A confluence of topics dealing with mental health, substance abuse, health, public health, Social Work, education, politics, the humanities, and spirituality at the micro, mezzo, and macro levels. In short, this blog is devoted to the improvement of the quality of life of human beings in the universe.
Thursday, December 17, 2020
What is your interior spiritual life like?
Wednesday, December 16, 2020
What's the best way to change an abuser?
In the May/June, 2019 issue of Mother Jones magazine there is an article entitled, "What's the best way to change an abuser?"
There is no one best way.
My clinical experience of over 50 years has taught me that the first step is a mental health evaluation to understand the person's psycho-social functioning which is composed of thoughts, feelings and behavior. The causes of domestic violence are multi fasceted.
The Mother Jones article notes that 86% of mass shooters studied had a history of perpetrating domestic abuse.
One program that seems to help somewhat is Men Creating Peace in California. In Rochester, NY, a Social Work colleague of mine had pioneered a program for men who perpetrated domestic violence back in the 70s and 80s. I am not sure if the program any longer exists.
For services in Rochester, NY regarding domestic violence contact Willow Domestic Violence Center.
Tuesday, December 15, 2020
U. S. birth rate below replacement levels
U. S. birth rate below replacement levels
|U.S. birthrate falls to 32-year low|
The U.S. birthrate dropped to a 32-year low last year, the Centers for Disease Control and Prevention reported Wednesday. About 3.8 million babies were born in the country in 2018, 2 percent fewer than in 2017. It was the fourth straight annual decline. The fertility rate "in 2018 was again below replacement — the level at which a given generation can exactly replace itself," according to the report. "The rate has generally been below replacement since 1971 and consistently below replacement for the last decade." The replacement rate is 2,100 births per 1,000 women; the 2018 rate was 1.728 births per woman. "We're clearly in the throes of major social change with regard to women getting married and choosing to have children," said Donna Strobino, a professor at Johns Hopkins Bloomberg School of Public Health. [USA Today, NBC News]
With U.S. birth rate below replacement levels, it will have to increase immigration rates to maintain its population.
Monday, December 14, 2020
Wednesday, November 4, 2020
How to assess your level of emotional maturity.
Tuesday, November 3, 2020
Why do we choke and how to stay calm under pressure.
Tuesday, October 6, 2020
Bruce Feiler interviewed on Ten Percent Happier podcast on 09/14/20 about his work on life transitions.
The Ten Percent Happier podcast interview with Bruce Feiler published on 09/14/20.
Monday, October 5, 2020
What is the shape of your family' s story?
Sunday, October 4, 2020
Book of the month discussion - Life Is In The Transitions: Mastering Change At Any Age by Bruce Feiler
A new feature on Markham's Behavioral Health is a book discussion of the month. Every month a different book will be featured which will be discussed throughout the month. Follow along and comment as you are moved.
This month we will be discussing Life Is In The Transitions: Mastering Change At Any Age by Bruce Feiler.
The borderline Queen - "It's all about me!"
Borderline Personality Disorder can manifest itself in multiple ways. In her book, Understanding The Borderline Mother, Dr. Christine Lawson describes four role types which BPD is exemplified by: the Waif, the Hermit, the Queen, and the Witch. These role types are not mutually exclusive and characteristics of these types over overlap and inter mix.
Dr. Lawson writes that Borderline Queens are driven by feelings of emptiness, and that they seek special treatment because they felt emotionally deprived as children. The Queen has learned how to win special treatment through persistence and intimidation.
Dr. Lawson writes:
She can be intrusive, loud, inpatient, and flamboyant. She is easily frustrated, often bursting into rages than can terrify her children. She can be disingenuous and may lie in order to get what she wants." p.104
Dr. Lawson points out that giving in to the Queen is easier than resisting, and Dr. Lawson further points out that those who dare to confront the Queen may be treated as infidels and, as such, may be banished for their disloyalty. In this way, the Borderline may create new borderlines in their children by terrorizing them with rejection and abandonment to punish them for not following her will. Husbands of Queens learn that any peace and equanimity that can be obtained in the relationship with her will require that they acquiesce to her demands or arguments will ensue that will escalate until the Queen gets her way. For similar reasons, the Queen will be right about everything and never take responsibility for her own mistakes or problems. She will never apologize or say she is sorry or seek forgiveness. The Queen is sovereign and expects all to serve her faithfully and compliantly or as the Queen in Alice In Wonderland would hysterically shout, "Off With Their Heads!"
