Personality is dynamically formed via multiple inputs from many others. It becomes consolidated in our late teens to early 20’s. Around age 30 or so it becomes relatively fixed.

According to Daniel Siegel personality is deeply rooted in the human mind by the flow of information in the brain and between brains, is created via neural/mental representations during this flow, and interpersonal exchanges shape its formation and maturation (1999).

Siegel further adds that these interpersonal interactions construct our personal interpretations of reality. And according to Siegel, maternal and paternal attachments are fundamental in creating the necessary foundation of intrapersonal and interpersonal development. And he indicates emotions are the primary linkage between our intrapersonal and interpersonal worlds. And I believe this early foundation sets for us a lifelong paradigm.

Our life trajectory involves a series of developmental opportunities to build a healthy sense of self and others. This constructs our self-concept in regards to how others see us and feel towards us. It impacts our sense of self-efficacy, confidence and competence, and how others perceive us as being prosocial, asocial, or antisocial; which I refer to as global personality orientation.

For example, Erik Erickson proposes a series of lifelong psychosocial stages. They consist of the following: Trust or Mistrust; Autonomy or Shame and Doubt; Initiative or Guilt; Industry or Inferiority; Identity or Role Confusion or based on my own clinical observations, Role Diffusion; Intimacy or Isolation; Generativity or Stagnation; Integrity or Despair (Plotnik, 2014). And I dare add an additional stage based on my clinical observations, Transcendence and Relief or Dread and Decay.

From the field of Sociology, I borrow the concept of Perceived Social Value (PSV). This applies to the various roles that all of us enact and the concepts of “front-stage and back-stage personas”. Some refer to this as our private and public selves. As a clinician, I am very interested in the extent of the concordance or disagreement between these selves. Those with disordered personalities tend to show a decided disconnect between the two!

Referring back to the notion of roles, over time, we enact multiple roles, sometimes simultaneously. For instance, I was a child, an adolescent, a male, a college student, an Air Force medic during the Vietnam Conflict. Now I am retired. I’m also a father, grandfather, brother, a former university faculty member and the like. Our personality shapes how well we do or do not in these various roles. Those with disordered personalities exhibit rigidity and dysfunction across the various roles.

So as you can readily see, personality has a heck of a lot to do with who we are, and how we interact with the many others we come in contact with!

Richard G Kensinger, MSW

References

Nevid, J., Rathus, S., & Greene, B. Abnormal psychology in a changing world.

Plotnik, R., & Kouyoumdjian, H. Introduction to psychology.

Siegel, D. (2001). The developing mind. New York: The Guilford Press.

Wolfe, D. Abnormal child psychology. (2010).

Image via VSRao/Pixabay.

I also served temporary duty (TDY) at Lackland AFB working with airman stationed in Vietnam, presenting with PTSD and substance abuse disorder (SUD).  As a clinician in Behavioral Health Care, I dealt with folks presenting with multiple psychosocial trauma, including combat Vets from Vietnam.

I’ve not witnessed directly the ghosts of combat. Those who have repeatedly are haunted by those of comrades killed (KIA) and by those who they killed, especially those who are civilians. Thus, they experience what I refer to as “compacted grief”. During war, there is little room and energy to grieve.

I completely agree with Lt. Col. Grossman that most of us possess a natural inclination to not kill other humans. No amount of combat training can prepare soldiers for the realities of war and combat. I see war as an extreme expression of insanity, even when war is deemed by some to be necessary and the participants are “voluntary”. War and combat sear us at the limbic level, a necessary encounter which I refer to as “Dark Beast”. The Vets I have treated and my many clients in BHC have taught me so much about this Beast. The following account here centers on my running commentary as I read “Shooting Ghosts”, using my observing clinical ego.

When I embarked on reading their candid descriptions of encountering repeated episodes of violent death, At times I felt guilty for not having served in Vietnam. I joined the Air Force after my college deferment lapsed once I graduated. I did not really support our endeavor there. I never felt this Conflict to be an urgent and immediate threat to our nation’s integrity. I became a medic so that I would not have to kill anyone, nor would anyone would be killing me. I did therapy with some of the field medics who were confronted with killing. Killing is counterintuitive to our ethical oath to: above all else, do no harm.

From Chapter One, I disagree that “Misfits Go to War”. We join the military for a number of reasons. For the most part, the Armed Forces want servicemen with integrity who join for a higher purpose like serving our country and protecting others. The bonds forged with comrades begin during advanced training and intensifies early in deployment. Individual survival is directly associated within this group that we refer to as our squad. It is this commitment that soldiers go into battle and come back as a group which I refer to as “affiliative aggression”. Soldiers are protecting one another!

The second disagreement is that war and journalism do mix in order to inform the rest of us about the horrors and terrors of war, and the tremendous cost borne by those who directly experience it. And none of us are “fearless and invincible”. In fact, my professional experiences assure me that life is quite precious and tenuous at the same time; so we dearly need to hold onto it! And guns and cameras are valuable tools of the respective trades.

