Part 4 increase in the diagnosis of bi-polar disorder.
“Oh my God! Mrs. Johnson totally freaked out on me for being like 5 minutes late, she is so bi-polar!”
I cringe when I hear statements like this, and I hear them a lot. A person having mood swings does not make them bi-polar. In fact most people with bi-polar disorder do not cycle (change from low to high or vice versa) on a daily or even weekly basis. One of my relatives lived in a hypo-manic (really up) cycle for over two decades but when he crashed, he was down big time.
All bi-polar (aka manic-depression) means is that a person at times suffers from depression and at other times gets into extremely highly energetic impulsive phases. During the up phases the person can be incredibly bright and productive which is why bi-polar is sometimes called the genius disorder. When I say extremely energetic and impulsive I mean the person might go days without sleeping, spend several thousand dollars they don't have, engage in indiscriminate sex and drug use, and feel like there is nothing that they cannot do.
Some great books on bi-polar include: Kay Redfield Jameson's An Unquiet Mind, Alex Vonnegut's The Eden Express and (the extreme and disturbing but good) Marya Hornbacher's Madness.
Why is bi-polar being diagnosed so often now? Like ADHD Bi-polar did not exist as a disorder until relatively recently. Until the 1980's Bi-Polar was lumped under schizophrenia and many of the medications that are used for it even today are also used to treat schizophrenia. The main difference between the two is the cycling and energy. People with schizophrenia have good days and bad days but the change in energy in a bi-polar patient is much different. Also, while some people with bi-polar will, at the ultimate end of the Up (manic) phase, have hallucinations and delusions, many people will never reach that level. Some people with schizophrenia will have hallucinations and delusions even when calm and in a low period.
In the past many people who self medicated their bi-polar symptoms and ended up on “skid-row” were simply diagnosed as drunks and looneys. Those people are now more correctly diagnosed as bi-polar. There is very high degree of co-morbidity (two disorders occuring side by side) between bi-polar and addictions.
On the false positive side, today many children with hyperactivity and behavior problems who are unsuccessful with treatment for ADHD are often by default diagnosed as bi-polar. This is particularly true if they have a family member who also has a diagnosis of bi-polar. While the genetic link is very strong with bi-polar, as with ADHD, it is poor diagnostic work to just assume that because one family member suffers from bi-polar so does the other, but it happens.
I have heard people complain that once they mention a family history of bi-polar to a psychiatrist it is as if the interview is over and the diagnosis is made. I hate that.
Bi-polar is usually not diagnosed until the late teens, because many symptoms will not emerge until then and will often not appear into the middle 20's. In addition, depression or ADHD is often diagnosed first until other symptoms emerge because these disorders respond better to treatment and doctors like to be hopeful until the evidence demands they must change course.
Bi-polar symptoms respond very well to medication. The problem is getting the person to take their meds because they often miss the Up phases, and to be honest who wouldn't. People are more likely seek and follow treatment when they are feeling depressed because no one enjoys depression.
I feel that in the future what we now call bi-polar will be split into several different conditions and diagnosis will be far more accurate, especially in children and early teens.
Thursday, July 30, 2009
Monday, July 27, 2009
Part 3 increase in Depression and Anxiety disorders
Part 3 Depression and Anxiety Disorders and the role of managed care.
Isn't anyone just sad anymore? Why does everybody seem to have depression or some disorder?
Remember diagnosis is not a label that defines a person, it just suggest a course of treatment. So if you just happen to be really sad, not depressed, and you go to a therapist you are going to leave with some sort of diagnosis because your insurance company wants to know what they are paying for.
A disorder just means that part of you is not functioning at the optimal level. When you seek
treatment for that issue the professional you are working with picks the type of treatment they are likely to provide.
The problem comes in when a person needs a level of treatment that the insurance company will not pay for if they have a certain diagnosis. Lets say a person moves to a new town to live with his girlfriend, then they break up and he feels alone and stranded. He isn't suicidal but his level of functioning is so low that he is not grooming himself very regularly and he may loose his job soon. He has been in counseling with a diagnosis of adjustment (to the move) disorder with depressed mood. He and his therapist feel he needs to be in the hospital while proper medication is determined. Insurance might not pay for that without a shift in diagnosis to major depression or bi-polar because those disorders suggests a level of danger that can lead to law suits if service is denied.
So while it is in an ethical gray area I feel that there are many people get a diagnosis that sounds more severe than what they are actually dealing with so that insurance will pay.
As I said in an earlier post, however, I think more people than ever are anxious and depressed because of all of our freedom and options. Horatio Alger and Barack Obama are conspiring against us. People like the president, Steve Jobs, and Bill Gates have “made it”. Because we live in a free society where everyone could be the next Bill Clinton and go from a trailer park in Arkansas to the White House, everyone of us who isn't can feel like we have failed.
The thing about depression is most people who have it will survive it without any medication or counseling. This leads to the false notion that because they CAN suffer and merely survive that they SHOULD. (note I believe "should" is a dirty word and I will not allow people to use it in my office without a a solid nagging)
America believes in rugged individualism and that those who seek help are weak. What a load of crap! None of us make it on our own and you don't get extra points for suffering.
Depression and anxiety disorder respond very well to treatment. The fact that the shame and stigma for getting help are starting to lift a little might mean a reduction in suicides, and addictions for future generations.
