Introversion Extroversion or Both in which I get my geek on

Before I launch into today's festival of nerdishness, I'd like to:

1. Thank all the individuals, past and present, who have served in the United States military, and on this day, remember and honor those who gave their lives in the service of this country. Amidst the barbeque and the giddiness over the beginning of the summer season, let's take some time to remember the reason this day is a holiday.
2. Thank each of you. Saturday was my six-month blogoversary, and since the end of last November, nearly 300 of you have become followers of this blog. I'm really touched by all your comments and participation, and I'll keep working hard to make The Strangest Situation worth your time.

NOW: Introversion vs. Extroversion.

On Friday, I asked you if you were one or the other or both. A significant majority of you (24 out of 37, or 65%), indicated you were introverts. Many of you used phrases like "100%" or "hands down", indicating you're quite definitely introverted. Several of you referenced your Myers-Briggs Type (I have GOT to do a post on that thing, and I will sometime this summer)--and they all started with "I".

Now, this shouldn't be surprising, right? Most of us are writers. And ... generally, writing is a pursuit that includes a lot of activity between the ears. Yes, to be good, you've got to get out of your own head and get others involved, but a lot of the process is solitary. In other words, we are NOT a randomly selected sample. If you polled individuals in the House of Representatives or actors on Broadway, you'd probably get a different result.

If any of you are wondering, yes, I am most definitely an introvert. When I was in college, I took Personality Psychology, and the professor handed out personality inventory results for the entire class (we'd all been assigned numbers, so no one was publicly outed or anything). But my number ... was on the extreme end of the continuum. According to that test, I was the most introverted person in that class of 40 people.

That doesn't mean I'm not socially skilled or don't enjoy being with other people. I do. I'm also quite a good public speaker, and I actually enjoy that kind of thing as long as I know what I'm talking about. However--I dislike parties and crowds. They wear me out quickly. I am easily overwhelmed by both the social expectations and the sensory stimulation. And in general, I am happiest when I have A LOT of alone time.

Many of you said very similar things. Quite a few of you were asking questions or stating you had tendencies toward both extraversion and introversion. In other words, you were saying you didn't fall neatly into either category. A lot of you were really trying to puzzle out "which one" you were--introvert or extrovert.

Now--if you are to believe a lot of these "personality type" tests, personality traits would be distributed like this:

This is a cute little bimodal distribution.

If this was the reality, most people fall into one category or another, and only a few people would fall in between. But is that the way things are?

No. Here's the way things are:

Personality traits like introversion-extroversion are normally distributed. MOST people fall somewhere in the middle (about 68%). In other words, if you randomly selected a hundred people from the general population and gave them a test that measured introversion-extroversion, only a few would come out as extremely introverted or extroverted.

Admittedly, if you take our little sample, our curve would probably look more like this:

This is an adorable positively skewed distribution.

As a group, we are probably more introverted than the general population. Even so, most of us will have scores that fall somewhere in between. We're not one or the other!

We're on a continuum.

 So! Don't feel bad if you couldn't figure out what type you are, or if you felt like you had qualities of both, or if you are an introvert in some situations/moods and not in others. I'm quite sure you're right. And if you think about this as a continuum, it might make it easier.

On Wednesday, I'll talk more about introversion-extroversion as it relates to social media.  But for today--does this make sense? Are you more comfortable thinking about introversion-extroversion (or any persoanlity trait) as a continuum rather than a category you have to fall into? Or do you feel more comfortable as a "type"?

Are the National Institute on Drug Abuse and Big Pharma in Bed

Nora Volkow, M.D.

At the annual meeting of the American Psychiatric Association (APA) in San Francisco in May, Nora Volkow, the director of the National Institute on Drug Abuse (NIDA) was just brimming with a lot 'o news about the square of the hypotenuse. No, I'm sorry, I mean about how much more we know about drug abuse because of brain imagining techniques. This new knowledge she spoke of was summarized in the Psychiatric News, the newspaper of the APA, in the June 21 issue.

The gist of the story was that the drugs themselves impair certain brain circuits, which must then be somehow strengthened through treatment.

One of the points she raised is that drugs like methamphetamine cause dopamine receptor signaling to be decreased in the pre-frontal cortex - the part of the brain known to be crucial in executive control (decision making). Thus, the normal brakes on someone indulging in something are supposedly damaged.

If this be true, one might think that she would be up in arms about the widespread, indiscriminate use of amphethamines like Adderall in children. At the very least, a high percentage of ADHD diagnoses are given to kids suffering from the effects of living in a chaotic environments of one sort or another, and for whom family therapy would be the most important treatment. Perhaps there are some cases of ADHD that are due to neurotoxin exposure or something like that in which the benefits of the use of stimulants outweigh the risks - a questionable assertion itself since the average academic gain for ADHD-diagnosed kids on stimulants is all of about three whole months.

For some reason, however, while she acknowledges in other venues that prescription drug abuse, including that of stimulants, is a major problem, she continues to maintain that stimulants are safe and effective when used for ADHD.

She does admit in one article that ritalin basically works the same way in the brain as cocaine! So is she saying that there is some point at which the alleged adverse affects on executive functioning she was going on and on about at the APA magically become inconsequential?

And yet, she also spends some of her time exaggerating the adverse effects of the devil weed , marijuana, in a campaign to keep it illegal.  It seems there is a double standard she has towards the risks of the drugs sold by Pharma compared to those that are not.

How much worse than the physiological effects of pot, one might ask, are the adverse effects on potheads of jailing them and turning them into felons for the rest of their lives. Or the risks to black kids? They are no more likely than white kids to smoke pot, but are four times more likely to be arrested for it. These are not adverse effects?

"Think about it: Do you want a nation where your young people are stoned?" she was quoted as asking.  I hate to break this to her, but any kid who wants to get marijuana already can. It's like one of the biggest cash crops in several states.

