The Dr. Drew Response

Lately, I’ve been reading Dr. Drew’s latest book, “The Mirror Effect.”   It addresses celebrity narcissism and the extreme behavior that goes along with it. Dr. Drew does a great job at highlighting what has become typical tabloid material – multiple stints in rehab, sex tapes, drug use, eating disorders, etc. – and explaining the self-destructive pathology behind it.

Dr. Drew references troubling celebrity behavior over and over throughout the book. As I read, I found that most responses to this self-destructiveness fit in one of three categories (depending on one’s own background):

3 responses to troubling celebrity behavior:

1. Dr. Drew (empathetic / sympathetic)
2. “Regular” society (intrigued)
3. Relaters (Individuals with their own psychopathology)

The Dr. Drew Response

“As a group, however, [celebrities] often behaved in ways that unnerved and puzzled me.”

“…their behavior makes my heart ache for them.”

I’m coining this the Dr. Drew Response since I can’t think of any other word to better describes the reaction. His heart aches! He sees someone being self-destructive and he cares and feels their pain. It’s sympathy + knowledge + understanding + insight.

“Regular” society

“…this kind of behavior is portrayed as tragically glamorous, dramatically alluring, and, most alarmingly, normal and expected.”

A lot of people are interested in the self-destructive behavior of celebrities. It is a little bit of an obsession: Is Nicole Richie losing weight? Is Lindsay using? Is Amy Winehouse still alive? People want to know. The troubling behavior is intriguing and the press does a great job at, in essence, kicking celebrities when they’re down.

Relaters

“Witnessing such behavior also tends to provoke our own narcissistic impulses, causing us to feel envy, and tempting us to act like the celebrities we admire.”

“But for anyone who has experienced childhood trauma – the fundamental source of pathological narcissism – surrendering to such impulses can lead even mildly narcissistic people to spiral out of control with devastating results.”

Individuals with their own psychopathology or traumatic histories can be tempted (or even feel envious) by the self-destructive behavior of celebrities. There’s something triggering about it that makes these people want to engage in the same self-destructive behavior.

So there we go: In this world we have Dr. Drews, Regulars, and Relaters. I think that your response can change depending on the situation, and that it applies to anyone struggling – not just celebrities.

For example, I think about this girl who went to my college and was very obviously struggling with an eating disorder. “Regular” people would gossip about how sick she was. You’d hear the “I see her at the gym every single morning” and “I heard she eats a plate of broccoli for dinner” comments. Yes, it’s wrong and mean, but unfortunately that’s reality (at least on college campuses). Now, I was a Relater (struggling with an ED myself), so this girl kind of triggered me. I didn’t want to be that sick, but seeing her around campus would almost encourage my eating disorder; tempt me to cut corners, lose just 5 lb., eat a plate of broccoli for dinner, etc. That drove me CRAZY. I didn’t want to be a Relater – I wanted to be a Dr. Drew. I wanted to just empathize with her, wish she would get help, recognize how miserable she probably felt, and know how tough things were for her right now.

This is still a goal of mine: That Dr. Drew Response.

Group therapy — where to draw the line?

Group Therapy May Help Memory

“Memory lapses could initially be caused by psychological stress. If the memory lapses are noticed, they can lead to anger and fear. Ultimately, this leads to heightened stress levels, which in turn increase the risk of memory lapses. This vicious circle capturing the sufferers is best characterized by models of somatoform disorders.”

So many studies (of different populations) have proven group therapy to be helpful: cancer survivor groups, alcoholics anonymous, grief & lost groups… there is definitely a lot to be said about sharing your feelings, relating to the experiences of others, getting advice, and giving some back.

I thought this article was interesting because of the direct connection between memory and mental illness…

stressor –> anger and fear –> heightened stress levels –> memory impairment

This isn’t really anything new… really post PTSD literature will tell you the same thing. You experience a traumatic event, it is too stressful (stressful can meaning scary, hurtful, etc.) for you to be able to handle/comprehend. You repress (or suppress — that’s another discussion in itself) the memory, but unconsciously/subconsciously it still bothers you. This distraction results in decreased memory function.

The biggest advantage of group therapy? Relating to others’ experiences and understanding more of your own. The biggest disadvantage? The trigger of these relatable experiences and the reliving of your own.

I’ve never been in an ED group that allowed talk about trauma. Even in the trauma groups I’ve been to, details of everyone’s stories have always vague. That’s pretty counterproductive, now that I think about it… discouraging talk about already isolating and taboo subjects… but there was some common understanding that sharing experiences with others could be a bad thing — you don’t want to bring up more trauma issues for anyone. You have to be careful.

I’m not sure how I really feel about those groups or that whole concept, and memory disturbance-causing stressors are probably rarely traumatic events… but how ironic that this treatment proposal is exactly what we were told not to do.

This is the same relationship between my ED treatment experiences and the Maudsley approach. I was always told that it’s not about the food — if you’re talking about the food, then you’re concentrating on that because it’s easier to obsess over that than to deal with more painful emotions. Not that Maudsley doesn’t involve any therapy (not making that assertion at all), but it strikes me as very “yes it IS about the food.”

I definitely keep up on psych research more than anyone I know… but it kinda makes you lose faith in the field. So much is contradictory… it’s not a hard science, so we don’t really know what works.

Maybe you can argue that treatment can be whatever you want it to be (you can definitely argue that different people require different kinds of treatment). I really believe that there has to be some more systematic approach to handling mental illness, though.

How revolutionary is the stress gene?

