Monitoring Your Teen: Your Perspective VS Their Reality

istock_000015515974small_2_2I recently watched an episode of Dr. Phil where a mother thought her 15 year old daughter was a popular teen and earning good grades. This mom thought she had the perfect teen, until one day her daughter disappeared and was found days later by the police.

Only then did her mother find out that this teen had not only recently witnessed a murder, but that the life she actually lived was is stark contrast to the life her parents believed she was living.

In reality, their daughter was not this popular teenager with good grades, but she was a drug using, bullied teen who was meeting and sleeping with older men she would meet online on a regular basis. Some were more than twice her age and married. One even committed suicide and she was the one who found his body.

This reality, was nothing that her mother could  ever imagine her daughter going through.

This got me to thinking about a lot of the teens I work with and how their reality often totally differs from the their parents perspectives.

Many teens I work with have parents who believe that they are doing good in school and are really active in after school activities like band and drama, while often these kids are failing school, skipping classes and using after school activities as covers to do other things such as having sex and using drugs.

As a matter of fact, I was so alarmed at the amount of teenage girls who told me that they were having sex after school (while they were supposed to be in drama or band) in an unsupervised location on campus, that I went to multiple school administrators and school resource officers to crack down on the number of teens on campus unsupervised after school.

Here you have parents thinking their child is staying after school to rehearse for a play, yet they are having sex in a storage closet, or leaving campus altogether to have sex or use drugs, but returning to campus later to be picked up by their parents who have the slightest idea of what is really going on in their teens lives.

I’ve sat down with numerous parents who were stunned to find out that their kid was failing multiple classes, missing dozens of unexcused days from school or wasn’t actually in the school play she had been supposedly staying after school for everyday for the past two months.

Teens will be teens, and most of these parents I spoke with took it for granted that they had “good kids” so they rarely checked on them or monitored their activities. They just assumed that they were always doing the right things.

On the Dr. Phil show, he drew the contrast between this young girls realty and her parents’ perspective:

Her Parents’ Perspective                                                                                    Daughters’ Reality

Spent time playing computer games                                                         Spent time meeting men online

Spent the night at friends’ houses and didn’t leave                          Snuck out of friends’ houses to meet men

Popular at school                                                                                                 Bullied at school

Relationship was wonderful                                                                         Parents were distant

I don’t mean for this to scare any parents, but I want you to understand the importance of monitoring your child, even when they are teens… especially when they are teens. It’s important that you trust your teens, but it also important that you verify what ithey tell you is going on.

Monitoring Your Teen

Monitoring your teen means asking questions. It means knowing where they are, who they are with, what they are doing and what time they will be back home. It also means having them check in regularly. Your teen may not like this, but over time they will grow accustomed to it if it is consistent and they know what to expect.

This is especially important when your teen starts getting involved with more activities outside of the home including school activities. Many parents think that as long as their child is at school they are safe and being monitored, but that often is not the case. After school activities can create time and opportunity for teens to get themselves into trouble.

If your teen stays after school for an activity, drop in every now and then to make sure they are where they said they will be.

You don’t have to make it obvious. Maybe bring them a snack or genuinely be interested in whatever the activity they are involved in. The same goes for school. If you can’t drop in every now and then to make sure they are at school, most schools  have websites just for parents where you can monitor your child’s attendance, grades and assignments.

Monitoring your teen is about communication and respect on both ends. Here are a few tips:

  • Let your teen know that you will be monitoring them so that they won’t be surprised. Like I said, they may not like it but they will grow used to it if they know what to expect and it is consistent.
  • If you sense trouble, make those surprise visits to the school, the park, the football field, or call their friends’ parents to make sure your teen is where they said they would be. Let your teen know this is something you may do sporadically.
  • Get involved in the activities your teen is doing at school. If your teen is in band, try to become a band parent, or a drama parent, or just show up to support your teen and the school. The more likely the chance that you will be around, the less likely your teen will do things you disapprove of.
  • Have a rule: “No parents, no party”.  The amount of unsupervised parties the teens I work with go to that are filled with sex, drugs and alcohol is astonishing. Make sure that if your teen is going to a party there will be adequate adult supervision.
  • Get to know the other adults in your teens’ life such at teachers, mentors, coaches, employers, etc. This is important for a number of reasons, but this can also be a network where you can compare notes. If you think your teen is doing great in school, a teacher could tell you that they are missing class a lot or getting bullied for example.
  • Monitor how your teen is spending their money. You wouldn’t believe how many parents I work with who would give their kids money and have no idea what they are doing with it.
  • Monitor your teens online and electronic devices such as phones and ipads. Teens get in all sorts of trouble online and they generally don’t want you in their online lives, but when their safety is your priority then compromises have to be made.
  • Monitor their physical and mental health and look for signs of changes so that you can address them early or seek professional help if needed.

