My Take on the Wall Street Journal Article About YA

Yesterday I watched Twitter explode in response to a Wall Street Journal article by Mrs. Meghan Cox Gurdon, entitled "Darkness Too Visible." In the article, the author makes the argument that YA is rife with all flavors of depravity and peddled by editors eager to "bulldoze coarseness and misery into children's lives."

My initial reaction to the article was incredulous amusement--when my agent sent me the link, I assumed I was going to be reading something well-informed and balanced. However, it was immediately apparent by the contemptuous and smugly dismissive tone that this was a completely one-sided opinion piece.

OK. The lady is entitled to her opinion.

The problem I have is if her opinion is mistaken for thorough, well-informed analysis.

Here there be dragons. Or, er,
OCD and depression. BEWARE.

Her argument: YA is full of "hideously distorted portrayals of the way life really is." And then she targets several books (most of which I have read, some of which I have discussed here on this blog) that include main characters grappling with mental illness, trauma, or substance abuse. She implies that describing these struggles in "stomach-clenching detail" is harmful to teens, and further implies  books that either omit or gloss over these conditions are preferable.

To which I say: huh?


Guess what? One in five teens has a diagnosable mental illness. Anxiety? Thirteen percent. Mood disorders? Seven percent. Disruptive behavior disorders (this includes ADHD and conduct disorder)? Ten percent. And that's just a few categories. In EVERY high school classroom, there are at least a few adolescents struggling with one of these conditions, not to mention abuse, bullying, dating violence, or other trauma.

To pretend these individuals don't exist is offensive. To imply books written for teens should not include them--as if their experiences are not real, as if knowing what they really go through is harmful to others, as if reading books full of sunshine and light will fix them--is highly distressing. And, I'll say it: harmful.

I mean, is that the message we want to send to teens? Let's brush kids with problems under the rug? Let's only tell the stories of well-adjusted kids from two-parent homes? If you read about someone doing drugs, having sex, self-mutilating, feeling depressed, going through a trauma,  or living the brutal reality of poverty and violence, you'll be messed up or catch a mental illness like a bad cold?

There's NO empirical evidence to suggest that is true.

Mrs. Gurdon asserts that reading about a behavior, such as self-mutilation, gives teens ideas they do not otherwise have and encourages them to try it. Although she probably didn't know it, she was referring to the concept of social learning, a well-tested theory which postulates that human beings learn through watching others engage in a behavior and get rewarded for it. An example: teenage girls might watch ultra-skinny models vaunted for their beauty and portrayed as living glamorous lives, and get the idea that starving themselves is a good idea. There is evidence to suggest that is, to some extent, true (though the mechanisms behind eating disorders are MORE COMPLICATED than that by far, or every girl in the US would have an eating disorder).

However, is that really the case with YA? For those of you who read this blog regularly, you know the kind of books I read. Nearly all of them are about mental illness or trauma. I've read dozens of them. Not once have I read a YA book that glorified unhealthy behavior. YA authors are brilliant at showing the complex consequences of their protagonists' choices. No, the writers are not preaching. But OH YES are they showing realistic outcomes. Do they cultivate sympathy for their characters? Absolutely. Do they show their characters getting out of situations unscathed? No way.

If someone publishes a peer-reviewed prospective study of how reading specific content in YA leads directly to the portrayed behavior (while controlling for other predictive factors, of course), I will humbly eat these words. Until then ...

Mrs. Gurdon also laments that YA books that realistically portray mental illness or disturbance might normalize this stuff.

To which I say: ARGH.

Again, recall how many teens experience mental illness. Think about what they face. In one study, ninety percent of kids diagnosed with a mental illness (and taking medication) reported experiencing some type of stigma. They were socially isolated and felt ashamed of their conditions. Do increased feelings of shame and isolation help a person to heal? One guess as to the answer.

Research shows that the more middle schoolers and older teens know about mental illness and its treatment, the more healthy their attitudes become. Research also shows that fostering empathy is an important tool to prevent bullying. Based on my observations, YA does two things relevant to those research findings: it shows kids they're not the only ones going through this stuff. And it shows all kids the perspectives and experiences of others with whom they share the world.

