Free the Child!

Recently I visited a lovely open farm in rural East Anglia. During a brief interlude (a pee-break) I was standing there minding my own business, when I overheard the following conversation:

Boy, around 7/8 years old: "Dad, why didn't you feed the Alpacas too?"

Dad (disparagingly) "That's a children's activity!"

Boy: " (pauses)..... Mum fed the Alpacas......"

Dad: "Wash your hands."

For a long time, therapists have described people has having a young child within them. Of course every 'flavour' of therapist has their own way of describing this psychic structure, whether conscious or unconscious. But it turns up in therapeutic situations time after time, when someone experiences that familiar inner conflict between their natural spontaneous desires and the conditioning of the environment.

In Transactional Analysis, it's commonly described as the conflict between the Free (or Natural) Child ego state and the Adapted Child. The Natural Child is capable of uninhibited acts of joy (or aything else for that matter), and is spontaneous, creative, and free. The Adapted Child (as the name suggests) has learned what "works" in his/her environment - I can get good feedback for behaving like this.... and people don't love me if I do this.....

So begins a process where kids learn how to behave... and as grown-ups they find themselves holding back from certain acts of spontaneity.

The most obvious forms of parental shaping of the child in this context, then, are the positive reinforcement of 'acceptable' behaviours and the sanctions against unacceptable ones. The Adaptation takes place in the context of good or bad feedback.

When I overheard the conversation above, my heart sank. It reminded me how important it is for kids to be given Permission to have (and keep) their Natural Child. Otherwise, they risk becoming inhibited, too grown-up, and maybe unfulfilled in all kinds of ways.... in their work, in their relationships, in the bedroom, and elsewhere.

I realise now that I like working in this area. I often find myself asking people to consider their Natural Child needs, and inviting them to give themselves Permission if they need it. On other occasions, I have found myself offering it - usually in some irreverent comment, or playful act. (I remember once climbing up and standing on my desk, Dead Poets-style!).

When I heard that Dad speak, I would really have liked to have appealed to the Child in him - perhaps through humour - and invited him to go and PLAY with his kid. What a valuable Permission he would have been offering! One that he most likely lacked himself, of course....

Something in the air......

I was interested to read, after my cynical musings last time, that I'm not the only one to be asking who is making money from the DSM-5. Crazy thought it may sound, it seems that a large proportion of the DSM team have ties with drug companies. As they say - go figure.

I'm rather happy to see that there is a growing number of individuals, groups, and organizations who are rallying to show their opposition to DSM-x, on ethical, moral and political grounds. They range from the satirical: Here, on a page called DSMSucks! there is even a link to a "new psychiatric disease generator" which is funny and has a point ...

... to the serious call-to-arms of an 'occupy' movement who are planning a protest at the APA meeting in May. It has obvious echoes to a similar protest in September, 1969.

One of the root traditions of Transactional Analysis is that of Radical Psychiatry - a movement which sought a move away from diagnostic labelling, with all its interpersonal, societal and political implications, and back to the practice of 'soul healing'. This wasn't a 60's love-in... it was a move against the rise of Big Psych, one of Big Pharma's older cousins.

These days, the arguments are familiar and just as relevant. People are being labelled, and they shouldn't be. People are making money and gaining power over others because of this. The process is mystified so the power dynamics are camouflaged. People are alienated - from themselves, each other, the medical establishment, and from any feeling of what's normal and human.

"Call out the instigators, because there's something in the air
We've got to get together, sooner or later, because the revolution's near
.... and you know it's right" (Thunderclap Newman)

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DSM 5 - it's all medicalized now

One vocal critic of the DSM-5 bereavement issue is Allen Frances, MD. He has been blogging for some time that the 'mission creep' of the DSM has slipped out of control.
He speaks from experience, as a member of the task force that worked on DSM-IV.

So, why the 'mission creep'? How come the DSM's land-grab in the world of psychic difficulty has extended so far? Here in the UK I would expect the average Daily Mail reader to voice the (reasonable) suspicion that 'someone somewhere is making money out of it'. Perhaps - after all, the production, publishing, and distribution of the DSM is a high-value business. Most successful businesses need to update their stock from time to time - keep the customers interested. Offer a 'new, improved' version of the old product, and suddenly you have a new revenue stream.... for the APA - and oh, lest we forget - for the drug companies who will no doubt profit hugely from the new avenues of prescribing that are offered.

But I don't think for a second that it's just about the money. I think it's also about power and control. In the face of human suffering or distress, the medical model usually responds with an effort to contain or remove it.... diagnose, treat, cure. One could see this as a way of defending against the (more difficult?) reality that life is tough, and sometimes awful, and not always can we do anything about it. As existential psychotherapist Irvin Yalom said, "the medical model is a wafer-thin barrier against uncertainty".
One suggestion to add, then - DSM-x (I'm adding an algebraic symbol here, as I am assuming the revisions will continue....) is revamped time after time, to give the APA further reassurance that they have the power over all these individually classified sufferings. The mission-creep into territory that is NOT mental illness, but represents genuine and normal human life, serves to add to the fantasy of control - we can even help with this horrid stuff too, you see.

The idea that we could (or should) try to map all the ups & downs of the human psyche seems a bit grandiose to me, actually. We mapped the human genome, which has had some useful implications, but we still know that there are huge complexities and gene interactions that we have yet to fathom. So it is with our internal world. Why assume that we can solve all the mysteries?

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DSM 5 - Some thoughts.....

I see that a major journal of the medical establishment has spoken out about the American Psychiatric Association's new revision of the "Bible" - the DSM.
An article in the Lancet questions the rationale for removing the 'exclusion' of bereavement.


This exclusion, at present, draws a distinction between those who are suffering grief from an understandable recent loss, and those who are clinically depressed. In my view, this is an important boundary to maintain, for two reasons:

1. People who are suffering from a normal grief reaction aren't normally helped by being told they have some kind of disorder

2. Medics need to be reminded sometimes that there is a difference between a normal emotional reaction and a 'disorder'. See my comments on this in the palliative care field


There was some reaction from the President of the APA, Dr John Oldham. I'll offer some thoughts on his statements later.

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