Philosophy of Mind

• Posted on November 19, 2009 at 9:43 am

Philosophy of Mind is a branch of modern analytic philosophy that studies the nature of the mind, mental events, mental functions, mental properties, consciousness and their relationship to the physical body, particularly the brain. The mind-body problem, i.e. the relationship of the mind to the body, is commonly seen as the central issue in philosophy of mind, although there are other issues concerning the nature of the mind that do not involve its relation to the physical body.

Most modern philosophers of mind adopt either a reductive or non-reductive physicalist position, maintaining in their different ways that the mind is not something separate from the body. These approaches have been particularly influential in the sciences, especially in the fields of sociobiology, computer science, evolutionary psychology and the various neurosciences. Other philosophers, however, adopt a non-physicalist position which challenges the notion that the mind is a purely physical construct. Reductive physicalists assert that all mental states and properties will eventually be explained by scientific accounts of physiological processes and states. Non-reductive physicalists argue that although the brain is all there is to the mind, the predicates and vocabulary used in mental descriptions and explanations are indispensable, and cannot be reduced to the language and lower-level explanations of physical science. Continued neuroscientific progress has helped to clarify some of these issues. However, they are far from having been resolved, and modern philosophers of mind continue to ask how the subjective qualities and the intentionality (aboutness) of mental states and properties can be explained in naturalistic terms.

Philosophy of Mind and Science

Humans are corporeal beings and, as such, they are subject to examination and description by the natural sciences. Since mental processes are intimately related to bodily processes, the descriptions that the natural sciences furnish of human beings play an important role in the philosophy of mind. There are many scientific disciplines that study processes related to the mental. The list of such sciences includes: biology, computer science, cognitive science, cybernetics, linguistics, medicine, pharmacology, and psychology.

Neurobiology

The theoretical background of biology, as is the case with modern natural sciences in general, is fundamentally materialistic. The objects of study are, in the first place, physical processes, which are considered to be the foundations of mental activity and behavior. The increasing success of biology in the explanation of mental phenomena can be seen by the absence of any empirical refutation of its fundamental presupposition: “there can be no change in the mental states of a person without a change in brain states.”

Within the field of neurobiology, there are many subdisciplines which are concerned with the relations between mental and physical states and processes: Sensory neurophysiology investigates the relation between the processes of perception and stimulation. Cognitive neuroscience studies the correlations between mental processes and neural processes. Neuropsychology describes the dependence of mental faculties on specific anatomical regions of the brain. Lastly, evolutionary biology studies the origins and development of the human nervous system and, in as much as this is the basis of the mind, also describes the ontogenetic and phylogenetic development of mental phenomena beginning from their most primitive stages.

Psychology

Psychology is the science that investigates mental states directly. It uses generally empirical methods to investigate concrete mental states like joy, fear or obsessions. Psychology investigates the laws that bind these mental states to each other or with inputs and outputs to the human organism.

An example of this is the psychology of perception. Scientists working in this field have discovered general principles of the perception of forms. A law of the psychology of forms says that objects that move in the same direction are perceived as related to each other. This law describes a relation between visual input and mental perceptual states. However, it does not suggest anything about the nature of perceptual states. The laws discovered by psychology are compatible with all the answers to the mind-body problem already described.

Philosophy of Mind in the Continental Tradition

Most of the discussion in this article has focused on one style or tradition of philosophy in modern Western culture, usually called analytic philosophy (sometimes described as Anglo-American philosophy). Many other schools of thought exist, however, which are sometimes subsumed under the broad label of continental philosophy. In any case, though topics and methods here are numerous, in relation to the philosophy of mind the various schools that fall under this label (phenomenology, existentialism, etc.) can globally be seen to differ from the analytic school in that they focus less on language and logical analysis alone but also take in other forms of understanding human existence and experience. With reference specifically to the discussion of the mind, this tends to translate into attempts to grasp the concepts of thought and perceptual experience in some sense that does not merely involve the analysis of linguistic forms.

Philosophy of Mind in the Eastern Tradition

Eastern traditions such as Buddhism and Hinduism do not hold to the dualistic mind/body model but do assert that the mind and body are separate entities. Buddhism in particular does not hold to the notion of a soul, or atman. Some forms of Buddhism assert that a very subtle level of mind leaves the body at the time of death and goes to a new life. According to Buddhist scholar Dharmakirti, the definition of mind is that which is clarity and cognizes. In this definition, ‘clarity’ refers to the nature of mind, and ‘cognizes’ to the function of mind. Mind is clarity because it always lacks form and because it possesses the actual power to perceive objects. Mind cognizes because its function is to know or perceive objects. In Ornament of the Seven Sets, Buddhist scholar Khedrubje says that thought, awareness, mind and cognizer are synonyms. Buddha explained that although mind lacks form, it can nevertheless be related to form. Thus, our mind is related to our body and is “located” at different places throughout the body. This is to be understood in the context of how the five sense consciousnesses and the mental consciousness are generated. There are many different types of mind—sense awarenesses, mental awarenesses, gross minds, subtle minds, and very subtle minds—and they are all formless (lacking shape, color, sound, smell, taste or tactile properties) and they all function to cognize or know. There is no such thing as a mind without an object known by that mind. Even though none of these minds is form, they can be related to form.

