web analytics
April 20, 2014 / 20 Nisan, 5774
At a Glance

Posts Tagged ‘American Psychological Association’

Agudath Israel slams NJ Gay Therapy Law

Tuesday, August 20th, 2013

Agudath Israel of America condemned a New Jersey law prohibiting gay reparative therapy for minors as an infringement on religious freedom.

The statement from Agudah came just hours after Gov. Chris Christie signed a bill barring licensed therapists from providing treatment to help gay teenagers become straight.

“The new law tramples on the rights of mental health therapists to engage freely in their profession, and it unfairly denies teenagers seeking therapy for issues that are troubling them the ability to obtain professional help,” the group said.

“Under the new law, therapists, social workers or counselors who work with minors on these issues risk losing their licenses to practice their professions, and minors who sincerely want to obtain professional help will have nowhere to turn. This is an unconscionable infringement on personal liberty and a trampling of personal rights, including religious and free speech rights.”

New Jersey joins California as the only states with laws barring so-called reparative therapy. The New Jersey bill passed both houses of the state Legislature in June with bipartisan support.

In signing the bill into law, Christie, a moderate Republican who is widely believed to be eyeing a presidential run in 2016, appended a note indicating his reluctance to intrude on parents’ ability to determine the right treatment for their children.

“However, I also believe that on issues of medical treatment for children, we must look to experts in the field to determine the relative risks and rewards,” Christie wrote. “The American Psychological Association has found that efforts to change sexual orientation can pose critical health risks including, but not limited to, depression, substance abuse, social withdrawal, decreased self-esteem and suicidal thoughts. I believe that exposing children to these health risks without clear evidence of benefits that outweigh these serious risks is not appropriate.”

Diagnosing Mental Illness: How DSM-5 Will Change the Rules

Thursday, May 31st, 2012

Mental health specialists tend to speak about their patients according to a classification referred to as the DSM, which stands for the Diagnostic and Statistical Manual of Mental Disorders. This classification system was first published in 1952 by the American Psychiatric Association as a method to classify mental disorders and develop a statistical baseline through which disorders can be understood, studied and treated. It is not the only classification system available: the International Classification of Diseases, published by the World Health Organization, contains mental health diagnoses that parallel those of the DSM, but the DSM is most widely used in the mental health field, especially in the United States.

All classification systems evolve over time, and we are about to receive the latest iteration of the DSM in 2013. To understand why changes are made, one need only look at the changes made in each of the DSM revisions in the past. In the first DSM, which was based primarily on soldiers’ reactions to the stresses of World War II, all of the 106 diseases listed were termed reactive, or caused by reactions to social or environmental factors. This limited classification to traumas and environmental stressors.

In the DSM II, which contained 182 illnesses, the word reactive was removed, allowing for a broader approach to understanding possible biological or genetic contributions and other non-stress induced disorders.

DSM III, published in 1980, formulated a system that included a description of 265 diagnostic categories without any suggestion as to cause, unless it was very well documented, and conformed to very specific diagnostic criteria.

In 1994, the DSM IV added and deleted a variety of categories based on the research available at the time. In that version, which was further revised in 2000, only symptoms that caused clinically significant distress or impairment in functioning were included. Definitions of Attention Deficit Hyperactivity disorders and Autistic Spectrum disorders were expanded, and all of the disorders had a checklist of specific diagnostic criteria that had to be met in order to apply a diagnosis. This gave both clinicians and researchers a measurable way to classify their patients, the goal of which was to help find empirically validated treatments.

Every revision of the DSM causes a reaction among professionals and the public. Changes are often attributed to political considerations rather than research that supports the suggested changes. For example, in 1973, the DSM declassified homosexuality as a disorder, and the diagnosis was replaced by the category of Sexual Orientation Disturbance (SOD) because research failed to identify a specific abnormality caused by this sexual preference. Over the years, SOD has been modified and expanded to include a wider variety of sexual disorders and paraphilias. Some individuals still believe that gay activists advocating for their own agenda brought about this change, although that is highly unlikely.

