Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Saturday, June 17, 2017

Who Should Be Punished When Maternal Mental Illness Kills Children?

In 2014, a young mother who had been evaluated and given prescription medication for a mood disorder killed her two young children (as described in http://www.oxygen.com/blogs/mom-suffocates-her-two-kids-to-death-with-plastic-bags-and-duct-tape; see also Lynh Bui, “Mother who suffocated children with plastic bags and duct tape sentenced to 45 years”, Washington Post, June 7, 2017). She had initially threatened to kill herself and her daughter, and her own mother called the police, who took the younger woman to a hospital for a mental health evaluation. Against her mother’s objections, the young woman, Sonya Spoon, was released with a prescription for antidepressants four days later. Hospital staff apparently did not have information about her threats to the children. A day and a half after that, Sonya Spoon killed her 3-year-old and 1-year-old children by suffocating them, and put the same plastic bag and duct tape around her own head, but then went to get her mother to help remove the suffocating material. The children were unconscious and died later. Sonya subsequently said she did not know what was wrong with her and apologized to her dead children.

Arguments about mitigating circumstances for Sonya Spoon’s actions included the off-base claim that she suffered from an attachment disorder because of having been abandoned as a young infant by her Russian biological family, spending several years in an orphanage, and finally being adopted to the United States. This experience, although very sad and distressing , might well have interfered with her cognitive and language development, but attachment disorder is less likely and in any case would not make her likely to be either suicidal or harmful to others. A factor with a more probably connection to her behavior was a traumatic brain injury from and accident when she was 18—an event likely to interfere with her cognitive abilities and possibly to produce post-traumatic stress disorder. At least one of her children was fathered by an abusive man, who wanted custody, which she resisted. Either in addition to or because of these experiences, Sonya Spoon had perinatal mood disorder—often called post-partum depression, but sometimes continuing well after the post-partum period.

Shifting and negative moods are typical of the days soon after childbirth, but most women experience only “baby blues” in which they feel easily overwhelmed and ready to cry. Many traditional cultures have made sure that new mothers are honored, cared for, and petted during these days, which do not last long. A small number of women experience much more profound anxiety and depression, often focused on whether there is something wrong with the baby, and this may not begin at once. Whenever depression and anxiety are in the picture, suicidal thoughts and actions are very possible, and these may be part of the more severe perinatal mood disorders. Finally, a very small proportion of women experience a post-childbirth period of psychosis which again may not begin at once. They may have delusions of hearing voices that tell them to harm themselves or their children, and some obey. In the famous Andrea Yates case of some years ago, Yates drowned her five young children in the bathtub in obedience to “voices”; she also gave the rationale that she felt they should die and go to heaven at once rather than risking the sins of childhood and adulthood.

Andrea Yates had experienced perinatal mood disorders with each of her five children, but her husband was said to have encouraged further pregnancies. She was found competent to stand trial, a very low bar for which it only had to be shown that she could understand the charges and could work with her lawyer, but she was eventually found not guilty by reason of insanity (the death penalty had been sought). Sonya Spoon was also found competent to stand trial and convicted; the judge said some of her actions had been “selfish”.

Yes, it’s true that the children did get the death penalty, and their terror and pain as they died hardly bears thinking about. But who is really in the wrong here? Does Sonya Spoon deserve 45 years in prison, but the child’s father who did not pay attention to her state of mind is not to be punished? How about hospital staff who did not explore her situation far enough to know that she had threatened the children? For that matter, what about insurance and other regulations that limit the amount of mental health care available even to those who desperately need it? And what about a judge who brought a trivial view of the human mind to the trial by declaring Sonya Spoon “selfish” because she asked her mother to release her from the suffocating bag before seeing to the children? Just like Andrea Yates’ husband and family, these people contributed much to the tragedies, but punishing mentally ill mothers alone is a fine old tradition that apparently must be kept up.



Friday, June 16, 2017

Unborn Babies and Faces: What to Make of This?

I recently received an email from an anti-abortion group who referenced a recent study about the visual behavior of 34-week fetuses—still 6 weeks before they would typically be born. Although the number of abortions that take place at that point in gestation is vanishingly small, my correspondents wanted to use the study to argue against terminating pregnancy at any point. That’s what they do, so I won’t argue with it, but I’d like to look at the study itself and what it means about early development of human beings.