Consequences of Philosophy of Mind

There are countless subjects that are affected by the ideas developed in the philosophy of mind. Clear examples of this are the nature of death and its definitive character, the nature of emotion, of perception and of memory. Questions about what a person is and what his or her identity consists of also have much to do with the philosophy of mind. There are two subjects that, in connection with the philosophy of the mind, have aroused special attention: free will and the self.

Free Will

In the context of philosophy of mind, the problem of free will takes on renewed intensity. This is certainly the case, at least, for materialistic determinists. According to this position, natural laws completely determine the course of the material world. Mental states, and therefore the will as well, would be material states, which means human behavior and decisions would be completely determined by natural laws. Some take this reasoning a step further: people cannot determine by themselves what they want and what they do. Consequently, they are not free.

This argumentation is rejected, on the one hand, by the compatibilists. Those who adopt this position suggest that the question “Are we free?” can only be answered once we have determined what the term “free” means. The opposite of “free” is not “caused” but “compelled” or “coerced”. It is not appropriate to identify freedom with indetermination. A free act is one where the agent could have done otherwise if it had chosen otherwise. In this sense a person can be free even though determinism is true. The most important compatibilist in the history of the philosophy was David Hume. More recently, this position is defended, for example, by Daniel Dennett, and, from a dual-aspect perspective, by Max Velmans.

On the other hand, there are also many incompatibilists who reject the argument because they believe that the will is free in a stronger sense called libertarianism. These philosophers affirm the course of the world is either a) not completely determined by natural laws and deterministic natural law is broken by dualistic sentient beings, or b) determined by indeterministic natural law only, or c) determined by indeterministic natural law in line with the will of a non physical agency. Under Libertarianism, the will does not have to be deterministic and, therefore, it is potentially free. Critics of the second proposition (b) accuse the incompatibilists of using an incoherent concept of freedom. They argue as follows: if our will is not determined by anything, then we desire what we desire by pure chance. And if what we desire is purely accidental, we are not free. So if our will is not determined by anything, we are not free.

The Self

The philosophy of mind also has important consequences for the concept of self. If by “self” or “I” one refers to an essential, immutable nucleus of the person, most modern philosophers of mind will affirm that no such thing exists. The idea of a self as an immutable essential nucleus derives from the idea of an immaterial soul. Such an idea is unacceptable to most contemporary philosophers, due to their physicalistic orientations, and due to a general acceptance among philosophers of the scepticism of the concept of ’self’ by David Hume, who could never catch himself doing, thinking or feeling anything. However, in the light of empirical results from developmental psychology, developmental biology and neuroscience, the idea of an essential inconstant, material nucleus – an integrated representational system distributed over changing patterns of synaptic connections – seems reasonable. The view of the self as an illusion is widely accepted by many philosophers, such as Daniel Dennett and Thomas Metzinger.

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Borderline Personality Disorder

• Posted on July 12, 2009 at 8:06 am

Borderline Personality Disorder

What is Borderline Personality Disorder

Borderline Personality Disorder (BPD) is an often misunderstood, serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self image and behavior.  It is a disorder of emotional dysregulation. This instability often disrupts family and work, long-term planning and the individual’s sense of self-identity. While less well known than schizophrenia or bipolar disorder (manic-depressive illness), BPD is just as common, affecting between 1 – 2 percent of the general population.

The disorder, characterized by intense emotions, self-harming acts and stormy interpersonal relationships, was officially recognized in 1980 and given the name Borderline Personality Disorder. It was thought to occur on the border between psychotic and neurotic behavior.  This is no longer considered a relevant analysis and the term itself, with its stigmatizing negative associations, has made diagnosing BPD problematic. The complex symptoms of the disorder often make patients difficult to treat and therefore may evoke feelings of anger and frustration in professionals trying to help, with the result that many professionals are often unwilling to make the diagnosis or treat persons with these symptoms.  These problems have been aggravated by the lack of appropriate insurance coverage for the extended psychosocial treatments that BPD usually requires.  Nevertheless, there has been much progress and success in the past 25 years in the understanding of and specialized treatment for BPD.  It is, in fact, a diagnosis that has a lot of hope for recovery.

What are the Symptoms of Borderline Personality Disorder?