Dr. Lawson writes:
"The darkness within the borderline Queen is emptiness. Emptiness and loneliness are distinctly different emotional experiences. Whereas loneliness results from loss and evokes sadness, emptiness results from deprivation an triggers anger. However, not all Queens experienced loss in early childhood. The common denominator among borderline Queens is emotional deprivation. As children they felt robbed; consequently, they feel entitled to take what they need." p. 105
In my clinical experience, it is this sense of deprivation which gives the Queen her sense of entitlement. This sense of entitlement allows her to justify her exploitation, lying, steeling, and deprivation of others. This entitlement may lead to behaviors such as shoplifting, embezzlement, fraud, and stinginess.
The Queen can be very charming and seductive pursuing attention to fill the void of the underlying deprivation. The Queen can be quite competitive and envious of others and devalues others who are a threat to her or who do not provide gratification or special treatment. This sense of deprivation often impairs moral judgment and the Queen can be vindictive without feeling guilt or remorse. The Queen will rarely give credit to others unless there is something in it for her. People quite attracted to the Queen initially, because she usually has quite a charismatic personality, will sooner or later get burned by the Queen when they realize that for the Queen everything must be about her and if possible they will avoid her.
Dr. Lawson writes:
"The Queen relates to others with superficiality and an air of detachment. She may perceive others, including her children, as a threat to her own survival unless they relinquish their needs for hers. Queen mothers compete with their children for time, attention, love, and money. Superficial interest and a lack of attunement to the child's emotional needs are typical of Queen mothers." p.108
A little further on the same page, Dr. Lawson writes:
"In order to win admiration and love, her children must reflect her interests, values, tastes, and preferences. The Queen expects her children to dress the part, to reflect her importance." p.108
The borderline Queen motto is: "It's All About Me!"
Dr. Lawson points out that although Queen mothers emotionally sacrifice their children, their children may go to their graves protecting her.
Monday, August 31, 2020
Sunday, August 30, 2020
Saturday, August 29, 2020
Attachment theory - How childhood experiences affect later life relationships
I find attachment styles a very helpful idea in understanding the problems that people experience and their interactions in relationships.
Friday, August 28, 2020
How to teach a child to safely cross the street.
Thursday, August 27, 2020
Wednesday, August 26, 2020
Tuesday, August 25, 2020
Monday, August 24, 2020
Sunday, August 23, 2020
Father's who physically play with their kids help them develop more emotional self regulation.
Saturday, August 22, 2020
How to make a new friend
A way of understanding later life problems in living is to understand the trauma we may have experienced in childhood. This trauma is called "adverse childhood experiences."
If a person has a high score on the ACE screening tool, what can they do to lower their over all anxiety and tension level? Dr. Nadine Burke Harris describes 6 components of wellness one of which is social connections.
Tuesday, June 30, 2020
People who smoke and vape at higher risk for Covid IX
Research at the University of Rochester Medical Center has found evidence of why COVID-19 is worse for people who smoke and vape than for the rest of the population.
Irfan Rahman, who runs a lab at URMC that studies the effects of tobacco products on the lungs, said people who smoke and vape often have elevated levels of receptors for an enzyme called ACE2.
Those receptors also allow the novel coronavirus to enter lung cells. More receptors means more viral load, which means more severe infections, Rahman said.
Thursday, June 25, 2020
How Can You Do This Work?
How Can You Do This Work?
I get asked this question fregquently.
Here is my attempt to respond.
For more click here.
Tuesday, June 16, 2020
Fatal car crashes up 13% for 15 - 24 year old males in states with decriminalized marijuana laws
States with marijuana decriminalization laws experienced a 13% increase in fatal car crashes among 15 - 24 year old males. There was no increase in females, and no increase in drivers over 24.
There also were no increase in fatal car crashes in states with medical marijuana laws. It is hypothesized that the reason for the difference between deciminalized states and medicalized states is that medical marijuana laws require that the marijuana only be used at home.
From the American Journal Of Public Health, March, 2020.