The task force working on the DSM-5 was initially sworn to secrecy. This caused an uproar in the scientific community, which rightfully demanded an open process. Once the revision process was publicized and the recommendations for change became available, critics of the DSM-5 voiced three primary concerns. These include lowering of diagnostic thresholds that would increase the number of individuals who fit a diagnosis, introducing new disorders that are currently considered normal behavioral patterns, and questions regarding the scientific validity of certain categories.

If the DSM-5 goes forward as proposed, it could include changes such as a significantly broader definition of Attention Deficit Hyperactivity disorder; an Attenuated Psychosis Syndrome which would allow the diagnosis of individuals without a psychotic disorder to be classified as having one; and the categorization of shyness as a pathology.

Another proposed change would be a complete overhaul of the category now referred to as personality disorders. Perhaps the greatest concern of the scientific community is the neuro-biological emphasis of the DSM-5, and what some are calling the “over-medicalization” of disorders that are clearly a combination of biological, psychological, and social stressors. This is of great concern because it would provide justification for wider use of psychotropic medications, many of which have questionable utility, in vulnerable people who might benefit more from psychotherapy or counseling.

The need for practical interventions that are proven effective should be the primary motivator, but financial considerations are a pragmatic driving force. In the end, there is a great fear that the new criteria proposed in the DSM-5 will favor medical interventions, which may be seen by insurance companies as cheaper than therapy.

When Religious Doctrine Undercuts Mandated Reporting On Abuse

Wednesday, June 1st, 2011

The New York Times got it right. In an editorial published on Thursday May 19, the Times castigated the Vatican for issuing “flimsy guidelines” for combating the sexual abuse of children by the clerical hierarchy.

According to the Times, the Vatican “issued nonbinding guidance,” giving authority to local bishops which in effect bypasses the need to report the criminal offense of sexual abuse, or for that matter any abuse performed by an official of the Church, to the proper legal authorities.

In essence the report places Church doctrine ahead of the law and allows the local diocese the religious right to shield abusive priests from prosecution. At about the same time the guidelines were released, a study, funded primarily by Church sources, was released. The study allegedly reviews the causes for the sexual abuse scandal in the Church and, in an interesting twist of propaganda, blames the social climate of the 1950s, 60s and 70s for priestly indiscretion.

Taken together, this bizarre approach to coming to grips with the depth of the problem and working to set up parameters to prevent further transgressions is not just counter-intuitive, it’s absolutely backward.

The law is quite clear. Individuals who are mandated reporters must report any suspected abuse to the proper authorities. In most states mandated reporters are teachers, doctors, lawyers and child care workers. In many locales clerics are also mandated reporters. Apparently the Church feels that reports are not mandated by Church doctrine and that the best needs of society are secondary to religious doctrine. This could be humorous if it wasn’t so sad. Unfortunately, the Church is not alone in this folly.

Last month Agudath Israel of America held a conference for professionals at which the topic of how and when to report suspected abusers was discussed. The presentation of the topic included a good deal of source review and explanation. The presenter was knowledgeable about the issue. But, shockingly, the position advocated by the Agudah sounds astoundingly similar to that promulgated by the Vatican.

The conclusion stated in the Agudah position is that you must first ask a senior rabbi with experience or “even better, you should ask a full beis din” before you can call the proper authorities to report suspected abuse.

As a mental health professional I am a mandated reporter. What this means is that if I am made aware of a situation that raises a reasonable a measure of suspicion that abuse of any type is taking place, I am obligated by law and my professional license to report the situation to the proper authorities.

Nowhere in my professional training are rabbis considered proper legal authorities in this matter. In fact, if I report only to a rabbi, I put not just my professional license in jeopardy but also the welfare of the individual who is being abused.

Rabbis are not generally trained in forensics or police work and simply have no authority to intercede in any legal capacity to aid the abused person or apprehend the abuser. In addition, I may be breaking certain HIPAA laws related to confidentiality if I discuss a situation related to someone I am treating with someone who has no legal standing.

It is important to understand that most professionals do not have to report often, and certainly they do not do so lightly when they feel the need to report. Further, the reporting system, at least in New York and several other states, allows for a discussion with the agency to which the professional reports in order to better determine if a particular case merits investigation.