Even with the complications of insurance, based on my experience I would say that 95% of people diagnosed with a mood disorder or an anxiety disorder are diagnosed correctly. I would say that less than 1/10th of the people who need treatment are getting it and I think every person could benefit from counseling/life coaching/ or therapy at some point in their lives.
The sooner we can change the question from “Do I need help?” to “Could my life be better with help?” the healthier our society will be.
Isn't anyone just sad anymore? Why does everybody seem to have depression or some disorder?
Remember diagnosis is not a label that defines a person, it just suggest a course of treatment. So if you just happen to be really sad, not depressed, and you go to a therapist you are going to leave with some sort of diagnosis because your insurance company wants to know what they are paying for.
A disorder just means that part of you is not functioning at the optimal level. When you seek
treatment for that issue the professional you are working with picks the type of treatment they are likely to provide.
The problem comes in when a person needs a level of treatment that the insurance company will not pay for if they have a certain diagnosis. Lets say a person moves to a new town to live with his girlfriend, then they break up and he feels alone and stranded. He isn't suicidal but his level of functioning is so low that he is not grooming himself very regularly and he may loose his job soon. He has been in counseling with a diagnosis of adjustment (to the move) disorder with depressed mood. He and his therapist feel he needs to be in the hospital while proper medication is determined. Insurance might not pay for that without a shift in diagnosis to major depression or bi-polar because those disorders suggests a level of danger that can lead to law suits if service is denied.
So while it is in an ethical gray area I feel that there are many people get a diagnosis that sounds more severe than what they are actually dealing with so that insurance will pay.
As I said in an earlier post, however, I think more people than ever are anxious and depressed because of all of our freedom and options. Horatio Alger and Barack Obama are conspiring against us. People like the president, Steve Jobs, and Bill Gates have “made it”. Because we live in a free society where everyone could be the next Bill Clinton and go from a trailer park in Arkansas to the White House, everyone of us who isn't can feel like we have failed.
The thing about depression is most people who have it will survive it without any medication or counseling. This leads to the false notion that because they CAN suffer and merely survive that they SHOULD. (note I believe "should" is a dirty word and I will not allow people to use it in my office without a a solid nagging)
America believes in rugged individualism and that those who seek help are weak. What a load of crap! None of us make it on our own and you don't get extra points for suffering.
Depression and anxiety disorder respond very well to treatment. The fact that the shame and stigma for getting help are starting to lift a little might mean a reduction in suicides, and addictions for future generations.
Even with the complications of insurance, based on my experience I would say that 95% of people diagnosed with a mood disorder or an anxiety disorder are diagnosed correctly. I would say that less than 1/10th of the people who need treatment are getting it and I think every person could benefit from counseling/life coaching/ or therapy at some point in their lives.
The sooner we can change the question from “Do I need help?” to “Could my life be better with help?” the healthier our society will be.
Friday, July 24, 2009
Part 2 increase in ADHD dx
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Part 2 Increased diagnosis and ADHD
“Blindness is not a disability in the dark.” I do not know whose quote this is but it isn't mine so I won't claim it. In order to begin to understand ADHD we must know the difference between a symptom and a disorder. Just because someone has a symptom it is not a disorder unless it impairs their functioning in some way. In addition, a person cannot be diagnosed with a disorder if their symptoms are better explained by behavior, something in the environment, or another disorder.
Attention deficit disorder (ADHD) is the most over and under diagnosed disorder in our society today. How can this be? The over and under is all about the presence or absence of the H in ADHD: Hyperactivity. Not every child who is hyperactive has ADHD, but most of them get diagnosed with it because the treatment for ADHD (counseling to improve organization and stimulant medication) tends to improve performance in almost anyone.
A child might be hyperactive for many reasons, and if this reason is related to environment (trauma, family instability, poor diet...) it would be unethical to medicate them for a disorder they don't have. So why is that the first choices of parents and doctors? Because it often works, and it is easier to blame a problem on the internal biology of a child than change the dynamics of a family. Also there is very little to lose by trying an ADHD medication. They are in and out of the system in 24 hours and are not physically addictive. Is it any wonder that so many people say why not, rather than why when it comes to medicating hyperactive kids?
But what about the other part? What if you are just inattentive? How can you tell the difference between someone who is inattentive and someone who is just lazy? It is really really hard. Especially when you consider how likely it would be to give up and become lazy if you had a much more difficult time paying attention than your class chums and everyone was calling you dumb.
But don't we all have difficulty paying attention sometimes? Yes. Every person in the world meets some of the criteria for ADHD some of the time. In fact there are many people who meet most of the criteria almost all of the time and yet they would not qualify for a diagnosis? Why? Because no matter how hyper or inattentive you are if it does not cause a problem in your functioning then it is not a disorder.
Highly intelligent people often don't get diagnosed with things like ADHD or even dyslexia until late high school or college because up to that point they have found strategies that allow them to succeed in their own way.
People with ADHD are often resistant to doing things any way but their own, they don't know why, but when we slow them down in counseling and explore it they have usually determined that the “typical” way of doing things won't work for them.
Contrary to popular belief people do not out grow ADHD. They just find strategies that work for them in helping them negotiate their environment. Often once people leave the academic world they no longer need medication, just as some people only need glasses for reading.
