Saturday, 22 November 2008
Character problems
For a very good blog post go to Myalterego in my “Blogs I like list”. The post is titled - Does long term, non-remitting mental illness need a psychiatrist. A very nice statement from the client’s perspective about some of the basic assumptions that mental health professionals work from. And comes to a conclusion that I happen to agree with, which always helps!
Also Myalterego asks a question to my post, Transference - the good and the bad, about characterological problems. At the moment I am writing a lot of case studies and have one that clearly illustrates a characterological problem so I thought I would use it here. As usual some of the client data is fictionalised.
The term ‘character’ and ‘characterological’ has been used in a variety of ways over the years. The way I use the term and which is not an uncommon way originally comes from the writing of Wilhelm Reich (Now there is a guy you could do a couple of very good blog posts on, and I probably will).
He wrote a landmark book called Character Analysis (third edition). Now I highlight the title ‘third edition’ as he had a very bad literary habit. Originally he wrote a book called Character Analysis. It was very popular and so the publishers wanted to do re-runs of it. However before this was done he rewrote significant parts of it as his thinking had evolved on the topic. The problem is he still kept the same title - Character Analysis. Then they did the same later again when he rewrote it for a second time and still named it - Character Analysis!!. So he essentially ended up with three different books all with the same title. This, as you can imagine has caused much difficulty over the years.
Over time his writings on character have been very influential especially in areas like Gestalt therapy and all the body or energy therapies. Many of these have based their theories on the work of Reich.
When one talks about a person’s character one is usually referring to the basic sense of who they are, not the changing behaviours or feelings which come and go many times a day. A person’s character is much more stable and resistant to change. It refers to who they are and their basic beliefs and feelings about the world.
World view
There is a german word - Weltanschauung - that translates as, world view, in english and that’s what character in this sense means. Our basic world view, natural disposition and temperament. So a neurosis is not a character problem. A character problem is deeper in the personality.
So people with a characterological problem are often seen as having what is sometimes called a Personality Disorder. A characterological problem is a developmentally based disorder of a person basic character. This needs to be distinguished from biologically or genetically based emotional disturbances. The term characterological problem refers to psychological problems that have been caused by problems in a persons normal psychological development and not because of their genes. It has been caused by aberrations in the primary parent child relationship or attachment, not because of the biology that the child was born with.
Take the case of M. A 12 year old boy who is very disruptive. Been suspended from school on numerous occasions, at times he has assaulted others and damaged property in many instances. Has been diagnosed as Oppositional- defiant by just about everybody and even gets the occasional diagnosis of Aspergers just for good measure.
Oppositional - defiant
Whilst his mother works very hard at her mothering she has many of her own emotional demons. She has had numerous psychiatric hospitalisations since he was born. In earlier days they were one or two weeks in length and now they tend to be for a few days at a time. M’s response to this has been to form a very strong and singular attachment to her. As far as attachments go she is IT for him. The one and only.
Of course this has been most problematic because it means he has been psychologically abandoned numerous times since as early as he can recall. Thus he has developed an strong insecure attachment to her. He is very angry about the abandonments and thus the aggressive behaviour. However he also uses this aggression to isolate him and his mother so that they can be together.
When he is suspended from school where does he go? He stays at home with mother. If they go out to visit friends and relatives he breaks their property so they are not asked back. He has no interest in seeing friends on the weekends and prefers to stay at home with mother. He makes frequent requests for homeschooling. The magical thinking is that if he can finally create the situation when he and mother are alone together then at last he will feel secure in his attachment to her. This will not happen as the mother will be repeatedly hospitalised for many years to come.
Because this problem began when he was an infant and it involves a disturbance in the basic attachment with mother then it could be diagnosed as a characterological problem. The anxiety, anger and insecurity are part of his basic character.
