Many of my readers may know that, in addition to blogging, television, and the Friday Rorschach, I also have a clinical practice. Since 2004, I have been on my own, which has been great. But, I am excited about a new chapter in my professional career: I have joined a group. I am now a part of The Colorado Center For Clinical Excellence, and it is an amazing group of clinicians. Together we offer a wide range of services, including individual therapy, couples counseling, assessments, and special programs. The most exciting aspect of my switch is the Colorado Center's focus on quality outcome. We don't just hope our clients are getting better--we measure it. The head of the practice, Dr. Jason Seidel, has done extensive research on Feedback Informed Therapy (FIT), which is a model for receiving ongoing information from our clients to make sure the therapy is working. We use this approach at the Colorado Center, and it allows us to make changes in therapy as soon as we discover something might not be as effective as it should be. This FIT model is one of the main reasons I was interested in joining the Colorado Center, and I know it is going to help my clients get what they need out of their time in therapy. In my practice, I will be focusing on individual counseling for adolescents and adults, and I will also continue to offer the same psychological assessments I have been conducting for years. Thanks for reading-- Max Wachtel, Ph.D. www.thecoloradocenter.com
The shooting and stabbing spree in Isla Vista,
California on Friday, May 23, which left seven people dead including the shooter, is the latest
in an ever increasing number of public mass murders in the United States.
With each tragedy, it is normal to look for an explanation—a
reason why it happened. There has been no shortage of mental health experts on
local and national television speculating as to why the killer went on his
rampage. This particular case is fueled by YouTube videos and hundred-page
manifestos from the murderer himself.
Up to this point, almost everything that psychologists and
psychiatrists have been saying about the shooter has been speculation.
What little we know at this point can be boiled down to a
few main points:
1. The
shooter was very angry.
2. He
was at an age where mental illness typically emerges and can be dangerous
because people do not fully understand the impact of their symptoms yet.
3. He
was already in mental health treatment and his parents were worried about him.
Regardless of the causes of the tragedy, it is important to
recognize the killer’s mental health providers may have been doing everything
they could for him. In many states, Colorado included, people cannot be
committed to a psychiatric institution against their will unless they are an
imminent threat to themselves or others.
In hindsight, it is obvious the killer was imminently
dangerous. But, if he told his therapists he felt fine and that he didn’t have
a plan to harm anyone, there was nothing more they could have done. They might
have worried he was dangerous, but as far as they knew, he was not imminently dangerous and he could not be
hospitalized against his will.
Colorado is now grappling with the problem of how to deal
with potentially dangerous individuals in the wake of the Aurora theater
shooting. Some legislators are pushing to change civil commitment laws in the
state to remove the requirement of an “imminent” threat in order to get people
the help they need and avoid further tragedies. Others in the state have argued
this would give therapists and doctors too much power and would infringe on an
individual’s civil liberties.
Making the issue even more complicated is that many people
who desperately need treatment are not yet connected to a mental health
provider. In cases such as these, it is often difficult for someone to know
where to turn for help. Even people who want
mental health treatment get turned away due to lack of care. In an environment
such as this, people who are refusing treatment tend to get overlooked.
Until states grapple with these tough issues, we as
Americans run the risk of continuing to allow individuals who could become
mentally unstable to go untreated (keep in mind, most individuals with mental
illness are no more dangerous than those without mental illness—but untreated
mental illness is one cause--of many--of the recent rash of public mass murders).
The unfortunate reality is that more preventable suicides and homicides are
likely if we do not deal with the crisis of mental health treatment and mental health laws in our
country.
What it is: This is one of my son's paintings. For those of you familiar with The Friday Rorschach, you might recognize the subject: Stanley, The Cat. For those of you who are unfamiliar, we had a cat named Stanley when our kids were very young. But, we needed to give him away because my daughter is horribly allergic to just about everything, including cats. We all miss Stanley, and we have a picture of him in our art studio:
It is a bit on the abstract side, but you might be able to see the relationship between this photo and my son's painting.
