mind.
Q: What is the solution that would help the youth tackle pain, sorrow and rejection and dealing with it without doing any harm?
A: The best way to deal with these emotions is to try to feel them. I am aware that in South East Asian culture, much attention is placed upon mind and behaviour; and emotions are usually disregarded. In reality, emotions (and instincts) are the driving forces in our lives. Suppressing or disregarding these is a clear recipe for depression. If people find it difficult to deal with feelings then they should seek professional psychological help.
Q: Do you think that by reporting on depression and suicide in media or reporting on deaths, that causes a copy-cat suicidal trends among youth?
A: Copy-cat suicidal trends are as old as the hills. For example the reactions on Goethes book "Die Leiden des jungen Werthers" (the sorrows of young Werther) in Germany in the late 18th century are partly to blame for copy-cat suicides.
But reporting on depression and suicide in the media usually has a significant preventive effect. Young people will become more aware of the problems and get informed about betters ways to deal with them.
The link to the original article is here
For teachers the perfect class is a concentrated, quiet and obedient one. Nowadays, when children stand out by what used to be called naughty, rebellious and boisterous behaviour, it is much easier than before for teachers to have these children drugged with for example Ritalin or Concerta (psycho-stimulant medications). For psychiatrists, jotting down abbreviations like ADHD, PDD-NOS and ADD and subsequently prescribing drugs has become routine.
Is there a psychiatric epidemic or is there something else going on? Leading American psychiatrists think that ADHD (supposedly an attention and hyperactivity disorder) is severely over-diagnosed; it s a false epidemic. Before 2000, only very serious cases were labeled with this diagnosis and only people who really needed it, were allowed to receive medication. As a consequence of the less stringent definition after 2000, the diagnosis of ADHD has increased spectacular. Everybody knows now somebody with ADHD.
Another reason might be that qualities that used to be attributed typically to boys such as an urge for noisiness, action, and forcefulness were formerly accepted, but are now regarded as a problem, especially at schools. It appears that not the boys, but the educators have changed. Boys are in essence the same as before, but the school system has become more feminine and looks upon their abundance of physical energy and enthusiasm as being an issue.
For concentration problems without hyperactivity, a separate category was devised called ADD (Attention Deficit Disorder). Therefore, many girls and women were included into the diagnostic criteria. PDD-NOS (Pervasive developmental disorder not otherwise specified) was brought in as a kind of residual category for people who don't quite fit into other more specific categories.
It is to be expected that the existing criteria will be eased up more so that an increasing amount of people will be labeled as suffering from a mental illness with all the dire consequences. The pharmaceutical industry has maintained strong ties with the psychiatric community and they have jumped at this opportunity. Big Pharma s marketing machine is working full time in trying to sell the new drugs.
New target groups are continuously defined. At first it were predominantly the overactive little boys which were not concentrated enough. Now the dreamy girls are coming into the picture. They are diagnosed with ADD and that is supposed to be treated with medication too. Finally it s the turn of the grown-ups; 5% of the adult population is said to be suffering from ADHD.
Using medications for ADHD involves a number of risks. The most important ones are decreased appetite and cardiovascular complaints. But also anxiety, stomach problems, dizziness, tics, skin problems and bruising are named. Less common, but potentially lethal results from taking these pills is, that they can cause suicidal thoughts and psychosis.
Research about the long-term effects of these medications is almost non-existent. There is only one such study, the so called MTA (The multimodal treatment of ADHD), sponsored by the National Institute of Mental Health in the USA. It shows that after two years, there is no difference between groups of children who do and don t use medication. Despite this and other critical studies, the use of ADHD medication has skyrocketed. The scary thing is that we don t know what the precise working is of the medication in our children s brains and we are also in the dark about the long-term side-effects. It s comparable to the enthusiasm with which Valium was introduced in the 1960 s. It was only later that the severe adverse effects became known.
ADHD (if it exists) is nothing more than a description of a number of behaviour symptoms. ADHD is NOT a mental disorder that causes you to be badly concentrated and noisy. The thinking about ADHD becomes problematic when the child is not seen as a person in relation to its environment (for example family, school, and neighbourhood), but only as an individual without a context. You just tally up some symptoms and voila, there you have ADHD! It becomes dramatic when you realise the enormous amount of children that are given potential dangerous drugs without proper effect evaluation.
An interesting article: "Ritalin calms hyperactive children and prescriptions are soaring - but experts warn of serious side-effects and it's even being linked to suicide", the link is here
Another interesting article: "Dr Laura Batstra: ADHD is not an illness", the link is here
And here is a video where Dr. Peter Breggin discusses his book "Talking back to Ritalin", the link is here
Some time ago a teenage boy came to my practice because he felt depressed and anxious. He had taken prescribed medicine from a psychiatrist who had told him that his symptoms were caused by a chemical imbalance in his brain. The pills had brought about suicidal thoughts and a huge weight increment, but fortunately his parents had wisely taken him off these drugs. After 5 psychotherapy sessions the boy felt a lot better, healthier and the real cause of his symptoms had been taken care of.
A lot of people (including many medical doctors) still believe in this chemical imbalance story. Chemical imbalance in the brain is nothing more than a marketing concept from the pharmaceutical industry. There is no scientific medical proof for it. Big Pharma has spent billions and billions of dollars to promote this myth and they have succeeded brilliantly. Because this is a hugely profitable business, the pharmaceutical companies have kept close ties with psychiatrists. With all kinds of (financial) incentives, subtle and not so subtle, they have gained much influence in drug prescribing behaviour.
The chemical imbalance theory is used to promote the sales of antidepressants and any other class of pills that supposedly restores the balance in our brains. The simple truth is that our brains are perfectly in balance of their own. There are no known biochemical imbalances and there are no tests for them. The only chemical imbalance that is brought about is caused by taking these psychiatric drugs!
Different psychotropic drugs alter our minds in different ways:
- Antidepressants (like Prozac, Zoloft, Paxil, Effexor, and others) cause an emotional numbing sensation. Sometimes they give a kind of euphoric short-lived fake relief from emotional pain. There are many reports and studies confirming that SSRI antidepressants can cause violence, suicide, mania and other forms of psychotic behaviour.
- Antipsychotic drugs (like Risperdal, Seroquel, Abilify, Thoraxine, and others) disrupt the frontal lobe function causing apathy and indifference. Users of these drugs become more submissive and are less able to feel. Long term (more than 3 months) users have an increased risk on tardive dyskinesia: non-curable involuntary, repetitive body movements.
- Mood stabilizers (like Lithium, Depacon, Lamictal, Tegretol, and others) slow down the overall brain function and they damp down emotions and vitality.
- Stimulants (like Ritalin, Concerta, Adderall, amphetamines, and others) blunt spontaneity and implement obsessive behaviours in children, making them less energetic, less social, less creative and more obedient.
In the long run, all psychiatric drugs tend to disturb the normal processes of thinking and feeling. They make the individual less able to deal with personal issues and they can cause irreversible harm to the brain.
Of course the attraction of these drugs seems obvious; they promise a quick fix and they put you into your comfort zone. The blame of the mental disease is not on the parents, the environment or the person himself, but on some alleged neurotransmitter deficiency in the brain. Psychotherapy on the contrary focuses on the real causes and empowers you. You do the work yourself and you re not dependent on pills, which you supposedly have to take for the rest of your life with all the dire consequences.
Some interesting links are here and here
The number of American children and adolescents that was treated for bipolar disorder has risen 40 times in the period 1994 2004. Today it is still at an all-time high. This inflated use of bipolar disorder as a pediatric diagnosis has made children the fastest-growing part of the US market for antipsychotics, mood stabilizers and other drugs.
Before 1995, bipolar disorder, once known as manic-depressive illness, was rarely diagnosed in children; today nearly one third of all children and adolescents discharged from child psychiatric hospitals in the USA are diagnosed with the disorder and medicated accordingly.
This increase is a consequence of the change of the classic term manic-depression into the use of the much broader definition of bipolar disorder, strongly influenced by clever marketing activities from the pharmaceutical companies. Children do have mood swings: one moment they are happy and then all of a sudden they turn into being very naughty or angry. But this is very normal for that age. Nowadays psychiatrists call this normal behaviour bipolar and prescribe children antipsychotic drugs.
There is no scientific evidence to support this conviction. In fact, the case against the existence of pediatric bipolar disorders is very strong. The effect of the fashionable new kind of thinking is very serious: children are given prescribed medicine that is not effective for them. These drugs have grave side-effects such as a major weight gain, hormone problems, diabetes, increased suicide risk, etc. Furthermore, children are supposed to take them for the rest of their lives.
The diagnosis of bipolar disorder in children and adults is a tricky one and it takes time. There are no blood samples or tests to rely on. Only self-reporting from the client, behaviour observation from relations and a thorough clinical assessment from a mental health professional can generate reliable results. This is not done in three minutes time and it takes effort, dedication and most importantly an open mind (usually there is nothing wrong with the person involved).
Make no mistake; classic bipolar disorder is not an easy illness to bear. It can be severely disabling and extremely difficult to live with. There is no proof for a genetic or neurobiological cause. Subsequently scientists assume that the disease is caused by a complex interaction between biological and environmental factors.
Usually, advertisements from the pharmaceutical industry suggest that manic-depression is the cause of mood swings. While in reality it s the opposite. Bipolar disorder is used by psychiatrists as a label. It s an agreement that when somebody exhibits certain behaviour (such as rotating between two extreme feelings) they can use the name bipolar disorder.
In the past years there has been much criticism on medication for ADHD. Because of this, many ADHD diagnoses have been replaced by Bipolar Disorder. The children involved are typically difficult to handle, quick-tempered and have mood swings. The latest fashion for these behavioural problems appears to be prescribing antipsychotics. Despite the fact that these drugs are meant for hallucinations and delusions, they are now used to suppress emotional peaks and troughs.
Bipolar Disorder seems to be the fashion of the day. But it is a costly trend because of the heavy medication, the alledged life-long prescription and the severe side-effects involved. It s typical that nowadays antipsychotics (like Zyprexa, Seroquel, Abilify and Risperdal) are the biggest selling class of drugs in the USA
About half a year ago, a distressed girl with her mother came to my practice. In a tense period of almost a month the girl had become sleep deprived because of preparations for exams at her college. At the same time she had heard that her grandmother was serious ill, which made her feel her heart racing.
She had gone to the emergency room of a reputable hospital in the USA (she studied there) where after a very brief intake the psychiatrist had told her that she had bipolar disorder. Subsequently, she was transferred to the psychiatric ward where she was put on heavy medication which caused side-effects. She failed her exams, had to quit her studies and back in Sri Lanka she continued the medication with another psychiatrist who (again) had hardly spoken with her.
The psychiatrists bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM, the fifth edition is out now), describes the criteria for putting on psychiatric labels on patients. Somebody can fall into a bipolar category having only one manic episode. The girl had to deal with a lot, so it was to be expected that she was irritable, her speech was quick, her mind was racing, she was easily distracted, and she was intensely focused on worrying about her grandmother and studies. And there a bipolar diagnosis (hypo-manic episode) starts to emerge.
Several months later the concerned mother took her off the (six!) different drugs and came to me for a second opinion. After having spoken to the girl for half an hour the story behind the symptoms became clear and also a logical explanation for her behaviour. This was no bipolar disorder at all, but just the consequence of sleep deprivation and concern for her sick grandmother. The girl went into therapy with me. Most of the time was spent diminishing the shock of being (falsely) labelled bipolar with the prospect of being on drugs for life, the fact that she had to give up her studies, and she had to deal with some of the side effects of the drugs (for example hair loss long after she had stopped taking the pills).
This exemplifies the difference between the assessment of a psychologist and a psychiatrist. Psychiatrists make use of the so called medical model where typically after a brief consultation medications are prescribed, in order to try to reduce symptoms of mental illnesses. The specific working of these medications is mostly unknown, many have (serious) side-effects and they are much less effective than people think. Psychologists on the contrary focus on the causes and the whole story behind the symptoms. There are no side-effects and the client is not dependent on pills (which often work as a placebo) to feel well. In therapy the client learns to deal with her issues by herself and finds her emotional balance.
The aforementioned DSM is only meant for categorisation. But psychiatrists more often than not differ in how to label a patient. The DSM diagnoses are scientifically and clinically untrustworthy. Worse than that, there is hardly a connection with a subsequent treatment. And that treatment typically consists of prescribing drugs which disturb the normal processes of thinking and feeling.
The American Psychiatric Association (APA) is in the first place a lobby organisation for its members where different groups fight for dominance. It s alarming to know that more than three quarters of the committee members of the APA who were involved with editing the new DSM 5, in one way or another are on the payroll of the pharmaceutical industry. This means that Big Pharma has a huge influence on which (new) category of symptoms can be classified as a mental illness .
It s remarkable that members with this conflict of interest are most often found in subcommittees for illnesses where as first treatment medication is recommended. In the subcommittee for mood disorders, 62% has interests with the pharmaceutical industry, the subcommittee for psychotic disorders 83% and sleep disorders 100%.
The DSM is a psychiatric classification system that doesn t pay attention to the causes of psychological problems and has no therapeutic intentions except the chemical suppression of symptoms. It s never too late to realise that for the majority of the mental illnesses a visit to a professional psychologist can be very sensible
An interesting article in The Guardian of May 2013 questions the role of the DSM. The article is here.
Almost everybody dislikes having arguments. But it s part and parcel of being in a relationship: even in the best marriages once in a while there are fights between spouses. Before you know it, you vent all the frustrations and irritations of the recent period, while your partner reciprocates in the same way. This doesn t mean that having a fight is negative. It can be very healthy; a good fight can clear the air and clean up bottled up issues. However, it s important to maintain a number of rules to keep it fair.
Speak from yourself. This is a very important basic rule that permeates through everything. Don t say for example You re always pressuring me , but I feel pressured by you . At first glance it doesn t appear to make much difference or even artificial, but the I-message is of vital importance. In real life it is essential different from the You always or Yes, but you where you accuse and pressure somebody. With the I-message you convey more how you feel and how you experience it. You share what what s going on inside you without explicitly blaming or accusing your partner. This increases the chance to be heard and understood, even when it s done in an emotional or fierce manner.
Keep it private. Your children, friends, family or neighbours have nothing to do with the fight between you and your partner. Before involving other parties, first try to work things out between yourselves.
Keep listening. Having a fair fight implies having a good quality communication. That means that you not only explain clearly what you think and feel. It also means that you listen carefully to what your spouse has to say. Try to listen to the other side of the story without interrupting and commenting on your partner.
Try to really understand your partner. It might sound strange, but with fights it isn t about winning or having it your way. Having an argument is basically a process where the end result should be to have come to an agreement. It s about trying to understand your partner, where he or she comes from, to be aware of what the other really says (or shouts). Even when you think that you know what is coming.
It could be a good idea to allow the other to vent his anger, without having it derail into a fight. This is not easily done, but it s important. We have to learn how to conduct a fair fight. Most people don t have the skills for this or have this competence by nature.
Don t try to change the other. People in general are only willing to change if they feel understood and they have the feeling that they are accepted (even when they are in the wrong). You can do your best to change your spouse, but he or she has to do the work. People only change in a genuine way when they want that from within themselves.
Stay to the point. When you are angry, there is the temptation to unleash everything you have bottled up against your partner. This is one of the biggest mistakes that are made in fights. Most people can hardly handle one point of criticism, let alone concentrate on three or four.
Often there is a temptation to bring in issues of the past when you re angry. This is not advisable, the fight becomes more intense and a possible way out seems further away than ever. Try to stick to the issue that the fight is about.
Take a break and try to meet each other halfway. When you are in a fight it s important to vent your feelings. Following this, try to take a brief time-out or cooling down in order to let things sink down a bit. This kind of break usually makes it easier to reach a compromise or come to an agreement. At least it generates a less hectic and less strained atmosphere.
In the Western world there is a lot of criticism concerning the use of antidepressants. An impressive amount of studies and research shows that they don t work as the pharmaceutical industry wants us to believe. For a detailed and more scientific discussion please read my article "Antidepressants and the chemical imbalance hoax ; you ll find it on my website www.marcelderoos.com.
When antidepressants (in about 30% of the cases) actually do give some feeling of improvement it is in fact a placebo sensation. People expect them to work (the setting at a medical doctor s office helps too!) so there is a chance that they will believe it and make it work. This is especially the case with so called active tablets : they give a certain feeling of numbness so people think that it s working.
If it was merely the financial scam (patients buy expensive tablets which can easily be replaced by cheap placebo sugar pills) then it would be only that. But the grim reality is that quite a large group of people have problems because of these drugs. It is not only the possible (serious) side effects such as weight gain, sexual problems, aggressiveness or even suicidal tendencies, but many people find it also difficult to stop with these tablets (the so called withdrawal effects). They feel compelled to continue with the pills, sometimes for 20 years or more!
Leading Western psychiatrists and psychologists time after time have stressed the point that the use of these drugs must be restrained. Doctors should be more careful with prescribing antidepressants. Only extreme severe depressed people ought to receive these drugs as a last resort. The fact is that for the majority of the patients with a depression theirs is a light or moderate one. There is an abundance of research evidence that for this large group of patients, placebo pills or psychotherapy does a much better job when compared with antidepressants. Nevertheless, for pharmaceutical industries their biggest sales are within this mild and moderate group of depressed patients.
Depression shouldn t be treated with tablets; psychotherapy gives much better results because it focuses on the causes. It enables patients to do the work themselves so they won t feel dependant on pills. There are no side effects and people feel empowered. Of course the attraction of these drugs seems obvious; they promise a quick fix and they put you into your comfort zone. The blame of the mental disease is not on the parents, the environment or the person himself, but on some alleged neurotransmitter deficiency in the brain.
Psychiatrists and General Practitioners tend to overmedicate people with antidepressants. This is especially rampant in Sri Lanka where people very often feel that if they haven t received medicine for an illness they are not taken seriously. Psychiatrists and GP s have to deal with many patients and little time. Besides this they have to face aggressive marketing from the pharmaceutical industry. Also, as a doctor they want to do something for the patient (who expects prescribed tablets).
When in the 1980 s these kinds of pills became popular, almost everybody thought that it would provide an easy solution for depression. Fortunately nowadays we know better; these tablets don t solve the problem at all and in many cases they add extra symptoms because of the side effects. In Western countries like Germany and the Netherlands doctor s organisations have committed themselves to change the depression protocols in favour of psychotherapy. In the United Kingdom the government has intervened and more than 10,000 psychotherapists are being trained as a replacement for psychiatrists. In the near future antidepressants will be banned.
In Sri Lanka many medical doctors and psychiatrists still believe in the chemical imbalance theory while it is clear that it is a fabrication of the pharmaceutical industry. Countless people continue to take antidepressants which cause much harm, but they don t address the problem for which they were prescribed! The only significant effect of these pills is that people continue using them and as a result the pharmaceutical industry is making billions of dollars profit.
When the decision has been made to separate from each other, sooner or later the children have to be informed. How do you tell your children that you will divorce? A divorce with no hurt feelings for the children seems impossible, but as parents we can do a lot to prevent the divorce derail into something traumatic for them.
Being in a divorce is a very major, intense and emotional experience. Especially for children! They usually react with feelings of anger, sadness and insecurity. Even when they had anticipated it and the divorce in itself brings closure to a period of fighting and tension.
For your children you are the centre of their universe. You are the first and foremost person to support your child with his/her emotions. It s challenging because you have your own emotions to deal with too. It s also demanding for your child, because there will be a lot of changes. Quite often they blame themselves for being the cause of the divorce, or they feel that they can t burden you with their worries.
Below you ll find some information and advice. Please be aware that your children need special care under these circumstances. If you have any questions it can be wise to look for professional help.
- Tell your children about what is going to happen, preferably together with your spouse. Take your time talking with them, and answer (where possible) all their questions. Even if one parent was against the divorce, it s important that the children don t have the feeling that they must take sides . For children the contact with both parents is essential. Their relationship with you as parents is a totally different one as between two adults.
- Explain to your children that you as parents can t get along with each other anymore. Give them clarity; don t provide them with false hope that some day everything will be fine. Stress the fact that both of you love the children, and that won t change.
- Try to inform the children some time before the actual divorce is there. Children need time to process what is going on. When for example there is little time between the explaining of the divorce and one parent actually leaving the house, children can become emotionally very upset.
- Make it very clear to them that the divorce is not their fault . Especially younger children have a tendency to blame themselves. Be aware of this! Tell them as much as you can that you love them and that you will always take care of them.
- With young children it s important to hold on to certain set rituals. That could be singing a song or to be read to from a book before going to sleep. Daily habits should be kept intact as much as possible. Many unsafe feelings will be compensated in this way.
- Try to tell the children about the divorce at their level of understanding. If you notice that the child gets distracted, or makes it clear to you that they don t want to listen anymore, stop the conversation immediately. It s their way of communicating to you that they can t take it any longer at that moment.
- Children have an inclination to take over the parenting role in order to support a parent who is in pain. This is not healthy for the well being of the child, in the long run it can be damaging. A child needs to stay child and is not ready for an adult responsibility!
- Tell the family, the parents of your children s best friends and inform the school. Inform these people after you have told the children! In this way your children don t have to carry a secret and they don t run the risk of hearing it from a third party before they heard it from their parents.
- Make time for talks with your children about their thoughts and feelings concerning the divorce. Ask them about feelings of sadness, fear and anger. You know your children best, observe how they behave and don t hesitate to ask for help when you notice that something is wrong.
Contrarily to popular views, in therapy more often than not the concept of forgiveness is something that rather hinders progress than enhances it. In my psychology practice clients frequently open up about their horrible experiences. They had to go through ordeals like sexual abuse by a family member, physical and emotional cruelty or neglect. Why on earth should one forgive such a person?
Many religious and spiritual movements consider forgiveness as an ultimate goal. It is regarded as a necessity to carry on in life without remorse. But forgiveness is something quite different from coming to terms with yourself, with finding your emotional balance. In therapy, the latter is the best that can happen to a client. In situations where a parent is the abuser, strong beliefs like honour your father and mother can do much harm and can delay or obstruct the therapeutic process in a serious way.
Martha (45) was sexual abused by her father between her seventh and fifteenth year. She feels that forgiveness is not possible. Not only because she can t, but more importantly because she doesn t want to. The father (her mother divorced him and he lives in another town) has never taken his responsibility and he has never shown remorse. All her life Martha had to cope with feelings of low self esteem, insecurity, depression, emotional numbness and fear of intimacy.
Martha has forgiven herself in the sense that she has let go of inappropriate feelings of guilt. For example the feeling of guilt that she should have stopped the abuse much earlier than at her fifteenth. Forgiveness in general can be important to mend broken relationships, but Martha has no reason to wish for a normal contact with her father. She has gone through the process of coming to terms with her feelings of anger, depression, betrayal, helplessness and pain. She feels much more balanced than she ever was and she is finished with her father.
In order to be able to forgive, the perpetrator should take responsibility, there ought to be acknowledgment by the outside world of the damage done, you should acknowledge your own feelings about what has happened and you should take the time to come to terms with your sufferings. Forgiveness is a choice. In Martha s case forgiveness was not possible and she is a clear example of how you can continue with your life without it.
Very often, there is the danger of wanting to forgive too quickly. Because you hope that forgiving will bring you the inner peace that you long for, or because you have been taught that it is the (religious) done thing to do, or that you want the relationship to be normal again at all costs, or that you want to make a beautiful highly moral gesture. In all these cases, forgiving usually brings you nothing.
What if the perpetrator doesn t take his responsibility, doesn t repent and doesn t acknowledge that he has hurt you a lot? Besides this, the most important thing is to feel your emotions like anger, hurt and revenge. You have to wade through these and more painful feelings in order to find emotional balance. At the end of this journey you have the choice whether you feel if the person responsible for your suffering is worthy of your forgiveness. Many people don t forgive and they have fulfilling and meaningful lives.
People who hear from their therapist that they must forgive ought to think twice and should consider changing therapists. If not, they will stay captive in the position of the small child that thinks it loves its parents, but in reality continues to be controlled by the abusive internalized parents and they will remain powerless. An abused child has the illusion that if it continues to behave good , one day its abusive parent will give it the love that it needs. By refusing to forgive as an adult, you abandon this illusion and you can experience your true painful emotions. As an adult, we ought to feel the suffering we were forced to endure as a child. In this way, the cycle of child abuse will stop with the next generation. Alice Miller, a Swiss psychotherapist, has written extensively about this topic (www.alice-miller.com).
A link to the original article is here
With drugs like antidepressants and above all benzodiazepines (for example Xanax, Valium, Librium, Ativan) users should be very aware of the adverse effects of these tablets.
Long-term users (more than 2-4 weeks) of benzodiazepines (whether they are taken as sleeping pills or anti-anxiety drugs) should know that these pills can give many unwanted effects, such as poor memory and cognition, emotional blunting, depression, increasing anxiety, physical symptoms and dependence. For antidepressants possible (serious) side-effects are weight gain, sexual problems, aggressiveness or even suicidal tendencies.
On top of this, after several weeks of regular use all benzodiazepines typically lose their effectiveness. This is a result of the increasing tolerance (the user needs more and more of the drug to experience the same effect), People who take for example Xanax (with a potency 20 times stronger than Valium!) should do this only for a couple of weeks and no longer!
When users of antidepressants and benzodiazepines reduce their dosage or stop with these drugs, then usually withdrawal effects appear. The body is used to a regular shot and lessening the daily amount causes symptoms.
With antidepressants withdrawal effects can be for example irritability and aggression, anxiety and depression, insomnia, nausea, headaches, dizziness, flu like symptoms, stomach cramping, electric shock sensations, tremor and muscle spasms. It depends also on the kind of drug; Venlafaxine (brand name Efexor) for example has a bad reputation regarding withdrawal effects.
With benzodiazepines the withdrawal effects can consist of severe sleep disturbance, irritability, increased tension and anxiety, panic attacks and tremor, sweating, difficulty in concentration, confusion and cognitive difficulty, memory problems, dry retching and nausea, weight loss, palpitations, headache, muscular pain and stiffness, a host of perceptual changes, hallucinations, seizures, psychosis and suicide.
People become afraid to stop with these drugs because of these withdrawal effects, and especially the reoccurring sensation of depression or anxiety can give much confusion. It causes many users feeling compelled to start taking these tablets again! Long-lasting serious withdrawal effects typically occur with long term users of benzodiazepines who stop without tapering off or with a too brief tapering off period.
When you want to stop taking these tablets then the best way is to do it gradually. Do not discontinue all of a sudden! Discuss with your medical doctor which tapering schedule is best suited for you. If your doctor is unaware of this (which happens quite often), then please go and read on the internet the so called Ashton Manual (www.benzo.org.uk/manual). When you understand the reason for any symptoms that occur then you will become less afraid.
Most users of antidepressants and benzodiazepines feel a lot better after having stopped with the drugs. A lot of of them tell that they have come out of a cloud ; for many years the tablets have caused them to live in a more or less zombie state. They feel that their mind has become much clearer, their mood is better, the world appears to be brighter, they feel more energetic and they have no more anxiety and fear.
Paradoxically the same tablets that promise relief from anxiety, depression or sleeplessness cause a lot of unwanted simular effects. Going to a psychologist instead of taking these tablets usually gives better results. Talking about your issues and venting your feelings to a professional psychologist typically gives much (long term!) relief and there are no side- or withdrawal effects.
In my psychology practice I treat a lot of people (usually women) who have fallen prey to overeating due to internal emotional conflicts, the so called emotional overeaters. Sadly enough, these women have become theoretical experts in dieting and exercising but their weight keeps increasing. They have yo-yo dieted themselves into despair and have done every new fitness hype on the horizon.
In the western world obesity is a serious problem, in Sri Lanka it soon will be. Researchers indicate that the increase of the percentage of people that are suffering from obesity is predominantly caused by emotional overeating. Nowadays, half of all obesity patients fall within this category.
With obesity there are the usual suspects like the rising popularity of unhealthy fast food, a less physical active life-style and in some cases medical causes. The almost epidemic emotional overeating is different: here the reasons can be found in social developments and individual emotion regulation. Families don t eat that much together anymore at meal times and social cohesion is diminishing. This can cause negative feelings.
Typically, emotional overeaters react abnormal on emotions. One of the explanations is that this unusual response can be linked with education. When children are comforted or rewarded with food then they associate food with emotions and they can t recognise anymore feelings of satisfaction. Another explanation is that nowadays, as a result of the growing individualisation, people feel more isolated and medicate themselves with food. Also, in Southeast Asian countries like Sri Lanka it s not done to speak about your problems, so people tend to eat them away .
Emotional overeaters should be treated by psychologists. With this kind of obesity, campaigns to induce people in eating less and exercise more are of no use at all. Eating healthier and exercising more is of course good in itself, but the cause of overeating is not addressed. The same goes for all these diets, they concentrate only on the symptoms (and usually very briefly); most people on a diet become heavier when they stop.
Try to find out first why you are overweight. Many emotional overeaters have learned to deal with issues or traumas in their past by overeating. People should come to terms with themselves in therapy and as a result become emotional more balanced. Only then they can start to manage their feelings in a successful way.
By regaining their emotional balance, people will develop an increased self esteem and reducing their weight for the long term won t be that difficult anymore. Basic and simple life-style advice is needed, but most of all the emphasis should be on emotions! For example, when you feel that you have a craving for food outside mealtimes, try to identify the feeling that s underneath the desire for food. It could be for example loneliness, sadness, hurt. Feel that emotion and try to ride it out instead of running to the fridge.
This is a very rudimentary description of the therapy that I give. In practice it is much more comprehensive and it involves the whole spectre of psychological facets and not only the habitually short-lived willpower (as in most diets). In therapy people learn to stop avoiding and suppressing negative emotions. Instead of this, they acknowledge and manage them in another way than overeating. This results in a better way of dealing with your emotions and in a more balanced eating pattern.
Many people still believe that the cause of depression is something in the genes . This is a remnant of the school of thought ( nature ) that oscillated upwards again in the 1980-ties when researchers assumed that more or less everything was genetically determined. Nowadays most scientists don t accept this explanation anymore. As a matter of fact, there are no known genes for any psychiatric disorder (for instance ADHD, depression, schizophrenia, etc.).
For all these illnesses there exists no robust body of research in favour of genetics. Although there are illnesses that occur comparatively more frequently with relatives, there is a frustrating lack of progress in understanding the genetics of mental disorders. Even twin research (applied to this field), what used to be the hallmark of the nature school, has come under serious methodological criticism. Experts are in severe doubt whether the underlying genes regarding for instance mood disorders will ever be found.
On the contrarily, the support for the school of nurture is becoming stronger and stronger. For example, when you grow up in a family where one or more family members are depressed, it is more likely that if and when you yourself become depressed it has more to do with the circumstances and family dynamics you grew up with, than with genetics. If there are any genes involved, then they play a very distant and minor role. With psychiatric disorders there usually is a complex interaction between nature and nurture, but the gene part is much less than previously assumed.
Furthermore, the medical model that psychiatrists use is based upon a number of certain symptoms (5 out of 9, 4 out of 7, etc.), which determine what kind of illness-label they should place upon these. With physical illnesses this usually works, but most mental illnesses are too complicated for this model. For starters, mental illnesses are typically ill-defined; nobody knows for example what schizophrenia exactly is. Also, with mental illnesses one should view the symptoms in the context of the personal history and circumstances. If the story fits and explains the symptoms in a different way, then there is no innate disorder and many of the ill persons should be labelled normal . And unlike physical diseases, the connection between the different possible causes and treatment options is not very clear. In research terms: the explained variance with mental illnesses is much less than with physical diseases.
Take for example a 35 year old man who comes to a doctor s office. He has a high temperature, muscle pains, headache and loss of appetite. The doctor bundles these symptoms to an objective general syndrome called fever . He administers medicine and in a few days the patient is well again.
But in the following example a 35 year old man brings his wife to a psychiatrist and tells him that she is depressed. In the Sri Lankan context the psychiatrist has little time and the wife usually doesn t speak until she is spoken to. So the end result would probably be that the husband receives a prescription for antidepressants for his wife.
A psychologist would probably have taken the trouble to ask the husband to leave the room and subsequently have spoken with the wife separately and confidentially. Perhaps then the wife would have told him that she suspects her husband of infidelity and that she feels angry, hurt and lonely and not depressed. Then a couple-therapy instead of focusing on the wife would be appropriate. Both of their personal histories and the marriage itself would be addressed.
In the medical model one works from the individual person to generalised diseases. The symptoms (high temperature, muscle pains, etc.) lead to the conclusion of fever (a very common condition, N=millions). Psychologists on the contrarily start and end with N=1. Mental conditions are typically very individual and are extremely difficult to generalise.
When you combine this with the failure of the chemical imbalance theory , the questionable independence of pharmaceutical industry funded research, and the fact that antidepressants don t perform better than placebo tablets then you can ask yourself whether the treatment of depression should be left out of the repertoire of psychiatrists and medical doctors. Depression is too complicated and too serious to be treated by non-effective tablets with side-effects and withdrawal-effects.
Oh, East is East and West is West, and never the twain shall meet,
Till Earth and Sky stand presently at God's great Judgment Seat;
But there is neither East nor West, Border, nor Breed, nor Birth,
When two strong men stand face to face, though they come from the ends of the earth!
The first line of this famous poem The ballad of East and West (1889) by Rudyard Kipling is often quoted as to emphasise the insurmountable differences between Eastern and Western people. But the less known third and fourth lines strongly point out that Asians and Europeans are equals and can put aside their differences. Psychology has its roots in the West and Buddhism in the East. But perhaps they can learn something from each other on an equal basis too.
Buddhism has rich and deeply layered teachings about traditions, beliefs and practices. It is not just a collection of spiritual or therapeutic techniques (for example mindfulness, meditation) from which we can take out aspects to our liking. In these teachings, Buddhism does mention emotions, although they are not in the forefront and are more or less seen as obstacles on the path to enlightenment.
For example, Buddhism advocates the concept of embracing your pain . In order to acquire a harmonious life you shouldn t run away from your painful emotions but instead make the reverse action and accept and embrace the pain. According to Buddhism it isn t the pain itself that makes us suffer, but the fear and resistance against it. So subsequently, an important condition for happiness should be to live your life without anxiety and defence mechanisms.
Another concept is living in the moment . A central theme in Buddhism is that you can learn to experience everything what happens in your life from moment to moment. When for example you do the dishes, don t try to see it as a chore that has to be done quickly. Feel the warm water, smell the soap and enjoy the smoothness of the plates. This is an example of how to practice living in the moment.
When you combine these two concepts then similarities with modern psychology becomes apparent. One of the key elements there is the focus on emotions. Feelings are in evolutionary sense much older than the cerebral functions and in the long run they usually win . We cannot control our emotions for long without causing damage to our well-being. Trying to influence them with our thoughts ( cognitive behaviour therapy ) is just a variant of positive thinking and is doomed to fail rapidly.
When I started practicing almost thirty years ago, the emphasis in psychology was on trying to change the thoughts of clients. The assumption was that as a result their feelings would improve. As I got more experienced I realised that it wasn't helping my clients in the mid- and long term. There seemed to be something missing. The feelings of depression or anxiety in many cases reappeared very quickly. The inclusion of feelings and making them the focal point of counselling changed a lot for my clients. Emotions are very strong, pure, there and cannot be ignored.
The most important thing for our well-being is to connect with our feelings. Not allowing ourselves to accept and feel the hurt is a recipe for unhappiness. It will bottle up and cause depression. Feelings have only one message and that is to be felt. When you allow yourself the time and space to feel (also physically) then the sadness won t last long; it will lift up and disappear. If you have paid enough attention to your feelings then you can move on and have a great day.
With depression, the way out lies in making the emotional link between the trigger in the present that makes you feel down and the experiences in your past where the real causes lie. Again, allowing yourself to feel these past and stuck emotions brings you out of the maze of depression. So East and West can stand face to face on an equal footing .
Youngsters today deal with a lot of stress. Sri Lanka's rapid development is driving many youths to despair. Job anxiety, failure to meet up to their higher expectations in life, competitive education system battling to get highest marks to get into the best schools and best university, it's constant circulation of stress, confusion, self-doubt, depression, anger, growing up experienced by teenagers.
Students are forced to take up in to many extracurricular activities or none at all, to the extent where 'fun' has become historic. And for some teens suicide may appear to be the easiest and best solution. Sadly, today there are so many suicidal deaths reported in Sri Lanka. It leaves behind a devastating grief and shame to the loved ones.
According to Dr Marcel de Roos, a psychologist, there is also a prevalent notion that problems should be kept within the family, it is not done to talk with your friends about your personal issues and on top of that, Sri Lanka has a strong gossip-culture which makes keeping things for yourself safer. When it comes to parents, taboo subjects are never discussed. Parents typically are revered and children do their utmost to live up to their expectations. Even when choosing a study at university, teenagers are more prone to obey their parents. When there is no safety valve to relieve the pressure by talking about it, then suicide seems to be a realistic option.
Following are excerpts of the interview with Dr. de Roos.
Q: In what way can parents identify depression and how can they help their child?
There are a few tell tale signals regarding depression. The two main symptoms are that people have a depressed mood and have no interest in activities for at least two weeks for most of the time almost every day. Furthermore they must have at least three more symptoms out of seven (for instance weight change, sleeping problems, thinking about death or suicide). The best way for parents to tackle depression with their child is to listen. When your child trusts you enough it will tell you what s on its mind and the story will come out. Be aware that depression has nothing to do with the so called "chemical imbalance" in the brain. There is no medical scientific proof for this; it is just a marketing concept from the pharmaceutical industry. Taking pills is not the answer, but the best way is to talk and to vent your feelings.
Q: Are all suicidal people crazy. Do they recover completely from this mindset?
People who try to kill themselves are of course not crazy. They are just in a temporary mindset where they feel that there is no other way out. Please be aware that it can happen to anyone. You ll be surprised how many stable persons when put into the right circumstances can act in this way. The vast majority of persons who were suicidal recover completely. For them it is a period in their past they can live with and have learnt from.
Q: What to do when you suspect that someone you know wants to commit suicide?
The most important principles are to make it clear to the person that you are there to talk with him or her and that you take the person very seriously. To ask somebody whether he thinks about suicide doesn t bring him on ideas; this is a big misunderstanding! On the contrary, when you ask about his plans to kill himself you create openness. In that way he can speak about his thoughts and feelings which can be the first step to seek help.
The link to the original article is here
I hardly felt the physical pain; the mental terror was the worst . This is what I usually hear in my psychology practice from women who were in an abusive relationship. The international statistics are devastating: about 20% of the women are (were) involved in a violent relationship. In Sri Lanka with its male dominated culture the figures are probably even higher. Why do abused women stay with their partner? And how can they get out?
Hiruni (29) tells about her relationship with Tharindu. During the two years that they dated she did get some signals but she was very much in love with him. She felt that he was a bit dominant and possessive but she thought it was because he was masculine and that he loved her too in his own way. Right after the marriage things started to change. He became increasingly dominant, he checked her ways, isolated her from her friends and slowly the physical abuse crept in.
For the slightest reason he beat her up, dragged her by the hair over the floor and started again. She thought that she was to be blamed: he loved her and he wouldn t hit her without reason, so she must have done something wrong. Only until much later she realised that Tharindu of course didn t love her at all. But the mental abuse was the worst; she felt so scared, so inferior and so humiliated. Sometimes during the abuse she urinated out of fear and Tharindu gloated about that. He constantly told her that she was ugly, used foul language against her and mocked her posh accent. He told her that if she would leave him he would find her and kill her. It took Hiruni six years to break away from him; six long years of physical, verbal and emotional abuse.
Hiruni went into therapy in order to come to terms with all that has happened and now her life is back on track. She remarried with a very loving man who is the opposite of Tharindu, she has a good job as a lawyer and she has a social life. She has found herself again, strong and independent. When she sometimes tells one of her new friends about her previous marriage, then they can t believe that someone like her could have been in such a situation.
In Sri Lanka there is a very strong tendency to keep problems for yourself or inside the family . Many people feel it s not done to speak about personal issues with friends or even with their parents. In addition to this, Sri Lanka has a strong gossip culture which makes things worse. Also, as a consequence of the abuse victims develop an extremely low self-esteem. Very often victims feel ashamed about the abuse and as a result nobody knows about it. All this makes it very difficult for the victims to seek help. And there are financial reasons as well. In many cases the husband is the breadwinner and wives are concerned what might happen after a divorce with the children and themselves.
In abusive relationships there is often a cycle of violence . At first there is usually a built up of tension which slowly leads up to (new) violence. The explosion doesn t need to have a direct cause; the trigger is typically something small. When there is physical violence involved, then as a rule it becomes gradually more extreme. After the outburst there are the habitual apologies and remorse. Promises are made that it will never happen again but after some time the pressure become stronger and the cycle starts all over.
The consequences of abuse are serious and multifold: low self-esteem, lack of confidence in people, not being able to deal with emotions like anger and shame, difficulty in finding your own direction in life. It s not easy for women to get out of this kind of relationships. Sometimes there comes a moment when the violence becomes too much for them (or directed at their child or pet) and they find their inner strength. What they need is an understanding friend or preferably a professional who listen to them and who can give them guidance. Professionals need to be aware of the dynamics of abusive relationships and the dos and don ts as a therapist.
There is something terrible going on in Sri Lanka. Bipolar depression seems to be invading our country. Almost every week new clients tell me that a psychiatrist has diagnosed them as (mildly) bipolar . Subsequently they are put on heavy medications (which are known to have serious side-effects, for example excessive weight gain, heart disease, tremors of the hands) with the message that they have to take them for the rest of their life. This also includes children and adolescents.
The pharmaceutical industry has made bipolar depression one of their spearheads in their efforts to maximise their profits. Their business is very lucrative (second best to the arms industry!) and they have extremely powerful (financial) resources. The strong financial relationship between Big Pharma and the American Psychiatric Association (APA) is reason for the American Congress to put this under congressional investigation. Every one of the APA s members involved in the mood disorders panel overseeing the editing of the psychiatrist s bible DSM IV and V (Diagnostic and Statistical Manual of Mental Disorders), has financial ties with the drug companies. Psychiatrists top the list of doctors receiving pharmaceutical company gifts. They are influenced in many ways to recognise bipolar depression (including children at an early age). A real moneymaker when patients have to buy on regular base 4 or 5 expensive medications for life..........
Before 1995, bipolar disorder, once known as manic-depressive illness, was rarely diagnosed. Today, strongly influenced by clever marketing activities from the pharmaceutical companies, the change of the classic term manic-depression into the use of the much broader term bipolar spectrum has made medications for this disorder a sales hit. Countless people who objectively speaking were for example suffering from stress in a certain period or were just anxious are now labelled hypomanic (simply put: the euphoric period of bipolar).
There is no scientific evidence that depression can be caused by biological factors; the so called chemical imbalance theory is just a pharmaceutical marketing campain. Experts are also very pessimistic about alleged hereditary factors like (combinations of) depression genes or even less likely, neurotic personality traits . It becomes more and more apparent that environmental factors like family dynamics, traumatic events, etc. are the main causes for depression. With bipolar depression researchers are in the dark, there is no valid causal explanation for it; it s only a label for a number of symptoms.
In the articles Bipolar Madness and "Psychological / Psychiatric Assessment (see my website www.marcelderoos.com) I discussed the alarming increase of bipolar-diagnoses , in particular with children. But also many adults very easily get the label bipolar depression without a thorough professional assessment. And very often this assessment has been done in less than 5 minutes time. Bipolar depression isn t something that you can measure quickly; there are no tests or blood samples to rely on. Only self-reporting from the client, behaviour observation from relations and a careful clinical assessment from a mental health professional can generate reliable results. Especially with such a complex possible diagnosis as bipolar depression, a mental health professional should have ample time and more crucially, an open mind.
The medical model that psychiatrists use is based upon a number of certain symptoms (5 out of 9, 4 out of 7, etc.), which determine what kind of illness-label they should place upon these. With physical illnesses this usually works, but most mental illnesses are too complicated for this model. Also, psychiatrists more often than not differ in how to label a patient. The DSM diagnoses are scientifically and clinically untrustworthy. Psychologists on the contrary focus on the possible causes and the whole story behind the symptoms. Most importantly, with mental illnesses one should view the symptoms in the context of the personal history and circumstances. If the story fits and explains the symptoms in a different way, then there is no innate disorder and many of the ill persons should be labelled normal .
When I speak with a client, then generally between half an hour and one hour s time the story and circumstances behind the symptoms becomes clear. It very often means that the previous diagnosis bipolar depression was wrong. Clients have to deal then with diminishing the shock of being (falsely) labelled bipolar with the prospect of being on heavy medications for life (!) and with the side effects of the drugs. It s so important to be very meticulous in diagnosing a serious illness like bipolar depression.
Psychologists and psychiatrists usually don't work well together, mainly because of the above mentioned differences. Psychiatrists typically focus on trying to subdue the symptoms with medications which blunt the emotions while psychologists try to get to the bottom of the person's emotional state. For psychologists medications usually are an interference with their therapies which aim to coach the person into a more emotional balanced state of mind.
In the past months readers have mailed me numerous questions about depression. All questions have been answered individually in detail. Below are a few of the most frequently asked themes:
Q: We read and hear conflicting opinions about the alleged biological causes of depression and about the so called chemical imbalance theory. Could you please give your opinion on this?
There is no valid foundation for the belief that biological factors cause depression. The powerful pharmaceutical industry, in tandem with psychiatrists organisations, has done its utmost in trying to sell this idea to the public. Big Pharma s marketing specialists have developed the so called chemical imbalance theory which lies at the core of this effort. Simply formulated (for an extensive discussion please read my article "antidepressants and the chemical imbalance hoax on my website www.marcelderoos.com), modern antidepressants are said to increase brain levels of the neurotransmitter serotonin which supposedly puts you in a better mood. But there is no direct evidence: when healthy people's serotonin levels are lowered, it does not change their mood. Neurotransmitter depletion has been attempted in at least 90 studies with conclusive results: reducing serotonin and other neurotransmitters in healthy volunteers does not affect their mood. The authors of the most complete meta-analysis of serotonin depletion (Ruhe et al., 2007) conclude that there is no direct correlation between serotonin in the brain and mood. There is even an effective antidepressant called tianeptine (a few years ago approved in France) that LOWERS the level of serotonin. This raises the question why depression can equally be affected by drugs that increase levels of serotonin and by drugs that decrease it. After half a century of propaganda by the drug companies, the chemical imbalance assumption has been sufficiently invalidated by experimental evidence.
On top of this, independent (not financed by the pharmaceutical industry) research has shown numerous times in the past 15 years that antidepressants do not perform better than placebo tablets. The American researcher Irvin Kirsch has written extensively about this. He is widely regarded as one of the world s leading experts on psychiatric drugs and the placebo effect. He is the author of The emperor s new drugs, exploding the antidepressant myth (2009) and has written more than 200 research papers. In 1998 he published Listening to Prozac but hearing placebo, a meta-analysis of antidepressant medication , where he showed that in the case of mild, moderate and severe depression antidepressants do not outperform placebo tablets. These results have been replicated many times after by other scientists. A recent study published in the Journal of American Medical Association confirmed this again. In other published studies (for example by Moncrieff) with active placebo s (an innocent pill with side-effects in order to make people feel that something is working ) antidepressants don t outperform these placebo s as well, including patients with very severe depression.
One problem with medications is the high relapse rate. Depression comes back over time in about 90 percent of people on antidepressants. Studies show that relapses are far less common when people are treated with psychotherapy. Another is the possible serious side-effects (not a pleasant thing when you are already depressed!) such as excessive weight gain, sexual dysfunctions (like loss of sexual drive, failure to reach orgasm and erectile dysfunction), and when pregnant women take these tablets then there is a bigger chance of genetic damage in the fetus. American psychiatrists like Dr. Peter Breggin (www.breggin.com) and Dr. Allen Frances http://www.huffingtonpost.com/allen-frances) are very concerned about the growing medicalisation of mental illnesses like depression.
Q: In your articles you often lash out against the pharmaceutical industry ( Big Pharma ). Are you dead against prescribing medications for mental illnesses?
The pharmaceutical industry has contributed in its own way in making the world a healthier place. But it is a very lucrative (second best to the arms industry!) commercial business and good quality healthcare for patients and profit do not necessary walk hand in hand. This is especially true regarding drugs for mental illnesses. The pharmaceutical industry yields a lot of (financial) power and tries its utmost to influence patients and psychiatrists prescription behaviour in order to maximize its profits. One of their biggest money makers lies within the mild and moderate group of depressed patients (annual sales of billions of dollars). With most mental illnesses there is no need for medication and/or the standard prescribed drugs are ineffective (for example antidepressants and benzodiazepines) and have (serious) side-effects and withdrawal effects. Only in special or severe cases medication can be of use but it doesn t address causes and it merely numbs or subdues people.
Q: Are children being over-diagnosed with depression or bipolar depression?
Parents, teachers and healthcare workers are getting increasingly concerned about the ease with which children are getting diagnosed with for example ADHD, bipolar depression and depression and subsequently receive prescribed psychiatric brain-medication . ADHD is not a brain disease , it s just a label for a number of behavioural symptoms, which in most cases can be adequately addressed with parental advice (including for the parents themselves!). Furthermore, there is no scientific evidence at all that children can have bipolar depression. And lastly, children do get depressed but this is most of the times explained by circumstances and personal history. One of the most common mistakes made by psychiatrists, besides having a limited time allocation for their patients, is to only look at symptoms and not taking into account the context. This context (for example parents behaviour, the child s personal history, family, school, neighbourhood) in most cases explains the child s behaviour. An open mind and adequate psychological help usually can take care of the situation. ADHD and (bipolar) depression is not just tallying up some symptoms and putting a label upon a child.
Q: Can neurotic personality traits be inherited?
This belief stems from the 1980-ties when researchers were overconfident that they could find genetic explanations for almost everything. Nowadays we know better; there are for example no simple or combination of known genes responsible for any psychiatric disorder. Perhaps there is a complex interaction with genetics, but the influence of the environment (for example the family dynamics you grew up with or traumatic experiences) is paramount. After 50 years of intense and extremely costly (trillions of dollars) genetic research for psychiatric disorders, experts are very pessimistic about ever finding these genes. For personality traits this is even more complicated, and there is no evidence at all that neurotic personality traits can be inherited. This assumption is too complex; at the same time it has become clear that the influence from the environment is the key factor.
Q: Can electroconvulsive therapy ( electro shocks ) be of help with depression?
With the vast majority of clinical depressed people the answer is short and simple: no. Only with life threatening depression where there is no other possibility ECT can be tried out. But the relapse rate of ECT is extremely high and most patients have to be put on heavy antidepressants soon again. This rapid relapse, and in a significant amount of cases for example the permanent loss of memory, loss of concentration, impaired judgment, emotional instability and loss of personality are a huge and disabling problem. Especially young and elderly people form a high risk group. Many people feel that they were insufficiently informed about these side effects. Much research about ECT is done or funded by stakeholders; independent long-term studies (at least 4 weeks after the last treatment) usually show that the cost-benefit analysis of ECT is very poor. They conclude that the risk of damage caused by it cannot justify its continued use.
One of the most persistent myths is that psychotherapy is supposed to be based upon protocols. When somebody is for example depressed then protocol demands that this person should be treated with cognitive behaviour therapy (CBT). Especially medical doctors are trained in this way and they often assume that CBT falls within this protocol-thinking way too. But psychologists with a few years of practising behind their belt know that it doesn t matter much which therapy or method they use.
The most important success-factors for any therapy are the therapeutic relationship and an active client. Therapists have to be able to install trust and hope in the client and the client herself should be engaged in the therapeutic process. On top of this, the therapy should include the present, the past (!), cognition, emotions (!) and behaviour.
Cognitive behaviour therapy is typical American in its assumption that the way you think will influence your feelings. When you are depressed you should challenge your negative thoughts ( positive thinking ). From the clinical practice we know that you can tell a depressed person a hundred times that he should think positively but that won t bring about a lasting change. Why is CBT then so popular?
CBT is seen as a relatively quick fix , is comparatively cheap and appeals to our sense of logic: think positively, be strong and you have to work for it! While in reality coming out of a depression means accepting and actually feeling your painful emotions. This is also a lot of work but in a quite different sense! Depression is an emotion and it has nothing to do with our thoughts. Emotions are in evolutionary sense much older than our cognitive brain and in the long term they usually win . Trying to influence your feelings with your thoughts is a hopeless enterprise. Feelings want only one thing and that is to be felt! So the best way to come out of a depression is not to fight it with our thoughts, but actually starting to feel it and finding out where it stems from. Depression has to do with your past history and what others have done or said to you.
It s difficult to measure therapeutic success; it depends on the school of thought that lies behind the specific method. With CBT success is seen as less negative beliefs. With for example psychodynamic therapy and psycho-analytic therapy (the latter usually last for years!) it is about understanding yourself, balancing your feelings and learning to live with your issues. With these last two forms of therapy depression means something quite different than with CBT and it isn t simply about a lower score in a general depression test.
Most of the research with CBT is done like this: a group of depressed persons CBT intervention results. And of course the outcome is often that CBT works . But when you compare different therapy methods with each other (and taking into account the observations made above) then there isn t much distinction in success between the methods. There is a robust amount of research for this. One of the most recent is a big meta-analysis (2013 PLoS Med 10(5): e1001454) where seven psychotherapeutic interventions for depression (including CBT) were compared. The findings were that none of the therapies stood out as being better than others. This means that there must be other factors (like the therapeutic relationship and an active client) that are responsible for the efficacy of psychotherapeutic interventions and not the researched method.
In medical science randomized controlled trials (RCT) are allegedly seen as the golden standard for research regarding medications. There is a lot criticism about these RCT s but in this article there is no space to discuss these. Concerning the use of RCT s with psychotherapies it should be noted that these RCT s are strictly regulated in an artificial environment (not real life ) and meant for extreme short term treatments. Most therapies can t be moulded into a RCT-format, which means that RCT s favours certain methods only because of the nature of the RCT s.
Cognitive behaviour therapy is accepted because it supposedly generates (usually short lived) results with for instance depressed patients. But it is a wrong assumption to think that CBT works. Evidence based research concerning the effectiveness of therapies is a minefield. Based upon what meta-studies have showed so far, extraneous factors like the role of the therapist and an actively participating client are crucial in the success of a therapy and not the chosen method of therapy. If cognitive behavioural therapy was that all powerful then there wouldn t be any depressed psychologists; reality tells us something quite different
In the past years there has been a huge increase in the use of Facebook in Sri Lanka. As there is not much reliable data available about its impact on our society and culture, I can only mention some general remarks. Social networks do have a positive influence; there is no denying that. The ease where you can participate or intensify in friendships is there. The world can enter through your screen . But that also indicates that same ease can become a threat. Sri Lanka s society is rather conservative and vulnerable. Generally speaking, young people are raised here in a protective manner. Many of them are not prepared for the dangers that lurk on the internet.
Facebook does seem to have different forms of psychological impact on its users. A recent study from the University of Michigan seems to indicate that people who are active on Facebook are less happy than people who don t use Facebook. On top of this, the more they use Facebook, the more their life satisfaction levels will decline over time. As always with research, it s important to be critical about the study itself. The number of participants was only 82, the examined period was short (14 days), and the participants were young (average age 19). And the influence on the feeling of well-being was rather limited: only a few percent; there are many factors that determine how we feel.
But other published studies from the Universities of Utah, Berlin and Madrid also point out that Facebook has a negative effect on our happiness. To put it in a nutshell, Facebook users appear to more jealous and more unhappy. The jealousy seems to stem from the fact that most Facebook profiles are unrealistic. They usually only show the successes in the users lives and not the less positive sides. But other users tend to believe this image and that makes them jealous. According to a British study, hardcore users of Facebook put in extra effort to participate in fun activities in the weekend in order to be able to post the pictures on Facebook. They have their camera always on the ready.
Many users tend to vent out their emotions on Facebook; the underlying causes can be multifold. Psychologists believe that it has to do with the perceived safety of doing so. People sit safely behind their screen. Also, social networking on the internet is different from the real world. There is a distinct lack of overlapping cues how the receiver reacts to the sender s message. Communicating has shriveled into messaging without facial, emotional or body language. Tell tale pointers in real life conversations like a hurt or angry body language are absent so there are far less deterrents. In extreme cases people can feel no restraints and can become socially awkward. One has to be careful with generalisations but when Facebook users constantly spill out their emotional life then apparently there is a lack of real life persons with whom they could share this in private. For Facebook users who have a balanced life with enough real life contacts, Facebook is just a small (and often pleasant) part of their lives. But for the group that sort of relies on Facebook for contacts, their socialising and communication skills are very limited. Their self-esteem for a big part depends on the feedback they get from other users. And as pointed out previously, Facebook profiles are usually not very realistic or accurate.
From a psychologist s point of view, there are some measures that could be taken in order to reduce the psychological impacts on individuals due to social networking. But as with many things it s important to be moderate. Social networking can be fun and useful, but when your life is more or less defined by your Facebook-buddies then it s high time to meet some real people. Real life friends are the best; they give you the feedback coming from a whole person and not just flat character -personalities and messages coming from a screen. As for young people (children) it s better to be careful. In Southeast Asia and in Sri Lanka especially, children are raised in a rather conservative way and they seem to be innocent and childlike for a longer time than in the West. Prepare your children well for the internet and better don t let them have a Facebook account at a too young age.
Compared with the rest of the world, it s hard to say where Sri Lanka stands when it comes to individuals who get psychologically affected by social networking, because there are no comparative studies. But from what I personally observe, in many ways Sri Lanka is still a bit of an innocent society with strong moral values. That in itself is very positive, but it s fraying around the edges. In Sri Lanka the family and social support networks are still in place and protective for individuals, whereas in large parts of the rest of the world individualism has gone to the extreme.
A link to the original article is here
Depression is about stuck emotions. You feel dead inside; life seems to have no more meaning. You feel hopeless, lifeless, empty, and apathetic. But there is practically always a story behind the symptoms of being depressed. A story that explains these symptoms, that they started somewhere in the past and that there are emotional causes for them.
What do we really know about (clinical) depression? We know that there is an agreement amongst mental health care workers to label a number of symptoms as clinically depressed . Psychologists and psychiatrists make use of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD) which describes these symptoms (at least 5 out of 9). Descriptive symptoms like a depressed mood for more than two weeks every day, weight change, change in sleep, change in activity, suicidal thoughts, etc.
We know that there is no proof that biological or genetic factors cause depression. We know that chemical imbalance in the brain is nothing but a marketing hoax of the pharmaceutical industry. We know that antidepressant tablets don t work with depression (enough said about that in previous articles), apart from the placebo effect. We know that positive thinking won t help; that our thought process has nothing to do with the feeling of utter depression.
But we also know that depression has everything to do with FEELING depressed. Since depression is about stuck emotions, it makes sense to treat it from that angle. An empathic psychotherapist with sufficient knowledge about depression can coach the client in making the stuck feelings fluid again. It s about making the client feel that she is understood and that her story and symptoms are taken seriously. It s about empowering people. In therapy there is a lot of talking, but in essence it s about venting your feelings and coming to terms with yourself.
Psychotherapy practised by an empathic professional therapist and with an active client does work. Depression has to do with a person s past history and what others have done or said to him. So therapy should focus on the emotional link between the triggers in the here and now and the painful causes in the past. The next step should be the painful job of trying to feel these stuck emotions. It s crucial that the client has a well trained professional psychologist who supports him. When the client feels more emotional balanced because the influence of his past has diminished, and the client has learned to handle his past emotions, then the time has come for the therapist to step back.
Empathy in therapy is a key concept and although it s complicated to define it, generally speaking we assume that it s an ability to imagine oneself in the situation of others and to sense the emotional state of others. The therapist should make it clear that he understands the emotions of the client. Besides this affective aspect, empathy also has a cognitive part and it enables us to understand the perception of the environment of the other person. The quality of empathy increases when the therapist is able to be authentic with himself and in the contact with the client (congruent).
The importance of an empathic therapist with mental illnesses can t be emphasised enough. The American psychiatrist Peter Breggin (www.breggin.com) has written extensively about this.
In Sri Lanka there are many family owned businesses. They form an important part of the economy and they usually have their idiosyncratic features. In my psychology practice I regularly speak with clients who work in a leading capacity in their family business.
Family-run companies (once established) have generally speaking a good reputation. International research shows that these companies usually are financially better organised than stock market listed ones. They don t get affected that much by an economical dip because they are managed for generations by the same family so they know from experience what to do. Because they focus more on the long term and they are not pestered by pushy shareholders, they are better prepared to tackle upcoming crises. They typically hold on to a chosen strategy, don t take on more than they can handle, and take care of their employees, customers and suppliers.
One the downside, one of the biggest risks of failure in family businesses lies in a lack of adequate soft skills regarding family- and management issues. I often advise family members about these, and in particular about succession issues. Succession has to do with legal, organisational, business but above all with emotional factors.
In South-East Asia very often children (in particular sons) are more or less groomed from a young age to take over the family business. Usually this works out well: there is a sense of duty, respect for the parents and in quite a lot of cases a genuine interest in the business itself. But it doesn t always materialise like this. Children might have other interests, or their parents don t find them competent of taking over, or the parents are without children. Then a different solution has to be found.
Succession is one of the most critical periods in the existence of a family business. Succession issues are predominantly about handling the emotional charged family dynamics. Pure technical solutions seldom generate success. It s important that during this transition there is an independent coach to maximise the chance of success. Above all, it s vital that the company continues to develop itself and that the family relations stay intact. The human dimension should be placed central with decisions regarding strategy, difficult dilemmas or conflicts.
At some point succession planning for the family business must be taken into consideration. There are three main participants: the director, the successor and the family.
As a director and main share holder there might be questions like how long do I want to continue in an active role within the family business and what kind of role do I want for myself in the future? Can I (financially) afford to stop at an early age (is there a pension and/or shares from the family business)? Do I feel comfortable with (temporary) non-family management when the children are not ready for the job? How do I feel about a long-term cooperation with the children in a role as equal share holder or as director?
As a successor questions might arise like how to deal with a variety of issues. A few examples are: financial aspects, whether you are accepted and not constantly are compared with the previous director and main share holder. Sometimes the previous director has difficulties with letting go so you don t feel free to manage the company as you feel you should. Do I have an objective opinion about my capacities and do they fit within the responsible role that I have or do I have to invest in training or a coach? Do I enjoy working together with my siblings and/or cousins?
The family has to feel at ease to discuss all these issues without creating emotional problems.
The role of the coach is to ensure that all parties are equally involved and to function as a mediator in this often very complicated process.
(For a previous article about ADHD ("ADHD, psychiatric epidemic or hype? ) please visit my website www.marcelderoos.com).
Some thirty years ago when I started practicing, children diagnosed with ADHD were rare. These were children who were really extremely out of control. Nowadays many children who are diagnosed with ADHD can easily be taken on a family outing. The bandwidth of the criteria regarding ADHD has dramatically widened. In the 1980-ties the name ADHD was introduced in the third edition of the Diagnostical and Statistical Manual for Mental Disorders (DSM).
Today one out of four children is supposed to have a behavioural disorder, ranging from ADHD to light forms of autism. To label these problems a disorder is creating a much bigger problem. The phenomenon lies deeper and isn t solved with medication. Basically children need attention, love, ground rules and structure. This doesn t mean that the parents are to blame, but that (for example) ADHD is a development problem and not a medical condition. Because of the surplus of stimuli and speed we live in an ADHD-world so we mustn t be surprised that we produce ADHD-children.
Problem children usually have more than one problem at the same time. The big question is where these problems stem from! The wrong way to react is done in threefold. The first is to label a complex issue as a disorder and subsequently partition it into ADHD, conduct disorder, non-verbal learning disorder, oppositional defiant disorder, etc. Secondly each of those disorders is separately pseudo-medicalised, as if it s a brain condition that can be determined in a neurological or even in a genetical way. And finally all problems are taken out of their context and totally attributed to the child. Society, social-economic context, school, parents, family, are not taken into consideration. ADHD is then nothing more than tallying up some symptoms of the child and voila, there is your diagnosis.
Instead of pseudo-medicalisation it s better to give the sum of all the problems a name like developmental problem . British researchers have conducted a study about ADHD in the USA and in the UK (Hart, N. & Benassaya, L. (2009) Social deprivation or brain dysfunction?). They thoroughly interviewed more than 10,000 families and it showed that ADHD has a strong correlation with social problems. Compared with children without ADHD, children with ADHD have much more to deal with poverty and family problems (like divorce, financial problems, serious illnesses in the family, psychiatric problems with a parent, and judicial problems). This indicates that there is a connection between the context in which a child grows up and lively, boisterous and inattentive behaviour.
Most people think that ADHD is a neurological problem that should be treated with medication. This is complete nonsense. ADHD is what the abbreviation says: a shortage of attention and a surplus of activity. This is purely a descriptive terminology and it is now defined as an illness. But there is no scientific basis for that. There is no scientific study that can show why we should treat ADHD as a disease.
It s quite possible that in Ancient Greece the impulsive and dashing Alcibiades (one of Socrates pupils) would fit neatly in the ADHD description of the DSM-5, but that doesn t mean that he was suffering from the millennia old illness ADHD . It only indicates that the description of ADHD in the DSM-5 is now completely out of proportion. Thirty years ago ADHD hardly existed. Nowadays teachers advise parents to think about giving Ritalin to their child when it s showing naughty, rebellious and boisterous behaviour in class that they find difficult to handle. The teacher acting as a psychiatrist! The child has ADHD as if it s a brain disorder! And a short visit to a psychiatrist will usually confirm this belief.
The DSM-5 is an arbitrary classification system with no psychological or psychiatric use. Despite the term statistical in the title, it does not mean that the book is based upon sophisticated research about types of psychiatric problems. On the contrary, the classification criteria and categories were chosen by vote by people in working committees who have strong financial ties with Big Pharma. The DSM is written as an extension of the pharmaceutical industry. There is no solid theoretical foundation, nor a clinical pragmatic practice. The pharmaceutical industry used its influence to dramatically extend the criteria for ADHD in 2000 and again in 2013 with the introduction of the DSM-5. This means more medication and is extremely profitable for them.
The diagnostic criteria for ADHD are very vague (why not 5 or 7 symptoms instead of 6, does often means once a day or once a week/month, what is forgetful, etc., etc.). As a consequence there is a huge variety by different assessors in interpreting the criteria. Even worse, there are two equally comparable classification systems, the DSM-5 and the International Classification of Diseases, 10th edition (ICD-10). When children are diagnosed for ADHD with the ICD-10, then there are HALF as much ADHD children than with the DSM-5. This shows how arbitrary this diagnosis is.
Research about the long-term effects of psycho-stimulant medications like Ritalin is almost non-existent. There is only one such study, the so called MTA (The multimodal treatment of ADHD), sponsored by the National Institute of Mental Health in the USA. It shows that after two years, there is no difference between groups of children who do and don t use medication. In addition to this, children s brains are vulnerable and we don t know what strong medication like Ritalin does to them. There are well known side-effects like a decreased appetite and cardiovascular complaints. But also anxiety, less social interaction, numbing of the emotional life, sleeplessness and addiction are named. Less common, but potentially lethal results from taking these pills is, that they can cause suicidal thoughts and psychosis. Despite this and other critical studies, the use of ADHD medication has skyrocketed.
A competent parental guidance counsellor or child psychologist should be the first choice. She/he can determine causes of the individual child s behaviour and give tips concerning a structured life style, parental advice, food, etc.
Here is a video where Dr. Peter Breggin discusses his book "Talking back to Ritalin", the link is here
In the Western world about twenty to forty percent of the women have issues with their sex lives. Examples are experiencing pain during intercourse, a low libido or problems with having an orgasm (many women have never experienced an orgasm). Very often they don t want to discuss this even with their doctor because of the taboo subject . In Sri Lanka, where sexuality is a much stronger taboo than in the West, these figures are probably a lot higher.
It s quite normal that there are periods on our lives where we experience sexual problems. During a stressful period you re not that much into having sex as you used to. Or when there are issues within the relationship it s very understandable that you have trouble getting excited. But when it is not possible to enjoy sex in a relaxed way for a longer period then various problems might develop. The most important causes of these sexual problems are: fears and inhibitions, physical problems, negative experiences, lack of skills, relational problems and values and beliefs.
With women sexual problems very often have a psychological context. When you re not doing well in a psychological sense then typically sexuality is one of the first areas where you experience a change such as:
-Sexual need. In a relationship it s very rare that both partners have exactly the same sexual need. It depends on factors like social circumstances, how much time and effort you put into the relationship, how much time and effort you put into yourself, tiredness, stress, depression, menopause, relational issues, pregnancy and post pregnancy.
-Sexual anxiety and fears. When there are sexual problems related with (lack of) desire, vaginal dryness or erectile dysfunction then they can cause a lot of sexual tension within the relationship. They can prevent having a satisfying sexual relationship.
-Lack of desire. Possible causes can be medical illnesses like diabetes and multiple sclerosis; medications like antidepressants, tranquillizers, blood pressure tablets and beta blockers; too much alcohol; inexperience; bad communication between the partners. Another possibility could be that from the onset of your sexual active life you experience problems with sexuality because you don t know what excites you or you have fear or aversion to sex. Also, in a long-term relationship it can be difficult to maintain a satisfying sexual life.
-Vaginism. This is an involuntary vaginal muscle spasm, which makes sexual intercourse very painful or impossible. Women are usually very sensitive. A bad sexual experience in the past, fear of painful sex or a strict (religious) upbringing can totally spoil the interest in any sexual activity. With vaginism professional help from a psychologist or a sexologist is very often needed.
In essence sex is a way of communicating between two persons, verbal as well as non-verbal. You are in a relationship with each other where trust is one of the most important factors. You open yourself up in a physical and in an emotional sense and as a consequence you make yourself very vulnerable. It is not so strange that within this relationship there can be a lot of problems. Very often these are problems where you feel ashamed of, and it becomes difficult to discuss this with your partner. Sexual problems can develop into relationship problems and many people keep these problems for themselves too long. It s important to bear in mind that a professional psychologist can give valuable advice and guidance.
There appears to be a growing number of cases of depression among teenagers and young adults in Sri Lanka. It seems that they have to cope with a lot of pressure. In Sri Lanka much emphasis is placed upon education. It's not uncommon that children have a lot of tuition hours next to their regular school hours. The schooling system itself is geared upon achievements too. Getting high marks, participating in extracurricular activities, trying to get into the best schools, it's all very competitive. Too much competition or not being able to accomplish your high standards can cause depression. Parents play a role in this too because in many cases they promote the said high standards.
It is not only in schooling that high standards are placed. In relationships there is also a yearning for the "ideal" partner. It's in the culture, brought about by parents and enhanced by taking concepts as palm reading and horoscopes very seriously. When for some reason the relationship isn't as "fantastic" as the young adult had perceived it at the start, it can cause depression.
Another factor is that in Sri Lanka there is no tradition of talking about one's issues. On the contrary, there is a strong pervading notion that problems should be kept within the family. This also can cause depression.
The above factors have been for a long time prevalent in Sri Lankan society. Why depression amongst teenagers and young adults seems to be more than before could be attributed to a number of reasons:
- better recognition amongst the public. The internet, newspapers and other media give more information than before.
- better recognition in the health sector.
- inability to fulfill their dreams, for example forced to stay in the country for economic reasons and not go abroad. Or reading on the internet about possibilities and opportunities and not be able to achieve those.
Love affairs that have gone awry can be linked to depression, anger, pain and sorrow. Love affairs, especially in Sri Lanka (and in more Asian countries) are seen as very special. Much effort, energy, hopes and dreams are connected with them. Usually, Sri Lankan young people don't have much "relationship experience" before they get involved into "the" ultimate one. As a consequence, when they go through a relationship breakup, the pain is very deep and can easily transform into depression. In Sri Lanka, this is enhanced because of the schooling system where most of the children attend boys or girls schools, so there is little opportunity to get familiar with the opposite sex in a natural way.
