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An boy dealing with autism interviews his mother.

I have completed my thesis, entitled “Metaphorical Language and the Nature of Hope Among Mothers of Children who Deal with Mental Illness.” If you are interested in a complete copy, please email me.

A qualitative study of mothers’ experiences raising a child who dealt with mental illness is presented. Twelve (n=12) mothers participated in this grounded theory study. Metaphorical analysis was used to understand how mothers conceptualized mental illness and hope. Mothers described mental illness in both static and dynamic terms, meaning that for some mental illness was primarily a fixed entity, or a “fact of life,” whereas for others, mental illness was an active entity that maneuvered to change their children’s and their own lives. Mothers described hope in terms of striving for presence, “normality” and productivity. Emotional experiences of mental illness, grief and loss, and stigma were also discussed. Recommendations for further research are made.

Final excerpt…

…This study contributes to existing research by exploring and analyzing metaphorical language mothers use with regard to mental illness and hope. It also contributes to understanding some of the emotional responses mothers may have to their children’s mental illness. Additionally, by highlighting metaphor as used by mothers of children who deal with mental illness, this study emphasizes the importance of the abstract, spiritual and meaning-based structures that frame experiences of mental illness. Anticipating, exploring and understanding the abstract elements of an individual’s experience with mental illness may promote therapeutic alliance, and thusly, would improve treatment outcomes. By including another family member (in this case, mothers), this study also contributes toward development of a systemic conceptualization of mental illness…

 

Thesis Excerpts Continued:

…Mental illness affects not only the individual who personally deals with it, but that individual’s family and friends. Research on microsystemic experiences of mental illness has generally focused on recommendations for social service providers and caregiver burden. Little research has been completed on the wider lived experience of family members and loved ones who may or may not be primary caregivers for individuals who deal with mental illness.

Familial caregivers of those who deal with mental illness report a variety of experiences and outcomes. The care giving experience, as perceived by caregivers, is at once described as stressful, unsatisfying and upsetting, and at the same time critical and therapeutic (Chang & Horrocks, 2006). When an individual presents with mental health concerns, it is not typical for family supports to be immediately offered. Additionally, it is rare for family members to report their own needs (Heru, 2000). Parents and families of those who deal with mental illness may be reluctant to seek psychotherapy for themselves, possibly because of a denial of their own trauma or the belief that their loss is not worth mourning (Burkhalter, 2010). A psychotherapist who wrote of that loss described his own experience parenting a special needs child as trauma: “There is the initial trauma, which for us was the realization that those silent ten fingers/ten toes prayers had gone unanswered…” (Burklalter, 2010, p. 23)…”

As I’m sure you’ve noticed, my posting has slowed down quite a bit on this blog. I’m working on my thesis, so for the next few months I’m going to focus on putting out excerpts from my thesis. If you are interested in a final copy of this project when I am finished, please feel free to email me.  The first excerpt begins below:

“The preoccupation with categorizing and diagnosing mental illness has led to an emphasis on the tangible and objective, and a corresponding de-emphasis of the subjective, emotional, spiritual and symbolic” (Young, Bailey & Rycroft, 2004, p. 191).

            Current conceptualizations of mental health and illness focus on the diagnosable individual. However, individuals who deal with mental illness also have families, friends, partners and other loved ones who are affected by their experience of the mental illness. Minimal research exists on loved ones’ experiences of mental illness. This is problematic because as Cowling, Edan, Cuff, Armitage and Herszberg, (2006) state: “the unwell person is enmeshed in a family context. The distress of the unwell person is also the distress of the family. Clinicians should be acutely interested in the family context” (p. 416)

Most developmental disorders are diagnosed on the basis of behavior alone.  However, they originate in the brain – why not use brain imaging to try to confirm diagnoses?  Up to 50% of children dealing with what seems to be autism, may actually be dealing with a particular type of brain seizures.  Knowing that means that we can treat those seizures effectively, and a previously pervasive developmental disorder becomes something that is significantly less chronic.

One of the more interesting ideas I’ve ran across in my studies is the idea that mental illness exists in social construction.  I really appreciate this especially given that psychology and the idea of “normal” has been used for years to justify existing systems of oppression.  I don’t buy into the extreme of this idea, that mental illness is a totally made-up entity and that if “everyone just accepted each other, people who are dealing with mental illness wouldn’t have any problems.”  The requirement of “clinically significant impairment or distress” is an important one.  That being said, for the most part, I really think it is important to consider any mental illness diagnosis or designation in a personal, familial and societal context – in other words, who is being empowered and oppressed by this statement? Does it work for, and best serve the client and the client’s system?

