Through my career, I have often been asked to speak on the topic of holiday depression. The problem is that research indicates that it may not exist--at least for our country as a whole.
There is no evidence that there is more depression around Christmas than at other times of the year. In fact, the suicide rate is highest in the spring, not at Christmas. There is no apparent in suicide around Christmastime.
Most clinicians do find a rise in depression in late fall, for persons who are normally prone to depression. While this could be due to the approaching holidays, there is more evidence to support the idea that it is due to Seasonal Affective Disorder and the lessening sunlight of fall.
There is no doubt that Christmas is depressing for some people. We are bombarded by happy images on the TV, and if our family isn't/wasn't like that, then we may indeed feel down. However, for other people, Christmas is a time that lifts their spirits, and so there is an offsetting effect for people in general.
I don't want to make light of the problems that some people have with Christmas and Thanksgiving. For some, it may be really difficult. But the idea that there is more depression at Christmas is essentially an urban myth. There can be depression at any time of the year, and like any depression, if it goes on long enough, it might be wise to seek treatment.
Saturday, December 11, 2010
Friday, December 10, 2010
Getting "Over the Hump"
Many times my depressed patients find themselves stuck. They are at home, fatigued, sad, and filled with negative thoughts. What is often needed at times like that is to get out of the house and get some new experiences. Staying at home and watching TV is not sufficient stimulation to distract them from their internal negative thoughts. However, getting out can be difficult. It requires energy, and that is something they often don't have.
But once they are out, they usually feel better than if they had stayed at home. It would seem like a paradox. Why don't we do what is good for us?
I think that one answer is to use the example of a lawnmower. It takes initial energy to get the process started. Then once it is started, it runs on its own. A scientist patient of mine compared it to the energy of activation of a chemical reaction. It takes an external input of energy to get the reaction started; after that it is self-sustaining.
So the depressed individual needs something to get them "over the hump," to get them going. Then once they are out of the house, they often feel better than they would have felt if they just stayed at home watching TV or sleeping.
What is the solution? In therapy, I find that it works best if there is a plan. Once the patient has a plan, they are more likely to follow through. One plan is to make a commitment to get together with other people. Another type of plan is to buy tickets. People often will follow through with a concert or event because they have already put money down on the tickets. Another type of plan is to have someone come by to pick up the person and go out. It is hard to turn someone down who has made the trip over. There are probably many other types of solutions to this, but these are a few.
I think that another important type of plan is to look objectively at the consequences of staying home. Does it make the person feel better? If not, then the next time they have a chance to get out, they need to remember that staying home may be the easiest thing to do for a few minutes or an hour, but it may lead to more depression over the next several hours than getting out would.
But once they are out, they usually feel better than if they had stayed at home. It would seem like a paradox. Why don't we do what is good for us?
I think that one answer is to use the example of a lawnmower. It takes initial energy to get the process started. Then once it is started, it runs on its own. A scientist patient of mine compared it to the energy of activation of a chemical reaction. It takes an external input of energy to get the reaction started; after that it is self-sustaining.
So the depressed individual needs something to get them "over the hump," to get them going. Then once they are out of the house, they often feel better than they would have felt if they just stayed at home watching TV or sleeping.
What is the solution? In therapy, I find that it works best if there is a plan. Once the patient has a plan, they are more likely to follow through. One plan is to make a commitment to get together with other people. Another type of plan is to buy tickets. People often will follow through with a concert or event because they have already put money down on the tickets. Another type of plan is to have someone come by to pick up the person and go out. It is hard to turn someone down who has made the trip over. There are probably many other types of solutions to this, but these are a few.
I think that another important type of plan is to look objectively at the consequences of staying home. Does it make the person feel better? If not, then the next time they have a chance to get out, they need to remember that staying home may be the easiest thing to do for a few minutes or an hour, but it may lead to more depression over the next several hours than getting out would.
Thursday, December 09, 2010
Stress, Cortisol, and Depression
What’s the evidence to think there’s a link between stress and depression?
There are 23,000 references in PubMed if you type in stress and depression.
The first type of evidence is epidemiological: People who have just had major stressful events are statistically more likely to fall into a depression.
Stressors are 2.5 times more likely in depressed patients compared to controls.
In community samples, 80% of depressed cases were preceded by major life events
Most episodes of major depression are preceded by stressful life events (although
most people do not become depressed even if they experience a negative life event).
It all seems so obvious that stress could lead people to be depressed. But actually it’s not.
For example, why doesn’t excessive stress cause something else? Why doesn’t it cause us to run amok, doing all sorts of wild and crazy things? Why depression?