What you thought it was: Absolutely no one thought this was a cat.
Most of you thought it was a minion (of Despicable Me fame) wearing a costume:
Several of you saw a cave of sorts (both of these tweets seem rather Freudian to me):
@mwachtel cave, with fire at the back, and bushes beside the cave on the outside. I like this one!.
— Dogenonymous (@canadaanon_anon) May 23, 2014
@mwachtel Light at the end of a rather short tunnel.
— Bret Higgins (@DeadBeatBert) May 23, 2014
A lot of you combined several different objects into one image. On the actual Rorschach, these types of responses are often indicative of severe brain damage or psychosis (if a person combines two objects in an unnatural way, it says something about his/her impaired perception of reality). On the Friday Rorschach, it is not problematic, though--it is a sign of creativity:
What you might have missed: No one saw the mouse sitting on a piece of cheese next to the cat. Scroll back up to the full picture at the top of this post. It will change your perception of what is taking place in the painting.
One last thought: Did you happen to see what looked like sperm cells swimming around in the background?
It is possible that many people saw the sperm cells but chose not to incorporate them into their responses. This is a normal process when one is publicly interpreting art--we all need to make choices about what we are comfortable mentioning out loud and what we want to keep to ourselves. And, if something in a piece of art makes us uncomfortable, we often do not even see it. (by Max Wachtel) Friday Rorschach is a fun project designed to engage readers' creativity. To participate, follow Max on twitter. He posts the drawing every Friday morning at 10am ET/8am MT. There are no wrong answers to the Friday Rorschach, and there is no judgment, either. This should not be considered a psychological evaluation.
Cat parents sometimes behave badly at sporting events too.
I was on 9News this morning talking about what happens to children when parents react with overblown anger at their sporting events. Even if the child is not the target of the anger, he/she can be psychologically harmed by an angry parent. Here is the video:
Last summer, I compiled a list of books that would make for good summer reading. If you were locked in jail. Here is the list. I am now looking for a new batch of summer reads for those in less fortunate circumstances. Any suggestions you have are greatly appreciated. Here are the rules: 1. The book must been published in 2013/2014. Books about to be published are fine. 2. It is fine to submit a book you have not written. If you love it and think it would make for good summer jail reading, suggest it. You don't need to send me a copy of a book you have not written yourself (although I would gladly accept books from strangers). 3. eBook-only suggestions will not be accepted. I have nothing against people who only publish their books electronically, but it is impossible to read an eBook in jail. No electronic devices allowed. 4. If you are submitting a physical book you have written for consideration and want it to be reviewed, please mail copies to Maximillian Wachtel, Ph.D., 720 S. Colorado Blvd., #610-S, Denver, CO 80246. Physical copies of books will not be returned. 5. Send email submissions to jailbooks@cherrycreekpsychology.com.
6. It is fine to submit a book you have not written. If you love it and think it would make for good summer jail reading, suggest it. You don't need to send me a copy of a book you have not written yourself (although I would gladly accept books from strangers). Thanks, and I can't wait to start reviewing! (by Max Wachtel, Ph.D.)
Last week, 9 News aired my story on the potential problems with video game playing. The video game industry is huge--experts estimate its annual revenues at $20 billion, which is roughly the size of the NFL, Major League Baseball, and the NHL. Combined. For most people, it is a fun and harmless pastime. For others, it becomes an addictive problem. National surveys estimate that 1 in 20 adults and 1 in 12 children have what could be considered an unhealthy addiction to video games. Here is my story:
In addition to the video, I wrote a web article outlining some of the warning signs to look for to determine if you or a loved one might be engaging in problematic video game play. I also created a list of tips in case you feel like you are playing a bit too much. Click here to read the article. And if you want to have a bit of fun, take this quiz to see how well you know your classic video games. (by Max Wachtel)
Yesterday, I spoke to Brandon Rittiman on 9News about two recent deaths in the Denver area that are related to marijuana edibles. In one case, a college student allegedly ate a cookie and then panicked and fell from a balcony to his death. In another case, a 47 year-old man allegedly shot and killed his wife after eating a small edible candy. His wife was on the phone with 911 at the time, saying she thought he was hallucinating.