There is much more that could be added to this list, but this is a good start. Most parents will add their own tailored made to their child.

How much monitoring is enough depends on your teen. If they show you that they can be trusted, are accountable and reliable, then you may back off some and only monitor them every now and then, but if they have shown you that they can’t be trusted, you may have to monitor them more.

Look for changes in your teen such as new friends, different behaviors or activities. These are signs that you may want to monitor your teen a little more; also when things are changing such as moving to a new neighborhood, school or when things at home are changing such as divorce or a death in the family.

We all did things as teenagers that make us uncomfortable to think about today, but we are glad that we came out relatively un-scathed. Monitoring your teen so that your perspective matches closely with their reality will hopefully help your teen avoid some of those unnecessary situations, some of which can be life altering and deadly.

Some Of My Frustrations With The Mental Health System And How It Fails Those It’s Supposed To Help

DGStory92211editAfter the tragedy at Sandy Hook Elementary School, there was a lot of talk about our broken mental health system. As a mental health counselor, I have worked in the mental health system since 2006 and could go on and on about why I think the mental health system fails many of those who need it the most.

It basically boils down to politics and money.

When I worked at the psychiatric hospital, I would see severely mentally ill people come in, but because they had no insurance, they were generally released back onto the streets within 24 hours without any medication or follow up appointments. At the same time, patients with insurance, regardless of the severity of their mental state at the time, were almost always hospitalized for at least 72 hours and released with medication, prescriptions, and/or follow up appointments.

Needless to say, the patients without insurance returned on a regular basis, to the point that I got to know them all pretty personally and could even predict when they would return. These clients were considered indigent clients or “regulars” as some of the hospital staff would call them.

They never got better, not necessarily because they didn’t want to, but many of them never really got the chance to get better.

Sure, many of them were homeless, some of them drug and alcohol abusers, and some even used the hospital like a hotel knowing that if they said the right words they would at least have a place to stay for several hours, but the large majority of them never really got the chance to get the help they needed because they didn’t have the money or insurance.

So, they would be back out on the street, most harmless, some committing petty crimes and a few were pretty scary as far as what they were capable of doing to an innocent person unaware that this person was in the midst of a psychological breakdown.

It was sad and frustrating which is one reason I left the psychiatric hospital and started working with juveniles, but even now I see how the system fails many people.

Now things are much more billing and money driven. They don’t care much about clients, giving quality therapy, making sure that counselors are well trained and given opportunities to stay well-trained and updated. All they care about is how many clients you can see and bill for in a day.

We are given three times as many clients as we can properly manage and give quality therapy to, but agencies don’t care about that because they are under pressure and in competition with other agencies and what’s called a “Managing Entity” that holds all the funds given to mental health and substance abuse facilities and can decide which facilities get and lose funding.

It’s frustrating and sometimes makes me want to quit my job because I can’t effectively do my job to the standard I feel like I’m obligated to by my own ethics and the ethics of the American Counseling Association.

On top of all that, my frustrations with the mental health system include a time when I had to have a young woman hospitalized after she had growing paranoia, anxiety and delusions that she was being controlled by other people who were raping her and turning her into a dog. She even crawled around on all fours and urinated on her mom’s carpet.

She was released from the hospital without any diagnosis and was only given a prescription for anxiety. This did not stop or even decrease her paranoia and delusions and I had to have her hospitalized again when her paranoia was so bad she started having thoughts of killing herself.

The reason I had her sent to the mental hospital the first time was because they had the resources and staff needed to truly help her better than I did working out of a school based program. Yet, they basically put a patch on a wound and sent her on her way.

In another situation I had a client stab himself in the neck during an argument with his girlfriend. Sure, this was impulsive and maybe he didn’t need to be hospitalized for an extended amount of time or given medication, but he didn’t even spend the night in the mental hospital before they released him without a diagnoses or any follow up.

If this same guy decides next time to stab his girlfriend in the neck, she may try to sue the hospital, or if she dies, her family may want to try to sue the hospital and everyone will be talking about how the mental health system failed her.

This reminds me of another aspect of working in the mental health hospital.