Sometimes teenagers and young adults look to suicide as a form of escaping the depression and rejection by their lovers, instead of solving it or moving on. This is probably because of the lack of a "talk" culture here. Problems, if they are talked about, are kept within the family. It is not done to talk with friends about your personal issues. When there is no safety valve to relieve the pressure by talking about it, then suicide seems to be a realistic option. In the end, life seems to be a black tunnel with taking your life as the only possibility. This can be aggravated by feelings of shame or guilt associated with the breaking up. Apart from mental illnesses, there can be all kinds of strong emotions leading to the conviction that this is the only "way out".
Parents can identify and tackle depression as well as love affair problems with their children. There are a few tell tale signals regarding depression. The two main symptoms are that people have a depressed mood and have no interest in activities for at least two weeks for most of the time almost every day. Furthermore they must have at least three more symptoms out of seven (for instance weight change, sleeping problems, thinking about death or suicide). The best way for parents to tackle depression with their child is to talk with it. When your child trusts you enough then the story will come out.
Taking antidepressant pills doesn't solve the problem. First of all these antidepressant pills don t work, if they do have some effect it is placebo. Secondly if they do numb you a bit then it s only about the symptoms. So it is best to tackle it from the root cause and tell the teenager that they can always talk about anything that is bothering them. Please be aware that depression has NOTHING to do with the supposedly "chemical imbalance" in the brain. There is no medical scientific proof for this; it is just a marketing concept from the pharmaceutical industry. To make this perfectly clear: there exists no test to determine whether you have or don t have this chemical imbalance . Talking and venting your feelings is the best way to deal with depression.
There is a significant number of teen depression cases (especially in love affairs) that often goes unreported due to misconception or plain ignorance. Perhaps the cause lies in the fact that parents don't take it that serious. "Oh it's just a broken love affair, is that all?". Or parents simply don't know what to do, or feel ashamed to talk about it.
Amongst the better educated, more affluent and assertive younger generation Sri Lankans, modern love affairs are more accepted. Still, on the emotional side there is a void. Rationally they can think things over, but emotional factors like the way they were brought up or cultural factors play a big role. In my psychology practice I have to deal often with this dichotomy of emotions versus mind.
The best way to deal with these emotions like pain, sorrow and rejection is to try to feel them. I am aware that in South East Asian culture, much attention is placed upon mind and behaviour; and emotions are usually disregarded. In reality, emotions (and instincts) are the driving forces in our lives. Suppressing or disregarding these is a clear recipe for depression. If people find it difficult to deal with feelings then they should seek professional psychological help.
Some people say that by reporting on depression and suicide in the media, it can cause copy-cat suicidal trends amongst the youth. But copy-cat suicidal trends are as old as the hills. For example the reactions on Goethe's book "Die Leiden des jungen Werthers" (the sorrows of young Werther) in Germany in the late 18th century are partly to blame for copy-cat suicides. But reporting on depression and suicide in the media usually has a significant preventive effect. Young people will become more aware of the problems and get informed about better ways to deal with them.
Psychological testing has become well known in almost every aspect of our society. In the educational world, in the corporate world or just a relationship test in a magazine, the tests seem to pop up everywhere.
Intelligence, extroversion, empathy, leadership, learning difficulties, there seems to be a test for everything. The conclusion of a test is often used in the selection of employees or students because it supposedly tells something about their future functioning. But can we really measure human qualities?
Psychological tests are extremely untrustworthy. Especially personality tests based upon self-reporting questionnaires are notorious. Still, personality testing has become a booming business ($400 million a year), and very much sought after, in particular in the corporate world. It promises quick answers (in percentages and numbers) to complex staff and management issues.
The most important problem with psychological tests is their lack of validity. The validity of a test is a scientific term that estimates how well the test measures what it claims to measure. Very often I see psychological tests praised for their supposedly high validity. However, in science there are different kinds of validity. The scope of this article is such that I can t go into detail about this. Information can be obtained through relevant books or the internet. The kind of validity that test-developers usually speak about is internal validity and refers to the consistency of the test. It says nothing about the kind of validity that matters, predictive validity, which is mostly very low or even absent. Predictive validity is the way in which the test has predictive value. For example a test to determine which candidate will perform well in a job.
Personality tests are in theory designed for this purpose but in practice most of them score extremely low on predictive validity and therefore are pretty much useless. A 2007 review of the academic literature (Morgeson, et al., Are we getting fooled again? Coming to terms with limitations in the use of personality tests for personnel selection, 60 Personnel Psychology 1029, 1037) found in authoritative studies correlations between personality and job success close to zero (between 0.03 and 0.15). Other studies found that personality tests used in employee selection account for approximately 5% of an employee s job success while the other 95% of their performance is unexplained by personality.
Take for instance the very popular (over two million administered every year) Myers-Briggs Type Indicator (MBTI) test which is much used in the corporate world. Eighty-nine companies out of the US Fortune 100 make use of it, for recruitment and selection purposes. The MBTI is a psychological assessment system based on the book Psychological Types (1921) of the Swiss psychiatrist and psychotherapist Carl Jung. The theories of Jung are controversial and subject to numerous criticisms and he himself is seen as rather mystic. The MBTI was first published in 1962.
The MBTI places you in one of 16 personality types, based on dichotomous categories such as whether you are an introvert or an extrovert, or have a disposition towards being logical or emotional (what it calls thinking and feeling ). The alarming fact about the MBTI is that, despite its popularity, it has been subject to sustained criticism by psychologists for over three decades. One problem is that it has a low test-retest reliability. If you retake the test after for example a five-week gap, there s about 50% chance that you will fall into a different personality category compared to the first time you took the test. Another point is (you might have guessed it) that the predictive validity is extremely low.
The MBTI is not valid to use for personnel assignments, hiring or promotion. It does not have predictive value for such uses. Despite its popularity and steady marketing, its archetype summaries of personality are much alike astrology or reading a horoscope. Although in Southeast Asian culture these two are taken pretty seriously, seen from a business and scientific point of view there are better ways to spend your money..........
At the end of the 1990 s the American psychologist Seligman introduced the name positive psychology as opposed to negative psychology . He mistakenly meant with the latter that traditional psychology victimises people and undermines their resilience. This shows a fundamental lack of historic sense and a complete misunderstanding of the aim of traditional psychology.
The history of psychology, seen in a broad sense, doesn t place emphasis at all on negative aspects of human life like failure, hopelessness or despair. These factors are mentioned but it underlines hope, persistence and meaning of life as well. The study of psychology in a philosophical context dates back to ancient times. Most of the Western, Eastern, Egyptian and Arabic philosophies highlight resilience towards life s adversaries. So positive psychology isn t about something completely new, on the contrary!
In Graeco-Roman thinking, much was written about the method and the creative aspect of the art of life (HOW to live a good life?) but also about the values and goals (WHAT is a good life?). Aristotle for example wrote about eudaimonia (human flourishing) which was to be reached by practical wisdom acquired through experiences. The Epicurians thought that a life with moderate hedonism would lead to their ideal of ataraxia (non suffering and freedom from distress and worry). The Stoics focused on the ratio and denied emotions; their ideal was apatheia (imperturbable). Many regard the way that Seneca, a well known Roman Stoic, faced his own death (Nero forced him to kill himself) as an example of this. A very readable and for a change quite humouristic book about Greek philosophers is Luciano De Crescenzo s The history of Greek philosophy .
The wisdom of the middle way (moderation and balance) is apparent. A morally mature person has experienced life in all its facets and acknowledges the value of life s adversities. Negative emotions and experiences have a positive value and form an inseparable part of life and should not by definition be avoided or disregarded. In order to accomplish growth and integration, negative emotions and memories must be co-activated too. Life has its ups and downs and each part has to be felt. When you franticly only want to grip the positive times then you re suppressing emotions and that will eventually lead to depression. You also deny yourself the wisdom acquired through digesting and coming to terms with your emotions.
Within the positive psychology there is this vague, confusing and evasive concept of the optimum human being . The emphasis on making constantly rational perfect choices will almost certainly lead to obsession. Furthermore positive psychology typically focuses on the individual without taking into account the social, cultural and material context, which makes it very limited. It s an illusion to think that positive thinking, expressing gratitude and smiling a lot is sufficient to lift yourself out of a situation that poverty, insufficient education and cultural disadvantages has brought you in.
On top of that, there exists no balanced discussion of the limits of research within the positive psychology or even acknowledgments of the limitations of research or of the effectiveness of positive psychology interventions (see for example Coyne JC, Tennen H. Positive psychology in cancer care: bad science, exaggerated claims, and unproven medicine. Annals of Behavioral Medicine 2010; 39: 16-26). A recent 100 million dollar five year programme in the U.S. army to use positive psychology (partly based on Seligman s book Flourish ) to for example lower the incidence of post traumatic stress disorder has received much scientific critique (Steenkamp MM, Nash WP, Litz BT. Post-traumatic stress disorder: review of the Comprehensive Soldier Fitness program. Am J Prev Med. 2013 May;44(5):507-12.).
Positive psychology leans for an important part on techniques that favour positive thinking . In practical terms, positive psychotherapy or wellbeing therapy is much like cognitive behavioural therapy. A client for example keeps a journal to identify the positive events that occur each day. Then the client is supposed to recognise negative thoughts and beliefs that distract from or disrupt positive events. According to positive psychology, by challenging and eventually change negative ways of thinking, the positive events will have more of an impact on the client s life. In general, the assumption is that when you feel depressed one should pay attention to the thoughts that you had before you felt depressed (the erroneous belief of thoughts form the cause of emotions ). This technique promises a quick fix and is widely used in the lucrative corporate world. Reality is of course much more complicated and these quick fixes usually backfire.
The simplistic concept of to restructure your thoughts in order to change how you feel is almost too much. Emotions are typically deeply layered and complicated and can t be changed by mere thoughts. To put it very straightforward, our emotions are based in the limbic system which is in evolutionary sense the oldest part of our brains while our thoughts dwell in the neo-cortex which is a relatively newcomer. These two parts find it very difficult to communicate with each other. When I have a depressed patient in my practice, I can try for all I want to install positive thoughts into the patient s mind but it won t change the feeling of depression.
If cognitive behavioural therapy was that all powerful then there wouldn t be any depressed psychologists; reality tells us something quite different . In my psychology practice I have treated many motivational trainers, positive thinking gurus and self-proclaimed life coaches for depression. The irony is that they couldn t treat themselves with their shallow theories which are sold to the public in usually very expensive workshops .
Psychiatrists as a rule take far too little time for their patients, they more often than not differ in how to label a patient and they are not trained in psychological assessment. The psychiatrists bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM, the fifth edition is out now), describes the criteria for putting on psychiatric labels on patients.
A few examples from my daily practice
A young client who was diagnosed in 3 minutes by a psychiatrist as being bipolar was put on heavy medication for 7 years. While in reality he had only anger issues.
A client was put for 10 years on medication after being labeled in a few minutes time as schizophrenic and depressed. Each time she went to see the psychiatrist he started writing a repeat prescription while she entered his office. What was really going on was that she had been sexual abused at a young age and bullied at school. In therapy she felt for the first time in her life the possibility to talk about it and to vent her emotions.
Another client (described in more detail in my article "Psychological/Psychiatric assessment", see my website www.marcelderoos.com) was also given the wrong label bipolar and was put on strong drugs which affected her life in a bad way.
The DSM labels/diagnoses are scientifically and clinically untrustworthy. Worse than that, there is hardly a connection with a subsequent treatment. And that treatment typically consists of prescribing drugs which disturb the normal processes of thinking and feeling. Psychiatrists only look at symptoms which they compare with the mental disorders mentioned in their DSM-book. Psychologists on the contrary focus on the possible causes and the whole story behind the symptoms and subsequently they try to treat those causes with their therapies. Psychologists try to see the whole person with his idiosyncratic story instead of a few symptoms on which a label is attached.
The DSM is an arbitrary classification system with little psychological or psychiatric use. Despite the term statistical in the title, it does not mean that the book is based upon sophisticated research about types of psychiatric problems. On the contrary, the classification criteria and categories were chosen by vote by people in working committees who have strong financial ties with Big Pharma. The DSM is written as an extension of the powerful pharmaceutical industry. There is no solid theoretical foundation, nor a clinical pragmatic practice. The pharmaceutical industry used its influence for example to extend dramatically the criteria for ADHD in 2000 and again in 2013 with the introduction of the DSM-5. This means more medication and is extremely profitable for them. On the positive side the classifications of the DSM are worldwide used and embedded in the psychiatric/psychological practices. In this way there is a certain (with all its shortcomings) standardisation and mental health care professionals can communicate with each other about mental diseases.
The DSM-5 has introduced various new disorders which labels normal human behaviour as abnormal. For example having a temper is now called disruptive mood dysregulation disorder; old age becomes minor neurocognitive disorder and the bereavement exclusion from depression has been removed so human grief is now seen as depression . And all of these new disorders have to be treated of course with medication. In addition the criteria of certain existing disorders have been lowered. ADHD for adults has now 5 criteria instead of 6; bipolar disorder is also easier to label; the same goes for anxiety disorders & phobias (one of the most common disorders). Apparently these changes seem to be minor tweakings but they will most likely generate a massive amount of new patients .
The pharmaceutical industry has the clout to disregard negative research results, for example regarding bipolar disorder and ADHD, and highlight the positive ones. Take for instance the licence for the drug Concerta for adults with ADHD in 2010. It was denied in Europe because the British authority for regulating medicine MHRA concluded that the effectiveness of Concerta was extremely poorly and the side-effects were (quote) a potential serious risk to the public health . But the conclusions of the MHRA were not allowed to be made public and the manufacturer of Concerta started a powerful and successful campaign to promote the drug.
Medical doctors are being induced by the pharmaceutical industry in various ways (financial, careerwise, sponsored trips to conferences in luxurious environments, paid travel expenses to workshops abroad like flights, 5-star hotels, daily expenses, etc., etc.) to detect bipolar disorder and ADHD with adults. There is no medical scientific way of justifying this, but these two fields are spearheads of the marketing specialists of Big Pharma. Not in the last place because people diagnosed in this way are being put on heavy and costly medication. A real moneymaker when patients are being told that they have to buy these expensive medications on a regular base for life..........
In the Western world, for example in the United Kingdom and in the Netherlands, governments are extremely concerned about the increased prescription of drugs like Ritalin and Concerta for children and teenagers. But also adults with ADHD-like symptoms have become an important and lucrative market for the pharmaceutical industry.
First some facts about ADHD:
- ADHD is NOT an illness
- You are NOT born with it
- Medication is very often NOT the appropriate way of dealing with ADHD symptoms.
The classic mistake (also made by quite a few prominent psychiatrists) is to think that ADHD is the cause of hyperactivity, impulsiveness and concentration problems. It s very tempting and understandable to accept the pseudo-explanation of psychiatry. Because nobody is to blame and there is this simple story that the behaviour of the child is caused by something in the brain. In reality ADHD is a name that has been given for certain behaviour. ADHD is not some neurobiological brain abnormality which explains certain behaviour. No, ADHD IS that behaviour. And that behaviour has not one unequivocal cause; there are always several (environmental) factors which influence each other. But most important, the diagnosis ADHD can only be made if, besides looking at ADHD-behaviour in its proper context, there are serious problems with social functioning and/or functioning at school or at work.
With family, twin and adoption studies it s almost impossible to separate the effect of hereditary factors from environmental factors. Is the child of a restless mother restless because of the reaction and copying of the mother s behaviour or because of the genes that it has from the mother? Besides this, studies show that there are for example no simple or combination of known genes responsible for any psychiatric disorder. After 50 years of intense and extremely costly (trillions of dollars) genetic research for psychiatric disorders, experts are very pessimistic about ever finding these genes. Perhaps there is some complex interaction with genetics, but the influence of the environment (for example the family dynamics you grew up with, or other experiences) is paramount.
ADHD is not a medical but a behavioural problem and psychologists are better equipped to deal with that than medical doctors. Many psychiatrists want to do what they are trained for: to treat serious complex problems as best as they can, but most ADHD behaviour doesn t fall within that category. The best way of dealing with ADHD behaviour is a treatment that starts with advice and training and when nothing else works then medication can be considered. Needles to say, that when an extremely demanding child does need medication (for a short time) it should be given straight away. ADHD is a label for behaviour that can be caused by numerous factors. Tensions between the parents, the noisy class at school has too many children, the teacher can t handle the class because of stress, a sibling is in a difficult phase and demands much attention from the parents, the child goes to bed at an inappropriate time, etc, etc. Medication can only suppress unwanted ADHD behaviour for a maximum of two years and has a number of serious disadvantages (see my previous articles about ADHD). Sometimes in difficult cases medication is appropriate. In many cases parental advice, teacher training and psychological support suffices. It s important to create an environment that is clear, quiet and predictable. There should be clear boundaries and positive behaviour should be noted and rewarded.
Many studies conclude that the outcomes of research that has been financed by the pharmaceutical industry are much more positive about the studied pill or illness than non-financed studies. Numerous ADHD-researchers (like the American psychiatrist Joseph Biederman and the epidemiologist Ronald Kessler) have strong financial ties with the pharmaceutical industry which makes their findings at the least suspect. Kessler s World Mental Health Survey Initiative (WMH), part of the World Health Organisation, extremely overestimates the prevalence of ADHD with adults. These findings are particularly important for Big Pharma because existing ADHD licenses are usually limited to the age category 6 till 18 years. This WMH study has many serious shortcomings. To name one, the interviews were done by laymen who had only received a short interview training (no medical doctors as is required in the DSM) and who were not equipped to assess a difficult ADHD diagnosis. Another WMH study that concluded that ADHD with children is a good predictor for ADHD in adulthood, has broken practically every rule for conducting proper research and is best disregarded. It s disturbing that figures from these WMH studies are used in policy making papers concerning ADHD.
Eighty to ninety percent of the adults, who meet the criteria of ADHD, simultaneously meet the criteria of other disorders like depression, bipolar disorder, anxiety and obsessive-compulsive disorders, addiction to alcohol and drugs, and personality disorders. This huge overlap shows in the first place the pointlessness of the concept ADHD for adults. Many people who are suffering from problems, have difficulties with concentration and are restless and irritable, something that is hardly surprising. There is no foundation for the claim that ADHD is the cause of the other disorders. Secondly, this high percentage of other disorders shows that this is a group of vulnerable people, who often have battled their whole lives with issues. There is no independent research that shows that lifelong existing problems will disappear or diminish with ADHD medication. Furthermore, a meta-analysis (Koesters et al, 2009) concluded that the effects of methylphenidate (the most used ADHD medication) with adults are only short term and at best mediocre. Adult people with problems are talked into a diagnosis plus medication while most of them are not helped with these at all.
Here is a video where Dr. Peter Breggin discusses his book "Talking back to Ritalin", the link is here
Electroconvulsive treatment (ECT) or electroshock as it used to be named remains a very controversial topic. In Sri Lanka it is not openly discussed and the official line is that it s a safe and effective treatment. Internationally speaking, the debate over ECT rages for decades and is often emotional and murky.
Much information and research about ECT is done or funded by stakeholders. A striking example of this is Professor Edward Shorter. He speaks at psychiatrist s conferences and in 2012 he wrote a book (with David Healy) called Shock therapy: a history of electroconvulsive treatment in mental illness . As with any scientific book or article, and especially with such a controversial topic like ECT, it s important to be critical.
Edward Shorter is not a psychiatrist but an historian who writes about psychiatry. The above mentioned book is biased, if only because the authors combine both historical analysis and advocacy. They give a very one sided account of the existing ECT-literature, they leave out important studies, they totally disregard important issues (like the rapid relapse of most patients after shock and high percentages of permanent memory loss and loss of concentration), there is no mentioning of the reluctance in the psychiatric world to set up proper studies about the effects of ECT, there is no evidence of a long-term protective effect against suicide, the experiences of patients are mostly dismissed, etc., etc.
Even worse, on the first page of the Acknowledgments section of the book it becomes clear that an important part of the funding for the writing of the book (according to public records $ 34,000) came from a foundation of Max Fink (often called the grandfather of shock ). He has been promoting ECT for decades, has interests in a shock machine manufacturing company, publishes books and articles denying any adverse effects of ECT, and in effect co-wrote Shorter s book. For a historian, Edward Shorter hasn t done a good job and he pays lip service to the ECT industry and its advocates.
Marcia Angell, for some twenty years an editor of The New England Journal of Medicine, wrote about her disappointment that in particular psychiatry has allowed itself to be thoroughly corrupted by its extensive ties to the pharmaceutical industry. In a similar way, the National Institute of Mental Health in the USA, which is the prime source of funds for ECT research, has been controlled for decades by a small group of psychiatrists of which many with strong financial ties to shock machine manufacturers. Therefore, as researcher it s very difficult to get funding for a study about for example the side effects of ECT. It s much easier to write about shock industry approved topics. ECT is the most lucrative psychiatric procedure and the majority of the insurance companies will pay for it. The rate of imbursement by insurance is higher than anything else a psychiatrist can do in 30 minutes. Given these financial rewards and the fact that psychiatrists don t make much money, it s clear that the stakes are high. Psychiatrists rely on literature, conferences and workshops that in most cases are influenced by ECT-friendly stakeholders. As a psychiatrist one should be aware of all this and be critical.
Besides the likes of Shorter there are other authors, such as Professor Linda Andre and psychiatrist Dr Peter Breggin, who in their books and articles DO write about the above mentioned shortcomings in the ECT-literature. Linda Andre (who received ECT herself) wrote in 2009 Doctors of deception: what they don t want you to know about shock treatment . Like Shorter, her book is also about the history of shock treatment since its appearance in 1938, but written from a totally different angle. She meticulously investigated court records, medical research, Federal Drug Administration (FDA) archives and other primary sources. Her book challenges claims of safety and efficacy made by the medical establishment (which promotes and profits from ECT) and explains that those claims are not validated by scientific evidence. She asserts that a huge amount of the positive accounts and information regarding ECT is fraudulent and given by clinicians and or manufacturers with vested interests. Andre presents a large volume of documented evidence to prove this. She reveals how by an aggressive PR approach ECT- stakeholders for decades have manipulated government-funded research, the FDA, professional medical journals and the media.
The American psychiatrist Dr Peter Breggin is a critic of biological psychiatry and psychiatric medication. On his website www.breggin.com there is an ECT Resources Center with more than 125 scientific annotated articles, a glossary of searchable terms and a brochure for patients and families. He wrote many scientific articles and more than twenty books about psychiatry. In his 2008 book Brain-disabling treatments in psychiatry: drugs, electroshock and the psycho-pharmaceutical complex and in his articles about ECT he describes it as follows: ECT involves the application of two electrodes to the head to pass electricity through the brain with the goal of causing an intense seizure or convulsion. The process always damages the brain, resulting each time in a temporary coma and often flat lining of the brain waves, which is a sign of impending brain death. After one, two or three ECT s, the trauma causes typical symptoms of severe head trauma or injury including headache, nausea, memory loss, disorientation, confusion, impaired judgment, loss of personality, and emotional instability. These harmful effects worsen and some become permanent as routine treatment progresses .
In my psychology practice I hear on regular base stories from Sri Lankans who have received ECT while good alternatives were available. In cases of moderate depression, anxiety, or in one case simply a stubborn young woman it was administered in a manner like: let s just try this out Perhaps in extremely serious cases ECT can be used when there is no alternative. Independent long-term studies (at least 4 weeks after the last treatment) show that the cost-benefit analysis of ECT is very poor. They conclude that the risk of damage caused by it cannot justify its continued use. ECT is NOT as safe and innocent as many proponents say. The side effects are often much more intense, lasting and serious than a simple headache .
A link to the original article is here
Whenever I start preparing for an important office presentation or a class speech, I feel this intense wave of fear and I feel sweaty and dizzy. My body starts shaking and my head starts spinning. I can feel my heart beating so fast and I feel like I am going to throw up in any second. Because of this condition, I try to avoid such occasions as much as possible.
Q. Why do I feel uncomfortable in these social situations?
A. It s very common that people feel uncomfortable in challenging social situations like a class speech or an office presentation. Especially when you are a teenager it is normal that you experience this, because these are formative years where you go through a lot of physical and emotional changes. Most people feel that their heart rate goes up, their breathing becomes a bit higher and they are acutely aware that a group of people is watching them. But although it might feel somewhat uncomfortable, many people can handle it.
It becomes different when the symptoms are as many and as intense as written in the introduction. Then it starts to influence the quality of your life. Anxiety is a feeling that occurs when there is fear of an imminent danger. When there is no real cause for this fear and the person experiences social or professional problems because of it, we speak of a disorder. In psychiatry, anxiety disorders have the highest prevalence among all diseases. A few well known anxiety disorders are:
- Social anxiety disorder. People who suffer from this type of anxiety have a fear of speaking in public, going to parties, attending meetings and so on. As a result from the huge fear of rejection and criticism they can get isolated. There is a difference with shyness. Many children are shy and most will overcome their shyness with the normal help children get from their parents and teachers. They grow out of their shyness because they learn through repeated experiences that they don t have to be afraid to speak in front of a group.
- Agoraphobia. If you have this kind of fear, then you are likely to avoid crowded places such as city squares, shopping malls and movie theatres. Generally speaking agoraphobia is the fear to leave a safe and comfortable environment. In severe cases people might only feel safe at home.
There is no indication that anxiety is genetic. If more family members are suffering from anxiety, then most likely it has to with the dynamics of the family environment.
Q. Is this an abnormal situation? Is it only me who has this?
A. Social anxiety is one of the most common anxiety disorders. According to different studies in the USA, in a given year the prevalence of social anxiety disorder is between 2 and 7% of the population.
Q. Will these uncomfortable feelings ever go away?
A. When these feelings are intense and are interfering with your normal life routine then there is a big chance that they won t just disappear. It s important that you seek help from a professional.
Q. Can it get worse?
A. Because most people start to avoid the situations they are afraid of the symptoms will grow worse. It s a vicious cycle: because of the increased feeling of anxiety the symptoms will become worse which will make you feel more anxious.
Q. What kind of help can I get?
A. For treatment the preferred method is psychotherapy. In some selected cases (like panic attacks) this can be combined with (short term!) medication. In Sri Lanka, possibly because of a lack of psychologists, as a rule medication seems to be the only available option. This said, medication only suppresses the emotions but it doesn t solve the problem. There is also the danger of dependency and possible side-effects. Psychotherapy looks for root causes and real solutions; it is not a quick and superficial fix. There is no one size fits all. As always it is essential to see the person in whole. Listen to his story, not only to the symptoms. Each person is different. In my professional experience, people with an anxiety disorder have reasons to feel anxious. Usually the fear is the expression of a complex hurtful past and often combined with depression. It is about FEELINGS of anxiety, and how to overcome them. In therapy the essence should be to look for the tale behind the anxiety. Each fear tells an enciphered but real story. You re suffering from your survival mechanism that points you to the wrong path by directing your attention to the present, instead of your past where the cause of the danger lies. In therapy you ll be learning to face your original feelings and the hurt that accompanies them. Anxiety is like a lady clad in brightly red. Don t send her away out of fear of the colour but try to listen to her story. Only then it is possible to find emotional balance. Some simple tips are to practice muscle relaxation techniques and breathing exercises in order to calm you down when you feel the anxiety growing. One of the most important tips is to continue facing your fear. Don t avoid difficult situations, it may give you relief in the short term, but in the long run the fear will only become bigger. Make a list of social situations (ranging from easy to difficult) and practice them starting with the less fearful ones. Talking with a professional who can support you helps!
Q. Where can I go to get help?
A. If you want professional advice you should go to a counsellor or psychologist. It s important that there is click between you and your psychologist. Only you can determine if that is the case. Do you feel taken seriously and do you feel safe? Do you feel safe enough to open up about your issues? Trust your gut-feeling; usually you quickly feel if there is a connection between the both of you.
Q. Why is it important that I get help at this level?
A. When you are at this level, the anxiety has developed into something that you almost can t control anymore. There is a risk that the anxiety will turn into depression. Some people start to use alcohol or drugs to reduce their fears, this can lead to addiction.
My mother died in a car accident when I was 14. This was a sudden shock and I felt totally overwhelmed and lost without her. Everyone around me was asking me to be strong since I am the oldest of the family. I was not given a chance to cry. Although my mother wasn't around me, I had to move on with my life and attend to usual businesses along with an extra burden of responsibilities. I was doing quite all right for sometimes.
After a couple of years, I started getting migraines and flashback memories about my mother. All of a sudden I wasn t the strong child I was, I felt weak and vulnerable. I started crying a lot at nights, when no one is around.
I feel irritated most of the time and I seem to have developed a habit of getting into fights. And I feel disturbed. Sometimes I think I should get help, but then again, it would be silly if I went and tell someone that I miss my mother who passed away 8 years back.
Q. Can a person feel sad about an event which occurred many years back?
A. Every human being has to cope with loss in his or her life. Grief is a natural reaction to loss; it s the emotional suffering you feel when something or someone you love is taken away. The passing away of a beloved person causes grief but also a broken marriage or friendship, declining health, the death of a pet or losing one s job are experiences where people feel sorrow.
It s very normal that a person feels overwhelmed, depressed or angry, years after a trauma happened. It s called delayed grief. Sometimes it isn t possible to go through the grief right after the shocking experience like mentioned in the introduction. It also shows the strength of emotions; we can try to suppress our feelings but after some time the pressure becomes too big and repressed feelings come out.
Q. Some need to grieve only two three days about a death. But some cry over a dead person for years. Why is it different from person to person?
A. There is no right way or right amount of time to grieve. It s a very personal experience. To grieve has nothing to do with trying to forget or with closure. A deceased loved one will always have a place in your life. But at a certain moment you will be able to look back with compassion, love and without much hurt and be thankful that the person was part of your life. The interpersonal duration of grief varies a lot. Sometimes you ll experience a relapse. A sudden memory can make you momentary very sad. But it won t hinder you anymore in your daily functioning. It s important to know and accept that you need time to cope with your loss.
Everybody deals with loss and the accompanying pain in his or her own way. Influences on the process of grieving are the kind of relationship one had with the deceased, the way in which the person has died (suddenly or a after a long illness) and the age of the deceased and the next of kin.
Q. Can I be helped?
A. The process of grieving usually takes place in phases and can last for a long time. Sometimes this process seems to be stuck; one can t get over the loss. When grief turns into depression you shouldn t hesitate to seek professional help, preferably a psychologist.
Q. Is this happening because I couldn't cry to relieve myself?
A. No, it isn t about not being able to cry. It s about that the whole normal process of grieving should take place (see below). Grieving is very personal and sometimes quite complicated. It goes with ups and downs.
Q. How will a counsellor or a psychologist help me?
A. A professional will help you with the process of mourning. He also will explain to you how grieving works , that it is a very normal human reaction to loss.
There are several theories about grieving. From my experience in my psychology practice I know that theories are just that: theories. We can say certain general things about the above mentioned process of grieving, it usually looks a bit like this:
Immediately after the death of the loved one you typically live in a kind of intoxicated state of mind. When that passes you start to realise the truth of the loss: you are angry and sad, confused and you want to go back to the time when everything seemed good and carefree. Usually you don t function well in this phase and the demise of the beloved is in your mind during the whole day.
After this follows a period that you are more capable to look back to what the person has meant to you, what the two of you have shared. Subsequently you gradually are able to give your attention to other people. Little by little you get on with your life and you realise that you slowly can enjoy beautiful and nice things.
During these three phases it is important that certain tasks are done. It s not about a sequence (in reality they will intermix with each other) but more about completion of these tasks.
- Accepting the reality of the loss; this knowledge has to be felt.
- Feeling the pain and the hurt.
- Adapting to a life where the deceased isn t there anymore.
- Transforming the emotional energy you had with the deceased into a memory in order to be able to continue with your life.
Q. Can I help myself without going to see a counsellor?
A. Here are some practical tips:
- Try to share your feelings with friends and family in a way that suits you. This is beneficial to yourself and it gives others the opportunity to support and help you.
- Although it is fine to express your feelings, you don t have to give in to every emotion. Sometimes it s good to cry or to be angry, sometimes it s good to seek distraction and focus on something else. It is only yourself who can feel what works for you, which way is helpful for you.
- It is also important to take care of yourself, try to maintain a good physical health.
- Try to sustain a regular life that gives you a sense of balance. Don t take important decisions until you feel stable enough.
- You could start to write letters or to a make collage book about the person. You can write down your feelings and thoughts, memories, paste pictures, poems or songs that you like, which have an association with the loved one.
- You could also talk with friends and family about who the person was, and bring back memories.
- During the period of grieving all kinds of physical complaints may occur, like eating and sleeping problems. When you decide to go to a medical doctor for these complaints, tell the doctor about your loss.
- Be careful with sleeping tablets and tranquilizers. These medicines can help to calm you down for a while but because of their suppressive effects they can disturb the grieving process. When you are mourning it hurts, and that pain cannot be taken away with medicine. Sleeping tablets and tranquillizers can be addictive so it s best to be cautious with these pills.
- With the introduction of their new manual DSM 5, psychiatrists don t recognise normal grief anymore. They regard grief as depression and they want to medicate it. If that happens then the normal process of grieving is disrupted because the medication will numb your feelings. So if you want to seek professional help, it s better to look for a psychologist.
My friend is in his mid 20s. Since his early 20s, he was out drinking with his friends every night and out clubbing every weekend. Although others could recognise it, my friend doesn't notice that when his friends are ready to go home that he always wants to stay out and drink some more. When he started using alcohol he was feeling tipsy with a glass or two and I have noticed that it takes much more alcohol than that for him to be tipsy. He was unable to hold down employment due to the amount of sick days he was taking, mostly due to hangovers and had had to move back in with his parents since he was no longer able to pay the rent on his flat. He still denies accepting that he has a problem with alcohol. I am really worried about his life and future.
Q. How does alcohol affect a person? What is excessive alcohol use?
A. Of all the drugs available in Sri Lanka alcohol is still the one most frequently used. It is socially accepted, easily available, comes in many forms and tastes and is affordable for most people. To many users its effects are seen as pleasant: it relaxes, inhibits and is usually stimulating. But alcohol impairs your memory functioning too, and has an influence on your locomotion, breathing, reaction speed, temperature regulation and appetite.
Dependency on alcohol is a slow and gradual process. One has to go through several phases before one is addicted.
- Social drinking. A social drinker takes a glass of alcohol for social fun and because he/she likes it. Generally speaking the amounts of alcohol are not that high and drinking isn t a daily routine.
- Habitual drinking. Drinking occurs on most days of the week with a couple of glasses. That could be for example at the end of the day after work to relax. The social context has disappeared and the only consumed drink is alcohol. In this phase the habitual drinker or his/her surroundings finds no problems with the regular use of alcohol.
- Problem drinking. A problem drinker drinks alcohol every day and needs the drink to feel good. It can be an escape from the daily tensions or problems, but actually it is a flight from reality. Because of the excessive alcohol intake chances are great that there will be physical, social and/or psychological problems. A special form is the so called binge drinking: episodic excessive drinking. This binge drinking can cause severe health risks. Most problem drinkers try to hide their drinking problem from the outside world. Withdrawal symptoms like trembling hands and anxiety start to occur. The tolerance for alcohol has built up which means that to get the same effect one has to increase the quantity.
- Alcoholism. In this last phase the user is addicted to alcohol. Basically his/her life is controlled by drinking. Very often drinking starts in the morning and is continued throughout the day. In this phase there is a severe physical and a psychological addiction. The withdrawal symptoms become intensified and there is a real craving for alcohol. The alcoholic starts to neglect him/herself. Long term alcohol abuse can cause a number of physical and psychological symptoms like cirrhosis of the liver, alcoholic dementia, Korsakoff syndrome, depression and so on.
Q. Usually what is the acceptable alcohol consumption for a person?
A. For healthy men the limit should be no more than 2 standard glasses of alcohol per day and for healthy women no more than one standard glass per day. Each kind of alcoholic drink has its own standard glass. In this way a standard glass of beer of 5% (250 cc), wine of 12% (100 cc) and liquor of 35% (35 cc) have all the same amount of pure alcohol (about 10 gram). There are no standard glasses for cocktails so one has to be careful with those.
- The use of alcohol as a reaction on stress or personal problems is risky. There is a big chance that the drinking will increase. It can become a habit to drink when there are tensions.
- Be careful with drinking when you use medication. Alcohol can decrease the working of a medication or increase the side-effects. Read the instructions or ask your family doctor or pharmacist.
- Don t use alcohol when you have to work, study, sport or drive a car.
- Do not drink alcohol when you re pregnant or when you breastfeed.
Q. How would a person identify whether he is abusing alcohol or dependent on alcohol?
A. There are certain dependency signals like- Increased tolerance: you need more alcohol to be able to feel the effect.
- Withdrawal symptoms like feeling sick, trembling, sweating, craving for alcohol and just feeling awful.
- Drinking in the morning to get rid of a hangover or to manage your nerves.
- Feeling irritated about remarks concerning your drinking, feeling guilty about your drinking habits.
- Psychological and social problems like losing interest in hobbies or fights and issues with your partner, family or at work.
- Physical complaints like problems with sleep, gastrointestinal problems, sexual problems, tremors, tiredness, heavy transpirations, blackouts, etc.
Q. How do I convince my friend that he has a drinking problem?
A. It can be very challenging to address friends or colleagues with their alcohol problem. If you start at once about the drinking issue then very often the result will be a denial or a very defensive response: it s not that bad , I have everything under control , it s none of your business , etc. This kind of talks can easily turn into arguments.
Some tips are:
- Be open and try to talk in the I-form and not about you . Be clear about when you are affected by his excessive drinking. For example agreements that haven t been met, insults when under the influence of alcohol, etc. You even don t have to talk about the drinking itself, but tell about what has hurt or upset you. In this way the drinker can get an insight about the social consequences of alcohol use, and that might become an initial impetus to change.
- Be careful with solving problems that are related to the drinking of your friend. When you keep doing this then you re facilitating the drinker to continue drinking. The decision to stop comes from weighing the pros and cons. If the environment takes away most of the cons then there will be no motivation to stop.
- You can t save your friend or making him stop with drinking; it s a decision he has to make. If you are asked for help with reducing the drinking, please be aware that you are not kept responsible for his behaviour.
- If you do want to talk about the alcohol intake, try to find an appropriate time for that. Don t start when your friend is drunk. Don t try to convince or to blame him or to discuss the amount of drinks, this will only end up in a fight.
- Sometimes it can be a good idea to talk about the advantages of alcohol. The high, the numbing of painful or depressed feelings, or the feeling of being on top of the world. It takes out the edge of the conversation. Possibly the drinker himself starts about the negative aspects of drinking. It s always better when he tells this and he doesn t have to defend himself.
- A person who becomes dependent on alcohol has probably often been blamed and accused. This can cause low self esteem. When you focus on his positive characteristics for a change and compliment him, it generates positive feelings. That could facilitate a behavioural change.
- As a friend you can listen to the underlying problems. But be aware of your limits. You can say that you are worried and that you want to help if possible. But you re not a professional, so please take care of your possibilities and limitations!
Q. What health problems are associated with excessive alcohol use?
A. Excessive and long term alcohol abuse can cause a number of physical and psychological risks.
- Dependency. There is the physical dependence, you rely on alcohol to function or you feel physically compelled to drink. But there is also a psychological dependence, the deeply felt feeling that you can t live without it. You have to drink in order to function normally and feel good.
- Weight gain. Alcohol contains a lot of calories which makes you fat. In addition it inhibits fat burning capabilities of your body. This results in more fat stored in your body, for example in the belly and hips.
- Cirrhosis of the liver. Excessive drinking can lead to fatty liver. This regenerates when you stop with drinking. With long term alcohol use you can get liver inflammation (hepatitis). If you continue to drink then the cells in the liver will be destroyed and replaced by connective tissue (liver cirrhosis); this damage is irreversible.
- Brain damage. Long term drinking has consequences for your memory, concentration and the ability to think critically and analytically. Early dementia is common with long term excessive alcohol use. It varies from memory loss to the serious Korsakoff syndrome. At the start you can t remember recent things that well anymore. It develops into not being able to remember whole episodes and you fantasise all kind of stories to fill in those gaps. The brains of alcoholics shrink some 10 to 15%. In puberty and in the teenage years the brains are developing and are extremely vulnerable. Alcohol can have a negative influence on these developments.
- Cancer. There is a clear relationship between alcohol use and cancer of the mouth, throat, larynx and esophagus. Heavy drinkers have an increased risk of cancer of the liver and the large intestine. Women who drink more than two glasses of alcohol per day have an increased risk of breast cancer.
- Social problems. People who drink too much often have serious problems with family, friends, colleagues, and with the police. Relationships come under pressure and absenteeism at work becomes a problem.
- Anxiety and depression disorders are the most prevalent psychological symptoms associated with alcohol. These symptoms typically initially worsen during alcohol withdrawal, but usually disappear with continued abstinence.
- Sexual problems. With men prolonged alcohol use can cause a diminished desire, erectile dysfunction, inability to ejaculate and impotence. With women a diminished desire, diminished intensity of the orgasm or even a complete blockage of the orgasm.
Q. Where can I direct my friend to get help? How will he be helped in a professional level?
A. Your family doctor can direct him to psychologists, psychiatrists or specialised organisations for alcohol treatment.
The most important element in the treatment of alcohol addiction is that the user learns to be responsible for his addiction (alcoholism is not an illness, you re not powerless). Usually this takes some time for the problem drinkers; for the alcoholics it takes a long time. Addictions help us to stop feeling what we would feel without them. By administration ourselves with a shot of our favourite addiction we don t feel the pain of for example emptiness or loneliness. Generally speaking we don t feel our unfulfilled needs (from the past), we anaesthetise them. When the endogenous opiates (beta-endorphins) can t help us adequately with dealing with painful emotions we can try exogenous opiates like drugs, alcohol or cigarettes. The physical addiction is relatively easy to stop (the so called detox), contrarily to the psychological addiction because addictions work twofold. They suppress painful emotions and at the same time create the illusion that we can get what we need . The object of our craving is after all available in the present! It is this illusion that persistently stimulates each addiction. But this high is only temporary, the longing for our needs from the past to be fulfilled stays. But no addiction whatsoever can do that. People who are addicted very often have a history of structural abuse (physical, emotional or sexual). As a consequence an addictive personality is formed.
The approach to deal with addictions isn t an easy one. Willpower won t work ( what you resist persists ); you can achieve a lot with willpower but your Monster (your compulsory side, your addiction) is much stronger than yourself. A punish and reward system doesn t work well either. What usually does work is to find out what you REALLY crave for or are afraid of. It is crucial to find out how you tick and what you want to do with your life. When you are addicted you usually have lost contact with your body and feelings. You not only have a mind with compulsory thoughts but you have also feelings which can tell you a lot about yourself. You ll get insight into yourself, in your pros and cons, in your behaviour, in your emotions. Practically it means: stopping with the addiction; each time when the need comes up try to feel this emotion in your body (not your thoughts) and focus on it; and lastly try to accept the pain when you feel that you will never get what you needed in the past. To succeed in all this you ll need a dedicated and professional therapist. In psychotherapy one learns the personal addiction history and to recognise the trigger moments in the present which can activate emotional issues from the past.
Other important topics to enhance the quality of life are building up your self-esteem, how to cope with worrying, being able to deal with temptations and setting realistic personal goals. It is also important to change the lifestyle. Starting to exercise three times a week and eating a healthy diet are the basics. Ultimately it s about reinventing your life, giving meaning to your life and changing your outlook upon your life.
My brother spends most of his time in front of the computer; playing games, chatting with people, reading or watching videos on YouTube. When he is asked about the amount of time he spends online, he always comes back with an answer convincing that the time spent online is productive. He seems to be addicted in such a way to Facebook that when he is not in front of the computer, he is busy checking his smartphone constantly. I strongly feel that his internet usage is unhealthy. He has for example developed a habit of having dinner not with the family, but in front of his computer. It is like the computer is his only friend.
Q. How would healthy internet usage be distinguished from unhealthy internet usage?
A. A healthy internet usage has (of course) everything to do with moderation. There is no common set of rules for everybody, it s very individual. But try to look for warning signs like wanting to spend more and more time on the Internet. Step away from the computer once in a while and see how that feels. Look at your behaviour and see how much time you spend interacting with real people as opposed to people online.
It s important to have a healthy ergonomically adjusted working environment. A computer screen that is too high, too little working space, a chair that is too low, the mouse that is too big or disturbances with sound, climate or illumination can cause numerous complaints. Make sure that you take a sufficient amount of breaks.
Q. How do people become addicted to the internet?
A. Nowadays almost everybody is active on the Internet. It s more or less always available, especially since the use of a smartphone has become fairly common. The reasons why somebody can get internet-addicted are for example:
- Instant satisfaction of certain human needs like social contact, acknowledgement, status and prestige;
- The possibility to enter a virtual reality where everything is possible and where you can escape your daily problems;
- You can remain anonymous and it s relatively cheap.
People are not addicted to the Internet itself, but to an application of it. Some well-known forms of addiction are porn, social media (constantly checking of updates and likes), gaming, chatting, constantly communicating on forums and surfing on the Internet.
Certain people are prone to get addicted to the Internet; especially persons who suffer from low self-esteem, loneliness and who are shy. Also at risk are people who are extra sensitive to the rewards that internet gives them and who have difficulties controlling their impulses. Finally the role of the environment; are there sufficient alternatives for amusement? And does the direct environment or society put limits or regulations to games?
Q. What are the warning signs of internet addiction?
If you are in doubt whether you are internet-addicted or not, here are some warning signals:
- You spend increasingly more time on the Internet than you planned or wanted;
- Other activities like school, work and sport are neglected;
- You continue with spending time on the internet despite the fact that you know it will cause problems for relations and sleep;
- If you stop or lessen there will be withdrawal symptoms like unrest, irritation and aggression;
- You use the Internet as an escape from thinking about daily problems.
Q. What are the negative effects? (physical, social and psychological)
A. Short-term effects of this addiction are unfinished tasks, forgotten responsibilities and weight gain (!). The long-term negative effects can be depression, anxiety, euphoric sensations when you are on the Internet, social withdrawal and feeling more at ease communicating with people online than in real life. But you can also develop physical complaints like inflamed and irritated eyes, neck complaints, RSI.
Q. What kind of support can be given to a person to come out of this addiction?
A. Nowadays it s practically impossible to stop completely with online activities. You still have to do for example your internet-banking or answering emails. You can first try to get out of this addiction by yourself. If that doesn t work then you can contact a psychologist. The treatment of internet addiction is focused upon managing your use of the Internet. It usually can be achieved with short-term therapy.
In therapy the following points will be addressed:
- In the first place it s important to find out what emotions cause this behaviour. Addictions are usually for a big part caused by unfulfilled needs. What happens just before you decide that you want to go online? What feelings are there; is it boredom, loneliness, stress, anxiety? The next step is to actually FEEL these emotions instead of rushing to the Internet. Try to ride these feelings out and see where that leads you;
- Discuss the pros and cons of the internet-addiction. It s important to find out what you gain and what you lose with being on the Internet and how reducing this will affect you;
- Formulate a goal and determine on which date you want to have trimmed down your internet use and how much;
- Take some self-control measures like not being online after 10 pm and no longer than 1.5 hours at a time. Create a support system by telling some friends what you are trying to accomplish;
- Develop a plan for dealing with difficult situations. It s important to recognise these situations and to be prepared for it.
Next week Dr Marcel de Roos will write about the influence of Facebook on people s wellbeing.
I smoked my first cigarette when I was 11. I didn t want to but all my friends were smoking and I didn t want to be out of the group. Once I d started I couldn't stop. I was addicted I wish I hadn't started. I knew it was wrong and I didn t want to.
Q. Why do people give in to negative peer pressure?
From a very young age on people want to belong to a group. Peer pressure is almost everywhere and people try to belong, for example at school, at sport clubs, and at work. There is nothing wrong with peer pressure, unless you are robbed of your own opinion. Practically everybody strives for acknowledgement from the environment and people unconsciously influence others. It s a basic need to fit in.
But peer pressure can cause you to behave in a way that you actually don t like. For example to drink before you have to drive. Or to persuade you to smoke when your whole group of friends smokes. When your colleagues at work wear expensive brand clothing it can be difficult to wear a cheap non-branded T-shirt. Negative peer pressure can have serious consequences. Perhaps you notice it around you. For instance a group at school or at your work that is very controlling. When you re part of that group then you have to do things that you don t agree with. Out of fear of rejection you don t express yourself. You can become very scared of the group and bottle up your feelings which is not healthy at all.
There are of course also positive consequences of peer pressure like a group of jogging friends can incite you to start practicing sports too. Or when you know that your best friend aces English because she regularly reads books it can motivate you to start reading as well. And being encouraged to join the school debate team can have a positive impact on your self-confidence and it can improve your speaking and listening skills.
Q. What are signals of negative peer pressure?
A.:
- Often there is one person or a small group of people in a (big) group that pressurises the rest of the group and nobody speaks out;
- No one is allowed to do something different than the rest of the group. If so, then it s considered as uncool;
- Often so called funny comments are made about somebody in the group which aren t funny at all; there isn t much respect in the group;
- Apart from the leaders of the group, nobody really likes it in the group.
Q. How do I walk out of this?
A. It s always useful, when you re faced with choices, to ask yourself whether there is peer pressure or not. Sometimes it isn t that obvious that you are influenced. You could check the following points:
- What do I think is important?
- What makes me feel good?
- Where are my limits?
- What kind of feeling does making this choice give me?
- Am I doing this for myself or for my friends?
- What happens when I say Yes ?
- What happens when I say No ?
A useful way in decision making is the traffic light allegory:
- RED = STOP. Take a break and don t make a decision. Tell yourself and your environment that you want to think about it. Don t let yourself be forced into making a decision at that moment. Make sure that you have more time, in that way you can postpone a decision.
- ORANGE = THINK. Think about what you want to do and ask yourself the questions mentioned above. If needed, talk it over with others, like peers or others whose opinions you respect. You can take a few days before you decide.
- GREEN = ACTION. Do what you have decided. Go with your own decision even when others don t agree with it!
When you feel that you re influenced by negative peer pressure:
- Ask yourself why you comply with the behaviour of the group;
- If you become aware that you don t agree with this, try to stop with it. To continue doing something that you don t want, will make you feel very unhappy in the end;
- Stand up for yourself and dare to say no ;
- When in doubt, ask advice from people you trust;
- Find someone who thinks like you because then you re not alone in this;
- If you notice that somebody else is a victim of negative peer pressure, try to talk with that person. It will be very reassuring for him/her to hear that he/she isn t the only one who thinks like that. That it is not okay to steal, to bully or to use drugs.
It s very easy to say, be assertive! , but how do you do this? You don t want to let down your friends or to become a target. Here are a few tips on how to say No :
- Think beforehand what your opinion is on certain subjects. If you don t want to accept an offer for using drugs then you could say for example that you think that drugs are unhealthy, that you prefer sports, that you prefer spending your money on something else, that you don t need drugs to have fun, that you might give it a try, but only when YOU feel that you want;
- Support your own views. YOU have an opinion about something and if someone doesn t like you because of that, then that is his loss and not yours. Be proud of yourself! It s brave to voice something you feel is right;
- Reverse the question. Do you want to smoke some weed? No, thanks ; Why not? Why should I? ; Because you will get high . Why should I want to get high? .
- Perhaps you know that there are more people in the group who don t like certain things. You usually sense this. Talk with them and discuss how you can support each other;
- Change the subject if somebody keeps on annoying you.
- If you feel that after trying many times people in the group don t listen to you, then you can ask yourself whether you can be yourself in this group. Are these friends beneficial for you? Do they give you a good feeling?
My 14 year-old cousin was admitted to the hospital. Her weight dropped from 75 kilos to 62 kilos and her menses stopped. She initially received compliments for her weight loss, but then her parents grew concerned because of her lost menses and her rapid weight loss. She was exercising excessively and engaging in restrictive eating. She was hospitalized due to her low pulse and low blood pressure.
How would you differentiate between a person going on a diet and a person who is affected from an eating disorder?
A person with a weight problem has an unhealthy weight (underweight, overweight or has often weight changes). An eating disorder (anorexia nervosa, bulimia nervosa, and binge eating disorder) is a serious and complicated psychological illness.
What exactly is an eating disorder?
An eating disorder is a psychological disorder that is characterised by dysfunctional eating behaviour. Some people eat too little, others too much, and others switch between both behaviours. Usually people try everything to compensate calorie- intake, like self-induced vomiting, the use of laxatives and excessive sport activity. Most people with an eating disorder have a distorted body image and an intense fear for gaining weight. Very often they are obsessed with thoughts about food, their own body and weight. Subsequently they develop an addiction to accompanying behaviour like dieting, having binges and/or compensation behaviour.
The root causes of the dysfunctional eating behaviour predominantly have to do with underlying psychological factors. When in stressful or difficult situations, people very often look for distraction by treating themselves with food. Food can also serve as a way to handle difficult emotions; you can medicate or numb yourself with food (or alcohol or drugs) in order not to feel these emotions. Many people with an eating disorder say that it has a strong connection with control. They feel that they have no control over their lives and try to be in charge of at least one area: eating and dieting. Furthermore eating can be used as for example comfort or punishment, consciously or unconsciously.
It often happens that people with an eating disorder minimise the symptoms and the severity of their condition. In addition they are typically not aware that they are for example underweight because of their distorted body image. The symptoms of the disorder frequently cause limitations in their lives in a social and professional context. For example not being able to perform in your work or education and/or having increasingly conflicts with family and friends. The physical, psychological and social consequences can be extremely damaging.
Having an eating disorder is not a choice or fashionable rage; it s a serious psychological illness. It can be treated successfully and the sooner the person gets a suitable therapy, the higher the chances on recovery.
Who are likely to get it?
Eating disorders like anorexia nervosa and bulimia nervosa have a higher incidence with women than with men. It s estimated that 90 till 95% of the people with anorexia nervosa are women. With bulimia nervosa that is between 85 and 90%. With these two illnesses they are predominantly girls and young women between 15 and 30 years of age. But there are more and more children and (young) men who develop this disease. The incidence of binge eating disorder seems to be equally high with women as with men, and is predominant in the age category 18 till 65.
Possible causes.
It continues to be an interesting question why one person develops an eating disorder with a certain life history and certain traumatic experiences and somebody else with similar experiences doesn t. There are different factors which might play a role in the development of an eating disorder, but there is no clarity about the precise process.
Risk factors.
The following aspects are frequently named as risk factors in the development of an eating disorder:
- Low self-esteem;
- Negative feeling about one s body or disturbed body image;
- Having a history of being over- or underweight;
- Constant dieting;
- Having a history of depression;
- Being raised in a family environment with extreme focus on food, weight and appearance. The same goes for modeling and some sports like classical ballet and gymnastics;
- Family members with an eating disorder or being overweight, depression, addictions, and compulsive (personality) disorders;
- Personality traits like excessively wanting to please and being concerned about others, introvert, anxious to fail (in a social context), perfectionist, goal orientated, impulsive and obsessive personality traits;
- Negative experiences with being bullied, abuse (emotional, physical or sexual) and neglect.
How can an eating disorder be identified?
The main types are anorexia nervosa, bulimia nervosa and binge eating disorder.
Anorexia nervosa
Anorexia nervosa is the most well known eating disorder. Although other eating disorders like bulimia nervosa are more common, with most people the word eating disorder has an association with extremely thin girls. It s an external symptom that characterises people with this disease. It s good that of lately there is increasingly more information about anorexia in the media, because there exist still a lot of misunderstanding about this illness.
People with anorexia are often condemned: children in Africa are dying of hunger and they have food in abundance but chose not to eat. Ridiculous and arrogant, they just should eat normally! Unfortunately this is easier said than done. Eating disorders are psychological illnesses. As the name Nervosa suggests, it means that there is a psychological cause. So there is much more beneath the dysfunctional eating behaviour then you should think at first glance.
Besides much misunderstanding, there are still a lot of ideas about the illness that are not correct. The Greek word anorexia means without appetite , while this has nothing to do with the disorder. People with anorexia nervosa actually do have an appetite and feelings of hunger, but suppress these feelings out of fear of losing control and gain weight (or even from the desire to lose weight). People who suffer from anorexia have disturbed body image. They think that they are too fat, even when they are extremely underweight. The most important characteristics of anorexia nervosa are:
- having a disturbed body image;
- an intense fear of gaining weight;
- loss of weight;
- Irregular menstruation periods or even absence of menstruation.
Approximately 0.5 to 3% of all young women have anorexia in their lifetime. There is a danger that the illness becomes chronic. About 5 to 10% of them die as a result of the disease. This is one of the highest mortality rates compared with other psychological illnesses. The chances that somebody suffering of anorexia dies are three times higher than with depression, schizophrenia or alcoholism and twelve times higher than people who don t have a psychological disorder. The chances of recovery are greater when the treatment starts early.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a classification system for psychiatric disorders. This American manual (the 5th edition is out now) is developed in particular for research and international communication. The DSM is only a classification system and NOT (as many think) a diagnostic system. That means that it only describes the symptoms of a disorder but not the cause. The origin and complexity of a psychiatric illness differs of course per person. Furthermore, the DSM labels/diagnoses are scientifically and clinically untrustworthy. Despite the term statistical in the title, it does not mean that the book is based upon sophisticated research about types of psychiatric problems. On the contrary, the classification criteria and categories were chosen by vote by people in working committees. There is no solid theoretical foundation, nor a clinical pragmatic practice. The clinical diagnosis plus treatment should encompass the whole individual story of the person and not just a few DSM criteria.
According to the DSM 5 criteria, to be diagnosed as having anorexia nervosa a person must display:
- Persistent restriction of energy intake leading to significantly low body weight (in context of what is minimally expected for age, sex, developmental trajectory, and physical health);
- Either an intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain (even though significantly low weight);
- Disturbance in the way one's body weight or shape is experienced, undue influence of body shape and weight on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
It mentions two subtypes:
- Restricting type: Individual does not utilize binge eating nor displays purging behaviour as their main strategy for weight loss. Instead, the individual uses restricting food intake, fasting, diet pills, and/or exercise as a means for losing weight;
- Binge-eating/purging type: Individual utilizes binge eating or displays purging behaviour as a means for losing weight.
Bulimia Nervosa.
Bulimia, isn t that something with vomiting? , indeed, that is possible. Bulimia nervosa is the most common specific eating disorder and is characterised by binge eating without control, and of taking certain actions to compensate the calorie intake. That can be self induced purging, the use of laxatives and excessive exercising.
Furthermore people with this eating disorder are over-concerned about their body and weight. The name bulimia nervosa literary means: hungry like an ox with a psychological cause. This isn t entirely correct as people with bulimia also have eating binges when they aren t hungry. But the behaviour stems from underlying psychological problems.
According to the DSM 5 criteria, to be diagnosed as having bulimia nervosa a person must display:
- Recurrent episodes of binge eating. An episode of binge eating is characterised by both of the following:
- Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
- A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating);
- Recurrent inappropriate compensatory behaviour in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise;
- The binge eating and inappropriate compensatory behaviours both occur, on average, at least once a week for three months;
- Self-evaluation is unduly influenced by body shape and weight;
- The disturbance does not occur exclusively during episodes of Anorexia Nervosa.
Experts have defined two types of bulimia: purging, characterized by vomiting or use of laxatives, diuretics or enemas to counteract the effects of bingeing, and non-purging, in which periods of excessive exercise or fasting follow binges. Non-purging bulimic behaviour is similar to anorexic behaviour. Sufferers may alternate between the two types.
Binge eating disorder (BED).
Binge eating is the least known eating disorder. People with BED typically suffer from rapid weight gain and out of control eating binges, but unlike bulimia they don t vomit, purge or exercise excessively. As a result they become very overweight; BED is much more visible than bulimia. Feelings of shame can result in having more psychological problems and eating binges. Usually underlying emotions play a role such as stress, hurt, anger or the need for comforting. Contrasting to anorexia and bulimia, BED is not a predominantly women s disease , although it is twice as common among women as among men.
The differences between anorexia and bulimia appear to be big. But people with these kinds of eating disorders have huge similarities!
- Obsessed by everything that has to do with food, weight and exercise;
- Extreme fear of gaining weight and being fat;
- They don t listen to their body. Signals of hunger or saturation are ignored. They always perceive their body as more overweight than it is in reality and they hate their body;
- They keep their eating problem secret and they live a double life with excuses, tricks and lies.
According to the DSM 5 criteria, to be diagnosed as having BED a person must display:
- Recurrent episodes of binge eating. An episode of binge eating is characterised by both of the following:
- Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
- A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating);
- The binge eating episodes are associated with three or more of the following:
- eating much more rapidly than normal;
- eating until feeling uncomfortably full;
- eating large amounts of food when not feeling physically hungry;
- eating alone because of feeling embarrassed by how much one is eating;
- feeling disgusted with oneself, depressed or very guilty afterward;
- Marked distress regarding binge eating is present;
- Binge eating occurs, on average, at least once a week for three months;
- Binge eating not associated with the recurrent use of inappropriate compensatory behaviours as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa, or anorexia nervosa methods to compensate for overeating, such as self-induced vomiting.
Can overeating or obesity be categorized as an eating disorder?
No, in the case of overeating or obesity in itself the symptoms are less and they don t comply with the diagnostic criteria of an eating disorder. The consequences for the psychological and social life are restrictive and limiting, but not by definition severely disruptive. The physical risks can be dangerous just as with eating disorders. Especially, when there is a weight problem like obesity.
Treatment.
Treatment of eating disorders is difficult and usually takes a long time. First step is to admit that you have a problem; this alone can be difficult because of the ingrained beliefs about weight, food and body image. Psychotherapy can only start when patients are in a reasonable physical condition. Severe undernourishment can be life threatening and causes dissociation from feelings. This is important because people with eating disorders use food to deal with uncomfortable or painful emotions. When in therapy the quality of the relationship between the therapist and patient is crucial, there has to be trust. A good therapist always focuses on the deeper psychological issues behind the outward eating behaviour. The essence is the confrontation with the original hurtful emotions which led to the eating disorder.
What is stress? Is stress an Illness?
Stress basically speaking is just tension. We all need a bit of tension in order to function well. This tension enables our body to be ready for action. Only when there is too much of tension it can lead to complaints. Very often this end-result is called stress.
With stress the body prepares itself to fight or flight. Your brains release a signal that makes your body produce the hormone adrenaline. As a result of this your heart rate goes up, your breathing goes faster and your muscles start to tense. More oxygenated blood goes to your heart and muscles and less to for example your digestive system. In this way you can react in an optimal way to the danger . If the danger hasn t disappeared in a few minutes then your body produces cortisone, another stress hormone that keeps you alert . The effects are usually short term after which the body needs some time to recuperate.
What kinds of stress are there?
Stimulating stress. This is a positive form of stress. It helps you to perform well and to be extra alert in certain situations. That can be for example a job interview or driving your car outstation.
Frustrating stress. This can happen in circumstances that bring out frustrations, such as standing in a queue, a colleague who underperforms in a joint project or driving your car in Colombo.
Damaging stress. This is the worst kind of stress. It can occur when for example an employee has to do more work than possible, when somebody is bullied regularly or after a traumatic experience like a bank robbery. When the body doesn t return to a normal base level then we speak of chronic stress.
Is stress always caused by 'working too much' or a 'heavy work load'?
Different situations can cause stress. A well known example is a high workload, but also a serious illness or death of a loved one can cause much stress. But not everybody is the same concerning susceptibility towards stress. This has to do with the balance between what you can bear and the amount of stress that you have to endure. When you can bear a lot then you can endure more in stressful situations. A high workload in itself is not enough to cause damage. What plays a big role is the organisation of the work. When you have a big say in how the work is done then there is less chance of too much stress or even worse a burn-out.
What are the symptoms of stress? How do I know whether I am stressed?
When a stressful situation lasts too long or when multiple stressful situations succeed each other too soon, your body has no time to recuperate. The stress accumulates until it becomes too much. The symptoms of stress can be divided into three kinds.
Physical complaints:
- Headaches, back pain, stiff shoulders;
- Digestive complaints like stomach pains;
- Restlessness, sleep disturbances and tiredness.
Psychological complaints:
- Quickly irritated and frustrated or quick to cry;
- A feeling of unhappiness, powerlessness and gloominess;
- Lack of concentration, difficulty with thinking clearly;
- Absentmindedness, problems with memory;
- Problems with creativity or finding solutions.
Behavioural symptoms:
- Being short tempered, bitchy and extremely critical;
- Too much drinking, smoking, eating.
Does chronic stress lead to depression?
Stress can cause somber moods, wanting to cry and sleep deprivation. With chronic, long term stress there is more chance that it can cause depression but also a burn-out.
Is there proof that stress causes coronary heart disease, cancer - or physical health issues?
A continuous high level of cortisone, the stress hormone that keeps us alert , suppresses the immune system which makes us more vulnerable for diseases like heart diseases and cancer. Stress, depression and anxiety cause a higher chance on coronary heart diseases because emotions enhance the strain on the heart by increased blood pressure and heart frequency. These strong emotions also influence biological processes like blood clotting and inflammatory responses. Those biological processes can accelerate the course of coronary diseases. For example a heart attack can occur because of increased arteriosclerosis in the coronary arteries.
What can I do to relieve stress and what are the most effective coping strategies?
The keyword in reducing stress is relaxation. It s important that you acknowledge that you re stressed and that you take the time to address it. The sooner the better, because the recuperation period takes longer when the time that you re stressed is longer. A few tips:
- Relaxation exercises. Meditation and yoga are excellent ways to unwind;
- Talk with somebody or start writing it down. Talking and venting your feelings helps but writing (journaling) can have a similar effect and it s private;
- When you have high expectations of yourself try to think why that is and try to lower the bar a bit;
- Dare to say no . Don t bite off more than you can chew;
- Have a healthy lifestyle. Start an exercise or a sport that you enjoy (a simple outdoors walk every day is extremely healthy) and eat three healthy meals a day. When you feel physically healthy then usually you feel mentally better too;
- Be careful with medication. Although sleeping tablets or medication against anxiety can give short term relief, it doesn t solve anything and it doesn t address the root causes.
How do I know if I need professional help for stress management?
When you feel that the stress is there for some time and the stress level doesn t seem to decrease (the stress turns into damaging, chronic stress) then it s time to seek for professional help.
Can there be any adverse effects in using relaxation methods available online (eg: Youtube / online support groups)?
No, an excellent relaxation exercise is for example progressive muscle relaxation (or Jacobson as it called). You can find that on Youtube by typing in progressive muscle relaxation . And online support groups can give you a lot of support and help.
In the past months readers have mailed a variety of questions. Generally speaking, it was about wrong diagnoses and psychiatrists with little time (a few minutes) who were very trigger-happy to prescribe lots of (unnecessary) medicine. In addition to this, many clients complained that psychiatrists didn t inform them about frequent occurring side-effects of tablets. For example with antidepressants well-known possible side-effects are weight gain and sexual dysfunctions (like loss of sexual drive, failure to reach orgasm and erectile dysfunction). Below I ll highlight the most frequent asked clusters of questions. For an extensive discussion about the chemical imbalance myth, bipolar depression and ADHD please read the relevant articles on my website www.marcelderoos.com.
The chemical imbalance myth revisited.
There were a lot of people who were told by psychiatrists that they have a chemical imbalance in their brain, which is the supposed reason why they feel depressed and subsequently they were prescribed antidepressants. In many previous articles I have written about this misconception, but this belief is still much widespread in Sri Lanka. Sadly enough, it will not change until health care professionals become critical and start to read independent literature that is not financed or influenced by the pharmaceutical industry. Big Pharma wants to sell, which is their good right, but not to the extent that they misinform the public in order to boost their sales. At the same time psychiatrists should do their job as health care providers and begin to acknowledge this chemical imbalance for what it is: a scam.
Bipolar depression.
Numerous people had questions about bipolar depression. Again the number of clients has risen who were falsely diagnosed with being bipolar . Often they just had anger issues, or other problems which had nothing to do with bipolar depression. They lacked the requested typical highs and the lows of being bipolar. Before 1995, bipolar disorder, once known as manic-depressive illness, was rarely diagnosed.
Today, strongly influenced by clever marketing activities from the pharmaceutical companies, the change of the classic term manic-depression into the use of the much broader term bipolar spectrum has made medications for this disorder a sales hit. Countless people who objectively speaking were for example suffering from stress in a certain period or were just anxious are now labelled hypomanic (simply put: the euphoric period of bipolar). Nowadays people only need to have one high to be diagnosed as bipolar and with this the rot has set in the system. The introduction of the term bipolar spectrum seems to have opened up a quick highway to incorrectly diagnose a whole lot of people with bipolar depression. Psychiatrists are influenced in many ways by Big Pharma to recognise bipolar depression (including children at an early age). A real moneymaker when patients have to buy on regular base several expensive medications for life..........
When diagnosing clients, it s important to go beyond the symptoms which are mentioned in the much criticised DSM-5, and to see if the story of the client fits and explains the symptoms in a different way. If so, then there is no innate disorder and many of the ill persons should be labelled normal . When I speak with a client, then generally between half an hour and one hour s time the story and circumstances behind the symptoms becomes clear. It very often means that the previous diagnosis bipolar depression was wrong. Clients then have to deal with diminishing the shock of having been falsely labelled bipolar (with the belief that they had to take heavy medications with side-effects for life). It s so important to be meticulous in diagnosing a serious illness like bipolar depression.
ADHD.
The French philosopher Michel Foucault and the Austrian philosopher Ivan Illich have written a lot about the medicalisation of psychosocial problems (the making of a disease ). Especially Foucault has expanded on this in his discourse theory. ADHD seems to be the latest fashionable disorder . A lot of people came with examples of their child being diagnosed with ADHD. In many cases it had started with a teacher at school. Teachers want a concentrated, quiet and obedient class. Nowadays, when children stand out by what used to be called naughty, rebellious and boisterous behaviour, it is much easier than before for teachers to have these children drugged with for example Ritalin or Concerta (psycho-stimulant medications). For psychiatrists, jotting down abbreviations like ADHD, PDD-NOS and ODD and subsequently prescribing drugs has become routine.
ADHD is not a medical but a BEHAVIOURAL problem and psychologists are better equipped to deal with that than medical doctors. You are not born with ADHD, it s not a typical illness and medication is very often not the appropriate way of dealing with ADHD symptoms. The best way of dealing with ADHD behaviour is a treatment that starts with advice and training and when nothing else works then medication can be considered. ADHD is a label for behaviour that can be caused by numerous factors. Tensions between the parents, the noisy class at school has too many children, the teacher can t handle the class because of stress, a sibling is in a difficult phase and demands much attention from the parents, the child goes to bed at an inappropriate time, etc, etc. Medication can only suppress unwanted ADHD behaviour for a maximum of two years and has a number of serious disadvantages (see my previous articles about ADHD). Sometimes in difficult cases medication is appropriate. In many cases parental advice, teacher training and psychological support suffices. It s important to create an environment that is clear, quiet and predictable. There should be clear boundaries and positive behaviour should be noted and rewarded.
What do we know about depression?
Depression is about stuck emotions. You feel dead inside; life seems to have no more meaning. You feel hopeless, lifeless, empty, and apathetic. But there is practically always a story behind the symptoms of being depressed. A story that explains these symptoms, that they started somewhere in the past and that there are emotional causes for them.
What do we really know about (clinical) depression? We know that there is an agreement amongst mental health care workers to label a number of symptoms as clinically depressed . Psychologists and psychiatrists make use of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD) which describes these symptoms (at least 5 out of 9). Descriptive symptoms like a depressed mood for more than two weeks every day, weight change, change in sleep, change in activity, suicidal thoughts, etc.
We know that there is no proof that biological or genetic factors cause depression. We know that chemical imbalance in the brain is nothing but a marketing hoax of the pharmaceutical industry. We know that antidepressant tablets don t work with depression, apart from the placebo effect. We know that positive thinking won t help; that our thought process has nothing to do with the feeling of utter depression.
But we also know that depression has everything to do with FEELING depressed. Since depression is about stuck emotions, it makes sense to treat it from that angle. An empathic psychotherapist with sufficient knowledge about depression can coach the client in making the stuck feelings fluid again. It s about making the client feel that she is understood and that her story and symptoms are taken seriously. It s about empowering people. In therapy there is a lot of talking, but in essence it s about venting your feelings and coming to terms with yourself.
