Just a drive-by post. I'm in the middle of writing a much longer one, but it's taking me a while and I didn't want to go too long without posting.
There has been a fair amount of discussion in the mainstream news media recently about veteran suicides:
Miami Herald story
CBS news story
Rawstory
This really highlights the "environment" vs. "individual biology" question a lot of people struggle with when dealing with mental health issues. I think most people would agree that soldiers aren't predisposed to mental illness, although they may be, as a group, less able to access care (this is especially true of older veterans, as opposed to Iraq or Afghanistan war veterans), which could in turn influence suicide and attempt rates. But I think it's also clear that the experience of conflict can be extremely damaging. (I've written about the psychological stresses of battle - especially the stress of overcoming one's natural revulsion at the thought of killing another human, and the attendant guilt - at my other blog, here.)
Obviously individual differences play a major role here, otherwise many more people would be suicidal. But at the same time, I think it would be foolish to claim that the trauma of war is not causing, at least in part, some of these soldiers' suicides. If we can accept that the environment is systemically producing "mental illness" in these soldiers, why can't we accept that it might be doing so in other circumstances and in less obvious ways?
Saturday, February 23, 2008
Suicide and War
Saturday, February 2, 2008
On Disease
There's an article by Bruce Levine up at Alternet about Oppositional Defiant Disorder (ODD).
In 1980, the American Psychiatric Association (APA) created oppositional defiant disorder, defining it as "a pattern of negativistic, hostile and defiant behavior." The official symptoms of ODD include "often actively defies or refuses to comply with adult requests or rules" and "often argues with adults." While ODD-diagnosed young people are obnoxious with adults they don't respect, these kids can be a delight with adults they do respect; yet many of them are medicated with psychotropic drugs.
Apparently the diagnostic criteria listed in the DSM-IV-TR are:
• Deliberately annoying people
• Blaming others for own mistakes
• Easily annoyed
• Angry and resentful
• Spiteful or even vengeful
Meeting four out of five of these criteria gets you a diagnosis of ODD.
ODD seems like a perfect example of the way our society pathologizes behavior, especially behavior that we find discomforting. Levine emphasizes the ways in which these behaviors might be a natural response to a negative environment - controlling parents, a school that doesn't meet one's approval or one's needs, etc. He points out that most children diagnosed as ADHD will show no symptoms when engaged in an activity that they've chosen and they enjoy.
While I enthusiastically agree with much of Levine's article, some of the sentiments expressed in the comments disturbed me. I think there is a tendency in this movement to discount the possibility that some people may really be suffering from a disease.
I was raised by a psychologist who is a passionate advocate for mental health parity. I have always believed that mental illness is as "real" as physical illness - as cancer or arthritis or the common cold. I support the expansion of health care to cover the costs of treating mental illness (whether with medication, therapy, or some other treatment) and I hope, as most people do, for a day when it is no longer stigmatized. And I think there are clearly some examples which back up this point of view - Alzheimer's disease, drug addiction, disorders which involve severe psychosis, just to name a few.
So for me, seeing certain behaviors as a disease is something that can be empowering. And while I believe in challenging our conceptions of mental illness - what causes it, how we should treat it, whether we should treat it - I think we run the risk of denying people the right to understand and categorize their own experiences in whatever manner they see fit.
I think this is a conflict where mental health and radical psychology advocates can draw something from other progressive movements. I've noticed, for instance, a strong focus among supporters of GLBTQ rights on letting individuals define themselves and their experiences. There is a deep respect for people's autonomy, for the diversity and the validity of each of their experiences. Another example is abortion rights - forced abortion is just as unacceptable as not having access to abortion. That's why feminists work against laws and conventions which pressure women in one direction or the other. Because when it comes to people's lives, choice is paramount.
What is so disturbing about ODD is not that we are given a person a certain label - it's just a label after all - but that we are using that label to justify treating them in certain ways, frequently against their will. When it comes to labeling children, this is even more troubling, as children are less likely to understand their situation, more likely to internalize the opinions and judgments of others. However, we have to be careful not to go too far in the other direction. We don't want to tell someone they're sick, when they're not. But it's not necessarily our place to tell someone they aren't, if they are.
Hat tip to Laurie Corzett on the RadPsych list.
Monday, January 28, 2008
Depression, Learned Helplessness, and Education
I don't think anyone is exactly sure what depression is - what defines it, what causes it, what alleviates it - but there is little disagreement that it is a major problem. According to NIMH, depression affects over 14 million people a year, and when one looks at depression in adolescents and children, the statistics only become more chilling. As many as 15% of all children experience depressive symptoms at any given time, with recent studies suggesting that even preschoolers may be depressed. And depression is strongly linked to suicide. According to the American Psychiatric Association, over half of children suffering from depression will attempt suicide, and seven percent will commit it. Suicide is the fifth leading cause of death among those 5-14 years old and the third leading cause of death among 15-24 year olds.
Given the wide-spread and long-lasting effects of depression, I think it is important to embrace a variety of theories, experiences, and treatments, especially those which challenge our assumptions about the kinds of things which can "cause" depression, and the types of treatments which can "cure" it.
At the same time, let me preface this entry by saying that depression is a complex and little understood illness, and what contributes to one person's depression may have little impact on another's. I'm not trying to describe or explain everyone's experiences here, only provide a theory that might help us understand (and maybe prevent) the suffering of some.