I don't think she has come out in favor of prohibition against alcohol or tobacco, two substances with far more potential adverse physiological effects than pot ever thought about having, so that she might at least be consistent. Does she think that young people aren't already getting "stoned" on booze? As mentioned, she does not seem to be all that concerned about the adverse effects of the stimulants - that she herself describes - when used for legal and "proper" uses. More on that in a sec. Nor does she mention that prescribed stimulants are diverted to "non-medical" uses far more often than even opiates!

It seems almost like she thinks the risks of drugs are entirely dependent on whether or not drug companies make money from them.

I am not surprised by any of this. Many years ago I listened to a talk from someone from NIDA about the horrible effects of dopamine depletion in the brains of regular amphetamine users.  I thought about getting up and asking a question, but someone beat me to it. "Doesn't this happen in kids taking stimulants for ADHD?" the fellow asked. 

The answer? "But the drugs work so well!" As if that were an answer. Now I don't know if NIDA and Big Pharma are in bed together, but that answer sure made me wonder about it.

Another truely breathtakingly bizarre point Volkow made at the APA, as reported in the newspaper (unless the journalist got it wrong):

"Among both lab animals and humans, voluntary initiation of drug use leads to subsequent loss of control and development of addiction among 10% of subjects. The lab rats and mice are uesful for refuting old stereotypes.

Some people still consider addiction moral turpitude, she said. 'But how can you develop the same phenotype in a rat, who have no moral precepts?'"

This argument is a bit of a straw man, since thoughtful mental health professionals these days are not so much concerned with the issue of sin, but more with the question of whether or not drug abuse is due to deliberate and purposeful self-destructiveness. The fact that the 10% figure applies to both rats and people seems to argue for some sort of genetic cause, does it not?

But rats having the same phenotype as human beings? Really?!? I personally have never met any rat that understands the negative effects that a drug might be having on it, or that is able to anticipate the future consequences of continuing to imbibe. People do have these abilities. Furthermore, as I have already pointed out in various venues, scientists still have yet to locate any rats that hide bottles of alcohol.

And now back to that whole executive functioning thing. Methinks she is grossly exaggerating certain of the risks from drugs used entirely to get high. (Anyone remember the scourge of "crack babies?"  Turns out that was all one big - and racist - lie).

Seems to me the supposed "impairments" in executive functioning in addicts that she talks about are awfully specific and limited. In the past, a lot of cocaine addicts, for example, used to burglarize houses and fence the goods to support their habits without even getting caught. It would seem to me that quite a bit of executive functioning is being exhibited in that endeavor. Imagine what master criminals they might be if they had unimpaired executive functioning. It boggles the mind!

And if addicts do have a sort of brain damage, how can some of them suddenly just stop using after attending just one meeting of a 12 step program, and then stay sober by continuing to be in the program? Not as many as we'd like, but still many do. The 12 steps were based originally on techniques used by Protestants to get others to adopt their religious beliefs, not treat brain dysfunction. So how is it that what is essentially a change in cognitive beliefs can fix a brain overnight?

I have argued that many of the brain changes observed in MRI studies are actually conditioned responses due to neural plastic changes in brain structure and function in response to the social environment (No, not all of the observed changes. Some can indeed be due to drug effects, trauma, or disease. Duh). The conditioned changes can indeed happen in relatively short time frames. But literally overnight? Please.

I tried the antidepressant Mirtazapine and was soon trapped in a relentless dream about the Smurfs

Dear FDA,

The loony psychiatrist gave me a drug to sample that he said, if taken even in a small dose, would take care of my occasional insomnia and also perk up my spirits a bit. It is called Mirtazipine  Mirtazipone Mirtazapine (aka Remeron), and it messed my head up so badly I can no longer spell and now write love sonnets to Gargamel, the evil wizard from the Smurfs, in my spare time.

Write down "Mirtazapine" so that you NEVER TAKE IT, FDA officer! Is your name Gladys, or Bob? I would like to make this as personal as possible.

This drug is the most vile and evil poison since the invention of "roofies," "mickeys," and other potions favored by date rapists. I took 1/4 of a 15 mg pill Thursday night before bed. Within minutes, I was out colder than a whacked haddock and had started to dream about the fucking Smurfs. I was hanging out with Gargamel and his horrible cat Azriel. I wasn't even on the side of good! Gargamel's eyebrows sit on top of his misshapen skull like two fat black caterpillars. His hair is extremely oily.

Do you think I liked looking at this, Bob? Gladys? No! I did not.

"Jazz hands" would have looked a little less sinister, Gargamel. Just sayin'.

Note I say 1/4 of one pill. If I had taken the whole pill, I would probably have been swept into the Smurf Vortex FOREVER and Smurfette would be my best pal, and we would be texting each other some shit all the time, like about this Smurf and that Smurf, and how—oh God, this is all really horrible to contemplate.

I warn you, FDA officer, that this drug is bad news. At one point I woke up because one of my sons was crying, right in my ear. He was crying so hard he was blowing bubbles of snot. He gets growing pains in his legs and sometimes, at night, he wants them rubbed. I heard my husband groan: "Not again! I was up with him an hour ago."

I couldn't remember how to sit up. When I finally figured it out, I couldn't remember how to stand up. My legs looked like stuffed scarecrow legs, and I stared down at them stupidly. I tried to speak but all that came out was "wuh-no-no-no-no." I slumped back into the bed.

This time I had dreams in which I read entire books of 17th-century poetry, ate buttered toast from a giant toasting rack, and was allowed to visit the Smurf village and consort merrily with the Smurfs in fields of daisies. They seemed to accept me and forgave the fact I had so recently spent time with the wicked Gargamel (whom I missed, as he had been something of a father figure to me).