Feelings of depression are in many cases symptoms of an underlying conflict. Usually these symptoms stem from feelings from the past which are still too painful to be felt. When you succeed in making the connection, then those old feelings (usually mixed with present ones) explain to you the cause of your present state. Finally you can start to feel the painful feelings from the past in full. The intensity of these painful feelings will diminish each time when you are triggered in the present by a representative of that old feeling.
Depression often has a double diversion trick. In the first place it focuses our attention to our self instead of towards those who have done us harm. Secondly the attention is placed on the present instead of the past where the cause of the pain lies. This double diversion trick works very well: we endlessly wander in the maze of depressed feelings constantly further away from the entrance. People around us often try to convince us with well meant advice: that you have to think positively, that life and you aren t worthless, that the glass is half full instead of half empty, that you have to do things that you like, and so on. This won t help you at all! Feelings and thoughts of depression aren t cured by well meant positive advice and they keep devastating our lives. It means that all the attention we give towards our own functioning in the present is in vain. The only way out of this gruesome maze is that we consciously release our attention from our own functioning and start looking for the repressed functioning of others in the past.
In therapy you will learn to become familiar with your personal depression history . You will recognize the causes, the triggers in the present that link to the causes and you will learn to get yourself out of your depressed state. Moreover, you learn to do this by yourself so that you will become independent of the therapist.
The chemical imbalance hoax, medication doesn t solve the problem.
Some time ago a teenage boy came to my practice because he felt depressed and anxious. He had taken prescribed medicine from a psychiatrist who had told him that his symptoms were caused by a chemical imbalance in his brain. The pills had brought about suicidal thoughts and a huge weight increment, but fortunately his parents had wisely taken him off these drugs. After 5 psychotherapy sessions the boy felt a lot better, healthier and the real cause of his symptoms had been taken care of.
A lot of people (including many psychiatrists) still believe in this chemical imbalance story. Chemical imbalance in the brain is nothing more than a marketing concept from the pharmaceutical industry. There is no scientific medical proof for it, for an elaborate discussion about this, please visit my website www.marcelderoos.com and read my article "Antidepressants and the chemical imbalance hoax . Big Pharma has spent billions and billions of dollars to promote this myth and they have succeeded brilliantly. Because this is a hugely profitable business, the pharmaceutical companies have kept close ties with psychiatrists. With all kinds of (financial) incentives, subtle and not so subtle, they have gained much influence in drug prescribing behaviour.
The chemical imbalance theory is used to promote the sales of antidepressants and any other class of pills that supposedly restores the balance in our brains. The simple truth is that our brains are perfectly in balance of their own. There are no known biochemical imbalances and there are no tests (!) for them. The only chemical imbalance that is brought about is caused by taking these psychiatric drugs!
In the long run, psychiatric drugs tend to disturb the normal processes of thinking and feeling. They make the individual less able to deal with personal issues and they can cause irreversible harm to the brain. Taking antidepressant pills doesn't solve the problem. First of all these antidepressant pills don t work, if they do have some effect it is placebo. Secondly if they do numb you a bit, then it s only about the symptoms. Of course the attraction of these drugs seems obvious; they promise a quick fix and they put you into your comfort zone. The blame of the mental disease is not on the parents, the environment or the person himself, but on some alleged neurotransmitter deficiency in the brain. Psychotherapy on the contrary focuses on the root causes and empowers you. You do the work yourself and you re not dependent on pills, which you supposedly have to take for the rest of your life with all the dire consequences.
Placebo effect.
On top of this, independent (not financed by the pharmaceutical industry) research has shown numerous times in the past 15 years that antidepressants do not perform better than placebo tablets. The American researcher Irvin Kirsch has written extensively about this. He is widely regarded as one of the world s leading experts on psychiatric drugs and the placebo effect. He is the author of The emperor s new drugs, exploding the antidepressant myth (2009) and has written more than 200 research papers. In 1998 he published Listening to Prozac but hearing placebo, a meta-analysis of antidepressant medication , where he showed that in the case of mild, moderate and severe depression antidepressants do not outperform placebo tablets. These results have been replicated many times after by other scientists. A recent study published in the Journal of American Medical Association confirmed this again. In other published studies (for example by Moncrieff) with active placebo s (an innocent pill with side-effects in order to make people feel that something is working ) antidepressants don t outperform these placebo s as well, including patients with very severe depression.
One problem with medications is the high relapse rate. Depression comes back over time in about 90 percent of people on antidepressants. Studies show that relapses are far less common when people are treated with psychotherapy. Another is the possible serious side-effects (not a pleasant thing when you are already depressed!) such as excessive weight gain, sexual dysfunctions (like loss of sexual drive, failure to reach orgasm and erectile dysfunction), and when pregnant women take these tablets then there is a bigger chance of genetic damage in the fetus. American psychiatrists like Dr. Peter Breggin (www.breggin.com) and Dr. Allen Frances http://www.huffingtonpost.com/allen-frances) are very concerned about the growing medicalisation of mental illnesses like depression.
There is no evidence of genetic causes.
Many people still believe that the cause of depression is something in the genes . This is a remnant of the school of thought ( nature ) that oscillated upwards again in the 1980-ties when researchers assumed that more or less everything was genetically determined. Nowadays most scientists don t accept this explanation anymore. As a matter of fact, there are no known genes for any psychiatric disorder (for instance ADHD, depression, schizophrenia, etc.).
For all these illnesses there exists no robust body of research in favour of genetics. Although there are illnesses that occur comparatively more frequently with relatives, there is a frustrating lack of progress in understanding the genetics of mental disorders. Even twin research (applied to this field), what used to be the hallmark of the nature school, has come under serious methodological criticism. Experts are in severe doubt whether the underlying genes regarding for instance mood disorders will ever be found.
On the contrarily, the support for the school of nurture is becoming stronger and stronger. For example, when you grow up in a family where one or more family members are depressed, it is more likely that if and when you yourself become depressed it has more to do with the circumstances and family dynamics you grew up with, than with genetics. If there are any genes involved, then they play a very distant and minor role. With psychiatric disorders there usually is a complex interaction between nature and nurture, but the gene part is much less than previously assumed.
Furthermore, the medical model that psychiatrists use is based upon a number of certain symptoms (5 out of 9, 4 out of 7, etc.), which determine what kind of illness-label they should place upon these. With physical illnesses this usually works, but most mental illnesses are too complicated for this model. For starters, mental illnesses are typically ill-defined; nobody knows for example what schizophrenia exactly is. Also, with mental illnesses one should view the symptoms in the context of the personal history and circumstances. If the story fits and explains the symptoms in a different way, then there is no innate disorder and many of the ill persons should be labelled normal . And unlike physical diseases, the connection between the different possible causes and treatment options is not very clear. In research terms: the explained variance with mental illnesses is much less than with physical diseases.
Take for example a 35 year old man who comes to a doctor s office. He has a high temperature, muscle pains, headache and loss of appetite. The doctor bundles these symptoms to an objective general syndrome called fever . He administers medicine and in a few days the patient is well again.
But in the following example a 35 year old man brings his wife to a psychiatrist and tells him that she is depressed. In the Sri Lankan context the psychiatrist has little time and the wife usually doesn t speak until she is spoken to. So the end result would probably be that the husband receives a prescription for antidepressants for his wife.
A psychologist would probably have taken the trouble to ask the husband to leave the room and subsequently have spoken with the wife separately and confidentially. Perhaps then the wife would have told him that she suspects her husband of infidelity and that she feels angry, hurt and lonely and not depressed. Then a couple-therapy instead of focusing on the wife would be appropriate. Both of their personal histories and the marriage itself would be addressed.
In the medical model one works from the individual person to generalised diseases. The symptoms (high temperature, muscle pains, etc.) lead to the conclusion of fever (a very common condition, N=millions). Psychologists on the contrarily start and end with N=1. Mental conditions are typically very individual and are extremely difficult to generalise.
When you combine this with the failure of the chemical imbalance theory , the questionable independence of pharmaceutical industry funded research, and the fact that antidepressants don t perform better than placebo tablets then you can ask yourself whether the treatment of depression should be left out of the repertoire of psychiatrists and medical doctors. Depression is too complicated and too serious to be treated by non-effective tablets with side-effects and withdrawal-effects.
Cognitive behaviour therapy doesn t really work.
One of the most persistent myths is that psychotherapy is supposed to be based upon protocols. When somebody is for example depressed then protocol demands that this person should be treated with cognitive behaviour therapy (CBT). Especially medical doctors are trained in this way and they often assume that CBT falls within this protocol-thinking way too. But psychologists with a few years of practising behind their belt know that it doesn t matter much which therapy or method they use.
The most important success-factors for any therapy are the therapeutic relationship and an active client. Therapists have to be able to install trust and hope in the client and the client herself should be engaged in the therapeutic process. On top of this, the therapy should include the present, the past (!), cognition, emotions (!) and behaviour.
Cognitive behaviour therapy is typical American in its assumption that the way you think will influence your feelings. When you are depressed you should challenge your negative thoughts ( positive thinking ). From the clinical practice we know that you can tell a depressed person a hundred times that he should think positively but that won t bring about a lasting change. Why is CBT then so popular?
CBT is seen as a relatively quick fix , is comparatively cheap and appeals to our sense of logic: think positively, be strong and you have to work for it! While in reality coming out of a depression means accepting and actually feeling your painful emotions. This is also a lot of work but in a quite different sense! Depression is an emotion and it has nothing to do with our thoughts. Emotions are in evolutionary sense much older than our cognitive brain and in the long term they usually win . Trying to influence your feelings with your thoughts is a hopeless enterprise. Feelings want only one thing and that is to be felt! So the best way to come out of a depression is not to fight it with our thoughts, but actually starting to feel it and finding out where it stems from. Depression has to do with your past history and what others have done or said to you.
It s difficult to measure therapeutic success; it depends on the school of thought that lies behind the specific method. With CBT success is seen as less negative beliefs. With for example psychodynamic therapy and psycho-analytic therapy (the latter usually last for years!) it is about understanding yourself, balancing your feelings and learning to live with your issues. With these last two forms of therapy depression means something quite different than with CBT and it isn t simply about a lower score in a general depression test.
Most of the research with CBT is done like this: a group of depressed persons CBT intervention results. And of course the outcome is often that CBT works . But when you compare different therapy methods with each other (and taking into account the observations made above) then there isn t much distinction in success between the methods. There is a robust amount of research for this. One of the most recent is a big meta-analysis (2013 PLoS Med 10(5): e1001454) where seven psychotherapeutic interventions for depression (including CBT) were compared. The findings were that none of the therapies stood out as being better than others. This means that there must be other factors (like the therapeutic relationship and an active client) that are responsible for the efficacy of psychotherapeutic interventions and not the researched method.
In medical science randomized controlled trials (RCT) are allegedly seen as the golden standard for research regarding medications. There is a lot criticism about these RCT s but in this article there is no space to discuss these. Concerning the use of RCT s with psychotherapies it should be noted that these RCT s are strictly regulated in an artificial environment (not real life ) and meant for extreme short term treatments. Most therapies can t be moulded into a RCT-format, which means that RCT s favours certain methods only because of the nature of the RCT s.
Cognitive behaviour therapy is accepted because it supposedly generates (usually short lived) results with for instance depressed patients. But it is a wrong assumption to think that CBT works. Evidence based research concerning the effectiveness of therapies is a minefield. Based upon what meta-studies have showed so far, extraneous factors like the role of the therapist and an actively participating client are crucial in the success of a therapy and not the chosen method of therapy. If cognitive behavioural therapy was that all powerful then there wouldn t be any depressed psychologists; reality tells us something quite different .
What does work with depression?
It s important to go for the root causes and not only treat symptoms with medications. Psychotherapy practised by an empathic professional therapist and with an active client does work. Depression has to do with a person s past history and what others have done or said to him. So therapy should focus on the emotional link between the triggers in the here and now and the painful causes in the past. The next step should be the painful job of trying to feel these stuck emotions. It s crucial that the client has a well trained professional psychologist who supports him. When the client feels more emotional balanced because the influence of his past has diminished, and the client has learned to handle his past emotions, then the time has come for the therapist to step back.
Empathy in therapy is a key concept and although it s complicated to define it, generally speaking we assume that it s an ability to imagine oneself in the situation of others and to sense the emotional state of others. The therapist should make it clear that he understands the emotions of the client. Besides this affective aspect, empathy also has a cognitive part and it enables us to understand the perception of the environment of the other person. The quality of empathy increases when the therapist is able to be authentic with himself and in the contact with the client (congruent).
How can we support a loved one who is suffering from depression?
Your care and support is important for a family member or for a friend who suffers from depression. Probably you re asking yourself what is the best way to show that person that you are there for her. There are several ways to do this. But please don t forget to take care of yourself too!
Go and search for information. It s important to inform yourself as much as possible about depression and the accompanying symptoms. As a result it will be much easier for you to identify with the situation and the feelings of your loved one;
Try to be an active listener. Somebody who suffers from depression is in need of compassion, warmth and understanding. Simple questions like How can I help you? or saying I am here for you if you need to talk can do wonders. Don t be afraid of the intense emotions that your loved one might express. You don t have to talk all the time, just being with the person can give a lot of support too;
Give a hug or a warm pet on the shoulder. (Physical) affection is a good way to show that you care about your friend or family member;
Don t try to trivialise the depressed feelings. Don t say It isn t that bad, my uncle Lakhsman had it much worse or Why can t you just snap out of it? ;
With a serious depression you need professional help. That person can also assess the risks. Be alert on suicidal tendencies and talk about it. A very common mistake is the view that when you talk about suicide that you put ideas into the head of your friend, but this is absolutely not true. When you sense that your friend thinks about suicide, try to talk about it in a subtle way. People who think about committing suicide very often feel lonely and they feel that nobody cares about them. When you take the time to listen and to empathise, your friend will be encouraged to open up about her feelings. People who consider killing themselves, very often don t want to die. They want to get out of a seemingly hopeless situation and they can t endure the emotional pain anymore. When your friend talks about a specific way of committing suicide and when there is an actual opportunity to do so then it s wise to talk with a professional;
When you feel depressed you feel very sad, hopeless and helpless, so it s important that there is safety and rest in your environment. You can help your family member by taking care of tasks like grocery shopping, washing the dishes, taking the children to school, etc.;
Take good care of yourself! Be aware that you don t get overloaded by taking care of your friend. If needed ask for advice and take sufficient time to relax (for example regular exercising);
Try to ensure that your family member eats regularly and healthy. Taking walks or swimming can help to lift the mood and to stay fit.
Bipolar Depression.
There is something terrible going on in Sri Lanka. Bipolar depression seems to be invading our country. Almost every week new clients tell me that a psychiatrist has diagnosed them in a few minutes time as (mildly) bipolar . Subsequently they are put on heavy medications (which are known to have serious side-effects, for example excessive weight gain, heart disease, tremors of the hands) with the message that they have to take them for the rest of their life. This also includes children and adolescents.
The pharmaceutical industry has made bipolar depression one of their spearheads in their efforts to maximise their profits. Their business is very lucrative (second best to the arms industry!) and they have extremely powerful (financial) resources. The strong financial relationship between Big Pharma and the American Psychiatric Association (APA) is reason for the American Congress to put this under congressional investigation. Every one of the APA s members involved in the mood disorders panel overseeing the editing of the psychiatrist s bible DSM IV and V (Diagnostic and Statistical Manual of Mental Disorders), has financial ties with the drug companies. Psychiatrists top the list of doctors receiving pharmaceutical company gifts. They are influenced in many ways to recognise bipolar depression (including children at an early age). A real moneymaker when patients have to buy on regular base 4 or 5 expensive medications for life..........
Before 1995, bipolar disorder, once known as manic-depressive illness, was rarely diagnosed. Today, strongly influenced by clever marketing activities from the pharmaceutical companies, the change of the classic term manic-depression into the use of the much broader term bipolar spectrum has made medications for this disorder a sales hit. Countless people who objectively speaking were for example suffering from stress in a certain period or were just anxious are now labelled hypo manic (simply put: the euphoric period of bipolar).
There is no scientific evidence that depression can be caused by biological factors; the so called chemical imbalance theory is just a pharmaceutical marketing campaign. Experts are also very pessimistic about alleged hereditary factors like (combinations of) depression genes or even less likely, neurotic personality traits . It becomes more and more apparent that environmental factors like family dynamics, traumatic events, etc. are the main causes for depression. With bipolar depression researchers are in the dark, there is no valid causal explanation for it; it s only a label for a number of symptoms.
In the articles "Bipolar Madness" and "Psychological / Psychiatric Assessment (see my website www.marcelderoos.com) I discussed the alarming increase of bipolar-diagnoses , in particular with children. But also many adults very easily get the label bipolar depression without a thorough professional assessment. And very often this assessment has been done in less than 5 minutes time. Bipolar depression isn t something that you can measure quickly; there are no tests or blood samples to rely on. Only self-reporting from the client, behaviour observation from relations and a careful clinical assessment from a mental health professional can generate reliable results. Especially with such a complex possible diagnosis as bipolar depression, a mental health professional should have ample time and more crucially, an open mind.
The medical model that psychiatrists use is based upon a number of certain symptoms (5 out of 9, 4 out of 7, etc.), which determine what kind of illness-label they should place upon these. With physical illnesses this usually works, but most mental illnesses are too complicated for this model. Also, psychiatrists more often than not differ in how to label a patient. The DSM diagnoses are scientifically and clinically untrustworthy. Psychologists on the contrary focus on the possible causes and the whole story behind the symptoms. Most importantly, with mental illnesses one should view the symptoms in the context of the personal history and circumstances. If the story fits and explains the symptoms in a different way, then there is no innate disorder and many of the ill persons should be labelled normal .
When I speak with a client, then generally between half an hour and one hour s time the story and circumstances behind the symptoms becomes clear. It very often means that the previous diagnosis bipolar depression was wrong. Clients have to deal then with diminishing the shock of being (falsely) labelled bipolar with the prospect of being on heavy medications for life (!) and with the side effects of the drugs. It s so important to be very meticulous in diagnosing a serious illness like bipolar depression.
Psychologists and psychiatrists usually don't work well together, mainly because of the above mentioned differences. Psychiatrists typically focus on trying to subdue the symptoms with medications which blunt the emotions while psychologists try to get to the bottom of the person's emotional state. For psychologists medications usually are an interference with their therapies which aim to coach the person into a more emotional balanced state of mind.
DSM(5): Bestseller with little psychiatric use.
Psychiatrists as a rule take far too little time for their patients, they more often than not differ in how to label a patient and they are not trained in psychological assessment. The psychiatrists bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM, the fifth edition is out now), describes the criteria for putting on psychiatric labels on patients.
A few examples from my daily practice
A young client who was diagnosed in 3 minutes by a psychiatrist as being bipolar was put on heavy medication for 7 years. While in reality he had only anger issues.
A client was put for 10 years on medication after being labeled in a few minutes time as schizophrenic and depressed. Each time she went to see the psychiatrist he started writing a repeat prescription while she entered his office. What was really going on was that she had been sexual abused at a young age and bullied at school. In therapy she felt for the first time in her life the possibility to talk about it and to vent her emotions.
Another client (described in more detail in my article "Psychological/Psychiatric assessment", see my website www.marcelderoos.com) was also given the wrong label bipolar and was put on strong drugs which affected her life in a bad way.
The DSM labels/diagnoses are scientifically and clinically untrustworthy. Worse than that, there is hardly a connection with a subsequent treatment. And that treatment typically consists of prescribing drugs which disturb the normal processes of thinking and feeling. Psychiatrists only look at symptoms which they compare with the mental disorders mentioned in their DSM-book. Psychologists on the contrary focus on the possible causes and the whole story behind the symptoms and subsequently they try to treat those causes with their therapies. Psychologists try to see the whole person with his idiosyncratic story instead of a few symptoms on which a label is attached.
The DSM is an arbitrary classification system with little psychological or psychiatric use. Despite the term statistical in the title, it does not mean that the book is based upon sophisticated research about types of psychiatric problems. On the contrary, the classification criteria and categories were chosen by vote by people in working committees who have strong financial ties with Big Pharma. The DSM is written as an extension of the powerful pharmaceutical industry. There is no solid theoretical foundation, nor a clinical pragmatic practice. The pharmaceutical industry used its influence for example to extend dramatically the criteria for ADHD in 2000 and again in 2013 with the introduction of the DSM-5. This means more medication and is extremely profitable for them. On the positive side the classifications of the DSM are worldwide used and embedded in the psychiatric/psychological practices. In this way there is a certain (with all its shortcomings) standardisation and mental health care professionals can communicate with each other about mental diseases.
The DSM-5 has introduced various new disorders which labels normal human behaviour as abnormal. For example having a temper is now called disruptive mood dysregulation disorder; old age becomes minor neurocognitive disorder and the bereavement exclusion from depression has been removed so human grief is now seen as depression . And all of these new disorders have to be treated of course with medication. In addition the criteria of certain existing disorders have been lowered. ADHD for adults has now 5 criteria instead of 6; bipolar disorder is also easier to label; the same goes for anxiety disorders & phobias (one of the most common disorders). Apparently these changes seem to be minor tweakings but they will most likely generate a massive amount of new patients .
The pharmaceutical industry has the clout to disregard negative research results, for example regarding bipolar disorder and ADHD, and highlight the positive ones. Take for instance the license for the drug Concerta for adults with ADHD in 2010. It was denied in Europe because the British authority for regulating medicine MHRA concluded that the effectiveness of Concerta was extremely poorly and the side-effects were (quote) a potential serious risk to the public health . But the conclusions of the MHRA were not allowed to be made public and the manufacturer of Concerta started a powerful and successful campaign to promote the drug.
Medical doctors are being induced by the pharmaceutical industry in various ways (financial, career wise, sponsored trips to conferences in luxurious environments, paid travel expenses to workshops abroad like flights, 5-star hotels, daily expenses, etc., etc.) to detect bipolar disorder and ADHD with adults. There is no medical scientific way of justifying this, but these two fields are spearheads of the marketing specialists of Big Pharma. Not in the last place because people diagnosed in this way are being put on heavy and costly medication. A real moneymaker when patients are being told that they have to buy these expensive medications on a regular base for life..........
One of the most famous experiments in social psychology is the so called Milgram experiment. After the Second World War everybody was stunned about the horrors that had taken place in Nazi-Germany and they asked themselves how this could have happened. Some even thought that the Germans as a race must have evil tendencies. The American social psychologist Stanley Milgram showed in 1963 that the presence of an authority figure can coerce people to administer to others deadly electric shocks.
The experiments began in July 1961 at Yale University, three months after the start of the trial of Adolf Eichman in Jerusalem. Milgram devised the psychological experiment to answer the nagging question in those years: "Could it be that Eichmann and his accomplices in the Holocaust were just following orders? Could we call them all partners in crime?"
Milgram got his subjects for the experiment through an advertisement in a newspaper. In the advertisement he had asked for 500 male subjects from all strata of society: factory workers, businessmen, construction workers, clerks, professional people, etc. They were invited to come to a nameless small building where they met the experimenter and another subject. They didn t know that this other subject was in fact an actor and an accomplice of the experimenter.
The subjects were told that they participated in a study about the effect of punishment in the learning process. Therefore they had to perform in the role of a teacher and read aloud word pairs to the other subject (the actor) who performed in the role of the student . The student had to remember these word pairs as good as possible, because if he couldn t reproduce them he would be punished with an electrical shock. The shocks were administered by the teacher and with each wrong answer the voltage would be increased with 15 volts increments. Milgram had placed an impressive looking bulky device in the room that was supposedly meant for administering the shocks. At some point prior to the actual test, the "teacher" was given a sample electric shock from the electroshock generator in order to experience firsthand what the shock would feel like that the "student" would supposedly receive during the experiment.
The teacher and the experimenter observed how the student (the actor) was being tied on a chair with electrodes hanging from his body. After that the teacher and the experimenter went to an adjoining room where the teacher sat in front of the impressive shock treatment device. The experimenter (an authority figure in a white coat) was seated in the same room as the teacher. There was no visual contact between the actor in one room and the teacher in the other one, the contact went through microphones and speakers. This was needed because in reality of course the actor didn t receive electric shocks at all; he merely acted out the effects of them.
There were no subjects who refused to participate with the study because they didn t want to deliver electric shocks to others. When the electric shocks became heavier (according to the device very dangerous ) many teachers did start to feel uncomfortable; they could hear groaning and screaming from the other room. When they looked in despair at the experimenter in their room, he then told them that it was okay and that he took all responsibility. So the teachers continued even when the screaming became louder and louder, and even when at the highest volts there was no screaming at all. They repeatedly administered shocks of 450 volts because the student didn t answer anymore, although the device had then the ominous indication XXX .
About 65% of the subjects were prepared, pressurised by the experimenter, to administer deadly electric shocks to (what they thought) another person. Nobody stopped before a voltage of 300 was reached. Afterwards the subjects said that that they were powerless; the experimenter had forced them to continue.
Milgram s experiment has been reproduced many times in different countries, with only females/males or mixed, with different ethnical groups, different educational levels, etc., etc. The percentage of obedient followers each time was round the 65%.
According to Milgram, his experiment showed that human behaviour can t be explained by suppressed anger or aggression, but by their relation towards authority. Most people find it more difficult to disobey a person higher in hierarchy than to do something they don t believe in. When Milgram repeated his experiment with more than one teacher , the importance of dissidents became clear. As soon as there are people who dare to stand up against the leader, there will be others who are disobedient too. No wonder that dictators want to get rid of their political dissidents as soon as they can!
The Milgram experiments were very taxing for the subjects. To deliver a deadly electric shock to somebody isn t something you can just brush off. These experiments were the reason that all universities developed strict ethical guidelines for conducting experiments; subjects must be protected against experiments that can harm them in an emotional or physical way.
An authority figure can persuade 65% of us to deliver deadly shocks to people, only by telling us (in a certain defined situation) that we have to continue. He does not have to be armed, and we even don t have to be afraid of him. If there is one lesson to be learned from these experiments, it s that in most of us there is a potential concentration camp executioner.
I dread group work for some unexplainable reason and I am mostly comfortable working on my own. I rarely feel like raising my hand in class even though I happen to know the answers. I prefer to listen to others rather than talking. I also prefer quieter places and I m happy to stay home with a good book and coffee. I don t like to party and am not a fan of social gatherings. I love interacting with people, but I have my limits, especially in noisy environments. I wouldn t mind a long meaningful conversation with another person but I am not comfortable in small talk. And I m a much better writer than I am a speaker.
Can we label this person as a shy character? Or is there another explanation for this behaviour?
The person depicted here isn t shy but is rather introvert. The concept introvert was first used by Freud in his theory about the libido. Later in the 1920-ties Carl Jung removed the sexual character and made both terms introversion and extroversion central to his personality types. Introversion is not simply being shy. Extroverts get energy from company and are generally speaking most content when surrounded by people. Introverts can behave in a social sense often very flexible but it takes them more energy. They are normally more contemplative individuals who can enjoy solitude and are satisfied with their inner ideas and imagination. Most people have extrovert and introvert traits, depending on the situation and the company they re in.
Is introversion a negative personality trait?
Introversion is not negative at all. According to some studies extroverts have more confidence than introverts. That is only partly true. Because extroverts are more orientated on the outside world than on their inner emotions, they are prone to disengage from their possible internal doubts and warning signals. Their decision making system is therefore cruder and has a more simple structure than with introverts. Extroverts appear to have more confidence because they see fewer problems.
Introverts, according to the same studies, have a tendency to first internally look for possible problems. Then there is automatically more space for doubt and lack of confidence. The time to come to a decision is usually longer.
Extroverts are on average more sensitive to external pressure or negative feedback than introverts. They are more easily influenced in their decision making by authority figures than introverts.
When you put this all together then it doesn t mean that introverts are automatically better with making the correct decision and that extroverts aren t better with decision making at the right moment. Both have their good sides, and both have their shortcomings.
Why are some people introverts while others are extroverts? What contributes to these traits?
Several studies show that on average, introverts and extroverts differ in brain activity. On a MRI scan the 3D map of the brain pops up happily. But brain differences that CORRELATE with introversion or extroversion do NOT mean that these differences (if any) CAUSE introversion or extroversion. When there is a positive correlation between the number of storks in a certain area and the amount of new born babies, it doesn t mean that there is proof that babies are delivered by storks as the legend tells. There are no experiments that really address whether brain differences play a causal role. Scientists are very pessimistic about ever discovering a scientific description of personality differences at the level of cells and synapses. It s also important to keep in mind that our brain structures vary from person to person along all sorts of axes that can make up personalities (not just introversion and extroversion).
As above mentioned, a common misconception about introverts is that they are shy. What are the other misconceptions about them?
Misunderstanding 1: introverts don t like to talk.
Introverts love to talk; when they are enthusiastic about something then they are almost unstoppable. But they don t excel in small talk, which takes too much energy. Secondly they often need a bit of extra time before they react to what others say. They have to process what they have heard to see how it fits with previous experiences and knowledge. It s not as if they don t want to talk or to keep things for themselves.
Misunderstanding 2: Introverts don t like to cooperate.
Introverts enjoy working together with colleagues. But many forms of cooperation are tailor-made for the way how extroverts operate. Extroverts get energy from discussions with each other, they think by talking. For introverts it s the opposite; they talk after they have thought about it. They gather information whilst talking, but the real thinking comes afterwards. Usually there isn t much time for that because extroverts constantly want to discuss. This causes much frustration and that s why extroverts get the idea that introverts don t like to cooperate.
Misunderstanding 3: Introverts are boring.
When you get to know an introvert a bit better then it becomes apparent that they are not dull at all. They are usually deep thinkers with original and creative ideas. They don t participate much in social activities and have less contact with colleagues than extroverts. It s not about the amount but it s about the depth. Introverts live intensely, and depth in relationships, activities and conversations give them the idea that they are alive.
Misunderstanding 4: Introverts are not competent.
The fact that introverts won t give their opinion right away in a discussion doesn t mean that that they don t have views or ideas. They do have, and they are usually well founded and thought of. But they need to feel safe enough and to have the time and space to express these views.
Misunderstanding 5: Introverts are socially not competent.
Introverts can be a bit absentminded and into their own world. They love to think about their ideas and to think about their experiences. They are good at putting themselves into the shoes of others and to look at things from another perspective. They have a lively interest in others and are concerned and interested. What more do you want?
Extroversion is so prized in our culture that many introverts tend to feel ashamed or uncomfortable about their introverted ways. What can be done to help them?
Many introvert professionals feel extremely tired at the end of their work week. Here are some tips to keep your energy stable.
- Focus on your strong points. It s better to develop the things you re good at and what comes more or less natural to you. This will give you energy while if you try to improve your less strong points it will cost energy. Choose for example a leadership style that suits you. Do not try to be a very vocal and assertive extrovert but pick a style that agrees with your natural way to structure and lead from the back . As a result meetings usually will go smoothly, the participants are involved and a lot of work will be done. Use your creativity as an introvert to organise your work utilising your qualities.
- Work on a daily basis to realise your ideals. Introverts are less tired if they work in an inspiring environment that connects with their ideals. Not every job is inspiring but try to find in your work at least one thing where you believe in and which gives you a drive. Prioritise that to other tasks. The results you will accomplish with that can generate so much energy that those other tasks will seem easier too.
- Learn to handle your inner critic. It s that little voice inside your head that constantly critisises your behaviour; with introverts it s often very dominant and persistent. The best way is to develop compassion for yourself. It s about understanding how you are now in the context of your personal history.
- Reserve time to reflect. Introverts need on a regular base time to think and to digest experiences. Make time for this in your daily schedule! An introvert client of mine for example takes every day during lunchtime a walk for 45 minutes. She reflects, eats a sandwich and enjoys nature. When she returns she feels refreshed and has plenty of energy for the second half of her working day.
Sexuality: introduction.
Some time ago a young client of mine came to my practice shaking with fear. He had had unsafe sex with a girl. His girlfriend didn t know about this and he was petrified that he had a STD like HIV. He had himself tested by a doctor but it takes at least three months (depending on the kind of test) to have a highly accurate test result that you are not infected with HIV. It took a lot of counselling to make him feel stable again, also because he couldn t talk about it with anybody else. He couldn t tell his family or his friends because he felt they wouldn t understand and he couldn t trust their confidentiality. Luckily he was not infected and it turned out to be a good lesson for him.
For young people, it s important to learn about sexuality and other related subjects. It s about discovering your own body and what sexuality means to you, intimacy and sex in your relationship, how to have safe sex, and possible problems with sex as well as how to deal with those. In Sri Lanka sex related topics are usually considered a taboo and are hushed up. People are not used to talk openly about it. This can cause ignorance about the above mentioned topics and can have dire consequences, for example problems with intimacy, sexually transmitted diseases (STD s), unwanted pregnancy, etc.
You have influence on being in de mood for having sex, it doesn t happen out of its own. You have to be open to sexual stimulations like touch, a fantasy, sexual images from a movie, a picture or music. But also being engaged in sex, like kissing and caressing, can make you feel to want to explore further. You decide if you accept sexual stimulations; it depends on your relationship and the circumstances whether you proceed or not. Do you feel relaxed and comfortable with your partner? Do you feel the freedom to accept your desire? Do you have positive experiences? Then your mood for having sex will increase. It s different for everyone so it s important that you explore which things are titillating your senses.
You can for example make contact with your erogenous zones or your happy spots . Sexuality is much more than your genital zones. You can get excited in places all over your body. To become more familiar with these spots here is a good exercise. Take a green, a red and a blue pencil and a printout of the human body (front and back). Colour with green on the printouts of your body (front and back) which spots feel like erogenous zones ( nice spots ). Do the same with red which spots where you absolutely don t want to be touched. And lastly with blue colour these spots where you re not certain if they are erogenous zones. How easy or how difficult was this exercise? What strikes you about the spots you have coloured in? Did you discover something new about yourself?
Having an orgasm is the sexual discharge during intercourse or masturbation. Many women can have multiple orgasms but men can t. How it feels is different for everybody, from very intense to fleeting and superficial. It can depend on how you feel, your level of tiredness or how much desire you had. For many people the orgasm is literary the climax of having sex but that is not necessary always true. A lot of people do not have an orgasm during intercourse while they still enjoy it intensely. The pressure on climaxing can cause that the pleasure in having sex becomes less and actually reduce the chance of having an orgasm.
With relationships it s very important to be aware of your wishes and boundaries during sex. Talk about it with your partner and be very clear about your boundaries. If you don t know what you enjoy and like please do think about it. Even more importantly, find out what your limits are in what you like and what you don t like! It can be about who takes the initiative, your wishes what you enjoy during sex, where you want to be touched, when or how often you want it or performing sexual fantasies.
There can be several problems concerning sex like not being in the mood for having sex for some time, erectile issues, problems with having an orgasm, pain during intercourse, etc. First of all try to talk about it with your partner and when that doesn t give relieve consider seeking professional help.
In the coming weeks we will present you a series of articles about sexuality:
1.Sexually Transmitted Diseases
2. Sexual Orientation
3. Sexual and Reproductive Health
4. Sexual dysfunctions
5. Sexual deviants and victims
Sexuality: Sexual Transmitted Diseases
STDs are sexually transmitted infections. In Sri Lanka, there are no reliable estimates how many people on a yearly basis catch a STD. People can go to special STD clinics (who do register) but also to hospitals, private medical doctors, etc. Some STDs have serious consequences if they are not treated in time. Fortunately, most are easy to cure. STDs are infectious and you can have one without even noticing it. As a result, you can inadvertently transmit a STD. Examples of STDs include: HIV infection which causes AIDS, chlamydia, genital warts, genital herpes, hepatitis B and syphilis.
Most STDs are transmitted through unprotected sex like vaginal intercourse without a condom (penis in the vagina), anal intercourse without a condom (penis in the anus), oral sex (blow jobs and cunnilingus) without a condom. A number of STDs are transmitted through blood. You can catch HIV, hepatitis B and syphilis as a result of tattoos and piercings that are unhygienically applied. Or if you use someone else s needles, syringes and other equipment for drug use. During pregnancy, HIV, hepatitis B and syphilis can be transmitted from mother to child. You cannot get a STD by drinking from someone else s glass. You also cannot get one from coughing, insect bites or a dirty toilet seat.
You usually are not directly aware that you have a STD; depending on the type of STD it can take weeks or sometimes years. General symptoms from which you can recognise a possible STD infection are:
- Discharge of pus from the penis, vagina (or anus). The separation can be an annoying smell and have a yellow or green colour. With women, the separation is stronger than normal and can have a different colour.
- Warts, blisters or sores on or around the penis, vagina, anus or mouth.
- Itching, pain or a burning sensation during or immediately after urination.
- Reoccurring itching in the pubic area (pubic hair, penis, vagina or anus).
- Loss of blood during or after intercourse or abnormal bleeding outside the menstrual cycle.
- With women: abdominal pain / men: pain in the testicles.
- Swollen glands in the groin.
(You will never experience all of the symptoms at the same time, but often only one or two). Please visit http://www.cdc.gov/std/ for an accurate description of the different STDs.
Some STDs are serious, others simply a nuisance. STDs caused by viruses are called viral STDs. Once you ve caught a viral STD, the virus will remain in your body. This means that the symptoms may recur over and over again. Viral STDs are: genital herpes, hepatitis B, genital warts and HIV. HIV is the virus that can cause AIDS. STDs caused by bacteria are called bacterial STDs. These infections can be completely cured, but it is important that you don t wait too long before going to see a doctor. Otherwise the STD could have some unpleasant complications. Examples of bacterial STDs are: chlamydia, gonorrhea and syphilis. Finally, there are also STDs that are caused by parasites, such as pubic lice.
How do you prevent a STD? Safe sex, that is having sex with a condom, is the best protection against STDs. If you always have sex with the same person, if he or she has only have sex with you, and if neither of you have a STD then sex is safe without condoms. But please remember this, the only way to know for sure whether neither of you have a STD, is by having yourself tested. When someone becomes infected with HIV, syphilis or hepatitis B, then a test can only prove that after three months. That s why it s important to always use condoms for the first three months of a relationship. Because during that period you won t yet know whether either of you are infected.
How do you say that you want to have safe sex? It can feel a bit awkward. Suddenly you really want to have sex but you don t have any condoms with you. Or you ve had too much to drink and are not being careful. Or you think sex with a condom is a bit of a nuisance. There are enough excuses for not having safe sex. Sometimes you do intend to have safe sex but it just doesn t happen. Afterwards you regret having had unsafe sex. Unsafe sex is easy to avoid if you talk about using condoms. How do you do that? And when do you start? These tips may help: Work out beforehand when and how you ll say you want to have safe sex. If you know that before you start having sex, it s easier to stick to it. Say honestly that you don t want to catch a STD. That doesn t mean you don t trust the other person. You re just telling them what you think. If you say I always do it with condoms! , then anyone will know what you mean. You don t even have to mention STDs. But talking isn t the only way to make it easier for you to always have safe sex: Just grab a condom and put it on you or your partner. Make sure you always have condoms with you! Sex often happens spontaneously. You don t usually know beforehand when you ll have sex with someone. Remember this: don t do anything you don t want to! Say how far you ll go.
Sexuality: Sexual Orientation
In my psychology practice it frequently happens that people tell me they are gay or lesbian. Although it seems less of a problem for the younger generation than for the 30+ ones, there still is a lot of controversy about sexual orientation in Sri Lanka. It s usually a big relief for them to experience that I am open- minded and not biased. The mere fact that they can talk freely and without fear of being exposed to the outside world (everything clients say to me is very confidential) is often a therapy in itself .
Sexual orientation is about amorous or erotic feelings you have with regard to another person. The orientation is basically innate ( nature ), but can also be influenced by external factors, such as society, education, or culture ( nurture ). In one culture one form of orientation is less acceptable than the other and therefore will be less or even not at all expressed. However, this is only the expression, and not about the existence. The orientation itself is defined in a person and is consistent, but this need can be suppressed by acquired factors.
It can be said that there are basically three or four groups of sexual orientation:
Heterosexuality: Amorous or erotic feelings for a person of the opposite sex.
Homosexuality: Amorous or erotic feelings for a person of the same sex. The term homosexuality is a combination of the Greek word homoios which signifies "equal", and sexus, the Latin word for sex. Research shows that 5 to10% of the world's population is homosexual or bisexual. However, this is difficult to calculate precisely because it is not always clear when somebody falls within these groups. The taboo on homosexuality has often emerged with the rise of religions, which prohibited a relationship or marriage between two men or two women. However, this does not mean that only in religious circles homosexuality is seen as "bad".
Bisexuality: Amorous or erotic feelings for a person of either sex. Just as homosexuality, bisexuality has to do with feelings, behaviour and identity: what you feel for another, what kind of sexual contacts and relations you initiate and how you call yourself. Many people have bisexual feelings and fantasies, much fewer people do something with these and even less call themselves bi. Bisexuals are often categorised as heterosexuals or homosexuals, depending on the relationship they have. That s why bisexuality is often invisible.
While asexuality is considered the fourth category of sexual orientation by some researchers and has been defined as the absence of a traditional sexual orientation. An asexual has little to no sexual attraction to males or females. It may be considered a lack of a sexual orientation, and there is significant debate over whether or not it is a sexual orientation.
Human sexuality is often seen as a continuum with at both ends hetero- and homosexuality and bisexuality in the middle (the Kinsey scale ), where asexuality has a place out of this continuum. However, this classification is also criticized because it ignores individuality and cultural issues. It s an invention of 19th century Europe and therefore also culturally bound. Sometimes deviations from heterosexuality are expressed in other culture-specific ways, such as Two Spirit (a male and a female spirit in one body) in North America and Hijra, (a man with a female gender identity) in the Indian subcontinent. The layout hetero-gay-bi is static and does not consider transitions as transgenderism (your gender identity does not correspond with your biological sex assigned at birth, for example John was born a male but as a person is a woman) and intersexuality (when your sexual anatomy doesn t seem to fit the typical definitions of female or male; they may also have male and /or female secondary sex characteristics, such as body shape). The Charter of Fundamental Rights of the European Union banned any discrimination on grounds of sexual orientation.
Sexualty: Sexual and Reproductive Health
Sexual and reproductive health means, that everybody has a right to have pleasant and safe sex. It also means for example that people must be able to decide for themselves if and when they want to have children. In many countries this isn t natural.
There are a number of fundamental rights regarding sexual and reproductive health:
The right to equality and non-discrimination
The right to privacy
The right to have the highest possible standard of health and social security
The right to marry and starting a family free of any compulsion
The right to decide about the number of children and the age gap between them
The right on information and education
The right on freedom of expression
A few key areas of importance are:
Family planning can prevent unwanted pregnancies, reduce the number of abortions, and it can produce better obstetric care. Additionally, the use of condoms can protect against both unwanted pregnancy and sexual transmitted diseases (STD). What's more, for adolescent girls it can be life saving to have access to modern contraception. Complications from pregnancy and childbirth are leading causes of death for girls in the age group 15 19. Their babies have also a higher risk of dying than the babies of older women.
Gender equality is a human right; women are entitled to live their lives with dignity, respect and without fear. It can only be achieved when women are empowered and they enjoy the same opportunities, rights and obligations as men. That means financial independence, good education and the ability to realise their ambitions. It s most important that women have reproductive rights: when a woman can plan her family, she can plan the rest of her life.
Protection against HIV infection and AIDS continues to be extremely important. That includes access to essential information and services to prevent and treat HIV. Because the majority of HIV-infections are sexually transmitted, it s paramount to focus on methods of safe sex for example the use of condoms. In addition to this, adequate attention should be given to ways of preventing mother-to-child transmission of HIV.
Maternal health, making motherhood safer is an important human right. Most maternal deaths and complications related to pregnancy or childbirth are preventable. Especially unsafe abortions can become a tragedy. It s essential that all women have access to contraception in order to prevent unwanted pregnancies, pregnant women should have skilled care at delivery and women with complications should have timely access to quality emergency obstetric care.
Sexuality: Sexual dysfunctions
In the Western world about twenty to forty percent of the women have issues with their sex lives. Examples are experiencing pain during intercourse, a low libido or problems with having an orgasm (many women have never experienced an orgasm). Very often they don t want to discuss this even with their doctor because of the taboo subject . In Sri Lanka, where sexuality is a much stronger taboo than in the West, these figures are probably a lot higher. Although men seem to be a bit more forthright in talking about sexual issues like erectile dysfunctions or lack of desire, it s still a difficult topic to speak about.
It s quite normal that there are periods in our lives where we experience sexual problems. During a stressful period you re not that much into having sex as you used to. Or when there are issues within the relationship it s very understandable that you have trouble getting excited. But when it is not possible to enjoy sex in a relaxed way for a longer period then various problems might develop. The most important causes of these sexual problems are: fears and inhibitions, physical problems, negative experiences, lack of skills, relational problems and values and beliefs.
Sexual problems very often have a psychological context. When you re not doing well in a psychological sense then typically sexuality is one of the first areas where you experience a change such as:
Sexual need. In a relationship it s very rare that both partners have exactly the same sexual need. It depends on factors like social circumstances, how much time and effort you put into the relationship, how much time and effort you put into yourself, tiredness, stress, depression, menopause, relational issues, pregnancy and post pregnancy.
Sexual anxiety and fears. When there are sexual problems related with (lack of) desire, vaginal dryness or erectile dysfunction then they can cause a lot of sexual tension within the relationship. They can prevent having a satisfying sexual relationship.
Lack of desire. Possible causes can be medical illnesses like diabetes and multiple sclerosis; medications like antidepressants, tranquillizers, blood pressure tablets and beta blockers; too much alcohol; inexperience; bad communication between the partners. Another possibility could be that from the onset of your sexual active life you experience problems with sexuality because you don t know what excites you or you have fear or aversion to sex. Also, in a long-term relationship it can be difficult to maintain a satisfying sexual life.
Vaginism. This is an involuntary vaginal muscle spasm, which makes sexual intercourse very painful or impossible. Women are usually very sensitive. A bad sexual experience in the past, fear of painful sex or a strict (religious) upbringing can totally spoil the interest in any sexual activity. With vaginism professional help from a psychologist or a sexologist is very often needed.
In essence sex is a way of communicating between two persons, verbal as well as non-verbal. You are in a relationship with each other where trust is one of the most important factors. You open yourself up in a physical and in an emotional sense and as a consequence you make yourself very vulnerable. It is not so strange that within this relationship there can be a lot of problems. Very often these are problems where you feel ashamed of, and it becomes difficult to discuss this with your partner. Sexual problems can develop into relationship problems and many people keep these problems for themselves too long. It s important to bear in mind that a professional psychologist can give valuable advice and guidance.
Sexuality: Sexual deviants and victims.
Sexual deviants are people who find pleasure in their sexual activity that society sees as abnormal . They typically have long-term sexual fantasies or acts involving for example the use of lifeless objects, or pain or humiliation of oneself, the partner or involuntary partners. Some of these fantasies or acts could be associated with major psychological problems. Most sexual behaviour is general and is more or less accepted, while other behaviour is disturbing and in rare cases dangerous. Deviant sexual behaviour is (as far as we know) more common in men than in women.
Examples of sexual deviant acts that are usually not tolerated and/or prohibited:
- Exhibitionism: sexual arousal by showing their own genitals to strangers.
- Incest: sexual intercourse with blood relatives; particularly between adults and children under 16 and often under psychological pressure and / or physical threats.
- Pedophilia: sexual preference for children under 16.
- Sexism: discrimination on grounds of sex.
- Sexual harassment: making sexual gestures or remarks to others seen from a dominant position.
- Bestiality: sexual act between humans and animals.
- Voyeurism: sexual arousal by means of secretly watching the sexual activity of others ( peeping ).
- Fetishism: being attracted to and having erotic feelings for objects which may involve body parts or clothing, such as female underwear.
- Rape: forcing sexual intercourse against the will of the other (usually with violence).
- Sadism: sexual arousal by means of the torment of others.
- Masochism: The sexual excitement of the masochist stems from the violence that is done to him/her. Masochists allow themselves being humiliated, beaten, bound, or otherwise made to suffer.
The extent to which sexual behaviour is or isn t accepted or tolerated depends strongly on the group, community, religion and/or culture to which one belongs (the sexual morality), including the prevailing legal provisions in this regard.
The victims of sexual deviant acts like sexual harassment, rape, incest, pedophilia, or any kind of (emotional) harmful behaviour should seek psychological help. The damage done to these victims is usually intense and family or friends lack the professional skills to support them in an adequate way.
A link to the original article is here and here and here and here and here and here
Recently, a friend of mine sent me a collection of articles written by perhaps well-meaning but most likely ill-informed, naive and misguided psychiatrists who are strong advocates of psychiatry in its present form and of prescribing medications or treatments for conditions where (even in the medical world) there are severe doubts whether this is the correct thing to do.
They were using well known manipulative tactics like citing only studies beneficial to their cause and leaving out ones that oppose it, or using only part of the information given in articles. Usually they only gave information that came from the tip of the iceberg, without bothering to investigate the huge structure underneath it. Or they even try to link opinions and persons they don t like to the Scientology Church. I am not an advocate of this extreme movement but that doesn t mean that they might not have a point with some of their writings about psychiatry. Another tactic involves selectively citing articles of unrealistic or out of control opponents and subsequently ridiculing them.
One of these authors is the Harvard psychiatrist Dr Joseph Biederman. He had promised the pharmaceutical branch of Johnson & Johnson favourable results beforehand (!) in a study about the use of Risperdal for children, adolescents and even preschoolers (Rubenstein, 20-3-2009, Wall Street Journal blogs, Court papers: Biederman told J&J study results would be positive ). Risperdal is a drug used for schizophrenia with adults. A Congressional Inquiry brought to light that Biederman and his two colleagues received huge sums from pharmaceutical companies; Biederman himself got 1.5 million dollars. He and his team also wanted to state that bipolar depression is chronic so that children would need Risperdal for life. He is now one of the leading ADHD medication spokes persons (!) and played a significant role in the decision to lower the threshold for the ADHD diagnosis in the DSM5. Another author mentioned above is even a lecturer at a small town university. One cannot but feel pity for his students about the kind of education they receive . The general public should be aware of the context these people write from. They also cause immense damage to the name of psychiatry.
The idea of the hero researcher in his/her lab frantically trying to invent new medications for illnesses is completely pass . Nowadays universities and research institutions are highly commercialised and they depend more and more on financial input from for example the pharmaceutical industry. That means that research is very often biased (subtle or not so subtle) in favour of the paying company.
What I am trying to say is that it s not about bashing psychiatrists or medicine for mental illnesses but it s about being CRITICAL. This means being open to criticisms about your own profession and reading relevant opposing studies that perhaps make you think about your own convictions. In the same way that you don t have to be a nuclear scientist to have a balanced opinion about nuclear energy, you can have a well informed opinion about psychiatry or medicine for mental illnesses without being a psychiatrist. Especially when you are a practising psychologist (in my case in Sri Lanka), you are continuously confronted with many shortcomings of psychiatry.
Medication for certain mental illnesses can be extremely helpful. Some time ago I witnessed a client in an acute psychosis. In situations like this one can t be but thankful for the availability of reliable medications for this condition. The same goes for the (if correctly diagnosed!) very rare illness bipolar depression. But what is very worrisome is that for many other conditions, for example depression and anxiety, the prescribed tablets are not effective and/or only address (partly and for a short while) symptoms and not the root causes of the issues. More alarmingly, the pharmaceutical industry is using its immense influence to induce psychiatrists to prescribe more (expensive) medications for questionable conditions. Mentally healthy people are turned into drug using consumers for numerous years. In many cases adequate psychological treatment could have helped more effectively and is much cheaper. The average 5-10 minutes consultation time of a psychiatrist is generally speaking not sufficient for understanding the problem at hand and its root causes. In my psychology practice it frequently happens that a client only in the second or third session comes with the real (and often very personal and painful) issue ..
It is true that certain medications alleviate symptoms without us knowing what the exact working mechanism is. But with for example antidepressants we know for almost 20 years for certain that they don t perform better than placebo (see for instance Kirsch I, Sapirstein G. Listening to Prozac but hearing placebo: A meta-analysis of antidepressant medication. Prevention and Treatment. 1998;1:Article 2a). That means that we not only don t know the working of the drug but we also know that the drug doesn t work! The same goes for electroconvulsive therapy (ECT). Apart from the fact that we don t know how it works, there is even no independent scientific evidence that it has a beneficial effect! In addition to the extreme high relapse rate (patients need to go back on heavy medication soon after) there is also for example in a significant amount of cases permanent memory loss and reduced concentration.
Once in a while an article or publication pops up regarding the so called black box suicide warning for youth who take antidepressants. These articles suggest that black box warnings about increased suicidality in youth who take antidepressants actually lead to increases in adolescent suicide attempts. The most recent was in 2014 from another Harvard researcher, Christine Lu (British Medical Journal, June 18; 348: g3596). After having actually read the research paper it became abundantly clear that this study has so many methodological shortcomings that the claim the author made can t be true. This study was widely criticised; after one month of being published, there were at least 10 critical articles by well-known researchers. For example Catherine Barber and colleagues of the Harvard School of Public Health wrote in a letter to the BMJ (BMJ 2014;348:g3596) that after carefully reexamining the data, the evidence shows no increase in suicidal behaviour among young people following the drop in antidepressant prescribing. The end result was that Christine Lu s paper isn t taken seriously anymore. For an extensive discussion (the structure beneath the tip of the iceberg) about the possible relation between SSRI s (antidepressants) and suicide tendencies please visit my website www.marcelderoos.com for the article "Black label warnings for antidepressants, the real story .
I want to finish with the American psychiatrist Allen Frances. He was the chair of the taskforce that produced the fourth revision of the Diagnostic and Statistical Manual (DSM-IV) and is a critic of the DSM5. He warns against the epidemic growth of the diagnosis ADHD, autism and bipolar disorder with children. He wrote that by stretching the definitions of these disorders, too many patients were caught who would have been much better off if they had not ended up in the mental health system .
An interesting article in the Huffington Post of September 15 2015 about Risperdal and Johnson & Johnson is here
The debate about the possible relation between SSRI s and suicide tendencies already started in the 1980-ties before these tablets had actually penetrated the market. The German Bundesgesuntheitsambt (BGA) time after time blocked fluoxetine (Prozac) from entering the German market because shortages in the proof of effectiveness and of the suicide risk (Bundesgesundheitsambt, 1985, cited in Arzneitelegramm, 1990, p.42). In 1992 it was admitted, be it with clear warnings in the leaflet and a stipulation that the prescribing doctor should observe the patient carefully for some time.
In the USA fluoxtetine had entered the market in 1988 and almost instantly there were cases of users who all of a sudden developed enormous restlessness, with thoughts incessantly racing through their minds and with aggression towards themselves or others. Before they didn t have suicidal thoughts, but after taking Prozac they developed an intense aggressive preoccupation towards suicide (Teicher, Glod & Cole (1990). Emergence of intense suicidal preoccupation during fluoxtine treatment. American Journal of Psychiatry, 147 (2), 207-210). After this many more signals kept coming in about this and it resulted in the first hearing on this topic of the Food and Drug Administration (FDA) in 1991. People came from all over the country to testify about their horrible experiences with these drugs, frequently leading to suicide (FDA, 20-9-1991). Expert witnesses pointed out that many of the people who had committed suicide had only simple problems when they started to take the medicine, which makes it clear that the suicide not always was the result of the depression. In addition they argued that akathisia, the huge agitation that some people get from the SSRI s, is not a characteristic of depression at all. A representative of the FDA said that they had noticed that in the original data of the study, there were persons who had developed suicidal thoughts. Unlike the German BGA, the FDA had interpreted this as an inherent characteristic of depression. Representatives of the Prozac manufacturer Lily received an excessive amount of time to tell that an extra analysis of the study didn t produce signals of an increased suicide risk. Finally the commission, from which by their own admission five member had financial strings with the pharmaceutical industry, decided with six against three votes that there was no need for warnings on the medicine leaflets (FDA 20-9-1991). Since then, the reports kept coming about a sudden huge agitation, aggression and suicide after taking SSRI s.
In 2002 and 2003 the BBC aired a program called Secrets of Seroxat ; it was about paroxetine which is the most prescribed antidepressant. Some people told about the benefits they have with Seroxat, but many others told about unwanted and serious side-effects. The program broke records of viewers, phone calls, emails and website visitors.
The UK medical journal The Lancet published in 2004 an article that increased the international turbulence (Whittington et al, The Lancet, 363, 1341-1345). Graig Whittington and his coauthors did a meta-analysis on experiments with children and teenagers ranging from five till eighteen years old. A number of published articles about these experiments suggested a positive balance between favourable and unfavourable effects of the tablets. But the researchers also wanted the unpublished experiments in their analysis. The drug companies refused to deliver those but the registration authorities did give them. When the outcomes of these unpublished experiments were included in the analysis, the positive effects of the tablets didn t weigh up against negative ones (the risk of for example suicide). The Lancet placed editorial comments and reactions concerning this article which were outspoken angry. The omission of the publication of the negative results concerning SSRI tests with children (with financial profit as the only reason) was considered manipulative and criminal.
The British registration authority MHRA wrote in 2003 a letter to medical doctors where they forbade antidepressants for children. In the USA the EMEA and FDA also warned from 2003 on. The FDA demanded a black box warning on the drug leaflets, which is the most serious warning there is.
In 2006 The FDA decided to have a second hearing about the question whether the chance on suicide with SSRI s increases. Again people from all over the country came with horrible accounts of unexpected aggression and horrendous actions. They again pointed out that many of the murderers / people who had committed suicide were not in that bad state of mind before they started taking the pills. This means that the explanation by the manufacturers of the SSR s that the problems are caused by the depression can t be true. The critical psychiatrists David Healy and Peter Breggin were also heard as expert witnesses at the hearing. They told the commission that problem of suicidal risk isn t age-related and they warned the commission that the experimental data that they had received from the pharmaceutical industry were manipulated. Breggin had been an expert witness in several court cases and he had seen the sealed data of experiments, He told the committee that the data had been carefully edited and expurgated. Patients who responded badly to the drugs were taken out and fake patients were included. Especially the occurrence of akathisia (a non-curable movement disorder characterised by a feeling of inner restlessness and a compelling need to be in constant motion) had been taken out of the reports regarding the side-effects of the drugs.
The committee judged that the suicide risk increases in children and young adults (18-24 years). The comments of the advocates of the drugs, that these tablets actually save lives were not honoured, mainly because of the incomplete data. Suicide attempts in these experiments were coded as personality disorder or in the case of taking an overdose medication error (Harris, G., 24-1-2008 FDA requiring suicide studies in drug trials. The New York Times).
In 2007 there was a publication (Gibbons et al. The American Journal of Psychiatry, 164, 1356-1363) that caused much upheaval, especially in the popular media in the USA. The article suggested that in both the United States and in the Netherlands, the suicide warnings on SSRI prescriptions had increased the suicide figures for children and adolescents. What these media hadn t seen were the many critical comments from experts on Gibbon s article. These comments showed that there was no evidence of effectiveness of antidepressants with children while there are indications of harmful effects on the developing children brains. Other experts pointed out that Gibbons and his co-authors had only cited studies that supported their position and had ignored the vast amount of studies that opposed it. Also, suicide figures have a tendency to fluctuate and Gibbons should have researched it over a much longer time. A few months later the British Medical Journal published two huge population studies (Biddle et al, British Medical Journal, 336, 539-542 and Wheeler et al, British Medical Journal, 336, 542-545) which ascertained that the number of suicides in the UK had strongly decreased since the nineties, but also that this declining trend had continued after the strong decline in the use of antidepressants since 2003 in the UK. The critique on Gibbons and his team became even stronger when it became known that the pharmaceutical company Pfizer had donated 30,000 dollar for their study and that Gibbons and his team had received more often money from the pharmaceutical industry.
Even quite recently in 2014 another Harvard researcher, Christine Lu, suggested that black box warnings about increased suicidality in youth who take antidepressants actually led to increases in adolescent suicide attempts (Christine Lu et al, British Medical Journal, June 18; 348: g3596). Again there was a lot of coverage in the popular media. But this study has a lot of methodological shortcomings and was widely criticized; after one month of being published, there were at least 10 critical articles by well-reputed researchers. For example, Catherine Barber and colleagues of the Harvard School of Public Health wrote in a letter to the BMJ (BMJ 2014;348:g3596) that drug-poisoning rates are not, in fact, a reliable proxy for suicide attempts. Furthermore, they report that "five readily available, online data sources that provide more reliable and valid measures of youth suicidal behaviour" showed no increase in suicide attempts following the black box warnings. In effect, after carefully reexamining the data, the evidence shows no increase in suicidal behaviour among young people following the drop in antidepressant prescribing. The end result was that Lu s paper isn t taken seriously anymore.
An antidepressant called Paroxetine (with trade names as Paxil, Seroxat) does not work with adolescents with severe depression and more importantly, it only causes damage. Sometimes there can be severe damage, such as suicidal thoughts and suicide attempts. That is the conclusion of a reanalysis of research data from an influential study originally published in 2001. The 2001 publication with the same data stated that Paroxetine is effective against depression with teenagers and that there are hardly any side-effects. It was a study with 275 adolescents between 12-18 years old and it was sponsored by the pharmaceutical industry. This new publication on September 16th 2015 in the prestigious British Medical Journal (http://www.bmj.com/content/351/bmj.h4320) is the definitive exposure of a study that already had been critisised one year after its publication in 2001. Later on proof surfaced that the manufacturer of Paroxetine Smith Kline Beecham (now part of GSK) had concealed data regarding damaging side-effects and had made them invisible . This fraud was an important factor in the record fine of 3 billion dollar that GSK had to pay in 2012 for misbehaviour to the American government. Despite the doubts about the efficacy and detrimental effects, children and teenagers still get prescriptions for Paroxetine or similar antidepressants (the so called SSRI s). Most other pharmaceutical companies wanted to profit too from this niche market and produced similar SSRI - antidepressants (the so called me too drugs ). There have been many clear warnings against these drugs. The American Food and Drug Administration for example issued a black box warning concerning antidepressants with patients younger than 25 years. It states that there is an increased chance on suicide and suicidal thoughts and adequate monitoring is mandatory. The reanalysis has been done by a group of international researchers who focus on suspicious, misreported or unpublished trials in order to publish undisclosed outcomes or to correct misleading publications. In court cases against GSK the original study from 2001 has become known as Study 329. The researchers write that that Study 329 is an example of a misreported trial in need of restoration . This reanalysis became possible after GSK finally had to give access to the original research data. The restored result is completely different from the one of 2001. The editors of the British Medical Journal are campaigning for years to curtail the influence of the pharmaceutical industry on research outcomes. One of the editors, Peter Doshi, describes how since its publication in 2001, Big Pharma has prolifically used Study 329 for marketing purposes. Medical doctors were persuaded to prescribe Paroxetine to depressed children because this study has showed that the drug is remarkable safe and with very good efficacy . Later on the scandals erupted concerning insufficiently documented suicidal thoughts. Doshi describes how he before the publication of this reanalysis (everybody knew that it was coming) had asked all involved with Study 329 why this publication from 2001 never had been retracted. But researchers, their universities, the head editor of the Journal that had published the article and the publisher (which is the professional association of American child psychiatrists) never replied on questions from Doshi and other critics. According to Doshi, the American Academy of Child and Adolescent Psychiatry (AACAP) receives annually 500,000 - 1,000,000 dollars (direct or indirect) from the pharmaceutical industry, that s about 20% of their revenues. Critical members are being opposed and the upcoming chairman is one of the authors of Study 329. People often state that science corrects itself but it s very clear that the system has failed here. We know for almost 20 years that antidepressants do not perform better than placebo tablets (see for instance Kirsch I, Sapirstein G. Listening to Prozac but hearing placebo: A meta-analysis of antidepressant medication. Prevention and Treatment. 1998;1:Article 2a). Study 329 is an unambiguous example to what extend the pharmaceutical industry can go to mislead the general public. Lack of access to primary data from most clinical randomised controlled trials (since the pharmaceutical industry finances them and restricts access) makes it difficult to detect biased reporting. The misleading conclusions from these publications of those trials can seem definitive, but Study 329 proves that we have to be very careful with statements from the pharmaceutical industry.
Much of the above research has been translated from Prof. Dr. G.C.G.Dehue's Dutch book "De depressie epidemie", Uitgeverij Augustus, Amsterdam, 2008.
ADHD, psychiatric epidemic or hype?
For teachers the perfect class is a concentrated, quiet and obedient one. Nowadays, when children stand out by what used to be called naughty, rebellious and boisterous behaviour, it is much easier than before for teachers to have these children drugged with for example Ritalin or Concerta (psycho-stimulant medications). For psychiatrists, jotting down abbreviations like ADHD, PDD-NOS and ODD and subsequently prescribing drugs has become routine.
Is there a psychiatric epidemic or is there something else going on? Leading American psychiatrists (for example Dr Allen Frances) think that ADHD (supposedly an attention and hyperactivity disorder) is severely over-diagnosed; it s a false epidemic. Before 2000, only very serious cases were labeled with this diagnosis and only people who really needed it, were allowed to receive medication. As a consequence of the less stringent definition after 2000, the diagnosis of ADHD has increased spectacular. Everybody knows now somebody with ADHD.
Another reason might be that qualities that used to be attributed typically to boys such as an urge for noisiness, action, and forcefulness were formerly accepted, but are now regarded as a problem, especially at schools. It appears that not the boys, but the educators have changed. Boys are in essence the same as before, but the school system has become more feminine and looks upon their abundance of physical energy and enthusiasm as being an issue.
For concentration problems without hyperactivity, a separate category was devised called ADD (Attention Deficit Disorder). Therefore, many girls and women were included into the diagnostic criteria. PDD-NOS (Pervasive developmental disorder not otherwise specified) was brought in as a kind of residual category for people who don't quite fit into other more specific categories.
It is to be expected that the existing criteria will be eased up more so that an increasing amount of people will be labeled as suffering from a mental illness with all the dire consequences. The pharmaceutical industry has maintained strong ties with the psychiatric community and they have jumped at this opportunity. Big Pharma s marketing machine is working full time in trying to sell the new drugs.
New target groups are continuously defined. At first it were predominantly the overactive little boys which were not concentrated enough. Now the dreamy girls are coming into the picture. They are diagnosed with ADD and that is supposed to be treated with medication too. Finally it s the turn of the grown-ups; 5% of the adult population is said to be suffering from ADHD.
Using medications for ADHD involves a number of risks. The most important ones are decreased appetite and cardiovascular complaints. But also anxiety, stomach problems, dizziness, tics, skin problems and bruising are named. Less common, but potentially lethal results from taking these pills is, that they can cause suicidal thoughts and psychosis. The majority of the research concerning ADHD is financed by the pharmaceutical industry and therefore causes credibility problems. They brush off the possible side-effects as benign , while independent studies come with less reassuring results. The British Medical Journal published an article that described how the pharmaceutical industry influences the outcomes of clinical research with medications (Lenzer et al, (2013). Ensuring the integrity of clinical practice guidelines: a tool for protecting patients. BMJ (Clinical research Ed), 347, f5535-f5535).
Research about the long-term effects of these medications is almost non-existent. There is only one such study, the so called MTA (The multimodal treatment of ADHD), sponsored by the National Institute of Mental Health in the USA. It shows that after two years, there is no difference between groups of children who do and don t use medication. Despite this and other critical studies, the use of ADHD medication has skyrocketed.
The scary thing is that we don t know what the precise working is of the medication in our children s vulnerable brains and we are also in the dark about the long-term side-effects. It s comparable to the enthusiasm with which Valium was introduced in the 1960 s. It was only later that the severe adverse effects became known.
ADHD (if it exists) is nothing more than a description of a number of behaviour symptoms. ADHD is not a mental disorder that causes you to be badly concentrated and noisy. The thinking about ADHD becomes problematic when the child is not seen as a person in relation to its environment (for example family, school, and neighbourhood), but only as an individual without a context. You just tally up some symptoms and voila, there you have ADHD! It becomes dramatic when you realise the enormous amount of children that are given potential dangerous drugs without proper effect evaluation.
ADHD, what is it again (and what NOT)?
Some thirty years ago when I started practicing, children diagnosed with ADHD were rare. These were children who were really extremely out of control. Nowadays many children who are diagnosed with ADHD can easily be taken on a family outing. The bandwidth of the criteria regarding ADHD has dramatically widened. In the 1980-ties the name ADHD was introduced in the third edition of the Diagnostical and Statistical Manual for Mental Disorders (DSM).
Today one out of four children is supposed to have a behavioural disorder, ranging from ADHD to light forms of autism. To label these problems a disorder is creating a much bigger problem. The phenomenon lies deeper and isn t solved with medication. Basically children need attention, love, ground rules and structure. This doesn t mean that the parents are to blame, but that (for example) ADHD is a development problem and not a medical condition. Because of the surplus of stimuli and speed we live in an ADHD-world so we mustn t be surprised that we produce ADHD-children.
Problem children usually have more than one problem at the same time. The big question is where these problems stem from! The wrong way to react is done in threefold. The first is to label a complex issue as a disorder and subsequently partition it into ADHD, conduct disorder, non-verbal learning disorder, oppositional defiant disorder, etc. Secondly each of those disorders is separately pseudo-medicalised, as if it s a brain condition that can be determined in a neurological or even in a genetical way. And finally all problems are taken out of their context and totally attributed to the child. Society, social-economic context, school, parents, family, are not taken into consideration. ADHD is then nothing more than tallying up some symptoms of the child and voila, there is your diagnosis.
Instead of pseudo-medicalisation it s better to give the sum of all the problems a name like developmental problem . British researchers have conducted a study about ADHD in the USA and in the UK (Hart, N. & Benassaya, L. (2009) Social deprivation or brain dysfunction?). They thoroughly interviewed more than 10,000 families and it showed that ADHD has a strong correlation with social problems. Compared with children without ADHD, children with ADHD have much more to deal with poverty and family problems (like divorce, financial problems, serious illnesses in the family, psychiatric problems with a parent, and judicial problems). This indicates that there is a connection between the context in which a child grows up and lively, boisterous and inattentive behaviour.
Most people think that ADHD is a neurological problem that should be treated with medication. This is complete nonsense. ADHD is what the abbreviation says: a shortage of attention and a surplus of activity. This is purely a descriptive terminology and it is now defined as an illness. But there is no scientific basis for that. There is no scientific study that can show why we should treat ADHD as a disease.
It s quite possible that in Ancient Greece the impulsive and dashing Alcibiades (one of Socrates pupils) would fit neatly in the ADHD description of the DSM-5, but that doesn t mean that he was suffering from the millennia old illness ADHD . It only indicates that the description of ADHD in the DSM-5 is now completely out of proportion. Thirty years ago ADHD hardly existed. Nowadays teachers advise parents to think about giving Ritalin to their child when it s showing naughty, rebellious and boisterous behaviour in class that they find difficult to handle. The teacher acting as a psychiatrist! The child has ADHD as if it s a brain disorder! And a short visit to a psychiatrist will usually confirm this belief.
The DSM-5 is an arbitrary classification system with no psychological or psychiatric use. Despite the term statistical in the title, it does not mean that the book is based upon sophisticated research about types of psychiatric problems. On the contrary, the classification criteria and categories were chosen by vote by people in working committees who have strong financial ties with Big Pharma. The DSM is written as an extension of the pharmaceutical industry. There is no solid theoretical foundation, nor a clinical pragmatic practice. The pharmaceutical industry used its influence to dramatically extend the criteria for ADHD in 2000 and again in 2013 with the introduction of the DSM-5. This means more medication and is extremely profitable for them.
The diagnostic criteria for ADHD are very vague (why not 5 or 7 symptoms instead of 6, does often means once a day or once a week/month, what is forgetful, etc., etc.). As a consequence there is a huge variety by different assessors in interpreting the criteria. Even worse, there are two equally comparable classification systems, the DSM-5 and the International Classification of Diseases, 10th edition (ICD-10). When children are diagnosed for ADHD with the ICD-10, then there are HALF as much ADHD children than with the DSM-5. This shows how arbitrary this diagnosis is.