Chapter Three: Ambushed

Now it is kill or be killed by the enemy. Affiliative and defensive aggression is rising. They sustain some injuries and every squad member returns to their outpost. No time for “mental casualties”; the BB is really present for the first time! An RPG creates a concussion suffered by the squad leader.  Back at the outpost “Air Force medics” come to the rescue. Everyone is alive, but are they really? Concussions are quite serious. Each skirmish does not change the outcome of the war; yet indeed changes those who participate!

Chapter Four: Walking Wounded

The human brain consists of about One Trillion nerve cells, and about ½ of our genome is dedicated to the form and function of this organ. Sounds like a lot and many that can be spared. Indeed, the brain is well known for its neuroplasticity! I’m uncertain as well if God has or has not allowed us to contemplate going to war let alone engage in it. Traumatic Brain Injury (TBI) also occurred in Vietnam, not just in our more recent conflicts. Perhaps it is garnering more clinical attention? We know that it is also intimately related to Clinical Depression and PTSD. I agree that repeated combat encounters result in a “kinship and loyalty” that many of us will never know!

Chapter Five: The in-between

The brain and all of our human senses process all of our internal and external experiences. I refer to the brain as a “master accountant”. Much of what we process occurs beneath our conscious awareness.

In fact, there are at least seven streams of awareness. Some are deeply embedded suggesting that we better remember certain experiences more than others to ensure our survival.

Those in combat continue to experience the traumas once confronted repeatedly by the DB! Being back “home” and away from the front lines does not matter. We are genetically primed by our “threat alarm” in responding to perceived and/or real threats by fighting, fleeing, or freezing. Our primary cognitive processes regarding threats pertain to harm, loss, and challenge. We must not ignore them!

Even photographers and journalists are not immune to being harmed or killed! Immunity from stress and trauma is indeed an “illusion”. During adolescence, males exhibit an increase of invincibility (probably due to the significant infusion of testosterone). And there is no “magical cure” for real trauma. And life is more important than what each of us do for a living.

Chapter Six: Human Triggers

Another death of a platoon member, who is very experienced in combat; and he is survived by a wife and children, gets a lot of attention. His loss impacts more than this soldiers. And indeed death is all around as the “Dark Beast” possesses an insatiable appetite for “kills and body counts”.

The effects of TBI on the squad leader are apparent. And there is no room for complacency and lapses of concentration! They are becoming human targets and increasingly aware of this reality. The sights, smells, and sounds of violent death are deeply etched in the collective minds of these soldiers. Home for them seems a long way off! The platoon leader earns a Purple Heart. And he feels he doesn’t deserve it. So far, he and his men are alive.

Chapter Seven: Lost Limbs and Skull Tattoos

Another photographer is severely injured having stepped on an IED. It is natural to “dread” the “damaged cargo” carried by the MEDEVAC choppers. Some photojournalists become resigned to this possible occupational fate. There is a growing sense that these soldiers may not ever win the “hearts and minds” of the Afghan civilians despite their best efforts to do so.

Some of the violence and deaths of comrades that these soldiers experience are etched on the largest sense organ—the skin. No time to deal with any of this in a combat zone, no time to grieve! Suppression of trauma from previous combat excursions does not work either! And the photojournalist embedded with this squad begins to question his witness position and “feels predatory, repulsive, and a betrayal of human decency”.

Chapter Fourteen: Coming Undone

The home front is becoming undone. Interpersonal relationships are becoming frazzled. The natural regression after repeated exposure to the “Dark Beast” is taking its toll. All the prescribed psychotropics (chemical cocktails) in the world won’t make that much difference. BTW suicide among combat vets is rising despite priority efforts to prevent them.

Chapter Sixteen: Echoes of Iraq

The Boston Marathon bombing reawakens images of the “DB” on US soil for the second time since the attack on 9-11. Surely there is no safety and security now! Understandably, cemeteries and headstones serve as triggers. For soldiers converting back to civilian life, there exists a natural disconnect between military culture and the civilian role; clinicians refer to this as cognitive dissonance, and it penetrates much deeper than just our thinking!

Advanced combat training does not really train soldiers to kill the designated enemy, only the illusion of them. And the military certainly does not prepare them to kill civilians such as children, women, and the aged. Yet, this happens in actual combat. For example, during the Vietnam Conflict, it is estimated that more civilians were killed than enemy combatants on both sides. This distinction gets lost in the insanity of combat. Yet the civilian-soldier has to come to terms with this reality; and based on having conducted psychotherapy with Vietnam combat Vets, the grief and regret become almost unbearable! I refer to this state as psychosocial death. Sociologist, Erving Goffman, refers to this as “mortification”. Killing the innocent does not reflect affiliative or defensive aggression. To me, it is an adverse consequence of encounters with the “Dark Beast”.