A professional can discuss in total confidence what he or she sees as suspected abuse – without providing any identifying information – if there is any uncertainty about the situation being a reportable offense. The specialist helps the mandated reporter determine what is reportable. The system is not generally set up as an immediately reflexive and overwhelmingly reactive response – unless there is clear and obvious abuse.

By issuing the doctrine of rabbis as the first report, Agudath Israel has put my license, my parnassah, my professional integrity and the law of the land in jeopardy. And while that alone is sufficient cause to ignore the position, there is one even more imperative justification for not following the mandate. So many poskim, from Rav Elyashiv to Rav Hershel Schachter, have declared that individuals who abuse children are in the category of a rodef  (a pursuer) and should be reported to the police.

Abuse And The Brain

Wednesday, March 23rd, 2011

We may not want to accept it, but abuse occurs everywhere, even in our own communities. The effects of abuse are devastating and long lasting – not only on those individuals who are abused but on their families as well. Even one act of abuse against a person, regardless of age, can have a significantly negative impact that may last a lifetime.

The impact is often much worse when the abuse occurs to a child. People, especially children, who are abused can and often do develop a constellation of different mental health problems including anxiety, depression, suicidal ideas and acts, post-traumatic stress, eating disorders and a variety of other problems most notably character flaws referred to as personality disorders. We understand that abuse is wrong and harmful and should not be tolerated but we are not all that clear on why and just how severe abuses’ bearing is on the most basic quality of life issues.

Recent neuropsychological research is beginning to explain why abuse can harm even the most resilient of individuals. What we are learning is that the old nature versus nurture controversy is simply a straw man. Both components – the genes we are born with and the nurturing we are provided – work together, virtually in equal measure, in forming who we are. This finding has led to an area of research entitled epigenetics. The epigenetic approach has found that the environment an individual is exposed to has an impact on both the expression of the underlying genetics a person is born with and can also actively alter the internal structure of genes themselves. Advertisement

Not only genes but certain basic structures within the brain may be altered by the exposure to abuse. Two structures set deep within the brain, the hippocampus and the amygdala, have been found to be smaller in people abused in childhood as compared with people who were not exposed to trauma. The hippocampus is known to be involved in the process of learning, memory and depression. The amygdala helps to regulate emotions, mood, fear and sleep. It is no wonder, then, that traumatized people can suffer from so many problems. While the young, developing brain may be more vulnerable to these actual physical changes, trauma has been found to alter brain make up regardless of the age of the maltreated person.

What is most interesting is that just as the brain may be altered by horribly traumatic experiences, positive experiences may also alter the brain. Loving, nurturing, supportive and encouraging experiences help the developing brain make connections at the cellular level that enhance experiences later in life. A warm early life has been linked to the development of a resilient approach to life. People who are resilient tend to see challenges as opportunities and have a “can do” attitude about life. They have a healthy network of social and family support, are often very spiritual and have a religious perspective on the meaning of life.

Abused people are more likely to avoid social involvement and discount the spiritual aspects of life. Treatment is predicated on the concept of “plasticity.” Just as the brain may be molded by traumatic experiences it may also be reshaped into a healthier functioning mode by the right therapy and the correct positive social and emotional experiences. For some people the process of change may take many years, even decades; for some the change may never come; but for many it may happen in just a few years.

Of course, one of the best ways to help stop the spiraling negativity and subsequent pathology that traumatized people experience throughout their lives is to stop their abuse and give them the social support and nurturing they so desperately need. That unfortunately does not seem to be a real possibility just yet. Abuse will probably continue and in most communities there is still an entrenched habit of blaming the victim.

While abusers are likely to have been abused themselves when they were young, only about 20 percent of those who were abused become abusers. The remaining 80 percent tend to lead internally troubled lives. Both these groups need to be identified and dealt with. There is not much clinical or research evidence that supports a treatment that successfully stops abusers from continuing their abusive behaviors there are however ways to contain abusers so that they no longer hurt others.

Printed from: http://www.jewishpress.com/indepth/opinions/abuse-and-the-brain/2011/03/23/

Scan this QR code to visit this page online: