Concerned About Unconventional Mental Health Interventions?

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

Tuesday, December 31, 2013

Adoptive Nursing, Part 2: The Dependency Question

Yesterday I discussed some issues about adoptive nursing--  breastfeeding a child who is in one’s care but who was born to a different mother. I concluded that adoptive nursing can be valuable for the health of very young babies or others who have poor immune reactions to infection, but that it is irrelevant to the social and emotional development of the child, and relevant to mothers’ emotions only in that they may expect it to influence their relationship with a child.

Today, I want to look further into advice about early emotional development as it is given by proponents of adoptive nursing like Alla Gordina and Karleen Gribble.  These authors, as well as Gordina’s colleague Ronald Federici, propose that it is essential for adopted children to experience complete dependency on their new parents. For example, Gordina says in her PowerPoint presentation (www.wiziq.com/tutorial/693267-ADAPTIVE-NURSING-APC): “Promote dependency on you providing food for your child (hand/finger feeding by caregiver even for snacks, feeding/drinking in the breastfeeding position and/or on caregiver’s lap, bottle feeding, eye contact, etc”.  She also says (without further explanation in the PPT): “Not to give such a child a sippy cup; use a bottle with the hole as large as the child needs, slowly decreasing the opening; straw cup or a regular cup can be used too”.  Bottle-feeding for all ages is encouraged.

What is the reasoning here? Why would either breastfeeding, or continued bottle-feeding of an older child, be expected to benefit the child’s emotional development? This viewpoint, shared by Gordina, Gribble, Federici, and others, seems to be part of a naïve psychology that expects imitation or re-enactment of desirable events of early life to have positive effects, as if they had  really occurred early on. This is a form of magical thinking in which symbolic actions are “mapped’ onto actual events, and the outcome of a ritual is expected to be the same as the outcome of the real occurrence. Similar thinking can be found in various alternative psychologies and psychotherapies like the screaming and convulsing of “primal therapy” and the apparently-painful infant massage done by people like William Emerson.  

Specifically, the rationale for associating breast- or bottle-feeding with attachment would seem to be the following: Young infants who are breastfed or bottle-fed  are completely dependent on their caregivers and indeed would not survive without adult care. Such infants are still completely dependent some months later, when they start to show signs of attachment behavior to their familiar caregivers. Therefore (and here’s the tricky part), the dependency must have caused the attachment--  so, if dependency can be fostered in an older child, that child will also show attachment as infants and toddlers do. In addition, if that child can be made to appear like a dependent young child  by replicating breast- or bottle-feeding or other infant care routines, he or she will actually BE dependent, and therefore (again) become attached and show this as younger children do.

When the rationale is spelled out like this, it’s clear that it resembles the thinking behind rituals like the couvade or like spitting if someone compliments your child, so evil spirits won’t get interested.

But there’s more. Looking at remarks by Karleen Gribble (https://www.breastfeeding.ans.au/bf-info/adoption), we can see another reasoning problem behind some of the claims of adoptive nursing advocates. Gribble says: “…it is important to bear in mind that the emotional and developmental ages of a child may be very different from their chronological age and that breastfeeding can help nurture the baby inside the older body” (my italics--  JM).  This view is common among “attachment therapists” and others whose work is not evidence-based, especially therapists who are focused on multiple personalities or dissociative conditions. The concept of independent entities within a personality has many sources, but the idea of the “Inner Child” was popularized in the 1970s as part of Transactional Analysis. The posited need to care for this entity goes back much further to “wild psychoanalysts” like Sandor Ferenczi. 

The belief that some “inner baby” needs to receive care suitable for an infant is an aspect of a “parts” psychology that ignores the integration of components of any person. Of course a child may  act in some ways as if he or she is younger than is chronologically the case, but this does not mean that the child has younger “parts” that need care different from what the whole child needs. To assume this ignores the whole nature of the child, and resembles thinking that a 20-year-old with an IQ of 50 would do well in a school class of 10-year-olds with IQs of 100, or that a 15-year-old who behaves “childishly” should be given a time-out.   

An adopted 5-year-old may seem emotionally “young” or “immature” when he or she has trouble resisting temptation or tolerating frustration, but that child does not have an “inner baby” who needs special care. Instead, the child is a person with many typical 5-year-old abilities who is having difficulty mastering some emotional capacities. To treat such a child like a baby (unless this is what he asks for) is to dismiss his most mature capacities as if they did not exist, and thus to remove points of pride and the senses of autonomy and initiative that are characteristic of his developmental stage. This situation is similar to one in which the 5-year-old has difficulty using speech; high-pitched, repetitious infant-directed talk is suitable and useful for an infant to hear, but however poorly the older child may speak, he is beyond the stage when infant-directed talk  will help him, and needs support that is appropriate for his entire developmental picture.

Again, I want to be clear that I am not rejecting adoptive breastfeeding, and I believe it can be very appropriate for babies with some medical conditions or with poor immune reactions. However, the social and emotional reasons claimed for it are without grounds.

One final point: Gordina’s PowerPoint gives one piece of advice which I wish could be given to all parents, adoptive or otherwise. She says, “Not to stare on your child, while he/she is eating unless you and he/she are ready to initiate the eye contact”. I’m not too sure what that last part means, or how you would know this readiness, but I’m convinced that the anxious stares of parents have exactly the opposite effect from what’s wanted. Babies don’t like blank or frightened-looking faces and are likely to avert their eyes and avoid looking at a staring adult. If you find you are staring, try “flirting” instead--  look away, glance back, look away again, and keep smiling until the baby gets interested in you. That’s how you get relationships rolling.



Adoptive Nursing: What Are the Reasons?

At the end of the war in Vietnam, there was some publicity about the fact that staff caring for babies who were to be airlifted to the U.S. took medications that caused them to lactate so they could feed infants in the absence of their usual food supplies. Over a number of years, there has been increasing emphasis on the idea that adoptive mothers can breastfeed their babies--  and that if at all possible they ought to do so.  One person who has pressed this idea is Alla Gordina, a Russian physician who practices in New Jersey.  A PowerPoint by Gordina can be seen at http://www.wiziq.com/tutorial/693267-ADAPTIVE-NURSING-APC.

