Chapter 11 My Professional Life Reflections on Some Key Mental Health Perspectives from Carpe Diem - Seize the Day, A treatise of my Mental Health Experiences
Dr. David Koehn is a psychologist practicing in Fort Myers, FL. Dr. Koehn specializes in the treatment of mental health problems and helps people to cope with their mental illnesses. As a psychologist, Dr. Koehn evaluates and treats patients through a variety of methods, most typically being psychotherapy or talk therapy.... more
My Professional Life Reflections on Some Key Mental Health Perspectives
A Potpourri of Ideas
Importance of Communications
Throughout my experiences as a clinical psychologist, communication comes up almost every time as a critical issue no matter what the problem may be. In order to build intimacy and feel healthy about oneself, excellent communication skills is critical. To help you decipher what belongs in your communication toolkit I have defined five essential ingredients.
Ingredient One – Effective Self-Expression
Mathew McKay has written a wonderful treatise on effective self-expression in his book Messages. There are four building blocks. Each is to be expressed separately and in a given order. It takes time to feel confident and not awkward in presenting these components but with practice you gain confidence and can become unconsciously competent. The first component is to state your observations. Note just the facts of the situation, what your senses are telling you. The next component requires you to state what you think about what you observed. That is, your interpretation, your opinion, your value proposition, your perception or your judgment. Once you expressed your observation and what you think about it, you need to express your personal feelings as to how the situation impacts you. This is often difficult because you may feel vulnerable or feel you might hurt the other person by expressing your true feelings. Even though expressing feelings may be difficult, it can build real intimacy, understanding and empathy. The final component to be expressed is what you need, want or desire from the issue being addressed. If all four components are completed without a negative overtone or overture the message is clear and not left to a whole lot of assumptions by the receiver.
Ingredient Two – Assertiveness Skills
Sometimes people try to make you do things you do not want to do or try to make you feel bad. When this happens use assertiveness skills to deflect or diffuse the manipulation. Assertiveness is not being aggressive. It is about making sure you stay focused on what is important and not be maneuvered. There are four good assertiveness techniques: broken record, fogging, negative inquiry/probing/peeling back the onion and negative assertion. Broken record involves stating and re-stating your position over and over again so that the other person gets exhausted and gives up on trying to get you to do something that you do not want to do. Fogging entails neither agreeing nor disagreeing with what the other person is saying about you. You basically note the possibility that it could be without saying that is the way it is. Negative inquiry is used when you want to explore deeper what the person is saying about you by asking a series of why (typically rule of thumb five times) they see the situation as they do. After their expression of concern, ask why they see it that way. With that being revealed, ask again as to why they see that exposed perspective. Do this enough times (peel back the onion) and you either get to the root of their concern, which you can then address or you unveil to them that there really is not an issue in the first place. The fifth technique, negative assertion is used when you actually did something wrong. In this case, you simply admit the mistake and promise to do better in the future. Such a response keeps them from continuing to go after you and blows the smoke out of their tires or clears the air.
Ingredient Three – Power of Future Conversations
Often people have difficulty making changes in their lives. We normally think life goes from the past to the present to the future. When making changes to your lifestyle, what is needed is to move from the past to the future and then back to the present. Kim Kriscoe has laid out a very powerful approach. Basically you ground yourself in the past. Do not spend a lot of time cogitating here but make sure everyone understands “what is.” Once conceived, jump to the future and ask what the possibilities could be. After spending more time here generating ideas, move back to the present and ask what actions we need to do today to make that future happen. With this triad of interactive questioning, you will be in a better position to make new things happen than just stuck in the past and gain no momentum.
Ingredient Four – Natural Inquiry
Conflict is a natural part of life. How you handle it will make the difference in being successful in resolving tough differences. A four step process called natural inquiry is excellent in resolving conflicts in business and in relationships. The first step requires person one to state their position using effective self-expression and having person two state what they heard and both agreeing that person one’s position is understood. The second step is the reverse of the first step. Person two states their position. Person one restates person two’s position. Both agree that person two’s position is affirmed. Step three involves both addressing whether there are better positions than either of the two stated and creating a novel solution that is considerably better than either of the two came up with by themselves. If accomplished, the new solution is instituted. Sometimes this positive outcome does not occur and a fourth step needs to be added. Here the question to ask is: “How do we manage our differences for now and what date or time will we meet again to rehash our positions and attempt to get a resolution to the conflict." Step four keeps people from walking away from each other and feeling extremely negative about the encounter and somewhat optimist about their future encounter.
Ingredient Five – Controlling Emotions, Body Language, and Verbal Expressions
In all interactions it is imperative to remember that being in emotional control is critical. Rule number one, if emotional, take a time out to gain a balance to one’s harmony before entering the ring to continue the discussion about the issue at hand. Besides understanding and measuring where your emotions are, you need to be cognizant of your body language and your voice. Make sure both voice and body language are concurrent with the message being transmitted. Many people do not even realize that their voices increase in loudness or speed up or slow down or become soft or almost inaudible. Intonation and emphasis can either positively influence thoughts or cause an alarm to go off in how the message is perceived. People’s faces, body position, and hand gestures contribute greatly to how the message is received. Be careful as to make sure that these orientations are being received tastefully by the receiver.
Summary on my Thoughts About Communication
This is a reader’s digest version of five important ingredients that should be part of everyone’s communication toolkit. The magic, art and science is how you gain competence across all five and play them like an orchestra as needed. Hopefully I have made you inquisitive and whet your appetite to learn more about each of the five ingredients and become a much better communicator in the future.
The Paradox of Coping
Every human being has the natural instinct to want to survive. Each one of us seeks out pleasure and attempts to avoid displeasure. When things become uncomfortable we do anything to reduce this discomfort. One could say, we make adjustments towards harmony and goodness, developing a feeling of being okay. In a general sense, we call this coping. We find common sense ways to remove our angst. When they work we are back in balance. When they do not work, we then start doing things that most society would find not helpful in eliminating the negative in our life. Such things as drinking, substance abuse, avoiding situations, over control, and excessive eating, to name a few, are all attempts to get us feeling better. In your head, you are attempting to avoid the dis-pleasurable and seek out something pleasurable. This paradox is often caused by the drive to be whole and be functional.