Borderline Personality Disorder Diagnosis:  DSM IV Diagnostic Criteria

A pervasive pattern of instability of interpersonal relationships, self image and affects, and marked impulsivity beginning by early adulthood ** and present in a variety of contexts, as indicated by five (or more) of the following:

1)   Frantic efforts to avoid real or imagined abandonment.

• Note:  Do not include suicidal or self-mutilating behavior*** covered in Criterion5.

2)   A pattern of unstable and intense interpersonal relationships characterized by alternating between  extremes of idealization and devaluation.

3)  Identity disturbance:  markedly and persistently unstable self-image or sense of self.

4)   Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating).

• Note:  Do not include suicidal or self-mutilating behavior*** covered in Criterion5.

5)   Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior***.

6)   Affective [mood] instability.

7)   Chronic feelings of emptiness.

8)   Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).

9)   Transient, stress-related paranoid ideation or severe dissociative symptoms.

*Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association

** Data collected informally from many families indicate this pattern of symptoms may appear as early as the pre-teens

***The preferred term is self-harm or self-injury

Important Considerations about Borderline Personality Disorder

1.   The five of nine criteria needed to diagnose the disorder may be present in a large number of different combinations. This results in the fact that the disorder often presents quite differently from one person to another, thus making accurate diagnosis somewhat confusing to a clinician not skilled in the area.

2.  BPD rarely stands alone.  There is high co-occurrence with other disorders.

3.  BPD affects between 1 – 2 percent of the population.  The highest estimation, 2 percent, approximates the number of persons diagnosed with schizophrenia and bipolar disorder.

4.   Estimates are 10 percent of outpatients and 20 percent of inpatients who present for treatment have BPD

5.  More females are diagnosed with BPD than males by a ratio of about 3-to-1, though some clinicians suspect that males are underdiagnosed.

6.   75 percent of patients self-injure.

7.   Approximately 10 percent of individuals with BPD complete suicide attempts.

8.  A chronic disorder that is resistant to change, we now know that BPD has a good prognosis when treated properly.  Such treatment usually consists of medications, psychotherapy and educational and support groups.

9.  In many patients with BPD, medications have been shown to be very helpful in reducing the severity of symptoms and enabling effective psychotherapy to occur.  Medications are also often essential in the proper treatment of disorders that commonly co-occur with BPD.

10. There are a growing number of psychotherapeutic approaches specifically developed for people with BPD. Dialectical behavioral therapy (DBT) is a relatively recent treatment, developed by Marsha Linehan, Ph.D. To date, DBT is the best-studied intervention for BPD. Find out more about DBT in NAMI’s Borderline Personality Disorder Brochure.

11. These and other treatments have been shown to be effective in the treatment of BPD, and MANY PATIENTS DO GET BETTER!

Theories of Origins and Pathology of Borderline Personality Disorder

At this point in time, clinical theorists believe that biogenetic and environmental components are both necessary for the disorder to develop.  These factors are varied and complex.  Many different environments may further contribute to the development of the disorder.  Families providing reasonably nurturing and caring environments may nevertheless see their relative develop the illness. In other situations, childhood abuse has exacerbated the condition. The best explanation appears to be that there is a confluence of environmental factors and a neurobiological propensity that leads to a sensitive, emotionally labile child.

Co-occurring Disorders

Borderline Personality Disorder rarely stands alone.  BPD occurs with, and complicates, other disorders.

Co-morbidity with other disorders:

Treatment

One of the preliminary questions confronting families/friends is how and when to place confidence in those responsible for treating the patient.  Generally speaking, the more clinical experience the treatment provider has had working with borderline patients, the better.  Most often, a good “fit” with the primary therapist is the “key” to successful therapy intervention.

A discussion of hospitalization and treatment techniques, including specialized treatment for BPD, follows:

A.  Hospitalization:  Hospitalization in the care of those with BPD is usually restricted to the management of crises (including, but not limited to, situations where the individual’s safety is at risk).   It  is not uncommon for medication changes to take place in the context of a hospital stay, where professionals can monitor the impact of new medications in a controlled environment.  Hospitalizations are usually short in duration.

B.   Medications play an important role in the comprehensive treatment of BPD.  For more on this topic, refer to the section on this website “Medications Used and Studied in the Treatment of BPD”.

C.  Psychotherapy:  Psychotherapy is the cornerstone of most treatments for Borderline Personality Disorder.  Although development of a secure attachment to the therapist is generally essential for the psychotherapy to have useful effects, this does not occur easily with the BPD diagnosed individual, given the intense needs and fears about relationships.  The standard recommendation for individual psychotherapy involves one to two visits a week with an experienced clinician.  The symptoms of the disorder can be as difficult for professionals to experience as those experienced by family members.  Some therapists are apprehensive about working with individuals with this diagnosis.

