The NYT has an interesting article that highlights the constant need for humility and objectivity when treating people with mental illnesses by Michael W. Kahn, M.D. titled “When Battlefield Humor Backfires.” Here is an excerpt:

Consider an emotionally volatile patient whom the doctors pigeonhole as borderline. Curiosity about her behavior vanishes, replaced by a pseudo-certainty about “how to handle” her. Clinicians assume that all borderlines cut themselves and “split” others (that is, pit one caregiver against another), that they violate established boundaries and need firm limits.

But this is more a composite caricature than a real person, a patient who obediently lives up to the very low expectations held by her caregivers. The defiant or untrustworthy patient — the alleged sociopath — suffers a similar fate. Everyone “knows” that sociopaths are liars and manipulators, cannot be trusted and need to be treated with an iron fist. The fact that lying and manipulating exist on a continuum of severity and can at least have semiproductive uses (Congress, are you listening?) is obscured by moral outrage.

And so the doctor’s determination not to lose a contest of wills undermines the opportunity to have successful discussions about treatment. The patient instantly senses that the doctor distrusts and dislikes him, and this, coupled with the patient’s lack of respect toward authority figures, leads to a rapidly deteriorating situation, often ending in a discharge against medical advice — much to the team’s relief.

Quinn O’Neill at 3 Quarks Daily has a post titled “A Rational Approach to Irrationality.” Here is an excerpt:

If we are to be rational and scientific, we ought to appreciate the value of diversity and the role of evolution in shaping our minds. We are predisposed to delusional thinking because our brains have evolved this way; it was evolutionarily advantageous. It is human nature to be somewhat delusional. To expect people to be perfectly rational is to ask us to defy our own nature. It isn’t reasonable.

None of us is completely rational. Many of our social conventions have no rational basis, and some of the things we do to be sexually attractive or likable are just plain ridiculous. I consider myself to be relatively rational, yet I often find myself doing things that don’t make a lot of sense. I reconcile this with the words of Walt Whitman: “Do I contradict myself? Very well, then I contradict myself, I am large, I contain multitudes.” We are complex animals.

(Find the image above here.)

Talking to people all of the time about the arc of their life, where they were, where they are, and where they want to be you can get a sense how many of us don’t view our lives as a work in progress. Our limited view of ourselves, others, and the world around us is that everything is and must be happening now. It’s an amazing thing to witness how we don’t see the possibilities and starker realities of our own lives by observing how the lives of others play out over a lifetime. In affect, other people’s lives and history are our greatest teachers for how to move through the world and live a more engaged life. Read more…

Dr. Atul Gawande, the author of the book The Checklist Manifesto: How to Get Things Right, describes the value of developing checklists to deal with complex situations rather than rely mostly on intuition and expertise, although both have tremendous and important value. Implementing a clear criteria for professionals to follow and adhere to and defining each person’s role are fundamental to an individual’s, field’s, and organization’s success. The ability to consistently check in on ourselves individually, as a group, field of practice and/or organization, is how we get it as right as possible.

As an organizational management consultant I witness so many professionals in mental health, social services, the law, and a variety of for and non profit sectors rely on their own intuition and not enough on established procedures, clearly defined roles, and the facts in front of them. Our procedures, roles, and the facts, are the structure we build to remain focused, consistent, and a part of a team of players trying to achieve specific goals. Complexity is always swirling around us, waiting to trap us into thinking we have the answer when at times there are none. Checklists, roles, and recognizing we are a part of a team of people grappling with issues allows us to remain humble in the presence of what we don’t know or haven’t figured out yet.

The NYT’s Consults section has a post titled “Is Sexual Anorexia the Flip Side of Sex Addiction?” that interviews Dr. Drew Pinsky, asking the question “Is Too Little Sex as Much of a Problem as Too Much Sex?.” Here is an excerpt from Dr. Pinsky’s response:

Categorically, professionals do take this problem very seriously. It is often referred to as sexual anorexia, and it is treated with the same rigor as sexual addiction.

Many times patients with sexual addictions and compulsions will have a “bipolar,” so to speak, swing to their sexual desire, in which they may move between periods of intense sexual activity followed by periods of sexual anorexia. Treatment usually is a slower process and does not require the sort of immediate interventions like an inpatient rehab that would be directed toward behaviors that can become threatening to livelihood, legal status and even one’s very life.

Read more…

We continue to have a strong sense that people want information that challenges them emotionally and intellectually. In fact, we tend to search for content that illuminates, inspires and mirrors our reality. For us, sharing content and our thoughts is a way of helping others and ourselves in the process. This site and the work of our agency is a testament to the belief that most of us want and can handle difficult subject matter as we look for ways to deal with and get through the challenges we face. The NYT has an article about research study showing what kind of content people like to share titled “Will You Be E-Mailing This Column? It’s Awesome” that strengthens this belief and gets at the essence of why sites like ours exist. Here is an excerpt:

But why send someone an exposition on quantum mechanics? In some cases, it, too, could be a way of showing off, particularly if you accompanied the article with a note like, “Perhaps this will amuse, although of course it’s a superficial treatment. Why can’t they use Schrödinger’s full equation?”