When we use dysfunctional coping strategies, they more often than not keep us from being healthy. Just the opposite of the intention of the individual trying to correct his/her imbalance. The corrective path to wellness and positive mental health requires a systems approach and multi-dimensional approach to treatment. Nutrition, natural supplements, psycho-therapy, medical interventions, social and family support, and psychiatry can and should be considered part of the equation in re-directing the energies of human beings struggling for balance in their life. Do not let the desire to seek pleasure at the expense of doing maladaptive coping strategies get in your mindset of being who you want to be, which is to be a super healthy person.
Attention, Respect and Empathy
Creating a Universal Positive Spirit
Three attributes—attention, respect and empathy—are universal tenets desired by all. Attention is making sure you look the person in the eye and transmit a sense of providing them a breath of fresh air, love and life. It’s like the Hawaiian word, Aloha, which is made up of two words. Alo, meaning look me in the eyes, and Ha, which means with a breath of fresh air, love and life. We provide attention through paraphrasing what the person has expressed, clarifying what has been said, asking questions and providing feedback. Such active listening gives the individual the impression that you are interested in what they are saying. Respect is provided when you not only pay attention but through one’s congruent and positive body and verbal language you demonstrate that you appreciate their position without being critical. Empathy is evident when you not only see it from the other person’s viewpoint but you feel the emotions the person is experiencing. In some regards it is like having good emotional intelligence.
Dealing with Personality Disorders
While these aforementioned attributes make for a positive interaction, they are extremely critical to be applied upfront when dealing with personality disorders. Specifically, borderline, narcissistic, histrionic and anti-social. Borderlines react to situations in which they feel a sense of abandonment, handle criticism poorly, and often misinterpret or distort their perceptions. Narcissistic persons are self-absorbed to the nth degree and they feel a sense of extreme low self-esteem. They react in ways that protect their self-worth at all cost. Histrionics need an enormous amount of recognition. They blow everything out of proportion, much like Chicken Little where the sky is falling. They want to be the center of attention and go to extremes to make sure they get attention by fabricating and making things up. Anti-Socials look to validate their power and when threatened seek to subterfuge those they see being disruptive to their power base. Often they have no conscience about their actions and are con artists. They are extremely manipulative and usually backdoor their actions so that you do not even know they are coming after you. Of the four personality types, anti-social is the scariest. If you ever watch the Netflix series called "House of Cards" you will have seen a solid portrayal of anti-social personality by the two main characters.
Breaking a Maladaptive Process
What all four have in common is that many become high conflict persons. They cycle through a process where their identity is brought into question, their psyche is threatened, they look for targets of blame, and they seek out negative advocates to validate their perspective. Their cycle of high conflict thinking starts with a mistaken assessment of danger, moves to behaviors that are aggressive in nature, and leads to negative feedback where they become very defensive. The negative feedback then reintroduces another mistaken assessment of danger and the cycle escalates. What is needed is to break this cycle and hopefully move them towards more rationality. Bill Eddy in his book It’s all your Fault – 12 Tips for Managing People Who Blame Others for Everything, provides a way forward to dealing with high conflict people, especially with those who, by Diagnostic and Statistical Manual of Mental Disorders (DSM-5) standards, meet the criteria for Cluster B personality disorders (i.e. the four aforementioned personality disorders referenced here).
While intuitively not obvious when someone is acting inappropriately, like a high conflict person, it is essential to employ attention, respect and empathy to help break their maladaptive cycle. Also, an important part of the equation is to make sure you place boundaries on their negative behavior. The trick is to make sure you have the power to enforce those boundaries and set limits on behavior. Do not put in place a boundary constraint that you are incapable of enforcing. Containment should be your primary focus.
Summary on Thoughts Associated with Attention, Respect and Empathy
Being attentive, showing respect and expressing empathy go a long way in creating a positive atmosphere when interacting with others. This happens to be essential when dealing with personality disorders. The 12 targeted tips in dealing with high conflict people, as stated by Bill Eddy, are:
- Don’t take their personal attacks personally
- Don’t give them negative feedback
- Don’t bend boundaries with borderlines
- Don’t diss the narcissists
- Don’t get hooked by histrionics
- Don’t get conned by antisocials
- Don’t be a negative advocate
- Connect using attention, respect and empathy
- Analyze your realistic options
- Respond quickly to misinformation
- Set limits on misbehavior
- Choose your battles
Previously I wrote on the importance of communication. When you use the tactics and techniques from the book Messages by Mathew McKay , and front-end it with the treatise of It’s all my Fault, you will be helping to create a universal positive spirit.
Alzheimer's Versus Dementia
Based on an article written by Katherine Fifield, the terms dementia and Alzheimer’s have been around for more than a century, which means people have likely been mixing them up for that long as well. But knowing the difference is important. While Alzheimer’s disease is the most common form of dementia (accounting for an estimated 60 to 80 percent of cases), there are several other types. The second most common form, vascular dementia, has a very different cause, namely high blood pressure. Other types of dementia include alcohol-related dementia, Parkinson’s dementia and frontotemporal dementia; each has different causes as well. In addition, certain medical conditions can cause serious memory problems that resemble dementia. A correct diagnosis means the right medicines, remedies and support. For example, knowing that you have Alzheimer’s instead of another type of dementia might lead to a prescription for a cognition-enhancing drug instead of an antidepressant. Finally, you may be eligible to participate in a clinical trial for Alzheimer’s if you’ve been specifically diagnosed with the disease.
In the simplest terms, dementia is a nonreversible decline in mental function. It is a catchall phrase that encompasses several disorders that cause chronic memory loss, personality changes or impaired reasoning, Alzheimer’s disease being just one of them, says Dan G. Blazer, M.D., a professor of psychiatry at Duke University Medical Center. To be called dementia, the disorder must be severe enough to interfere with your daily life, says Constantine George Lyketsos, M.D., director of the Johns Hopkins Memory and Alzheimer’s Treatment Center in Baltimore.
Alzheimer’s is a specific disease that slowly and irreversibly destroys memory and thinking skills. Eventually, Alzheimer’s disease takes away the ability to carry out even the simplest tasks. A cure for Alzheimer’s remains elusive, although researchers have identified biological evidence of the disease: amyloid plaques and tangles in the brain. You can see them microscopically, or more recently, using a positron emission tomography (PET) scan that employs a newly discovered tracer that binds to the proteins. You can also detect the presence of these proteins in cerebral spinal fluid, but that method isn’t used often in the U.S. A doctor must find that you have two or three cognitive areas in decline. These areas include disorientation, disorganization, language impairment and memory loss. To make that diagnosis, a doctor or neurologist typically administers several mental-skill challenges. In the Hopkins verbal learning test, for example, you try to memorize then recall a list of twelve words where a few similar words may be thrown in to challenge you. Another test, also used to evaluate driving skills, has you draw lines to connect a series of numbers and letters in a complicated sequence.
