Another controversy erupted last month over a proposed revision to one of our field’s most important tomes, the Diagnostic and Statistical Manual (DSM). This time the debate swirls around bereavement and depression.
In the current DSM-IV-TR, the criteria for Major Depressive Episode include an exclusion for bereavement. A client, in other words, is not experiencing a depressive episode if his symptoms are better accounted for by loss-related bereavement (DSM-IV-TR, p. 356). Bereavement is listed as a separate V-code (V62.82). The assumption is that depression-like symptoms are sometimes normal after a significant loss and therefore not a disorder.
In the proposed fifth revision (DSM-5), slated for publication in May 2013, the bereavement exclusion is eliminated from Major Depressive Episode, as is the V-code for bereavement.
In other words, even if a client’s depressive symptoms are related to a recent loss, the clinician may still diagnose the individual as suffering from a major depressive episode.
But a new article authored by Jerome Wakefield and Michael First of NYU analyzes available studies and challenges the validity of removing the bereavement exception (BE). After examining the studies cited in support of removing the BE and subsequent literature, the authors concluded:
[T]he claimed evidence for the BE’s invalidity does not exist. The evidence in fact supports the BE’s validity and its retention in DSM-5 to prevent false positive diagnoses. We suggest some improvements to increase validity and mitigate risk of false negatives.
The debate, as covered in outlets such as The New York Times and The Daily Beast raises fundamental questions about our field’s stance on “normal” versus “disordered” emotional behavior. Given that depression is often treated with medication, altering the diagnostic criteria for depression can be especially impactful for clinicians and patients alike.
Visit the DSM website for more information about the manual, the proposed changes, and the process for offering input.
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Friday, February 3, 2012
Saturday, December 31, 2011
The Fourth Great Leap: Why Networked Community is a Revolution
I WROTE THIS IN 2004. I was cleaning out my hard drive and came across it. I thought I would share it one more time... Macdara
The "Great Leap"of human development -- from homo erectus (or proto-homo sapiens) to homo sapiens, creators of art, tools, etc. -- occurred because of the evolution of the voice box, which allowed for complex human language. Others argue that the expansion of the part of the brain causing language was the trigger.
--From Jared Diamond, Third Chimpanzee
Communication is the thing that makes us human, that creates the vast chasm between us and the rest of creation. Why? Other animals communicate through language. Wolves, apparently, use their howling to send information across the Canadian tundra about the approach of spring or potential harm. Birds use sound to initiate mating rituals and find their young. Our closest cousins, the great apes (and chimpanzees??) use language…? . The difference, though, is that we use language to collaborate and innovate -- to build on the knowledge we're born with or taught in youth. Throughout our lives, we add the knowledge of others to our own, either by reading the words of those we don't know or by talking with our coterie and working together to solve problems. "Brainstorming" is uniquely human and requires complex language. Brainstorming means that we are not limited to the intelligence of any one human, but rather that all human endeavor builds on the collective intelligence of many humans.
Spoken language was the first great revolutionary innovation of human history. Written language was the second. Why? Because now humans were not learning only from those they knew personally, but could build on the knowledge of people they would never meet. Information could be stored and retrieved. The third great communications revolution is born out of the invention of the printing press and moveable type. Guttenberg responded to a need of his day -- literacy was on the rise and people were hungry for things to read. So his press met that need and, for the first time, made recorded human knowledge available to a wide swath of people.
And now the Internet. The Web practically eliminates the barriers to being "published," to archiving your own knowledge so that people you will never know, people who are not even alive yet, will have access to your wisdom. More significantly, your brainstorming circle -- that fundamental human gift -- is not limited to people you live near or work with or are related to. Now, through online communities, people are brainstorming with people from entirely different walks of life, different countries. People problem-solve with each other not because geographic chance has thrown them together, but rather because their shared knowledge and experience makes them uniquely qualified to find solutions together. Networked community is the fourth great leap.
In Braintalk.org, for instance, a community of neurological patients, a group of people who share a rare disease collaborated to advance the research into their affliction. Sears Kenmore tapped an online community of unpaid innovators for new product ideas.
The great communication leaps jar the trajectory of human history, and send us on a new path. Before collaborative communication skills, proto-humans lived as small bands of foragers, barely staying ahead of stronger predators by use of simple tools and mental agility. After, we became the farmers and soldiers, the makers of art and complex tools, and, ultimately, the conquerors of all other species. Before printing, humans were governed by superstition and religion. The printing press ushered in the age of science and reason and, ultimately, capitalism and computers. Before networked community, we are a people of nation-states and border battles. In a hundred years, when networked community has become as entrenched in our culture as the printed word is today, what sort of species will we be?
The "Great Leap"of human development -- from homo erectus (or proto-homo sapiens) to homo sapiens, creators of art, tools, etc. -- occurred because of the evolution of the voice box, which allowed for complex human language. Others argue that the expansion of the part of the brain causing language was the trigger.
--From Jared Diamond, Third Chimpanzee
Communication is the thing that makes us human, that creates the vast chasm between us and the rest of creation. Why? Other animals communicate through language. Wolves, apparently, use their howling to send information across the Canadian tundra about the approach of spring or potential harm. Birds use sound to initiate mating rituals and find their young. Our closest cousins, the great apes (and chimpanzees??) use language…? . The difference, though, is that we use language to collaborate and innovate -- to build on the knowledge we're born with or taught in youth. Throughout our lives, we add the knowledge of others to our own, either by reading the words of those we don't know or by talking with our coterie and working together to solve problems. "Brainstorming" is uniquely human and requires complex language. Brainstorming means that we are not limited to the intelligence of any one human, but rather that all human endeavor builds on the collective intelligence of many humans.
Spoken language was the first great revolutionary innovation of human history. Written language was the second. Why? Because now humans were not learning only from those they knew personally, but could build on the knowledge of people they would never meet. Information could be stored and retrieved. The third great communications revolution is born out of the invention of the printing press and moveable type. Guttenberg responded to a need of his day -- literacy was on the rise and people were hungry for things to read. So his press met that need and, for the first time, made recorded human knowledge available to a wide swath of people.
And now the Internet. The Web practically eliminates the barriers to being "published," to archiving your own knowledge so that people you will never know, people who are not even alive yet, will have access to your wisdom. More significantly, your brainstorming circle -- that fundamental human gift -- is not limited to people you live near or work with or are related to. Now, through online communities, people are brainstorming with people from entirely different walks of life, different countries. People problem-solve with each other not because geographic chance has thrown them together, but rather because their shared knowledge and experience makes them uniquely qualified to find solutions together. Networked community is the fourth great leap.
In Braintalk.org, for instance, a community of neurological patients, a group of people who share a rare disease collaborated to advance the research into their affliction. Sears Kenmore tapped an online community of unpaid innovators for new product ideas.
The great communication leaps jar the trajectory of human history, and send us on a new path. Before collaborative communication skills, proto-humans lived as small bands of foragers, barely staying ahead of stronger predators by use of simple tools and mental agility. After, we became the farmers and soldiers, the makers of art and complex tools, and, ultimately, the conquerors of all other species. Before printing, humans were governed by superstition and religion. The printing press ushered in the age of science and reason and, ultimately, capitalism and computers. Before networked community, we are a people of nation-states and border battles. In a hundred years, when networked community has become as entrenched in our culture as the printed word is today, what sort of species will we be?
Tuesday, August 18, 2009
Comforting Our Anxious Parts
As summer winds down, friends I bump into invariably look down at my children and say, “Oh! School’s about to start. Aren’t you excited?” My son buries his face in my leg while looking quizzically at the speaker, as if something completely ludicrous had just been uttered.
And the truth is: It had. The question gets things wrong in so many ways. First, my son is not primarily feeling excited. He’s feeling scared. Maybe you have one of those children, too. A worrier. It’s estimated that 13% of children experience some sort of anxiety disorder during ages 9 to 17. So when well-meaning adults assume my son he ought to be feeling excited, I cringe.
But I don’t just cringe at the incorrect read of his feelings. I cringe because I hear in the statement a common misunderstanding about us human beings and our emotions.
When we say to children (or adults) “Aren’t you excited (or happy, or sad, or anxious),” we’re speaking as if we are our emotions. We’re not. Our emotions are a part of us. And even when we’re feeling something quite strongly--for instance, fear--only a part of us is experiencing that emotion. Other parts of us are feeling other things--say hot, tired, energized or even excited. We all know that we often have conflicted emotions, which is how we end up with internal debates like “A part of me really wants to eat that ice cream sundae but a part of me knows I shouldn’t.” Or, “a part of me is sad summer is over, and a part of me can’t wait for the kids to get back into school.”
As Walt Whitman said, “I am large, I contain multitudes.”
This multitude of parts within us--referred to in psychology as a multiplicity of personality--is totally normal. And helpful. Because once you realize that only a part of you feels something, it’s much easier to deal with it. When only a part of you is feeling anxious, then it’s less overwhelming. You’re not being limited by a label. Plus, by acknowledging that only a part of you feels one way, you’re also acknowledging that other parts are feeling other things. In fact, you always have available within you a calm, confident Self that can comfort the other parts.
These insights are developed in a therapeutic model created by Dr. Richard Schwartz called IFS Thearpy. You can use aspects of his approach to help your child get to know and comfort her anxious parts.
Start by introducing “parts” language to your child. So, if she says, “I’m scared about school” you can simply echo back, “A part of you is anxious about school.” Then tell her that her anxious part probably needs a little attention. Ask her to close her eyes and see if she can picture that part of herself. She might picture where in her body her “anxious part” lives (maybe in her stomach, or her head). Ask her to get to know her anxious part. What is it afraid of? What would make it feel better? Tell her that she can give her anxious part the comfort it needs.
My son was having nightmares. He would awake screaming and come running to our room. I suggested to him that only a part of him was afraid at night and asked if he wanted to get to know that part. He said okay. He closed his eyes and found the part (in his chest). The part was scared that someone was going to steal him away in the night. I suggested he give the part a big hug and reassure it that he wouldn’t let the part be taken away.
It may sound crazy, but my five-year-old sat there, eyes closed, reassuring himself. He opened his eyes and said, “My scared part says it’s still scared. But it liked the hug.”
“Do you think you could reassure it again?” I asked.
He nodded. Although the fear of the dark hasn’t totally gone away, he learned that day that he had scared parts and brave parts, parts in need of comfort and parts that could comfort. And each time he gives himself a hug, he feels a little better.
As the start of school approaches, we’re once again seeing lots of visits from anxious parts. But he knows he can talk to his parts and find out what they need. And even when he’s on his own, he’s got a strong Self ready to give a hug.
And the truth is: It had. The question gets things wrong in so many ways. First, my son is not primarily feeling excited. He’s feeling scared. Maybe you have one of those children, too. A worrier. It’s estimated that 13% of children experience some sort of anxiety disorder during ages 9 to 17. So when well-meaning adults assume my son he ought to be feeling excited, I cringe.
But I don’t just cringe at the incorrect read of his feelings. I cringe because I hear in the statement a common misunderstanding about us human beings and our emotions.
When we say to children (or adults) “Aren’t you excited (or happy, or sad, or anxious),” we’re speaking as if we are our emotions. We’re not. Our emotions are a part of us. And even when we’re feeling something quite strongly--for instance, fear--only a part of us is experiencing that emotion. Other parts of us are feeling other things--say hot, tired, energized or even excited. We all know that we often have conflicted emotions, which is how we end up with internal debates like “A part of me really wants to eat that ice cream sundae but a part of me knows I shouldn’t.” Or, “a part of me is sad summer is over, and a part of me can’t wait for the kids to get back into school.”
As Walt Whitman said, “I am large, I contain multitudes.”
This multitude of parts within us--referred to in psychology as a multiplicity of personality--is totally normal. And helpful. Because once you realize that only a part of you feels something, it’s much easier to deal with it. When only a part of you is feeling anxious, then it’s less overwhelming. You’re not being limited by a label. Plus, by acknowledging that only a part of you feels one way, you’re also acknowledging that other parts are feeling other things. In fact, you always have available within you a calm, confident Self that can comfort the other parts.
These insights are developed in a therapeutic model created by Dr. Richard Schwartz called IFS Thearpy. You can use aspects of his approach to help your child get to know and comfort her anxious parts.
Start by introducing “parts” language to your child. So, if she says, “I’m scared about school” you can simply echo back, “A part of you is anxious about school.” Then tell her that her anxious part probably needs a little attention. Ask her to close her eyes and see if she can picture that part of herself. She might picture where in her body her “anxious part” lives (maybe in her stomach, or her head). Ask her to get to know her anxious part. What is it afraid of? What would make it feel better? Tell her that she can give her anxious part the comfort it needs.
My son was having nightmares. He would awake screaming and come running to our room. I suggested to him that only a part of him was afraid at night and asked if he wanted to get to know that part. He said okay. He closed his eyes and found the part (in his chest). The part was scared that someone was going to steal him away in the night. I suggested he give the part a big hug and reassure it that he wouldn’t let the part be taken away.
It may sound crazy, but my five-year-old sat there, eyes closed, reassuring himself. He opened his eyes and said, “My scared part says it’s still scared. But it liked the hug.”
“Do you think you could reassure it again?” I asked.
He nodded. Although the fear of the dark hasn’t totally gone away, he learned that day that he had scared parts and brave parts, parts in need of comfort and parts that could comfort. And each time he gives himself a hug, he feels a little better.
As the start of school approaches, we’re once again seeing lots of visits from anxious parts. But he knows he can talk to his parts and find out what they need. And even when he’s on his own, he’s got a strong Self ready to give a hug.
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