It’s been reported that God has a special fondness for fallen sparrows, fools, and small children which may be why he gets such a kick out of startling me. This morning, he arose in a ghostly puff of sawdust from the bottom of the woodpile and like a gleeful child, said “Boo.” “NOT FUNNY,” I […]
Today I’m in Bozeman on my way to present to the Montana School Counselors in Belgrade, MT. As my friends at the Big Sky Youth Empowerment Program like to say, “I’m stoked!” I’m stoked because there’s hardly anything much better than spending a day with Montana School Counselors. Woohoo!
My topic tomorrow is “Strategies for Supporting Students with Common Mental Health Conditions.” That means I’ll be reviewing some DSM/ICD diagnostic criteria and that brings me to reflect on the following. . . .
Not long ago (July, 2019), Allsopp, Read, Corcoran, & Kinderman published an article in Psychiatry Research, not so boldly titled, “Heterogeneity in psychiatric diagnostic classification.” Hmm, sounds fascinating (not!).
A few days later, a summary of the article appeared in the less academically and more media oriented, ScienceDaily. The ScienceDaily’s contrasting and much bolder title was, “Psychiatric diagnosis ‘scientifically meaningless.” Wow!
The ScienceDaily summary took the issue even further. They wrote: “A new study, published in Psychiatry Research, has concluded that psychiatric diagnoses are scientifically worthless as tools to identify discrete mental health disorders.”
Did you catch that? Scientifically worthless!
In an interview with ScienceDaily, Allsopp, Read, and Kinderman stoked the passion, and avoided any word-mincing.
Dr. Kate Allsopp said, “Although diagnostic labels create the illusion of an explanation they are scientifically meaningless and can create stigma and prejudice. I hope these findings will encourage mental health professionals to think beyond diagnoses and consider other explanations of mental distress, such as trauma and other adverse life experiences.”
Professor Peter Kinderman, University of Liverpool, said: “This study provides yet more evidence that the biomedical diagnostic approach in psychiatry is not fit for purpose. Diagnoses frequently and uncritically reported as ‘real illnesses’ are in fact made on the basis of internally inconsistent, confused and contradictory patterns of largely arbitrary criteria. The diagnostic system wrongly assumes that all distress results from disorder, and relies heavily on subjective judgments about what is normal.”
Professor John Read, University of East London, said: “Perhaps it is time we stopped pretending that medical-sounding labels contribute anything to our understanding of the complex causes of human distress or of what kind of help we need when distressed.”
In contrast to the authors’ conclusions, nearly every conventional psychiatrist believes the opposite–and emphasizes that psychiatric diagnosis is of great scientific and medical importance. For example, the Midtown Psychiatry and TMS Center website says, “A correct diagnosis helps the psychiatrist formulate the most effective treatment that will result in remission.”
No doubt there.
In addition, although I literally love that Allsopp, Read, and Kinderman are so outspoken about the potential deleterious effects of diagnosis, I think maybe they take it too far. For example, “Shall we pretend that we should provide the same intervention for panic attacks as we provide for conduct disorder, autism spectrum disorder, and gender dysphoria?”
That’s me talking now . . . and as I discussed this with Rita, she amplified that, of course, if you have a student who’s intentionally engaging in violent acts that harm others, we’re not treating them the same as a student who’s suffering panic attacks. Obviously.
Psychiatric diagnosis is a great example of a dialectic. Yes, in some ways it’s meaningless and overblown. And yes, in some ways it provides crucial information that informs our treatment approaches.
This leads me to my final point, and to my handouts.
What’s our School Counseling take-away message?
Let’s keep the baby and throw out with the bathwater.
Let’s de-emphasize labels – because labelling, whether accurate or inaccurate and whether self-inflicted or other inflicted, are possibly pathology-inducing.
Instead, let’s focus on specific behavior patterns, as well as abilities, impairments, stressors, and trauma experiences that interfere with academic achievement, personal and social functioning, and career potential.
In case you’re interested in more on this. My handouts for the workshop are below.
The Powerpoints: MFPE 2019 Belgrade Final
Managing fear and anxiety:Childhood Fears Rev
Student de-escalation tips: De-escalation Handout REV
In my great and unmatched wisdom I hereby proclaim that today Opposite Day.
Never mind that Opposite Day is a fictional children’s holiday and that it’s officially celebrated on January 25. Just because today’s not January 25 and I’m not a child, doesn’t mean I don’t get to say opposite things. I get to say opposite things because I’ve said I get to say opposite things.