In the story, I am quoted as saying we will look back at this time 15-20 years from now and be shocked that edibles were ever legal.
Needless to say, I caught some grief from pro-legalization folks because of that statement. I can understand why--marijuana has been illegal for a long time and numerous people have argued it is safer than many other legal substances. Now that it is legal, it must feel terrible to hear stories of people doing stupid, dangerous things while high.
To put my comment in some context, here is my thinking:
1. Edibles are small. One piece of candy is approximately the size of, well, a piece of candy. The cookies are normally sized cookies.
2. Many edibles are supposed to be more than one serving, with each serving containing 10mg of THC, the psychoactive substance in cannabis.
3. In the case of the student who fell to his death, the cookie he ate (mind you, this cookie is about the size of an Oreo) had 65mg of THC in it. Can you imagine cutting an Oreo into 6.5 equal pieces?
4. In the case of the man who killed his wife, he ate a piece of candy about the size of a Halloween-sized Tootsie Roll. It had 101mg of THC in it.
5. It can take up to two hours for an individual to start to feel intoxicated after consuming an edible.
6. It is common to hear of new cannabis users who eat a small portion of an edible, don't feel anything, and then eat the remainder of the product a few minutes later. This is was happened with the student who died, according to witnesses.
7. Cannabis strains that are selected for intoxication (as opposed to those used as pain relievers) are bred to maximize the amount of THC in the product and minimize the amount of CBD.
9. CBD acts as a natural antipsychotic, so when it is missing from an edible that has a high THC level, the effects of the THC can be magnified.
10. Kids like candy.
It is important to point out that the vast majority of the time, marijuana does not cause psychosis. It does not cause suicide. It does not cause homicide. And, it is also important to point out that there are many other legal psychoactive substances that are dangerous (alcohol and cigarettes immediately come to mind). Finally, there is no question that the nation's drug/alcohol laws are, at best, hypocritical at times.
Also, I hope the marijuana experiment works. It is legal in Colorado now, and it looks like it is here to stay. There may even be some positive benefits to society, such as cutting down on black market drug-related violence.
But, research points to the notion that highly potent edibles are dangerous. They have the potential to be abused, sometimes accidentally. And, their accidental abuse potential increases amongst new users, who are not aware of how potent they are. These are the very users who are most at risk for cannabis-induced psychosis and acting out in a dangerous manner while overly intoxicated. When THC is mixed with prescription medications, which may have been the case with the man who killed his wife in Colorado, the danger level can increase significantly.
Even worse, kids are at high risk for accidental ingestion.
It is my opinion that the risks associated with high-potency edibles are not something the public will be willing to accept, and because of that, I don't think they will be on the market much longer. Something else might replace them, such as edibles that only have 10mg of THC per food unit. But, we will look back at the beginning of the marijuana legalization experiment and be shocked that edibles, in their current form, were ever legal.
It is hard to believe that personality traits are genetic. We all know people whose personalities are very different from their parents, after all.
In order to clear up some confusion about what it means to have a gene for procrastination (or anything else for that matter), here are five facts that might help:
1. There is a difference between a person's genotype (his/her genetic make-up) and that person's phenotype (his/her set of observable characteristics that are dictated by both genes and environment).
For example, a person's genes dictate, to some extent, how tall he will be. But, if he was malnourished as a child, he will be shorter than if he was well-fed.
The same is true of personality characteristics. Many are genetically linked, but the environment in which a person grows up strongly influences the expression of those genes.
2. Most studies have shown that, with regard to personality and intelligence, genes account for about 50% of a person's phenotype and the environment accounts for the other 50%.
3. Many genetic personality traits are linked to the same gene--one that controls the number of dopamine receptors we have in our brains.
