Concerned About Unconventional Mental Health Interventions?

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

Tuesday, December 20, 2011

Those Empathic Rats: Take Two

I jumped the gun the other day by trying to comment on a research report as it was described on an NPR interview and in the Science Times. As a result, I missed an important factor (although I stand by my remarks about the role of empathy and altruism in rats’ daily lives). Now my copy of Science has come and I can comment more constructively on the article by Bartal, Decety, and Mason, “ Empathy and pro-social behavior in rats”, Science, 9 December 2011, pp 1427-1430.

The basic study involved observing laboratory rats (the usual little Sprague-Dawley guys with the white fur and beady red eyes) to see whether they would work to open a door and release a familiar cagemate from a container. To be able to claim that rats were motivated to release a trapped rat, the authors also needed to show that the door releasing a trapped rat was opened more often than the door to an empty container or the door to a container with a toy rat in it. The rats were tested daily over several weeks, and on the average managed to open the door and let the trapped rat out after about a week. Twenty-three of 30 rats eventually opened the door for a trapped rat, and 5 out of 40 opened the door when there was no trapped rat. All 6 of the female rats who saw a trapped rat opened the door, but only 17 of 24 males did so. The authors concluded that the rats showed motivation by empathy when they released the trapped cage mate.

In an additional study, where the free rats could choose between opening a container that held chocolate chips and releasing a trapped cage mate, they did the two things about equally. In addition, they ate fewer of the chocolate chips when they had released another rat than they did when they were alone with the chips (these animals had free access to food and water and were not especially hungry). The authors referred to this as “sharing” with the other rat.

The general conclusion of the article was that the free rats were “not simply empathically sensitive to another rat’s distress but acted intentionally to liberate a trapped conspecific”. I believe this conclusion raises many questions, as does the use of the term “share” with respect to eating fewer chocolate chips. I don’t reject the idea that empathy might be part of rat psychology, but I consider the study to suggest as many questions as it answers.

One of my questions comes from watching the video of one of the rats at work, to be seen at www.sciencemag.org/cgi/content/full/334/6061/1427/DC1. As the free rat succeeds in opening the door to the container, it does not step aside and let the trapped rat out. Instead, it squeezes past the trapped rat into the container so they are both briefly inside; when the trapped rat emerges, the free rat explores the container for a moment, then finally comes out and follows the formerly-trapped rat closely, sometimes appearing to mount it briefly (not an unusual thing for a rat to do). My question is, what was the exploration of the container about? Did rats other than the one selected for the video also show this activity? To what extent would it be appropriate to say that a more parsimonious explanation--- that the container and the other rat are interesting-- may be more appropriate than the “empathy” conclusion?

A second set of questions has to do with the role of the trapped rat in triggering its “rescue”. The authors refer to the possibility that high-pitched distress cries were annoying to the free rat, who might have released the cagemate in order to stop all that crying. However, they used a bat-cry detector to record the calls, and reported that such calls were infrequent. This assumes that the pitch of the cries was the disturbing part, whereas human infants’ cries differ in many ways other than pitch during different emotional states, and the same may be true of rats. Although the report alluded in a note to the role of smell in rat emotional contagion, and although the container and “arena” were carefully washed between observations, there seems to have been no attention paid to the role of airborne pheromones in possible distress of the free rat. Finally, although the researchers reported the sexes of the free rats, they did not specifically state this about the trapped rats. Because the trapped rats were said to be cagemates of the free rats, and because normal procedure would be to cage males and females separately, it seems likely that male free rats were with male trapped rats, and females with females. This raises the question whether the “unhelpful” 7 out of 24 males would have been helpful to trapped females, and conversely whether the helpful females would not have helped trapped males. Again, it may be more parsimonious to consider environmental factors that led to the door-opening rather than assuming that some form of empathy was in operation.