Almost twice weekly we would get handfuls of inmates being released from jail, inmates the jail didn’t feel were mentally stable enough to be released back onto the streets. Most of these inmates didn’t have any insurance so we would take them in and release them in the morning.

How scary and sad is that? The jail didn’t feel safe letting this inmates free to roam the streets, but they couldn’t legal hold them beyond their sentences, so they entrusted the psychiatric hospital to stabilize these inmates before releasing them, and all we did the majority of the time was give them a place to sleep and then let them out the next day.

In defense of the psychiatric hospital, a lot of it came down to funding and unfortunately, not much funding is given for those without insurance. We would have what were called indigent beds, beds paid for by the state for those without insurance, but there weren’t many and they didn’t pay as much as insurance beds did.

I believe most of the people who work in the mental health field, those who haven’t been tainted or sold their soul so that they can become program managers, directors and supervisors who are more concerned about funding and stats than actually quality of care, really do love and care so much for those who suffer from a mental illness that we go far and beyond what is expected of us and definitely far and beyond what we are paid to do.

Places I’ve worked typically don’t pay their therapists/counselors what they deserve. Those who are licensed could make more as program directors or supervisors who don’t see clients. Positions that once required masters degrees are starting to only require bachelors degrees so that agencies can lower the salary, which usually lowers the education, experience and dedication of those being hired for a lesser salary.

Quality of patient care is sure to suffer.

The mental health system is so broken and so politically and funding driven, that if things don’t change drastically and soon, I can only see much darker days ahead for all of us.

One Teens Attempted Suicide

Today I got one of those out of the blue phone calls that I dread. I was out of the office preparing files for an upcoming audit when I got an email from one of the teachers at the school I work at asking me to call her as soon as possible.

There’s always a lot going on at the school, but I assumed she wanted to ask me for advice with dealing with one of her students or to refer a student to me for counseling. I called her and she informed me that one of my students was in the hospital in critical condition after attempting suicide the night before.

I almost cried. I know that’s not the professional way I was supposed to feel, but I am human and have passion for my clients. Sometimes too much, but that feeling felt appropriate. I have never (fingers crossed) had a client actually commit suicide, but I know it’s always a possiblity. I’ve done crisis counseling at enough schools after a teen has committed suicide to know that it happens all too often. As a matter of fact, 3 weeks ago a student at a high school not too far from the one I work at killed herself.

It’s not that this is the first client of mine to attempt suicide, but this is probably the first client of mine to make a serious suicide attempt. I don’t want to underplay any suicide attempt, but I have had many clients who have made superficial lacerations to their wrists or took three ibuprofens in a “suicide attempt”. Most never needed to go to a medical hospital for medical attention.

Sure, I had to have them sent to the psychiatric hospital because they were having suicidal thoughts and any attempt has to be taken seriously, but it never shocked me because I knew that while they were hurting emotionally and psychologically, they didn’t want to die. They wanted help, they wanted people to see and know that they were hurting, but they didn’t really want to die. The fear in that though is that they could accidentally kill themselves.

This situation was different for a number of reasons.

1) I was very close to this client. I had been working with this particular client for almost two years helping him get through depression, grief and anxiety. I actually tried to become more of his mentor than his counselor because that’s what I felt like he needed most as a young man approaching adult hood.
2) A few months ago this particular client came to me and told me that they were seriously thinking about ending their life. I had him admitted to the psychiatric hospital where he was prescribed medication for anxiety and depression. I was surprised and scared that he didn’t come to me this time before he tried to take his life.
3) He had a lot to look forward to. He was graduating after almost not qualifying to graduate. I had just giving him a graduation card saying that I was excited for him about his future.
4) And lastly, I had just saw this client the day before and he was his normal, apathetic self. I saw no warning signs that less than 24 hours later he would take 3 months worth of medication all at once.
5) While all suicidal talk, gestures and attempts have to be taken seriously, from personal experience, the teens that actually kill themselves do so with little real warning. Some may tell all their friends that they love them, or apologize for past wrongs, but from the crisis counseling I’ve done at different schools after a student has committed suicide, there is rarely any apparent warning signs yet in hindsight, grieving students, faculty and parents usually see subtle signs that they missed.

His mother found him in his room, unresponsive and called 911. He was rushed to the hospital where a host of procedures were done to save his life. When I went to the hospital to see him he was still unresponsive, a result of all the medication he had taken, but the doctor was pretty sure he would make a full recovery… physically.

