Dx's and Rx's for kids...

Children Labled as "Bipolar" up 4000%

     Articles like this one on diagnosing (Dx) and the changes that come from it are often unsettling to me. For every one true case of childhood bi-polar, conduct disorder, ADHD, and the other “hot” childhood psych disorders, there seem to be thousands of others who just the same label without merit.
     This article hints at that it helped many doctors prescribe meds for the children (I’m hoping they mean psychiatrists, and not just general practitioners). That’s truly disturbing as well. Psychotropic meds aren’t like Advil. These drugs have major, long lasting side effects and, unless there’s a true chemical imbalance, can be very harmful.  There’s often many other causes for why some acts the way they do, besides poor brain chemistry.
     I can’t tell you how many charts I’ve looked at that have a wrong Dx, a mutually exclusive Dx, or a list so long of Dxs that it took up half a page.  This often happens so that people can get reimbursed for treatment. Insurance companies don’t like paying for preventative psych services, or psych services that will take a long time.
     It often seems like they’re much more willing to pay lots of money for extremely strong meds that lead to other health problems to deal with underlying issues, rather than spending a little more at the beginning to help the person learn to cope and eventually get off the meds. So essentially mopping up the water on the floor and turning off the running faucet at the same time as opposed to just putting lots of paper towels down.

How to get your [co-worker, neighbor family member, pet, significant other] to do what you want – Part 3

I’m a drug dealer. You’re a drug dealer. The fix we give is so good people will work hard for it, people will literally clamor over each other for it, some commit crimes for a fix, and babies die without it. What’s the fix? Attention.

In part one and two I talked about planned ignoring, and positive reinforcement, here’s how to tie them together via selective attention, a very powerful tool.

Part of being social animals means we all crave attention and praise. Sure the level varies from person to person. We all know people who want it all the time.  They’re the ones always trying to be in the spot light, and all but the most reclusive hermits want at least a little attention.

This is part of what makes therapy such a unique experience for people. In theory, therapists are expert attention payers, we listen, processes and respond to you. It’s often very Fight Club-esc, “…They really listen to you instead of just...Instead of just waiting for their turn to speak.”

Since attention and praise is so powerful, giving out a little extra here and there can work wonders in shaping someone’s behavior in all kinds of environments. Stopping a kvetch? Easy. Constant complaining is one way of scoring some attention, although it also usually repels people shortly after. Now remember, you’re the person who handing out their fix, so give it out on your terms.

You- ::look them in the eye and give your full attention:: “Hi Bob! What’d you do this weekend?”

Bob- “Ehh, nothing really, it was too short, now back to the grind of data entry for our terrible boss, I think she knows how looking at the screen gives me migraines…”
You- ::go back to doing paper work as soon as the complaining starts::

Bob- “Yeah, but no migraines this weekend, just nice and quite with the wife and kids.”
You – ::look them in the eye and give your full attention when hearing the little positive things:: “Sounds Nice! How are the little one’s doing?”

If you keep going like this, pretty soon Bob’s behavior will change to get the most attention possible. Just keep giving Bob a fix of attention when he’s acting positively and don’t pay him any mind when he’s not.

Same thing works for getting work done on time, or ahead of schedule. Improving organization, phone habits and anything else really. Once you get the basics of this down, you can use Shaping and Chaining to get just the kind of behavior you want from people, even if they’ve never done it before.

Mind, Body, Stim.

According to a new journal article, we move our bodies forwarded when thinking about the future, and lean back when recalling the past is a great. I’m always amazed how strongly thought, stimulation and body are tied together. Thought I shouldn’t be. There are lots of articles about how people’s thoughts that things are harming them make, them ill. Airport security screeners think that honey is a bio weapon and make themselves sick enough to go the hospital. And "ElectroSensitives" get better over night once they're told a radio tower is off, even though it's really been off for a month already....

The reverse is true too. NPR’s Radiolab recently did an excellent show on placebo affect (scroll down on the show panel on the right hand side for the podcast) the final segment, on how even doctors wearing white coats has been shown to help their patients get better is.

Stimulation is also so key, but so few people every think about it explicitly.
ARC’s Snoezelen room does amazing things for people. While it was developed to work with adults on the autism-aspergers spectrum, everyone loves it.