A curious thing about empathy is that it may be just as important in negotiating hostility as it is in causing prosocial, helping behavior. Empathic responses are a matter of identifying and even experiencing another individual’s emotions, and are easy to recognize when we are sorry for a sad person and want to help him or her. But what about situations where someone may be angry at us, or frightened and ready for self-defense? To recognize those feelings before the other acts on them allows us to escape, to placate the other, or even to attack first--- all possibly related to survival of the individual and of the group, but not prosocial in the usual sense. And a mixed picture is surely possible. What if the rats had been confronted with a human hand restraining their cagemate? Would biting the hand be prosocial or hostile behavior? Like oxytocin, which can be involved in both maternal care and fighting, empathy has a complex function. We may reach some wrong conclusions when we assume that behavior must be empathically motivated.

Tuesday, December 13, 2011

Those Empathic Rats: Motivation and a Missing Measure

N.B.-- 12/14: I may have been wrong in my remarks here. Read the comments that follow, too.

On NPR, in blogs, in Science, in the New York Times' Science Times, everybody’s talking about a study reported by Peggy Mason of the University of Chicago and her co-authors. To people’s surprise, these researchers reported that rats would make a lot of effort to open a door that would release a confined fellow-rat, and they would do this even if the other rat was beyond a barrier and they could not play together. The free rats opened the door to release the confined one as much as they opened it to get chocolate chips.

Quite a few people have interpreted the free rat’s “jailbreak” behavior as due to empathy with the confined one-- that the free rat feels unhappy when he or she perceives the displeasure of the rat in the container, and feels better when the other rat is happier, just as many human beings feel relieved when they can help a suffering human. Others have asked whether there might be an alternative explanation. Could it be that the confined rat squeals in distress, at frequencies higher than humans can hear, and that the free rat works to get rid of that awful squeaking? No, it seems that most of the confined rats did not squeal, so that explanation cannot replace empathy as a reason for the behavior.

Several bloggers have been extremely interested in the implications of the idea that rats, like humans, might be motivated by empathy. Some have argued that this is a blow for human exceptionalism and suggests that humans are not qualitatively different from other species.

Before we go to town on the implications of the study, though, it might be a good idea to consider whether avoidance of painful squeals is the only explanatory alternative to rat empathy. (I have no objection to the idea that rats could have empathic responses, but I don’t like conclusion-jumping.) As far as I can see, the study did not include an important comparison measure that might offer a better explanation for the behavior: it did not test what the rats did if given the chance to open a container with nothing in it. As a result, it confounded opening containers in and of itself, with opening containers and getting an outcome that might be gratifying.

Why would a rat open a container “for nothing”? Why, for that matter, do toddlers carry large objects from place to place? Why does my cat meow outside every closed door until it is opened, then walk away without going in? Why do I shut a drawer left open by a 16th of an inch? All of these actions can be considered in terms of mastery motivation, a tendency found across species and across ages to behave in ways that control the environment, even when there is no evident advantage to exerting that kind of control.

Jerome Kagan, in his book Three seductive ideas, criticized what he called the “pleasure principle”, the idea that all behavior comes down to a search for gratification of needs. Of course much of what any organism does is associated with needs and satisfactions, but this does not mean that everything is motivated in exactly the same way. Like humans, rats may do things simply in order to do them, and this is probably especially true of lab rats in cages. They ordinarily exist in a boring environment that offers them none of the usual activities of their species’ normal habitats. They don’t get to tunnel, gnaw different kinds of things (they do gnaw at the cage’s wire mesh), catch and eat bugs or other small animals, court, or mate. Occasionally some clumsy student reaches in to pick them up the wrong way and they get to bite that person, but that’s about the sum of the drama in their lives. Now, in the study we’re discussing, they get an opportunity to deal with exciting new technology. It’s time to be motivated by the need for mastery of the environment... maybe. I’m not saying that mastery motivation explains it all-- just that there is at least one alternative to interpreting the free rat’s behavior as empathic in nature.

The NPR “Science Friday” discussion of the study alluded to maternal care as the foundation of empathy, and so it may be, but anyone who has observed a breeding colony of lab rats is not likely to think of these animals as displaying much empathy. When babies get out of the nest, get cold, and squeal, the mother retrieves them and brings them back in, but that’s about it. They can find nipples and latch on by themselves (and they are so tiny, pink and hairless that you can actually see the bubble of milk in each stomach). The mother doesn’t do much more except lick them clean. And let one be sick, or injured, or die-- well, Mom tidies up the nest by eating the pup. If a male rat gets into the area, he’ll often tidy up further by eating the live pups too.