There’s no definitive test; doctors mostly rely on observation and ruling out other possibilities. For decades, diagnosing Alzheimer’s disease has been a guessing game based on looking at a person’s symptoms. A firm diagnosis was not possible until an autopsy was performed. But that so-called guessing game, which is still used today in diagnosing the disease, is accurate between 85 and 90 percent of the time. The new PET scan can get you to 95 percent accuracy, but it’s usually recommended only as a way to identify Alzheimer’s in patients who have atypical symptoms.
In the medical world, the terms “Alzheimer’s” and “dementia” are often thrown around, often interchangeably. However, they refer to two different things. One of them is more of a category, the other is a specific disease. While many of the symptoms, including memory loss and confusion, can occur in dementia diseases as well as Alzheimer’s, there are some differences. Knowing what they are can help doctors properly diagnose the problem and administer any available treatments. Here are twelve ways to differentiate between dementia and Alzheimer’s.
1. Dementia Is Not a Disease
- According to Healthline.com, dementia is a syndrome, unlike its counterpart Alzheimer’s, which is a disease. A syndrome, notes the source, is when a group of symptoms doesn’t lead to a specific diagnosis. According to Healthline, “Dementia is an overall term used to describe symptoms that impact memory, performance of daily activities, and communication abilities.”
- The site acknowledges that symptoms can “overlap,” but it’s important to treat them as separate entities to best address them medically and otherwise. Both young and elderly people can develop either dementia or Alzheimer’s (although the latter is much more common in seniors).
- While Alzheimer’s actually falls under the dementia umbrella, the Alzheimer’s Association in Chicago notes there’s something called “mixed dementia,” which is when “abnormalities linked to more than one cause of dementia occur simultaneously in the brain.”
- The source notes that studies have shown this may occur more than previously thought. This mixed version often involves Alzheimer’s along with what’s known as vascular dementia, which was once known as “post-stroke” dementia and is characterized by impaired judgment and difficulty organizing (as opposed to memory loss).
- While Alzheimer’s is a disease unto itself, dementia symptoms could result from other diseases, notes Alzheimers.net. For example, according to the source, common causes of dementia are Huntington’s Disease, Parkinson’s Disease and Creutzfeldt-Jakob disease.
- The Creutzfeldt-Jakob is actually a fatal neurogenerative disease, while Huntington’s results in the death of brain cells (and often emerges in patients in their 30s and 40s, while dementia is often regarded as a condition of aging). Those who have Parkinson’s, most often associated with shaking, will typically develop dementia over a long period of time following the initial diagnosis.
- Alzheimers.net explains that once someone is diagnosed with Alzheimer’s, the outlook is quite grim. “It is degenerative and incurable at this time,” notes the source. Sources note the average life expectancy of a patient following a diagnosis of Alzheimer’s is about eight to ten years.
- Meanwhile, adds the source, there are some causes of dementia (not already mentioned) such as a negative drug interaction or a vitamin deficiency that can actually be reversed with the right diagnosis and treatment. “Until a proper diagnosis is made, the best approach to any dementia is engagement, communication and loving care,” adds the site
- A blog post from The Mayo Clinic explains there can be some “clear differences” between Alzheimer’s and other forms dementia in the early stages. One form of the syndrome called dementia with Lewy Bodies (which can mimic symptoms of a variety of diseases) does not have the memory loss associated with Alzheimer’s, the clinic explains.
- Dementia with Lewy Bodies is actually the second most common form of dementia (following Alzheimer’s), notes the source, and instead of forgetfulness, it can be marked early on by hallucinations and confusion. However, the source explains as dementia progresses, it can be more difficult to distinguish one type from another.
- The Mayo Clinic says that a whopping 95-percent of Alzheimer’s patients are aged 65 or older (that’s based on its assertion that only 5-percent of patients develop what is known as early-onset Alzheimer’s before age 65).
- However, as noted earlier, some other diseases that can develop earlier in life can lead to dementia, so symptoms can show up in middle age. However, among younger people (at least in the UK), Alzheimer’s is still the most prevalent form of dementia, followed by vascular dementia, notes youngdementiauk.org.
2. You Can Have More Than One Type of Dementia
3. Other Diseases Can Trigger Dementia
4. Alzheimer’s is Not Reversible
5. Early Symptoms Can Vary
6. The Onset Age Can Be Different
7. Alzheimer’s Can Cause Physical Impairment
- As Healthline.com points out, there are a few similarities between “regular” dementia and Alzheimer’s, including cloudy memory, impacted cognitive skills, and trouble communicating properly.
- However, Alzheimer’s can go beyond just a decline in memory or thinking capabilities, adds the source. The disease can cause the patient to have trouble swallowing, as well as difficulty walking in the later stages.
- In the case of Alzheimer’s disease (and another type of dementia called LBD, which we’ll get to), medical professionals can actually see changes to the brain tissue under a microscope, says the National Institute on Aging.
- The source says beta-amyloid proteins form between neurons, which is associated with the disease. It notes that one form of these proteins in particular, called beta-amyloid 42 “is thought to be especially toxic” and that abnormally high levels of the protein leads it to clump and form plaques that interfere with cellular function.
- There can be more involved in arriving at a diagnosis of Alzheimer’s versus other forms of dementia. Aside from reviewing your medical history and ruling out other conditions, you might be evaluated by a neuropsychologist trained in brain conditions, notes the Mayo Clinic.
- However, further to that, you might undergo brain-imaging tests that may indicate a progressive loss of brain cells that is associated with Alzheimer’s disease, it adds. However, it is difficult to distinguish normal brain cell decline with Alzheimer’s from scans. Because of this, it is not normally used in the diagnosis, explains the source. Researchers are working on other methods to distinguish Alzheimer’s, such as using a scan that can detect an abnormal protein called tau.
- To further the last point about doctors being able to see the effects of Alzheimer’s on the brain tissue, this can only be confirmed after the patient has died, notes LiveScience.com. “Alzheimer’s can be diagnosed with complete accuracy only after death, when the brain is thoroughly examined during an autopsy,” it explains.