But here's the thing: each kid is an individual with strengths and vulnerabilities. So is every parent. What will be good, even redemptive and life-changing, to one teen will be triggering or disturbing to another. Just like everything else, literature isn't one-size-fits-all. When parents come into my office and ask if roughhousing or video games are okay, for example, I do NOT say, "no." I answer based on my knowledge of the child (and the parent). And the answer is not AN ANSWER. It's a discussion. A collaborative consideration of the individual kid, parent, and environment.

With teenagers, it's a more complex conversation. At that point, it becomes a matter of negotiation and problem-solving rather than one of parent-decides-kid-obeys (actually, ideally, parents begin having problem-solving discussions with their children long before adolescence--the earlier you're in the game, the more likely your kid is to keep letting you play). Parent-child communication--and appropriate parental limit-setting-- protects kids from all sorts of risks. Parental autocracy? Doesn't.

What I've seen many, many YA authors suggest is that parents should read alongside their kids. These authors are NOT saying every kid should read every book. Rather, they are saying parents should talk to their kids. Decide together (and the older the teen, the more freedom he/she has to make independent decisions). Have frank discussions about the material. Be open and receptive and don't freak out. This is the approach mental health professionals happen to advocate as well.
All right, I'm done.

Have you read the WSJ article? What did you think? Are you concerned about teens being desensitized? That mental illness or substance abuse will be "normalized"? Do you find there is a dearth of light-hearted or "innocent" books out there? Are you a parent? Are you having to negotiate the world of books with your kid, and how are you accomplishing that?

An Internet Article about Abusiveness

http://saludify.com/why-do-people-abuse-psychology-of-abuser/

How Did I Learn About the Family Dynamics I Write About

From Mark Anderson, https://www.andertoons.com/

In my Psychology Today blogpost of 10/14/13, Don't Ask, Don't Tell, I discussed how patients in psychotherapy do not volunteer a lot of information about their family dynamics unless they are asked very specific questions - and often not even then until (and unless) they have formed a trusting relationship with their therapist. I mentioned the case of a patient who was smart enough to have been a Ph.D. candidate, came in complaining of anxiety, and did not think it relevant to tell me until months into therapy about the daily conversations with her mother that literally made her nauseous.

So, therapists who think that what they see and hear in the office is indicative of what is really going on in a patient's life may be sadly mistaken. For example, a woman may complain that her father is "controlling." The therapist should want to invite the father in at some point to see if this is accurate. Most do not. However, even if the therapist does this, both of them may then mislead him or her. 

The father may at first appear to be anything but controlling - telling the therapist about how he gives the adult daughter money to do whatever she wants without obvious restrictions, and never stopping her from doing anything she wants. What neither might mention, however, is that he always calls her incessantly on her cell phone whenever she goes anywhere!

When I was in training as a therapist during my psychiatric residency, psychoanalysis was the king of psychotherapy paradigms, and I was not taught about how to ask my patients about repetitive dysfunctional interactions with family of origin members occurring in the present. A lot of both analysts and CBT therapists seem to think that patients' problems reside entirely within the confines of their own heads, as if we are not social organisms at all.

When I write in my blogs about the types of family dysfunction that I have seen with my patients, a frequent criticism I get is that I am taking patients at their word, and that since patients often distort things, I am surely getting a distorted picture - which by implication must have led me to form distorted ideas about what actually is and has been taking place.

So how do I know that these patterns are real? Well, let me tell y'all how I discovered them. (Hey, I've lived in South now for over twenty years).

When I was a beginner as a therapist, I kept noticing that my patients usually did not respond to various interventions in the ways described in the psychotherapy literature. I would sometimes have some success with these interventions, but the results were often rather inconsequential. So in response I started reading about other paradigms one at a time, and each time, I would have the same experience. Perhaps I was not doing them right, but other therapists would tell me that they noticed the same limitations.