After sleeping and sleeping like the dead through noises of all kinds, and perhaps even a fire (who knows?), I finally awoke to a blistering headache and a hideous hungover feeling, as if I'd been up all night doing shots of Jagermeister. I spent all day feeling like hot, groggy poo, and nearly walking into walls. Plus I feel like the Smurfs may have stolen some of my IQ and are using it to brew new potions to tempt unwary depressives and anxiety sufferers.

I hate medications. 

Into the garbage with ye, Mirtazapine! Badbadbad poison. Smurf go 'way. Make a note of it, Gladys!

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Therapy in the digital age

"Recalibrating Therapy for Our Wired World" is one psychiatrist's take on the changes forced on the practice by 21st century digital connectivity:

For some, the new technology is clearly a boon. Let’s say you have the common anxiety disorder social phobia. You avoid speaking up in class or at work, fearful you’ll embarrass yourself, and the prospect of going to a party inspires dread. You will do anything to avoid social interactions. 

You see a therapist who sensibly recommends cognitive-behavioral therapy, which will challenge your dysfunctional thoughts about how people see you and as a result lower your social anxiety. You find that this treatment involves a fair amount of homework: You typically have to keep a written log of your thoughts and feelings to examine them. And since you see your therapist weekly, most of the work is done solo. 

As it turns out, there is a smartphone app that will prompt you at various times during the day to record these social interactions and your emotional response to them. You can take the record to your therapist, and you are off and running... 

When it comes to collecting and organizing data, software is hard to beat. But information has a tendency to spread, especially digital information. To wit, electronic medical data containing sensitive personal information can be released, either accidentally or deliberately, and disseminated. Anyone who has followed the hacking of supposedly secure and encrypted financial databases knows this is not a remote possibility.

Interesting.

Should being Happy be the Most Important Thing in our Life

When I went to teachers’ college, our psychology teacher handed us a questionnaire on priorities. It went something like this:

Priorities Questionnaire

Below is a list of common priorities. Completing this questionnaire will help us to see what the most important things in our life are. Please number them from 1 to 12, ‘1’ assigning the number 1 to the priority which means the most to you at the moment, and 12 to the one which means the least. Note that there are no right or wrong answers.

__Job Security
__Financial Prosperity
__Being Happy
__Excitement/Adventure
__Famous
__Health
__God
__Great Food
__Recreational Hobbies & Interests
__Positive Self-Concept
__Romance
__Family

Of the twenty-five students in my class, twenty-three of them chose ‘Being Happy’ as their highest priority. One other student and I, both Christians, chose ‘God’ instead.

Western society has become obsessed with the pursuit of happiness. You only need to browse online booksellers such as Amazon.com to see that a staggering number of books have been written about how to be happy. Yet hand-in-hand with this obsession with happiness is an increase in the number of people suffering from depression. Billboards and radio-advertisements claim that one in four people have suffered or will suffer from depression.

Why can the goal of being happy as highest priority cause problems?

Happiness is a wonderful emotion and I treasure it as much as anyone does. However, happiness was never meant to be our highest priority. Why? Because happiness is completely dependent upon our circumstances. When things go our way, when we feel in control of our lives, when intense or prolonged suffering is absent, we feel happy. Yet when things spiral out of control, when things do not go our way, when persistent trials afflict us, happiness vanishes. Suddenly we are faced with the ugly situation of having a life goal that is constantly being frustrated.

So what should our highest priority be?

But seek first his kingdom and his righteousness, and all these things will be given to you as well. Matthew 6:33 ‘These things’ refers to health, food and clothes, that is, the things we need.

Seeking first God, His Kingdom and His righteousness, should be our highest priority.

Let us take a moment to examine the fruit of the Holy Spirit, which He seeks to develop within the lives of Christians.

But the fruit of the Spirit is love, joy, peace, patience, kindness, goodness, faithfulness, gentleness and self-control. Galatians 5:22-23.

As we can see, happiness is not listed as one of the nine fruits of the Holy Spirit, whereas joy is. Unlike happiness, joy is not dependent upon our circumstances.

Joy runs much deeper than happiness, and springs forth from our relationship with God, from the knowledge that through Christ, God has saved us from sin so that we can spend eternity with Him in heaven.

Restore to me the joy of your salvation and grant me a willing spirit, to sustain me. Psalm 51:12

Come, let us sing for joy to the LORD; let us shout aloud to the Rock of our salvation. Psalm 95:1

We also need to keep things in perspective. This human life is not all we have - it is not all about eating, drinking, and material possessions. It is not about, “Let us eat, drink and be merry, for tomorrow we die.”

For the kingdom of God is not a matter of eating and drinking, but of righteousness, peace and joy in the Holy Spirit, Romans 14:17


The fact is that Christians are travellers passing through this world on the way to eternal life in heaven.

But our citizenship is in heaven. And we eagerly await a Savior from there, the Lord Jesus Christ, Philippians 3:20

They are not of the world, even as I am not of it. John 17:16

Dear friends, I urge you, as aliens and strangers in the world, to abstain from sinful desires, which war against your soul. 1 Peter 2:11

The knowledge that my trials, such as epilepsy and deafness, are only temporary fills me with joy. What a wondrous hope those who trust in Jesus have – that one day we shall spend eternity in heaven, where we can see the face of God and Jesus everyday, a perfect place filled with love, joy and peace. We shall also have a brand new body that is perfect in every way.

When I consider the unimaginable, eternal riches that await us in heaven, the temporary trials we endure on the earth fade into insignificance.

'Now if we are children, then we are heirs—heirs of God and co-heirs with Christ, if indeed we share in his sufferings in order that we may also share in his glory. I consider that our present sufferings are not worth comparing with the glory that will be revealed in us.' Romans 8:17-18

Let us look at Christ’s example. He willing endured the shame and agony of the cross because of the joy that was set before Him. That joy was to spend eternity with those who would believe in Him and follow Him as Lord.