Given my interest in mental illness as a social construction, I found a study reported by Science Daily on the potential of a urine test for autism to be really interesting.  Researchers at the Imperial College in London and the University of South Australia have found that children with autism have distinct markers in their urine that differ from children who do not have autism.  With further research, this could potentially lead to a urine test that could lead to a diagnosis of autism, or at least the confirmation of biological markers that are associated with it.  (As the DSM has been built on behavioral indications since at least the third edition, even if a child tested positive for autism they would still need to demonstrate the significant deficit in social skills required by the current edition.)

When I ran across this study, at first I was really excited.  How cool would it be if we could identify mental illness earlier and thus begin treatment earlier?  Additionally, I can see where having a biologic test for a mental illness may decrease stigma that is associated with it – it would seem like our modernist culture may have an easier time digesting behavioral disturbances if they have a marked biological cause.  However, I can also see where having a biologic test for a mental illness may create the bandwagon fallacy that the condition is inevitable or certain.  Or, am I missing the forest for the trees: can mental illness have both solely biologic etiologies and still be socially defined?  IE, if we say that an individual has traits A and B which equal condition X, if that individual still has traits A and B, but we decide that they equal Y, or X without a social stigma, is it still a mental illness?

What defines mental illness?  Should professionals consider the effect of social stigma in the maintenance of “clinically significant distress or impairment”?  How powerful is “normal”?  Is biologic tests for mental illness a good or bad thing?  Why?

Imperial College London (2010, June 3). Autism finding could lead to simple urine test for the condition. ScienceDaily. Retrieved June 3, 2010, from http://www.sciencedaily.com­ /releases/2010/06/100603091641.htm

Empathic responding has been associated with a number of positive outcomes including: more satisfaction in peer relationships, lowered aggression, fewer instances of rule-breaking and disregard for the rights of others (antisocial behavior), and greater general social competence (Eisenberg, 1997).  This greater social competence, especially the ability to “stand in another’s shoes” also has broader social and systemic consequences.

Although each person is bound by a particular body, skin color and hair texture, through empathy individuals can say if not “I can understand where you are coming from,” at least “I understand that your experience is different than my own and that it is different does not make it any less human than my own.”  From this understanding of experiential mirroring and validation, individuals, families, communities and nations can move toward a more peaceful coexistence.

The positive effects of empathy are not doubted either actually or academically.  However, noticing that positive behaviors are resultant from empathy, does not mean that the reverse is also true.  Prosocial behaviors do seem to have a cascading effect, in which they spread throughout existing social networks and onward into the wider world.  But, what happens though when an individual member of an existing social network is “immune” to “catching” prosocial behaviors?

As Eisenberg suggested, empathy development seems to be largely related to both temperament/heredity and learned behaviors, like emotional regulation/socialization.  If an individual is born with genetic material from two people with severe and untreated mental illness, lacks early attachment objects, does not experience any tangible benefits to using emotional regulation and engages in coercive processes with both family and peers, they may be more likely to develop Antisocial Personality Disorder (1997; American Psychiatric Association, 2000; Granic, 2006).

Individuals with Antisocial Personality Disorder lack the ability to feel empathy.  For a variety of reasons, they lack the neurological connections required to engage sympathetically with others, and instead engage in highly manipulative ways.  When these individuals experience negative consequences as a result of negative behaviors, they may demonstrate negative affect, but under further investigation it becomes clear that the emotional upset has more to do with “getting caught” and having to deal with the consequences than remorse or shame (American Psychiatric Association, 2000; Maddux, 2008).

In an interview with a young man diagnosed with Antisocial Personality Disorder and serving a life sentence for raping and murdering two prepubescent girls, Dr. Bruce Perry described the man’s version of the story as being one in which he fell victim to the girls’ unfulfilled insinuations of sexual activity, and that his actions were, in turn, understandable given their provocation.  During the interview, Perry noted the young man’s lack of affect while describing the crime in detail, but apparent affect while speaking about his current prison sentence.  The young man’s upset was due to the consequences he currently experienced, and was entirely divorced from the anguish he caused (2006).

Although the adjective “antisocial” is somewhat overused and sensationalized in popular media, Antisocial Personality Disorder is a distinct, pervasive mental illness characterized by a consistent disregard for the rights of others.  Although all brains demonstrate plasticity, these individuals’ brains seem to lack much of the required structural development needed for advanced planning and social interest.  Additionally, the axiom “use it or lose it” is quite descriptive when it comes to general brain function; if an individual has been diagnosed with Antisocial Personality Disorder, the individual has been operating without empathy for many years and did not learn or practice the skill during developmentally critical periods (American Psychiatric Association, 2000; Maddux, 2008; Perry, 2006).

