Psychology

The history of homeopathy

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…explained by the “tall guy who writes“. You’ll love this…

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Darth Vader is borderline

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This happens when scientists have too much time at their hands: Jeremy Hsu from LiveScience had a closer look at the Star Wars movies and found out that Anakin Skywalker / Darth Vader meets most of the criteria for Borderline Personality Disorder according to the DSM-IV and the upcoming DSM-V, which is now to be called “The Empiry Strikes Back” ;-)

LiveScience: The Psychology of Darth Vader Revealed.

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Psychology: Autism and Asperger’s

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On the able2able website I just saw a call for bloggers about the subject of Asperger’s and Autism. Since I haven’t written a serious entry in a while, I’d like to seize the opportunity and write a serious article from a psychological point of view rather than from a parent’s or patient’s point of view. So my advice to parents whose child has just been diagnosed with Asperger’s or an Autism Spectrum Disorder:

1. Before anything else: Make sure the diagnosis is waterproof! Do not trust “hunches” or the “gut feeling” of a physician. As for any kind of mental illness or disorder there are certain defined criteria described in the “Diagnostic and Statistical Manual of Mental Disorders, Revision IV” (DSM-IV) published by the American Psychiatric Association and there are numerous standardized tests a qualified psychologist, psychoanalyst or psychiatrist (preferably specialising in children and adolescents) can use, along with physical, neurological tests, to determine whether the diagnosis is valid and how great the extent of the Disorder is. The extent of the testing sessions may vary on a case-by-case basis, so if you plan to have the diagnosis verified in a clinic, prepare for a short-term hospitalization of your child. Larger clinics usually have a pediatric ward in their psych-department which has mother-and-child rooms or parents-and-child rooms which allow one or both parents to stay with the child throughout the whole period of hospitalization.

2. The diagnosis is not the end, it’s the beginning. If the diagnosis has been validated by a professional you should have been told about the extent of the disorder on the autism scale, the actual type of disorder (Asperger’s/”high functionality level” Autism or “regular” Autism) and about means of therapy to improve your child’s capabilities. Do not aim for “normality”…the is no such thing als normality anyway, but aim for individual improvement relative to your child’s individual abilities. And keep in mind that development of children is hardly predicable…While in most cases of Asperger’s a high degree of functionality in terms of social interaction, education, finding and keeping a job etc. can be achieved, more severe cases of Autism Spectrum Disorders will leave the patients dependant on external help for the rest of their lives…as cynical as this may sound, you will not live forever, so your aim must never be to “be there” for your child indefinitely but rather help your child to lead a life on its own as far as this is possible within the boundaries of the disorder.

3. Learn to communicate on the digital level rather than on the analogue level. The distinction between analogue and digital levels of communication were defined by the psychologist Paul Watzlawick. The digital level of communication defines the pragmatic, literal content of a verbal message. The analogue level is the socio-emotional level of communication, the “context” or what is said “between the lines”. Everything you say can be considered a “speech act“, which can be a lot different from the digital content of the utterance. You might for example not ask a person to close the window or turn the heating up a little directly, but rather say “It’s cold in here.” On the digital level this is just a description of the environmental conditions. On the analogue level however this will be interpreted as asking for the conditions to be changed. Other speech acts which have no meaning other than social communication are such things as to greet people with “good morning” or “good afternoon”, not necessarily because you actually care how they are feeling, but rather because “this is what you do”. A good example is the greeting “how do you do?” which is answered with the same line without any of the people communicating actually stating how they are doing…it is just a ritual of greeting with no digital meaning whatsoever.
A common symptom of autism is a thing called “literalism”. People with Autism or Asperger’s have trouble communicating on the analogue level, some are completely incapable of understanding non-literal meanings. They will almost always take any expression literally, often not understanding the actual intended message. Hence a large part of the therapy involves teaching children and adults with Asperger’s or Autism how to interpret certain speech acts, enabling them to extend their social capabilities. This also applies for body language and facial expression, which are part of the analogue level of communication. People with Asperger’s or Autism usually have problems telling a happy face from an angry or sad one and their capabilities of interpreting body language are usually limited. While people without such a disorder just internalize these things in the process of their socialization, children with any of these conditons need to be taught all these things we consider “normal” or “socially acceptable behaviour”. This symptom is usually the most challenging, since deficiencies on the analogue level are often interpreted as “bad behaviour”, rudeness or even hostility, especially by children. So:

