The first generation of antipsychotic medications, known as the typical antipsychotics, has demonstrated great effectiveness in treating a variety of mental health issues. Schizophrenia is the most frequent cause for the prescription of a typical antipsychotic. These typical antipsychotics also cause a variety of side effects, including sleep disturbances and movement disorders.

Tremors and loss of muscle tone can sometimes become so severe that patients have to discontinue treatment. More recently, the atypical antipsychotics have offered the same clinical results with fewer side effects. However, the side effects that can occur with this class of medications are troubling in their own right.

Although the reasons aren’t clear, atypical antipsychotics can lead to serious metabolic side effects. Prolonged use of these medications can result in obesity and even diabetes. Zyprexa (olanzapine) has the greatest risk of causing harmful metabolic effects. Previous research has indicated that a little-understood relationship between atypical antipsychotics, glucose, and insulin is responsible for weight gain and fat accumulation in those who take atypical antipsychotics.

At Penn State University, researchers conducted a study with live rats to better understand how and why antipsychotic medications lead to changes in human metabolism. One group of rats received daily Zyprexa for several weeks, while another group had a single, acute dose of the drug. The rats given the single dose exhibited an almost immediate drop in their activity levels, without a matching decrease in food intake.

In essence, these rats took in more nutrition than necessary. At the same time, significant changes to insulin meant that the extra calories were converted into fat stores. The acute responses were also observed in the chronically-dosed rats. Surprisingly, the rats did not all gain significant amounts of weight. Still, the body composition of these rats changed in drastic way whether they gained weight or not. Fatty tissue as a proportion of body weight increased steadily for the first three weeks of the study before plateauing. Similar effects have been observed in humans in small studies.

Measurable and significant weight gain is the primary concern when prescribing an atypical antipsychotic. It is arguably the most serious side effect, as increased body mass raises the risk of numerous chronic health problems. However, the rat study at Penn State showed that even without large weight gains, body composition can change in distinctly unhealthy ways. More fatty tissue leads to altered hormone levels and potentially more plaque in the blood stream. This study makes a strong case that patients taking atypical antipsychotics, especially Zyprexa, should have regular blood work to ensure healthy insulin and glucose levels.

References:

1. Albaugh, V.L., Judson, J.G., She, P., Lang, C.H., Maresca, K.P., Joyal, J.L, and Lynch, C.J. (2011). Olanzapine promotes fat accumulation in male rats by decreasing physical activity, repartitioning energy and increasing adipose tissue lipogenesis while impairing lipolysis. Molecular Psychiatry, 16, (5), 569-581.
2. Olanzapine – PubMed Health. (n.d.). National Center for Biotechnology Information. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000161/

One of the reasons many children do not tell anyone about being sexually abused is because they fear that their loved ones will not believe them. Often, their abuser is a friend or family member, and although children may know that what occurred is wrong, they may be confused and worried that their caregivers will think they have misconstrued the behavior. Children who feel neglected or maltreated by caregivers may feel reluctant to disclose abuse, and many abusers threaten children, creating more reasons for nondisclosure. However, when children do reveal abuse, getting them to explain the abuse in a way sufficient to lead to prosecution can be challenging.

Various methods of interrogation are used on child-abuse victims, including open-ended questions, yes/no questions, “What happened?” questions, and “How did that make you feel?” questions. For the most part, open-ended questions and “what” questions tend to provide the least amount of detail. Children often are unable to articulate the details of their abuse. And while “how” questions that prompt children to reveal their physical reactions and feelings allow them to detail their personal experience in great detail, this is the most rarely used form of interrogation. To explore which method would provide the most accurate recollection of abuse and elicit emotional responses that could demonstrate credibility to jurors, judges, and therapists, Thomas D. Lyon of the Department of Psychology at the University of Southern California recently examined transcripts from more than 100 child-abuse cases.

Lyon discovered that when children were asked closed-ended questions such as yes/no, their responses were narrow and they exhibited little emotion. Similarly, when they were asked “What happened?” they were hesitant to reveal details and appeared emotionally undisturbed. But when children were asked how the abuse made them feel and what their physical reactions were, the responses were extremely vivid and consistent. They demonstrated emotional responses and used words such as angry, sad, afraid, confused, “sick to my stomach,” and dirty. They manifested facial and physical reactions that allowed those interviewing them to see the damage of the abuse in ways that the children could not articulate when prompted with direct questioning. “Children can be surprisingly articulate about their reactions to sexual abuse, despite their apparent lack of affect in describing the abuse itself,” Lyon said. He hopes that these findings will motivate interviewers, prosecutors, and mental health professionals to evaluate physical and emotional reactions of abuse as a means to gather details from child sexual abuse victims.