Although she includes in the PPT instances where an adoptive mother was unsuccessful or unhappy with breastfeeding, Gordina stresses the benefits of adoptive nursing and focuses on social and emotional as well as biological factors. She refers to the practice as “adaptive nursing”, followed by “TM”, so it would appear that she has trademarked this term (?). Her PPT lists some of the advantages of adoptive nursing in the following order: promotes secure attachment and trust; augments their sensory and physical development; provides a therapeutic effect on the correction of oral deficits and/or aversions.

Gordina discusses a number of general practical issues about feeding children adopted from institutions where they might have received poor care, including fears they may have if they have been fed roughly or insensitively. These are important considerations, but my concern today is to discuss the statements she makes about the social and emotional aspects of breastfeeding.

  1. Breastfeeding and attachment. Emotional attachment of young children to their caregivers is based not on food but on the sharing of pleasant social interactions and play. For young infants, most of those interactions ordinarily center around physical care routines, including feeding. These are the events that happen most often in the infant’s day and are always a time when another person is present to socialize (except when people prop bottles, but let’s not think about that). They are also times when the caregiver is focused strongly on the infant and is not doing much else, although of course there may well be side activities, conversations with others and so on. Pleasant social interactions often occur during feeding, when the baby eats enthusiastically and the caregiver is pleased to see this.
      However, it makes no difference to social interaction whether the young child is breastfed  or not. Any feeding method or routine can be linked with pleasant shared experiences and communications. These are the real basis of attachment:  attachment is not the    “cupboard love” proposed in the past, but involves satisfaction of a hunger for social  contact. Otherwise, young children would not become attached to their fathers, brothers,    sisters, grandmothers and fathers, nannies, and child care providers--  which they do.

Initially, attachment is shown as a sense of safety and security associated with familiar people, and many authors, including Gordina, have jumped to the conclusion that attachment at all ages is shown by “staying near”. But as children get older, their attachment to adults is expressed in terms of new developmental needs such as needs for autonomy and the ability for independent actions. Pleasurable experiences with adults involve children’s pride in their new abilities, not the sense of happy dependency that was evident earlier. Bowlby’s attachment theory  stresses the growth of a “goal-corrected partnership” in which the maturing child and the parent gradually shift their ways of interacting to satisfy the developing needs of both and to preserve their relationship--  not simply to preserve dependency.
(It’s interesting, by the way, that Gordina refers to the possibility that adopted children will have “Developmental Trauma Disorder”, a diagnostic category that remains poorly defined and “unofficial” in spite of recent attempts to bring it into use. )

  1. Breastfeeding and bonding. The term “bonding” is best used to describe the powerful positive feelings and intense interest of a parent with respect to a young infant. Writing decades ago, Klauss and Kennell originally used the term “maternal-infant bonding” to refrer to this, but for the second edition of their book chose the term “parent-infant bonding”. In that second edition, they also attempted to correct the misunderstanding that bonding occurred instantaneously for all parents or even for mothers alone, or that all aspects of the parent-child relationship were somehow determined by some bonding event soon after birth.
Nevertheless, quite a few people continue to assume that some event pushes a button, which causes bonding, which in turn causes good parenting. The events that push the button are usually expected to be related to “primitive” or “traditional” folkways. They include an emphasis on skin-to-skin contact and of course on breastfeeding immediately after birth (although in fact a number of  “traditional societies” do not let the baby nurse at once and regard colostrum as dirty, and many others have traditionally swaddled the newborn, making skin-to-skin contact minimal).  The actual association of such experiences with parental attitudes and with effective parenting has never been demonstrated.  It seems most unlikely that there are such associations, as human beings care for and feed infants in a wide variety of ways, usually with good outcomes--  just as they feed both children and adults on a wide variety of diets.

 It’s thus improbable that breastfeeding causes bonding. However, if mothers are told that they cannot do a good job caring for their infants unless they breastfeed, wear purple for the first year of the child’s life, or play pinochle regularly throughout the third trimester, they are likely to believe these things because of their strong wish to do well. If they are told that breastfeeding will make them bond, and that without it their feelings for the child will be fragile, they will be distressed by any “failure” they experience.
 Gordina’s presentation notes the needs of adoptive mothers who have been distressed by infertility, miscarriage, or infant death, and suggests that successful adoptive nursing can help them recover from these traumatic experiences. She does not support this statement with evidence, nor does she examine in this PowerPoint the possible effects of lack of success either in lactation or in nursing. Given a mother who has never breastfed or even been pregnant, and a baby who has learned to suck an artificial nipple (a different suck-swallow pattern than is used at the breast), the chances of experienced failure can be pretty large.

  1. Breastfeeding and older children. Gordina’s PowerPoint references Karleen Gribble, an Australian nurse who has apparently recommended breastfeeding for adopted children as old as school age, and who says that it may take as much as a year for breastfeeding to be accomplished (https://www.breastfeeding.asn.au/bf-info/adoption). Curiously, Gribble also notes that a child may need to attach before being abIe to nurse, but that at the same time nursing supports attachment.
I am far from opposing toddler nursing or even culturally-appropriate nursing of older children who have been at the breast since birth, but there are some obvious difficulties for children who were bottle-fed from an early age. One is, as I mentioned in the last paragraph, that these children have learned to suck and swallow differently when using a bottle than they would have if breastfed exclusively. (If the latter, of course, they would not have learned how to nipple-feed and could have a difficult time adapting if suddenly weaned from the breast before they drank from a cup.) A second problem is that most children learn by preschool age that breasts are “private parts” and are not to be touched—most adoptive parents, in fact, would be very concerned and speak of sexualized behavior and even a history of sexual abuse, if a child touched the adoptive mother’s breasts.