Final Thoughts and Observations

First of all, I express my sincere gratitude to all those who have, do now, and will serve in the Armed Forces; and my gratitude to all the loved ones who endure this journey with them. I want you all to know, that in my clinical view, soldiers do what they do out of affiliative and defensive aggression; they are not predators!

Those who send humans to war need to examine much more closely the human damage done to the participants and family members for whatever gains are earned in doing so.

And it is my clinical observation that group counseling/therapy could be more efficacious in treating those who are haunted by the ghosts of combat. Group therapy can recapitulate the crucial military unit- the squad. This offers a better opportunity for some healing from the repeated exposure to the “Dark Beast”.

Richard G Kensinger, MSW

Image via DasWortgewand/Pixabay.

During my 1977 through 2000 stint at the Altoona Hospital as a BHC clinician, I had the privilege of conducting psychotherapy in our outpatient clinic and treated some of my comrades referred to us from our local veteran affairs (VA) center. I did therapy with the armed combatants who killed and some of the field medics and corpsmen that killed; but far more importantly, could not save some of their brothers from death.

Prior to my military service, I studied psychology in college. I paid some attention to the Vietnam War and was comforted by my deferment from the draft. The day I graduated from college, my protection ended. I did not go into teaching and would have had an additional deferment.

During my time in college, I had serious reservations about Vietnam and war in general. Though others protested Vietnam, I never did because of my respect for all men and women in the military. I detested those who protested as they directly, maybe not willingly, were supporting our enemy. So, once I lost my deferment protection, I enlisted in the Air Force mainly because my chances of having to kill someone were greatly reduced.  After completing basic, I enrolled in medical training at Sheppard AFB. By the grace of God, my first and only duty station was Andrews.

A number of my maternal uncles served either during WW2 or Korea. Two of my paternal cousins graduated from military academies and both made the military a career. Both were combat pilots in Vietnam. They were older than me and I really had limited contact with them.

My wife’s uncle, Mike, was killed during the Battle of the Bulge. He is buried at Arlington. My father-in-law served in the Navy during WW2 on a combat destroyer in the Pacific Ocean theater. He was part of a large flotilla the day the Japanese surrendered. He tells us he slept right through this historical event! He very rarely talked about his military service with any of us.

My older brother served in the Marine Corps, fortunately during “peacetime” as part of a howitzer platoon. My younger brother got drafted in the Army during Vietnam in a non-combat role, and did not serve “in country”.

In retirement, I now serve as a volunteer at our local VA Center. With four other fellows, we serve as sentries and guardians to what we refer to as “The Wall That Heals”. It is one of a few Vietnam traveling memorials that is now retired. It honors the legacy of all who served in Vietnam, including those who died, were killed or were wounded there. Soon I will be “deployed” to our on-site branch health clinic (BHC).

I am deeply indebted to the significant work in Lt. Col. Dave Grossman’s On Killing. And I am deeply inspired by the revelations of Marine Sgt. TJ Brennan and Finbarr O’Reilly in Shooting Ghosts. So here are some of my clinical observations about the impact of combat and its ensuing trauma:

1. War and combat are extreme expressions of insanity. Those who serve are not insane!
2. You killed due to a deep regard for self and others. I have two published articles on Brain Blogger about killing in combat and the other on aggression and violence in which I describe 6 types of aggression that I have encountered in my clinical work. The two that apply here are defensive and affiliative.
3. No kind of training can prepare you for the sheer horror and terror of combat!
4. Very few combatants enjoy killing!
5. In combat zones you have no time to grieve your multiple losses. When you return home, you now have to face them!
6. I am now very sure that I could kill under these extreme circumstances!

In conclusion, I am deeply moved by your experiences and don’t feel completely worthy to speak about your experiences. To you who are Marines, in the AF we called you “Gyrenes”. We are not worthy to unfasten your combat boots, and I readily admit that I served in the “cub scouts” of the armed forces as one ex-marmine observed when visiting The Wall!

Richard G Kensinger, MSW

Image via Pexels/Pixabay.

The Stone is a series moderated by philosopher Simon Critchley for the use of contemporary thinkers in various cognitive and social science to present research done in the natural environment, and that done in the laboratory.

Howard Gardner is a psychologist who, along with some others, discuss the notion of humans evidencing multiple intelligences, two of which are:

• Interpersonal: insight; the capacity to know ourselves as well as we can.
• Intrapersonal: empathy; the capacity to know others as well as we can.

Each ability is critical to adaptation and survival.

There seems to be consensus that via introspection, we derive a position regarding our human existence; our immaterial mind and soul emerging from physical matter; a basic meaning of our life experiences; and some core, universal human values.

How many pieces of what I believe are my mind, and are truly genuine to my own experience and completely independent of the minds of many others? We assemble data both at a conscious and not-so-conscious manner from our various sensory modalities. We then process this simultaneous data via our affective, executive, and operational platforms. The ultimate consequence is an action that only best approximates “our own mind”.