Could be that assisting in the jailbreak has some cause other than empathy.

Sunday, December 11, 2011

Invisible England is Back and Talking About Holding Therapy

I want to make sure everyone knows that Invisible England, a blog commenting on semi- officially-sanctioned Holding Therapy in the United Kingdom, is back after a short hiatus, at http://invisibleengland2.wordpress.com. The blog includes a personal statement and description of Holding Therapy by a young man who was subjected to the treatment. Another unique post on this blog is a videotaped interview with Dr. Edzard Ernst, the well-known critic of complementary and alternative medicine, who comments on Holding Therapy as an example of CAM psychotherapy. The blog also has a link for advance access to my paper in British Social Work Journal, responding to recent efforts to rehabilitate Holding Therapy; these efforts ignore the treatment's rejection by a task force of the American Professional Society on the Abuse of Children in 2006.

Friday, December 9, 2011

Faith-Based Child Abuse

I want to call attention to two interesting comments on my post from several days ago, http://childmyths.blogspot.com/2011/12/prevention-v-cure-in-adoption-service.html. One contributor brought up the death of Kairissa Mark of Mt. Juliet, TN, within 90 days after her adoption from China by a pediatrician, Deborah Mark, and her husband, Steven, with the help of Bethany Christian Services. The contributor noted that Steven Mark had called Kairissa a “demon child” and had not made arrangements for family counseling as he might have. The child was beaten to death.

A second anonymous contributor reported that she (I think) knows the Marks and that they are not evil people. She believed that they must have been praying for a “miraculous cure” (she did not state what needed to be cured), but should have called in an exorcist or deliverer. I am assuming, based on this contributor’s remarks, that the Marks believed the child to be possessed by a demon and beat her as part of their efforts to end the possession. There was presumably some behavior or mood unsatisfactory to the adoptive parents which they believed indicated the presence of a demon.

When people come across the idea that religious beliefs can be associated with abusive treatment of children, they often think in terms of sexual abuse by Roman Catholic and other clergy. Disturbing as those events are, I suggest that in fact there are two other religious factors that create greater dangers for children. One of these involves a high degree of authoritarianism and the belief that absolute obedience to parents is a forerunner of absolute obedience to God, and that such absolute obedience is necessary for the salvation of the soul following the death of the body. A second risk factor is present when parents and religious groups believe that child behavior is caused by demons.

I have written about the authoritarian approach in several places, including a paper in the Scientific Review of Mental Health Practice (“Destructive trend in alternative infant mental health approaches”, Vol. 5, 2007, pp. 44-58). One relevant issue is the use of the Ezzo and Bucknam book On becoming babywise, discussed at http://www.gfi.org/. This book, and others in the “Babywise” program, date from the 1990s and emphasize the needs of adults. The program offers methods described as training the child to obedience and facilitating the parents’ relationship by preventing the child from making demands on the mother. The original version of the Babywise program advised moving the infant quickly to a reduced feeding schedule, with 6-month-olds receiving three meals a day and one liquid feeding at bedtime. (Writing for the American Academy of Pediatrics in 1998, M.T. Arney pointed out problems of dehydration and malnutrition that had been caused by the Babywise plan.) The goal of this program appeared to be to place the marital relationship (and perhaps above all the gratification of the father) as a priority, and to justify this in terms of the importance of learning obedience and humility.

A similar goal has more recently been set in the book To train up a child, by Michael and Debi Pearl, which has been widely discussed in various blogs including this one. The Pearls’ authoritarian approach involves physical punishment that is potentially severe and has even been fatal.

Question and answer material presented by Michael Pearl’s church includes belief in demonic possession, but I have not found any references to children’s behavior as caused by demons. However, the belief that a child can be demonically-possessed, and sometimes that painful treatment may be required to end the possession, is rather common among Christian fundamentalist groups. Doris Wagner’s book How to cast out demons (2000; Ventura, CA: Renew Books) states that demon possession is increasingly likely for children who are adopted, have had difficult births, or who fail to be “bonded at birth” (not defined by the author). [Incidentally, this book includes an informed consent document to be used by exorcists!] Other sources suggest that a child who has been sexually molested is more easily possessed by demons.

