How seeing problems in the brain makes stigma disappear

 

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A pair of identical twins. The one on the right has OCD, while the one on the left does not.
Brain Imaging Research Division, Wayne State University School of Medicine, CC BY-SA

David Rosenberg, Wayne State University

As a psychiatrist, I find that one of the hardest parts of my job is telling parents and their children that they are not to blame for their illness.

Children with emotional and behavioral problems continue to suffer considerable stigma. Many in the medical community refer to them as “diagnostic and therapeutic orphans.” Unfortunately, for many, access to high-quality mental health care remains elusive.

An accurate diagnosis is the best way to tell whether or not someone will respond well to treatment, though that can be far more complicated than it sounds.

I have written three textbooks about using medication in children and adolescents with emotional and behavioral problems. I know that this is never a decision to take lightly.

But there’s reason for hope. While not medically able to diagnose any psychiatric condition, dramatic advances in brain imaging, genetics and other technologies are helping us objectively identify mental illness.

Knowing the signs of sadness

All of us experience occasional sadness and anxiety, but persistent problems may be a sign of a deeper issue. Ongoing issues with sleeping, eating, weight, school and pathologic self-doubt may be signs of depression, anxiety or obsessive-compulsive disorder.

Separating out normal behavior from problematic behavior can be challenging. Emotional and behavior problems can also vary with age. For example, depression in pre-adolescent children occurs equally in boys and girls. During adolescence, however, depression rates increase much more dramatically in girls than in boys.

It can be very hard for people to accept that they – or their family member – are not to blame for their mental illness. That’s partly because there are no current objective markers of psychiatric illness, making it difficult to pin down. Imagine diagnosing and treating cancer based on history alone. Inconceivable! But that is exactly what mental health professionals do every day. This can make it harder for parents and their children to accept that they don’t have control over the situation.

Fortunately, there are now excellent online tools that can help parents and their children screen for common mental health issues such as depression, anxiety, panic disorder and more.

Most important of all is making sure your child is assessed by a licensed mental health professional experienced in diagnosing and treating children. This is particularly important when medications that affect the child’s brain are being considered.

Seeing the problem

Thanks to recent developments in genetics, neuroimaging and the science of mental health, it’s becoming easier to characterize patients. New technologies may also make it easier to predict who is more likely to respond to a particular treatment or experience side effects from medication.

Our laboratory has used brain MRI studies to help unlock the underlying anatomy, chemistry and physiology underlying OCD. This repetitive, ritualistic illness – while sometimes used among laypeople to describe someone who is uptight – is actually a serious and often devastating behavioral illness that can paralyze children and their families.

In children with OCD, the brain’s arousal center, the anterior cingulate cortex, is ‘hijacked.’ This causes critical brain networks to stop working properly.
Image adapted from Diwadkar VA, Burgess A, Hong E, Rix C, Arnold PD, Hanna GL, Rosenberg DR. Dysfunctional activation and brain network profiles in youth with Obsessive-Compulsive Disorder: A focus on the dorsal anterior cingulate during working memory. Frontiers in Human Neuroscience. 2015; 9: 1-11., CC BY-SA

Through sophisticated, high-field brain imaging techniques – such as fMRI and magnetic resonance spectroscopy – that have become available recently, we can actually measure the child brain to see malfunctioning areas.

We have found, for example, that children 8 to 19 years old with OCD never get the “all clear signal” from a part of the brain called the anterior cingulate cortex. This signal is essential to feeling safe and secure. That’s why, for example, people with OCD may continue checking that the door is locked or repeatedly wash their hands. They have striking brain abnormalities that appear to normalize with effective treatment.

We have also begun a pilot study with a pair of identical twins. One has OCD and the other does not. We found brain abnormalities in the affected twin, but not in the unaffected twin. Further study is clearly warranted, but the results fit the pattern we have found in larger studies of children with OCD before and after treatment as compared to children without OCD.

Exciting brain MRI and genetic findings are also being reported in childhood depression, non-OCD anxiety, bipolar disorder, ADHD and schizophrenia, among others.

Meanwhile, the field of psychiatry continues to grow. For example, new techniques may soon be able to identify children at increased genetic risk for psychiatric illnesses such as bipolar disorder and schizophrenia.

