Posts Tagged ‘Choice Theory’

By Peter R. Breggin, MD
December 22, 2012

The Newtown tragedy has sent us searching for answers to mass killings. There are many important questions to be addressed, such as “Is tighter gun control feasible and consistent with the Second Amendment?”, “Can we prevent so much teen exposure to violent games and movies?”, “Would it help to put armed guards in schools or to arm teachers and principals?”, and “How much mass murder is driven by psychiatric drug exposure?” These are critical issues.

Recently, another issue is being pushed by both the political left and the political right. In the last few days, talking heads on TV and even some of my friends have been arguing that we need stronger commitment laws and other psychiatric interventions to protect people from maniacal shooters. In additional to gun control, President Obama is talking about increased mental health services.

As a psychiatrist, I know that increasing the power of psychiatry in our society is not the way to go.

To begin with, we need to distinguish between good mental health services and the kind of services that will result from government promotion of mental health services. In the mid-1960s I was an officer in the U.S. Public Health Service, and for a year I was a fulltime consultant at NIMH helping to build and staff community mental health centers around the country. They were supposed to address a broad range of needs and services, but utterly failed to do so. The remnants of them are nothing more than drug dispensaries.

We know exactly what happens when the government pushes mental health services, because we can examine their results. The VA, state mental hospitals, and county clinics offer little else than drugs. Or consider the scandals involved in government-run foster care where children are routinely subdued with drug cocktails..

It is becoming increasingly clear that Adam Lanza, the Newtown shooter, was very emotionally disturbed and socially incapacitated. But what does psychiatry have to offer in protecting society from individuals who have serious psychological or psychiatric problems, and who may sometimes become violent? Does it offer treatments that will help these individuals live more normal lives? Can it screen for violence and protect us from disturbed and destructive people?

First of all, making involuntary treatment even easier won’t reduce violence. Every state in America already has laws to temporarily incarcerate individuals in mental hospitals if an official suspects them of being a danger to other people. Short-term, depending on the state, this temporary certification process can be carried out by a wide range of health professionals and law enforcement officials. It does not require a judge or a hearing in order to accomplish this–just one or two officials to sign the papers. It is especially easy for a parent to initiate this process, because health and law enforcement officials are especially responsive to parental concerns about violence.

Second, after an individual is locked up in a mental hospital on a temporary certification, it is always possible to detain that individual long enough to obtain a court hearing for more lengthy involuntary commitment. It is well known that these hearings compromise individual rights and are almost always won by the committing agency and doctors.

Third, in recent years a growing number of state, now a total of 44, have passed draconian legislation whereby individuals can be committed and forced to accept psychiatric drugs on an “outpatient” basis. That is, they can be forcibly drugged into a stupor while remaining otherwise free. This has become a widespread affront to civil liberties while causing considerable misery and physical harm through medication toxicity.

Fourth, so many people harbor feelings of violence, and so few perpetrate them, that it is impossible to screen society for violent individuals without untold numbers of “false positives.” In a general psychiatric practice such as my own, a number of patients will be struggling to control their violent feelings and usually a few will have acted aggressively or violently in the past. Within society as a whole, there will be thousands of “suspicious-looking” people locked up and drugged for every genuine threat. The recent demise of the nation’s largest screening program for mental disorder in the schools took place in part because it was criticized for being both ineffective and a threat to individual rights.

Fifth, meanwhile, psychiatry and individual psychiatrists have no way of determining who poses a real risk of violence other than the common sense indicators, such as the person is making threats or has already committed violence. Nowhere in the scientific literature is there a study that confirms that psychiatrists can determine who will, or will not, perpetrate violence. Scientific risk assessment approaches cannot be relied upon to make decisions about treatment or incarceration.

Sixth, “mentally ill” people, that is, people who get diagnosed psychiatrically, are not more dangerous than the general population, including neighbors in their communities. However, individuals suffering from substance abuse do have increased rates of violence, but largely toward family members rather than the public.

