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Sunday, January 22, 2012

How Do You Spoil a Child?

I had an interesting conversation the other day with an acquaintance on the issue of spoiling children.  He was saying that we needed to watch out and not spoil our children--that it was important not to give them too many things.

I generally agree with that statement.  However, he was using the word "spoil" in one way, and I use it in a slightly different way.  I think we all need to keep clear on what it would mean to "spoil" a child.

In a larger sense, for something to spoil is for it to go bad.  So the essential issue for me in whether children have been "spoiled" is not whether they have been given too much (although this is one way for them to become "spoiled") but whether they have been treated in such a way as to harm their psychological development.  In my way of thinking, if a child is deprived of everything, they can be "spoiled" or made bad in a totally different way.  I know that this is not the way that "spoiled" is normally used, but it makes more sense to me.  A spoiled child in the larger sense is one whose development has been seriously harmed.

So the issue in my mind is not simply one of whether a child gets a lot of things.  For some children, that might not "spoil" them.  I think that spoiling might or might not occur when children have a lot of possessions.    Now having said that, I would generally agree that children getting too much too quickly is a real hazard to them emotionally.  Here is why.

1.  I think it creates problems for children to give them everything they want so quickly that they do not have to work for anything.  Working for something builds skills and psychological strengths. 

2.  It may create problems for children to give them so much that they cannot really appreciate any one thing because it is just one thing in a mountain of things.  If we do not appreciate what we have, we cannot appreciate the fact that we are blessed to have anything.  We also are not likely to appreciate the fact that others may have very little.

3.  I think that having too much too quickly also keeps us from learning patience.  The desire to have it now, or the feeling that we need it right now, has to be tempered by the ability to be patient for what we want.

So I do not believe that the essence of spoiling a child is simply in having many things, although that creates a hazard.  I think that the essential aspect of spoiling children (in this particular sense) is depriving them of the opportunities to learn to work for something, to learn patience, and to learn to appreciate each and every object they own.

So while I might quibble with my friend over some details, I do believe that if we do give our children too much, then it is hard, if not impossible, for them to appreciate each item.  And if we give our children too much too quickly then the acquisitions will come so fast that they cannot learn patience.  And if we give our children too much too quickly, then they will only have the opportunity to work for a small fraction of what they have.

But overall our emphasis in parenting needs to be helping our children grow up straight and healthy; it does not need to be keeping them in a state of semi-deprivation.  We need to focus on giving them the real gifts of life: patience, a work ethic, and appreciation for what they have. 

Tuesday, January 17, 2012

What Makes a Family Functional? Here's Two Thoughts

First, let me say that don't really think of families in all or nothing terms, either as functional or dysfunctional.  I don't think that I have ever known a fully functional family.  Families exist on a continuum between the two.

Secondly, to write about what makes a family functional in general would be a whole blog in itself.  Perhaps I will devote more space to this in the future.  But here I  just want to write about two processes or behaviors which I think are important for families as they struggle to be more fully functional.

1.  First of all, let's start with a relatively easy behavior--getting through the holidays without arguing.  It is my experience that when families cannot get through Thanksgiving or Christmas without arguing that it lowers the overall sense of family self-esteem.  It tends to create a sense of "what's wrong with us that we can't even get through Christmas (or Thanksgiving)"?

There are also other events besides holidays which I think are equally important to get through without family meltdowns.  Weddings would be one.  People going into the hospital with a health crisis would be another.  There are simply times that we have to put aside our desire to "stand our ground" or "be right" or "make a point," and we just need to "grin and bear it" in order not to detract from the well being and happiness of others.

If we are going to insist on making a point, winning an argument, or having a family showdown (and I am not sure that any of these are all that necessary), then at least they need to occur aside from one of these "exceptional" days. 

Funerals pose a particular problem for this rule, because many families do seem to have meltdowns soon after a patriarch or matriarch has passed away.  It is as if the "glue" of the family has been lost; at that point, the children's squabbles often break out in the open.  But again, my rule of thumb would be that if it is absolutely necessary to have a squabble or showdown, the day of the funeral is inappropriate.

