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Wednesday, March 28, 2012

An Evening with Marie Osmond

Last night Marie Osmond spoke in the grand ballroom of the Skirvin Hotel in Oklahoma City about her post partum depression.  I was impressed with her honesty and authenticity as she shared the incredible depths of the depression she went through following the birth of one of her children.  As with so many women now, she had very little time in the hospital to recuperate.  But on top of it all, her producers were demanding that she back in slim, tip top shape in just a few weeks to return to her entertainment job.  This seemed to produce just the opposite effect of what they had wanted.  Instead of motivating her, it drove her deeper into depression.

She shared how she left her children with someone and then just drove to get away from it all.  Her mother eventually tracked her down.  After that point, she finally was able to start receiving help.  Her primary care doctor told her it was only "baby blues," which for her discounted her experience and only made her more depressed.  But she was eventually able to find a doctor who listened to her and helped her.  Her doctor chose a variety of treatments including nutrition, acupuncture, and antidepressants.

When there was an opportunity for questions, I asked her what coping skills she had taken away from her treatment--what worked for her.  Here's what she said:

1.  Her doctor telling her that she is not crazy.  Most depressed patients are not psychotic.  But depression and anxiety can make a person feel "crazy."

2.  Her doctor really listening to her.

3.  Her doctor telling her that they would work through it together and that she would get better.  I liked this statement by her doctor.  Although I think it every time I meet with a new patient--that we will work through this together, I probably don't say it enough.

3.  Developing better nutrition.  Here's something else which I probably don't do enough of.  The evidence is not clear that nutrition helps depression.  But it is my personal belief that there is a downward spiral of depression leading to poor nutrition, which leads to more depression.  And I also believe that oftentimes as people recover, an improved sense of well being leads them to take time for better meals, which leads to an overall improved sense of well being, and so on.

4.  Reading books on positive emotion.  She found a way of combining exercise and reading such books by downloading them to her iphone and listening to them as she walked.  She joked about her initial reaction when the doctor her told her to exercise--exercise at that point in her life was just being able to get herself up and walk down the hall!  But this combination of walking and listening to positive books makes a lot of sense to me.  Walking is not an impossible exercise for depressed persons, although they may need to start slowly and build up.  And listening to something positive and uplifting at the same time provides motivation to walk and something positive to feed the mind.

After her talk, I was struck by how she had been at the ultimate low point in life, when nothing, not even her own life seemed to matter anymore.  Now, she and her brother have been voted as having the top Vegas show.  The myth of the Phoenix bird rising from the ashes came to mind.  Now she is not only a star, she has done much to reach out and help others.  For example, she is co-founder of the Children's Miracle Network and an outspoken advocate for depressed people getting the help they need.  How many of us, I wondered, go through a time of rising from the ashes?  How many of us go through a period of feeling that things cannot get any better and feel devoid of hope?  If ever there was a story of someone recovering from an absolute low point and finding that life had more in store for them, this was it.

Friday, March 16, 2012

The Scientific and the Moralistic--Two Ways of Viewing Human Behavior

I like to tell my patients that there are essentially two ways of looking at any human behavior--the scientific and the moralistic.  These are two very different ways of viewing human behavior.  And these can lead to very different ways of feeling towards others and trying to influence others. 

I will tell you in advance that I subscribe to both of these views, although at times it seems impossible for me to reconcile them.  They each have their strengths and their weaknesses.

I will also say in advance that I know I am greatly oversimplifying a difficult subject in this blog post.  I apologize in advance.  A person could spend a very long time contemplating these issues and  still be confused.  The following oversimplifications are meant to be thought provoking--not necessarily totally accurate.  It is a very complex subject.  Fortunately, in my everyday life, I don't have to confront the full extent of the complexities and contradictions.  But when I try to put something down on paper, then every sentence seems to raise questions.