There are currently three major psychotherapeutic approaches to treatment of BPD:

  1.  Psychodynamic

  2.  Cognitive-behavioral

  3.  Supportive

D.  Group Modalities:  DBT and CBT interventions are often like classes with much focus and direction offered by the group leader(s) and with homework/practice exercises assigned between sessions based on the material presented during the session.  DBT, for example has a manual that is followed each week where both the lectures and the practice exercises are put together for easy access.  Some patients with BPD may be resistant to interpersonal or psychodynamic groups which require the expression of strong feelings or the need for personal disclosures.  However, such forums may be useful for these very reasons.  Moreover, such groups offer an opportunity for borderline patients to learn from persons with similar life experiences, which, in conjunction with the other modalities discussed here, can significantly enhance the treatment course.  Many individuals with BPD find it more acceptable to join self-help groups, such as AA.  Self-help groups that provide a network of supportive peers can be useful as an adjunct to treatment, but should not be relied on as the sole source of support.

E.  Family Therapy:  Parents, spouses and children bear a significant burden.  Often, family members are grateful to be educated about the borderline diagnosis, the likely prognosis, reasonable expectations from treatment, and how they can contribute.  These interventions often improve communication, decrease alienation, and relieve family burdens.  Some mental disorders, as in the treatment of schizophrenia, require close family involvement in the treatment process to be optimally effective.  There are now preliminary research data that suggest that family involvement is also very important in the effective treatment of borderline disorder.

Several organizations offer education programs and/or support to families challenged with mental health issues.  The National Alliance on Mental Illness (NAMI), The National Education Alliance for Borderline Personality Disorder (NEA-BPD), The Depression and Bipolar Support Association (DBSA) and the Mental Health Association(MHA) offer programs across the nation. 

Family training and support programs such as NAMI’s Family to Family  and NEA- BPD’s Family Connections  (http://www.neabpd.org/) are in great demand.  Nonetheless, too often many psychiatrists and other mental health clinicians continue to deny meaningful input from family members of a client with BPD.  This situation is especially frustrating for family members, who often provide the sole financial support for everyday living and treatment expenses, and much of the moral support, but who receive little or no response from the treating professionals.  Families are especially distressed when the treatment plan is not effective, and their loved one isolates them from their therapists.  Given the importance of the family in establishing functional relationships in the lives of people with borderline disorder, families should actively seek “family friendly” treatments and/or treatment providers and investigate family classes and support groups in their communities.

Suicidality and Self-harming Behavior

The most dangerous and fear-inducing features of BPD are the self-harm behaviors and potential for suicide.  An estimated 10 percent  kill themselves.  Deliberate self harming (cutting, burning, hitting, head banging, hair pulling) is a common feature of BPD.  Individuals who self harm report that causing themselves physical pain generates a sense of release and relief which temporarily alleviates excruciating emotional feelings.  Self-injurious acts can bring relief by stimulating production of endorphins, which are naturally occurring opiates produced by the brain in response to pain.  Some individuals with BPD also exhibit self-destructive acts such as promiscuity, bingeing, purging and blackouts from substance abuse. 

It is important for the client, family, and clinician to be able to draw a distinction between the intent behind suicide attempts and self-injurious behaviors (SIB).  Patients and researchers frequently describe self-injurious behavior as a means of reducing intense feelings of emotional pain.  The release of the endogenous opiates provides a reward to the behavior.  Some data suggest that self-injurious behavior in BPD patients doubles the risk of suicide attempts. This dichotomy of intent between these two behaviors requires careful evaluation and relevant therapy to meet the needs of the patient.

Medications Studied and Used in the Treatment of Borderline Personality Disorder

There are two reasons why medications are used in the treatment of BPD.  First, they have proven to be very helpful in stabilizing the emotional reactions, reducing impulsivity, and enhancing thinking  and reasoning abilities in people with the disorder.  Second, medications are also effective in treating the other emotional disorders that are frequently associated with borderline disorder like depression and anxiety.

The group of medications that have been studied most for the treatment of borderline disorder are neuroleptics and atypical antipsychotic agents.  At their usual doses, these medications are very effective in improving the disordered thinking, emotional responses, and behavior of people with other mental disorders, such as bipolar disorder and schizophrenia.  However, at smaller doses they are helpful in decreasing the over-reactive emotional responses and impulsivity, and in improving the abilities to think and reason for people with BPD.  Low doses of these medications often reduce depressed moods, anger, and anxiety, and decrease the severity and frequency of impulsive actions.  In addition, clients with borderline disorder report a considerable improvement in their ability to think rationally.  There’s also a reduction, or elimination of, paranoid thinking, if this is a problem.

