Is psychoanalysis still valid?

Freud is dead. His views are antiquated. His theories of women are sexist. His ideas about homosexuals are homophobic. He has nothing to say to us now. He lived in the Victorian era and we live now.

These are just a few of the things one hears about Freud and psychoanalysis these days. To many people psychoanalysis is no longer valid, either as a system of thought or a form of psychotherapy.

As a licensed psychoanalyst, I often find myself having to justify using psychoanalytic theory or therapy, and I gladly do so, for I think both are indeed still valid. I say, “Let’s not throw the baby out with the bath water.”

Freud made many monumental discoveries that continue to be important and valid. He discovered the unconscious mind and, by implication, nonverbal communication. He discovered the unconscious defense mechanism such as repression, projection, denial, and compensation, which are now part of our everyday speech. He discovered transference and resistance and he was a pioneer in the study of narcissism, both in individuals and groups.

Psychoanalysts today have made many modifications, especially in how we do therapy. We no longer see patients 6 days a week, as Freud did. I currently see many patients twice a week, once in individual therapy and once in group therapy. Nor do we use psychoanalysis for every patient. Each patient dictates his or her own interventions. Cognitive or behavioral therapy is more successful with some.

In Freud’s day, patients came for a year, six days a week, and then were pronounced cured. Today patients continue in treatment for years, and there is no finite end to the therapy. Patients terminate therapy not because they are “cured,” but because they decide, along with the therapist, that they have found enough balance and inner strength to function successfully in their personal and professional lives.

The most valid thing, and the thing that makes psychoanalytic therapy stand out from other therapies, is the therapy relationship. In psychoanalytic therapy, the therapy relationship is seen as the key to progress.

A patient can talk about what’s going on in his life, but that is second hand. When he talks about his thoughts and feelings about the therapist, he is being more direct. Often, the biggest turning points come when the patient develops a transference neurosis. For example, he unconscious sees his therapist as a demanding parent who is trying to control him. He starts threatening to quit the therapy, making up excuses about not having money. The therapist bides his time. One day the patient angrily says he is quitting. The therapist says that will be fine.

“So you’re not even going try to talk me out of it!”

The patient suddenly becomes incensed. “You’re just like my father. He didn’t care about me and you don’t either!” The therapist waits. Right then, at that moment, he finally becomes clear about something.

“The anger that I’ve been feeling toward you is really meant for my father,” the patient finally admits. And he is able to make an important distinction, in therapy, and then out of therapy.

Do babies born in winter fare worse?

Children born in the winter months already have a few strikes against them. Study after study has shown that they test poorly, don't get as far in school, earn less, are less healthy, and don't live as long as children born at other times of year. Researchers have spent years documenting the effect and trying to understand it.

Recently a new study by two professors at the National Bureau of Economic Research theorizes that babies born in winter fare worse because their mothers are poorer and less educated.

"What we're actually doing is asking how children born at different times of year might be different at birth, said Kasey Buckles, one of the authors of the study. "And we think an important way that they're different is that they're born to different types of families."

"Past studies have argued that children born in the winter have lower wages because they get less education," said Dan Hungerman, the other author. "We're showing that children born in the winter are often born to women of a lower socioeconomic status and that fact might explain both the education result and the wage result."

To do the study, the authors collected data on over fifty million births from all parts of the United States. "Women who give birth in the winter are more likely to be without a high school degree, they're more likely to be non-married, they're more likely to be teenagers than other women," concluded Hungerman.

When you read their research more closely, you find out that women who give birth in winter are 10% more likely to be without a high school degree and also about 10% more likely to be teen-aged mothers. This seems like a small fraction on which to base their conclusions. However, it must be noted that both are economists so, naturally, their focus is primarily on socioeconomic factors.

However, economic factors do not explain all aspects of the research. For example, how does the fact that mothers are teenagers and less educated explain research showing that babies born in winter have shorter life spans?

What they ignore are the psychological factors. It has been well established by research that there is more depression in the winter months as well as a higher suicide rate. It would seem to follow, then, that mothers who give birth in winter are more likely to suffer from depression. The question then becomes, how much does a mother’s depression affect the child in her womb as well as the baby after birth?

Also well established is research that shows that children of depressed mothers do not perform as well as other children in school, due to the fact that depressed mothers are too distracted by their depression to pay adequate attention to their kids. And the neglect of depressed mothers translates into lowered self-esteem of their kids, which does not bode well for their functioning as adults.

Yes, economy may well be a factor in the diminished functioning of winter babies, but psychology may be a bigger factor. But in today’s climate, the psychological factor is often swept under the rug.

Do you have Facebook Narcissistic Disorder?