2.  Shock absorbers versus shock amplifiers.  When one family member begins creating tension in a family (and all of us have our little meltdowns from time to time), then there are basically two options that any other family member has.  One is to react in a stronger fashion, adding negative energy to the family system, and the other option is to dampen down our reaction.  Members of the family have the choice of giving out less negative energy than they receive, which would tend to calm the situation, or they can choose to amplify the first person's upsetting statements, adding to the family tension.  When the latter happens, then there is escalation, and sometimes an explosion.  In chemical and nuclear explosions, energy is released from some trigger which then affects neighboring matter, releasing more energy than was received.  This process is repeated over and over, microsecond by microsecond in an explosion.

In thinking about how family members can react to each other in a knee-jerk fashion, I often think of the analogy of a rack of pool balls.  A little known fact about pool balls is that they are extremely elastic.  That is, they tend to transmit energy very, very well rather than absorbing energy.  Once the cue ball hits the rack, then there is an automatic, inevitable transmission of energy to the other balls.  They all react.  If we then imagine the balls to be family members and the cue ball as being one particular family member who stirs things up in the family system, then the cue ball hitting the rack is analogous to one person stirring things up in the family and everyone automatically reacting to that person.

Let's say a father walks in and says, "It's been a terrible day at work; and to top it off, somebody left their bicycle in the driveway, and I ran over it!"  In the pool ball example, all of the family members would automatically react to his upset feelings and statements and start saying equally upsetting things, such as "Well, why don't you pay more attention to your driving!" or "You're going to have to buy me another bicycle!" and so on.

An alternative possibility to the cue ball example, however, is to imagine little shock absorbers between each ball in the rack.  The cue ball hits it, and then the shock absorbers cause there to be a kind of thud, where some energy but not all energy is transmitted from one to another and to another.  Then the balls move but not with a perfect transmission of energy.  There is no automatic reaction carrying the energy around the family system.  And there is certainly no amplification of the energy.

On the other hand, imagine little battery packs inside each pool ball, and when one one is hit, then it actually moves with greater energy than the one that hit it.  Pretty soon all of the balls would be bumping into each other with greater and greater energy.  That is how some other family systems operate.  They amplify the negative energy coming in, and pretty soon everyone is in an uproar with very hurtful things being said or done.

I would want to live in a family with shock absorbers.  I am not suggesting that we don't react to negative events.  We're just human.  But if the family members tone down their reactions, then pretty soon all of the energy is dissipated, and life can return to normal.  Maybe it would take a few seconds or several minutes.  Or maybe a little longer.  But it would not turn into a nuclear explosion.  So my second choice of behaviors for a functional family (relatively speaking) would be for there to be the shock absorber effect.

How can this be put into action?  Well, one way to absorb the negative energy is to delay.  For example, if someone said, "Let's take a look at the bicycle and see if it can be fixed," then there is a delay.  The reaction is put on hold until there is more information and a better understanding of the problem.  Rather than jumping to conclusions, or imagining it being a mangled piece of irreparable steel, there could be time taken to simply take a look at it.  It is possible that minor repairs rather than major repairs might suffice. 

This leads to a third issue--not jumping to conclusions.  There are a variety of negative communication behaviors that can cause problems in families, and jumping to conclusions would be one.  But then that would require a whole other blog post.

Wednesday, January 11, 2012

Increasing Your Self-Control

There are always new concepts being explored by psychologists. And one fascinating one that I have just recently been reading about is the concept of willpower. It is the ability to restrain oneself from an activity, whether it is eating a dessert, or shoplifting, or sex that one might regret later.  This blog post is based on an article in the Monitor on Psychology, a publication of the American Psychological Association.  In a recent article, psychologist and researcher Roy F. Baumeister discussed his work regarding will power.  He has written a book entitled Willpower: Rediscovering the Greatest Human Strength.

Here are some of the areas which Baumeister lists as being helped by self-control and willpower:
domestic violence
sexually transmitted diseases
unwanted pregnancy
educational failure
under performance in school and work
lack of savings
failure to exercise

Looking at the above list, it makes one realize just how important willpower is.  With it, there is the capacity to form a civilization.  Without it, there is chaos and no civilization.

Now we may think of willpower as only something we have to use now and then, as when there is chocolate cake on the kitchen counter.  But in fact research has shown that people use willpower many times a day.  It is a capacity worth cultivating because we are going to use it over and over in life.

