Author: Dr. Jeffrey Rubin

Jeffrey Rubin grew up in Brooklyn and received his PhD from the University of Minnesota. In his earlier life, he worked in clinical settings, schools, and a juvenile correctional facility. More recently, he authored three novels, A Hero Grows in Brooklyn, Fights in the Streets, Tears in the Sand, and Love, Sex, and Respect (information about these novels can be found at http://www.frominsultstorespect.com/novels/). Currently, he writes a blog titled “From Insults to Respect” that features suggestions for working through conflict, dealing with anger, and supporting respectful relationships.

Exaggerating the Benefits of Anger

Post author By Dr. Jeffrey Rubin
Post date October 29, 2014
7 Comments on Exaggerating the Benefits of Anger

“Are you going to vote for the new school facility plan, Marc?”

“No, Phil. It calls for combining the two high schools in our town so that there will be nearly 2,000 students in the combined school. I prefer small schools. I say, keep them small, keep them personal.”

Turning red and glaring into Marc’s eyes, Phil begins to holler, “What are you, stupid? We can’t afford two high schools in this town. You’re nuts!”

The next day. “Hi Marc, you still going to vote against the combining the two high school plan?”

“You know, Phil, I’m hesitant to discuss anything with you. You get angry and you begin to put me down and you start with the glares….”

“Oh, don’t be a baby, Marc. Don’t you know that anger is a good thing. Research shows it can make us push on towards our goals in the face of problems and barriers. And hiding anger in relationships can be detrimental. When you hide your anger, your partner doesn’t know they’ve done something wrong, so they keep doing it. That doesn’t do your relationship any good. There’s also some evidence that anger can be useful as a negotiation strategy. If people see that you are angry, studies show that the other party will make more concessions.”

Now, it is not hard to understand why Phil, and others, might make such statements about anger. After all, if you go on the internet and glance at some of the articles that come up in search engines when we insert in the search box the words, “benefits of anger,” people can get a similar impression as Phil. There is, for example, “The Upside of Anger: 6 Benefits of Getting Mad,” or “When Anger is a Plus,” etc. However, a careful reading of the actual research studies lead one to dramatically different conclusions.

The two biggest mistakes that people make when interpreting the research on this topic is, 1. not taking a good look at what the expression of anger is being compared with, and, 2. not noticing how broadly the term anger is defined. Let’s focus quickly on these two types of mistakes.

Not Taking a Good Look at What the Expression of Anger is Being Compared With

If people only told their partners in their relationship what they feel he or she did wrong when they become angry, then there probably are times when the expression of anger might do more good than never saying anything. In such studies, comparing the expression of anger with saying nothing is, in my opinion, potentially misleading. People can learn to provide negative criticism in a far more helpful way than what we typically call anger (see my post titled “Providing Negative Criticism: Five Levels of Maturity“).

For the negotiation studies that found that people who became angry did fairly well compared to some other subjects who did not become angry, again let’s look at what “becoming angry” was compared to. Those who didn’t become angry really didn’t care all that much about whether or not they obtained the reward. They did make some halfhearted effort to achieve it, but then quickly gave in. Those folks who were confronted with someone who was angry and ended up settling for something that was less than what they would have settled for if they were confronted by someone who was not angry, also had little of real value at stake. They were also given extremely few options to use in the negotiation. Under these types of situations, a person might prefer to give the other party, if he or she becomes angry, a little more than they might otherwise do rather than to put up any longer with what felt to them like abuse.

What would have happened if the study would have compared not only a group of people who portrayed anger during the negotiation process with a group who didn’t, but also looked at a group of individuals who were well trained to respond to negotiation situations with “challenge?”

Challenge allows you to accomplish all of what anger positively does without anger’s negative consequences.

In brief, challenge has us:

Working up a heightened sense of determination to achieve our desire
Meanwhile, we consider the twin beliefs that the stress we have been experiencing is normal and fulfillment is not found in easy comfort, security, and routine, but rather in the continual growth in wisdom through what is learned from negative and positive experiences of an active, changing life[1]
Then, we take a deep breath and resolve to get down to the task at hand—carrying out a two-step process.

Step 1. Consider if the most obvious resolution is sufficient.

In such cases in which you become convinced that the resolution that you came up with poses no serious risks, it makes sense to you, and you feel comfortable with it, the only job you have left is to carry out your plan with charm, courage, and determination. However, if the most obvious solution does pose a serious risk, or you just don’t feel comfortable with it for any reason, it’s time to go to Step 2.

Step 2. Carrying out a more complete decision process.

There are numerous benefits that occur when we learn how to transform anger into challenge. Just becoming angry is, of course, far easier in the short term, but excellent studies demonstrate that those who learn to respond to difficult situations with challenge, in the long run do far better than either just becoming angry or making halfhearted efforts.

Learning to respond to anger-arousing situations with challenge takes some practice, but it can be achieved with practice. You can find free practice sessions HERE, and HERE, and HERE.

Moreover, a great way to learn how to transform anger into challenge is to read the “Cool Steve” trilogy, a series of three novels that portrays a coming of age tale that takes psychological suspense to new heights and sophisticated humor to new lows. Struggling to find respect, our hero faces many of the same struggles we all faced while growing up, and a few not so typical ones as well. Mistakes are made, but in the end, the value of challenge is portrayed in a manner you will long remember.

And so, either to respond with anger or not to respond with anger are not really our only two choices. Not responding with anger actually involves many different choices and one of them, transforming anger to challenge, is one of them, and a distinctly better choice than giving free range to anger.

Not Noticing How Broadly the Term Anger is Defined

In seeking to understand studies that seem to suggest that anger can be beneficial, it helps to look at how anger is defined in those studies. In one study that seems to suggest anger is helpful, the authors make a distinction between constructive anger and destructive anger. They then explain that it is constructive anger that can be beneficial. What they call constructive anger is responding to frustration without name calling or shouting, but with determination to achieve a goal. This sound to me more like challenge than anger.

In another study that talks about the benefits of anger, it was actually mild frustration that was beneficial in increasing motivation to achieve a goal. Despite this, as the authors wrote up the study results they claimed that frustration was a lot like anger, and therefore the results may suggest that anger is beneficial. A quick glance at this study’s results can mislead people because some people who become frustrated don’t begin to yell at people around them, nor do they start to throw insults and threats at them. They may, instead, feel challenged to vigorously respond in a constructive, problem solving manner, and it is these people who may be the ones responding in a more beneficial way than those who act in a manner that is clearly anger. Calling anger, frustration, and challenge all forms of anger, can confuse people into thinking all expressions of anger are beneficial. It would be far better to use words that clearly distinguishes these experiences so that people would be less likely to end up exaggerating the benefits of anger.

OK, so those are some thoughts to ponder for this week. I hope you’ll join us again sometime next week for another presentation on dealing with anger, conflict and respect.

[1] The value of this attitude is discussed in: S. R. Maddi, D. M. Khoshaba, R. H. Harvey, M Fazel, & N Resurreccion, 2011, “The Personality Construct of Hardiness, V: Relationships with the Construction of Existential Meaning in Life,” Journal of Humanistic Psychology, 51(3), 369-388.

———————

Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional intelligence. To begin at the very first post you can click HERE.

Tags anger, challenge, conflict management, free social intelligence and emotional intelligence curriculum, frustration, insults, negotiation, threats

anger conflict management conflict resolution emotional intelligence free social intelligence and emotional intelligence curriculum negative criticism perfectionism providing criticism suicide

Suicide, Perfectionism, and Criticism

Post author By Dr. Jeffrey Rubin
Post date October 20, 2014
7 Comments on Suicide, Perfectionism, and Criticism

Sometimes I’m asked why I write so much about dealing with criticism. The answer mostly has to do with the types of concerns that have been expressed to me over the years. Some involve the desire to be liked and respected. Others have to do with seeking to gain control over anger. And still others come from parents who find that how they go about disciplining their children has been a serious source of stress in their lives. Providing and responding to criticism in a pleasant, thoughtful manner involves skills that can be learned fairly quickly, and are clearly helpful when addressing these types of concerns.

Additionally, conflicts that bring forth negative criticism, if handled in an immature manner, can escalate and result in a destructive relationship between parent and child, the parting of a relationship between two valued friends, the loss of a job, serious injury, and prison time. And then there is the relationship between certain ways that people handle criticism and suicide.