When my nephews were little, we never waited for Opposite Day. Instead, we’d suddenly start playing the Opposite Game. It’s just like Opposite Day, but spontaneous. We’d say hello when we meant goodbye. I’d say things like, “Tommy, you’re the smartest person I know!” Or, “Paul, you’re one good looking guy.” I was totally hilarious, maybe the funniest uncle ever to exist on planet Earth.
Sometimes our spontaneous opposite games got a little out of control, but that was the point. One time, when grandma showed up and Tommy and Paul rolled their eyes and said, “It’s terrible to not see you” she looked hurt. We had to call time-out and explain the game to her. Even after the explanation, she didn’t seem to get it.
Funny thing, even when you’re playing at saying things that are the opposite of the truth, sometimes people don’t catch on. People get confused. For example, if the media happened to be listening to us, they might get confused and literally report things we said, even though we meant the opposite. That’s especially funny. When that happens, whether it’s by accident or on purpose, the correct response is to say, “I was only joking.”
After a while, if you intermittently play the Opposite game and mix it with being normal, people won’t know when to take you seriously and when to not take you seriously. For example, the other day I made a phone call, it was a perfect phone call. I said, “Hey dude, I’ll bring you over some of that medicinal plant you’re needing for nausea. It really sucks to feel sick, and I want to help. I’d like you to do me a favor though. If you could spontaneously give my boss a call and tell him how much you appreciate my great and unmatched wisdom, that would be nice.”
To be certain that I’d communicated perfectly, I ended the conversation by saying, “I’m only joking you know. I’m quite the humorist. Never mind what I said before. You look really nice today.”
The best thing about being in charge of the opposite game is that it keeps everybody else off balance. In comparison, I’m always on my game, because I’m the only one who knows when the opposite game rules are in effect.
I remember how that worked with my nephews. At the end of the day, sometimes I’d hug them and yell, “I hate you.” They knew what I really meant.
Oh, and BTW. Thanks for reading this. I value you as a person and I hope you love yourself. You know one thing that might help. If you’d just keep this blog post to yourself. Don’t share it. Seriously. I’m joking.
Affect is how you look to me.
Affect involves me (an outsider) judging your internal emotional state (as it looks from the outside). Whew.
Mood is how you feel to you.
Mood is inherently subjective and limited by your vocabulary, previous experiences, and inclination or disinclination toward feeling your feelings.
Independently, neither affect nor mood makes for a perfect assessment. But let’s be honest, there’s no such thing as a free lunch, and there’s no such thing as a perfect assessment. Even in elegant combination, affect and mood only provide us with limited information about a client’s emotional life.
Our information is limited and always falls short of truth because, not only is there always that pesky standard error of measurement, also, emotion is, by definition, phenomenologically subjective and elusive. Emotion, especially in the form of affect or mood, is a particularly fragile and quirky entrepreneur of physiology and cascading neurochemical caveats. Nothing and everything is or isn’t as it seems.
As an interviewer, even a simple emotional observation may be perceived as critical or inaccurate or offensive in ways we can only imagine. Saying, “You seem angry” might be experienced as critical or inaccurate and inspire the affect you’re watching and the mood your client is experiencing to hide, like Jonah, inside the belly of a whale.
Oddly, on another day with the same client, your emotional reflection—whether accurate or inaccurate—might facilitate emotional clarity; affect and mood may re-unite, and your client will experience insight and deepening emotional awareness.
As a clinician, despite your efforts to be a detached, objective observer, you might experience a parallel emotional process. Not only could your understanding of your client deepen, but ironically, because emotional lives resist isolation, you might experience your own emotional epiphany.
Rest assured, as with all emotional epiphanies—including our constitutionally guaranteed inevitable and unenviable pursuit of happiness—you’ll soon find yourself staring at your emotional epiphany through your rear view mirror.
Just for fun, below I’ve included a link to a brief clip of me doing a mental status examination with a young man named Carl. A longer version of my interview with Carl is available with the 6th edition of Clinical Interviewing. https://www.youtube.com/watch?v=1lu50uciF5Y
Buddhists often say that life is suffering. Some days, for many of us, that feels about right.
But on other days, the inverse also rings true. Life is joy. Joy is the dialectical sunshine that intermittently breaks through clouds of suffering to interrupt our melancholy.
Don’t worry. Even though there’s currently a September Winter Storm Warning happening in Montana, I’m not going all weather on you. Besides, there’s not much I love more than clouds, rain, and winter storms. Also, to be fair, Buddha and the Buddhists recognized long ago that there’s a road we can take to get away from storms of suffering.
