ShrinkWrapped

"Where Do I Come From?"

There is a large body of psychoanalytic literature dealing with the particular difficulties adopted children have negotiating the developmental dilemmas of childhood.  My profession's interest in the problems of adopted children is natural.  Freud once remarked that the first question every child has is "where do I come from?" 

It is a question that mankind has spent untold amounts of mental energy and financial resources attempting to answer.  The answers range from the Religious to the Biological to the Cosmological; all offer powerful ways to understand our world and all leave unanswered questions (though there are those who insist all questions have already been answered.)   

For an adopted child, the question raises vexing problems.  On the one hand, there is the inescapable difficulty of coming to terms with their birth mother giving them up for adoption.  It is inherent in the child's experience of being adopted to feel some level of rejection.  When dealing with the usual developmental trials and tribulations and the usual inter-generational conflicts that all children must negotiate, the adopted child has more than the usual fodder for fantasies about how his life would be different (better? worse?) with their "real" parents.  The lucky child raised by loving parents is able to resolve his ambivalence, in part, by recognizing that his adoptive parents are (psychologically and in every meaningful way) his real parents and that they chose him; if he can also accept that his mother gave him up out of love rather than our of rejection (hate) he has the best possible outcome for a difficult psychological task.

In the Boston Globe yesterday there is a story which, if only obliquely, deals with a child who is facing a uniquely disastrous array of psychological choices. [HT: Sigmund, Carl and Alfred]

Learning Disabilities

Mark was 9 years old when his Mother brought him to me for a consultation.  She explained that she and her husband were distressed because despite Psychological testing which showed Mark had an excellent IQ, his teachers consistently complained about the poor quality of his work and had labeled him an "under achiever."  They feared Mark had a severe learning disability, though the private Psychologist who had tested him, as well as the school Psychologists (in less extensive testing) had been able to find no evidence to support a diagnosis of LD; nonetheless, Mark seemed to have significant difficulty learning.   Worse, his frustration in school was increasing by the day and he had begun to act out in aggressive ways. 

Previous treatments for Mark had been unhelpful.  He had been tried on various medication regimens, none of which helped and several of which had unacceptable side effects.  They felt he was falling farther and farther behind in school and his problems were escalating.  The bright, happy youngster they had always adored was turning into an unhappy, angry, and mean child.

Mark was an only child.  His father was highly successful, and rarely home; his absence during the evaluation and treatment were reflective of his relative absence in Mark's life.  His mother, on the other hand, was devoted to Mark and from an early age had worked over time to supply him with the best opportunities for enrichment.  Even before starting kindergarten, Mark had been enrolled in multiple programs.  He was always very bright and capable and excelled in most things he did.  However, there was one disquieting note.  From an early age, Mark had a tendency to throw tantrums if he was frustrated.  At such times, his Mother would do all she could to sooth him and clam him; she was alarmed by his tantrums and felt that they were somehow reflective of her shortcomings as a mother.

Mark and I began to meet three times a week. 

Saying Whatever Comes to Mind XXIX

The Sanity Squad has turned its attention to the DSM (the Diagnostic and Statistical Manual, ie the full panoply of Psychiatric diagnostic nomenclature) and makes some helpful suggestions for future inclusions in the next version.  Not surprisingly, the current political scene offers a great deal of fodder for our tongue-in-cheek diagnoses.

Listen to, or Download, Sanity Squad: Diagnose Me Baby, and Neo-neocon, Dr. Sanity, Siggy, and I will clarify almost everything.

On Science and Uncertainty

I have made the point over and over that our rational minds are fairly recent, and very fragile, developmental constructs.  Our rationality is the tip of an iceberg in which the 90% of our minds which are under the surface (the unconscious) are based on primitive irrationality.  It has always struck me as an incredible feat that homo sapiens has been able to leverage that tiny mote of rationality to rise above our primitive savagery. 

With civilization, rationality became idealized and most people believed that once they had achieved the appearance of rationality, they were indeed rational.  In reality, most of the time, we merely use our rationality to disguise the irrational roots of our desires.  This was one of Freud's lasting insights.  While many of his theories have been eclipsed or refuted, his brilliant insight was to recognize how close we remain to our unconscious irrationality.

With the invention of the scientific method, our ability to harness our rationality in the service of reality became exponentially enhanced.  The beauty of the scientific method is that it offers a way to control for the pervasiveness of the irrational and find our way to greater understanding of the world as it is rather than the world as we desire it to be. 

Unfortunately, scientific education for most people is sadly deficient in offering an understanding of how science works and how the scientific method works. 

For example, few lay people recognize that most scientific studies end up giving wrong results. 

"Hooking-Up"

The transition from adolescence to young adulthood is a particularly difficult one in our society. Traditional adolescence has been extended by the four year sojourn through college for a great many of our young people. Children who have been coddled and cosseted, protected from the demands of reality for 20 plus years, graduate college unprepared for a world that is not only shifting beneath their feet but is suddenly unaccommodating to their feelings in ways which they have become accustomed to through the nurturing ministrations of our elite colleges.