Medications Studied and Used in the Treatment of Borderline Disorder 

is adapted from the book, “Borderline Personality Disorder Demystified ”

by Dr. Robert O. Friedel, Marlowe & Co., 2004.

Side Effects of Medications Used to Treat Borderline Personality Disorder

All medications have side effects.  Different medications produce different side effects, and people differ in the amount and severity of side effects they experience.  Side effects can often be treated by changing the dose of the medication or switching to a different medication.  Antidepressants may cause dry mouth, constipation, bladder problems, sexual problems, blurred vision, dizziness, drowsiness, skin rash, or weight gain or loss.  One class of antidepressants, the monoamine oxidase inhibitors (MAOIs) have strict food restrictions with the consequence of life threatening elevation of blood pressure. The SSRIs and newer antidepressants tend to have fewer and different side effects such as nausea, nervousness, insomnia, diarrhea, rash, agitation, sexual problems, or weight gain or loss.  Mood stabilizers could cause side effects of nausea, drowsiness, dizziness and possibly tremors.  Some require periodic blood tests to monitor liver function and blood cell count.

The group of medications that have been studied most for the treatment of borderline disorder are neuroleptics and atypical antipsychotic agents.  The neuroleptics were the first generation of medications used to treat psychotic disorders.  The atypical antipsychotics are the second generation of  medications developed to treat psychotic disorders.  A specific side-effect the neuroleptics may produce is called tardive dyskinesia.  This is an abnormal, involuntary movement disorder that typically occurs in those receiving average to large doses of neuroleptics.  The risk appears to be less with low doses of neuroleptics or the atypical antipsychotic agents.  Atypical antipsychotics and/or traditional narcoleptics could have the ability to produce weight gain, drowsiness, insomnia, breast engorgement and discomfort, lactation, and restlessness.  Some of the side-effects are temporary and others are persistent.  Before starting on a traditional neuroleptic or atypical antipsychotic, review the side-effect profile with the treating psychiatrist.

Borderline Personality Disorder Demystified by Robert O. Friedel, M.D., Marlowe & Co., 2004

National Education Alliance for Borderline Personality Disorder’s Teachers Manual for Family Connections, 2006

A BPD Brief, An Introduction to Borderline Personality Disorder by John G. Gunderson, M.D., 2006

Source: NAMI

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July Is National Minority Mental Health Month

• Posted on July 4, 2009 at 8:52 am

  In 2008 Congress declared the month of July as

• Improved access to mental health treatment and services and public awareness of mental illness are of paramount import- ance; and

An appropriate month should be recognized as Bebe Moore Campbell National Minority Mental Health Awareness Month to enhance awareness of mental illness and mental 

 Mental Illnesses

Easy-to-understand information about mental illnesses, mental health care, diagnosis, treatment and recovery.

Bipolar Disorder | Depression | PTSD | Borderline Personality Disorder | Eating Disorders | OCD
Schizophrenia | More…

NAMI Programs

NAMI’s programs and services for people whose lives have been affected by serious mental illness.

NAMI Basics | Family-to-Family | In Our Own Voice Peer-to-Peer | NAMI Connection | Hearts & Minds Parents and Teachers as Allies | Provider Education

Support 

Find a support group, connect online in NAMI’s discussion groups, contact your state or local NAMI and more.

Child/Teen | Discussion Groups | Multicultural
State/Local | Consumers | NAMI FaithNet
Missing Persons | Veterans | NAMI On Campus

Inform Yourself

Inform yourself about medication, treatment, recovery, public policy, research, mental health care issues and more.

Medication and Treatment | Policy Topics
Recovery | Medicare Part D | Public Policy
Research | Events

 ______________________________________________________________________________

NAMI Videos

NAMI’s education program videos, PSA and other videos that address wellness, mental illness, education and recovery.

Peer Run Services Playing Pivotal Roles in Promoting Health, Recovery

Judi Chamberlin’s seminal 1978 book about:

•  Sharing, validating and normalizing similar experiences

•  Building empathy, sharing opportunities for connection and knowledge

•  Building honest mutually responsible relationships

•  Based on the intention to change patterns and get unstuck

•  Full respect for each person? unique process of change

Willingness to challenge each other

Peer support offers people an alternative to traditional treat-ment relationships peers have often found pathologizing, distanc-ing and alienating, judgemental and/or artificial, culturally un-aware and/or insensitive, controlling and/or rescuing, infantilizing and disempowering.

Too often, people’s… story, is defined and mirrored back by our system as “snapshot of me at my worst moment” and one that nei-ther promotes hope, dignity and full citizenship or healing and spirituality.

Peer support has been seen as a different way of forming rela-tionships and sharing power. It offers a new way of thinking about help and helping that is open to new ways of thinking about our experiences and ourselves. In peer support, we teach and learn from each other, we challenge our status quo and move towards what we want, in an atmosphere of full respect for the individual process of change.