Seventh, when psychiatry becomes involved, drugs are dispensed, and psychiatric drugs can cause or worsen violence. A recent study of reports to the FDA of drug-induced violence has demonstrated that antidepressants have an 840% increased rate of violence.

In particular, there is no doubt that the Columbine High School shooter Eric Harris had an effective level the antidepressant Luvox (fluvoxamine) in his blood at the time of the massacre. For the first time, I’m making public the drug company report to the FDA confirming that Harris had a “therapeutic” level of the drug in his body at the time of the murders. This is the official report to the FDA on March 17, 1999, from Luvox (fluvoxamine) manufacturer Solvay Pharmaceuticals confirming “the presence of a Luvox blood level at autopsy.” I was an expert in cases surrounding the Columbine shootings and can also confirm that Eric Harris was taking the drug for a year, had a dose increase to 200 mg per day two and one-half months before the assault on the high school, and was showing signs of toxicity in the form of a drug-induced tremor five weeks before the event. Meanwhile, his writings indicate he was becoming more and more violent while taking Luvox.

The most devastating recent shooters were all involved with psychiatric treatment and evaluation, and it did not prevent their violence. In some cases, it undoubtedly increased it. Eric Harris, as noted, was in treatment for at least a full year leading up to assault on Columbine High School. Cho, the Virginia Tech shooter, came to the attention of police and then mental health authorities as a result of harassing another student and threatening suicide in 2005. A voluntary mental examination found him “mentally ill and in need of hospitalization” and Cho was hospitalized and found to be a danger to himself and others. In December 2005, he was court-ordered to have follow-up treatment but this was never enforced. There is no record of any further psychiatric treatment.

James Holmes, the Aurora, Colorado theater shooter, in the months leading up to his violent assault, was in psychiatric treatment with psychiatrist Lynne Fenton, medical director of student health services at the Anschutz campus of the University of Colorado, where Holmes was a graduate student in neuroscience. Fenton was considered an expert on campus violence and had written the protocol for her campus threat assessment team. She was sufficiently worried about his propensity for violence to report him to the campus police and the campus threat assessment team in early June, a few weeks before the theater assault. When the assessment team suggested putting Holmes on a 72 hour involuntary hold, psychiatrist Fenton rejected the idea. When Holmes quit school, the school washed its hands of all responsibility for him.

Adam Lanza’s psychiatric history remains undisclosed but there are indications that he was at some time psychiatrically diagnosed and taking psychiatric medications. The Washington Post quoted a family friend as stating he was “on medication.” Given his affluent family, he was almost certainly taken to psychiatrists.

Many people who could be helped by psychological or socially-oriented counseling or therapy avoid seeking psychiatric treatment for fear of being locked up and/or drugged against their will. There is some indication that the Newtown shooter was triggered in part by fear that his mother was going to have him treated involuntarily. My own clinical experience indicates that most violence perpetrated by “mental patients” takes place in reaction to and in resistance to having treatment forced upon them.

Overall, psychiatry has a history, both past and current, of trampling on the rights of untold millions of innocent, nonviolent individuals in the name of protecting society from dangerous people. The two hundred year history of state mental hospitals is one of the most oppressive in the western world. The current widespread psychiatric diagnosing and drugging of America’s children is another tragic example. It’s dangerous folly to seek solutions to violence from within psychiatry.

So, we need to get down to business of figuring out how to reduce school shootings and mass violence. We need to come together with determination to find solutions. Increasing psychiatric power is a distracting mirage; it is not one of the solutions that will work.

Families do need improved services to help with difficult, distressed, or potentially violent children, and a wide variety of empathic, caring approaches are available to provide this help. Schools also need more services to reach out to children and youth who are withdrawn and isolated, and on very rare occasion potentially violent; and again there are numerous effective ways of offering this help. I describe a number of these child and family-oriented interventions in my book that focuses on the Columbine High School massacre and other school shootings: Reclaiming Our Children: A Healing Plan for a Nation in Crisis.