ADHD is real. It is as genetically linked as height but up until the 1970's we called it things like “minimal brain dysfunction.” and so parents often do not realize that they had it themselves until they go to the doctor to get their child diagnosed.
Today about 1 in 25 children are diagnosed with ADHD, but if the diagnostic trend continues at its current pace I believe that number will go to 1 in 10. My experience suggests that this will be close to the actual rate but 50% of people diagnosed with ADHD will not actually have it, and 50% of people who have it will not be diagnosed.
ADHD is more prevelant now because we live in a society of near constant stimuli so when the demand for extended concentration is placed upon a mind that is pre-disposed toward ADHD they are going to be more likely to struggle.
People with ADHD CAN focus on certain things, like video games, or other things they like. This does not mean they do not have the disorder. In fact, people with ADHD tend to have hypo (not enough) and hyper (too much) focus, when confronted with different stimuli.
The good news is ADHD is extremely treatable and there are very few side effects from treatment. If you think you or your child is suffering from ADHD go to a qualified professional and begin the process of diagnosis. Beware any one who does not at least give you a checklist to be filled out by parents, teachers, and the student. If a person suffers from bi-polar disorder the stimulant medication usually used for ADHD can lead to highly agitated behavior and that is why all medications need to be prescribed and reviewed by a doctor.
A final warning. Many people with ADHD try to self medicate using marijuana. This is the WORST thing you could do. A brain with ADHD is like a heavily loaded truck trying to drive up a hill. It doesn't have quite the energy so the engine is whining and straining. A stimulant medication is like a burst of turbo boost to get it over the hill. Marijuana is like suddenly throwing the truck in reverse. Sure the engine stops straining, but we never get over the hill and that shift of gears will make it harder to get over the hill the next time.
Part 2 Increased diagnosis and ADHD
“Blindness is not a disability in the dark.” I do not know whose quote this is but it isn't mine so I won't claim it. In order to begin to understand ADHD we must know the difference between a symptom and a disorder. Just because someone has a symptom it is not a disorder unless it impairs their functioning in some way. In addition, a person cannot be diagnosed with a disorder if their symptoms are better explained by behavior, something in the environment, or another disorder.
Attention deficit disorder (ADHD) is the most over and under diagnosed disorder in our society today. How can this be? The over and under is all about the presence or absence of the H in ADHD: Hyperactivity. Not every child who is hyperactive has ADHD, but most of them get diagnosed with it because the treatment for ADHD (counseling to improve organization and stimulant medication) tends to improve performance in almost anyone.
A child might be hyperactive for many reasons, and if this reason is related to environment (trauma, family instability, poor diet...) it would be unethical to medicate them for a disorder they don't have. So why is that the first choices of parents and doctors? Because it often works, and it is easier to blame a problem on the internal biology of a child than change the dynamics of a family. Also there is very little to lose by trying an ADHD medication. They are in and out of the system in 24 hours and are not physically addictive. Is it any wonder that so many people say why not, rather than why when it comes to medicating hyperactive kids?
But what about the other part? What if you are just inattentive? How can you tell the difference between someone who is inattentive and someone who is just lazy? It is really really hard. Especially when you consider how likely it would be to give up and become lazy if you had a much more difficult time paying attention than your class chums and everyone was calling you dumb.
But don't we all have difficulty paying attention sometimes? Yes. Every person in the world meets some of the criteria for ADHD some of the time. In fact there are many people who meet most of the criteria almost all of the time and yet they would not qualify for a diagnosis? Why? Because no matter how hyper or inattentive you are if it does not cause a problem in your functioning then it is not a disorder.
Highly intelligent people often don't get diagnosed with things like ADHD or even dyslexia until late high school or college because up to that point they have found strategies that allow them to succeed in their own way.
People with ADHD are often resistant to doing things any way but their own, they don't know why, but when we slow them down in counseling and explore it they have usually determined that the “typical” way of doing things won't work for them.
Contrary to popular belief people do not out grow ADHD. They just find strategies that work for them in helping them negotiate their environment. Often once people leave the academic world they no longer need medication, just as some people only need glasses for reading.
ADHD is real. It is as genetically linked as height but up until the 1970's we called it things like “minimal brain dysfunction.” and so parents often do not realize that they had it themselves until they go to the doctor to get their child diagnosed.
Today about 1 in 25 children are diagnosed with ADHD, but if the diagnostic trend continues at its current pace I believe that number will go to 1 in 10. My experience suggests that this will be close to the actual rate but 50% of people diagnosed with ADHD will not actually have it, and 50% of people who have it will not be diagnosed.
ADHD is more prevelant now because we live in a society of near constant stimuli so when the demand for extended concentration is placed upon a mind that is pre-disposed toward ADHD they are going to be more likely to struggle.
People with ADHD CAN focus on certain things, like video games, or other things they like. This does not mean they do not have the disorder. In fact, people with ADHD tend to have hypo (not enough) and hyper (too much) focus, when confronted with different stimuli.
The good news is ADHD is extremely treatable and there are very few side effects from treatment. If you think you or your child is suffering from ADHD go to a qualified professional and begin the process of diagnosis. Beware any one who does not at least give you a checklist to be filled out by parents, teachers, and the student. If a person suffers from bi-polar disorder the stimulant medication usually used for ADHD can lead to highly agitated behavior and that is why all medications need to be prescribed and reviewed by a doctor.