I find the concept of human consciousness as it is defined in this forum to be very useful. We can understand it as a manifestation of a global broadcast as I’ve articulated above.

This dynamic is worthy of further research and disucussion as it relates to normative and non-normative processes.

References

Gardner, H. (2006). Multiple intelligences: New horizons. New York: Basic Books.

Rosenberg, A. (July 18, 2016). Why You Don’t Know Your Own Mind. The New York Times. Accessed online 1 August, 2016.

Image via geralt / Pixabay.

In this article, I elaborate on the optimal conditions necessary to become the best persons we can possibly be. Some psychologists refer to this ultimate state as self-actualization. I call it the optimal phenotype. I will also expound on the core features of what it is like to become self-actualized, as per Maslow.

Genetic underpinning is only a part of who we are. Genes create possibilities. Our internal and external experiences have more to do with the structure of our autobiography.

Getting our biopsychosocial needs met consistently and met over time is an important accomplishment. We need to experience essential survival needs, needs for safety and security, of affiliation and affection, for recognition and approval, to be in place before moving towards self-actualization.

According to Erickson, achieving mastery at each of the nine psychosocial developmental levels is another significant achievement. We learn to: trust others, show autonomy, demonstrate initiative, form an identity, realize intimacy with others, show generativity by serving others, and experience integrity and transcendence at the end of our days.

Those who eventually realize self-actualization evidence four common qualities. One, they have several, very close friendships as opposed to many “friends” on the varied social internet sites. Secondly, they are intrinsically motivated as opposed to some who seek external rewards for their actions. They experience a clarity about who they are and not in the world. Finally, periods of intense joy and contentment are frequent.

We all have an opportunity to be and do the best we can, and the end result is absolutely amazing!

Image via Unsplash / Pixabay.

The above determination is far from an exact science. However, there are some criteria and psychometric tools that demonstrate solid validity and reliability. I highlight some of the core criteria here.

Male gender is one. Testosterone is responsible for sexual appetite in males and females. We men get a whole lot more at puberty (18 times as much as women, in fact). Men are known to be more sexual in a number of ways: masturbation, reporting more sexual partners, being purveyors of pornography. With respect to psychosocial intimacy and sustained commitment to one partner, we are more ambivalent. There are also differences in our normative human sexual response cycle. This entails appetite, excitement, peak arousal, orgasm, and recovery.

The diagnosis of pedophilia is another factor. 63% of offenders meet the clinical criteria. This involves those who are evaluated and civilly committed to treatment.

Another criterion involves a disordered personality such as antisocial personality disorder. Such personality disorders can be highly detected, in my clinical experience, using the MMPI (Minnesota) and MMCI (Millon).

Competency or incompetency is a further criterion. To what extent does the person in question show control and volition or not?

And the chances of offending are quite high in this sub-population, after being charged or arrested for sexual offenses involving at least two victims. Of all the subtypes of paraphilias, I regard pedophilia to be the most dangerous. Yet unfortunately, I remain unsure how VSOs can be effectively treated and rehabilitated. I myself have never evaluated or treated one.

References

Miller HA, Amenta AE, & Conroy MA (2005). Sexually violent predator evaluations: empirical evidence, strategies for professionals, and research directions. Law and human behavior, 29 (1), 29-54 PMID: 15865331

Image via AMC Photography / Shutterstock.

These incidents are revealed in the searing and troubling movie Spotlight. This movie’s focus is on the very courageous efforts of investigative journalists to expose the wide complicity of many in that community who protected these predators. The article is entitled “The Catholic Churches Sins Are Ours”.

In Bruni’s article, he highlights how “churches benefit from the American Way of giving religion a free pass”. He ends his article by indicating that “if it takes a village to raise a child, it takes a village to abuse one”!

My intent here is to discuss the clinical impact of this type of abuse by focusing what happens to these innocent victims. In a previously published article appearing on BrainBlogger, I offer a profile of a serial preferred predator in my area: Jerry Sandusky and the Penn State Scandal still rocking our community.

I am guided in my clinical focus by Erik Erickson’s stages of psychosocial development, Abraham Maslow’s needs hierarchy, and Judith Herman who published a book in 1992, Trauma and Recovery. I present here the accumulative damage of lifelong development of this kind of trauma.

In psychology and other related social sciences, we recognize the abuse of children commences at a very vulnerable age, takes multiple forms, and continues well through adolescence. Judith Herman highlights three prominent themes of abuse: terror, psychosocial disconnection, and captivity.

In regards to child sexual abuse, we know that these predators choose vulnerable children and families and spend tremendous time “grooming” them before betraying them multiple times. The end result for the victim is mortification, a term offered by the sociologist Erving Goffman. I call this psychosocial death. The final stage in my deconstruction of a self is suicide. And we know that in our church community a number of these victims have, in fact, killed themselves.