We all know that at certain times we have more or less will power than at other times. What people may not know, is that willpower can be temporarily "used up."'  Research shows that if people have to resist temptation in one situation, they are likely to have less power to resist in another situation which comes soon afterward.  If you successfully resist temptation for an hour to eat chocolate chip cookies you just baked, and then you try to do homework, you are likely to be less able to resist temptations that would take you away from homework.

One might expect that resisting temptation in hour one would be good exercise to resist temptation in hour two.  However, while it may help to exercise the self-control "muscle" for the future, it does not help immediately afterwards; instead it hurts or depletes one's immediate ability to exert self-control.  In some way, it uses it up for the moment.

So, just as with exercising a muscle, using it helps strengthen it for the long run but may use up its energy and power immediately afterwards.  Baumeister refers to this process as "ego depletion."  Not only does resisting temptation use up this resource, even making decisions depletes it to some degree.  And that makes total sense to me.  There have been times that I had to make so many decisions that I was just tired and didn't want to make another decision.  It also makes sense to me because I would view both activities as involving the prefrontal region of the brain, so what would affect one capacity could also affect the other.

The good news is that we can increase our willpower and self-control. It is not fixed and unchangeable.  Just like a muscle can be strengthened.  Unfortunately, I believe that our society is not training children well in this area today.  Moreover, I suspect that drug use works to undermine this ability in the brain.

Surprisingly, glucose (a form of sugar) aids in impulse control.  A simple glass of lemonade can improve self-control.

The main point that Baumeister makes in the article is that we do not need to fatalistically accept the idea that self-control is a limited resource.  It is not; it can be increased over time.  In the long run, practicing self-control leads to even more self-control.

Friday, January 06, 2012

The Vicious Cycles of Depression

There are plenty of theories about what causes depression.  And many of them overlap with each other in some of their concepts. But here is another theory, one that is often in my mind as I am treating patients.  It is not necessarily different from other existing theories, but it has a somewhat different emphasis.

It seems to me that depression is an illness involving numerous vicious cycles.  Event A leads to Event B, which leads back to more of Event A, which leads to more of Event B, and so on.  There are a variety of these cycles in depression.  If there was just one, it would be easier to treat.  But there are several, and each keeps perpetuating itself. 

The theory doesn't really address the issue of what starts depression in the first place.  But it does help explain how a mild depression can turn into a severe one.

Here are some of the vicious cycles which I see in the depressions my patients struggle with:

Cycle #1--Withdrawing from the World.  Depression increases passivity and decreases social interaction.   This in turn isolates the person and deprives them of interpersonal stimulation. They don't get the social support and distraction from negative thoughts which they would otherwise get from interpersonal relationships.  They are increasingly left alone to deal with negative thought distortions on their own without any corrective input from non-depressed persons.  This in turn increase depression.  Which increases social isolation.  And so on.

Cycle #2--Negative Thinking.  Depression increases negative thinking about self, world, and future. The increase in negative thinking increases the depression level. The more depression a person has, the more negative thoughts are generated in the brain.  This is the basis of cognitive therapy. The cycle of negative thinking to depression and back to negative thinking has to be interrupted.

Cycle # 3--Possible Negative Effects on Nutrition.  Depression often decreases the appetite, which in turn may be depriving the person of important nutrients relevant to mood, well being, and health, thus increasing depression, and so on.  The depressed person may opt for a high carbohydrate (high sugar), junk food diet because they don't want to eat, or don't feel up to cooking a more balanced diet.  They seek out foods that will medicate their immediate feelings, not foods that will provide good nutrition for their brain.  Lacking good nutrition, the brain may be more susceptible to depression.  The link between nutrition and depression has not been proven, but there are some studies suggesting that there may be a connection.

Cycle #4--Decreasing Assertiveness.  Depression  makes people less assertive and less likely to use good problem solving techniques.  When people are less assertive, they don't get their needs met.  Aggravations in their environment can continue unabated.  Problems pile up.  And depressed persons generally do not follow well thought out problem solving approaches that would be needed to deal with the stresses they face.  The ongoing presence of stresses keeps them depressed.  The lack of assertiveness and/or problem solving allows stresses to get worse (such as by building up finance charges on credit cards), which can make the person more depressed.  And so on.

Cycle #5--Downward Spiral of Physical Activity.  Depression makes people less active, which means that some of the benefits of exercise (e.g., brain derived neurotrophic hormone and so on) are not obtained.  (Neurogrowth hormone is a naturally occurring substance in the brain which helps nerve cells grow.)  Theoretically, nerve cell growth or regrowth in the brain may be necessary to recover from depression.