Reference:
Lyon, Thomas D., Nicholas Scurich, Karen Choi, Sally Handmaker, and Rebecca Blank. ‘How did you feel?’: Increasing child sexual abuse witnesses’ production of evaluative information. Law and Human Behavior 36.5 (2012): 448-57. Print.

One of the basic ingredients of good psychotherapy is being understood. People often do not consider what it means for a therapist to understand. Ideas vary from one school of therapy to another—even from one therapist to another.

Some look for understanding through causes. How did you get to be the person you are? What early experiences may have taken part in forming your personality?

Some therapists focus on understanding in a manner rooted in biology. Do you have a shortage of neurotransmitters that are designed to make you feel happy—to give you a sense of well-being?

Others are more interested in understanding what you experience as you go through the world. What does it feel like to be in your shoes—to have your anxieties, loves, fears, and hopes?

Most therapists use a combination of these modes, as well as many others I haven’t mentioned. In my view, there is a critical part of understanding that provides a profound respect for your humanity—a sort of understanding that is familiar to all of us, but is not an ordinary part of the therapeutic literature.

I’m referring to the process of understanding a person precisely how that person understands himself or herself. I believe the modes of understanding that I have mentioned are critical, but having someone see you in the way you see yourself is foremost. There is subtle disrespect in a therapist’s bypassing your self-understanding toward an investigation that lies beneath—whether it be unconscious phenomena, biochemistry, or even felt experience—as your experience in the world is not quite the same as your evaluation of it.

[fat_widget_right]It’s true that we all have blind spots, and therapists are in a position to notice things we may not. We collaborate with our therapists to investigate the mysteries of the unconscious, the unknown, and what we don’t understand about ourselves. That quest has been a part of therapy since its inception. But wouldn’t it make sense for therapist and person in therapy to have dialogue about that first?

For example, does your understanding of self-discovery differ from that of your therapist? Presumably, nobody is the expert when it comes the most important human questions—those that matter most to us. Therapists in their craft have something to teach: Sigmund Freud’s technique ignited a passion for self-inquiry lasting more than 100 years and still burning. However, the extent to which you may have something to teach often is overlooked.

Following one of Freud’s favorite metaphors, as the archaeologist penetrates beneath the earth’s surface, the psychoanalyst does the same with the mind. In a descending excavation, the height of great aspirations—the astronomer’s sky—may be inappropriately understood.

Therapists can become preoccupied with your biases and misconceptions. They may lose sight of the independent dignity of what you see. What are the things you love and hold dear? Why do you love them? What are the things that guide your life? Love? Family? Truth? Beauty? Security? What are your highest aspirations? Your virtues? Strengths? What are your opinions about the most important things? The universe? And how do you understand your place in it?

Many therapists develop understandings of people in therapy in relation to these questions. However, it might be a mistake to believe these investigations lead only to an illusory superstructure under which your real truth lies. These questions are integral to being human and hold an independent dignity. They cannot be reduced to something else. It is a terrific advantage if your therapist welcomes the things that are most dear to you and understands them on your terms with the utmost seriousness.

Most people experience some form of irrational fear or anxiety, and many are concerned about germs and disease in particular. Amid a flurry of films and media reports about antibiotic-resistant infections and life-threatening flu strains, it’s easy to understand why some people actively worry about what they touch and breathe.

While concern about germs can motivate people to make health-conscious decisions such as frequently washing their hands, a serious germ phobia can drastically alter how a person functions and engages with society. Even actor and television host Howie Mandel concedes he has been unable to shake the grip of mysophobia—the technical term for fear of germs. Phobias are differentiated from general fears by degree. A person who is concerned about germs might wash his or her hands or get a flu shot, but a germ phobia can interfere with every area of life. Phobias are treatable, and people experiencing them should seek medical or psychological assistance.

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Symptoms
The primary symptom of mysophobia is an irrational fear of germs. This can manifest differently in different people. One person, for example, might be fixated on a specific germ or disease, while another person might be afraid of germs and dirt in general. Common behaviors associated with mysophobia include:

• Compulsive hand washing
• Excessive use of disinfectants and antibacterial soap
• Fear of physical contact with others
• Extreme fear of getting sick
• Reacting with extreme fear to media reports of new diseases
• Fear of certain locations, such as doctor’s offices and airplanes, where germs or sick people might be present or confined

Effects
Mysophobia doesn’t simply inspire fear and avoidance. The phobia can be all-encompassing and life-altering. While people with mysophobia often recognize that their reactions are irrational, they can’t control them. They may avoid going out in public, developing intimate relationships, or eating food they did not cook. Because mysophobia affects so much of a person’s life, it can lead to other mental health issues such as depression, social isolation, and anxiety. Complete avoidance of germs can actually contribute to the development of health problems. Overuse of antibacterial and disinfectant products has been implicated in the spread of new, resistant infections, and children who are not exposed to germs are more likely to develop allergies.