According to current estimates about 400 million people and counting are now members of a social networking website such as Facebook or Myspace. In a sense, this constitutes the largest community in the world.

It’s easier to communicate with someone on Facebook than at your office or on a park bench at lunch. The people on Facebook don’t see or hear each other. They only get text messages from one another. This makes communication on Facebook much less personal, much more anonymous, and much less threatening.

The ease and anonymity of communication on social networks has given rise to what I call Facebook Narcissistic Disorder. People who have a lack of social skills or friends can go on Facebook and build up a list of hundreds or even thousands of friends. This list of friends on Facebook not only fills the gap of empty or nonexistent friendships in the real world, but also creates a number of illusions (or, perhaps, delusions).

One illusion is that people begin to think the friendships on Facebook are real. However, these online friends are different than real friendships. Online you can play roles. You can pretend to be a wise or nice person. Nobody can hear your voice or see your eyes or your body language, so it is easier to pull off a fake.

If you’re a person with frustrated social needs, you are more likely to believe the pretenders, whereas offline, you are less likely to do so. Hence, people begin to believe their own pretences; they begin to think that their social networks are real; and they begin to believe what people say to them, even outrageous thing.

The whole network atmosphere begins to take on an importance and an intensity that convinces a person that life on Facebook is actually more real than the real world. People spend hours on Facebook. They can’t wait to get on Facebook. They look for opportunities at work, at home, even while shopping or driving (using their iphones). Facebook becomes their life. Their long list of friends, their apparent involvement with these friends, the apparent caring attitude of these friends, the sense of belonging, all combine to provide a new feeling of well-being and hightened self confidence.

This is when Facebook Narcissistic Disorder can become full blown. People start to buy in to the Facebook world to the extent that they make poor and risky decisions. They set up dates with strangers and put far too much trust in them. They take tips from people they hardly know and invest in risky ventures (all their “friends” are doing it).

For some, Facebook becomes an addiction. They actually feel negative physical symptoms when they are not online.

One case I heard about recently involved a teen-aged girl who kept meeting men on line, only to have them borrow money and disappear. Each of these men would praise the woman, telling her she was the wisest, warmest, most beautiful girl he had ever met. This of course stoked her narcissism. After the girl was let down, she did not tell her parents, her real friends, or, God forbid, seek counseling. Instead, she went online and complained to her Facebook friends They were magnificently sympathetically. None of them bothered to question her in any way about her own complicity in the matter, as a real friend might do. Instead they trashed the man and told her she was perfectly fine.

Facebook may be the largest community of enablers in the world.

Do today's college students lack empathy?

Current college students are 40 percent less empathic than their elders. So say the authors of an “Empathy Quiz” that was given to over 14,000 college students between the years 1979 and 2009. The study was done by Sara Konrath of the Univerity of Michigan and was presented last week at the meeting of the Association for Psychological Science in Boston.

In the quiz, students were asked to rate themselves with respect to statements such as, “I sometimes find it difficult to see things from the ‘other guy's’ point of view," and “I often have tender, concerned feelings for people less fortunate than me."

Dr. Konrath used the term “me generation” when discussing the results of the study. "Many people see the current group of college students—sometimes called 'Generation Me'—as one of the most self-centered, narcissistic, competitive, confident and individualistic in recent history," said Konrath, who is a psychiatrist affiliated with the University of Rochester.

She attributed this lack of empathy primarily to exposure to media and to online social networking. She contends that video games with violent content numb people to the pain of others. As for social networking, she and her assistant Edward O’Brien note, “The ease of having 'friends' online might make people more likely to just tune out when they don't feel like responding to others' problems, a behavior that could carry over offline.”

I find it interesting that neither Konrath nor her assistant traced empathy (or the lack thereof) to primary relations with parents or other humans. Instead they pointed to technology such as online networking and video games. This seems to be the trend nowadays—blaming things instead of people.

Long before children start playing video games or networking online, they learn about empathy through relations with their parents, siblings, uncles, aunts, grand-parents, kindergarten teachers and others with whom they are intimate. If children are shown empathy by their earliest caretakers, they begin to learn empathy.

But teaching empathy requires more than being an empathic parent. It also requires that parents set boundaries for their children and teach them to respect those boundaries and to respect their parent’s feelings. Perhaps this explains the disparity between the results of the Empathy Quiz by this generation and the previous generation. The previous generation understood empathy, but they didn’t understand how to teach it.

Instead of teaching empathy, they gave, gave, gave to their children without asking anything in return. The result is the “me generation,” a generation that demands human rights, but is not big on human responsibility. The result is also a culture that no longer values empathy as it once did. What do people value today? The most popular video games are about killing off other people and various monsters. The most popular movies seem to be about powerful people—sometimes superheroes—who “kick ass”. Movies or television shows (or video games) about empathic people are rare, if nonexistent.