Let us fix our eyes on Jesus, the author and perfecter of our faith, who for the joy set before him endured the cross, scorning its shame, and sat down at the right hand of the throne of God. Hebrews 12:2

He died for us so that, whether we are awake (on earth) or asleep (in heaven), we may live together with him. 1 Thessalonians 5:10

Through Christ’s strength and the power of the Holy Spirit, we can do the same. We too can endure trials because of the joy that is set before us - eternity in heaven with Him.

Rather than lamenting when things do not go our way, the Bible says to praise God in all and every circumstance.

Be joyful always; pray continually; give thanks in all circumstances, for this is God's will for you in Christ Jesus. 1 Thessalonians 5:16-18

The Bible also says to consider it pure joy when undergoing trials of many kinds, as these trials help us to mature and grow in our faith.

Consider it pure joy, my brothers, whenever you face trials of many kinds, because you know that the testing of your faith develops perseverance. Perseverance must finish its work so that you may be mature and complete, not lacking anything.’ James 1:2-4

Paul tells us of the many trials he endured.

I have worked much harder, been in prison more frequently, been flogged more severely, and been exposed to death again and again. Five times I received from the Jews the forty lashes minus one. Three times I was beaten with rods, once I was stoned, three times I was shipwrecked, I spent a night and a day in the open sea, I have been constantly on the move. I have been in danger from rivers, in danger from bandits, in danger from my own countrymen, in danger from Gentiles; in danger in the city, in danger in the country, in danger at sea; and in danger from false brothers. I have labored and toiled and have often gone without sleep; I have known hunger and thirst and have often gone without food; I have been cold and naked. 2 Corinthians 11:23-27

How did Paul respond to these trials? Did he worry, grumble, or blame God?

No, he relied upon Christ’s strength instead of upon his own. Therefore I will boast all the more gladly about my weaknesses, so that Christ's power may rest on me. 2 Corinthians 12:9

He learned to be content whatever his circumstances.

Philippians 4:12-13 ‘I know what it is to be in need, and I know what it is to have plenty. I have learned the secret of being content in any and every situation, whether well fed or hungry, whether living in plenty or in want. I can do everything through him who gives me strength.’


More Bible Verses about Joy

We receive joy from meditating upon God’s word and His wonderful promises. The precepts of the LORD are right, giving joy to the heart. The commands of the LORD are radiant, giving light to the eyes. Psalm 19:8

Being able to take refuge in the Lord during the storms of life also gives us joy. But let all who take refuge in you be glad; let them ever sing for joy. Spread your protection over them, that those who love your name may rejoice in you. Psalm 5:11

Knowing that the Lord gives us strength fills us with joy. The LORD is my strength and my shield; my heart trusts in him, and I am helped. My heart leaps for joy and I will give thanks to him in song. Psalm 28:7

Whereas happiness flees when the going gets tough, the joy of the Lord sustains us during difficult times. Do not grieve, for the joy of the LORD is your strength." Nehemiah 8:10

Contemplating the work of God’s hands, His amazing creation, gives us joy. For you make me glad by your deeds, O LORD; I sing for joy at the works of your hands. Psalm 92:4


In conclusion, happiness is wonderful but as it is dependent upon our circumstances, it must not be our highest priority or life goal. When our highest priority is to seek first the Kingdom of God and His righteousness, we can experience a deep joy that is not dependent upon our circumstances – it comes from our relationship with Him, from our salvation - the anticipation of eternity with Him.

All verses from the NIV.

Performance versus Ability Another Issue Frequently Ignored in Psychiatry Research

In previous posts, I have discussed some bizarre assumptions made in psychiatry research papers when the data is analyzed. I wrote about how, for example, differences in brain area size and functioning between different groups on fMRI scans are automatically interpreted as abnormalities.

Nassir Ghaemi, a blogger on Medscape with whom I have had some strong disagreements about borderline personality disorder and bipolar disorder, nonetheless had a great quote on this with which I wholeheartedly agree:
             

"All things biological are not disease, even though we can define disease in such a way that all diseases are biological. This matter is obvious once pointed out. A few assumptions,  which seem either patently true or very likely: all human psychological experience is mediated by the brain; each person only has one brain; therefore the brain will always be biologically changing as we have psychological experiences. Reading a blog post about the brain is a psychological experience. Having delusions from schizophrenia is a psychological experience. The first brain change does not reflect disease; the second does. So showing MRI changes with adult ADHD or borderline personality does nothing to demonstrate that those conditions are diseases. If you watch TV and play video games inordinately, you will have changes in your brain, and you might also develop clinical symptoms of ADHD. If you are repeatedly sexually abused, you will have changes in the brain, and you might also develop clinical symptoms of borderline personality. But those changes in the brain do not have the same causal role as the neuronal atrophy that happens with trisomy 21, or with schizophrenia, or bipolar illness..."

Another major nonsensical assumption that litters the psychiatric literature (the literature littering alliteration?) is that one can totally disregard the motivations of research subjects as well their past experiences and the environmental context in which they live when evaluating their performance on psychological tests. 

I mentioned an example of how this is utter nonsense in a previous post: The performance of African-Americans on IQ tests just might be related to the fact that for several generations Blacks who looked too smart were at high risk of being lynched. Do you think they are just as motivated as other folks to want to look smart on an IQ test which is being administered by White researchers?

What I have seen more and more lately, particular in the personality disorders literature, are studies that look at differences between various diagnostic groups on such issues as how much "impulsive aggression" they show, or how and how well they read the emotional state of ambiguous faces of strangers in photographs. When differences are found, once again the "lower" performing groups are just assumed to be "impaired" or "abnormal."

This, of course, confuses performance with ability. Without knowing anything about what the subjects in the experiments are motivated to do in their daily lives on any particular dimension for whatever reason, or what environmental contingencies they are worried about that may relate to the task at hand, it is literally impossible to say for sure whether any difference in their performance is related to what they would be able to do if those other issues were not operative.