A final warning. Many people with ADHD try to self medicate using marijuana. This is the WORST thing you could do. A brain with ADHD is like a heavily loaded truck trying to drive up a hill. It doesn't have quite the energy so the engine is whining and straining. A stimulant medication is like a burst of turbo boost to get it over the hill. Marijuana is like suddenly throwing the truck in reverse. Sure the engine stops straining, but we never get over the hill and that shift of gears will make it harder to get over the hill the next time.
Wednesday, July 22, 2009
Is America going crazy?
Question: Is it just me or does it seem like everyone is diagnosed with ADHD, Depression, Bi-Polar, or Autism? Do you think it is because professionals are better at recognizing the symptoms or have we turned into a society that needs an excuse for everything? Or is there something in the environment that is making us crazy?
This is such a good question that I think I will have to do a separate post for each disorder, and a general one to start on diagnosis.
Part 1: General increase in mental health disorder diagnosis in our society.
The short answer to your question is...yes. I think professionals are far better at recognizing symptoms and since the introduction of better diagnostic tools (like the DSM III, IV, and IV tr) more professionals are speaking the same language and using the same objective criteria to make a diagnosis.
A diagnosis is not a label that you stick on someone and say, “Ok we're done.” It is a suggestion for a course of treatment. The DSM (big book of disorders) is not a menu. Any person looking through it would find at least 10 disorders they thought they had by going through the check lists. That is not how it is supposed to work.
The way it is supposed to work is a licensed professional meets with a client/patient and they get the feeling, based on their experience and the symptoms they observe, that this person may have a particular disorder. Then they check the DSM to make sure there is nothing that they missed, so they don't try a form of treatment that might be more harmful than helpful.
Assessment and Diagnosis are never complete, they are a statement of the best course of treatment so far based on the information we have. If the symptoms go away there is a pretty good chance the diagnosis was correct.
Does our society just need an excuse for everything? I think our society needs a reason for everything, and wants a cure for everything. We are taught that if we feel discomfort something has gone wrong and we ought to diagnose and cure the problem. Diagnosis is not an excuse, it is a reason, and suggests a course of treatment, but there are many people who use a diagnosis as an excuse.
Also I think that while every disorder in the book has been around for centuries (just read Shakespeare or Greek mythology) our environment lends itself to mental illness in a way it never has before.
Why? Kids today have everything right? I mean it is so easy for them, they don't have to work for anything what do they have to be stressed about?
Every mental health disorder is made worse by (and some are caused by) stress. Stress comes from having to make choices and decisions. Freedom and choices are wonderful things that we value, but when you have the freedom to choose there is a possibility that you might choose wrong and that knowledge grinds people down.
Our society has changed more in the last 150 years than it had in the 10,000 years prior to that. I am glad to live in our world today, but with each passing year as we give our children more leisure, freedom, and choices we pile the stress on. It is hard to have a nervous break down when you are a peasant who doesn't have time to worry about anything more than whether or not you are going to have enough to eat.
Finally there is something biological occurring in our present environment which cannot be denied. The increase in peanut allergies in the last generation requires a physical explanation. As does the increase in Aspergers and ASDs (autism spectrum disorders), these disorders exist. We do not know why yet but it is certainly not a failure of parenting, or over protective mommies making up excuses for the children.
The end result is we have a lot of people who are struggling. The good news is we can help and we are getting better at it all the time. I believe we are in the infancy of our understanding and treatment of metal health disorders. In 50 years as our understanding of the brain matures they will look back at our techniques as we do the blood letting of George Washington's generation.
This is such a good question that I think I will have to do a separate post for each disorder, and a general one to start on diagnosis.
Part 1: General increase in mental health disorder diagnosis in our society.
The short answer to your question is...yes. I think professionals are far better at recognizing symptoms and since the introduction of better diagnostic tools (like the DSM III, IV, and IV tr) more professionals are speaking the same language and using the same objective criteria to make a diagnosis.
A diagnosis is not a label that you stick on someone and say, “Ok we're done.” It is a suggestion for a course of treatment. The DSM (big book of disorders) is not a menu. Any person looking through it would find at least 10 disorders they thought they had by going through the check lists. That is not how it is supposed to work.
The way it is supposed to work is a licensed professional meets with a client/patient and they get the feeling, based on their experience and the symptoms they observe, that this person may have a particular disorder. Then they check the DSM to make sure there is nothing that they missed, so they don't try a form of treatment that might be more harmful than helpful.
Assessment and Diagnosis are never complete, they are a statement of the best course of treatment so far based on the information we have. If the symptoms go away there is a pretty good chance the diagnosis was correct.
Does our society just need an excuse for everything? I think our society needs a reason for everything, and wants a cure for everything. We are taught that if we feel discomfort something has gone wrong and we ought to diagnose and cure the problem. Diagnosis is not an excuse, it is a reason, and suggests a course of treatment, but there are many people who use a diagnosis as an excuse.
Also I think that while every disorder in the book has been around for centuries (just read Shakespeare or Greek mythology) our environment lends itself to mental illness in a way it never has before.
Why? Kids today have everything right? I mean it is so easy for them, they don't have to work for anything what do they have to be stressed about?
