C.R. writes: No. The title of this blog post isn’t a joke. It is based on a series of alarming articles I just read about the new edition of the perennially controversial DSM.

In a Reuters piece, Peter Kinderman, a British clinical psychologist and head of the Institute of Psychology at Liverpool University was quoted as saying:

“The proposed revision to DSM … will exacerbate the problems that result from trying to fit a medical, diagnostic system to problems that just don’t fit nicely into those boxes,” said Peter Kinderman at a briefing about widespread concerns over the book in London.

He said the new edition – known as DSM-5 – “will pathologise a wide range of problems which should never be thought of as mental illnesses”.

“Many people who are shy, bereaved, eccentric, or have unconventional romantic lives will suddenly find themselves labeled as mentally ill,” he said. “It’s not humane, it’s not scientific, and it won’t help decide what help a person needs.

Whatever the politics, wherever the money-trail leads, the truth is that the DSM has its good points and bad. As a non-mental health professional, merely an amateur (in the good sense of the word, I hope), a psychological and social psychological sleuth, my opinion might be on the simple side, but here it is: It is good that the DSM has categorized mental illnesses because this can lead to more effective treatment and it is not so good that the DSM has categorized mental illnesses because this can lead to pathologizing what are mere “personality differences or lifestyle choices.”

I also worry about the trend towards therapeutically treating children for everything from a lisp to a bit of rebelliousness. For example, shyness isn’t pleasant, but many children really do grow out of it (I did). I’m not talking about a pervasive, omnipresent phobia, but still, somewhat serious shyness.

Grief and sadness aren’t pleasant either, but they are appropriate feelings at many times in our lives. An over-eager diagnostician might label one person’s appropriate sadness as clinical depression.  If we rush to judgment anytime we feel or display an “unacceptable” emotion we can turn anything into a mental illness.

For example, study after study shows that divorce has a lasting effect on children. Children are saddened, often deeply, to see their parents split up, for a variety of reasons. Do they need counseling? Maybe. Do they need medication? Only in very rare instances. Grief as a response to the losses divorce entails is a very natural, healthy response to the situation.

A couple of years ago an editing client of mine asked me what I thought about her daughter. The school felt she had “oppositional defiant disorder.” I knew both mother and daughter and had spent time with them together. I felt she was a basically loving young teen who just going through a normal phase of declaring her autonomy. I hesitated to tell my friend my opinion—after all, I’m not a therapist (and I took pains to tell her my opinion was personal, not professional).

But I did anyway. And you know what? Within 16 or so months, her daughter had worked her rebelliousness through. If she had gone for an evaluation, she might have been told she needed therapy. Or medication. What she eventually found she needed was to sit down and talk with her mom about who she was becoming, who she was, and how to find balance between being part of a family and being an individual. She had to make sense of her limitations and her options.

The DSM in general is helpful, but some of the information coming out is particularly worrisome because of the chance children will be over-diagnosed and unnecessarily medicated. I’m in a multi-family dwelling where each day numerous children play in the common area right outside the door where I work. (It’s fun to open it and say hi and see their cute, surprised faces). They scream and shout and spin themselves around until they are dizzy. They pretend they are firefighters and astronauts and mommies and teachers. They talk to themselves. They sulk and sometimes hit each other. They experiment with smashing tricycles into my door. They share secrets and invent hysterically funny (at least to them) scenarios. Not a day goes by without a mom getting slightly fed up and a child shedding at least a few tears. All in all, normal kid stuff.

Objectively speaking, children look and act out of touch with reality. That’s because they need to live part of the time in their imaginary worlds where they can test out various scenarios safely. They can explore and go beyond boundaries in their imaginations and through this, they learn who they are.

When they test things out behaviorally, the behavior might be annoying, upsetting, or inconvenient. That is one of the challenges of raising children. Today, many caring parents are so well-informed and so involved that they may at times over-analyze these behaviors.

Meanwhile, most of the time, sadness is not a mental illness or indicative of mental illness, especially when it is in response to recent painful events. If you lose a friend, pet, or job; if you move; if you have an argument with your best friend you’ll probably feel sad. Maybe even for awhile. We read the list of what might indicate depression and what is “normal”. But if we’re narrowing in on sadness in general, we might be off track. There are people who are quieter, not so overtly happy, maybe even a little melancholy but those might be a part of a person’s personality, not an illness.