Patients with borderline personality disorder, for example, grow up in families in which double messages are flying in all directions, and with parents who can switch from being over-involved to neglectful at the drop of hat. They are bound to have a higher index of suspicion about what facial expressions on strangers might mean than someone who grew up in a more consistent and predictable environment. If they did not, they would be morons.

Another major issue ignored in the literature is the difference between a research subject's real self versus their persona or false self in certain social situations. We all present different "faces" to the outside world depending on social context. Researchers who do not consider this must think that men, for example, present themselves exactly the same way around their children, their bosses, and their mistresses. Really?

With personality disorders, as I described in several previous posts, people play social roles designed to stabilize family homeostasis. These roles are merely a much more pervasive version of the different roles played by the above "normal" man interacting with different people. So someone with antisocial tendencies, for example, which are part of the role of avenger, are motivated to show more impulsive aggression than other people - on purpose - and have literally trained themselves to be like that. They do so habitually, automatically, and without thinking. Of course they will show more impulsive aggression in the experiment! Why wouldn't they? 

In fact, showing a lot of impulsive aggression might be considered to be part of the definition of antisocial behavior. The experiments therefore do nothing more than prove that anti-social people act habitually in an anti-social manner. Like, duh!

These types of results in no way indicate any "deficits," "deficiencies," or "abnormalities." One wonders how people who make these ludicrous assumptions ever manage to get through medical or graduate school.

Insomnia – an Exercise in Frustration

Insomnia, or being unable to sleep at night, is one of the most frustrating things I have had to deal with.

Overwhelmed by fatigue and so sleepy that I could barely keep my eyes open, I would crawl into bed at a good hour, looking forward to a good night’s sleep. My mind was at peace, content, even empty of thought - yet I would lie there, awake, hour after hour. Sleep simply would not come.

As this continued, I began to crawl into bed in an anxious state of mind. I knew I desperately needed sleep but was worried it would not come. This tension made sleep even more evasive. My heart raced, my mind developed a habit of glancing about fearfully, which often trigged panic attacks.

As insomnia became more frequent, I tried to wait patiently for sleep to come. Yet as the hours continued to tick by I became more and more frustrated. My body was telling me that I needed sleep. I was so tired that I could not keep my eyes open, so why was I lying awake hour after hour? I would pray, beg, and plead with the Lord to give me sleep, quoting scriptures at Him, trying to convince Him to stretch out His hand or speak a word over me to put me to sleep. Then, after lying awake for five or six hours, frustration would blossom into rage. I lost count of how many times I shook my fist at the ceiling and said, “Jesus, why do you just sit there! Can’t you see that I need sleep? Why don’t you act? Don’t you care?”

As well as getting angry with God, I became enraged with my mind and body. What was wrong with them, couldn’t they see what they were doing to me? I was so tired and sleepy yet my useless, stupid mind simply would not shut off! It was as though my body conspired against me, and I hated it, I wrote in my diary.

Following these sessions of rage against God and myself, came anguish, repentence and guilt. I knew I should not react like this, but I needed sleep!

Eventually the insomnia became so bad that for five days I would fall asleep when the sun came up, and on the sixth, sleep would not come at all. On those days I felt robbed, cheated, betrayed. When I rose, I felt dirty and unclean. Then the cycle started again.

Finally, due to a number of factors, I fell into strong depression towards the end of 1989. Panic attacks afflicted me 24 hours a day, my mind never ceased to churn through terrifying fearful thoughts, and insomnia continued to afflict me.


Attitudes We Cannot Afford to Have Towards Insomnia

As you can see from what I have shared above, the ways I reacted to insomnia made it worse. These negative reactions of fearing or fighting it released negative adrenalin into my system, elevated my anxiety levels and made it harder to sleep. What a vicious cycle – insomnia begets tension and fatigue, which in turn make insomnia worse, which causes further tension and fatigue.

Here are some reactions we cannot afford to have towards insomnia:
1. going to bed fearful that we may not sleep
2. becoming frustrated when we cannot sleep
3. worrying how this lack of sleep will affect us tomorrow
4. letting the frustration boil over into rage


Helpful Attitudes Towards Insomnia

Here is a list of what reactions we need to have towards insomnia.

1. when we go to bed, be prepared to stay awake all night
2. be content to stay awake all night instead of getting frustrated or angry
3. recognize that resting contentedly all night in bed, even without sleeping, is still beneficial
4. if we don’t sleep tonight, there is always tomorrow night.


Some Things that May Help with Mild Insomnia

In my dealings with insomnia over the decades, I have learned a few tricks that can help alleviate mild insomnia.

1. a glass of hot milk, or a bowl of hot cereal, taken immediately before bed, can be helpful
2. if still awake two to three hours later, have another glass of hot milk or cereal
3. regular exercise is crucial. This may be going on brisk 30-45 minute walks three times a week, or doing aerobics, swimming, jogging, etc. Working out with light hand-weights several days a week also helps. (Small note - avoid the above types of exercise near bedtime!)
4. eat a good, balanced diet, with lots of fruit. Drink plenty of water
5. if you must have a nap during the day, make it a 15 minute power nap, no longer. Set an alarm.
6. listening to soothing or relaxing music immediately before going to bed can also be helpful.

Another point I would like to make is that we humans have a tendency to take on too many responsibilities and get involved with too many activities. Sometimes it is good to take a step back, sit at Christ’s feet and wait on Him, and then prayfully examine our life. Are we doing too much? Are there some aspects of our life that are placing us under pressure unnecessarily? Are there some things that we can quit or that can be put off until next year? Frantic, stressful lifestyles can cause insomnia or make it worse. I learned this lesson the hard way. (Twice…)


Severe Insomnia

If insomnia has become so bad that we cannot sleep night after night, (this is typical for those suffering from depression), seek medical assistance - we must not struggle through it by ourselves. A doctor can help determine insomnia’s causes (there are many different causes) and recommend medical treatment. For someone suffering from strong depression, sleep is a necessary part of the healing process. I am so glad that after three to four months of trying to cope with depression and insomnia on my own, I finally saw a doctor and went onto anti-depressant medication that included a mild tranquilizer. The combination of the medication and being able to sleep again were important factors in dulling depression’s effects, which helped me to concentrate on the task of recovery.