A competent parental guidance counsellor or child psychologist should be the first choice. She/he can determine causes of the individual child s behaviour and give tips concerning a structured life style, parental advice, teacher training, etc.
ADHD with adults: a lucrative new market.
In the Western world, for example in the United Kingdom and in the Netherlands, governments are extremely concerned about the increased prescription of drugs like Ritalin and Concerta for children and teenagers. But also adults with ADHD-like symptoms have become an important and lucrative market for the pharmaceutical industry.
First some facts about ADHD:
- ADHD is NOT an illness
- You are NOT born with it
- Medication is very often NOT the appropriate way of dealing with ADHD symptoms.
The classic mistake (also made by quite a few prominent psychiatrists) is to think that ADHD is the cause of hyperactivity, impulsiveness and concentration problems. It s very tempting and understandable to accept the pseudo-explanation of psychiatry. Because nobody is to blame and there is this simple story that the behaviour of the child is caused by something in the brain. In reality ADHD is a name that has been given for certain behaviour. ADHD is not some neurobiological brain abnormality which explains certain behaviour. No, ADHD IS that behaviour. And that behaviour has not one unequivocal cause; there are always several (environmental) factors which influence each other. But most important, the diagnosis ADHD can only be made if, besides looking at ADHD-behaviour in its proper context, there are serious problems with social functioning and/or functioning at school or at work.
With family, twin and adoption studies it s almost impossible to separate the effect of hereditary factors from environmental factors. Is the child of a restless mother restless because of the reaction and copying of the mother s behaviour or because of the genes that it has from the mother? Besides this, studies show that there are for example no simple or combination of known genes responsible for any psychiatric disorder. After 50 years of intense and extremely costly (trillions of dollars) genetic research for psychiatric disorders, experts are very pessimistic about ever finding these genes. Perhaps there is some complex interaction with genetics, but the influence of the environment (for example the family dynamics you grew up with, or other experiences) is paramount.
ADHD is not a medical but a BEHAVIOURAL problem and psychologists are better equipped to deal with that than medical doctors. Many psychiatrists want to do what they are trained for: to treat serious complex problems as best as they can, but most ADHD behaviour doesn t fall within that category. The best way of dealing with ADHD behaviour is a treatment that starts with advice and training and when nothing else works then medication can be considered. Needles to say, that when an extremely demanding child does need medication (for a short time) it should be given straight away. ADHD is a label for behaviour that can be caused by numerous factors. Tensions between the parents, the noisy class at school has too many children, the teacher can t handle the class because of stress, a sibling is in a difficult phase and demands much attention from the parents, the child goes to bed at an inappropriate time, etc, etc. Medication can only suppress unwanted ADHD behaviour for a maximum of two years and has a number of serious disadvantages (see my previous articles about ADHD). Sometimes in difficult cases medication is appropriate. In many cases parental advice, teacher training and psychological support suffices. It s important to create an environment that is clear, quiet and predictable. There should be clear boundaries and positive behaviour should be noted and rewarded.
Many studies conclude that the outcomes of research that has been financed by the pharmaceutical industry are much more positive about the studied pill or illness than non-financed studies. Numerous ADHD-researchers (like the American psychiatrist Joseph Biederman and the epidemiologist Ronald Kessler) have strong financial ties with the pharmaceutical industry which makes their findings at the least suspect. Kessler s World Mental Health Survey Initiative (WMH), part of the World Health Organisation, extremely overestimates the prevalence of ADHD with adults. These findings are particularly important for Big Pharma because existing ADHD licenses are usually limited to the age category 6 till 18 years. This WMH study has many serious shortcomings. To name one, the interviews were done by laymen who had only received a short interview training (no medical doctors as is required in the DSM) and who were not equipped to assess a difficult ADHD diagnosis. Another WMH study that concluded that ADHD with children is a good predictor for ADHD in adulthood, has broken practically every rule for conducting proper research and is best disregarded. It s disturbing that figures from these WMH studies are used in policy making papers concerning ADHD.
Eighty to ninety percent of the adults, who meet the criteria of ADHD, simultaneously meet the criteria of other disorders like depression, bipolar disorder, anxiety and obsessive-compulsive disorders, addiction to alcohol and drugs, and personality disorders. This huge overlap shows in the first place the pointlessness of the concept ADHD for adults. Many people who are suffering from problems, have difficulties with concentration and are restless and irritable, something that is hardly surprising. There is no foundation for the claim that ADHD is the cause of the other disorders. Secondly, this high percentage of other disorders shows that this is a group of vulnerable people, who often have battled their whole lives with issues. There is no independent research that shows that lifelong existing problems will disappear or diminish with ADHD medication.
Furthermore, a meta-analysis (Koesters et al, 2009) concluded that the effects of methylphenidate (the most used ADHD medication) with adults are only short term and at best mediocre. Adult people with problems are talked into a diagnosis plus medication while most of them are not helped with these at all.
A link to the original article is here and here and here
Stress basically speaking is just tension. We all need a bit of tension in order to function well. This tension enables our body to be ready for action. Only when there is too much of tension it can lead to complaints. Very often this end-result is called stress.
With stress the body prepares itself to fight or flight. Your brains release a signal that makes your body produce the hormone adrenaline. As a result of this your heart rate goes up, your breathing goes faster and your muscles start to tense. More oxygenated blood goes to your heart and muscles and less to for example your digestive system. In this way you can react in an optimal way to the danger . If the danger hasn t disappeared in a few minutes then your body produces cortisone, another stress hormone that keeps you alert . The effects are usually short term after which the body needs some time to recuperate.
There are different kinds of stress:
- Stimulating stress. This is a positive form of stress. It helps you to perform well and to be extra alert in certain situations. That can be for example a job interview or driving your car outstation.
- Frustrating stress. This can happen in circumstances that bring out frustrations, such as standing in a queue, a colleague who underperforms in a joint project or driving your car in Colombo.
- Damaging stress. This is the worst kind of stress. It can occur when for example an employee has to do more work than possible, when somebody is bullied regularly or after a traumatic experience like a bank robbery. When the body doesn t return to a normal base level then we speak of chronic stress.
Different situations can cause stress. A well known example is a high workload, but also a serious illness or death of a loved one can cause much stress. But not everybody is the same concerning susceptibility towards stress. This has to do with the balance between what you can bear and the amount of stress that you have to endure. When you can bear a lot then you can endure more in stressful situations. A high workload in itself is not enough to cause damage. What plays a big role is the organisation of the work. When you have a big say in how the work is done then there is less chance of too much stress or even worse a burn-out. When a stressful situation lasts too long or when multiple stressful situations succeed each other too soon, your body has no time to recuperate. The stress accumulates until it becomes too much. The symptoms of stress can be divided into three kinds.
Physical complaints:
- Headaches, back pain, stiff shoulders;
- Digestive complaints like stomach pains;
- Restlessness, sleep disturbances and tiredness.
Psychological complaints:
- Quickly irritated and frustrated or quick to cry;
- A feeling of unhappiness, powerlessness and gloominess;
- Lack of concentration, difficulty with thinking clearly;
- Absentmindedness, problems with memory;
- Problems with creativity or finding solutions.
- Stress can cause somber moods, wanting to cry and sleep deprivation. With chronic, long term stress there is more chance that it can cause depression but also a burn-out.
Behavioural symptoms:
- Being short tempered, bitchy and extremely critical;
- Too much drinking, smoking, eating.
What can I do to relieve stress and what are the most effective coping strategies?
The keyword in reducing stress is relaxation. It s important that you acknowledge that you re stressed and that you take the time to address it. The sooner the better, because the recuperation period takes longer when the time that you re stressed is longer. A few tips:
- Relaxation exercises. Meditation and yoga are excellent ways to unwind;
- Talk with somebody or start writing it down. Talking and venting your feelings helps but writing (journaling) can have a similar effect and it s private;
- When you have high expectations of yourself try to think why that is and try to lower the bar a bit;
- Dare to say no . Don t bite off more than you can chew;
- Have a healthy lifestyle. Start an exercise or a sport that you enjoy (a simple outdoors walk every day is extremely healthy) and eat three healthy meals a day. When you feel physically healthy then usually you feel mentally better too;
- Be careful with medication. Although sleeping tablets or medication against anxiety can give short term relief, it doesn t solve anything and it doesn t address the root causes.
- An excellent relaxation exercise is for example progressive muscle relaxation (or Jacobson as it called). You can find that on Youtube by typing in progressive muscle relaxation . And online support groups can give you a lot of support and help.
Some time ago a young client of mine came to my practice shaking with fear. He had had unsafe sex with a girl. His girlfriend didn t know about this and he was petrified that he had a STD like HIV. He had himself tested by a doctor but it takes at least three months (depending on the kind of test) to have a highly accurate test result that you are not infected with HIV. It took a lot of counselling to make him feel stable again, also because he couldn t talk about it with anybody else. He couldn t tell his family or his friends because he felt they wouldn t understand and he couldn t trust their confidentiality. Luckily he was not infected and it turned out to be a good lesson for him.
For young people, it s important to learn about sexuality and other related subjects. It s about discovering your own body and what sexuality means to you, intimacy and sex in your relationship, how to have safe sex, and possible problems with sex as well as how to deal with those. In Sri Lanka sex related topics are usually considered a taboo and are hushed up. People are not used to talk openly about it. This can cause ignorance about the above mentioned topics and can have dire consequences, for example problems with intimacy, sexually transmitted diseases (STD s), unwanted pregnancy, etc.
You have influence on being in de mood for having sex, it doesn t happen out of its own. You have to be open to sexual stimulations like touch, a fantasy, sexual images from a movie, a picture or music. But also being engaged in sex, like kissing and caressing, can make you feel to want to explore further. You decide if you accept sexual stimulations; it depends on your relationship and the circumstances whether you proceed or not. Do you feel relaxed and comfortable with your partner? Do you feel the freedom to accept your desire? Do you have positive experiences? Then your mood for having sex will increase. It s different for everyone so it s important that you explore which things are titillating your senses.
You can for example make contact with your erogenous zones or your happy spots . Sexuality is much more than your genital zones. You can get excited in places all over your body. To become more familiar with these spots here is a good exercise. Take a green, a red and a blue pencil and a printout of the human body (front and back). Colour with green on the printouts of your body (front and back) which spots feel like erogenous zones ( nice spots ). Do the same with red which spots where you absolutely don t want to be touched. And lastly with blue colour these spots where you re not certain if they are erogenous zones. How easy or how difficult was this exercise? What strikes you about the spots you have coloured in? Did you discover something new about yourself?
Having an orgasm is the sexual discharge during intercourse or masturbation. Many women can have multiple orgasms but men can t. How it feels is different for everybody, from very intense to fleeting and superficial. It can depend on how you feel, your level of tiredness or how much desire you had. For many people the orgasm is literary the climax of having sex but that is not necessary always true. A lot of people do not have an orgasm during intercourse while they still enjoy it intensely. The pressure on climaxing can cause that the pleasure in having sex becomes less and actually reduce the chance of having an orgasm.
With relationships it s very important to be aware of your wishes and boundaries during sex. Talk about it with your partner and be very clear about your boundaries. If you don t know what you enjoy and like please do think about it. Even more importantly, find out what your limits are in what you like and what you don t like! It can be about who takes the initiative, your wishes what you enjoy during sex, where you want to be touched, when or how often you want it or performing sexual fantasies.
There can be several problems concerning sex like not being in the mood for having sex for some time, erectile issues, problems with having an orgasm, pain during intercourse, etc. Try to talk about it with your partner or your family and when that doesn t give relieve consider seeking professional help.
There is a difference between a person going on a diet and a person who is affected by an eating disorder. A person with a weight problem has an unhealthy weight (underweight, overweight or has often weight changes). An eating disorder (anorexia nervosa, bulimia nervosa, and binge eating disorder) is a serious and complicated psychological illness.
What exactly is an eating disorder?
An eating disorder is a psychological disorder that is characterised by dysfunctional eating behaviour. Some people eat too little, others too much, and others switch between both behaviours. Usually people try everything to compensate calorie- intake, like self-induced vomiting, the use of laxatives and excessive sport activity. Most people with an eating disorder have a distorted body image and an intense fear for gaining weight. Very often they are obsessed with thoughts about food, their own body and weight. Subsequently they develop an addiction to accompanying behaviour like dieting, having binges and/or compensation behaviour.
The root causes of the dysfunctional eating behaviour predominantly have to do with underlying psychological factors. When in stressful or difficult situations, people very often look for distraction by treating themselves with food. Food can also serve as a way to handle difficult emotions; you can medicate or numb yourself with food (or alcohol or drugs) in order not to feel these emotions. Many people with an eating disorder say that it has a strong connection with control. They feel that they have no control over their lives and try to be in charge of at least one area: eating and dieting. Furthermore eating can be used as for example comfort or punishment, consciously or unconsciously.
It often happens that people with an eating disorder minimise the symptoms and the severity of their condition. In addition they are typically not aware that they are for example underweight because of their distorted body image. The symptoms of the disorder frequently cause limitations in their lives in a social and professional context. For example not being able to perform in your work or education and/or having increasingly conflicts with family and friends. The physical, psychological and social consequences can be extremely damaging.
Having an eating disorder is not a choice or fashionable rage; it s a serious psychological illness. It can be treated successfully and the sooner the person gets a suitable therapy, the higher the chances on recovery.
Who are likely to get it?
Eating disorders like anorexia nervosa and bulimia nervosa have a higher incidence with women than with men. It s estimated that 90 till 95% of the people with anorexia nervosa are women. With bulimia nervosa that is between 85 and 90%. With these two illnesses they are predominantly girls and young women between 15 and 30 years of age. But there are more and more children and (young) men who develop this disease. The incidence of binge eating disorder seems to be equally high with women as with men, and is predominant in the age category 18 till 65.
Possible causes.
It continues to be an interesting question why one person develops an eating disorder with a certain life history and certain traumatic experiences and somebody else with similar experiences doesn t. There are different factors which might play a role in the development of an eating disorder, but there is no clarity about the precise process.
Risk factors.
The following aspects are frequently named as risk factors in the development of an eating disorder:
- Low self-esteem;
- Negative feeling about one s body or disturbed body image;
- Having a history of being over- or underweight;
- Constant dieting;
- Having a history of depression;
- Being raised in a family environment with extreme focus on food, weight and appearance. The same goes for modeling and some sports like classical ballet and gymnastics;
- Family members with an eating disorder or being overweight, depression, addictions, and compulsive (personality) disorders;
- Personality traits like excessively wanting to please and being concerned about others, introvert, anxious to fail (in a social context), perfectionist, goal orientated, impulsive and obsessive personality traits;
- Negative experiences with being bullied, abuse (emotional, physical or sexual) and neglect.
Treatment.
Treatment of eating disorders is difficult and usually takes a long time. First step is to admit that you have a problem; this alone can be difficult because of the ingrained beliefs about weight, food and body image. Psychotherapy can only start when patients are in a reasonable physical condition. Severe undernourishment can be life threatening and causes dissociation from feelings. This is important because people with eating disorders use food to deal with uncomfortable or painful emotions. When in therapy the quality of the relationship between the therapist and patient is crucial, there has to be trust. A good therapist always focuses on the deeper psychological issues behind the outward eating behaviour. The essence is the confrontation with the original hurtful emotions which led to the eating disorder.
An antidepressant called Paroxetine (with trade names as Paxil, Seroxat) does not work with adolescents with severe depression and more importantly, it only causes damage. Sometimes there can be severe damage, such as suicidal thoughts and suicide attempts.
That is the conclusion of a reanalysis of research data from an influential study originally published in 2001. The 2001 publication with the same data stated that Paroxetine is effective against depression with teenagers and that there are hardly any side-effects. It was a study with 275 adolescents between 12-18 years old and it was sponsored by the pharmaceutical industry.
This new publication on September 16th 2015 in the prestigious British Medical Journal (http://www.bmj.com/content/351/bmj.h4320) is the definitive exposure of a study that already had been critisised one year after its publication in 2001. Later on proof surfaced that the manufacturer of Paroxetine Smith Kline Beecham (now part of GSK) had concealed data regarding damaging side-effects and had made them invisible . This fraud was an important factor in the record fine of 3 billion dollar that GSK had to pay in 2012 for misbehaviour to the American government.
Despite the doubts about the efficacy and detrimental effects, children and teenagers still get prescriptions for Paroxetine or similar antidepressants (the so called SSRI s). Most other pharmaceutical companies wanted to profit too from this niche market and produced similar SSRI - antidepressants (the so called me too drugs ). There have been many clear warnings against these drugs. The American Food and Drug Administration for example issued a black box warning concerning antidepressants with patients younger than 25 years. It states that there is an increased chance on suicide and suicidal thoughts and adequate monitoring is mandatory.
The reanalysis has been done by a group of international researchers who focus on suspicious, misreported or unpublished trials in order to publish undisclosed outcomes or to correct misleading publications. In court cases against GSK the original study from 2001 has become known as Study 329. The researchers write that that Study 329 is an example of a misreported trial in need of restoration .
This reanalysis became possible after GSK finally had to give access to the original research data. The restored result is completely different from the one of 2001.
The editors of the British Medical Journal are campaigning for years to curtail the influence of the pharmaceutical industry on research outcomes. One of the editors, Peter Doshi, describes how since its publication in 2001, Big Pharma has prolifically used Study 329 for marketing purposes. Medical doctors were persuaded to prescribe Paroxetine to depressed children because this study has showed that the drug is remarkable safe and with very good efficacy . Later on the scandals erupted concerning insufficiently documented suicidal thoughts.
Doshi describes how he before the publication of this reanalysis (everybody knew that it was coming) had asked all involved with Study 329 why this publication from 2001 never had been retracted. But researchers, their universities, the head editor of the Journal that had published the article and the publisher (which is the professional association of American child psychiatrists) never replied on questions from Doshi and other critics.
According to Doshi, the American Academy of Child and Adolescent Psychiatry (AACAP) receives annually 500,000 - 1,000,000 dollars (direct or indirect) from the pharmaceutical industry, that s about 20% of their revenues. Critical members are being opposed and the upcoming chairman is one of the authors of Study 329. People often state that science corrects itself but it s very clear that the system has failed here.
We know for almost 20 years that antidepressants do not perform better than placebo tablets (see for instance Kirsch I, Sapirstein G. Listening to Prozac but hearing placebo: A meta-analysis of antidepressant medication. Prevention and Treatment. 1998;1:Article 2a). Study 329 is an unambiguous example to what extend the pharmaceutical industry can go to mislead the general public. Lack of access to primary data from most clinical randomised controlled trials (since the pharmaceutical industry finances them and restricts access) makes it difficult to detect biased reporting. The misleading conclusions from these publications of those trials can seem definitive, but Study 329 proves that we have to be very careful with statements from the pharmaceutical industry.
Austin Pledger, an American boy with a serious form of autism, was only a child when a doctor prescribed him a drug to keep him quiet: the antipsychotic drug Risperdal. When he was twelve years old he started growing male breasts, which when he was 21 have grown into size 46DD. The judge concluded that the breasts were a side-effect of Risperdal. Therefore he blamed the manufacturer Johnson & Johnson which had stimulated the doctor to prescribe this drug without any warning for the risks involved.
Johnson & Johnson, one of the biggest medicine manufacturers worldwide, has earned billions of dollars in the recent years with the illegal sale of Risperdal. This drug against psychosis (with brand names like Risnia, Risperdone) was forbidden to prescribe (so called off-label ) to children and the elderly because of the dangers involved. Although the Federal Food and Drug Administration warned the company, Johnson & Johnson continued to do this for no other reason than the profits involved.
The way Johnson & Johnson did that is the subject of an article series by the American lawyer and investigating journalist Steven Brill. This 15 chapter detailed story in The Huffington Post (http://highline.huffingtonpost.com/miracleindustry/americas-most-admired-lawbreaker) is a blood chilling account of how Johnson & Johnson deliberately marketed Risperdal to millions of people that were not supposed to receive the drug.
In a Letter from the Editors of The Huffington Post the editors write that you will get to know about the culture of the industry that produced the Risperdal scandal, and who the people are behind these life-and-death decisions. Steven has made all of that clear. You read the damning emails, you examine the internal documents, you see the close relationship between the J&J salespeople and their hired scientists and you will feel as if you re inside the room when plaintiffs attorneys figure out a way to fight back .
The 15 chapters give a shocking and revealing picture of the dubious way how the sales people of Johnson & Johnson were driven to ever higher sales targets. In order to achieve this, they not only broke the legal rules themselves but they also have manipulated and corrupted doctors, scientists and health care institutions.
Up till now Johnson & Johnson has paid some three billion dollars to fines, settlements and damages. This is for boys developing male breasts, but also for elderly people who died of strokes and heart failure, which were known side-effects. But every pharmaceutical company has to deal with court cases. They don t care about it too much. The few billions that amount for court cases are peanuts compared with the tens or hundreds of billions that they earn with the sales of medications.
The world s second most prosperous industry (the first one is the arms trade) is healthcare. Johnson & Johnson belongs to the ten most profitable corporations in the USA and is an investor s favourite because the profit margins on medications are huge. But manufacturers can only reap these profits as long as there is a patent on a particular drug. When that expires, the inexpensive generic medicines appear and will wipe out the profits.
The latter threatened to happen when in the early 1990-ties an existing patent on an anti-psychotic drug (Haldol) was about to expire. Therefore Johnson & Johnson introduced a successor (Risperdal) which was presented to investment analysts as a new sales blockbuster. But the Federal Food and Drug Administration (FDA) had warned them to not pitch the new drug as being better than Haldol and the FDA only wanted to register it as a drug for a limited group of psychotic patients. The FDA stated that Risperdal was not better and in some ways worse than older less expensive antipsychotic medications.
In order to make real money Johnson & Johnson had to expand this limited group. There was only one way and that was to encourage doctors to prescribe this drug off-label. Doctors are allowed to prescribe a non-registered medicine to an individual patient if they think that this one patient can benefit from it. But Johnson & Johnson was NOT allowed to propagate the use of Risperdal for children and the elderly. The side-effects of Risperdal were too much of a risk for these groups.
Despite these restrictions, the sales department of Johnson & Johnson did everything they could to sell Risperdal. Doctors who prescribed much Risperdal received presents, generous compensations for speeches and articles in favour of Risperdal and consultation fees . The most important doctor on their payroll was the child psychiatrist Dr Biederman. The controversial Dr Biederman (already mentioned in the July 2015 article of Lanka Woman) received 1.5 million dollars and played an important role in the marketing of Risperdal.
Please read Steven Brill s article-series in The Huffington Post. It s a real eye-opener about the ways Big Pharma is controlling our lives and to what extent they are willing to go. Their interest lies NOT with the patients but most and for all with their profits.
I dread group work for some unexplainable reason and I am mostly comfortable working on my own. I rarely feel like raising my hand in class even though I happen to know the answers. I prefer to listen to others rather than talking. I also prefer quieter places and I m happy to stay home with a good book and coffee. I don t like to party and am not a fan of social gatherings. I love interacting with people, but I have my limits, especially in noisy environments. I wouldn t mind a long meaningful conversation with another person but I am not comfortable in small talk. And I m a much better writer than I am a speaker.
The person depicted here isn t shy but is rather introvert. The concept introvert was first used by Freud in his theory about the libido. Later in the 1920-ties Carl Jung removed the sexual character and made both terms introversion and extroversion central to his personality types. Introversion is not simply being shy. Extroverts get energy from company and are generally speaking most content when surrounded by people. Introverts can behave in a social sense often very flexible but it takes them more energy. They are normally more contemplative individuals who can enjoy solitude and are satisfied with their inner ideas and imagination. Most people have extrovert and introvert traits, depending on the situation and the company they re in.
Introversion is not negative at all. According to some studies extroverts have more confidence than introverts. That is only partly true. Because extroverts are more orientated on the outside world than on their inner emotions, they are prone to disengage from their possible internal doubts and warning signals. Their decision making system is therefore cruder and has a more simple structure than with introverts. Extroverts appear to have more confidence because they see fewer problems.
Introverts, according to the same studies, have a tendency to first internally look for possible problems. Then there is automatically more space for doubt and lack of confidence. The time to come to a decision is usually longer.
Extroverts are on average more sensitive to external pressure or negative feedback than introverts. They are more easily influenced in their decision making by authority figures than introverts.
When you put this all together then it doesn t mean that introverts are automatically better with making the correct decision and that extroverts aren t better with decision making at the right moment. Both have their good sides, and both have their shortcomings.
Several studies show that on average, introverts and extroverts differ in brain activity. On a MRI scan the 3D map of the brain pops up happily. But brain differences that CORRELATE with introversion or extroversion do NOT mean that these differences (if any) CAUSE introversion or extroversion. When there is a positive correlation between the number of storks in a certain area and the amount of new born babies, it doesn t mean that there is proof that babies are delivered by storks as the legend tells. There are no experiments that really address whether brain differences play a causal role. Scientists are very pessimistic about ever discovering a scientific description of personality differences at the level of cells and synapses. It s also important to keep in mind that our brain structures vary from person to person along all sorts of axes that can make up personalities (not just introversion and extroversion).
Many introvert professionals feel extremely tired at the end of their work week. Here are some tips to keep your energy stable.
- Focus on your strong points. It s better to develop the things you re good at and what comes more or less natural to you. This will give you energy while if you try to improve your less strong points it will cost energy. Choose for example a leadership style that suits you. Do not try to be a very vocal and assertive extrovert but pick a style that agrees with your natural way to structure and lead from the back . As a result meetings usually will go smoothly, the participants are involved and a lot of work will be done. Use your creativity as an introvert to organise your work utilising your qualities.
- Work on a daily basis to realise your ideals. Introverts are less tired if they work in an inspiring environment that connects with their ideals. Not every job is inspiring but try to find in your work at least one thing where you believe in and which gives you a drive. Prioritise that to other tasks. The results you will accomplish with that can generate so much energy that those other tasks will seem easier too.
- Learn to handle your inner critic. It s that little voice inside your head that constantly critisises your behaviour; with introverts it s often very dominant and persistent. The best way is to develop compassion for yourself. It s about understanding how you are now in the context of your personal history.
- Reserve time to reflect. Introverts need on a regular base time to think and to digest experiences. Make time for this in your daily schedule! An introvert client of mine for example takes every day during lunchtime a walk for 45 minutes. She reflects, eats a sandwich and enjoys nature. When she returns she feels refreshed and has plenty of energy for the second half of her working day.
In my psychology practice it frequently happens that people tell me they are gay or lesbian. Although it seems less of a problem for the younger generation than for the 30+ ones, there still is a lot of controversy about sexual orientation in Sri Lanka. It s usually a big relief for them to experience that I am open- minded and not biased. The mere fact that they can talk freely and without fear of being exposed to the outside world (everything clients say to me is very confidential) is often a therapy in itself .
Sexual orientation is about amorous or erotic feelings you have with regard to another person. The orientation is basically innate ( nature ), but can also be influenced by external factors, such as society, education, or culture ( nurture ). In one culture one form of orientation is less acceptable than the other and therefore will be less or even not at all expressed. However, this is only the expression, and not about the existence. The orientation itself is defined in a person and is consistent, but this need can be suppressed by acquired factors.
It can be said that there are basically three or four groups of sexual orientation:
Heterosexuality: Amorous or erotic feelings for a person of the opposite sex.
Homosexuality: Amorous or erotic feelings for a person of the same sex. The term homosexuality is a combination of the Greek word homoios which signifies "equal", and sexus, the Latin word for sex. Research shows that 5 to10% of the world's population is homosexual or bisexual. However, this is difficult to calculate precisely because it is not always clear when somebody falls within these groups. The taboo on homosexuality has often emerged with the rise of religions, which prohibited a relationship or marriage between two men or two women. However, this does not mean that only in religious circles homosexuality is seen as "bad".
Bisexuality: Amorous or erotic feelings for a person of either sex. Just as homosexuality, bisexuality has to do with feelings, behaviour and identity: what you feel for another, what kind of sexual contacts and relations you initiate and how you call yourself. Many people have bisexual feelings and fantasies, much fewer people do something with these and even less call themselves bi. Bisexuals are often categorised as heterosexuals or homosexuals, depending on the relationship they have. That s why bisexuality is often invisible.
While asexuality is considered the fourth category of sexual orientation by some researchers and has been defined as the absence of a traditional sexual orientation. An asexual has little to no sexual attraction to males or females. It may be considered a lack of a sexual orientation, and there is significant debate over whether or not it is a sexual orientation.
Human sexuality is often seen as a continuum with at both ends hetero- and homosexuality and bisexuality in the middle (the Kinsey scale ), where asexuality has a place out of this continuum. However, this classification is also criticised because it ignores individuality and cultural issues. It s an invention of 19th century Europe and therefore also culturally bound. Sometimes deviations from heterosexuality are expressed in other culture-specific ways, such as Two Spirit (a male and a female spirit in one body) in North America and Hijra, (a man with a female gender identity) in the Indian subcontinent. The layout hetero-gay-bi is static and does not consider transitions as transgenderism (your gender identity does not correspond with your biological sex assigned at birth, for example John was born a male but as a person is a woman) and intersexuality (when your sexual anatomy doesn t seem to fit the typical definitions of female or male; they may also have male and /or female secondary sex characteristics, such as body shape). The Charter of Fundamental Rights of the European Union banned any discrimination on grounds of sexual orientation.
A six year old child has a cough, fever, inflamed eyes, a sore throat and white spots inside the mouth. The worried parents phone their family doctor for a house call. He/she checks the child, concludes that it has the measles, reassures the parents and advises rest and some supportive medications.
This is a perfect example of the medical diagnostic model, which has also an implicit social relationship: the power of the expert doctor and the layman patient . The symptoms are bundled into an objective general syndrome (in this case called measles ). They are based upon an underlying knowledge system with a clear distinction between health and illness. The end result is a diagnosis and prognosis assisted by diagnostic instruments. The aim is assessment and treatment and a return to the status quo ante.
A 35 year old man comes for consultations. His marriage is on the rocks, he feels depressed, he has aggressive moods (shouts at his wife and young children), he has a drinking and drug issue, and he has suicidal thoughts. In what way can we compare the PSYCHODIAGNOSTICAL PROCESS with the above described MEDICAL PROCESS?
In the first session the client gives further information about his present situation with his family and at work. He also provides some more information about his suicidal thoughts and about his drinking and drug habits. It appears that the client drinks and takes drugs to suppress anxious emotions. Although he is well educated, he has a strong feeling of inadequacy. His suicidal thoughts have to do with a feeling of utter loneliness.
In the second session the psychologist is focusing more on the history of the clients life, how he was raised, his schooling and his previous work environments. His father was aggressive and loud, his mother rather submissive and quiet and tried to manage the two children and the household. His mother was physically, emotionally and sexually abused by his father. The client can remember clearly the many nights that he couldn t sleep because of the shouting and crying. The client was put down many times by his father too because he was the son and father wanted to dominate him. The outside world didn t notice because father was the perfect gentleman outside the house. The client could not talk to anybody about this because nobody would believe him.
In the third session the client feels that he can trust the psychologist and tells how he was sexually abused by an uncle (a brother of his father) when he was five years old. The uncle came often and took the client to a room in the house to play with him . His parents trusted the man and it lasted for two years.
With the knowledge from the three sessions the symptoms at the start in this example have a complete different meaning. A psychiatrist who uses the medical process only focuses on the symptoms, typically doesn t have more than 5 to 10 minutes to spare and prescribes medicine which has usually nothing to do with the root-cause of the problems. In addition we know that there exist no effective medication for depression, anxiety, suicidal thoughts, substance abuse, low self esteem and loneliness. Having said this, medication for certain mental illnesses can be extremely helpful. Some time ago I witnessed a client in an acute psychosis. In situations like this one can t be but thankful for the availability of reliable medications for this condition. The same goes for the (if correctly diagnosed!) very rare illness bipolar depression.
In his book On being normal and other disorders: a manual for clinical psychodiagnostics the Belgium psychologist prof. dr. Verhaeghe discusses the differences between the two diagnostic processes. The first difference with the medical diagnostic process is that in the psychodiagnostical process it s NOT about one individual but also about the CONTEXT wherein this individual lives. The diagnosis usually doesn t come at once, but much later after more sessions and very often it will be adjusted. A second difference is that in the medical model one works from the individual person to generalised diseases. The symptoms (high temperature, muscle pains, etc.) lead to the conclusion of fever (a very common condition, N=millions). Psychologists on the contrarily start with a general story and end with N=1. Mental conditions are typically very individual and are extremely difficult to generalise. In the above example the psychologist gathers more information and the situation becomes more specific. A third difference is that in the medical diagnostic system the VIEW is central, it s focused on the discovery of signs which direct to objectively measurable parameters. Whereas within the clinical psychological perspective the therapist is primarily LISTENING to signifiers, which remain open to interpretation. Medical signs refer to an illness scenario, while signifiers derive their meaning and function from a special relationship with the context. A fourth difference is that in the medical field the disparity between illness and health can be measured and generalised. But psychological normality and abnormality are always relative and therefore individual. In addition, certain psychological symptoms can be interpreted as solutions for deeper lying problems.
The comparison between medical and clinical-psychological diagnostics is one with predominantly differences. What works well with symptoms related to physical illnesses doesn t necessary goes with mental illnesses. The final diagnosis is a description of an INDIVIDUAL CASE and not some generalised label. So you can ask yourself if diagnosis in mental health issues is warranted.
N.B.: The Diagnostic and Statistical Manual of Mental Disorders (DSM) is an arbitrary CLASSIFICATION system, meant for mental health workers to communicate with each other, and NOT a diagnostic book. Please read previous articles for a more detailed discussion about this.
Nobody believed that her nice and friendly mother was such a mean bitch at home . For the outside world narcissistics are charming and engaging. But as soon as the front door is closed their true nature emerges and they are aggressive, manipulative, arrogant and sadistic. The concealed hurt that the narcissistic causes, is immense. Besides their partners, it s typically their children who have to take the brunt of it. They usually bear lifelong deep emotional scars.
Narcissists are arrogant; they believe that they have unique talents and that nobody is as good as they are. A narcissist is a versatile person, everybody in the environment of a narcissist sees a different person.
A narcissistic mother has devious ways and she turns her children s life into a true hell. Most people don t understand why children raised by a narcissistic mother don t show normal behaviour and why they often at a later age break with their mother. A child of a narcissistic mother often feels lonely and not understood.
Some important characteristics of a narcissistic mother are:
Denying . The narcissistic mother always has an excuse or a simple explanation for her behaviour. She deludes her children, but in essence the outside world, that she is a supportive and concerned mother. In the meantime she gossips and lies to the extreme. When her lies are exposed she twists her story in such a way that others are to blame.
Humiliations .. She humiliates her children almost on a daily basis. She compares her children with others but does it in a completely wrong context. On a regular basis she tells her children how good somebody else is and how much she appreciates others. The intention is to let them know that they are not valued. She does this without clear concrete wordings. She torpedoes every little enjoyment the children might have. When they have bought for example a new blouse and ask her opinion then she just keeps talking about her experiences of her day. The children of a narcissistic mother incorporate the feeling that they are unimportant and that they don t matter. In this way the children become uncertain and the narcissistic mother can take over and manipulate their lives.
An extension of mother . A narcissistic mother views her children as an extension of herself. She gives away their belongings without their permission. She talks, calls and messages with their friends as if they are hers and tries to control their lives. Children of a narcissistic mother have to be at the ready for her day and night; otherwise she will blame them that they take advantage of her and that they don t love her. The children have no control over their own lives as long as they keep in contact with her and as long as they time and again give her access to their lives.
Destruction hidden in care and concern .. A narcissistic mother can crush her children in the presence of others without anybody noticing it. Her gossip and malicious words are wrapped in love and care by for example praising others for a lesser achievement than her own children have accomplished. By means of this veiled manner of devaluating, for outsiders it s almost impossible to see what is really happening in a narcissistic family. It happens quite often that therapists ignore the children of the narcissistic mother while in reality it s SHE who is the cause of the distorted behaviour of the children.
The golden child and the scapegoats . Usually narcissistic mothers choose one or two favourites who are treated like a prince or princess and receive privileges as long as they do exactly what the mother wants of them. The other children are seen as scapegoats. They have to completely disregard their own needs in favour of the needs of the mother and her favourites. Her favourites can t do anything wrong in her eyes. If a favourite does make a mistake then the scapegoat gets the blame for it. As a consequence of this unfair treatment there will be conflicts between then children. The mother happily safeguards this friction because in this way she can continue unobtrusively with her lies and inappropriate destructive behaviour.
Undermining . The mother undermines the achievements of her scapegoat children. She cannot bear the thought that somebody else is in the centre of attention and she will do anything to prevent this. She can go to the extent of creating a huge scene or faking medical complaints. Exceptions are situations where mother can credit herself with the accomplishments of her children.
Jealousy Every time a child of a narcissistic mother has a positive experience the mother gets jealous. She will try to manipulate the positive incident into something negative. The dictionary of a narcissistic mother doesn t contain the word satisfaction. When their children grow older in a sexual sense the mother typically will compete with her daughters. This can vary from showing exceptional friendly and welcoming behaviour towards the boyfriend of the daughter to actually having sex with him. A narcissistic mother won t stop until she has destroyed everything that her children enjoy or value.
Pitiful behaviour . When the lies of a narcissistic mother do come to light, then she will drown in her sorrows and self-pity. She will continue her act by declaring to everybody that s that everything is her fault and that she never can do anything right. She feels such a bad person! But she won t do what most people would do; she won t take responsibility for her behaviour and change it. The pitiful and hopeless behaviour is only a way to try to force you in forgiving her. If her children refuse to do this she will tell everybody what cold, heartless and insensitive children she has. Furthermore, she will emphasise that she has always has ignored her own needs for her children and that these same children drop her just like that.
The conclusion is that living with a narcissistic mother is an impossible challenge. For the children every day is a serious survival journey. They never know where they stand and they are helplessly searching for a morsel of sincere love and recognition of their mother. When they grow older the children often understand that their mother has the personality disorder called narcissism. Because of all the pain and injustice that they had to endure for many years these children often decide to ban their mother out of their lives. In the case of a narcissistic mother this is the only realistic way out.
In my psychology practice I hear time and again stories about sexual abuse. I am quite appalled by the number of incidents reported by clients. When I compare this with the incidents I heard in my practice in the Netherlands then in Sri Lanka or in the Maldives the prevalence must be at least ten to twenty times higher.
It s usually people you know (uncles, aunties, other relatives, domestics, drivers, etc.) who commit these horrendous crimes, and not the proverbial scary stranger. Perhaps it s the culture of keeping children innocent for a long time, or not talking about sexuality, or the practice of telling children to cuddle with relatives ( let uncle carry you or go and sit on uncles lap! ), or the male dominated culture that enables this to continue on a big scale.
Sexual abuse consists of all sexual acts that someone is forced to perform, to suffer or to be forced to witness. Examples are to be forced to satisfy someone sexually, forced to undress for someone or to be touched or to be penetrated. You can be forced physically or be threatened or perpetrators make use of the victim s feeling of guilt. Often the victim is dependent on the perpetrator or afraid of him so you can be forced. Especially children can be easily made victims but also rape within a marriage occurs often because of the dependent situation of the wife.
One of the most persistent myths is that the victim must have asked for it by wearing provocative clothing or by behaving in a provocative way. Wearing a short skirt or behaving in a certain way is NOT an invitation to be assaulted. Or it s condoned by the saying boys will be boys . We have surpassed the cavemen times and we are supposed to be civilised.
Nowadays sexual abuse is seen as a widespread and a multiform phenomenon that can have far reaching consequences for the victim. For many victims the abuse causes a trauma (and often they will suffer from a post traumatic stress disorder). After sexual abuse your basic feeling of safety is damaged. In order to function as a person (and especially as a child) you need to feel safe in your own environment. With sexual abuse there is no safe environment at all and no control over your own life. Everything you need to develop as a child and to feel stable as an adult has been affected.
In Sri Lanka there is a big taboo on speaking out after sexual abuse. Just forgive and forget, so many girls have experienced it, you must have provoked it, why were you outside after 8 pm, your husband has his needs , etc. Because you continue to carry the memories there will be an ongoing tension. With children this often translates itself into psychosomatic complaints like stomach pain and headaches. Adults repeatedly isolate themselves and try to avoid situations which can remind them of the trauma. This frequently leads to emotional anesthetised behaviour and they react as if they are numb.
In cultures like in Sri Lanka where honour and shame play an important role, victims find it very difficult to talk about what has happened to them. Many of them are convinced that the sexual abuse has happened to them for a reason. In addition, feelings of guilt can slowly destroy you. The guilty feeling can occur out of self protection or because others have imposed that on you. By blaming the perpetrator it can give you an unbearable feeling of powerlessness and helplessness. When you feel that you are responsible for the abuse then that gives you a certain feeling of control.
The sexual abuse will influence the relationships of the victim too. For the partner of the victim it can be very difficult: anger, powerlessness, hurt and supportive feelings wrestle with each other. The sexual abuse can cause serious relationship issues. Sexuality, intimacy and trust aren t as natural as they were. Much determination and openness from both partners are mandatory in trying to solve this. They have to be able to express what they feel but they also have to be good listeners. Very often counselling is needed.
Treatment of sexual abuse is not something that anybody can do. Because of the severity of the trauma and the complexity of it, it is recommended that therapy should only be given by professional psychologists.
For teachers the perfect class is a concentrated, quiet and obedient one. Nowadays, when children stand out by what used to be called naughty, rebellious and boisterous behaviour, it is much easier than before for teachers to have these children drugged with for example Ritalin or Concerta (psycho-stimulant medications). For psychiatrists, jotting down abbreviations like ADHD, PDD-NOS and ADD and subsequently prescribing drugs has become routine.
Is there a psychiatric epidemic or is there something else going on? Leading American psychiatrists think that ADHD (supposedly an attention and hyperactivity disorder) is severely over-diagnosed; it s a false epidemic. Before 2000, only very serious cases were labeled with this diagnosis and only people who really needed it, were allowed to receive medication. As a consequence of the less stringent definition after 2000, the diagnosis of ADHD has increased spectacular. Everybody knows now somebody with ADHD.
Another reason might be that qualities that used to be attributed typically to boys such as an urge for noisiness, action, and forcefulness were formerly accepted, but are now regarded as a problem, especially at schools. It appears that not the boys, but the educators have changed. Boys are in essence the same as before, but the school system has become more feminine and looks upon their abundance of physical energy and enthusiasm as being an issue.
For concentration problems without hyperactivity, a separate category was devised called ADD (Attention Deficit Disorder). Therefore, many girls and women were included into the diagnostic criteria. PDD-NOS (Pervasive developmental disorder not otherwise specified) was brought in as a kind of residual category for people who don't quite fit into other more specific categories.
It is to be expected that the existing criteria will be eased up more so that an increasing amount of people will be labeled as suffering from a mental illness with all the dire consequences. The pharmaceutical industry has maintained strong ties with the psychiatric community and they have jumped at this opportunity. Big Pharma s marketing machine is working full time in trying to sell the new drugs.
New target groups are continuously defined. At first it were predominantly the overactive little boys which were not concentrated enough. Now the dreamy girls are coming into the picture. They are diagnosed with ADD and that is supposed to be treated with medication too. Finally it s the turn of the grown-ups; 5% of the adult population is said to be suffering from ADHD.
Using medications for ADHD involves a number of risks. The most important ones are decreased appetite and cardiovascular complaints. But also anxiety, stomach problems, dizziness, tics, skin problems and bruising are named. Less common, but potentially lethal results from taking these pills is, that they can cause suicidal thoughts and psychosis.
Research about the long-term effects of these medications is almost non-existent. There is only one such study, the so called MTA (The multimodal treatment of ADHD), sponsored by the National Institute of Mental Health in the USA. It shows that after two years, there is no difference between groups of children who do and don t use medication. Despite this and other critical studies, the use of ADHD medication has skyrocketed.
The scary thing is that we don t know what the precise working is of the medication in our children s brains and we are also in the dark about the long-term side-effects. It s comparable to the enthusiasm with which Valium was introduced in the 1960 s. It was only later that the severe adverse effects became known.
ADHD (if it exists) is nothing more than a description of a number of behaviour symptoms. ADHD is not a mental disorder that causes you to be badly concentrated and noisy. The thinking about ADHD becomes problematic when the child is not seen as a person in relation to its environment (for example family, school, and neighbourhood), but only as an individual without a context. You just tally up some symptoms and voila, there you have ADHD! It becomes dramatic when you realise the enormous amount of children that are given potential dangerous drugs without proper effect evaluation.
An interesting article: "Ritalin calms hyperactive children and prescriptions are soaring - but experts warn of serious side-effects and it's even being linked to suicide", the link is here
Another interesting article: "Dr Laura Batstra: ADHD is not an illness", the link is here
And here is a video where Dr. Peter Breggin discusses his book "Talking back to Ritalin", the link is here
Almost every week new clients come to my office who were diagnosed before as being bipolar . In three previous articles ("Bipolar Madness", "Psychological/Psychiatric Assessment" and "Bipolar Madness revisited", see my website www.marcelderoos.com), I discussed the alarming increase of bipolar-diagnoses with children and adults.
Usually they were seen for only five or ten minutes by a psychiatrist who checked some symptoms from a list in the DSM5 (the psychiatrist s bible) and subsequently prescribed heavy medications like antidepressants and mood-stabilizers (which have serious side-effects like excessive weight gain, involuntary movements, and sexual problems). The message they get is that they have to take these medications for the rest of their lives.
Quite often these clients were misdiagnosed because they had for example a combination of depression and anger issues. This is of course NOT bipolar depression. Depression and anger are (stuck) emotions and usually there is an underlying story that fits as an explanation of these feelings. Bipolar depression is only bipolar depression if there is no other physical or psychological explanation of the symptoms. It s an extremely rare illness and very often misdiagnosed. Make no mistake; classic bipolar disorder is not an easy illness to bear. It can be severely disabling, extremely difficult to live with and medication is indispensable. There is no proof for a genetic or neurobiological cause. Subsequently scientists assume that the disease is caused by a complex interaction between biological and environmental factors.
Advertisements from the pharmaceutical industry typically suggest that bipolar depression is the cause of mood swings. While in reality it s the opposite. Bipolar disorder is used by psychiatrists as a label. It s an agreement that when somebody exhibits certain behaviour (such as rotating between two extreme feelings) they can use the name bipolar disorder. There is medication that can take away most of the symptoms but we don t know the working mechanism of it.
Bipolar depression is characterized by manic and depressed episodes. In the manic phase the person is euphoric, overactive and with extremely quick erratic thinking. Lots of energy and the person thinks the world of himself. Often there is a tendency to spend a lot of money, use of drugs and alcohol and increased sexual activity. Psychiatrists use the DSM5, which provides a list of symptoms for each disorder with usually a cut-off point (5 out of 9, 4 out of 7, etc.). A manic period is a disaster for the person himself and the family. But again, it s paramount that the psychologist/psychiatrist invites the client to tell the whole story behind the symptoms. Very often that story explains these symptoms in a different way which means that the person is NOT bipolar and there is no need for medication.
Until the 19th century, illnesses (including mental illnesses) were seen as a disruption of the natural balance between the individual and his environment, which could differ per person. Sicknesses are the result of a unique pattern of factors, like the sick person s constitution, his behaviour and his living conditions. This is the so-called holistic model. In the second half of the 19th century people started to think differently about this. An important contributing factor was the discovery that bacilli can make people sick. Illnesses gradually became independent entities that could affect people in identical ways. Medical historians speak of a transition from a holistic to an entity-model. That seems to work well with physical illnesses but not with mental ones.
An early proponent of the entity-model was the German psychiatrist Kraepelin. In his Psychiatrie, Ein Lehrbuch fur Studierende und Artze (1893), Kraepelin used the word depressed in combination with the word manic for people who changed somber periods with times of heightened activity and elation. According to him the root-causes of manic depression were still unknown but he was convinced that all mental disorders were the result of underlying biological causes which were to be discovered in the future. He considered his book as a description of behaviour that he observed. Since Kraepelin nothing much has changed; there is no biological or other explanation for the causes of bipolar depression. What is worse, after all these years of intense and costly (billions of dollars) research there are no biological explanations found for any other psychiatric disorder. Despite this, modern psychiatry is still based upon the biological model.
When I speak with a client, then generally between half an hour and one hour s time the story and circumstances behind the symptoms becomes clear. It very often means that the previous diagnosis bipolar depression was wrong. Clients have to deal then with diminishing the shock of being (falsely) labeled bipolar with the prospect of being on heavy medications for life (!) and with the side effects of the drugs. It s so important to be very meticulous in diagnosing a serious illness like bipolar depression. As I always tell my clients, when you want to stop with medicine for mental illnesses it s important that you do this under medical supervision. In many cases you shouldn t stop right away, but you should taper it off.
And here is an interesting video with Dr. Peter Breggin about psychiatric drugs, the link is here
Is psychology a science? Psychology does make use of scientific methods such as measurement and data gathering, research design, and advanced statistical techniques. But it has failed to produce a clear cumulative body of knowledge (like the Periodic Table in chemistry) that is agreed upon by mainstream psychologists. In this sense psychology has definitely failed to be a science.
There are no indications that the effect of a therapy is a result of the specific psychological mechanisms which are the focus of that therapy. Cognitive behaviour therapy for example tries to treat depressions by making the clients aware of their negative thoughts in certain situations. With the help of the CBT method therapists try to reduce these thoughts. But practically every other therapy (or medication) has the same result, everything works .
The major part of the therapeutic effect often shows already after a few sessions, before clients have learned how to master certain techniques. This is probably because the therapist has given them hope that they can change something about their situation. People usually start with going to a psychologist when they have become demoralised and they feel powerless to do something about their problems. The therapy gives them new hope and they feel supported.
Some therapists are significant more successful than others, but there is no connection with the theory or method they embrace. There is also no indication that their treatment has more effect when they are better trained or more experienced. Good therapists have certain personal qualities. They are warm, empathic, supportive, trustworthy and hopeful. They don t adhere strictly to their manual but adjust the treatment to the goals and conceptions of the client.
Psychotherapy is NOT an applied science. If you want to start with a therapy it s best to look for a therapist who has a good reputation and who uses an undisputed method that appeals to you and which you trust. And listen to your gut-feeling, if it doesn t feel right at the start then please stop and look for another therapist. It s your time, money and energy.
Concluding, contrarily to what some experts say, therapeutic success doesn t depend on the method, technique, the qualification or the title of the psychologist. The most important success-factors for any therapy are the therapeutic relationship and an active client. Therapists have to be able to install trust and hope in the client and the client him/her-self should be engaged in the therapeutic process. On top of this, the therapy should include the present, the past (!), cognition, emotions (!) and behaviour.
Recently positive psychology has become quite popular but it has one of the worst evidence-based track records. For scathing critical evaluations please visit for example James Coyne PhD blog. Quoting James Coyne from http://blogs.plos.org/mindthebrain/2014/10/28/positive-psychology-interventions-depressive-symptoms/: Studies of positive psychology interventions are conducted, published, and evaluated in a gated community where vigorous peer review is neither sought nor apparently effective in identifying and correcting major flaws in manuscripts before they are published. Many within the positive psychology movement find this supportive environment an asset, but it has failed to produce a quality literature demonstrating positive interventions can indeed contribute to human well-being. Positive psychology intervention research has been insulated from widely accepted standards for doing intervention research. And As seen on its Friends of Positive Psychology listserv, the positive psychology community is averse to criticism, even constructive criticism from within its ranks. There is dictatorial one-person rule on the listserv. Dissenters routinely vanish without any due process or notice to the rest of the listserv community, much like under disappearances under a Latin American dictatorship.
Forgiveness therapy is another strong religiously formed gated community . They perceive anger as something undesirable (must forgive!) while anger can be a great therapeutic tool. And denying or suppressing anger can lead to disastrous consequences. But most of all they fail to notice that almost any therapy works as long as there is a strong therapeutic bond and an active client.
Most of the research with cognitive behaviour therapy is done like this: a group of depressed persons CBT intervention results. And of course the outcome is often that CBT works . But when you compare different therapy methods with each other (and taking into account the observations made above) then there isn t much distinction in success between the methods. There is a robust amount of research for this. One of the most recent is a big meta-analysis (2013 PLoS Med 10(5): e1001454) where seven psychotherapeutic interventions for depression (including CBT) were compared. The findings were that none of the therapies stood out as being better than others. This means that there must be other factors (like the therapeutic relationship and an active client) that are responsible for the efficacy of psychotherapeutic interventions and not the researched method.
Whether it s the illusion that emotions can be directed by our thinking ( cognitive behaviour therapy or positive psychology ) or that changing our exterior will make us happier, or if everything fails there always is medication, the existential quest for meaning in life and the individual meaningfulness of your own life are hardly touched. It s a given that life is for a big part trying to handle unfulfilled longings. At the same time there are the alleged euphoric accomplishments of both genetic and biological factors in psychiatry which in reality are virtually non-existent. Psychotherapy with an empathic professional psychologist can give you answers to the deeper emotional layers of your experienced problems.
The Belgian psychoanalyst Prof. Dr. Paul Verhaeghe wrote a fascinating book called Love in a time of loneliness . In this book he discusses what drives us in sex and love.
Is there such a thing as a typical male fantasy or a typical female fantasy? Scientific research in this area is rare and not very reliable because it is mostly done with questionnaires. Self reporting questionnaires are notorious unreliable in themselves and in particular with the two subjects where people lie the most about: sex and money. It s better to turn to another source of research, the commercial expression of our imagination.
With males, it s easy to find these images since pornography is a typical male product. It s an open secret that most clients of porn internet sites are men. The women depicted in these videos are usual similar. If there is any story (!), it s usually about the archetypical big breasted, long legged nurse/secretary who seduces her doctor/boss in no time. Apart from being very desirable they are also immediately sexually available. The women want only one thing, here and now and as long and as often as possible. In other words, this is the perfect projection of the male fantasy. Male sex is visual and genitally phallic orientated with a clear goal: orgasm. After that it s time to go or turn around and fall sleep.
For women, it s quite a different story. There is hardly any female visual pornography as there is in male porn. The distinctive characteristic of the male fantasy is the preoccupation with the female body and on certain parts of the female anatomy. The female sexual fantasy on the contrarily has much less to do with physical aspects; it s much more emotional focused. The books and magazines for women are for sale in the same shops as male pornography. Harlequin, Mills & Boon and other romance books (despite feminist s indignation) have an incredible world-wide sales that makes many writers of literature water their mouths. The stories in these kinds of books are as stereotype as the male fantasies, but the emphasis is completely different. Quoting (with a smile) Dr. Verhaeghe: A thirty-something woman with an unhappy love affair behind her goes to work as an au pair for a company executive (doctor, film director, etc.) whose wife has just died. She looks after his two small children. Despite their initial dislike, she falls in love with him, but unfortunately he is in love with a film star who is merely using him to get on with her career. After many misunderstandings they discover that they love each other, etc.
Even the success of Fifty shades of grey can be explained by the above. Simple, innocent university student gets a (kinky, but these are the times) complicated relationship with mysterious powerful and wealthy man (who of course also supports a good cause).
The female eroticism usually is almost devoid of visual content, is never genitally focused and has no clear goal. In the woman s fantasy the man is the central element and is special not so much because his looks, but because of his position. The man in these romance stories is not bound by a current love and he tends to be withdrawn. He has to be won over. The book is filled with all sorts of difficulties which they have to deal with in order to feel a mutual love for each other. If there is any sex it has only a supporting role, it s never the main part.
This kind of man is the perfect projection of what a woman wants herself, similar to the sex-crazed woman mentioned above was the perfect projection of man s desires. These two fantasies are not mutually exchangeable. A woman doesn t understand what her husband sees in pornography: it s always the same thing. A man doesn t understand what his wife finds attractive in these stories: it s always the same.
There is of course no average woman or an average man. Men do want a loving and permanent relationship too and women do have erotic fantasies that might surprise their partner. But basically for men the sexual act is a goal in itself. And women complain that their partner only wants sex and there is no time to talk or tenderness. For women the sexual act is more like a way to achieve a different goal, establishing or maintaining the relationship. And then men complain that when the relationship is stable the woman isn t much interested in having sex.
In brief, men and women are wired in a different way. The causes stem from nature and nurture. It is not surprising then that they often have trouble in understanding each other. Couples have to learn to understand each other s drives and come to a compromise (well, that s life ).
Teams that perform well, the so called dream-teams are very rare. In the corporate world, well-paid advice about creating such teams is a golden opportunity for many consultants and advisors. Typically, they promise a lot but even if they produce some results initially, these are usually not very sustainable.
As a rule these consultants focus on personality tests (quite often with the non scientific and low in validity tests like the Myers-Briggs Type Indicator) and tests about ideal team composition which also have a low validity and are usually based upon Jung s Archetypes ( should you put together a Jester with a Hero and a Magician? ).
In 2012 Google started a study with the name Project Aristotle. The company involved its best organizational psychologists, sociologists, statisticians, engineers and researchers. The aim was to find out what is needed for really good team performances. Google s People Operations department studied a huge amount of scientific articles about teamwork. They also scrutinized and analysed data from 180 Google teams. No matter how the researchers arranged the data, it was impossible to find patterns or any evidence that the composition of a team was of importance. No mix of specific personality types or skills or backgrounds made any difference.
All the little tests that pretend they can tell you what kind of type you are and which team role is best suited for you are in essence meaningless nonsense. But MOST important is how people in a team interact with each other (the so called group-norms). Out of all the examined literature and data Google extracted five pillars for creating a top team:
- Psychological safety: do we dare to say or try out opposing views without feeling embarrassed?
- You can count on each other: do our colleagues deliver their work in time and is it up to standards?
- Structure and clarity: does everybody know their goals, tasks and action plans?
- Meaningfulness: Do we all contribute to something that we all find important on a personal level?
- Impact: Do we all believe that our work has an influence?
According to the specialists of Project Aristotle, of these five building blocks psychological safety is by far the most important. This concept was introduced a few years ago by the Harvard professor Amy Edmondson. Psychological safety is about the conviction that you can take social risks. That you can ask questions without reservations, that you can ask for help, that you can admit your mistakes and that you re critical about your own performance.
The next step is of course HOW do you make your team psychological safe? At Google they found out that in all strong teams the individual team members had an equal say in the conversations. And very importantly, that team members recognised and respected each other s emotions. According to the researchers team leaders play a vital role. They must show and stimulate the correct behaviour: let colleagues finish their sentences, react in a respectful way on everybody s opinion and encourage people to speak out.
In her publications Edmondson gives a few advices too. First of all leaders must emphasise that work is all about learning; that the aim is to solve problems TOGETHER in an uncertain environment. On top of this, leaders should highlight their own fallibility. Frequently saying things like Can you explain this to me one more time slowly? . And finally they must show curiosity and ask many questions. And NOT pretend that they know everything.
The conclusions and recommendations from Google are bad news for the countless advisors who work with personality tests and tests for optimal team composition. In its simplicity and essence Google s five pillars are very stimulating for everyone who wants to work as a team in a pleasant and effective way.
Many therapists believe that evidence based therapies like cognitive behaviour therapy are the best that psychology has to offer. But psychotherapy based upon emotions(!)/cognition/behaviour plus the present/past(!) is often a superior approach to suffering than mainly cognitive based therapies (these focus primarily on only symptoms, thoughts and the present). Removing symptoms without paying attention to the underlying causes often leads to recurrence of for example depression.
We can t understand human suffering with quantitative empirical scientific methods because the human being is far too complicated for a simplistic empirical approach. Quantifying suffering is impossible. Depression for example is different (root causes, process and impact) for different persons. It is possible to select certain symptoms and then categorise and label them as depression (like the DSM does), but that doesn t mean that you can quantify it. When you have hundred depressed people then there are hundred different stories, personality structures and development stages and each of these people need tailor-made approaches.
In medical science randomised controlled trials (RCT) are allegedly seen as the golden standard for research regarding medications. There is a lot of criticism about these RCT s but in this article there is no space to discuss these. Concerning the use of RCT s with psychotherapies it should be noted that these RCT s are strictly regulated in an artificial environment (not real life ) and meant for extreme short term treatments. Most therapies can t be moulded into a RCT-format, which means that RCT s favours certain methods (like cognitive behaviour therapy) only because of the nature of the RCT s. Another caveat is that the lack of access to primary data from most clinical randomised controlled trials with psychotropic medications (since the pharmaceutical industry finances them and restricts access) makes it difficult to detect biased reporting. The often misleading conclusions from these publications force us to be very careful with statements from the pharmaceutical industry.
Much of the suffering that psychologists try to alleviate can only be addressed by a response from the humanity and nonjudgmental understanding of the individual. It can t be done with a standardised protocol based upon some rigid and shallow theory or research. Human relationships are much too complicated and much too individualistic to grant an approach that is said to be applicable to everybody.
All different therapies are based upon different underlying beliefs about human nature and practitioners who use these theories are (unconsciously) accepting these beliefs. It s important to realise this because the underlying concepts may not be in accordance with your own values. Cognitive behaviour therapy for example urges us to think rationally but we perceive the world frequently as mysteriously and non-rational and human behaviour is often unpredictable.
Many so called scientific therapies ignore meaningfulness, spirituality, self-awareness, intuition, morality, introspection, creativity, literature & the arts (which teaches us a great deal about human nature). All of these are hard to prove in an experimental design. There is no scientific answer on how to deal with for example changing jobs, leaving a marriage, a major loss, loneliness or spiritual questions. All these issues demand the entire personality of the therapist, everything he or she has learned or has experienced through life (of which emotional maturity, compassion and empathy are essential).
Empathy in therapy is a key concept and although it s complicated to define it, generally speaking we assume that it s an ability to imagine oneself in the situation of others and to sense the emotional state of others. The therapist should make it clear that he/she understands the emotions of the client. Besides this affective aspect, empathy also has a cognitive part and it enables us to understand the perception of the environment of the other person. The quality of empathy increases when the therapist is able to be authentic with him/herself and in the contact with the client (congruent). The importance of an empathic therapist with mental illnesses can t be emphasised enough.
Psychotherapy practised by an empathic professional therapist and with an active client does work. Depression for example has everything to do with FEELING depressed. Since depression is about stuck emotions, it makes sense to treat it from that angle. An empathic psychotherapist with sufficient knowledge about depression can coach the client in making the stuck feelings fluid again. It s about making the client feel that he/she is understood and that his/her story and symptoms are taken seriously. It s about empowering people. In therapy there is a lot of talking, but in essence it s about venting your feelings, letting them sink in and coming to terms with yourself.
Depression has to do with a person s past history and what others have done or said to him/her. So therapy should focus on the emotional link between the triggers in the here and now and the painful causes in the past. The next step should be the painful job of trying to feel these stuck emotions. It s crucial that the client has a well trained professional psychologist who supports him/her. When the client feels more emotional balanced because the influence of his/her past has diminished, and the client has learned to handle his/her past emotions, then the time has come for the therapist to step back.
Knowing that in Sri Lanka sexuality is a hush hush topic, there is all the more reason to write about it. In my psychology practice I hear from many couples that they have problems with sexual intercourse.
In brief, men and women are wired in a different way. The causes stem from nature and nurture. It is not surprising then that they often have trouble in understanding each other. In Sri Lanka this is enhanced because of the schooling system where most of the children attend boys or girls schools, so there is little opportunity to get familiar with the opposite sex in a natural way.
The typical (Asian) gender roles seem to be culturally defined. Generally speaking boys are raised like little princes and are geared for studies or vocational jobs. Girls usually have to apply themselves to the domestic chores and while more often than not they can do their studies, marriage seems to be the primary goal. As a consequence Sri Lanka appears to be a male dominated society where many women feel second best. Men often take their marriage, their role in it and their spouse for granted. This pattern predominantly occurs with the 35 plus generation; the younger age group seems to be more open to different views.
Also, in Sri Lanka there is not much (if at all) attention to sex education. Generally speaking, men and women have to find out for themselves. Because girls are typically raised in a subdued way without much education where sexuality is concerned, there is a lot of shame and ignorance around this topic. Boys often learn about sexuality from friends or watching porn. With friends you don t know what the quality of the advice is while with porn it s clear that this is a far cry from reality. Many Sri Lankan women haven t learnt to enjoy sexuality with as a result that whilst having intercourse they frequently suffer from a dry vagina. Countless Sri Lankan men are not used to give a long foreplay which also results in a dry vagina of their partner. A lubricant only helps from the male perspective and women don t experience pleasure with it.
The difference in wiring between men and women also goes for sexuality. When men get aroused they will have an erection and basically that s all men need to start penetration. With women it s different. First and foremost, for women emotions are important. The emotional side of foreplay is essential, the feeling of being respected, becoming one with your partner, and the strengthening of the bond with your partner. It s a combination of emotional and physical stimulation. Before penetration becomes enjoyable for women, it is necessary that the natural vaginal moisture increases. As the woman gets more and more sexual excited, the vagina becomes wetter. Usually this takes some time.
Foreplay means more than straight away starting to stimulate the vaginal area and clitoris. There is a whole body that can be pampered! Often it s much more erotic NOT to begin with the genitals and breasts. It can start during the day with flirting, teasing and pleasing and eventually leading up to the bedroom. Important is a loving, sensual and exciting attention for each other and trying to be creative. Slowly undressing each other, kissing, caressing, complimenting, massaging can be very stimulating or by just being very caring and sweet. Communicating is essential; let your partner know what you like and what you don t like!
The term foreplay doesn t mean that you HAVE to have intercourse. Kissing, caressing, manual and/or oral sex can be very satisfying too. There is no obligation in sex. You can excite and spoil each other by being with your attention in the here and now, and then you can see if you want to go further.
There is not one big cosmic meaning for all; there is only the meaning we each give to our life, an individual meaning, an individual plot, like an individual novel, a book for each person. (Ana s Nin).
I believe that I am not responsible for the meaningfulness or meaninglessness of life, but that I am responsible for what I do with the life I've got. (Hermann Hesse).
Giving meaning to your life is about the significance we give to our experiences. Every human being has the need to BE worthy and to DO worthy things. The word meaning indicates: emotion, desire, sense, memory, significance and value. Meaning is not for sale and it s personal, somebody else can t give it to us. Meaning colours our image of the world, our behaviour and our thoughts. What gives meaning to our lives? And what is needed to find meaning when you have lost it? Meaning is never finished but it s a continuing process. Your story about your life colours the way you look at life. Your personal history, your norms and values form the basis for your sense of having a meaningful life.
Thinking about meaning in your life often starts in times of crisis, bereavement or loss, when the meaning of life isn t that natural anymore. At moments when you for example have lost your job, have a serious illness or a divorce you re deeply touched in your life, your existence. SLOW questions well up, questions which are connected with the experience of finiteness, uncontrollability and powerlessness. There are no ready-made answers to questions like why is my loved one dying? or what is the meaning of this suffering? .
Questions about meaning are SLOW because they require time and attention. Giving meaning to your life is a very personal process but it s always in relation to others. Searching for meaning and significance isn t something that you do alone; you ll find it in the relation with and between others. Traditionally, applied philosophies and religions offered answers to questions concerning meaningfulness. As a result of individualisation and secularisation these traditional certainties have faded away and many people are searching for meaning in their lives.
As a professional psychologist you can t talk about meaning without looking at your own existence. You have to reflect on your own values and behaviour (normative professionalism). What is your drive to do your work?
Giving meaning to your life has two dimensions: an implicit one and an explicit one. Implicit meaning is the continuing natural meaningfulness of daily life. It s about the little everyday things of life, like celebrating a birthday, watching a sunrise/sunset, or a nice chat with a friend. This includes having a meaningful day with things you enjoy like fishing or gardening.
Explicit meaning revolves around questions like why is this happening to me? , what is the meaning of my life? , why are we on this earth? . You place your life in a broader context of experiences. You sense a direction, a purpose or a value. This form of meaning refers to an existential level. Explicit questions usually emerge when there is a major crisis or change in your life. They put your life in a total different perspective. A special form of existential meaning is spiritual meaning. Most spiritual experiences have in common that the person who goes through it experiences a profound connection with life, nature or a higher power. Spiritual meaning can help to place existential questions into a broader perspective.
A way to discover what is important for you is to find out what your VALUES are. Your personal values are a central part of who you are (your sense of right and wrong) and what you ought to be. It s essential that you become aware of these important factors in your life, they are your ethical compass in decision making. Examples of values are fairness, justice, integrity, attention, freedom, fame, respect. With a sparring partner you can discuss and discover why these values are so important for YOU.
The arts represent an effective way to learn about meaning in your life. Music, poetry, theatre, painting, drawing, sculpture .. these are all forms of art which can help you to explore (enjoy, be touched, feel, experience) meaning. Music for example, appeals to us on a completely different level than words. Sometimes you can get emotional when you hear certain music; everyone has his/her favourite music. You can discover what music can do with you and how it can be a source of vitality and consolation.
Connecting with nature (a simple walk in a beautiful park can do wonders) is another way; or having a chat about pictures or objects which symbolises questions regarding life; or starting a course in meditation; or going to Temple or to your church.
The quest for meaning in your life becomes easier if you constantly ask yourself what is meaningful for ME or what do I find useful for MYSELF? It gives you concrete answers and it agrees more with your own identity and with your choices in your life. It encourages you to take steps instead of feeling overwhelmed by the big questions about the meaning of life.
In Sri Lanka, burnout is quite unknown and hardly diagnosed. People usually continue with their work until they just can t anymore. They lose their job and stay at home and in many cases get some medication for a different diagnosis. In the Western world when people have a burnout, the typical advice from medical doctors or psychologists is to take a rest, do a course in time-management or start yoga/meditation. But is this the correct solution?
There is an abundance of information about burnout but there are a number of misunderstandings; for instance the belief that you get a burnout from working too hard. It typically happens to people who have high demands (for themselves and/or others) and who don t take sufficient time to relax. By wanting to do too much they detach from themselves. There is some truth in the saying that we have to re-learn to feel bored sometimes again. But this is not the whole story.
When research indicates that one out of seven employees feel emotionally exhausted because of the work, you hardly can speak of an individual problem . More importantly, why don t ask employers themselves how they can keep their employees productive? Especially in the corporate world, too many white collar workers whilst climbing the corporate ladder frantically try to fulfill the expectancies and demands of their superiors. At the same time they get less and less energised because they can t implement their own ideas which in the long term will end up in a burnout. They have turned into that sour and dour colleague who has become convinced that most and for all you have to produce and deliver .
In psychiatry there is no official diagnosis called burnout. The complaints about stress are usually labelled as an adjustment disorder (DSM IV) or a somatic symptom disorder (DSM 5). But it is recognised by the ICD-10 (International Classification of Diseases, tenth revision). In Europe, the burnout syndrome is quite often used as a basis for being unfit to work.
Psychologists often define burnout as a work related chronic fatigue, caused by exhaustion and cynicism. Someone with a burnout is so exhausted that there isn t much energy left to function well at work. This results in a downward negative spiral of lower performance, lower productivity, increasing cynicism and an ever-increasing feeling of inadequacy. Although the causes of burnout can be individual like having too high demands and taking not enough time to recuperate, in most cases the work itself appears to be the prime suspect. Employees can have too little control regarding their work situation, they don t have the feeling that they have sufficient input in the end result that they produce, or they can have a bad relationship with their manager. But employers have a tendency to only look at individual problems when somebody ends up being sick at home. In the recovery phase there is characteristically an emphasis on self-development. The employee has to change, to adapt more to the work environment.
While in reality it can also be that the work has to change. So many corporates become corporate robots , running from meeting to meeting defending interests that are not their own. It s more important to go with the flow than having a brilliant new idea. People survive but they have ceased to be inspired and lack enthusiasm. They give more energy than that they receive. In a healthy work environment there should be a balance between these two. We get energy from sufficient positive feedback, adequate autonomy how we do our work and plan our time, and enough social support. When there are too many demands then the resources will dry up. The solution should be to restore the resources, with the help of the organisation. It s no use sending someone to a mindfulness course or giving that person less tasks. Instead of this, have a private chat with the employees and ask them what they need. Then they will experience again the feeling of being in control over their own life.
