Tag Archives: mental health

February 14, 2011 · 5:59 am

Resources about narcissism?


Cover of "The Drama of the Gifted Child"

Cover of The Drama of the Gifted Child

A few weeks ago I was asked about resources on the topic of narcissism, things a person struggling with some of the features might read to better understand their inner world. I didn’t have any really great “lay” materials on the topic so I’m going to poll the audience. A perfect entry for Valentine’s Day when we celebrate those people who make us feel special!

Narcissism is an ugly word if it is used about you, as in, “you’re so narcissistic!” This usually means someone sees us as being self-centered.

The truth is…most of us have a touch of it at times. We desire affirmation, we fantasize about being recognized for our achievements, we want to be special (or at least seen that way), we have times of feeling entitled and may even manipulate the feelings of others to get what we want. Our focus on self may limit our empathy towards others. We may be haughty. All of have some of these features some of the time. Some of us have these features most of the time.

Having these feelings doesn’t mean we are personality disordered. But, our willingness to acknowledge and work on being more other centered MAY reveal whether we meet diagnostic criteria. Meaning, if you can admit to the problem and improve your capacity for empathy then you probably aren’t meeting criteria for a personality disorder.

What causes narcissism?

The simple Christian answer is sinful self-focus. But since ALL of us are sinners and flawed…can we be more specific why some people seem to struggle more with the problem, why some have an enduring bent  or a fixed pattern of relating to the world? One theory suggests that narcissistic features arise out of a lack of mirroring which results in a deep fear that we aren’t special…or worse, are worthless. There is likely some truth to this. However, it seems that some narcissism is encouraged in a me-first culture.

Resources?

So, what resources do you know that get at some of these experiences, desires, feelings of narcissism that could help a person be more aware of their impact on others.

Here’s a few reads I know about:

1. Drama of the Gifted Child, by Alice Miller. A classic psychodynamic read about our emotions. She does a nice job illustrating the fears/cravings of narcissism and borderline features and how we all have a touch of these. Not necessarily helpful in what to do about the experience but good to delve into the experiences of depression, grandiosity, denial, and self-contempt and what these do for us.

2. Re-inventing Your Life, by Jeffrey Young. In particular, look at chapter 16. In fact, if you follow the link, you can search “entitlement” in the “search inside” box on the left and once you get results, scroll down to the one on p. 314. You can read a bit of the chapter to see how the authors do a good job describing the common symptoms of narcissism.

3. Anatomy of Secret Sins, by Obadiah Sedgwick. Well, not exactly about narcissism but definitely about uncovering our true self-centeredness. Sedgwick lived between 1600 and 1658! Excellent read on the problem of self-deception.

If you try to search for books on this topic, you will discover (not surprisingly) most are written to those who either have to live with the person or are trying to get free of them. Few are written to the person with the problem.

Any resources you might add to the list?

7 Comments

Filed under Christianity, conflicts, counseling, counseling science, personality, Relationships, Uncategorized

Tagged as , , ,

January 18, 2011 · 7:48 pm

Adult Asperger’s?


DSM-IV-TR, the current DSM edition

Image via Wikipedia

In last night’s Psychopathology class I was discussing the significant changes throughout the history and editions of the Diagnostic & Statistical Manual (I-VI), especially in regard to the growth of mental health diagnoses. That led us to talk about a couple of diagnoses, once added, that have become “popular.” By popular I don’t mean en vogue or fun or the like. What I mean is that there has been a significant increase in the usage of that diagnosis.

What diagnosis? Asperger’s Syndrome.

Why? Some feel it is because the diagnosis is known and now those who went undiagnosed now are more likely to receive a correct diagnosis. Others feel that therapists are over diagnosing–lumping in every kid who has any hint of a social quirk.

It will be interesting to see what happens to the numbers being diagnosed when DSM5 comes out (2013?) and Asperger’s is subsumed into a generic Autistic Spectrum Disorder. I’d be willing to bet that fewer people will get the diagnosis because of stigma alone.