Incidentally, Gribble and Gordina both allude to adopted children showing their wish for breastfeeding, but they give no details that I can find, nor does there seem to have been any systematic investigation of this issue.


So, am I saying that there is never any good reason for adoptive nursing? No, indeed. Breastfeeding has some real physical benefits in terms of development of the jaw and resistance to infectious diseases. The breastfeeding mother’s mature immune system serves as an auxiliary support to the immature infant’s reaction to infection, and this can be very important for babies who are poorly nourished, exposed to many infections, or in a dirty environment. When breastfeeding can be established for the young adopted baby, there will be real physical health benefits. It’s also beneficial that a mother enjoys nursing and that families may regard the nursing relationship as a more “real” connection than any other.

But what about attachment, security, and other emotional benefits? No, these are not reasons to do adoptive nursing, because they are not based on breastfeeding in any case.

Tomorrow, I want to go on to talk about some of Gordina’s views on the need for child dependency, and on her connections with other authors like Gribble who propose that older children need to be treated as if they were infants.  






Wednesday, December 18, 2013

What Was the Rationale For Water Births? Or, Pseudoscience Aplenty

A reader commented the other day that water births were sometimes said to be less painful for the mother than ordinary births. If there were any evidence of that advantage, it’s easy to see why women would want to choose the water method--  but in fact there is no evidence. Of course, the water birth guru I.B. Charkovsky and his followers have claimed that women giving birth “his way” experience lengthy orgasms, suggesting painlessness at the very least (as well as suggesting that Charkovsky assumes there is a sucker born every minute who becomes ready as an adult to buy his beliefs).  

My thanks go to Yulia Massino for discovering more information about water births  as approved by the Association for Pre- and Perinatal Psychology and Health (APPPAH). At http://www.birthintobeing.com/index.php?option=com_content&view=category&id=85&Itemid=482, one of Charkovsky’s protégées, Elena Tonetti, speaks of having been welcomed as a speaker at an APPPAH conference, and on another part of the birthintobeing site quotes the praise of Thomas Verney, author of The Secret Life of the Unborn Child, a piece of fantasy following the beliefs of the “wild psychoanalyst” Nandor Fodor, and a founder of APPPAH. (I am emphasizing this APPPAH connection to show that the problems of beliefs about water births and similar practices are a world-wide problem, not just a peculiarity of Russians.)

In a passage written by Tonetti on the birthintobeing website, we see an explanation of Charkovsky’s belief that water births are advantageous for babies: “The idea to place laboring women in the water came to him [Charkovsky] when he was looking for the ways to relieve a baby’s brain from the shock of gravity. He considered this the main reason why the human brain is not fully available for our use. He states that whales and dolphins have a much better use of their brains, on levels unreachable for humans, because they are not exposed to gravity shock at birth. As proof of their higher intelligence and superior use of their brain, Charkovsky points out that these animals are not territorial and do not kill their own. He suggested that the concussion human beings experience as we emerge from the weightless environment is far more devastating than we care to understand. By the time we grow up and the function of understanding is available to us, we have no reference point to compare our brain power to what it could have been if we had not been, literally, smacked on the head by the immense pressure of our earthly gravity.”

Let’s look at this explanation painful line by painful line, because reading the whole thing at once produces the smack-upside-the-head sensation equivalent to what Charkovsky posits for babies:

“… he was looking for the ways to relieve a baby’s brain from the shock of gravity”.

Charkovsky is apparently unaware that gravitational attraction is acting on all objects close enough to a planet, whether or not they are floating in water. He seems to conflate floating in water with floating in space in a zero-gravity environment. If gravity were not at work on all objects, everything including the water would fly off into space. The sense we have of lightness when in water has to do with the water supporting our bodies against the pull of gravity, thus making limbs movable with less muscular effort, but the support of the water is different only in degree from the support offered by the floor or a bed. That gravity is still at work for the unborn baby or one in the birth process is shown by two obvious things--  first, that most unborn babies move into the head-down position, the weight of their heads being a major factor in this movement, and second, that even Charkovsky wants birthing mothers to be upright rather than reclining, so that the baby is helped to move downward by the pull of gravity, rather than “uphill” as would be determined by the slant of the vagina if the woman is lying down. Can even Charkovsky believe that gravity is operating on the body of the infant but not on the brain? Perhaps he has some concept of brain levitation that has not been included here, but otherwise the logic escapes the reader. Gravity is acting on the brain in the same way from conception to birth and after birth as well, therefore there is no “shock of gravity” to be experienced.

“…the main reason why the human brain is not fully available for our use.”

Here we have one of the most common errors of understanding of brain functioning, the old “only 10%” misconception. It may well be true that only 10% of the brain is used for cognitive functioning, but absolutely essential tasks are performed by the remaining 90%. The brain analyzes visual and auditory input with large areas, organizes and sends signals to muscles to create all voluntary movements, and monitors and controls vegetative functions like blood pressure and salt-water balance. The parts of the brain that do those critical jobs are specialized for their own tasks and cannot be recruited to do cognitive work. We humans may not be as clever as we would like to be, but it is not because we do not use our whole brains. We don’t need to look for a reason why we don’t use our whole brains, because there is no truth to this notion.

“… whales and dolphins have a much better use of their brains, on levels unreachable for humans…”

Romanticizing the intelligence, goodness, and benevolence of marine mammals is an interesting residue of the ‘60s and ‘70s, when John Lily claimed to be able to understand and use dolphin languages, and “whale music” for nurseries was much in favor. Swimming with dolphins and even dolphin therapy remain with us as alternative psychotherapies with unsupported claims for treatment of autism and other disorders. That these animals use their brains more effectively, or have cognitive capacities superior to those of humans, has not been demonstrated--  although of course it is true that in their natural environments they do much better than a human being could do, just as we do better than they could in our environment.