Truly beneficial therapies and educational interventions do not rely on psychiatric diagnoses or drugs. Instead, they are based on what our Center for the Study of Empathic Therapy calls its “Guidelines for Empathic Therapy.” But federal, state and county governments will push for “modern” biopsychiatric treatments which will, beyond any doubt, do more harm than good.

http://breggin.com/index.phpoption=com_content&task=view&id=299&Itemid=133

Peter R. Breggin, MD is a psychiatrist in private practice in Ithaca, New York, and the author of more than forty scientific articles and twenty books, two of which are very relevant to current events in regard to medication-induced violence. In Medication Madness (2008) Dr. Breggin examines fifty cases of medication-induced violence, mayhem and suicide. His latest book is Psychiatric Drug Withdrawal: A Guidebook for Prescribers, Therapists, Patients and Their Families. It presents reasons to withdraw from psychiatric drugs and describe a safe and effective patient-centered approach for prescribers, therapists, patients and their families to use. Dr. Breggin’s website is www.breggin.com.

Check this out about labeling our children, its only a minute.

By Timothy D. Evans and Raymond J. Corsini

Grousing is a common behavior that is highly destructive to relationships. It increases interpersonal conflict and provokes revenge while generating attitudes of resentment and no cooperation. Parents grouse at their children because they believe it will make them more responsible. One or both members of a couple may grouse at each other, convinced they know what is best for their partner. Despite its prevalence, grousing is a discouraging way of interacting. It destroys the potential for developing an encouraging and intimate relationship.

What is grousing? Webster defines grouse as “to grumble or complain.” It is related to the word “grouch.” Roget equates the term with “fret, chafe, frown, crab, or pout.” The usual synonym for grousing is nagging. The phrase, “Get off my back” means to stop grousing.

The initial step in encouragement training is to teach couples, parents, and teachers how their seemingly innocuous behavior irritates and discourages others. Nothing will improve in marriage until one starts working on him- or herself without trying to change the other person (Evans, 1989; Meredith & Evans, 1990). Marriage reconstruction requires the grouser to stop nagging, complaining, arguing, judging, criticizing, punishing, or rewarding (anything that irritates the other person). In short, the grouser needs to shut up and be pleasant.

GROUSING EXERCISE: An especially effective exercise for improving relationships entails the elimination of grousing for 4 consecutive days. After the therapist explains what it means to grouse, the following directions are given to couples or individuals: If you are guilty of grousing, are you willing to stop it for four consecutive days? If so, here is the assignment: You must stop grousing immediately and completely for four consecutive days. If you’ve been attacking, criticizing, yelling, reminding, nagging, threatening, bringing up the past, comparing, or pointing out mistakes, stop it now. This includes all negative behavior, no matter how “nicely” presented or well-intentioned.

Instead of grousing, act “as if” you are a sensible and self-controlled person who has decided to get off your spouse’s back and enjoy their company in spite of their shortcomings. You are not to do anything else other than to avoid grousing at your partner, child, or the person closes to you. After four consecutive days you have the choice of reverting to your old behavior.

You are only to participate in this exercise if you agree to do it for four consecutive days. This means that if you go for three days and grouse, you need to start over. You are not to perform this exercise with the intention of shaping-up the other person. You are changing your behavior because it is the decent and reasonable thing to do.

Assuming you follow through with this experiment, what might happen! There are several possibilities:

1. You will feel better about yourself. After all, who likes to be a prison guard monitoring someone’s behavior?

2. You will look better. Nags look like nags.

3. You will show/generate goodwill. Your mate will have evidence of your intention to improve the marriage.

4. You will become a more encouraging person.

5. You will reduce tension.

Your family will develop a friendly, supportive atmosphere. The Grousing Exercise is one that benefits everyone as both therapists and their clients can encourage themselves and their families. Practicing encouragement via the elimination of grousing is a win-win quality relationship proposal. ‘

REFERENCES

Evans, T. (1989). The Art of Encouragement. Athens, GA: University of Georgia, Center for Continuing Education.