- It notes a microscopic analysis of the brain tissue will reveal the “plaques and tangles,” which are the proteins we mentioned that are connected to Alzheimer’s disease. Until the patient passes away, doctors can rule out other causes, and can provide a diagnosis of dementia based on certain criteria.
- A post on the Journal of Neurology, Neurosurgery & Psychiatry explains that dementia with Lewy bodies, also known more simply as Lewy Body Dementia or LBD, that can cause sudden changes in behavior that are unlike Alzheimer’s.
- While LBD patients also have abnormal protein clumps in their brains, the study detailed on the site mentions “fluctuating cognition in LBD had a spontaneous, periodic, transient quality,” compared to fluctuations associated with Alzheimer’s, which have a “more enduring state shift in the form of good and bad days.”
- There are approved medications to lessen the symptoms of memory loss, but in the case of Alzheimer’s, it would not save the patient. “In the case of most progressive dementias, including Alzheimer’s disease, there is no cure and no treatment that slows or stops its progression,” says the Alzheimer’s Association.
- That being said, the source says drugs approved by the FDA for memory loss include two types of medications – cholinesterase inhibitors (Aricept, Exelon, and Razadyne) and memantine (Namenda) – to treat the cognitive symptoms of Alzheimer’s. The treatment administered depends on the stage of the disease.
8. You Can See Alzheimer’s Up Close
9. The Diagnostic Process May Differ
10. Alzheimer’s is Only Properly Diagnosed After Death
11. Certain Forms of Dementia Can Fluctuate Differently
12. Treatments Won’t Cure Alzheimer’s
When the frontal lobe is not operating at 100%, a person may lose or partially lose the ability to update his or her self-image, a condition called anosognosia. For a person with anosognosia, this inaccurate insight feels as real and convincing as other people's ability to perceive themselves. But these misperceptions cause conflicts with others and increased anxiety. Lack of insight also typically causes a person to avoid treatment. This makes it the most common reason for people to stop taking their medications. There are six ways to help when someone has anosognosia in dementia.
- Do not try to convince them they have dementia. Using reason and evidence to explain or insist that someone has dementia is not going to help. It will only upset them and will likely make them even more convinced that they are right and you are discrediting them. A far more effective strategy is to discreetly make changes that will help them live safely. And overall, stay calm and focused on their feelings when expressing your concerns and keep it as subtle and positive as possible.
- Work with their doctors and care team. When your older adult’s dementia symptoms are interfering with their daily lives, it’s time to start working with their care team – including doctors, relatives, friends, in-home caregivers, or assisted living staff. Explain the problems your older adult is having and help the team understand that they aren’t aware of their dementia and why it won’t help to try to convince them. Work together to creatively provide your older adult the help they need without waiting for them to ask for it or making it clear that they have a problem.
- Discreetly make their life as safe as possible. Making your older adult’s everyday life simpler and safer can help prevent someone with anosognosia in dementia from hurting themselves or others. Some people might try to drive, manage money, cook, or do other activities that could be dangerous because of their cognitive impairment. Without mentioning dementia as the reason, you may need to make changes like finding creative ways to stop them from driving, working together so you can prevent problems with finances, making the kitchen safer, or making the home safer overall. Use positive approaches and present it as removing burdens from their life so they can do more of what they enjoy rather than doing chores. Focus on allowing them to do as much as they can independently while yourself or another caregiver is available to help when needed or observe for safety. Finding ways to help that still preserve pride will be most effective. For example, you might say that you don’t enjoy eating alone or you want to spend more quality time together so you want to eat dinner with them. Or, say that you have some amazing new recipes you need their help to taste-test so you’ll leave the prepared dishes in their fridge to eat during the week. Others have found it effective to use different ways to introduce an in-home caregiver so it won’t seem like the older adult needs help.
- Avoid correcting them and having confrontations; pick your battles. When someone has dementia, their brain may experience a different version of reality because of the damage the disease has caused. Dementia care experts recommend stepping into their reality rather than trying to correct them. Their brain is losing the ability to process information and forcing them to join the real world only causes confusion, anxiety, fear, and anger. If something is a serious safety issue, you may have no choice but to insist on doing things your way. But as much as you can, try to solve problems without them knowing, choose your battles, and let the non-serious things go to avoid conflict as much as possible – stress only makes challenging dementia symptoms worse.
- Present solutions positively and subtly. The less your older adult feels that they’re being limited for reasons they don’t understand, the less likely they are to become angry or resist help. Generally, when someone has anosognosia, it helps to be creative and offer solutions in a positive way rather than talking about the problem. For example, you might say, “It’s a beautiful day outside. Let’s go for a walk together so we can both enjoy the fresh air.” That is positive and much easier to accept than if you had said, “You know you can’t go outside alone, you’ll fall or get lost. I have to go with you.” Or, offer a compromise with a positive incentive, like “Let’s clean the house together so we’ll be done twice as fast and have plenty of time to watch your favorite show.” Reminding them about taking medicine can also be done in a positive way. For example, say “It’s time for both of us to take our medicine. We both need these to keep ourselves in tip-top health.” If the person does not need medication at that time, you could give M&Ms, frozen peas, or something else that appears to be a pill, but is harmless.)
- Learn more about dementia and dementia care techniques. Many of the most effective dementia care and communication techniques aren’t easily figured out and might even be the opposite of our instincts. Not knowing these helpful techniques can cause added frustration and stress for both you and your older adult. That’s why educating yourself is so important. Learning as much as you can about the disease helps you solve top challenges and improves quality of life for both of you.
In conclusion, a recent assessment tool has been developed that you can download on an IPad and assess the possibility of memory loss and monitor over time. For no cost go to: https://braintest.com/. Your results will be analyzed by a group of professionals and you will receive a report of your results. For a nominal annual fee, follow-up reports can be administered as well as a receipt of additional resource information.
Power of Schemas
People dying from guns. Gun control; hatred towards the minorities and immigrants; anti-Semitism; political gridlock; bullying behavior; social welfare standstill; and military to name a few conundrums all can be traced back to how people’s belief systems get established and entrenched. These strong beliefs are called schemas and this article hopefully provides you some insight as to just how powerful they guide our thinking, attitudes and behaviors. Sometimes in a positive direction and other times in a misguided direction.