It was not until seventeen years after insomnia began to plague me that I discovered that I was suffering from complex partial epilepsy. This typically begins to become apparent in one’s late teens, and I believe this was the primary cause of the insomnia. (However, the way I reacted to it during the first few years made it much worse.)

I no longer take anti-depressant medication, only epilepsy anti-seizure meds. On most nights, I fall asleep easily, but several times a year I still have those sleepless nights. Instead of getting frustrated or angry, this is what I say to myself when it happens, “If I stay awake all night - that’s fine. I’ll make myself comfortable and snuggle up in the blankets. If I fall asleep eventually - great! If not, that’s fine too. Resting all night in bed is still beneficial.” I submit my mind to Christ, dwell in His peace and take refuge in His presence. I have learned to be content, whatever my circumstances, including those sleepless nights.

Philippians 4:12-13 ‘I know what it is to be in need, and I know what it is to have plenty. I have learned the secret of being content in any and every situation, whether well fed or hungry, whether living in plenty or in want. I can do everything through him who gives me strength.’

Colossians 3:15 ‘Let the peace of Christ rule in your hearts, since as members of one body you were called to peace. And be thankful.’

Philippians 4:6-7 Do not be anxious about anything, but in everything, by prayer and petition, with thanksgiving, present your requests to God. And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus. (Special thanks to a reader for reminding where to find this verse!)

Download a pdf booklet of this blog's articles

All verses from the NIV.

Adventures in the Veterans Hospital Mental Health Clinic Last Part

This post continues on from my post of 4/28/15 about the practice of psychiatry in the outpatient mental health clinic at the Veterans' Affairs Hospital in Memphis, from which I retired a few months ago. In the last post, I discussed the first of two reasons for my quitting my position about a year earlier than I had planned.

The issue of being short staffed relates to the second issue that caused me to abruptly curtail my expected period of employment with the VA. That will be the subject of this post.

In line with recent trends everywhere in psychiatry, the MD's on staff at the VA were basically not expected to do regular psychotherapy but were there only to write prescriptions for psychoactive medication. This policy was of course never clearly spelled out, but everyone knew it. As mentioned before, however, there were nowhere near enough Ph.D. psychologists to provide psychotherapy to all who needed it.

Furthermore, there were no psychologists on staff who specialized in what I specialize in, the individual psychotherapy of borderline personality disorder (BPD). Such patients are not at all uncommon in the VA population. The clinic did provide some of the "skills-training" therapy groups that are but one of three parts of a treatment known as dialectical behavior therapy (DBT), but even the DBT purveyors' own studies show that the groups without the individual psychotherapy component of DBT are not very effective.

I was able to provide regular psychotherapy for two of these patients anyway, but only because one of the doctors on the inpatient psychiatry unit was having a lot of trouble with these particular ones. Their behavior was creating significant problems on the ward, and additionally they were using up a lot of resources. 

The inpatient doc literally begged my supervisor to accommodate my schedule in order to allow me to see them regularly, and she reluctantly agreed. Of course, if I had been the one to ask for psychotherapy time for a patient I was seeing, it was highly unlikely that such accommodations to my schedule would have been forthcoming.

Then one day there appears a note in the electronic medical record for one of my medication-management-only patients with BPD, alerting me to the fact that she was making vague suicide threats. Luckily, I knew the patient fairly well, and surmised that she was probably just reacting to her frustrations at the limitations on her own treatment at the VA, and was probably not an imminent suicide risk.

But then I thought: What if she had been? In such a case, there would have been a note in the chart advising me of a potentially life-threatening problem for which I was technically responsible, but which I was not being allowed to actually treat. And there would be no one else to send her to so she could get adequate treatment. 

Inpatient treatment could buy time if the suicide risk were very high, but it usually causes patients with BPD to get worse in the long run, and is therefore best avoided except in extreme circumstances. And one still needs to refer the patient for continuing psychotherapy after discharge. That was the very problem the inpatient doctor had with my two therapy patients!

In response to the warning about the patient I had received, I documented my dilemma in the patient's electronic medical record - consequences be damned. I then finally admitted to myself that I had to get out of the VA very soon.

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The Impact of Intervention in Addiction Through an Amy Winehouse Scope

Today's post in a guest post courtesy of Allison Gamble, a writer for psychologydegree.net. 

“They tried to make me go to rehab, I said, "No, no, no"

Yes, I've been black but when I come back you'll know, know, know

I ain't got the time and if my daddy thinks I'm fine

He's tried to make me go to rehab, I won't go, go, go”

           ~ "Rehab" Amy Winehouse

The late singer Amy Winehouse released “Rehab” in 2007, a now haunting song that revealed her struggles with drug and alcohol abuse, her reluctance to seek help, and the role her family and friends played in her life. Some attempted to push her towards treatment, while others seemed to enable Winehouse's destructive behavior and ignored warning signs that may have caused her sudden death. While Winehouse’s plight has gained media attention, her celebrity is one of the only factors that separated her situation from the problems that many individuals who abuse drugs and alcohol deal with every day.

Like many other families who have loved ones with a substance abuse problem, Amy’s family is placing fault on others for her sad demise. It doesn’t take a degree in psychology to smell the denial in the air. Interviews with her parents show they lay blame for her death on detox methods instead of also looking at both their behavior and having not intervened in time to possibly help Amy.  Of course, losing a child is awful enough, but they are likely also feeling tremendous guilt that they had not taken more steps to try to protect her from a fate no one wanted to believe would come to fruition.