At its purest, peer support is about the quality and integrity of relationship, often unconnected with service models. Peer support values do, however, drive the nature of peer-run services like:

Peer Drop-in centers: a safe haven for peers to combat isolation and loneliness, meet others and participate in social, educa-tional and vocational activities.

Peer Crisis Diversion services: warm, home-like environments where peers can learn to manage stress and find compassion and understanding from a trained peer staff, as well as learn new skills to cope and prevent relapse, such as Mary Ellen Copeland’s Wellness Recovery Action Planning (WRAP).

• Peer Advocacy services: Helps peers become more aware of men-tal health policies and issues, and encourages them to become more involved in planning and delivering mental health ser-vices and developing mental health policy.

• Peer Employment supports: Helps peers obtain and keep jobs.

• Peer Bridger services: Helps ease the transition from the hospital into community life and to significantly decrease people?s need for readmission.

• Peers are poised to play yet another major role in emerging new responses to help those with complex medical, mental health and substance abuse conditions.

• Peer services are an approach whose time has surely come, whether it be to promote recovery, empowerment and employment or to provide timely interventions to help people avoid crisis and improve their health and wellness!

 Source:  Mental Health News, Summer 2009 Mental Health News, Summer 2009  

Depression Gene? Maybe Not, Study Shows Gene Has No Effect on Major Depression 

New research dismisses the widely held notion that a “depression gene” makes a person facing stressful life events more likely to develop depression.

WebMD Health News, June 16, 2009  

In 2003, mental health researchers announced that a genetic variation that affected the body’s serotonin levels increased a per-son’s risk for major depression if they endured several emotional events. Yet efforts to repeat and confirm that study’s findings have been inconsistent, according to the National Institute of Mental Health.

The research team went back over data from 14 studies from 2003 through 2009 and analyzed the data collectively. Among the 14,250 patients in the studies, 1,769 had depression; 12,481 did not.

The analysis showed a strong association between depression and stressful life events across all the studies, confirming earlier research. However, the team could not find a link between the serotonin transporter gene and major depression. They also found no association between the gene and stressful life events on de-pression risk.

The scientists say their findings show why it is so important to confirm results that reveal any type of genetic association for a disease.

“A more serious concern … is that the findings of this [earlier 2003 study] and other nonreplicated genetic associations are now being translated to a range of clinical, legal, research, and social settings such as forensics, diagnostic testing, study participants, and the general public,” writes Neil Risch, PhD, of the University of California at San Francisco, and colleagues. “It is critical that health practitioners and scientists in other disciplines recognize the importance of replication of such findings before they can serve as valid indicators of disease risk.”

If you think you might have depression, seek medical help. There are a number of different treatment options available to make you feel better. Depression is different for everyone. In gen-eral, symptoms can include:

• Persistent feelings of sadness, anxiousness, restlessness, and/or irritability

• Feeling hopeless

• Feelings of guilt, worthlessness, and helplessness

• Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex

• Fatigue, feeling “slowed down,” or decreased energy

• Difficulty concentrating, remembering, and making decisions

• Sleeping troubles, including insomnia, waking up too early or sleeping too much

• Changes in appetite, which can lead to weight loss or weight gain

• Thoughts of death or suicide; suicide attempts (Seek help right away if this happens.)

• Physical symptoms that do not go away or get better with treatment, such as headaches, stomach problems, and chronic pain .

Source: WebMD Health News, June 16, 2009

Source: NAMI

The Long-Term Consequences of Child Abuse and Neglect

• Posted on June 26, 2009 at 5:14 pm

Long-Term Consequences of Child Abuse and Neglect

          An estimated 905,000 children were victims of child abuse or neglect in 2006 (U.S. Department of Health and Human Services, 2008). While physical injuries may or may not be immediately visible, abuse and neglect can have consequences for children, families, and society that last lifetimes, if not generations.

In reality, however, it is impossible to separate them completely. Physical consequences, such as damage to a child’s growing brain, can have psychological implications such as cognitive delays or emotional difficulties. Psychological problems often manifest as high-risk behaviors. Depression and anxiety, for example, may make a person more likely to smoke, abuse alcohol or illicit drugs, or overeat. High-risk behaviors, in turn, can lead to long-term physical health problems such as sexually transmitted diseases, cancer, and obesity.  