“Conventional exorcists”, if I may use that term, appear to address demonic possession by prayer. Fasting is also mentioned, although it is not clear whether the exorcist or deliverer is to fast, or the possessed person, or both (see http://www.stmichael.pair.com/laitydeliverance.html); it would be interesting if fasting as a form of purification ritual were related to the limitation of food used in some unconventional child psychotherapies. Nevertheless, there may be rituals that use physically-painful and injurious methods, or there may simply be frequent misunderstandings among adults who seek to change their child’s behavior by exorcism, because deaths as a result of exorcism rituals are frequently reported (http://www.tylerpaper.com/apps/pbcs.dll/article?AID=/20081203/NEWS01/812030289/0/FRONTPAGE; http://www.tldm.org/news8/possession2.htm; http://www.journalgazette.net/article/20110528/LOCAL03/305289976).

Adoption agencies, including Bethany Christian Services, make a point of screening adoptive parents for health, education, financial security, and so on. Isn’t it time that we screened for faith-based risk factors like beliefs in absolute obedience to parents, and in demonic possession as a cause of behavior problems? My anonymous correspondent was quite right when she said there are a lot of whackos out there. Screening for these beliefs would be a way of keeping adopted children out of their hands.

Tuesday, December 6, 2011

When Superstition Claims to Be Science: The Conscious Conception and Peace Lark

A reader recently called my attention to the forthcoming publication “Parenting for Peace” by Marcy Axness. This book, and Axness’s website www.quantumparenting.com/ , claim to integrate science (“quantum”, right?) with spiritual insight, and stress neurobiology as a major source of information. In reality, though, much of the material Axness promulgates is nothing more nor less than superstition. If she wants to present her views as a matter of faith, well and good-- but to state that they are based on science is incorrect.

Here is one example from the quantumparenting site:

In discussing fertility issues, Axness quotes Laura Uplinger’s description of her beliefs about becoming pregnant. “My husband and I sent out a call to the universe—as if posting an ad on a galactic website—stating who we were and what we could offer to a soul who wished to join us. We carried on our daily activities in a mood of solemn expectation and profound surrender; was a soul going to be drawn to us?” In commenting on this and similar ideas, Axness refers to the idea of thought as an organizing principle that can influence even conception and development.

Are these views correct? Do souls wait in some nonmaterial world until they join bodies at the time of conception? Do our thoughts shape our physical structure and function? Those who believe these things don’t want or need systematic evidence to support their beliefs, and I don’t want to argue with their universe of discourse. However, I can say that those beliefs aren’t science. Science as a modern human endeavor is based on certain assumptions that are contrary to the ideas Axness promulgates. Science is mechanistic, assuming that even the most complex human functions are based on the same physical and chemical events that occur in the non-human, non-living world. Axness’s views are vitalistic-- she assumes that living organisms contain some factor that is absent from non-living substances, a factor that may be thought of as a spirit or soul. She also appears to assume that the soul is not just an animating principle, but is instead a personality with intention and power to make decisions, and one that can at all times be influenced by thought (cf. the “primal wound”). These assumptions are by definition not scientific, and ideas based on them are not scientific, no matter how many tidbits of neurobiology they are bolstered with.

Axness has a strong tendency to try to shape material from scientific study so it matches her vitalistic and transcendentalist view, with its characteristic tone of the 19th century’s New Thought. For example, in a statement on http://icpa4kids.org/ (website of a chiropractic organization), she says this: “A child who is securely attached to his parents is deeply motivated to behave in harmony with them.” Now, certainly it is true that conduct disorders, extreme risk-taking, and age-inappropriate oppositionalism can all be associated with a poor attachment history or with other evidence of insecure relationships. But this does not mean that secure attachment is characterized by “easy” relationships in which little discipline is required-- which is what seems to be implied by “deeply motivated to behave in harmony” and by other comments Axness has made about children who are brought up according to her principles. Axness assumes, and presumably believes, that easy and desirable outcomes can be produced by thinking in the right ways. (Is this part of that “idealization of motherhood” that can be so problematic?)