Two Views of Human Nature

Here are the two basic ways of viewing human behavior:

View 1--What I would call the older, more traditional view.   People have free will because there is something in us that is more than the sum total of our molecules.  We are more than physical beings.  There is a soul (or whatever you want to call it) in us that can make decisions.  We can choose to do right, or we can choose to do wrong.  

This view has been linked to and related to the idea that there is something in us that is not physical, sometimes called a soul.  This has been disparagingly referred to by academics as the "ghost in the machine" view.  Descartes, a philosopher, subscribed to this view, and so it has been termed Cartesian dualism (the "dual" part meaning a physical body and a non-physical one).

This leads us to view # 2.

View 2--I would call this the modern, scientific view.  I do not mean by this that it is right or wrong, just more in line with current academic modes of thought.  This view would say that people act the way that they do because of how their brains are constructed.  Their brains are made of neurons and glial cells.  These are made of molecules.  Molecules obey the laws of physics.  Molecules have no free will.  It is therefore illogical to blame someone for doing what their brain makes them do.  If an ADHD child is hyperactive, there is no sense in blaming them.  They haven't chosen to be this way. 

Now this may seem like an academic question--is there or is there not free will?  But the fact is that many people use blame in their everyday speech with their other family members, or with their students, or with others.  And blame generally makes the most sense if someone could have done something else.  If there were psychological or physical reasons that someone did what they did, blame is kind of beside the point.

Why Do I Care?

Why is this an issue for me?  Why do I really care?  It is important in two kinds of counseling situations that I see over and over: the depressed person who blames themselves for being "lazy" and unmotivated; and the ADHD kid who is getting blamed for his/her behavior.  In both cases, the blame is both misguided and harmful to the treatment of the person.  The depressed person tends to blame themselves.  The ADHD kid gets it from others.

Let's say that a sixth grader keeps getting into trouble for being out of their seat in class and talking too much.  The traditional approach has usually been to scold and to blame, with the idea that Johnny can control his behavior if he will only choose to do so.  However, many times it eventually turns out that Johnny has ADHD.  His prefrontal lobe executive functioning is inadequate for the demands of the classroom.  He doesn't know this.  He can't explain why he does what he does--either to himself or to others.  The scolding and blaming does not make things better.  It only makes him more depressed and more alienated from school.

Or perhaps I am working with a depressed person who just can't motivate themselves to clean house.  And they blame themselves for being lazy.  This only serves to deepen their depression.  It doesn't get the house cleaned, because the deeper depression only makes it harder for them to do their work.

The Real World: Dealing with Science and Morality At the Same Time

How in the world can these two different types of models of reality be reconciled?  I will leave that for philosophers.  All I can say is that sometimes I use one concept, sometimes another, and sometimes both.  Let me give some examples.

1.  Example one.  Let's go back to the sixth grader with ADHD.  He can't stay in his seat.  He gets in trouble for talking too much in class.  Here I use the scientific paradigm.  There is no sense trying to shame him or blame him.  We simply need to do what we can to help him behave more adaptively (medication, better structure in the classroom, use of positive reinforcement, education of the parents, etc.)

2.  Example two.  Or consider a person who inherits depression or bipolar disorder, etc..  Maybe they stay in bed sleeping much of the time.  They can't get out of bed.  Again, I use the scientific paradigm.  They are not to be blamed.  Blame will only make things worse.  It will make them more depressed, which will lead them to stay in bed more.

3.  Example three.  A person is speeding down an interstate, creating a hazardous situation for others.  Here I might be thinking on two levels.  Why is this person being impulsive?  Is there an explanation in scientific terms for their impulsivity (bipolar disorder, frontal lobe brain damage)?  On the other hand, I would definitely see this as making a bad choice.  Drug use could fall into this same category.  Their brain is developing a craving for the drug.  That is at the molecular level.  At the same time, what choices led to them using the drug in the first place?

Complications--the Buck Still Stops Here

I hope that clarified why I am against using the moralistic approach all of the time.  Now, here is where it gets even more complicated.  There are definite reasons for using the free will/responsibility approach to seeing the world at times.