You can find a discussion of the study in a number of places, but here’s one you might try: www.usatoday.com/story/news/2017/06/08/womb-view-fetuses-can-recognize-faces-while-still-inside-mom/102625620/. The researcher was able to shine a bright light through the uterus and amniotic fluid that surrounds the fetus and at the same time to do imaging that would reveal how the fetus turned toward the light. What does this have to do with faces? Well, there were two kinds of lights, each involving three dots arranged in a triangle, which adults might perceive as “two eyes” and “one mouth”. The lights were shown either in a position where they looked like the basic elements of a face, or “upside down” so that the “mouth” was above the “eyes’. The babies moved to “look at” the right-side-up face more than at the upside down non-face.

Because the fetuses discriminated between the two patterns by moving differently, it was concluded that they could were reacting differently to things like faces than to other things that were not so face-like. It was that discrimination that led to the statement that they recognize faces while in the womb. It would be less exciting but a good deal more accurate to say that they respond differently to the face-like triangle than to the other. They do not recognize faces in the adult sense of being able not only to tell one actual face from another but even to know which person has which face. No such claims were made, and for good reason. You might as well say that unborn babies recognize point-down triangles as that they recognize faces in the sense that even a three-month-old does.
Under ordinary conditions, there is no light inside the uterus, so an unborn baby has no visual experience whatsoever. He or she has had no opportunity to learn what people, dogs, moons, or crib bumpers look like. Any visual response that occurs—either in the womb or right after a preterm or full-term birth—has to be produced by functions that are built into the visual system as a result of genetic commands to the developing brain. (Brain? Yes, because developmentally the retina or light-sensitive part of the eye is actually a part of the brain.)

The visual system is the last sensory system to begin its development in the prenatal period, so we might not expect vision to be very good at 34 weeks gestational age—it’s not great at 40 weeks or full term. When babies look at faces after birth, they tend to scan the eye areas and the mouth area a lot, but as is shown by all the comments I get from mothers worried about lack of eye contact, the very young babies do not look at faces very much. They just look at them more than they look at other things. Babies in the first month or so after birth are also very limited in their ability to see objects that are too close or too distant, so even then they do not get a lot of time to look at and learn about faces.

So how does it come about that before birth they can “look” at a face-like pattern and respond to it as if it means something special to them? The most likely reason is that in their still very immature brains they already have feature detectors that are activated by a seen pattern. A feature detector is a cell in the visual system of the brain that is connected to a particular part of the retina and responds only to certain kinds of images that fall on that retinal area. This is a lot easier to demonstrate with frogs than with human beings (who tend to excuse themselves when you want to do things to their brains), but frogs have feature detector cells that are “fly detectors” and become activated when an image the size and shape and speed of a nearby moving fly falls on the retina. The frog feature detectors signal the tongue, and zip, the tongue nails the fly. Mammals too have feature detectors, although fortunately they do not make us catch flies with our tongues. Face detectors are among them—brain cells that are activated when the image of a shape that resembles a face falls on part of the retina. Even sheep have face detectors that respond to human faces. Sheep “recognize” faces in the same sense that unborn babies do.

It’s really interesting and important for researchers to show how early and how gradually human sensory and other systems begin to develop. Those systems don’t just “come on line” instantaneously at some point, and although birth is a dramatic event in the course of development, not all developmental changes are closely related to it.  However, when the researchers have done their job, it’s also important for the media and their audience not to jump to conclusions about the implications of findings. We humans don’t seem to have feature detectors that respond to exaggerations!



Sunday, June 4, 2017

Children, Family Systems, and Parental Alienation


Yesterday I was listening to an audio recording of an appeals court hearing related to a high-conflict divorce and the wish of two teenage daughters to avoid contact with their mother. The father’s attorney brought up the point that one of the girls was headstrong, obstinate, difficult to persuade, and always had been so. The characteristics attributed to the girl were presented as an argument why the father could not force her to visit her mother, but there was no mention of the role her characteristics might have played in her initial reluctance to have contact with one of her parents.