          This factsheet provides an overview of some of the most common physical, psychological, behavioral, and societal consequences of child abuse and neglect, while acknowledging that much crossover among categories exists:

• Factors Affecting the Consequences of Child Abuse and Neglect
• Physical Health Consequences
• Psychological Consequences
• Behavioral Consequences
• Societal Consequences
• Summary
• References

  The Federal Government has made a considerable investment in research regarding the causes and long-term consequences of child abuse and neglect. These efforts are ongoing; for more information, visit the websites listed below:  

LONGSCAN (Longitudinal Studies of Child Abuse and Neglect) is a consortium of longitudinal research studies on the causes and impact of child abuse and neglect, initiated in 1990 with grants from the National Center on Child Abuse and Neglect. The size and diversity of the sample (1,354 children from five distinct geographical areas) enables LONGSCAN to examine the relative impact of various forms of maltreatment, alone and in combination. LONGSCAN studies also evaluate the effectiveness of child protection and child welfare services.  

NSCAW (The National Survey of Child and Adolescent Well-Being) is a project of the Administration on Children, Youth and Families to describe the child welfare system and the experiences of children and families who come in contact with the system. Its 2005 report provides a snapshot of the functioning and the potential service needs of children and families soon after a child protective services investigation has taken place. NSCAW will continue to follow the life course of these children to gather data about services received during subsequent periods, measures of child well-being, and longer-term results for the study population. This information will provide a clearer understanding of life outcomes for children and families who come into contact with the child welfare system.     Factors Affecting the Consequences of Child Abuse and Neglect   Not all abused and neglected children will experience long-term consequences. Outcomes of individual cases vary widely and are affected by a combination of factors, including:

• The child’s age and developmental status when the abuse or neglect occurred
• The type of abuse (physical abuse, neglect, sexual abuse, etc.)
• The frequency, duration, and severity of abuse
• The relationship between the victim and his or her abuser (English et al., 2005; Chalk, Gibbons, & Scarupa, 2002)

  Researchers also have begun to explore why, given similar conditions, some children experience long-term consequences of abuse and neglect while others emerge relatively unscathed. The ability to cope, and even thrive, following a negative experience is sometimes referred to as “resilience.” A number of protective and promotive factors may contribute to an abused or neglected child’s resilience. These include individual characteristics, such as optimism, self-esteem, intelligence, creativity, humor, and independence, as well as the acceptance of peers and positive individual influences such as teachers, mentors, and role models. Other factors can include the child’s social environment and the family’s access to social supports. Community well-being, including neighborhood stability and access to safe schools and adequate health care, are other protective and promotive factors (Fraser & Terzian, 2005).  

Physical Health Consequences  

The immediate physical effects of abuse or neglect can be relatively minor (bruises or cuts) or severe (broken bones, hemorrhage, or even death). In some cases the physical effects are temporary; however, the pain and suffering they cause a child should not be discounted. Meanwhile, the long-term impact of child abuse and neglect on physical health is just beginning to be explored. According to the National Survey of Child and Adolescent Well-Being (NSCAW), more than one-quarter of children who had been in foster care for longer than 12 months had some lasting or recurring health problem (Administration for Children and Families, Office of Planning, Research, and Evaluation [ACF/OPRE], 2004a). Below are some outcomes researchers have identified:  

Shaken baby syndrome. Shaking a baby is a common form of child abuse. The injuries caused by shaking a baby may not be immediately noticeable and may include bleeding in the eye or brain, damage to the spinal cord and neck, and rib or bone fractures (National Institute of Neurological Disorders and Stroke, 2007).  

Impaired brain development. Child abuse and neglect have been shown, in some cases, to cause important regions of the brain to fail to form or grow properly, resulting in impaired development (De Bellis & Thomas, 2003). These alterations in brain maturation have long-term consequences for cognitive, language, and academic abilities (Watts-English, Fortson, Gibler, Hooper, & De Bellis, 2006). NSCAW found more than three-quarters of foster children between 1 and 2 years of age to be at medium to high risk for problems with brain development, as opposed to less than half of children in a control sample (ACF/OPRE, 2004a).  

Poor physical health. Several studies have shown a relationship between various forms of household dysfunction (including childhood abuse) and poor health (Flaherty et al., 2006; Felitti, 2002). Adults who experienced abuse or neglect during childhood are more likely to suffer from physical ailments such as allergies, arthritis, asthma, bronchitis, high blood pressure, and ulcers (Springer, Sheridan, Kuo, & Carnes, 2007).    

Psychological Consequences  

The immediate emotional effects of abuse and neglect—isolation, fear, and an inability to trust—can translate into lifelong consequences, including low self-esteem, depression, and relationship difficulties. Researchers have identified links between child abuse and neglect and the following:  

Difficulties during infancy. Depression and withdrawal symptoms were common among children as young as 3 who experienced emotional, physical, or environmental neglect. (Dubowitz, Papas, Black, & Starr, 2002).  