Meredith, C., & Evans, T. (1990). Encouragement in the Family, Individual Psychology, 46, 187-192.

The Family Journal: Counseling and Therapy for Couples and Families ~ Vol. 2, No. 1 (1994) pp. 70

[1] Appeared in: The Family Journal: Counseling and Therapy for Couples and Families ~ Vol. 2, No. 1 (1994) pp. 70

Life is made of one-third what I choose to do with my thoughts, behaviors, and attitude. Another one-third is the choices people around me make, in which I have no control. Hopefully, my wife will continue to choose to be with me. I cannot control her choice. I can decide how I will behave in hopes that she will find me pleasant and interesting, but in the end, the choice is hers. The final third, which again I cannot control, is what the universe, biology, nature, or what some believe God determines. I have no control over a hurricane hitting Tampa, my cat having heart disease, or a friend getting cancer. This is biology. I do have a choice in how I interpret and relate to those specific events (again my one-third).

If we live long enough, we will encounter events that force us to face our vulnerability as human beings. This can be interpreted as an injustice because “I have been doing everything right (if there is such a way) therefore nothing bad should ever happen to me.” This “injustice” may be because of someone else’s choice or biology. When it occurs, I will experience vulnerability and know that I am not totally independent. Some may guard against these feelings of vulnerability and say his wife’s cancer is the work of the devil. These life events will test our emotional self-reliance (self-responsibility) and push us to need others.

When we confront and experience our vulnerability we receive a dose of humility, which connects us to others. From these incidents, we will learn there is only one genuine need we all have and that is other people.

Since the beginning of time, human beings have misbehaved and made poor choices. Take for example the story of Joseph in the Book of Genesis. His brothers sold Joseph, the youngest and special son, into slavery. This was the beginning of Joseph’s trouble. He was falsely accused of having sex with his owner’s wife and thrown into prison. Yet he survived. Before he reached age 30 he was appointed as a top official by the ruler of Egypt. He predicted a famine and was put in charge of a food storage that saved the region. His brothers were forced to journey into the city seeking food, starving, and begging. Who did they appear before? Joseph! His chance to get even.

So it would seem that justice will prevail and what goes around comes around. His brothers did not recognize him and Joseph’s natural inclination was revenge. However, Joseph recognized that revenge was an easy way out. The courageous choice — and the only way to be happy — was forgiveness. One difference between happy and unhappy individuals is the ability to forgive.

Tragedy, error, inhumanity, and struggle will not go away. However, the realization that you have a choice in how you respond is powerful and influences your happiness and well-being, in spite of the other two-thirds. Forgiveness is done through the use of good psychology. It requires courage, emotional self-reliance, and a desire to be free.

Anyone who has done you harm will continue to have a stranglehold on your life, until you are willing to forgive them and free yourself from the resentment, anger, hurt, injustice, and sometime hatred.

Joseph took an active approach to the injustice and pain inflicted upon him. He used the situation to become socially interested instead of self-interested.

Forgiveness is an active process that requires these steps:
• I will not bring up the incident again and use it against you.
• I will not talk to others about this incident.
• I will not let this incident stand between our personal relationships.
• To do this I will not dwell or ruminate over the problem or punish you by withdrawing and keeping emotional distance.
• I will free the relationship to develop, unhindered of the past wrongs.

Psychiatric Drug Withdrawal is a book for the seasoned professional and the beginning graduate student, as well as for the patient and the family. This is in keeping with Dr. Breggin’s emphasis on a collaborative team approach to treatment and especially to drug withdrawal. This is not a book you will read once, but one you will have by your side, as a reference, for helping a love one or your client.

The first ten chapters inform us of the effects psychiatric drugs have on our brains and educate us regarding specific drugs. In chapter 11, Dr. Breggin, using his years of clinical experiences, puts all the ingredients together and demonstrates how to help individuals regain their lives from the disabling effects of drugs. Dr. Breggin does this by putting counseling and psychotherapy back in the forefront as the intervention and not the drugs. He gives respect and dignity back to the counseling process, including the active participation of the client and at times the family.