In an earlier post, titled “Teenage Suicide and Cyberbullying: A Case Study,” I wrote about 12-year-old Rebecca Sedwick who had leaped to her death after more than a year of being incessantly criticized by a coterie of 15 middle-school children. Today, once again I take up the subject of the relationship between criticism and suicide because of an article I just read in this September’s Review of General Psychology by Gordon L. Flett, Paul L. Hewitt, and Marnin J Heisel titled, “The Destructiveness of Perfectionism Revisited: Implications for the Assessment of Suicide Risk and the Prevention of Suicide.” It’s written for research-minded people and has far more nuanced information than I can share in a single blog post designed for the general reader. Nevertheless, I’m going to summarize a few of its key points for I think they are very much worth considering as we move forward in our quest to become masters at dealing with name calling, insults and teasing.

Suicide and Criticism

The media is filled with stories about the Ebola virus, which has so far killed close to 4,000 people worldwide, and one person in North America. In contrast, it is estimated that over one million people worldwide, including 40,000 people in North America, kill themselves on an annual basis. Recent U.S. data indicate that suicide is the second leading cause of death among people who are under 40 years of age. For every person who commits suicide, several more attempt it, resulting in anguish for family and friends, and financial costs from emergency room and aftercare services that are estimated to be several billion dollars.

Of course, there are a number of reasons why people kill themselves, but the article I just read makes the following argument:

Chronic exposure to situations and contexts that place excessive pressure (or percieved pressure) on the individual to be perfect can have a destructive effect on most individuals and this is heightened among those people who are vulnerable and hypersensitive to criticism and social comparison feedback. Consider, for instance, the vulnerable perfectionist exposed regularly to a hypercritical parent, (boss/supervisor) or romantic partner who is ever-present and seemingly impossible to please. Alternatively, the vulnerable perfectionist may have a work environment where mistakes are simply not allowed and excessive standards are required by a tyrannical boss.

Now, I hasten to point out that most parents, bosses and supervisors who encourage quality performance don’t cause anyone to commit suicide. Moreover, the vast majority of people who may view themselves as perfectionists, even those who see themselves as particularly sensitive to criticism, don’t end up killing themselves. Nevertheless, the consistent evidence from studies that link suicide behavior with chronic exposure to external pressure to be perfect and the relationship between perfectionistic characteristics and an increased risk of lethal suicide behavior leads one to pause. Perhaps there may be some ways to encourage quality performance without increasing suicide risks.

Ideas about Prevention

Many people who view themselves as perfectionists tend to remain silent about any despair that they may experience. And those who demand that their children or workers be perfect don’t see anything wrong with this. So these people are unlikely to show up and ask to learn some skills to improve their behavior. Prevention programs, therefore, must be designed proactively and implemented broadly to reach these people. Schools, colleges and business organizations, if they are to impact people at risk, must provide education about these issues to their entire population. Thus, Flett and his colleagues recommend the following key themes be incorporated into school-based programs:

(a) fostering self-acceptance and compassion instead of experiencing shame and self-criticism; (b) promoting appropriate goal-setting and goal appraisal versus setting and maintaining impossible standards; (c) combating ambivalence about giving up the need to be perfect since the distressed perfectionist must be highly motivated to change; and (d) developing resilience to feelings of shame and ability to cope with interpersonal conflict and feelings of being rejected by others.

For the work environment, Flett and his colleagues state:

Prevention efforts should include an organizational focus on reducing pressures to be perfect. When perfectionism prevails as part of the culture and values of the workplace, it tends to promote poorer performance rather than superior performance (Gillett & Stenfert-Kroese, 2003) and it is linked with job dissatisfaction, poorer communication quality, role conflict, reduced likelihood of staying, and a poorer perceived fit between the person and the work environment (Balthazard, Cooke, & Potter, 2006; Rousseau, 1990).

Although, as a general statement, these ideas are worthwhile to think about, a far more detailed process is necessary to foster the goals of these researchers. For those who can afford counseling services designed to teach self compassion, along with addressing each individual’s concerns, I recommend working with either of the two counselors described HERE. For those who can’t access counseling services because of the financial costs, although not as ideal as direct one to one counseling, there is available for free a curriculum that teaches the necessary skills at this blog site (see below).

——————————-

Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional and social intelligence. To begin at the very first post you can click HERE.

Tags Assessment of Suicide Risk, conflict management, conflict resolution, criticism, free social intelligence and emotional intelligence curriculum, Gordon L. Flett, insults, negative criticism, perfectionism, relationship, suicide, violence

conflict management conflict resolution criticism emotional intelligence feedback free social intelligence and emotional intelligence curriculum interpersonal conflicts providing criticism providing negative criticism psychological maturity

Providing Negative Criticism: The Newest Guidelines

Post author By Dr. Jeffrey Rubin
Post date October 13, 2014
No Comments on Providing Negative Criticism: The Newest Guidelines

Readers of this blog well know that I often discuss immature and mature ways to provide negative criticism. Originally, I presented a post titled PROVIDING NEGATIVE CRITICISM: FIVE LEVELS OF MATURITY. There, in addition to providing an outline of what I believed was a good starting point to think about this topic, I asked readers for suggestions on how the outline could be improved. Many readers were not at all shy. While this was going on, I continued my own reading, and from time to time, I shared what I had learned. And now, just this week on the internet, I came upon an article that provided a new set of guidelines. I kind of like them, and therefore, decided to see what kind of reaction they might lead to. But first let’s quickly review what we already covered.

THE ORIGINAL FIVE LEVELS OF MATURITY FOR PROVIDING NEGATIVE CRITICISM

Below you will find preliminary descriptions of how people at five developmental levels of maturity provide negative criticism, that is, criticism that points out what we don’t like about someone’s actions, beliefs, or appearance. Level one is the most immature and uses observations of babies as its starting point. Each successive level is more mature:

This level requires displaying one or more of the following:

Cries without stating what the crying is about
Physically attacks the person being criticized
Damages property

Although these three descriptors may not sound like providing criticism, in some situations we can see that it is the very beginning of the development of this skill. Let’s say Jill takes baby Bob’s crayon away believing he is done with it. Bob begins to cry and takes a swipe at Jill. She manages, by moving away, to avoid Bob’s swipe. Bob now looks even angrier and crumbles up a piece of paper and flings it on the floor. An observer to this may conclude that Bob, in a sense, is criticizing Jill for taking the crayon.

2. This level requires displaying one or both of the following:

The criticizer does not explain what the offending behavior is, but instead expresses displeasure with glares, insults, shouting, silence, or threats that do not involve bodily harm. (For example, someone might be making too much noise and the criticizer might turn to the noise maker and glare, or cry out, “Jerk!”)
Threatens bodily harm regardless of what else is said.

3. The criticizer clearly states the criticism with enough detail so the criticized person, if he or she wills, can improve the behavior, idea, or appearance, but couples it with glares, insults, shouts, or threats that are not about bodily harm.

4. The criticizer states the criticism without bodily attacks, damaging property, glares, insults, threats, or shouts, and with enough details so that the criticized person, if he or she wills, can improve the behavior, idea, or appearance. If the person receiving the criticism becomes defensive or angry, the criticizer empathizes without returning glares, insults, threats, or shouts.

5. When the criticizer provides criticism, he or she does so in a manner very similar to a level four response, but beforehand, the criticizer considers the person who is the target of the criticism and the situation that he or she is in. As a result of such considerations, the criticizer may decide to alter the criticism.

IDEAS THAT FOLLOWED

After proposing the five levels of maturity, several additional ideas came my way. One person suggested:

Hey there. One thing that potentially could be even better than a level 5 way to provide criticism would be to ask the person permission to offer them a criticism. You could say like, “hey, would it be alright if I make an observation about the way you handled that situation” or “do you mind if I offer you a couple constructive criticisms about your song” or whatever. Then, if the person says yes, they won’t feel like they are being attacked because they’ve given consent. Or they’ll have the opportunity to say “you know what? I’m really sort of feeling on edge so maybe another time would be better for us to talk.” That way, instead of gauging for yourself whether or not the person is in a state to tolerate the criticism, you can let them decide for themselves. What do you think about this idea?

I responded:

I like your idea. It goes along with considering person variables. For me, personally, I’m almost always up to hearing criticism, even if it may sting. Therefore, always asking me for permission would eventually become tiresome. But until you know someone well, starting off the relationship as you suggest, makes sense. And if, in time, you learn the person is very sensitive about criticism, continuing asking for permission would be the wise course of action.

Others argued that unless you are invited to provide criticism, you should keep your mouth shut. And others argued that even if you are invited to provide criticism, if you don’t have anything nice to say, don’t say anything at all. I address these issues in a post titled, UNSOLICITED CRITICISM: GOOD OR BAD? Very briefly, I agreed that these ideas were worthwhile to consider before providing criticism, but after this consideration there were times when providing uninvited criticism makes sense.