New, more sophisticated brain imaging and genetics technology actually allows doctors and scientists to see what is going on in a child’s brain and genes. For example, by using MRI, our laboratory discovered that the brain chemical glutamate, which serves as the brain’s “light switch,” plays a critical role in childhood OCD.

What a scan means

When I show families their child’s MRI brain scans, they often tell me they are relieved and reassured to “be able to see it.”

Children with mental illness continue to face enormous stigma. Often when they are hospitalized, families are frightened that others may find out. They may hesitate to let schools, employers or coaches know about a child’s mental illness. They often fear that other parents will not want to let their children spend too much time with a child who has been labeled mentally ill. Terms like “psycho” or “going mental” remain part of our everyday language.

The example I like to give is epilepsy. Epilepsy once had all the stigma that mental illness today has. In the Middle Ages, one was considered to be possessed by the devil. Then, more advanced thinking said that people with epilepsy were crazy. Who else would shake all over their body or urinate and defecate on themselves but a crazy person? Many patients with epilepsy were locked in lunatic asylums.

Then in 1924, psychiatrist Hans Berger discovered something called the electroencephalogram (EEG). This showed that epilepsy was caused by electrical abnormalities in the brain. The specific location of these abnormalities dictated not only the diagnosis but the appropriate treatment.

The ConversationThat is the goal of modern biological psychiatry: to unlock the mysteries of the brain’s chemistry, physiology and structure. This can help better diagnose and precisely treat childhood onset mental illness. Knowledge heals, informs and defeats ignorance and stigma every time.

David Rosenberg, Professor, Psychiatry and Neuroscience, Wayne State University

This article was originally published on The Conversation. Read the original article.

Narcissistic personality disorder explained – very good!

The “very good” refers to the videos below.

I talked about this disorder in relation to Donald Trump, before. Please, do remember that persons with narcissistic personality disorder DID NOT CHOOSE to have this disorder. In most cases, something happened in early childhood while the person’s personality was being formed. (There is a video below about that.)

It’s my interest in bioethics in combination with a zen tinge of acceptance, among other things (including two personal situations), that is causing me to look deeper into particularly these personality disorders.

Bioethicist Julian Savulescu, for instance, advocates for removing essentially all disorders and diseases from the human gene pool, even when we can do a lot to prevent certain conditions or keep them under control (think asthma and air quality). A lot of what he wants is like demolishing homes to prevent that they ever burn down. He also is highly critical with regard to various personality disorders.

If you are able to be compassionate and keep in mind that the line between compassion and stupidity is very thin, you may find that dealing with a narcissist becomes much easier. Also, not everyone with narcissistic personality disorder has the affliction to the same degree or in the same way.

It is, for instance, possible to be friends with someone with narcissistic personality disorder. You have to be very steady on your feet and recognize every instance you’re being played so that you can stop each manipulative game before it starts (such as being told that you’re wrong, that red is black and then when you agree it’s black, being told it’s red).

Recognize the toddler part in narcissists when they behave like toddlers. Respond the way you would respond to a toddler. (Calmly.)

You also have to be aware of what may be happening behind your back (lies that are being told about you) and realize that if you try to talk to third parties about the disorder or about what is going on, YOU will sound like the “crazy” and “jealous” one. Can you handle that?

I am not recommending that we all become friends with narcissists, but they are a part of human diversity so we run into them whether we like it or not. Being able to deal with them well is better for everyone.

You can often choose how you respond emotionally to all sorts of occurrences and being able to choose how you respond can make a great difference. Often, you can either choose to get upset and feel victimized or shrug, smile and calmly carry on with whatever you were doing (or walk away). Understanding more about narcissistic personality disorder can facilitate this ability to choose your own responses.

The upside? Narcissists may all have a great sense of humor and no one can ever accuse them of being boring. Sometimes, you can actually learn from them, or from having encountered them.

The downside? They may have ruined you (your life) completely before you even know what hit you. Taking the zen approach of mentally letting go of what you lost and acceptance can help you deal with it and enable you to stay “whole” (but that is hard to explain without sounding shallow or even flippant or, worse, as an encouragement for accepting abuse).

Video 1: How to understand people who irritate or upset you

Video 2: Understanding the mind of a narcissist

Video 3: The emotion at the heart of narcissism

Video 4: The childhood origins of narcissism

Video 5: 5 key strategies for dealing with narcissists

Video 6: How the narcissist destroys your physical health

Video 7: 5 destructive fantasies empaths have after the narcissist has left.
(This is a video about lingering beliefs or ideas some people have after the breakup of a relationship with a narcissist.)