Most people regulate their stimulation level from different senses implicitly. Choosing clothes with a fabric you like (tactile), tapping your foot or spinning a pen (proprioceptive), choosing a scent (olfactory), going for a walk or a run (vestibular). Those are just a few ways we modulate our stim level, and one of the main features of people on the autism-aspergers spectrum is marked difficulty in managing their own stim levels. Have you ever been somewhere and the lighting was to high or too low? The music was too much, or not enough? You felt bored or much too stimulation? Makes you feel gross right?

A Snoezelen room is the exact opposite. The person running the room changes all the aspects of stimulation in the room (and there are toys, and a chair that makes you feel weightless, and different areas and textures and a little alcove and…and…and…) so that you can find exactly the correct amount of stimulation you want and it does amazing things. Your muscles relax, your head clears and often develop this great sense of well being. It’s a lot like waking up from the best nap ever.

Our thoughts, our environment, and our bodies all play off one another. It’s almost comical to me how people organize school, work and sometimes even out own homes in ways that our culture says is appropriate and the “best way” to get things done, and then everyone in there fights against it all day.

Anyone want to help me make the world be more ergonomic?

So Quick To Punish...

One of the major issues I saw while working with people who have intellectual disabilities is how often the people around them, who are there to support them, and help them make the most out of their lives, are so quick to chastise and “correct.”

This seems to be the ruling thought for our penile system, school management and other traditionally institutional systems. They all seem focused on stopping the end disruptive behavior, but seem to invest so few resources in analyzing the precipitating causes. It’s kind of like cleaning up the mess from an over flowing sink, without bothering to turn off the tap.

Does punishment work? Sometimes, but not often. Numerous articles and other work has been written illustrating the failures of the American prison system, a few things get found over and over again, longer, stiffer prison sentences do not reduce crime. What does? Rehabilitation and working on the initial causes that create the problems in the first place.

This works from an economic standpoint as well. Removing drug dealers from the streets doesn’t make drugs go away (unless you get all of the dealers) it just make the drugs that are there more expensive. So what you end up with are addicts going greater lengths to get the cash to buy them. What does remove drugs? Making people not need, or not want them. If there’s no market for drugs, they won’t be profitable and no one will bother to sell them.

Think even closer to home. Think about the last time someone yelled at you. Did it make you think positively of the person? Did it really make you want to change your behavior, or just figure out how to do things so you wouldn’t get yelled at next time?

All behavior is communication, misbehaving is communicating that there is a need that isn’t being addressed. Either there’s a lack of understanding, resources, or ability in being able to meet the need in a better way. Fix that need, replace it with a “better” behavior and there’ll be no more need to yell.

We need a mask for the outer world…?

I was listening to an interview from npr and that statement was made. It caught me off guard. I think most people agree with it, but why? Why do we need a mask? What does it do for us? Keep “us” safe? Safe from what?... Before I built a wall I'd ask to know
What I was walling in or walling out… I just re-read mending wall, (go ahead, it only takes a min or two) Why keep ourselves safe from being known…. There is no difference between those who cannot read and those who do not read according to Mark Twain. Is there a difference between the struggles of being unknown, or being known and being rejected? Maybe, at least if you’re known to yourself and others then the “option” of being accepted exists….

How to get your [co-worker, neighbor family member, pet, significant other] to do what you want – Part 2

Planned ignoring, while effective, is not a very fun way of interacting with people. It takes a lot of consistency and fortitude and generally causes headaches before the major results kick in.

The best way to get people to act how you want is by what’s called “Proactive” positive behavioral supports. This is by far the effective and enjoyable way to effect change in people. It’s simple, effective, and makes you feel good too.

So here’s what it all boils down to “Go out of your way to tell people you like what they’re doing.” Yep, that’s it. A few well placed “thank you”s and some pats on the back will make everything great. How does that happen you ask? And why then isn’t everyone great now?

Two things:

First, very few people go out of their way to give compliments and approving statements.

Second, the person shouldn’t be doing something extraordinary, they should just be doing behavior you’d like to see them do again in the future.

Your significant other takes out the trash for you? Give them a compliment. Your child is sitting quietly focused on their homework? Tell them how great they are for doing their math. Your dog has happily greeted you at the door without jumping all over you? Milkbones for everyone!

I know this all seems crazy. I mean, why should people get praise for doing what they’re doing anyway? That’s the “trick” with this stuff, anytime you reward a behavior, you make it more likely for the behavior to occur again.