I have now been seeing him for 18 months. The treatment goal is for him is to form a basic attachment to me. If he does that then he will be developing a secure attachment because there wont be abandonments by me. If he achieves that then he will begin to get a sense of security in his basic character. If he does that then his need to isolate him and mother using aggression will subside.
Whilst he is doing well, indeed better than I had anticipated, there are a lot of “ifs” in that. Treating a characterological problem takes a lot of time and takes money as well. So only time will tell how much success M will have in the long term.
Graffiti
15:29 Permalink | Comments (30) | Email this
Comments
I really hope the therapy succeeds with M. It really brings tears to my eyes to hear you say you won't abandon him. Of course nothing is garanteed in life but as much as is in your power, you won't abandon him. I think that is a beautiful part of therapy - the steadiness of the bond that eventually exists when it becomes apparant that the therapist is not going to let you down.
Posted by: KazzaB | Saturday, 22 November 2008
Well that is a good point KazzaB,
that nothing in life is garanteed.
And to some extent represents magical thinking by clients and children. Children feel safe in their attachment to mother knowing that she is there, when in fact mother could die tomorrow. In one sense it is a delusion on behalf of the child or magical thinking perhaps
Graffiti
Posted by: Tony | Saturday, 22 November 2008
I prefer to think of it as magical thinking Tony. And I suppose we have to have that because otherwise life would be pointless. If we were constantly thinking someone won't be here tomorrow, that something could happen, life would be a bit unbearable.
I suppose that's the whole thing with your client 'M'. He is trying to make sure that his mother never leaves him, which can't really happen. But if his attachment to you suceeds, he'll have a positive role model and can see that abandonment doesn't always happen.
Posted by: KazzaB | Saturday, 22 November 2008
Yes KazzaB,
It would seem like it is unbearable if a child constantly realized that its primary attachment figure could be dead within 24 hours.
And as you say if M's attachment succeeds than yes he will realize that the world is not as unstable and unpredictable as he currently believes
Cheers
Tony
Posted by: Tony | Saturday, 22 November 2008
I know of a woman( if you google mctriplet, you can read her blogs).
I have been following her story since 2-3 years.She has 4 year old triplets, one born at 23 weeks (L) and other two at 26 weeks (s and i).(regular pregnancy is 40 weeks)
She always says L is very intelligent but one has to look past his behaviour.
Your case reminded me of him.
She herself takes antidepressants.In 2006, right in front of my eyes that woman had lost 80 pounds or so and now right in front of my eyes she has gained it all back.
Life should not be so hard really.
Shruti
Posted by: Shruti | Saturday, 22 November 2008
I am trying to get a comment up here, but it isn't going...can I email it to you? I can't find an email on the site.
Posted by: s | Saturday, 22 November 2008
This is a comment by s, (Myalterego)
----------------------------------
Wow, thanks. This was a question I asked when the post was new, but it somehow disappeared into cyberspace.
But of course, this just raised more questions about this and also about the opinion piece (thanks for the link and props, by the way).
Ok, so you say this:
"The treatment goal is for him is to form a basic attachment to me. If he does that then he will be developing a secure attachment because there wont be abandonments by me. If he achieves that then he will begin to get a sense of security in his basic character."
I sort of now think I understand what the shrink is trying to do with me. But I have to know, how does this:
"... he will be developing a secure attachment because there wont be abandonments by me."
lead to this:
"If he achieves that then he will begin to get a sense of security in his basic character."
For me, there is a tremendous logical leap in there. Why should forming an attachment to you change anything about this kid's life? Or does it have to do with his age and developmental stage? And is it theory or is there real evidence?
You don't have to answer in depth, a link would be good. Anything I've ever found sounds like voodoo.
And why would some kids whose parents are often absent (military life, job travel, jail, whatever) turn out fine and one kid like this?
Ok, next topic. You agree that people with the long term not really fixable problems don't need a psychiatrist. Let's say this kid in your story is 30 years old and no one can really make any progress with him? What's the solution?