4. Keep your temper! If your child does not react to you as you would expect it to, this is usually because it could not understand your message. Not reacting to “good morning” is not rudeness or hostility – the child just does not see the point of responding to a description of how you find the morning. Also, do not expect the child to understand non-verbal requests or facial expression. Rather say “this made me angry” than just put on an angry face. Ask literal questions rather than use conventional expressions (“How are you feeling”, rather than “good morning”). Do not use irony, sarcasm or cynicism, since an understanding of such means of expression are far beyond the child’s abilities.
Do not interpret denial of communication as a sign of reject. Depending on the level of Autism, your child may not want to communicate at all, may not want to be touched by you or may not even want you to be near it. Accept that without feeling rejected. The child is unaware of this analogue message.

5. Do not force anything. A common form of therapy for Autism and Asperger’s in the last century used to be the “Festhaltetherapie” (holding therapy) by Dr. Jirina Prekop. The basic idea behind the “holding embrace” was that children with autism could be “taught to like” physical contact to people by forcefully(!) embracing them until they stopped resisting. Nowadays this method is no longer used (except by conservative traditionalists) in modern therapy since now the common understanding of Autism is a lot different. Psychologists now usually believe this method only teaches children to endure physical contact rather than to enjoy it and it is considered unethical. At least here in Germany (I don’t know about America) a number of lawsuits for physical abuse have successfully been filed against therapists still using Prekop’s form of therapy. There a patients who can tolerate physical touch, while others never get accustomed to it. There is no real way of “changing” this and the tolerance for physical contact varies on a case-by-case basis. Accept that autists and people with Asperger’s almost literally live in a different world. There is no way to “drag them out of it” and bring them to your worl. You only chance is to gain their trust so they allow you to be a part of theirs…and it is theirs to determine, how much importance you have in their world…like I said, do not take that personal. It does not mean your child rejects you, it’s just an autist’s way of interpreting the world.

6. It won’t “go away” over time. Certain personality disorders have a tendency to “burn out” over time (such als certain forms of Borderline Personality Disorder), but this does not apply for any disorder from the autism-spectrum, including Asperger’s. There is room for improvement, but depending on the degree of severity the symptoms will more or less stay the way they are. “High functionality” autists and people with Asperger’s may lern to “blend in” with society and function as society would expect them to, but this is also different in each individual case. There is no “cure” as Asperger’s and autism are not “diseases” or “illnesses” one can catch…

7. Stay away from clinical literature and Wikipedia! One of the most common effects we observe when laymen are confronted with clinical literature and other more or less reliable sources of information is that laymen can understand the statistical information provided along with predictions about the outcome of different disorders, but are (due to lack of clinical experience) unable to estimate the likelyhood of the various things they may have read. Usually, reading clinical literature will lead to disorientation rather than focus. Statistical data you cannot fully interpret will make you more afraid instead of helping you. If you have questions about your child, ask a professional to answer them based on the individual structure of your child. I won’t give you a single table or any figures here, because in real clinical life, anything has a possibility of 50 per cent – it’s either true or it is not…percentages of how likely it is for your individual child to develop symptom X or Y won’t help you as your child either has symptom X or Y, or it doesn’t…don’t read yourself into an outrage…
Another bad side-effect of reading clinical literature is the problem of projection. If you read about symptom X, chances are, you will start seeing this particular symptom in your child…not because it’s actually there, but because reading about it raised your awareness for it…this happens to everyone, even professionals…
The good approach is: Observe, and if you happen to see something “odd”, THEN ask about it…do not internalize a page from the DSM-IV – you’ll start seeing ghosts immediately…

Ok, so much for this subject for now. I hope, you will find some of the things I wrote helpful.