Why doesn’t stress cause us to work harder? That would be logical–for our bodies to pump out more adrenalin and make us work harder to fix the problems we face.
The answer is we don’t know.
But to have any chance of understanding the human stress response and depression, we have to start with the basic nature of the human stress response.
We have a generalized response to a variety of stresses. Psychological stress and physical stress on the body generally lead to the same set of hormonal responses within the body, which is in itself unusual, or at least, counterintuitive.
We have one main stress response syndrome in our body:
Perception of threat
Hypothalamus activation
Pituitary activation
Adrenal gland activation
Adrenalin+Noradrenalin+Cortisol
During stress, a chain reaction of physical and chemical processes prepares the body for a fight or flight situation. After the logical, thinking part of the brain recognizes that danger is present, another part of the brain, the hypothalamus releases Corticotropin Hormone Releasing Factor (CRF). This in turn stimulates the pituitary (the “master gland”) to release Adrenocorticotrophic Hormone (ACTH). The release of ACTH triggers the secretion of cortisol from the adrenal cortex (the adrenals are located on the kidneys) to provide energy and to help suppress inflammation. Through a neural pathway (that is, via a nerve rather than chemical release in the blood stream), the adrenals are also stimulated to produce more chemicals called adrenaline and noradrenaline. These in turn serve to accelerate the pulse rate, elevate blood pressure, and stimulate the central nervous system.
The fight or flight response is a good thing. It has saved many of our forbears from saber tooth tigers and other dangers. But what is good for us in the short run is not necessarily good for us in the long run.
And cortisol is one of those things. I believe that our best bet at the current time to understand why stress would lead to depression is cortisol.
We do have some evidence that that may be true.
Cortisol like drugs, i.e., steroids, can cause depression as one of their side effects.
People who are given high levels of synthetic glucocorticoids for autoimmune disorders or inflammatory issues have greatly increased risk of going into a depression.
Secondly, we know that long term exposure to cortisol results in some really nasty effects on the brain, particularly the hippocampus. The hippocampus is the memory center of the brain. It also does something else. It modulates the release of cortisol. Long term exposure of the hippocampus to stress leads to loss of neural branches called dendrites. And it leads to problems with memory loss.
If cortisol has a damaging effect on the hippocampus, then it also might have a damaging effect on other parts of the brain. There is only one article I found on this , but it could be true. The negative effects of prolonged cortisol exposure occur throughout the body, so it is not a far stretch to believe that we have only begun to understand the negative effects of it on the brain.
Thirdly, about 50% of people with depression hypersecrete cortisol. Of course, by itself this proves nothing. But it would be consistent with the hypothesis that too much cortisol leads to – too much cortisol. In other words, stress leads to too much cortisol, which can lead to damage of the hippocampus, which unleashes more cortisol.
By the way, elevated cortisol levels occur in mania as well as depression.
Now, let’s transition from looking at depression as a biological disorder to looking at the psychological aspects of depression.
It is certainly possible that once we become depressed, the depression itself stresses us. It enhances our negative thoughts, which increase our perception of threat and stress, which increases our cortisol output, which in turn would further cause disorder of brain functioning.
There is some evidence that the anterior cingulate, a curved bundle of nerves around the corpus callosum between the limbic system and the prefrontal cortex is affected by or is causing depression. And there is a small amount of evidence that high cortisol levels can cause atrophy or smaller volume in the anterior cingulate.
And there, the physiological trail runs cold. We just don’t know the rest. But sometimes a bad theory is better than no theory at all.
So here is the theory in my head when I am working with patients.
Stress begins for most people as a psychological process, although there are also physical components. If my wife is in the hospital, I may sleep different hours, eat different meals, and so on. But also there is mainly psychological stress.
Then the HPA axis causes the release of cortisol. If this is on a sustained basis, the long term effects of cortisol affect the hippocampus and perhaps the anterior cingulate.
Since the hippocampus is supposed to help regulate the HPA axis, if it is impaired, then the HPA axis may get further out of control leading to more cortisol.
Ultimately, the anterior cingulate and the serotonin pathways are affected, leading the person to become depressed if this goes on for too long, and the person has certain genetics.
But even if the trail runs cold, we may know enough to inform our decision making. Stress, particularly prolonged and severe stress is not our friend. Combatting stress takes time and energy, and in some ways it is simply easier to let ourselves be stressed out, even if that is more painful. But it is not good for our brains and it is not good for us. And depending on our genetics, it is often a luxury that we just can’t afford.
Thinking about stress psychologically.