This usually works pretty quickly, and once you get into the habit of it, you can start getting into the fancier techniques, and getting totally new behaviors you’ve always dreamed of but never thought possible. Some day, you too could have children who clean their rooms on their own, a spouse who interacts with you how you want, or a staff who’s ahead of their work. :-)

Are Terrorism and Borderline Personality Disorder a Difference of Scale?

Right off the bat let me state three things.

1.) I do not support terrorism, I do however think exploring its cause can lead to an understanding of why it is used, how it can be dealt with, and how it can stopped before it starts.

2.) I am not implying in any way, shape, or form that have knowledge of the mental status of people who are involved in terrorism. I do, however, think that there may be parallels “terrorist activities” as a concept and behaviors that can be used to identify some psychological disorders.

3.) I fully admit to making glib statements and gross generalizations about extremely complex, multi-faceted issues that have people many many many many different ideas and opinions on.

And now! On with the show!

“Once upon a time a famous pirate prisoner was brought in front of Alexander the Great. Alexander asked him: ‘Why do you infest the seas with so much audacity and freedom?’ The pirate answered: ‘For the same reason because you infest the earth; but because I do it with a little ship, I am called a pirate; because you do it with an armada you are called an emperor.’”
De Civitate Dei, Augustine of Hippo

The Parallels that I see:

Purpose of terrorism

To disrupt the environment in a manor that cause people and nations chaos so that; they will be noticed, their distress and grievances heard, in hopes that they will receive what feel they need from the global community to lead a good life.

Purpose of “acting out” by a person with borderline personality disorder (BPD)

To disrupt their environment in a manor that cause the people in their lives chaos so that; they will be noticed, their distress and grievances heard, in hopes that they will receive what feel they need from them to lead a good life.

Causes of terrorism

Some research shows that a good way to get a revolution going and radicalize groups of people is the following: do not allow moderate levels of decent. This tends to push people towards the poles of thinking. “Pangea is the best place in the world!” “Pangea is terrible” because all the people who start saying “Well, Pangea is nice, but I’d like to see some improvements,” Get disappeared and the grievances and concerns of the people become ignored because “hey, it’s only words, besides we’re in charge!”

Now the only voices not being 100% pro-Pangea are the ones who want to tear Pangea apart. The ones who are really upset, and the ones that have been taught that words are not enough to be heard by the powers that be. Their logical course of action? Ramp up the volume. Ramp it up till it’s loud enough that people take notice and work with them to fix the problem.

Causes of “Acting out” by people with BPD
(NOTE: this is not the cause of BPD, just a general idea of why they act out.)

People with BPD feel extremely distressed and need help from the people around them. At some point they learned that saying “I’m upset and could use some support,” would get them in trouble. As such they learned to stay very quiet and not express themselves, but that only works to a point. Once that’s been reached they lash out destructively either against themselves, others, or objects so that people will know how upset they are and have the hope that someone will come in and fix the problem.

Therapy for BPD:
The course of treatment that seems to do the most food for people with PBD is modality called “Dialectic Behavioral Therapy.” Which, at its core, is a combination of having strong boundaries, and teaching the person with BPD how to express themselves moderately, which ideas and expectations they have of others are realistic and which aren’t (along with “traditional” and other types of skill building). Over the course of many months the client and therapist build trust and a rapport. Often during this time the client will act out, to which often the response is “I will not work with you if you are being destructive. We can continue working when you’re calm, and can talk about your problems.” With the key being that the person with BPD knowing and trusting that they will be heard when they communicate correctly.

Potential therapy for “terrorism”
Any terrorist act immediately shuts down communication with the powers that be. No negotiation, no trades, no communication until there has been X months of non-violent activity. The people involved in the terrorist acts must believe that there is an entity that will hear their grievances, and help with support their ideas with in reason.

“No you cannot have your own nation, besides, the land you want doesn’t have an independent infrastructure and ya’ll would be in the dark and hungry with in the week. However, you do make up 3% of the population, so lets work on getting you representation in the government.”

Conclusion
Would it work? Who knows, at best I’m an arm chair political theorist. I do know that the parallels seem strong to me, and I know at least on the scale I’m used to working on it works well. Often people with BPD make you want to pull your hair out and go screaming into the night, but they’re still a great group of people to work with and can have such amazing positive results in the end.