Dopamine is a neurotransmitter that gives us a highly pleasurable sensation when it is released. Depending on genetics (and the environment in which we grow up) the number of dopamine receptors in our brains can vary. Here is a quick list of some of the personality traits that have been specifically linked to the dopamine gene:
4. Remember all that information about Dominant and Recessive genes that you learned in high school biology class? Most genes don't actually work that way. At least not completely.
Genes are messy. Some are recessive. Some are dominant. Some cross over. Some mix with one another. A good example of this can be seen in the children of multiracial families. When a person with dark skin has children with a person with light skin, very often their children have skin tones that are somewhere in between the two parents. We know skin tone is genetic and if it were a strictly dominant/recessive issue, the children would end up having skin tone exactly like that of one of their parents. 5. Genes are not our (complete) destiny. With certain traits, such as height or intelligence, our genes dictate an upper limit--under ideal environmental circumstances, our genes will flourish and allow us to achieve our full potential. And, if we have 'bad' genes (like a gene for Diabetes), those genes may make it easier to get sick. But, our environment plays a huge role in the expression of our genes (our phenotype). So, you may have a slightly harder time solving a puzzle, or finishing a project on time, or avoiding certain diseases. But, living a healthy lifestyle can go a long way toward manipulating your phenotype in a positive way.
And, as parents, you have a lot of control over how your kids develop, so try not to mess them up too badly.
What it is: This is one of my son's drawings. I am not going to reveal what it is yet. But, when I told him I was going to use this drawing this week, he said, "Don't use it yet. This is just the sloppy copy!"
The sloppy copy is what his art teacher calls the drawing kids use to prepare and plan their actual artwork (I used to call them thumbnail sketches).
He eventually agreed to let me use his sloppy copy. As soon as I saw it, it occurred to me that Friday Rorschachers were going to have a difficult task. There is obvious phallic imagery in the drawing, and I suspected most people would choose to suppress that image and search of a less obvious response. It is not that I think people are sexually repressed. Rather, Twitter is a highly public forum and it can be uncomfortable for a lot of people to start talking about penises in a child's drawing in front of the whole world.
In fact, suppressing and censoring responses is a normal part of the real Rorschach experience. What happens is that people see the inkblot, which starts a complicated set of mental exercises. They see forms in the ink, and then they need to quickly, and sometimes unconsciously, decide which ones they are willing to say out loud to a stranger in the middle of a psychological assessment procedure.
What you thought it was: Several of you saw an alien or a monster (in Rorschach terms, this would be a fictionalized human response):
@mwachtel caught betweeen a monster& some sort of saw? w/a green BIRD in monster's mouth #FridayRorschach it's gotta be a bird, right? :)
— neditsimple (@neditssimple) April 11, 2014
@mwachtel#FridayRorschach That's the cookie monster's cuzin the Crescent Monster. He eats crescent rolls-arch enemy of the Pillsbry Doghboy
— Ed Endicott (@WYSIWYGFOTO) April 11, 2014
In an act of foreshadowing, two of you flipped the picture upside down and responded. In the Rorschach, this is perfectly acceptable:
@mwachtel#FridayRorschach turning the card upside down... It’s the Kraken devouring a submersible...with lots of texture ;)
— Thom Knudsen (@docintheboxx) April 11, 2014
@mwachtel It's upside down. It's a green eyed monster with an argyle sweater & punk hair with a green sub on his head. #FridayRorschach
— Robin Wiesneth (@Abrushwithhumor) April 11, 2014
The Twist...what it actually is: I post the Friday Rorschach photo at 10:00 ET/8:00 MT and get a flurry of responses over the next two hours. But, this time I threw the Friday Rorschachers a twist--I sent a second tweet at 1:30/11:30:
@mwachtel John Lennon cogitating on the first draft: "we all live in a green submarine"
— Theresa Benson (@radiantmeatball) April 11, 2014
@mwachtel Coming to this one late. Busy, busy day. A Blue Meany and the Yellow Submarine only neither blue nor yellow. #FridayRorschach
— Bret Higgins (@DeadBeatBert) April 11, 2014
What you might have missed: It was a totem pole. Specifically, it was my son's sloppy copy drawing of a totem pole face. His class is studying Native American art, and he described to me, in fairly accurate detail, the meaning of a totem. When I asked him about the one he is drawing, he said, "Mine doesn't mean anything. It's just art."