But what if a manager doesn t listen or if there is no space for what you want? In the end you have your own responsibility to create a healthy balance and if needed you should look for another job or start your own business/profession. Work is a huge part of your life, it s SO important to do work that you at least like and if possible that you love. Go for your drive, passion and don t accept a humdrum mediocre existence.
As part of their training, psychologists have to undergo a stringent and extensive schooling regarding research. Psychiatrists and other medical doctors are generally speaking not trained in conducting and understanding research. Not only plain statistics like multiple regression analysis but more about the art of how to set up proper research studies and how to read them. In Sri Lanka, and in many other countries, the educational system (including universities) is more focused upon memorizing and reproducing than in critical thinking. As a consequence of all this one reads very unscientific and biased statements that electroconvulsive treatment (ECT) is an adequate treatment with depression or that negative thoughts can kill brain cells .
In Sri Lanka there are numerous psychiatrists who still believe that ECT can cure depression. There are of course financial interests, ECT is one of the most lucrative psychiatric treatments there is. In addition, many studies about ECT are extremely biased in favour of ECT, like the book of the historian Edward Shorter (see my article "Shocking truths about shock treatment on my website www.marcelderoos.com). Independent studies, unlike the earlier mentioned financially and personally involved Edward Shorter, show a completely different picture.
One of the most vocal critics of ECT is Professor Dr. John Read from the University of Liverpool. In 2010, John Read and Richard Bentall co-authored a comprehensive literature review on "The effectiveness of electroconvulsive therapy . It examined placebo-controlled studies and concluded that ECT had minimal benefits for people with depression and schizophrenia. The authors said "given the strong evidence of persistent and, for some, permanent brain dysfunction, primarily evidenced in the form of retrograde and anterograde amnesia, and the evidence of a slight but significant increased risk of death, the cost-benefit analysis for ECT is so poor that its use cannot be scientifically justified".
Dr. John Read says that what happens is a little like recharging a car battery. It's not difficult to get artificial changes in the brain, you could do it with cocaine, but it doesn't last and three or four weeks later the person is either back at the same level of depression or many studies show worse levels of depression. Opponents say that ECT patients can enter into an addictive cycle of repeated treatment and that any improvement beyond the very short term is likely to be little more than an extreme form of the placebo effect, with patients benefitting psychologically from the extra care and medical attention associated with ECT. It's not in any way addressing the root-cause of their depression. It's systematically and gradually wiping out their memory and cognitive function.
Another literature study by Colin A. Ross (in Ethical human psychology and psychiatry, February 2006) comes to a similar conclusion. The author reviewed the placebo-controlled literature on (ECT) for depression. No study demonstrated a significant difference between real and placebo (sham) ECT at 1 month post-treatment. Many studies failed to find a difference between real and sham ECT even during the period of treatment. Claims in textbooks and review articles that ECT is effective are not consistent with the published data.
In December 2016 C.R. Blease stated in the Journal of medical ethics that since there is still no explanation how ECT works, although there are a few cases where ECT seemed to have been beneficial, plus the risks of serious side-effects that ECT may produce, the informed consent must include a comprehensive account of these uncertainties.
In the light of the lack of evidence that ECT works and the compelling risks of serious side-effects one should be very careful with deciding to administer ECT. Dr. John Reed is convinced that in 10 or 15 years we will have put ECT in same rubbish bin of historical treatments as lobotomies and surprise baths that have been discarded over time.
A na ve medical doctor: you can prescribe a pill and receive sponsor money from the pharmaceutical industry for it, but it still can be a good and adequate pill (because you are a doctor and you know what is right). This is a so called (logical) syllogism. Whilst sitting in his leather arm chair, drinking port and citing Homer, this doctor s syllogism might be correct in a rhetorical sense (a correct logical analysis) but it s not a CRITICAL analysis. There is also something called reality.
Numerous studies have proved that doctors who are sponsored by the pharmaceutical companies prescribe more of these (typically more expensive) drugs than non-sponsored doctors. The pharmaceutical industry knows what it is doing: the lion share of their promotional budget is spent on trying to influence medical doctors. Money usually has a persuasive influence but doctors don t always recognise this. People are manipulated with money; when you receive something you (unconsciously) feel obliged towards the supplier. And the pharmaceutical industry understands perfectly well how to exploit this.
In the Western world there is a huge discussion going on about this. The pharmaceutical industry should stop with paying doctors for all kinds of questionable services. Patients should be able to rely on their doctors prescribing the best medicine and not the most profitable one for the pharmaceutical industry. GSK, one of the biggest pharmaceutical companies worldwide, has already stopped with these payments.
One of the most recent studies comes from Belgium and was published in November 2016 in the Journal of Medical Ethics ( Prescription preferences in antipsychotics and attitude towards the pharmaceutical industry in Belgium ). Belgian psychiatrists and family doctors who have a frequent contact with agents of the pharmaceutical industry prescribe more of the latest and more expensive antipsychotics. While according to experts, these medications do not perform better than the older and cheaper generation tablets.
In Germany, more than half of the doctors admit that their prescription behaviour is influenced by contacts with the pharmaceutical industry (PLOSOne, October 2014, Contact between doctors and the pharmaceutical industry, their perceptions, and the effects on prescribing habits ). In the UK, payments to British doctors are made public since 2016. In the USA, things are done on a much bigger scale. In 2016, American researchers published four comprehensive studies which show a connection between the prescription behaviour of doctors and payments from the pharmaceutical industry. On the website dollarsfordocs, initiated by an American group of investigating journalists, there are publications which show that doctors who are paid by the pharmaceutical industry prescribe more brand name medicine.
The American online newspaper The Huffington Post published a blood chilling article series ( americas most admired law breaker ) from the investigating journalist Steven Brill about how a big medicine manufacturer has earned billions of dollars in the recent years with the illegal sale of Risperdal. This drug against psychosis (with brand names like Risnia, Risperdone) was forbidden to prescribe (so called off-label ) to children and the elderly because of the dangers involved. Although the Federal Food and Drug Administration warned the company, it deliberately marketed Risperdal to millions of people who were not supposed to receive the drug. It continued to do this for no other reason than the profits involved. Every pharmaceutical company has to deal with court cases, but they don t care about that too much. The few billions that amount for court cases are peanuts compared with the tens or hundreds of billions that they earn with the sales of medications.
So how do doctors get influenced by the pharmaceutical industry? Their sales are made by means of the prescriptions of the medical doctors so their marketing focuses on them. They earn the most with new, patented medicine of which they can unilaterally determine the pricing. These new medicines are always unproven safe and unproven effective. Only after admitting them to the (worldwide) pharmaceutical market the phase-4 studies begin: huge, long lasting studies where the medicine is being tested for the first time on rigorous criteria like a longer and better life. In these phase-4 studies many drugs fail. Countless patients would have suffered less if these studies had been mandatory before a new drug was released on the market. The worldwide marketing machine of Big Pharma eagerly exploits the shortage of reliable test data at the start. They don t steer clear of deception. They publish unfounded statements which can t be proven false because of the lack of initial test data. This manipulation is so successful that doctors prescribe these medications within a short time in massive quantities.
In the past decades hundreds of thousands patients worldwide died because of new medicine which weren t tested by phase-4 studies. Avandia, a new drug against diabetes caused a deadly heart attack for 47,000 people, according to an American Senate committee in 2010. Eighty percent of the American diabetes patients used Avandia when it was taken from the market in that year. There was no court case. The manufacturer settled the case for 3.7 billion dollars whilst having earned many times that amount in profits from the sales of the drug.
In order to influence doctors to prescribe a certain drug, the pharmaceutical industry makes use of so called key medical opinion leaders. These are experts in a certain medical field, publish in medical journals, speak on medical conferences and doctors perceive them as guides and mentors. If you want to conquer the market you have to win over these opinion leaders. Big Pharma has meticulously forged strong relationships with opinion leaders in every lucrative medical field. They are persuaded with profitable research assignments, well-paid participations in phase-4 studies, nominations for an advisory on a scientific board, funding of foreign trips, professor by special appointment, and many other emoluments. All this creates a dependent relationship with the manufacturers, which translates itself into compliance with the marketing of their products.
Another trend is that nowadays universities and research institutions are highly commercialised and that they depend more and more on financial input from for example the pharmaceutical industry. That means that research is very often biased (subtle or not so subtle) in favour of the paying company. And medical doctors rely on these research results.
For doctors continuing training courses are mandatory. But governments won t facilitate this because lack of funds. So the pharmaceutical industry happily provides for this and offers these courses dirt cheap or even free of charge. And they pay their key opinion leaders to participate as speakers. This is one of the first things that should be changed. Our doctors need to be trained in independent training courses. And the testing of new drugs should be done by independent research institutes. A long way to go
Experts in the UK estimate that in 2015 1.5 million young people (50%) have been bullied and that out of these one out of five were bullied every day (www.ditchthelabel.org: Anti Bullying Survey 2016). When you are being bullied for some time it can destabilise your life in a serious way, not only as a child but also as an adult.
Bullying is the use of force, threat or coercion to abuse, intimidate or aggressively dominate others. There is hostile intent, an imbalance of social or physical power and it is repeated in time and it s habitual. It can happen at school, at work but also in an elderly care home. Since the introduction of the internet, there is also cyber bullying through social media.
The consequences of being bullied can be quite severe. Feelings of lower self-worth, loneliness, anxiety, fear, panic, lesser performance at school or at work, being afraid to make new friends, sleep disorders, burn-out, serious depression and suicide. When you are bullied you feel often ashamed to talk about it. It s very hard to try to deal with bullying alone, it s best to look for professional help.
When a child is bullied at school, parents often blame the school of negligence. The school in return, tells the parents that they have an anti-bullying programme and that they did what they could to stop the bullying. Researchers time and again conclude that the most respected and professional anti-bullying programmes hardly change the situation at schools. Several meta-analyses about school anti-bullying programmes indicate that at best there is some change in knowledge and attitudes but that the actual bullying behaviour isn t influenced.
Even when schools use the best (the most widely used and often referred to as the golden standard) anti-bullying programme, the Olweus Bullying Prevention Programme, the results are disappointing. A huge and comprehensive study of this programme found that after two years of implementation there was a mere 12% reduction in the number of children who reported being bullied twice or more times per month. Many other effect-studies about programmes are not very trustworthy because stakeholders are involved in it.
It s undeniable that schools should be aware that bullying takes place on their premises. School can be a wonderful environment but you can also encounter physical / verbal abuse and emotional intimidation like harassment, hazing, name-calling, condescending people, peer pressure, cliques, two-faced friends, and anonymous cyber-bullies.
But instead of focusing on schools to give the solution it s better to empower the victims of bullying. Not just by saying that they should toughen up, but to take the whole situation into consideration. Every individual is different; the first step should be to LISTEN. Make a thorough assessment of the victim s personal history, the home situation, the school situation, and possible other factors. Before children can learn anti-bullying skills and be effective in stopping bullies, they need to develop the internal courage, strength, determination and endurance to succeed. Having that one person whom they can trust and can open up to is a good start. Personal problems need to be addressed; how is the relationship with the parents and siblings, what is the personal history? And how can you deal with feelings of isolation, helplessness and depression, how can you increase your confidence and self-esteem.
There is no standard solution, every case is different. But it s clear that being nice to bullies doesn t work. Bullies understand only one language and that is when they meet resistance, boundaries. Victims have to learn skills in a verbal, non-verbal and sometimes in a physical way. Skills like making friends and allies at school, or improving their body language, or joining a martial arts club, or learning to stop being nice and push back verbally and physically.
Assertive children and adults are less inclined to be bullied. When you are assertive then you stand up for your own opinion, rights and points of view. You have clear boundaries but you acknowledge the boundaries of others too.
Many questions have been asked and answered in the past months. Below are the three clusters of the most frequent asked topics.
ECT.
The article about electroconvulsive treatment ("Shocking truths about shock treatment on my website www.marcelderoos.com) caused several readers to think twice about submitting themselves or their loved ones to this kind of treatment. And with good reason, as written in the article there is no scientific / medical proof that ECT works. Worse than that, the frequently occurring adverse effects like (permanent) memory loss plus the staggering costs are worrisome. Clients of mine who have experienced it complained about the financial burden: seven Lakhs for two series of treatments seems to be quite normal.
Drinking problems.
Generally speaking, in Sri Lanka alcohol consumption is seen (especially for males) as part and parcel of society. But drinking becomes an issue when there are no boundaries. This starts with so called binge drinking and soon after it becomes a huge problem when addiction starts to creep in. Much has been written about alcohol addiction and how to get out of it. There are successful and less successful ways. In recent years a whole rehab industry has emerged that offers help. This industry is quite lucrative and usually recommends a three months stay in a centre or in a more luxury resort-like environment. Besides therapy and medical treatment, all kinds of activities are given such as meditation, yoga, water sports, hiking, etc.
But there is this dirty little secret about rehab. Most problem drinkers have quit alcohol without going to rehab. Also, independent research about the effectiveness of rehab centres/resorts is usually lacking. Many keep their (generally speaking disappointing) results to themselves (very often these results are temporarily) or tell people that it s their own fault and they have to do the same (expensive) treatment again.
Typically these programs work with evidence based therapies. But in reality there are no evidence based therapies. The therapist client relationship is the most important factor plus an active client. A recommended approach is one that covers emotions, cognition, behaviour, the past and the present. Root causes of the drinking problem should be uncovered and dealt with. After that comes learning how to deal with triggers and the underlying emotions. There is a lot more to say but there is no space for that here. In previous articles I have given more information.
Anxiety.
We all experience anxiety once in a while. But it can become quite a different story when anxiety and panic attacks control your life. About 10 to15% of the population gets an anxiety disorder in their life, so it s relatively common.
It s important that you admit that you have a problem. Anxiety and panic attacks are there for a reason and you can try to find out why you feel as you feel. By coming to terms in an emotional way with the root cause it will go away. A specialised psychologist can help you with that.
There are some tricks to handle anxiety and panic attacks in the here and now. Basically it s about practicing deep breathing techniques to calm yourself down, positive visualisation before a stressful event, during stressful moments thinking about positive important people in your life and meaningful things in the near future in order to ground yourself .
Some facts about ADHD:
- ADHD is NOT a disease and NOT a neurological problem.
- You are NOT born with it.
- Medication is very often NOT the appropriate way of dealing with ADHD symptoms.
There exists no scientific / medical evidence that invalidates the above statements about ADHD. ADHD is not some neurobiological brain abnormality which explains certain behaviour. No, ADHD is nothing but a DESCRIPTION of that behaviour. And this behaviour has not one unequivocal cause; there are always several (mostly environmental) factors which influence each other.
Psychiatrists, pediatricians and other medical doctors are trained to look for symptoms and subsequently treating these. Psychologists on the other hand are more interested in the whole story of the client (see for example my article "Do we need a diagnosis with mental health issues? on my website www.marcelderoos.com). This difference can lead to complete different conclusions regarding the client and the treatment.
The only(!) study about long-term effects of psycho-stimulant medications like Ritalin is very clear in its conclusions. It is the so called MTA (The multimodal treatment of ADHD), sponsored by the National Institute of Mental Health in the USA. During sixteen years the researchers have followed 515 children diagnosed with ADHD. It shows that after two years, there is no difference in symptoms between groups of children who do and don t use medication. Also, recent findings from the MTA show that medication users are on average more than two centimeters shorter than non-users.
In addition to this, children s brains are vulnerable and we don t know what strong medication like Ritalin does to them. There are well known side-effects like a decreased appetite and cardiovascular complaints. But also anxiety, less social interaction, numbing of the emotional life, sleeplessness and addiction are named. Less common, but potentially lethal results from taking these pills is, that they can cause suicidal thoughts and psychosis.
In reality it s often an underpaid and overstressed teacher with a class of 30+ children who can t handle an overactive child. A phone call to the parents is quickly made with the message do something with a reference to ADHD and the machine starts working. The parents visit a psychiatrist who typically doesn t take into account the environmental factors and prescribes medication within minutes. The danger with prescribing medications like Ritalin is that you give a psychological message to your child that there is something wrong with him/her. While in reality there is something wrong with us, the society.
Another recent study in The Lancet Psychiatry (Hoogman et al, April 2017) tried to prove that ADHD is a disorder of the brain. The authors (many of them have strong ties with the pharmaceutical industry as shown in the conflicts of interest list at the end of the article) gave their study the headline subcortical brain volume differences between people with and without ADHD . They recommend that this should be communicated to children diagnosed with ADHD and to their parents.
But the results of their study show the opposite! First of all they demonstrate that the brain volume differences between children with and without ADHD are negligible. Secondly they show that these almost non-existent differences disappear when the children are adults.
The authors collected data from all kinds of smaller studies and compared the brain volumes of 1713 people with and 1529 without ADHD diagnosis. Between the two groups there were differences with an average of a few percent in five brain areas. But differences between groups can never be translated into individuals because for most individuals there are no differences. On top of this the effect size called Cohen s d (which in this study is an appropriate measure for the differences between the ADHD and non-ADHD group) was very small.
Practically this means that if you are shown a brain scan of a child and on the basis of that scan you have to assess if a child shows behaviour that we call ADHD, the chance that your assessment is correct lies 1 or 2 percent above chance. We are talking about an almost non-existent effect.
Problem children usually have more than one problem at the same time. The big question is where these problems stem from! The wrong way to react is done in threefold. The first is to label a complex issue as a disorder and subsequently partition it into ADHD, conduct disorder, non-verbal learning disorder, oppositional defiant disorder, etc. Secondly each of those disorders is separately pseudo-medicalised, as if it s a brain condition that can be determined in a neurological or even in a genetical way. And finally all problems are taken out of their context and totally attributed to the child. Society, social-economic context, school, parents, family, are not taken into consideration. ADHD is then nothing more than tallying up some symptoms of the child and voila, there is your diagnosis.
Medication can only suppress unwanted ADHD behaviour for a maximum of two years and has a number of serious disadvantages as mentioned above. Sometimes in difficult cases medication is appropriate. In many cases parental advice, teacher training and psychological support suffices. It s important to create an environment that is clear, quiet and predictable. There should be clear boundaries and positive behaviour should be noted and rewarded.
In our brain some billions of neurons are in contact with each other by means of long nerve fibers. And they transmit small electrical and chemical pulses which travel rapidly to other neurons, which in their turn generate new pulses or on the contrary stop with sending pulses.
Nobody understands how from the same pulses in one part of the brain vision is created and in another part hearing . All of our mental activity (thinking, calculating, praying, remembering, etc.) stems from our brain. But we have no clue in which way this is exactly happening.
Has psychiatry made any progress in the past thirty, forty years when it tried to explain and treat psychiatric illnesses as brain dysfunctions? Modern psychiatry tries to influence the abnormal mental state of psychiatric patients (delusions, bipolar depression, anxiety, depression, etc.) by manipulating the pulse traffic . That is the idea of psychopharmacology or brain pills . With a few illnesses it seems to work (bipolar depression, psychosis), although the sometimes serious side-effects of the medications are not to be taken lightly. And the beneficial effect of most medications has been found by sheer accident. But we have really NO idea why it seems to work because we have no insight regarding what has changed in the pulse pattern causing the mental illness.
The conclusion is that in the past forty years there have been no (major) developments in psychiatry. At present, despite billions of dollars in research, the concept that psychiatric problems are biological / neurological in nature has failed. It is very regrettable that as a result of this continuous neurobiological hope, psychiatrists have more and more ceased to be understanding and empathic.
With depression, antidepressants can give you a sensation that they help (we don t know why) but quite often they don t work. They numb your feelings and common side effects are weight gain and sexual dysfunctions.
The classic mistake made by psychiatrists with for example anxiety and depression is not to look for root causes. It s not an exaggeration to state that the graveyards are littered with drugged depressed people. Despite being medicated up to their eyebrows with antidepressants and mood stabilisers people do commit suicide (maybe BECAUSE of this). They don t have access to the root causes of their depression and they feel numbed. This can be life threatening.
No biological or genetic explanations have been found for depression or for any other psychiatric disorder. Notwithstanding this, modern psychiatry is still based upon the biological model. But we also know that depression has everything to do with FEELING depressed. Since depression is about stuck emotions, it makes sense to treat it from that angle. An empathic psychotherapist with sufficient knowledge about depression can coach the client in making the stuck feelings fluid again. It s about making the client feel that he/she is understood and that his/her story and symptoms are taken seriously. It s about empowering people. In therapy there is a lot of talking, but in essence it s about venting your feelings and coming to terms with yourself.
Prevention of depression is quite simple in itself. People have to learn to talk about their problems. They have to vent their feelings. In a society like Sri Lanka, where talking about personal problems is not done, this is not easy. There is a lot to gain with more open mindedness in this respect.
In 2002 a committee was formed for the preparation for the fifth edition of the Diagnostic and Statistical Manual of mental disorders (DSM). They wanted to know if people with the same DSM diagnosis form homogeneous groups, whether the same treatments are effective with them and if any explaining biological / genetic factors have been found. There were no positive conclusions about any of these three questions. The report of David Kupfer (the chairman of the American Psychiatric Association committee for psychiatric diagnostics) and co-writers was shocking. They concluded that there is NO (not even a very weak) relation between depression and genetics. Nor are there any biological causes for any psychiatric disorder (including depression). A person can often be described with different DSM labels and people regularly change from disorder . Also the fact that antidepressants are prescribed for all kinds of disorders from the DSM signifies that the categorisation of the psychiatric problems could have been completely different.
A group of thirteen leading neuroscientists, on behalf of the American National Institute of Mental Health (NIMH), wrote a state of the art report (2002) about the research regarding depression and biology. Eric Nestler and his co-authors described the progress DISAPPOINTING and RUDIMENTARY. Antidepressants seem to work in about 30% of the cases but we don t know why (a big part is placebo) and we don t know why some antidepressants that hinder the serotonin transmission also seem to be working (which is the opposite of what the theory claims).
Another group of experts (Kathleen Merikangas et al) came to a similar result in 2002 with their NIMH report regarding depression and genetics. Although there are illnesses that occur relatively frequently with next of kin, that doesn t mean that there is a genetic cause. This group writes about a substantial pessimism whether the underlying genes for mood disorders will ever be found.
Since then nothing much has changed. But for some thirty years one still reads that the exact underlying brain dysfunctions have not yet been identified, but research will give us the answers soon . This sounds like the belief that very soon water will replace petrol as fuel for car engines.
Nowadays most of us are busy, very busy. We re running from one thing to another and we don t take time for awareness and contemplation, we are losing connection with ourselves. Today there is hardly any emotional connection with our internal time. Characteristic of the present way of dealing with time is that everything has to be efficient. We live in a 24-hours economy where time equals money and slowing down means a loss of profit.
There is a difference between clock time and internal time . The clock time is the objective measurable time; like we know from our watch. The internal time is the moment where we come to new insights by means of slowing down and deep concentration. The experience of the internal time can be understood as enthusiasm, concentration and reflection. The Dutch philosopher Dr. Hermsen has written several books about this. One of her latest books is translated into English, it s called Kairos Castle: the art of the moment .
The Greek word schol signifies peace of mind, free time, daydreaming. Our word school has derived from that because Plato saw this as a requisite condition for the thought process. It s similar to the Chinese wu wei (non-doing) which in Taoism is a source of knowledge. New ideas don t emerge by means of time pressure and stress. In the educational system and in our daily life this concept of peace of mind seems to have disappeared. You can question yourself how much awareness you can generate if you continuously switch from screen to screen. We need peace of mind, daydreaming, to become creative, but also for critical reflection. It s like you have to empty your mind first before new ideas can emerge. Peace of mind can originate from staring out of the window enjoying nature, a walk, doing an active sport, playing an instrument, enjoying art, as long as there are no expectations of external goals, profit or publicity.
In Greek mythology there are two gods of Time. Chronos stands for the god of clock time, the minutes and hours which brings order, structure and continuity. Kairos, (who is the youngest and most rebellious grandson of Chronos) on the other hand is the god of the opportune moment . This has nothing to do with the counting of seconds and minutes. Awareness, peace of mind and the careful weighing of arguments and circumstances are the most important conditions to create the Kairotic moment. In classical antiquity it meant simultaneously good timing and the catching or utilising of the right chance or opportunity. This can reveal itself to you as a result of concentration, being alert and studying the specific context.
Because Kairos was able to accomplish change, insight and positive reversal he was depicted as a young, strong and muscled god. Grandpa Chronos on the contrary was shown as an old man with a long beard and an hourglass in his hand for measuring the time. An important part of the aesthetic experience of Kairotic time is that it guides you into a different time zone where the ticking of the clock stops. It s a time that feels more spacious, full and more personal. Whereas Chronos time (the one of the full agenda) feels as a too tight jacket. In the continuous static Chronos time the Kairotic time is an interval which can lead to new insights.
Time in the sense of peace of mind, coming to terms with your feelings and reflection can also be a healthy way to deal with melancholic moods. In our present restless and hectic times these feelings are often quickly suppressed with activities or with a box of pills. While in reality the realisation of loss and transience (which is often represented in art) can be a rich source for empathy, self compassion and creativity. If these feelings of melancholy are ignored then they can turn into depression.
In brief, unproductive daydreaming can lead to beneficial developments like a more balanced personality, coming to terms with feelings of loss, feeling more assertive and having creative ideas and new insights. This is not to say that we should spend our days staring out of the window. But a more balanced way of life with inspired work, some regular physical exercise, eating healthy and time for reflection and daydreaming will most certainly enrich your life.
There can be all kinds of reasons why you can t or don t want to visit a psychologist. Perhaps you have a busy schedule or the travelling time is too much or you feel it s just a too big step. In these (and other cases) online therapy can be useful.
Online therapy is a treatment method for psychological problems where the contact between the client and the therapist goes by email, chat or video (for example Skype, FaceTime). It s mostly used for typical counseling problems, like light depression, career advice or personal development.
Advantages of online (Skype) therapy are:
- Flexible hours. You can speak with a therapist at any time of the day. It s possible to have sessions during your lunch break instead of taking time off to make an appointment.
- In your own environment. You can talk from your comfy chair.
- There is no time, effort and money involved with travelling.
- It can be cheaper than normal therapy.
- With email or chat therapy (or Skype with the video switched off) you stay anonymous.
There are of course drawbacks too:
- Concerns regarding confidentiality and privacy. Transmitting your personal information online makes privacy leaks and hacks more of a concern.
- Unreliable technology. Disturbances in video and/or sound quality can make treatment difficult.
- It s complicated with more complex problems and in crisis situations or with suicidal feelings it s difficult for the therapist to react.
- Even with Skype it can be difficult for the therapist to detect the non-verbal communication of the client. You often only see a face and not the rest of the body. In addition, online video can give a picture of the situation but it often lacks the intimacy and intricacy of real-world interactions.
- Online therapy businesses that work with therapists from abroad (for example from the USA) often lack insight in Sri Lankan customs and way of life. It is important to be sensitive to cultural, linguistic, religious and political issues.
- There is a question whether empathy can be carried through a microphone and webcam. The actual REAL presence of a highly trained, attentive and compassionate professional in front of you while undergoing therapy seems vital. For the therapist, it is important to be able to notice your client s behaviours and reactions and at the same time extend warm and empathic support. As a therapist I conduct Skype sessions too but for me a major drawback is that I don t sense the client s emotions that well as in a normal therapy session.
- The actual therapeutic environment (the office room) cannot easily be replaced with online therapy. It plays an important role in terms of safety, a neutral place away from home and work; it s not attached to the client s everyday life. You re not disturbed by emails, phone calls or visitors. At the end of a session, the client can close the door of the office room and leave behind the distress. This is not possible with online therapy.
The bottom line is that everybody has different needs and expectations. It seems that online therapy might be a good option for relatively uncomplicated issues or for those who cannot afford or who don t have access to traditional therapy. But online therapy is not suitable for those who have serious problems and for people who will benefit from a long-lasting, deep and solid connection with a therapist. Online therapy can be a good first try with therapy or a supplement, but regarding it as a time and money saver compared with traditional therapy sessions seems to be pennywise but pound foolish.
Bestseller writers like Norman Vincent Peale ( The power of positive thinking , 1952), Anthony Robbins ( Awaken the giant within , 1991), Rhonda Byrne ( The Secret , 2006) and Martin Seligman, the founder of the positive psychology movement ( Authentic Happiness , 2002 and Flourish , 2011) make us believe that continuous happiness is within our reach. We just have to follow what they advise in their books and our worries will disappear. From this list, The Secret is by far the shallowest one and filled with silly quotes and superstitious nonsense.
All these books more or less say the same things: stay positive and focus on your goals, pay no attention to negative thoughts and self-doubt, and visualise what you desire. Then you will get what you want .. This quest for happiness is an existential mistake. Nowadays many people not only want to be non-stop happy , but they also want this experience each time to become deeper and more intense. But with this constant pursuit of kicks and pleasure you will lose meaning in life.
Happiness is NOT the absence of negative emotions. It s not about being happy and smiling 24 hours a day, seven days a week. Happiness is not about being numb to negative feelings. Nietzsche wrote: "Mankind does not strive for happiness; only the Englishman does that." With this he meant that those who aim at being happy (as the English utilitarian philosophers of his time did) are doomed to fail. We can only become happy as a by-product of something else.
In order to live the full human life, you have to experience the full range of human emotions, the positive and the negative. They both play an important role in our ability to thrive. Positive emotions make you feel good, negative emotions make you feel uncomfortable but they also make you aware of things that are wrong and of possible ways how to change them.
Positive psychology uses cognitive behaviour theory and techniques, gratitude journals and positive affirmations in order to challenge your negative thoughts. But we can t THINK ourselves happy. You simply have to understand and come to terms with the disturbing feelings that CAUSE these thoughts; you can t push them away or ignore them. These feelings are too strong and they invariably will surface again but then much more powerful. IF YOU DON'T DEAL WITH YOUR FEELINGS, YOUR FEELINGS WILL DEAL WITH YOU. Positive psychology also promotes resilience , and in order to become more resilient they urge you to have stronger and closer relationships. But the only way to do that is to become more vulnerable. In other words to communicate about your negative emotions ; in life there are periodically inescapable challenges like suffering and deprivation. People in relationships encounter for example conflicts, anger and sadness. Which is a no go area for the positive psychologists .
The Harvard Medical School professor and psychologist Susan David wrote a book called Emotional agility . She states that in our present culture the happiness obsession and the positive-thinking movement have caused a tyranny of positivity ( just be positive and things will be fine ; you can beat cancer with positive thinking, and if it didn t work then you weren t positive enough ). People are used to avoid or repress feelings like grief, sadness, guilt or anger. And we are taught not to probe our feelings (negative or positive) too deeply.
But instead of this we should pay close attention to our emotions. In adverse situations the steady stream of thoughts and feelings that form our inner self can become our best teacher. Our emotions can tell us what we value most, and these values can guide us to become more resilient, stable, compassionate and courageous. Life guarantees us that you will become sick, your loved one might leave you, your work might become a lot less interesting. We will experience anger, sadness, guilt, grief, etc. Our resilience will only grow if we learn to process and become comfortable with the whole range of our feelings. The present strong focus on happiness and positive thinking makes us less resilient. More importantly, emotions like anger, sadness, guilt and grief make our values clear. We get angry or sad about things that we care about. If we ignore these emotions then we lose an opportunity to learn about ourselves. Thinking positive and putting our negative emotions aside, just doesn t work.
To be in a relationship with a person who has a narcissistic personality disorder (NPD) is typically a destructive one. People who have a NPD are not good at maintaining relationships. Falling in love with a person who has this disorder isn t difficult at the start because they can be very charming and energetic. But when the real personality (the narcissist) becomes clear then the relationship often changes into one where manipulation, humiliation and feelings of helplessness play a major role.
Narcissists appear to be quite interesting at the start; they radiate confidence which can be very attractive. Because they are experts in manipulation the first months will probably seem nice. But as soon as a narcissist senses that the victim feels attached to him/her, the manipulation starts in earnest.
Characteristic for a narcissistic relationship is that it is based upon a twisted power balance. The narcissist has a suffocating hold over his/her partner, and gets energy from keeping her/him small. Please be aware that narcissists come in many forms. At the one end of the scale comes the person who displays some annoying narcissistic traits. Even with a few of these traits, a relationship can become very difficult. At the other end is the person with a full-blown NPD. It s paramount that you realise what you re into before you start a relationship with such a person. You will be at risk of becoming the victim of physical, sexual and emotional abuse. Please seek professional help as soon as possible.
A few signs that your partner may have narcissistic traits:
- having no form of empathy; there is no capability of having consideration with others.
- having an exaggerated sense of self-importance, expects to be recognised as superior even without achievements that warrants it.
- having fantasies about unlimited success in whatever they do.
- requires constant admiration and appreciation from you and from others.
- exaggerates their achievements and abilities and underestimates the contribution of others.
- believes to be superior and can only be understood by equally special people.
- having a strong sense of entitlement.
- lacks insight into themselves and their behaviour.
- lacks appreciation of you, your feelings, your values and beliefs, your interests and concerns.
With a narcissist you can t have conversations about emotions, you will receive no emotional support or empathy, there is extreme anger when criticised, and an excessive dominance. You live in an unhealthy relationship where you constantly feel unhappy, insecure and not worthy. You always adjust yourself to your partner to prevent him/her becoming angry, critical or dissatisfied; with the result that you feel that you have lost your identity.
Reality is that relationships with a narcissist are doomed. These relationships usually end in a painful and ugly way. Narcissists will do their utmost to quickly trap a new victim. A few pointers for when you want to leave your narcissistic partner:
- Realise that there is no hope to mend the relationship; your partner will not change.
- Make a plan about what to say, when you want to say it and how you want to say it.
- Prepare yourself well (a place to live, get legal advice from a lawyer).
- Tell your partner that the relationship isn t working, don t fight or start blaming.
- Leave the relationship and don t hope for reconciliation.
- It is possible to change your situation and to restore your confidence.
If you recognise yourself as a partner of a narcissist and you want to talk about the difficult relationship then it can be very useful to speak with a professional psychologist. Like with most other mental problems, there exists no adequate medication for this disorder and it can be difficult to find a psychiatrist with a sufficient experience and an in-depth understanding of the actual working mechanisms of psychological treatments and with a sound knowledge of psychology itself.
Psychologists and psychiatrists are both mental health professionals who assess and treat (complex) mental disorders. A psychologist is an academic who has studied psychology and a psychiatrist is a medical doctor who is specialised in psychiatry. Psychiatrists work from the belief that mental disorders are biological in nature and try to treat the symptoms with medication. Psychologists assume that most mental disorders have a strong emotional, behavioural and cognitive component, look at the deeper and more comprehensive context and root causes, and treat these with psychotherapy.
Psychiatrists are trained to look for symptoms and subsequently label ( diagnose ) them according to a classification system. In the USA and in Sri Lanka this is usually the Diagnostic and Statistic Manual of mental disorders, fifth edition (DSM 5) while in Europe the International Classification of Diseases, tenth edition (ICD-10) is widely used. There are quite a few significant differences (for example with ADHD) between the two classification systems which signify the arbitrary nature of the classification. After a usual quick (5 10 minutes) symptom-focused interview a diagnosis is formed and a prescription for medication is handed over to the patient.
Psychological assessment is quite different. Psychologists are also trained to diagnose and treat mental disorders but they focus on the root causes and the whole story behind the symptoms. In therapy the client learns to deal with the issues and finds emotional balance. Most mental health issues can and should be treated by psychological interventions. There are a few exceptions like bipolar depression (if correctly diagnosed!) and schizophrenia. Depression is a too serious and too complicated illness to be only treated with psychiatric medication. Medication can have its use for some time to make certain people with severe depression feel more stable, but a comprehensive psychotherapy focused on the root causes should be the mainstay. See also my article "Benefits of psychotherapy" on my website www.marcelderoos.com.
The comparison between medical and psychological diagnostics is one with predominantly differences. What works well with symptoms related to physical illnesses doesn t necessary goes with mental illnesses. Please read my article "Do we need a diagnosis with mental health issues? on my website www.marcelderoos.com for a more detailed discussion.
Psychiatrists and other medical doctors are generally speaking not trained in conducting and understanding research. Psychologists on the other hand, have to undergo a stringent and extensive schooling regarding research. Not only plain statistics like multiple regression analysis but more about the art of how to set up proper research studies and how to read them. Research is difficult; you need to have an extremely critical mindset. But in Sri Lanka the educational system (including universities) is more focused upon memorizing and reproducing than in critical thinking. As a consequence of all this, one often reads in the media unscientific and biased statements. For example the chemical imbalance in the brain regarding depression or the "serotonin reuptake" story (people are encouraged to believe that depression is caused by a deficiency of serotonin as in the analogy with diabetes and insulin); these are just clever marketing concoctions of the pharmaceutical industry without any scientific medical proof.
Psychologists and psychiatrists can work together but it s a complicated relationship, mainly because of the above mentioned differences. Psychiatrists typically focus on trying to subdue the symptoms with medications which blunt the emotions while psychologists try to get to the bottom of the person's emotional state. For psychologists medications usually are an interference with their therapies which aim to coach the person into a more emotional balanced state of mind. Also, psychiatrists may have heard or read something about cognitive behaviour therapy or interpersonal therapy but they often fail to understand the actual working mechanisms of psychological interventions, they typically lack the experience with those methods and they usually have no knowledge of psychological assessment.
A mental disorder like bipolar depression (or for example ADHD ) is a CONSTRUCT: it s a definition made up by humans to describe certain symptoms. A heart disease can be identified with the help of blood tests and electrocardiograms. Diabetes is diagnosed by measuring blood glucose levels. But there is no blood test for depression and no x-ray test to measure bipolar disorder.
Bipolar depression is a very serious illness that should be treated with medication. But in my 30 plus years of practicing I have seen how the definition of bipolar has changed. More and more people have been included by transforming the definition in the Diagnostic and Statistical Manual of Mental Disorders (DSM) 3, 4 and 5 from dichotomous (yes/no) into spectrum , bipolar 1 and 2, and even into sub-threshold . Sadly enough they have even tried this with children too.
It s NOT true that bipolar depression or ADHD shows itself in subtle ways ; this is a prime example of how some psychiatrists make the mistake of so called reification. Reification is the fallacy of treating an abstraction as if it were a real thing. Bipolar depression is just a definition; there exists no subtle signs of it. Only if you change the definition into a broader sense then more people will be included.
Bipolar depression is a very lucrative business for the pharmaceutical industry. It s any manufacturer s ultimate fantasy: people are told to buy expensive products (medication) for the rest of their lives. The pharmaceutical industry is an extremely profit seeking and often immoral business where the stakes are high (trillions of dollars). In the stock markets the pharmaceuticals are doing exceptionally well for many years. Constant lobbying of the pharmaceutical industry in the past decades has increased the chance of being labeled as bipolar significantly.
Bipolar depression is a RESIDUAL category. That means that it s imperative to make a thorough, comprehensive and time consuming assessment of other possible explanations of the symptoms. Psychiatrists have a tendency to go for symptom hunting and stop when the symptoms seem to fit in the category of bipolar depression. This is a gross mistake; a false positive diagnosis causes a lot of problems in terms of pointless lifelong heavy medications, strong side effects, having an unnecessary tainted quality of life and high costs.
According to a publication on the website of the American National Institute of Mental Health the prevalence of bipolar disorder among adults in the USA is 2.6%. It s very interesting to have a look at the source of this information. The epidemiologist Ronald Kessler is head of the World Mental Health Survey Initiative (WMH-survey) for research of the prevalence of psychiatric disorders in the population. The head office of this worldwide project is located at Harvard University where Kessler works as a professor, and it s a project of the World Health Organisation. But most of the researchers are sponsored by the pharmaceutical industry.
Kessler himself works with Shire, GlaxoSmithKline, Lilly, Pfizer, Sanofi-Aventis, and other pharmaceuticals. This is mentioned only once in his many publications. His views regarding the focus of his research are not very neutral as is shown in an article in Nature (456, 7223, 702-705) about cognitive enhancing drugs. This is relevant because much decision making is needed for research of the prevalence of disorders in the population. There is a choice of classification systems (DSM5 or ICD10) and the design of the measurement instruments to determine if somebody meets the criteria for that particular psychiatric category. Subsequently a decision must be made about what kind of people will be examined, how much of them and in which setting the testing will take place. After all of these choices, the results need interpretation too. Because research groups take different decisions in all of these phases, the figures regarding the prevalence of for example bipolar depression and ADHD differ enormously.
The WMH-survey didn t follow the DSM classification system s restriction that the diagnosis bipolar depression can only be made after an extensive assessment by a psychiatrist/psychologist regarding the life of every individual patient, including interviewing the family and the social environment. Contrary to this, the survey was done by merely laymen who only had received an interview training. They asked the participants questions which are a far cry from what is meant by bipolar depression. The participants were of course volunteers, but this can cause a non-representative selection of people who already think in medical terms about themselves.
But most and for all, the symptoms in this survey that have been gathered, can NOT directly be translated into bipolar depression. They need further interpretation from a professional in a proper (lengthy) interview to assess if there is no alternative explanation. In my own psychology practice the vast majority of the clients who have been diagnosed before as being bipolar turn out to be NOT bipolar after a comprehensive (30 60 minutes) interview about their STORY and not just the symptoms. When the story explains in a valid alternative way the symptoms then there is of course NO bipolar depression. For example gambling, a bit of manic behaviour and depression can be explained by a lack of meaning in life; or a period of stress can cause all kinds of symptoms.
All these considerations make the prevalence figure of 2.6% for bipolar depression extremely questionable. The disturbing fact is that this and other prevalence figures from the WMH-survey (e.g. for ADHD) pop up in many policy papers. Psychiatrists are compelled to believe that these are correct prevalence figures; they translate these percentages to their own country and subsequently try to label more people with bipolar depression and other disorders.
N.B: A big thanks to the Dutch Professor Dr G.C.G. Dehue whose book Betere mensen was an inspiration to write this article. I have quoted freely from her critique on the WMH-survey.
Sri Lanka is a country where gender roles are still quite specific. Generally speaking boys are raised like little princes and are guided into doing studies or vocational jobs. Girls usually have to apply themselves to the domestic chores and while they can do their studies, marriage seems to be the primary goal. As a consequence Sri Lanka appears to be a male dominated society where many women feel second best. Men often take their relationship, their role in it and their partner for granted. Although this pattern predominantly occurs with the 30 plus generation; the younger age group doesn t seem to be immune to it either.
In brief, men and women are wired in a different way. The causes stem from nature and nurture. It is not surprising then that they often have trouble in understanding each other. In Sri Lanka this is enhanced because of the schooling system where most of the children attend boys or girls schools, so there is little opportunity to get familiar with the opposite sex in a natural way.
Parents and family often put pressure on girls from their mid twenties onwards to get married. With boys usually the pressure is less and comes at a later age. Proposals are put forward from newspapers and through family and friends. Dating as is typical in the Western world is not very much known here. The advantage of dating is that you can get to know the other person better, with less fixed expectations and for a longer time than through a proposal. There is no sound of imminent wedding bells.
Women should learn to become more aware of this situation and try to change it where wanted or possible, especially with their own children. In order to become more independent an adequate education is paramount. It gives you financial independence but more importantly your self-esteem will improve and your cognitive abilities will develop.
In my psychology practice I hear many stories from (Sri Lankan) women. Very often they experience condescending and humiliating situations with Sri Lankan men. Be it on the streets, in their workplace or in their marriage, they are frequently subjected to behaviour that is unfair and at worst threatening. The contrast is of course more sharply felt by foreign women from a Western background. But also many Sri Lankan women feel uncomfortable.
It s hard to step out of behaviour that has been ingrained into you from an early age. But women should realise that they don t deserve to be treated in an unjust or demeaning way. For many married Sri Lankan men it s often acceptable to have (physical) relationships with other women while they would be appalled if their wives would have these relationships with men outside the marriage. It s quite double-standard.
Gender research tries to elucidate the ways in which complex processes define gender and gender relations. More specifically, how the perception of gender influences power and hierarchies in society. Factors which can contribute to unequal treatment and unequal opportunities are for instance:
- Possible general differences between men and women (for example performance orientated versus social and caring, directive communication style versus participating communication style);
- Stereotype ideas concerning men and women (for example typical male and typical female behaviour and jobs). This stereotype thinking hinders the emancipation process;
- Discrimination (for example differences in salary, there are more men in management roles);
- Preferences in studies and professions are often gender related (there are more women in languages and social studies while more men choose for technology and the exact sciences);
- Unwanted intimacy especially at the workplace (the #MeToo movement followed soon after the public revelations of sexual misconduct allegations against the American film producer Harvey Weinstein).
It s important to be aware of unequal situations and not to accept them as this is how it is in our society . Although cultural changes go slow, it will happen if enough people get informed and become motivated.
We can t understand human suffering with quantitative empirical scientific methods because the human being is far too complicated for a simplistic empirical approach. Quantifying suffering is impossible. Depression for example is different (root causes, process and impact) for different persons. It is possible to select certain symptoms and then categorise and label them as depression (like the DSM does), but that doesn t mean that you can quantify it. When you have hundred depressed people then there are hundred different stories, personality structures and development stages and each of these people needs tailor-made approaches.
Scientists have tried to grasp the difference between psychological normality and abnormality in contemporary scientific terms. Psychological normality is therefore understood in terms of average scores, standard deviation and modal personality. This implies the application of mathematical criteria on psychological characteristics where the famous Gauss bell curve represents the image of a normal distribution: the big normal group in the middle and the smaller abnormal groups on the left and right sides of the centre.
Within the CLINICAL field there is no such quantification. The big question is if this is even possible at all. If you want to measure something you need an objective unit of measurement: centimetres, kilos, degrees, etc. But within the clinical discipline we don t have such an objective unit. What is the unit of measurement for depression, and how would an average depression quotient look like? Contemporary psycho-diagnostics does have a number of scales through which they try to measure for example depression and anxiety. However, further analysis shows that these measurement processes simply refer to the counting of mere words and expressions in sentences. The patient has to estimate to what extent he thinks it s applicable to his state of mind. Although the end result of these scales is numerical, it s not an objective measurement and they always need a thorough interpretation in a proper interview with the patient.
The numerous failed attempts to establish such objective norms inevitably led to experiments with biological parameters. The quantity of aggression for example was supposed to concur with the objectively measurable quantity of testosterone in the blood. But the evidence shows that subjective behaviour is never directly linked to these objective markers.
The saga of the so-called lie detector is a good illustration of this. Despite objective measurements of sweat, heartbeats, and blood pressure, there is hardly a direct connection between the test results and the degree of truth communicated by the test subject. To sum it up, with psychopathology there is no solid connection between objective measurable parameters for a specific psychological problem and the subjective experience and expression.
It s understandable that mental health specialists like psychologists and psychiatrists would like to have a quick diagnosis with a questionnaire but with mental illnesses the only valid diagnosis is a thorough and time consuming interview that focuses on the individual comprehensive story plus the root causes.
Clinical depression is just an agreement to label a number of symptoms (within a certain range). There exists no serotonin deficiency or any other biological (or genetical) marker. It makes better sense to move towards trying to treat the depressive feelings instead of labelling them.
And the treatment shouldn t just consist of prescribing medication (which at best only numbs you instead of addressing the root causes) or a standardised and protocolised method based upon some rigid and shallow theory or piece of research (for example cognitive behaviour therapy or positive thinking ).
Much of the suffering that psychologists try to alleviate can only be addressed by a response from the humanity and nonjudgmental understanding of the individual. Clients slowly come to terms with their pain and hurt; the relief gradually sinks in. Human relationships are much too complicated and much too individualistic to grant an approach that is said to be applicable to everybody.
I tore myself away from the safe comfort of certainties through my love for truth, and truth rewarded me , Simone de Beauvoir
The real voyage of discovery is not in seeking new places but in seeing with new eyes , Marcel Proust
The Belgium psychotherapist Esther Perel, who lives and works in New York, has written a fascinating book about infidelity. In her book The State of Affairs she discusses the tension between the two extremes security and freedom. We want to be close with somebody but we also have a drive to be adventurous and explore our (erotic) desires.
The discovery of an affair can mean the end of the relationship, happiness and identity. Having an affair is of all times (since marriage was invented), but we still don t know much about the deeper layers and motives for it. It s still considered forbidden and a taboo but it s practiced universally.
Why do people cheat? When we say infidelity, what exactly do we mean? Is there such a thing as an affair-proof marriage? Is it possible to love more than one person at the same time? Can an affair ever help a marriage?
Perel states that we have to look in an existential way to infidelity: infidelity as an expression of the complexities and dilemmas of love and desire. According to the common vision, infidelity is a symptom of a failed marriage. If you have at home everything you need, then there shouldn t be a reason to go and look outside for something else. The loyal partner in this perception is the more mature, dedicated, and realistic of both; the one that deviate is selfish, immature and doesn t have self-control. But the complexities of love and desire can t be labelled in simplistic categories as good and bad, victim and perpetrator.
People stray for a multitude of reasons. But one theme is prominent there: an affair as a form of self-discovery, a quest for a new or lost identity. What Perel hears most is the feeling that they are alive, and that it would be self-betrayal to deny these feelings. Infidelity includes secrecy, sexual alchemy and emotional involvement and all three of them combined form an extremely passionate triumvirate.
The adulterous women and men in Perel s office use words as growth, research and transformation. The escape from the marital anesthesia causes an erotical shiver which makes us feel alive. We are often not looking for another lover but more for another version of ourselves. And it s typically not our partner who we want to depart from, but the person whom we have become.
To understand modern infidelity one has to understand the modern marriage. Our increasingly individualistic society causes a paradox: the need for loyalty becomes stronger but the attraction of infidelity too.
The high expectations we have from our partner makes us more vulnerable for infidelity. Intimacy has become the antidote for a life of escalating fragmentation. We expect from one person that fulfillment which in previous times a whole village provided and we live twice as long. This is an enormous task for a duo. The bestie feeling that evolves out of that strangles the erotical vitality; fire needs oxygen.
Because we are emotionally so dependent of our partner, nowadays relationships have a more devastating energy. In a culture which demands individual satisfaction and seduces us with the promise of more happiness, we are more than ever tempted to stray.
Perel describes three basic post-infidelity outcomes for couples who stay together:
- The Sufferers, those couples who get stuck in the past. Even five years later they still talk about it like it happened yesterday. With every argument the infidelity is the epicentre of the discussion.
- The Builders, couples who remain together because they value commitment and the life they have created. They avoid talking about the infidelity and they try to regain the lost stability, but they haven t used the crisis to learn something from it. Under the surface there is still a lot of anger and fear.
- The Explorers, couples for whom the affair has become a catalyst for transformation. They have come to see the infidelity as an event that, though insanely painful, contained the seeds of something positive. They have built a new relationship which has become much stronger and resilient. They feel alive and are deeply engaged. They know that there are no clear-cut answers, so they are able to discuss the betrayal with a fundamental acceptance of their human flaws.
In the Sri Lankan context the sense of community appears to be still strong. It s also a shame-culture where it matters a lot what people (family, friends, neighbours) will say . Affairs do happen quite often for various reasons. Proposed marriages continue to be the mainstay in this country which means that there is usually little time to get to know each other well. In addition, parents habitually have a big say in the decision. There is still a sense of shame regarding being divorced and women typically lack the financial means to live independently. All of this (and more) can lead to unhappy married couples who stay together for external reasons. An affair can be considered as a possible escape. Esther Perel s book can help couples to find a way out of the quagmire of the tumultuous experiences that affairs usually lead to.
For many years the British cardiologist Aseem Malhotra fulminates against Big Food and Big Pharma in The Guardian and in The Huffington Post. According to him the vast majority of the patients and doctors are not well informed. One of the main factors is that the industry finances the lion share of the research studies. This creates a distorted picture of the results of those studies, in the professional scientific magazines and in the media. On top of that the majority of the psychiatrists and other doctors are unable to interpret the methodological and statistical outcomes. Big Pharma finances the research and they manipulate the results. Between 2009 and 2014 they had to pay 13 billion euro s in fines because of illegal marketing and the manipulation of data. But nobody was fired and there were no big sanctions.
In February 2018 another study was published in The Lancet concerning a meta-analysis of 522 previous studies (between 1979 and 2016) on antidepressants by Cipriani et al. : Comparative efficacy and acceptability of 21 antidepressant drugs . The outcome was that all 21 antidepressants reviewed in the study were found to be more effective than placebo, BUT THE EFFECT SIZES WERE VERY MODEST. Studies with patients with more severe depression showed a little bit more effectiveness than studies with moderate/low depression for most drugs.
Journalists made some dramatic media headlines: Study proves anti-depressants are effective (Channel 4 news); Antidepressants: Major study shows they work (BBC News); It s official: Antidepressants are not snake oil or a conspiracy---they work (The Guardian).
Cipriani himself appears to be prone to making certain bold statements that his and his co-authors study does NOT cover. He considers his study the final answer to the controversy over whether or not antidepressants work.
After I read Cipriani s study, I was left with an emperor s new clothes feeling. Although the study in itself seems to be reasonable well done, it tells us very little that we didn t already know, and it has a number of limitations. But most and for all, the results are a far cry from the above mentioned media headlines.>/p>
Dr James Davies, from the UK Council for Evidence-based Psychiatry, is distinctly unimpressed. He calls Dr Cipriani's claim to have the 'final answer' to be both 'irresponsible and unsubstantiated'.
Dr Davies says that while the new study apparently shows that antidepressant drugs to be better than placebo pills at lifting people's moods, the differences between placebo and antidepressants are so minor that they are CLINICALLY INSIGNIFICANT. They hardly register at all in a person's actual experience.
Neurosceptic , a British neuroscientist who has a reputation of being fair and nuanced in assessing psychiatric research, wrote a review of Capriani s article ( About that New Antidepressants Study ) and he correctly pointed out the following:
Here s why the new study doesn t tell us much new. The authors, Andrea Cipriani et al., conducted a meta-analysis of 522 clinical trials looking at 21 antidepressants in adults. They conclude that all antidepressants were more effective than placebo , but the benefits compared to placebo were mostly modest . Using the Standardized Mean Difference (SMD) measure of effect size, Cipriani et al. found an effect of 0.30, on a scale where 0.2 is considered small and 0.5 medium .
The thing is, effective but only modestly has been the established view on antidepressants for at least 10 years. Just to mention one prior study, the Turner et al. (2008) meta-analysis found the overall effect size of antidepressants to be a modest SMD=0.31 almost exactly the same as the new estimate.
Cipriani et al. s estimate of the benefit of antidepressants is also very similar to the estimate found in the notorious Kirsch et al. (2008) antidepressants don t work paper! Almost exactly a decade ago, Irving Kirsch et al. found the effect of antidepressants over placebo to be SMD=0.32, a finding which was, inaccurately, greeted by headlines such as Antidepressants no better than dummy pills! .
The very same newspapers are now heralding Cipriani et al. as the savior of antidepressants for finding a SMALLER effect
Here are a few of the many limitations of the study:
- Nearly 80% of the analysed studies were funded by the pharmaceutical industry, which has a huge financial interest in the promotion of the drugs. Hiding or miss-coding unfavourable data along with fraud and deceit is quite common.
- Only 18% percent of the included trials were rated as having a low risk of bias (9% a high risk and 73% a moderate risk). Most of the analysed studies were unpublished results which mean they haven t undergone the rigorous peer-review required by reputable medical journals.
- The drug trials only covered eight weeks of antidepressant use while antidepressants can take up one month before start having an effect. The study tells nothing about the medium or long term effect. Long term use doesn t have any benefits; in the real world the outcomes are very poor.
- The study completely ignores a problem for many millions of long term antidepressant users: the sheer hell of getting off the drugs. The withdrawal effects include plummeting mood levels and suicidal thoughts, and bizarre physical manifestations such as electric shock sensations.
- A modest increased efficacy was only found in severe depression while the vast majority of antidepressant users are suffering from light or moderate depression.
- Dr Joanna Moncrieff wrote an excellent analysis about the Cipriani study ( Challenging the new hype about antidepressants , 2018) pointing out that efficacy was measured using scores on depression rating scales like the commonly used Hamilton Rating Scale for Depression (HRSD). But when the actual scores are compared, differences are trivial, amounting to around 2 points on the HRSD which has a maximum of 54. These differences are unlikely to be clinically relevant. Moreover, these small differences are easily accounted for by the fact that antidepressants produce more or less subtle symptoms (dry mouth, drowsiness, emotional blunting) which enable participants in guessing correctly that they have received an active drug instead of the placebo. And many participants to these trials have experienced antidepressants before.
- The analysed trials did not include those with suicidal depression (perhaps the most important group to treat effectively), the young, the old, those with medical comorbidities, those on other medications and those who are treatment-resistant .
Concluding, this is NOT the final answer to the question if antidepressants work. It just confirms what we already know about these drugs. Also, nothing has been said about the chemical imbalance or the serotonin reuptake marketing-stories. Psychotherapy remains the preferred option because it deals with the root causes of depression and it gives you the tools to become a more emotionally balanced person.
In my psychology practice I hear too many stories about sexual abuse at schools. Each story is horrifying in itself. Very often these experiences have far reaching (emotional) consequences for many years: dropping school results, low self-esteem, extreme self-doubt, feelings of guilt and even suicide.
Especially sport coaches on girl schools have the opportunity and they can make use of their authority to influence vulnerable young girls. They are easily impressed and persuaded by charismatic coaches who are experts in so called grooming their victims.
Because a child that is involved with a sport trusts a trainer/coach, grooming can take place quite easily. GROOMING is the process where a perpetrator slowly tries to gain the confidence of the victim (and her social environment), and consciously isolates the victim and prepares her for sexual abuse. This is a process that can take months or even years and can be also partly done online. There are four stages in the grooming process: choosing a victim; building up a friendly relationship and trust; the isolation of the victim and implementing control and loyalty; and lastly the initiation of the sexual abuse and the maintaining of the secret.
In a successful grooming process it often seems that the child agrees with the abuse. A child can even fall in love with the coach. But since children below 18 years are not adults there is ALWAYS an unequal relationship between a mature coach and a dependent under age child. It is NEVER okay to have a sexual relationship with an underage child.
Because sport is a very physical activity a coach has permission to touch a child in order to instruct it. This creates a culture where physical contact is accepted but the child can t always decide what is normal and what not. Because coaches often have a father/brother figure attitude, the child won t easily protest and communicate to the coach that he/she won t appreciate the contact.
Several victims have told me how they were groomed. It went along the four stages mentioned above. A sports coach of a leading girl school in Colombo offered massages to girls and after some time he slowly started to touch their private parts. In the end he forged sexual abusive relationships with his victims. Because of his impeccable public image nobody dared to oppose him. He is still working there and in all probability continues to make new victims.
Schools should be very vigilant. A strict policy against perpetrators and monitoring sport coaches on a regular base should be mandatory. At schools there should be a confidential advisor with whom children can talk about such things. But in Sri Lanka the good name of a girl often plays an important role too. The culture is such that (even at a police station) a girl is habitually blamed for provoking the abuse. All of this makes it very difficult for a girl to speak out. Unlike in most Western countries there are no (legal) safeguards; victims are dependent on the goodwill and personal relationships with authority figures.
Sport coaches should be trained to become more familiar with their own sexual feelings. What if you feel attracted to a student or if you fall in love? Many coaches don t know what to do with these feelings. It can lead to confusion, moral dilemmas and unspeakable feelings of guilt. If you try to suppress these feelings then it s like trying to keep a football under water: after some time it emerges with a power that you don t expect. A professional should talk about his feelings with other professionals or with a psychologist. Teacher intervision can be organised with one or several other colleagues inside or outside the school with whom he feels safe. The sharing of thoughts and feelings helps and it s very professional to do this. It normalises (we re all humans) and it gives support which facilitates to lessen the built up tension and stress.
A psychopath is a kind of person that many will describe as friendly, intelligent and very charismatic. But they don t feel empathy, remorse or emotional depth like us; they only pretend it in order to manipulate us more effectively to get what they want. They always act out of pure self-interest without thinking for a second about others. Because they suppress and destroy the free will of others to make their own choices, they are by far the most dangerous group of people. The majority of psychopaths are men; the majority of their victims are women.
In literature (Alex in Anthony Burgress A Clockwork Orange ; Patrick Bateman in Bret Easton Ellis American Psycho ) and in movies (Hannibal Lecter in Silence of the Lambs ; Anton Chigurh in No country for old men ) psychopaths are usually depicted in an extreme form. In real life we know of examples like the Belgian Marc Dutroux or the Dutchman Joran van der Sloot.
Psychopaths can be found in all strata of life. But the military or the corporate world (for example CEO s, directors, managers, lawyers) seems to be a natural habitat for them. They thrive in a high risk, uncertain and stimulus-rich environment. A well-functioning psychopath can control his impulses and can use his typical characteristics like charm, high verbal intelligence, determination, optimism, cool under pressure and ruthlessness to achieve his professional goals.
A psychopath has an anti-social personality disorder. That means that this person constantly behaves in an anti-social or criminal way. He can t adjust to the social norms that society has installed. Psychopaths act bold because they hardly experience fear. They are very self-assured and socially assertive. Their uninhibited behaviour stems from their impulsivity and their problems with planning and anticipating. They are not familiar with their emotions, they want instant gratification and they have little self control.
Their ruthlessness has to do with the lack of empathy, involvement and connection with others. They use their cruelty to become stronger, to express their impulses and to experience their destructive desires. A psychopath is very cold-blooded. He looks for vulnerable victims and is only satisfied with total control; he will make your life impossible until you collapse. He isolates his victim from her environment and can become the archetypical stalker in a process of years.
Nobody knows the exact cause of psychopathy. In all probability it s a combination of the social environment they grew up in, genetics and interpersonal factors. Psychopathy can t be cured although treatment of psychopathic children has shown some very modest results.
The Canadian psychologist Robert Hare has developed a 20 points checklist for recognising psychopathology. Eight of the most important ones are:
- Pathological lying;
- Taking no responsibility of their own behaviour;
- They lure you with their charm and verbal intelligence;
- Manipulative and cunning and little self-control;
- No empathy or remorse or guilt, very cold-blooded;
- Inflated self-esteem;
- Impulsive and always in search for new stimuli;
- Short relationships and multiple superficial sexual contacts.
The most vital tip regarding psychopaths is to try to avoid any form of communication with them. Don t try to outsmart them, they are masters of intrigue. He will always win and will do anything to harm you, without feeling remorse. He might be very handsome and totally charming but he has NO conscience and is utterly selfish. Trust your intuition; even if it s an animal lover, a teacher or a doctor, if you have a strange gut-feeling with a person, take this feeling very seriously!
Contrary to psychopaths, sociopaths are capable to emotional attachment and experiencing feelings of guilt and empathy. Although psychopaths and narcissists have in common that they lack empathy, psychopaths can be best described as a predators. They constantly seek people out to abuse for their selfish gain without any remorse. Please bear in mind that there are no clear cut categories but the above are just some general differences in order to simplify things.
Playing football is very simple, but playing simple football is the hardest thing there is . Johan Cruijff, famous Dutch football player.
In Sri Lanka advising is a sort of national pastime. Parents, uncles, aunties, anyone who is older than you are, feel that they are almost entitled to advise you on a variety of subjects. Why seniority is such an important factor probably stems from the enforced respect for parents, teachers and other authority figures that Sri Lankan children are taught from a young age on. But respect is something you have to earn, you can t demand it.
Psychologists and counsellors are not immune to advising either. However, professional psychologists should refrain from this and embrace the art of LISTENING.
When somebody has a problem, it s important NOT to advise. It s much better to help the other person find her/his own solution. It sounds simple but apparently it isn t. Every advice that you give, discloses most and for all something about yourself.
Some time ago a client came to me with relationship problems. She felt that her husband gave her not enough attention. He spent much of his time at work and when he came home he was on his computer or watched cricket. She had to take care of the children practically by herself. When they argued he kept mostly silent and went into his computer room. She told me that she didn t want to go on like this.
Her previous counsellor had advised her after half an hour that she should divorce. She had done it herself too and she was still happy about it. My client felt totally misunderstood and she had walked away. She didn t want to divorce her husband at all.
You have to be VERY careful with giving advice. We often can hardly wait to advise; we feel that the other asks for it, he presents his problem to me so he asks for a solution. And helping feels good, it enhances our feeling of wellbeing and our feeling of self-worth. But no matter how tempting it may feel to come with solutions for somebody else s problems, you have to stay away from it.
Contrary to what we think, in many cases finding a solution of a problem is not a rational but an emotional process. There are always feelings included which stem from individual values. As an outsider, you never know exactly which personal values are involved. Because you can t fathom what risk somebody is willing to take to act against those values, you can never know what the best advice is. This is exactly the reason why we typically don t follow the advice from someone else. And in addition it s annoying to hear that the other person knows better; apparently he does have better judgment, courage and skills than us.
It s more effective to work with a coaching approach. Try to put yourself into the position of the other, without straightaway thinking about solutions, and subsequently ask the appropriate questions. Like, what is your major problem? That seems an obvious question but the remarkable thing is that this question is hardly asked, also not by professionals. It s because most people think after hearing the story that they know where the other person wrestles with. This is a mistake because most people experience a chaos in their mind because they have been worrying a lot. A short and concise problem definition makes the answer to the next question a lot easier: what would you like to do with your problem?
It sounds very simple but in practice it s complicated. We are prone to direct the conversation in a subtle way; a direction that seems the best for us. Everything the other says goes through your filter, which is based upon your character, your personal history, your preferences, your fears.
How NOT to advise:
- Be a mirror; let the other tell his/her story. Ask about fears and about what is important, in this way possible connections and priorities emerge.
- Let her formulate her own diagnosis. Ask for a concise formulation without influencing her.
- Discuss the emotional context. Strong emotions are positive; they show the willingness to work for finding a solution.
- Let him formulate his favourite solution, find out if that is feasible and map out the journey (obstacles plus possible solutions).
"Physical punishment teaches children in accepting and tolerating aggression. It always plays a prominent role in the roots of aggression with adolescents and adults, especially in the antisocial form of aggression, like criminality." B.F. Skinner, Harvard professor in Psychology.
In Sri Lanka it s still quite accepted to physically punish your children. It's often done with hands, feet, canes and/or belts. In my psychology practice I see a lot of adults who are wrestling with anger issues. In many cases the root cause of their (sometimes uncontrollable) anger lies in the fact that they were physically abused by their parents. As a child you can't fight back and in Sri Lanka the prevailing guilt and shame culture ("respect your elders") makes children "swallow" their anger.
The Swiss psychoanalyst Alice Miller (www.alice-miller.com) has written many books and articles about the devastating effects that these humiliations have on the integrity and dignity of a child. Even worse, when they are adults abused children often beat their own children because they believe that when they were young themselves they deserved the beatings and are convinced that it was done to them out of love and for their own good.
Nowadays the negative effects of corporal punishment are substantiated by the scientific literature. This view is shared by experts in mental health and development of children and other professionals in related fields.>/p>
But as a parent you are only human. In theory we know what to do but in day to day life we all have our limits too. We often have a busy life, as a parent but also in our working life or with friends. It's stressful doing this, doing that, quickly out of the house and back. All of this can lead to behaviour we that we know is incorrect. But as humans we are not always rational. This is not bad as long as we become aware of it later that night in bed and think "perhaps I should have handled that differently".
To be very clear, it's NOT about the smack you give your child that's about to climb over a balcony, cross a busy street without paying attention or put their fingers into a wall outlet. In those situations a smack can be appropriate. But using violence as a regular instrument for raising your children is wrong.
Should the smack at home become a taboo? Do we have to stop doing this? Not everybody is against it. About half of the parents do it and most of them are not violent, mentally distorted people. It's not about judging them but trying to change their behaviour. Because this is what all experts agree upon: we must stop smacking children. It doesn't do any good. Several studies point out that children who are regularly smacked or hit become more aggressive. And moreover, the only thing they learn from it is that violence is acceptable if you are in charge. There is a huge probability that they will follow suit as an adult.
There are alternatives:
- Prevention. Place the cake a bit higher so they can't eat the cream from the top.
- Talking. Try to explain; but NOT infinite. It's okay to say "and now it happens because I say it. Period".
- Punishing in a different way. Earlier to bed, no watching TV, not playing their favourite game, etc. You have to be creative and you can think of anything, as long as there is relation between the punishment and the "violation". If something was broken on purpose, let the child buy it and there will be no pocket money for some time. If something was stolen, let your child return it with excuses.
Does this mean that there will be never be a reason to smack your child? Once in a while it's okay, it's better than to be grumpy the whole day. As long as it's an exception instead of a rule.
According to Harry Tracy, founder of NI Research, a bureau which analyses research regarding medications, the number of psychiatric research programmes with the big pharmaceuticals has declined from 105 in 2009 to only 16 in 2018. It's a clear trend that there is an impasse with the research for new psychiatric drugs against depression, anxiety, psychosis and other mental disorders. The focus is now on developing lucrative cancer drugs.
We have to cease believing the idea that the pharmaceutical industry prioritises their customers health. The expectation that pharmaceutical companies develop new drugs with social awareness and social responsibility is very naive. The best solution is to radically change the way that drug research is organised. New products should be tested, independent of the big pharmaceuticals, in autonomous research centres. These centres should be able to develop new medications, but not profit-driven. And lastly a total restriction on advertisements and on influencing the prescription behaviour of doctors.
Fluoxetine ("Prozac") entered the market in 1986 and was hyped as the new "wonder-drug" against depression. Soon after other so called SSRI's (Selective Serotonin Reuptake Inhibitors) like paroxetine ("Seroxat") and later SNRI's (Serotonin and Norepinephrine Reuptake Inhibitors) followed suit. For the pharmaceutical industry these were the golden years; worldwide they earned billions and billions of dollars. But after that it became silent, very silent.
Over the years the reputation of SSRI and SNRI antidepressants became worse and worse. Many meta-studies have shown that these pills do not outperform placebo pills (they are not clinically significant more effective). We have no idea about the working mechanism (if any) of these drugs. Unlike psychologists, psychiatrists are generally speaking not trained in conducting and understanding research. There exists no "chemical imbalance in the brain" and this and the "serotonin reuptake" story (people are encouraged to believe that depression is caused by a deficiency of serotonin as in the analogy with diabetes and insulin) are just clever marketing concoctions of the pharmaceutical industry, there is no scientific medical proof.
On top of that antidepressants have a whole list of (possible) side-effects, of which weight gain and sexual dysfunctions (not a pleasant thing when you're already depressed) are the most common ones. But the main thing is that they only suppress some symptoms and don't treat the root causes of depression like psychologists do.
Our brains are still an enigma for scientists. The human brain contains some 100 billion brain cells which are connected with each other through complicated networks. Brain-scans can show which part of the brain is active but they give little information about the working mechanism of the brain, let alone about mental disorders. With cancer you can take a biopsy of the tissue and then determine if there are malignant cells in it. But you can't take a biopsy form the brain to see if there is a mental disorder.
Researchers abuse rats to make them anxious and depressed with electrical shocks, "forced swimming tests", etc. Another method is the "tail-suspension test" where rats or mice hang six minutes from their tail with and without antidepressants. Computers register the energy and length of their resistance. This exemplifies what the current definition of depression is: the antonym of the neo-liberal concept of individual assertiveness. Within this definition the criterion for progress (less depressed) is not if the animals are more at ease with their kindred, or are lying together and licking each other as they do in nature. The more effective antidepressant according to these tests is also not the drug that makes them calm in adverse situations in order to conserve their energy. No, the researchers focus upon the maximum possible intense physical activity. This conceptualises the contemporary idea of preferred behaviour as opposed to being depressed.
But research with rats doesn't answer the question what a human depression exactly is let alone that we can cure it in the brain. "Antidepressants" sometimes reduce certain symptoms but we have no drugs to treat the root causes of depression.
Barbara Ehrenreich, publicist and author of many bestsellers, investigated in her book 'Smile or Die: how the relentless promotion of positive thinking has undermined America' (2009) the possible beneficial effects of positive thinking on the recovery of breast cancer. She found no empirical evidence whatsoever.