In a post titled “PROVIDING NEGATIVE CRITICISM: A LESSON FROM THOMAS JEFFERSON” I explained that recently I had been reading an excellent biography of Jefferson by Jon Meacham. There, I learned that early in a relationship Jefferson typically avoided mentioning any fault in his new companion. He felt that later, once the relationship was well developed, was a better time to discuss differences of opinion. As Meacham describes Jefferson’s style, “people often talk too much and listen too little, which can be self-defeating, for in many instances the surer route to winning a friend is not to convince them that you are right but that you care what they think. Everyone wants to believe that what they have to say is fascinating, illuminating, and possibly even epochal.” In that line of thinking, Jefferson advised a daughter: “Much better…if our companion views a thing in a light different from what we do, to leave him in quiet possession of his view. What is the use of rectifying him if the thing be unimportant; and if important let it pass for the present, and wait a softer moment and more conciliatory occasion of revising the subject together.” Now Jefferson clearly recognized there was exceptions to this general rule, but nevertheless it makes a great deal of sense that whenever we are tempted to provide negative criticism careful consideration of this idea makes sense.

Another set of comments came from a few parents who argued that although the five levels of maturity made sense when adults were interacting with other adults, when parents provided negative criticism to their children, yelling, and even hitting were perfectly permissible. I responded to this in a post titled, PROVIDING NEGATIVE CRITICISM: DEFENDING THE FIVE LEVELS. The issues this raises are simply too complicated to summarize here, so I’ll just refer interested readers to that post.

Finally, someone on Facebook presented the idea that it is helpful to use the sandwich approach to providing negative criticism. Here you begin with a slice of some positive comment, then you put on top of that the negative criticism, and then, on top of that, you provide another slice of positive criticism.

OK! So, basically, in a very abbreviated manner, those are some ideas we have already discussed. Now, to a new set of guidelines.

Philosopher Daniel Dennett’s Approach to Providing Negative Criticism

Recently on the internet I came upon a post by Maria Popova titled, “How to Criticize with Kindness: Philosopher Daniel Dennett on the Four Steps to Arguing Intelligently.” There I learned that Mr. Dennett has provided the following guidelines for composing a successful critical commentary:

You should attempt to re-express your target’s position so clearly, vividly, and fairly that your target says, “Thanks, I wish I’d thought of putting it that way.
You should list any points of agreement (especially if they are not matters of general or widespread agreement).
You should mention anything you have learned from your target.
Only then are you permitted to say so much as a word of rebuttal or criticism.

I kind of like this. Whereas it is not inconsistent with the original five levels of providing negative criticism, it provides some additional ideas to consider.

Over the course of a week or two I’ll come up with some specific examples that demonstrate Dennett’s approach. Until then, my best wishes to you all,

Jeff

———————

Tags conflict management, conflict resolution, criticism, Daniel Dennett, dispute management, feedback, free social intelligence and emotional intelligence curriculum, negative criticism, providing criticism, psychological maturity, respect, Thomas Jefferson

conflict management conflict resolution DSM Name calling psychiatrists psychiatry The Diagnostic and Statistical Manual of Mental Disorders

Psychiatric Name Calling: Is it Helpful?

Post author By Dr. Jeffrey Rubin
Post date October 6, 2014
14 Comments on Psychiatric Name Calling: Is it Helpful?

Today I offer a follow-up to my earlier post titled “Name Calling by Psychiatrists: Is it Time to Put a Stop to it?” Among the points that I had tried to make is that psychiatrists falsely claim that the names they use to describe patients are “diagnoses.” In actuality, all that they do is convert someone’s expressed concerns into medical jargon.

I received a great deal of positive and negative comments about the post from readers, but my focus today is on the negative ones. Most of them argue that in contrast to my position, they had personally found their psychiatric diagnosis very helpful.

Those who Found the Psychiatric Pathologizing Helpful

I just finished an excellent book on this topic by Lucy Johnstone titled, A Straight Talking Introduction to Psychiatric Diagnosis. There we find several quotes from people who received a so-called diagnosis from psychiatrists and spoke of its positive personal impact. For example, some felt that it provided relief at knowing “what was wrong.”

I had something that I could firmly grasp, and, you know, I could find out more and try to resolve it…[I] felt relief that this whole jungle was going to be sorted out.

Another person wrote,

It gave me the comfort of explanation…. When I was told I was depressed it gave me a framework of understanding and a first grip on what was happening.

Some felt that it gave them hope for treatment and support.

Illness meant treatment and the possibility of cure.

Acceptance of my illness was a turning point…. By accepting treatment I could actively seek the right medication, access support, and turn my life around.

I think I prefer my illness having a name because it makes me feel less lonely, and I know that there are other people experiencing my kind of misery.

Then there were those who felt it provided them freedom from blame and guilt.

Diagnosis implied that this was an illness and not my fault—important for someone whose depression has always been riddled with guilt.

Commentary

Although there are many, many people who feel this way, Ms. Johnstone points out that the relief that these people experience is based on their assumption that the diagnosis itself is valid. If it isn’t, they are simply being offered a circular explanation—“Why are my moods so up and down?” “Because you have bipolar disorder.” “How do you know I have bipolar disorder?” “Because your moods are so up and down.”

Keep in mind, as well, that these people came to view their so-called diagnosis as helpful without ever having an opportunity to compare the pathologizing approach to any alternative approaches. For example, what would be the reactions of these same people whom I have just quoted if they were provided an option that avoided simplistic, misleading terminology, while professional mental health providers and peer support groups assisted the person to find their own stories and provided a choice of treatment options?

Moreover, finding freedom from blame and guilt by playing the blaming-the-brain game may not be anywhere as helpful as the pharmaceutical companies would have us believe. Many of us have learned that we all, from time to time, do things that violate our image of our ideal self and spend some time suffering the consequences. We come to realize that we not only violated the image of the ideal self in the past, but we’ll no doubt do so again and again in the future. The experience of suffering over these lapses is the spur that, after a period of difficult reflection, eventually gets us off our butts, learn new skills and seek out the type of support that moves us to make improvements. It can take time for this to happen. It can take more time than we in our modern pressure pot world may feel we have any right to take, and our loved ones may lose their patience. However, in the long run, drugging these feelings away have always produced more harm than good.

Those who Found the Psychiatric Pathologizing Unhelpful

In contrast to those who tell of some positive reactions to psychiatric name calling, there are other people who tell a dramatically different story.

For a number of years, I accepted the medical model as a framework of understanding…. But I gradually came to appreciate drawbacks to the framework. My reading suggested the model might not stand up scientifically…. By the time I was entering my second decade of service use, the medical model, which I had initially found reassuring, seemed increasingly unsatisfactory, without the capacity to encompass the complexity of my interior or exterior life and give it positive value. As a result, I began to actively explore frameworks that better met my needs.

I already knew something was wrong with me. Now I knew I was mad…. The diagnosis becomes a burden… you are an outcast in society…. It took me years to feel OK about myself again.

My diagnosis label promoted despair and threatened to become a self-fulfilling prophecy.

I have been diagnosed with dysthymic disorder since I was thirteen. One kind of harm I suffered from receiving a diagnosis, in and of itself, was that it seemed so final and despairing to receive as a teenager. For me, having a diagnosis seemed so final. Like it wasn’t just a tempory issue that I was having, adjustment or adolescence or something, but this disorder that I was going to have for the rest of my life no matter what I did.

But the worse part of this, which I have only been able to shake within the last year…is the defectiveness I felt. Just kind of in some core way. Like I’m totally different.

I was so offended. I was really offended. I thought well, ‘F*** you! You’re attacking my personality; you’re attacking me. You’re attacking the very soul of me, you know; who I am, and what I am, that’s a disorder.

I no longer identify with my previous role as a severely ill psychiatric patient but a human being that is experiencing and surviving life in my own unique way… just like every other human being on this planet.

Commentary

In her book, Ms. Johnstone summarizes what she has learned from these quotes:

It is understandable that service users, reaching desperately for an escape from anguish, confusion, guilt and blame, might see diagnosis (at least initially) as ‘salvation’. However, these benefits may be bought at the high price of taking on profoundly destructive messages of defect, dangerousness, damage and despair.

In my view, we can come up with a much better approach to the psychiatric pathologizing of people, an approach that doesn’t label anyone, but rather, classifies mental health concerns. For those who found the pathologizing approach helpful, this alternative approach would provide the professional and peer support that they value without misleading name calling. Psychiatric terms confuse questions of fact with questions of value, and superficially declare that a person’s experience is bad when it may have some pluses and minuses.

Undoubtedly, there are kind and decent folk who have a very different position than I on this subject. In no way do I mean to suggest that those who hold a different opinion are stupid, for I have met many who are as bright as a cloudless summer day. If they want to continue to use the DSM approach, it will continue to be available. All that I seek, all that I hope for, is that those who are uncomfortable with the DSM approach, can still assess mental health services using an alternative. All that I seek is that we all take some time to think more deeply about the nature of melancholy, sadness and tears.

