In Search of the WHY

On Monday, you guys made some extremely thoughtful comments in response to my post about cyclothymia, and specifically, about whether a person's disclosure of a mental illness affected how you thought about the person's behavior.

Also on Monday, Julie Musil guest-posted on unlikeable characters over at Lisa Gail Green's blog . She gave a thoroughly excellent analysis about how to help readers sympathize with a character who on the surface appears entirely unsympathetic, and her primary suggestion was to help the readers understand WHY the character had become the way he/she was. If you haven't read this post, you should!

Now, I deal in the business of understanding why. Pondering the why is what keeps helping professionals from something called client-blaming. Client blaming ... is sucky. However, it happens with stunning frequency. A client engages in the exact behavior he/she sought help for, and we're like, "ARGH. Why doesn't he just [insert whatever you've told him/her to do here]?!?" And then we get mad. We get frustrated. We want to give up.

When I get a whiff of this kind of sentiment, either from my supervisees or inside my own head, I know it's time to get back to the drawing board. And I know exactly what I need to do: I need to dig a little deeper and get to the WHY. It's the only way I'll be helpful, the only way I'll be able to provide the kind of help my client deserves.

Amazingly, also on Monday, I READ A BOOK THAT CAPTURES THIS PERFECTLY. And by "this", I mean the why of it. It's Julie Musil's post come to life. For anyone trying to write a potentially unsympathetic, seriously flawed, at-risk-for-being-unlikeable character, this book is a must read. Oh, and for the rest of you, too. It's so very good.

Something Like Hope, by Shawn Goodman (who happens to be a school psychologist), is about seventeen-year-old Shavonne, who resides in a juvenile detention center and is at high risk for not having much of a future. This lean little book is about how she decides how she's going to live.

The book begins with Shavonne in an isolation room after she's busted the face of one of the guards--one who's stuck by Shavonne and clearly cared about her. Maybe I should mention that Shavonne does this after stealing the lady's sandwich and lying about it. Shavonne then tells her new, kind, and well-meaning therapist to eff-off and screams her way out of the therapy session.

Yeah, she does.

Shawn Goodman manages a very difficult task here. Despite Shavonne's hostile behavior, it's not difficult at all to care about her, like her, worry for her, or emotionally invest in her.

Because this book is relentlessly focused on the why.

Many of the characters in Something Like Hope are kids NO ONE likes (and who most people fear). These kids do bad things. These are kids no one wants to "excuse." They've hurt people, and stolen things, and broken things, and messed stuff up. And frankly, they're likely to do it again if pushed the wrong way. Or maybe, even if they're not.

And yet, in simple, clean prose, Mr. Goodman gets inside Shavonne's head, shows us what she's been through, what ALL the girls in that place have been through, what they're dealing with now, why it's so hard to hold it together. Without wiping away the things they've done or glossing over their jagged edges, he shows us the why. He shows us where they came from, what was taken from them ... and what was never given to them in the first place.

I read this book in one afternoon and was grateful to have a box of tissues nearby. It made my heart hurt, but it also made me so happy. Shavonne's story is beautiful in a terrifyingly fragile way. I've known kids like this in real life, and I know that if I really understood the why, it would read like Something Like Hope.

Have you read this book? Can you recommend others that focus on the WHY? Do you ponder the why of characters' behaviors in the books you read (or write)? How about in real life?

For the Sisterhood of the Traveling blog this month, Lydia asked: “What formal writing experience do you have? (classes, degrees, major/minors). Did it shape your writing?Have you ever considered getting an MFA?” She answers it today on her blog. Laura gave her answer last week, and I'll give mine next week!

Borderline Personality Disorder Why They Dont “Get Used to It ”

At the annual meeting of the American Psychiatric Association in New York this year, I learned about a new finding from one study with patients who exhibit borderline personality disorder (BPD). The same finding also applied, although to a lesser degree, to those with avoidant personality disorder (AVD), which is pretty much identical to the diagnosis of Social Phobia.  I suspect that the reasons for the similar findings may be different for the two disorders.

The finding involved a part of the brain called the Amygdala. This little doohickey is central to a lot of brain functions, but in particular, it is the center for the body’s “fight or flight” response. I always though it fascinating  that the amygdala also has specific cells which respond only to one’s own mother (or other primary female attachment figure) and nothing and nobody else, and other specific cells which respond onlyto one’s father (or other primary male attachment figure). 

Although one cannot prove such things, this fact suggests to me that primary attachment figures may be the most potent of all of the environmental triggers to fear-based flight or fight reactions. They are certainly more powerful that a therapist can ever be for doing so, for instance.

The finding may relate to one of the primary symptoms of BPD, which goes by a variety of names. In the actual DSM criteria, it is described as “affective instability, or marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days.)” It is also called high reactivity, and lay people often label it hypersensistivity. In psychological tests, it is called neuroticism. Clearly, amygdala activation is intrinsic to this phenomenon.

Therapists have a tendency to think that patients with BPD over-react because they misperceive the behavior of others as being emotional slights, when the behavior is not at all meant as such. In fact, these therapists do not even know to what exactly the patient may be reacting to, or alternatively, that sometimes patients with BPD feign such reactions in order to provoke a specific response in others in order to recruit them to be enablers of the patients’ spoilerrole.

For example, one patient would go ballistic if anyone ever even implied that her mother might have been a loving parent. Of course, if one knew all the horrible things her mother had done to her, one could easily see why she would find such a comment annoying - to say the least!

The study I am discussing here is by Harold Koenigsberg and others (Journal of the American Psychiatric Association 171:82-90, January 2014). Study participants were asked to look at a series of pictures with either highly negative or neutral content, and the activation of the amygdala and another region of the brain called the dorsal anterior cingulate was measured using a specific type of brain scan. The subjects also subjectively rated their emotional responses to the pictures. 

Exposure to these pictures and these measurements were then repeated. Repeated only once, I’m afraid. The study would have been a lot more powerful if they had repeated the exposure several times.

The changes in emotional arousal and brain activation after a repeat viewing of the negative images was small but signficantly different between patients with BPD or AVD and the "normal" control subjects.  

The brains of the controls seemed to habituate, while those of the patients with BPD did not.  Habituation means that the controls got used to or became accustomed to the awful pictures, and their arousal levels decreased from what it had been after the initial viewing.

If anything, the emotional arousal of patients with BPD actually increased with the repeat viewing.

This finding, if it can be replicated, might seem to indicate that the brains of those with BPD are abnormal in this regard. However, as I have ranted in the past, a difference is not automatically indicative of an abnormality. In fact, it may be a conditioned response that is highly adaptive in particular environments.

In the case of patients with BPD in particular, they invariable grow up in chaotic family environments in which “getting used” to the chaos and not reacting to it when one needs to could be hazaradous to their and their family’s health, as described in my post on Error Management Theory.  If the chaos continues, such individuals need to pay even more attention to it, not less. 

This new research finding fits my ideas about that to a tee.

Why Are Teens So Moody

  source -asap science..

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