The use of schemas as a basic concept was first used by a British psychologist named Frederic Bartlett as part of his learning theory. Bartlett's theory suggested that our understanding of the world is formed by a network of abstract mental structures. People use schemas to organize current knowledge and provide a framework for future understanding. Examples of schemas include academic rubrics, social schemas, stereotypes, social roles, scripts, worldviews, and archetypes. Schemas are something that all people possess and continue to form and change throughout their lives. Object schemas are just one type of schema that focuses on what an inanimate object is and how it works. For example, most people in industrialized nations have a schema for what a car is. Your overall schema for a car might include subcategories for different types of automobiles, such as a compact car, sedan, or sports car.
Other types of schemas that people often possess include:
- Person schemas are focused on specific individuals. For example, your schema for your friend might include information about her appearance, her behaviors, her personality, and her preferences.
- Social schemas include general knowledge about how people behave in certain social situations.
- Self-schemas are focused on your knowledge about yourself. This can include both what you know about your current self as well as ideas about your idealized or future self.
- Event schemas are focused on patterns of behavior that should be followed for certain events. This acts much like a script informing you of what you should do, how you should act, and what you should say in a particular situation
- Idealized person schemas are called prototypes. The word is also used for any generalized schema.
- Role schemas are about proper behaviors in given situations.
- Trait schemas about the innate characteristics people have.
- Object schemas to reiterate are about inanimate things and how they work.
Description (A Further Elaboration) - A schema is a mental structure we use to organize and simplify our knowledge of the world around us. We have schemas about ourselves, other people, mechanical devices, food, and in fact almost everything. Schemas can be related to one another, sometimes in a hierarchy (so a salesman is a man is a human).
Schemas affect what we notice, how we interpret things and how we make decisions and act. They act like filters, accentuating and downplaying various elements. We use them to classify things, such as when we pigeon-hole people. They also help us forecast, predicting what will happen. We even remember and recall things via schemas, using them to ‘encode’ memories. Schemas help us fill in the gaps. When we classify something we have observed, the schema will tell us much about its meaning and how it will behave, hence enabling threat assessment and other forecasting.
Schemas appear very often in the attribution of cause. The multiple necessary cause schema is one where we require at least two causes before a ‘fit’ to the schema is declared. Once we have created or accepted a schema, we will fight hard to sustain it, for example by ignoring or force-fitting observations that do not comply with the schema. It is only after sustained contrary evidence that many of us will admit to the need to change the schema.
Schemas are often shared within cultures, allowing short-cut communications. Every word is, in effect, a schema, as when you read it you receive a package of additional inferred information. We tend to have a favorite schema, which we use often. When interpreting the world, we will try to use these first, going on to others if they do not sufficiently fit. Metaphorically, a given set of schemas for a person is like a deck of cards where each card is a separate schema. We proceed by shifting through the deck to find the schema that best makes sense out of the world we live in.
Schemas are also self-sustaining, and will persist even in the face of dis-confirming evidence. This is because if something does not match the schema, such as evidence against it, it is ignored. Some schema are easier to change than others, and some people are more open about changing any of their schemas than other people. The plural of Schema is Schemas (USA) or Schemata (UK). Schemas are also known as mental models, concepts, mental representations and knowledge structures (although definitions do vary—for example some define mental models as modeling cause-effect only).
In Piaget's theory of development, we construct throughout life a series of schemas, based on the interactions we experience, to help us understand the world. For example, a person might have a schema about buying a meal in a restaurant. The schema is a stored form of the pattern of behavior, which includes looking at a menu, ordering food, eating it and paying the bill. This is an example of a type of schema called a script. Whenever they are in a restaurant, they retrieve this schema from memory and apply it to the situation.
What Are Schemas?
A schema is a cognitive framework or concept that helps organize and interpret information. Schemas can be useful because they allow us to take shortcuts in interpreting the vast amount of information that is available in our environment. Imagine what it would be like if you did not have a mental model of your world. It would mean that you would not be able to make so much use of information from your past experience or to plan future actions. Wadsworth (2004) suggests that schemata, the plural of schema, be thought of as 'index cards' filed in the brain, each one telling an individual how to react to incoming stimuli or information.
Piaget emphasized the importance of schemas in cognitive development and described how they were developed or acquired. A schema can be defined as a set of linked mental representations of the world, which we use both to understand and to respond to situations. Schemas are the basic building blocks of such cognitive models, and enable us to form a mental representation of the world. Piaget defined a schema as: "a cohesive, repeatable action sequence possessing component actions that are tightly interconnected and governed by a core meaning."
In more simple terms Piaget called the schema the basic building block of intelligent behavior – a way of organizing knowledge. Indeed, it is useful to think of schemas as units of knowledge, each relating to one aspect of the world, including objects, actions, and abstract (i.e., theoretical) concepts. Piaget emphasized the importance of schemas in cognitive development and described how they were developed or acquired. A schema can be further thought of as a set of linked mental representations of the world, which we use both to understand and to respond to situations. Piaget emphasized the importance of schemas in cognitive development and described how they were developed or acquired.
Adaptation Principles Applied to Schemas
When Piaget talked about the development of a person's mental processes, he was referring to increases in the number and complexity of the schemas that a person had learned. When existing schemas are capable of explaining what it can perceive around it, it is said to be in a state of equilibrium, i.e., a state of cognitive (i.e., mental) balance. Two important adaptation principles apply when challenging existing schemas: (1) assimilation and (2) accommodation. Both are necessary to keep one balanced and positively developing as a human being. Assimilation is all about taking in new information and inserting it into existing mental mind set. If the data aligns then the adjustment is healthy. If the data does not align but the person forces the data to be interpreted to meet the existing schema, then the adjustment is maladaptive. In accommodation, existing schemas might be altered or new schemas might be formed as a person learns new information and has new experiences. This is healthy but as we get older we become more inflexible to be able to do this – this rigidity sets in. To keep one cruising on a positive path and not get stuck in a schema Gordian knot one must constantly be in a discovery, open-mind framework where learning is constantly reinforced. Shut down learning, lock in schemas.
What Is the Trouble with Schemas?
These mental frameworks also cause us to exclude pertinent information to focus instead only on things that confirm our pre-existing beliefs and ideas. Schemas can contribute to stereotypes and make it difficult to retain new information that does not conform to our established ideas about the world. This is when we get so stuck that we cannot and are unwilling to adjust that we get as a society and individuals in a real messy place of being unhealthy.