“…[they] are not territorial and do not kill their own”

Desirable as such traits may be for human beings, there are two problems here. The first is that differences in aggressive behavior between different species can be very strong, and to make the same claim for all whales and all dolphins is inappropriate. In addition, many claims about the nonaggressive behavior of specific animals, for instance that gorillas and other primates did not kill for food, current in the 1960s, have not turned out to be correct upon further observation. Second, assuming for the sake of argument that whales and dolphins are peaceful, there is no reason to think that human beings can gain this characteristic by imitating one chosen behavior of those species; if such imitation could be helpful, why not imitate eating plankton or fish, or going naked at all times?

“…far more devastating than we care to understand”
Here we have a typical argument of the pseudoscientific ilk. Rather than disagreeing with the logic or facts of Charkovsky’s views, or even simply failing to understand, opponents must be actively choosing their opposition because they do not want to understand. This choice would presumably be made because of their distorted thought processes and lack of intelligence, caused by their birth experiences--  just as those who oppose “attachment therapies” are said to suffer from attachment disorders. I suppose we could call this rhetorical device “proof by diagnosis”.

“… no reference point to compare our brain power to what it could have been…”
This is very true, but omits to say that Charkovsky & Co. also have no reference point except their own unsupported claims.

Well, there you have it--  the incredibly faulty reasoning behind the belief that being born in water is beneficial for infants’ development. And of course this reasoning assumes that the child survives the experience, which according to news reports has not always been the case.
  



  

Monday, December 16, 2013

"Victorious Occultism": Unconscionable Treatment of Infants in Russia, and Matching Attitudes in the U.S.


Over the last few weeks I have been sent a lot of news by Yulia Massino and Nina Sokolova, two Russian women who are very concerned about potentially harmful “New Age” practices related to childbirth and child-rearing. Much as I sympathize with these problems in Russia, I’m equally disturbed about the fact that the United States is also home to related belief systems and practices. The less centralized government of the U.S. may make it even more difficult than it is in Russia to regulate treatment of pregnant women and infants in ways that will prevent harm, and American views of tolerance for religious-based practices may have a similar effect.  

For those of us with little or no Russian, being at the mercy of Google Translate can make news from Russia quite confusing. For example, the name of a Russian birthing center is translated as “erysipelas” (an unpleasant skin disease), which has nothing to do with any of the problems to be dealt with. However, with repeated readings some information does filter through.

First, let’s have a look at the practice of “water births”, as espoused by a number of earlier mystical thinkers like Mme. Blavatsky, but practiced in the 1980s by one I.B. Charkovsky (see https://translate.google.ru/translate?sl=ru&tl=en&js=n&prev_t&hl=ru&ie=UTF-8&u=http%3A%2F%2Flena-malaa.livejournal.com%2F45160.html&act=url. As all observers of the “New Age” know, this technique involves having the laboring mother more or less immersed in water, so the baby emerges into a water environment. As humans are lung-breathers, this situation would be fatal if the baby were kept underwater too long, but in fact, because there is no air in the uterus, at birth the infant has its lungs and respiratory passages filled with amniotic fluid and mucus. Although much if this fluid has been squeezed out by pressure during a vaginal delivery, babies usually need some help in draining and suctioning the liquid that impedes breathing of air. Born into water or air, the baby has the same possibility of needing assistance to start breathing air. (Anecdotally, I’ve come across some accounts of infants being slow to start breathing on their own if born into warm water, but I know of no systematic study of this issue.)

What was Charkovsky’s reasoning about  water births? The claims for both spiritual and physical benefits were numerous and can be seen at the link given above. (One interesting one is the idea that women giving birth in water experience orgasms at the time; I will leave this ludicrous suggestion to the imagination of women who have had babies.) Having persuaded himself and others that water births were beneficial, Charkovsky carried his reasoning further, to claim that sick infants and children could be cured by repeated immersion in icy water, and that this would prevent or cure mental retardation. The immersion is repeated rapidly with scarcely the opportunity for a breath between dips, thus closely resembling the torture practice of “waterboarding”.

I don’t think we have to fall for the idea that all problems are caused by trauma to realize that such a practice has the potential for powerful traumatic effects. It’s clear that newborn babies, especially less mature ones, can respond to being chilled with a cascade of internal responses that can include brain damage from increased blood flow toward the brain and death of intestinal tissue from a reduced blood supply there. As for older infants and children, the terror of this experience must be greatly multiplied by the awareness that a parent is nearby and does not stop what is happening. Why, then, would any parent choose this treatment? Part of the answer presumably has to do with the sad readiness of desperate parents to follow any guru who offers hope, but in addition I think we have to look to common metaphors of contamination as the cause of illness and washing as a health measure--  and these we see in the myth of Achilles, who was dipped into a river to make him invulnerable (except that that heel did not get wet), or in the custom of baptism by total immersion. These familiar ideas may prepare parents to accept what would otherwise be seen as a bizarre and dangerous practice.

Another practice advocated by those who recommend water births is “baby yoga”. The link above contains very disturbing photos of extremely young infants whose limbs have been forced into “yoga postures” (and I should point out that in the newborn the hips are not nearly as flexible as you might think, with a limit on the movement of the leg that gradually decreases until at  5 or 6 months the baby can pull the foot to the mouth ). How this was done, or what the occurrence of hip dislocations was, is not made clear.

But there is even more to “baby yoga” than this. Some readers will already have come across the claim that babies can be made extra strong by adults who essentially fling the babies around,  holding on by one hand or one foot as the baby shrieks. A discussion and some footage of this can be seen at http://www.thedoctorstv.com/videolib/init/6483 (why do these guys have to wear scrubs to be on TV, I wonder?). Elena Fokina, a proponent of “baby yoga” and of Charkovsky’s methods, is presently the subject of an on line petition: http://www.thepetitionsite.com/978/068/511/stop-lena-fokinas-pracitce-of-baby-yoga/. (Yes,”pracitce” is what it says.)