Causes
No one knows exactly why people develop phobias, but mental health experts have developed a few theories. Some believe that people are more likely to develop phobias that protect from danger. These phobias include germ phobias, fear of large animals, and fear of heights. People who develop phobias may take these natural fears too far and react with extreme anxiety, placing them in danger they are believed to be trying to avoid.

Early experiences also can make a person more likely to develop a phobia. Childhood illness, the death of a parent, or painful medical procedures can condition a person to be extremely fearful of germs and to take extreme measures to avoid them. Phobias also tend to run in families; they may be genetic or simply learned from parents.

Treatment
Phobias are highly treatable and often require only a few sessions with a qualified mental health professional. Cognitive behavioral therapy, which helps people to reframe intrusive and phobic thoughts, can be extremely beneficial. Desensitization, a process whereby a person is slowly exposed to a frightening stimulus, also is highly effective. Some doctors may prescribe anti-anxiety medications to help people with mysophobia cope with their fears during treatment or to enable them to function in public. Some clients also experience success with hypnotherapy, often in only two or three sessions.

References:

1. Audesirk, T., Audesirk, G., Byers, B. E. (2008). Biology: Life on earth with physiology. Upper Saddle River, NJ: Pearson Prentice Hall.
2. Overcoming your Fear of Germs. (n.d.). Fear of Germs. Retrieved from http://www.fearofgerms.com/
3. Kring, A. M., Johnson, S. L., Davison, G. C., Neale, J. M. (2010). Abnormal psychology. Hoboken, NJ: John Wiley & Sons.
4. Phobias. (n.d.). U.S. National Library of Medicine. Retrieved from http://www.nlm.nih.gov/medlineplus/phobias.html

This is the third in a series of articles designed to explore some of the issues and concerns that arise around what is currently called Asperger’s syndrome, which will soon be incorporated into the broader spectrum of autism disorder when the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is published in 2013.

I had a client we’ll call Brian, a man in his mid-thirties with a diagnosis of Asperger’s syndrome who came to me to discuss what he referred to as “issues he was having with people at work.”

It is not an unusual request for a person with Asperger’s to want to work on the confusion that surrounds social interactions in general. Interactions at work often are more challenging because in the office, not only do the normal social protocols apply, but there often is an additional layer of a particular corporate culture overlaid upon this basic structure, invisibly directing everything.

Bryan was a pleasant and engaging man. He held good eye contact, spoke with precision, and demonstrated a light touch with humor. His demeanor changed, though, when I asked him about his colleagues in the office where he worked as a certified public accountant.

A quiet earnestness overcame him. He spoke clearly and without breaking to collect his thoughts or in expectation of response. He discussed one individual after another in great detail, including information about the kind of work they did, their areas of responsibility, and where they stood in the hierarchy. This was precisely the sort of information I expected to get from Brian on the topic of work relationships.

Then, however, he began to speak of his colleagues in more personal terms. He knew who was married and who was single. He knew who had children, their names and ages, and the schools they attended. Brian told me who had recently vacationed and where they had gone; who golfed and who played tennis; who had iPhones and who used Androids. He knew the makes and models of everyone’s cars. He knew the names of spouses. He knew which neighborhoods his coworkers called home. He even knew who had housekeepers and who did not.

It might appear surprising on first glance to read that I was given such detailed and personal information about others from a man with Asperger’s who came into my office with self-identified problems related to interpersonal relationships. But I have seen this before. Once you look at this apparent contradiction in another light, you may recognize it, too.

I’m talking about the illusion of friendship.

Further discussion with Brian demonstrated to me that he had gleaned all this information about his coworkers not from interactions with them over time, the way you or I might imagine getting to know the people we work with. Instead, Brian had developed his extensive knowledge of everyone around him by listening and even eavesdropping on conversations others were having around him, but in which he had not once been involved personally.

And he was having problems with his coworkers when he would make a statement revealing his knowledge about a person, info he had no apparently legitimate way of knowing. People became uncomfortable around him because of this and withdrew from him, which left him utterly confused.

Of course, this became the starting point for our work together. Brian had to learn about the ways that acquaintanceships and friendships develop over time. Importantly, he also had to learn the concept of reciprocity: It is not enough to know things about another person, but one must also share personal information about oneself as well in the give-and-take manner of casual conversation. This is how trust develops between people. This is the foundation from which we can make a statement such as, “Oh, yes, I know Brian,” with legitimacy.

Brian had to learn that knowing confidential or intimate facts about another person without that reciprocity was considered socially gauche, and that it had the potential even to be frightening to some individuals. Brian had to learn the difference between having friends and having the illusion that he had friends.