In my private practice I have used Mental Health Schemas with patients, especially based the work by Charles Elliot in a book he wrote called Why Can’t I Get What I Want. Elliot basically has framed three zones to consider: (1) Self-Worth zone; (2) Empowerment zone; and (3) Relationship zone. Each zone has four schema facets to consider. Each facet is defined with a balanced orientation with a negative pole that underemphasizes that facet and a positive pole that overemphasizes that facet. Tables 1-3 illustrate these three aforementioned zones picturing mental health schemas.
Table 1 - Self-Worth Zone
I feel I have failed or am inadequate compared with my peers in achievement such as school, career, sports, or other activities. I often do not have the intelligence, talent, or abilities to succeed.
I am adequate and feel good about myself regardless of my accomplishments
I tend to pursue high standards and expectations relentlessly in areas of achievement, recognition, status, money, or any activity in which I am involved. This pursuit is often at the expense of happiness, health, pleasure, and relationships.
I feel often I deserve punishment or harsh criticism. I tend be overly critical or punitive of myself when I make mistakes.
I realize that, as a human being, I am going to make mistakes. I can accept responsibility for my mistakes and can apologize comfortably to others. Although I may choose to change, I do not make myself overly guilty.
I feel I have to be right. It is hard for me to admit I am wrong or that I have made a mistake. It is hard for me to say I am sorry.
I feel I do not deserve attention, concern, or consideration from those that deserve to have my needs met. If on occasion, I believe I deserve it, I do not expect that my needs will be met. I feel there is something about me about my background that is defective or inferior.
I feel am worthy of having my needs met but not at all unnecessary expense to people. I feel I am as good as anyone else.
I feel I should have whatever I want. Sometimes I don’t think about whether my wants are reasonable or what they would cost others. Sometimes others think I walk over them. Nothing less than the best is good enough for me. I feel there is something about me or my background that is superior to others.
I feel I am in some way outwardly undesirable to others, either I am unattractive, poor in social skills, boring, or have other flaws that turn off other people.
I am comfortable with my looks , social skills and any other visible characteristics
I believe I am highly desirable to others in terms of looks, social skills or other visible characteristics
Table 2 - Empowerment Zone
I tend to give in to others’ preferences and decisions. I try to avoid conflict whenever I can.
My decisions and preferences are important, and I will express readily. It is important for me to listen to the decisions and preferences of others. I will work out compromises whenever possible. I will not let anyone walk over me and won’t take advantage of them
I like to be in control. I am often critical of other peoples’ decisions and preferences and can discount them easily. Basically, I like to have it my own way.
I often feel incapable of handling everyday decisions and responsibilities. I usually seek help from others.
I believe I am capable of handling most everyday decisions and responsibilities. However, when I do need help, I don’t hesitate to ask for it.
Stubbornly Independent (+)
I believe I can handle almost anything. It is hard for me to ask for help. Sometimes I will even refuse appropriate and essential substance.
I often feel I can do little to change things. Frequently, I feel overwhelmed by life’s events and powerless to do much about them.
I believe there are many outcomes I can influence to one degree or another. At times, there are things I can’t change and can accept that.
I believe I can make almost any situation come out the way I want to.
I often worry about terrible things happening to me or to those close to me.
I recognize that harm and illness will occur at various points in my life and I take reasonable precautions to prevent them. I also believe that when some things happen, I can bounce back.
I believe I am virtually immune to harm or illness. I don’t worry about what I eat or exercise or about my personal safety. What other people think of as high-risk (hang gliding, parachuting, etc.) I find exhilarating.
Table 3 - Relationship Zone
I focus very much on meeting the needs of others, even at the expense of my own needs and preferences. I might, at times, resent those in my care. I am far more likely to take the perspective of other people than consider my own. When others are upset, I Think it is up to me to do something about it.
I am adequate and feel good about myself regardless of my accomplishments
I believe my own perspective is sufficient for understanding. I worry a lot about how other people look at things. People can take care of themselves. I don’t have to worry about their needs.
I worry a lot about losing a person or persons close to me. I am afraid they will leave or be taken from me through death or other circumstances. I need a great deal of emotional reassurance to feel secure. Reassurance never seems to last. I sometimes test the emotional commitment of others in ways that are not necessarily constructive. I am very sensitive to rejection.
I enjoy and feel getting emotionally close to someone comfortable
I don’t feel the need to become emotionally involved. I generally keep people at a distance.
I don’t have a strong sense of who I am. I define myself in terms of other people who are close to me (that is, my partner or my children). I tend to adopt their beliefs, attitudes, and identities. When I have no one else close to me, I often feel empty.
I have a clear sense of who I am. I am aware of my purpose, attitudes, beliefs, and values. However, I don’t expect those close to me always to agree with my beliefs. People who love me are free to disagree with me within reasonable limits.
I do not trust other peoples’ motives. I often believe that other people intentionally hurt, abuse, cheat, lie, and manipulate, or take unfair advantage of me.
I generally trust people, unless they give me a reason not to. However, I do show reasonable caution, which has prevented me from being taking advantage of very often.
I believe everyone can be trusted. I don’t believe there is a need to question other peoples’ motives. Sometimes I don’t even take reasonable precautions to protect myself in relationships.
Patients review their assessments and do a cost/benefit analysis of those schemas that they are demonstrating to a great degree. Typically, each schema trait is rated on a four point scale from 0 to 4 with 4 being defined as most of the time. Patients then put an action plan in place that they execute. It is important to remember to modify any dysfunctional schema through using discovery and learning. Those that have taken this journey are finding their experience extremely value-added.
One of the most persuasive and deleterious schemas that is all too common in our society is called the “Pike Syndrome.” It is based upon a false assumption that because of one’s past experience that dictated a certain outcome, current conditions, even when the evidence is clear that things changed, are not seen as changed at all. You go on as nothing happened. A short ten minute video via YouTube illustrates an experiment that Dr. Eden Ryle, a renowned attitude development professional, so beautifully demonstrates this phenomena of using the Northern Pike as the subject. You might be surprised with the outcome. After watching the video, do you see yourself at times displaying the Pike Syndrome?