The fear is, when he finally comes to, is he going to be happy that he’s still alive, or disappointed that he failed to end his life?

That’s why I want to be there for him. I stayed with him in the hospital today for as long as I could, but the hospital staff that was in charge of sitting with him around the clock because he is on suicide watch, told me that it would be at least another day or two before they expected him to start coming around.

I don’t feel like I failed as a counselor. That’s one of the first questions I asked myself. I think that the reason it bothers me so much is because he is my client and I feel a sense of responsibility for him, although I know I can’t be responsible for the decisions he makes.

Looking at him laying in the hospital today was depressing. At times he looked dead except for the frequent rapid eye movement visible through his closed lids. I just hope that when he comes to that he realizes that he is alive for a purpose and rejoices in attempting to discover what that purpose is. I’ll definitely be here to help him anyway I can.

Taking Back Control Over Your Thoughts, Feelings And Emotions is one of my favorite quotes, not because it is brilliant, which it is, not because it is simple and true, which it also is, but because it is something I teach daily to my clients and something that I personally struggle with.

A large majority of my clients are suffering from various issues because of interpersonal problems, many which could be eliminated or at least greatly reduced if they just stopped allowing other people to control their thoughts, feelings and emotions.

Matter of fact, learning to control your thoughts, feelings and emotions is the hallmark of cognitive behavioral therapy which is the main theoretical orientation I work from.

When I listen to my clients vent in anger, cry in sadness or hyperventilate through anxiety, what I hear a lot of is that they are giving other people too much power over them, many of them who don’t have their best interest at heart and who wouldn’t be sitting across from me in emotional and psychological pain if the tables were turned.

These people my clients let control them, for the most part, couldn’t care less about the agony they were causing them.

Most of my clients allow boyfriends, so-called friends, family members and even mere acquaintances dictate how they feel about themselves, how their day is going, what they think about their life and even their future.

It goes much deeper than that, but the point is that they have given other people power over them and I have to teach them how to start taking it back and keeping it for themselves.

I also try to teach them that nothing matters until they make it matter, something I got out of the book I AM: Discovering Who You Really Are by Howard Franco.  It basically means that you decide what effects you, how it effects you and what doesn’t.

Most people’s emotional thermostat is set on automatic, they automatically respond to certain situations the same, usually either with anger, fear or self-pity.

Learning that nothing matters until you interpret why it matters, how much it matters and how to respond to it, allows you to keep your power and decide rationally how and if you should respond to a situation. It takes the automatic response out of it, and allows you to slow down and make a much more fair decision.

Often our emotions and actions are out of line with the actual situation which causes a lot of emotional turmoil, but I don’t want to stray too far from the main topic. The bottom line is, we have to stop the cycle of allowing other people to control us, especially those who invest so little into us in a positive way.

I used to have an ex-girlfriend who I let control my thoughts, feelings and emotions to the point that I was probably a bit neurotic. How I felt about myself depended on how she felt about me that day. If she was happy with me and showing me love, I felt great about myself. If she was in a bad mood and treating me poorly, I hated myself. My life was full of anxiety trying to figure out how to keep her happy with me, something that was totally out of my control.

It took too many anxious days and crying at night for me to realize that she had too much control over me and I needed to take that control back. It took some self-help books, talking with friends who actually cared about me, and even some meditation before I finally found the strength to take back control and leave that person.

Sometimes however you can’t just leave that person because that person is in your family, or your husband or someone you don’t want to lose contact with, but you want to stop allowing them to control you. In that case, the person who has to do the work is you and only you.

It is not easy, but it is one of the most liberating personal experiences you may ever have.

I’ll end this with a line from chapter three in the book I AM: Discovering Who You Really Are, which is titled “You Decide What Matters”:

“What you experience can only have an effect on you in a tangible way if you make it matter. If you don’t make it matter,  it will have no effect on you.” – Howard Falco

Helping A Loved One Who Has A Mental Illness

womencare-support-groups_istock_000010775681The other day, a friend of mine asked me how she could help a friend of hers that was mentally ill.

She explained to me that her friend had bipolar disorder, something she had been suffering from for years and had a long history of self-injury and suicide attempts.

According to my friend, this person was currently in a deep depression and posting dark posts on Facebook including some alarming ones such as wanting to give away her pets (giving away possessions is often associated with suicidal thoughts).