Video 8: The hidden emotion that makes empaths vulnerable to narcissists

Video 9: 7 traits of Narcissistic Abuse Victim Syndrome

Also, this happens when you ignore a narcissist, apparently:

Knowing how manipulation works is helpful too.

Below is an example of a behavior that narcissistic personality disorder can also result in, apparently. (Notice that no one seems to have realized yet that hackers can also have narcissistic personality disorder.) I am not sure yet how that comes about. Perhaps from the realization that in real life, relationships are too hard for someone with such a personality disorder?

I post the following from the work of Dr Lorraine Sheridan.

Typology 4: Sadistic stalking (12.9%)

Characteristics

· victim is an obsessive target of the offender, and who’s life is seen as quarry and prey (incremental orientation)
· victim selection criteria is primarily rooted in the victim being:

(i) someone worthy of spoiling, i.e. someone who is perceived by the stalker at the commencement as being: – happy – ‘good’ – stable – content and
(ii) lacking in the victim’s perception any just rationale as to why she was targeted

· initial low level acquaintance

· apparently benign initially but unlike infatuation harassment the means of intervention tend to have negative orientation designed to disconcert, unnerve, and ergo take power away from the victim

– notes left in victim’s locked car in order to unsettle target (cf. billet-doux of infatuated harassment)
– subtle evidence being left of having been in contact with the victim’s personal items e.g. rifled underwear drawer, re-ordering/removal of private papers, cigarette ends left in ash trays, toilet having been used etc.
– ‘helping’ mend victims car that stalker had previously disabled · thereafter progressive escalation of control over all aspects (i.e. social, historical, professional, financial, physical) of the victim’s life

· offender gratification is rooted in the desire to extract evidence of the victim’s powerlessness with inverse implications for his power => sadism
· additional implication => self-perpetuating in desire to hone down relentlessly on individual victim(s)
· emotional coldness, deliberateness and psychopathy (cf. the heated nature of ex-partner harassment)
· tended to have a history of stalking behaviour and the controlling of others · stalker tended to broaden out targets to family and friends in a bid to isolate the victim and further enhance his control
· communications tended to be a blend of loving and threatening (not hate) designed to de-stabilise and confuse the victim
· threats were either overt (“We’re going to die together”) or subtle (delivery of dead roses)
· stalker could be highly dangerous

– in particular with psychological violence geared to the controlling of the victim with fear, loss of privacy and the curtailment of her social world

· physical violence was also entirely possible

– especially by means which undermine the victim’s confidence in matters normally taken for granted e.g. disabling brake cables, disarming safety equipment, cutting power off

· sexual content of communications was aimed primarily to intimidate through the victim’s humiliation, disgust and general undermining of self-esteem
· the older the offender, the more likely he would have enacted sadistic stalking before and would not be likely to offend after 40 years of age if not engaged in such stalking before
· victim was likely to be re-visited after a seeming hiatus

Case management implications

· should be taken very seriously
· acknowledge from outset that the stalker activity will be very difficult to eradicate
· acknowledge that there is no point whatsoever in appealing to the offender – indeed will exacerbate the problem
· never believe any assurances, alternative versions of events etc. which are given by the offender
· however, record them for use in legal action later
· the victim should be given as much understanding and support as can be made available
· the victim should not be given false or unrealistic assurance or guarantees that s/he will be protected
· the victim should carefully consider relocation. Geographical emphasis being less on distance per se, and more on where the offender is least able to find the victim
· the police should have in mind that the sadistic stalker will be likely to:

(i) carefully construct and calculate their activity to simultaneously minimise the risk of intervention by authorities while retaining maximum impact on victim,
(ii) be almost impervious to intervention since the overcoming of obstacles provides
(iii) new and potent means of demonstrating the victim’s powerlessness (ergo self-perpetuating) and,
(iiii) if jailed will continue both personally and vicariously with the use of a network.

http://www.le.ac.uk/press/ebulletin/archive/speaker_sheridan.html

http://www.le.ac.uk/ebulletin-archive/ebulletin/features/2000-2009/2007/07/nparticle.2007-07-17.html

http://news.bbc.co.uk/1/hi/uk/6300291.stm

http://www.le.ac.uk/press/stalkingsurvey.htm