We talked about the critical nature of being open minded, discovery-oriented, and having a thirst for learning as nuggets to insure we are not fooled by our schemas. Dr. Ryle discusses three freedom factors that unlock that anchor so we see the light, no, so we can chase the light. These three freedom factors are: Indexing, dating and etcetera. All three are intended to keep you from overgeneralizing and helping you see the differences of things that exist. They help you remove the anchors that keep you stuck. Indexing is about subdividing what you see like the way books are in a library. Dating is about time stamping – person A three months ago is not the same person today, person A at 7 am is not the same person as person A at 1 pm. Etcetera is all about adding on, not accepting what you thing you see but being curious enough to peel back the onion.
While somewhat dated in video content, Eden Ryle has a series of tremendously impactful attitude development programs. They are: You pack your own chute; You can surpass yourself; Grab hold of today (Pike Syndrome embedded); and Joy of Involvement. All can be helpful in correcting a dysfunctional set of schemas.
Hopefully this exploration of schemas has open your mind to what has powerful influence over us in all aspects of our lives. We also expect that you do not get so comfortable with your schemas, so much so that you do not reevaluate them often. A great little vignette on this revaluation can be found in a TED talk by Julia Galef about being a scout. Again, schemas do give us short cuts and quickly help us make sense of the world. If we do not stay vigilant, be discovery oriented, never stop learning, and be curious, schemas will come back to bite/sting you in a downward spiraling, mentally-ill, unhealthy way.
Evaluating Thinking Processes
Https://www.myersbriggs.org/my-mbti-personality-type/mbti-basics/home.htm?bhcp=1 is an excellent link to a general description of the MBTI. At D J Koehn Consulting Services you can request to take the MBTI by emailing me at DrK@koehnconsulting.com. I will send you a specific invitation from my Consulting Psychology Press website (CPP) to take the assessment. The recommended report to receive is the MBTI Form Q Step II. It is a comprehensive review that includes primary and subtype preferences. It reveals how you deal with yourself and others as well as how you adjust to change, deal with conflict and communication and interact with other preferences. The Step II™ Interpretive Report is a highly personalized narrative and graphical report that helps you understand your MBTI® Step I™ and Step II™ results. The 17-page report then applies those results to four important components of professional development: communication, decision making, change management, and conflict management.
During our MBTI® feedback session, you receive a profile report of your MBTI results. There are many different kinds of profile reports, which vary in size and design, but all give you the basics of your MBTI profile. A sample profile report (.pdf) from CPP, Inc., is available for you to view. In addition to the profile report, you should also receive descriptions of the sixteen types so that you may verify your best-fit type.
MBTI reports tell you your preference for each of four pairs:
- Extraversion or Introversion E or I
- Sensing or Intuition S or N
- Thinking or Feeling T or F
- Judging or Perceiving J or P
The four preferences together make up your whole type. There are types. Some types are more common than others and studies have been done to determine the breakdown in percentages of the MBTI types in the general population. When you receive your MBTI profile, you might not agree with it. Only you can decide which personality type fits you best, and there are circumstances that explain why you may decide to choose a different type than your MBTI results. There are some steps that can help you find your best-fit type.
Sometimes circumstances of your life can lead you to answer the questions on the MBTI instrument so that your reported MBTI type does not reflect your true preferences. There are many reasons why your reported type may not be your best-fit type. Occasionally, even after going through the steps to choose your best-fit type, you may remain uncertain about your MBTI preferences. There are several reasons for uncertainty about your best-fit type. Knowledge of your personality type preferences can be used in many ways. Only you can decide how to use what you learn. To read about some of the many ways that MBTI results can assist you in understanding yourself and others, please go to Using Type in Everyday Life.
I have used the MBTI to help others see themselves and use it to improve their development. A critical outcome is understanding Type Development. At the most basic level, type development is the process of gaining comfort and command of your preferred way of taking in information, and your preferred way of coming to conclusions. Developing a function involves consciously differentiating it from the others, exercising it, and becoming more skilled with it. Jung believed that all the functions are largely unconscious and undeveloped in infants. As we grow and develop, the different functions develop. The timing of this development has been the subject of considerable study. It is generally believed that the dominant generally develops up to age seven, the auxiliary up to age twenty, the tertiary in their thirties and forties and the inferior or fourth function at midlife or later.
As you develop your type, the way you see the world and the way you behave tends to change and broaden. Comfort with your dominant and auxiliary functions forms the basis for much of your self-esteem. If the use of your dominant and auxiliary functions is not supported by your environment, it will still press to reach the surface, like a beach ball held under water. When a function is never allowed to develop naturally, a person can experience stress and frustration. As you develop your tertiary and least-preferred functions later in life, the range of behaviors available to you opens up even further. But the dominant and auxiliary functions will always be the core functions of your conscious personality.
Over time, I have administered the MBTI to both individuals and groups that come to over two thousand in my professional career. The insights and guidance have helped people immensely interact with others effectively. Hopefully you found this article and hyperlinks useful and take advantage of taking the MBTI. While I am knowledgeabe and experienced in using other Jungian type assessments, the MBTI is extremely valuable when used for individuals and couples for therapy sessions.
Is It Bipolar or ADD?
Symptoms of ADHD and bipolar disorder are often confused -- and often coexist in the same person. William Dodson, M.D. has written an interesting treatise that focuses our attention on how to look at these two mental health conditions side by side. I hope you find his perspective enlightening – I have edited his paper with minor changes.
It can be difficult enough to obtain a diagnosis of attention deficit disorder (ADD, ADHD), but to complicate matters further, ADHD commonly co-exists with other mental and physical disorders. One review of ADHD adults demonstrated that 42 percent had one other major psychiatric disorder. Therefore, the diagnostic question is not “Is it Bipolar Disorder or ADHD?” but rather “Is it both?”
Perhaps the most difficult differential diagnosis to make is between Bipolar Mood Disorder and ADHD, since they share many symptoms, including mood instability, bursts of energy and restlessness, talkativeness, and impatience. It’s estimated that as many as twenty percent of those diagnosed with ADHD also suffer from a mood disorder on the bipolar spectrum—and correct diagnosis is critical in treating bipolar disorder and ADHD together.
ADHD is characterized by significantly higher levels of inattention, distractibility, impulsivity, and/or physical restlessness than would be expected in a person of similar age and development. For a diagnosis of ADHD, such symptoms must be consistently present and impairing. ADHD is about ten times more common than BMD in the general population.