Maybe it’s my penchant for bad weather that’s drawn me, for the past two years, deeply into the professional monsoon of clinical depression, suicide assessment, and suicide interventions. What’s odd about that is that I don’t believe that depression or suicidality should be as pathologized as they have been. I’m a proponent of the right to die. I also find light and hope in the existential perspective that encourages us to embrace and integrate our darker, depressive sides, so we can emerge more whole and, as the existentialist Kirk Schneider likes to say, experience a Rediscovery of Awe.
For the past two years, focusing on suicide has felt very important. Our society isn’t very good at discussing suicide in an open and balanced way. All too often, suicide gets inaccurately conflated with illness or shame or moral weakness. These inaccuracies have inspired me to talk openly about suicide whenever given the opportunity.
But, to be honest, talking and writing about suicide—even from a professional perspective—isn’t all that fun. Those who know me know how much I like to tell funny stories. For years, I’ve had an untreated addiction to showing Far Side and Calvin and Hobbes cartoons during presentations. You wouldn’t believe how hard it is to find suicide cartoons that are workshop-worthy. When I show my cartoon with the white rat in the cage hanging itself and the lab scientist saying, “Looks like discouraging data on the antidepressant” if there’s any laughter it’s a painful and strained laughter, at best.
I do have one amazing depression cartoon; it’s a Gary Larson Far Side scene of a sad looking man on a bed in a messy room with the caption, “The bluebird of happiness long absent from his life, Ned is visited by the Chicken of Depression.”
But let me get out of my addiction and to the point. In my work on suicide prevention and intervention, I’ve slowly realized that we need to paddle upstream. I won’t stop talking about depression and suicide, but I want to more explicitly acknowledge that disabling depression and tragic suicides are often the inverse of well-being or happiness turned upside down. To address this effort at integration, I’m preparing materials to teach and present on the science of happiness. This is where I need your help. Yes, please send more suicide and depression cartoons, but even more importantly, send me happiness cartoons! I’m expanding my focus, and getting ready to spend more time talking about how we can all live happier and more meaningful lives. One way I’m doing this is by teaching a new “Happiness” course this spring at the University of Montana.
As background, I should let you know that I’m familiar with the Yale Happiness Class, the Penn Positive Psychology Center, and other popular resources. Although I’ll use this mainstream material, I want to do something different.
Here’s how you can help.
I’m looking for lecture material and happiness lab activities. Examples include,
- Video clips
- Songs with meaning
- Demonstration activities
- Quirky/meaningful stories
- 30-60 minute specific experiential activities that can deepen student learning
- Evidence-based experiential activities that demonstrate how to counter depression or embrace meaning
Because I’ll be delivering the course to undergraduates, as you contemplate sending me a map with directions to happiness, please put on your 19-year-old hat and help me find destinations with academic substance, but that will still appeal to the college-age generation.
As always, thanks for reading. I wish you a weekend (and life) filled (at least intermittently) with the sort of happiness and joy that’s palpable enough to sustain you until the next bluebird of happiness lands on your shoulder. And if you live in Montana, be sure to stay warm in the winter storm.
Donald Trump told another joke today. Problem is, his jokes frequently include death threats. I recall back in the day when he implied that his 2nd amendment supporters might want to stop Hillary from appointing Supreme Court justices. He played that off as a joke. Today the joke was about how America used to treat spies.
Like most things Donald Trump, what he says is usually half-impulse, half-informed, half-truths, half-ass, but wholly designed to trumpet his dominance.
The focus right now is on Trump’s Mafioso-like negotiation with Ukraine’s President. The press and politicians call it a “quid pro quo.” I think they’re using their fancy Latin to refer to a shake-down, which, if you read the transcript is obviously happening. To be more accurate, the Latin refers to “this for that.” But the Urban Dictionary might put it clearer with, “I want something, you want something. You give me what I want, I’ll give you what you want.” Even better, if you want to really know what’s going on, check out Urban Dictionary’s definition for “Quid pro quo-job” (which, because of my PG-13 rating, I’m unable to share here).
Some people act surprised that Donald Trump’s behaviors are so reminiscent of the Godfather. I’d say Mafioso, but Trump’s not Italian and consequently cannot qualify . . . which is probably at least partly why he’s acting so much like he’s trying to gain Mafioso status without having it. As Alfred Adler would say, that’s the way psychological compensation works.
If you’re a conscious and sentient being, there’s nothing particularly surprising here. Trump was being Trump. To review (which us academics do all the time, mostly because we’re forgetful), let’s look at the personality traits I wrote about in Slate Magazine last year around this time.
The following descriptions are summarized or paraphrased from the famous personality psychologist, Theodore Millon. Millon’s work was immense and immensely interesting. Read the following descriptions and contemplate two things:
- Do they fit Trump?