I somehow stumbled on a version of a therapeutic questionthat had, unbeknownst to me, first been proposed by Alfred Adler, one of the three founding fathers of psychodynamic psychotherapy. I had started to ask my patients why they were not employing the obvious solutions to their problems. If I could think of an obvious solution such as "why don't you just leave your abusive husband?" no doubt the patient has already thought of it, and has decided against it for some seemingly strange reason. 

When a therapist asks a question like that, the first answers he or she often gets in response is one described by Eric Berne. It goes something like, “Yes, I could do that but…” followed by some lame excuse for why they cannot do that. This is known as the game of Why Don’t You – Yes But.

I decided I would play my own version of the game that I called Why I Can’t – Yes But. Every time I heard a yes-but answer to my original question, I would counter with, “Yes, but you could handle that obstacle by doing [such and such].” This solution would of course also be yes-butted by the patient with another lame excuse - for which I would provide another obvious solution.

An example from my last book: one adult female could not seem to hold a job and always seemed to end up going back home to live with and depend upon on her abusive father and inadequate mother. I knew other relatives also lived in the home but I had no clue as to their significance. The patient was bright and had made it to the upper echelons of a sport that she liked to play, so I knew she was highly capable of holding a job. 

Every time she offered an excuse such as “I’m no good in school so I can’t learn new skills,” I would counter with my own yes-but. I went through a seemingly endless array of lame excuses in this manner, until finally she said, “If I’m not at the house, my father molests my niece.”

Whaaat??? She never thought to mention this before????  

So, a bit off guard, I said, “Have you thought about reporting him to child protective services?”  She replied, “Of course, but if I did that my mother would end up on the street because she cannot support herself." Her mother would suffer, and it would be all her fault. No doubt she would be blamed by the family.

Well, lessee. She could handle that obstacle to holding a job by…by…by…er, how exactly could she handle that problem? I had no answer. She could write her mother off, I suppose, but since when is caring about the survival of family members or her niece's safety a bad thing? This was a really devilish conundrum. As mentioned, I also wondered why she had not told me about this in the first place. That was the moment that I was first confronted by evidence that family members may be acting for altruistic motives rather than selfish ones, and that family problems might be incredibly difficult to solve.

I then found an easier way to get to this answer than playing a long game of yes-butting: the Adlerian question: What would happen if I could wave a magic wand and you suddenly got better and stayed better?

At first, patients would often answer with such non-answers, "I'd just find some other way to screw things up" or "I cannot even imagine what that would be like." I would not accept those "answers" and pressed on. Then I started getting the real answers. 

But were they really real? Was I just being fooled by my patients with distorted perceptions. Well, just so readers know, I do not just take them at their word.

I began to have conjoint sessions with the patients and their parents. I have had both the mothers of patients with BPD and their daughters with BPD as patients in individual therapy separately, some at the same time, on several occasions. As a psychotherapy supervisor, I have watched videotapes of the mother of a daughter with BPD in a session with one therapist and the daughter with another therapist describing the very same interactions.

Even more revealing, I have had patients who were sick and tired of being accused of distorting everything bring in audiotapes of phone conversations with their parents when the parents did not know they were being recorded. Illegal in some states to record, but not for me to listen to. I heard some of the most unbelievable things come out of their mouths.

In individual sessions, I listen very carefully to what the patients say and ask follow-up questions about anything that seems contradictory - when the patients with BPD are in "spoiler"mode (which is when they are distorting things, but sort of on purpose), they do that all the time. But knowing a few tricks of the trade, it's easy to get them to stop doing that.

One still needs a good theory in order to interpret the behavior that I had been observing. Luckily, as I started to try to make sense of the evidence before me, I came across some relevant ones. For example, there was Sam Slipp, who wrote about the dysfunctional family roles of savior, avenger, and go-between. And then there was family therapy pioneer Murray Bowen, who wrote about family emotional processes and the intergenerational transmission of dysfunctional family patterns.

So no, my ideas about family dynamics do not come just from listening to my patients alone.

More Great Quotable Quotes from People Who Agree with Me About Stuff

Today's post is the second of a series of two containing some of my favorite recent quotes that center around themes discussed in this blog. 