She wanted to know what should she do or say to her to make her “feel better” and I told her that there was no magic word or act she could to that would just bring her out of her current mental state. It’s like trying to help a friend who has a serious medical condition. You can help alleviate the pain, maybe make them feel more comfortable, but there is nothing you can actually do that will just cure the person of the condition.

Many people think they can or should be able to, and thus get very frustrated with themselves and/or the person they are trying to help when the reality hits that it’s just not that simple. The best thing you can do, and what I told my friend to do is to be a support system for her friend and show her love. Let her see that she has a friend who is going to stand by her side no matter what.

People suffering from a mental illness often feel broken, unlovable and fear that people will abandon them if they can’t keep it together. The best gift you can give them is showing support and love. There are no magic words or acts, but you may be surprised how a simple walk around the park talking about nothing in particular or just being present with that person, can have huge positive effects.

Many people who want to help someone they love who has a mental illness often don’t do that because as simple as it sounds, it can actually be quite difficult to actually sit with and be present with someone instead of lecturing, ordering and dictating to them what they should or need to be doing. That’s why actually just being with them, showing love and support can be such a precious gift.

Also, you may need your own support system to help yourself while helping someone you love and that’s okay.  There are many support groups tailored towards supporting loved ones of people with various illnesses including mental illnesses.

You may also need to make appropriate boundaries so that you don’t become overwhelmed and exhausted. Don’ try to be a superhero, you are only one person so do what you can when you can, but don’t feel obligated to do everything.

However you choose to support your loved one who has a mental illness is a blessing. They may not be able to tell you that or appreciate it right away. Your support doesn’t have to be perfect in order to be effective  You are doing what few people do, which is showing support and love instead of ignoring or stigmatizing.

Some Tips

  1. Learn about their illness. It’s easier to help and support someone with any illness when you have some information and insight about what they are going through. My friend who wants to support her friend with bipolar disorder actually had no working knowledge of the disorder.
  2. Let them know that they are not broken or defective and that they are the same person they have always been, they are just suffering from an illness, but they are NOT their illness.
  3. Help them if you can to get to their appointments, make sure they are taking their medications and actually talking to their doctors and/or other mental health professionals. That help can come from driving them to their appointments to simply reminding them to take their medication or to go to their appointments.
  4. Show and tell them that you love them and that you are there for them through thick and thin.
  5. Ask them what they need. Don’t just assume. The person who is sick generally knows what is best for them. They may need you to help clean the house or bring them dinner if they are too sick to do so.
  6. Check in with them, make sure that they are okay and following their treatment plan. This not only helps keep them accountable and responsible, but it also serves as a reminder that they have someone who cares about them

Counseling Minors and Confidentiality

Little-boy-shhhh-cropped-300x297Confidentiality is a crucial part of counseling. Clients have to believe that they can tell me practically anything and it won’t be repeated to anyone, including their parents.

All of my clients know that everything they tell me stays  between us except:

  • If they tell me they plan on killing themselves or someone else
  • If they tell me that are being abused
  • If I am court ordered to release information, and because I work in a school
  • If they have drugs or weapons on campus.

Also, because I work primarily with juveniles, I leave a little wiggle room by saying I will also report anything “life threatening” which may not include marijuana or alcohol use, but may include intravenous drug use or meeting adults online.

Even with these rules of confidentiality, teens will still inevitably tell me things that need to be reported to their parents, the school, law enforcement or child protective services.

More often than not, the child already knows this before they tell me so they aren’t usually upset when I have to make that phone call.

The problem generally comes from parents, who may not understand confidentiality. They think that their child is in counseling and as the counselor, I should tell them any and everything their child is doing and can get testy when I have to explain to them that confidentiality doesn’t work that way and that it’s actually illegal for me to tell them any information that doesn’t fall under the exceptions above, without their child’s permission.

I understand these rules and have worked within the confines of them for many years, even when I am hearing information that I wish I could tell parents. Information I actually knew would help the situation, if the parents knew.

For instance, last year a young lady was devastated when she went to a friend’s party and got raped by him and four guys she didn’t know. She was in tears when she confided in me and after calming her down, I practically begged for her to give me the name of the guys, some who went to the same school as her, or to report it to law enforcement.I gently repeated this request each session as we processed the trauma.

I offered to go with her to make the report, but she was adamant about not telling me any identifying information. She told me that she was scared that they would come after her if she told. No amount of me trying to convince her worked and at the end of it all, I had to allow her to make that decision she will have to live with for the rest of her life.