———————

Tags A Straight Talking Guide to Psychiatric Diagnosis, conflict management, conflict resolution, criticism, dispute management, DSM, Lucy Johnstone, mental disorders, mental health, mental health concerns, mental illness

assertiveness conflict management conflict resolution criticism empathy fairness free social intelligence and emotional intelligence curriculum insults interpersonal conflicts negative criticism respect types of criticism Uncategorized

Women and Criticism

On this blog, I often discuss immature and mature ways to deal with criticism. The advice that I offer is designed to be helpful to males and females alike. But recently, in an Op-Ed piece in the New York Times, Tara Mohr argues that when it comes to criticism, women can benefit from advice specifically targeted to the unique cultural situation that they find themselves in.

The New York Times Article

Ms Mohr, in her thoughtful article titled “Learning to Love Criticism,” tells us:

Criticism stings for all of us, but women have been socialized to not rock the boat, to be, above all else, likable. By the time a girl reaches adolescence, she’ll most likely have watched hundreds of films, television shows and advertisements in which a woman’s destiny is determined not by her own choices but by how she is perceived by others. In those hundreds of stories, we get the message: What other people think and say about us matters, a lot.

In addition to these messages in the media, for centuries women have had less rights than men. Being likable, or at least acceptable to stronger, more powerful men, became a primary survival strategy. For many women around the world, this is still the reality.

Given this history, we might think that women have mastered the skills to insure that they are liked, but in the business world there is some evidence that problems exist.

A Recent Survey

In a recent survey that looked at 248 performance reviews from 28 different companies, both men and women gave more negative feedback to the women being reviewed. Here are a few examples:

“You can come across as abrasive sometimes. I know you don’t mean to, but you need to pay attention to your tone.”

“Your peers sometimes feel that you don’t leave them enough room. Sometimes you need to step back to let others shine.”

“The presentation ultimately went well. But along the way, we discovered many areas for improvement. You would have had an easier time if you had been less judgmental about R—‘s contributions from the beginning.”

This kind of negative criticism showed up twice in the 83 critical reviews received by men. It showed up in 71 of the 94 critical reviews received by women.

There are three possibilities that present themselves here:

1. The women received more negative criticism despite not acting in any distinctively different way than the men because of distinctively different expectations of how women “should” act;

2. The women who received more negative reviews actually acted distinctly different in certain ways than the men and it is these differences that led to the additional negative criticism;

3. It is a little of both.

An Informal Survey

Interestingly, from my perspective, are the results of an informal survey of someone I know who was intimately involved in evaluating and promoting personnel. Here, early criticism was about equal between men and women, but more women took the negative criticism they received to heart and made changes prior to their following evaluation. This ultimately led to their promotions. The majority of the men who got negative feedback seemed uninterested in making any changes and subsequently lost their opportunity for promotion.

From this, I think that it is not only possible, but perhaps even probable, that despite the pattern suggested in the more thorough survey, there is great variability across settings.

Some bosses may have an archtype that a great leader is a tough, no nonsense person who only projects a demanding sense of profits. Such an attitude will provoke a very different style of criticism around the office than one that supports the idea working for profits doesn’t have to mean that we must abandon basic principles of human dignity.

Let me just add that the person involved in providing and promoting personnel in the informal survey happened to be a master at providing very specific feedback. Consider the example provided above in which someone stated in a review:

“You can come across as abrasive sometimes. I know you don’t mean to, but you need to pay attention to your tone.”

Such a statement potentially can be helpful as one looks within and seeks to come up with a less abrasive way to respond in situations. However, the feedback would be far better if a supervisor, let’s call him Bill, invited a subordinate, let’s call her Mary, to a one-on-one meeting shortly after an abrasive incident occurred. At that meeting, Bill does several things. He gently explains that he is about to imitate how Mary had acted, using her tone of voice and what was said. Then, after imitating for her how she acted, he displays for her in a role-play how he would prefer she act when a similar incident arises. He then proceeds to ask Mary to imitate what he just acted out. Then he goes through this process with Mary until she can actually copy the less abrasive style to his satisfaction. If Bill provided this level of specific feedback, it would be potentially far more helpful then the two-sentence feedback that was actually provided.

Advice

I very much support the recommendations that Ms Mohr provides in her New York Times piece. For example, at one point she writes,

If a woman wants to do substantive work of any kind, she’s going to be criticized — with comments not just about her work but also about herself. She must develop a way of experiencing criticism that allows her to persevere in the face of it.

How can this be done? “A woman,” says Ms Mohr, “can identify another woman whose response to criticism she admires. In challenging situations, she can imagine how the admired woman might respond, and thereby see some new possible responses for herself.”

I won’t go into all of the recommendations of Ms Mohr, suffice it to say her article is well worth reading. But I do think it is essential to point out that a single article will not do the trick for most of us, women or men, who want to learn to become a master at dealing with criticism. It takes several months of regularly bringing before our minds examples of criticism, followed by a discussion of how to transform each specific example into something better. My blog provides one way to go about doing just this. Readers can begin with the introduction to this blog, and move forward at their own pace by clicking on the next newer entry post. Additionally, by reading the trilogy of novels that I’ve written, people become immersed for a few months in adventures that illustrate the struggle to seek respect even under the most trying circumstances.

Well, that’s this week’s edition of From Insults to Respect. Here’s to hoping you’ll join us again real soon.

Jeff

——————————-

Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional and social intelligence. To begin at the very first post you can click HERE.

Tags conflict, conflict management, criticism, dispute management, disrespectful, insults, negative criticism, negative feedback, New York Times Op Ed, psychological maturity, respect, Tara Mohr, types of criticism, women and criticism

conflict resolution DSM Name calling psychiatrists psychiatry respect The Diagnostic and Statistical Manual of Mental Disorders William James wisdom

Psychiatric Name Calling: Is Science to Blame?

Post author By Dr. Jeffrey Rubin
Post date September 22, 2014
14 Comments on Psychiatric Name Calling: Is Science to Blame?

A couple of weeks ago I raised the question, “Name Calling by Psychiatrists: Is it Time to Put a Stop to it?” In response, some blamed the insurance companies and other third party payers for the name calling. Because it is true that these payers do require the pathologizing of people seeking mental health services, in last week’s article, I took a close look at that issue.

Others responding to my question argued that diagnosing mental illness is based on the principles of science. So, let’s look at this line of thought.

The Nature of Science

Science enquires what is the nature of something? what is its constitution, origin, and history? Human beings also make enquires of a different sort, What is the object’s importance, meaning, significance, or value now that it is once here? Neither judgment can be deduced immediately from the other. They proceed from diverse intellectual preoccupations, and the mind combines them only by making them first separately and then adding them together.

As Steven Jay Gould, professor of zoology and geology at Harvard University, explains it:

“The net of science covers the empirical realm: what is the universe made of (fact) and why does it work this way (theory). The net of religion extends over questions of moral meaning and value. These two magisteria do not overlap, nor do they encompass all inquiry (consider, for starters, the magisterium of art and the meaning of beauty). To cite the usual clichés, we get the age of rocks, and religion retains the rock of ages; we study how the heavens go, and they determine how to go to heaven.”

In the natural sciences there is a branch called pathology that classifies tumors, lesions, bone fractures, tissue tears, toxic reaction to a chemical, blockage of blood flow within the circulation system, blockage within or to an organ, and microbe infections. Pathologists have reliable ways of identifying and categorizing these naturally occurring entities. When we take a science view of each of these entities of interest to pathologists, it is not a value judgment if they exist or not. If ten pathologists look at a tumor, they can all see it, describe its color, density, weight and what each of the tumor’s cells look like under a microscope.

Pathologists, as scientists, have been studying these entities and sometimes they found that some of them are associated with certain physical complaints. For example, some people complain about headaches and vision problems. When they died, autopsies were carried out and often a tumor was present that was pressing against the optic nerve.

This finding led to a theory that for people who expressed this type of physical complaint, if an operation was carried out while the patients were still alive and this type of tumor was indeed pressing on the optic nerve, perhaps removing it would alleviate the complaint. Studies were carried out and it led eventually to a valued treatment.

The connections between the research findings of pathologists gave doctors some understanding of what was causing some of the physical complaints of their patients. But often doctors could not find evidence that any of the entities of interest to pathologists were the cause of the complaint. When this occurred, most doctors merely changed the expressed complaint into some medical jargon that sounded somewhat like those concerns that had been shown to be due to a pathological condition. In such cases, they offered some treatment that was often based more on the commercial art of medicine rather than science.