As mentioned, I have been collecting the quotes and putting them on my Facebook fan page at http://www.facebook.com/pages/David-M-Allen-MD/80658565761?fref=ts. The ones posted here started in January of 2014, and are loosely organized by topic. 

Family Dysfunction

"Taking responsibility for something and self-blame are horses of two entirely different colors. The former is empowering; the latter is paralyzing." ~ John Rosemond, Ph.D

Chronic Mental Illness

Our prison population is bigger than Slovenia
Cause we put people in jail instead of treating schizophrenia 
        ~ John Oliver

On trying to find the cause of schizophrenia: "30 wasted years of looking for bad mothers followed by 30 wasted years looking for bad genes." ~ E. Fuller Torrey, M.D.

Psychiatric Practice, Electronic Medical Records, and Managed Care

"The shift from benzodiazepines [for anxiety disorders] to antidepressants is one of the most spectacular achievements of propaganda in psychiatry." ~ Giovanni Fava, M.D., clinical professor of psychiatry at SUNY in Buffalo.

"You're complaining about a Freudian slip? Freud should be able to wear whatever he wants." ~ Tony Kreitzberg

"Why would anyone want to teach me to tolerate my pain? My only interest is in removing it!” ~ Cynthia Mueller, a blog reader, when first exposed to the DBT treatment model for borderline personality disorder.

"Methadone and Buprenorphine [suboxone] should be our first line opiates for use in the treatment of severe acute pain. That way, if patients become addicted to them, they would already be taking the appropriate treatment for their addiction!" ~ Steven A. King, M.D.

"The current EHR has destroyed the narrative, especially in psychiatry, and converted the basis of care to a checklist." ~ George Dawson, M.D.

"It's not just about doing the right thing for your patients, it's about proving to someone else that you've done the right thing, and sometimes "I can't quite remember if I'm an underpaid physician or an overpaid data entry clerk!" ~ Dr. J.D., Family physician.

"The proving [that I did right by a patient] takes longer than the doing." Chrisitine Sinsky, M.D.

"You don't need any research to show that if you are cycling people with serious mental illnesses in and out of short stay psychiatric units in 3 - 5 days and basing their stay there on whether or not they are "dangerous" and using treatments that take weeks to work that by definition you are appearing to treat many more patients but providing adequate treatment to very few. You don't need any research to show that when you shift mental health care from psychiatric units run by psychiatrists to county jails that the outcomes will be worse. You don't need any research to show that when people do not get research-based psychotherapies in the manner that they were designed and instead get a few crisis oriented sessions that do not address their basic problems that outcomes cannot hope to be better. When your attitude is that all mental health treatment can proceed by treating common problems with definite social etiologies with medications as fast as possible and not having an intelligent conversation or working alliance with the person affected - it is logical that treatment outcomes will not improve. Treatment outcomes do not improve if you do not provide effective treatment and that is the mental health landscape at this time." ~ George Dawson, M.D.

"I don’t know if anyone has ever not tensed at being told to relax." ~ Carolyn Hax

"Health care systems that allow patients to rate their doctors on satisfaction ratings without considering that patients might be dissatisfied with reality should be held to task." ~ George Dawson, M.D.

"You want a tale of two cities...look how the financial services industry has captured regulation to their advantage vs. how doctors have been battered by regulation. But it's based on the mind-set of Goldman Sachs vs. the mindset of the family practitioner...who politically shows up for a gunfight with a butter knife." ~ James O'Brien, M.D.

"Managed care has done an expert job of cost shifting by developing business friendly treatment criteria, abandoning the social and community mission of treating difficult problems associated with mental illness and addiction, and removing the element of humanism from psychiatric treatment. When I first started to practice, discharging people from a hospital when a psychiatrist had serious concerns about whether or not they could make it or whether they would be safe was very uncommon. Today those discharges are the rule rather than the exception largely due to the imaginary dangerousness criteria. "~ George Dawson, M.D.