As much as I wanted to report that crime to law enforcement and her parents, I couldn’t. I had no identifying information, she wasn’t abused by a caregiver or someone in authority and she wasn’t a danger to herself or others so my hands were tied. All I could do was try to help her get through the emotional and psychology pain she was feeling. She went through a period of deep depression and eventually transferred schools.

I have had teens who have had abortions and miscarriages without their parents ever knowing they were pregnant. Kids who have battled substance and alcohol abuse right under their parents noses.

I always strongly encourage my teenage clients to involve their parents in their treatment though family counseling, but most teenagers are hesitant to let their parents know the things they do when they are not looking, or think that their parents will just be angry, judgmental or not listen if they do open up.

I usually only do a couple of family sessions a month and those usually happen after emergencies such as suicidal thoughts, severe panic attacks that require medical attention or another extreme circumstance  that causes the parents to be concerned.

That’s usually when, with the child’s permission, I feel like I can finally truly help them without restraints. Trying to help a child solve a problem that need parental involvement, when they don’t want the parent to be involved is truly handicapping.

However, this is usually also the time when parents get upset that I knew about the abortion, or the drug use, or the date rape that they didn’t know about, months sometimes even years before.

I let them know about the confidentiality regulations set by the Health Insurance Portability and Accountability Act (HIPPA) that prevented me from giving them that information, even when it was valuable information about their own child.

Most parents calm down once they realize that without the confidentiality between their child and myself, it would have been unlikely that their child would have told any trusted adult and received at the minimal, mental and emotional support as well as guidance and encouragement.

Some minors want help or at least to talk about issues in their lives that are concerning them, but will only do so if they know that their parents will not be notified. Not all parents are supportive and some parents could use the information to further cause damage to their child, knowingly or not.

Take for instance a girl I know who is scared of her father who has a past history of physical abuse against her. He’s told her that if he ever finds out she is having sex he will kick her out on the streets. Yet, she is having sex and thinks she may be pregnant. Should I risk her losing her housing in order to tell her father that she may be pregnant?

I believe breaching confidentiality, while it will give parents more information about their child, it is less likely to truly make a difference if that child just learns to hide their problem or not admit or talk about their problem anymore, resulting in them getting less help.

I definitely understand when parents are frustrated with confidentiality when it comes to their children, which is why I always encourage open communication and family therapy, but most kids I deal with would never want their parents to know their issues and unless it’s something that puts them or someone in immediate danger, my hands are usually tied pretty tight.

The Ohio Missing Women And Psychological Resilence

Berry_and_DeJesus_20130506191340_320_240Many people when they first heard of the unbelievable miracle that three women, Amanda Berry, Gina DeJesus and Michele Knight so far unnamed woman who all went missing in three separate incidents were found alive and well, at least physically, 10 years later, asked themselves the same questions:

1) How could this happen in the middle of a neighborhood in a big city? and;

2) Did this women, years later as adults, have chances to escape their captors and if so, why didn’t they?

From a psychological point I understood some of the  damage these women went through. Systematic abuse for long periods of times at the hands of someone who basically has your life in their hands, can create overwhelming feelings of hopelessness and worthlessness, especially when the abuse is taking place in a confined space where you are isolated or severely limited to contact with the outside world.

They most likely had no idea if they would live, die or survive the trauma they faced and struggled to make sense of it.

As human beings we always try to find meaning in things, our survival is based on placing meaning on situations and thus I am sure these women struggled with trying to find a meaning to why this was happening to them. It’s likely one of many reasons they were resilient enough to survive and to not be completely mentally broken, although I am sure their captors did their best bo break them.

Physical, sexual and psychological abuse were all most likely used repeatedly to make these young women feel devalued and worthless.

Jaycee Duggard, who was kidnapped in 1991 when she was 11 and held captive for 18 years before she was rescued, said that once she was raped, she felt defiled and as like she was worthless. As a Christian she held her virginity deeply precious and thought she was practically worthless once the sexual abuse begun.

Elizabeth Smart, who was kidnapped in 2002 when she was 14 and abused repeatedly by her abductor for 9 months before she was rescued, spoke at a human trafficking forum last week and said that her abductor broke her down to the point that she felt like:

“a chewed up piece of gum. Nobody re-chews a piece of gum, you throw it away. And that’s how easy it is to feel like you no longer have worth, you no longer have value. Why would it even be worth screaming out? … Your life still has no value.”

What Elizabeth is describing to some degree is what is called learned helplessness.