These doctors usually called both types of physical complaints (those with pathological findings and those without) “illnesses” or “disorders.” By doing so, the science of medicine and the art of medicine became blurred. And then, business interests became wrapped up in the various treatment options and principles of science began to become more and more murky when applied to the medical world.

Disorders and Psychiatry

In a book titled Psychiatric Persuasion by Elizabeth Lunbeck, there is considerable documentation that back at the turn of the 20th century when the main job of psychiatrists was running insane asylums their professional organization decided to expand their market by doing two things. 1. Persuade the public that more and more normal behaviors are pathologies that require psychiatric treatment, and 2. Develop a category system that converts all psychological concerns that a person might want to get help for into a language that sounds like a pathological condition. This would legitimize the treatment of anyone who came to their office, thus the argument that the current psychiatric “diagnosis” system has become a business tool while being promoted as science.

Now, it is certainly possible to create a categorical system consistent with science for the problems that come to the attention of psychiatrists and other mental health service providers that don’t confuse conditions that are associated with pathological findings and those that are not. Such a system would classify “mental health concerns,” rather than calling people names. A mental health concern occurs when a person seeking mental health services expresses to a mental health service provider a concern about any of the following topics: behavior, emotion, mood, meaning of life, managing chronic pain, work, relationships, education, eating, cognition and sleep. Two classes of mental health concerns are concerns expressed about oneself and concerns expressed about someone else.

One benefit of classifying “mental health concerns” rather than “mental disorders” has to do with inter-rater reliability. Consider being in a room with 100 psychologists, or even 100 average Joes and Jills, and a person in front of the room says she has been feeling depressed. A questioner asks the client, “Are you concerned about feeling depressed?” and the person says, “Yes.” If you asked for a survey of how many people in the room thinks the person has expressed a concern about being depressed, you would get, I believe, 100 percent agreement. Expressing a mental health concern is a specific action that people do, and therefore it is clearly observable.

Research on the inter-rater reliability of the mental disorders classification system has demonstrated that its inter-rater reliability is very problematic.

Science is Not to Blame

It is not science that is to blame for psychiatric name calling; it is the psychiatric business tool that is cleverly designed to capitalize on the public’s respect for science.

When we begin to use a classification system that does not clearly separate principles of science from values involved in business interests, other values start to slip into the classification process as well. Early on when the pathologizing of human experience was just getting underway, William James made a number of relevant comments about this.

James argued that experiences that are commonly viewed as unhealthy or morbid are really “an essential part of every character” and give life “a truer sense of values.” To support his contention, James first provided three examples of famous individuals who expressed concerns about melancholy. Such experiences today, if expressed to a psychiatrist, would probably be converted into a so-called “diagnosis” of “major depressive disorder.” St. Paul, the religious figure of the New Testament, Cesare Lombrosa, a late 19th-century Italian criminologist, and Immanual Kant, the 18th-century German philosopher, became, according to their biographies, better as a result of their troubling experiences.

Although hallucinations can mean madness to some, James presented the case of Socrates who “once stood motionless for many hours in the cold and spoke of having a guiding demon.” Attempting to counter the association between pathologies and hallucinations, James stated, “Even if this demon [of Socrates] were really meant hallucinations of hearing, we know now that one in eight or ten of the population has had such an experience and that for insanity we must resort to other tests than these.”

James stated that there is no end to the possible types of obsessions that we see all around us. What benefit can such experiences have? James wrote about Henry Borg, founder of the American Society for the Prevention of Cruelty to Animals in 1866; Charles Henry Parkhurst, a Presbyterian clergyman and reformer who held a New York City pastorate from 1880 to 1918 and who launched a furious attack on organized crime in state government that led to an official investigation; Dorothea Dix, a mid-19th-century humanitarian who visited the insane asylums and successfully advocated for legislation to improve the care for those labeled mentally ill.

Later, James stated, “Individuals are types of themselves and enslavement to conventional names and their associations is only too apt to blind the student to the facts before him.”

James concluded that,

“Any peculiarity that is of use to a man is a point of soundness in him, and what makes a man sound for one function may make him unsound for another. Moreover we are all instruments for social use, and if sensibilities, obsessions and other… peculiarities can so combine with the rest of our constitution as to make us the more useful to our kind, why, then, we should not call them in that context points of unhealthiness, but rather the reverse . . . The trouble is that such writers [pathologizers]. . . use the descriptive names of symptoms merely as an artifice for giving objective authority to their personal dislikes. The medical terms become mere appreciative clubs to knock a man down with. . . . The only sort of being, in fact, who can remain as the typical normal man, after all the individuals with degenerative symptoms have been rejected, must be a perfect nullity… Who shall absolutely say that the morbid has no revelations about the meaning of life? That the healthy minded view so-called is all?”

To illustrate what James means here, consider an article in the American Journal of Psychiatry (May, 2004), titled “Virginia Woolf (1882-1941).” Although she is described by psychiatrists as having bipolar disorder, her diaries and letters, document movingly, her emotional extremes and her capacity to savor the “ordinary rhythms of life.” At times Woolf railed against her distressing emotional experiences, felt frustrated and impeded by them, and at other times she felt it was essential to her. In diaries and letters, she returned to the question repeatedly without reaching a resolution: were her emotional experiences a terrible obstacle to her art, or were they the necessary condition for it?

For those trying to sell psychiatric drugs, a simplistic answer to this question is eagerly promoted. Science has not provided a definitive answer to this question as far as I am concerned, and throwing around phrases such as “the brain is malfunctioning in depression,” or “the brain has a chemical imbalance in depression” goes way beyond the available evidence.

Psychiatric labels are like masks held on by rubberband straps. They hide some of the characteristics of an individual. Wearing such masks may serve some purposes, but after a while they start to get uncomfortable for many, particularly around the ears. Let those who want to wear these masks be free to do so. But let those who want to meet us face to face, also be free to do so.

——————————-

Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional and social intelligence. To begin at the very first post you can click HERE.

Tags disrespectful, DSM, free social intelligence and emotional intelligence curriculum, insults, mental disorders, mental health, mental health concerns, mental health services, mental illness, name calling, psychiatry, science, Steven Jay Gould, William James

conflict resolution DSM psychiatrists psychiatry The Diagnostic and Statistical Manual of Mental Disorders

Psychiatric Name Calling: Are the Insurance Companies to Blame?

Post author By Dr. Jeffrey Rubin
Post date September 16, 2014
5 Comments on Psychiatric Name Calling: Are the Insurance Companies to Blame?

Last week, I posted an article titled “Name Calling by Psychiatrists: Is it Time to Put a Stop to it?” It created quite a stir and it’s currently challenging my two previous most popular posts—“Teaching Children How to to Deal with Criticism” and “Is it Wise to be Assertive?”—for the number one spot.

The article points out that by using the term “diagnosis” in psychiatric terminology it misleads people in a variety of ways. For example, when psychiatrists provide their patients a so-called diagnosis many people believe there is now a valid explanation for why they are struggling with their personal difficulties. Instead, all that has really happened is that the psychiatrist has converted the expressed concern of the patient into pathologizing language.

The manual that psychiatrists use when deciding which words to use when converting concerns to “diagnoses” is called The Diagnostic and Statistical Manual of Mental Disorders (DSM). Of course as this manual was developed there was a huge financial interest to utilize language that encourages the perception that an expressed concern is a very, very serious life-long condition that requires medical treatment for a lifetime. Consequently, when patients express a concern about being depressed, the psychiatrist informs them that they have “major depressive disorder,” and often couple this with statements such as, “This is a serious lifetime condition that must be managed for a lifetime.” Any language that suggests that there is substantial evidence that most people recover even without treatment runs counter to the psychiatric business plan.

Among the many comments that I received about the name calling article are those that point out that most of the doctors who are using the psychiatric terminology provided in the DSM are not psychiatrists. Pediatricians, general practitioners, internists, psychologists, and neurologists daily call people these names. Other comments present the argument that it is the pharmaceutical companies that promote the pathologizing of human concerns in order to convince people to ingest their drugs.

I’ll be exploring these issues in coming weeks. But today, let’s focus in on the argument that the real group of people at fault for this type of name-calling is the third party payers such as insurance companies, Medicaid, Medicare, and Social Security. After all, by far, the DSM terms are used most by these types of entities.

The DSM and Third Party Payers

Most people in the United States who seek mental health services don’t directly pay for them. Instead, they have insurance policies that cover some, or all, of the fees; or they qualify for Medicaid, Medicare, or Social Security benefits. Insurance companies and these other agencies are called third party payers.

Third party payers currently have a form that must be filled out whenever someone seeks mental health services under their plan. That form has boxes for the name of the person seeking services, his or her contact information, policy number, some information about who is being asked to provide services, and then, imbedded in all of this, is a little box that currently says, “Diagnosis.” In that box, mental health professionals must fill in the DSM code that corresponds to their “diagnosis” of the person seeking services.