Drug War

"When we talk about marijuana as a gateway drug, we have to remember that the last three occupants of the White House have smoked marijuana. We can very well say marijuana is a gateway drug to the White House” ~ Carl Hart, Ph.D

Psychiatric Diagnosis

"Then there’s the matter of testing a child to determine if he has ADHD. The plain fact is that none of the published diagnostic criteria depend upon test results. They refer to behavior, period." ~ John Rosemond, Ph.D.

"A [mental] disorder does not operate with [social environmental] discrimination. If something was “wrong” with [your child], she would be obnoxious in front of friends, their parents, teachers, and the people in white coats who came to take her away (tra la, for those who appreciate the reference)."
~ John Rosemond, Ph.D.        

            ("Actually, "Ha Ha" and not "Tra La" ~ Napoleon XIV)

A reader writes that her friends 'recently spent around $300 on their daughter’s birthday party—her first. They bought lots of stuff to entertain their young guests and extended family. The child, a baby, obviously had no clue what was going on. I should mention that the parents are struggling to make ends meet.' As my readers know or should know, I am a psychologist. That qualifies me to determine and assign psychological diagnoses. As such, it seems obvious to me that these parents suffer from a now-commonplace parenting malady known as just plain nuts." ~ John Rosemond, Ph.D.

"One symptom does not make a diagnosis " ~ John Rosemond, Ph.D.

"Test anxiety is frequently not an aberrant psychological response - it is instead the normal anxiety anyone would feel in facing a situation for which they were inadequately prepared." ~ Barbara Oakley, Ph.D.

"Under the influence of intense affects, EVERYBODY becomes an idiot."~ Otto Kernberg, M.D.

"Only in America does 'gotta' substitute for 'wanna' so we can avoid the guilt. " ~ The Last Psychiatrist

ADHD

"An often trivialized cause of irritability, difficulty concentrating, reduced vigilance, distractibility, decreased motivation, lack of energy,and disturbed mood: insufficient sleep syndrome. People with this syndrome, common in our 24 hour society, intentionally curtail sleep for work, social, family, or other reasons. According to the International Classification of Sleep Disorders, a practical and effective remedy does exist: more sleep." ~ Psychiatric News.

"The maps of child obesity in the U.S. look suspiciously like those of the ADHD epidemic, with the highest rates in the deep South." ~ Psycritic

"It’s truly surprising how many parents have been told that if their child did not have ADHD the child would not respond to stimulant drugs. In the blitzkrieg of World War II, German bomber pilots took a stimulant drug with a chemical structure similar to that of Adderall. When the American military discovered how much the stimulants helped German pilots, they put stimulants in the kit of every American and British bomber pilot to improve their concentration and alertness on long-haul missions. Surely not all these pilots had ADHD." ~ Marilyn Wedge, Ph.D.

"...after taking the [drug company-designed screening] ADHD quiz, I've realized that both I and my cat have the dreaded disease. I'm off to get us both the treatment we need." ~ Anonymous comment on one of my blog posts.

Evolutionary Psychology

"Selfishness beats altruism within groups. Altruistic groups beat selfish groups. All else is commentary." ~ David Sloan Wilson, Ph.D.

"We mammals are curiously preoccupied with social hierarchy. You may say you don’t care about status, but if you filled a room with people who said that, they’d soon form a hierarchy based on how anti-status each person claims to be." ~ Loretta Breuning, Ph.D.

Short films about agoraphobia

There are more and more videos about panic and agoraphobia on YouTube all the time -- everything from art films to people vlogging about their problems to videos describing treatments. It's a great way to discover what others are going through and how they're coping with it.


"Agoraphobia Diary" contains some beautiful images.


Filmed entirely via mobile phone, "Agoraphobia" really captures the stranded feeling - "outside the world is going on without me" - of agoraphobia. Bravo.

A Few Things About Bullying

My posts this week are going to be about bullying. One large nationwide study of over 15,000 kids in 6th-10th grade indicated that about 10% of children report being bullied. Another 6% report both being bullied AND bullying others. And another 13% report bullying others but not being victims of it themselves.