Whether over or under used, there are adults who meet criteria for this diagnosis and who might be helped (along with their spouses) if they had some hooks to use to understand what was happening in their relationships. If you are involved in counseling folks who meet criteria for this diagnosis…or think you might, check out the this website.

Click the link “tests” and check out a couple of the free adult forms you might use in the diagnostic process. They may not be quite as robust in their statistical properties, but they do give you a good way to narrow the conversation with your clients.

6 Comments

Filed under counseling, counseling science, Psychology

Tagged as , ,

January 17, 2011 · 12:03 pm

Interesting take on the DSM 5


A student of mine (thanks Andrew!) pointed out this essay about the future DSM in Wired magazine. Sometime in the next 2 years the American Psychiatric Association hopes to release version 5 to replace version IV-TR. Yes, they are doing away with roman numerals.

For those of you not in the counseling world, the DSM is what professionals use to diagnose mental health disorders. The original DSM was first published in 1952 and totaled 132 pages including appendices. Version IV-TR totals a whopping 942 pages. In it’s best form, the document enables professionals to communicate to each other about the symptoms of their clients. Further, individuals with a combination of symptoms may find that diagnostic criteria helps them understand that others have similar problems and can give some hope to finding effective treatments. From an economic standpoint, receiving an axis one diagnosis enables those with insurance benefits to receive some financial assistance in their treatment.

And while this document is founded upon scientific research and years of clinical expertise, the DSM is in no way free from politics. When the DSM moved from a psychodynamic view of illness (illnesses were couched in terms of their “reactions” from problems) to a supposed atheoretical, descriptive view of illness, certain diagnostic labels were kept. In the words of Theodore Millon (said at a seminar I attended), labels such as Borderline Personality Disorder were kept because, “We’d taken everything else from the analysts and so we kept that unfortunate label so they wouldn’t feel so bad.”

So, with the above in mind, take a read of the current political controversies surrounding new diagnoses and the problems with pediatric bipolar diagnoses. If you haven’t time to read the whole article, be sure to skip to the bottom and start reading after the photo of artistic renderings of heads. Read from there to the bottom. It gives you a view of the controversy.

4 Comments

Filed under Uncategorized

Tagged as , ,

January 10, 2011 · 10:04 am

Thoughts on causation and tolerating complex answers


Three things have me thinking about causation: a comment on autism my wife heard on the radio…the Arizona shooting…and the ending of my Congo book (mentioned in the previous post). We love to know WHY something has happened. Why autism or any other illness? Why a senseless shooting? Why so much corruption and unrest in central Africa?

Why is a good essential question. Might it be part of being an image bearer of God? It is hard to have dominion over our world if we don’t have the capacity to understand cause and effect. But, being human and therefore limited hands us a challenge. How do we understand complex facets of problems. Too often we mistake correlations for causes. And even more often we limit the cause to one simplistic answer.

Simple works for us. It is more efficient. We consider a problem, conclude an answer, and move on to other subjects. If we couldn’t move on, we might bog down and lose traction in our lives. Simple also works for us humans when we want to lay the blame for something that has happened at someone else’s feet.

Here’s what I notice in many of these kinds of conversations. If you try to single out a particular causal facet for focused discussion, there will be others who say, “yes, but, you also need to consider…”. It is extremely hard to play out one part of the cause/effect without being accused of being biased.  And if you try to develop a laundry list of causes…the conversation often loses traction and some hear you as letting others (e.g., vaccine manufacturers, Sara Palin, Mobutu, etc.) off the hook.

Try this experiment!

So, try to have a conversation today where you either (a) try to single out a particular cause for some widely discussed situation, or (b) try to list the complexities of the situation…and see what happens. Would love to hear your experience! What happens when you single out a possible cause? What happens when you try to include all of the possible causes?

