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Dr. Robert, 

I have trouble focusing on the particulars of getting better. I smoke every night with my friends, yet complain (to myself) about being unproductive. I'm a 19 year-old gay male living in southern CA. My psychiatrist says I don't need anxiety or add medication, but i find my mind traveling 100 different places at much too fast of a speed. I can't do anything I want to do, or at least anything I tell myself to do.

I am on cymbalta, lamictol, and gabapentin. I want to do many things with my life, and those around me keep telling me I am so talented and intelligent that I could do almost anything. Yet, I do nothing. I don't want to be on medication, and I am contemplating getting away-- Joining the peace corps, getting a new perspective on life in hopes of changing the course of my thoughts (detrimental). I want to be a worldly wise person. I'm always searching to be that better person, and I take pride in that, but at the same time it hinders my ability to get better-- i think. thats my dad in me, never good enough. my psychologist has outlined it all... but nothing has gotten to the core of me. I am lost and cornered, and (I feel) border-line psychotic. I'm a constant analyzer, and can't seem to keep friends around. I have trouble with relationships in general. I'm afraid I might be insane, and I can't accept that.

Thank you for your time. I appreciate what you are doing,


ask dr-robert


Thanks for writing. In my opinion you may already be overmedicated, so your desire to get off the drugs makes good common sense. Unfortunately, many, if not most, psychiatrists attempt to treat problems such as yours with drugs alone—without any real, ongoing, person-to-person communication, I mean--and that is always, in my view, a mistake, if not tantamount to malpractice. Not so long ago, psychiatrists spoke at length with their patients in order to understand the lives of the people they treated, and they conducted regular sessions of psychotherapy aimed at providing psychological support, healing counterproductive ideas and attitudes, and getting to the roots of emotional difficulties. Now this form of treatment has largely changed into prescription writing (which is much more profitable, and much less work), so that the majority of psychiatrists spend only a few minutes with a patient, write a script, charge as much or more as they used to do for an hour of real therapy, and send the troubled person out the office door in no better frame of mind than when he or she arrived. In my view, this is a sad state of affairs which I do not support. In fact, now that psychiatry has largely transformed itself into medication management, not psychological treatment, I recommend that troubled people seek help first from a psychologist, not a psychiatrist. If medication is advisable, the psychologist will then refer the patient to a competent psychiatrist for that part of the treatment, while continuing to provide the support, understanding, and wise counsel which should be the bedrock and principal component of any mental health therapy.

ask dr-robert

Judging from your letter to me, you need wise counseling and effective psychotherapy, not further medication. In fact, I imagine that a good therapist would be able to help you reduce the amount of meds you now use, and perhaps, in time, to eliminate them completely. In any case, in my opinion, medication for depression should never, never, never be prescribed without accompanying regularly scheduled hours of psychotherapy.

I understand your desire to join the Peace Corps so as to run away from your current situation, and perhaps to find a new basis for living, but I imagine that now is not the time for that. Try the psychotherapy for a while first, at least until you feel more focused, and calmer, and until you are not so dependent on medication. Then you will know what to do next.

Your analysis regarding your dad, and "never good enough," makes sense too. The New York Times recently published a useful piece on how parental approval and disapproval can set children up for later problems which might require psychotherapy to heal. I will attach this below.

If possible, you should refrain for a while from the marijuana smoking. While smoking pot might be good for some people at some times, it is not the right medicine for a person who finds his mind "traveling 100 different places at much too fast of a speed." Marijuana will only amplify that kind of outlook, and should, in my experience, be avoided by anyone who has trouble being happily grounded in ordinary consciousness. I want to emphasize that I say this without moral judgment and with none of the knee-jerk, blanket disapproval of psychedelic experiences trumpeted by the "just say no" idiots. In fact, I think marijuana (and stronger psychedelic substances also) can, as they have since prehistoric times, occupy a useful place in the human experience, but such mind-altering medicines must be used at the right time, in the right way, by a person in the right frame of mind. Otherwise they can be harmful, or even dangerous.

Be well.

ask dr-robert

New York Times

September 15, 2009

When a Parent’s ‘I Love You’ Means ‘Do as I Say’


More than 50 years ago, the psychologist Carl Rogers suggested that simply loving our children wasn’t enough. We have to love them unconditionally, he said — for who they are, not for what they do.

As a father, I know this is a tall order, but it becomes even more challenging now that so much of the advice we are given amounts to exactly the opposite. In effect, we’re given tips in conditional parenting, which comes in two flavors: turn up the affection when they’re good, withhold affection when they’re not.