Here again we have statements that do not follow a basic rule of science, the rule that all information must be considered unless there is a very good reason for omitting it. What Axness omits is the fact that failing to “behave in harmony” with parents may be an essential step in a child’s development. Bowlby’s attachment theory describes a set of events that do not stop with parent-child affection and commitment. Attachment is about learning to deal with other people, knowing whom to trust, knowing what to expect, and these lessons must eventually be applied to persons outside the family. A big portion of that learning has to do with the practice of negotiation and compromise, a major emphasis of development in the preschool years and again in early adolescence. When parents are helping children learn to negotiate, negative feelings can run high on both sides; Indeed, this may be a desirable situation, as it helps the child learn that people can be very mad at each other but still work out a satisfactory compromise. The child is deeply motivated to move along its own developmental pathway-- which includes autonomy--- but this really cannot be seen as behaving “in harmony”.

The First Amendment permits Axness to make what statements she prefers about early development, but the fact is that there is no science involved in her views. Neither, by the way, is she a leading figure in child development circles, as some websites say. Axness has a Ph.D degree from the Union Institute in Ohio, an intermittently-accredited organization that as far as I know allows students to choose the academic field where they feel a dissertation belongs and to have the degree granted in that field. (Other alums are Lark Eshleman, a therapist involved in the Nathaniel Craver case; Gregory Keck, a Ohio attachment therapist whose degree is said to be in criminology, and Bill Goble, who diagnosed Candace Newmaker over the telephone before recommending that she be taken to the Colorado therapists at whose hands she died.) Although her website suggests that she does some form of therapeutic work, I do not see a California license verification for Axness as either a psychologist or any kind of counselor; she refers to her work as “psychoeducational”, so perhaps she doesn’t need a license.

Whatever Axness is, she isn’t a scientist. Whatever her beliefs are, and however often she mentions brains, her principles aren’t based on science. Is it even pseudoscientific to claim that thought shapes the physical world? Frankly, I’d call it superstition.

Addendum, 12/10/11: The statements about the Union doctorate in the following are presumably also true about Axness's degree claims: www.signorile.com/2011/07/what-kind-of-doctor-is-marcus-bachmann.html.

Thursday, December 1, 2011

Prevention v. Cure in Adoption Services

In a recent publication, the Evan B. Donaldson Adoption Institute commented on the need for post-adoption services, and cited the comments of parents and professionals in two focus groups (http://adoptioninstitute.org/publications/ParentFocusGroup2.pdf and http://adoptioninstitute.org/publications/ProfessionalFocusGroup.pdf). These focus group summaries make interesting reading and make it clear that in spite of hybrid parent-professional organizations like ATTACh, the goals and attitudes of parents and professionals overlap only partially.

One parent is quoted as saying, “It’s very difficult because there’s a lot of biases built into how the professionals see our children. One of the things I’ve often seen is that the first thing that is asked when the child has a problem is ‘What’s going on in your home?’ There’s no thought given to this child’s history, the child’s background. There’s got to be something wrong with you in your home, and it’s a frustrating situation to be in when you’re trying to get assistance for the children.” It’s not surprising that parents resent feeling “blamed” for children’s problems, and they appear to find it very hard to see the situation from the professional’s perspective. What if the caseworker immediately focused on the child’s history, and neglected to ask whether there had been a change in the family-- to find out later that it was the family’s alteration that had triggered the child’s problem behavior? Finding out first what is happening right now is common sense, especially because the present events may be open to change, as the past cannot be. A well-known case in the infant mental health field involved a child’s inexplicable behavior that turned out to result from a conflict between a grandfather and grandmother, and the resulting changes in the family system.