There’s one more person that I must fit into this post, because she provides such a good example of how politics can confuse views of these practices.  This is Janna Tzaregradskaya, whose perinatal advice organization (or cult) was in the news because of some gunfire (http://translate.google.ru/translate?sl=ru&tl=en&prev_=t&hl=ru&ie=UTF-8&u=http://www.kp.ru/daily/26171.4/3057635/). In an interview (http://translate.google.ru/translate?sl=ru&tl=en&prev_=t&hl=ru&ie=UTF-8=http://nekin.info/q27.htm), Tzaregradskaya volunteered her opinions that ultrasound causes birth defects and that criminality and alcoholism are explained by such people having been born in hospitals. She also commented elsewhere that 90% of children remember their births.

Unfortunately, the criminal charges for the shooting incident described in the link above were not emphasized in a Daily Mail (www.dailymail.co.uk/news/article-2471806/Rusian-breastfeeding-expert-arrested-cult-leader.html) article that claimed that breastfeeding was an uncommon practice in Russia and that Tzaregradskaya was being hounded for encouraging breastfeeding rather than for persuading families to avoid medical care. This was, I think, less a matter of reportage than of carrying on with the current cross-fire of political pop-guns between Russia and the West.

Obviously, Russia has some difficulty controlling practices that are potentially dangerous to women and children, but that are easily framed as “ancient wisdom” or “the ways of our ancestors”. What about the United States? Do we have similar difficulties? Yes, and many of them also derive from what is now called the “New Age”, but is actually identical with the “New Thought” of the 1880s (yes, that’s the correct century). ( Some others, like the advice of Michael and Debi Pearl of Tennessee or of the now-diminished “Baby Wise” group, are descendants of Calvinistic views of submission and obedience to parents as analogous to the Christian’s submission to God. ) Among the “New Age” group the paramount organization is the Association for Pre- and Perinatal Psychology and Health (APPPAH), whose members have fostered Lloyd DeMause’s beliefs in the “poisonous placenta” and its psychological damage as well as  the position taken by Stanislav Grof that LSD or oxygen deprivation could yield true pictures of experiences during gestation and birth (rather than images of what someone imagined gestation and birth to have been like). The APPPAH member David Chamberlain has claimed that all children recall all the details of their births and even earlier events, while another member, William Emerson, specializes in massaging young infant’s heads and necks so they will re-experience the pains of their birth and “cry out” those traumas. Emerson’s viewpoint is an example of the belief held by some of these people, that infant crying is a necessary way of getting rid of negative emotion and should not lead to attempts to comfort or soothe the baby—an ideal of indifference to the child that also seems displayed in the Charkovsky cold-water method.

State laws in the U.S. do not prohibit the teaching of most such beliefs or the use of potentially dangerous methods for birth or for child-rearing--  especially if it is claimed, as it is both here and in Russia, that there is some religious principle associated with a practice. Although it would be possible for professional organizations in medicine and mental health to ban the use of these methods by members, and to make efforts to educate the public about the practices, this has only very rarely been done. In fact, the ethics code of the American Psychological Association discourages such moves by requiring psychologists who object to a therapy to speak directly to one of its proponents in an attempt to resolve the conflict, rather than ”going public’.

A prominent Russian thinker has used the term “victorious occultism” to describe the situation in Russia. We’ve got it here, too, and the only way out I can see is for concerned people to speak up loudly.
     








Thursday, December 12, 2013

Should Therapy Hurt?

Everybody knows that medical and surgical treatments can be frightening, humiliating, and painful to undergo. When there’s evidence that they are effective, though, we grit our teeth and make ourselves go through with them. Parents may have to make decisions to put young children through very distressing treatments, without being able to explain the reason to them, and as an article in the most recent issue of Zero to Three points out, the experience may be traumatic for the child.

But let’s suppose that the treatment we are talking about is not medical or surgical, but psychological or behavioral. If those treatments are frightening, humiliating, or painful, is that acceptable? The German psychologist Michael Linden recently wrote that such experiences created additional “emotional burdens” for patients, and that if there were an effective treatment that was not frightening, humiliating, or painful, it would be completely unethical for a therapist to impose those burdens. Where some degree of fear is likely to be experienced, as in desensitization treatments for anxiety, therapists do their best to offer support and make the experience bearable for the patient. Humiliation and pain are not normal parts of most mental health interventions, and painful aversive treatments are expected to be used only when a behavior is uncontrollable and dangerous enough to justify deliberate causing of pain.

There seem to be a lot of rules about not distressing adult psychotherapy clients--  but many clinicians of various disciplines seem much less concerned about frightening or hurting children. In fact, there seems to be a whole school of thought that holds that pain and fear are needed to cause psychological and behavioral change, or at least that they are harmless byproducts of such change. I’ve repeatedly referred to the various schools of “holding therapy” as having this position, but it appears that there are a number who share these attitudes among professionals whose focus is not on mental health.

Ute Benz’s edited book Festhaltetherapien notes a similar viewpoint among occupational therapists in Germany. In Benz’s chapter in that book, she describes how she was contacted by a number of teachers and others who were disturbed by hearing about  occupational therapists doing a form of holding therapy, KIT or Koerperbezogen Interaktions-Training (body-related interaction training). According to one commenter, in KIT the child is ultimately forced under the control of the mother by physical and emotional contact; he goes on to say that  for many children who could trust no one, this method gives a helpful lesson in the persistence of love.  The commenter also notes how much sincerity it takes to restrain a child who fears or hates you, who screams, curses, complains, cries, scratches, bites, pees his pants in self-defense and despair.  I would point out that such last-ditch defense behavior is unlikely unless a child is frightened or hurt, and that fear and pain are apparently tools of the “sincere” KIT therapist.

Authors in Benz’s edited book also refer to the “Vojta method” which had been [happily] unknown to me. This method was originally developed for treatment of the spasticity resulting from disorders like cerebral palsy, but is now promulgated for a range of other problems, including those of children and even newborn babies. The website www.vojta.com notes that “The therapeutically desired activated state often expresses itself during treatment in newborn babies as crying. This understandably leads to parents feeling concerned, and makes them assume that it is ‘hurting’ their child. At this age, crying is an important and appropriate means of expression for the little patients, who react in this way to unaccustomed activation. As a rule, after a short familiarization period, the crying is no longer so intense, and in breaks from exercise as well as after the therapy, newborn babies calm down immediately. In older children who can express themselves in speech, crying no longer occurs.” However, the following clip of treatment of a three-year-old, who is old enough to talk, appears to contradict this claim [N.B. This is quite a distressing display--  please do not watch it while children can hear or see]: www.youtube.com/watch?v=GrtF415N3Gc.