Once we began to tease this distinction apart, Brian began making progress in his social interactions. We used role-playing techniques and many “what-if” exercises, and Brian’s distress around the topic of his work environment noticeably decreased over time.

What was once considered a rarity—step-siblings, step-parents, and step-in-laws—has become more common than not. When couples marry, there is a very good chance that one of them brings an extended family that branches by halves and steps. And if that couple winds up divorcing, the tree splinters even further. Because there is no biological bond that obligates a step-family member to stay in contact with other steps, the rules of engagement can be confusing and tense. In a recent article, marriage experts explain how to navigate the rocky road of step-relationships after divorce.

Take, for example, the case of an ex-wife who spent decades raising her step-children. Should she continue the relationship with these nonbiological children, even though she has no legal claim to them? Mary T. Kelly, a marriage therapist from Colorado, notes that often step-children can be a contributing factor to divorce. Many blended-family parents disagree over how to raise his, hers, and their children. Tension that exists between step-children and step-parents seems like normal childhood rebellion, but in many cases may actually run deeper.

Paul Hokemeyer, a New York therapist, says couples and children need to determine if they want those relationships to continue after divorce. Many children may not be permitted to make contact with their ex-step-parents while they are minors, but can make the choice whether to have a relationship with that significant person when they reach adulthood. Even step-grandparents get caught in the mix when step-families divorce. Grandparents who become attached to step-grandchildren, only to have them taken away, may not be willing to invest as much into future step-family members.

One Massachusetts psychologist, Patricia Papemow, recommends that clients try to initiate contact through letters rather than personal visits or phone calls. It is important for step-children to be allowed to have time to process the shift in the relationship on their own terms. Letting them know a step-parent is there through cards and letters is a noninvasive and subtle way to continue contact and keep the door open for future communication. Regardless of how an individual chooses to stay in contact with their step-children, Hokemeyer insists that they review their motives so that all parties will be receptive. “Make sure that you are acting out of genuine love and concern for the other person, and not out of anger and attempts to manipulate,” Hokemeyer says. Following these tips could help step-exes maintain important family ties in a world of ever-changing family dynamics.

Reference:
Gootman, Elissa. When branches tangle in a stepfamily tree. (n.d.): n. pag. The New York Times. 3 Oct. 2012. Web. 8 Oct. 2012. http://www.nytimes.com/2012/10/04/fashion/-step-family-trees-with-tangled-branches.html?pagewanted=all&_r=0

There are many parallels between living with a disability and dealing with an uninvited house guest. If you have ever had an uninvited house guest, I am sure you remember moments when things may have been uncertain and, at times, tense or uncomfortable. At the very least, having an uninvited guest requires some adjustments, much like living with a disability.

An uninvited guest may arrive unannounced, leaving no time to plan or prepare. Likewise, in many cases people living with disability have little or no time to plan for the many changes to come. While there may have been no way to prevent the disability and requisite life changes, having time to prepare—psychologically and literally—can make a huge difference in a person’s ability to adapt and cope.

A period of psychological adjustment is required for a person who has a disability, his or her spouse/partner, parents, and other family members. The adjustment process people frequently talk about resembles the grief process in many ways. Like the grief process, people often experience feelings in what seem to be stages. Similar to the grief process, this adaptation process usually begins with a period of denial.

Denial
In my work with couples and families living with multiple sclerosis, I often hear concerns that one person seems to be “stuck in denial.” To people who have moved through the initial denial stage, it may seem as if their loved one is not progressing as quickly as others. The truth is, different people work through this period of adjustment differently, and it takes as long as it takes. The denial stage usually happens at the time of diagnosis or disability, and may come up again at other times. For example, in a progressive illness, if one begins to lose mobility or other limitations arise, the initial stage of the adjustment process may be triggered again.

It may seem clear to a caregiver/partner or family member who has been helping someone walk even short distances that a mobility device is needed (cane, walker, scooter). For the person who is having mobility difficulty, admitting that it is time to talk to a doctor about a mobility device may affect his or her identity, hope for recovery, or future progress. If so, working through the denial and bargaining, and then later stages of adaptation, may be necessary. It is not unusual to see all members of the family triggered by new developments that start the process over.

Denial is believed to be a protective measure that prevents us from becoming emotionally overwhelmed. Denial slows down the process of coping with traumatic events, giving us more time to psychologically prepare ourselves for the onslaught of feelings. The process of denial, known as a defense mechanism, should not be rushed or sabotaged by well-meaning loved ones who are at a different place in the adaptation process. Doing so can cause the person who needs more time to become emotionally overwhelmed without the necessary skills to cope effectively.