- What might the future of a Trump Presidency hold?
As I said last year, Trump has virtually all the qualities of someone with narcissistic personality disorder. But that’s not particularly interesting because most big-time politicians, media personalities, and rock stars have at least some narcissistic qualities. What’s unusual (and dangerous) is that Trump also has antisocial personality traits.
Generally, Millon summarized antisocial personalities as:
“Driven by a need to . . . achieve superiority.” They act “to counter expectation of derogation and disloyalty at the hands of others,” and do this by “actively engaging in clever, duplicitous, or illegal behaviors in which they seek to exploit others for self-gain.”
With that general description as backdrop, here are specifics.
Impulsive Imprudence. Antisocial personalities are “. . . shortsighted, incautious, and imprudent. There is minimal planning, limited consideration of alternative actions, and consequences are rarely examined.”
Blaming Others for Shirked Obligations. Antisocial personalities “frequently fail to meet or intentionally negate obligations of a marital, parental, employment, or financial nature.” This is the equivalent of a personal philosophy in direct opposition to President Harry Truman’s, “The buck stops here.”
Pathological Lying. Millon wrote, “Untroubled by guilt and loyalty, they develop a talent for pathological lying. Unconstrained by honesty and truth, they weave impressive talks of competency and reliability. Many . . . become skillful swindlers and imposters.”
Declarations of Innocence. During times of trouble, antisocial personality types employ an innocence strategy. “When . . . caught in obvious and repeated lies and dishonesties, many will affect an air of total innocence, claiming without a trace of shame that they have been unfairly accused.”
Empathy Deficits. Antisocial personalities are devoid of empathy and compassion. Millon called this “A wide-ranging deficit in social charitability, in human compassion, and in personal remorse and sensitivity.” He added that “many have a seeming disdain for human compassion.”
Counterattacks. Millon noted that antisocial personalities are hyper-alert to criticism. He “sees himself as the victim, an indignant bystander subjected to unjust persecution and hostility” feeling “free to counterattack and gain restitution and vindication.”
Moral Emptiness. Antisocial personalities have no ethical or moral compass. As Millon described, they “are contemptuous of conventional ethics and values” and “right and wrong are irrelevant abstractions.” Antisocials may feign religiosity—when it suits their purpose. But the moral litmus test will always involve whether they stand to gain from a particular behavior, policy, or government action.
Whether you think Donald Trump’s personality is captured in this short list of descriptions probably depends on your politics. I should also add that it’s perfectly possible for someone to have all these qualities and still have positive qualities as well. We’ve known—probably since the beginning of time—that people with antisocial personalities can be quite charming and charismatic. What’s crucial, and also intuitive, is that we the people recognize that despite his intermittent charm and charisma, Donald Trump is not to be trusted . . . which is likely why one of his favorite lines is “Trust me.”
My perspective is precisely the opposite. Please don’t trust me. Do the work, think about Trump’s pattern of behavior. It’s about far more than this latest incident regarding Ukraine. Take a look at the long list of behaviors that are consistent with Millon’s criteria. And then decide where you stand on a future with Donald Trump.
The views expressed here are my own. They’re not representative of anyone else. They’re also not part of a quid pro quo.
For the whole long version of the Millon and Trump’s personality article, go here: https://johnsommersflanagan.com/2018/09/03/the-long-version-of-the-trump-personality-slate-magazine-article/
Several days prior to driving across the state to a party with her family, a friend met up with Rita and me. We talked about happiness. She said she liked the word contentment, along with the image of hanging out in a recliner after a day of meaningful work.
Following the party, she wrote me an email, sharing, rather cryptically, that her party planning turned out just okay, because,
“Sigh. Some days happiness runs so fast!”
I loved her image of chasing happiness even more than the image of her reclining in contentment.
As it turns out, being naturally fleet, happiness prefers not being caught. Because happiness is in amazing shape, if you chase it, it will outrun you. Happiness never gets tired, but usually, before too long, it gets tired of you.
In the U.S., we’ve got an unhealthy preoccupation with happiness, as if it were an end-state we can eventually catch and convince to live with us. But happiness doesn’t believe in marriage—or even in shacking up. Happiness has commitment issues. Just as soon as you start thinking happiness might be around to stay, happiness suddenly disappears in the night.
Maybe our preoccupation with happiness is related to that revered line in the U.S. Declaration of Independence about the right to life, liberty, and the pursuit of happiness. Grandiose words indeed, because, at this point in the history of time, I’m not so sure any of us have an inalienable right to any of those three wondrous ideals.