Mental health professionals are expressing a lot of concern at the changes in the DSM. Sure, there may be politics and, naturally, money-related stuff going on, but:

Allen Frances, Emeritus professor at Duke University and chair of the committee that oversaw the previous DSM revision, said the proposed DSM-5 would “radically and recklessly expand the boundaries of psychiatry” and result in the “medicalisation of normality, individual difference, and criminality.”

Even if he’s only partially correct, he gives us serious food for thought.

Richard’s out. C.R. writes

Is anyone really surprised by the findings in this UCLA study on marriage? As PsychCentral’s Rick Nauert reported, couples that are willing to make “sacrifices” have better, longer-lasting marriages than people who aren’t.

Still, I have a problem with the language. “Sacrifice” implies something that costs you—big time. An online dictionary defines the definition of sacrifice (after the offering of a life as propitiation or homage)  as: the surrender or destruction of something prized or desirable for the sake of something considered as having a higher or more pressing claim. 

“Surrender” and “destruction” don’t give me the warm fuzzies. Here are some of my own ideas (based on a variety of sources) of what makes a marriage satisfying and lasting. You are welcome to add your own ideas in the comments:

When both spouses view marriage as (at least somewhat) more important than self. I know that this is going to tick off people who feel that self-actualization is the be all and end all. But I have personally witnessed friends’ marriages self-destructing when each person is very focused on their own needs (whether they be spiritual, emotional or physical).

Putting the marriage first is slightly different than putting the other person first (although certainly in marriage as in any relationship, that has to happen at least some of the time).

Of interest: It’s great if both partners agree to put their marriage first.  That the preferred ideal. However,  Judaism teaches that one person might actually be able to save a sinking marriage. How?  By viewing the relationship as bigger than the individuals involved and thinking about and working on one’s own character. In other words: focusing on what you can do to be a better person and let go (at least for awhile) of expectations.

The old saw, “the only thing you can change is yourself” holds true in marriage, too. I guess you could view this as sacrifice, but I don’t think it is surrendering or destructive to step back, work on yourself, and wait a bit. Your spouse is a mirror for you, and vice versa. Surprising changes can occur when one person makes an effort.

Several years ago I watched a friend view herself as a martyr to her marriage. It made her bitter and holier-than-thou. Her role became one giant surrender for the sake of being able to say, “Look what I’ve sacrificed for my husband.”

I also watched a couple in the throes of obsession with their own, personal desires (there were legitimate needs mixed in with those desires, but both people were unable to discern the difference. This was a couple that fought viciously over…wallpaper). They were both very dedicated to never pushing themselves beyond their comfort level. I watched their marriage implode. It was ugly.

Agreement on what marriage is. Without a clear-cut idea of what marriage is, how can you possibly get married? Yet, we’ve all seen people get married without having any idea how their spouse defines marriage. Or how they themselves define marriage. That’s why pre-marriage counseling is an excellent idea, whether done by clergy or other qualified mentors. I believe most people would like to think of themselves as honorable, as the type to honor contracts. By being explicit about what is expected in a marriage as in any contract, potential spouses are able to discover if their values are really in sync. By the way, love does not conquer all when love is merely longing and desire.

A recognition of the holiness/spiritual potential of marriage. Yes, I know this is an old-fashioned idea, but remember, for every spouse who felt stuck in an old-fashioned marriage (before the days in which divorce was commonplace), there were others who felt that participating in the contract/institution of marriage was a holy, very important, and ultimately spiritually rewarding thing to do.

Today, most religions still teach that marriage, in and of itself, is a sanctified and even noble venture. If you believe that your marriage has been blessed by the Creator, you tend to regard it as a thing of wonder, to be treasured and nurtured. (At least some of the time).

Recognize that marriage helps you grow both spiritually and emotionally. Judaism teaches that we cannot become complete souls without marriage. Interestingly enough, though Judaism prescribes marriage for men, it emphasizes it slightly less for women. One of the reasons I’ve been told, is that without the mirror that is marriage, men aren’t quite as capable as women as becoming emotionally and spiritually well-rounded. In the Jewish religion men are actually urged to marry (at least in part to develop good character). But frankly, with today’s cultural equality of the sexes, the challenges and rewards of marriage can help both men and women become stronger, more compassionate people.

Don’t say sacrifice, say “self-development.” Unless you are in an abusive marriage, focusing more on giving than getting is key to making marriage work. Giving feels good. It helps us become stronger. It gives us self-respect and personal dignity. Giving can actually teach us how to have healthy boundaries. (This doesn’t mean giving at the expense of being abused). Successful giving has some important components: What is given must be what the other person needs. Giving into unreasonable or unhealthy demands isn’t giving. It’s giving up.