Yulia Massino kindly sent me materials about advertisement in Russia of the Vojta method and the collection of funds for parents who want to take their children to Germany or the Czech Republic for treatment (e.g., http://forum.sibmama.ru/viewtopic.php?t=830157--  in Russian,so please use a translation service if you need to). Vojta therapy is also advertised in English, but apparently not in the U.S.

Yulia also sent information about Elena Fokina’s method of treating children, including young infants, by repeatedly plunging them into cold ocean water, as well as by throwing them around in the infamous “baby-yoga”. Here is an account of Fokina’s “swimming” methods by an observer: http://www.liveinternet.ru/users/nianfora_n/post220258301 (again, in Russian). There is no recording of screaming here, but I warn you that this account disturbed me considerably even though I spend much of my time reading about horrible treatments.

Can these frightening and painful treatments be effective therapies for any childhood problem, physical, neurological, or psychological? They do not offer anything but anecdotal evidence to support their claims. However, as a general rule, sensitive and responsive parenting  methods have been shown to nurture good development, and rough, insensitive treatment to have the opposite effect. Psychotherapies for children are often (whether correctly or incorrectly) thought of as operating in analogy with good parenting methods. There seems to be no rationale for inverting this analogy so that good therapy would imitate bad parenting methods. The obvious conclusion is that neither research nor theory supports the use of methods that frighten and hurt children. On the contrary, these methods involve an “emotional burden” (as Linden had it) that can be expected to exacerbate old problems and create new ones.

What sources can such actively harmful treatments have? KIT and Vojta therapy appear to share with the often-rejected American method of “patterning” the view that imitation of early behavior and events will cause those aspects of development to “re-wind” and re-play in a more typical fashion. In both cases, and in other methods pushed by the Association for Pre- and Perinatal Psychology and Health (APPPAH), crying in pain is either dismissed as “expression” or encouraged because of the belief that it erases memories of earlier distress. In these and similar techniques, there may also be a metaphoric glance at exorcism, where a fight with demons, and the distress of the possessed person, are necessary before healing can occur.

Fokina’s cold-water plunges and baby-yoga are more difficult to comprehend. Are these simply the sadistic acts of a woman whose personal charisma attracts the adulation of people who are desperate for a guru and supernatural guide? Is it all just the culmination of a commercial enterprise? I’m at a loss to say, but there seems to be no shortage of parents who will pay someone to tell them to do cruel and pointless things to their children.

What happens with these treatments is not, as the Vojta method author says, “hurting”.  It’s hurting with no quotation marks. And therapy for children should not hurt, unless there’s a very good reason.








Monday, December 9, 2013

The "Primal Wound" versus "The Wound": Same Basic Idea?

I happened to be reading The great derangement by Matt Taibbi, the Rolling Stone contributing editor, with an eye to seeing his comments about how Congressional rules have changed--  when I saw that he also included an account of being an “undercover atheist” in a weekend encounter group/retreat run by the Texas Cornerstone Church. As I mentioned in my last post about a German therapy weekend, these things all follow a predictable pattern, even though details about family constellations or speaking in tongues may be different. But Taibbi interested me by speaking of a concept put forward by the minister leading this weekend, one Philip Fortenberry.

I’m about to say how Taibbi described this concept, but I must note that I have only his description to go on. The Cornerstone Church website alludes to it slightly, but my search of the Internet has not revealed any other information about it. The basic idea, however, is identified in this way by Taibbi: “The program revolved around a theory that Fortenberry quickly introduced us to called ‘the wound’.  The wound theory was a piece of schlock Biblical Freudianism in which everyone had one traumatic event from their childhood that had left a wound. The wound necessarily had been inflicted by another person, and bitterness toward that person had corrupted our spirits and alienated us from God. Here at the retreat we would identify this wound and learn to confront and forgive our transgressors, a process that would leave us cleansed of bitterness and hatred and free to receive the full benefits of Christ” (pp. 70-71). Identification of the wound was apparently carried out by recounting personal stories in small groups, and cleansing proceeded on the final day through a service in which people spoke in tongues and vomited up demons.

The connection between being wounded and filled with hate and having to get rid of indwelling demons may not be obvious to non-charismatics, but there is a logic when the omissions are filled in. Cruel actions and hatred or pain attract demons, who in turn prevent the afflicted person from being filled with the Holy Ghost (I am referring here not to Taibbi’s account, but to various materials about charismatic thinking.)  Being cleansed of the demons, it seems, causes one to be cleansed of the aftereffects of the ‘wound’, including the hatred and bitterness that attracted the demons to begin with. (I am not sure where forgiveness comes into the picture, but in the “family constellation therapy”  I mentioned in the previous post, hurt people are asked to beg the forgiveness of those who have hurt them; this includes sexually-abused children, who are to beg the forgiveness of the abusing adult, and, no, I don’t have this backward.)

The parallel with Nancy Verrier’s “Primal Wound” is easy to see. For Verrier, the important “wound” is the one she believes to take place when an infant is separated from its birth mother, to whom (according to Verrier) the child has already established a prenatal bond. Adoption by another family is accompanied by the ill effects of the separation wound and makes it impossible for adopted individuals to be truly happy. Verrier recommends that all the details of the separation and adoption be discussed in order to have a good developmental outcome, but does not suggest any therapeutic approaches that could support this (and indeed she has been criticized by otherwise-accepting authors for her failure to offer guidance on this point).