Stress is not just the result of a situation. It is the combination of the situation and our way of perceiving the situation.
We used to think of, or I used to think of, stress as something which could go away. And once it went away, then everything would return back to normal. This way of thinking clearly has gone out the window. Memory will sometimes return back to normal after exposure to chronic stress is over, but not always.
And multiple depressions leave us even more vulnerable to further depressions. Thus, we cannot conclude that we simply return back to normal.
I sometimes say to my patients that stress is a luxury that we can’t afford. What do I mean by that? Because oftentimes, there is little that we can do about stress. Either we are stressed or we aren’t.
But that’s not quite true. There are things we can do about stress.
Cognitive therapy, for example, is aimed at helping people to be less stressed by situations than they otherwise would be.
So there is some sense in saying that stress is a luxury that we can’t afford. To the degree that we do have any control at all over our stress, we cannot afford to let ourselves sink to the bottom of the pit, with the idea that we will eventually bounce out. For some of us, this undoubtedly triggers a genetic response of biological depression. For others of us, it may impair our hippocampus if this goes on for months or years. And for others of us, it may do both.
So if stress is a luxury that we cannot afford, what can we do about it?
This is where the panoply of typical depressive therapies comes in.
Cognitive therapy works to reduce irrational negative thoughts. Why is this important? Because without excessive negative thinking, our body just might turn off the stress response. Which could turn off the cortisol. Which would give our brains a chance to heal.
Behavior therapy sometimes works on assertiveness training. Why is this important? Because assertiveness often fixes situations that we perceive as threatening, which means we don’t have to be stressed, which means that our bodies can turn off the cortisol, which lets our brains heal.
Interpersonal therapy works on improving interpersonal relationships. Which again often fixes situations that we perceive as threatening, which means we don’t have to be stressed, which means that our bodies can turn off the cortisol, which lets our brains heal.
Therapy sometimes helps the person to gain control, or at least enhance their feeling of control, which etc etc.
Get the picture? We cannot afford the luxury of stress. If there is anything that we can do which can turn off the stress response, then we need to do it. If we can divert our attention for a few hours, so much the better. If we can fix the situation, so much the better. If we can find more adaptive ways of thinking about the problem so much the better.
There are 23,000 references in PubMed if you type in stress and depression.
The first type of evidence is epidemiological: People who have just had major stressful events are statistically more likely to fall into a depression.
Stressors are 2.5 times more likely in depressed patients compared to controls.
In community samples, 80% of depressed cases were preceded by major life events
Most episodes of major depression are preceded by stressful life events (although
most people do not become depressed even if they experience a negative life event).
It all seems so obvious that stress could lead people to be depressed. But actually it’s not.
For example, why doesn’t excessive stress cause something else? Why doesn’t it cause us to run amok, doing all sorts of wild and crazy things? Why depression?
Why doesn’t stress cause us to work harder? That would be logical–for our bodies to pump out more adrenalin and make us work harder to fix the problems we face.
The answer is we don’t know.
But to have any chance of understanding the human stress response and depression, we have to start with the basic nature of the human stress response.
We have a generalized response to a variety of stresses. Psychological stress and physical stress on the body generally lead to the same set of hormonal responses within the body, which is in itself unusual, or at least, counterintuitive.
We have one main stress response syndrome in our body:
Perception of threat
Hypothalamus activation
Pituitary activation
Adrenal gland activation
Adrenalin+Noradrenalin+Cortisol
During stress, a chain reaction of physical and chemical processes prepares the body for a fight or flight situation. After the logical, thinking part of the brain recognizes that danger is present, another part of the brain, the hypothalamus releases Corticotropin Hormone Releasing Factor (CRF). This in turn stimulates the pituitary (the “master gland”) to release Adrenocorticotrophic Hormone (ACTH). The release of ACTH triggers the secretion of cortisol from the adrenal cortex (the adrenals are located on the kidneys) to provide energy and to help suppress inflammation. Through a neural pathway (that is, via a nerve rather than chemical release in the blood stream), the adrenals are also stimulated to produce more chemicals called adrenaline and noradrenaline. These in turn serve to accelerate the pulse rate, elevate blood pressure, and stimulate the central nervous system.
The fight or flight response is a good thing. It has saved many of our forbears from saber tooth tigers and other dangers. But what is good for us in the short run is not necessarily good for us in the long run.
And cortisol is one of those things. I believe that our best bet at the current time to understand why stress would lead to depression is cortisol.
We do have some evidence that that may be true.
Cortisol like drugs, i.e., steroids, can cause depression as one of their side effects.