You'll see me writing about learned helplessness a lot - it's one of my personal favorite theories, and I believe a number of social ills, such as political apathy, are partly caused by it.
So, what is it? The theory was first proposed by Martin Seligman, a researcher at Cornell University in the late 1960s. In a series of experiments, Seligman harnessed two groups of dogs and subjected them to painful electric shocks*. The first group of dogs could end the shocks by pressing a lever in their cage. The second group was "yoked" to the first - that is, the group two dogs received shocks of the same intensity and length as the group one dogs, but to the group two dogs, the shocks seemed to be coming completely at random. Seligman found that the group one dogs recovered fairly quickly from their experiences, whereas the group two dogs developed symptoms of chronic depression.
Following up this experiment, Seligman put the dogs in a new type of cage called a "shuttlebox". This cage consists of two chambers, both of which are electrified and can potentially provide shocks. However, only one side gives shocks at a time, and it is possible to avoid shocks entirely by learning to recognize patterns or learning to associate a conditioned stimulus such as a flash of light with the shock. Basically, the dogs were put into new situations where once again they were exposed to electric shocks, except in this case, all of the dogs were given the opportunity to learn to escape them.
Seligman found that dogs in the first group - those who had previously been able to control the shocks - learned how to escape from shocks in the shuttlebox. The dogs in the second group did not even try to escape the shocks - they just laid down and whined.
Take home message? If you put a dog - or, possibly, a human - in an environment where they have no control over the negative aspects of their lives, not only will they be traumatized by it, not only will they conclude that they're helpless in this situation, they'll learn that they're helpless in other situations, too. Many of us who have experienced depression will recognize that sense of helplessness - that feeling that nothing we do will ever let us escape. It doesn't extend to every facet of our lives, but it is pervasive.
So that's learned helplessness. How does it relate to education?
There is nothing that dominates a child's life quite like school. Eight hours a day, five days a week, nine months out of the year - and often more, if you consider the hours spent on homework, discussing school with friends and family, or participating in school-like activities such as Hebrew School or Sunday School. This is not a temporary emersion, either. Most people attend school from the age of three or four to the age of eighteen. That's fourteen years - one hundred twenty six months - two and a half thousand days - twenty thousand hours. By the time you graduate high school, you've spent a full fifth of your life in school. And you have little choice in the matter - education is a given, legally required and socially expected. While other options exist - home schooling, Montessori and Waldorf schools, and some special charter and magnet schools - for many children this is simply not feasible, either due to their location, lack of funds, or a simple ignorance that these other options exist.
If a child really enjoys regular public school, then this is not much of a burden. But if a child dislikes school, for whatever reason - peers who bully them, an inability to sit still, an interest in subjects not commonly taught at school, teachers who are unable to meet their needs, either because they learn too fast, too slow, or just differently - and these problems are not addressed, then the child becomes one of Seligman's dogs, subjected to a painful stimuli again and again, unable to escape, left only to lie down on the floor of their cages and whine.
Is it any wonder, then, that so many children are depressed? That they feel helpless, hopeless, unable to control their own lives? While many young people's depression may be caused by problems outside of school, problems with drug abuse, or neurobiological reasons, it seems foolish to discount the possibility that their depression is being caused or at least exacerbated by an environment over which they have little control.
There has been a fair amount of research into learned helplessness as it relates to children who do poorly in school, especially special education students, although few emphasize the link with depression. However, what I'm proposing is broader than that. A gifted student who has no trouble completing assignments may still develop a learned helplessness response to school if there is some other aspect of school that bothers them and is not being addressed. Imagine a student constantly bullied who turns to teachers and parents for help and is told to grow a thicker skin. Imagine a child who can't sit still - who finds it painful and exhausting to try to do so - but who is yelled at every time they try to get up. Imagine someone who loves astronomy, radical theory, rap music, but who is frustrated and resentful that they have to learn geometry instead. The problem lies with the totalizing nature of school. If parents and educators do not help the student, or help the student help themselves, well, no wonder they begin to feel helpless. No wonder they begin to feel depressed.
If we accept that the school system itself might be a contributing factor in depression, then there are a number of potential steps we could take to combat it. Relaxing school requirements for depressed children, offering students more choice in shaping their school experiences, and treating complaints of bullying, boredom, and unhappiness as more than just "something everybody goes through" are only the most obvious options.
When it comes to combatting childhood depression, we need to be willing to consider radical solutions.
References:
Seligman, M.E.P. and Maier, S.F. (1967). Failure to escape traumatic shock. Journal of Experimental Psychology, 74, 1-9.
Saturday, January 26, 2008
Mission Statement
The word radical means "from the root". To be a radical, then, one must always be looking at the roots of problems, questioning fundamental assumptions and going beyond common understanding and conventional wisdom.
In the context of psychology, we take radical to mean a commitment to challenging the status quo and exploring new ideas. This blog has three main goals:
1) a new approach to psychological issues which forgoes common conventions and draws inspiration from feminism, queer theory, anti-racism, disability rights activists and radical politics, among others
2) critique of psychological institutions and standards such as the DSM, pharmaceutical industries, and academia
3) exploring ways in which psychology can inform political and social action and thought
We hope to build a community of people committed to these goals and dedicated to a vibrant, respectful discussion of our experiences and issues. We believe that establishing a community which values the experiences of professionals and laypeople alike is one of the most important aspects of radical psychology. As such, we invite comments, criticisms, and contributions. So long as you speak with respect, anyone is welcome here.
~ Kale & Shauna