In American and the UK alike, due to the absence or failure of family members and friends intervening, many addicts like Amy are left to cycle through pricey rehab clinics and wind up taking endless supplies of anti-psychotics, anti-depressants, anti-anxiety meds and more. Gaining the approval of doctors, rehab clinics and pharmaceutical companies, families are held harmless as they look at addiction as a disease. With this medical model, the one loser winds up being the addict.

While little has been revealed about Winehouse’s upbringing, it is known that her parents separated when she was 9 years old. Father, Mitch Winehouse, claimed in a 2008 interview, titled “How my affair made Amy suffer,” with British newspaper The Daily Mail, that a longstanding affair with a colleague was an open secret in their home. Winehouse’s paramour was even known by Amy and her siblings as “Daddy’s work wife.” Mitch Wineshouse claims he never realized that their family’s dysfunction had impacted Amy so negatively until years later when he heard her song “What it is About Men” that the line “all the shit my mother went through” referred to his deception.

Amy’s mother Janis claims her Amy had always been a rebel but that her defiant streak intensified when Amy became a teenager. In an unusual move by Janis, Amy was allowed to leave home to live with a friend at the age of 15. "It would have been fine but she moved out for her own convenience. She wanted to live with a friend. Perhaps she wanted her mum to fight to make her stay. But I felt she had grown up by then,” her mother said in a January 2008 interview, eerily titled “Amy Winehouse’s mum says she’ll be dead in a year,” with the Sunday Mirror. This is not to say that Janis is solely responsible - there are surely hundreds of children who move out early without overdosing at 27. But could a firmer hand have helped steady the wheel? We’ll never know.

Janis went on to say that she while she doesn’t feel responsible for Amy’s decline into drugs, she reveals being lackadaisical when Amy started running into trouble. "Amy was never an easy child and she was always open to any new bad influence. Her life became a bit muddled when she left home. She started smoking marijuana and got her first tattoo - a Betty Boop on her back. I just said, 'Oh well.’”

Amy’s family always seemed to have a disturbing dynamic. Janis was unhappy; Amy was rebellious, but always trying to please her out-of-the-picture father Mitch. "I don't do happy. [Amy] doesn't, it seems, do emotion either. But it's just her way of coping,” Janis explained.

As a Amy became an adult, her family unit added another dysfunctional member: ex-husband Blake Fielder-Civil. A self-admitted addict, Blake claims to have introduced Amy to narcotics usage. “I’m not trying to defend his behavior and I know him for what he is: he’s an addict and he has done some terrible things. He feels enormous grief and responsibility for some of the things that have happened, as well he should,” Fielder-Civil’s mother, Georgette, told the Daily Mail in “Don’t blame my son for Amy’s death: Blake Fielder-Civil's mother's plea as she insists the couple were still in love.”

Although some families shift the blame for a substance abuse problem on medical issues, they are often the ones who have, perhaps unwittingly, facilitated the problem to a significant degree. In 1991, The Journal of the Academy of Child and Adolescent Psychiatry reported that researcher James R. McKay and colleagues had studied adolescent substance abusers and confirmed what we know anecdotally: that greater perceived degrees of dysfunction were linked to increased levels of substance abuse prior to hospitalization.

With modern medicine focusing on the disease model of addiction, pharmaceutical companies have been instrumental in keeping substance abusers like Amy addicted by flooding the market with painkillers and psychoactive meds, while also profiting from drugs to counter addiction.

In July 2011, financial website This is Money reported that one such company, Reckitt Benckiser Pharmaceuticals, was delighted to announce that its newest delivery system for the heroin addiction drug, Suboxone, would now be a big moneymaker. “As is well known, our Suboxone tablets can become subject to generic competition in the U.S. at any time, and moving more of our business into the film remains a key priority. At the end of June 2011, the Suboxone film had captured a 41 per cent volume share of the U.S. market,” he said.

Talk show host and former journalist Piers Morgan knew Winehouse and told Entertainment Tonight in “Piers Morgan hits out at Amy Winehouse’s record company after singer’s death,” that while the troubled singer ultimately succumbed due to her own addictive behavior, others in her life failed to take responsibility. Echoing a common question, Morgan wanted to know where everyone was when she needed help. He stated, “I do blame people. Where were all the people making money out of her when it mattered? Really, where were they? You know, it's just not good enough that they're all going to make millions out of it now she’s dead.”

Blake Fielder-Civil’s mother seems to agree. “We all played our part in what happened to her. I have had to look deep into my heart and wonder if I could have helped, done things differently,” she said.

While we may never know what caused Amy's death, ultimately she was responsible for her actions. However, family members, “friends,” doctors, rehab centers and pharmaceutical companies must also accept responsibility for the role they played in her destruction. We need to move towards a more cohesive model that merges psychology and psychiatry to prevent more parents from losing their daughters.

Fear in the brain

This is one writer's depiction of having his head scanned by a functional magnetic-resonance imaging (fMRI) machine to see how fear works in the brain:

My head was recently scanned by clinical psychologist Philippe Goldin, a researcher in the lab of James Gross, director of the Stanford Psychophysiology Laboratory. Goldin and his team are studying 30 "healthy controls" and about 60 social phobics in an effort to plot the pathways of anxiety—and, more important, how people are able to damp down their impulses to fight or flee.

On the monitor, the story of my mortification is interrupted by a single line of words in bold:

I AM A LOSER

I read more of my story, then this line pops up:

I'M TOO INSECURE TO STAND UP FOR MYSELF

Two primary regions of the brain show increased blood flow in the scanner—to use the vernacular, they "light up"—in response to an anxious or frightening situation. One is the amygdala, which is associated with emotions; the other is the hypothalamus, which gets you ready to take action by increasing your heart rate, respiration, and sweating.

Next, the write is asked to regulate his emotions with reason:

I do what Goldin has asked: I tell myself in the scanner that I'm not a loser; that I do stand up for myself.