The benefit of the doubt/looking for the good.  These are two other Jewish teachings.  We are taught we should give a person (until proven otherwise), the benefit of the doubt as well as focus on the good. This doesn’t mean making excuses for abusive, illegal or addictive behavior. We have to use judgment and not excuse crimes or abuse. But, it does mean sticking up for your spouse at least as much as you stick up for yourself.

How many times do you let yourself slide? Many people gloss over their own “failings” or imperfections, yet they can’t let them slide by in others. It is human to: oversleep, feel lazy, overlook dust/dirt, run late. It is human to have flaws that are repetitive, sometimes even constant. He chews with his mouth open. She leaves candy wrappers all over the car. He is a bit loose with the truth (as you see it). She exaggerates others’ faults. He has a slight temper, she sometimes says unkind things she doesn’t mean.  And so on.

You have a choice. You can certainly tell the other person about their flaw. And if they don’t change, you can remind them. Over and over again. Or, you can accept that you’re not perfect either. And look the other way.

Look at all the positives. She occasionally sulks when she doesn’t get her way, but she slips sweet notes into your briefcase along with your daily supply of vitamins. He finds it uncomfortable to have heart to heart talks, but he always makes sure your tires are filled with air and your oil is changed.

Life can be hard. Work can be frustrating. We all struggle. Marriage should be a refuge from the world, a place where each spouse can find a safe place to be themselves and accepted, with all their flaws. A place where they are judged gently or not at all.

Self-reflection. Being accepted and not judged at home doesn’t mean that you can treat your spouse disrespectfully or impolitely. (Yet, you must remember, change must start with the self). Judaism teaches that in the afterlife a person is judged far more on how they treated their spouse, more than any other relationship. Did they speak kindly to their coworkers but come home and yell at their spouse? Did they laugh and tell jokes with their friends but complain constantly to their spouse? Do they attire themselves impeccably when outside the home, but walk around in unwashed sweats at home (this implies disrespect for your spouse, perhaps clean sweats are okay?)   Reflecting on who you are in your marriage vs. who you are elsewhere can be eye-opening. Think about it.

Here in the U.S. we have NAMI’s Stigma Busters, NKM2 (No Kidding, Me Too), and numerous other organizations, grass-root and otherwise, educating the public about mental illness in order to fight stigma.

Although I could find no major studies showing that there was a high level of effectiveness of these campaigns, there is evidence some impact has been made. (If you have links to studies showing that stigma-fighting protocols have a major impact, please send them to us)!

In some non-Western countries, religious and cultural beliefs might reinforce stigma (and discrimination, maltreatment, and even violence against those with mental illness).

Here are some stories that inspire hope:

Biking Around the World to Fight Stigma!

Africa (Kenya)

Africa (South Africa)

India

Qatar

Jordan

WPA’s Global Anti-Stigma Program

Take these fun video tests. (We’re not claiming these tests are scientifically accurate, or psychologically useful, or represent the opinions of anyone except the video makers).

My score is next to the links below—what are yours?

Video Test A  (I’m a 98% clone).

Video Test B (I belong to the unique and creative 2%).

Video Test C (I’m an occupier-I belong to the 98%).

Video Test D (I cheated. Not on purpose, I just read the comments before I did the test and disqualified myself. So, don’t read the comments first!).

Video Test E (I am, once again, a disappointing 98 percenter.)

So the real test is, why do we want to be “different” and “creative”? Why do we instinctively feel we should be more special, different than the rest?

C.R. writes

“There was tons of real stuff I had to deal with. The cult wasn’t only my social and spiritual life, but my job and home too. My roommates were cult members so I was for all intents and purposes, homeless. But in order to get to this point where I was ready to make the external changes I needed to do, I had to accept that [the leader's] behavior towards me was abusive. That took a while.

“During one special event a celebrity member, one of our most visible ones, who gave tons of money to the cult and promoted it wherever she went, was visiting the headquarters with her kids and her nanny. She had visited many times before.

“For some reason this time I watched the way she treated the nanny, ordering her around, giving her tight, quick smiles when she thought people were looking and glaring at her when she thought no one could see. It really bothered me. She was so entitled and arrogant and abusive. She treated the nanny like a slave or robot, not a person. I don’t know why it really got to me that day since I had actually seen her do this before.