Not sure what to talk about? Try one of these:

Consider autism. Why does it happen and why does it seem to start happening soon after a vaccine? There are known neurotoxins in vaccines…child seems to develop them after being vaccinated…thus it is the fault of companies who make them (and the medical establishment that promote them). See if you can talk about the relationship between the two without getting into an argument. Or you might decide to discuss the fact that autism is higher in subsequently born children if they arrive within one year of their older sibling. (Of course, if this were true then we should be able to document higher autism rates in Catholic families from the previous century!)

Consider the Arizona shooting. Why would someone shoot so many people and have so little disregard for human life? Sounds like the shooter was delusional and probably suffering from paranoid schizophrenia (armchair diagnosis). Try discussing the possible causes of this behavior? Schizophrenia? Over the top political fighting language? Failure of the educational system to get him to treatment?

Consider the Congo. Why is there so much corruption and unrest? African culture? The sad effects of so many decades of European rule and racism? Greed over the countries natural resources?

 

5 Comments

Filed under Cultural Anthropology, News and politics

Tagged as , ,

December 1, 2010 · 10:24 am

Chantix and PTSD


For those of you who know, live with, or work with those diagnosed with PTSD, be aware that the smoking cessation drug, Chantix, has been found to be seriously problematic. Apparently, the drug has been linked to a number of suicides as well as to increased agitation, mania, panic, nightmares, and suicidal ideation. One might expect that those suffering the distress of PTSD might experience even more of these side effects.

This isn’t new information. There are news items you can find going back to 2008. Given that there is a lawsuit underway, probably most providers already know about it. But, it was news to me so I’m passing it on to you just in case you know of a vet who is trying to kick the nicotine habit.

Leave a comment

Filed under Psychiatric Medications, ptsd

Tagged as , ,

November 19, 2010 · 6:46 pm

International Suffering and Trauma Treatment


Am working with a student on building a future course for students, licensed mental health providers, NGO workers to train them on the matters of trauma treatment in international settings with the course goal to take these trainees to a location where they train local trainers to use lay trauma healing measures.  I am imagining a course that is primarily on-line (using a course website, discussion board, webcasts, etc.) with some face-to-face time just prior to having the international experience. The course would enable licensed therapists to receive continuing education credits with the ultimate goal that those who complete this experience would be then prepared to replicate it in other parts of the world. Topics would include:

  1. Overview of trauma symptoms and the things that cause them (genocide, war, trafficking, domestic abuse, rape, natural disasters, etc.)
  2. Overview of local culture and customs re: health, strength, and medical intervention to ensure culture consistency and avoiding colonialistic approaches.
  3. Introduction to training lay trainers
  4. Secondary trauma and compassion fatigue issues

I have two reasons for a course like this: 1. trauma is everywhere, and 2. interventions need to be sustainable (not relying on western therapists to keep doing the direct service) and maintained by local individuals.

So, here’s my question: If you had an opportunity to shape a course like this, what would you want to see as part of the course? What would you want to avoid?

6 Comments

Filed under Abuse, counseling, counseling science, Post-Traumatic Stress Disorder

Tagged as ,

October 22, 2010 · 5:07 am

Normalizing Psychiatric Problems: Pro and Con


One of the hallmarks of the Biblical Counseling movement has been the clear articulation that psychiatric problems are not different in kind from any other set of problems. This assertion is made by some for a couple of reasons:

  1. To make sure everyone knows that the bible speaks to every kind of experience. if one draws lines between “regular” anxiety and pathological anxiety, those who meet the criteria for a DSM diagnosis might think that biblical material cannot speak to their situation–that they need to go elsewhere for help. God cares for and addresses every concern.
  2. To level the playing field between professionally trained counselors and biblical counselors. If the roots of human problems are common no matter the outer expression of them, then pastors and lay counselors can understand the issues (pride, suffering, fear, despair, etc.) and walk alongside anyone. One may not need special training to help another.
  3. To communicate to the healthy that they are not different from the more obviously unhealthy. The point is to reduce stigma and promote unity.