Every mental health disorder is made worse by (and some are caused by) stress. Stress comes from having to make choices and decisions. Freedom and choices are wonderful things that we value, but when you have the freedom to choose there is a possibility that you might choose wrong and that knowledge grinds people down.
Our society has changed more in the last 150 years than it had in the 10,000 years prior to that. I am glad to live in our world today, but with each passing year as we give our children more leisure, freedom, and choices we pile the stress on. It is hard to have a nervous break down when you are a peasant who doesn't have time to worry about anything more than whether or not you are going to have enough to eat.
Finally there is something biological occurring in our present environment which cannot be denied. The increase in peanut allergies in the last generation requires a physical explanation. As does the increase in Aspergers and ASDs (autism spectrum disorders), these disorders exist. We do not know why yet but it is certainly not a failure of parenting, or over protective mommies making up excuses for the children.
The end result is we have a lot of people who are struggling. The good news is we can help and we are getting better at it all the time. I believe we are in the infancy of our understanding and treatment of metal health disorders. In 50 years as our understanding of the brain matures they will look back at our techniques as we do the blood letting of George Washington's generation.
Tuesday, July 21, 2009
Molten Heart Pledge
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I hate when my clients, particularly women, treat others better than they treat themselves. I hate it when they settle for relationships with people who treat them poorly. I hate it so much that years ago I created a pledge for them to sign and promise not to do this anymore. I found it today when searching through some documents and I thought I would share it with all of you. If you have a friend you are sick of watching suffer, make them take the pledge. If you want a printable copy please just e-mail me and I'll send it to you.
The Molten Heart Pledge
(To be read out loud, line by line, and then signed)
I hate when my clients, particularly women, treat others better than they treat themselves. I hate it when they settle for relationships with people who treat them poorly. I hate it so much that years ago I created a pledge for them to sign and promise not to do this anymore. I found it today when searching through some documents and I thought I would share it with all of you. If you have a friend you are sick of watching suffer, make them take the pledge. If you want a printable copy please just e-mail me and I'll send it to you.
The Molten Heart Pledge
(To be read out loud, line by line, and then signed)
I solemnly pledge
That from this day forward
I will give to myself
And demand for myself
The same love and respect
That I would grant to any other person
That from this day forward
I will give to myself
And demand for myself
The same love and respect
That I would grant to any other person
I will never settle
For a relationship with anyone
Who does not recognize my worth
And treat me with dignity
For a relationship with anyone
Who does not recognize my worth
And treat me with dignity
I will hold in my memory
That I have been told this day
By one whom I trust
That I am beautiful
Both inside and out
That I have been told this day
By one whom I trust
That I am beautiful
Both inside and out
And if I hold to this pledge
I will find many
Who recognize my beauty
I will find many
Who recognize my beauty
For I am as deserving of love
As any other person
I am an important, unique, individual
And the love that I have to offer
Is a marvel
of value beyond estimation
As any other person
I am an important, unique, individual
And the love that I have to offer
Is a marvel
of value beyond estimation
Signature_______________________
Witness________________________
Monday, July 20, 2009
why give love another chance?
Question:
If you touch something hot and you get burned you don't touch it anymore. If you do you are crazy or stupid. So why do people keep telling me to give relationships another shot? I'm just going to get burned again. When is it time to accept that you are better off alone?
Answer:
"We who are about to die salute you!" That line from the movie Gladiator sums up my whole philosophy of facing the pain that will come our way in life. The Gladiators know they are going to die in a very painful fashion. They have no reason to try, except they know that in the struggle and pain there may be a moment of glory and they will certainly feel more alive than they have ever felt before.
We are all going to die. We are all going to feel pain. There is no avoiding these facts of human existence. Our only choice is how we will face the moments in between. We can curl up in a ball and wait for pain and death to find us, or we can charge forward and pry as much life as possible out of the moments that we have.
What you feel when you get "burned" by love is loss, isolation, rejection and self doubt. Do you think that the person who avoids relationships is free of these feelings?
My personal bias is that there is no better feeling in this world than to be connected to another person. Friendship, romantic love, even two strangers sharing the same sight at a concert and knowing the other saw it too. For me life without these connections would be empty.
This does not mean you need to be stupid and give your heart away at every opportunity. Trust is something that must be earned and if you have recently had a heart break then you should take your time before you open up again.
At the end of the day, however, there is no life without risk. Those who try to avoid pain at all costs are merely waiting to die.
If you touch something hot and you get burned you don't touch it anymore. If you do you are crazy or stupid. So why do people keep telling me to give relationships another shot? I'm just going to get burned again. When is it time to accept that you are better off alone?
Answer:
"We who are about to die salute you!" That line from the movie Gladiator sums up my whole philosophy of facing the pain that will come our way in life. The Gladiators know they are going to die in a very painful fashion. They have no reason to try, except they know that in the struggle and pain there may be a moment of glory and they will certainly feel more alive than they have ever felt before.
We are all going to die. We are all going to feel pain. There is no avoiding these facts of human existence. Our only choice is how we will face the moments in between. We can curl up in a ball and wait for pain and death to find us, or we can charge forward and pry as much life as possible out of the moments that we have.
What you feel when you get "burned" by love is loss, isolation, rejection and self doubt. Do you think that the person who avoids relationships is free of these feelings?