Coping skills: A person with disability and his or her family members should try to be empathetic and understand things from the perspective of others. Be honest, but gentle, about your perceptions. Choose the time to discuss these issues carefully—not when either of you are tired, frustrated, or angry. Always talk to your loved one(s) before bringing up concerns with doctors or other professionals.  Caregivers and family members should keep in mind that their needs are important, too. Take care of yourself and make sure you have plenty of support. When children are involved, be very careful what and how you share information with them. Children need to hear things based on what is appropriate for their age and stage of development. Ask for guidance from a professional if you are unsure how much to tell children or how to talk to them about disability.

Bargaining
The stage that usually follows denial is bargaining. During this time, people often are looking for second opinions, alternative therapies, and other remedies. It can also be a time when we promise the gods that we will turn our lives around if given a second chance without the disability or diagnosis.

It is true that finding the best medical providers, keeping a positive outlook, and staying informed of new research and possibilities is important. However, this can also be a time when people are vulnerable to scams and false promises. Unfortunately, there are a lot of companies and people who offer products and services that guarantee outcomes without doing the necessary research required to back up those assurances.

It is a good idea to check out any new or experimental treatments carefully before trying them—particularly if there is a large commitment of money, resources, or time involved. Check with local and national nonprofit organizations that provide services to people with your specific issue or health challenge. Agencies such as the National MS Society, American Cancer Society, and others often have information about ancillary and alternative therapies. They may be able to send you information or answer your questions.

Coping skills: Make decisions together based on facts. Find local and national organizations that you trust to support you and provide well-researched information. Be sure that any second opinions or ancillary providers have access to all the information you have from other providers. In some cases, taking medications or treatment without being fully aware of how they interact with your other treatment can be life-threatening. Make a commitment to fully investigate any new or experimental treatments before deciding to try it. Ask for and check references when appropriate. Verify the credentials of all providers before visiting them. At some point, you may have to accept a new reality that you had not planned for and do not welcome. If you have prolonged difficulty coping with the diagnosis or prognosis, find support from a professional or support group to help you with the transition.

Over the next few months, I will explore additional aspects of disability, how it affects the lives and relationships of the people involved, and ways of coping with these situations. If you have ideas to share about how you have effectively coped with any of the situations presented, please join the discussion by leaving comments below. Likewise, if you have questions, feel free to ask for input from others who read the blog.

The benzodiazepines are a class of drugs typically prescribed for the treatment of anxiety or chronic seizure. They work by slowing the electrical activity in the brain, resulting in a sedative effect. Doctors may prescribe these drugs for brief or prolonged periods, or simply as needed—such as in the event of a panic attack. The potential adverse effects of benzodiazepines are fairly well understood by the medical community. People may experience drowsiness, headache, dizziness, and an unsteady feeling. High doses have an intoxicating effect similar to alcohol consumption.

However, the effect of chronic low doses of medications like Xanax (alprazolam) and Klonopin (clonazepam) on human tissue and organs is still to be determined. Previous studies have suggested that long-term administration of benzodiazepines may weaken the immune system, although no conclusive evidence of such a link exists.

A clinical experiment with rats tested the effects of Klonopin and Xanax on stressed and nonstressed male rats. The stress procedure involved confining the rats to a small mesh cage for 2.5 hours each morning. Some rats received Klonopin, some Xanax, and others only a control solution of distilled water. The study continued for four weeks, after which the rats were euthanized and the clinicians carefully examined them. The research team was most interested in the health of the immune system, and they primarily investigated lymph glands and blood cell counts. The findings have implications for the treatment of anxiety in humans.

Both stressed and nonstressed rats showed immune system deficits after treatment with either Klonopin or Xanax. Rats treated with Xanax demonstrated the most serious deficits, possibly because of the medication’s unique chemical structure. Because of the experimental design, researchers were able to distinguish between immune deficiencies caused by stress alone and those caused by medication. Nonstressed, medicated rats showed less decline than their stressed counterparts, but the decline was still clinically meaningful. It’s worth noting also that these rats received relatively low doses of medication. Continued administration beyond four weeks might reveal even more profound immune system effects.

These results argue for more caution when prescribing anti-anxiety medications. Both Xanax and Klonopin appear to degrade the immune system in distinct ways. Overall, Klonopin’s effects were less severe than those of Xanax, but were still worrisome. Patients with already compromised immune systems may want to avoid this class of medications if possible. Otherwise, Klonopin may be the safest choice. In addition, short-term use of the drug is definitely preferable to a long-term prescription.

