Frozen Watchfulness

I am dysphasic when looking for some right words to use at the right time. This evening I was looking for the word, ‘frozen watchfulness’ while teaching on special character or marker of children with physical abuse. It simply means a situation in which the child is extremely tense, hypervigilent and watchful of the adult’s every move and expression.

This term was first described by Ounsted at. al. (1974) to describe symptoms like lack of initiative, hypervigilance and pseudoadult behavior where basic trust and secure environment have not been established.

Older children may become extremely passive and withdrawn, show little initiative, avoid attracting attention to themselves and typically do not act until they are fairly certain of the adult reaction. The child may become hypervigilant, acutely sensitive to adult mood changes and concentrate all resources on his or her caregivers in order to please them and avoid further harm.

Since abuse children are only appreciated when they meet adult needs, they only take on pseudoadult behaviors. In other word, they tend to become too matured, role-playing as the adult in order to please those who abuse them.

Because so much have been invested emotionally in this relationship and also because to do so may be hazardous, the child play little, does not explore the environment and does not develop peer relationship outside the family.

It is difficult to demonstrate clinically how it looks like but those who have seen these children would remember for life.

In a condition called reactive attachment disorder when the abused child minimally turn to their mum or attachment figure for comfort, support, protection and nurturance, frozen watchfulness is one of the signs to watch for. It does happen in foster-care, abuse children even at home with foreign maids as well as traumatized victim of natural disaster and war.

I am lucky to use information technology to correct my dysphasia or may be I’m too ancient to show off my talent in teaching as the correct word did not deliver at the correct time.

Not Too Late To Save ‘Normal’

The new module for diagnosing mental illness, DSM-V has reach its final stage i.e for public viewing vis-a-vis scrutinizing. Here is the comment from chairman of the DSM-IV task force, Prof Allen Frances.

As chairman of the task force that created the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which came out in 1994, I learned from painful experience how small changes in the definition of mental disorders can create huge, unintended consequences.

Our panel tried hard to be conservative and careful but inadvertently contributed to three false “epidemics” – attention deficit disorder, autism and childhood bipolar disorder. Clearly, our net was cast too wide and captured many “patients” who might have been far better off never entering the mental health system.

The first draft of the next edition of the DSM, posted for comment with much fanfare last month, is filled with suggestions that would multiply our mistakes and extend the reach of psychiatry dramatically deeper into the ever-shrinking domain of the normal. This wholesale medical imperialization of normality could potentially create tens of millions of innocent bystanders who would be mislabeled as having a mental disorder. The pharmaceutical industry would have a field day – despite the lack of solid evidence of any effective treatments for these newly proposed diagnoses.

The manual, prepared by the American Psychiatric Association, is psychiatry’s only official way of deciding who has a “mental disorder” and who is “normal.” The quotes are necessary because this distinction is very hard to make at the fuzzy boundary between the two. If requirements for diagnosing a mental disorder are too stringent, some who need help will be left out; but if they are too loose, normal people will receive unnecessary, expensive and sometimes quite harmful treatment.

Where the DSM-versus-normality boundary is drawn also influences insurance coverage, eligibility for disability and services, and legal status – to say nothing of stigma and the individual’s sense of personal control and responsibility.

What are some of the most egregious invasions of normality suggested for DSM-V? “Binge eating disorder” is defined as one eating binge per week for three months. (Full disclosure: I, along with more than 6% of the population, would qualify.) “Minor neurocognitive disorder” would capture many people with no more than the expected memory problems of aging. Grieving after the loss of a loved one could frequently be misread as “major depression.” “Mixed anxiety depression” is defined by commonplace symptoms difficult to distinguish from the emotional pains of everyday life.

The recklessly expansive suggestions go on and on. “Attention deficit disorder” would become much more prevalent in adults, encouraging the already rampant use of stimulants for performance enhancement. The “psychosis risk syndrome” would use the presence of strange thinking to predict who would later have a full-blown psychotic episode. But the prediction would be wrong at least three or four times for every time it is correct-and many misidentified teenagers would receive medications that can cause enormous weight gain, diabetes and shortened life expectancy.