It is refreshing to read a book renewing the use of the core conditions (empathy, genuineness, and positive self-regard) as necessary and sufficient in helping clients’ function effectively. This is a long stretch from the medical model, which mistrusts human nature, relies on brain drugs, and denies self-responsibility. Dr. Breggin invites us to use what works, empathy and a therapeutic relationship.

This is a book that is both academic and clinical, and at the same time easily read by clients and families. A rare combination for the practicing therapist. His years of experience researching the effects of psychiatric medications combined with being an excellent practitioner are explained in a systematic and effective manner. You will learn the effects of drugs and how to approach your client in a collaborative and humane manner. This is what we need. The idea that drugs are the answer has failed and at the high cost of human suffering.

“You cannot solve your problems by taking psychoactive substances that impair your mind and the expression of your sprit. From illegal drugs to psychiatric medications, drugs suppress and distort our real emotions and should be avoided, especially in time of suffering and fear when we need to know what we are feeling to control our actions.”

Peter Breggin, M.D., Medication Madness

“Whatever goes on between two people is reciprocal and promoted by both, although it may look as if one of them started the motion hence is responsible for the action.” R. Dreikurs

1. Needing to be Right
a. Finding out whose view is more “valid” or “accurate”.
b. Leads to endless “objectivity” battles
c. Fuels the psychological violence of self-righteous indignation.

2. Controlling Your partner
a. Can be direct or indirect such as using one’s “sensitivity” such as tears (water power)
b. Humans do not like being controlled.

3. Unbridled Self-Expression
a. “I have the right and need to share my feelings with you –and you will listen.
b. Idea that all sharing is authentic and will increase closeness. Not true.
c. Rarely engenders generosity in other.

4.Retaliation
a. Perverse justice: “offending from the victims position.
b. Getting even, “you will suffer like I suffer”.

5. Withdrawal
a. Differs from responsible distance taking.
b. Another form of a fight—engaged or disengaged same end of the stick.
c. Form of punishment-I will teach you a lesson.

1. Stop criticizing. Not an easy step to take. However, it is an effective beginning toward changing the lines of communication from negative to positive.
2. Restructure relations. Tell your teenager at a quiet time that you have been thinking things over and wish to make some changes in your own attitude.
3. Establish a relationship of equity with your teenager. This, of course, does not mean that you, the parents, should give the child things which are excessively costly or service which puts you in the position of servant.
4. Set some logical limits. For example discuss where you think he or she should go socially, the appropriate hour for getting home, and the number of times per week for going out. If all are quietly talking and trying to solve the problem, letting go of the power struggle between each side, it is possible to reach some agreement.
5. Once an agreement is reached the teenager should then take the responsibility to carry through. It should not be the parent who has to ask, “Where are you going?” or the child who asks, “May I go to Ann’s house?” The teenager should simply state, “I am going to Ann’s house and will return at 10:30.” In turn, the adults should tell there teens where they are going and when they expect to return home.
6. When you talk, state your feelings, but do not imply that only you are right.
7. Listen to what your teenager has to say. Do not interrupt. Take the time to think about what has been said and ask the same courtesy for yourself, but stress that what you say is only your opinion.
8. Do not expect more from your teenager than you do from yourself.
9. You may have to change the lesions you are teaching by example. For example, if you want a teenager to stop smoking and you, yourself, smoke; see if you can both agree to stop. And even if no agreement is reached, you stop anyway!
10. Become willing to be taught by your teenager. Show interest in what he or she tells you. This will encourage friendship.
11. Enjoy the companionship of your teenager. Parents may invite the teenager to join them in some activity, which they enjoy. Do not be hurt if you are refused; remember this is the age for breaking away from parents.
12. Try to learn the teenage language and do not get angry at its use. This does not mean that you have to use it.
13. Live and let live. Trying to fashion your teenager in your own image will not work.
14. You may need counseling. A psychologist or family counselor may save much time and effort and help you change yourself or your behavior.
15. Let go, and let your teenager grow up.
16. Show your affection for your teenager with an occasional hug, an arm around the shoulder, a pat on the back, and expressions of appreciation.
17. You cannot give permission for a teenager to do anything illegal or allow the teenager to break the law while living with you.
18. You do not have to spend money on teenagers for any object or activity of which you disapprove.
19. You should be willing to listen carefully to proposed ventures and to discuss these sympathetically, giving your opinions. You may withhold your blessing, but you should not threaten or give an outright refusal.
20. In crisis situations, such as accidents while driving or arrests, the less said in heat, the better. Wait until everything has calmed down.