The lack of activity also means that the depressed person is deprived of positive environmental stimulation (lights, sounds, tastes, etc.)  Even though these stimuli may be less interesting and less pleasurable than when the person was non-depressed, they may still give some pleasure, and these may be almost totally absent as the person withdraws into their house and/or room.

Cycle #6--The Cortisol Loop.  Psychological stress causes increases in cortisol.  Cortisol has a negative impact on brain function, although we are not sure all of the different ways this may affect it.  The impact of cortisol on the brain (or of other stress related chemicals)  may then cause the brain to go into deeper depression.  Which causes more negative thinking, less energy, and so on.  And so on.

Cycle #7--A Lowering Availability of Mental and Physical Energy to Cope with Stressors.  Let's say a person goes into a mild depression. This reduces their energy and likely increases their negative thinking about how much they have to do. A molehill starts to seem like a hill; a hill starts to seem like a mountain; a small mountain starts to seem like a big mountain.  There is a perceived difference between what they have to do and overcome on the one hand, and how many resources they have for the task.  The person may get an overwhelming feeling of, "I just can't do it all." This is not just a thought process. It is visceral--felt in the gut. They see their tasks as overwhelming, but they also feel it to be overwhelming because they are so fatigued due to the depression.

These vicious cycles all have the capacity of deepening depression to moderate or even severe levels.  For that reason, intervention can be needed to help someone recover. 

In other cases, depressed persons may succeed in eliminating the external source of stress.  That is, if they are without a job, they may succeed in getting another suitable position.  In still other cases, time may cause the external stress to seem less important.  If we lose a job today, it may feel overwhelming, but in two years, it may seem much less important.

Whatever the reason, the vicious cycles of depression fortunately do not go on forever for most people.  If, on the other hand, a person's depression does seem to be going on and on without any let up, then it would be logical to bring in an outside influence such as a psychotherapist, to help break up the cycle.

Monday, January 02, 2012

What Does It Mean to Be Strong or to be Weak?

One of the things I often hear from patients is that they is that they feel they are weak for having depression, or they feel they are weak because of coming to a counselor.

Because I have heard this so much from my clients, I have thought a lot about that term, "weak," and to tell you the truth I am confused about it.  I am still not sure whether it has any place in psychology and in the way we think of ourselves and others.

One way of thinking about depression is that under the pressure of environmental stresses, the brain has quit working properly.  (This is an oversimplification, but just stay with me for the moment on this.)  Depression means that some pathway in the brain, or some segment of it, is not working correctly.  That could be compared to the weak link in a chain.  It could be compared with a bridge giving way under the strain of an excessive load.  Some grouping of nerve cells has quit operating properly.  We talk about a weak link in a chain, so why not talk about "weak" nerve cells? 

If a bridge collapses, we would speak of it being weak, or would we?  We might simply say that the bridge was put under an excessive load.  We might blame the load as being too heavy rather than blaming the bridge for being too weak.

If we were going to talk about the brain being weak, wouldn't we need to talk about "weak" pancreases when people have diabetes or weak bones when there are broken bones?  But we generally don't.  If a bone is broken, we assume that it was under too much stress--the person fell or was in a car accident.  We don't normally talk about weak bones unless the person is old.  We do talk about weak bones when there is osteoporosis. But with younger people, we don't say that they or their bones were weak when a break occurs.  We assume that the load was just too much for the bone to bear, as when bones break in an automobile accident.

What do we really mean by saying that someone is weak?  Are we referring to "weak" nerve cells?  Probably not.  When a depressed person calls themselves weak, they are not referring to nerve cells; their are generally referring to their character.   I think when people use the term "weak," they are really  making some kind of a moral judgment.  They are talking about something which is not physical but almost metaphysical--something invisible.  If we call someone weak, we are in essence implying that they just shouldn't be that way.  They should suck it up and be stronger, whatever that means.

But "strength" is after all only a metaphor.  What does it really mean in human behavior?  We can measure weakness in structural materials in an engineering sense when a component breaks under pressure.  How many newtons or pounds of force are required before a physical object breaks?  That is a clear statement about strength in physics.  But surely the use of the term "strength" and "weakness" if someone develops a mental disorder is something quite different.