But in general, people who share this kind of article seem to have loftier motives than trying to impress their friends. They’re seeking emotional communion, Dr. Berger said.

“Emotion in general leads to transmission, and awe is quite a strong emotion,” he said. “If I’ve just read this story that changes the way I understand the world and myself, I want to talk to others about what it means. I want to proselytize and share the feeling of awe. If you read the article and feel the same emotion, it will bring us closer together.” (Go to nytimes.com/tierneylab to discuss your motives for e-mailing articles.)

(See (nz)dave’s photostream here.)

Following up on such previous posts as “Cultural Symptoms: Depth not Speed” and “Fostering Care: Speed of Thought and the Value of Timing” where we target the need for thinking, feeling, living, more deeply while embracing complexity NPR has a post by Michael C. Kalton titled “The Faster We Live, The Shorter We Seem To Be On Time.” How we perceive ourselves, others, and the world around us is distorted by speed and the need for easy answers and simple narratives. To take more time to see, think, and feel more deeply and live with and through the multiple aspects of people and issues is not fostered enough by our culture.

We look to others to think for us instead of doing the hard work of finding information, making changes, and being accountable to and responsible for ourselves and those we care for and love. The crises we face right now require our attention, commitment, and capacity to see, think, and feel more deeply. In order to meet the challenges we face we start with slowing down, not speeding up, our lives and avoiding as much as possible the many distractions that get in our way. It is not the number of connections we have, how fast we get things done, or how much we can take on in our lives that matters. Take the time, make the effort, and go deep. Here is an excerpt from the NPR post:

This disconnect between our perception of how things work and how things actually work is generating countless planetary and existential crises. We have specialized and elaborated our rapid temporal framework and achieved unprecedented mastery over our immediate circumstances, in the process detaching our responses from groundings in the slower processes of nature. We have become the fastest-living creature on earth, producing more than the earth can absorb or sustain, changing entire ecosystems and environments faster than lifeforms can adjust, and straining our own capacity to deal with our ever more dense, eventful, experience-packed lives in which the dominant feeling is that we never have enough time.

(See the image of perception and others like it here.)

Job numbers continue to be tough for the working people and the term “discouraged workers” can best describe the employment climate we are in. This population of people who have not found work yet or fallen out of sight and off the map because they have not worked for so long has always been with us. It should be noted that people who are placed in this category of “discouraged workers” are rarely discussed openly or as a part of the unemployment numbers for a general audience unless it is an extremely difficult economic time like the one we are in. In fact, I can’t recall since I have been tracking the discussion of unemployment numbers for the past twenty plus years where we have looked so deeply and openly into who is in fact unemployed for a broader audience.

The unemployment number of ten percent does not fully illustrate the real numbers of people who are underemployed or don’t show up on any index as if they have disappeared. I have wondered this last year if the idea of ten percent unemployment itself as we dial in on it and use it as a barometer for our economic health won’t be around with us for some time. These numbers and percentages are more symbolic then detailed for most Americans that hear them. Ten percent is the new indicator that we are not doing well enough. You hear pundits talk about getting back to seven percent or lower unemployment as if this dictates that we are in a fuller recovery. But, what about all of the people who are and will always remain in the shadows of our economy. They don’t go away just because a group of pundits and economists with their own agendas say we have reached a certain threshold of recovery. Read more…

University of Oxford mathematician Peter Donnelly “reveals the common mistakes humans make in interpreting statistics — and the devastating impact these errors can have on the outcome of criminal trials.” He discusses the importance of exploring genetic differences to “have a window into the way disease works” as well. This lecture can be particularly relevant when thinking not only about how statistical evidence is used during trials, but also when thinking about how the diagnostic process can and should work in terms of identifying the chances that someone has a psychiatric disorder like autism. As he says in this video, “It is very well documented that people get things wrong. They make errors of logic in reasoning with uncertainty.”

We see this uncertainty, fueled by anxiety and fear, when probing behaviors and symptoms we don’t completely understand or have answers for yet. We use available statistics in these circumstances to fit our need for definitive answers. The greatest challenge we face is holding the tension of uncertainty and not reaching beyond what we know for an answer. Real understanding, administering justice, and developing effective diagnostic models and treatment plans for people who are suffering and their families, comes from our capacity to grapple with and hold uncertainty, randomness, and chance in our everyday lives.

(Hat tip to Dr. Shock.)

We spend a lot of time reviewing the latest developments in neuroscience for the discoveries of how the brain works and the ways in which we can reframe our understanding of behaviors and emotions. Behaviors and emotions are what we track. What we are most interested in knowing is can a person change certain behavioral patterns as he or she ages? The idea of a person being set in his or her ways at a certain point in life or as the saying goes “you can’t teach an old dog new tricks” intrigues me. After repeated failed relationships, trying to get away from responsibilities, not being accountable for his or her actions, a history of abuse/violence, and numerous other failures is it possible to learn to be responsible and accountable after so much time has passed? Read more…