"Understanding what is “wrong” with people currently is more a question of the mindset of the practitioner (and of what insurance companies will pay for) than of verifiable, objective facts." - Bessel van der Kolk

Hey guys,

A couple of hot takes below, be warned!

(Simpsons quote in title, I basically have become Reverend Lovejoy's wife since speaking to Erica Komisar on the podcast last week (see below) so really stepping into it)

First up from The Body Keeps the Score, by Dutch psychiatrist, Bessel van der Kolk.

Let's identify as humans and not psychiatric labels
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​How do we organise our thinking with regard to individuals like Marilyn, Mary, and Kathy, [victims of childhood abuse he talks about earlier in the book] and what can we do to help them? The way we define their problems, our diagnosis, will determine how we approach their care. Such patients typically receive five or six different unrelated diagnoses in the course of their psychiatric treatment. If their doctors focus on their mood swings, they will be identified as bipolar and prescribed lithium or valproate. If the professionals are most impressed with their despair, they will be told they are suffering from major depression and given antidepressants. If the doctors focus on their restlessness and lack of attention, they may be categorized as ADHD and treated with Ritalin or other stimulants. And if the clinic staff happens to take a trauma history, and the patient actually volunteers the relevant information, he or she might receive the diagnosis of PTSD. None of these diagnoses will be completely off the mark, and none of them will begin to meaningfully describe who these patients are and what they suffer from.

Psychiatry, as a subspecialty of medicine, aspires to define mental illness as precisely as, let’s say, cancer of the pancreas, or streptococcal infection of the lungs. However, given the complexity of mind, brain, and human attachment systems, we have not come even close to achieving that sort of precision. Understanding what is “wrong” with people currently is more a question of the mindset of the practitioner (and of what insurance companies will pay for) than of verifiable, objective facts.​
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​The first serious attempt to create a systematic manual of psychiatric diagnoses occurred in 1980, with the release of the third edition of the Diagnostic and Statistical Manual of Mental Disorders, the official list of all mental diseases recognized by the American Psychiatric Association (APA). The preamble to the DSM-III warned explicitly that its categories were insufficiently precise to be used in forensic settings or for insurance purposes. Nonetheless it gradually became an instrument of enormous power: Insurance companies require a DSM diagnosis for reimbursement, until recently all research funding was based on DSM diagnoses, and academic programs are organized around DSM categories. DSM labels quickly found their way into the larger culture as well. Millions of people know that Tony Soprano suffered from panic attacks and depression and that Carrie Mathison of Homeland struggles with bipolar disorder. The manual has become a virtual industry that has earned the American Psychiatric Association well over $100 million. The question is: Has it provided comparable benefits for the patients it is meant to serve?​
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​A psychiatric diagnosis has serious consequences: Diagnosis informs treatment, and getting the wrong treatment can have disastrous effects. Also, a diagnostic label is likely to attach to people for the rest of their lives and have a profound influence on how they define themselves. I have met countless patients who told me that they “are” bipolar or borderline or that they “have” PTSD, as if they had been sentenced to remain in an underground dungeon for the rest of their lives, like the Count of Monte Cristo.

This book is so good. Strongly recommend!
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​Why Prioritising Motherhood in the First Three Years Matters​
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Erica Komisar is a NY based psychotherapist who wrote the book Being There: Why Prioritising Motherhood in the First Three Years Matters (longer bio below). Controversial stuff (you would think, but actually I haven't come up against any strong resistance to her arguments when I've discussed it in passing (yet)). Here are some of the punchy things she said on the pod (details of how to listen below):
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​Why are young people in such a rush?​
EK: Have the patience and the wherewithal to know that your career that you started... is not going anywhere.

It's still there.

It will be there when you're ready to go back to it.

You know, if we're all going to live till 120 with technology, your generation certainly maybe not mine, but your generation will live a long time.

And so what's the rush? I have never understood why young women feel so trapped, and so much in a rush.

It's like in a race. To go where? In a race to go nowhere. Fast.
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​Your kids don't care about the fancy ski holiday. They want to be loved.​
DB: But then I guess those people would be like, well, I have to work so hard because I want to provide and like my I want to give my child like the best possible education down the track or lifestyle or whatever it is.