“That evening when I was walking home, something went off in my head. I realized that [the leader] treated me the same as [the celebrity] treated her nanny. I actually remember asking myself a question out loud, something like: Am I a robot? My answer was: I feel like a robot who has no feelings. What I mean is, I felt like I was being treated like a robot and expected to have no feelings.

(Lisa and I share an e-mailed chuckle—how does one “feel” like a robot?)

“When I got home I mentioned this to one of my roommates, the whole nanny-robot thing. She looked pretty uncomfortable and the said that perhaps it was my spiritual fate to serve [the leader] to make up for bad stuff I did in another incarnation. I had been taught to believe that the leaders were all very evolved and knew what was best for each recruit but this time the whole thing sounded really false, really untrue. It was fake and phony and manipulative and I recognized this. It was like the old light-bulb going on in my head.”

Next, Lisa touched base with a study partner from college who wasn’t in the cult and in fact, didn’t know Lisa was in it. Lisa asked her if she could get together with her and talk. They ended up meeting for dinner a few days later and talked until early morning.

Lisa told her life story beginning with much of her childhood. Except for Shire, Lisa had never really told anyone of the abuse that went on in her family. She also told her all about the cult. Her friend listened and then recommended that she see a therapist. She even helped Lisa find one who had experience with working with ex-cult members.

“Perhaps one of the most interesting things I learned about my particular vulnerability to joining a cult was that emotionally, I was no different than the big celeb with her millions of dollars and tons of babysitters and husbands and ex-husbands. We looked different on the outside, but inside, we sought love and approval from outside.”

Of course, not everyone responds to emotional neediness or the need for validation from others by joining a cult! But many cults are in the unique position of supplying answers to people who are actually searching for self.

Cult members might believe that what draws them to a cult is the sense of seeking (and finding) the “truth.” They are willing to overlook that the truth involves taking all the money, massaging their egos (or controlling them through abuse), and other not-so-appetizing tactics. Lisa agrees.

“For example, [the cult] broke up tons of marriages. The leaders and other members said that the marriage partners weren’t at the “level” of the cult member and weren’t their true soulmate. The real reason was that the spouse didn’t want their life savings going to the cult.

“Also, it had a hierarchy, not only of leader and member, but different levels of members. So, if you were a narcissist, the cult wooed you with food for narcissism, praise, special treatment, all that kind of thing. And if you were like me, with a poor self image and depressed, then it wooed you with the mixture of love and humiliation you were used to.”

The tactics are incredibly effective and range from the most sophisticated to the seemingly ridiculous, but when you’re caught up in it, you are willing to suspend disbelief. From a personal perspective (not a professional one) I tried to think of times where I was willing to suspend disbelief and afterwards, found out that I had been misled or manipulated. There definitely have been a few times, and I imagine it’s the same for most people. Perhaps not to the extent of cult involvement. I think if you have ever been the victim of a scam or have been “ripped-off,” that might feel somewhat in the short-term what a cult is like in the long term.

Next, Lisa describes therapy and her struggle with depression and PTSD.

Cult Seduction

Cult or Religion?

How I Ended Up In A Cult

Cult Trap

6 Reasons I Was An Easy Target For A Cult

Betraying A Cult

C.R. writes:

I caught up with *Lisa again recently. She told me some of the ways in which she moved deeper and deeper into the cult’s “spell” and how she felt when her relationship with the cult began to crumble.

“Basically I gave up my identity little by little which is how cults brainwash you. Of course because my core identity wasn’t so strong to begin with I was an easier target. I think cults often attract people with [flawed] self-images. For example [some] celebrities only come “alive” in the presence of others. They feel empty when alone or even with their spouses and kids because unless they are being adored they cannot function right.

“I came alive in [the cult]. I became important and adored and the holder of valuable secrets. I was so special, they changed my name and gave me one that is part of the cult’s culture. That further cut me off from the outside world. Because my parents weren’t so interested in me, at least my mom wasn’t, they stepped in to fill the vacuum.

“They filled my need for a parent, a sibling, a friend, a lover. They made me feel special. Which is why I was totally unaware of the severity of their response when I began to ask questions.”

Lisa found at some point she had become a “pet” of one of the top leaders (family members, all), which roused the jealousy of a couple of other members.

“I noticed that [the leader] actually encouraged our disagreements. She encouraged us to be jealous of each other. I saw with my own eyes how she played me off against two of the other young members who were all vying for her attention.”