When children of high-conflict divorces have strong preferences for one parent and avoid the other parent, the non-preferred parent may allege that the preferred parent has intentionally alienated the child and turned him or her against the non-preferred one. This is especially likely to occur if certain attorneys or mental health practitioners or “coaches” are in the picture. These advisers rather piously allude to family systems theory and the need for all members of a family to work together, even though they live apart. They invoke family systems theory as a reason why courts should order changes of custody and forced treatment of children who avoid one parent. They argue that unless a child has a “reasonable” explanation for avoiding a parent, the avoidance must be a result of parental alienation (PA) by the preferred parent; that parent should be punished, and the children should be rescued so they can reunite with the non-preferred parent. (“Reasonable” explanations are limited to substantiated child abuse.)

But let’s look at family systems theory for a minute. This fruitful theory considers all members of a family to bring their unique characteristics into family and dyadic interactions. This means children too, of course—but PA proponents generally focus on the preferred parent, who is described as narcissistic and emotionally disturbed, but who has almost never been seen or interviewed by the person giving this description. Little is said about the personality characteristics of the non-preferred parent, and even less about the personality characteristics of the children.

Going back to the “headstrong” girl described in the first paragraph of this post, let’s speculate (yes, SPECULATE, because no one has really studied this) about how child characteristics could lead to avoidance of a parent even when there was no demonstrable abuse by the non-preferred parent and no intentional or unintentional attempts at alienation by the preferred parent.

What I am about to say has nothing to do with diagnostic categories of mental illness, although a child with real mental disturbance or developmental problems like autism might rather readily come to avoid a parent who did not handle those problems very well. But all children, whether emotionally or mentally typical or atypical, have from the time of birth individual patterns of responsiveness to the environment, created by their own unique constitutions. These patterns are often referred to as patterns of temperament, and although no one could claim that temperament explains everything about personality, this concept is of enormous help to understanding of social interactions and why two people do or do not get along well.

Studies of temperament suggest that the patterns unique to an individual in infancy are stable and are still present at 2 years, 5 years, 10 years, and into adulthood. Naturally children do not continue to express their temperaments in the same ways as they get older, because they mature and learn to behave conventionally, but they do retain basic constitutional characteristics. For example, the person who cried a great deal and was easily distressed as an infant will not cry so much as an older child but will still show more negative mood quality than most other children of the same age.

Research on temperament has focused on characteristics that make an infant difficult to care for. Difficult infants tend to have negative mood quality, to react intensely to internal or external events, and to be slow to adapt to changes. They are often distressed and are hard to soothe. They need a lot of time to get used to new situations like starting out-of-home child care. Because these temperamental characteristics are rather stable, we can predict that these difficult babies will also later be the children who go to the beach all summer but will not go into the water until Labor Day, who cry when there is a clown at the birthday party, and who need to be taken to visit a new school several times before opening day so they will be able to cope.

So what does all this have to do with avoiding the non-preferred parent? Again, let me say that this is pure speculation on my part, because as far as I know work on PA has largely ignored child characteristics (I have just seen one reference to this factor in an on line paper by Bala and Fidler.) But a plausible hypothesis can be offered: children who have the temperament of difficult infants may bring to high-conflict divorce an unusual readiness to prefer one parent and avoid the other. A tendency to a generally negative mood quality pushes such children in the direction of disliking whatever new situation they find themselves in. Intense reactions predispose them to strong distress that may be very difficult for them – or for either of their parents—to tolerate. The factor of poor adaptability means that these children will take a good deal of time before they can feel comfortable with changing circumstances, including new living conditions and contacts with parents’ new romantic partners (and possibly those people’s children). Children of difficult temperaments need appropriate parental support to help them deal with the world and eventually master the skill of looking beyond their own temperamental reactions, but in high-conflict divorces the chances are that neither parent will immediately be able to provide such support. The entire situation seems designed to cause such children to decide that they can only tolerate what is happening if they can choose one parent and stay with that person.

Yes, I’m speculating when I hypothesize about how child temperament may be relevant to PA. But I’m not speculating when I say that family systems theory would demand attention to child characteristics. The question is, which characteristics are the ones that interact with high-conflict divorce to create avoidance of one parent?  Temperament is a strong possibility, but not the only one.


N.B. Readers may notice that I don’t speak of children “rejecting” a parent. I believe that language plays into the sense of humiliation and frustration that motivates some non-preferred parents to believe that the former spouse has manipulated the children.  To speak of “avoidance” seems to me to make the issue less personal and more focused on the child’s needs and feelings.