I left that statement alone, but I thought to myself, "It is never just art."
One last thought: A few of you saw several different images in the same drawing. That is perfectly normal. In fact, most people who take the Rorschach see more than one image in each of the ten cards presented to them. Most completed Rorschachs have somewhere between 17 and 25 responses. And, if a person only gives one response per card (for a total of ten responses), the Rorschach administration is invalid and the test giver needs to start from the beginning and administer it all over again.
Here is a great example of a multiple-response tweet:
@mwachtel The sword from Minecraft, an angry E.T., and a caterpillar with a propeller. Makes perfect sense. #FridayRorschach
— Hans Tishmack (@hansincolorado) April 11, 2014
And then there is the phallic imagery. I received more than 60 responses between the two photos, but only two of those responses mentioned a penis. I am wondering if people honestly did not see it or if it somehow registered in their minds but they chose not to mention it on Twitter. Any thoughts?
Friday Rorschach is a fun project designed to engage readers' creativity. To participate, follow Max on twitter. He posts the drawing every Friday morning around 10am ET/8am MT. There are no wrong answers to the Friday Rorschach.
Yesterday was opening day for Major League Baseball. I wait all winter for the first day of the season, and my favorite team, the Colorado Rockies, lost in spectacular fashion (which is not atypical).
More enjoyable for me than watching my team fall apart (which was still fun--it is only a game after all), was the pregame Pop Psych Twitter conversation.
I asked people to pick a song based on the following scenario:
Your team is ahead one to nothing. It is the bottom of the ninth inning. You are the closing pitcher, which means your sole job (the one you get paid millions of dollars for) is to get the last three outs of the game and secure the win. In order to get the crowd excited and to psychologically demoralize the other team's batters, you need to pick a song that will play as you walk onto the field.
What should that song be?
Before I get to the responses, let me share the walk on song for one of the game's all-time best closers, Mariano Rivera (who, interestingly enough, was also the last active player to wear Jackie Robinson's number before it was completely retired). Watch the video and imagine if you would want to be the first batter facing him:
Portrait of Stanley, The Cat, 2013, tempera paint on paperboard
What it is: It is a cat. Specifically, it is a portrait of the family cat, Stanley. This is one of my daughter's paintings, and she was embarrassed by how it turned out, because she thought it looked like an owl. I, however, love its style. It is a very flat painting, and she mixed interesting colors. She also put a great deal of effort into Stanley's white fur, giving it great texture. She has a good sense of balance, which forces the viewer to look at the whole piece, not just the enormous white part of Stanley's body.
The real Stanley
The flatness of the painting (the lack of dimensionality) is what made me think this would be a good Friday Rorschach post. The background jumps into the foreground, and many of you incorporated it into your responses.
detail of Stanley's fur
What you thought it was: Most of you thought it was a bird of some sort:
@mwachtel an astonished chicken because of all the fire surrounding it which came from the fireplace in the corner 🐥💥 #FridayRorschach
— Jesús M Hernández (@jesusmhdz) March 28, 2014
An even more surprising number of you saw this as a penguin:
@mwachtel#FridayRorschach a cowboy penguin/dove in a fabulous Puerto Rican landscape inspiring to salsa 💃💃
— Arundhati Sharma (@arundhatisharma) March 28, 2014
Several of you saw this as a bird wearing clothes. On the Rorschach, this would be considered a troubling sign--when an animal is engaging in an activity that is impossible, it is usually a sign of psychosis or traumatic brain injury (Remember, don't diagnose yourself with anything based on what you saw in this picture. I saw a bird wearing a hat, and I am neither psychotic nor cognitively impaired, as far as I know):
@mwachtel it's a puffer bird w/an oddly appropriate wide brimmed hat in distance
— neditsimple (@neditssimple) March 28, 2014
There was a lot of fire in this week's responses. In the Rorschach, fire responses are typically negative, as though the form is being destroyed. These responses, however, seem to be more of an indication that the black and orange paint in the lower right corner looks like a campfire:
There is always at least one Friday Rorschacher who uses the word obviously or clearly. As in, "it obviously looks like blah blah blah." On the Friday Rorschach, it is usedin a joking manner, because the Rorschacher's response is never very obvious.