She herself had been diagnosed with breast cancer and she knows firsthand how the constant urge "to fight" can be detrimental. Her legitimate feelings of fear and anger were labelled as "negative" and even as an obstacle for her recovery. She experienced it as a kind of blaming the victim.
James C. Coyne (former Director of behavioural Oncology at the Abramson Cancer centre Pennsylvania and presently professor Health Psychology at the University of Groningen in the Netherlands) wrote the paper 'Positive psychology in cancer care: bad science, exaggerated claims, and unproven medicine' (2010) and came to the same conclusions as Ehrenreich.
"Positive psychology" started in the late 1990-ties and Martin Seligman is considered to be the founder of this movement. He wrote the books 'Authentic happiness' and later 'Flourish'. Basically "positive psychology" asserts that it's a much needed alternative for the dominant "negative" psychology which supposedly focuses upon mentally ill people. But mainstream psychology has been focusing for many decades on both positive and negative experiences. As early as the Ancient Greeks (Aristotle, the Epicureans, the Stoics, etc.) and in Ancient Egyptian and Arabic philosophies the emphasis was on finding ways how to live a life that is balanced and meaningful.
As I have written earlier in two articles ('"Positive psychology": old wine in new bottles' and 'Why choosing for happiness doesn't work' on my website www.marcelderoos.com) there exists no serious methodological sound evidence to support Martin Seligman's various claims on success in his many papers and books. He sounds very authoritative whilst using big words about statistics and empirical data. But the research findings are often invalid, overstated and misleading. "Positive psychology" is NOT a science, it's just a set of beliefs (like his so called PERMA-model) without scientific proof and without an integrated comprehensive theoretical framework. Basically it's an all American warmed-up and rehashed version of Vincent Peale's book "The power of positive thinking".
But although his evidence is flimsy, his marketing is extremely sound. Seligman succeeded to wrap "the power of positive thinking" into a veneer of hard science. "Positive psychology" became a billion dollar worldwide industry. It's like a commercial motivation circus. Many scientists within the "positive psychology" movement are more interested in selling training programmes and books than in doing scientific research.
Seligman s one-sided emphasis on positive emotions ignores the darker side of life; the challenges, suffering and deprivation that every so often afflict us all. Happiness is NOT the absence of negative emotions. It s not about being happy and smiling 24 hours a day, seven days a week. Happiness is not about being numb to negative feelings. We can only become happy as a by-product of something else.
In order to live the full human life, you have to experience the full range of human emotions, the positive and the negative. They both play an important role in our ability to thrive. Positive emotions make you feel good, negative emotions make you feel uncomfortable but they also make you aware of things that are wrong and of possible ways how to change them. It creates wisdom, maturity and a balanced personality. Besides the positives, we all NEED negative emotions and experiences too.
Many women experience sometimes pain when having sex with their partner or they have difficulties inserting a tampon. But when you can't have sex because of the pain or you can't insert a finger or a tampon into your vagina, it's possible that you are suffering from vaginismus.
When you have vaginismus then the muscles round your vagina involuntarily tighten when you have sexual intercourse or when you want to use a tampon. The pelvic floor muscles round your vagina are extremely powerful. With vaginismus it can feel that your vagina is completely "locked". The intensity of this feeling can differ per person. Some women can manage to insert a tampon but penetration is too painful. With others it's not possible to put anything inside the vagina.
Vaginismus can be very challenging, you want to have intercourse with your partner but it fails time after time. It can cause relational problems because there is no sexual intercourse. Because you associate sex only with vaginismus and pain you lose the pleasure and drive for having sex with your partner. It also can be difficult to get pregnant in a natural way. You can feel guilty and ashamed and you can start to question your femininity. But you're not the only one and there is no reason to be ashamed of it. Usually the prognosis of vaginismus treatment is good, so it's important to look for professional help.
The causes of vaginismus are diverse but they are predominantly psychological. It could be that you're very anxious because you have had a painful first sexual experience. Relational problems or a sexual trauma can also cause vaginismus. In my psychology practice in Sri Lanka vaginismus is quite common. The lack of sex education in Sri Lanka is probably an important factor. Men and women very often lack the essential knowledge regarding a healthy sex life. Sex is not a topic that is discussed openly here. Many women don't know how to experience an orgasm and many men don't know how to stimulate a woman. Generally speaking men and women typically differ in their sexual arousal and you need to be aware of that.
Usually a treatment starts with a visit to a gynaecologist who checks if there are any physical issues. After that it's very important to see a psychologist who can help you with the emotional aspects. Also, a physiotherapist can teach you how to get more control over your pelvic floor muscles. The physiotherapist will explain how the muscles round your vagina work and what happens when you tighten or relax them. There are several exercises for this. An (for Sri Lanka) unusual suggestion is that you could try belly dancing moves. In Western Europe it's quite fashionable amongst women. Belly dancing improves the connection that you have with your abdominal and your pelvic floor muscles. It makes them stronger and more flexible. There are practice videos that you can order on the internet.
Some tips for yourself and your partner:
- Talk about vaginismus with each other, how it influences the relationship. It will give a relieve to talk about the frustrations and the emotional hurt.
- As a partner you can be supportive and you can listen and talk about the (sexual) relationship but realise that you're not a professional psychologist.
- Read more about vaginismus and about the working of the muscles round the vagina.
- Don't try to avoid sexual contact and don't force anything. Realise that sex is more than having intercourse. Talk about each other's sexual wishes and needs.
When somebody has a depression, it's usually difficult to understand for friends and relatives who haven't experienced it themselves. But family and friends are very important for a depressed person and more often than not they can do more than mental health professionals.
It's nearly impossible to describe how a depression feels. Experienced psychologists can empathise a bit with most other mental health disorders, but with depression there are no reference points to fully explain this condition.
A depression is not comparable with the depressed feeling we all have sometimes. A person with a serious depression experiences mainly emptiness. There is no sense of enjoyment anymore and there is also an enormous feeling of guilt and worthlessness. Often it's accompanied by a disturbed sleeping pattern and food intake (eating less or overeating). And a preoccupation with thinking about death and problems with concentration and decision-making.
The best treatment of depression is psychotherapy. People get depressed for reasons and an experienced psychologist can help you to uncover the root causes and treat the person with a therapy that deals with the past, present, thoughts, behaviour and FEELINGS. Please be aware that medications can at best only numb you, they don't address the root causes (there exists no such thing as "a chemical imbalance in the brain") and they frequently generate several typical unpleasant side effects (like weight gain and sexual dysfunctions).
It's important that you keep in touch with the depressed person, your support is needed. Here are a few tips about what to do and what NOT to do:
PLEASE DON'T:
- Don't judge the thoughts and feelings of the other person ("you're so gloomy,can't you brighten up a bit?")
- Don't play the saviour or the therapist.
- Don't be over-concerned; if you do you strengthen the feeling of helplessness in the other person.
- Don't take decisions (big or small ones) behind the other person's back.
PLEASE DO:
- Please realise that depression has nothing to do with weakness of character or lack of motivation. Depression is not a matter of "not wanting" but of "not being able to want".
- Try to stimulate the person to start again with things she liked before the depression, like walking half an hour every day. And try to support her with giving structure to her day.
- Be patient, depression has its own rhythm with ups and downs. It takes time to work yourself through a depression. Your help and support is very much needed but it please don't expect quick results.
- Try to be there for the other person, but without "advising". Try to accept her as she is with all her emotions, complaints and problems.
- Try to give the impression that you are confident that the depression will pass (it will!), but don't try to be over-optimistic. Please praise the other person with what she does. Even if it's not perfect or unfinished.
- Explain to other family members and friends what a depression is and what it does to a person. This prevents that people get discouraged and stop seeing the depressed person.
When you have a healthy personality you are capable to adjust your behaviour according to the circumstances. When somebody has extreme variations of "normal" personality traits and he or she can't adjust to the environment we label that with the term "personality disorder". People who are for example extremely jealous, extremely shy or extremely sensitive to criticism can experience all kinds of problems in their daily lives. But if they have extreme personality traits and they function well in society then they have NO disorder. Only a professional can diagnose a personality disorder.
Borderline Personality Disorder (BPD) is a label that is given to people who have certain symptoms. Because of the huge variety of symptoms and behaviour, people with a BPD differ a lot from each other. There are similarities too: with BPD you often feel unstable and you can react sometimes in a unpredictable way. You tend to see the world in a polarised, over-simplified, all or nothing way. You quickly feel not accepted and you are afraid to be abandoned by people who are important in your life. When this appears to happen, you can behave in a strong emotional way. You distrust other people and it's hard to maintain friendships and relationships. Anxiety, depression, suicidal threats and self-harm are quite common with BPD.
But personality disorders like BPD (as is the case with all mental disorders) are just labels without any biological/genetic causes. It's an agreement between mental health professionals that a certain number of observations (4 out of 7, 5 out of 9, etc) can be attributed to a label. On top of this, "personality disorders" are quite vague and imprecise constructs and they tend to "blur" into another.
Many mental health professionals often talk about BPD patients as if they show certain behavioural and interaction patterns BECAUSE they suffer from BPD. This the classic mistake of reification. Reification is the fallacy of treating an abstraction as if it were a real thing. BPD is just a definition; there exists for example no subtle signs of it. Only if you change the definition into a broader sense then more people will be included.
The diagnosis "Borderline Personality Disorder" is very ambiguous. A person must have 5 out of the 9 described DSM-criteria (the Diagnostic and Statistical Manual of Mental Disorders) in order to acquire this label. This means that according to the DSM one can be "Borderline" in 256 different ways (a colleague who excels in Maths explained it to me). It's possible that two "Borderliners" can have only one out of the nine described criteria in common and that they differ completely from the rest.
What is missing in this useless quest of symptom-hunting is the CONTEXT. It's much better to listen to the whole story of the client, determine the root causes of client's present issues and treat those (instead of the standard brief "cognitive behaviour therapy") with an effective form of long term individual psychotherapy that covers the present, past, emotions, cognition and behaviour.
Countless research studies have demonstrated that in more than 80% of the cases people with the label BPD have been chronically abused in their childhood. This means that there is sufficient evidence that their symptoms have been developed as a result of their traumatic history. It's much better to speak of a complex post traumatic stress disorder than to label it with BPD. The treatment should be in line with this.
Psychiatrists, paediatricians and other medical doctors are generally speaking not trained in conducting and understanding research. Psychologists on the other hand, have to undergo a stringent and extensive schooling regarding research. Not only plain statistics like multiple regression analysis but more about the art of how to set up proper research studies and how to read them. Research is difficult; you need to have an extremely critical mindset. But in Sri Lanka the educational system (including universities) is more focused upon memorising and reproducing than in critical thinking. As a consequence of all this, one often reads in the media unscientific and biased statements.
One of the most persistent myths is that psychotherapy is supposed to be based upon protocols. When somebody is for example depressed then protocol demands that this person should be treated with cognitive behaviour therapy (CBT). Especially medical doctors are trained in this way and they often assume that CBT falls within this protocol-thinking too. They may have heard of read something about CBT but they have no training nor experience with it and they are mostly unaware what the real working mechanisms are of a therapy.
Psychologists with a few years of practising behind their belt know that psychotherapy based upon emotions(!), cognition, behaviour plus the present/past(!) is often a superior approach to suffering than mainly cognitive based therapies (these focus primarily on only symptoms, thoughts and the present). Removing symptoms without paying attention to the underlying causes often leads to recurrence of for example depression.
The most important success-factors for any therapy are the therapeutic relationship and an active client. Therapists have to be able to install trust and hope in the client and the client herself should be engaged in the therapeutic process. The client needs time to be able to "work through" the root causes in the presence of a listening, empathic and supportive therapist; the root causes need to be understood, felt and integrated.
With CBT there are a few helpful steps like getting a more realistic view on your problems and to actively confront your depression or anxiety. But CBT is typical American in its assumption that the way you think will influence your feelings. When you are depressed you should challenge your negative thoughts ( positive thinking ). From the clinical practice we know that you can tell a depressed person a hundred times that he should think positively but that won t bring about a lasting change. Also, CBT only focuses on the present and not on the root causes in the past that causes these emotions. Even with the so called "third wave" of CBT methods - acceptance and commitment therapy (ACT), dialectical behaviour therapy (DBT) and mindfulness-based cognitive therapy (MBCT) -, the accent is still on the cognitive part and on the present. Why is CBT then so popular?
CBT is seen as a relatively quick fix , is comparatively cheap and appeals to our sense of logic: think positively, "be strong" and you have to work for it! While in reality coming out of a depression means accepting and actually feeling your painful emotions. This is also a lot of work but in a quite different sense! Depression is an emotion and it has nothing to do with our thoughts. Emotions are in evolutionary sense much older than our cognitive brain and in the long term they usually win . Trying to influence your feelings with your thoughts is a hopeless enterprise. Feelings want only one thing and that is to be felt! So the best way to come out of a depression is not to fight it with our thoughts, but actually starting to feel it and finding out where it stems from. Depression has to do with your past history and what others have done or said to you.
What does work with depression is that you go for the root causes and not only treat symptoms with medications. Psychotherapy practised by an empathic professional therapist and with an active client does work. Therapy should focus on the emotional link between the triggers in the here and now and the actual causes in the past. The next step should be the painful job of trying to feel these stuck emotions. It s crucial that the client has a well trained professional psychologist who supports him. When the client feels more emotional balanced because the influence of his past has diminished, and the client has learned to understand, handle and integrate his past emotions, then the time has come for the therapist to step back.
Stand by your man...... the song (1968) by Tammy Wynette could be very appropriate to the Sri Lankan culture. In Sri Lankan society respect is important, especially women are generally speaking raised in a tradition to respect their (future) husbands.
In my psychology practice I hear countless stories from women who have taken a lot of suffering from their husband. It is not only "respect" that prevents them from taking action, but also the fear of what family, neighbours and friends will say. Malicious gossip is rife and quite often it's the woman who get the blame when a marriage fails.
On top of this there is often the financial dependency on their husband. When they have enough and think of divorce then the only option is usually returning to their parents home where they are subjected to the parental authority.
Sri Lanka is still a very male dominated society where many men feel entitled in the streets, in the workplace and at home. Sexual harassment is common and many women feel powerless because it seems "normal" and "accepted". "Boys will be boys", "just ignore" and "you should forgive" are just some of the remarks that women hear.
Things are slowly changing within segments of the younger generation but there is still a long way to go. Cultural changes take their time and it's interdependent on factors like political will (the firm intention or commitment of a government to carry through a policy, especially one that is not immediately successful or popular), getting access to different values, adequate education to provide financial autonomy, role models in society, more mixed gender schools, and an education system where children and students are taught to think critically and not just memorise and reproduce.
To change an existing culture you need (informal) leaders who practice what they preach, who show in their behaviour the values that they talk about. Peter Drucker, an Austrian-born American management consultant, emphasised the importance of culture: "culture eats strategy for breakfast". The implementation of any strategy needs a serious study of the existing (organisation) culture. In order to change it's crucial to take stock of the shared norms and values; to become aware why we behave as we do. And why and how we are going to do things differently.
A bottom-up strategy can work too in the absence of inspiring formal (political) leaders. Informal leaders can start a campaign. It's important to try to give meaning to words like desired values, norms and culture. Discuss this because different people have different connotations for the same words. Make sure to use inspiring and clear language and examples of recognisable situations in the daily practice followed up with desired behaviour. Create a code of conduct: this is how we interact with each other, this is our culture!
And then action...., behaviour is the key. Talk the talk and walk the walk. Cultural change is a matter of thinking and acting. To act differently will lead to new behaviour. The desired behaviour should be stimulated in a formal and informal way. And last but not least keep an open context where discussion is possible about apparently contrasting views.
The horrific experiences on Easter Sunday have left so many people with unspeakable losses. The passing away of a beloved person causes grief. It's a natural reaction to loss; it s the emotional suffering you feel when something or someone you love is taken away.
The process of grieving usually (but not always) takes place in phases and can last for a long time. Sometimes this process seems to be stuck; one can t get over the loss. When grief turns into depression one shouldn t hesitate to seek professional help.
Everybody deals with loss and the accompanying pain in their own way. Influences on the process of grieving are the kind of relationship one had with the deceased, the way in which the person has died, and the age of the deceased and the next of kin.
Immediately after the death of the loved one you typically live in a kind of intoxicated state of mind. When that passes you start to realise the truth of the loss: you are angry and sad, confused and you want to go back to the time when everything seemed good and carefree. Usually you don t function well in this phase and the demise of the beloved is in your mind during the whole day.
After this follows a period that you are more capable to look back to what the person has meant to you, what the two of you have shared. Subsequently you gradually are able to give your attention to other people. Little by little you get on with your life and you realise that you slowly can enjoy beautiful and nice things.
During these three phases it is important that certain tasks are done. It s not about a sequence (in reality they will intermix with each other) but more about completion of these tasks.
- Accepting the reality of the loss; this knowledge has to be felt.
- Feeling the pain and the hurt.
- Adapting to a life where the deceased isn t there anymore.
- Transforming the emotional energy you had with the deceased into a memory in order to be able to continue with your life.
There is no right way or right amount of time to grieve. It s a very personal experience. To grieve has nothing to do with trying to forget or with closure. A deceased loved one will always have a place in your life. But at a certain moment you will be able to look back with compassion, love and without much hurt and be thankful that the person was part of your life. The interpersonal duration of grief varies a lot. Sometimes you ll experience a relapse. A sudden memory can make you momentary very sad. But it won t hinder you anymore in your daily functioning. It s important to know and accept that you need time to cope with your loss.
Some practical suggestions:
- Try to share your feelings with friends and family in a way that suits you. This is beneficial to yourself and it gives others the opportunity to support and help you.
- Although it is fine to express your feelings, you don t have to give in to every emotion. Sometimes it s good to cry or to be angry, sometimes it s good to seek distraction and focus on something else. It is only yourself who can feel what works for you, which way is helpful for you.
- It is also important to take care of yourself, try to maintain a good physical health.
- Try to sustain a regular life that gives you a sense of balance. Don t take important decisions until you feel stable enough.
- You could start to write letters or to a make collage book about the person. You can write down your feelings and thoughts, memories, paste pictures, poems or songs that you like, which have an association with the loved one.
- You could also talk with friends and family about who the person was, and bring back memories.
- During the period of grieving all kinds of physical complaints may occur, like eating and sleeping problems. When you decide to go to a medical doctor for these complaints, tell the doctor about your loss.
- Be careful with sleeping tablets and tranquilisers. These medicines can help to calm you down for a while but because of their suppressive effects they can disturb the grieving process. When you are mourning it hurts, and that pain cannot be taken away with medicine. Sleeping tablets and tranquillisers can be addictive so it s best to be cautious with these pills.
"Forgiveness therapy" has blossomed in the past two decades. In itself, forgiveness sounds like a wonderful idea but there can be serious drawbacks to this quite limited concept (see below). Although there is little evidence that forgiveness therapy is superior over other forms of therapy it's promoted, often on Christian moral grounds, as a cure for a wide range of human suffering. But why should we opt for a flimsy forgiveness concept instead of proven robust psychotherapeutic methods that take the whole personality and the whole emotional range into account as opposed to only focusing on anger reduction and a cognitive change towards "forgiveness"?
Funding of forgiveness research is often done by private Christian sources like the Templeton Foundation which only offer rewards for research that exclusively will show the benefits of forgiveness therapy instead of a more scientific position where you explore IF something works. "Positive psychology" front-man Martin Seligman gave another boost to promote forgiveness, as he sees it as an integral part of positive psychology.
With forgiveness, it all depends on the definition you use. The American Psychological Association defines forgiveness as a conscious, deliberate decision to release feelings of resentment or vengeance toward a person who has harmed you, regardless of whether they actually deserve your forgiveness. Forgiveness does not mean forgetting, nor does it mean condoning or excusing offenses. Some definitions go further and point out that it should lead to feelings of understanding, empathy and compassion for the one who has hurt you.
An excellent critical overview of "forgiveness therapy" is from Sharon Lamb (2005): Forgiveness Therapy: The Context and Conflict. Journal of Theoretical and Philosophical Psychology, 25(1): 61-80. James C. Coyne in his coyneoftherealm blog makes methodological mincemeat of positive psychology (including forgiveness therapy). Please also read the Swiss psychotherapist Alice Miller's article "Concerning forgiveness: The liberating experience of painful truth" (2013). The well known American psychotherapist Irvin Yalom is critical about so called "evidence based therapies". He points out that therapy is an individual journey, depending on the context and history of the client, and that there are no one size fits all fail-safe methods. The two most important success-factors for any therapy are the therapeutic relationship and an involved, active client.
Effectiveness of forgiveness therapy is disappointing: it shows only small effects when compared with waiting-list or control groups, and it shows very moderate drops in anxiety and depression and MOST IMPORTANTLY, it confounds therapy with the therapist (see also Lamb, 2005). James C. Coyne dismissed Sin and Lyubomirsky's 2009 meta analysis regarding positive psychology interventions (including forgiveness therapy) as a poorly conducted, totally biased and seriously flawed assessment of the efficacy of positive psychology interventions.
Where Western civilisation is concerned, during Graeco-Roman times there existed no notion of interpersonal forgiveness as such. In early Christianity the accent was more on divine than on human forgiveness. Only in the past three centuries forgiveness in an interpersonal sense started slowly to emerge which culminated in the present day forgiveness boom. A Christian belief system can give a lot of strength, but if you only have this and the Bible (although it's a fascinating book full of stories) as your guidance through the process of dealing with a trauma then you run the risk of selling yourself short.
One of the possible dangers with forgiving unilaterally is when people just want their pain taken away, the hurt to stop and to forgive in order to forget. However, life is more complicated than that and psychotherapists should point out to their clients that in this way they very well might run into emotional problems. We have to learn to live with the complexity of life and that can mean that at times we have to find an emotional balance between different feelings like anger, fear and a longing for peace of mind.
Forgiveness interventions may actually cause low self-esteem because it's trying to restrain the victim's personal feelings against the offender. This can result in the victim experiencing negative feelings towards him/herself. By implying that the negative emotions towards the perpetrator are not correct and forgiveness is the only acceptable way, it might result in feelings of shame and remorse.
Suggesting forgiveness to someone who is traumatised can re-victimise this person into experiencing helplessness or even into a dissociation disorder (as a defense mechanism). Anger can be a very healthy coping strategy with overcoming trauma. Attempts "to work" on the anger can cause feelings of self-blame for not yet being ready to forgive. Many authors have voiced their concern about forgiveness having a detrimental effect. Resolving a trauma has everything to do with FEELINGS and NOT with efforts to change your thoughts towards forgiving. Forgiveness therapy that focuses on anger reduction and trying to nudge people in a cognitive way towards forgiveness can cause confusion: why should you THINK when a trauma has everything to do with FEELINGS.....
Anger should be explored, felt and integrated. In this way it becomes a natural process and it's also a safeguard against bitterness. There is an analogy with sadness in grieving. We don't propagate that we should focus on ending the sadness as a part of grieving (only if the grieving process seems to be "stuck", then a psychotherapeutic intervention is indicated). There is no extra concept necessary (like the spiritual/religious "forgiveness"-gurus propagate after a trauma) to come to terms with the loss. Grieving is a natural process that takes its own time with different people.
Nowadays there is a strong demand (as a result of the "cost-effective" managed care policies) for short term problem-focused "evidence based" therapy. This, despite the fact that the vast majority of clinicians report this managed care has a strong negative impact on their work. "Forgiveness therapy" neatly fits into this, it focuses on only one problem instead of on the individual's general personality and the full range of emotions. In addition it promises quick relief from symptoms in a set number of phases and steps. The therapy itself can be protocolised so that less skilled and less trained clinicians can practise it. In brief, forgiveness therapy can be seen then as a short term therapy, with anger reduction as the main objective.
For many years psychotherapy has been doing a very good job with helping clients work through their anger. Exploring feelings of anger can be extremely healthy in giving them a sense of righteousness and can enhance self-esteem. Even exploring symbolic revenge fantasies in a confidential environment with the therapist can create some distance. Because "forgiveness therapy" puts the emphasis on "to do" something about your anger it gives a message that anger is inappropriate and you have no right to experience all of the anger inside you.
Letting go of your anger in a natural way is NOT forgiveness. You don't have to show compassion with the perpetrator and you don't have to forgive. His/her past can be an explanation but NOT an excuse. What you can do is slowly come to terms with what has happened and see the offender in a different light. For example that this person must be mentally unstable or worse. You can create a healthy distance from the trauma but at times in your life your anger might emerge again (which is quite normal). When you accept it and you go through the process your anger will cease. Where needed it's a therapist's job to support clients with this task of balancing your emotions.
Grieving (with emotions like anger and sadness) is a healthy natural process; why should we interfere with that by means of "forgiveness"? In the case of traumas psychotherapy, as opposed to forgiveness therapy, has a good track record with alleviating them, but it doesn't promise to do it in ten steps or in ten weeks.
One of my favourite authors is the American existential psychiatrist/psychotherapist Dr Irvin Yalom. He is one of the old-style psychiatrists who received his three year psychiatric residency at Johns Hopkins Hospital in Baltimore and his career started in the turbulent early 1960s at the Stanford Psychiatry Department in Palo Alto (California). Although well in his eighties Irvin Yalom is still practising in his private practice in Palo Alto.
This is a psychiatrist who seldom prescribes medication, he is an old school psychiatrist who is specialised in psychotherapy. He has written extensively and I have most of his books. Besides being well acquainted with the professional literature in psychology, he is extremely well read in philosophical works and in the classics of international literature.
What stands out in his books about tales of his patients (their true identities well hidden) is the love and understanding he has for them. He gives the readers a rare insight of their dilemmas, their personal desires and motivations. But most of all he expresses his willingness to expose (with a lot of humour) his own imperfections and vulnerabilities.
In "Love's executioner & other tales of psychotherapy", "Momma and the meaning of life" and in "Creatures of a day", each a collection of case studies, Yalom describes the hard working but flawed therapist in conjunction with his patient's struggles, especially their struggles with what death (although usually far away) means in their lives. These are fascinating erudite good reads about the unveiling of layers of secrets, intrigue, deep emotions and often an unsuspected ending.
In "When Nietzsche wept" and "The Schopenhauer cure" Yalom mixes the psychological and philosophical worlds. Nietzsche's and Schopenhauer's views (together with the Buddhist influences on the latter's work) are explored and discussed to explain certain behaviours of fictional characters in the books. At the very least you will find yourself thinking about some classic philosophical questions but the tone of the books is light and entertaining.
In "The gift of therapy" Yalom gives advice and warnings to young therapists. Avoidance of diagnosis (it's just a label which tells nothing about the reality of the patient), showing empathy, the negatives of cognitive behavioural therapy (for example it doesn't deal with the root causes), there exist no "evidence based therapies" (the individual story is what counts), do include in your sessions talking about the meaning of life, create a new therapy for each patient, and a host of other practical suggestions.
In his latest book "Becoming myself, a psychiatrist's memoir" Yalom takes us chronologically through many memories of his personal and professional life. He also describes the birth and writing process of several of his books. Yalom reveals with quite refreshing candour his difficult relationship with his parents, especially with his mother. In the end he seems to have come to understand and appreciate them and he has found peace of mind. His willingness to discuss and to face the fear of death of his patients and with himself contributed to the development of his existentialists views. This is highlighted in his magisterial book "Staring at the sun".
This brilliant therapist and gifted story teller has a lot of meaningful insights to share with the next generation of psychologists or with anybody who is interested in the workings of therapy.
Existential psychotherapy is a form of psychotherapy that is based upon the existential tradition in the European philosophy. It focuses on concepts like death, freedom, responsibility and the meaningfulness of life. Furthermore it stresses that by means of a process of development and maturation about these concepts, an individual should be able to positively influence her /his life.
The origins of existential philosophy go back to the works of the 19th century philosophers S ren Kierkegaard and Friedrich Nietzsche. They protested against religion and the so called objectivity of science and they emphasised living with passion and with an individual personal perspective. Some well known international representatives of existential psychotherapy are Albert Camus, Jean-Paul Sartre, Victor Frankl, Rollo May and Irvin Yalom.
Existential psychotherapy is founded on some fundamental considerations from the existential philosophy:
- Life will end; it s unpredictable, never perfect, and in essence meaningless.
- A life without fear is neither possible nor desirable; nobody is without existential fear.
- Your identity, your life and your world are formed through the interaction with others. Fundamentally life is the way you are related with others.
- In your life you are faced with countless dilemmas which you can only solve by making moral choices. That means that you have the freedom to choose but you re also condemned by it.
By being courageous and by taking responsibility for your life (including the choices you have to make) you will make the existential anxiety manageable. You are responsible for yourself and for your life (Nietzsche s become who you are ). But responsibility means not that you will succeed in everything you do.
Many American authors/books ( Anthony Robbins , The Secret ) and recent therapy-forms (like Positive Psychology ) have made a caricature of this principle. They all have more or less the premise that you have total control over your life and you only have to find the right key (buy their book/therapy/method) to become happy.
But in reality it s not that easy and simple. You re only partly in charge of your life; you also have to accept your circumstances. Maybe you will be happy, maybe not. And happiness is far less important than finding balance, meaning and peace in your life. A meaningful life will give you immense satisfaction and at times happiness.
The American psychiatrist/psychotherapist Irvin Yalom considers existential psychotherapy as an addition or enrichment to traditional psychodynamic psychotherapy and not as a specific separate methodology. In his book Existential Psychotherapy he discusses four ultimate human concerns: death anxiety, freedom and responsibility, existential isolation and meaninglessness. He looks upon death anxiety as a universal cause of many fears, depression, etc.
Yalom hasn t written a simplified self-help book like five easy steps to overcome your anxiety ; his book is a 500+ pages introduction to the real psychological stuff that comes with facing your mortality, taking responsibility of your life, and finding meaning in an inherent meaningless universe. He interprets many difficult philosophers, not only the usual suspects like Kant, Hegel, Schopenhauer and Nietzsche, but also classical schools of thought like the Epicureans and the Stoics and using many of their insightful ideas. Yalom doesn t assert that there is an easy way in finding a meaningful life, but he is convinced that there is positivity and hope (but no guarantee!) that people can change (with a lot of effort) and free themselves from their debilitating emotional shackles.
There are many mental health professionals (psychiatrists, psychologists, nurses) who don t understand much about suicide. They think for example that suicide is a conscious choice that people make, and they often treat these patients disrespectful.
In my psychology practice I hear horrifying stories from countless clients how they were treated after a suicide attempt in hospitals and in private practices. So many nurses and doctors seem to believe that they have to scold people after a suicide attempt. Especially when faced with women with children or teachers. How irresponsible they are and aren t they ashamed of themselves? Think about the poor children and loved ones that you have hurt!
This means a double traumatising after a suicide attempt by these doctors and nurses from hell ..These people need to receive proper training and education about how to deal with traumatised persons and leave their twisted personal morals at home and not bring them into their workplace. If not then these individuals need to think seriously of pursuing their career in different fields where they have little contact with vulnerable persons.
A decision to attempt suicide is not something like a picnic. It s very rare that people really want to die. It s more that they look for a way to end a situation that they experience as extremely painful and hopeless. In their difficult and agonising state of mind they perceive only one solution and that is to end their life. It seems the only way to end the excruciating emotional pain that appears to be endless.
There exist many misunderstandings concerning suicide, here are some facts:
- Suicide is not an illness and it s not hereditary.
- The vast majority of the people who attempt suicide don t want to die, but they feel they can t live anymore with the emotional pain. A person who has attempted suicide before has a substantial higher chance in succeeding than first-timers. It s as if after a first attempt there is less inhibition.
- 75% of the people who have taken their lives have spoken about their wish to die beforehand. This warning signal should be taken very serious. Listening to a suicidal person is one of the best ways to prevent it.
- Suicide is not an impulsive act. A suicidal person goes through a long process (months, years) from thought to the actual attempt. Often there is a trigger that leads to the suicide. By talking (and above all listening!) about the thoughts and death wishes the suicide threat becomes clear and the suicidal process can be stopped.
Establishing a safety-plan can be very helpful with suicidal persons. You discuss the suicidal thoughts and panic attacks. What can you do when you re panicking? How do you feel that coming? When this happens who will you call? Is there a fall back person to call? Which things can you do to make yourself feel calmer? Studies show that many suicidal people benefit from such a plan.
As mentioned before, talking and above all LISTENING to the story of the person who is suicidal is paramount. The person must feel that he/she is heard and understood. Mental health professionals should be trained how to deal with suicidal persons. It s NOT about finding the correct DSM-category or deciding whether the person should be hospitalised or not. Paying attention to the STORY of the person and having an emphatic conversation makes all the difference in the world.
Dick Bijl, a Dutch medical doctor and epidemiologist, has been for 22 years the chief editor with Het Geneesmiddelenbulletin . This is a Dutch independent governmental magazine which informs impartially about medications to doctors, pharmacists, patients and students. He has read tens of thousands international articles about drug research and he has published many scientific articles.
In his book Antidepressiva en depressie he describes how the pharmaceutical industry tries every trick in the book to embellish their products, and how they mislead scientific magazine editors, regulatory authorities, doctors and patients. Editors and peer-reviewers are totally not equipped against this, and admission authorities like the American FDA and the European EMA are typically controlled by doctors and researchers who have strong ties with the pharmaceutical industry. Even worse, these authorities are primarily financed by the pharmaceutical industry. And they frequently select (former) top administrators from the FDA and EMA to come and work for them.
Antidepressants are big business, and in the stock markets the pharmaceuticals are seen as highly profitable blue chip companies. Since the financial interests are astronomical, you can imagine that the pharmaceutical industry will do almost anything to safeguard their profits.
You can t measure depression; there exists no blood test, x-ray or scan for it. So the only way to determine the level of depression is with a self-questionnaire, usually the Hamilton Depression Rating Scale (HAM-D). The range of the scale is from 0 52 points. A difference of one point (!) between patients who received an antidepressant and those who had a placebo is seen as statistically significant (if both groups are big enough, say a few hundred patients).
For example in a research study, patients with a serious depression have a mean HAM-D score of 20. The group that takes antidepressants goes for instance from 20 to 12 and the group with the placebo from 20 to 13. This difference of one point is statistically significant if your study group is big enough.
But no one, neither a doctor nor a patient, will be able to experience this one point difference as a clinical improvement. A CLINICAL significant difference should be at least three or four points. But antidepressants are officially registered when they have a STATISTICAL significant difference (one point) with placebo tablets. We know from several meta-analyses that antidepressants only work with people with a very serious depression, but they work only a little bit in the sense that people say they feel a bit better.
The registration authorities approve antidepressants if manufacturers can show two studies (which the manufacturers finance and control!) with a statistical significant difference. The manufacturers often have nine or ten studies but for the approval there need only be two positive in terms of efficacy. If eight out of ten studies have no efficacy then the drug will be accepted on the basis of two positive studies.
In 2015 independent researchers have done a re-analysis of a published study in 2000 about antidepressants with children and adolescents. By means of a court order they had access to all the data that the manufacturer hadn t published. The re-analysis showed that the antidepressants showed no efficacy with children and adolescents, and there were considerable side-effects.
There exists no "chemical imbalance in the brain" and this and the "serotonin reuptake" story (people are encouraged to believe that depression is caused by a deficiency of serotonin as in the analogy with diabetes and insulin) are just clever marketing concoctions of the pharmaceutical industry, there is no scientific medical proof for this.
The concept of evidence based therapies has had an enormous negative impact on the field of psychotherapy. Nowadays universities and managed health care providers solely concentrate on these evidence based therapies . But because of the way that psychotherapies are evaluated through this concept, it basically means that only brief cognitive behaviour therapy can be accepted .
In medical science randomised controlled trials (RCT) are allegedly seen as the golden standard for research regarding medications. There is a lot of criticism about these RCT s but in this article there is no space to discuss these. Concerning the use of RCT s with psychotherapies it should be noted that these RCT s are strictly regulated in an artificial environment (not real life ) and meant for extreme short term treatments. Most therapies can t be moulded into a RCT-format, which means that RCT s favours certain methods (like cognitive behaviour therapy) only because of the nature of the RCT s.
Cognitive behaviour therapy is accepted because it supposedly generates (usually short lived) results with for instance depressed patients. But it is a wrong assumption to think that CBT works. Evidence based research concerning the effectiveness of therapies is a minefield. Based upon what meta-studies have showed so far, extraneous factors like the role of the therapist and an actively participating client are crucial in the success of a therapy and not the chosen method of therapy. If cognitive behavioural therapy was that all powerful then there wouldn t be any depressed psychologists; reality tells us something quite different
Therapy is an individual journey, depending on the context and history of the client, and there are no one size fits all fail-safe methods. Psychotherapy based upon emotions (!)/cognition/behaviour plus the present/past (!) is often a superior approach to suffering than mainly cognitive based therapies (these focus primarily on only symptoms, thoughts and the present). Removing symptoms without paying attention to the underlying causes often leads to recurrence of for example depression. It s important that root causes should be uncovered and dealt with. After that it s about learning how to deal with triggers and the underlying emotions.
The American psychologist PhD Dr Jonathan Shedler wrote an excellent article Where is the Evidence for Evidence-Based Therapy? (The Journal of Psychological Therapies in Primary Care, Vol. 4, May 2015: pp. 47 59). The key points of this article are:
- The term evidence-based therapy has become a de facto code word for manualised therapy most often brief, highly scripted forms of cognitive behaviour therapy.
- It is widely asserted that evidence-based therapies are scientifically proven and superior to other forms of psychotherapy. Empirical research does NOT support these claims.
- Empirical research shows that evidence-based therapies are weak treatments. Their benefits are trivial, few patients get well, and even the trivial benefits do not last.
- Troubling research practices paint a misleading picture of the actual benefits of evidence-based therapies, including sham control groups, cherry-picked patient samples, and suppression of negative findings.
We can t understand human suffering with quantitative empirical scientific methods because the human being is far too complicated for a simplistic empirical approach. Quantifying suffering is impossible. Depression for example is different (root causes, process and impact) for different persons. It is possible to select certain symptoms and then categorise and label them as depression (like the DSM does), but that doesn t mean that you can quantify it. When you have hundred depressed people then there are hundred different stories, personality structures and development stages and each of these people need tailor-made approaches and not just one size fits all cognitive behaviour therapy (with all its limitations).
Reading the British psychotherapist Susie Orbach s book In therapy, the unfolding story makes you realise what REAL psychotherapy entails. One of cognitive behaviour therapy s (CBT) latest sprouts acceptance and commitment therapy fails to impress in every aspect compared with (short term) psychodynamic therapy which is the Rolls-Royce of psychotherapy.
Changing your irrational thoughts , just accepting them , flavouring it with mindfulness , staying in the present, a commitment to change, it s all done with the purpose of getting control over your emotions and behaviour.
But emotions (simply put, the limbic system regulates them) are in evolutionary sense much older than thoughts (which are controlled by the cerebrum). Since the anatomical structure of the brain is quite a hotchpotch, the different parts of it are not always in sync with each other. Trying to influence your emotions with your thoughts (as CBT tries to do) is a hopeless enterprise.
Psychodynamic therapy invites you to go beyond that. Feelings are very important if you want to change your psychological make-up. If we don t engage them we will end up in big trouble. We can be full of strong emotions (like anger) which can repeatedly engulf us, thus creating the problem that we are not in touch with the more subtle feelings which are the root-cause why we feel what we feel. When we take the time and space and probe a bit, we might be able to discover a wider spectrum of feelings underneath the anger. This can be hurt, sadness, disappointment, loneliness, shame, guilt. When you explore these feelings it can enable you to move out of the stuck place. You become more aware of the complexity of the deeper feelings, perceiving them more accurately which allows change and new ideas about them.
Verbalising your thoughts in therapy can make you aware of issues. It can open up a space to reflect without forcing a solution . You start to feel a bit deeper about it and at another level you either feel more clarity or even more complexity. While discussing this further, a deeper level of understanding can be integrated.
Without forcing it, one can try to catch the wandering thoughts, the not so comfortable feelings, the things that don t seem to match, the part of life that is in exile, fenced off. By doing that you can sense that for example a feeling of anxiety masks and transforms deeper feelings of emptiness and a sense of purposelessness.
In this example anxiety carries a message. It s like a lady in a red dress; don t send her away because of the colour of her dress because you might miss an interesting tale. You could slowly try considering what the message tries to tell. This might open up some space, and then questions might pop up like do I want to continue with my job and if not what holds me back? What am I feeling now? If you don t try to cover it up with easy solutions or suppressing your feelings then these reflections might open up the sensation that what you are missing is exactly that is producing your sense of purposelessness.
Self-harm, for instance cutting in the arm or leg, can also be explained and treated with psychodynamic therapy. Self-harm is often provoked by a complex or crushing feeling which you don t understand and makes you feel helpless. The cutting gives some relief in the sense that instead of emotional discomfort you experience physical pain which can take your attention away from your emotions. In therapy you can discover that emotions can emerge without the need of suppressing them. There isn t an off/on switch. They can just be there and slowly you can discover the hidden message they contain. This goes far deeper than merely trying to suppress symptoms.
In the past decades more and more research has shown that (short term) psychodynamic therapy is far superior to CBT in terms of efficacy. See for example the article The Efficacy of Psychodynamic Psychotherapy by the American psychologist PhD Dr Jonathan Shedler (www.jonathanshedler.com).
Eating disorders like anorexia nervosa and bulimia are on the rise since decades. People with an eating disorder are obsessed with their food-intake. Their feeling of self-worth correlates highly with how they can or can t control their eating habits. In this article I want to focus more on the possible psychological treatments than on other aspects.
Anorexia and bulimia have more in common than you would expect. In both cases clients have an enormous fear of gaining weight and their whole existence is centered about eating (as less as possible). They are alienated from their body and they put enormous effort in trying to control it. They try to hide their eating problems. That s why they have to continuously make up stories and have to lie to be able not to eat. As a result people with an eating disorder can get easily socially isolated.
The onset of anorexia and bulimia is typically during or shortly after puberty. Ten times more women than men suffer from it and it s usually quite persistent. They are also life-threatening disorders, either by suicide or by heart failures caused by shortages of essential nourishment because of the frequent purging.
Although cognitive behaviour therapy (the universal snake oil) and interpersonal psychotherapy (IPT) are recommended for eating disorders, there are only a few research studies where they seem to be effective. Research time and time again shows that other factors have a more positive impact; like the client therapist relationship and an active client.
Psychodynamic psychotherapy is the therapy form that is least studied on efficacy, mainly because by its open structure (it s not protocolised as in CBT and IPT). But it s possibly the most used therapy with clients suffering from anorexia nervosa or bulimia.
The open structure of psychodynamic psychotherapy makes it very useful to explore the many possible underlying root causes of eating disorders. During the therapy it becomes clear to the client that the symptoms of her eating disorder are intertwined with her life history and how this stagnates further development and growth.
In weekly sessions the therapist invites the client to talk about what goes on in her life. In this way a safe and trustworthy client therapist relationship develops which enables the client to talk freely about her personal history. The main focus is on the exploration and discovery of the personal meaning of the eating disorder symptoms. It becomes clear that the symptoms of the eating disorder are illusory solutions which are obstacles for recovery.
During the talks, the client often tries to search and find words to describe certain feelings. This empowers her to take responsibility for a new activity (feeling) and she becomes curious about a new kind of passivity (being open to new ideas). Anorexia clients often have a serious imbalance between activity and passivity. Rigid activity (a compulsive control over eating, weight and physical activity) is contra-productive to relaxation. During the therapy the client feels more and more relaxed and open to emotions and ideas that well up, for example about sexuality and aggression.
Gradually the eating disorder symptoms diminish and the client starts to feel a bit better. It becomes easier to accept and tolerate anxiety, fear and frustration instead of transforming them into a defence mechanism. Eventually the client accepts more and more aspects of herself and control changes into balance . The personal development and autonomy increases and the eating disorder will fade away.
One of the most complicated things for two people is to learn how to live together. Each has their own personality, values and personal history. It takes a lot of communicating and adjusting to find a balance. Here are a few tips:
Have healthy fights.
When you re in a relationship, it doesn t mean that you can say everything at any moment to your partner. Refrain from using swear words or expressions that can be potentially hurtful. Don t spit out your annoyances or your craving for attention. Choose a moment to have a meaningful chat with each other. It sounds very commonsense but often you re too occupied or you feel too bottled up. Try not only to talk about functional matters like children, finances, work, and etc. but also about your personal feelings.
According to the attachment-theory, relationships are based upon an emotional connection. When this connection is threatened we get upset and the well known coping mechanisms fight (engaging in a conflict), flight (avoiding a conflict) or freeze (become silent) pop up. It can be helpful to realise this when for example your partner accuses you that you re prioritising your work. In a deeper sense it s not an accusation but a fear of losing connection.
Sex is more than foreplay.
Foreplay means more than straight away starting to stimulate the vaginal area and clitoris. There is a whole body that can be pampered! Often it s much more erotic NOT to begin with the genitals and breasts. It can start during the day with flirting, teasing and pleasing and eventually leading up to the bedroom. Important is a loving, sensual and exciting attention for each other and trying to be creative. Communicating is essential; let your partner know what you like and what you don t like! Be affectionate and caring outside the bedroom too. Plan to make time for each other and keep your promises.
Be assertive.
It s important to be egoistic in a healthy way. When you adapt too much to the wishes of your partner then you will make his life easier, but in the long run it s toxic. You have to be aware of what YOUR needs are. Don t expect that your partner can read your mind. In a relationship you continue to be your own person and you have to be assertive. You need to be able to negotiate about annoyances and wishes. You can t wait until your partner gets a light flash and understands what you want.
Furthermore, have lots of physical activity, a healthy lifestyle, be passionate in your life and be aware of the difference in wiring between men and women (for example men tend to come with solutions while women often know the answers but just want to share their feelings and want their partner to listen to them).
The importance of having a good relationship was also highlighted in the famous Harvard Study of Adult Development. This study began tracking the health of 268 Harvard sophomores in 1938 and the researchers hoped that the longitudinal study would reveal the clues to leading healthy and happy lives. It proved that having good relationships helps us to live a longer and healthier life.
The current corona-virus pandemic is a source of anxiety for most people. It varies from small annoyances about the scarcity of certain groceries to big worries concerning elderly loved ones with health problems. People are anxious, depressed and they have sleeping issues.
In order to maintain/acquire resilience we can learn a lot from the Stoics. It s a philosophical school of thought which originated in the third century BC in Ancient Greece. It became popular amongst the Roman Emperors and their administrative elite. A few prominent examples of Stoic thinkers are Marcus Aurelius and Seneca. Although I am myself more of an Epicurean, I do believe that the Stoics have something to teach us in times of a crisis.
The core of the Stoic philosophy is the concept of ta eph hemin , which literarily means that is up to us . The only discretion we have is the power to choose our own response. Stoics differentiate between what is within your power and what is not. They propagate that you should only focus on what is in your circle of influence. With the Stoics it s all about having a good, RATIONAL(!) life.
Who you are does not depend on your circumstances , essentially we are who we are, based upon how we deal with situations ; these are a few typical Stoic sayings. Even if you are in prison, or with a pandemic in quarantine, you still have many choices how you can handle these situations. The fact that we have to be indoors is according to a Stoic objectively speaking not bad. But because we perceive it as awful it nags us and it will disturb our inner balance. Instead of that, we should focus on the things that are within our possibilities: spending more time with your family, start a new hobby or interest, reading books.
Regarding the corona-crisis we should remember that we are not responsible. We didn t cause it, we are not the foreign political leaders who made mistakes, and we didn t ask for to be locked up in our houses or be all of a sudden out of work. It s all very unfair but we can t change it. What we can do is to learn from this situation, how we can spend our time more meaningful and how we can emerge stronger out of this.
Another core concept from the Stoics is Ataraxia , which means imperturbable. It s important that you take your decisions based upon reliable (news) sources instead of sources that spread fear or anger. The key is to control your emotions and that you can start being productive asap. You don t have control over news about Trump s latest policy or news about the duration of the lockdown. But you DO have control over washing your hands, staying at home as much as possible and helping a neighbour in need.
When we are calm and rational, according to the Stoics, we are better equipped to act serving the community. They emphasise that the individual is a part of something bigger. We should do good to others in order to improve the world a bit.
Stoics say that there are four virtues which you have to apply to every situation: courage, discipline, justice and wisdom. Don t panic, prepare yourself well and stay indoors, help the needy and be rational.
Sexual abuse is every sexual action where there is exploitation of an age- or power difference. It can happen within a family, extended family, with friends, in boarding- schools and houses, a sports club, a religious organisation, etc. And it can last for a long time.
People who have been sexual abused, frequently experience feelings of shame, guilt, anger and fear. Sometimes you feel loyalty AND anger towards for example a parent who has abused you in the past. All these emotions can hinder you to do things that you would like to do.
Talking about what has happened to you can be at first be daunting, but expressing it and going through the emotional process usually gives a tremendous relief.
Many studies have demonstrated that sexual abuse during childhood often is the root-cause for a variety of psychiatric disorders at a later age. There is a clear relationship between a sexual trauma and (to name a few) anxiety-, dissociative-, mood-, borderline, eating- disorders.
Adult victims of child sexual abuse frequently have strong feelings of guilt, substance abuse, emotional lability, focusing predominantly on the needs of others, negative self image and problems with setting boundaries, suicidal tendencies, sexual problems, relational problems and loneliness. Since sexual abuse is rampant in Sri Lanka, it s important that mental health professionals realise that the above mentioned complaints can be the result of sexual abuse.
In my psychology practice I am always alert on signals of sexual abuse. I often ask clients if in their lives anything sexually has happened against their will. Not only women, but also many men have experiences with sexual trauma.
The above mentioned emotional- and behaviour patterns have been developed as a result of the trauma in conjunction with the reactions of others after the trauma. There is practically never an adequate response to the sexual abuse. Practically never the child had been able to tell the whole story, be listened to and directly brought into safety. Practically never the child had been guided to process the trauma. Practically never adults take their total responsibility. Practically never they admit that they should have protected the child. Practically never they let the child know that it is innocent, that it never had been able to prevent what did happen.
The cognitive behaviour therapy - brigade should stay far away from treatment of sexual abuse. A psycho-therapy with an open structure and focusing on emotions (like psycho-dynamic therapy) is the best here. Victims need someone who listens to them in a non-judgmental way. In my experience many clients have previously told somebody a bit about their ordeals but far too often they didn t receive a supportive reaction. It s so long ago, are you still busy with that? , or just let go of the past, you must move on . These ignorant people just don t understand; if it was THAT simple then clients would have dealt with it by themselves a long time ago.
What matters in therapy is a good therapeutic relationship between the client and therapist. Especially with victims of sexual abuse trust is a rare commodity. For an effective psychotherapy trust and the ability to slowly open up about their experiences are paramount.
In the eleven year that I live in Sri Lanka I have seen certain things change. To name a few: the horrible bloody civil war came to an end, the economy revived, the infrastructure improved, the Colombo skyline changed dramatically, the recent Easter bomb attacks, the present Corona virus situation.
But what stayed the same is the mindset of many Sri Lankans. There seems to be an hierarchical power culture which is paralysing the population. It starts with the education of Sri Lankan children. The predominant pattern is that at home they should obey and respect their parents and stay silent when their parents speak; there are strict rules that children should adhere to.
At school (and even at university) there is an authoritarian top-down structure where generally speaking children and students are taught to memorise and reproduce instead of thinking independently and critically. In the governmental and corporate culture there is a similar pattern. It s quite normal to shout at employees to get things done and micro-managing is common. Grownups are not trained to take responsibility and to think for themselves.
This system can be partly traced back to the colonial history where the Dutch and the British tried to subjugate the country with a divide and rule system. It was installed to create suppression and dependency with the least possible effort. The rule of the law was maintained with hierarchy, fear and punishment.
This whole system is still ingrained in our society, in our politics, educational structure, in our personal and working life.
There are also the typical Asian gender roles which seem to be culturally defined too. Generally speaking boys are raised like little princes and are geared for studies or vocational jobs. Girls usually have to apply themselves to the domestic chores and while they can do their studies, marriage seems to be the primary goal. As a consequence Sri Lanka appears to be a male dominated society where many women feel second best. Men often take their marriage, their role in it and their spouse for granted.
Men and women are wired in a different way and the causes stem from nature and nurture. It is not surprising then that they often have trouble in understanding each other. In Sri Lanka this is enhanced because of the schooling system where most of the children attend boys or girls schools, so there is little opportunity to get familiar with the opposite sex in a natural way.
Things are slowly changing within segments of the younger generation but there is still a long way to go. Cultural changes take their time and it's dependent on many factors. But in history there have been leaders (like Martin Luther King, Nelson Mandela) or movements like the anti-smoking campaign which in a relatively short time made a huge impact. We need more of these brave, creative, independent and charismatic people.
Sri Lanka is the second wealthiest nation (after the Maldives) in South Asia and is a lower middle income nation. More emphasis on modernising the schooling and educational system can contribute immensely to its economy and the well-being of its population.
How can we invite customers to follow health and safety rules without creating a negative emotion which in the worst-case scenario can lead to avoiding your business? It s now more than ever before crucial to win your (potential) customer s trust says Dr. Marcel de Roos, Psychologist PhD, the Netherlands.
The coronavirus crisis has been an enormous challenge for the travel, tourism and hospitality industry. The industry has worked hard on health and safety measures regarding COVID-19. At the same time, we know the importance of an optimal customer experience. The questions that arise are As a business, what should you do when people start to travel again? How and what should you communicate and which psychological insights and tools can you use?
Psychological insights and tools that can be helpful:
You need to be very clear in your communication about how you have implemented the new health and safety measures in your organisation. That generates trust.
Emotional design is quite a novel field in psychology. We might think that we are rational beings but emotions are central in how we interpret reality. Emotional design can be used while designing your website, the actual hotel building, and also in how you communicate. It s used to formulate your communication in such a way that it evokes positive emotions with your (potential) client and mitigates negative ones. This is very important in order to prevent escalations and to maintain the trust of your customer.
In order to create a positive emotional engagement, your website should have a friendly presence in its design plus lots of other emotional reinforcers in addition to happy customer testimonials and pictures of your team.
If a customer has a problem with your product or service then the most effective technique is to take responsibility, even if due to circumstances it s not your fault. Show empathy to prevent escalations. The customer feels that you understand him and that is exactly what most humans want. Prioritise your customer and his questions. It s of paramount importance to know what the customer wants, and you should be digitally proactive. This also means that you must have an excellent customer service with representatives who are trained to build up trust with the customer they are friendly, attentive and authentic.
Where decision making is concerned, nowadays we know a lot more about how our brain functions. One important insight is that 99 per cent of our decisions and behaviour is influenced by factors which we unconsciously notice, and more or less automatically react to. One of these signals is called social proof when you see that other people do something and you trust these people then this is an incentive to do the same.
FactFile:
Emotional design is quite a novel field in psychology. We might think that we are rational beings but emotions are central in how we interpret reality.
It s of paramount importance to know what the customer wants, and you should be digitally proactive.
The link to the original article is here
It s common belief that girls are significantly more prone to experience sexual abuse than boys. One possible reason for that could be that the taboo about this subject is stronger amongst boys than amongst girls. But sexual assault and sexual abuse of boys is more common than you might think.
Recent Dutch studies amongst children and teenagers show that from all victims between 12 and 18 years old one third are male; from all victims till 12 years old HALF are male. With boys in 40% of the cases the perpetrator is a woman. Estimates are that about one in every twenty-five men has been the victim of forced anal penetration or forced oral sex, and most probably the majority of this happened before they were 18. It s most likely that in the Sri Lankan context these figures will be even higher.
Generally speaking, boys don t want to show that they are vulnerable, afraid, sad or upset. They don t want to be seen as helpless victims. These ideas prevent boys who have been sexually abused to speak out and expose themselves as weak . There is a huge taboo on male victimhood.
Sexual abuse can have an enormous impact on your life. It can severely damage your confidence and it can cause you to react by means of survival-mechanisms like being over-responsible, high demands on yourself, pleasing others, and above all blunting your emotions by alcohol, drugs, extreme physical activity with sports or working very hard. You can develop all kinds of psychological (PTSD, shame and guilt, depression, suicidal thoughts, fear of becoming a perpetrator yourself) and physical (tension, hyperventilation, chronic pains, irritable bowel syndrome) complaints which can affect your life in a serious way.
Emotional problems can develop in the sense that if you have been sexual abused as a boy you can have difficulties with experiencing and handling your emotions. They can be too strong like feeling extremely angry, deeply sad or very hurt in situations where that is not necessary. You can feel so ambushed by them that it s impossible to think and act rationally. You react from your emotion and people don t understand that because they try to communicate by means of reasoning with you.
Another possibility can be that you hardly experience any emotions, you feel emotionally flat and nothing seems to affect you. You often feel an intense void and very lonely and misunderstood. In situations where others react in an emotional way you start at once with logical reasoning and practical behaviour. As a consequence, people can experience you as cold and rigid.
When you have been abused as a boy you can feel utterly abandoned by those people who should have protected you. Trust issues will be there, and starting and maintaining (intimate) relationships can be very difficult because you find it hard to completely commit. As a result, you can feel that you re all alone; despite the fact that it s you who keeps people at a distance you think that nobody cares about you.
There can also be problems with your sexual identity. When you have been sexually abused you can develop serious complications with your masculinity and sexuality. You can feel humiliated because you feel used as a woman by a man or you feel that as a boy you have let yourself being abused by a woman (if the perpetrator was female). As a result, you might not feel a real man anymore.
Unconsciously you can compensate this by behaving extremely tough and manly . This can result in dominant, aggressive and unacceptable behaviour. Or you can develop an aversion against anything that has to do with masculinity and even become scared that you yourself might become a perpetrator.
It s important to talk about your experiences with sexual abuse. It s the only way to process your emotions and to deal with your problems. It can be difficult because the perpetrator can be a known person like a family member, a sports coach, a teacher, a clergyman, a neighbour or a classmate. Especially boys and men find it difficult to talk about their feelings and they try to avoid it. Also, strong emotions like shame, guilt and fear for people s reactions makes it difficult to open up. In Sri Lanka it s usually best to speak with a professional psychologist because they are trained to treat these traumas.
An Inner Critic is a forceful inner voice, which appears regularly, which criticises you, which tells you in no uncertain way what to do or not to do, and which breaks you down unmercifully. It s a source of guilt, shame, depression, anxiety and lack of self-esteem.
The neuroscientist Antonio Damasio explains in his book Self comes to mind: Constructing the conscious brain (2010), that, contrarily to popular belief, the emotional parts of our brain play a very important role in our daily functioning.
There are two systems in the brain: rational decisions you take with that part of the brain where processes are conscious and logical. If you want to lose weight then you choose consciously what and how much you want to eat in order to reach your desired weight. That sounds easy ...
But in reality, it usually doesn t work like that; it s because we have a second brain system where the processes are illogical and associative. That part of the brain is activated by emotions we experience with what is actually happening and it has little to do with logic. And it s exactly these associative processes from the emotional brain that control us instead of the logical processes. It s important to realise this when we talk about the Inner Critic. Because the tendency to criticise yourself is connected with the emotional associative system in the brain.
When you want to change something about yourself then it s much more productive to realise which EMOTIONS are involved with the behaviour you want to change than to stick to logical reasoning. Because the emotional part of our brain is substantially more powerful, it s no use to force yourself to stop something. The behaviour will cease but not the inner restlessness that causes it. In order to change yourself, it s also important HOW you try to do that. Try to look at yourself as a fascinated and benevolent researcher and try to understand your inner self. That s strange, that I am so affected by that one remark. I am sure that it was meant in an innocent way but what is it in me that keeps thinking about it ?
We can t change our past but we can change how we feel about it. Which can make our life a lot easier because we can become more compassionate and forgiving about ourselves.
Shame and guilt:
Shame is about who you ARE, guilt is about what you DO. Shame has to do with your identity, with who you are. Guilt has to do with what you think, feel or do.
Shame: WHO AM I, if I think, feel or do this?
Guilt: Who am I, if I THINK, FEEL OR DO THIS?
You can minimize the harshness of your Inner Critic by:
- Being proud on qualities of yourself which are special or good, even if you don t have to make an effort.
- Try to be realistic and feel that making mistakes can be shameful of can cause guilt. Try to look at these shameful or guilty experiences as incidents which will pass. Realise that these are symptoms of experiences earlier in your life which made you more sensitive to be shameful or guilty. With being more empathetic and understanding for yourself you will become more aware of the stories underneath these emotions (like becoming more independent of your parents, sexual fantasies, angry thoughts, etc.).
The deeper cause of shame often lies in the childhood family situation where experiences of one or both parents being condescending, scornful or negative towards you. It s important to make the emotional link between present emotions and where they are rooted.
With thanks to Dr. F. Schalkwijk, a Dutch psychotherapist who has written several books about psychotherapy.
Nowadays it happens quite often that when a client visits a psychologist for the first time, she has to fill in a long questionnaire of some 800 questions for a so called assessment . Then the psychologist will be able to tell her in which spectrum she falls . This is a quite useless exercise in symptom-hunting, because unlike in the medical model, in psychology it s NOT about symptoms but it s about the STORY behind the symptoms.
In his book On being normal and other disorders: a manual for clinical psychodiagnostics the Belgium psychologist prof. dr. Verhaeghe discusses the differences between the two diagnostic processes. The first difference with the medical diagnostic process is that in the psycho-diagnostical process it s NOT about one individual but also about the CONTEXT wherein this individual lives. The diagnosis usually doesn t come at once, but much later after more sessions and very often it will be adjusted. A second difference is that in the medical model one works from the individual person to generalised diseases. The symptoms (high temperature, muscle pains, etc.) lead to the conclusion of fever (a very common condition, N=millions). Psychologists on the contrarily start with a general story and end with N=1. Mental conditions are typically very individual and are extremely difficult to generalise. A psychologist gathers more information and the situation becomes more specific. A third difference is that in the medical diagnostic system the VIEW is central, it s focused on the discovery of signs which direct to objectively measurable parameters. Whereas within the clinical psychological perspective the therapist is primarily LISTENING to signifiers, which remain open to interpretation. Medical signs refer to an illness scenario, while signifiers derive their meaning and function from a special relationship with the context. A fourth difference is that in the medical field the disparity between illness and health can be measured and generalised. But psychological normality and abnormality are always relative and therefore individual. In addition, certain psychological symptoms can be interpreted as solutions for deeper lying problems.
The comparison between medical and clinical-psychological diagnostics is one with predominantly differences. What works well with symptoms related to physical illnesses doesn t necessarily goes with mental illnesses. The final diagnosis is a description of an INDIVIDUAL CASE and not some generalised label.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is an arbitrary CLASSIFICATION system, meant for mental health workers to communicate with each other, and NOT a diagnostic book. Despite the term statistical in the title, it does not mean that the book is based upon sophisticated research about types of psychiatric problems. On the contrary, the classification criteria and categories were chosen by vote by people in working committees who have strong financial ties with Big Pharma. The DSM is written as an extension of the powerful pharmaceutical industry. There is no solid theoretical foundation, nor a clinical pragmatic practice.
Mental health workers more often than not differ in how to label a patient. The DSM diagnoses are scientifically and clinically untrustworthy. Worse than that, there is hardly a connection with a subsequent treatment. A psychiatrist who uses the medical process only focuses on the symptoms, typically doesn t have more than 5 to 10 minutes to spare and prescribes medicine which has usually nothing to do with the root-cause of the problems. In addition, we know that there exists no effective medication for depression, anxiety, suicidal thoughts, substance abuse, low self-esteem and loneliness.
Psychologically speaking, personalities of men and women are very much alike. And cross-culturally they are more similar than they are different. But there are differences too.
Regarding those differences please be aware that we are talking about AVERAGES, on an individual level people can differ a lot. But on average men are less agreeable, more aggressive and more risk prone, whereas women are friendlier, more risk averse and worry more which makes them extra vulnerable for anxiety and depression.
The largest psychological difference between men and women is in terms of interest: men are comparatively more interested in things and women are more interested in people. This of course influences for example occupational choice. All of this has been extensively researched and there is an impressive amount of literature to substantiate this.
There is a huge influence from hormones, as studies with transgenders demonstrates. Women who received treatment with a higher testosterone level in order to become more masculine, report that they felt more confident and their tendency to take risks increased. They also became quicker irritated and less modest.
Simone de Beauvoir in her book The second sex (1949) wrote that women aren t born as women but they are taught to behave feminine by society. But we know now that the influence of testosterone is massive and it starts before a child is born, in the uterus. Of course, there is some influence of society but it s relatively small. Parents can help their daughters to develop more spunk and a higher sense of self-worth by encouraging them: of course you re smart! , of course you can do this!
Then there is the so called gender paradox ... In summary it means that as societies become more gender-equal in their social and political policies (like in the Scandinavian countries or in the Netherlands), men and women become more different in certain aspects, rather than more similar. In recent years there have been many methodological well conducted studies with tens of thousands of participants which show that the more egalitarian and wealthier the country, the LARGER the differences between men and women in interest.
Although the social constructionist theory says the opposite, the Scandinavian studies suggest something else. The best explanation, so far, for the fact of the growing differences in occupational choice is that there are two reasons for the differences between men and women: biology and culture. If you minimize the cultural differences (as you do with egalitarian social policies) then you allow the biological differences to manifest themselves fully. So that means that there will be for example more male engineers and more female nurses.
Policies that maximize equality of opportunity make equality of outcome increasingly impossible. What all of this signifies is that ideologies which propagate that sex differences are only socially constructed seem to be wrong
When you have decided for yourself that you want to have psychological help it would be convenient that you could talk soon with a suitable professional. But how can you find such a person? There are a several methods but the most important factor is that you have a good feeling, a click with this therapist.
There exists an enormous quantity of studies regarding the efficacy of treatment for different psychological issues. It s too much to discuss here and it s about a vast number of diverse complaints, disorders and treatments. But if you re looking for a specific type of treatment for a specific complaint or disorder then it can be useful to read up a bit about these particular studies.
In general, amalgamated research indicates that the percentage of clients that feels better after treatment is approximately 50 to 60%. Concurrently, many people feel better without treatment: approximately 30 to 40%. Please be aware that this is a statistical conclusion where GROUPS of people are compared. It doesn t necessary tells something about your situation. It does indicate that apparently people can make progress on their own, and an suitable therapist can improve this result significantly.
Numerous studies time and time again indicate that the most important variable in a successful therapy is the bond between the client and the therapist. Most importantly, trust your own feelings with this person: are they negative or positive? Therapy is very personal and it involves human beings. So please be critical when choosing a psychologist or counsellor. You ought to have a feeling of trust and being at ease with this person.
Finding a suitable therapist for you depends on several factors:
Gender: you can have a preference for a female or male therapist. Both have their qualities; your psychological complaints can be determinative, but also your feeling of comfort and safety and your stage of life. Follow your feeling and when in doubt ask for an introduction consultation.
Age: the age of a therapist can play a role in your choice. There is a rule of the thumb that the therapist should be at least ten years older but that is not a prerequisite. Young therapists can have qualities and other skills than more experienced therapists.
Your issues: it s advisable to find out who this therapist is. What is her or his education/training, which methods, what are the specialisations and has the therapist experience with your issues? Most therapists are capable to treat various complaints and issues. In the initial consultation you can discuss your issue and see if the therapist can be of help for you.
Accessibility: here is the practical side. A nearby therapist can be better combined with work and family. On the other hand, it can be preferable for privacy reasons to choose a therapist further away. There is of course also online therapy but the consensus is that face to face therapy is more effective.
The therapist: finding out if there is a click between you and the therapist is more important than the method or education of the therapist. You need to feel safe and comfortable! Apart from the professional qualities, it has also to do with the therapist s personality. Take your time to find the right therapist for you. Read their websites, ask people you know about their experiences with the therapist and book an initial consultation in order to get to know him/her better. Follow your gut-feeling!
Nowadays there is a strong tendency to attribute identity totally to genetic and biological causes but there is not a shred of evidence to support this. From a young age onwards, our identity is basically formed and developed by our environment.
According to the Greek writer Pausanias, one of the three inscriptions on a column before the Temple of Apollo in Delphi read: Gnothi Seauton , which means Know Thyself . We are continuously searching for ourselves through soothsayers, astrologers, priests, psychologists and even brain specialists but their answers are never satisfying. Our identity is not a deeply hidden, immutable essence within. On the contrary, it s more like a collection of ideas that the outside world has imprinted on us.
Take for example adoption. If a Sri Lankan baby is taken away from her native village in Nuwara Eliya and raised in Cologne in Germany, she will develop a Cologne identity. If this same baby was adopted by French parents in Paris, she would become a typical Parisienne. When as an adult woman she returns to Sri Lanka in order to find her roots she will be utterly disappointed because they are simply not there. In her country of birth, she probably will be considered as even stranger than other women from Cologne or Paris. All the more so, because her external similarities (colour of skin, hair) make Sri Lankan people expect an internal similarity which doesn t exist. The conclusion is that our psychological identity depends on our environment.
The development of our identity is a continuous struggle between attachment and detachment. This is extensively discussed in the attachment theory of John Bowlby. From the start onwards there are two processes simultaneously at work: identification (or mirroring) with the other (initially the mother) and striving for autonomy (separation). In this way we learn to develop our own individuality by detaching ourselves and choosing our own definition of me . This only happens if the child is raised in a loving way; if a child is treated with indifference then it will lack a foundation.
Our brains have a number of ready-made structures (the hardware) which determine the processes by which our identity (the software) is being formed. Mirror-neurons for example, play an important role with understanding and interpreting of the actions of other people, and the acquisition of new skills by means of imitation. They are essential for identification but WHAT is being mirrored depends on the environment. That environment has a very clear influence on the development of our brains, which continues many years after birth. Our neural networks in the brain have the ability (neuroplasticity) to adapt to changes in an individual s environment by forming new neural connections over time. Our brains are important for our identity, but the content comes from the outside world.
But a baby is also not a tabula rasa (without mental content) waiting for the environment to deliver its imprint. We are the result of a continuous interaction between our brains, or better, our genetic-neurological-hormonal basis and our environment. Every baby is different, for example languid or energetic, reluctant or persistent. Another example, introversion-extraversion is typically a result from a certain genetic make-up which is intensified by the feedback from the parents. We are unique, because we are an inimitable combination of everything that our parents (genes) and environment have passed on to us.
When you start counselling or psychotherapy it s of the utmost importance that everything you communicate with your psychologist stays confidential. Even more so than a visit to a medical doctor, because instead of a broken arm, a flu or gastritis you re typically talking about very personal potential shameful sensitive issues like traumatic experiences, sexuality, relationships with family, partner or friends.
In the Sri Lankan context confidentiality appears to be a rare commodity. According to many of my clients it doesn t seem to be a priority among mental health workers. A psychologist should be responsible, respectful, professional, ethical and have integrity. The guidelines and rules of conduct in the professional code are derived from these five basic principles.
In the contact with their clients, psychologists have a confidential relationship. Psychologists must understand that people ought to feel comfortable talking about personal information. They need to be able to communicate without fear that this information will leak from the room and be assured that their psychologist takes their privacy very seriously. No written, telephonic or electronic information about the client should be communicated to third parties without written permission of the client.
You can speak about anything with your psychologist: your life, your feelings, your thoughts, your fears, your study, work, home situation, your parents, friends, relationship, family. Because you need trust and safety to be vulnerable, confidentiality is imperative.
There are four situations where the duty of confidentiality might be broken. If it s foreseeable that such a situation might occur, the psychologist will inform the client that he is obliged to break the confidentiality unless such a statement will endanger himself or third parties.
1. If the client might be a danger to himself or to others. In these cases, the psychologist s duty of confidentiality can be broken but the psychologist must make a thorough assessment to ensure if there is an actual danger.
2. To share diagnosis information with an insurance company or a relevant medical doctor. The psychologist must explain this to the client and a written permission of the client is mandatory.
3. If there are reasons to believe that there is for example child abuse or abuse of the elderly.
4. If there are legal provisions. These are exceptional situations like an unnatural death of the client or a compulsory psychiatric treatment.