A new category for temper problems could wind up capturing kids with normal tantrums. “Autistic spectrum disorder” probably would expand to encompass every eccentricity. Binge drinkers would be labeled addicts and “behavioral addiction” would be recognized. (If we have “pathological gambling,” can addiction to the Internet be far behind?)

The sexual disorders section is particularly adventurous. “Hypersexuality disorder” would bring great comfort to philanderers wishing to hide the motivation for their exploits behind a psychiatric excuse. “Paraphilic coercive disorder” introduces the novel and dangerous idea that rapists merit a diagnosis of mental disorder if they get special sexual excitement from raping.

Defining the elusive line between mental disorder and normality is not simply a scientific question that can be left in the hands of the experts. The scientific literature is usually limited, never easy to generalize to the real world and always subject to differing interpretations.

Experts have an almost universal tendency to expand their own favorite disorders: Not, as alleged, because of conflicts of interest-for example, to help drug companies, create new customers or increase research funding-but rather from a genuine desire to avoid missing suitable patients who might benefit. Unfortunately, this therapeutic zeal creates an enormous blind spot to the great risks that come with overdiagnosis and unnecessary treatment.

This is a societal issue that transcends psychiatry. It is not too late to save normality from DSM-V if the greater public interest is factored into the necessary risk/benefit analyses.

Allen Frances is professor emeritus and former chairman of the department of psychiatry at Duke University. He wrote this for the Los Angeles Times. (c) 2010, Los Angeles Times. Distributed by McClatchy-Tribune Information Services.

A Man Will Forever Be A Man

My wife and I were talking to our son on the need to organize. Indeed, that was the gist of my talk to Master students last week. I had to present him a diary in order to familiarize him to self-organization and multi-tasking. But then why my daughter is quite different? That questions popped up suddenly in my head. Perhaps one size does not fit all. Individuals differ.

Genetic diversity? Well, they are from the same parents. Culture and experience? More or less the same. But my daughter went to a religious school. May be, somehow, religious school shapes the student differently. I guess, I have no complaint about character building since religious schools are doing a very good job. Minor complaint lies with relatively less sociability and poor communication skill in a small number of students.

I have complimented my son on some good characters that he has and he has been reminded that our comments are made for improvement, not just a dire criticism to kill his creativity and initiative. After all, raising children is a duty to be accomplished during our life time as a parent.

The question that I have next in mind is what is he going to do with the diary, since he never write any notes in any diary. They are all in his head.

After all he is a man and will forever be a man.

Are We the Victim of Israelis Propaganda?

Last night, CNN aired an exclusive interview with Mosab Hasan Yousef, the son of one of the founder of Hamas, who had published a book entitled “Son of Hamas”. This interview has turned out to be a big propaganda for Israel by attacking ‘the God for Muslim’, ‘the ideology’, ‘Quran” and the just cause of killing ‘targeted terrorist’ (as proclaimed by Shen Bet: Israel Intelligent agency). At the same time Hamas was accused of killing civilian and Islam as an ideology was accused by Mosab as influencing his dad, Hamas and Muslim in general for going against rational thinking, humanity, love and dignity.

This revelation comes in time when Mossad (Israel Foreign Intelligence service) was accused taking part in the murder of the senior Hamas leader, Mahmoud al Mabhouh, on January 19. 11 suspects were found to use British, Irish, French and German passports which are fake and they all bore fake identities. The victim, was a founder of Hamas’s military wing, the Ezzedeen al Qassam Brigades. He was wanted by the Israeli government in connection with the kidnappings of two Israeli soldiers in 1989.

No doubt that Hamas and Israel are at war. But by attacking the God of 1.4 billion people is too much. The way the propaganda was aired seem to be just synonymous with Islamophobic propaganda. My intellect makes me slowly and gradually believe what has been said over and over again that Zionist is behind most of the tragedy in this world. Don’t forget what is happening to thousand of children who suffered from chemical weapon in Gaza and that was confirmed from BBC report a few days ago. These children are basically living in dilapidated camp, without proper amenities which I think, a place like hell on earth!

Finally, I believe, those who study journalism will clearly see motive behind the airing of Mosab’s disclosure. It is a kind of counter-attack and damage control strategy. It is more efficient to use your own people to attack you compared to the outsiders. The trick is obvious, guys.