People who are given high levels of synthetic glucocorticoids for autoimmune disorders or inflammatory issues have greatly increased risk of going into a depression.
Secondly, we know that long term exposure to cortisol results in some really nasty effects on the brain, particularly the hippocampus. The hippocampus is the memory center of the brain. It also does something else. It modulates the release of cortisol. Long term exposure of the hippocampus to stress leads to loss of neural branches called dendrites. And it leads to problems with memory loss.
If cortisol has a damaging effect on the hippocampus, then it also might have a damaging effect on other parts of the brain. There is only one article I found on this , but it could be true. The negative effects of prolonged cortisol exposure occur throughout the body, so it is not a far stretch to believe that we have only begun to understand the negative effects of it on the brain.
Thirdly, about 50% of people with depression hypersecrete cortisol. Of course, by itself this proves nothing. But it would be consistent with the hypothesis that too much cortisol leads to – too much cortisol. In other words, stress leads to too much cortisol, which can lead to damage of the hippocampus, which unleashes more cortisol.
By the way, elevated cortisol levels occur in mania as well as depression.
Now, let’s transition from looking at depression as a biological disorder to looking at the psychological aspects of depression.
It is certainly possible that once we become depressed, the depression itself stresses us. It enhances our negative thoughts, which increase our perception of threat and stress, which increases our cortisol output, which in turn would further cause disorder of brain functioning.
There is some evidence that the anterior cingulate, a curved bundle of nerves around the corpus callosum between the limbic system and the prefrontal cortex is affected by or is causing depression. And there is a small amount of evidence that high cortisol levels can cause atrophy or smaller volume in the anterior cingulate.
And there, the physiological trail runs cold. We just don’t know the rest. But sometimes a bad theory is better than no theory at all.
So here is the theory in my head when I am working with patients.
Stress begins for most people as a psychological process, although there are also physical components. If my wife is in the hospital, I may sleep different hours, eat different meals, and so on. But also there is mainly psychological stress.
Then the HPA axis causes the release of cortisol. If this is on a sustained basis, the long term effects of cortisol affect the hippocampus and perhaps the anterior cingulate.
Since the hippocampus is supposed to help regulate the HPA axis, if it is impaired, then the HPA axis may get further out of control leading to more cortisol.
Ultimately, the anterior cingulate and the serotonin pathways are affected, leading the person to become depressed if this goes on for too long, and the person has certain genetics.
But even if the trail runs cold, we may know enough to inform our decision making. Stress, particularly prolonged and severe stress is not our friend. Combatting stress takes time and energy, and in some ways it is simply easier to let ourselves be stressed out, even if that is more painful. But it is not good for our brains and it is not good for us. And depending on our genetics, it is often a luxury that we just can’t afford.
Thinking about stress psychologically.
Stress is not just the result of a situation. It is the combination of the situation and our way of perceiving the situation.
We used to think of, or I used to think of, stress as something which could go away. And once it went away, then everything would return back to normal. This way of thinking clearly has gone out the window. Memory will sometimes return back to normal after exposure to chronic stress is over, but not always.
And multiple depressions leave us even more vulnerable to further depressions. Thus, we cannot conclude that we simply return back to normal.
I sometimes say to my patients that stress is a luxury that we can’t afford. What do I mean by that? Because oftentimes, there is little that we can do about stress. Either we are stressed or we aren’t.
But that’s not quite true. There are things we can do about stress.
Cognitive therapy, for example, is aimed at helping people to be less stressed by situations than they otherwise would be.
So there is some sense in saying that stress is a luxury that we can’t afford. To the degree that we do have any control at all over our stress, we cannot afford to let ourselves sink to the bottom of the pit, with the idea that we will eventually bounce out. For some of us, this undoubtedly triggers a genetic response of biological depression. For others of us, it may impair our hippocampus if this goes on for months or years. And for others of us, it may do both.
So if stress is a luxury that we cannot afford, what can we do about it?
This is where the panoply of typical depressive therapies comes in.
Cognitive therapy works to reduce irrational negative thoughts. Why is this important? Because without excessive negative thinking, our body just might turn off the stress response. Which could turn off the cortisol. Which would give our brains a chance to heal.
Behavior therapy sometimes works on assertiveness training. Why is this important? Because assertiveness often fixes situations that we perceive as threatening, which means we don’t have to be stressed, which means that our bodies can turn off the cortisol, which lets our brains heal.
Interpersonal therapy works on improving interpersonal relationships. Which again often fixes situations that we perceive as threatening, which means we don’t have to be stressed, which means that our bodies can turn off the cortisol, which lets our brains heal.