Proposing to teach individuals with Antisocial Personality Disorder empathy, as in true relational mirroring and validation, is by definition a lost cause.  Instead, if systems and practitioners want to increase prosocial behaviors in individuals with Antisocial Personality Disorder, they should focus on behavioral reinforcements and the idea that looking out for oneself is not ultimately best served by hurting other people in the process.  Increasing inhibition and conscientiousness, if possible, would also be an effective step toward decreasing antisocial behaviors.  When teaching new skills, it is important that instructors scaffold learning from the same theoretical foundation as the person they are trying to teach.  Since individuals dealing with Antisocial Personality Disorder are not standing on a foundation of empathy, clinicians must stand with them on the foundation of self-interest.  Perhaps this unique population can not only decrease antisocial behaviors, but also increase prosocial behaviors.

American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders (text revision). Washington, DC: Author.

Eisenberg, N. (1997) The development of empathy-related responding. Gender and Motivation, 45, 73-117.

Granic, I., Patterson, G.R. (2006) Toward a comprehensive model of antisocial development: A dynamic systems approach. Psychological Review, 113(1), 101-131

Maddux, J.E. & Winstead B.A. (eds.) (2008)  Psychopathology: Foundations for a contemporary understanding. New York: Routledge.

Perry, B.D., Szalavitz, M. (2006) The boy who was raised as a dog: and other stories from a child psychatrist’s notebook. Basic Books: New York, NY

I finished my first semester at UW – Stout with flying colors.  Over the course of the semester I learned a ton of things, notably, the differences between the classic family theories (Structural, Bowenian, Strategic, ect), that due to the fact that we live in a pervasively racist society, everyone really is a racist, and at the end of the day I want to be a female version of Carl Whitaker.  (Carl Whitaker, for those of you who don’t know, was a sort of grouchy old man who believed that everyone was crazy and to effectively create change in families, they must have the motivation within themselves to do it.  He was very confrontational and often was accused of “not liking his clients.”  He agreed with his accusers.)  In short, I am taking on the socially constructed identity of a marriage and family therapist and liking it.

One thing that I did not like very much over the course of the semester was working full-time while doing school full-time.  Although I was able to successfully do both of those things, I was not able to do things like have free time or invest in friendships.  Both free time and friendships are important to me and because of that, I am cutting my hours at CRTC to part-time.  I am looking forward to having time to be more than a great student and employee.  At the beginning of February, I will be in the Part Time Overnight position.  Although the sleep schedule will take some adjusting, I think that it will be worth it, especially because I will be able to use some down time during the overnight to do homework.  I am also hoping to have some more time to keep this blog maintained.

Over the course of Holiday break, I have been spending time with family, playing the Sims, and reading “fun” books.  (It should be noted that “fun” is in quotes because I decided to see what all of the Twilight fuss was about.  It is as bad as you’ve heard.)  One of the things I want to try in the Sims is make a polygamist relationship and a polyamourous relationship.  I want try this: 1) to see if I even can with the way the game is coded and 2) to see how harmonious I can make both of those types of relationships work within the game.  The problem I run into with running social experiments on the Sims is that I start to feel attached to my avatars – I don’t want them to suffer.  So when they start fighting with each other and sobbing into their hands (you Sims players know what I am talking about), I fold like a cheap suit and start giving them what they want. Does anyone else experience this?  With a simulation game (one without a win point), do you find yourself feeling bad for your avatars?  Assuming that I don’t just have an excessively sensitive heart, I wonder if people who struggle with empathy would empathize with their avatars in a game like the Sims.  Would someone who is dealing with Antisocial Personality Disorder or Reactive Attachment Disorder feel bad for or attach to their Sim?

Thoughts?

According to a recent report from PsychPort, it sounds like recent immigrants who deal with mental illness are finding themselves dealing with deportation and a lack of mental health services.  Recent immigrants also have to deal with the fact that they are not required to stand competency hearings before trial and rarely are able to find lawyers.  Additionally, at the end of the day “judges are forced to go with their gut.”  Because of a variety of factors, mentally ill individuals who are citizens but were foreign born are also suffering deportation.  Finally, due to a strapped system the mental health workers who do work for U.S. Immigration and Customs Enforcement are dealing with ratios of 2700 detainees to 1 psychiatrist.

This seems absurd to me.  How do we expect to find out the facts about an immigrants background if they are mentally ill?  It raised a variety of questions as well.  What happens when immigration, criminal justice and social services intersect?  Does the American social service system have a responsibility to provide services for illegal immigrants?  What types of services should be required to ensure humane treatment of detainees?  What questions does this raise for you?

Mentally ill immigrants have little hope for care when detained.  (2009, July 19th)  From PsychPort.com.  Retrieved July 20th, 2009 from http://www.psycport.com/showArticle.cfm?xmlFile=krt_2009_07_19_kniga_1586-0020-IMMIGRANTS-MENTALHEALTH-ADV19.DA.xml&provider=

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