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ADHD and Ritalin

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Every now and then a more or less comprehensive article about Attendion-Deficit Hyperactivity Disorder (ADHD) is published in a mainstream magazine. Hours later, one ends up with outraged parents who think they have seen “symptoms” in their children. To clarify some of the common misconceptions about ADHD, I’d like to make a few points:

1. Not every child who doesn’t listen seconds after you barked an order at it, has an “attention deficit”. Nor do children who like to “play rough” necessarily have a “hyperactivity disorder”.

2. Real ADHD (sometimes ADD as deficits in attention can also occur without hyperactivity as a symptom) is caused by certain parts of the brain regulating drive and attention malfunctioning. It’s a genetic condition which causes a paradox reaction to certain stimulants and sedatives in the brain chemistry. In laymen’s terms (all neurologists and medical doctors please cover your ears now): A child who suffers from genuine ADHD needs coffee to sleep and Valium to wake up…

3. Methylphenidate (“Ritalin”) only has a calming effect if it’s genuine ADHD. The substance is similar in structure to amphetamine. So if your kid happens to be “regular hyperactive” instead of “ADHD hyperactive” administering Ritalin leads to the following problem: Hyperactive kid + Ritalin = Hyperactive kid on speed!

4. “My child has disorder X or disease y” is easier to accept than “I suck as a parent.” Unfortunately, the latter is the most frequent cause of “abnormal behaviour”. Medication won’t help…get some professional advice…against which most parents are quite resistant by the way…

5. Dear parents: If in doubt, have a certified neurologist or psychiatrist check your child thoroughly. Don’t just go to any garden-variety physician even if they have a fancy “I went to Vegas and all I got was this lousy medical degree” thingy on the wall…physicians tend to say “Not working, eh? Let’s increase the dosage…” and believe me, the last thing you and your children’s teachers want is a kid on even more speed…

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German School Shootings: 1 – Robert Steinhaeuser (Erfurt 2002) in a nutshell

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Alright, since killing sprees have become all the rage (literally…) here in Germany and since this is a major research field for me and also because most of the available material is in German, I decided to drop the “Dude, you bent my tower” series for a while and start a “Brief history of the killing spree” instead.
While the cases of Tim Kretschmer and Georg R. are far more recent, the Steinhaeuser case is still widely considered “the original school shooting” here. That’s why I start with him.

The following information is taken from the final report of the official investigation conducted by the state of Thuringia. The unabridged report in German language is available for download here.

On the 26th of April 2002 the former pupil Robert Steinhaeuser (original spelling: Robert Steinhäuser) armed himself with a Glock 17 9mm semiautomatic pistol and a Mossberg 590 pump-action shotgun and entered the Johannes Gutenberg Gymnasium in Erfurt, Eastern Germany to take revenge for having been expelled.
He had faked a doctor’s certificate to circumvent an examination but was caught and kicked from the shool by the headmistress (US English: principal).

He shot twelve teachers, a secretary, two pupils and a policeman before killing himself in room 111 with a contact-shot to the temple using the Glock after one of the teachers had locked the door behind him. He did not fire a single shot with the shotgun.
As a sports marksman he was licensed to buy and own both weapons and ammunition of the above type.

On his killing spree he carried a total of roughly 110 rounds of 9mm Luger in five clips and 19 twelve-gauge shotgun shells made by Baschieri&Bellagri (9 in the gun, 10 more in his pocket) with him. Furthermore he had a Cordura-holster for the Glock strapped to his thigh, was dressed all in black and wore a black ski mask and hearing protection.