References:

1. Elmesallamy, G. E., Abass, M. A., Refat, N., and Atta, A. H. (2011). Differential effects of alprazolam and clonazepam on the immune system and blood vessels of non-stressed and stressed adult male albino rats. Interdisciplinary Toxicology, 4(3), 132-143.
2. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Alprazolam. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000807/

Marriages aren’t like fine wines. They are not harvested in vineyards and they do not always get better with age. However, many marriages far exceed any expiration date. According to a recent article by Matt Richtel, Pulitzer Prize-winning writer and columnist, modern marriages—which divorce at rates upward of 50%—may benefit from an exit strategy after, say, five, 10, or 20 years. Richtel said that many marriage contracts already exist. Prenuptial agreements are rampant among the wealthy, some couples who live together make paperless commitments to each other, and many celebrities and politicians have legalized business/marriage agreements. In fact, the idea of contractual marriage has been picked up in Mexico, where lawmakers recently introduced the idea of renewable marriages. Good idea or bad, the law didn’t pass.

But should it have? Should the institution of marriage be updated to keep pace with other cultural advances in areas such as medicine and technology? This was the question that Richtel asked several marriage therapists, psychologists, and divorce attorneys. The responses were varied. Author and professor Pepper Schwartz commented that marriage has been getting picked apart for decades and needs to be fully examined. Today’s marriages have less connection to religion and family, which creates a weaker support system, and modern technology encourages people to expect instant gratification from marriage. Schwartz said something like a 20-year marriage contract is an option, and that nuptial contracts including dowries and financial arrangements are not new.

Dr. Robert E. Emery, a professor of psychology at the University of Virginia, says the problem with marriage is the expectation of longevity that it comes with. Children of divorced parents bear the immediate emotional devastation of losing one parent, or having their family rhythm disrupted. If the possibility of divorce was anticipated, and marriages were not supposed to last past a certain point, it would be more culturally acceptable and emotionally tolerable. Emery says the best way to approach marriage is to understand that it is not a union filled with unlimited sex with someone who is beyond perfect, but rather an investment of every available resource that can reap emotional, sexual, and physical rewards. “There are good reasons to be romantic about marriage,” Emery said. “The big benefit of marriage is precisely the commitment over the long term.”

Reference:
Richtel, Matt. Till death, or 20 years, do us part. (n.d.): n. pag. The New York Times. 28 Sept. 2012. Web. 1 Oct. 2012. http://www.nytimes.com/2012/09/30/fashion/marriage-seen-through-a-contract-lens.html?pagewanted=all&_r=0

Sports generally are viewed as harmless pursuits, a source of social interaction and bonding, exercise, and stress relief. But in recent years, highly publicized incidents of fan violence have raised concerns about the culture surrounding sports. The vicious 2011 beating attack on Bryan Stow at Dodger Stadium in Los Angeles is just one such example. Alcohol-fueled fights and skirmishes are increasingly common at all levels of competition, from playgrounds to professional leagues. Most people who have attended a sporting event have witnessed at least one example of an out-of-control fan.

What’s behind this surge in violence? The problem may not be the nature of sports themselves, but rather the way society treats sports in conjunction with personal factors. A closer look at some factors that may contribute to fan violence:

Overidentification

For many sports fans, their teams of choice become a proxy for their own identities. Overidentifying personally with a favorite team may be a contributing factor to sports violence. A person who watches a favorite team lose, or witnesses an unfavorable referee call, may behave as if he or she has personally suffered. The advent of Facebook and other social media, as well as message boards and other gathering places for fans, may make it difficult to disengage from favorite teams or let go of bad memories. These platforms also provide more access to inflammatory views from rival teams’ fans, fueling deep feelings of loyalty, protectiveness, and anger that boil to the surface amid the emotional current of a live game.

Alcohol

Alcohol plays a significant role in many fan altercations. At National Football League games in 2011, more than 7,000 fans were ejected for inappropriate or violent behavior. Some fans spend all morning and afternoon tailgating and drinking with friends before watching the event and then celebrating—or grieving—afterward. People often are intoxicated before even entering a venue. The feelings of deep loyalty and anger that many fans feel can be exacerbated by alcohol consumption.

Hypermasculine Culture

Despite years of progress toward gender equality, many men feel pressured to meet expectations of traditionally masculine behavior. Sports can be a significant platform for masculine identity, and people who identify with hypermasculine culture may be more likely to attend sports events. Combined with adrenaline, overidentification, and ready access to fans with opposing allegiances, some men may be inclined to be violent when exposed to triggers. Likewise, women in hypermasculine environments that promote disrespectful or violent behavior may also be more inclined to engage in it.

Sociological Factors

Certain people are at a greater risk of engaging in violent behavior. People who have experienced a recent stress such as job loss, the death of a loved one, or a perceived humiliation are already on edge and more likely to react emotionally. Many people attend sporting events to alleviate stress. However, when a favored team loses, a person is heckled, or a person loses a significant bet associated with a game’s outcome, stress may explode into rage.