Let's go back to Johnny.  Let's say that we have determined that it is not his fault that he is not staying in his seat.  Let's say that a full evaluation has been conducted on his ADHD and that he is receiving medicine and counseling.  Let's also say that his parents are in parent counseling as well.  Systems are set up to help him to remember to get his homework done, turn it in, and so on.  Ultimately, the success or failure of the systems set in place will depend on him.  He will need to cooperate to some degree for it to all work out.  This will become increasingly true as he goes into high school and then becomes an adult.  Even if someone is not to blame, the responsibility for change may still fall on their shoulders.

Or let's say that a person goes through cognitive behavioral counseling for depression and is prescribed medication.  Only the person themselves can decide whether they are going to do the homework assignments and use the coping mechanisms.  Only they can decide whether they are going to take their medication.

One other problem with the molecular view of people is that it may lead us to treat them as objects, rather than as people.  Perhaps we are more likely to think of people as numbers rather than real human beings.  I think it would be easier for a dictator to send people to concentration camps if they viewed people as only a collection of molecules.  It would be easier to mistreat people.  I believe that to think of people as real live agents with free will and feelings may make us more sympathetic and empathic.  I think that an over reliance on the molecular viewpoint would tend to make us less caring towards others.

What is the Takeaway Here?

Ultimately, I believe that if the concept of free will can be presented to people in the right way, in a way that can keep it separate from blame and shame.  It can be liberating.  It can emphasize that persons are not simply a product of their genes and environment, and that there may be a way out of their predicament.  In that way, it can also create even better self esteem.  When we make good choices, it enhances our feelings about being who we are.

On the other hand, if we misuse the concept of free will, ignoring the biological and scientific foundations of behavior, then  we may fall into the trap of blaming and shaming.  This in turn can unleash a variety of negative consequences--both for ourselves and for those around us.


It is conceivable that someone could have a non-free will (deterministic) belief about human nature and still choose to use blame as a means of trying influence or coerce others.  However, I believe this is wrong headed in two ways.  First, it makes no logical sense to blame others for things over which they have no control.  Secondly, I believe that the negative, boomerang effects of blame make it a very poor choice for trying to influence others.  Blaming someone is different from disciplining them. Positive and negative consequences can still be used in thoughtful, caring ways for healthy discipline.

Some philosophers would maintain that even though we are just molecules, we are still more than the sum of our parts and that the concept of making true choices still makes sense, even if we are ultimately just molecules. Thus, the idea that we are more than just the sum of our molecules has been judged by some philosophers to be consistent with modern physics. I don't agree. I believe that modern physics does not leave room for us to be more than the sum of our molecules. I think that a larger view of the nature of reality is needed to be consistent with the idea of free will and choice.

Thursday, March 08, 2012

Staying Mentally Flexible Throughout Our Lifetime

It has been said  that science does not progress by old scientists changing their minds.  It progresses by old scientists dying and new ones taking their place. Throughout the history of humankind we can see how this drama plays out.  Young rebels come up with new ideas, and then in the end they, too, become inflexible, holding onto the new scientific dogmas that they have created.  I was reminded of this recently when I read that the 2011 Nobel prize winner for Chemistry had earlier in his career been forced out of his research group for theorizing about quasi-crystals.  He had even been derided by the famous scientist Linus Pauling for his idea. 

When Einstein built on the work of Max Planck in coming up with quantum theory, Planck could not adjust to the new ideas at first. Einstein was the rebel; Planck was the old guard. However, after Einstein convinced the world of the basics of quantum theory, even he could not adapt to all of its unusual implications; he ironically became the "old guard" that the young new physicists had to fight against. If this process of revolutionary turned defender of the scientific faith occurred with Einstein, then I guess it would occur with just about anyone.

How is it that creative and brilliant persons sometimes become inflexible in later years?