I now walk the reader through Eric Erickson’s psychosocial stages. All of us proceed through these stages: trust or mistrust; autonomy or doubt or shame; initiative or guilt; industry or inferiority; identity or role confusion; intimacy or isolation; generavity or stagnation; integrity or despair; and transcendence and joy or dread and decay. In my own work I’ve added role diffusion in stage five of Erickson’s paradigm based on my clinical experiences with victims.

Maslow highlights our essential human needs on a hierarchy. At the base level are essential survival needs such as food, water and physical protection. The next level entails psychosocial safety and security. Affiliation and affection are prominent themes at the next level. Recognition and approval are prime themes in level four. At the peak of our human development is self-actualization that entails becoming the best persons we can possibly be.

I am a faculty member in psychology and community counseling at Mount Aloysius College. When we discuss child abuse, I assign my students a critical analysis of abuse as it pertains to the psychosocial and essential needs perspectives. So now I lead the readers through this analysis.

This kind of abuse results in the following: pervasive amounts of mistrust, doubt and shame, guilt, inferiority, role diffusion, isolation, stagnation, despair, and dread and decay. In other words, they become significantly developmentally arrested; and none of this is their fault!

As per Maslow, they experience unmet safety needs, they experience little or no affection and affiliation, little or no recognition or approval, and will likely never experience self-actualization. Their experience also involves multiple betrayals at multiple levels by those who are supposed to protect them from harm; and none of this is their fault!

Sociologists discuss the various roles we enact. With each role comes responsibilities, obligations, and duties. I hope that some of our child victims will read this article and realize that none of this is their fault!

References

Bruni, F. (4 November 2016). The Catholic Church’s Sins Are Ours. New York Times. Accessed online 7 March 2016.

Herman, J. (1992). Trauma and Recovery.. Basic Books.

Image via Meewezen Photography / Shutterstock.

Recalling Erickson’s psychosocial stages of development, one of the early stages during childhood involves the mastery of enhanced autonomy or shame and doubt.

We think of shame as a paralyzing emotion with destructive implications. We know that in Asian cultures, humility and shame play a prominent role in personal development by reminding us that we do have obligations and responsibilities to others. As one of many emotions, it is universally experienced, but not considered one of the universally expressed emotions like sadness or happiness or anger.

Satel and Lilienfeld acknowledge the potentially destructive impact of shame, as it can be associated with serious trauma which needs to be addressed and resolved in psychotherapy. They indicate that disorders such schizophrenia or bipolar disorder are beyond the person’s scope to control. However, they indicate the opposite is true about substance abuse. They emphasize, and so do I, that we all need to take a degree of responsibility to correct our destructive patterns.

They cite research presented in the Journal of Personality and Social Psychology conducted at the University of Connecticut by Colin Leach and Attila Cidom as a confirmation of the importance of focusing on shame during professional care.

Psychology recognizes the important functions of human emotions as crucial to our survival. They also energize us and function as potent social signals. Psychology also references the concept of locus of control, whether or not it is internal or external. Those with an internal locus will assume more responsibility for self; whereas the external locus indicates little responsibility for self. And when working with substance-abusing clients, clinicians will confront their defensive triad: denial, minimization, and projection of responsibility onto others.

As we examine the 12 steps of recovery, at least initially, the client must accept her powerlessness over her drug abuse; however, in later steps, taking a self-inventory becomes important. Then they make amends to those they’ve hurt. And in substance abuse work, I point out to my clients all those around them that they destroy. I refer to this consequence as the co-connected experience. The final step involves reaching out to others who are abusing substances. All this involves taking direct responsibility of our actions.

So, professionally, I agree with Satel and Lilienfeld about harnessing the power of shame in psychotherapy once the therapeutic alliance between client and clinician is established. Shame indicates to me that the client cares about their situation. Otherwise, our clients will continue down a destructive path towards premature death, and will take others down with them.

References

Carducci BJ. (2006). Psychology of Personality. Boston: Blackwell Publishing.

Erickson, EH. (1963). Childhood and Society. NY: Norton.

Erickson, EH. 1982). The Life Cycle Completed: Review. NY: Norton.

Satel, S. & Lilienfeld, S. (23 January 2016). Can Shame Be Useful? New York Times. Accessed online 31 January 2016.

Image via StockLite / Shutterstock.

Researchers have discovered common themes across cultures in regards to the most desirable traits that we search for in a mate. These include in rank order: kindness/understanding, exciting, intelligent, attractive, healthy, easy going, creative, wants children, and earning potential. There are minor gender and cultural variations across the above-qualities. Most of these traits are widely regarded by clinicians, such as myself, as prosocial, not asocial, or anti-social attributes.