Group Dynamics

Millions of people attend sporting events every year, and the vast majority never commit a violent act. When 100,000 people pack a stadium, though, the odds are high that a number of them are under the influence of alcohol. Combine this with an emotional, hypermasculine environment and exposure to opposing sentiment, and you’ve created a recipe for fan violence. Proactive measures such as reporting inappropriate behavior immediately, limiting alcohol intake, and actively encouraging sportsmanship among peer groups, can help address an increasingly challenging threat to our enjoyment of sporting events.

References:

1. Aguirre, B. E. (2008). Sports fan violence in North America. Contemporary Sociology: A Journal of Reviews, 37(2), 157-158. doi: 10.1177/009430610803700235
2. Associated Press. (2012, May 31). Witnesses describe violent scene. ESPN. Retrieved from http://espn.go.com/los-angeles/mlb/story/_/id/7991565/witnesses-depict-violent-scene-bryan-stow-beating
3. Handwerk, B. (n.d.). Sports riots: The psychology of fan mayhem. National Geographic. Retrieved from http://news.nationalgeographic.com/news/2005/06/0620_050620_sportsriots.html

A client recently described how thrilling it was to take her daughter to see the Broadway musical Annie.  She recalled that her mother took her to see it when she was a child, and it had been an indelibly wonderful experience. Now she had the pleasure of providing the same thrill for her daughter. I thought how special it was for my client to share this with her daughter and how lucky my client was that her daughter had the same feelings about the experience. It also reminded me that so many parents who want to provide what they believe to be all the right things for their children are not always met with such good feelings.

I recalled another client whose desire to recreate his delight for his son was dashed when he took him to the rodeo and was met with the response, “This is stupid.” In spite of their most nurturing and positive intentions, parents may find that their wishes and rules for their children are met with rejection. This can create painful feelings, including insult, hurt, anger, and disappointment. “Drew,” a 42-year-old client, was in a prolonged struggle with his 8-year-old daughter about piano lessons she adamantly refused to take. He told me, “When I was a kid, I refused to continue piano lessons after a few months. My parents never insisted I continue. I’m not going to let that happen to my daughter. She isn’t old enough to know what she wants or what the consequences of her actions will be.”

As Drew and I explored his feelings, it became clear that he not only felt disappointed, he felt rejected by his daughter. “It feels like she is telling me, ‘Get out of here, you don’t know what’s good for me,’ ” he said. I responded: “I can see how upset you are about this, but I wonder what it is that makes you feel so personally rejected. Is it possible that your daughter is different from you?” Drew’s first response was, “She’s my daughter and she is like me. I just know this is very important for her to do. When I was a child, I didn’t know I was making a terrible mistake. My parents should have known and pushed me to continue.”

It took a lot of talking for Drew to become aware of his many disappointments about the ways his parents had been involved in his life when he was a child. He began to consider that he might not need to protect his daughter from this disappointment. He recognized that his daughter might, like him, regret not learning the piano, but forcing her to take lessons could easily turn her away from the piano. He realized that her experience and development was and will be different from his and she is a different person with her own thoughts and feelings. After all, she has different parents than he did. The more Drew could understand his daughter’s need to differentiate from him, the easier it was not to feel so rejected and hurt.

When parents assert their desires for their children, it is not unusual for them to be met with expressions of different or opposing wants and needs. Pushing back against what parents want is a necessary part of a child’s development. For a healthy sense of self to grow, children need to differentiate from their parents and become unique, separate, individual selves. This doesn’t mean children are totally different from or always in opposition to their parents. It does mean children need to develop minds of their own. Having one’s own mind is about being able to think about your needs and wants without being overly influenced by others. Ideally, the wishes of others are considered, but ultimately one makes his or her own life choices. Obviously, the degree of autonomy for a 4-year-old differs from that of a 13-year-old and again for a 20-year-old. When children are not given the space to differentiate from their parents and don’t develop a self that is confident and strong, they will not have developed the autonomy to make life choices and get what they want as they enter full adulthood.

At age 53, “Anne” was struggling with her teenage son, “Noah.” She came to therapy expressing feelings of anger and insult from their encounters. She explained that he fought her at every turn about anything she asked of him: cleaning his room, doing household chores, getting his college applications completed.  “I don’t believe how he treats me,” she said. “He says things like, ‘Leave me alone and mind your own business.’ Is that any way to speak to your mother? I feel so hurt and insulted. Doesn’t he know I only want what’s best for him?” In great distress, Anne added, “He has become a terrible person. He is so mean and inconsiderate. He seems like a completely different person than the son I felt loved me a year ago.”