Could he benefit from a different kind of provider? What is fair to give me, of more than zero benefit, and might help at this stage? So far, on my own, I'm back to "go spend the same amount of money on a nice haircut."
Seeing that you found that interesting, well, I'll finish the story, maybe as a separate post. I asked the shrink about this. I didn't phrase it as, "Are you pretty much useless at this point?" but said, "Should we be shifting from a focus of fixing me into getting to accept and live with how I am now?" and the answer was an absolute no, that this could be fixed, I could be in good shape again.
I was forced to wonder who had the denial problem.
Posted by: Tony | Sunday, 23 November 2008
Hello Shruti,
Life does sound hard for the woman you mention and indeed it is very hard for the mother of M.
I find it strange the lottery of life. Some have very difficult circumstances thrust on them for their big parts of their lives and others have an easy run.
Certainly it is not fair but such is life I suppose
Tony
Posted by: Tony | Sunday, 23 November 2008
Hello s,
You ask a number of questions there and I will address the last one first. In my work as a psychotherapist I am finding my self sometimes saying to clients, “Perhaps this is as good as it gets”, and suggest they go and watch the movie which is most entertaining BTW. That scene in the psychiatrist’s office waiting room when Jack Nicholson says those words is very funny. Its up there with “The truth, you can’t handle the turth!”
Some clients have tried just about every type of therapy possible and still they suffer crippling anxiety or depression and so on. At that point I will work with them on accepting and living with their disability. This is usually done in a progressive fashion I may add. Some people are born with one leg, or heart problems, or downs syndrome or develop diabetes and we accept those disabilities. Their therapy goal is to emotionally accept the disability and live the fullest life they can.
Why should psychological disabilities be any different?.
Often when one attends suicide assement workshops they will start with the myths about suicide, like, someone who talks about it wont do it and so forth.
To counter the myth that there is sometimes no hope
One thing inevitably cited is, “There is always hope”.
That is simply wrong and is included to make the therapist feel better rather than the client.
And indeed it often makes the client suffer more. Its like telling a child with an intellectual disablility that if he just tried harder and studied more he could read and write like others. Thus the child suffers more.
I will address other parts of your comment after my morning exercise on the beach
Graffiti
Posted by: Tony | Sunday, 23 November 2008
I love that - that at some point the saying there is always hope is to make the treater feel better. We run up against that a lot in medicine too. It is VERY hard for doctors to really tell patients that they are terminal. And you always see these reports where the person walked out of there thinking something totally different, while when you ask the doctor, he thinks he was very clear about the condition.
And thank you for that analogy...it actually makes me feel a lot better. One of the things I have most struggled with is my not being able to make this go away by force of will, intellectual tricks, and so on. Just relief of guilt is a huge thing. Often, a patient with cancer or some horrible disease will ask, "Why did this happen to me?" I know that a lot of the time the right answer isn't why it happened, which we don't have, but why it didn't happen. It didn't happen because you didn't take vitamins or forgot your sunscreen that one time or were a bad mother. Those answers mean a lot to people.
Posted by: myalterego | Sunday, 23 November 2008
And don't feel obligated to answer every question I ask!
Posted by: s | Sunday, 23 November 2008
I have left 3/4 comments and they havent appeared. May take a few days to come through like once before.
Posted by: Kahless | Sunday, 23 November 2008
Hello Kahless and Myalterego,
I have contacted the big cheese, the main man, the big banana, numero uno, Mr Blogspirit.
I told him that comments were not getting through
Graffiti
Posted by: Tony | Monday, 24 November 2008
There is always hope Tony. Always.
Posted by: roses | Monday, 24 November 2008
They seem to come through if i dont fill out the url box on comments.
As regards your books, thanks for the nose!
Cant say I have any books the same, but I have a couple of WW11 books and an Islam photo book.