How does the PW compare to “the wound”? It’s a specialized form of wound, occurring under specific circumstances, and not to be found in most of the population. However, it otherwise parallels the “wounds” posited by Fortenberry. It occurs in early life and hangs on, accumulating ill feelings, and interfering with ordinary happy life. According to advertisements for Verrier’s other book, Coming home to self, people with childhood traumas feel they are living “unauthentic” (sic)  lives, just as those with Fortenberry’s “wounds” feel they need to “know the truth” and “be set free”. If Verrier did not base the PW on the “wound”, or vice-versa, the two must be descendants of the same belief system. And of course they both resemble closely the Scientological practice of “clearing engrams” acquired before birth and in early postnatal life.

One more interesting point about the PW: charismatics too give adoption a privileged position as a cause of emotional distress. For them, the circumstances behind adoption--  lust, unwanted pregnancy, accident or illness, infertility, or death of a parent--  all attract demons to the adopted person as well as to those around him. There may even be generational curses at work, so the actual adoption, lust, death, etc. may have occurred many decades ago (coming full circle back to Bert Hellinger, it seems), but affecting someone living today.

Who started this, I’d like to know? Whoever it was, it’s clear that all these stories are versions of religious beliefs. That’s why it’s so repugnant to the believers to attempt to argue in terms of observable events--- even when their stated beliefs are presented as if they come from the observable.  


Further "Festhaltetherapien": A Therapy Weekend

I’ve been reading further in Ute Benz’s edited book Festhaltetherapien, which examines various aspects of holding therapy as promulgated by Jirina Prekopova in Germany and the Czech Republic and by Martha Welch in the United States. Today I want to discuss Marika Sommerfeldt’s chapter on a weekend of family constellation and holding therapy in Prekop’s style. Once again, I have to say that I have not asked permission to translate or to post any of this material, so I will summarize most of it and translate only a few passages. This translation, by the way, is my own and my dictionary’s, and to paraphrase Mark Twain, it was “clawed into English by unremitting toil.”

Sommerfeldt signed up for a therapy weekend as one who had read about it and wanted to know more, but as an excuse for her participation she invented a fictional grandchild who cried a great deal and was difficult to comfort. The story she tells of this weekend is strongly reminiscent of any “encounter group”, church-sponsored retreat, or (for those who remember this) the National Training Labs events of the late ‘60s and ‘70s. Each person has a story to tell and “shares” his or her difficulties with others, a proceeding managed by several qualified and student therapists. These self-revelations are followed by various group rituals and by individual therapy sessions intended to ameliorate the problems.

Sommerfeldt seems to have brought to the weekend a genuine willingness to observe, and a real interest in her fellow weekenders, combined with common sense and a delicate sarcasm. To amuse herself when on her own, she also brought a copy of Bulgakow’s The master and Margarita, a novel in which “madness” and its treatment play primary roles--  very appropriate for the milieu in which she found herself.  As advised, she packed comfortable clothes in the expectation that participants would be sweating.

Introductions over and stories told, with tears in several cases, the first day of the workshop began with a ritual farewell to accompanying children, who would be taken to be cared for by young people who were students of special education or of theater [! JM]. All sang a song about a mouse who was going on a trip around the world and all the things he packed. (Sommerfeldt noted at this point that the organizers addressed everyone in the familiar form, as if they were relatives or close friends.)

Further stories were told by the adults, some of them having to do with marital conflict. Sommerfeldt noted “I was always asking myself, how the others and I got to this level of intimacy. Perhaps this is usual in group therapy. I don’t know, but I found it misplaced. The speakers lost all restraint--  they cried and sobbed. The therapist tried to calm them, but it seemed to me a mistake to advise ‘deep breathing’ or ‘putting both feet on the floor to be grounded’. My first impulse was to take these crying women in my arms and comfort them, but perhaps this was also the wrong reaction. We were asked by Ralf [a therapist] to explain what we expected from the weekend. The hopes were very great.”

A later ritual for the adults was to form two circles, with men and children in the inner circle, women in the outer circle, singing in alternation. The children sang the song about the mouse again, following Jirina Prekop’s dictum that “children need rituals”.

An organizer then began a description of Bert Hellinger’s family constellation therapy, without mentioning his name. She explained the family hierarchy and the order of places of father, mother, children, and grandparents. The father is always at the top  of the hierarchy because he determines the descent of the children. For example, she said, if a mother is from Saxony and a father is French, their daughter will also be French. Sommerfeldt commented, “It’s never occurred to me in this way. The father of my children is of Saxon background, but he considers himself a Berliner, because he was born in Berlin. My children will not be too pleased when they hear that after this workshop they are no longer Berliners.”

The organizer also stated that the order of relationships remains the same even if the parents divorce. If the order is broken, the child feels unprotected and becomes oppositional and tyrannical. If the mother has conflicts with her own mother, the child will take over and display the conflicts. Indeed, it was said, there is a “seventh sense” and an instinct by which when the child sees her own mother in her child, the child cannot love her. Sommerfeldt commented, “this speech seemed to me completely confused, I simply couldn’t understand it.”

Now Sommerfeldt had to give a more complete story of the fictional crying grandchild. “No, mother and child were not separated after birth, and the mother showed very affectionate concern for the child, so ‘Philip’ was not suffering from a maternal deprivation syndrome, and no, the family’s relationships were not disturbed. Nor did the child go to day care. The rest of the extended family was somewhat odd.” The therapist Maximilian created a family tree, then he explained. “My problems obviously came from my father’s first wife, who had never been welcomed by the family and who died a long time ago. I understood that my grandchild cried a lot because my father never talked about his first wife and she no longer belonged to our kindred. Confusion had been brought into the family order. My mother, my sister, and I had profited from  the abandonment of the first wife and must thank her for this and bow before her sad fate. … I was happy when my therapy hour was at an end.”