My personal bias is that there is no better feeling in this world than to be connected to another person. Friendship, romantic love, even two strangers sharing the same sight at a concert and knowing the other saw it too. For me life without these connections would be empty.
This does not mean you need to be stupid and give your heart away at every opportunity. Trust is something that must be earned and if you have recently had a heart break then you should take your time before you open up again.
At the end of the day, however, there is no life without risk. Those who try to avoid pain at all costs are merely waiting to die.
Tuesday, July 14, 2009
Special Education: a parents fear
Question:
Recently we had a meeting at my son's school and they said they want to test him for special education services. I don't think he has a disability I think he is lazy and being a pain in the ass since my wife and I divorced. If we do this testing is he going to be labeled as a SPED kid. I'm afraid he will use whatever they come up with as a crutch and the school is not going to challenge him, they will just give him the easy classes and the easy way out. Am I just being paranoid?
Answer:
I was a history major and one of the things I learned early on is that if you want to figure out some person or nation's motive for something, follow the money.
Testing your son and giving him special education services and supports is going to cost the school a lot more money than leaving the situation as it is. In general the testing that schools provide to determine eligibility for special education can cost $9-15 thousand dollars if you were to pursue it on your own. Consequently, schools try everything else they can first, in fact now they are required to by law.
Illinois (where I work full time as a school social worker) requires RTI (response to intervention) before granting a student special education supports. That means if a student is struggling they have to try research based interventions and they have to measure how those interventions worked and only if those interventions indicate a need to move forward would they offer more support.
Notice I say offer rather than put a kid in special ed. Special Education is not a punishment, it is not a failure on any one's behalf, it is an acknowledgement that some individuals (up to 20% in some schools) are put at an unfair disadvantage by the way we teach and unless we do something to level the playing field they will not learn to their capability.
Your son may be lazy. He may be a pain in the ass. He may also have a disability that is making either of those factors worse. If you try special education and you think they are dumbing down the curriculum for him you can call a meeting at any time to insist that they ratchet things up and give him an appropriate level of challenge. If you really don't like the way they handle things you can always sign him out of special education completely.
No one outside the school will ever be told that he receives special education supports unless you tell them. Schools have this thing about not getting sued (hard to find space for a law suit in the budget) so they do not risk revealing ANYTHING about kids without parent permission.
If he does have a problem, particularly with reading or processing speed and you are hoping to get extended time on national college entrance tests like ACT or SAT the sooner you have documentation that these problems are legitimate and that he has been utilizing supports the more likely it is that he will be granted extended time. A better score on the ACT can mean entrance to a college or thousands of dollars in scholarships so it is worth finding out.
To be frank I wish every kid could have an IEP (individual education plan) where staff at the school got together with parents at least once a year to make sure we were doing things right for that student. To be honest I find the meetings to be terribly boring and we just don't have the time or the resources to give that to all students. If, however, you get the chance for that level of service from your local school don't be nervous, you just hit the jackpot.
Recently we had a meeting at my son's school and they said they want to test him for special education services. I don't think he has a disability I think he is lazy and being a pain in the ass since my wife and I divorced. If we do this testing is he going to be labeled as a SPED kid. I'm afraid he will use whatever they come up with as a crutch and the school is not going to challenge him, they will just give him the easy classes and the easy way out. Am I just being paranoid?
Answer:
I was a history major and one of the things I learned early on is that if you want to figure out some person or nation's motive for something, follow the money.
Testing your son and giving him special education services and supports is going to cost the school a lot more money than leaving the situation as it is. In general the testing that schools provide to determine eligibility for special education can cost $9-15 thousand dollars if you were to pursue it on your own. Consequently, schools try everything else they can first, in fact now they are required to by law.
Illinois (where I work full time as a school social worker) requires RTI (response to intervention) before granting a student special education supports. That means if a student is struggling they have to try research based interventions and they have to measure how those interventions worked and only if those interventions indicate a need to move forward would they offer more support.
Notice I say offer rather than put a kid in special ed. Special Education is not a punishment, it is not a failure on any one's behalf, it is an acknowledgement that some individuals (up to 20% in some schools) are put at an unfair disadvantage by the way we teach and unless we do something to level the playing field they will not learn to their capability.
Your son may be lazy. He may be a pain in the ass. He may also have a disability that is making either of those factors worse. If you try special education and you think they are dumbing down the curriculum for him you can call a meeting at any time to insist that they ratchet things up and give him an appropriate level of challenge. If you really don't like the way they handle things you can always sign him out of special education completely.
No one outside the school will ever be told that he receives special education supports unless you tell them. Schools have this thing about not getting sued (hard to find space for a law suit in the budget) so they do not risk revealing ANYTHING about kids without parent permission.
If he does have a problem, particularly with reading or processing speed and you are hoping to get extended time on national college entrance tests like ACT or SAT the sooner you have documentation that these problems are legitimate and that he has been utilizing supports the more likely it is that he will be granted extended time. A better score on the ACT can mean entrance to a college or thousands of dollars in scholarships so it is worth finding out.
To be frank I wish every kid could have an IEP (individual education plan) where staff at the school got together with parents at least once a year to make sure we were doing things right for that student. To be honest I find the meetings to be terribly boring and we just don't have the time or the resources to give that to all students. If, however, you get the chance for that level of service from your local school don't be nervous, you just hit the jackpot.