At one time, college was thought of as a refuge, a place where our young people could learn the basic knowledge that supported the great edifice of Western Civilization, and begin the arduous process of learning how to learn. In the increasingly complex work place environment our children are heir to, graduating college with a fund of knowledge and the mental flexibility to adapt to constant change, could well be considered the raison d'etre of our elite universities.

At the same time, creating a safe environment where our adolescents can grow up, fully encounter themselves and learn who they are (establish a stable identity) has always been an important aspect of college life. Part of such development is coming to terms with one's adolescent impulsivity, intense and often poorly contained sexuality, and more primitive omnipotence. The young men and women must learn that behavior has consequences, that passions must be tamed and directed appropriately, that not ever possibility remains open for all time. In this area, assisting our young in becoming adults, our colleges have been negligent. The latest evidence comes from Harvard University: (HT: Horsefeathers)

Distractions

Dick Meyer is one of our more thoughtful commentators and always a pleasure to read, even when I disagree with him, and his column today is no exception. He presents a thought provoking thesis in Barack, Britney, Rudy And Anna Nicole:

News Is Entertainment, But Then So Is Politics, Says CBSNews.com’s Dick Meyer

It has been a truism since the invention of television that politics has become more like entertainment. That truism is now too generous.

Much of what we call entertainment isn’t. It is, rather, gossip and voyeurism pertaining to celebrities who may or may not be entertainers: Britney, Anna Nicole and Zsa Zsa Gabor’s husband.

Similarly, much of what we call politics isn’t. The zany scrutiny of Mitt, Rudy, McCain, Hillary, Barack and Edwards 18 months before the 2008 election is gossip, fantasy and voyeurism masquerading as serious politics and statecraft. It is a form of societal distraction just as much as celebrity rehab watching is. Just as obsessing over Anna Nicole’s autopsy is a relief from credit card debt, dull jobs and dented Dodges, dissecting the latest dust-up between staffers for Hillary and Barack is a distraction from an Iraq problem that has no solution, a healthcare system that has cancer and an entitlement system that will screw our kids. The cliques are just different.

Dick Meyer concludes that the political elite needs Rehab.  I think he has the right diagnosis but an incomplete grasp of the etiology.

For my money, the single greatest deterrent to a more rational approach to public policy, a less cantankerous civic climate and a reversal of the decline in trust in government is the structure of the campaign system. It is a bi-opoly financed in an arcane way that deters many highly qualified participants and creates systemic disincentives for effective government policy-making. While the entitlement program quagmire is more than important than campaign shenanigans 18 months before Election Day, semi-intelligent repairs on entitlements will not occur until the campaigning system goes into detox.

Saying Whatever Comes to Mind XXVIII

This week the Sanity Squad turn our attention to "Narcissism on Parade", aka the Oscars.  We also discuss some of the issues around abortion on demand that I addressed in my series of posts last week and the discussion moves into all sorts of interesting areas from there.

Join Neo-neocon, Dr. Sanity, Siggy, and me as we discuss Movies, Culture and Kids. 

"Diagnosing" President Bush

Periodically, readers send me links to articles and/or posts by Psychiatrists that purport to diagnose various public officials. I wrote about one of the more egregious mis-uses of Psychiatry to pathologize one’s political opponents in my post on PsychBlogging and the Goldwater Rule.

Using Psychiatric diagnoses to discredit political opponents has a long pedigree. I can appreciate the tendency of so many non-professionals to use such terminology. Many people imagine Bill Clinton to be quite Narcissistic. While I might agree that Clinton’s behavior appears to fit the colloquial meaning of the word Narcissistic, ie he seems to be quite self-centered, with a volcanic temper when challenged and an overt insensitivity to how his behavior might affect those closest to him, that is a far cry from diagnosing him as exhibiting a Narcissistic Personality Disorder. NPD is a specific Psychiatric diagnosis which I reserve for those people whose inner world I have a certain specific entree into, who exhibit specific types of object ties in their most important relationships. I do not see how it is possible to make such a diagnosis without examining a patient in a setting specifically designed to elicit the requisite psychodynamic data. If anything, I attempt to be quite reserved in using such loaded terms as Narcissistic to describe a public figure, for fear it might be mistaken for my imprimatur on a Psychiatric diagnosis.  (If I occasionally fail in this, it simply means I am human.)

Sadly some Professionals do not share my scruples. Psymon recently directed my attention to a posting at the Daily Kos, which diagnoses President Bush with a Narcissistic Personality Disorder. Paul Minot claims to be a Psychiatrist and occasionally posts on the Daily Kos diaries. His post on Bush’s NPD was quite popular, generating 746 comments.