Third party payers initially developed their form for people who were seeking medical services for physical complaints. Physicians would fill in the diagnosis box with a code that corresponded to a list of diagnoses in their pathology manuals based on a visual inspection of a tissue tear, the results of x-rays, blood test, or a pathologist examining a tissue sample of a tumor under a microscope. Sometimes it was based on a report from a toxicologist because it was theorized that the patient had been exposed to some toxic substance. In each of these cases, the diagnosis that was provided actually did provide some understanding for why patients were struggling with their expressed physical complaints.

However, I hasten to point out that in many cases physicians were unable to uncover the reason for the physical complaint. At such times they often did pretty much what psychiatrists do today—they converted the physical complaint into medical jargon, typically using Latin derived syllables, and then stuck them into the third party payer’s “diagnosis” box on the third party payer forms, prescribed some treatment, and low and behold, third party payers paid the doctors just like they did when a real diagnosis was provided.

A physician once confided in me that for the majority of his cases he was unable to identify the reason for the physical complaint but he nevertheless provided some diagnosis and a prescription for a pill. “If I didn’t,” he said, “my patients would feel that they wasted their money by coming to see me.” I then asked him how he felt about misleading his patients in this way. “Well,” he replied, “if my patients feel that I have made a real diagnosis and prescribed some pills, they feel a sense of being reassured and the pills can have a placebo effect which may be very curative in its own way.”

“The pills that you prescribe,” I replied, “are not simply substances with no physical effects beside the placebo effect, they have a number of real serious side effects associated with their use. Is that really ethical?”

“Well, the physical side effects often help the placebo effect because the patient feels something is really physically happening. It is part of what reassures them that what was prescribed has a powerful effect. When weighing the risk of serious side effects versus the minor side effects that can be helpful, I make my decisions on what to prescribe.”

And so, that’s a little of my understanding of the reasoning behind this type of misleading name-calling and prescribing practices of physicians dealing with physical complaints. I prefer honesty. However, for those who prefer this fatherly treatment that is mixed with huge financial interests, I’m advocating that they continue to get what they want.

Now, once third party payers began to provide coverage for mental health services, their administrative forms didn’t have to be changed. There was already a precedent for placing in the “diagnosis” box on the form fake diagnoses, and psychiatrists seeing that this business model was a source of a great deal of money created the DSM.

What would be a Reasonable Alternative to the DSM?

For those who prefer to be treated honestly, can an alternative to the DSM be developed?

The alternative I’ve been working on is called The Classification and Statistical Manual of Mental Health Concerns, or, for short, the CSM. With this approach, no individuals would be classified, only their expressed concerns.

With the CSM proposal, all that we would be asking insurance companies to do differently in order to add value to their customers, is to slightly change that little box that currently requires a diagnosis or a word pretending to be a diagnosis. Instead of just saying “Diagnosis” as it currently says, that box would just add two little words, so it would end up saying “Diagnosis or Concern.” Then, when mental health professionals fill in the box, they would be given the choice to either write in the letters DSM and its code number that corresponds to its so- called diagnosis, or they would write the letters CSM and its code number that corresponds to the expressed concern.

The cost and efforts for insurance companies would be minimal, and we would have numerous testimonials from customers that documents that this change would be viewed as a significant improvement.

Now, some of the insurance company executives might pause and say, “Wait a minute. You’re asking us to permit the use of the CSM as an alternative to the DSM. Just wait a minute. The DSM has been developed by mental health experts and is backed by a major mental health professional organization—the American Psychiatric Association. Does the CSM have that type of authority to back it up?”

If we prepared for this, we will be able to answer that the CSM was also developed by mental health experts and does have several mental health professional organizations backing up its use as an alternative to the DSM. I believe this can be achieved. We have in our alternatives group several people who would qualify as mental health experts, and I think we can get some more involved as well. And when the latest edition of the DSM was released several professional organizations expressed a strong desire that an alternative to the DSM be developed. I think it’s reasonable to assume that at least some of them would agree to back this alternative, especially if we involve them in its development.

In short, the creation of the CSM would permit us to present to insurance company executives and other third party payer administrators a real alternative to the DSM. It would be virtually cost free for them to permit its use, it would have the authority of being developed by experts in the mental health field, the backing of mental health professional organizations, and it adds value for a significant number of their customers.

The CSM Would also Help Mental Health Service Providers

Now, besides the insurance companies and other third party payers, the other big group of people in America that is currently using the DSM is mental health services providers. How would they react to being given the choice to replace the DSM code with the CSM code on third party payer forms when they felt in their professional judgment that it was appropriate? Well, we get a little sense of what their reaction would be from a survey Paula Caplan tells us about in her book, They Say You’re Crazy. According to this survey, over 70 percent of those practitioners who responded to the survey said that the only way they use the DSM is to fill out the insurance form. Other than that, it doesn’t help them at all.

To those who believe that the use of the current DSM terminology helps to enhance the placebo effect of treatment, keep in mind that this is a testable theory. We can arrange for studies that compare the outcomes of service providers that utilize the DSM coding system with service providers that employ the CSM coding system. But that would be an approach that employs basic principles of science, rather than unsupported claims backed by enormous financial interests.

——————————-

Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional and social intelligence. To begin at the very first post you can click HERE.

Tags disrespectful, DSM, insults, insurance companies, mental disorders, mental health, mental health services, mental illness, name calling, psychiatric disorders, psychiatry

conflict resolution Name calling

Name Calling by Psychiatrists: Is it Time to Put a Stop to it?

Post author By Dr. Jeffrey Rubin
Post date September 8, 2014
55 Comments on Name Calling by Psychiatrists: Is it Time to Put a Stop to it?

On one fine spring day, I was sitting on a Central Park bench and two women were sitting one bench just to my right reading their newspapers. Suddenly, one of them cried out, “Sophie, can you believe this! The story I’m reading here, oh my God! This young boy, seventeen years old mind you, the same age as my Jonathan, he’s struggling with ideas about suicide. Seventeen years old, his whole life before him and he wants to kill himself. What would lead a boy to this?”

“Such a young boy, Bessie?”

“Yes. My God.”

“He must have some type of mental illness.”

“Oh, you’re right, Sophie. I just glanced at the next paragraph, and a psychiatrist explains that the boy has a mental illness called major depressive disorder.”

With that explanation, the two women nodded to one another, and continued on to another story, seemingly satisfied that they now knew why the boy was dealing with this issue.

This notion that when a psychiatrist says someone has a mental illness, or some type of mental illness, that this offers a valid explanation for why the person is struggling with personal difficulties is, as far as I’m concerned, a bunch of nonsense. Just before the incident in the park, I had seen a performance of Shakespeare’s Hamlet, which tells the story of a boy about the same age as the one in the story Bessie was reading and is also struggling with feelings of committing suicide. As Shakespeare’s story unfolds, the audience is presented with a character that has motivations, conflicts, frustrations, disturbing situations and emotions. In the end, I left with some insights into why a character such as Hamlet might struggle with feelings of suicide.

In my opinion, even a play, which lasts but two or three hours, can only provide in its narrative a simplified account of what real life stories are all about. And yet, in today’s world, for many people a very different type of play is sufficient for providing the reason why someone is dealing with a challenging concern. This new type of play begins with the curtain rising. A character says to the audience he is struggling with feelings of suicide. A psychiatrist then proclaims the character has the mental disorder known as major depressive disorder, and then the curtain comes down. That’s the whole play. And people walk away fully satisfied that an adequate explanation has been provided.

When psychiatrists start calling people names, they get them from a book called The Diagnostic and Statistical Manual of Mental Disorders (DSM). They claim that they are not just calling people names, but, instead, they are making a diagnosis. Diagnosis, as it is defined in Wikipedia, “is the identification of the nature and cause of anything” (http://en.wikipedia.org/wiki/Diagnosis).

It would be reasonable to assume, therefore, that the DSM would assist in identifying the nature and causes of the types of personal concerns that come to be called mental disorder. But the DSM uses a descriptive approach that attempts to be neutral with respect to theories of the nature and cause of the various “disorders” that it describes. Therefore, referring to the DSM as a “diagnostic” manual is contrary to reason.

My Personal Understanding of the Nature of Diagnosis

When I was fifteen years old, I was tackled hard in a football game. After the pile of tacklers got off of me, I found that when I tried to put any weight on my left leg I felt excruciating pain. Shortly after this unwelcome discovery, I arrived at the Coney Island Hospital. A doctor asked a few questions and decided to take an x-ray of my left leg. Minutes later, he showed me the x-ray, and pointed to where a bone in my leg was broken. His “diagnosis” was that my left leg had a fractured fibula.