Monday, July 13, 2009
why girls are crazy
Dear Maigler, okay so I saw you post saying guys are dumb. So is it just me or is every girl nuts? I mean every girl I have ever dated was crazy in one way or another, are they all that way or do I just find the super emotional ones?
Crazy Magnet
Dear Crazy,
[a note: throughout this post (and many others) I will be making generalizations about men and women. This clearly does not apply to all but in the interests of time and space I am not qualifying every sentence]
What does it mean to be crazy?
Women are not crazy, they are just responding to a crazy society. If you were to play chess but you were given nothing but pawns the chances of winning would zero. So if you refused to play by the “rules” and you swept all the pieces to the floor your opponent might think you were crazy or irrational.
Our society was set up by men with the rules designed for them. If a man goes aggressively after the things he wants and gets them (sex, money, power, a nice house, prestige) he is called a success. If a woman goes after those same things in the same way some might call her a success but far more would call her a bitch. Women are constantly caught in a trap where every action will be thought wrong in some one's mind. Consequently women are often split wanting two opposite things at the same time.
For example should a woman go back to work after she has a child or should she stay home to raise him/her? There is no right answer to this. A man would say "well just choose one and accept it", but for a woman there will be many times when she wants both things and does not want to let either go, she knows she can't have both but doesn't stop wanting them. Does that make her crazy?
How about this one, when dating how good should a woman be at sex? Not being good could lead to being dumped but being too good could lead to the notion that she is a slut? That catch-22 would drive me crazy.
The most important thing though to understand is that most women value relationship and emotional connection over reason. For men feelings are compartmentalized, that which is rational is good, that which is irrational or impossible is not just bad but must be ignored and dismissed. Men are concrete and women tend to be fluid.
I imagine a man as a desk with a file cabinet and each issue is separate in it's own place. Family life should not touch work, romantic life does not taint sports, a place for everything and everything in it's place. Now I imagine a woman needing to use that desk but pouring herself, a gallon of life, in the top drawer of the desk. It pours down into all the files, everything is soaked, everything is impacted.
Does that sound crazy? To pour liquid in a file cabinet? It only sounds crazy because we are using the male construct for our basis of what is right and wrong. If we started with an aquarium and the man tried to stick his files in it he would be the one who seemed crazy.
For women whether or not something is reasonable is less important than if it is right. Once I realized that and stopped dismissing the ideas of the women in my life just because they were impossible we got along much better and the world seemed to balance in a new way.
So if you define crazy as irrational, then yes, every woman I have ever met at times values something over reason. Every woman I have ever met has at times been ruled by her emotions and has felt trapped by our society and felt like there was no way she could win.
So if every woman is “crazy” and every man is “dumb” what can we do? You have to find the right balance where one's crazy and they other's stupid complement each other. The key to happiness is finding the right fit and we all have to deal with the failings of the other, or be alone. I'll take a partner and a headache every time.
Crazy Magnet
Dear Crazy,
[a note: throughout this post (and many others) I will be making generalizations about men and women. This clearly does not apply to all but in the interests of time and space I am not qualifying every sentence]
What does it mean to be crazy?
Women are not crazy, they are just responding to a crazy society. If you were to play chess but you were given nothing but pawns the chances of winning would zero. So if you refused to play by the “rules” and you swept all the pieces to the floor your opponent might think you were crazy or irrational.
Our society was set up by men with the rules designed for them. If a man goes aggressively after the things he wants and gets them (sex, money, power, a nice house, prestige) he is called a success. If a woman goes after those same things in the same way some might call her a success but far more would call her a bitch. Women are constantly caught in a trap where every action will be thought wrong in some one's mind. Consequently women are often split wanting two opposite things at the same time.
For example should a woman go back to work after she has a child or should she stay home to raise him/her? There is no right answer to this. A man would say "well just choose one and accept it", but for a woman there will be many times when she wants both things and does not want to let either go, she knows she can't have both but doesn't stop wanting them. Does that make her crazy?
How about this one, when dating how good should a woman be at sex? Not being good could lead to being dumped but being too good could lead to the notion that she is a slut? That catch-22 would drive me crazy.
The most important thing though to understand is that most women value relationship and emotional connection over reason. For men feelings are compartmentalized, that which is rational is good, that which is irrational or impossible is not just bad but must be ignored and dismissed. Men are concrete and women tend to be fluid.
I imagine a man as a desk with a file cabinet and each issue is separate in it's own place. Family life should not touch work, romantic life does not taint sports, a place for everything and everything in it's place. Now I imagine a woman needing to use that desk but pouring herself, a gallon of life, in the top drawer of the desk. It pours down into all the files, everything is soaked, everything is impacted.
Does that sound crazy? To pour liquid in a file cabinet? It only sounds crazy because we are using the male construct for our basis of what is right and wrong. If we started with an aquarium and the man tried to stick his files in it he would be the one who seemed crazy.
For women whether or not something is reasonable is less important than if it is right. Once I realized that and stopped dismissing the ideas of the women in my life just because they were impossible we got along much better and the world seemed to balance in a new way.
So if you define crazy as irrational, then yes, every woman I have ever met at times values something over reason. Every woman I have ever met has at times been ruled by her emotions and has felt trapped by our society and felt like there was no way she could win.