What she didn’t count on was Lisa’s keen insight into the divide and conquer model of control. Lisa had endured many years of it under her mother who constantly fueled the discord between Lisa and her siblings.

“I had figured out my mother’s game. Now I saw [the leader] doing this. She had sort of turned herself into a guru for celebrities and my role was to smooth out the wrinkles of dealing with these people. She’d put them on ‘mute’ and roll her eyes and ask me to call her away. I had to invent an emergency to get her off the phone. Or she would have a meeting with them and she’d ask me to come in at a certain time and say I needed her. Everything was deception.”

Unlike many in the cult, the deception didn’t make Lisa feel good and powerful. She disliked lies having grown up with constant lies from her parents and the lies they forced her to tell to protect the family image. She disliked the lies her previous boss at the bookstore had told. She began to resent what she felt was being forced to do the wrong thing.

At one point, this leader began to create a series of ads to lure people into the cult and had Lisa help her with them. She was assigned various tasks. Most of the tasks involved lying to one extent or another. Lisa couldn’t take it anymore and felt herself “dying inside, killed by lies.” She asked the leader for a meeting to discuss something that was bothering her.

The leader refused and demanded Lisa tell her what was bothering her on the spot. They were standing in a room full of people so Lisa hesitated. When the leader got furious and went into a rage, Lisa complied. She said that she felt that some of the work she was being assigned to do wasn’t exactly truthful. Lisa remembers the pain of what happened next.

“She grabbed me literally by the collar. I could feel myself turning red. I was so embarrassed. Everyone in the room watched as she steered me towards her office. Then she slammed the door and said, “Don’t you EVER betray me in front of people again.”

Lisa remembers feeling dizzy and confused and not like herself at all. Suddenly, she felt she had to rethink her commitment to the cult.

More soon…

*Previous Posts on Lisa’s Story:

Cult Seduction

Cult or Religion?

How I Ended Up In A Cult

Cult Trap

6 Reasons I Was An Easy Target For A Cult

At the age of twelve, Deborah found a letter, buried in her mother’s sachet-scented lingerie drawer.  In her newly released book, Even Tough Girls Wear Tutus: Inside the World of a Woman Born in Prison, she tells us what she read:

“Can you please alter Deborah’s birth certificate,” my mother asks in the letter to the family attorney, “from the Federal Women’s Prison in Alderson, West Virginia, to Seattle? Nothing good will come from her knowing she lived in the prison before foster care, or that her birth mother was a heroin addict.”

This mind-bending information triggered, unsurprisingly, a profound sense of disassociation. She begins a wild, emotional journey as she tried to reconcile her self, her roots, and her connection to both her mothers: “One mother in prison, behind bars, a criminal, a drug addict, a woman who tugs at me, her face and voice, images and her sound buried deep in my subconscious. The other mother, the one I face very day, the one who keeps fresh bouquets of flowers on our teak credenza. I don’t connect with this mother.”

Out of the depths of her pain and her eventual acceptance, Deborah created not only this ruggedly honest book (which entranced me—I read it in one gulp), but also some creative and important projects, including the unPrison Project. Deborah visits and talks to some of the one million women currently incarcerated in the United States. Because she’s genuine, she’s been there (she committed several crimes, became addicted to drugs, and “white-knuckled through withdrawal”), her candor and shared experience touch these women and give them real hope for themselves and their children.

Some of the statistics she cites in the back of her book are staggering: Between 5000 and 10,000 babies are born in prison in each year; last year, over 250,000 babies were born addicted to heroin, as Deborah herself was. But she was one of the blessed ones—half of all babies born addicted to heroin don’t survive. Those that do face many problems, including neurological damage. According to Americanpregnancy.org:

Using heroin during pregnancy increases the chance of premature birth, low birth weight, breathing difficulties, low blood sugar (hypoglycemia), bleeding within the brain (intracranial hemorrhage), and infant death. Babies can also be born addicted to heroin and can suffer from withdrawal symptoms. Withdrawal symptoms include irritability, convulsions, diarrhea, fever, sleep abnormalities, and joint stiffness. Mothers who inject narcotics are more susceptible to HIV, which can be passed to their unborn children.

“Prison is my birth country,” Deborah says upon visiting the prison where she was born, and goes on to describe the sense she has of the drug’s effect on her. “Like a dandelion puff in a flutter from a breeze, I fly off above the prison in a distortion of time and space, my cells in a dance. Did my mom feel mind flips like this, too?”