Thus, the talk show host Phil McGraw tells us in his book “Family First” (Free Press, 2004) that what children need or enjoy should be offered contingently, turned into rewards to be doled out or withheld so they “behave according to your wishes.” And “one of the most powerful currencies for a child,” he adds, “is the parents’ acceptance and approval.”

Likewise, Jo Frost of “Supernanny,” in her book of the same name (Hyperion, 2005), says, “The best rewards are attention, praise and love,” and these should be held back “when the child behaves badly until she says she is sorry,” at which point the love is turned back on.

Conditional parenting isn’t limited to old-school authoritarians. Some people who wouldn’t dream of spanking choose instead to discipline their young children by forcibly isolating them, a tactic we prefer to call “time out.” Conversely, “positive reinforcement” teaches children that they are loved, and lovable, only when they do whatever we decide is a “good job.”

This raises the intriguing possibility that the problem with praise isn’t that it is done the wrong way — or handed out too easily, as social conservatives insist. Rather, it might be just another method of control, analogous to punishment. The primary message of all types of conditional parenting is that children must earn a parent’s love. A steady diet of that, Rogers warned, and children might eventually need a therapist to provide the unconditional acceptance they didn’t get when it counted.

But was Rogers right? Before we toss out mainstream discipline, it would be nice to have some evidence. And now we do.

In 2004, two Israeli researchers, Avi Assor and Guy Roth, joined Edward L. Deci, a leading American expert on the psychology of motivation, in asking more than 100 college students whether the love they had received from their parents had seemed to depend on whether they had succeeded in school, practiced hard for sports, been considerate toward others or suppressed emotions like anger and fear.

It turned out that children who received conditional approval were indeed somewhat more likely to act as the parent wanted. But compliance came at a steep price. First, these children tended to resent and dislike their parents. Second, they were apt to say that the way they acted was often due more to a “strong internal pressure” than to “a real sense of choice.” Moreover, their happiness after succeeding at something was usually short-lived, and they often felt guilty or ashamed.

In a companion study, Dr. Assor and his colleagues interviewed mothers of grown children. With this generation, too, conditional parenting proved damaging. Those mothers who, as children, sensed that they were loved only when they lived up to their parents’ expectations now felt less worthy as adults. Yet despite the negative effects, these mothers were more likely to use conditional affection with their own children.

This July, the same researchers, now joined by two of Dr. Deci’s colleagues at the University of Rochester, published two replications and extensions of the 2004 study. This time the subjects were ninth graders, and this time giving more approval when children did what parents wanted was carefully distinguished from giving less when they did not.

The studies found that both positive and negative conditional parenting were harmful, but in slightly different ways. The positive kind sometimes succeeded in getting children to work harder on academic tasks, but at the cost of unhealthy feelings of “internal compulsion.” Negative conditional parenting didn’t even work in the short run; it just increased the teenagers’ negative feelings about their parents.

What these and other studies tell us, if we’re able to hear the news, is that praising children for doing something right isn’t a meaningful alternative to pulling back or punishing when they do something wrong. Both are examples of conditional parenting, and both are counterproductive.

The child psychologist Bruno Bettelheim, who readily acknowledged that the version of negative conditional parenting known as time-out can cause “deep feelings of anxiety,” nevertheless endorsed it for that very reason. “When our words are not enough,” he said, “the threat of the withdrawal of our love and affection is the only sound method to impress on him that he had better conform to our request.”

But the data suggest that love withdrawal isn’t particularly effective at getting compliance, much less at promoting moral development. Even if we did succeed in making children obey us, though — say, by using positive reinforcement — is obedience worth the possible long-term psychological harm? Should parental love be used as a tool for controlling children?

Deeper issues also underlie a different sort of criticism. Albert Bandura, the father of the branch of psychology known as social learning theory, declared that unconditional love “would make children directionless and quite unlovable” — an assertion entirely unsupported by empirical studies. The idea that children accepted for who they are would lack direction or appeal is most informative for what it tells us about the dark view of human nature held by those who issue such warnings.

In practice, according to an impressive collection of data by Dr. Deci and others, unconditional acceptance by parents as well as teachers should be accompanied by “autonomy support”: explaining reasons for requests, maximizing opportunities for the child to participate in making decisions, being encouraging without manipulating, and actively imagining how things look from the child’s point of view.

The last of these features is important with respect to unconditional parenting itself. Most of us would protest that of course we love our children without any strings attached. But what counts is how things look from the perspective of the children — whether they feel just as loved when they mess up or fall short.

Rogers didn’t say so, but I’ll bet he would have been glad to see less demand for skillful therapists if that meant more people were growing into adulthood having already felt unconditionally accepted.

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