This makes sense if we think about how the brain develops in early life and then how it ages in later life.  It begins with more neurons than it needs, and then as the child develops, unused neurons begin dying off.  The brain becomes committed to using certain pathways rather than others.  In our older years, there is shrinkage of frontal lobe neurons.  The brain shrinks 2% each decade.  There can be "hardening of the arteries" causing cell death; there can be changes in cell structure of neurons in the brain. One of the functions of the frontal lobes is to make it possible to shift in our ways of doing things. The baby's brain is almost totally flexible, but with the loss of function in the frontal lobes, we lose flexibility. 

Some people would argue that as we age it is our duty to resist change at times--to stick to our values and beliefs for the benefit of society.  This makes a certain amount of sense.  There are several changes occurring in our society that I do not like.  We need to hold on to certain ideas and conventions (think--Bill of Rights), for the benefit of future generations.

However, there are undoubtedly less altruistic motivations for holding on to the past as well.  Some might be economic, such as when people are part of an establishment group which benefits from the status quo.  Scientists may cling to old beliefs not only because they cannot conceptually conceive of the validity of new beliefs but also because their ego (and even their names) are often associated with old discoveries and theories.

But we can try to be open to new ideas, and when we see a good one, we can encourage it along. It may be our duty to resist and try to put a brake on to the wrong headed ones, but I don't think any of us wants to be known as the one who stood in the way of an improved life or vision for humanity.

If we need to be flexible at times and conservative at times, where do we draw the line?  Let's assume that some new ideas need to be resisted, either because they are not true, or because in the long run, they will be bad for society.  As a starting point, let's assume that 50% of the new ideas are good and useful, and 50% need to be resisted because of being destructive or wrong in some way.  This 50/50 ratio may not be the right proportion, but it is a place to start.  If we were to uncritically accept 100% of new social developments as good and logical, then that would probably just be wrong.  And if we were to resist 100% of new technological and social developments, then that would be irrationally inflexible.  So the farther we get from a 50/50 stance, the more we probably need to at least ask ourselves whether we are being flexible enough or whether we have a totally uncritical stance to change.

So, the bottom line would be, use your frontal lobes and try to remain flexible.  Try not to fall into the trap that many famous scientists and many of our forebears have fallen into.  Try to maintain a reasonable openness to new ideas and new ways of doing things, even as you try to maintain and conserve the best of the old.

Monday, March 05, 2012

Don't Give Up on the Steep Part of the Learning Curve

I started flying again yesterday.  I hadn't been up in the air for about 10 years (in a small plane), and I went up with an instructor to get my flight review.  It's been awhile, so it will take more than one review session.

Some things went smoothly and some were more difficult.  I've been here before--on the steep part of the learning curve. Actually, I'm on a re-learning curve, but it's just as steep as anything when I first learned to fly, because when I first learned, we took everything slowly.  Now, I'm trying to relearn everything about small plane flying in a few weeks. 

After my first hour back up in the air, I was both exhilarated and tired.  A part of me was asking, "Do I really want to do this?"  Fortunately, I recognize this steep part of the learning curve.  I've been there with my oil painting and with my jazz piano, and I know that the steepest part of the curve doesn't last.  The fun, easy parts are coming. 

Unfortunately, many of our children are not learning how to persevere.  We need to teach them that the steepest parts of the learning curve don't last, and that it is worth going through them to get to our goals.

This relates a little to another issue I was pondering last night.  I was watching my grandson with his first efforts at crawling.  My wife commented on how much energy he was putting into learning how to crawl.  Now, in my line of work, one of the main things on which I work with people is their motivation.  Clients often come in to my office with very little motivation to do things.  (Fortunately, they have enough motivation to get to my office--so that's a start!)  They may be depressed.  Or there may be some other issue which interferes with them accomplishing goals.  The thought struck me last night, as I was watching him struggle so mightily to crawl and to move himself around the carpet, "Don't all children start being motivated like this?  How and why does such tremendous motivation go away?  How do we become couch potatoes?"