For several generations now Americans have been presenting themselves to the world as “defenders of freedom” and “good guys that are saving the world.” But there may be a discrepancy between what we present and who we really are.

Should parents do therapy for their children's sake?

A new study indicates that mothers who are diagnosed with mental health problems a year after they give birth, tend to have children with behavioral problems.

Half the mothers in the study, reported on Forbes.com, had a condition a year after delivery in at least one of three categories: mental health, substance abuse, or domestic violence. At the same time 22 percent of the children had at least one type of behavioral problem such as aggression, anxiety-depression, or inattention/hyperactivity. The more problems a mother reported, the more likely her child would develop behavioral problems by the age of three.

After 30 years of practice in psychotherapy, I am not at all surprised at the results of this study. I have made this connection myself again and again when adult patients tell me about a mother who suffered from depression, was hospitalized due to a schizophrenic breakdown, had problems with alcohol or other drugs, was involved in an abusive relationship, or had some other severe mental disorder at the time they were born.

I have also made this connection when I work with young couples that are having and raising children. I have encountered a number of cases in which the father is in therapy with me but the wife is resistant to therapy. Mother are particularly important during the first few years of a child’s life.

In one such case many years ago a wife suffered from postpartum depression. She was unable to nurture her new baby after she came home from the hospital, so the father had to take over this role after work. Fortunately, the father had been in therapy for a few years and he was able to be loving and nurturing when he was home. But his job called for him to travel a lot and there were many weeks when he wasn’t home and the baby was neglected.

After a year, the mother had recovered to the extent that she was able to carry on with her life in a somewhat limited way. She was able to feed and care for the baby, but her depression caused her to be negative and critical toward the boy—as she was about life in general. Often she lost her temper and yelled at him.

Again and again, the father, at my urging, would bring up the notion that the mother should seek treatment. Whenever he did, the mother would be appalled.

“I don’t need therapy! You think everybody needs therapy.”

“Well, I’ve gotten a lot out of it and I think you could too.”

“I’m fine. I was a little depressed after I came home from the hospital. I just felt empty because everything was over. But I’m fine now.”

“But, you know, sometimes you get into fights with Joey over little things and you start yelling at him, and, well, I think therapy…”

“I know what I’m doing! Therapy is not for everyone!”

He never made any headway in these discussions.

A few years later the child began to have learning problems in school as well as problems getting along with other children.

Should parents do therapy for the sake of their children? What do you think?

Study: domestic violence isn't always a male issue.

The trend among today’s family counselors when it comes to treating couples who get into violent arguments is to view the man as the perpetrator of violence and the woman as the victim. Very often the two are treated separately; his treatment focuses on his control and power issues, while hers focuses on her being a victim.

“State treatment requirements are not always based on research but often ideology and beliefs,” notes Sandra Stith, a professor of family studies and human services at Kansas State University, an expert in intimate partner violence.

Stith, who has authored several studies of domestic violence, contends that standards of treatment often operate on myths, such as the myth that only men are offenders. Because men are more likely to be arrested for violence against a partner, most treatment programs target them.

“In most of our research we find that although women are more likely to be injured by intimate partner violence, both men and women are often violent,” Stith was quoted in a recent article on PsychCentral.com. She notes that too often the female partner in a domestic situation is automatically put in victim services.

In “Preventing Partner Violence: Foundations, Interventions and Issues,” published by the American Psychological Association in 2009, Stith’s research indicated that many women who are victims are also violent themselves. But, she adds that there has been little research on treatment for violent women. Domestic violence, she asserts, is not only about power and control; violence has multiple causes, including substance abuse, depression, and personality disorders.

Stith’s research is backed up by other studies, including one done by John Archer a few years back. He did an analysis of the available database on domestic violence in the United States and found that women were slightly more likely than men to use one or more acts of physical aggression and to use them more frequently, while men were slightly more likely to inflict injury. Overall, 62% of those injured by domestic violence were women, 38% were men.

In addition, studies comparing lesbian relationships with heterosexual relationships have shown that lesbians are prone to violent acts at about the same rate as heterosexual couples.

However, men rarely complain about domestic abuse, nor call in the police, because of fear they would be seen in as unmanly if they complained that a woman had physically abused them. It is usually women who do this, and thus they are seen as the victims.

As Stith asserts in her studies, a new treatment model must be developed to deal with domestic abuse, one in which the problem is seen as coming from both partners, and in which the emotional disturbances of both partners is understood and dealt with. What also needs to be recognized is that even though one partner becomes violent, the other partner may be provoking this violence through some kind of emotional abuse.