Over time, Deborah discovered the importance of being Deborah, the self comprised of her past and present and unfurling future—and beyond. Her language deftly conveys her experience of sensory disorder and I found myself riding on the waves of her emotions and her sense of time and her insights into the deep changes she made: ”Curiosity replaced drugs, crime, and thrill seeking.”

Deborah is a good argument for the truism that therapy and personal growth take hard work and perseverance and finally, acceptance. Today, poised and successful, she continues her unPrison Project work, writes a few blogs (one for Huffington Post), and is a public speaker. At one time she was even a contract writer-in-residence for public schools across the state of Minnesota.

As for the tutus of the title? She makes and wears them—over jeans, at the farmer’s market, with her daughters—and says the tutu “represents what so many of us grapple with: how to turn a rough past into a gentle future.”

I recommend Even Tough Girls Wear Tutus to anyone not reconciled with their past, their moms, their sense of self. You might find yourself in these pages, whether or not you were born in prison, have gone on crime sprees, or shot up speed and heroin.

Connect with Deborah at her web site.

For (somewhat) related stories:

Problems with Mom:    Reconciling with Mom,  Narcissistic Mom, Difficult Relationship

Addiction/Recovery: Self-Knowledge is the Key to Addiction Recovery, Addiction and Prison Alternatives, Addiction and Depression, Addiction and Mental Illness, America the Addicted

Other: PTSD, Mental Illness and Prison

Even when smokers used the patch or gum with support groups or quit-smoking programs, they still smoked!

A recent NY Times article quotes one of the study’s leaders:

“We were hoping for a very different story,” said Dr. Gregory N. Connolly, director of Harvard’s Center for Global Tobacco Control and a co-author of the study. “I ran a treatment program for years, and we invested” millions in treatment services.

There’s been a lot of controversy about previous studies because of perceived bias and potentially influential funding so we were pleased to see that outcome of this study wasn’t in line with hopes of the researchers.

In addition to mental health counseling I’m also an addiction counselor with some specialties. I admit smoking cessation isn’t my top priority, however, I do want to say based on my clinical observations alone, a significant amount of adults and teens who abuse drugs or alcohol also smoke. Research demonstrates that there is a a correlation between tobacco use and illicit drug and alcohol abuse, especially in youth (though the link is not demonstrated to be causal). Anyone who’s ever attended a 12-step meeting for drugs or alcohol can tell you that’s a given.

At the risk of sounding obvious: Giving up smoking isn’t easy. Because cigarettes are widely available and in some cases, socially acceptable (although that is definitely on a meteoric downfall), and because the use of tobacco doesn’t impair one’s cognitive or physical abilities (unless of course you count breathing problems, coughing, and related diseases, etc.), they still aren’t perceived as “bad for you” in the same way, say, heroin is.

So, how do you quit, especially since the research is conflicted?

Here’s advice from a former patient, Ryan. Ryan’s an ex-smoker who is also an ex-drinker (he attends regular AA meetings) and ex-ecstasy user. He also used ayahuasca on several occasions. I really like his success story because he describes how smoking (and his drug and alcohol use) was a spiritual/soul issue for him and so was the solution. He also has been diagnosed with bi-polar disorder and is currently on medication which helps him successfully manage his symptoms. He shared the following in an email (and shortened a bit by C.R. and me):

“It wasn’t easy. I had to change my entire belief system. For me, well, I surprised myself. I realized that like alcohol and other drugs, cigarettes were part of the cover up for my inherent state of spiritual search and belief. After my belief system gradually began to shift through examination of myself and applying the 12 Steps, I kept asking myself, “Would the Creator want me to kill myself like this?” It worked and the patch, gum, even hypnosis, didn’t.

“I had a relapse once, for several months. Then, finally,  as long as I kept on telling myself to believe in myself, that my life is really worth living in good health, I was able to quit for what I hope is forever. I’d like to say I applied my 12 Steps to quitting smoking, but it didn’t work, at least not directly. 12 Steps worked for drugs and alcohol, but not smoking.

“As a college professor, I found that it was hard to avoid getting together with my colleagues in academia. We always seemed to get together over really good scotch or wine, it was part of our entire attitude which also sometimes included [tobacco] pipes or the occasional cigar.