So it comes down to metaphors.  Words like "strong" and "strength" and "weak" and "weakness" are metaphors.  The question is are they good and useful metaphors or not?

Actually, I think these terms are bad metaphors because they often make the problem (depression, anxiety, etc.) worse.  The metaphor becomes an additional problem  Once we refer to ourselves as weak, we then are likely to begin to feel more depressed.  Which can cause more negative thinking.  Which can make us more depressed.  And so on.  Moreover, to tell ourselves that we are weak is an attribution which is internal, stable, and generalized, which does not help our feelings of self-efficacy.

Would there be a better metaphor besides being "strong" and "weak"?  Perhaps.  Perhaps we could say that people are resilient or not resilient.  That metaphor makes a certain amount of sense.  We have all seen how a blade of grass can bounce back after it has been bent down.  It can be resilient and bounce back after a stress.  I don't think any of us would feel nearly as bad about telling ourselves that we would like to be more resilient instead of telling ourselves that we are weak.  However, even here we have to watch out for labeling ourselves in a generalized sort of way.  For example, most of us are resilient in some situations but not others.  Rather than saying, "I am not resilient," the alternative would be to say, "I am having a hard time being resilient in this situation."

So maybe to say we are weak after becoming depressed makes a little bit of sense, but in the end, but the metaphor bs damaging in its own right because of what it implies.  It may be true that some system in our brain was "weak" enough that under a heavy load of stress, it "broke" or quit operating in a satisfactory manner.  We felt depressed, quit eating, couldn't sleep, and so on.  But I say we let go of that term because for many of us what we really mean telling ourselves that we are weak is that we are flawed, no good, worn out, etc.  And that would not be true.  And it would bring on more depression.ecom

Here's another problem with the "weakness" metaphor.  And this perhaps gets more to the heart of how illogical the metaphor really is.  Let's say that a cell can malfunction in two ways.  Let's say that it can fire too much or too little.  Now let's say that if that nerve cell fires too much, the person becomes more manic.  He or she has more energy.  The person has more confidence.  They take chances.  In battle, maybe they get up out of the foxhole and charge at the other line.  Now let's say that if the nerve cell fires too little, that the person holds back.  They feel tired and unsure of themselves.  In battle, maybe they would not charge at the other line.  They might appear weak.  It's all a matter of whether that nerve cell fires too much or too little.  Either way, the nerve cell would be malfunctioning.  And that might be a matter of genetics, or even a matter of what moment in time it is.  Certainly, a bipolar person could appear super humanly strong one day and "weak" on another day.  So if the nerve cell (purely theoretically for this example) malfunctioned by firing less, society would label the person as a coward, and if the nerve cell malfunctioned by firing more, society would laud the person as brave and give them a medal or promotion.  The "coward" would be referred to as "weak" and the soldier charging the enemy line as "strong."  Recall the scene in the movie Patton where the general was disgusted with the soldier with "battle fatigue" and berated him.

To put it another way, if the cell malfunctions and the person becomes manic, then there is a problem, but the term "weakness" would probably not be used.  Other metaphors are used for mania, such as "He had a nervous breakdown."

But now let's complicate it even further.  In the brain are excitatory neurons and inhibitory neurons.  We would expect that depression would result from too little firing of excitatory neurons.  But what if it actually results from too much firing of certain inhibitory neurons?  Then the neurons being too active would end up causing behavior which appeared to be "weakness."  That would seem somewhat contradictory.  Or putting it another way, it's all a matter of which neurons are overly active.  Certainly if certain neurons in the amygdala fire a lot then there is anger, perhaps causing bravery on the battlefield.  But if other neurons in the amygdala fire too much, then there is anxiety, perhaps causing someone to pull back in battle.  It might be just a matter of which set of neurons are firing the most, and they may not be far away from each other in the brain. 

When all is said and done, I think it is better not to use the concept of "weakness" in talking about people and psychological problems.  It confuses us.  It can make us look down on ourselves or on others.  It does not lead to solutions of problems.  It makes it harder to solve the problem of our depression or the depression of those close to us.  What is the alternative?  I think there are a variety of ways of thinking about depression without ever referring to weakness.  I think that the concept of resilience is a fairly good one.  "In this situation I am having a hard time being resilient."  That is likely to describe what is going on without adding to the problem.