Friday, June 21, 2013

Preserving Traditional Marriage is a Feminist Issue

I can’t decide if it’s retro or radical but traditional marriage is a feminist issue.
It seems crazy or somehow reversed and certainly politically incorrect, but allowing women to be feminine in the traditional sense is true feminism--liberating, not confining, restricting or unenlightened. Too bad it’s become gauche to point out that the two sexes are vastly, fundamentally opposite—and that each has a set of hard-wired characteristics that despite insistence to the contrary, can’t be compromised.

   This refutation of the value of femininity is most evident with the growing acceptance of—or resignation to—gay marriage.

     Defining marriage as any two people, male, female or what-have-you denies real and intrinsic gender differences. Differences that are honorable. That are honest.

    Differences that generations for thousands of years acknowledged and accommodated and elevated, but that we super-progressive geniuses now denigrate and negate.

How can anyone miss that physiologically, emotionally, mentally and behaviorally, men and women are different, not interchangeable? A raft of books explain clearly-identifiable characteristics of male versus female brains, and their indisputable manifestations. (A few on my shelf: Taking Sex Differences Seriously by Rhoads; The Female Brain by Brizendine; Same Difference by Barnett and Rivers; Sex on the Brain by Blum; Brain Sex by Moir and Jessel; Brain Gender by Hines…) Women’s innate desire to nurture children is no less powerful and important than men’s innate inclination to compete in the marketplace. Both are laudable, both are necessary, and together, both bring complementary wholeness.

    Our culture is crazy to insist that women adopt the traditional male definition of success—which means success in career; success via competition, where the winner gets to be the leader.

Success in traditionally feminine realms requiring cooperation, problem-solving and nurturing in less financially-oriented settings (like home, school, community) deserves to regain the same prestige, praise and worth as the male standard that now supersedes them.
Are we talking about stereotypes of women's "nature" that early feminists eschewed? Yes, but we are way beyond  thirty years ago when women were limited by and to those stereotypes. Women earn significantly more college degrees at all levels than men do. Just under half of all medical and law students are female. Opportunities are open--except that work in traditionally feminine fields ("helping professions") still offers lower status and remuneration than jobs that are overwhelmingly performed by men.

Sheryl Sandberg has done women a disservice. “Leaning in” should not mean pushing into business leadership with your shoulder ramming any obstacles in your path. Most women prefer “leaning in,” toward nuclear and extended families, friends and communities (though in the current climate they can’t admit it). Proving one’s competence now requires some nod to higher education and work experience. Forty percent of births are to unmarried mothers, most of whom must work to support themselves and their children. What percentage of these moms would rather stay home with their children if money were no concern? A recent Forbes poll found 84% of working women would opt out of their jobs if they could.

 Even Ms. Sandberg acknowledges her own pining to care for her two youngsters, and notes that working women do twice the housework and three times the childcare of their husbands.  Is that really because women just don’t demand enough of their spouses—or is it because women prefer control of their home domains, while their men do not? When marriage was a partnership that joined two very different genders in a way that split roles for maximum efficiency as well as maximum respect for natural inclinations, women were more highly honored. Now, women are told they’re victims because they hold fewer leadership roles in business. Now, women who don’t want to excel professionally because they prefer raising their children have to apologize for their “lack of accomplishment.”

When marriage becomes only a declaration of love and intention between any two people, masculine and feminine attributes lose respect. Everyone’s blurred. Mushed together into a unisex, meaningless glob without note of the very basis of human kind—the joining of male and female capabilities and desires to create new human life and an effective combination of opposites--called a family.

Celebrating women as distinct and inherently valuable is a feminist issue. Subjugating femininity in favor of a male standard is an issue for feminists to fight.

Tuesday, June 11, 2013

Mental Disorders Proliferate in Newly Expanded "Bible" of Diagnoses

If you've ever wondered if you've got a bona fide psychological "disorder," the new handbook for mental health providers, the Diagnostic and Statistical Manual of Mental Disorders, Volume 5 has the answer--and it's more likely than ever to be "yes." The list of definitions was first published in 1952 as a spiral pamphlet describing eleven categories of mental disorder. Subsequent volumes (1968, 1973, 1980, 1994) ballooned the number of ailments, and now the 947-page tome boasts nearly 400 maladies. Sounds like the US tax code (73,608 pages).
Like lawmakers who keep writing more laws, and the IRS, that keeps writing tax regulations, psychiatrists just can't stop defining who's sick. Of course, that's what they're all paid to do, and the ones who want to keep their jobs are invested in adding to the density of their fields. A politician gets famous and re-elected for creating landmark legislation. The IRS hires more people as citizens might be violating more rules. But psychiatrists?