As we talked, Anne described how when she was growing up she never went against her parents. When we explored her past and present relationships, Anne began to wonder if her early experiences being compliant are related to her difficulty asserting herself as an adult. She described how difficult it is for her to disagree with her husband and how she doesn’t always feel so good about herself. She realized that it wasn’t just with her son that she felt so badly treated. “I guess I don’t feel very powerful,” she said. “I have a lot of trouble believing that what I think and feel is OK. I always followed the rules with my parents. Maybe I didn’t develop what Noah needs to do—be someone who feels OK asserting himself when there is opposition.” Many parents with teenagers experience difficult feelings in their parent-teenager relationships. For Anne, the feelings of insult and rejection were intolerable. Even worse for her was the terrible shame she felt about her negative feelings toward her son: “I’m the terrible person. Mothers shouldn’t feel this way.”

How to handle this kind of situation with teenagers is controversial. Furthermore, how any parent hears what a child says is open to interpretation and may be related to how the parent differentiated from his or her own parents. While Anne felt insulted and hurt, another parent in these circumstances might shrug and think, “When will these awful teenage years pass?” On one end of the continuum of parental response, parents might believe that a child of any age should never be permitted to say anything that is hurtful, disrespectful, or angry to a parent. At the other end of the response continuum, parents might accept any expression their child makes without intervening. An extreme example might be if a teenager said, “You’re an awful parent, you have no business having children,” and a parent made no protest about being treated that way. On this far end of the continuum, the lack of a parental response to push against doesn’t provide the child with the feeling that there is a strong parental self to separate from. If there is no other out there to individuate from, it becomes difficult for a child to develop a sense of who he or she is and the ability to be autonomous. The child is left wondering, “Who am I?” Potentially more problematic, the child may be left with a feeling of powerlessness. He or she has not been given the experience of successfully asserting his or her developing self in the world.

There is a lot of room along this continuum for parents to develop responses that feel comfortable to them while allowing some room for their children to develop their unique selves. It helps if parents let their children know what behaviors are acceptable. For instance, telling a child, “You can’t talk to me that way” is not the same as saying, “You can’t be angry at me,” or “You are hurting my feelings.”

When children respond to parents in disappointing or unacceptable ways, it is important that parents stop and consider how they will meet that response. Each situation requires thought. Sometimes, interfering with the child’s wishes or experiences provides an opportunity for the child to push back against the parent and feel a sense of his or her developing self. At other times, supporting the child’s differentiation provides the child with a sense of confidence and recognition of his or her developing self. No matter the age of the child, parents who are curious and interested in why there is disparity or opposition are communicating their openness to more than one way of behaving and/or feeling. This openness to difference helps children develop into self-confident, autonomous adults. Moreover, parents are less likely to repeat the dynamics of their own childhoods if they consider their children’s behavior from a developmental perspective. They will be in a better position to not take things so personally and will feel less hurt, insulted, or disrespected by their children.

Nonsuicidal self-injuries (NSSI) are believed to be inflicted as a method of coping with distressing emotions. People who cut, burn, or otherwise harm themselves may do so in an attempt to escape overwhelming feelings of sadness, pain, guilt, depression, or shame. Although the research on NSSI is growing, little attention has been focused on the relationship between guilt and NSSI. Yoel Inbar of the Department of Social Psychology at Tilburg University in the Netherlands recently conducted an experiment to determine if people were more motivated to hurt themselves by feelings of guilt versus feeling of sadness or ambiguity.

For the study, Inbar recruited 46 college students and assigned them to either a neutral, sad, or guilty condition. The participants were instructed to recall an event that elicited the assigned emotion and write about the severity of their emotion at the time of the event and presently. They were then given one set of electric shocks, after which they were allowed to either increase or decrease the intensity of the remaining five sets of shocks. After the shock treatment, the participants were assessed for levels of sadness and guilt. Inbar found that the participants who recalled guilt-inspiring events chose to increase the shock severity, while those who remembered sad or neutral events did not. Additionally, the guilty participants reported feeling less guilt after they received the shocks than they had before.

The evidence presented in this study suggests that guilt acts as a motivator for self-injurious behavior. The participants in this experiment did not acknowledge being consciously aware of this relationship, but may have been prompted intuitively. “Such intuitively driven moral judgments are quite common,” Inbar said. Although some people who feel guilty may choose to diminish their guilt in other ways, such as doing a good deed to make up for their bad one, others may feel as if the level of their atonement must match the level of their transgression. Existing research has shown that certain emotions, such as self-anger and shame, often precede a self-injurious event. Inbar believes that future research should look at how these states influence the decision to self-injure compared to feelings of guilt. It would also be prudent to examine if people who have a history of self-injury to assuage guilt would choose a good deed if that option was available to them.

Reference:
Inbar, Y., Pizarro, D. A., Gilovich, T., Ariely, D. (2012). Moral masochism: On the connection between guilt and self-punishment. Emotion. Advance online publication. doi: 10.1037/a0029749