Now, what if the doctor did not take an x-ray, but instead just said to me after he asked me a few questions, “Your problem is that you have ‘Major Inability to Stand Disorder.’” Making such a statement, as far as I am concerned, is quite different from what the doctor did when he took an x-ray, looked it over, and declared that my left leg had a fractured fibula. To refer to both types of statements as examples of the same thing—that is, a diagnosis—makes it more difficult to see this difference.

Consider, if you will, another situation. A few years ago I had trouble starting my Ford Pinto. I brought the car in and the mechanic provided me a theory that perhaps I needed a new starter. This, it seemed to me, was his initial theoretical diagnosis. He then inspected the starter and found that it was in fine shape. Thus, his original theory of what was wrong proved incorrect. He then theorized that my spark plugs were dirty. He took a look and found that they were indeed dirty. He cleaned them up, put them back in their proper place, and the car started right up. In the end, as far as I was concerned, he “diagnosed” what was wrong with my car as having dirty spark plugs. If the mechanic had instead just asked me a few questions, and then told me that the problem with my car was that it had “Major Non-starting Disorder,” then this to me is something very different than “diagnosing” my car’s problem.

The DSM, by claiming it is a manual for making diagnoses, masks the difference between the following two statements:

1. “You have a fractured fibula.”
2. “You have ‘Major Inability to Stand Disorder.’”

Similarly, the DSM, by claiming it is a manual for making diagnoses, masks the difference between making the following two statements:

1. “My theory for why your car is not starting is it has dirty spark plugs.”
2. “Your car is not starting because it has ‘Major Non-starting Disorder.’”

In both of these examples, the number “1” statements offer some theory for understanding the cause for what we believe has gone wrong. The number “2” statements just restate the expressed concern about something we believe has gone wrong in some technical terminology. The DSM actually is just a classification system for expressed mental health concerns, and it would be far more accurate if it honestly said so.

Classification

A major reason why scientists classify is to speed up the process of obtaining useful information. The classification, when useful, is a labor-saving contrivance. Let’s look at an example that makes this vividly clear.

Biology Example

Suppose a biologist named Steve comes upon a whale for the first time. He has never seen such a creature before. He wants to learn more about it. He observes that it is a vertebrate, gives live birth to its offspring, and uses mammary glands to feed its offspring. Once this is observed, Steve can see if other biologists have collected any information on this creature by looking in a book that uses a certain classification system. By looking in the book under mammals, which has a pretty clear definition, he can save an enormous amount of time because he will not have to bother looking at all the insects, birds, and reptiles. This saves him from needlessly examining millions of specific listings—a clear time saver.

I hypothesize that there would be no significant difference between the so-called diagnosis system called the DSM and a classification system that simply classifies expressed personal concerns in retrieving valued scientific information. In an article that I published in The Journal of Humanistic Psychology, I fully explain this concern alternative (see HERE).

Briefly, with the concern approach individuals would not be classified, only their expressed concern. If I want to find out about any scientific studies that looked at different ways that addressed concerns about depression, in Google Scholar I can now simply put in the search engine— “depression, treatments.” Without adding the words “major” and “disorder” in the search engine, I can currently get numerous relevant hits. If the new concern classification system was adopted, soon the term “addressing concerns” would be receiving the same number of relevant hits that I now get by using the search term “treatment.” Thus, this scientific requirement would be amply fulfilled without using the search terms of “major depressive disorder” and “treatment.”

The DSM and the concern classification system would both serve a valuable scientific function—the retrieving of relevant scientific information in a time- saving manner. The accepted term for such a system in science is “classification,” not “diagnosis.” If “diagnosis” was clearly recognized as a perfect synonym for “classification” then it wouldn’t matter which term was used. But “diagnosis” indicates that something more than classification is being provided in the DSM, whereas the concern classification system would make no such claim. The concern system would not seek to present itself as something that it can’t back up as accurate. And it avoids the negative name calling of people that so many find offensive and stigmatizing.

Another Problem with Psychiatric Name Calling

Furthermore, when psychiatrists provide a so-called “diagnosis” of a mental disorder it indicates that there is something wrong with the person. This masks an alternative possibility. It is very possible that the experiences typically being diagnosed as mental disorders are more aptly construed as tools. That is, a hammer can be used to drive in nails in the construction of a life-preserving shelter or to bludgeon an innocent person to death. A car can be used to rush a child to an emergency room so that life-preserving treatment can be administered, or it can be used to tragically end a prom night. Similarly, there are numerous people who have had the experiences that are said to be diagnosed in the DSM as a mental disorder, who report that the experience ended up helping them to achieve enormous benefits; whereas, others became ambivalent, and others agree that they proved to be all bad. It may be very true that it is up to each one of us to find the wisdom to use these tools for good.

The percentage of people who report that the experiences now referred to in the DSM as mental disorders turned out to be good, bad or mixed is a question for science. Mental health practitioners when using the DSM participate in proclaiming that all of these experiences are all bad, thus masking these vitally important variations of experiences.

A scientific classification system is better when it helps us to see things of interest more clearly, rather than to mask them. The classification system of mental health concerns would serve to break us out of the DSM cloister of words and reopen us to the source of our experience.

——————————-

Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional and social intelligence. To begin at the very first post you can click HERE.

Tags criticism, DSM, insults, major depressive disorder, mental disorder, mental health concerns, mental illness, name calling, personal concerns, psychiatry, The Diagnostic and Statistical Manual of Mental Disorders

anger bullying conflict management conflict resolution criticism insults internet bullying

Internet Meanies

One day I happened to be flipping through the New York Times when I came upon a story titled Dealing With Digital Cruelty by Stephenie Rosenbloom. It had been a year since I had written a post about a particularly sad incident of internet cruelty. Back then, 12-year-old Rebecca Sedwick had leaped to her death after being cyberbullied by a coterie of 15 middle-school children who urged her to kill herself. Upon reading the Times story, I decided to revisit this issue.

The Times article begins, “Anyone who has ever been online has witnessed, or been virtually walloped by, a mean comment.”

Because communication on the internet can provide anonymity and invisibility it can lead many to feel uninhibited. If someone is sitting right in front of you, there is a chance that a mean comment could lead to the insulter ending up with a fat lip or witnessing streams of tears running down a sweet face. Not so when all you see is some letters.

The Times article offers us some advice. “One way to become proactive is to ask yourself if those barbs you can’t seem to shrug off have an element of truth.” An example is provided by a writer, Mr. Pozen, who became particularly upset upon reading that his book was too “U.S.-centric.” Mr. Pozen considered that idea — and decided that the reader, despite not having put it particularly nicely, might be right. “So I thought, ‘Well, if I ever write another version of this book I ought to take that into account,’ ” he said.

While I was doing some research on this topic, I came upon another good example of this:

The writer, Gina Trapani, tells us how she would handle the following type of internet comment,

“Hey asshat, way to waste my time with a stupid article that has no original information in it whatsoever. I wish you and your web site would drop dead, dry up and blow away.”…Once I got over the name-calling and the death wish, I might ask myself: Was this article unoriginal? Could it have been more in-depth or relevant? If nothing else make a mental note of the core problem minus the meanness, learn from it and move on. Put your critics to good use instead of letting them make you feel bad.

It’s not always possible, of course, to learn something from a nasty comment. Some are baseless; some are crass.

Illustration by Credit Kristian Hammerstad — Illustration by
Kristian Hammerstad

The Times article tells us that it helps to keep in mind that some people think of their online life as a kind of game with rules and norms that don’t apply to everyday living, a game for which they do not feel responsible. If bloggers and people who use social networks keep this concept in mind, he said, they will see the psychology of aggressors, and their comments may be easier to take — and possibly ignore.

Moreover,

Harsh comments can also be made to feel less potent by directly disputing to yourself what was said. If, for example, someone writes, “You’re an idiot and no one likes you,” you can marshal evidence against it by reminding yourself, Stuart Smalley-style, of the obvious: You have an education, a job, more friends than you have time to see in a week.

Speaking of time, be mindful of when you choose to glance at your blog or social media feeds. Researchers have discovered that feeling blue or even being in a so-called neutral mood makes people more vulnerable to nasty comments. In other words: Stay off Twitter if you just bombed a presentation.

These are just a few of the thoughtful advice the article provides. If you find yourself troubled by this type of experience, I highly recommend that you give it a thorough read.

Have a great week!

Jeff

——————————-

Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional and social intelligence. To begin at the very first post you can click HERE.