On the real Rorschach, someone will make an obvious or clearly response every now and then, but he or she is usually not joking. And, the responses are never obvious or clear. They tend to be bizarre responses like, "It is obviously a penis with wings that has just exploded out of the window of Rapunzel's castle. Anyone could clearly see that."
@mwachtel an ant with a mullet hatching from an egg in the middle of an orange sherbet river. Natch! #FridayRorschach
— Lindsey (@iremembernot) March 28, 2014
A theme that crosses weeks in the Friday Rorschach is poop. People always see poop in these pictures:
@mwachtel the new president for Hair Club for Birds...he's not only president, he's also a member.
— Theresa Benson (@radiantmeatball) March 28, 2014
What you might have missed: For me, the first image that popped into my head when I looked at this painting was an owl wearing a mortarboard. I mean, it was so obvious. Looking back on it, it might have been the 12 years I spent as a university professor...
One last thought: Stanley is no longer with the Wachtel family. My wife and I had him before we had children. When our daughter was born, it turned out that she was horribly allergic to cats. I don't think she could breathe for the first three years of her life.
It was a tough decision, but we ended up giving Stanley away. My daughter almost immediately felt better (especially after a thorough house cleaning). But, the whole family missed the cat. So, we have the portrait of Stanley (the photo and now my daughter's painting) to remember him. And no one sneezes when we look at them.
Friday Rorschach is a fun project designed to engage readers' creativity. To participate, follow Max on twitter. He posts the drawing every Friday morning around 10am ET/8am MT. There are no wrong answers to the Friday Rorschach.
Sandy Nguyen, accused of felony theft after allegedly faking a cancer diagnosis in her son.
You may remember one of the "dead people" the boy in The Sixth Sense saw because of the horrible way she died. She was the little girl whose mother was secretly poisoning her.
Here is a YouTube clip from the movie where the girl's father discovers what his wife has been doing to their daughter:
This is a Hollywood dramatization, but it turns out that some people actually do that to their children. What used to be called Munchausen Disorder By Proxy is now referred to as Factitious Disorder By Proxy (or Factitious Disorder Imposed On Another).
It is a rare mental illness that causes a person to either intentionally sicken another person or to pretend that other person is sick. The perpetrator is almost always a mother and the victim is almost always her child.
In Denver last week, news broke of Sandy Nguyen, a woman who faked a cancer diagnosis for her six year-old son. She allegedly shaved his head every day, lied about his so-called medical procedures, and posted elaborate claims on Facebook about how stressful it was to raise a sick child.
Sandy Nguyen also allegedly raised around $23,000 for her son's supposed treatment costs. Eventually, her story unraveled and friends discovered she had been lying about her son's illness. She was arrested and is currently in jail on felony theft charges.
Here is a 9News story where Megan Fitzgerald interviews me about the situation:
Although it is likely Nguyen has a somatoform disorder such as Factitious Disorder By Proxy, she may actually be struggling with other issues. One of the hallmarks of Factitious Disorder is that the person's main motivation is to gain attention by being sick (or by taking care of someone who is sick). In order to qualify for the diagnosis, the person's motivation cannot be financial gain.
Clearly, Nguyen gained financially from faking her son's illness, although it is not known if that was her original intent. If she had planned all along to fake the illness to make money, she would probably meet the criteria for a different disorder such as Narcissism or Antisocial Personality Disorder.
Also, please note, I have never met Nguyen or her son, and I have not conducted a psychological evaluation of her. I am not giving her a formal diagnosis. But, there seems to be enough information in the public sphere at this point to make an educated guess.
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