By diagnostic definition, mood disorders are “disorders of the level or intensity of mood in which the mood has taken on a life of its own, separate from the events of a person’s life and outside of [his] conscious will and control.” In people with BMD, intense feelings of happiness or sadness, high energy (called “mania”), or low energy (called “depression”) shift for no apparent reason over a period of days to weeks, and may persist for weeks or months. Commonly, there are periods of months to years during which the individual experiences no impairment. Of the many shared characteristics, there is a substantial risk of either a misdiagnosis or a missed diagnosis. Nonetheless, when determining if it is Bipolar Disorder or ADHD, use these six factors as a guide:
- Age of onset: ADHD is a lifelong condition, with symptoms apparent (although not necessarily impairing) by age seven. While we now recognize that children can develop BMD, this is still considered rare. The majority of people who develop BMD have their first episode of affective illness after age 18, with a mean age of 26 years at diagnosis.
- Consistency of impairment: ADHD is chronic and always present. BMD comes in episodes that alternate with more or less normal mood levels.
- Mood triggers: People with ADHD are passionate, and have strong emotional reactions to events, or triggers, in their lives. Happy events result in intensely happy, excited moods. Unhappy events — especially the experience of being rejected, criticized, or teased — elicit intensely sad feelings. With BMD, mood shifts come and go without any connection to life events.
- Rapidity of mood shift: Because ADHD mood shifts are almost always triggered by life events, the shifts feel instantaneous. They are normal moods in every way, except in their intensity. They’re often called “crashes” or “snaps,” because of the sudden onset. By contrast, the un-triggered mood shifts of BMD take hours or days to move from one state to another.
- Duration of moods: Although responses to severe losses and rejections may last weeks, ADHD mood shifts are usually measured in hours. The mood shifts of BMD, by DSM-V definition, the manic phase must be sustained for at least one week and the depressive episode must be maintained for at least two weeks. For instance, to present “rapid-cycling” bipolar disorder, a person needs to experience only four shifts of mood, from high to low or low to high, in a 12-month period. Many people with ADHD experience that many mood shifts in a single day.
- Family history: Both disorders run in families, but individuals with ADHD almost always have a family tree with multiple cases of ADHD. Those with BMD are likely to have fewer genetic connections.
Some articles have been published about the treatment of people who have ADHD and BMD. Dr. Amen has done extensive studies on both ADD and bi-polar. As a reminder here is a link on Dr. Amen’s treatise of ADD (https://www.amenclinics.com/conditions/adhd-add/). In Dr. Dobson’s experience, he has seen more than 100 patients with both disorders. He shows that coexisting ADHD and BMD can be treated very well. It’s important to always diagnose and treat the BMD first, as ADHD treatment may precipitate mania or otherwise worsen BMD.
Outcomes for my patients treated for both ADHD and BMD have thus far been good. The majority have been able to return to work. Perhaps more importantly, they report that they feel more “normal” in their moods and in their ability to fulfill their roles as spouses, parents, and employees. It is impossible to determine whether these significantly improved outcomes are due to enhanced mood stability, or whether treatment of ADHD makes for better medication compliance. The key lies in the recognition that both diagnoses are present and that the disorders will respond to independent, but coordinated, treatment.
Besides Dr. Dobson’s keen insights, Dr. Amen has provided two assessments that are quite helpful in reviewing brain type and ADD type. To take the brain type assessment the link is: https://brainhealthassessment.com/ . To take the ADD assessment the link is: https://addtypetest.com/ . Both assessments provide meaningful reports with a series of excellent recommendations. Two fascinating perspectives are provided. The first idea is that natural supplements can be extremely value added and the need to pursue a psycho-pharmacological approach may not be needed. The second idea is that a nutritional program should be put in place that supports brain and body health. A good diet that came out of the Lee Health System is called the Mitochondria diet. Mitochondria is like the energizer bunny for every organ in the body. To maximize your health the basic premise is to eat natural pure foods and stay away from process foods. Eating multi-colored vegetables and fruits, lean meats, fish and chicken, minimizing salt and eliminating sugar and drinking plenty of liquids is the formula for success.
The Value of Bio-Feedback
Using biofeedback, you can gain valuable insight into the health of your physiological state, including your heart rate, skin temperature, blood pressure, muscle tension and brainwaves. Understanding these measures allows you to gain greater awareness of your body states and gives you the opportunity to develop these states for improved health.
These physiological states are controlled by the autonomic nervous system (ANS), meaning the body performs them unconsciously. The ANS is made up of the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS). They work antagonistically, with the SNS activated during stressful events and the PNS activated for relaxation and regeneration. Any way to promote activation of the PNS is beneficial, and the ability for breath work to do this has been well-documented. Biofeedback devices work by using sensors which detect the body’s physiological states and transmit the signals to an app or program. The user watches in real-time how their thoughts, actions and respiration directly influence their internal systems. In some cases and as part of a healthy lifestyle, biofeedback may reduce the need for medication and alleviate symptoms of disease.
Many people believe that our heart beats like a musician’s metronome, that is, the time between heart beats is generally the same. However, this is not the case, as the time between each of our heart beats actually increases and decreases over time. This change is known as Heart Rate Variability (HRV). I am very interested in the biofeedback measurement of HRV, one of the well-researched types of biofeedback. I have chosen to use Unyte’s iom2 bio-feedback sensor. It is placed on the earlobe, where it detects each heartbeat which we then use to calculate HRV. A high HRV means that the amount of time between each beat varies quite a lot and a low HRV implies a small variation in the time between heart beats.
It might seem counterintuitive, but high HRV (a wide range of time between beats) suggests increased resilience to stress and increased cardiovascular fitness. This enables you to appropriately react to your environment, activating stress hormones during times of trouble, and promoting digestion and relaxation otherwise. A practical application of this is used by athletes. First thing every morning they measure their HRV. If their HRV is high, they know their body is resilient and strong, and it is a good day to undertake an intense workout.
Unyte helps you learn how to effectively control your HRV using our “resonance score”. Resonance is a well-known phenomenon in physics. It is when a vibrating system causes another nearby system to begin vibrating with even greater amplitude, enhancing the effect. We use this concept of resonance as follows: By measuring the user’s heart rate, we calculate HRV. These times between heartbeats generally follow a sinusoidal cycle, which is a smooth, periodic curve resembling a wave. Your respiration pattern also follows a similar cycle, increasing with each inhale and decreasing with each exhale. The closer these cycles match, the higher your resonance score. Using the breathing indicator, you can learn to align your respiration cycle with that of your heart beat cycle. This state of matching cycles is associated with a relaxed nervous system and many health benefits.