Therapy sometimes helps the person to gain control, or at least enhance their feeling of control, which etc etc.
Get the picture? We cannot afford the luxury of stress. If there is anything that we can do which can turn off the stress response, then we need to do it. If we can divert our attention for a few hours, so much the better. If we can fix the situation, so much the better. If we can find more adaptive ways of thinking about the problem so much the better.
A Very Sophisticated Book
One of the most sophisticated books I have read in a long time is The Neuroscience of Psychotherapy: Healing the Social Brain. Psychotherapy books in the 1970's (a long time ago when I was in graduate school) were often criticized as being "pop psychology." This is anything but. It is not easy reading for the layman. But for the sophisticated reader, it can't be beat as a way of understanding how psychotherapy relates to brain functioning. The book tackles the problem of integrating two very different paradigms, or heuristics--psychotherapy metaphors and neuroscience concepts. Both are important.
There is at least one more paradigm which has to be integrated with these two, which is the spiritual paradigm.
I once had a patient, a computer programmer, tell me that he had been reading about how computers can be described as operating at seven different levels. I'm no computer wizard, but I can imagine what he means: the atomic level, the circuit board level, the basic machine language level, the macro language level such as A++, the final interface level with the human operator, etc. The same is true of humans. Their functioning can be described at many different levels, and it is hard to integrate all of these together. It will be a long time before we can integrate all of them. But in the meantime, Louis Cozolino has made a really great start in this book.
There is at least one more paradigm which has to be integrated with these two, which is the spiritual paradigm.
I once had a patient, a computer programmer, tell me that he had been reading about how computers can be described as operating at seven different levels. I'm no computer wizard, but I can imagine what he means: the atomic level, the circuit board level, the basic machine language level, the macro language level such as A++, the final interface level with the human operator, etc. The same is true of humans. Their functioning can be described at many different levels, and it is hard to integrate all of these together. It will be a long time before we can integrate all of them. But in the meantime, Louis Cozolino has made a really great start in this book.
Tuesday, December 07, 2010
Settling on a Parenting Philosophy
Many times parents are overwhelmed by the task of parenting. And too often they have never settled on a parenting philosophy. They are just "flying by the seat of their pants," reacting to each situation in turn.
What is a parenting philosophy? It is a guiding set of principles. It is essentially the answer to the question, "What is the most loving thing we can do for our child?"
Here are some questions to consider. Most or all of these do not have a "right" answer. Parents can discuss these without having to always agree. However, I do think that it is important for parents to know where they disagree, and I do think that it is important for parents to agree more than they disagree.
Questions to consider:
Are rewards or punishments more important in raising a child?
Pro Reward View: Punishments tend to have temporary effects. They may cause resentment, anger, and further rebellion. They do not model the positive behavior parents are generally trying to teach.
Pro Punishment View: Sometimes it is necessary to get the attention of the child. Rewards do not necessarily do that. Moreover, setting limits is important, and it is hard to set limits sometimes without there being a punishment included.
Do children do best when left to grow up "naturally," or do they need to have enriched environments and experiences to grow up best?
Pro "Natural" Viewpoint: Many children do grow up well without fancy education or extra experiences. My parents and parents-in-law did quite well with this viewpoint. Children have a natural tendency to explore their environment and learn.
Pro "Enrichment" Viewpoint: Studies have shown that highly stimulating and enriched environments lead to greater proliferation of nerve cell connections in the brain. Additionally, there is just too much to be learned in the modern world without children receiving assistance. Public schools cannot provide this for a variety of reasons, including financial costs. While children may have a natural tendency to explore their environment, they can also get sidetracked into computer games and the internet. They are not necessarily exploring the world in the way our parents did.
Do children need limits more, or praise and warmth more?
This is probably a false choice. They need both. But parents often choose to focus on one or the other more. You probably have a preference and parents will have less conflict over parenting if they are generally on the same side of this issue.
Is it okay to be inconsistent with a child, or is consistency extremely important?
Pro-Consistency Viewpoint: Without consistency, children can be confused. They can pit parents against each other. Children may learn to manipulate. Moreover, they need to learn to deal with real life, and real life has many instances of consistency. When we do certain things, there are negative consequences--touching a hot stove, overspending our credit card limit, and so on. If parents are inconsistent, then children may be surprised and angered when they grow up and these life consistencies fail to budge to their manipulation and complaining.