Consider the pros and cons of this viewpoint.

Pro:

  • Reduction of stigma and ghettoization
  • Increase normalization (“so, I’m not so different from others) and similarity with the rest of humanity
  • Increase the confidence and courage of leaders to address and dialogue about all forms of suffering

Con:

  • Decrease in interest in the specific experiences of suffering thus narrowing problems down to a simplistic cause (sin?)
  • Possible over-confidence of some leaders leading to a reduction of empathy and listening to the experiences of other; failure to consider body/mind issues not specifically elaborated on in the Bible.
  • Failure to recommend outside helpers with specific expertise and training; dismissal of the need to have professional counselors who may have greater practice with certain kinds of interventions\

When I teach my Psychopathology course I want my students to see just a bit of themselves in descriptions of people with thought disorders, addictions, eating disorders and the like. I want to normalize these kinds of problems so that students don’t think of clients with the problem as somehow different from their own experiences. While I may not binge, I may be able to empathize with those who do. However, I do not want them to think their brief binge as exactly the same as someone else’s experience. Otherwise, they might assume it would be easy to “just say no” to the binge.

When I teach my Physiology course, I want my student so to see the complexity of the brain and body and thus recognize the unique forms of suffering some go through. I want them to realize just how little we understand how much the body influences our experience of the world and of self. However, I do not want them to medicalize psychiatric problems. If they did that they might believe that counseling has little influence on psychiatric disorders. They might think that biblical reflections on anxiety and depression have no place in the healing of serious problems in living.

What is your experience regarding christian leaders handling of psychiatric problems? Do you see too little normalization? Too much? Do you see minimization of psychiatric suffering?

7 Comments

Filed under biblical counseling, christian counseling, christian psychology, Christianity, counseling, counseling science, Psychology

Tagged as , , , , ,

October 15, 2010 · 1:02 pm

Save the Date! March 17-19 2011


Dr. Diane Langberg and Bethany Hoang (IJM) will be doing our next Conversations with Christianity and Culture seminar March 17-19, 2011 on the topic of sexual abuse in the christian community. They will also be speaking about sex and human trafficking.

This is a free conference at Biblical Seminary. I’ll post on-line registration information here when it is available but I’m tell you this now so you get it on your calendar.  You won’t want to miss their presentations.

We expect to offer CEUs for mental health providers for the conference (probably very nominal fee) and academic credit too (in the form of ind. study) for those wanting to do some further work on the topic.

3 Comments

Filed under Abuse, christian counseling, christian psychology, counseling, counseling science, counseling skills

Tagged as , , , ,

October 12, 2010 · 4:34 pm

Skype counseling? Know of anyone doing it well?


I recently set up an acct with SKYPE to participate in an upcoming meeting. I’ve had past requests to use SKYPE in counseling people unable to come to the Philadelphia area. While I’m open to doing this (at least for brief consultations), there are a number of issues to resolve. I’m interested in hearing from readers having used it for counseling (feel free to remain anonymous). What was it like? How were confidentiality and informed consent handled? Was any mention of jurisdiction mentioned? Not sure what I mean, read on to consider these issues:

  1. Confidentiality & Privacy. Are SKYPE video conferences really private? What is the likelihood that someone can tap in?
  2. Informed Consent. Read any good Telehealth informed consent forms lately? Seems that you have to consider how to deal with crises that might be happening in another state. Insurances cannot be used. What about what files are maintained? I believe it is possible to record SKYPE calls.
  3. Jurisdiction. It is clear that licensed mental health practitioners must not practice in another jurisdiction (i.e., state) without getting licensed or approved for that jurisdiction. But what about consultations? What about Internet based interactions? Which state has jurisdiction? Some seem to think that the state of the “caller” is going to want to maintain control of the care of its citizens. Others think that informing “callers” that the point of service resides with the Counselor will be enough. Check out what they say at eCounseling.com.