The psychologist must make a well-considered decision. He can t just breach the duty of confidentiality; this only happens when there is no alternative. He has to assess if it could be damaging for the client or others if the duty of confidentiality would not be broken. And he has to reflect if his decision gives him moral doubt. Only if he is convinced that the breach of confidentiality is the only option, then it s permissible.
Grieving is a very personal process. There is no standard way to grieve, there exists no manual which describes what you should and shouldn t do. Please stay away from the advisors (Sri Lanka is filled with them) who will tell you exactly what to do. A few well-meant but useless examples: be strong! , my aunty lost THREE children and she stayed positive , take a holiday to forget , etc., etc.
Do what you feel is right for you, even if you think it might be weird. The form and content of your grieving process depends on you, your character, earlier losses, your outlook on life, and the depth and pain of the experienced loss.
In case of a suicide, it s important to disengage from ignorant people who tell you that it s an easy way out . Apart from being totally rude, these people need to get familiar with proper information regarding suicide. A suicide is usually the end of a long painful dark road where this person doesn t see another way out from the excruciating emotional pain.
Grieving is a natural process that shouldn t be numbed with medication like antidepressants. Only where the grieving seems to be stuck then an intervention is appropriate, and counselling is the first and foremost choice. The duration of a grieving process is very individual, there is no set time limit for it. Also, when it s about the loss of a child, partner, father or mother it can last a life time. Grief about a break-up or the loss of a job can be intense too, but the impact is different.
In publications certain phases are mentioned during the grieving process. The Swiss-American psychiatrist Elisabeth K bler-Ross published about this in her book On death and dying (1969). Her grieving stage model generated a lot of criticism: grieving can t be rationalised; very often the grieving phases are intertwined and they can alternate on a daily basis. Here are the grieving phases that nowadays are often described:
- Denial and disbelief. This phase can useful as a protection for your emotions. The blow can be so devastating that it s impossible to face the reality of your loss. You could run the risk of getting into a shock. You need time to get used to what really happened.
- Anger and resistance. Anger is a natural and important part of a healing process. In our society anger is often misunderstood in a grieving process. You can be angry with the medical doctors who couldn t save your loved one, with God or the universe, with the unfairness of the loss, with yourself (guilt). It s an emotion that has to be felt and processed. It only surfaces when you feel safe enough; please don t ignore it because then it will find another way to express itself. Your pain lies underneath the anger so you have to feel the anger first.
- Disorientation. You feel lost and you re swamped with emotions. Feelings of despair, uncertainty, lethargy and exhaustion. How to proceed? You overthink: if I had done this then it wouldn t have happened; and perhaps it was my fault . You want to go back in time to prevent the loss. Your daily routine is gone, too little sleep, feeling inert and empty, sad and uncertain.
- Acceptance. This means that you acknowledge that somebody has definitively left your life. It still means that you can be at times in denial, feel sad or angry. Some losses you can perhaps eventually accept, other losses can take a life time to process. But you learn how you can remember your loved one and how you can come to terms with it. Continue to share memories, maintain certain rituals like once in a while having a dinner dedicated to the loved one.
The psychiatrist s bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM), pretends to be a scientifically well-founded overview of psychiatric diagnostics. It describes criteria for putting psychiatric labels on patients. But the impressive words Diagnostic and Statistical in the title of the book are quite misleading.
They are an illusion. The two requisites for a proper diagnosis are reliability and validity. A diagnosis is reliable if two psychiatrists come to the same conclusion with the same patient. Countless studies have shown that the same patient often gets a different diagnosis with different psychiatrists and that experienced psychiatrists were not able to distinguish normal people from people who were diagnosed with disorders. A diagnosis is valid if it relates to an existing entity. But even the American Psychiatric Association concluded that there is no proof for the alleged biological or genetic causes of the hundreds of DSM disorders.
And despite the term Statistical in the title, it does not mean that the book is based upon sophisticated research about types of psychiatric problems. On the contrary, the criteria and categories were chosen by vote by people in working committees who have strong financial ties with Big Pharma.
Only when perceived as an ARBITRARY CLASSIFICATION system, the DSM is successful in the sense that it is worldwide embedded in the psychiatric/psychological practices. As a result, in countries like the Netherlands regarding the latest official translation of the DSM, they have left out the words Diagnostic and Statistical and it s called plainly Manual for the classification of psychiatric disorders .
A few (of the many) examples of arbitrary classifications:
- With ADHD there are two equally comparable classification systems, the DSM-5 and the International Classification of Diseases, 10th edition (ICD-10). When children are diagnosed for ADHD with the ICD-10, then there are HALF as much ADHD children than with the DSM-5. This shows how arbitrary this diagnosis is.
- What are the criteria for assigning a label to a patient? And why 9 instead of 8 or 10? For a borderline personality disorder label you need to have 5 out of 9 descriptions. This means you can be borderline in 256 different ways so it s possible that two borderliners have only one description in common. In addition, if one patient scores on description 1 till 5 and the second patient on description 5 till 9 then they have only one description in common.
- Every DSM description is laced with adjectives like intense, clear, frequent, recurrent, persistent, convulsive, often, forgetful, etc., etc. How can you quantify these? For example, does often means once a day or once a week/month, what is forgetful, etc., etc. As a consequence, there is a huge variety by different assessors in interpreting the criteria.
Psychiatrists are not qualified as psychologists so, as I have exemplified in many previous articles, they are trained to assess in a medical way and they generally speaking fail to understand the completely different way in which a psychological assessment is made. A classic example is depression where the two disciplines differ hugely about the possible root causes of it: chemical imbalance in the brain versus stuck emotions.
N.B.: Depression is supposedly caused by a "chemical imbalance in the brain" as explained by the "serotonin reuptake" story (people are encouraged to believe that depression is caused by a deficiency of serotonin as in the analogy with diabetes and insulin). The marketing machine of Big Pharma is making frantic efforts to spread this idea but there is no scientific medical proof.
As it often happens when people go through traumatic times like the present covid-19 pandemic, many of us start to think about their lives. They ask themselves existential questions like what is life and how to live their life.
In the Classical Greek world (long before corona, in the fourth century BC) there were thinkers who thought about what makes us happy and what not. The antique word for happiness is the good life , and it connotates good also in a moral sense (which nowadays has been a bit snowed under).
Our identity is a moral construction. We absorb our moral norms from our parents and our environment (including the constant flood of advertisement messages). Freud already knew this, his term Uber-Ich for the conscience, is a part of the identity.
Aristotle in his Ethika Nikomacheia (and later Epicurus in his Letter to Menoikeus ) has written some very useful ideas about this. In his vision the development of a good person (how a free citizen should learn to behave) is related to a good society and this interplay is the foundation for a good life. This is very much unlike what you find in modern self-help books with tips like 5 steps to find happiness , write a gratitude journal , start the morning with making up your bed , or the ridiculous nonsense you can read in The Secret .
According to Aristotle the common goal for everybody is to become happy. In order to reach that we need to acquire a certain way of life. We can t do that by ourselves, what is needed is a learning process based upon upbringing and education. In addition to his Ethika Nikomacheia he wrote Politika in which he explained how the polis or city state should be organised, and where the right upbringing and education are embedded in laws. If implemented correctly it will according Aristotle result in the highest goal: Dikaiosune (righteousness).
His complete manual for a good life can be summarised in one sentence: choose for the golden mean, and in function of the circumstances. You can think for example of food and alcohol which we can consume more at a party than on an average day, but also of eroticism. The hypersexual male or female who jumps from one bed after the other and tries out every position, gender and gadget and who continually tries to excel by means of a cocktail of viagra and cocaine, finds his or her opposite in the frustrated ascetic who has denounced sex and as a consequence thinks of it the whole day. Likewise, braveness is the middle between recklessness and cowardice, calmness between hotheadedness and valium-apathy, and always depending on the context.
In addition to this it s also important to find meaningfulness in your life. Life in itself is meaningless but you can GIVE meaning to your own life. To paraphrase the famous psychotherapist Irvin Yalom, you can t find meaningfulness by sitting in your armchair and wrecking your brain about it. You CAN find meaningfulness in an oblique way, by getting involved with activities that make you forget about time. Meaningfulness is a byproduct of engagement and commitment.
In the last months many readers have mailed me with complaints about the usual subjects : psychiatrists who spend only little time (about three, four minutes) on complex situations, were predominantly focused on symptoms and not on the underlying story, prescribed many medications for symptoms while the root-causes stayed untreated, and didn t inform them about frequent side-effects of these medications. Besides this, below are a few of the most frequent mentioned clusters of questions. For more articles about various mental health topics, please visit my website www.marcelderoos.com.
ADHD.
The line Teach your children well ; from the iconic song of Crosby, Stills, Nash & Young is very applicable to the so called ADHD -symptoms. Please remember, ADHD (or for example borderline personality disorder ) is just a label for certain symptoms! And there is no indication that these symptoms have ANYTHING to do with a brain dysfunction or a deficit of a transmitter in the brain . Also, many health professionals make the classic mistake of reification: they speak about certain symptoms that children exhibit, BECAUSE they suffer from ADHD . But ADHD is just a definition, an abstraction without a real entity, and there exist no subtle signs of it.
It s important to invest in quality education/schooling and in quality day-care facilities, and parents should have the time to raise their children. There lies the key for a quality society. Raising kids is a slow process and it takes time, and this for many years. Many parents (and for single parents it s even worse) are short of time regarding work and other commitments. Children are often put in front of the TV while their parents bicker about last night s fight. There is a huge pressure to get high marks at school. And at school they have to sit still for hours while they are at an age when they are full of energy. School teachers are underpaid and are often underqualified to teach and guide children, school classes are too crowded to give individual attention. In a few years time many of these kids will have a brief chat with a psychiatrist who will be very trigger-happy to jot down (unnecessary) fancy little acronyms and abbreviations like ADD, ADHD, CD, ODD, PDD-NOS, etc.
What is needed is to stop diagnosing children with ADHD because they will think that there is something wrong with them. In many cases parental advice, teacher training and psychological support suffices. It s important to create an environment that is clear, quiet and predictable. There should be clear boundaries and positive behaviour should be noted and rewarded. And only when all of this doesn t work, then medication can be used as a last resort.
The Secret .
Bestseller writer Rhonda Byrne ( The Secret , 2006) tries to make you believe that success in life is something that you have in your own hands. Just visualise what you want, think positively, show gratitude, and you will receive what you wish for. Yessss, conveniently forgetting that being born in the Bronx New York (as opposed to being born in an affluent academic Bostonian family) there is extreme little chance that you will end up in Harvard.
This is how real life works: success often comes with commitment, but besides this a lot of other factors have to be in place. Like education, your parents social, academical level, their ability to guide you and to show empathy, your IQ, the neighbourhood and country you grow up in, your ethnicity, the family wealth, your network, they all play a significant role in your chances for the future.
And then the law of attraction : it states that by wishing things to happen they will eventually manifest themselves in your life. Positive (for example creating wealth) or negative (for example dying of cancer, because you weren't posititve thinking enough). And all because the Universe is made up of energy and if you are attuned to that energy things will happen. In essence, it's blaming the victim. Enough dribble, I need a drink ..
Nowadays (especially young) people get easily addicted to gaming. With as a result that a new addiction variant has been born: the gaming disorder . But not everyone gets addicted to gaming, drinking, porn or develops an eating disorder. There are certain important well-known contributing factors and circumstances but in this article the focus is more on the psychological side.
Addictions are there in many forms, for instance to gambling, chatting, internet games, porn, shopping, work, substances. With addiction to substances there is a physical and a mental component. Physically it means that the human body has been accustomed to this substance and has adapted itself to the use of it. When the administration of that substance stops this causes withdrawal symptoms. Usually there is a built up of tolerance which means that to get the same effect of the addictive substance one has to increase the quantity. Being mentally addicted means that you have the idea that you can t do anything without using the substance, that you can t perform without it. A special category is addiction to certain medications like sleeping tablets and anxiety-reducing drugs (the so-called benzodiazepines such as diazepam, oxazepam and alprazolam). Often prescriptions are used for many years to maintain the addiction and it becomes very difficult to stop.
Addictions help us to stop feeling what we would feel without them. By providing ourselves with a shot of our favourite addiction we don t feel the pain of for example emptiness or loneliness. Generally speaking, we don t feel our unfulfilled needs (from the past), we anaesthetise them. When the endogen opiates (beta-endorphins) can t help us adequately with dealing with painful emotions we can try exogenous opiates like alcohol, cigarettes, or the high we get from gaming or shopping. The physical addiction is relatively easy to stop, contrarily to the mental addiction because addictions work twofold. They suppress painful emotions and at the same time create the illusion that we can get what we need . The object of our craving is after all available in the present! It is this illusion that persistently stimulates each addiction. But this high is only temporary, the longing for our needs from the past to be fulfilled stays. But no addiction whatsoever can do that. People who are addicted very often have a history of structural abuse (physical, emotional or sexual). As a consequence, an addictive personality is formed.
The approach to deal with addictions isn t an easy one. Willpower won t work ( what you resist persists ); you can achieve a lot with willpower but your Monster (your compulsory side, your addiction) is much stronger than yourself. A punish and reward system doesn t work well either, neither does positive thinking or affirmations . What usually does work is to find out what you REALLY crave for or are afraid of. It is crucial to find out how you tick and what you want to do with your life. When you are addicted, you usually have lost contact with your body and feelings. You not only have a mind with compulsory thoughts but you have also feelings which can tell you a lot about yourself. You ll get insight into yourself, in your pros and cons, in your behaviour, in your emotions. Practically it means: stopping with the addiction (if necessary, in phases); each time when the need comes up try to feel this emotion in your body (not your thoughts) and focus on it; and lastly try to accept the pain when you feel that you will never get what you needed in the past. To succeed in all this, you ll need a dedicated and professional therapist.
The link to the article published in Ceylondigest is here
There is something very special about art in its many forms. Art is inspiring, it attracts your attention, makes you curious, it captivates you, and it can also give you solace.
In a more scientific sense, a 2019 WHO report that synthesises the results of 3,000 studies, clarifies the evidence on the role of the arts in improving health and well-being. Experiencing art for example supports the social and cognitive development of children, it can prevent and reduce depression, the impact of trauma and stress, and it stimulates self-worth and self-confidence.
Art-therapy enhances the resilience and vitality of patients, and their ability to recover and to overcome setbacks. The power of art lies in the preventive involvement with vitality. Several studies show that people who for example visit museums and exhibitions, acquire a better emotion regulation. They spend more time with introspection, enjoy beauty which is conducive for their mental health. In the UK doctors can prescribe art activities. Arts on Prescription has been used for around two decades in the United Kingdom as part of broader social prescribing schemes and is quite successful.
Senior people who enjoy art or who actively participate in art are better able to stand up against setbacks, are healthier, consume less medication and have less visits to the doctor. Active art forms like photography, learning to play an instrument, painting and drawing, and learning how to use social media are popular with senior persons. They find pleasure from these activities and they look forward to enjoy art with others. They specify that they find it meaningful and that it keeps them sharp.
In general, art can make the time seemingly go slower. You can get enraptured and forget about time with for example (amongst many others): the vivacious tomb paintings of the Etruscans in Italy, Monet s Impression, soleil levant , Botticelli s Primavera ; Sapfo s love poetry, Keat s To Autumn ; Rodin s sculptures in Mus e Rodin in Paris; the Renaissance architecture in Florence, the impressive sites that the ancient Greeks chose for their temples; the novel Brideshead revisited , Philipp Blom s historic description of La Belle Epoque The vertigo years .
People (grown-ups and children) can be touched in their core by art; it can entice the imagination. It can lead to what the ancient Greeks called a Kairotic moment: it s a moment where you are in a flow and where you forget about time. Very often it unexpectedly leads to new insights.
Many of us are locked in a busy world with little time. There is no space for random musing or daydreaming without any plan or utility. While daydreaming (just let your mind roam, and calmly see what happens) is the incubator of our creativity and imagination.
The Greek word schol signifies peace of mind, free time, daydreaming. Our word school has derived from that because Plato saw this as a requisite condition for the thought process. It s similar to the Chinese wu wei (non-doing) which in Taoism is a source of knowledge. New ideas don t emerge by means of time pressure and stress. In the educational system and in our daily life this concept of peace of mind seems to have disappeared. You can question yourself how much awareness you can generate if you continuously switch from screen to screen.
We need peace of mind and daydreaming to become creative, but also for critical reflection. It s like you have to empty your mind first before new ideas can emerge. Peace of mind can originate from enjoying art, staring out of the window, enjoying nature, a walk, doing an active sport, playing an instrument as long as there are no expectations of external goals, profit or publicity.
Cognitive behaviour therapy (CBT) has become the dominant psychological treatment in the past decades. In the late 1960-ies it spread from the USA to the rest of the world together with the belief of the malleability of people and nowadays it s presented as the only scientifically proved therapy form. While in reality it s quite superficial and it borders on a snake oil mental health technique.
With CBT there are a few helpful steps like getting a more realistic view on your problems and to actively confront your depression or anxiety. It s is typical American in its assumption that the way you think will influence your feelings. When you are depressed, you should challenge your irrational, negative thoughts ( positive thinking ).
But from the clinical practice we know that you can tell a depressed person a hundred times that (s)he should think positively but that won t bring about a lasting change. We can t THINK ourselves happy. You simply have to understand and come to terms with the disturbing FEELINGS that cause these thoughts; you can t push them away or ignore them. These feelings are too strong and they invariably will surface again but then much more powerful. If you don t deal with your feelings, your feelings will deal with you ...
Especially after the introduction of the managed healthcare a lot of emphasis has been placed on the use of the so called evidence-based therapies . It created a tunnel-vision by using methods from the pharmaceutical industry (such as randomised controlled trials ) which when used in the social sciences have strong methodological shortcomings, and as a result it s only applicable for very few therapy-methods.
Research invariably shows that sustainable psychotherapy efficacy depends for the most part on the therapeutic relationship (trust, attention and willingness to listen) and the extent where clients feel that they can play an active part in the therapy. Psychotherapy based upon emotions(!)/cognition/behaviour plus the present/past(!) is often a far superior approach than mainly cognitive based therapies (these focus primarily on symptoms, thoughts and the present). Removing symptoms without paying attention to the underlying emotional root-causes often leads to recurrence of for example depression.
Emotions (simply put, the limbic system regulates them) are in evolutionary sense much older than thoughts (which are controlled by the cerebrum). Since the anatomical structure of the brain is quite a hotchpotch, the different parts of it are not always in sync with each other. Trying to influence your emotions with your thoughts (as CBT tries to do) is a hopeless enterprise.
CBT only focuses on the present, has no environmental or societal context and has the underlying flawed assumption that insight and cognitive change is the correct remedy for symptoms like depression or anxiety.
Short term psychodynamic therapy goes far beyond that. It s not only the cognitive part (understanding) but most and foremost the emotional realisation that counts. An insight must be experienced and lived through. It should incorporate conscious emotions, unconscious ones and the underlying conflicts. By emotionally experiencing it under proper professional guidance it gets worked through and after several times the impact diminishes. Clients time and again acknowledge the richness and depth of this and it often leads to a real change in their lives.
Bestseller writers like Norman Vincent Peale ( The power of positive thinking , 1952), Anthony Robbins ( Awaken the giant within , 1991), Rhonda Byrne ( The Secret , 2006) and Martin Seligman, the founder of the positive psychology movement ( Authentic Happiness , 2002 and Flourish , 2011) make us believe that continuous happiness is within our reach. We just have to follow what they advise in their books and our worries will disappear. From this list, The Secret is by far the shallowest one and filled with silly quotes and superstitious nonsense.
Bestseller writer Rhonda Byrne ( The Secret , 2006) tries to make you believe that success in life is something that you have in your own hands. Just visualise what you want, think positively, show gratitude, and you will receive what you wish for. Yessss, conveniently forgetting that being born in the Bronx New York (as opposed to being born in an affluent academic Bostonian family) there is extreme little chance that you will end up in Harvard.
This is how real life works: success often comes with commitment, but besides this a lot of other factors have to be in place. Like education, your parents social, academical level, their ability to guide you and to show empathy, your IQ, the neighbourhood and country you grow up in, your ethnicity, the family wealth, your network, they all play a significant role in your chances for the future.
And then the law of attraction : it states that by wishing things to happen they will eventually manifest themselves in your life. Positive (for example creating wealth) or negative (for example dying of cancer, because you weren t positive thinking enough). And all because the Universe is made up of energy and if you are attuned to that energy things will happen. In essence, it s blaming the victim.
All these books more or less say the same things: stay positive and focus on your goals, pay no attention to negative thoughts and self-doubt, and visualise what you desire. Then you will get what you want .. This quest for happiness is an existential mistake. Nowadays many people not only want to be non-stop happy , but they also want this experience each time to become deeper and more intense. But with this constant pursuit of kicks and pleasure you will lose meaning in life.
Happiness is NOT the absence of negative emotions. It s not about being happy and smiling 24 hours a day, seven days a week. Happiness is not about being numb to negative feelings. Nietzsche wrote: "Mankind does not strive for happiness; only the Englishman does that." With this he meant that those who aim at being happy (as the English utilitarian philosophers of his time did) are doomed to fail. We can only become happy as a by-product of something else.
In order to live the full human life, you have to experience the full range of human emotions, the positive and the negative. They both play an important role in our ability to thrive. Positive emotions make you feel good, negative emotions make you feel uncomfortable but they also make you aware of things that are wrong and of possible ways how to change them.
Positive psychology uses cognitive behaviour theory and techniques, gratitude journals and positive affirmations in order to challenge your negative thoughts. But we can t THINK ourselves happy. You simply have to understand and come to terms with the disturbing feelings that CAUSE these thoughts; you can t push them away or ignore them. These feelings are too strong and they invariably will surface again but then much more powerful. IF YOU DON T DEAL WITH YOUR FEELINGS, YOUR FEELINGS WILL DEAL WITH YOU. Positive psychology also promotes resilience , and in order to become more resilient they urge you to have stronger and closer relationships. But the only way to do that is to become more vulnerable. In other words to communicate about your negative emotions ; in life there are periodically inescapable challenges like suffering and deprivation. People in relationships encounter for example conflicts, anger and sadness. Which is a no go area for the positive psychologists .
The Harvard Medical School professor and psychologist Susan David wrote a book called Emotional agility . She states that in our present culture the happiness obsession and the positive-thinking movement have caused a tyranny of positivity ( just be positive and things will be fine ; you can beat cancer with positive thinking, and if it didn t work then you weren t positive enough ). People are used to avoid or repress feelings like grief, sadness, guilt or anger. And we are taught not to probe our feelings (negative or positive) too deeply.
But instead of this we should pay close attention to our emotions. In adverse situations the steady stream of thoughts and feelings that form our inner self can become our best teacher. Our emotions can tell us what we value most, and these values can guide us to become more resilient, stable, compassionate and courageous. Life guarantees us that you will become sick, your loved one might leave you, your work might become a lot less interesting. We will experience anger, sadness, guilt, grief, etc. Our resilience will only grow if we learn to process and become comfortable with the whole range of our feelings. The present strong focus on happiness and positive thinking makes us less resilient. More importantly, emotions like anger, sadness, guilt and grief make our values clear. We get angry or sad about things that we care about. If we ignore these emotions then we lose an opportunity to learn about ourselves. Thinking positive and putting our negative emotions aside, just doesn t work.
The link to the article published in Ceylondigest is here
The line Teach your children well ; from the iconic song of Crosby, Stills, Nash & Young is very applicable to the so called ADHD -symptoms. Please remember, ADHD (or for example borderline personality disorder ) is just a label for certain symptoms! And there is no indication that these symptoms have ANYTHING to do with a brain dysfunction or a deficit of a transmitter in the brain . Also, many health professionals make the classic mistake of reification: they speak about certain symptoms that children exhibit, BECAUSE they suffer from ADHD . But ADHD is just a definition, an abstraction without a real entity, and there exist no subtle signs of it.
For teachers the perfect class is a concentrated, quiet and obedient one. Nowadays, when children stand out by what used to be called naughty, rebellious and boisterous behaviour, it is much easier than before for teachers to have these children drugged with for example Ritalin or Concerta (psycho-stimulant medications). For psychiatrists, jotting down abbreviations like ADHD, PDD-NOS and ADD and subsequently prescribing drugs has become routine.
Is there a psychiatric epidemic or is there something else going on? Leading American psychiatrists think that ADHD (supposedly an attention and hyperactivity disorder) is severely over-diagnosed; it s a false epidemic. Before 2000, only very serious cases were labeled with this diagnosis and only people who really needed it, were allowed to receive medication. As a consequence of the less stringent definition after 2000, the diagnosis of ADHD has increased spectacular. Everybody knows now somebody with ADHD.
Another reason might be that qualities that used to be attributed typically to boys such as an urge for noisiness, action, and forcefulness were formerly accepted, but are now regarded as a problem, especially at schools. It appears that not the boys, but the educators have changed. Boys are in essence the same as before, but the school system has become more feminine and looks upon their abundance of physical energy and enthusiasm as being an issue.
For concentration problems without hyperactivity, a separate category was devised called ADD (Attention Deficit Disorder). Therefore, many girls and women were included into the diagnostic criteria. PDD-NOS (Pervasive developmental disorder not otherwise specified) was brought in as a kind of residual category for people who don't quite fit into other more specific categories.
It is to be expected that the existing criteria will be eased up more so that an increasing amount of people will be labeled as suffering from a mental illness with all the dire consequences. The pharmaceutical industry has maintained strong ties with the psychiatric community and they have jumped at this opportunity. Big Pharma s marketing machine is working full time in trying to sell the new drugs.
New target groups are continuously defined. At first it were predominantly the overactive little boys which were not concentrated enough. Now the dreamy girls are coming into the picture. They are diagnosed with ADD and that is supposed to be treated with medication too. Finally it s the turn of the grown-ups; 5% of the adult population is said to be suffering from ADHD.
Using medications for ADHD involves a number of risks. The most important ones are decreased appetite and cardiovascular complaints. But also anxiety, stomach problems, dizziness, tics, skin problems and bruising are named. Less common, but potentially lethal results from taking these pills is, that they can cause suicidal thoughts and psychosis.
Research about the long-term effects of these medications is almost non-existent. There is only one such study, the so called MTA (The multimodal treatment of ADHD), sponsored by the National Institute of Mental Health in the USA. It shows that after two years, there is no difference between groups of children who do and don t use medication. Despite this and other critical studies, the use of ADHD medication has skyrocketed.
The scary thing is that we don t know what the precise working is of the medication in our children s brains and we are also in the dark about the long-term side-effects. It s comparable to the enthusiasm with which Valium was introduced in the 1960 s. It was only later that the severe adverse effects became known.
ADHD (if it exists) is nothing more than a description of a number of behaviour symptoms. ADHD is not a mental disorder that causes you to be badly concentrated and noisy. The thinking about ADHD becomes problematic when the child is not seen as a person in relation to its environment (for example family, school, and neighbourhood), but only as an individual without a context. You just tally up some symptoms and voila, there you have ADHD! It becomes dramatic when you realise the enormous amount of children that are given potentially dangerous drugs without proper effect evaluation.
It s important to invest in quality education/schooling and in quality day-care facilities, and parents should have the time to raise their children. There lies the key for a quality society. Raising kids is a slow process and it takes time, and this for many years. Many parents (and for single parents it s even worse) are short of time regarding work and other commitments. Children are often put in front of the TV while their parents bicker about last night s fight. There is a huge pressure to get high marks at school. And at school they have to sit still for hours while they are at an age when they are full of energy. School teachers are underpaid and are often underqualified to teach and guide children, school classes are too crowded to give individual attention. In a few years time many of these kids will have a brief chat with a psychiatrist who will be very trigger-happy to jot down (unnecessary) fancy little acronyms and abbreviations like ADD, ADHD, CD, ODD, PDD-NOS, etc.
What is needed is to stop diagnosing children with ADHD because they will think that there is something wrong with them. In many cases parental advice, teacher training and psychological support suffices. It s important to create an environment that is clear, quiet and predictable. There should be clear boundaries and positive behaviour should be noted and rewarded. And only when all of this doesn t work, then medication can be used as a last resort.
Transference is an unconscious phenomenon in the psycho-therapeutical treatment where emotions from the childhood (or sometimes later) are repeated and intensely experienced in the present with the therapist. Qualities of a person from the past are attributed to the therapist and feelings related to that person are experienced in a similar way with the therapist. It also occurs quite often in communication with others outside the therapeutic setting.
It s one of the core concepts in the theory and practice of psychodynamic therapy. A classic example is a client who tells the therapist that he truly understands and loves his father but at the same time unmistakably has deep feelings of hatred towards the therapist. Or a person who presents herself as someone who is always rejected by the ones she loves, will in order to protect herself be often the first to reject others and be very reserved until she is clearly invited. Generally, the transference is far more subtle than in these two examples.
Counter-transference refers to the total of the unconscious reactions of the therapist towards the client, especially towards the client s transference. Contrarily to what is mentioned in Freud s writings, nowadays it s regarded as something positive. By registering and being aware of his personal reactions the therapist can make use of his counter-transference for the benefit of the client. It s of course imperative that the therapist is a professional who is well versed with his own personal emotional history and has healthy boundaries. He must be able to register and interpret all his feelings, thoughts and physical sensations that transpire in reaction to the client.
Countless interactions that we had with our parents have left their footprints in the form of how you look at the world through emotional charged relational glasses. It gives us a useful and sometimes a less useful grip on how we perceive and treat others. Because these glasses have been formed at an early age, there is always a component of early childhood thinking which generates unrealistic fears, needs and expectations.
Reality gets a better chance to correct the distorting effects of the emotional charged relational glasses when a person is psychologically speaking quite healthy. With people who are psychologically less healthy the transference continues to overwrite reality and there will be more unrealistic feelings and presumptions. However, when psychologically healthy people are under enormous pressure, transference phenomena can also occur.
Transference-emotions materialise by definition more frequently in relationships where authority, dependency and intimacy play a role. The emotional charged relational glasses stem after all from childhood and the interactions between parents and children.
An essential aspect of transference is repetition. People continue to behave in a similar way in relationships (including with the therapist) even when it has negative or even harmful consequences. A plausible explanation could be that people tend to repeat their behaviour in the hope that this time things will turn out to be different. It s like trying to find an instant solution for an old problem or deficit. It can be lack of affection, lack of reassurance, problems with being dependent on others, etc.
Usually, (counter)transference can t be simply straightforward be interpreted to an experience in the client s past. It takes a lot of professional training, expertise and experience to do this. And it takes time and willingness to reflect and to discover the typical subtle mechanisms.
The essence of sex lies in equality, knowledge and pleasure. Girls (and boys too of course) for example ought to know how the female genitals are built and how they function. They need to be aware that the clitoris is a huge internal cavernous sponge-like erectile organ, which get filled with blood when there is sexual arousal. As a result, blood plasm is pushed through the vagina wall and the vagina gets wet.
In my psychology practice I speak with many women who when having sex, experience pain during penetration. Numerous women think that this is normal but pain during intercourse often signifies that you re not wet enough. A prerequisite for that is that your clitoris must be swollen, similar to that the man needs to have a swollen penis. If women get more familiar with the function the clitoris, it might enhance their confidence.
Many people still think that the extra sensitive top of the clitoris (the clitoral glans) is the whole clitoris, that small button. You can google the precise anatomy of the clitoris, where you can see the entire organ with the four long cavernous bodies which embrace the vagina. Knowledge about her body and in this case regarding the working mechanisms of the vagina gives a girl the possibility of putting boundaries: pain during sex is not normal! For boys it s easier to get to know their body, they see their penis getting hard when they are young and they learn in a playful way what they can do with it and what feels good.
There exists a huge orgasm-gap : the vast majority of heterosexual men gets an orgasm during intercourse, and most heterosexual women don t. Women in heterosexual relationships have on average less interest in sex than men. This interest is for a part determined by the expectation they have how pleasurable sex will be, primarily if you will get an orgasm. An orgasm is not a bonus, but it s indispensable for the reward system in the brain.
In general, women get an orgasm NOT because of the penis (sorry guys ) but because of stimulation of the clitoris. Although the penis during intercourse stimulates the inside of the clitoris, fingers are much more efficient to give a woman an orgasm than a penis. So try to make sex more pleasurable for women, and not with a lubricant or female viagra . If a woman wants a penetration, she only should start with it when she is sufficiently physically aroused.
Sex doesn t start with physical foreplay; it should start many hours earlier with slowly building up a pleasurable emotional tension. And sex is not situated between the ears and also not between the legs, it s much broader than that. The whole body is involved with the excitement and sex is also determined by earlier experiences, culture and your upbringing. By experimenting and having experiences everybody develops a personal love-map , with an individual preference for erotic stimuli. Everything is permissible as long as it s consensual and it doesn t harm others.
It's important to emphasise that boys and girls are much more alike than different, also in a sexual sense. Men should understand that women are also sexual beings, similar to men. In sex-education it s paramount to highlight the sexual pleasure. You will learn then that much sexual behaviour is okay, as long as you respect the boundaries of the other person. This can result in prevention of teenage pregnancies too! If it s self-evident for men and women that they are equal partners in experiencing sexual pleasure then they can together experiment with their limits, and not only one person with the other.
The Belgium professor dr. P. Verhaeghe is a psychoanalyst who (amongst other books) has written three fascinating essays with the above title about contemporary sexual relationships between men and women. These are thorough, in-depth psychodynamic commentaries and not your usual superficial self-help stuff.
In an illuminating and sharp analysis dr. Verhaeghe describes what activates and simultaneously paralyses us the most: sexuality and eroticism. He discusses the time-bound and timeless differences between female and male sexual fantasies. He also investigates the post-modern morality and the collapsing of the classical sex-roles: why cultural changes like the sexual revolution not only have liberated the gender issue but also made it more complex.
According to dr. Verhaeghe, depending on the family background, there are two different types of relationships that can develop. There is the mirror-love in which the other person must be the same as the self and where both in vain expect that they will compensate for each other s shortcomings. The oppressive nature of this relationship can be summarised as follows: I insist that I, and I alone can fulfill the other person s needs; and I demand that the other person fulfills my needs, and only mine .
The other relationship is called the triangular love because three elements are involved: the self, the other person and the lack as such, something that can t be removed but can become a source of creativity. Basically, it means that you can let the other be, because you can never give what the other is lacking. You try to let the other be different, which makes it possible to have a relationship based on differences. But this doesn t mean that it is not possible to give and receive. Since the compulsive element of the mirror-love is absent, it allows for an exchange where one gives or receives something without being forced. For example, a dad who lets his son win a game of football and tells him that he is the best player in town. In Milan Kundera s novel The unbearable lightness of being Tereza (Tomas s wife) and Sabina (Tomas s mistress) take a picture of each other naked, where both felt disarmed and enchanted.
Dr. Verhaeghe is also known for his criticism regarding the pills for problems culture that seems to be prevalent nowadays. Psychiatrists are focused on the medical imagery on the brain in the hope of pharmaceutical wonder-pills. All human problems are supposed to have neuro-genetical causes which can be fixed with medications.
While in reality there is no scientific or medical evidence of biological or genetic markers for any mental disorder. Most mental health issues can and should be treated by psychological interventions. Medication can have its use for a short time to make certain people with for example severe depression feel more stable, but a comprehensive psychotherapy focused on the root causes should be the mainstay.
Psychiatrists are trained to look for symptoms and subsequently label ( diagnose ) them according to a classification system. In Sri Lanka this is usually the Diagnostic and Statistical Manual of mental disorders, fifth edition (DSM 5). Despite the term statistical in the title, it does not mean that the book is based upon sophisticated research about types of psychiatric problems. It s an arbitrary classification system without a solid theoretical foundation, and without a clinical pragmatic practice. Psychological assessment is quite different. Psychologists are also trained to diagnose and treat mental disorders but they focus on the root causes and the whole story behind the symptoms. In therapy the client learns to deal with the issues and finds emotional balance.
Negotiating requires a complex skill-set. You need to be very flexible and be able to navigate between your own interests and goals and those of the other party. And finding the correct balance between being cooperative and assertive.
On top of that, during negotiations there is often an information-overload ; we humans are not as rational as we think we are and we try to reduce the complexity by relying on previous experiences, reflexively decisions or speculations. We can prevent these incorrect decisions by recognising and learning from these pitfalls.
You can t win negotiations with rational arguments. You ll have a much better chance with making use of the correct psychological insights. During a negotiating process your knowledge of human nature is constantly tested. How capable are you to assess what your interlocutors think and feel? Are they interested in your proposal, how much are they willing to give in, are they serious or are they playing a game?
First a few of the familiar rational tips regarding negotiating:
- Try to find a win-win solution, a result that is optimal for both parties.
- Get to know your adversary and start with small-talk. Personal contact is essential with any negotiation, because you build up trust. A personal click always works like magic.
- Build in negotiation power (leverage), don t expect to end up in the middle and maintain your least acceptable agreement.
- Negotiate about more than one aspect simultaneously and discriminate between what you want and what you need.
- Find out about your interlocutor s objectives and interests. Try to understand these, stay respectful and keep your emotions away from the negotiations.
Theoretically speaking, one should pursue a win-win situation, never try pushing too hard, etc. But when in negotiations the tensions rise, emotions get the upper hand and eventually parties go for their own interests.
Dirty tricks are ways to influence the emotions during negotiations, and are not about the content. Especially inexperienced negotiators are prone to fall for that. They prepare very well regarding the content, but negotiating is an emotional process and being able to manipulate emotions can have a huge impact on the desired result.
A few examples of dirty tricks:
- Framing. By using the right words and images you can evoke the desired emotions and associations in order to convince the other party (resistance is often irrational, unconscious and emotional).
- The Anchoring Effect. The tendency to give too much weight to the first offer ( dropping the anchor ) your counterpart makes. If the first offer is too extreme, then you need to defuse that offer first ( we re miles apart here, you need to be real ) before you come with a counter offer.
- The Nibble Effect. After long negotiations just before reaching an agreement, the other person asks you just a little more that will nibble away at your margin. The idea behind this is that the counterpart will agree with this in order to avoid the deal to collapse.
- The Bogey. The negotiator pretends that this point is of vital importance to him, but in reality, it s not. By agreeing to let go of this point, he expects you to concede to something important too.
There are numerous dirty tricks like the above ones that you can use to influence people but top negotiators (although of course being aware of these tricks) simply don t make use of them. Contrarily, they start with creating the appropriate climate, by generating an atmosphere of willingness and commitment. The emphasis is on the emotional aspect because if there is no cooperative spirit at the start of the negotiations, it s already a lost cause.
On almost a daily basis I notice in my psychology practice clients wrestling with the deeply felt belief that they are not good enough. It s a nagging, anxious feeling, sometimes culminating in an extreme fear or panic.
In my clinical experience in the Sri Lankan context, a major contributing factor seems to be the typical South Asian emphasis on education. Most parents raise their children with of course the best intentions. But creating high expectations (90% is not good enough, what happened to that last 10%?) and comparing your son or daughter in a negative way with siblings, cousins or other children can have a devastating effect on the confidence and self-esteem of your child.
Totally focusing on school results instead of seeing your child as a human being with many capabilities and interests can lead to lop-sided personalities who are dissatisfied with themselves. As far as study or career choice is concerned, we as parents should listen to our child s contributions and make that the focal point of these decisions. Yes, perhaps a study in law, medicine or business can generate a well-paid job but we don t want doctors and lawyers who hate their profession and as a result become a liability to society and to themselves.
More in general, the belief of not being good enough, is often the result of having deep feelings of guilt and shame. These are often accompanied by a very strict inner voice: the inner critic. That is not some little voice or person in your brain, it s yourself. Therapy can help you to make that inner critic milder by trying to accept that you have also unpleasant sides. And by subsequently slowly reducing the burden of shame and guilt about that.
The neuroscientist Antonio Damasio explains in his book Self Comes to Mind (2010) the profound influence of the emotional brain. If you want to change something about yourself, it s much more effective to realise which emotions play a role with the behaviour that you want to change instead of being logical and analytical. For example, with losing weight, but also with this belief of not being good enough. Trying to cognitively convince yourself that you ARE good enough won t work.
What can work is to try to distance yourself a bit from the inner critic. Like a friendly and fascinated researcher: that s curious, that I am so shaken by that small remark. It was not extremely shocking, so why am I so preoccupied by it?". Looking at yourself with an open and understanding attitude gives more opportunities for change than by being extremely self-critical and accusing. People with a harsh inner critic are judge, jailer and prisoner in one.
A strong tendency to feel guilty feeds your inner critic by keeping yourself responsible. Guilt is less damaging than shame, with guilt you feel bad about what you have done, but not about yourself.
A strong tendency to feel ashamed feeds your inner critic with self-devaluation. When you always attribute an incident to your personal weaknesses or shortcoming then it can become a negative self-fulfilling prophecy. It's a well-known fact that a high level of shame and depression are related.
By taking ownership of your strong negative feelings about yourself, you can slowly go deeper and realise WHY these feelings are there and what really causes them to manifest themselves. Invariably you will come to painful memories where you felt extremely hurt by others and how this has been transformed into self-hate. Allowing yourself to feel these emotions is the first step to recovery.
It s not the young man who should be considered fortunate, but the old man who has lived well . (Epicurus)
An epicurean in the modern sense of meaning is usually referred to as a person enjoying a luxurious and hedonistic lifestyle. But this is NOT at all what Epicurus, the founder of Epicureanism meant.
Epicurus was born in 341 BCE on Samos, a Greek island close to the then ancient Greek Ionian coast (present day Turkey). Growing up and later having settled in Athens, he founded his own school of thought ( The Garden ). Remarkable for that time was that women were also welcome and were treated as equals. His main question was how to live the best possible life. His answer was to live a life filled with modest pleasure, absence of pain and focus on mental wellbeing which will result in ataraxia (peace of mind and freedom of fear).
Although this doesn t sound like rocket science there is deeper meaning into this. Modest pleasure with regards to food and drink means according to Epicurus not to indulge in gourmet-meals and the finest wines but to live a life-style with healthy food and drink, taken in sufficient quantity to satisfy your bodily needs. Pleasure can also be derived from a life surrounded with friends; friendship played an important role in his school The Garden .
Physical pain is something we can t deny, but we can try to bear it by focusing on more agreeable past experiences. In this way we can create additional emotional balance to counter physical discomfort. Absence of fear for death and for the gods is another ingredient of his philosophy. These two will also contribute to mental stability and a state of ataraxia. Epicurus was a proponent of freedom, a radical existential form of freedom which is in essence not much unlike what the 20th century existentialists Camus and Sartre described in their works.
I have travelled Greece extensively and, on each visit, I was captivated by the totally different way of life. For example, the difference between clock time and internal time . The clock time is the objective measurable time; like we know from our watch. The internal time is the moment where we come to new insights by means of slowing down and deep concentration. In Greek mythology Chronos stands for the god of clock time, the minutes and hours which brings order, structure and continuity. Kairos, (who is the youngest and most rebellious grandson of Chronos) on the other hand is the god of the opportune moment , enthusiasm, concentration and reflection.
When you re young you have big plans, ditto goals and vacillating beliefs. When you grow older you are better equipped to let go of this and life gets easier. There is more (Kairos) time to reflect about your experiences in your life. You can amalgamate parts of your life history and that can be a way to find meaning in your own life. It s important to acknowledge that your abilities and desires change when you re older. Then you can take a well-informed decision about how you would like to spend the rest of your life.
It s not the young man who should be considered fortunate but the old man who has lived well, because the young man in his prime wanders much by chance, vacillating in his beliefs, while the old man has docked in the harbour, having safeguarded his true happiness . (Epicurus)
Carl Jung (1875 1961) was a Swiss psychiatrist and psychoanalyst who was quite influential in his time. He started as a gifted student of Freud but later he disagreed with parts of Freud s theory and developed his own theory which he called analytical psychology. Their personalities didn t match either, Jung experienced Freud as dogmatic and authoritarian.
In his book The Archetypes and the Collective Unconscious (1959), Jung described the fundamentals of his psychological system. Two of his well-known concepts (or archetypes) are the Persona and the Shadow. The Persona is the social image that you show to the outside world, a mask that you wear in order to conform and to be accepted. It gives you a flexible and safe feeling and it protects your vulnerable inner psyche.
The Shadow is in Jungian psychology that part of the unconscious mind consisting of repressed weaknesses, shortcomings and instincts. According to Jung, the Shadow is the person that you don t want to be, but who you most definitely are. Everybody does their utmost to hide the less acceptable sides of their personality, for the outside world but also for themselves.
A well-balanced Persona can suppress the tendencies of the Shadow, but they are also the source of creativity. Jung states that during the early childhood years the primitive instincts are being suppressed by the conscious mind, but these instincts also include spontaneity, creativity, sensitivity and insight. Artists use these sources of the Shadow for inspiration. A life without the Shadow would be boring and superficial.
The Shadow of our personality consists of everything that we disapprove of ourselves. The qualities which in your younger days were disapproved of by others or which didn t help you to get what you wanted the most: love and attention. But not accepting your perceived negative qualities takes a lot of energy. You can compare it with keeping a football under water, it takes much effort to keep it like that and sooner or later you have to let go. And that releases a lot of energy. It s similar with repressed anger, sexual feelings or jealousy; the harder you try to ignore these feelings the worse they will manifest themselves when they surface.
When you grow up with for example an aggressive father you can decide for yourself that you will never do this to others. As a consequence, you will suppress your aggression, your inner monster and you will become less assertive and no one will take you seriously. So it s important to dig out this part of your Shadow and integrate it in your personality. Then people will treat you differently, they sense that you can be aggressive (by keeping the door ajar of your inner monster) and that prevents others to take advantage of you. It s also very useful in sports: disciplined aggression makes you formidable in sports matches.
Another example is that many girls haven t learned to be assertive. It s a quality that was (and often still is) frowned upon for girls. As a girl you are supposed to be sweet and caring. Speaking up for yourself was not accepted so for many girls this was put away in the Shadow. Numerous adult women find it difficult to stand up for themselves. It s very empowering to take a look in your Shadow and learn to cultivate your Inner Monster .
As a side note, Jung s book Psychological Types (published in 1921) was used as an inspiration for the well-known Meyers Briggs Type Indicator (MBTI). Although widely used in the corporate world, it s disregarded by psychologists because it has extremely low validity and poor reliability. Nowadays, the Big Five personality traits are the accepted entities in the field of test-psychology.
Borderline Personality Disorder (BPS) is one of the most controversial diagnoses in contemporary mental health.
The available research studies regarding the cause of BPS are laced with dubious assumptions about the hereditary and environmental parts which can t be substantiated. When you actually read these studies with a critical mindset, the evidence is wobbly and they usually speak of it seems that and more research has to be done .
They are typically questionnaires, which have a lot of issues (for example self-reporting is notoriously unreliable). Furthermore, most of these studies have numerous methodological weaknesses like problems with assessment procedures, diagnostic validity, sample size, classic problems with the validity of twin studies, etc.
So called reification is a common mistake that many psychiatrists, paediatrics and psychologists make: it s the fallacy of treating an abstraction as if it were a real thing. They often talk about BPD patients as if they show certain behavioural and interaction patterns BECAUSE they suffer from BPD, this the typical mistake of reification.
As a consequence, BPD is perceived as situated within the individual and presented as a disease without a social and historical context. But you can t compare BPD with for example cancer or covid-19, BPD is just handful of symptoms (with a huge variability!) with no biomarkers (like lab tests, scans, blood pressure, etc.) to substantiate it. And BPD (or ADHD, bipolar depression, or any other disorder -label) is just a definition; there exists for example no subtle signs of it. Only if you change the definition into a broader sense then more people will be included.
A big factor here is the so-called DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition). It s an arbitrary DESCRIPTIVE psychiatric classification system with little diagnostic value (see for example Stijn Vanheule: Diagnosis and the DSM, a critical review ). The described labels are scientifically and clinically untrustworthy (they are not reliable and not valid) and they describe symptoms with no biomarkers (see above). While with all DSM-5 pseudo-medical classifications ( disorders ) the underlying assumption is that they are biological or genetical, there exists no medical or scientific evidence of these assumed genetic/biological causes. Even worse, about half of the patients can t be diagnosed with the DSM, because their issues do not fit in any category, and even if they do fit in two or three there is no intrinsic link with a particular treatment.
Almost all DSM labels show three layers: a psychological, a social and a medical. The psychological aspect is the noticeable exterior: with BPD for example frequent angry feelings, emotionally unstable. The second layer, the social norm, is more concealed behind words that signify too much or too little: with BPD for example intense, marked, frequent, recurrent, persistently, frantic. It s too much or too little in function of implicit applied social norms. The third layer is the most obscured one which is found in the introduction of the manual. It s the hopeful assumption that the described disorders are located in the brain, despite the absence of convincing scientific proof.
What is missing in this useless quest of symptom-hunting is the CONTEXT. It's much better to listen to the whole story of the client, determine the root causes of client's present issues and treat those (instead of a form of cognitive behaviour therapy like dialectical behaviour therapy) with an effective form of long-term individual psychotherapy that covers the present, past, emotions, cognition and behaviour.
Countless research studies have demonstrated that in more than 80% of the cases people with the label BPD have been chronically abused in their childhood. This means that there is sufficient evidence that their symptoms have been developed as a result of their traumatic history. It's much better to speak of a complex post-traumatic stress disorder than to label it with BPD. The treatment should be in line with this.
The psychiatrists bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM, fifth edition), is an arbitrary classification system with little psychological or psychiatric use. Despite the term statistical in the title, it does not mean that the book is based upon sophisticated research about types of psychiatric problems. On the contrary, the classification criteria and categories were chosen by vote by people in working committees who have strong financial ties with Big Pharma. The DSM-5 is written as an extension of the powerful pharmaceutical industry. There is no solid theoretical foundation, nor a clinical pragmatic practice.
With the label Borderline Personality Disorder (BPS) as an example, let s track the so- called evidence for this disorder . The available research studies regarding the cause of BPS are laced with dubious assumptions about the hereditary and environmental parts which can t be substantiated. When you actually read these studies with a critical mindset, the evidence is wobbly and they usually speak of it seems that and more research has to be done .
They are typically questionnaires, which have a lot of issues (for example self-reporting is notoriously unreliable). Furthermore, most of these studies have numerous methodological weaknesses like problems with assessment procedures, diagnostic validity, sample size, classic problems with the validity of twin studies, etc.
So called reification is a common mistake that many psychiatrists, paediatrics and psychologists make: it s the fallacy of treating an abstraction as if it were a real thing. They often talk about BPD patients as if they show certain behavioural and interaction patterns BECAUSE they suffer from BPD, this the typical mistake of reification.
As a consequence, BPD is perceived as situated within the individual and presented as a disease without a social and historical context. But you can t compare BPD with for example cancer or covid-19, BPD is just handful of symptoms (with a huge variability!) with no biomarkers (like lab tests, scans, blood pressure, etc.) to substantiate it. And BPD (or ADHD, bipolar depression, or any other disorder -label) is just a definition; there exists for example no subtle signs of it. Only if you change the definition into a broader sense then more people will be included.
A big factor here is the DSM-5. It s an arbitrary DESCRIPTIVE psychiatric classification system with little diagnostic value (see for example Stijn Vanheule: Diagnosis and the DSM, a critical review ). The described labels are scientifically and clinically untrustworthy (they are not reliable and not valid) and they describe symptoms with no biomarkers (see above). While with all DSM-5 pseudo-medical classifications ( disorders ) the underlying assumption is that they are biological or genetical, there exists no medical or scientific evidence of these assumed genetic/biological causes. Even worse, about half of the patients can t be diagnosed with the DSM-5, because their issues do not fit in any category, and even if they do fit in two or three there is no intrinsic link with a particular treatment.
Almost all DSM-5 labels show three layers: a psychological, a social and a medical. The psychological aspect is the noticeable exterior: with BPD for example frequent angry feelings, emotionally unstable. The second layer, the social norm, is more concealed behind words that signify too much or too little: with BPD for example intense, marked, frequent, recurrent, persistently, frantic. It s too much or too little in function of implicit applied social norms. The third layer is the most obscured one which is found in the introduction of the manual. It s the hopeful assumption that the described disorders are located in the brain, despite the absence of convincing scientific proof.
What is missing in this useless quest of symptom-hunting is the CONTEXT. It's much better to listen to the whole story of the client, determine the root causes of client's present issues and treat those (instead of a form of cognitive behaviour therapy like dialectical behaviour therapy) with an effective form of long-term individual psychotherapy that covers the present, past, emotions, cognition and behaviour.
Countless research studies have demonstrated that in more than 80% of the cases people with the label BPD have been chronically abused in their childhood. This means that there is sufficient evidence that their symptoms have been developed as a result of their traumatic history. It's much better to speak of a complex post-traumatic stress disorder than to label it with BPD. The treatment should be in line with this.
Recently (July 2022) an article in Nature) (which cited a comprehensive study in the journal of Molecular Psychiatry in July 2022) by the British psychiatrists Joanna Moncrieff and Mark Horowitz, debunked the story that depression is the result of a disturbance of the serotonin balance in the brain.
This proves again that there exists no "chemical imbalance in the brain". This, and the "serotonin reuptake" story (for more than three decades the general public has been encouraged to believe that depression is caused by a deficiency of serotonin as in the analogy with diabetes and insulin) are just clever marketing concoctions of the pharmaceutical industry, which have been continuously put forward, also by medical professionals.
If taking cocaine gives people a surge of energy, it doesn t imply that lethargy should be labelled as a disorder and that it develops because of a deficiency of cocaine which needs to be replenished by a medical supplement of cocaine. This idea that depression is caused by a deficiency of serotonin became very popular amongst medical doctors in the 1990-ies. It has contributed to the widespread belief that depression is caused by too little or too much chemicals in the brain. In the recent Nature-study, the researchers show that there is no compelling evidence that depression correlates or is caused by lower serotonin concentration or activity.
This all signifies that we need to find other causes of depression. The Nature-study doesn t mean that the so-called SSRI-antidepressants are useless; it could be that they contribute to treatment of depression while the alleged deficiency of serotonin is not the cause (and users shouldn t suddenly stop with these tablets, the so-called withdrawal effects can be dangerous).
For many years critical researchers, with no (financial) connections with the pharmaceutical industry, have shown that there is hardly a difference between the efficacy of placebo and the SSRI-antidepressants. And please bear in mind that the pharmaceutical industry herself does all the research which allegedly proves that antidepressants are working. Even with the whitewashed data of the pharmaceutical industry s studies that the researchers obtained through a court order, they proved that antidepressants do not outperform placebo. Please also read the article "Manipulations with antidepressants-research"
The researchers of the Nature-study conclude that the enormous amount of studies regarding the serotonin-hypothesis haven t given sufficient proof that there is a biochemical basis for depression. It could very well be that the working of these medications is based upon the BELIEF that they are working. Taking a tablet can be reassuring and can feel safe, it can signify that a problem is biochemical and it has nothing to with our personal life. We just want a pill that takes away our pain.
But depression has a lot to do with our historical life-experiences and speaking about this and processing the related emotions can bring about an enormous positive change. In therapy you will learn to become familiar with your personal depression history . You will recognize the causes, the triggers in the present that link to the causes and you will learn to get yourself out of your depressed state. Moreover, you learn to do this by yourself so that you will become independent of the therapist.
I am not against medication, if needed I refer clients to a psychiatrist. But with antidepressants we should learn to see pills not so much as a solution but more as a possible starting point. In therapy the true root causes of depression can be made clear so that after some time the medication can be tapered off.
One of the most elucidating books I have read about infidelity is Esther Perel s The state of affairs, rethinking infidelity . For the non-readers, please google her name, she has also made several interesting video s.
Although in Sri Lankan culture nowadays there is a bit more openness regarding sex, infidelity very often is still covered under a blanket of shame and secrecy. In addition, in this country women often get the blame for it, as it is seen that it s their job to keep and satisfy their partner. But as Esther Perel writes, it s important to find out more about the meaning and motives of affairs, what it says about our relationships and what we can learn from them.
Infidelity seriously damages trust and denying or lying about it will exacerbate it even more. Not being able to trust your partner is difficult, your partner should be your safe rock instead of a source of insecurity and stress. It s very scary that you realise that you don t know your partner as well as you thought you knew. Here are a few tips to restore trust:
- Be patient and be available for your partner. You shouldn t underestimate the pain, hurt and suspicion that is a result of infidelity. It takes a lot of time and patience to restore trust. A famous Dutch saying is Trust comes by foot but leaves on horseback , meaning that trust is hard to gain but easy to lose. The most important thing is that you re available for your partner, you should expect that your partner wants to talk a lot about the infidelity and has many questions and intense emotions. By showing that you are there for him or her, you take ownership of your actions and you make your partner feel that she or he is really important for you.
- Stop lying. If you have denied that you had an affair to your partner before then be aware that everything that you say will be seen in that light. You don t have to talk about painful details, but be open about with whom, why and if you still have feelings for the other person.
- Try to accept your partner s anger and acknowledge your partner s feelings. Don t be defensive and do listen to your partner. Understand that your partner is afraid that it might happen again. But you don t have to be an emotional punching-bag, there are boundaries.
- Let go of the other person and stop seeing and communicating (on social media) with that person. If necessary, say goodbye in a public and neutral place. Be aware of your weak moments and know what your alternatives could be: jogging, talking with a good friend about how you feel. Or even better, try to feel what these weak moments signify. Is it loneliness, exciting sex, a lack of warmth, companionship, etc.
- Infidelity is usually multifaceted and complex; it typically has more than one cause, and it s imperative that you know why it happened. Has it to do with your personal history, have you and your partner drifted apart, is it a dip in your relationship, etc. These causes can be used as a handle, a tool to change and improve your relationship. Your relationship has been damaged, so it needs now more than ever attention and priority. Make extra time for your partner, if you are willing to talk and to change your behaviour then your partner will notice that you re trying your best and this can contribute to repair the reduced trust.
The so-called empty nest syndrome is very real. Although many parents think that they are prepared for it, when your (last) child does leave your house for good, it often comes as a shock.
Especially mothers (and to a lesser degree fathers) find it difficult to get used to the empty house, but they often can t bring themselves to talk about it. There is a feeling of shame, we shouldn t burden our partners or children with this, and the typical Sri Lankan attitude of be strong! usually plays a significant role too. Emotions are denied or brushed aside and not processed so after some time, this can lead to depression. They also feel that there are worse things like the economic crisis, lack of doctors and medicine, the worries about their children abroad, etc.
There is an ocean of free time and parents should feel happy to finally be able to do what they always dreamt of. But there is also a feeling of guilt that they are not satisfied with this new phase in their lives and they feel ashamed of their feelings of unhappiness and sometimes deep sorrow. The emptiness is oppressive, no purpose, no energy, like an empty balloon. There seems to be a mix of pain, guilt and grief. The guilty feeling doesn t allow us to accept the sadness, we shouldn t feel like this and we should embrace the extra time, the togetherness with your partner, we should explore new activities or start a business.
In my psychology practice I regularly see clients wrestling with the empty nest syndrome. And it has been there in history and in every culture; children will leave some day their parental home. Different parents will experience this in different ways but for many the common denominator will be that it s a tough period.
But the corresponding pain is there too and it can t be ignored or suppressed; if so then there is a serious risk of developing a depression. Although it might seem shameful, it s important to feel what you have to feel. And it doesn t only happen to women or only to women without a paid job. There are plenty of working and economic independent women who experience a huge void after their children have left the house. And it s NORMAL to feel depressed and disorientated. To feel sad and missing the common meals, the hubbub, the unexpected, the joy. It takes its own time to come to terms with that.
In the literature about the empty nest syndrome there is an emphasis on moving forwards, taking on the challenge to find new activities and the changing relationship between the parents. There is hardly any mentioning of the necessity to grieve. Grieving is important to take away the obstacle that negates the actualisation of the future. When your children have left the house there is genuine despondency that needs to be validated and not brushed under the carpet. Fathers feel the pain too and they need to come to terms with it too in their own way. Both partners should communicate what the empty house means for them and they should be able to console each other.
Although guilt-tripping and gaslighting seem very similar and can have a certain overlap, they are not the same. Both are forms of psychological manipulation and emotional abuse.
Guilt-tripping is about trying to make somebody feel guilty about their behaviour, without saying that directly. Gaslighting has to do with the denial of someone s reality, spinning the truth in order to make the other increasingly doubt him/herself. It s a very extreme and serious form of manipulation.
Guilt-tripping happens regularly, but if you don t know what to look for it can surprise you without being aware of it. The objective of the other person is to evoke feelings of guilt, in the hope that will make you do something that this person wants. It s in the form of remarks that give the other person a bad feeling, the kind of accusations and attacks that make you feel smaller. This is classic manipulation, passive-aggressive behaviour because it indicates that the person is not able (or doesn t want) to communicate in a healthy way. It occurs in all sorts of relationships, be it romantic, friendship, or in the workplace.
Examples of common signals of guilt-tripping are refusing to say what is wrong but showing anger, remarks like I am glad that you finally can fit me in your busy schedule , I do so much for you , I am sure that I don t mean much to you , and any kind of passive aggressive behaviour.
A special Sri Lankan form of guilt-tripping is when parents make their children feel guilty because they have sacrificed so much for them. Like paid for their school fees, university study abroad, enduring their kids antics while raising them, and the like. This is of course utter nonsense. Children don t ask for to be born, and as a parent it s your job to guide them, love them, putting ground rules, pay for their education, etc., without asking anything in return. Bringing up children is a one-way street; the only reward is that you hope to see your children thrive in a healthy way.
Gaslighting is a form of extreme emotional manipulation. Someone twists the truth so convincingly that it makes you doubt yourself. This gives power, and the more insecure the victim becomes, the more she or he gets dependent on and trusts the perpetrator. Gaslighting is a subtle and insidious process, a victim can be oblivious of it for years. It continuously appears to be about insignificant things, but ultimately the impact on the victim s confidence is devastating. It can result in a complete loss of oneself, extreme uncertainty, isolation, loneliness and depression.
An example of gaslighting is to make your partner responsible for your anger: you make me do this . When the victim talks back then (s)he gets to know that (s)he can t take criticism. Or when someone cheats and when it s found out, the focus is put on the mistrust of the partner. This can go to the extreme that the victim feels that the cheating was her/his fault.
Especially in relationships it s common that with gaslighting the blame gets reversed. The confidence of the victim slowly erodes and (s)he slowly gets convinced that there is something wrong with him/her. It s noteworthy that women seem to be more susceptible to emotional manipulation than men. It s probably because women, more than men, have been taught from a young age onwards to empathise. As a result, they are more prone to doubt their own thinking and adapt to the other person.
When gaslighting results in the above-mentioned extreme symptoms then it s best to contact a professional psychologist.
The book The body keeps the score by Prof. dr. Bessel van der Kolk MD is an eyeopener for everyone who is interested in the etiology, context and treatment of traumas, be it professional or otherwise. Van der Kolk is a Dutch-American psychiatrist, researcher and educator based in Boston, United States.
He is one of the founders of the concept (complex) Post Traumatic Stress Disorder and he combines his expertise in clinical practice with brain research. Nowadays, traumas frequently are still not recognised as such by mental health professionals and they are labelled (often out of ignorance) with some arbitrary DSM diagnosis. As a consequence, clients don t get the correct treatment and after some time they will be labelled with another DSM disorder or even get institutionalised which makes it worse.
The medical term comorbidities, having two or more conditions at the same time, is in a psychological sense not very practical. The personal history explains the present idiosyncratic symptoms and situation of the client. Van der Kolk is very critical regarding the present DSM focused practice which works with about 300 labels ( disorders ) instead of an explanatory problem analysis and therefore misses the underlying history and often the damaging childhood experiences.
As a consequence, the disorder is perceived as situated within the individual and presented as a disease without a social and historical context. But you can t compare for example borderline personality disorder (BPD) with cancer or covid-19, BPD is just handful of symptoms (with a huge variability!) with no biomarkers (like lab tests, scans, blood pressure, etc.) to substantiate it. And BPD (or ADHD, bipolar depression, or any other disorder -label) is just a definition; there exists for example no subtle signs of it. Only if you change the definition into a broader sense then more people will be included.
Any psychological disorder is a combination of biological, psychological and social vulnerabilities. The behaviour of a traumatised client is a reaction and an adjustment to the trauma. Van der Kolk propagates attempts to integrate the past in the present without experiencing the anxiety and panic out of fear for the past.
The author presents a thorough scientific basis in neurological research combined with numerous case studies. It s a 400+ page handbook about trauma. A substantial part of the book is focused on different ways to recover from trauma. He gives mental health professionals practical tips. Van der Kolk rejects the medical model and the idea that PTSD can be compared with a broken arm that can be cured in a standardised and protocolled manner in six weeks time. He recommends not one method but is a proponent of self-management. The author describes different methods such as EMDR, yoga, internal family systems therapy (a form of psychotherapy), neurofeedback and theatre.
This book emphasises that trauma deeply affects our body and mind. But mental health professionals still don t know much about trauma and clients are often not given the proper treatment which can cause serious damage. Van der Kolk is right to make a clear case with PTSD for replacing the medical model for an integrated biological social psychological model.
When you walk nowadays into a classroom, almost one third of the adolescent children seem to have psychological problems. Mental health professionals see teenagers and students with issues regarding anxiety, depression, loneliness, concentration, anger, bullying, food intake, suicidal ideation, self-harm, obsessions, drugs and alcohol, school absenteeism, etc.
These are serious problems with which they (and often their parents) struggle. When they consult a psychologist or a psychiatrist, the parents want to know what is wrong with their child , which disorder has my child? And they re usually quite familiar with terms like ADHD, autism spectrum, borderline, etc.
With this question in mind psychiatrists and psychologists get started. They ask questions regarding the symptoms and take their voluminous disorder-book , the DSM5. The psychiatrists bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM, fifth edition), is an arbitrary descriptive classification system with little diagnostic value (see for example Stijn Vanheule: Diagnosis and the DSM, a critical review ). The described labels are scientifically and clinically untrustworthy (they are not reliable and not valid) and they describe symptoms with no biomarkers.
With each edition of the DSM, more disorders are added, in the present DSM5 there are some 300 disorders. These are just descriptions of symptoms (classifications) and each of them has a label (a name). These labels are profusely and frequently used by mental health professionals but also by teachers, coaches, parents and children. This way of disorder-thinking regarding mental health has spread like wildfire in our society, and this must stop.
There are of course psychological problems, there is no denying that. But we shouldn t look at these problems through a disorder-thinking lens, and we shouldn t put a label on psychological problems.
A disorder is about a social norm: what is absent and what should be there or vice versa. It s too much or too little: for example, too little concentration or too many angry moods. It s too much or too little in function of implicit applied social norms. By emphasising this we imply that somebody is not normal. Especially with children this can have a huge impact on their self-esteem.
In addition, a disorder-perspective compartmentalises our perception and thinking-process. The DSM classifications are very artificial, about half of the patients can t be diagnosed with the DSM-5, because their issues do not fit in any category. Real people are multi-dimensional and have a huge variation. When you try to force to look at psychological problems through a DSM lens then you fail to notice what is really going on, and possible solutions get obscured.
And lastly, with the disorder-narrative the focus is on the symptoms of the individual person that has a disorder . Which totally disregards the social context (family, school, friends, neighbourhood, etc.) and the individual history. These factors can play a decisive role in the development and in possible solutions of the problems.
What is missing in this useless quest of symptom-hunting is the CONTEXT. It's much better to listen to the whole story of the client, determine the root causes of client's present issues and treat those with an effective form of individual psychotherapy that covers the present, past, emotions, cognition and behaviour.
For example, a seventeen-year-old client had been diagnosed before with autism by a psychiatrist in three minutes time, by simply checking some symptoms. But after a thorough interview, it became clear that the client had learned to block his emotions after his father had left him and guilted him at age ten. The apparent autism symptoms could be clearly explained by his history and his environment and in therapy he learned to feel again.
Being bullied is terrible, it s a form of violence with words and/or physical abuse. It can feel like a never-ending hell, each day going to the same place (school or work) and knowing it will happen again. It can often have long lasting consequences, even after forty years. You learn at a young age that you are not accepted for who you are.
Bullying is a form of aggression which is conscious and structural. On top of that there is a power differential between the bully and the victim. The bully is for example physical and/or socially more powerful. And the victim can t defend her/himself adequately. A victim can be bullied for months or years by the same person or group.
Although in the short-term bullying often leads to a higher status of the bully in the group, it s mostly a false popularity based on fear. In the mid- and long-term bullies usually face social problems because they haven t learned to reach goals by socially appropriate behaviour. They also are more prone to get involved with domestic violence, substance abuse, becoming a teenage mother, and get in trouble with the law.
Bullying creates a toxic atmosphere at school or at work. People are turned against each other, and no one dares to be honest. Aggression replaces empathy and humour, and some people join the bullies out of fear of becoming a victim themselves.
Persons who have been bullied for a long time and in different ways, typically suffer from social and emotional problems. Many studies show that the more intense and longer the bullying, the bigger chance on negative consequences like loneliness, depression and even suicide.
Victims often feel impotent, lonely and bad about themselves. Even if you were quite assertive before, bullying can change your personality. Your body keeps the score: for example headaches, bowel problems, sleep and respiratory issues. There is also a growing doubt and desperation, decreased self-confidence, you regard yourself as stupid and ugly, you re continuously afraid and ceased to be spontaneous. After a while many victims blame themselves. You re constantly asking yourself what is wrong with me, while in reality there is no ground for that. Victims typically isolate themselves out of fear. Each day there is uncertainty and anxiety. Fear for the bullies, fear for what might happen today.
An article in the American Journal of Psychiatry (2014; 171:777-784) which cites a British National Child Development study, concludes that children who are bullied and especially those who are frequently bullied continue to be at risk for a wide range of poor social, health, and economic outcomes nearly four decades after exposure . It s the first study which exposes the long-term consequences of bullying. Schoolchildren who were frequently bullied had an increased chance on developing depression and their cognitive functions declined considerable. The researchers concluded that the children who were bullied forty years back had more depression, less meaningful relationships and a lower quality of life.
When you re being bullied, it s not easy to speak about it. But it s important that you do talk with someone that you trust. That can be a family member, a close friend, a colleague or a psychologist. Don t keep it to yourself but share your feelings and reach out for help.
Parents can help their child by listening and asking questions like who are the bullies, what are they doing to make you feel sad and afraid, where does it happen, etc. Don t advise but let your child feel that you are supportive and non-judgemental. Discuss with your child what kind of solutions you can think of together. Inform regularly how your child is doing, also after the bullying has stopped. In that way you show your commitment and you can timely intervene if the bullying starts again.
The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM5) describes disorder categories, but it lacks a definition of mental health. In contrast, psychotherapy assumes that trying to help clients to change certain problematic mental health behaviour, is only what you see on the surface. Therapists dig deeper and they try to improve their clients sense of agency, resiliency, self-esteem, aptitude for sensitivity and intimacy, accept their limitations, and accepting others for who they are, to name a few. Clients seldomly mention the lack of these capacities because they are often not aware of it; they come for treatment for a specific disorder and they just want to feel better quickly.
The reification of the above mentioned disorder categories (or labels) has resulted in many negative consequences. Reification is the fallacy of treating an abstraction as if it were a real thing. For example, talking about Borderline Personality Disorder (BPD) patients as if they show certain behavioural and interaction patterns BECAUSE they suffer from BPD. But BPD is just a label for a handful (of variable!) symptoms with no biomarkers, an abstraction without a real entity and there exist no subtle signs of it.
It's the assumption that psychological problems are nothing but a set of discrete symptoms that has benefitted (each in their own way) governments, insurance companies and the pharmaceutical industry. For the former two, this way of looking at mental health is an encouragement to define and reimburse only the minimal and cheapest possible treatment. For the latter it s an incentive to continuously expand their list of disorders for which they can market and sell their drugs. But by only focusing on some explicit symptoms, the biggest part of the emotional iceberg stays hidden, won t be treated and will cause more problems in the future.
So called comorbidities in mental health are two or more co-existing disorders, for example anxiety and depression. While it can be useful to be aware that such disorders can co-exist, it totally ignores the all-important underlying story that has led to the symptoms. Especially in the mental health sector it s paramount to spend a lot of time LISTENING to the client s story and to regard the comorbidities as no more than floating labels of little significance.