Posted by: Kahless | Monday, 24 November 2008
What happened to the book post??? It's goned and disappeared and just aint there anymore!! I LOVE books Tony and you made them all disappear!!
A disappointed Kazza!!
Posted by: KazzaB | Monday, 24 November 2008
Loads to say, in no particular order.
1. "There is always hope”. That is simply wrong and is included to make the therapist feel better rather than the client.
True and not true.
I think there are some whose spirit is domitable and they do see hope. I visited a concentration camp in Germany this last week. Check out my random blog, one piccie in particular drawn by the potato peelers. A jolly piece of artwork drawn in a place of death and absolute dispair.
2. Does boy M know the treatment goal (just being nosey and wondering how this knowledge impacts?)
3. As I read your post I was thinking to myself, you cant promise that you will be a secure attachment for him. You could die. Then I read Kazza's comment lol! then I thought it is about risk of attachment (prompting me to ask Q2 to see if M realises the risk.) Boy M needing to take a risk.
4. When you are saying attachment with M, are you becoming a father like role model? (again being nosey)
Posted by: Kahless | Monday, 24 November 2008
Did my comment on this post I made last night not come through?
How disappointing cos it is not one I could probably re-create with the same sentiment.
Oh well,
what will be, will be.
Posted by: Kahless | Monday, 24 November 2008
Hi Kahless,
No I don't think M knows the treatment goals. He doesn't even think he needs or is getting therapy in the first place.
Q 4 - Yes. Now even at times he calls me "dad" and asks me for hugs and in the last session he even wanted to curl up in my lap in the fetal position and have me hold him. The rate and degree of his attachment to me has surprised me. I did not anticipate it.
Graffiti
Posted by: Graffiti | Monday, 24 November 2008
Yeah, you might die, but I think there is a much bigger chance that you will vacation, Tony. How about that? He's just a little boy. How will he understand that differently from his mother being in hospital? Even if he understands intellectually, his feelings might not understand. Sometimes I think it is a mean thing for therapists to be too nice to little children. You can't really be his mother or father. Or maybe you can in this case since his mother sometimes goes away. Maybe it would help the boy for someone to help the mother.
Posted by: Lynn the Skeptic | Monday, 24 November 2008
What ever happened to Lynn the Spiller?
Yes i will go on a holiday and then M and I will not see each other for some time. then I will come back as I said I would and he will see that as well.
The mother has been getting treatment for the past 30 years. She currently has both a psychologist (not me) and psychiatrist which she sees regularly.
Cheers
Tony
Posted by: Tony | Monday, 24 November 2008
I see my missing comments finally came through; that is good.
Thanks for answering them.
Posted by: Kahless | Tuesday, 25 November 2008
Lynn the Spiller had to move her blog a while back. A local reader was picked up on the site meter over there, Tony. My link in this comment goes to the new place.
Posted by: Lynn the Highway Person | Tuesday, 25 November 2008
OK Lynn,
just as long as a change of blog does not mean a change of person.
Right?
I wouldn't want the Lynn I know to go away
Graffiti
Posted by: Tony | Tuesday, 25 November 2008
Wow. This just breaks my heart, because, you see, i could be that mother...and that could be my son. :(
Posted by: tfb | Wednesday, 26 November 2008
Except that my son is a dear who has never been violent nor been expelled. He has AS and attends a private school.
Posted by: tfb | Wednesday, 26 November 2008
Thank you, {{{{Tony}}}}. That's a very sweet thing for you to say. Yes, I am still me.
Posted by: Lynn | Wednesday, 26 November 2008
thats good to know Lynn
Tony
Posted by: Tony | Wednesday, 26 November 2008
Hello tfb,
Glad you could identify with the post and I hope things with you and your son work out OK in the long run
Tony
Posted by: Tony | Wednesday, 26 November 2008
Thank you, tony. We are both in treatment and i am on meds...here's "hoping"... i appreciate your response.
Posted by: tfb | Wednesday, 26 November 2008
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