But don’t let my pessimism get you down. Even though I’m not all that keen on pursuing happiness, I believe (a) once we’ve defined happiness appropriately, and (b) once we realize that instead of happiness, we should be pursuing meaningfulness, then, (c) ironically or paradoxically or dialectically, happiness will sneak back into our lives, sometimes landing on our shoulders like a delicate butterfly and other times trumpeting like a magnificent elephant.
Another reason not to feel down is because next Tuesday, October 1, I’ll be in Red Lodge, Montana as the speaker of the month for the Red Lodge Forum for Provocative Issues.
How cool is that?
My Red Lodge Forum presentation is: Suicide, Suicide Prevention, and the Pursuit of Happiness.
Just in case you’re passing through Red Lodge or happen to know someone in the general vicinity, below I’ve pasted the promotional email for the event. Please come if you can. There will be a fancy dinner, which inevitably involves a full stomach, which, even though I’m talking about suicide, might provide you with a twitch or two of happiness.
Here’s the promo:
From: Red Lodge Forum <email@example.com>
Sent: Sunday, September 22, 2019 2:13 PM
To: ‘Red Lodge Forum’ <firstname.lastname@example.org>
Subject: Tuesday October 1st Forum for Provocative Issues. Dinner reservations open
Forum for Provocative Issues
Suicide, Suicide Prevention, and the Pursuit of Happiness
Tuesday, October 1
Beginning in 2005, death by suicide in the U.S. began rising, and despite vigorous national and local suicide prevention efforts, suicide rates have continued rising for 13 consecutive years. Depending on which metrics you prefer, suicide rates are up from somewhere between 33% and 61% from their levels at the turn of the century.
In Montana, we have the dubious distinction of the highest per-capita suicide rates in the U.S., at about 29.0 per 100,000 Montanans. Why? What is so peculiar about Montana?
But suicide is about much more than numbers. Join us on Tuesday, October 1 when Distinguished Professor at the University of Montana, John Sommers-Flanagan talks about what contributes to suicide, why Montana’s rate is so high, what’s wrong with suicide prevention efforts, and how we should talk with friends about suicide. Although suicide is a difficult, emotionally charged, subject, John will explore emotions that can create and sustain happiness.
FORUM CATERER CHANGE
In the next section, you will notice our caterer has changed. Martha Young, who has faithfully served our delicious meals for eight years, first at Café Regis, and more recently at the Senior Center, is unable to caterer our October meal. Prerogative Kitchen, an outstanding local restaurant, has agreed to stand in.
DINNER RESERVATIONS NOW OPEN
Dinner at the Red Lodge Senior Center (13th St and Word Ave) will start at 5:30 pm and our program shortly after 6. If you plan to have dinner, email RedlodgeMtForum@gmail.com (no text or calls) with:
- your reservation request,
- your general meal choice (meat/fish, veggie, non-gluten), and
- your cell number
If you don’t receive an email confirmation of your request promptly, please resubmit it. When I know specific dinner choices later this week, I will ask you to confirm your choice.
If you plan to attend the forum but not eat, come around six but donate $5 to help defray room rental and other expenses.
The price for this dinner is $18. Please bring a check written prior to your arrival to Prerogative Kitchen for $18 per person. It will reduce traffic at the door, seat everyone faster, and make our cashier’s job easier. If you want to leave an additional gratuity, simply leave cash on the table. Do not include gratuities in your check.
If you have friends who are interested in attending the forum, feel free to forward this message.
HAS YOUR EMAIL CHANGED?
If you change your email address and want to continue receiving forum notices, remember to send the change to RedlodgeMtForum@gmail.com.
INFORMATION ABOUT UPCOMING AND PAST FORUMS
For quick access to all news about upcoming and past programs, become a member of our Facebook group page, which supports FPI programs. To access the page, simply search “Forum for Provocative Issues.” This is an open group, but we carefully screen applicants to avoid potential problems by asking three simple questions.
USE OF FORUM EMAILS
I never share the emails of forum members. However, I have on occasion sent information about community issues and events that I think members will find valuable.
If you have an idea for a forum, email it to RedlodgeMtForum@gmail.com.
The dates for our 2019/2020 season follow. Mark them on your calendar now to avoid conflicts.
- November 5, The Future of Nuclear Energy, Redfoot
- December 10, Japanese American Internment Camp Conditions in WWII, Russell
- January 14, Fighting Fires, Saving Homes, Trapp
- February 4, Apollo 8 and the Race for Space, Dragon
- March 3, Subject TBD, Darby
- April 7, Dark Money in Politics, Adams
- May 5, Genetics and the Future of the Human Race, Gunn