Tags anger, bullies, bullying, conflict management, disrespectful, insults, internet, negative criticism, New York Times, types of criticism

Abraham and Isaac Bible change conflict resolution free social intelligence and emotional intelligence curriculum negative criticism psychological maturity wisdom

Conflict Resolution and The Wisdom of Abraham

Post author By Dr. Jeffrey Rubin
Post date August 21, 2014
2 Comments on Conflict Resolution and The Wisdom of Abraham

Sometimes we observe people doing things that seem terribly wrong. We may then find, welling up from within, an urgent desire to provide negative criticism.

In earlier posts, in an effort to provide some guidance on how to avoid expressing our concerns in a form that can potentially make a bad situation far worse, I provided a description of 5 levels of maturity for providing negative criticism (see HERE). In many situations, by simply attempting to create a communication that is consistent with the level 5 description, we end up dramatically improving our chance to make a valuable difference. But there are certain subtle situations that require special considerations.

Sometimes the actions you hope to change are intertwined with certain entrenched worldviews. In these types of situations, to expect to encourage people all at once to make what might seem to them to be some enormous change, might be way too much to expect. How better to deal with these situations? In today’s post, I’m going to present a parable that I hope you will find helpful when dealing with these types of situations.

This little parable is based on a story that appears in the bible about Abraham. I’ve taken some creative license in its telling, and based on this altered narrative, I’ve come up with a dramatically different literary interpretation of its meaning than the typical religious interpretation of the actual biblical story. For those who have a deep sense of religion, I don’t mean any disrespect. I do realize that by using a biblical story in this way I may grate upon tender associations, but I simply am unable at this point to derive any alternative that contains this story’s emotional impact. In no way am I attempting to claim that it has some sort of religious authority that some of you may feel for the actual biblical story.

With that said, I now present the story of “The Wisdom of Abraham.”

The Wisdom of Abraham

A few thousand years ago a man named Abraham lived in a village whose inhabitants followed the religion of Ba’al. The village was bound to the economy of the land that depended on the regularity and adequacy of the rains. Anxiety about the rainfall was a continuing concern of the inhabitants and this gave rise to rites to ensure the coming of the rains.

Many of the elders of the community remembered a drought that was so severe that over half the village died of starvation. After that terrible year, some of the Ba’al leadership prayed and reported that their god had spoken to them and commanded that to avoid another similar severe drought the people of the village must sacrifice a couple’s first born child. The people reluctantly obeyed, and from that point on there had never been another drought quite as bad.

Now, in this community, it came to pass that Abraham had a wife, Sara, who, after many, many frustrating years of trying, she, at long last, became pregnant. When the community members heard about this, they all gathered in the village square.

The leader of the community, Hareesh, took out a knife with a golden handle encrusted with sparkling jewels. “Abraham,” Hareesh cried out so all could hear, “after all of your difficulties in getting Sara pregnant you have finally succeeded. God will indeed appreciate your great sacrifice when your child is born. All in the village are so fortunate, for because of your great sacrifice we will surely have a wonderful rainy season and our crops will be bountiful. Let us all thank god.”

“Well, um,” Abraham began to stutter, “um, well I know that in the past it was our tradition to sacrifice our first born child, but, um…”

“Abraham!” cried Hareesh in a booming voice, “there will be no buts about this matter. You will follow the will of god!”

Abraham saw the look on the face of this leader, and he glanced quickly over the faces of the others in the village and it was plain that if he was to object any more he and his wife would be put to the fire, and so he held his tongue.

On the day that Sara gave birth, all again gathered in the village square. And there stood Hareesh with the golden handled, jewel-encrusted knife. “Abraham,” he cried out, “do you want me to do the deed, or do you wish to do the deed yourself?”

“Last night,” Abraham replied, “I prayed and prayed, and then, just as I heard the first cry of my new born son, god oh mighty spoke to me and he did command me to do as other village fathers have done before me. God commanded that I indeed must sacrifice my son. Because of all that Sara and I went through to have this son, god has ordered that this sacrifice must occur in a special holy place up in the mountain in the region known as Mariah. I’m to take my best ram with me for it is a two-day journey to the special holy place and he will help to carry my supplies. I will also take two of my most capable servants. Give me the sacrificial knife and I will follow god’s commandment.”

“Abraham,” cried Hareesh as he fingered the gold handled jewel encrusted knife,” you must do the deed just as god has commanded. But bring back the dead body of your son so we can give him the respected burial he well deserves.” And then Hareesh handed the knife over to Abraham.

And so, Abraham took his son, along with his ram, and two servants up to the mountain. A few days later he returned with his son very much alive. Following beside him was Abraham’s two servants carrying the ram, which was dead, and it had the sacrificial knife stuck in him.

As soon as Abraham had been spotted descending from the mountain, the people of the village began to gather.

“Abraham, your son is still alive!” boomed Hareesh. “What is the meaning of this?!”

“Well,” said Abraham, “I did as god had commanded. On the third day of my journey, I looked up and saw the holy place in the distance. I said to my servants, “Stay here while I and the boy go over there. We will worship and then I will come back to you, having sacrificed my son, Isaac.”

“I placed my son on the holy site, and just as I reached back with the knife in my hand, the Lord called out to me from heaven, ‘Abraham! Abraham!’

“‘Here I am,’ I replied.

“And the lord said to me, ‘Do not lay a hand on the boy. Do not do anything to him. Now I know that you are my loyal servant, because you have not withheld from me your son, your only son. And I can see within you, Abraham, how hard it is to bring yourself to do this deed. I am a merciful god, and therefore, from now on no one in your village shall ever sacrifice their first born as a sacrifice for me. Instead, you must sacrifice one of your finest rams.”

“And so, I followed the lord’s commandment and, as you can plainly see, I killed the ram with the sacrificial knife.”

And as Abraham finished his story, his servants laid the dead lamb at the feet of the crowd standing before him. And suddenly a great cry rose up from one segment of the crowd, and Abraham saw that it was from all of the women who were currently pregnant. They were crying that the lord was merciful, and tears were running down their faces. They fell to their knees, yelling, Thank you oh merciful lord, thank you.” And the husbands, realizing they would not have to kill their first born, also began to cry out, “Thank you oh merciful lord, thank you!” And there followed quickly another wave of cries. This time it was from all of the young men and women who had recently married and knew that if this new change had not occurred, they too would have had to sacrifice their first born, and they were greatly pleased. And then, even the men who had sacrificed their own first born, seeing how thrilled their own young sons and daughters were at Abraham’s story, also began to thank god for being so merciful.

Now, Hareesh, and some of his followers, were somewhat skeptical of what Abraham had said, but seeing the great passionate joyful response from almost everyone in the crowd, he held his tongue. Later the leader said, “We will see how the rains come, and if there is a drought, we will know the truth.”

When the rainy season did come, there were at times some ups and downs. But, in the end, overall, there was great agreement that there had been an excellent harvest, and the people were pleased.

The following year, one day, Abraham, who had now become greatly respected in the village, announced to the people that while he was praying, the lord once again spoke to him, saying that he saw that many of the good people of the village who dutifully sacrificed their finest ram each year, were deeply grieved upon doing so. And therefore, the lord, being merciful, has now commanded me to tell you that no longer will we have to sacrifice a ram once a year, instead we must make a sacrifice by fasting once a year for a whole day, from sundown to the next sundown.

Now, most of the people liked this new change, but there were a growing number of villagers who felt that Abraham was beginning to take them too far away from the old ways. And this feeling grew. And in those days, people felt that the only way to settle this was to set up a war council meeting, plan a date to violently fight it out, and those who survived got their way.

But, on the day of the war council meeting, Abraham had many of his biggest warriors standing beside him. And he announced that while he was praying that morning, the lord again had spoken to him and he said, “Among those who want to follow the old ways I see that there are many with beautiful souls, and are good god fearing people. And among those who want to follow you, Abraham, there are also many with beautiful souls, and are good god fearing people. Both groups must live side by side in peace. And so I command that those who want to follow the old ways are to be free to do so, and those who want to follow my instructions to you, Abraham, are to be free to do so. Let both groups live together in peace.”

Many of the villagers were perplexed by this and said, “Hmmm, we can do that? You mean we don’t have to kill each other to decide this. Those who want to live the old way can live as they wish, and others can follow god’s instructions to Abraham?”

“Yes,” said Abraham. “Now let us all go in peace.”

The villagers who had been unhappy with Abraham, looked over at the big guys that Abraham had standing beside him, they looked over at Abraham and thought he was a pretty decent guy, and they started to warm up to this idea. And as the days passed, peace was found throughout the land.

Well, that’s my post for this week.

My Best,

Jeff

——————————-

Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional and social intelligence. To begin at the very first post you can click HERE.

Tags Abraham, Abraham and Isaac, conflict management, conflict resolution, dispute management, free social intelligence and emotional intelligence curriculum, maturity, maturity levels, parable, The Bible, types of criticism, violence, wisdom