In addition, there are a few theories that suggest index forces at work in the very earliest stages of mating. Here, I borrow Sternberg’s triangular paradigm. We are attracted to one another via sexual passion. The second powerful factor is commitment. Psychosocial intimacy is the third. It is my clinical view that commitment and intimacy are far more enduring than passion.

John Gottman and colleagues indicate that non-verbal communication between partners is absolutely critical. As a result of extensive research in their “Love Lab”, they identify that five positive exchanges for every one negative exchange is optimal in keeping a couple connected. Compatibility, shared power, and psychosocial development levels are also important factors. This is based on my clinical experience with couples.

Many couples are now waiting longer to commit to a longer-term relationship, and cohabitation is becoming a growing strategy. However, for those who subsequently marry, the likelihood of staying so, makes no difference.

In essence, an enduring relationship takes time, energy, and realistic expectations to make it work “until death does us part”. There are no short cuts!

References

Buss, DM. (1994). Mate Preferences in 37 cultures. In WJ Lanner and R Malpass (Eds). Psychology and Culture. Boston: Allyn and Bacon.

Buss, DM. (2003). The evolution of desire: Strategies of human mating. (2nd ed.). NY: Basic Books.

Gottman, JM. Gottman, JS, DeClaire, J. (2006). 10 lessons to transform your marriage. NY: Crown Publishers.

National Center Health Statistics. (2010). Cited in S. Jayson. “Living together first has little effect on marriage success”.

Sternberg RJ. (1999). Cupids arrow: The course of love through time. NY: Cambridge University Press.

Image via IzabelaGorz / Shutterstock.

Andrew was prescribed anti-convulsants. In a year or so, the toddler became increasingly aggressive and “violent”. The neurologist treating him prescribed the antipsychotic Risperdal, for what some refer to as behavioral dyscontrol.

As a class of psychotropics, they reveal very disturbing side-effects and adverse events. They are not approved at all for children under the age of eight. They have never been researched in this age group because of clinical and ethical concerns. They are usually approved for mania and psychosis in persons with schizophrenia.

According to the article, the use of neuroleptics in toddlers reveals a 50% increase in their use, along with a 23% jump in antidepressants and ADHD prescriptions. All psychotropic agents for ADHD are Schedule 2 controlled agents, are highly addictive, and can trigger psychosis. The U.S. consumes 85% of the world’s market!

Major side-effects include rapid weight gain, diabetes, rapid lowering of white blood cells to name just a few. As far as adverse events, these include tardive dyskinesia (TD), which are painful and irreversible movements and tremors of major muscle groups. Worst yet, they can trigger neuromalignant syndrome, that is amplified TD with death.

The reporter discusses this situation with child experts in the field. One of them is Dr. Ed Tronick, who is professor of developmental brain science at the University of Massachusetts. Dr. Tronick is very clear that these agents will impact the developing brain in ways that we cannot predict. We know that protracted and high dose use in adults, destroys brain tissue and neurons. And in fact, Dr. Tronic voices that the use of the above agents are “nuts”.

I agree with him based on my 43 years of clinical experience.

Both he and I know that physicians often prescribe “off label”, which means that they are not approved by the FDA for certain disorders. And all prescribing done in this manner also seriously deviates from all best, consensual clinical practices. This includes the American Association of Pediatrics.

By the way, antipsychotics are over prescribed in youngsters with autism who show “autistic irritability”. We are also overprescribing them to the aged who develop Alzheimer’s disease. It is my professional opinion that should always be prescribed with written informed consent, as I consider all psychotropics to be pervasive in regard to psychokinetic actions.

Ethically, all clinicians take an oath to “do no harm”. I’ve added a second obligation, that “when clinically necessary, do the least harm possible”. Finally, both Dr. Tronick and I know that a number of psychosocial interventions are known to be efficacious in the intervention of the above disoders, and show very few side-effects and no adverse events.

I strongly encourage parents and others who are concerned about toddlers to become much more aware and informed of these psychotropic agents. When used for the right disorders, and used within clinical guidelines, they reduce suffering, and even save lives.

Reference

Schwartz, Alan. (Dec 10, 2015). Still in a Crib, Yet Being Given Antipsychotics. New York Times.

Image via Sergey Novikov / Shutterstock.

There is no known cure or a way to prevent it. Much of the front-line intervention is to prescribe neuroleptics.

These agents can be efficacious in quelling florid hallucinations and delusions. However, they demonstrate very troubling side-effects and adverse events; some of which can be fatal. And medication compliance with these agents is a problem as a result given that these events are dose and duration related.

I reviewed an article by Benedict Carey, appearing in the New York Times on October 20, 2015. He reports on recently published research. This research is conducted in the US, and is deemed as the “most rigorous yet” in elucidating the impact of individual therapy combined with significant family support.

It involved 404 persons identified as experiencing their first psychotic episode. It involved an experimental and a control group. The control group received standard and typical care; while the experimental received medications combined with the above-mentioned elements.