Learned helplessness is a psychological condition that happens to both people and animals when they believe that a condition they are in will never get better and that they have no control over it. They will stop trying to get out of the situation and will miss opportunities to escape it. They may not run when the door is unlocked for example.

Another possible, but less likely answer is what is sometimes called Stockholm Syndrome, where victims bond and even start defending their captors. It’s a psychological defense aimed at trying to survive by taking on the views of your captor and making yourself seem less as a threat to hurt them or escape.

It’s similar to what is called called traumatic bonding:  “strong emotional ties that develop between two persons where one person intermittently harasses, beats, threatens, abuses, or intimidates the other.” (Dutton & Painter, 1981).

In traumatic bonding, their is an imbalance of power, the abuse is sporadic, and the victim will start to deny that the abuse is existing or is as bad as it seems as a way to mentally protect themselves. They may even start to disassociate and distance themselves from the physical trauma in what is called cognitive dissonance.

I’m not saying either of these things in part or in whole is what kept these three young women alive and resilient for so long, but it is likely that mentally they had to do some cognitive dissonance in order to keep their sanity.

I was glad to hear today that all of these women had been released from the hospital, but their psychological healing has just begun. They will need time, understanding, patience, their families and privacy to heal their psychological and emotional wounds.

Hopefully they will begin to put this tragedy behind them. Their captors and torturers have stolen so much of their lives, they don’t need to allow them to still any more of their present and future. Their future is still bright and they are still people of much worth and value. They have to believe that in order to not just be survivors of this tragedy, but thrivers.

The DSM-V: Coming Soon, Criticisms, Flaws and All

DSM-5_3DThe long awaited and controversial Diagnostic and Statistical Manual of Mental Disorders, version five (DSM-V) is slated to come out toward the end of this month.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is considered the bible of psychiatry. It is the guide we use in the mental health field to help us diagnose clients and this May, the newest version of the DSM, version five, is slated to be released, but not without much controversy.

The DSM is considered a research standard worldwide, yet, outside of the United States it is rarely used. Still, what is in the DSM is of international concern because trends in diagnosing in the United States (i.e., attention deficit disorder, autism) tend to spread worldwide especially in many European countries, China, Japan and Brazil.

Much of the criticism about the DSM comes from both the way illnesses are categorized and the ever expanding criteria for mental illness that basically makes everyday life issues a diagnosis.

Other  criticisms include weak scientific support and poor reliability in some of the DSM-V field trials, which leave some to believe that it will lose its role as the international standard for research journals.

One of the real dangers if the DSM-V is really that severely flawed is that all of the mental health field will also become tainted, with people not trusting those who are trusted to test, diagnose and help people in need.

With the DSM-V, we also put ourselves at more risk of mis-diagnosing, over-diagnosing and over-medicating individuals.

Some say that the changes to disorders such as Generalized Anxiety Disorder can include almost everyone, as well as a proposed new diagnoses called Somatic Symptom Disorder which will be diagnosed to any patient who has “excessive and disproportionate thoughts, feelings and behaviors” in relationship to an illness, which includes chronic pain and cancer. How much worry constitutes “excessive” worrying. Who wouldn’t be worried when they are dealing with a painful, chronic, potentially debilitating or life threatening illness?

Some believe that much of the flaws in the DSM period are because disorders are placed in discrete categories such as Bipolar Disorder and Schizophrenia, instead of “dimensionality” in which mental illnesses may overlap and people may be placed on one of several spectra such as the proposed Autistic Spectrum Disorders.

Most clients I see have a combination of symptoms, some which do not meet complete criteria for one specific diagnosis, but can meet several others and present differently at different periods, which is why I may see a client who has received three different diagnosis over the same number of years.

However, most in the mental health field prefer for mental disorders to continue to be categories as they already are which is one reason dimensionality won’t likely be introduced into the DSM anytime soon even in the face of growing evidence that disorders are more fluid and less rigid than previously thought.

It would take more research and funding into dimensionality for it to truly be accepted, but much of that research and funding is already put into confirming the categorization of mental disorders the way they already are.

Basically, people don’t really want change. Much of the mental health field, drug and insurance companies, like the rigidity of the DSM even though it is clear that it is failing many people.

Even patient groups and charities prefer the rigidity of the DSM because it highlights their disorder and keeps it visible. They do not want to see schizophrenia or bipolar disorder re-labeled into a spectrum just as Aspergers Disorder is slated to be dissolved into the autistic spectrum disorders.