For more click here.
Monday, June 15, 2020
The grieving process - Stage two: bargaining
The second stage of grief has to do with the undoing of the loss. We do a lot of second guessing. “Maybe if this, maybe if that then the loss would not have occurred.” There is often a lot of self blame and blaming of others and circumstances. “What if this had happened, or that had happened, then the death wouldn’t have happened at the time it did.”
Bargaining also involves a lot of “if onlys.” “If only I had done this or that,” or if others had only done this or that then this would not have happened.
We even, like Jesus in the garden at Gethsemane, plead with God to remove this cup. We promise to go to church every Sunday, give $10,000 to the church, put a bathtub Madonna in our yard, if only God would intervene to not let the death happen.
The bargaining stage is often the longest of the stages of grief and can last months and sometimes years. The bargaining stage prevents and forestalls acceptance that the loss has occurred and is permanent. As long as we bargain in our minds and hearts, we don’t have to accept the crushing sorrow and grief that acceptance entails.
Arguing with a person who is bargaining does not help. Reassurance does not help. Listening in a non anxious and a non judgmental way does help. As the grieving person expresses and articulates their alternative scenarios, the facts become clearer that circumstances did not allow the desired change to prevent the loss to occur and so their hopes and desires are merely a pipe dream. Having expressed their desire that things could have been otherwise, the grieving person comes to realize that the loss probably could not have been prevented or forestalled. “It is what it is” as the Buddhists say.
Bargaining can be exhausting and will eventually run its course because reality eventually begins to set in and life goes on. However as bargaining peters out, sadness and despair become more prominent. This increase in sadness and despair is the harbinger of acceptance which intensifies the emotional pain but also brings a release from which hope in a future meaningful life springs.
One of the things which helps people get through bargaining to acceptance is faith in the process of grieving. Once it is understood what is happening, it becomes less scary and more understandable. With understanding bargaining becomes easier to manage as both the person grieving and the witnesses who want to be supportive.
Sunday, June 14, 2020
Behavioral learning in the age of Covid-19 social distancing.
Why do people stockpile toilet paper during the Covid-19 crisis?
While it only explains about 12% of the reasons that people stockpile toilet paper during the Covid-19 crisis, a recent study found that people who stockpile toilet paper tend to be more frightened of the threat of Covid-19 infection, and they tend to be more "conscientious."
For more click here.
In my practice, I have observed that people who engage in this toilet paper stock piling tend to be more anxious, ruminate more, and tend to show signs of paranoia. The obtaining of large amounts of toilet paper seems to lower anxiety and enhance a sense of security and safety, but obtaining large amounts of toilet paper then leads to an obsession and compulsion to hoard other commodities.
Saturday, June 13, 2020
The grieving process - Stage one: Shock and disbelief
As we discuss the stages of grief it should be noted that the stages are just a general frame of reference and not prescriptive. People don’t have to go through the stages as described here. Further, people don’t experience the stages in a linear way but in an oscillating way going back and forth not one after the other. People often describe the grieving experience as a “roller coaster.”
The first stage is sometimes called “denial” but the word “denial” does not accurately describe the experience. People cognitively recognize death has occurred but often describe a sense of life being surreal. They describe being “numb” and disoriented. They say things like, “I just can’t believe this has happened and ____________ is gone.”
People describe themselves as being in a fog and going through the activities of daily life as if they were a robot on auto pilot. The feeling of disbelief is very powerful and there is a growing sense that the event of the death will be a milestone in their lives with the death marking the boundary of life before the death and after the death.
People often find it hard to eat, sleep, concentrate, and perform the normal tasks of their daily routines.
During this stage people need assistance with daily tasks and to be excused, if possible, from social obligations to others. They need to be left alone if the person wants to withdraw from social interactions or they need to be listened to if they want to share their thoughts, feelings, and anguish with a trusted other person. Providing a shoulder to cry on is a very important form of solace and consolation. The listener need not say anything to help the person feel better. Just allowing the grieving person to share their sadness, sorrow, anger, fears, regrets, and sense of loss is very helpful. Do not try to cheer the person up or reassure them things will be okay.