While I was really excited upon seeing this study, it left me with more questions than answers.

The finding that traumatic events can actually alter a stress-related gene is definitely a new idea.  However, it has been believed for years that these significant events cause some neurological change.  Previously, researchers have found:

1. In a study by Martin Teicher at McLean Hospital, boys who were neglected also had a smaller corpus collosum.  The same was true for girls who were sexually abused.  Teicher explains that “We believe that a smaller corpus collosum leads to less integration of the two halves of the brain, and that this can result in dramatic shifts in mood and personality.”

2. Patients with a history of sexual or verbal abuse show less blood flow in the cerebellar vermis — a part of the brain that helps with the maintenance of emotional balance.  According to Teicher, the vermis is strongly influenced by the environment as opposed to genetic factors.

3. Stress hormones released by abuse affect the brain’s ability to receive and send signals.  In this way, the brain is “rewired” to overrespond to stress — increasing fear, anxiety, and the fight-or-flight reaction.

These are just a few examples.  So, discovering that there is a stress gene definitely supports the argument that mental health has a biological component, but it leaves us with the same questions.

1. How do people with the PTSD-prone variation of the stress gene who don’t encounter a traumatic event react to other stress?  Do they still overrespond?
2. Why are symptoms not manifested until years after the event?
3. Is the stress gene only impressionable during childhood?
4. Do medication and therapy re-regulate the gene?  Or just treat the symptoms?

… personally, I am waiting for the therapy gene – the gene that determines who will / will not respond to therapy 🙂

Flawed studies extend far beyond PTSD research

Psychiatric News
Flawed Studies Underscore Need for More Rigorous PTSD Research — Aaron Levin

This article sums up [almost] all psychological / psychiatric research:

• “Significant gaps” in the evidence underlying treatments
• Poorly designed and executed studies that don’t account for important comorbidities
• Useless conclusions, including “treatments may or may not be effective,” and “inadequate evidence”
• Irrelevant research
• Overly conservative standards that are not applicable to looser, clinical standards
• Drug trials funded by pharmaceutical companies

It was exciting to see a written publication on the inadequacy of psychological research.  While I realize that that sounds pretty negative, often I think that I’m the only one who’s frustrated with the current methodology.  Every day I run into an article where I think, “WHY did they study this?”  Do we really need a study that says adult individuals with an anxiety disorder (and no depression, no substance abuse, a BMI between 18 – 23, and male between the ages of 25 and 30 with a college education) get an hour less sleep than non-anxious individuals?  … how is that helpful?  Probably 95% of patients don’t meet that criteria… and even if they do, what are you going to do with those conclusions?  Diagnose  (non-depressed, healthy weight, in their mid-to-late 20s with a college education) males with anxiety, based on their average amount of sleep?

The clinical relevance would be… ?

This article specifically addressed PTSD research, but I really think that the ideas can be applied to all psych diagnoses.  While I understand the importance of reliability, validity, participant and study controls, etc., those studies aren’t producing any stellar “this therapy works for 90% of patients” results.  Maybe one therapy isn’t going to be the solution… but if the goal is to be able to treat someone, you’re going to be looking for a treatment that can address person-to-person variability.

PTSD: The Fashionable Diagnosis of 2007

Commentary on: In Debate: Posttraumatic Stress Disorder Is Overloaded
Harold Merskey, DM, FRCPC1, August Piper, MD2; (Can J Psychiatry 2007;52:499–500)

Every disorder suffers from “inflation.” Females with strict diet regimens have eating disorders, freaking out before exams or big company meetings qualifies you for panic disorder, and any unreasonable behavior that cannot be otherwise defined means you must be borderline. PTSD isn’t really different in the realm of false positives… but I’d have to say that it’s more taboo to second-guess the impact of someone’s trauma.

In fact, you’d almost think that having issues were only valid if you did have trauma in the past. I have friends with major depression who claim that they don’t need therapy, because it’s “not like they were abused or anything.”

Huh. Well actually, in this age, you don’t even have to remember the trauma to have PTSD! There is a whole list of people who all too often diagnosed with PTSD:

1. Survivors of abuse, war, horrific events, and other trauma
2.  Any childhood anything. your camp counselor picked you up while you were in a bathing suit, and you felt that was violating? Abuse!
3. People who are convinced that they have PTSD, but don’t remember any trauma. They repressed all of it, of course. With some “regression therapy” and enough therapeutic suggestion, though, they can remember!
4. People who exhibit PTSD symptoms, even with no traumatic past. “You act like someone who was abused.” I guess you probably were, then.

Excuse the sarcasm. The article also makes this point–slightly less sarcastically:

In its initial formulation, PTSD could be diagnosed only after a genuine threat to life and limb; then, it could be offered as a diagnosis for people who felt they were in peril, even if they were not. Finally, PTSD may be attributed to any adverse experience, even normal experiences in childhood.

Besides the fact that anyone can claim that anything was traumatic… having trauma doesn’t necessarily mean you have PTSD! In fact, being UPSET after the event doesn’t necessarily qualify you! This article couldn’t say it better:

“Not all individuals who experience stress or trauma, whether in battle or in civilian life, and who develop symptoms, necessarily show the typical anxiety pattern. Some become depressed. Others resort to alcohol or inappropriate drug use or show a preexisting personality disorder or typical hysterical symptoms. It is a mistake to link all these responses under the heading of PTSD”

Maybe the article shoudl be titled, PTSD: The Fashionable Diagnosis of 2007.