It's a major international public health issue and has become even more prominent in recent years, with the tragic suicides of several kids who were plagued by bullying, including, Brandon Myers, Megan Meiers, and Phoebe Prince, whose death last year led to anti-bullying legislation in Massachusetts and serious charges against the kids who bullied her.

Bullying has always existed. I have memories of being bullied and witnessing bullying as a child, and I'm sure many of you do as well. I think the reason so many are talking about it now are:

1. the Internet and 24/7 news cycle means that, no matter where something occurs, the entire country knows about it in a matter of an hour or two, if that. Nothing is local anymore. And it's not just that everybody knows. Everybody is talking about it. And everybody has an opinion. So something like Phoebe Prince's death, which might have been a local event in the past, touches off a firestorm. (I think this phenomenon is both good and bad. But more on that another time)
2. youth have new ways of bullying, so the same behavior is occuring, just in more places and in new forms. Cyberbullying has become a recognized problem.

Bullying is about dominance, a power imbalance. It takes a lot of forms, from verbal behaviors to rumors to physical or sexual intimidation and harm, to name a few.

Kids who are bullied exhibit more symptoms of depression than other kids and are at higher risk for suicide. Lots of studies have shown that. What we're not sure of--is there some other factor, like vulnerability to psychiatric problems, that could lead to both victimization and depression/suicide? If that makes no sense, click on Brandon's name at the top of this post. Regardless of whether bullying causes suicide in some kids, though, there's no doubt it's bad for kids.

Kids who bully are, apparently, also at higher risk for suicide. But, oddly, they tend to have higher than average self-esteem. They overestimate their own popularity. They have low empathy--they are less aware of how others feel than kids who don't engage in bullying. They are more likely to hang out with peers who bully.

There are gender differences. Boys are more likely to be both the perpetrators and victims of physical and overt verbal aggression. Girls tend to exhibit relational aggression rather than physical aggression, which means they are more likely to bully through social alliances and exclusion, gossip and rumors. It's more subtle, but no less vicious.

GLBTQ teens are FAR more likely to be bullied than their hetero peers. This deserves a post of its own, and it shall have one in the near future.

There are some effective interventions for bullying. But research shows that they don't come in the form of classroom discussions and role playing and that kind of thing. Effective interventions are school-wide, which means that zero-tolerance for bullying is ingrained in the culture of the school, all the way up to the top.

On Wednesday, I'll be touching on cyberbullying, and on Friday, I'll be discussing Hate List, by Jennifer Brown, where bullying is a major issue. Until then--thoughts on bullying? Is it covered accurately in YA? In the media? What do you know about it, and how do you feel about it?

And be sure to check out Lydia's always fascinating Medical Monday post and, if you're feeling overwhelmed and stretched too thin, definitely read Laura's Mental Health Monday post for today!

A Bit About The Author

So you've read about my life, but you don't really know me.


Ive left the blog anonymous because I didnt want just a single group of people to identify with me, I wanted it to be able to help everybody who wished to know something.

For this reason I wont disclose my name or location but Ill let you know other random bits and bobs about myself.

I am, if you don't know, a female.
Im an Aries.
I'm the Director of a Company.
I like cats, dogs, rabbits, pigs and basically all animals and Im against animal cruelty.
I'm not a vegetarian, no. But fair enough if you are.
I prefer Horror over Comedy and Rom Coms but I do like 'Stand Up Comedians'
I'm very much a 'girlie girl' prefering all things aesthetic, rather than au-naturale
I have 4 Alevels and 2 years of a Degree.
I like documentaries on serial killers or 90s gritty, english crime scene shows - wire in the blood, waking the dead, jonathan creek (I know, not really policey)
I'm not big on music, I dont really have a genre, I think im quite open to very much all of it.
Politically I don't have a party, but I do vote (Im a woman, its basically a sin if i dont)
I'm not religious, but I respect my friends who are and I'm still interested.
I have 2 tattoos.
I love shopping and cocktails.


 At some point, I will reveal my identity but I think it will be very much in the future.
So until then, youve got 7.046 billion to guess through (If you've even bothered)

Have a lovely night or morning

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