Here are a few answers I came up with.

1. Depression
2. Dementia
3. Harsh parenting
4.  Lax parenting
5.  A culture that addicts us to TV and video games
6.  A general decline in physical energy
7.  Perhaps a programmed decline in mental motivation (that is, the natural life cycle of our brain)
8.  Negative learning experiences--experiences in life in which we "learn" or think that we learn that we are helpless and cannot influence our environment or achieve things.

Notice that I did not include laziness in my list.  Those who have read some of my past blogs will understand why.  I do not consider laziness to be a scientific explanation.  It is a moral explanation.  It does not really explain anything.  Consider my grandson for example.  Let's say that he becomes "lazy" by the time he is 14.  He does not look lazy now.  If he is acting "lazy" by then, there will have to be some kind of reason.  So enough of that word.  I don't like to use it.

So what other word can we use?  The word (or words) would be "lack of motivation."  It is a description without moralizing.  So let's look at the above list of reasons one more time.  (This list is in no particular order.  I just started with depression and dementia because I see a lot of them in my practice.)

1. Depression.  Depression can be inherited.  It can also be the result of severe stress.  Life sometimes wears us out by the stresses we face.  Clinical depression is more than just the blues, and it definitely results in a severe loss of motivation.  It is not clear just how much people truly recover from severe depression.  Not only may they be unmotivated during the depression, they may not return fully to their previous levels of interest and activity without some encouragement.

2. Dementia.  Dementia starts being a problem for some people in their '70s, and sometimes earlier.  In the early phases, people have less and less motivation to do new things.

3. Harsh parenting.  I think that harsh parenting may temporarily lead to more motivation of a sort.  People feel driven to do things out of anxiety and fear.  But I think it takes the joy out of life.  It removes the joy of exploring life and doing new things.  In the end, harsh parenting often leads to compulsive or passive-aggressive behavior, not to a joyous trying out new things. Harsh parenting often leads to low self-esteem and other types of negative thinking, such as pessimism; and these lead to low motivation.

4. Lax parenting.  Huh?  Am I not contradicting myself here?  Just because harsh parenting may lead to problems with motivation, that does not mean that lax parenting leads to good things.  (If I had to label the in-between type of parenting, I might call it something like "structured parenting.")  Lax parenting does not teach children how to persevere when they become discouraged.  We all feel like giving up on some new endeavor at times.  Parents who let us give up easily are not doing us any favor.  Parents who park us in front of a TV set or video game to keep us occupied all the time are not doing us a favor.  Which leads to #5.

5.  A culture of electronic media which are quite addicting.  I don't think that we have seen the end of this.  Future media will be more appealing and addictive--not less.  As  a culture we are going to have to find how to keep our children active mentally and physically in the face of more and more appealing electronic and virtual activities that will encourage passivity.

6. A general decline in physical energy.  Getting older takes our energy away eventually.  My grandson is motivated partly because he has so darn much energy--and he will have more and more for awhile.

7. Perhaps a programmed decline in mental motivation (programmed in our brain).  Our brains are probably programmed to be somewhat less exploratory as we get older.  This serves the purpose of conservation of mental and physical energy.

8. Negative learning experiences--experiences in life in which we "learn" or think that we learn that we are helpless and cannot influence our environment or achieve things.  The theory of "learned helplessness" and the research supporting the theory, show that if there are numerous enough--or severe enough--experiences where we do not have control, then a kind of depression results, and we just tend to give up.

I'm sure there are other reasons as well.  My point here is not to elucidate every single type of reason for people not being motivated.  I simply want the reader to ponder the following question:  "Am I motivated to keep trying new things in life or not?  And if not, why not?  What can I do to stay involved in life?"  Or if the reader has children or grandchildren, the question becomes, "What can I do to keep their motivation high and to encourage them to enjoy life, learn new things, and to persevere?"