When a client is for example sleep deprived with a stressed racing mind, anxious and depressed it s most probably NOT that the client can be labelled as hypo-manic as part of a bipolar disorder , but by taking the time and by carefully listening to her story will definitely explain the present symptoms. A suitable therapy like psychodynamic psychotherapy will enable the client to slowly come to terms with the factors that lead to her present predicament.
An example of the below-surface part of the emotional iceberg is shame. In a psychotherapeutic sense it s an important emotion, because it can be at the basis of serious problems (or disorders ). Shame can severely damage the autonomy of the feeling- and thinking process because it merges with low self-esteem and possible with feelings of guilt. In a therapeutic setting the intensity of the unconscious shameful feelings can be made tangible and memories can surface regarding certain poignant and harrowing experiences in for example childhood/teenage years. Therapy can decrease the paralysing and crippling power of shame and can have an extreme liberating effect that enables the client to think and feel freely without the accompanying overwhelming shame.
Irvin Yalom, an American psychiatrist, psychotherapist and author, wrote in his novel When Nietzsche wept a fictional dramatic story centred around Friedrich Nietzsche. This bestseller in many countries, is situated in nineteenth-century Vienna, and in this novel Nietzsche is subject to a new talking cure called psychoanalysis.
Nietzsche (1844 1900) was a German philosopher who s work influenced many modern philosophical thinkers and philosophical schools like existentialism and postmodernism. As he also wrote extensively about the art of living , he had a huge influence on the development of psychology. In Yalom s book When Nietzsche wept the author let his Nietzsche say: have you lived your life, or have you been lived?; did you love your life, or do you regret it?; have you consumed it entirely? Nietzsche was a huge proponent of living an authentic life: overcome your fear of being yourself, and embrace your inner strength.
Nietzsche stated that we have a rational, logical Apollonian side and an instinctive, creative Dionysian side. In our life we should be free and responsible and we should embrace our inner chaos, we need to balance both sides. If you are too passive, too reactive then you will feel empty inside. Try to be honest and brave enough to see reality, don t wait for life to happen and don t distract yourself. Think independently, create your own path, use others as a source of inspiration, but be your own person.
His expression amor fati signified a Dionysian pessimism, you know that life is absurd and useless but nevertheless try to embrace and love your fate. This does not mean to accept life in a fatalistic way, but make your life worthwhile and meaningful.
Nietzsche emphasises to be true to your core values, be proud of yourself, be authentic and figure out your reason to live. Find your personal why , one of his most famous quotes is: he who has a why to live for can tolerate almost any how .
Another famous quote is What does not destroy me makes me stronger . Suffering teaches you lessons and knowledge. Take risks and come out of your comfort zone. Life is a journey and suffering is an indispensable part of that road. It s painful and it makes you vulnerable but it also transforms you, be like a phoenix and rise from the ashes.
Nietzsche wrote several books, of which Thus spoke Zarathustra , The gay science , and Beyond good and evil are his most well-known.
Sigmund Freud (1856 1939), the founding father of psychoanalysis, said that he wasn t influenced by Nietzsche but in Freud s writings and published personal correspondence there are references to ideas of Nietzsche. Concepts like the unconscious mind, repression of uncomfortable thoughts and feelings (which later can be expressed in a veiled way), and dreams as a healthy symbolic way to express intense experiences.
Carl Jung (1875 1961), a Swiss psychiatrist and psychoanalyst and founder of analytical psychology, on the other hand was fascinated by Nietzsche s ideas. But he never openly admitted the exact influence of Nietzsche on his own thoughts. For example, Jung s concept of integrating the shadow shows strong resemblances with Nietzsche s Dionysian concept. The Shadow is in Jungian psychology that part of the unconscious mind consisting of repressed weaknesses, shortcomings and instincts. Also, Jung often referred to Nietzsche s book Thus spoke Zarathustra and frequently quoted the famous line out of this book I say to you, one must yet have chaos in himself in order to give birth to a dancing star.
Psychodynamic psychotherapy is a form of therapy that focuses on your development as a person. You look at your present thoughts, feelings and needs but also at experiences from your past. Amongst those there could be (painful) experiences that you have been (unconsciously) suppressing for a long time, and they can cause you to function not adequately in your daily life. Together with your therapist you start searching, by means of therapy sessions, for the root causes of your psychological problems and try to emotionally process and integrate them in your present personality.
It's about discovering the motives underneath your present behaviour, it could be something that you have experienced in your past, or something you have lacked. Or something that you unconsciously feel that you need now. By means of reflecting on your development as a person in your life so far, it s possible to understand your problems better.
In psychodynamic psychotherapy the emphasis is on your personal and interpersonal look on things. Your personal perception are your thoughts, fantasies, dreams, ideals and emotional and physical awareness. Your interpersonal perception is the thinking and feeling about yourself in relationship to others, and how this expresses itself in relational problems. Important factors to explore are (amongst others): defense mechanisms, coping styles, attachment styles and quality of the ability to form relationships.
In psychodynamic psychotherapy you talk about your (painful) feelings, how you deal with them and the influence of these feelings on your psychological complaints. After you have understood why you feel as you do, you can try to change a few things in your life. A psychodynamic therapist can give you specific tools to improve your capability in dealing with your mental problems in your daily life. In order to succeed with this, it s important that there is trust and a good therapeutic relationship between client and therapist.
Sometimes you only need a few sessions to deal with your problems and sometimes you need a longer therapy. It depends on many factors like the severity of the present complaints, on your personal history, on the complexity and intensity of past traumatic experiences, if you had a support system or you had to go through it alone, etc., etc.
Psychodynamic psychotherapy is very useful for people with the most common psychiatric disorders, like depression, anxiety, obsessive compulsive symptoms, eating disorders, PTSD, etc. It s particularly suitable for clients who want to get familiar with the background of their complaints. It s not suitable for people who only want to stop experiencing symptoms or for people who need instant psychological help.
Psychodynamic psychotherapy is an evidence based effective method, with long lasting results. Methodological sound studies and meta-analyses show a remission of psychological symptoms and disorders, better employability, improvement of attachment style, improvement of interpersonal functioning, and improvement of emotional balance. In general, there is no need to resume therapy time and again.
The outcome of the therapy depends for a significant part on the quality of the relationship between you and the therapist and secondly, on an involved client. Apart from that, goals, form and intensity of the sessions need to be agreed upon.
Eye Movement Desensitisation and Reprocessing (EMDR) is a relatively new method of dealing with trauma, developed by Francine Shapiro which she published in a text book in 1995. In later editions with the same title Eye Movement Desensitisation and Reprocessing (EMDR) Therapy. Basic principles, protocols and procedures , she expanded on her findings and gave a more detailed description.
With EMDR the client is asked to visualise the most traumatic trauma image, while simultaneously distracting stimuli are presented. The most widely used form of distraction is eye movements. The client is asked to follow a light moving from left to right, or to follow the therapist s finger.
There is no exact valid clarification regarding the working mechanism of EMDR. The most accepted explanation is that traumas plus their negative thoughts, emotions, beliefs, etc. are stored in the long-term memory. When you are asked to think about your trauma, and at the same time move your eyes back and forth, then your working memory gets activated as well. This causes that the working memory has to process an enormous amount of information and becomes overloaded. According to the theory, the end result is that the emotional impact of the traumatic memory will diminish, and this less intense memory will be stored in the long-term memory.
Another well-known (and validated) treatment option is imaginary exposure. With traumas there is often some kind of avoidant behaviour (similar with phobias or panic attacks). Clients with PTSD are often prone to avoid traumatic memories, in order not to be flooded with fear of sadness. They avoid locations, people and other triggers that can possible be linked to their trauma. This includes internal triggers like emotions or memories related to the trauma, which they try to avoid at the moment that these emerge. This culminates in a fear for the trauma.
With imaginary exposure clients are asked to experience the trauma as vivid as they can. They do this with their eyes closed, speaking in the present tense and in the first person, as if they go through it at this moment. Research has shown that the brain can hardly distinguish between imaginary situations and factual ones. Exposure to the emotions of fear and/or powerlessness which often are aligned with traumas, will diminish the impact of these feelings. The fear for the trauma will disappear and clients will be able to think about it and tolerate it and although at times it can be painful, the extreme distressing emotions will be absent.
Many studies about EMDR have been criticized for poor control groups, small sample sizes, high drop-out rates, limited follow-up data, and other methodological flaws. And there is a risk that unqualified therapists with no proper knowledge nor professional experience with traumas might use EMDR. The comparisons with other psychotherapies are hindered by insufficient and low-quality evidence. EMDR s effectiveness might be due to including most of the core elements of certain methods, for example cognitive behaviour therapy. It has been called a Purple Hat Therapy: only as effective as its underlying therapeutic methods, without any added value from its idiosyncratic features.
EMDR treats symptoms of traumatic anxiety better than doing nothing and possibly better than talking to a supportive listener. There are a few meta-analyses that have shown that EMDR is often comparable in efficacy to some exposure- and cognitive behaviour therapies. The American psychologist McNally (Harvard University) described EMDR as follows: What is effective in EMDR is not new, and what is new is not effective. On the other hand, if EMDR might be beneficial to you, you could just try it out.
Cognitive behaviour therapy (CBT) has become the dominant psychological treatment in the past decades. In the late 1960-ies it spread from the USA to the rest of the world together with the belief of the malleability of people and nowadays it s presented as one of the few scientifically proved therapy forms. While this evidence based statement is in reality quite questionable (see below).
.With CBT there are a few helpful steps like getting a more realistic view on your problems and to actively confront your depression or anxiety. It s is typical American in its assumption that the way you think will influence your feelings. When you are depressed, you should challenge your irrational, negative thoughts ( positive thinking ).
But from the clinical practice we know that you can tell a depressed person a hundred times that he should think positively but that won t bring about a lasting change. We can t THINK ourselves happy. You simply have to understand and come to terms with the disturbing FEELINGS that cause these thoughts; you can t push them away or ignore them.
These feelings are too strong and they invariably will surface again but then much more powerful. If you don t deal with your feelings, your feelings will deal with you ...
Especially after the introduction of the managed healthcare a lot of emphasis has been placed on the use of the so called evidence-based therapies . It created a tunnel-vision by using methods from the pharmaceutical industry (such as randomised controlled trials , see below) which when used in the social sciences have strong methodological shortcomings, and as a result it s only applicable for very few therapy-methods.
Research invariably shows that sustainable psychotherapy efficacy depends for the most part on the therapeutic relationship (trust, attention and willingness to listen) and the extent where clients feel that they can play an active part in the therapy.
Psychotherapy based upon emotions(!)/cognition/behaviour plus the present/past(!) is often a far superior approach than mainly cognitive based therapies (these focus primarily on symptoms, thoughts and the present).
Removing symptoms without paying attention to the underlying emotional root-causes often leads to recurrence of for example depression.
Emotions (simply put, the limbic system regulates them) are in evolutionary sense much older than thoughts (which are controlled by the cerebrum). Since the anatomical structure of the brain is quite a hotchpotch, the different parts of it are not always in sync with each other. Trying to influence your emotions with your thoughts (as CBT tries to do) is a hopeless enterprise.
It s essential to listen to the whole story of the client which usually explains the current symptoms. Depression and anxiety are not just a handful of symptoms (like in the DSM5, see below) but an idiosyncratic ontogenesis of these or other mental illnesses. CBT only focuses on the present, has no environmental or societal context and has the underlying flawed assumption that insight and cognitive change is the correct remedy for symptoms like depression or anxiety.
There are other therapy forms like (short term) psychodynamic therapy which goes far beyond that. It s not only the cognitive part (understanding) but most and foremost the emotional realisation that counts. An insight must be experienced and lived through. It should incorporate conscious emotions, unconscious ones and the underlying conflicts. By emotionally experiencing it under proper professional guidance it gets worked through and after several times the impact diminishes. Many clients time and again acknowledge the richness and depth of this and it often leads to a real change in their lives.
Evidence-based therapies
The concept of evidence-based therapies has had an enormous negative impact on the field of psychotherapy. Nowadays universities and managed health care providers solely concentrate on these evidence-based therapies . But because of the way that psychotherapies are evaluated through this concept, it basically means that only brief cognitive behaviour therapy can be accepted .
In medical science randomised controlled trials (RCT) are allegedly seen as the golden standard for research regarding medications. There is a lot of criticism about these RCT s but in this article there is no space to discuss these. Concerning the use of RCT s with psychotherapies it should be noted that these RCT s are strictly regulated in an artificial environment (not real life ) and meant for extreme short-term treatments. Most therapies can t be moulded into an RCT-format, which means that RCT s favours certain methods (like cognitive behaviour therapy) only because of the nature of the RCT s. Another caveat is that the lack of access to primary data from most clinical randomised controlled trials with psychotropic medications (since the pharmaceutical industry finances them and restricts access) makes it difficult to detect biased reporting. The often misleading conclusions from these publications force us to be very careful with statements from the pharmaceutical industry regarding the concept of RCT s.
Why is CBT so popular? CBT is seen as a relatively quick fix , is comparatively cheap and appeals to our sense of logic: think positively, be strong and you have to work for it! While in reality coming out of a depression means accepting and actually feeling your painful emotions. This is also a lot of work but in a quite different sense! Depression is an emotion and it has nothing to do with our thoughts. Emotions are in evolutionary sense much older than our cognitive brain and in the long term they usually win . Trying to influence your feelings with your thoughts is a hopeless enterprise. Feelings want only one thing and that is to be felt! So the best way to come out of a depression is not to fight it with our thoughts, but actually starting to feel it and finding out where it stems from. Depression has to do with your past history and what others have done or said to you.
It s difficult to measure therapeutic success; it depends on the school of thought that lies behind the specific method. With CBT success is seen as fewer negative beliefs. With for example psychodynamic therapy and psycho-analytic therapy (the latter usually last for years!) it is about understanding yourself, balancing your feelings and learning to live with your issues. With these last two forms of therapy depression means something quite different than with CBT and it isn t simply about a lower score in a general depression test.
Most of the research with CBT is done like this: a group of depressed persons CBT intervention results. And of course, the outcome is often that CBT works . But when you compare different therapy methods with each other (and taking into account the observations made above) then there isn t much distinction in success between the methods. There is a robust amount of research for this. One example is a big meta-analysis (2013 PLoS Med 10(5): e1001454) where seven psychotherapeutic interventions for depression (including CBT) were compared. The findings were that none of the therapies stood out as being better than others. This means that there must be other factors (like the therapeutic relationship and an active client) that are responsible for the efficacy of psychotherapeutic interventions and not the researched method.
Cognitive behaviour therapy is accepted because it supposedly generates (usually short lived) results with for instance depressed patients. But it is a wrong assumption to think that CBT works. Evidence based research concerning the effectiveness of therapies is a minefield. Based upon what meta-studies have showed so far, extraneous factors like the role of the therapist and an actively participating client are crucial in the success of a therapy and not so much the chosen method of therapy. If cognitive behavioural therapy was that all powerful then there wouldn t be any depressed psychologists; reality tells us something quite different
Therapy is an individual journey, depending on the context and history of the client, and there are no one size fits all fail-safe methods. Psychotherapy based upon emotions (!)/cognition/behaviour plus the present/past (!) is often a superior approach to suffering than mainly cognitive based therapies (these focus primarily on only symptoms, thoughts and the present). Removing symptoms without paying attention to the underlying causes often leads to recurrence of for example depression. It s important that root causes should be uncovered and dealt with. After that it s about learning how to deal with triggers and the underlying emotions.
The American psychologist PhD Dr Jonathan Shedler wrote an excellent article Where is the Evidence for Evidence-Based Therapy? (The Journal of Psychological Therapies in Primary Care, Vol. 4, May 2015: pp. 47 59). The key points of this article are:
The term evidence-based therapy has become a de facto code word for manualised therapy most often brief, highly scripted forms of cognitive behaviour therapy.
It is widely asserted that evidence-based therapies are scientifically proven and superior to other forms of psychotherapy. Empirical research does NOT support these claims.
Empirical research shows that evidence-based therapies are weak treatments. Their benefits are trivial, few patients get well, and even the trivial benefits do not last.
Troubling research practices paint a misleading picture of the actual benefits of evidence-based therapies, including sham control groups, cherry-picked patient samples, and suppression of negative findings.
We can t understand human suffering with quantitative empirical scientific methods because the human being is far too complicated for a simplistic empirical approach. Quantifying suffering is impossible. Depression for example is different (root causes, process and impact) for different persons. It is possible to select certain symptoms and then categorise and label them as depression (like the DSM does), but that doesn t mean that you can quantify it. When you have hundred depressed people then there are hundred different stories, personality structures and development stages and each of these people need tailor-made approaches and not just one size fits all cognitive behaviour therapy (with all its limitations).
Whether it s the illusion that emotions can be directed by our thinking ( cognitive behaviour therapy or positive psychology ) or that changing our exterior will make us happier, or if everything fails there always is medication, the existential quest for meaning in life and the individual meaningfulness of your own life are hardly touched. It s a given that life is for a big part trying to handle unfulfilled longings. At the same time there are the alleged euphoric accomplishments of both genetic and biological factors in psychiatry which in reality are virtually non-existent. Psychotherapy with an empathic professional psychologist can give you answers to the deeper emotional layers of your experienced problems.
Critique on the DSM5.
The psychiatrists bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM, fifth edition), is an arbitrary classification system with little psychological or psychiatric use. Despite the term statistical in the title, it does not mean that the book is based upon sophisticated research about types of psychiatric problems. On the contrary, the classification criteria and categories were chosen by vote by people in working committees who have strong financial ties with Big Pharma. The DSM-5 is written as an extension of the powerful pharmaceutical industry. There is no solid theoretical foundation, nor a clinical pragmatic practice.
It s an arbitrary DESCRIPTIVE psychiatric classification system with little diagnostic value (see for example Stijn Vanheule: Diagnosis and the DSM, a critical review ). The described labels are scientifically and clinically untrustworthy (they are not reliable and not valid) and they describe symptoms with no biomarkers (see above). While with all DSM-5 pseudo-medical classifications ( disorders ) the underlying assumption is that they are biological or genetical, there exists no medical or scientific evidence of these assumed genetic/biological causes. Even worse, about half of the patients can t be diagnosed with the DSM-5, because their issues do not fit in any category, and even if they do fit in two or three there is no intrinsic link with a particular treatment.
Almost all DSM-5 labels show three layers: a psychological, a social and a medical. The psychological aspect is the noticeable exterior: with BPD for example frequent angry feelings, emotionally unstable. The second layer, the social norm, is more concealed behind words that signify too much or too little: with BPD for example intense, marked, frequent, recurrent, persistently, frantic. It s too much or too little in function of implicit applied social norms. The third layer is the most obscured one which is found in the introduction of the manual. It s the hopeful assumption that the described disorders are located in the brain, despite the absence of convincing scientific proof.
What is missing in this useless quest of symptom-hunting is the CONTEXT. It's much better to listen to the whole story of the client, determine the root causes of client's present issues and treat those (instead of a form of cognitive behaviour therapy like dialectical behaviour therapy) with an effective form of long-term individual psychotherapy that covers the present, past, emotions, cognition and behaviour.
Do we need a diagnosis with mental health issues?
A six-year-old child has a cough, fever, inflamed eyes, a sore throat and white spots inside the mouth. The worried parents phone their family doctor for a house call. He/she checks the child, concludes that it has the measles, reassures the parents and advises rest and some supportive medications.
This is a perfect example of the medical diagnostic model, which has also an implicit social relationship: the power of the expert doctor and the layman patient . The symptoms are bundled into an objective general syndrome (in this case called measles ). They are based upon an underlying knowledge system with a clear distinction between health and illness. The end result is a diagnosis and prognosis assisted by diagnostic instruments. The aim is assessment and treatment and a return to the status quo ante.
A 35-year-old man comes for consultations. His marriage is on the rocks, he feels depressed, he has aggressive moods (shouts at his wife and young children), he has a drinking and drug issue, and he has suicidal thoughts. In what way can we compare the PSYCHODIAGNOSTICAL PROCESS with the above described MEDICAL PROCESS?
In the first session the client gives further information about his present situation with his family and at work. He also provides some more information about his suicidal thoughts and about his drinking and drug habits. It appears that the client drinks and takes drugs to suppress anxious emotions. Although he is well educated, he has a strong feeling of inadequacy. His suicidal thoughts have to do with a feeling of utter loneliness.
In the second session the psychologist is focusing more on the history of the clients life, how he was raised, his schooling and his previous work environments. His father was aggressive and loud, his mother rather submissive and quiet and tried to manage the two children and the household. His mother was physically, emotionally and sexually abused by his father. The client can remember clearly the many nights that he couldn t sleep because of the shouting and crying. The client was put down many times by his father too because he was the son and father wanted to dominate him. The outside world didn t notice because father was the perfect gentleman outside the house. The client could not talk to anybody about this because nobody would believe him.
In the third session the client feels that he can trust the psychologist and tells how he was sexually abused by an uncle (a brother of his father) when he was five years old. The uncle came often and took the client to a room in the house to play with him . His parents trusted the man and it lasted for two years.
With the knowledge from the three sessions the symptoms at the start in this example have a completely different meaning. A psychiatrist who uses the medical process only focuses on the symptoms, typically doesn t have more than 5 to 10 minutes to spare and prescribes medicine which has usually nothing to do with the root-cause of the problems. In addition, we know that there exists no effective medication for depression, anxiety, suicidal thoughts, substance abuse, low self-esteem and loneliness. Having said this, medication for certain mental illnesses can be extremely helpful. Some time ago I witnessed a client in an acute psychosis. In situations like this one can t be but thankful for the availability of reliable medications for this condition. The same goes for the (if correctly diagnosed!) very rare illness bipolar depression.
In his book On being normal and other disorders: a manual for clinical psychodiagnostics the Belgium psychologist prof. dr. Verhaeghe discusses the differences between the two diagnostic processes.
The first difference with the medical diagnostic process is that in the psycho-diagnostical process it s NOT about one individual but also about the CONTEXT wherein this individual lives. The diagnosis usually doesn t come at once, but much later after more sessions and very often it will be adjusted.
A second difference is that in the medical model one works from the individual person to generalised diseases. The symptoms (high temperature, muscle pains, etc.) lead to the conclusion of fever (a very common condition, N=millions). Psychologists on the contrarily start with a general story and end with N=1. Mental conditions are typically very individual and are extremely difficult to generalise. In the above example the psychologist gathers more information and the situation becomes more specific.
A third difference is that in the medical diagnostic system the VIEW is central, it s focused on the discovery of signs which direct to objectively measurable parameters. Whereas within the clinical psychological perspective the therapist is primarily LISTENING to signifiers, which remain open to interpretation. Medical signs refer to an illness scenario, while signifiers derive their meaning and function from a special relationship with the context.
A fourth difference is that in the medical field the disparity between illness and health can be measured and generalised. But psychological normality and abnormality are always relative and therefore individual. In addition, certain psychological symptoms can be interpreted as solutions for deeper lying problems.
The comparison between medical and clinical-psychological diagnostics is one with predominantly differences. What works well with symptoms related to physical illnesses doesn t necessarily goes with mental illnesses. The final diagnosis is a description of an INDIVIDUAL CASE and not some generalised label. So, you can ask yourself if diagnosis in mental health issues is warranted.
Again, it s about the CONTEXT. It's much better to listen to the whole story of the client (N=1), determine the root causes of client's present issues and treat those (instead of treating symptoms with cognitive behaviour therapy) with an effective form of long-term individual psychotherapy that covers the present, past, emotions, cognition and behaviour.
Conclusion.
CBT when embedded in the client s proper historical context, with an empathic counsellor, with emphasis on emotions, and focus on root causes in the past can be beneficial for a client. But then it goes beyond the conceptual framework of CBT.
Much of the suffering that psychologists try to alleviate can only be addressed by a response from the humanity and non-judgmental understanding of the individual. It can t be done with a standardised protocol based upon some rigid and shallow theory or research. Human relationships are much too complicated and much too individualistic to grant an approach that is said to be applicable to everybody.
All different therapies are based upon different underlying beliefs about human nature and practitioners who use these theories are (unconsciously) accepting these beliefs.
It s important to realise this because the underlying concepts may not be in accordance with your own values. Cognitive behaviour therapy for example urges us to think rationally but we perceive the world frequently as mysteriously and non-rational and human behaviour is often unpredictable.
Many so-called scientific therapies ignore meaningfulness, spirituality, self-awareness, intuition, morality, introspection, creativity, literature & the arts (which teach us a great deal about human nature). All of these are hard to prove in an experimental design. There is no scientific answer on how to deal with for example changing jobs, leaving a marriage, a major loss, loneliness or spiritual questions. All these issues demand the entire personality of the therapist, everything he or she has learned or has experienced through life (of which emotional maturity, compassion and empathy are essential).
Empathy in therapy is a key concept and although it s complicated to define it, generally speaking we assume that it s an ability to imagine oneself in the situation of others and to sense the emotional state of others. The therapist should make it clear that he/she understands the emotions of the client. Besides this affective aspect, empathy also has a cognitive part and it enables us to understand the perception of the environment of the other person. The quality of empathy increases when the therapist is able to be authentic with him/herself and in the contact with the client (congruent). The importance of an empathic therapist with mental illnesses can t be emphasised enough.
Psychotherapy practised by an empathic professional therapist and with an active client does work. Depression for example has everything to do with FEELING depressed. Since depression is about stuck emotions, it makes sense to treat it from that angle. An empathic psychotherapist with sufficient knowledge about depression can coach the client in making the stuck feelings fluid again. It s about making the client feel that he/she is understood and that his/her story and symptoms are taken seriously. It s about empowering people. In therapy there is a lot of talking, but in essence it s about venting your feelings, letting them sink in and coming to terms with yourself.
Depression has to do with a person s past history and what others have done or said to him/her. So therapy should focus on the emotional link between the triggers in the here and now and the painful causes in the past. The next step should be the painful job of trying to feel these stuck emotions. It s crucial that the client has a well-trained professional psychologist who supports him/her. When the client feels more emotional balanced because the influence of his past has diminished, and the client has learned to handle his/her past emotions, then the time has come for the therapist to step back.
The link to the original article is here
Hadley Freeman s book, Good Girls, a story and study of anorexia , is a page-turner. It gives a harrowing narrative of this bewildering and not well understood mental illness. The author tells about her own personal experiences with anorexia and gives a thorough kaleidoscope of inadequate and incomplete existing opinions, schools of thoughts, treatments and therapies.
For her book Freeman interviewed doctors of various disciplines, therapists, researchers, girls and young women who are suffering today, she tracked down some of the women with whom she had been hospitalised thirty years before, their families, many medical and psychiatric research studies. She even went back to the last hospital where she had been treated. But she discovered that up to date nobody really understands anorexia.
This deadliest of all mental illnesses is not your everyday disorder. Every year about five to ten percent of the patients dies (of which one out of five by suicide) of this extremely complex illness. We need to acknowledge that there is NO standard, one size fits all guaranteed treatment for it. Every human being is different (mental problems are no exact science), and sometimes the only truth is that we just don t know, and that we need to consult experts from many disciplines.
For mental health workers it s bewildering too, taking care of someone with anorexia often means taking care of someone who doesn t think she is ill (90% of the patients are female), even if she is in mortal danger. An anorexic patient doesn t WANT to eat healthy and to maintain a healthy weight.
Even more bewildering is the fact that anorexia in its essence has nothing to do with food. People think it has to do with wanting to be thin, and that it s just a matter of re-feeding the patient. It s also not a modern illness ; it s been there for centuries and it used to be associated with religion. Later the fashion industry with top-models and social media were blamed. But even nowadays no one can predict who will get anorexia and who not.
So many girls express anxiety by means of extreme self-control and self-denial, and anorexia is an extension of that all-too-common female tendency. So, it s not about the food, it s about internal confusion and unhappiness, and as Freeman describes it: trying to say something without having to speak; it s about fear of sexualisation and womanhood; it s about sadness and anger and the belief you re not allowed to be sad and angry because you re supposed to be perfect; and it s about feeling completely overwhelmed by the world so you create a new, smaller world with one easy-to-understand rule: don t eat .
It's about the scary realisation that as a young uncertain perfectionist you re doomed to become a woman in a world which clearly perceives women as second-rate humans and which judges them primarily on their looks. And you re not supposed to express your anxiety, anger, sadness and shame. And not eating distracts you from the constant anxiety and when your weight is below a certain threshold then emotions aren t felt anymore.
In the latter part of her book, Freeman describes the period that she had regained a healthy weight. For the outside world she had recovered , but her inner world was still mentally not well. She developed OCD and a cocaine-addiction, which is quite common amongst many former anorexia-patients, because the underlying root-cause emotions like anxiety and unhappiness are still present. And when you have lived your life for many years obsessing about food, then that is your identity. You need to learn and adapt to the real world and that takes strength, meaningfulness and luck.
In a popular sense, when we call someone a narcissist, it s usually meant as a label for someone with an inflated ego, a constant need of external validation, and self-centred behaviour.
But narcissism is not a comfortable and enjoyable state of feeling superior, there is a serious vulnerability in self-worth, problems with handling emotions and problems in interacting with others. Nowadays there is an abundance of research regarding the origin and development of attachment in relationships and in emotion regulating. This offers a scientific basis for understanding the origin and development of narcissism as a serious psychological form of suffering.
Narcissistic traits are a shell which protects a huge sense of vulnerability. And contrarily to the general belief, there exist no healthy narcissism. When you grow up in a normal sufficiently supportive environment, then you develop a solid and healthy sense of self-worth. Narcissism is always unhealthy, it s a serious mental illness (which develops in early childhood, there is no chemical imbalance in the brain ) that causes the individual to suffer, but unfortunately also his or her environment.
The scientific foundation of the narcissistic personality disorder is flimsy to say the least. The committee that prepared the fifth edition of the diagnostic and statistical manual of mental disorders (DSM5), concluded that the classification of personality disorders is based upon quicksand. As a note, the same goes for the whole classification system of the DSM5: the described labels are scientifically and clinically untrustworthy (they are not reliable and not valid) and they describe symptoms with no biomarkers. The overlap between the different personality disorders is so huge that it s almost impossible to discriminate between them. On top of that, regarding narcissistic personality disorder there has been almost no research with real patients . Most of the studies have been done with students who received study points for their cooperation.
In the modern psychoanalytical theory regarding narcissism, humans are apparently driven by biological determined relational needs and by evolutionary determined fundamental reaction-systems. Narcissism develops when the interaction with other important others is qualitatively insufficient. Because the normal biological need for satisfactory mutual interaction is disappointing, the child retreats into itself and closes itself off. This rejection of mutual contact happens at a very young age and unconsciously, and the narcissistic adult is not aware of this and perceives it as a normal state of being. Narcissism is seen nowadays as an aberration from a normal development.
There exist two subtypes of narcissism: the oblivious/grandiose variant and the hypervigilant/fragile variant. The oblivious/grandiose variant is unaware of the reactions of others, self-centred, arrogant or aggressive, has to be in the centre of attention, has a sender but no receiver , and is seemingly not easily offended.
The hypervigilant/fragile variant is very sensitive for reactions of others, is restrained or shy, focuses more on others than his/herself, avoids being in the centre of attention, listens carefully to others searching for small signs of criticism, and is easily affected and prone to feel ashamed or humiliated. One of the most famous books about this variant is The drama of the gifted child by Alice Miller. It describes children who are sensitive regarding the emotional absence of their mothers. These children neglect their own needs and focus on fulfilling the needs of their mother.
Needles to mention that the online questionnaires about narcissistic personality disorder (or borderline, depression, ADHD, etc.) are useless because they are based on the DSM5 and lack the layeredness and complexity of the different aspects of narcissism.
With thanks to the work of the Dutch psychotherapist F. Schalkwijk and especially his book Narcisme .Bestseller writer Rhonda Byrne ( The Secret , 2006) tries to make you believe that success in life is something that you have in your own hands. Just visualise what you want, think positively, show gratitude, and you will receive from the universe what you wish for.
The book promotes to visualise in positive detail your ideal life and your ideal self. An excerpt of the book: because visualising motivates you, and makes your fantasy reality. Visualisation transforms fear into dreams, and it transforms dreams into reality. Almost nobody knows this, but it s our thoughts which creates the world. And the dribble goes on
The problem (and success) of the so called law of attraction is that (just like any religion) it can t be proved nor invalidated. With success you thank the universe and your positive intention, in the case of an unwanted outcome, you blame your own insufficient efforts. It s supposedly fail-proof, which is exactly the danger. If you disregard the scientific shortcomings of this so-called theory, then you can start to believe that anything is possible and when reality hits you, you will blame yourself.
Feelings of guilt and depression will increase because unpleasant things will continue to be there in our lives. Which isn t only bad because it happens to you, but thanks to the law of attraction you re solely responsible for it too. And friends can get enough from your always positive view on things. Sometimes people just want to feel a bit lousy in order to come to terms with adverse experiences. Well-meant but meaningless expressions like the universe does this only to help you learn can break friendships.
A too obsessive emphasis on the positive can damage the grieving process. We need time to cope with painful losses and shocking experiences. Moments of pleasure and deeply felt happiness will come naturally after some time. And being too positive is a danger in itself: you tend to disregard the red flags on your way and you overestimate your abilities. You don t learn from your negative thoughts and emotions, these feelings have a story to tell which can be invaluable to your well-being.
To be very frank: believing in the law of attraction is quite psychotic. Thinking that you were rejected by an interesting person because you didn t send enough positive thoughts to the universe is a sad form of magical thinking. Connecting negative thoughts to negative outcomes, or vice versa positive thoughts to positive ones is denying other more plausible factors. The law of attraction is a vicious cycle which denies reality. For example, being born in the Bronx in New York (as opposed to being born in an affluent academic Bostonian family), there is extreme little chance that you will end up in Harvard. Real life works like this: success often comes with commitment, but besides this a lot of other factors have to be in place. Like education, your parents social, academic level, their ability to guide you and to show empathy, your IQ, the neighbourhood and country you grow up in, your ethnicity, the family wealth, your network, they all play a significant role in your chances for the future.
Nowadays, manifesting is the buzz word (see for example Gabby Bernstein). Believing that you attract with your negative/positive thoughts negative/positive things in your life, which the universe delivers. Positive gurus like Norman Vincent Peale ( The power of positive thinking , 1952), Anthony Robbins ( Awaken the giant within , 1991), Rhonda Byrne ( The Secret , 2006) and Martin Seligman, the founder of the positive psychology movement ( Authentic Happiness , 2002 and Flourish , 2011) make us believe that continuous happiness is within our reach. We just have to follow what they advise in their books and our worries will disappear. From this list, The Secret is by far the shallowest one and filled with silly quotes and superstitious nonsense.
In Sri Lanka (and in South Asia) there is a huge bias against having a dark skin. Even children at a very young age are confronted with this. The lighter skinned ones are often complimented by family and friends for being the fairer one . While the darker skinned children are often treated in an inferior and demeaning manner. This so called colourism is a form of discrimination based on skin-tone.
On the Indian subcontinent there exists a discriminating system that stems from 2500 BC, and was institutionalized by the white invading Arians. On top of that came the white superiority culture from British colonialism in South Asian countries. In Sri Lanka the western colonial powers (the Portuguese, the Dutch and the British) gave preference to fair skinned people.
Being raised in a society that equates fairness not only with beauty but also with success in a social and economic sense, can lead to considerable damage to people s sense of self-worth. The effect can be especially insidious to women, struggling to accept themselves and their chances on the relationship- and marriage-market. Dark-skinned people have to deal with painful experiences like name-calling, rejection from potential partners, being considered less intelligent, and having a difficult career path.
The publication in 1994 of the highly controversial book The Bell Curve (by Herrnstein and Murray) exacerbated these sinister views. The authors for example strongly suggest that people from African origin ( darker ) are less intelligent than Caucasian ones. The book caused a storm of critique by most of the mainstream scientific community. Nowadays the claims that these authors made, their references and sources are totally discredited.
In the beauty industry, there is hardly any make-up foundation for people with a darker skin. In the shops there are almost without exception only products for people with a white or lighter skin. Apparently, in the industry that is still seen as the norm, while more than half of the world population is non-white. There is clearly discrimination and racism in the make-up industry, while it s so important that young girls learn to love their natural skin colour.
Skin-whitening creams (a multi-billion dollar business) are marketed with the impression that a less dark skin is achievable and preferable. And all in order to obtain the alleged desired advantages mentioned above, and promising to make you fair and lovely . But skin lightening products often contain chemicals like hydroquinone and mercury. Hydroquinone can cause serious side effects like rashes, facial swelling, permanent skin discoloration and even leucoderma (white patches on the skin). Mercury can damage the digestive, nervous, and immune systems, and also the kidneys and lungs.
Everybody has the right to decide what they want to do with their appearance. But it s the task of the government and the medical community to ensure that this is done with safe products. This means providing information to (potential) users of these skin whitening products and to ensure that professional advice is administrated to health care providers.
When you read an article or a book about mental illnesses, then the strength of the relationship between genes and mental disorders like for example depression, schizophrenia, post-traumatic stress disorder and ADHD seems staggering. It s widely believed, also within the psychiatric community, that genetic factors play an important role in causing mental illnesses.
In the social sciences there is a more than hundred years old discussion going on regarding the perceived influence of genes versus environment on psychiatric disorders and medical problems. This discussion is often termed as the nature nurture debate. Central in this debate are the so called twin studies. They are often seen as the convincing natural experiments which clearly demonstrate the discerning influence of genes and nurture on people. And they are frequently cited as conclusive evidence of the considerable influence of genes on traits as intelligence, personality and mental illnesses.
But because there are many problems with twin studies, there is a growing critique on the validity of these conclusions. In his book The trouble with twin studies (2015) the American psychologist Jay Joseph explains in detail what these problems are. It goes beyond the scope of this article to go deeply into this. To summarise it, there are two kinds of twins: one-egg monozygotic who are 100% genetic identical, and two-egg dizygotic who have 50% of their genetic identical material. There are also two kinds of twin studies: one where the twins are raised in the same family (reared together) and studies where the twins are raised in different families after they have been separated by birth (reared apart). Especially the latter type of study is often portrayed as a strong proof of the significant influence of genes on intelligence and personality traits.
But the reared apart twin studies are problematic in many ways. There are only four of them in total and the three older ones, as Joseph points out, have an abundance of mistakes and faults. An important issue is that most of the twins have been reared some time together, were in frequent contact with each other, and had an intense emotional bond with each other. Therefore, the degree of separation was much less than was suggested in the studies. On top of that, even when twins were reared in different families, they usually were raised in similar cultural, social-economic circumstances, and very often in equal geographical regions. The more recent, very influential study, The Minnesota study of twins reared apart (MISTRA), by Bouchard et a. (1990), has the same problems with in addition many statistical and methodological issues. The researchers also denied critics access to the raw data of their study.
The reared together twin studies have their own problems. The core assumption is that one-egg identical twins and two-egg non-identical twins grow up experiencing roughly equal environments (the equal environment assumption, EEA). So the alleged conclusion is that differences in personality and psychiatric disorders must be due to genetic factors. This conclusion is false, because it s proven that identical twins are more prone to be subjected to a similar treatment and upbringing than non-identical twins. And this can be a strong argument for the environmental factors, and not genes.
In addition, all twin studies are correlational, this means that it s not possible to draw causal conclusions. And after decades of research, there are no single genes identified which are responsible for IQ, personality traits, or mental illnesses.
There is an ongoing scientific polemic between Joseph and Bouchart and it s fascinating to see where this will lead to. In my view genes are very important, but environmental factors too. It s questionable that the separate influence of genes on traits can be measured. What is important is the INTERACTION of genes with the environment. It s a fallacy to think that depression, ADHD, anxiety, etc. are largely genetically determined because twin research proves that .
Many Sri Lankans have an almost ingrained denial of mental health issues. It s fine to hobble around with your broken leg in plaster and share this inconvenience with everybody who cares to listen. On the other hand it s almost a taboo to talk with a friend about your depressed child or about the relationship problems you have with your spouse. In addition, Sri Lankans have a tendency to medicalise psychological issues (they prefer taking pills) instead of talking about their feelings. The shame culture seems to be very strong.
Apparently there are reasons for this, because the gossip culture is very powerful too. When clients finally come to my psychology practice to talk about their issues, very often they say that they chose me because I am a foreign resident (Dutch, and married to my Sri Lankan wife Manjula). They assume (which is true) that I don t gossip about my clients.
Outward appearances count: the husband has to earn well, the wife smiling and pleasant and the children must be well behaved and show good study results. To complete this fairy tale package, the house and car must be owned and regular holidays abroad should be included too.
Many families suffocate in this outward shell. In any marriage there are issues which need to be talked about: relationship problems (like a lack of affection/respect, conflicting personalities, sexual problems, unfaithfulness, communication problems, etc.), unhappy children (problems at school, anxiety, depression) and financial problems to name a few.
To top this, in South East Asian culture, much attention is placed upon mind and behaviour; emotions are usually disregarded. In reality, emotions (and instincts) are the driving forces in our lives. Evolutionary speaking, emotions are much older than our cognitive brain. We are often taken by surprise by instinctive reactions and emotional impulses. Although our thinking process is very quick and seems to be the powerful ruler, emotions are difficult to control from the neo cortex. It s one of the reasons why we sometimes feel driven without exactly knowing why. We can be filled with joy, overwhelmed by grief, engulfed with power or we can feel deeply depressed.
There seems to be a lot of misunderstanding about emotions and how to try to change unwanted behaviour and emotions. As a result, while attempting to change emotions people use here and now techniques which offers only short term recourse. Perspective ( the glass is half full instead of half empty ), positive thinking, concentrating on your strengths and positive points, and so forth. The problem with these techniques is that they are mind driven and focus on your behaviour whilst totally ignoring the uniqueness of the emotions. What is worse, they only concentrate on the present, while ignoring the influence of emotions from your past.
Another misconception is the chemical imbalance theory concerning emotions. This is just a theory and an incomplete one at that. At present, emotions cannot be corrected with fine-tuned medications to bring on the desired specific effect in the brain. The state of the art medication for depression is a good example for this. The underlying theory for the working of anti-depressant pills is incomplete and lacks direct evidence. In addition, the modern anti-depressants have a long list of (possible) serious side effects. For an extensive discussion about all this see my article anti-depressants and the chemical imbalance hoax on my website.
What does work is a combination of cognition, behaviour, emotions, influences from your past and the present. This blend will bring you balance in your life.
Thirty-five years ago when I started practicing, the emphasis in psychology was on trying to change the thoughts of clients. The assumption was that as a result of this their feelings would improve. As I got more experienced I realised that it wasn't helping my clients in the long term. The feelings of depression or anxiety in many cases reappeared after a while. That's why my motto in psychology is feelings are stronger than the mind . The inclusion of feelings and making them the focal point of the therapy changed a lot for my clients.
When people are feeling empty, depressed or burnt out, these are in many cases symptoms of an underlying conflict. Usually these symptoms stem from feelings from the past which are still too painful to be felt. Secondly, it focuses our attention to our self instead of towards those who have done us harm in the past. When you succeed in making the connection, then those 'old' feelings (usually mixed with present ones) explain to you the cause of your present state. Then you can start to feel the painful feelings from the past in full. At first you practise it with the help of a therapist and later by yourself. After a while the intensity of the painful feeling will diminish.
Focusing on your feelings can reveal the real cause of your issues and can allow you to feel the deeper, underlying root-causes. The new approach is that you don't focus on the 'thought' side, but that you work with your feelings. Present plus past combined. It is a very down to earth method. It is aimed at giving the client powerful tools to do the work himself so that in time he does not have to rely on the therapist.
Apparently psychotherapy seems to consist only of talking. But in reality it is all about FEELINGS. Regularly (once or twice a week) venting your feelings and speaking about your issues with a professional psychologist in a safe setting can significantly alleviate your burden.
What to say to a person who has lost a loved one? Or, how do you ask for support when you re grieving yourself? Besides death of a loved one or of a pet, people can grieve about a break-up, a child leaving the house (for example to study abroad), or a close friend who has migrated.
One of the most painful mistakes people make is to express platitudes like at least she didn t suffer , time heals all wounds , be strong! , it is as it is , or he reached a respectable age . This is often not experienced as helpful, but as trivialising the pain. You can t console a person by thinking that you can ease the pain for him. That is not consoling, that is denial of the grief. Consoling is to acknowledge that there is no remedy for the pain.
There are ways about how to talk about death, but the above mentioned remarks (although well-meant) do nothing but talk indirectly around death, and not about it. It is of course understandable, we humans are solution-focused beings. When someone that you know feels sad, or starts an emotional conversation about death, then our brains want to find a solution for that and to push down the sorrow.
Offering support to a person who is grieving starts with trying to understand what that person is going through. Everybody knows how it feels to be in love, which can be an extreme experience. Love and grief are two sides of the same coin, grief is a proof of love and a tribute to the deceased. Love and grief are very similar, they originate from the same source: an intense longing. In both cases it s nearly impossible not to think about that one person, we are filled with powerful emotions about him. Therefore we have a restricted perspective, are not good in making decisions, and have poor concentration. The world gets another colour: everything becomes warmer with infatuation, and with grief everything disappears under a grey blanket.
The most important meaningful thing we can give to a grieving person is TIME: to let the other tell her story, to be there for the other, to help in the household, to make sure that there are groceries in the house, to cook, and physical touch when it s appropriate and wanted. It s NOT about finding the right words , but by offering our limited free time we show that we acknowledge the significance of the loss.
Different people need different things to recover after the loss of a loved one. You can t always be in a sad state of mind. Sometimes you need to take a fresh breath by looking for distraction, to be active or to relax, and to feel a bit lighter. Of course the sadness will return, but it will be less steep than before and you re building the foundation for recovery.
What people need differs per person and differs in time. Do you want to talk, or just be silent, with or without company, do you want to cry or just chatting with others? The only way to find out is to keep asking. What do you need NOW, where can I help you with NOW? By only asking how are you? people tend to give a socially accepted answer. Keep asking, and don t fill in what you would want when you are grieving. It s about the other person, what she or he wants. Only then you are providing consolation.
The structure of the DSM-5, the handbook for mental disorders, is more or less based on the ideas of the 19th century German psychiatrist Kraepelin, the founder of European psychiatry, who was convinced that all psychiatric illnesses have an organic biological entity. The basic assumed premise of the committee that in 2012 reviewed the DSM-5 is that the more than Four Hundred (!) disorders that are mentioned, are neurological disorders.
While in reality there is no proof of neuro/biological factors for any of the disorders . In addition, the DSM-diagnoses form no homogeneous groups, and there is a huge problem of reification: the illusion that the DSM categories represent real illnesses. This leads to typical expressions like ADHD leads to attention deficit with children, or a bipolar disorder leads to having strong shifts in moods. This kind of poppycock totally ignores that the description of certain behaviour is presented as the cause of the descripton: a circular argument. Or that an Oppositional Defiant Disorder can be triggered by abuse in childhood, this is the fallacy of treating an abstraction as if it were a real thing, while it s just a definition.
Each DSM-diagnosis has a similar structure: there are descriptions of a number of behaviours, emotions or characteristics. These are grouped into little criteria. Take for example Borderline Personality Disorder (BPD), this diagnosis is based upon nine criteria, and you will be labelled as borderline if you have at least five out of nine. This means that according to the DSM one can be borderline in 256 different ways. It's possible that two borderliners can have only one out of the nine described criteria in common and that they differ completely from the rest.
There are no symptoms nor is there a medical discourse.There are only normal emotions like anger, and normal behavior, but they seem to be too much or too little. It s a social norm that is concealed behind words that signify too much or too little: with BPD for example non-quantifiable words like intense, marked, frequent, recurrent, persistently, frantic. It s too much or too little in function of implicit applied social norms. Despite this, diagnoses are given which are presumably neuro/biological based. This is a fundamental incongruity.
Dialectical Behavioral Therapy (DBT) was developed in the late 1970s by the American psychologist Dr. Marsha Linehan, and it s often used to treat BPD. DBT combines standard cognitive behaviour techniques for emotion regulation with elements of mindfulness practice based on Zen Buddhist teachings. It s focused on awareness, mindfulness and attentiveness and encourages emotional acceptance of the present situation.
Clinicians who are trained with DBT treatment tend to ignore past traumas and label present behaviour like suicidality, food-intake problems, self-harm and depression as problem behaviour or sometimes as attention-seeking behaviour that needs to be transformed. Talking about traumas is avoided and not encouraged.
Countless research studies have demonstrated that in more than 80-90% of the cases, people with the label BPD have been chronically abused in their childhood. This means that there is sufficient evidence that their behaviour has been developed as a result of their traumatic history. It's much better to speak of a complex post-traumatic stress disorder than to label it with BPD. The treatment should be in line with this.
Instead of checking numbers of criteria required for labelling a person as BPD, it s much more productive to go for the CONTEXT of these criteria. Make an effort to listen to the whole story of the client, determine the root causes of client's present issues and treat those not with DBT, but with an effective form of long term individual psychotherapy that covers the present, past, emotions, cognition and behaviour.
Anxiety is a useful defense mechanism that warns us against perceived danger. It brings our body systems in a state of alert by means of certain hormones (cortisol and adrenaline) in order to respond to a threat or fear. Physical reactions like increased heart rate, faster breathing and more muscle tension makes it possible to react quicker.
Some people are anxious while there is no real danger, but it s hard for them to ignore it or to let go of the anxiety. When the anxiety gets so involved in a person s life and situations are being avoided then it s important to seek professional help.
Anxiety has to do with fear of losing control. This can be in different areas like fear of losing control over your body, your thoughts, your behaviour (fear to fail, fear to disappoint others, fear to behave in a certain way, etc.), your environment (fear for judgement of others, fear to faint, fear of a medical illness, etc.).
Anxiety often starts with noticing that you re tense. This tension can lead to feelings of helplessness and fear. Then thoughts of being incapable or inadequate starts to pop up. By avoiding fear-provoking situations the anxiety will diminish in the short term but in the long term the avoidance will generate a tense feeling which will make the anxiety permanent.
Anxiety complaints have a tendency to be self-perpetuating because they influence your perception, interpretation and memory. It s called selective interpretation because you focus on what makes you anxious (for example palpitations, illnesses, crowds). With selective interpretation, experiences that confirm your anxiety are acknowledged and stored and other contradictory ones (that give an alternative explanation to the anxiety) are ignored.
There is no proof that anxiety is genetic. If more family members are suffering from anxiety, then most likely it has to with the dynamics of the family environment.
For treatment the preferred method is psychotherapy. In some selected cases (like panic attacks) this can be combined with (short term!) medication. Medication at best can only suppress emotions but it doesn t solve the problem. There is also the danger of dependency and possible side-effects. Psychotherapy looks for root causes and real solutions; it is not a quick and superficial fix.
There is no one size fits all. As always it is essential to see the person in whole. Listen to his story, not only to the symptoms. Each person is different.
In my professional experience, people with an anxiety disorder have REASONS to feel anxious. Usually the fear is the expression of a complex hurtful past and often combined with depression. It is about feelings of anxiety, and how to overcome them. In therapy the essence should be to look for the tale behind the anxiety. Each fear tells an enciphered but real story.
Anxiety is like a lady clad in a bright red dress. Don t send her away out of fear of the colour but invite her for some tea or wine, and try to listen to her story. Only then it is possible to find emotional balance.
You re suffering from your survival mechanism that points you to the wrong path by directing your attention to the present, instead of your past where the cause of the danger lies. In therapy you ll be learning to face your original feelings and the hurt that accompanies them.
Some simple tips are to practice muscle relaxation techniques and breathing exercises in order to calm you down when you feel the anxiety growing. One of the most important tips is to continue facing your fear. Don t avoid difficult situations, it may give you relief in the short term, but in the long run the fear will only become bigger. Make a list of social situations (ranging from easy to difficult) and practice them starting with the less fearful ones. When the anxiety gets too overwhelming then it s wise to talk with a professional psychologist.
With bipolar depression it s paramount to be very certain about the diagnosis. It needs to be checked and double checked before you label a person like this. It can t be done in five minutes time and it s not a number game , where you search for the required minimal amount of criteria from the DSM-5.
An incorrect diagnosis generates a lot of harm for the patient. Apart from unnecessarily taking strong medication for life, the medication comes with side-effects and can be difficult to maintain. The psychological damage can be quite high too, being (wrongly) diagnosed with a serious disorder. On top of that, many people believe that bipolar depression is genetic, although there is no definite proof for that. Most research focuses on family- and twin studies, but these typically have a small sample size, and many other methodological and statistical issues (see also on my website the article Mental disorders and genes: The trouble with twin studies ). Biased information concerning bipolar depression can lead to huge worries and sometimes guilt regarding their children.
Bipolar depression is a black box : we don t know why and how it starts and there are no root causes. It s important to first hear the whole story from the person. If the story explains the symptoms then it s of course NOT bipolar depression. For example, a long and intense period of stress at work, prolonged physical exhaustion, or strong emotional events in the family or in the personal life can generate bipolar-like symptoms. The emphasis should be on trying to invalidate the bipolar label and coming up with valid alternative reasons for the symptoms. This, to avoid a tunnel-vision with regard to bipolar depression.
The term diagnosis is often used for classification of the complaints according the DSM-5. But diagnosis has a much broader connotation than merely classification.
Psychiatric disorders are defined according criteria and then classified according the DSM-5. The classification is limited to the specific disorder, apart from the personal causes and circumstances of the individual.
The descriptive diagnosis is in contrast much more focused on the specific person. It consists of, including one or more classifications, the description of the symptoms, the causes, the consequences, which situations and events can trigger symptoms, a medical examination to rule out other causes, and most importantly an exhaustive description of the person s life in time, (pivotal) events, and the coherent and underlying mechanisms that contribute to the individual s problems.
In order to reach a diagnosis, the nature and course of the present complaints and life-problems plus the preceding health history needs to be thoroughly explored. Not only from the patient, but preferably also with help from relatives. In addition, results and experiences from eventual previous treatments. So classification and diagnosis are complementary. It should be avoided that classification becomes the mainstay of the diagnosis .
When the diagnosis is correct then the first line of treatment is of course prescribing the appropriate medication. The second line is a form of psychotherapy suitable for the individual person. That could be psycho-education, family-orientated therapy and other methods that focus on emotional stabilisation of the client s life. The longer you stay stable, the smaller the chance on a next manic or depressive episode. Stress has a negative impact, so regular physical activity, consistent and good sleep, and a healthy diet helps to prevent stress. Since bipolar depression is chronic and life-long, medication adherence is important. This can be enhanced with regular psychotherapeutic contact which can also can prevent relapses.
As a psychologist I often get questions from clients regarding what to do in a certain situation. It can be tempting to start advising: it increases our self-esteem (the other person needs us), and we think that we can provide them with a solution.
But most people don t like to receive advice. Usually we have been brooding on a solution for a considerable time, before we ask somebody else for help. It s painful to notice that someone already knows the answer after a few minutes, it trivialises the problem.
The famous psychiatrist and author Irvin Yalom warns for advising: he emphasises that as a therapist you should teach your clients to take responsibility for their actions (and taking no decision is also taking a decision).
Taking a decision is NOT a rational, but an emotional process. We often don t follow advice from others because they are seldom tailor-made for our situation, plus most importantly, our emotions often don t agree with the proposed solution.
Advising is thinking from your own perception, and based on your own experiences, preferences, fears, obsessions and values. You have no idea of the complex context of the other person nor about her (unconscious) emotional state of mind.
It often gives better results if you follow these steps:
- Try to see the story through the eyes of the client. Your attempts to understand the perspective of the client, will ensure that the client starts to think about her own problem and she will grasp many aspects better. Because she explains her story to you, and you listen attentively and asks her simple, direct and open questions, she will get a broader insight in her issues.
- Formulate a brief and concise description of the client s biggest problem, as seen through the eyes of the client! It s NOT your definition, but the client s. By asking for the biggest problem, it invites the client to reflect deeply. Continue to ask questions until the client tells you that he has clarity. Then offer the client a succinct summary what he has told you, using as much as possible client s own words. Take the time, and take as many attempts as needed to come to the summary of the problem until the client gives you the green light.
- And now comes the most important step: pay attention to the emotions that the client experiences with her problem. Ask her what she FEELS now, when thinking of the problem, and repeat (or mirror ) these emotions by naming them (anger, doubt, guilt, etc.). Please also include non-verbal signals of the client and try to translate them into emotions (for example clenched fists: anger). When someone is filled with emotions, they hold her hostage and balance is hard to find. Venting AND acknowledging these feelings is vital. By doing that, the intensity of the emotions diminishes, plus the client realises better in which direction she needs to find a solution of the problem. By paying attention to emotions, a bond of trust will be forged between client and therapist, and trust is necessary for finding a direction for a solution. Trust is not self-evident, it has to be won and proved repeatedly.
The Dutch-American primatologist Frans de Waal (he passed away in 2024) was an eminent and most respected scientist who also wrote many popular books about behaviour and social intelligence of primates.
The common denominator in his work is that apes are more similar to humans and humans more similar to apes than we realise. De Waal was not impressed by language. When he looked at non-verbal behaviour, he noticed mainly similarities between humans and apes.
In his book Different , which is extremely nuanced, detailed and littered with the latest research studies, he discusses gender differences between chimpansees / bonobos and humans. He reasons from a biological point of view: there are innate differences between men and women. Men are more inclined to competition and physical violence, women tend to look for the social context and pay more attention to children. This is not much different amongst humans than with chimpansees or bonobos (in both ape-species political power needs to be distinguished from physical dominance).
He stresses that behaviour in the real world is much more diverse than those innate basic tendencies. Characteristic behaviour doesn t give much information regarding what an animal or human is capable of. Divorced men can nowadays perfectly well raise their kids. Research shows that when men have a child their hormone profile changes: the testosterone decreases and the oxytocine increases.
The Waal writes that biological sex is predominantly binary: male or female, with small percentages of the in-between categories intersex, trans-genders, and (exclusive) homosexuality.
Gender behaviour is much more complicated: gender, gender expression and gender identity are vaguer: male and female and everything in between. Of these, gender has a more bimodal distribution, just like the height of humans: men are on average taller than women, but there is a significant group of women who are taller than most men. This is like many characteristics, for example hunting which is supposed to be typical male. But then there is too: who is talented for hunting and who is in the mood for hunting? Often men, but also a group of women. Then it depends on the flexibility of the society if women are allowed to participate: gender is a flexible concept.
The main theme of his book is: what do we know about men versus women? And how is that with chimpansees and bonobos? De Waal writes that most people prefer an easy answer, they think with apes they see biology, and with humans the culture. But he sees with apes also culture and with humans biology. Furthermore, there are huge differences between the two species: with chimpansees the men rule, and with bonobos the women. But it s a complicated picture, because even with chimpansees the women are not powerless, they can make alliances with other females or with males, which gives them subtle power.
There is also very little known about culture and gender-typical behaviour with apes. But de Waal had spent at least 10,000 hours observing chimpansee behaviour and he did have his thoughts about this. Sadly enough, his demise prevented another thought provoking book.
According to de Waal, the whole gender discussion has started in the 1960-ies because of the availability of the anti-conception pill. It liberated women, in the sense that they had a choice regarding motherhood. Also, men and women increasingly started to work together in offices and other workplaces. It became an interesting experiment which is still going on, with all its accomplishments and challenges.
When clients come to me, they often already have travelled a long road trying to find solace for their problems. They want to experience for example happiness, but somehow they just can t find it. And they feel it s hard to explain why, because on the surface their lives seem to be okay.
They are overthinking, constantly scrolling on their phones, drinking too much, etc., but they can t find a purpose, they think they are a failure. Sometimes there are happy moments like going out with friends or playing with the dog, but these are just fleeting instances.
The days go by with the same unsatisfying rhythm. Trying to change their lifestyle by going to the gym, start dancing lessons, dieting, jogging usually gives a short boost but after a while the same empty feeling starts again. Even more radical changes like taking a break and go travelling, spiritual attempts, changing careers into something more meaningful, or finding a different partner also won t result into more lasting happiness.
What is lacking here is that all these attempts to change are on the surface. Of course our lifestyle, relationships and work have an influence on how we feel. But there is much more, and although therapists don t have the answers, they can help you discovering them. They are lying within ourselves and waiting to be uncovered, underneath the visible tip of the iceberg.
Questions about your present emotions and behaviour that evoke negative reactions gives us a first insight about what s lying underneath. One of the concepts that can partly(!) explain our present behaviour are the so-called attachment styles. The British psychoanalyst John Bowlby, together with psychologist Mary Ainsworth developed the attachment theory during the 1960s. It emphasises that attachment bonds are important through life, and that later relationships and social and emotional functioning depends on the security of the first attachment to the mother. They discriminated four different attachment styles.
-Secure attachment: people with a secure attachment style can give and receive love. They feel safe in relationships and are open with others.
-Anxious attachment: when you have an anxious attachment style you are prone to feel rejected easily and you need a lot of reassuring.
-Avoidant attachment: people with an avoidant attachment style feel uncertain with intimacy. They find it hard to trust others and they protect themselves by keeping distance.
-Disorganised attachment: with a disorganised attachment style people usually feel torn between desiring a relationship but are simultaneously afraid of it.
The problem with this is, like with so many other concepts or labels ( borderline , narcissism , depression , etc.), that it s very general. What is missing here is the INDIVIDUAL STORY; people differ and one individual s depression isn t like the other. It s the idiosyncratic underlying story that explains symptoms and labels. On the internet there is an abundance of popularised articles and advice regarding attachment styles that promises you clear and concise solutions but reality is much more complex, intricate and multi-layered.
Other points of criticism are that experiences later in life can also influence attachment patterns, for example having been bullied for a long time. Or social factors like poverty or family conflicts; cultural factors like gender roles or views about parenting; too much emphasis on the mother while other attachment figures like fathers, grandparents and siblings can play a role too; and finally the innate temperament of a child like the level of activity or emotional state of mind.
Cognitive behaviour therapy (CBT) has become the dominant psychological treatment in the past decades. In the late 1960-ies it spread fromthe USA to the rest of the world together with the belief of the malleability of people, and nowadays it's presented as one of the few "scientifically proved" therapy forms. This, while in reality the alleged "evidence based" part is quite questionable (please read on my website previous articles about CBT).
With CBT there are a few helpful steps like getting a more realistic view on your problems and to actively confront your depression or anxiety. It's is typical "American" in its assumption that the way you think will influence your feelings. When you are depressed, you should challenge your irrational, negative thoughts ("positive thinking").
But from the clinical practice we know that you can tell a depressed person a hundred times that (s)he should think positively but that won't bring about a lasting change. We can't THINK ourselves happy. You simply have to understand and come to terms with the disturbing FEELINGS that cause these thoughts; you can't push them away or ignore them. These feelings are too strong and they invariably will surface again but then much more powerful. If you don't deal with your feelings, your feelings will deal with you....
Research invariably shows that sustainable psychotherapy efficacy depends for a significant part on the therapeutic relationship (trust, attention and willingness to listen) and the extent where clients feel that they can play an active part in the therapy. In addition, a form of psychotherapy based upon emotions(!)/cognition/behaviour plus the present/past(!) is often a far superior approach than mainly cognitive based therapies (these focus primarily on symptoms, thoughts and the present). Removing symptoms without paying attention to the underlying emotional root-causes often leads to "recurrence" of for example depression.
Emotions (simply put, the limbic system regulates them) are in evolutionary sense much older than thoughts (which are controlled by the cerebrum). Since the anatomical structure of the brain is quite a hotchpotch, the different parts of it are not always in sync with each other. Trying to influence your emotions with your thoughts (as CBT tries to do) is a hopeless enterprise. Depression has to do with a person's past history and what others have done or said to him/her. So therapy should focus on the emotional link between the triggers in the present and the painful causes in the past.
It's essential to listen to the whole story of the client which usually explains the current symptoms. Depression and anxiety are not just a handful of symptoms (like in the DSM5) but an idiosyncratic ontogenesis of mental problems. CBT only focuses on the present, has no environmental or societal context and has the underlying flawed assumption that insight and cognitive change is the correct remedy for symptoms like depression or anxiety. If CBT was that all powerful then there wouldn't be any depressed psychologists, but reality tells us something quite different.....
There are other therapy forms like (short term) psychodynamic therapy which goes far beyond this. It's not only the cognitive part (understanding) but most and foremost the emotional realisation that counts. An insight must be experienced and lived through. It should incorporate conscious emotions, unconscious ones and the underlying conflicts. By emotionally experiencing it under proper professional guidance it gets "worked through" and after several times the impact diminishes. Many clients time and again acknowledge the richness and depth of this and it often leads to a real change in their lives.
CBT when embedded in the client's proper historical context, with an empathic counsellor, with emphasis on emotions, and a focus on root causes in the past can be beneficial for a client. But then it goes beyond the conceptual framework of CBT.
It’s a question that many of us grapple with and each of us tries to come up with an answer that gives them a sort of understanding or solace. Some reach out to a religion or a belief system, others to philosophy or they try common sense.
Especially when we’re getting older and acquaintances and friends pass away, these experiences makes us very aware of the impermanence of life. “Everything changes and nothing lasts forever” as one important Buddhist doctrine says.
It’s often not death itself that evokes fear, but the apparent lightning speed with which life passes. We look at ourselves and at our loved ones and reflect on the transience of life.
In its essence life is typically not fair. When we are young then time seems endless and we don’t want to spend time on thinking about death. The privilege of being young is that you don’t have to think about death. And if a person we know dies young then that definitely feels unfair. So young and so much to live for!
When we grow older, which can be pleasant in its own way, life seems sometimes to accelerate and slipping away out of our control. And again, the fleetingness of life can stare at you. There is no one failsafe way of dealing with this. It’s about finding your own personal answers. What happens inside you when you are confronted with the pain of this? Literature, art and philosophy are excellent tools to swaddle your pain. We can’t take away the pain but we can face it and bear it. And pain changes when it gets in touch with art and literature, we experience a deeper context, and a deeper emotional understanding.
The author Vladimir Nabokov wrote that “life is just one small piece of light between two eternal darknesses”. The question is how to mitigate the pain of the not being (or the not knowing). The absurdity of life, such as described by the philosopher Albert Camus, can be taken away by simply ending it, but that is not advisable. Or we can turn to an ideology or a religion, which is a way of denying the eternal darkness. Or we can reflect what the looming eternal darkness means for us in our daily life (which is the most honest, but also the hardest option).
When the pain is still raw it’s best to alternate it with facing it, and swaddling it with tools of your choice. Stay with your pain as long as needed, no use to force it. Stare at your hurt till it fades away. And then return to life and be open to your future. When the deepest hurt has ebbed away you can ask yourself what does the awareness of the eternal darkness do with me. Do I seek more companionship with my loved ones, or do I become more reflective about life? We can become depressed about the proximity of death but it can make us exuberant too.
Therapy with young people is usually about processing the pain from the past in order to free the future for them. With older clients it’s often about meaningfulness. By acknowledging the impending end you look back at your past, and with coming to terms with it, you try to enhance and give meaning to your remaining time, so that in the end you can die courageously.
For treatment of traumas it's imperative that the therapist is a qualified psychologist who is well-educated, trained and experienced in psychotherapy. That doesn't mean having attended a few workshops or having obtained some certificates in certain methods, but most importantly it does mean being able to understand the underlying theories, intricacies, concepts, and their inherent shortcomings and flaws. Psychology has a long history, starting with the Greek philosopher Aristotle. Throughout the ages, different thinkers have added different elements to the knowledgebase that we call now psychology. It consists of many, and sometimes conflicting, theories and schools of thought.
The present-day accepted way of treatment of traumas is very specific. Perhaps it's better to first explain what is NOT the correct way to treat trauma. For example taking superficial and short-lived methods out of the extended tool-box like cognitive behaviour therapy, hypnotherapy, or dialectical behaviour therapy. These are not the "golden standards" but rather gold-plated standards. Eye movement desensitisation and reprocessing (EMDR) technique has some variable successes but it's a black box: nobody knows if and how it works. "The law of attraction" and "manifesting" are too bizarre and too airy-fairy to even consider taking remotely seriously.
Psychotherapy differs completely from the medical model. In the latter you apply medical treatment (usually medication) to a known and validated objective general syndrome (for example measles). The treatment is standardised to all patients, while in psychotherapy it's the idiosyncratic story in its proper context that matters, so N=1. In psychotherapy we don't apply standard treatments to different disorders and traumas. It depends on the individual person and the context.
The above mentioned examples of therapies are only superficial generalised methods. For successfully treating traumas you need a psychotherapist who understands that the most important "tools" are listening to the complete story (which usually comes out only in several sessions, with the most painful parts sometimes in much later sessions), showing empathy, and building trust in the therapeutic relationship. Emphasis on experienced emotions (and not only on thoughts) and where their root-causes might be. A comprehensive exploration of the client's life-history, with an accent on parents' behaviour and childhood, school experiences and relationships. Avoiding diagnosis (except for insurance companies). Being confidential (!) authentic, transparent, and professional. Life, death, and meaningfulness . Being able to read and interpret scientific psychological research studies. On top of that a thorough understanding of the psycho-dynamic literature and concepts like (to name a few) shame, guilt, resistance, transference and countertransference, the many different defense mechanisms, working-through, attachment theory and its flaws, psychological development theories, etc., etc.
Treatment of traumas takes time, and it's not about "changing thoughts" or "staying in the present" (the trauma is in the past!). There are several levels where the healing can take place. Speaking about and remembering painful experiences, creating a safe environment for the client, restoring an emotional connection with your body (Bessel van der Kolk gives several examples in his book "The body keeps the score"). Traumas need to be processed, and after that we can have a fulfilling and meaningful life. With compassion and understanding we can deal with the sometimes difficult moments which may occur.
Healthy relationships are by nature more or less balanced and they should be fairly reciprocal. There ought to be a mutual sense of care for each other. But when you totally neglect your own needs in a relationship because you feel responsible for the feelings of the other then you run the risk of becoming a people-pleaser.
Because you feel responsible for the other person's well-being, you tend to disregard yourself and it's probably hard to put boundaries or being assertive out of fear of starting conflicts. As a result you can easily find yourself in a co-dependent relationship, where one person gives and sacrifices most of the time, while the other typically only takes and receives.
This is a stereotypically unbalanced relationship. With co-dependent relationships one person uses unconsciously the other in order to express their emotional wounds. One person loses herself and ignores her own needs and the other one misuses this and exploits this to satisfy her own needs. With codependency the boundaries get blurred, and you lose your sense of independency, you're enmeshed with the other. It's a relationship where you don't know where you end, and where the other person begins.
If you recognise that you behave in a people-pleasing manner, you often mirror the kind of relationships that you had in your childhood/teenage years. If one of your parents was very controlling or narcissistic, then you probably haven't been able to form a strong and healthy sense of yourself and your needs. Perhaps growing up, you had a role of taking care of your parents or siblings and you learned to feel valued by nurturing others. Or you grew up in an unsafe environment where in order to avoid conflicts you learned to please people.
A healthy close bond with your parents is fine. But when you are too enmeshed with your parents it can lead to an unhealthy dependency, where family members use you to fulfill their own emotional needs. You have learned to please and you have lost the contact with our own feelings, needs and boundaries. In order to learn how to stop the pleasing, it's important to figure out for yourself when and how the pleasing behaviour started. Who were responsible for making you feel like this? Try to remember which family members or persons started this and how you were made to feel guilty, or unworthy, or small, or not good enough.
Maybe it wasn't one big incident but a series of smaller instances where you were repeatedly emotionally wounded. It's absolutely possible to heal from the deep root causes of people-pleasing behaviour. The crucial first step is to EMOTIONALLY process the root causes. Try to be aware of the emotional connections between your present behaviour and where they might stem from in your childhood/teenage years. And subsequently, with the maturity, wisdom and insights you have now, try to emotionally connect with how you must have been feeling as a child when you were exposed to these hurtful experiences. Secondly get in touch and respect your physical and intuitive reactions, they can give you much insight in boundaries. And lastly, take active steps to create healthy boundaries in your present relationships. With all these steps it's best to incorporate them in a comprehensive therapy with a professional psychologist.