I have conducted individual counseling with those suffering from this disorder. In my experience, they respond quite well to “talk” therapy.

The results of the above research, indicate that, indeed, by adding additional elements to the overall regimen ,the positive response to care is potentiated. The researchers note a trend that those in the experimental group required lower doses of neuroleptics. I find this study as reaffirmation for individual psychotherapy/counseling.

Reference

Carey, B. (20 October, 2015). New Approach Advised to Treat Schizophrenia, New York Times. Accessed online 5 November 2015.

Image via imtmphoto / Shutterstock.

Reading an editorial by a former Marine officer who served in Iraq and Afghanistan prompted me to produce this article. His editorial appears in today’s New York Times edition, and is titled How We Learned to Kill. It is composed by Timothy Kudo.

In his editorial, he cites the work of Colonel Dave Grossman, a marine officer and psychologist. According to Grossman, the following factors play a crucial role in “learning to kill”:

• the demands of authority
• group absolution
• combatant’s predisposition
• proximity/distance to the target
• target “attractiveness”

So, killing is the polar opposite of my professional training and experience. Here is my understanding of how it occurs in a combat situation. I’ve not viewed, nor will I, the much-heralded American Sniper movie.

One of the paradigms I teach my students, is what I refer to as, the “deconstruction of a self or selves”. I outline these five stages: invalidations, devaluations, dehumanizations, mortification (a concept from sociologist, Erving Goffman).

I view mortification as a “psychosocial death”. And the end stage is homicide. I suggest that under the enormous stressors in a combat zone, this process occurs quite rapidly; and it is absolutely necessary for individual and group survival. During basic and advanced infantry training, some priming to kill is instilled.

In a previous Brain Blogger article, I discussed the survival necessity of aggression; and I outlined six sub-types of human aggression: predatory, antipredatory, impulsive, defensive, affiliative, and dominant. I believe that these are also vital ingredients to homicide. In Vietnam, the ability to deconstruct the “enemy” and to act upon aggression is also necessary.

Another factor that is highly connected to killing is the combatant’s predisposition, or what psychologists refer to as personality. In humans, personality shows itself early and is called “temperament”. Temperament is considered genetic imprinting. However, life experiences contribute heavily to personality; and personality shows itself around age three, and is dynamically impacted until about age 30; then becomes relatively fixed. Personality is the consistent part of how we think, feel, and act.

So I teach students about what I refer to as “global personality orientations”, which consists of prosocial, asocial, and antisocial dispositions. I propose that is it more difficult for prosocials to kill than antisocials. Nevertheless, given the aforementioned dynamics, killing occurs.

And finally, I am struck by Capt. Kudo’s reflection of the killing of “innocents”. He talks about the exhilaration and celebration of enemy killings. However, the reaction to killing civilians is far more sobering. In fact, during the Vietnam and Iraq wars, civilian casualties and deaths are much higher than those of combatants on both sides. Consider the massive casualties of the atomic bombs on Hiroshima and Nagasaki, Japan.

I’ve conducted psychotherapy with Vietnam veterans. They most often struggle with having killed “innocents” than enemy combatants. I deeply respect all of my comrades who served and still serve in active war zones. As a clinician, I’ve gained a much greater understanding of war dynamics. And, I suspect, that I would be capable of taking lives within this particular context.

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What some professionals describe as “classical” autism consists of poor communication, lack of eye contact, lack of imagination, a requirement for excessively rigid daily routines, and an inability to decipher non-verbal signals. The latter is sometimes referred to as being “double mind-blinded”, meaning that people with autism are unable to develop a sense of their own mind and understand the minds of others.

We also believe that people with autism process senses across the sense modalities differently to those without autism. Some think the disorder can be detected at around 18 months, while some say detection is possible even earlier. To the best of my knowledge, autism cannot be detected in-utero. And we presume that the genetic contribution to this disorder is substantial.

Recent clinical findings have been outlined in a New York Times article written by Benedict Cary. He reports on an investigation of whole genome sequencing on 85 families that all have two siblings with this disorder. The study was funded by Autism Speaks – a prominent advocacy group – and carried out at the University of Toronto, Canada.

The conclusions based on the data reveal several points. Firstly, 100 genetic “glitches” have been identified. Siblings in the same family are far more different than similar in regards to their clinical presentation. About one-third of siblings who show some of the same mutations are in fact similar in its expression. The majority do not. This indicates that the genetic contribution is more polygenic than realized, and this disorder is indeed not homogenous. These researchers, and others who review their findings, observe that “genetic mapping for this disorder is weak”.

Given the poor to guarded prognosis for most of those with autism, these findings thus far are not very promising in regards to clinical interventions. The search for clues continues, as it must. Another group of investigators has compiled a registry of about 2800 families who contain at least one offspring with autism. Perhaps then, additional clues will surface.

References
Cary, B (26 January, 2015). More Differences Than Similarities Are Found in Autistic Siblings, New York Times. Accessed 29 January 2015.