On top of that health-insurance in the United States pay for treatment based on current DSM diagnosis. As a matter of fact, that is one of the most frustrating things about dealing with insurances.

In order to get paid for my services, they want a diagnosis almost immediately, usually after the first session or two of me meeting a client. Sometimes a DSM diagnosis is obvious, other times it is not and more time with the client is needed, but insurance companies won’t pay for that unless you diagnose them with something first. Insurance companies are probably the last ones who want to see the DSM categories dissolved.

According to Dr. Allen Francis, former chair of the DSM IV task force, the ten worse changes to the DSM-V are:

1) Disruptive Mood Dysregulation Disorder: DSM 5 will turn temper tantrums into a mental disorder- a puzzling decision based on the work of only one research group. We have no idea whatever how this untested new diagnosis will play out in real life practice settings, but my fear is that it will exacerbate, not relieve, the already excessive and inappropriate use of medication in young children. During the past two decades, child psychiatry has already provoked three fads- a tripling of Attention Deficit Disorder, a more than twenty-times increase in Autistic Disorder, and a forty-times increase in childhood Bipolar Disorder. The field should have felt chastened by this sorry track record and should engage itself now in the crucial task of educating practitioners and the public about the difficulty of accurately diagnosing children and the risks of over- medicating them. DSM 5 should not be adding a new disorder likely to result in a new fad and even more inappropriate medication use in vulnerable children.

2) Normal grief will become Major Depressive Disorder, thus medicalizing and trivializing our expectable and necessary emotional reactions to the loss of a loved one and substituting pills and superficial medical rituals for the deep consolations of family, friends, religion, and the resiliency that comes with time and the acceptance of the limitations of life.

3) The everyday forgetting characteristic of old age will now be misdiagnosed as Minor Neurocognitive Disorder, creating a huge false positive population of people who are not at special risk for dementia. Since there is no effective treatment for this ‘condition’ (or for dementia), the label provides absolutely no benefit (while creating great anxiety) even for those at true risk for later developing dementia. It is a dead loss for the many who will be mislabeled.

4) DSM 5 will likely trigger a fad of Adult Attention Deficit Disorder leading to widespread misuse of stimulant drugs for performance enhancement and recreation and contributing to the already large illegal secondary market in diverted prescription drugs.

5) Excessive eating 12 times in 3 months is no longer just a manifestation of gluttony and the easy availability of really great tasting food. DSM 5 has instead turned it into a psychiatric illness called Binge Eating Disorder.

6) The changes in the DSM 5 definition of Autism will result in lowered rates- 10% according to estimates by the DSM 5 work group, perhaps 50% according to outside research groups. This reduction can be seen as beneficial in the sense that the diagnosis of Autism will be more accurate and specific- but advocates understandably fear a disruption in needed school services. Here the DSM 5 problem is not so much a bad decision, but the misleading promises that it will have no impact on rates of disorder or of service delivery. School services should be tied more to educational need, less to a controversial psychiatric diagnosis created for clinical (not educational) purposes and whose rate is so sensitive to small changes in definition and assessment.

7) First time substance abusers will be lumped in definitionally in with hard core addicts despite their very different treatment needs and prognosis and the stigma this will cause.

8) DSM 5 has created a slippery slope by introducing the concept of Behavioral Addictions that eventually can spread to make a mental disorder of everything we like to do a lot. Watch out for careless overdiagnosis of internet and sex addiction and the development of lucrative treatment programs to exploit these new markets.

9) DSM 5 obscures the already fuzzy boundary been Generalized Anxiety Disorder and the worries of everyday life. Small changes in definition can create millions of anxious new ‘patients’ and expand the already widespread practice of inappropriately prescribing addicting anti-anxiety medications.

10) DSM 5 has opened the gate even further to the already existing problem of misdiagnosis of PTSD in forensic settings.

DSM 5 has dropped its pretension to being a paradigm shift in psychiatric diagnosis and instead (in a dramatic 180 degree turn) now makes the equally misleading claim that it is a conservative document that will have minimal impact on the rates of psychiatric diagnosis and in the consequent provision of inappropriate treatment. This is an untenable claim that DSM 5 cannot possibly support because, for completely unfathomable reasons, it never took the simple and inexpensive step of actually studying the impact of DSM on rates in real world settings.

Even with much of it’s flaws and criticisms, the DSM-V is likely to be the best guide for diagnosing mental disorders that we have had thus far. We can only hope that with further research and funding, the next revision of the DSM will be better and more forward thinking.