Same thing, especially the way health care payments are evolving under Obamacare, set to cover 32 million Americans who never before enjoyed this benefit. As descriptions of disorder include more people, mental health professionals' clientele and reimbursements grow.
A cynical view, maybe, but it's undeniable that a growing number of people now have a diagnosis to pin to their conditions. A review of the new psychiatric tome by Dr. Carol Tavris in the New York Times sheds light on what's going on.

As part of her look at the new "Bible" of mental ailments, she considers Gary Greenberg's bash, The Book of Woe. Greenberg doubts the entire enterprise of labeling clusters of symptoms. The new DSM-5 supposedly used ethical, empirical trials to verify that its categories are discrete, or at minimum that professionals would agree on diagnoses. Greenberg exposes the fallacy in all that, and says the American Psychiatric Association rushed to publication without adequate reliability testing because it desperately needed the money from its sale.
The new DSM tries to describe disorders so prescribers can choose appropriate medications. But even though more people than ever take pills to moderate feelings and behaviors, nobody's ever seen brain markers for specific illnesses, and as Dr. Tavris notes, "no lab tests yet exist for depression, schizophrenia, bipolar or obsessive-compulsive disorder, or, for that matter, any other mental disorders."

But plenty of professionals dismiss the touchy-feely aspect of therapy, and prefer nice, neat medical definitions, just like other illnesses have. The taxpayer-supported National Institute of Mental Health is spending our money basing a new competitor volume to the DSM-5 on exactly that idea, according to director Thomas Insel: "Mental disorders are biological disorders involving brain circuits that implicate specific domains of cognition, emotion or behavior." That one should be a really fun read.
But there has to be a middle road--don't some disorders have emotional or situational roots, while others are malfunctions of brain circuitry? It's also not an either-or thing--many disorders are combinations of both--and the proportions of physiological versus mental components in a single person's disorder can fluctuate. We just don't know enough about the mind-body connection to get haughty.
But docs are haughty enough to load the Psychiatric Association's manual with so many disorders that any creative or idiosyncratic person can surely find herself somewhere in its pages. Allen Frances, editor of the previous edition of the DSM, knocks the current volume (in his own new book, Saving Normal) for "new diagnoses that would turn everyday anxiety, eccentricity, forgetting and bad eating habits into mental disorders." Dr. Tavris responds that Frances' own DSM-4 "gave us a Disorder of Written Expression, Caffeine-Induced Sleep Disorder and Age-related Cognitive Decline, all of which I suffer on every deadline." Beneficiaries of Obamacare take note: you can be eligible for treatment as a result of normal living.
We need to see both individuals and diagnostic categories as fluid and changeable, especially since psychiatry is such an inexact science, but instead, we wrap our identities around them. But where does that leave the likes of me--a psychologist and not a psychiatrist? This is an issue I haven't seen discussed: that psychiatrists, those med-school-trained prescribers of pills that alter brain chemistry, wrote the book for the rest of us therapists, the ones whose best and only weapon is talk.

I see therapy as educating clients about patterns that keep them in nonconstructive habits, and suggesting personalized alternatives that allow them to reach their goals. Great for problems where the client can control his feelings or the situation, but what of the person whose anxiety comes unpredictably, or whose overwhelming compulsions have no logical basis?

I'm with the NIMH in seeing that brain chemical-altering medications can greatly improve not only serious disorders like schizophrenia, but many of the "neuroses" that we previously ascribed to volition. There's probably no way to know what part of behavior is physiologically/neurologically/hormonally caused and not really under a person's control, versus what part is psychological and attitudinal. Increasingly, researchers are finding that the physiological plays a dominant role in disorders.
Even if medication is likely to work, prescribing is an art, not a science, often a hit-or-miss dance where symptoms recede and return. The same medication may alleviate symptoms for one person and exacerbate them in another, even when both seem to have the same problem. Or the dosage or manufacturer may be the critical variable, and in any case, hitting the medication sweet spot with minimal side effects and maximized benefits is a personalized journey of trial-and-error.

That leaves the question of the usefulness of the DSM-5. With so many political, social and financial ramifications, collecting symptoms into diagnoses is fraught with peril.
To offer a controversial example: Plenty of people (gays included) continue to suffer from being homosexual or belief that it's deviant, even though it was deleted as a disorder two Manual editions ago. The justification for the cut would be that the diagnosis itself created suffering, and that once homosexuality is fully accepted, gays can be at ease with their orientations. But if that's the case, then expanding the number and scope of disorders, as the new Manual does, increases our nation's woe.