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Psychology identifies four core processes of human memory: registration, encoding, storage and retrieval. Psychology also differentiates among three types of memory: sensory, short-term (also referred to as working), and long-term. These various memory sub-types vary in duration and capacity, with long-term memory (LTM) exhibiting unlimited capacity and duration. In regards to LTM, facts and figures are stored in declarative, while actions are stored in procedural.

There are a host of factors that degrade human memory. I list only a few in this article. One, is natural distortion, another is a defense mechanism called repression. Biological and psychogenic amnesia due to trauma are also degrading factors. Contamination by a host of information at one time or over time, is another.

There are a number of ways to enhance human memory. One is through effective encoding. Another is via rehearsal. Chunking, bits of information, is a third.

Dr. Thomas Insel, Director of NIMH reports on two promising interventions. One is optogenetics and the other is functional Transmagnetic Stimulation (fTMS). Both approaches have been used with some success in mice and rats. They may offer some hope, eventually, to humans who exhibit serious memory deficiencies.

Using a highly focused beam of light to stimulate tracks of brain neurons to turn off and on, is the optogenetics approach. Essentially, it involves genetic alterations of these neurons. fTMS, on the other hand, works by directing magnetic beams at specific neuronal circuits.

Dr. Insel indicates that psychotherapy and counseling works at relieving negative memories of trauma, such as those we clinicians often encounter with post traumatic stress disorder (PTSD). Yet, he says that these newer interventions raise additional moral and ethical concerns. But why?

I regard memory formation, storage, and recall to be fundamental to our survival. In the limbic brain, (which I refer to as the reacting brain) are three critical structures involved in the memory processes.The amygdala imprints positive or negative emotions to our initial experiences. In time, the hypothalamus regulates these emotions. It is the role of the hippocampus to convert short-term to long-term memory. We tend to gravitate to experiences and memories that are pleasurable; while we tend to avoid those that make us feel uncomfortable.

It is the negative experiences and unpleasant memories that propel our clients to seek psychotherapy or counseling. People want relieved of some of this discomfort. However, it is a monumental clinical task to “erase” many of the negatives and enhance many of the positives. I believe we can learn as much, if not more, from unpleasant events. I pose this dilemma to students during critical thinking exercises in some of my courses in this regard. Invariably, they conclude that they would elect to delete certain positive memories/experiences and retain more significant negative ones. Both serve as fundamental reference points to future experiences. Therefore, retaining both sides of our experiences can enhance our ability to survive, even thrive!

So, by any means, we need to be extremely cautious in altering, even deleting a person’s memories. In life, we often take the good with the bad.

References

I highly recommend viewing the recently released movie, The Giver, for those who are very interested in this topic.

Thomas Insel, M.D. Director’s Blog. 28 August, 2014. Manipulating Memory. National Institute of Mental Health.

Rod Plotnik and Haig Kouyoumddjian. (2014). Introduction to Psychology. 10th Ed.Cengage Learning.

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Mental health patients do not have the ready access to office visit notes that, increasingly, other patients enjoy. But as discussed in the article, Mr. Baldwin is among about 700 patients at Beth Israel Deaconess Medical Center who are participating in a novel experiment.

Within days of a session, they can read their therapists’ notes on their computers or smartphones. The hope is that this transparency will improve therapeutic trust and communication.

The Department of Veterans Affairs, which began making medical and mental health records available online last year, is only just beginning to study the effect of this on mental health patients.

The Beth Israel project grew out of OpenNotes, a program by Dr. Delbanco and his colleagues that made physicians’ notes accessible to 22,000 patients at three institutions. A 2011 study showed that patients responded positively and became more involved in their care.

Mindful of any pitfalls, the Beth Israel psychiatrists have offered notes initially to only 10 percent of patients.

I have been sharing my clinical notes with clients for years now, with no discernible negative effects. However, I do so only at the next session as a review of our last session. I never post them in any electronic format, so as to preserve respect, confidentiality and privacy. I do not trust the safety of electronic information.

I have been doing this for a number of reasons, some I will discuss here.

For one, I believe that all healthcare recipients are entitled to an accurate recording of their care. Secondly, I believe that this approach also solidifies the therapeutic alliance, which is critical to effective care. Thirdly, it reinforces therapeutic momentum and keeps the client and clinician focused on the objectives and goals of the treatment.

So in my experience, the benefits outnumber the liabilities. I’m certain that some clinicians will disagree with the essential premise of this article; and I welcome robust discussion.

Reference

J. Hoffman (2014). What The Therapist Thinks About You. New York Times, July 7.

Leveille SG, Walker J, Ralston JD, Ross SE, Elmore JG, & Delbanco T (2012). Evaluating the impact of patients’ online access to doctors’ visit notes: designing and executing the OpenNotes project. BMC medical informatics and decision making, 12 PMID: 22500560

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