This is what is known as a “Point-of-Service” issue. In our terms of service which both clients and counselors agree to upon eCounseling.com sign up, it states the following in section 5.8: 5.8 POINT-OF-SERVICE. For a client who resides outside their eCounselor’s state of residence and professional licensure, there is an important issue that should be understood by clients before counseling begins: By utilizing these counseling services, the client agrees that he or she is soliciting the services of a professional outside of his or her state of residence. By doing this, the client agrees that the “point-of-service” of counseling is to occur in the counselor’s state of residence and licensure, not the client’s. In essence, the client is using the telephone or the Internet (the “information highway”) to virtually travel to the counselor (the counselor’s state of professional practice). Hence, counselors are accountable to and agree to abide by the ethical and legal guidelines prescribed by their state of licensure and residence. By agreeing to solicit the counselor’s services, the client agrees to these terms. If you do not understand, or have any questions regarding this issue, please feel free to ask the counselor about this issue, or contact eCounseling.com support at support@ecounseling.com DISCLAIMER: The above should not be construed as legal advice. If you have questions about legality or liability, please contact a qualified legal professional.

What do you make of these issues?

5 Comments

Filed under christian counseling, christian psychology, counseling, counseling skills, Psychology

Tagged as , , ,

December 22, 2009 · 2:57 pm

Interesting article in the American Psychologist


Just got my December issue of the American Psychologist (64:9). In it is an article but Brenda Major (and others) entitled, “Abortion and Mental Health.” These authors wrote a report in 2008 for the APA task force on Mental Health and Abortion (available at here). What I find interesting in the article is the discussion of the research on the association of mental health problems with abortion. Set aside, just for a moment, your strong feelings about the topic and consider this question: how would you go about studying the effects of abortion on women using robust measures?

You cannot do a randomized, double-blind study (you subjects get an abortion while you other subjects have your baby). Thus, you cannot fully control pre-existing or co-occurring risk factors. So, what do most researchers do? Try to indicate risk markers–correlations–that may point to possible but not proven causes. The writers of this article point out that the downside of correlation or associations is that folk tend to mistake them as causes. They give one specific example: If age is the “most important known risk factor for Alzheimer’s disease (AD)” one might assume that age causes AD. But it does not. Similarly, one can do a study that shows 100% of convicted sex offenders have their own sexual victimization and wrongly assume that sexual abuse leads to sex offending. Not so.

These authors emphasize the benefits of asking two other questions (on p. 865):

1. What is the relative risk of mental health problems associated with abortion compared to the same risks associated with having an unwanted baby (whether keeping or adopting out)?

2. What predicts individual variation in women’s psychological experiences following abortion?

The authors go on to say that the hypothesis of the researcher really impacts the kinds of research questions asked (and thus conclusions). Some research focuses on traumatic experiences, others on stress and coping, still others on the sociocultural context.

By the way, it is a long article but concludes this way (p. 886):

Mental health among women who experience an unwanted pregnancy reflects a number of factors. It reflects preexisting and co-occurring conditions in a woman’s life that place her at greater or lesser risk for poor mental health in general regardless of how she resolves her pregnancy. It reflects her appraisals of the meaning of a pregnancy and abortion and her appraisals of her ability to cope with either option.

There’s more to their final thoughts but you get the point. How you look at pregnancy, abortion, adoption is likely to have a big impact on your immediate mental health. Sadly, I suspect the research also reflects the biases of the researcher (how could it not?).

I found this article interesting because it does a great job illustrating the benefits AND drawbacks of research. Researching mental health of women with unwanted pregnancies is a good idea but will fail to address the moral and ethical questions that, in my mind, take precedence in the public debate.

Leave a comment

Filed under counseling, counseling science, Psychology

Tagged as , ,