“Also 12 Steps taught me about a Higher Power, which I admit I sneered at for many years before I actually attended a 12 Step program. I came to believe that we human creatures are created-I think I always actually believed it. That belief alone sustains me. (As you know that’s not necessarily a popular belief to have in the academic world). So we’re created. By extension, if we’re created, there’s a reason for it. Surely, that reason isn’t so I can hasten my death. That is a rejection of the gift of life.

“I guess desperation to stop letting anything control me was also a very strong motivator. I kept on telling myself I had free choice to do what I wanted. If I so chose, I could be free. When I first expressed my opinions I faced rejection even from my friends, especially my scotch and tobacco loving friends. I felt they’d rather see me drinking, smoking, and so on because otherwise, they’d have to examine what they were doing to themselves. I’m still in the process of figuring out how to reconcile my relationships with my sober, nicotine-free, self. I try to stay in touch with friends that do not go to bars or necessarily drink all the time.

“The biggest challenge at this point is trying to figure out how much of myself I can be in my professional environment. Although I’ve been on the receiving end of a few ad hominem attacks, I really do understand why people are bothered by my situation. I believe that in many cases it is because I ask the questions they bury. I never thought I’d be the kind of person that hides my beliefs but I am still wary of sharing my success story outside the bounds of 12 Step programs and my family.”

Why the gross photos? We didn’t want to trigger any smoking. Not sure if these were disgusting enough, but we hope so.

I’ve heard that other states are also considering legalizing or expanding various forms of gambling.

While I agree the economy in general stinks, I disagree that casinos actually increase revenues for states during a nationwide depression (okay, recession). I’m not alone in believing this, some economists and politicians agree.

In addition to the obvious risk of increasing problem gambling, the evidence seems to indicate that casinos and racetracks actually suffer financially in a bad economy. For example, despite news reports that say Nevada’s economy is turning the corner, it’s been pretty rotten for awhile and the casinos there are hurting.

It seems like Nevada’s economy is only “turning the corner” now that there are reports that the national economy might be picking up. (It’s true that I’m not an economist and giving you my less-than-expert opinion on matters economic, but hey, are the professional economists doing any better with their prognostications right now?)

I worry about promoting gambling in general. Yes, it’s legal. Yes, it’s a form of entertainment for some and a place of employment for others. But for many, the closer they live to a casino, the higher the chances that they’ll develop a problem. Anywhere in America, take a look in any casino, at any racetrack, at any OTB place, and you’ll see some examples of the ravages of pathological gambling.

The NYCPG says:

To be diagnosed as a pathological gambler, an individual must meet at least five out of ten diagnostic criteria established by the American Psychiatric Association:

• thinks constantly about gambling
• increases bets to sustain thrill
• exhibits agitation when cutting back
• gambles as an escape
• chases losses
• lies to conceal activity
• finances bets through illegal acts
• jeopardizes significant relationships
• relies on financial bailout
• fails in effort to control or stop

On the NYCPG site, they also list the warning signs (for both adults and adolescents):

Warning Signs

• Are you or a loved one haunted by bill collectors?
• Do you or a loved one gamble to escape worry, boredom or trouble?
• Do thoughts of gambling disrupt your sleep?
• Do you or a loved one ever gamble longer than originally planned?
• Do arguments, disappointments or frustrations cause you or a loved one to gamble?
• Do you or a loved one celebrate good times with gambling?
• Have you ever had self-destructive thoughts because of problems resulting from gambling?
• Have you or a loved one lost time from work or school due to gambling?
• Do you hide the rent/mortgage or food money because your spouse, partner or other family member gambles it away?
• Do you or a loved one borrow money to finance gambling or to pay back gambling debts?
• Does your spouse, partner or other loved one promise faithfully that she or he will stop gambling, yet continues to gamble?
• Have you noticed a personality change in a loved one as his or her gambling has progressed?
• Is your spouse, partner or other loved one away from home or unavailable to the family of long periods of time due to gambling?

Adolescent Warning Signs

• Unexplained absences from school or classes
• Sudden drop in grades or failure to complete assignments on time
• Change of personality or behavior
• Exaggerated display of money or other material possessions
• Daily or weekly card game
• Bragging about winning at gambling
• Intense interest in gambling conversations
• Unusual interest in newspapers/magazines/periodicals/sports scores
• Unaccountable explanation for new items of value in possession
• Borrowing or stealing money
• Withdrawing from family and friends
• Uncharacteristically forgetting appointments or dates
• Exaggerated use of word “bet” in vocabulary and/or use of gambling language in conversations (e.g. bookie, point spread, underdog, favorite)

1. MORE mental health and addiction treatment programs will incorporate nutrition education and other nutritional programs in their treatment of mental illness and addiction.