But somebody's gotta put names to what's ailing the populace. I have a friend whose 25-year-old daughter lives with Asperger's Syndrome. When the girl was growing up, before her problem was identified, the mom faced a frustrating and heart-wrenching task finding the right school for her. The girl "bounced off the walls," acted inappropriately, and couldn't follow through on anything. Once she was diagnosed with Asperger's Syndrome, the family could finally make sense of her symptoms and stopped blaming themselves. This allowed them to better shape their expectations of her, and more confidently approach sources of help.

So slotting symptoms into diagnoses offers both benefits and drawbacks. Sometimes, though, individuals slide through the slots onto a conveyor belt to certain standard treatments--when the patients would be better off as a unique sum of their particular assets and issues. As we learn more about the mind, what we discover is that its workings are more complex than we thought, not less. Its foibles become less likely to fit into defined parameters, and become more defiant of labeling--just as we're locking down those very labels in authoritative "bibles."
Mental health professions should heed Dr. Tavris' suggestion for responding to the revered tome: "If people treated the DSM the way most treat the other Bible--nod their heads to it, say they believe in it, and continue sinning--we might be all right."

Friday, June 7, 2013

Dismiss your Anger and Accept Your Mistakes--Two Useful Themes

I'm a huge fan of professor, writer and psychologist Carol Tavris. She's got two themes that help navigate life, every day. One of them aids when you're faced with difficult people and frustrating situations, and the other explains the way President Obama and his crew gets away with so many huge imbroglios.

On the personal level, here's a tip for when you get mad, from Dr. Tavris' first book (Anger, the Misunderstood Emotion): Anger builds on itself.

When I first started out in private practice, I accepted the idea that expressing one's anger was therapeutic. Get it all out there; let it fly. In graduate school, I learned that padded bats, bobo dolls, (those bounce-back sand-weighted inflatable figures), and pillows all helped clients cope with frustration, anger and stress. Primal Scream therapy was a famous modality (not a Scottish rock band), a way to tap deeply-seated rage from childhood. Past lives regression to repair soul damage from pre-birth experiences led to many hypnosis-enabled outbursts.

"We're mad as hell, and won't take this anymore!" righteously shrieked "Network's" character Howard Beale, the perfect icon for sensibilities of the era.

Then Carol Tavris actually looked at what researchers knew about anger. Oops: all those strategies for releasing rage actually backfire. Once you're angry, if you dwell on it, you just get angrier. If you and your spouse "share" your ire, it turns to fire rather than reconciliation. Each party increases the stakes and feeds off the other's intensity as fights escalate. My clients found this useful; they learned to redirect their anger or calm down.

Now we turn to another theme from Dr. Tavris that relates to recent headlines concerning Pres. Obama.

It's capsulized in the perfect title of her third book (2008, with Elliot Aronson), Mistakes Were Made (But Not By Me). The subtitle really isn't needed, but it's "Why We Justify Foolish Beliefs, Bad Decisions, and Hurtful Acts."  Everyone knows why we justify ourselves but just look at the news to see how cleverly the administration uses this technique to protect the POTUS from blame.
Some examples: The IRS targets only conservative groups for invasive scrutiny when they apply for nonprofit status; agency head Lois Lerner proclaims she did nothing wrong and then takes the Fifth Amendment. "Mistakes were made, but not by ME!" (Now left-leaning reporters are scurrying to show that non-conservative groups faced equally intense investigation.)

Requests for defense of the Benghazi, Libya consulate last September were ignored and four people die, covered up by UN Ambassador Susan Rice hitting Sunday Morning news shows swearing the attack was fueled by upset over a YouTube video. The President and Hillary Clinton shrug about their 24-hour "war-room" eye into the action there. "Mistakes were made, but not by ME!" Interestingly, Susan Rice, who appeared to be "thrown under the bus" a couple weeks ago when trotted out to quell outrage about Benghazi, is now rewarded by a promotion to advisor to the president on foreign affairs, and will ostensibly wield more power than before, "at the elbow of the president."

Dr. Carol Tavris

Editors' and reporters' phone records at the Associated Press were secretly collected by the Justice Department last month, in a frightening demonstration of government intrusion on press freedoms. US Attorney General Eric Holder claims no knowledge, passing the buck to his deputy, Eric Cole. In a perfect "Mistakes were made, but not by me!" statement, he said on May 15 he'd "recused himself" from involvement. How convenient.

The "mistakes were made, but not by me" response works. A couple weeks ago it looked like the president had, as Ricky Ricardo famously intoned about Lucy, "a whole lotta 'splainin' to do!" And now, all three stories are fading. Nothing of substance will result from these shocking revelations, and certainly nobody's recanting denials, claiming responsibility--or admitting hiding the facts. Instead, "...not by me!" keeps echoing as more information comes out and the administration mops up. Yes, it's an effective way to distance, using that passive, third-person voice. Keep that in mind when you need an effective diversion from the truth.