In fact, back in the managing editor's office, I did speak up, telling him I'd worked hard on that story and deserved to write it. I also suggested that next time he tell me first before announcing it to the staff. The editor responded by looking me over like he'd never noticed me before.

He said I was right, he should have come to me first, and that I was ready to write the story. But changing his mind didn't change his decision—I'd get a reporting byline, but the other guy would write it. "Next time, though, the byline will be yours," he said.

I kept my cool long enough to casually walk out of his office. Then I ran to the men's room, and nearly threw up. This episode is a key moment for me in learning to push down my anxiety to the point that it bothers me far less today—though it took years of similar episodes.

My struggle to overcome anxiety is exactly what Goldin and Werner are measuring in the f.M.R.I. They can actually see the pathways lighting up from the frontal lobe—the seat of rational thinking, and where we make decisions—essentially telling the amygdala to settle down.

"The amazing thing is that the brain can make changes," says Goldin. "Most of this happens in the amygdala, and it can be tempered to learn and adapt."

My results did show adaptation in action. When I read my story and saw the lines about being a loser, my brain grew anxious. But I was able to modulate its reaction—to tell my amygdala to chill out.

Meditation, cognitive-behavioral therapy...some of the best tools for coping with panic and anxiety depend on exactly this idea: while it might be a struggle, with mindful focus reason can mediate anxiety.

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Psychological Problems in Kids and Teens New Study Looks at Parental Discord as a Major Cause

One of the recurring themes of this blog is the tendency of mental health researchers and practitioners to look at patients' symptoms without any investigation into the home environment, and decide that they, or their brains, are the entire problem.

Psychological problems in kids are roughly divided into externalizing behaviors and internalizing behavior. The former is basically acting out: doing poorly in school, being hyperactive, being oppositional, getting  into fights, throwing tantrums and the like. 

The latter refers to things like anxiety and depression. Either way, today kids who have any of these problems are in danger of being labeled with mental disorders such as ADHD, bipolar disorder, and even "oppositional defiant disorder," which I refer to as "spoiled brat disorder." And of course there is "conduct disorder," which I refer to as "juvenile delinquency."

These know-nothing researchers act as if living in a tense or chaotic home environment is good for children's emotional life and that they do not become distractible or agitated under these circumstances.

As I have often joked, when it comes to looking at the home environment, most mental health professions will - if they say anything at all - label it as "within normal limits (WNL)." What WNL usually really means is "We never looked." If they do "look," they may ask the parents one or two questions about discipline, and take their answers at face value as well as valid or complete.

Or if they really want to pretend they have obtained the whole picture, they can ask the child's teacher what the kid's behavior is like at school. Of course, teachers are likely to have less patience with kids who are distractible, and then have lower expectations of them. The kids will pick up on this, and the teacher's attitude causes these kids to become even more distressed, which makes the teacher have even less patience and lower expectations of them, and so on in a vicious circle. (This long-term process was described by Peter M. Senge in his amazing book, The Fifth Discipline).

Researchers in psychiatry, as I described in a post about borderline personality disorder researchers, are even worse than practitioners at ruling out environmental causes as the explanation for symptomatic children. They never even read summaries of the literature produced by developmental psychologists.

One developmental psychologist, E. Mark Cummings, summed up quite nicely the type of results that this literature routinely shows . He was quoted in a recent article in the Atlantic (http://www.theatlantic.com/education/archive/2016/10/the-effects-of-a-simmering-parental-grudge/503015/#article-comments) that described a recent study ("The Multiple Faces of Interparental Conflict: Implications for Cascades of Children's Insecurity and Externalizing Problems,"  P.T. Davies, R.F. Hentges, J.L. Coe; E.M. Cummings, Journal of Abnormal Psychology [in press]):

“Children are like emotional geiger counters,” said E. Mark Cummings, a professor of psychology at the University of Notre Dame who has conducted extensive studies on the effects of marital discord on kids for more than 20 years. Children, he explained, are incredibly attuned to parents’ emotional communication with each other; they’re keenly aware that, for their parents, nonverbal expression is key to communicating feelings.

For many couples, holding onto a grudge—smoldering but not letting a disagreement erupt into a fighting match—may seem like the best way to deal with a conflict. But research shows this kind of discord can significantly interfere with a child’s behavior and sense of emotional security. When exposed to prolonged unresolved conflict, kids are more likely to get into fights with their peers at school and show signs of distress, anger, and hostility. They may also have trouble sleeping at night, which can undermine their academic performance. In fact, according to various studies that measured children’s emotional responses to interparental hostility, disengagement and uncooperative discord between couples has shown to increase a child’s risk of psychological problems, including depression, anxiety, social withdrawal, and aggression."

Here is the abstract of the study. Notice how the study was longitudinal - meaning it looked at parental behavior and children's reactions to it over an extended period of time - and used multiple measures and multiple observers. Researchers also actually observed the family members interacting with one another while engaged in various conflict resolution tasks. That's what a researcher has to do to in order vastly improve his or her chances to see what is really going on at home and to see what the most important causal factors are for psychological distress in young people.

This multistudy article examined the relative strength of mediational pathways involving hostile, disengaged, and uncooperative forms of interparental conflict, children's emotional insecurity, and their externalizing problems across 2 longitudinal studies. Participants in Study 1 consisted of 243 preschool children (M age = 4.60 years) and their parents, whereas Study 2 consisted of 263 adolescents (M age = 12.62 years) and their parents. Both studies utilized multimethod, multi-informant assessment batteries within a longitudinal design with 3 measurement occasions. Across both studies, lagged, autoregressive tests of the mediational paths revealed that interparental hostility was a significantly stronger predictor of the prospective cascade of children's insecurity and externalizing problems than interparental disengagement and low levels of interparental cooperation. Findings further indicated that interparental disengagement was a stronger predictor of the insecurity pathway than was low interparental cooperation for the sample of adolescents in Study 2. Results are discussed in relation to how they inform and advance developmental models of family risk.

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