It’s really frustrating. Very few mental health programs, in-patient or out-patient, allocate resources to nutrition education (or improved food/diet programs).

Every few months scientists tell us that diet isn’t only relevant to physical health but to mental health as well.  In our old newsletter C.R. and I wrote a column called Mood and Food. In it, we discussed the benefits of getting the proper nutrition and offered information on supplements as well as dietary suggestions.

We got only positive feedback on that column, leading us to belief that mental health consumers and their families, therapists, and others are hungry for nutrition news. We’ve written several posts on diet and mental health in Therapy Soup and plan to write many more in 2012. (For example  7 rules of mindful eating for health and weight loss, autism and nutrition, food, mood and weight loss,  etc.).

2. MORE psychotherapists will use evidence-based treatment methods and techniques as the bulwark of their practice.

Look, people need to talk. And there is nothing wrong with using some therapy time to build a relationship with unstructured, go-with-the-flow talking. I agree that some measure of un-directed talk is a necessary part of treatment. But many if not most people in therapy respond well to proven treatments, as I argue in Therapy Revolution: Find Help, Get Better, and Move On.

Incorporating treatment methods and techniques that have been shown to work (such as Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, Motivational Interviewing, etc.) should be on every therapist’s can-do list.

3. MORE faith-based future-therapists will enter university programs. There will be an increase (by educators, administrators, legislators) in tolerance, acceptance, and encouragement for those from traditional religious backgrounds to be able to maintain their deeply-held beliefs as they study in and graduate from university programs in the field of mental health. 

Spirituality, in general, and some Eastern religious practices such as Yoga and TM are somewhat in vogue with therapists, as are new-age forms of ancient Western religions. I’d argue however, that traditional forms of scripture-based monotheistic religions (like the more traditional Christian and Jewish observance) are not always so well-tolerated by the mental health field. In fact, it is even challenging for therapists from these backgrounds to find acceptance since our religious beliefs are sometimes in conflict with the psychological theories à la mode.

I do a lot of referrals and I always struggle to find qualified psychotherapists for more traditional Christian and Jewish patients and their families. I should also mention that I’ve noticed that Muslims, too are requesting therapists who are able to do Islam-appropriate therapy. It is challenging to find non-religious therapists (let alone religious ones, many of whom have very long waiting lists), who are able to offer therapy that does not conflict with traditional religious beliefs.

This NY Times article also notes that faith-based therapy is hard to find. It states:

Nearly three-fourths of Americans say their whole approach to life is based on religion. But only 32 percent of psychiatrists, 33 percent of clinical psychologists and 46 percent of clinical social workers feel the same. The majority of traditional counselor training programs have no courses dealing with spiritual matters.

I would add that outside of school, spiritual matters are a topic of discussion among therapists—religious matters, however, not so much. In general, our ilk appears to be more comfortable with “general spirituality” than specific religious beliefs. Our God in Therapy Series seeks to address topics related to these and other religion and spirituality questions from a non-mainstream perspective. We have a lot of exciting topics we hope to cover this year.

4. LESS pathologizing of everyone, especially kids.

I’m not saying mental illness doesn’t exist. It does. But it seems that more and more behaviors are labelled at younger and younger ages. For example, (and this is one story of many) a mother we know brought her child to a pre-kindergarten program (she was just going on five and a bit too young for regular kindergarten). After a couple months, the teachers recommended psychiatric evaluation for the child.

The psychiatrist recommended that the child have two different kinds of interventional behavioral therapies, as well as medication for adhd. I have never seen this child professionally, but C.R. and I have known her since she was born as both parents are close friends. Her behavior is well within the range of normal for her age but she does have a very confident, assertive and active nature. Personality differences are not mental illnesses. We can’t medicate for the convenience of adults.

5. LESS “winging it.”

I am a big believer in the use of mental health treatment plans. Most therapists agree. But some don’t. Read more about treatment plans and why I believe they are invaluable and often make the difference between successful and less successful, therapy.

6. Bonus: MORE people in need accessing appropriate treatment.

Although the Internet and other communication technologies have made it easier for people to get help, there is still some lag-time due to finance and insurance issues, education issues, and simply trial and error. We hope that more people who need help get the help they deserve.