Pro-Flexibility: Life is too complicated for total consistency. Often there are extenuating circumstances. Often children have learned their lesson without the full punishment being meted out. Setting a good example might not always mean showing total consistency. Setting a good example might mean showing good parental judgement when there are extenuating circumstances.
Is it better to correct children and point out what they have done wrong, or to empathize with their feelings and try to understand why they did what they did?
Should consequences and punishments be mutually agreed upon by parents? Or is it okay for one parent to act unilaterally?
How long should punishments last for? Is it okay to to rescind a punishment once it is stated, or not?
How involved should parents be in helping a child to do their tasks, such as clean their room, etc.? Is it okay to help them, as a way of modeling behavior and making it fun, or is this coddling or enabling?
How important is it for a parent to set a good example and to lead by positive role modeling? Is it okay for the parent to do one thing but then tell the child to do something else?
When children misbehave, is the behavior to be seen as a result of being bad, making bad choices, or as a result of dysfunction (such as brain dysfunction, immaturity, or family dysfunction)?
Some of these are very hard questions. And you may not come up with answers to all of them. But it is better to consider them now, when your children are growing up, than later when they are adults.
What is a parenting philosophy? It is a guiding set of principles. It is essentially the answer to the question, "What is the most loving thing we can do for our child?"
Here are some questions to consider. Most or all of these do not have a "right" answer. Parents can discuss these without having to always agree. However, I do think that it is important for parents to know where they disagree, and I do think that it is important for parents to agree more than they disagree.
Questions to consider:
Are rewards or punishments more important in raising a child?
Pro Reward View: Punishments tend to have temporary effects. They may cause resentment, anger, and further rebellion. They do not model the positive behavior parents are generally trying to teach.
Pro Punishment View: Sometimes it is necessary to get the attention of the child. Rewards do not necessarily do that. Moreover, setting limits is important, and it is hard to set limits sometimes without there being a punishment included.
Do children do best when left to grow up "naturally," or do they need to have enriched environments and experiences to grow up best?
Pro "Natural" Viewpoint: Many children do grow up well without fancy education or extra experiences. My parents and parents-in-law did quite well with this viewpoint. Children have a natural tendency to explore their environment and learn.
Pro "Enrichment" Viewpoint: Studies have shown that highly stimulating and enriched environments lead to greater proliferation of nerve cell connections in the brain. Additionally, there is just too much to be learned in the modern world without children receiving assistance. Public schools cannot provide this for a variety of reasons, including financial costs. While children may have a natural tendency to explore their environment, they can also get sidetracked into computer games and the internet. They are not necessarily exploring the world in the way our parents did.
Do children need limits more, or praise and warmth more?
This is probably a false choice. They need both. But parents often choose to focus on one or the other more. You probably have a preference and parents will have less conflict over parenting if they are generally on the same side of this issue.
Is it okay to be inconsistent with a child, or is consistency extremely important?
Pro-Consistency Viewpoint: Without consistency, children can be confused. They can pit parents against each other. Children may learn to manipulate. Moreover, they need to learn to deal with real life, and real life has many instances of consistency. When we do certain things, there are negative consequences--touching a hot stove, overspending our credit card limit, and so on. If parents are inconsistent, then children may be surprised and angered when they grow up and these life consistencies fail to budge to their manipulation and complaining.
Pro-Flexibility: Life is too complicated for total consistency. Often there are extenuating circumstances. Often children have learned their lesson without the full punishment being meted out. Setting a good example might not always mean showing total consistency. Setting a good example might mean showing good parental judgement when there are extenuating circumstances.
Is it better to correct children and point out what they have done wrong, or to empathize with their feelings and try to understand why they did what they did?
Should consequences and punishments be mutually agreed upon by parents? Or is it okay for one parent to act unilaterally?
How long should punishments last for? Is it okay to to rescind a punishment once it is stated, or not?
How involved should parents be in helping a child to do their tasks, such as clean their room, etc.? Is it okay to help them, as a way of modeling behavior and making it fun, or is this coddling or enabling?
How important is it for a parent to set a good example and to lead by positive role modeling? Is it okay for the parent to do one thing but then tell the child to do something else?
When children misbehave, is the behavior to be seen as a result of being bad, making bad choices, or as a result of dysfunction (such as brain dysfunction, immaturity, or family dysfunction)?
Some of these are very hard questions. And you may not come up with answers to all of them. But it is better to consider them now, when your children are growing up, than later when they are adults.