Subsequently, Sommerfeldt asked with some trepidation (brave woman!) for holding therapy. This was presented as being done in a modified form, and was done by several therapists rather than by a person with whom she was at odds [this seems to me contrary to what Prekop advises, but I suppose the arrangements are made to suit each case. JM]. It was done in her bedroom at the conference hotel, and a point was made of doing the holding on an extra bed, not on the bed she slept in. She was asked to sit leaning against a woman therapist, with her head on the other woman’s shoulder, and was advised that she should not talk and question and that her failure to understand with her heart was a cause of problems. Memories stored in the body were also mentioned.  Rather than lasting to exhaustion, as seems to be recommended for children, the holding sessions stopped after about an hour.

The weekend continued with various ritual performances, such as pretending to be hedgehogs in a nest, and concluded with a candle-lighting ceremony in which candles were to be dedicated to those each person loved. Sommerfeldt commented that she found the ceremony ludicrous, but others found it calming and good to do.   

Sommerfeldt was left with affectionate feelings toward the other participants and felt she would like to stay in touch with some. “When I left, my daughter was already waiting at the exit. She immediately asked me how it had been. By this time I really had holding therapy and constellations or whatever they’re called up my nose. I told her, I don’t want to talk about it now--  and didn’t stop talking until we got to Berlin.”


There are many more details that I’ve skipped, and this chapter is a real contribution to understanding of holding therapies and of the involvement of Hellinger’s ideas in the Prekop system.

Wednesday, December 4, 2013

Speak Roughly to Your Little Boy, and Beat Him When He Sneezes: More on "Festhaltetherapien", Edited by Ute Benz


A couple of weeks ago, I commented on an on-line sample from a new German book, Festhaltetherapien:Ein Plaedoyer gegen umstrittene Therapieverfahren, edited by Ute Benz. I have now received a copy of the book and am making my way painfully through it--  I began by looking up three words in every paragraph and am now down to two for most paragraphs, and even an occasional paragraph where (I think) I understand everything.

I didn’t begin at the beginning, but wanted to look at a chapter by Ute Benz on the historical development of Holding Therapies (pp. 121-143). (I should emphasize here that the title is in the plural, and that although the book focuses to a considerable extent on the treatment as done by Jirina Prekop and Martha Welch, in fact there are other methods that use restraint on children in almost the same way as Prekop and Welch.)  I am going to translate some parts of this chapter, but I do want to note that I have not asked permission to do so. I assume that the short sections I will present, and the fact that I have no commercial interest here, will make this acceptable, but if there are any objections from authors or publisher I will naturally take the post down.

I’ll begin with Benz’s description of Prekop’s holding method, which its proponents recommend for autistic children, for oppositional children, and for “any child who needs it”. “The picture of the classical holding scene looks like this: a boy or girl sits or lies on a mat with the entire body held tightly by adults, the mother and/or father and perhaps a third or fourth helper, so that the child can no longer move, but can only cry out. For the child to scream and cry during the procedure is considered normal and even desirable as the expression of emotion belonging to the method, so crying must be provoked if a child becomes compliant too quickly. This is to dissolve repressions. The child’s crying is much more easily tolerated by the parents when many children are treated and cry simultaneously. If a child immediately becomes still and resigned to his fate or goes to sleep or looks around the room, he is practicing a defense against the treatment and must be provoked in order to break through the defense.”

“When Holding Therapy is done in the home, the parents are warned to close the windows, so that neighbors will not hear the sound of screaming and call the police. Because the delaying tactics of the restrained child may cause him to scratch, bite, hit, or kick, a certain position needs to be taken, so there are no bruises as visible signs of mistreatment. The child must cross his hands and legs in a sort of straitjacket position and sit straddling the lap of the adult. His head must be laid or pressed against the crook of the adult’s neck. … the child must not be let go under any circumstances, such as begging, yelling, screaming , or desperately crying, even if he needs to go to the toilet, his nose runs, or he becomes sick, or when both bodies are bathed in sweat, or when the child trembles from stress or is hungry or thirsty. All these things are done in typical  evasive maneuvers [N.B. Benz is describing Prekop’s viewpoint, not her own opinion!] that must be overcome in the course of the process so that the goal of a tractable child is reached.” This goal is shown when the child allows eye contact as the parents wish it, lets himself be caressed, and says things like “I love you” or promises desired behavior. As Benz notes later, this end is thought to justify the means.

Benz, who estimates 10,000 cases of this treatment in Germany and Austria over the last 30 years, also notes people who have contacted her to ask for help or explanations. (She also notes that few German psychotherapists know about Holding Therapy or even know it exists.) In 2004, she was contacted by a divorced father who had custody of a seven-year-old boy; the boy was refusing to visit his mother. The boy told his father that the mother would restrain him while he lay on the floor, would stroke him and whisper “I am your mother, I love you.” Benz was also contacted by a town counselor who was concerned about accusations of mistreatment against a staff member in a children’s home, where there had already been repeated indications of trouble. The accused person had already resigned, but the town council now needed to review over a hundred videotapes although they did not know anything about the theory and practice of Holding Therapy. In 2011 Benz was contacted by a 27-year-old woman from the Netherlands, who had been given intensive Holding Therapy for years as treatment for cerebral palsy. For the first four years holding was done three times a day, which was later reduced to three times a week. At age 20 she had serious problems with being near other people and with physical contact. Her doctor advised her to seek therapy but could not say where to go.

Benz describes a number of similar cases who have contacted her, but as far as I have read does not suggest specific techniques for treating these effects of Holding Therapy, although she does note that practitioners need to explore whether new patients have been subjected to this treatment. As I have noted before, in one case I know in the United States, a young woman who as a child was subjected to treatment of the Prekop-Welch type suffered increasingly severe anxiety attacks in her 20s, but was relieved by desensitization treatment focusing on her memories of the treatment, particularly the screams of other children in the room.

I must say that distressing as I find treatment of this type for autistic children, the idea of trying to apply it to someone with cerebral palsy is really beyond anything I have encountered before. One wonders whether these people would use holding for appendicitis! Surely declarations of intense pain and vomiting could be interpreted as defensive delaying actions, too … and no doubt similar interpretations have been made by some practitioners.


In a later post, I want to go into what Benz has to say about the use of similar techniques by occupational therapists in Germany.