Perhaps we should coin a new term: emotional violence.

Army alarmed by suicides rates of soldiers.

The U.S. military is losing a battle to stem an epidemic of suicides in its ranks, according to an article in PsychPORT.

The Department of Defense reported last week that there were 160 active-duty suicides in 2009, compared with 140 in 2008. This report only covered soldiers who were actively serving, and did not include the large numbers of soldiers who return from the wars in Iraq and Afghanistan and commit suicide in the months and years afterward, when they often suffer from post traumatic stress syndrome and have problems readjusting to civilian life.

“There’s no question that 2009 was a painful year for the army when it comes to suicides,” said Col. Christopher Philbrick, the Deputy Director of the Army Suicide Prevention Taskforce, despite “wide-ranging measures last year to combat the problem.”

Col. Elspeth Richie, the Director of Behavioral Health for the Office of the Army Surgeon General, is alarmed by the easy availability of handguns on army bases and the ongoing stigma attached to suicide, mental illness, and the treatment of mental illness, despite the army’s attempt to change. Elspeth says, “In many ways we talk out of both sides of our mouths.”

There have been a number of conferences, taskforces, training programs and studies devoted to the problem of suicide, yet the problem gets worse. Soldiers who receive counseling are still committing suicide. “Many soldiers think that seeking treatment could ruin their army careers,” Elspeth notes.

Suicide among solders is not new. During the Viet Nam War of the 1960s and 1970s, almost as many soldiers committed suicide during and after the war as were killed in combat—about 60,000. The alarming rate of suicides associated with this war has been attributed to the unpopularity of the war.

This statistic has been largely hidden, as the army views suicides as shameful. It is a problem the army wishes would just go away. And the counseling they have devised to work with soldiers who have a suicidal tendency is geared to making them stop being a problem for the army as soon as possible. Nothing will make a suicidal person commit suicide faster than someone giving him the message he is being a nuisance.

The army’s attitude, however, is no different than the attitude of society in general. Suicide has historically been stigmatized. And mental illness has historically been stigmatized as well. Like the army, society is not particularly interested in understanding why people are suicidal. Society simply wants to put suicidal people on some kind of medication or some kind of quick fix program and get them out of their irksome funk as quickly as possible.

What I’ve learned about suicides during my 30 years of practice with suicidal people is that the all of them suffer from some kind of mental anguish, and the most effective way of helping them is to provide them with an empathic listener who will give them the space the talk through and unravel the conflicts inside of them.

Listening is not something the army—or most people—do well.

Do people want to know the truth?

If someone told you that something you believed was, in fact, not the truth, would you want to hear them out? According to a recent study, most people are not interested in finding out the truth. Most people would rather find out that what they believe to be the truth is the truth…and nothing but the truth.

In other words, they tend to pay more attention to those who agree with them.

So says a meta-study that was reported recently in Psychological Bulletin published by the American Psychological Association. The research project was led by professors at the University of Illinois and the University of Florida and included data from 91 studies involving nearly 8,000 participants.

The studies they reviewed generally queried participants about their opinions on a given topic and then allowed them to choose whether they wanted to view or read information that backed up their opinions or information that opposed them. The result: people are likely to select information that supports their point of view 67% of the time and are willing to consider opposing viewpoints only 33% of the time.

The study found that people are least interested in new points of view when their own views are associated with political or religious ideas. “If you are really committed to your own attitude—for example, if you are a very committed Democrat, you are more likely to seek congenial information, that is, information that corresponds with your views,” noted one of the authors, Deloris Albarracin.

When it comes to religion and politics, people tend to prefer viewing or reading information that is in agreement with their own thinking 70% of the time.

Cognitive psychologists—those who study the way people process and interpret information—refer to the tendency of sticking to an old way of looking at things and resisting a new or different way, as a “mental set.” This recent research appears to confirm the theory of the mental set.

Mental sets can hinder both individuals and groups in a range of ways. Mental sets come into play, for example, when you are trying to solve a problem in algebra. You keep trying again and again to find the solution and yet you can never find it. You go to sleep frustrated, and when you awake you suddenly try something completely different and, wham! You have the answer.

However, mental sets can be most harmful when it comes to human problems. A husband and wife continually have the same argument and neither will see the other side. Ethnic groups can’t stop feeling superior to each other. Liberals and conservatives can’t give up believing they are completely right and their opponent is completely wrong. Countries go to war rather than trying a new way of resolving their disputes.

The irony is that often those who regard themselves as open minded are in fact the most closed minded. They are closed minded about admitting they are closed minded.

Keats said, “Truth is beauty, beauty truth...and that is all ye need to know.” But most people say, “My way of thinking is truth and my way of thinking is beauty, and that is all I want to know.”