So if every woman is “crazy” and every man is “dumb” what can we do? You have to find the right balance where one's crazy and they other's stupid complement each other. The key to happiness is finding the right fit and we all have to deal with the failings of the other, or be alone. I'll take a partner and a headache every time.
Sunday, July 12, 2009
Why do I believe in God?
Dear Maigler,
Recently I've been questioning a lot of things in my life. I'm starting to wonder how much of what I believe and think is a product of just accepting what I was told and how much is my own thoughts. I believe in God, but I also believe in evolution. Is that a contradiction?
Floundering Faith
Dear Floundering,
I became a history major in college and things only got worse. I found out that a lot of what we thought we "knew" about historical figures were just educated guesses. I mean how do I know that George Washington is any more real than Paul Bunyan? I never saw him.
I also learned the danger of deductive reasoning. Aristotle was a very smart man. Before Newton he had an explanation of why that apple fell to the earth. Because it was from the earth. He reasoned that all things from the earth returned to the earth, and he could prove it, take anything from the earth and throw it into the sky, you'll "prove" that he is correct. Only problem, there was a much better explanation waiting to be discovered.
Today many people, particularly in America, without realizing it use science as their religion. They dismiss the existence of God by saying they believe in the big bang. WHAT? That is a meaningless statement, so what came before the big bang?
At the end of the day we all have faith in things. We have faith that when we wake up in the morning gravity will be the same as it was the day before, we don't fear that we are going to jump out of bed and hit the ceiling. Faith saves time. Without faith in certain things we would spend all day trying to put our underwear on.
I must confess that I am an agnostic. I believe in something because I am here. I like Plato's concept of the unmoved mover. I am always looking to challenge my beliefs and if I find something that makes more sense to me I take that in to my belief system, but I never pretend that my ideas are better or more correct than someone else's just because they are more logical. Logic does not equal truth.
Look to the evidence you can find, find out who benefits from spinning a story a certain way but if you find the people who do not benefit also agree you might be onto something. Don't be afraid to be inconsistent or to acknowledge that your beliefs are a work in progress.
Recently I've been questioning a lot of things in my life. I'm starting to wonder how much of what I believe and think is a product of just accepting what I was told and how much is my own thoughts. I believe in God, but I also believe in evolution. Is that a contradiction?
Floundering Faith
Dear Floundering,
The short answer is no. There does not need to be any contradiction between believing in evolution and believing in God. Many faith communities believe that evolution is part of God's grand design. There are very intelligent people, however, who believe that the evidence that explains evolution could also be explained by an all powerful God putting things on this earth they way he wanted them.
Socrates said "an unexamined life is not worth living" I believe that. I believe that we should question everything and if a belief is worth keeping it will stand up to a little shaking.
Religion is just the way we explain how the universe works. Organized religion is when a bunch of us agree on a lot of the same things. I remember learning about Apollo when I was six and thinking how foolish those ancient Greeks were that they could believe that the sun was a chariot wheel. As I grew older and I found out the Greeks and Romans were no fools I began to wonder if I was any better off with my belief that a man who was nailed to a cross came back to life. Where was my proof? Sure it was written down in some bible but that could be a pack of nonsense.I became a history major in college and things only got worse. I found out that a lot of what we thought we "knew" about historical figures were just educated guesses. I mean how do I know that George Washington is any more real than Paul Bunyan? I never saw him.
I also learned the danger of deductive reasoning. Aristotle was a very smart man. Before Newton he had an explanation of why that apple fell to the earth. Because it was from the earth. He reasoned that all things from the earth returned to the earth, and he could prove it, take anything from the earth and throw it into the sky, you'll "prove" that he is correct. Only problem, there was a much better explanation waiting to be discovered.
Today many people, particularly in America, without realizing it use science as their religion. They dismiss the existence of God by saying they believe in the big bang. WHAT? That is a meaningless statement, so what came before the big bang?
At the end of the day we all have faith in things. We have faith that when we wake up in the morning gravity will be the same as it was the day before, we don't fear that we are going to jump out of bed and hit the ceiling. Faith saves time. Without faith in certain things we would spend all day trying to put our underwear on.
I must confess that I am an agnostic. I believe in something because I am here. I like Plato's concept of the unmoved mover. I am always looking to challenge my beliefs and if I find something that makes more sense to me I take that in to my belief system, but I never pretend that my ideas are better or more correct than someone else's just because they are more logical. Logic does not equal truth.
Look to the evidence you can find, find out who benefits from spinning a story a certain way but if you find the people who do not benefit also agree you might be onto something. Don't be afraid to be inconsistent or to acknowledge that your beliefs are a work in progress.
If you like thinking about bigger picture questions try reading any book by Stephen Jay Gould, an evolutionary biologist and an essayist who will REALLY make you think.
When I encounter a crisis of faith I simply look at the face of a baby laughing or the perfection I see in the female form and the order and brilliance of these images restores my belief that this world did not come to this degree of complexity all by happy accident. I acknowledge that the world is big and my brain is small and I'm probably not supposed to understand it all but I will always continue to question.
Thursday, July 2, 2009
brief vacation
Hello all. I will be out of the country from July 2, until July 12 so look foward to a new post by July 14.
Enjoy the holiday and keep the questions coming. daniel.maigler@live.com
Enjoy the holiday and keep the questions coming. daniel.maigler@live.com
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