Tuesday, June 08, 2010
It's Been a Long Time Since My Last Post
And I think that it's about time that I shared some more of my thoughts here. One of the main things that I have been struck by in this last year is the importance of taking personal responsibility. Therapists don't cure patients. We are more like teachers and guides than we are like shamans or even medical doctors. We guide, we encourage, we even correct people when they are about to walk off of a cliff. But ultimately, we don't heal or cure. We each have to take the curative steps for ourselves. One of the problems, however, is that oftentimes, patients are so lost, they don't know what those steps are. And that's where the therapist comes in. So step one is that the therapist clarifies what steps need to be taken.
The therapist also clarifies and simplifies. I have often mused about how confused I would be if I was not a psychologist and had a mental health problem. I could imagine myself in front of a row of books at Barnes and Noble wondering which one to read. Or I could see myself looking through the Yellow Pages wondering which therapist to call. And even if I did buy an appropriate book, it would be doubtful that I would be able to stay with what it was recommending. So the therapist clarifies what is important. He/she does this partly by simplifying and leaving out the least important theoretical understandings.
And the therapist encourages. That's how people stay with things. Encouragement from a teacher. It is very difficult for any of us to teach ourselves. I have a jazz piano teacher. And I have an oil painting teacher. For all of the above reasons--to clarify, to simply, and to encourage. But ultimately, I have to practice and practice and practice. I would never expect that they could just magically make me into a good artist or jazz pianist just because I show up and pay them money. But I think that sometimes clients think that will happen. Effort, practice, thought, mistakes, persistence, and so on, are all part of the process.
The therapist also clarifies and simplifies. I have often mused about how confused I would be if I was not a psychologist and had a mental health problem. I could imagine myself in front of a row of books at Barnes and Noble wondering which one to read. Or I could see myself looking through the Yellow Pages wondering which therapist to call. And even if I did buy an appropriate book, it would be doubtful that I would be able to stay with what it was recommending. So the therapist clarifies what is important. He/she does this partly by simplifying and leaving out the least important theoretical understandings.
And the therapist encourages. That's how people stay with things. Encouragement from a teacher. It is very difficult for any of us to teach ourselves. I have a jazz piano teacher. And I have an oil painting teacher. For all of the above reasons--to clarify, to simply, and to encourage. But ultimately, I have to practice and practice and practice. I would never expect that they could just magically make me into a good artist or jazz pianist just because I show up and pay them money. But I think that sometimes clients think that will happen. Effort, practice, thought, mistakes, persistence, and so on, are all part of the process.
Saturday, June 20, 2009
The Death of the Frontal Lobes
Our frontal lobes are dying.
Well, maybe not really. But they may be suffering. The old quote "rumors of my demise are greatly exaggerated" comes to mind here. But if our frontal lobes have not died they are perhaps in peril.
The prefrontal lobes of our brains contain much, if not most, of what makes us human. Our ability to plan and solve problems. Our ability to initiate a course of action and persevere. Our ability to hold back our emotions when necessary. Our ability to do the hard thing rather than the easy thing. Our ability to notice when we are missing the mark and need to change our course of action to be more effective.
But these are not the types of abilities which are now reinforced in our everyday lives. We often do not read books so much as skim across web pages. We do not make conscious decisions about what will enter our brains so much as clicking the most interesting web page link in front of us.
I know of what I speak, for I too seem to at times become one of the emerging prefrontal lobe brain dead. I can sit down at the computer and encounter lines of email "famspam" (my term for the unending funny pictures, interesting Youtube videos, patriotic Powerpoints, and so on, sent by well meaning family members and friends). Once I have sat in front of the computer, my clicking on links sometimes leads me to forget what I originally intended to do at the computer.
This is a passive approach to the world and to information, and, I am afraid it is leading to a passive approach to life in general. We do not do the hard thing. We seek the easy or the most interesting thing to do with the click of a button. Check our email. Check Twitter. Respond to email. Respond to Twitter. Watch TV, surf the channels.
It is the adult version of what happens when children play video games. We become passive responders. We are responding, but without clear intent, planning, or moral effort. (There is effort in playing a video game, but only of a type.)
Human life needs to be more than passive responding, whether it is to a video game or to Twitter. But it is not just a matter of whether we will seek to do the hard thing. It is also a matter of whether we will be able to do it. Will our prefrontal lobes be there for us and have the necessary complexity and ability to do what does not come easily?
I believe that the proper functioning of the frontal lobes depends on the building up of the neural substrate, that branching of nerve endings which is so marvelously complex in our brains. And I believe that the branching of the nerve cells ("dendrite arbors") can only occur when we use our prefrontal lobes.