By Cameron W. Meredith, Ph.D., Professor Emeritus

It is educational and psychological madness that:

1. While everyone agrees on the tremendous value of education in our democracy, we provide only 180 days of public school education.
2. While there is considerable agreement on the psychological principle of spaced learning we jam it all in long school days and homework only 9 months of the year.
3. We all know about newer and encouraging psychology such as Adlerian and Third Force Psychology, we still practice first force psychology namely behaviorism and obedience training called assertive discipline with belief in punishment and bribing.
4. While, since WWII, we believe in freedom and democracy, we still have too many autocratic schools and families practicing order without freedom as well as compulsory homework.
5. While we all agree on the value of cooperation, the helping relationship, and getting along together, we impose competition in our classrooms namely the ABCDF grading system where helping or receiving help is considered cheating.
6. While we all know how encouraging it is to have the freedom to choose and, when we invite and involve students in an atmosphere of freedom and cooperation, they become more responsible and feel that they belong, we are often inclined to tell them what to do and learn with few if any choices.
7. While we do a pretty good job of imparting knowledge and encouraging memorization in preparation tests, we often do a poor job in teaching the use of knowledge for daily living.
8. While there is considerable need for compulsory school attendance in a democracy for thirteen years, there is little agreement on the length of the school day. There is pressure to lengthen the school day. Almost all teachers demand homework as if it is compulsory. Then, as if mandated, there is three months with no school.

There is a lot of evidence that supports the use of Choice Theory and other Third Force Psychologies that focus on maintaining and improving the relationships. Especially staying away from external control psychology (Rewards and Punishment) and instead making use of encouragement (not praise) natural and on occasion logical consequences (4R of a logical consequences). There is a lot of confusion over what constitutes “emotional attachment”. Choice Theory, Adlerian Psychology, Person-Center Therapy, all offer helpful ideas of how to stay connected to the important people in our lives. For instances, empathy is a way to provide understanding and therefore belonging to those we love.

Although, I think the quality of time is as important as the amount of time with our teens. You can spend a lot of disconnecting time with our teens, children, and spouse (deadly habits). In addition, being overly focused on the need of our teens, not only develops self-centered human beings, but also takes away their self-confidence and ability to leave home.

Tampa Tribune, September 11, 1997.
Secure teenagers don’t take drugs

A Washington Post report
Teenagers who have strong emotional attachments to their parents and teachers are much less likely to use drugs and alcohol, attempt suicide, engage in violence or become sexually active at an early age, according to the largest-ever study of American adolescents.
The study, published in Wednesday’s Journal of the American Medical Association, concludes that feeling loved, understood and paid attention to by parents helps teenagers avoid high-risk activities regardless of whether a child comes from a one or two-parent household. It is also more important than the amount of time parents spend at home, the study found.
At school, positive relationships with teachers were found to be more important in protecting teenagers than any other factor, including classroom size or teacher training.
Researchers also found that young people who have jobs requiring them to work 20 or more hours a week, regardless of family economic status, are more likely to use alcohol and drugs, smoke cigarettes, engage in early sex and report emotional distress.
While the amount of time spent with parents had a positive effect on reducing emotional distress, feeling connected to parents was five times more powerful. And this emotional bond was about six times more important than was the amount of various activities that teenagers did with their parents.