In one of the restrooms on the first floor the police found a stash of 142 12-gauge shells, 338 rounds of 9mm Luger, a large clip filled with 31 rounds, a small clip filled with 17 rounds of 9mm Luger, a machete and a diver’s knife.
72 bullet casings were found in the building, they had all been fired from Steinhaeuser’s Glock 17 except for one which had been fired by one of the policemen after Steinhaeuser had opened fire on them in the schoolyard.

While a lot of information circulating the internet is correct, I’d like to clarify some things here:

1. NOT A SINGLE SHOT was fired from the Mossberg.

2. The dead policeman was not shot inside the building when he “stuck his head through the door”!
He and his parter arrived second on the scene and observed their colleague firing a shot towards the schoolyard. The victim Go. and his partner waited a short while (“…a while…how long I cannot tell at all…”, p. 112) before proceeding towards the building. On the way Go. was still busy putting on his body armor when he was struck in the neck by a bullet fired from a “window almost directly above him” (p. 112). When he fell, he lost the body armor (it was the type one closes at the side, at least the back part “flipped to the side again”, p. 112) and was hit by three more shots. The fatal one went straight through his chest, from the fact that the fatal bullet was found in his clothing, the investigators assumed the bullet “hit him lying down”.

3. Due to a book which was published by Ines Geipel after the killing spree (“Fuer heute reicht’s”, = “That’s enough for today”, Steinhaeusers last words to the teacher who then locked him into room 111. When Steinhaeuser walked up to him and pointed the gun in his face, the teacher, Mr. Heise said: “You can shoot me now…” ) a lot of rumours spread in the German media that Steinhauser had taken the infamous “Tilidin”, an opioid-based painkiller (a prescription drug in Germany and Switzerland, but illegal in the USA) which is said to be used by various gangs before acts of gang violence. The drug causes rage when overdosed while at the same time it makes the aggressors “almost immune to pain”. Well…it’s a PAINkiller after all…;)
Whether the attributed effects are true in general is a different story, but regarding Steinhaeuser the post-mortem toxscreen was clean. No alcohol, no drugs in his blood (p. 60). They found some weed in his jacket, though…
So the Tilidin-story is clearly a hoax. In the quoted interviews, friends of Steinhaeuser’s admitted, they had “experimented” with various drugs, including Tilidin, LSD etc. The rumour hence is obviously “creative interpretation” which was then picked up by almost every German tabloid paper.

4. The reason for Steinhaeusers killing spree may not be as simple as it may appear to people unfamiliar with the German school system.

I. He was UNLAWFULLY expelled from the school! While faking a doctor’s certificate to circumvent an examination is forgery, this alone would not have been enough to kick him out for good. The headmistress had commited an ultra vires action by expelling a first-time offender rather than just suspending him for a certain time.
II. After expulsion he was left with absolutely nothing in his hands. In 2002 the law in Thuringia required pupils who wanted an intermediate graduation certificate before moving on to higher education (see also: Fun Facts about Education in Germany) to take the necessary examinations at a school of the respective type.
While here in North-Rhine-Westfalia for example one only needs to have a certain average at the end of the tenth grade to be awarded the “Hauptschulabschluss” or “Realschulabschluss” regardless of whether they want to stay in school and go for the “Abitur” or leave, in Thuringia this was not the case at that time.
Steinhauser had attempted the “Realschulabschluss”-exam, but had failed. His only hope now was going on and passing the “Abitur”. Not being a particularly good pupil, Steinhaeuser had had his doubts about whether he would make it.
The expulsion meant, he would not have had either of the possible certificates. Neither the “Realschulabschluss” nor the “Abitur”. Basically a future employer would have treated him as if he had never been to school at all…
I think with this background in mind, the desperation in Steinhauser and the anger towards the school and the teachers who he blamed for his failure becomes a lot more understandable and imaginable.

That’s enough for today….

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