Why are we in this position? Were our forebears morally superior "Giant Brains" and we are only "Tiny Brains?" (I am alluding here to the movie "Defending Your Life." If you haven't seen it yet, put it on your list to see.) I don't think that our forebears had better brains. They made many stupid mistakes, of which racial prejudice was just one. But we have so many interesting things to look at. We do not need to invent anything of interest because 10 things of interest have already been shoved at us in one way or another, constantly vying for our attention.
What happens when we don't exercise our frontal lobes? When writing a term paper becomes a simple exercise in cutting and pasting on the computer? My speculation is that we are not developing our frontal lobes and that as a result we will lose some of our self-directedness. We may also lose some our ability to do the hard things in life.
The most important "hard thing" is to set our own goals and then to pursue them. It is so much easier to fall in line behind people who will show us what to do, tempt us with something to do, and so on.
Time, as an empty, cavernous structure yawning before us does not comfort us. It seems to create anxiety in many. Visit a casino with the banks of slot machines. These slot machines can help us to "pass the time," "kill time," and "fill" our time. (I am not being a prude here; I like a little slot machine action once in a great while.) Killing time may also be a way of letting our frontal lobes atrophy.
What the world needs are people who can do that most difficult of all things, set meaningful goals, plan to complete those goals, and then make meaningful efforts to reach them.
Well, maybe not really. But they may be suffering. The old quote "rumors of my demise are greatly exaggerated" comes to mind here. But if our frontal lobes have not died they are perhaps in peril.
The prefrontal lobes of our brains contain much, if not most, of what makes us human. Our ability to plan and solve problems. Our ability to initiate a course of action and persevere. Our ability to hold back our emotions when necessary. Our ability to do the hard thing rather than the easy thing. Our ability to notice when we are missing the mark and need to change our course of action to be more effective.
But these are not the types of abilities which are now reinforced in our everyday lives. We often do not read books so much as skim across web pages. We do not make conscious decisions about what will enter our brains so much as clicking the most interesting web page link in front of us.
I know of what I speak, for I too seem to at times become one of the emerging prefrontal lobe brain dead. I can sit down at the computer and encounter lines of email "famspam" (my term for the unending funny pictures, interesting Youtube videos, patriotic Powerpoints, and so on, sent by well meaning family members and friends). Once I have sat in front of the computer, my clicking on links sometimes leads me to forget what I originally intended to do at the computer.
This is a passive approach to the world and to information, and, I am afraid it is leading to a passive approach to life in general. We do not do the hard thing. We seek the easy or the most interesting thing to do with the click of a button. Check our email. Check Twitter. Respond to email. Respond to Twitter. Watch TV, surf the channels.
It is the adult version of what happens when children play video games. We become passive responders. We are responding, but without clear intent, planning, or moral effort. (There is effort in playing a video game, but only of a type.)
Human life needs to be more than passive responding, whether it is to a video game or to Twitter. But it is not just a matter of whether we will seek to do the hard thing. It is also a matter of whether we will be able to do it. Will our prefrontal lobes be there for us and have the necessary complexity and ability to do what does not come easily?
I believe that the proper functioning of the frontal lobes depends on the building up of the neural substrate, that branching of nerve endings which is so marvelously complex in our brains. And I believe that the branching of the nerve cells ("dendrite arbors") can only occur when we use our prefrontal lobes.
Why are we in this position? Were our forebears morally superior "Giant Brains" and we are only "Tiny Brains?" (I am alluding here to the movie "Defending Your Life." If you haven't seen it yet, put it on your list to see.) I don't think that our forebears had better brains. They made many stupid mistakes, of which racial prejudice was just one. But we have so many interesting things to look at. We do not need to invent anything of interest because 10 things of interest have already been shoved at us in one way or another, constantly vying for our attention.
What happens when we don't exercise our frontal lobes? When writing a term paper becomes a simple exercise in cutting and pasting on the computer? My speculation is that we are not developing our frontal lobes and that as a result we will lose some of our self-directedness. We may also lose some our ability to do the hard things in life.
The most important "hard thing" is to set our own goals and then to pursue them. It is so much easier to fall in line behind people who will show us what to do, tempt us with something to do, and so on.
Time, as an empty, cavernous structure yawning before us does not comfort us. It seems to create anxiety in many. Visit a casino with the banks of slot machines. These slot machines can help us to "pass the time," "kill time," and "fill" our time. (I am not being a prude here; I like a little slot machine action once in a great while.) Killing time may also be a way of letting our frontal lobes atrophy.
What the world needs are people who can do that most difficult of all things, set meaningful goals, plan to complete those goals, and then make meaningful efforts to reach them.
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