One of the real – possibly insoluble-- problems with adoption services is that parents and professionals do have different goals and viewpoints. The parent focuses on personal experience and wants to settle into life with a family as he or she expects it to be (and these expectations may or may not be realistic, as Rachel Stryker and others have pointed out). The professional has many other families to consider, and wants to minimize both adoption disruptions and abuse of any kind, even though there may be a paradoxical relationship between these two events. In addition to these differences in perspective, parents and professionals are different in the power they are perceived to have and actually do have. The adoption professional has the power to disrupt an adoption under certain circumstances and to require parents to follow directives in order to avoid disruption or to get the services the parents ask for; the parents have no similar powers, but if they do not do well as a group, the caseworker does not look good either. The relationship between the parent and the professional thus has the makings of a sort of mini-Stockholm syndrome, or alternatively various levels of conflict and resentment.

It’s possible that adoption services will not be genuinely effective until the ambivalence and conflict between parents and professionals is settled. I would speculate-- without any real evidence-- that this may not occur as long as parent support groups are encouraged. These groups, like all that have spun off various 12-step programs, are much loved by their members, but may serve primarily to establish a perception of the parent group as supportive and knowledgeable in comparison with professionals, thus worsening the existing conflict.

The unfortunate conclusion to be drawn here is that until such time as parents and professionals can work out their differences, the chances are that post-adoption services may not be very effective. This leaves us with two possible ways to improve the experiences of adopted children and adoptive families. Both are preventative approaches rather than “cures”: pre-adoption services like parent education, and improved screening of adoption applicants.

A good deal is known about the process of adoption and the important characteristics of both parents and children. But both the Evan B. Donaldson focus groups express pessimism about the possibility of training adoptive parents before the child comes into the family. One professional said, “Although we give parents a lot of information in preparation, obviously they don’t hear it because they’re thinking about their goal of having a child.” People in the parent focus group agreed with this: “Yes, I went through training, but it wasn’t the right training, and I don’t think it was really the right time, because when you’re [becoming] an adoptive parent, you’re excited, you have these children…” “Let’s face it. When you’re just coming into being a foster or adoptive parent, you don’t know anything, so you’re all excited and you only remember a quarter of what’s being said in that training. It’s too much information all crammed into one, and you’re just thinking about getting that cute little child.”

We seem to be left with improved screening of adoptive parents as a possible preventative of some problematic adoption situations. This approach, of course, will be abhorrent to many adoptive parents-- in particular those who might be excluded by screening. Increased screening may not be welcomed by some adoption professionals, either, as they are often much concerned with getting children placed in homes. However, as it happens, there is a good deal of relevant information that might help a screening process.

Some of this information contradicts common assumptions about the kind of person who would make a good adoptive parent. For instance, the developmental psychologist Mary Dozier’s work has demonstrated that people who have fostered many children are less capable of forming an attachment relationship with a child than those with fewer of these experiences. Other work (like the suggestions by St-Andre and Keren [Infant Mental Health Journal, 2011, pp. 694-706] that I mentioned a few days ago) emphasizes not only problems of the individual like a history of depression, but also the social environment-- depression or bipolar disorder in the adoptive parent’s family, and a lack of social support existing even before the adoption. (As the Evan B. Donaldson parent focus group indicates, social support is often lost after the adoption has occurred and difficulties are manifested.) St-Andre and Keren also note the force of the interaction between existing parent characteristics and problems associated with the child, such as multiple simultaneous adoptions. Screening to prevent parents with certain histories from adopting more than one child at a time (or perhaps even successively) might be a service of great help to a child’s developmental outcome.

St-Andre and Keren made another suggestion that is of great interest, but not necessarily supportable. They referred to the use of the Adult Attachment Interview as a way of predicting the capacity of applicants to function well as adoptive parents. The AAI is a structured interview that classifies adults as secure or troubled in their own attachment concepts. St-Andre and Keren described a woman applicant as appearing “pleasant and motivated for the adoption”, but as giving contradictory statements about her childhood and becoming “derailed” when talking about the early loss of a child. As a result of these responses on the AAI, she was excluded as a candidate for adoptive parenthood. However (and this is my comment, not St-Andre’s), the AAI, like many tests of its kind, was designed for research purposes and for guidance of treatment, not as a way to predict an individual’s personal life.