EK: Well, you'd say, what are your priorities?

Your children don't care about the fancy clothes or the fancy house, or the fancy vacations, or the fancy schools.

There's a lot of very wealthy kids who are very seriously depressed and anxious and have eating disorders and addictions because their parents focused on the wrong things.

It's understandable and I think it comes probably from a good place to say I'm giving my child the best. And maybe that's where I stand up and say, well, the best is your love and attention and your time.

It's you.

They don't want the money, They don't want the material stuff.

They want you.

They want your love and attention, your interest in them.

They want the connection to you.

They would rather have you home making their snack after school and helping them with their homework than they would having a fancy ski vacation or a fancy private school.

So that's an adult's version of what's important.

That's not a child's version of what's important.

They didn't ask to be brought into the world​
EK: You know, I have this wonderful T-shirt that says maternal feminism because I believe in women's power and I believe in women's abilities out in the world.

I just don't believe that that is something that you focus on when you have very young children, that you either take breaks or you mitigate your ambition in those years.

So you can really prioritise these little people who did not ask to be brought into this world, who you have elected to bring into this world.

And as Penelope Leach said, who is British, she said, don't have children if you don't want to care for, because children need a lot of your care.

They're very vulnerable, they're very fragile, they're not born resilient and they need you.

And if you're not willing to give them what they need, then have a wonderfully successful professional life.

Getting married, had lots of freedom, but don't have children.

If you want to have children, then you have to want to care and they have to be the most important thing in your life and a priority, otherwise they will not be healthy.
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This (and last) week on Growing Up with Delia Burgess​
Ep. 101 - John Hittler: Russian orphans & talking his way into Georgetown
​Yes, it's true, this man's name is Hittler and I was interested to learn about what it was like growing up with that name so I invited him on. (He asked his mum whether they could please change their name as he was beaten up all the time and she said "adversity builds character.")
Some more fun facts about him: he grew up with eight siblings, he didn't leave the state of Michigan until he was 18, he has three adopted children from Russia, and my favourite: he turned up to Georgetown University without having been accepted (in fact having been rejected the previous year), and convinced them to give him a spot. Not only that, he convinced admissions to transfer him the federal financial aid of the four incoming undergrads who had pulled out last minute (absolutely not allowed but who was going to check?) So he almost had a fully funded place, which was helpful because meanwhile his 18 y.o. pregnant wife had just given birth very prematurely and he had huge medical bills to pay on top of tuition. He covered these massive expenses by working multiple jobs + studying full time, something he'd done since he was a child... (I think he got his first paper round at six so that might beat you, Dad, if you're reading... would have to go back to Ep. 5 of the podcast to check...)
Also! He has written a few books, done a couple of TED Talks & he's passionate about helping people find their genius talent which I think is really cool! I.e. we all have a unique gift to share with the world. Exciting when we work out what it is and can articulate it...
​www.evokinggenius.com​

Ep. 102 - Erica Komisar: prioritising motherhood & raising an emotionally secure future
​Erica Komisar, LCSW is a New York based psychoanalyst, parent coach and author. With 30 years of experience in private practice, she works to alleviate pain from individuals who suffer from depression, anxiety, eating, and other compulsive disorders.
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A graduate of Georgetown and Columbia Universities and The New York Freudian Society, Erica is a psychological consultant bringing parenting and work/life workshops to clinics, schools, corporations, and childcare settings.
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Erica is also the author of the book Being There: Why Prioritising Motherhood in the First Three Years Matters and Chicken Little The Sky Isn’t Falling: Raising Resilient Adolescents in the New Age of Anxiety and has appeared on major media networks such as CBS, ABC, FOX, and NPR. She is a regular contributor to the Wall Street Journal, Washington Post, New York Daily News, and FOX 5 NY.

She is a Contributing Editor to the Institute for Family Studies. She lives in New York City with her husband, optometrist, and social entrepreneur Dr. Jordan Kassalow with whom she has three teenage and young adult children.

Enjoy xx
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