It is very common at this stage to observe an expression of anger and blame and guilt that someone is at fault for the person’s death. People even blame God for letting this death occur. A regression to a narcissistic state where people take the death personally is common. “How could this happen to me!”
People often feel a disorientation, confusion, and perplexity and say, “Oh my goodness, what will happen now?” There is an anxiety about how life can go on as it was lived before the death.
People often hear the dead person’s voice, see glimpses of them, or are reminded in a hundred ways of the person as living. It is like deja vu when the person is uplifted momentarily believing that the person hasn’t died. Dreams of the dead person are very common.
This stage of shock and disbelief usually doesn’t last more than six weeks, if that. The grieving person needs to share their experience with an understanding other who can maintain a non anxious presence and non judgmentally listen to the person express their experience. Nothing need be said or done other than mere listening, and inquiring, when it seems helpful, about the person’s memories and experiences of their relationship with the person they have lost. Sometimes people want to talk about their memories of the relationship and sometimes they don’t. Either way is okay.
Thursday, June 11, 2020
Overview of grieving: general observations continued.
Before we get to describing the stages of grief there are few more topics worth mentioning about grieving in general.
Disenfranchised grief is grief that people experience without any social recognition or acknowledgement. A lover of a married spouse who dies without there ever being any public recogition of the nature of the relationship. Deaths of ex spouses after divorce.
Deaths experienced by professionals of patients or clients who were part of confidential relationships. This happens freguently to health care providers in all kinds of settings.
There are many other examples where loss is experienced alone without any social recognition, acknowledgement, or support. Miscarriages may fall into this category. People who die in institutions like prisons or nursing homes or by stigmatized circumstances like suicide, drug overdose, alcoholism.
Liberating losses - Sometimes death is experienced as a relief or as if a burden has been lifted. This often occurs after a long illness where the death is anticipated, but also can happen in a sudden death when the deceased is a part of a conflicted relationship.
Moral injuries - These are deaths witnessed or inflicted in war, capital punishment, or other acts of revenge or intentional or unintentional "accidents." Abortion is sometimes thought of as falling into this category.
Wednesday, June 10, 2020
Overview of the grieving process.
What are the stages of grief?
What is about to be described here is a frame of reference. Nobody goes through the stages exactly as described in a linear way. Most people oscillate back and forth through the stages but the person can probably identify where their emotions and thoughts are predominately at a given period of time when they are going through the stages.
What is presented here is boiled down from a clinical perspective. There are other descriptions but the one presented here is what seems most helpful when talking with people about their grieving process in my practice.
Here the stages:
- Shock and disbelief
Tuesday, June 9, 2020
PHQ - 9 overestimates prevalence of depression
More and more primary care medical practices are using the PHQ-9 depression screening tool and sometimes the abbreviated version. I've had it administered to me on my primary care medical visits along with my weight, blood pressure, and pulse.
A new study finds that these depression screenings over estimate the prevalence of depression. A symptom check list screening is not the same as a structured clinical interview for depression (SCID).
The most common misdiagnosis I find in my clinical practice is the depression for grief. Often I find that people who screened positive for depression in their doctor's office are actually experienced what is sometimes called "disenfranchised grief." Disenfranchised grief is sorrow and mourning triggered by a signficant loss that is not socially recognized, acknowledged, and therefore not supported with consolation and solace. Often I find that these patients have been started on an antidepressant medication which not treatment of choice for grief.
There is no substitute for good mental health care by a trained clinician.
For more click here.
Monday, June 8, 2020
During school closure teens getting more sleep but it needs to be on a regular schedule
During the pandemic with school closure teens are getting more sleep which is a good thing because it makes them more communicative, family friendly, less moody while at home. It is important though to stick to regular sleep schedule. Staying up all night playing video games and messaging with friends is not conducive to a regular sleep schedule which is necessary to reduce inflamation and enhance physical and mental health.
I hear in my psychotherapy sessions about teen's symptoms of anxiety, depression, and irritability. I ask about their sleep. Almost always the answer is that it is disturbed and irregular in some way. This leads to an interesting observation. Is it the anxiety and the depression interfering with the sleep or the lack of sleep contributing to the symptoms? Which comes first the chicken or the egg? However you answer the question, improving the sleep cycle goes a long way in enhancing the feeling of well being.
For more click here.