 Poor mental and emotional health. In one long-term study, as many as 80 percent of young adults who had been abused met the diagnostic criteria for at least one psychiatric disorder at age 21. These young adults exhibited many problems, including depression, anxiety, eating disorders, and suicide attempts (Silverman, Reinherz, & Giaconia, 1996). Other psychological and emotional conditions associated with abuse and neglect include panic disorder, dissociative disorders, attention-deficit/hyperactivity disorder, depression, anger, posttraumatic stress disorder, and reactive attachment disorder (Teicher, 2000; De Bellis & Thomas, 2003; Springer, Sheridan, Kuo, & Carnes, 2007).  

Cognitive difficulties. NSCAW found that children placed in out-of-home care due to abuse or neglect tended to score lower than the general population on measures of cognitive capacity, language development, and academic achievement (U.S. Department of Health and Human Services, 2003). A 1999 LONGSCAN study also found a relationship between substantiated child maltreatment and poor academic performance and classroom functioning for school-age children (Zolotor, Kotch, Dufort, Winsor, & Catellier, 1999).  

Social difficulties. Children who experience rejection or neglect are more likely to develop antisocial traits as they grow up. Parental neglect is also associated with borderline personality disorders and violent behavior (Schore, 2003).

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Behavioral Consequences   Not all victims of child abuse and neglect will experience behavioral consequences. However, behavioral problems appear to be more likely among this group, even at a young age. An NSCAW survey of children ages 3 to 5 in foster care found these children displayed clinical or borderline levels of behavioral problems at a rate of more than twice that of the general population (ACF, 2004b). Later in life, child abuse and neglect appear to make the following more likely:  

Difficulties during adolescence. Studies have found abused and neglected children to be at least 25 percent more likely to experience problems such as delinquency, teen pregnancy, low academic achievement, drug use, and mental health problems (Kelley, Thornberry, & Smith, 1997). Other studies suggest that abused or neglected children are more likely to engage in sexual risk-taking as they reach adolescence, thereby increasing their chances of contracting a sexually transmitted disease (Johnson, Rew, & Sternglanz, 2006).  

Juvenile delinquency and adult criminality. According to a National Institute of Justice study, abused and neglected children were 11 times more likely to be arrested for criminal behavior as a juvenile, 2.7 times more likely to be arrested for violent and criminal behavior as an adult, and 3.1 times more likely to be arrested for one of many forms of violent crime (juvenile or adult) (English, Widom, & Brandford, 2004).

Alcohol and other drug abuse. Research consistently reflects an increased likelihood that abused and neglected children will smoke cigarettes, abuse alcohol, or take illicit drugs during their lifetime (Dube et al., 2001). According to a report from the National Institute on Drug Abuse, as many as two-thirds of people in drug treatment programs reported being abused as children (Swan, 1998).  

Abusive behavior. Abusive parents often have experienced abuse during their own childhoods. It is estimated approximately one-third of abused and neglected children will eventually victimize their own children (Prevent Child Abuse New York, 2003).    

Societal Consequences  

While child abuse and neglect almost always occur within the family, the impact does not end there. Society as a whole pays a price for child abuse and neglect, in terms of both direct and indirect costs.  

Direct costs. Direct costs include those associated with maintaining a child welfare system to investigate and respond to allegations of child abuse and neglect, as well as expenditures by the judicial, law enforcement, health, and mental health systems. A 2001 report by Prevent Child Abuse America estimates these costs at $24 billion per year.    

Indirect costs. Indirect costs represent the long-term economic consequences of child abuse and neglect. These include costs associated with juvenile and adult criminal activity, mental illness, substance abuse, and domestic violence. They can also include loss of productivity due to unemployment and underemployment, the cost of special education services, and increased use of the health care system. Prevent Child Abuse America estimated these costs at more than $69 billion per year (2001).                          

Summary

Much research has been done about the possible consequences of child abuse and neglect. The effects vary depending on the circumstances of the abuse or neglect, personal characteristics of the child, and the child’s environment. Consequences may be mild or severe; disappear after a short period or last a lifetime; and affect the child physically, psychologically, behaviorally, or in some combination of all three ways. Ultimately, due to related costs to public entities such as the health care, human services, and educational systems, abuse and neglect impact not just the child and family, but society as a whole.

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Resources Provided by the Child Welfare Information Gateway or www.childwelfare.gov

Child Abuse and Neglect http://www.childwelfare.gov/can/  

Defining Child Abuse and Neglect http://www.childwelfare.gov/can/defining/  

Preventing Child Abuse and Neglect http://www.childwelfare.gov/preventing/  

Reporting Child Abuse and Neglect http://www.childwelfare.gov/responding/reporting.cfm      

Resource Guide for Women’s Mental Health

The impact of child abuse and neglect is often discussed in terms of physical, psychological, behavioral, and societal consequences.

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Sources:

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