SELF-DECEPTIONS AND MISCONCEPTIONS OF PSYCHIATRISTS, PSYCHOLOGISTS, AND OTHER MENTAL HEALTH PROFESSIONALS, THE

Adolescent Psychiatry, 2003 by Levine, Saul

In this scientific and managed-care era, one could expect that the current clinical practices of mental health professionals would be entirely data based and outcome substantiated. Of course, this is still far from reality, for many reasons, not the least of which are the inherent difficulties in rigorously, reliably, and validly evaluating those practices. But numerous practitioners nonetheless feel that their own unique techniques are unequivocally efficacious, and they act as if they have achieved the psychotherapeutic Holy Grail. Are they deceiving themselves, or others?

The word deception connotes or implies the active and conscious misrepresentation of reality with the express purpose of manipulating or deceiving others. Self-deception, on the other hand, like myths or misconceptions, has a less malevolent connotation (Mele, 1997; Trivers, 2000). Instead of duplicity, we are witnessing lack of knowledge, cognitive dissonance (Festinger and Carlsmith, 1959), or even denial and defenses, and entrenched beliefs, that enable individuals to unconsciously act in a manner that protects and enhances their own senses of self. Although usually not volitionally deceitful, the self-deceptions of some psychiatrists, psychologists, and other mental health professionals might well enable these "providers" (a decided minority of all mental health professionals) to espouse attitudes, behave therapeutically, or promulgate expert opinions in ways that are less than justified or not substantiated by empirical research.

MYTHS ABOUT PSYCHOPATHOLOGY

Let us review some of the myths and misconceptions that may have crept into some of our professional beliefs and actions, or into the way we are perceived.

Sturm und Drang in Adolescence Is Inevitable

There are still some mental health professionals (and certainly, many parents) who cling to this long-discredited notion. First postulated by Anna Freud (1966) a half century ago, it became a sacred belief and part of the professional teaching of many psychotherapists. But its roots lay in ancient cultural anlages. Hesiod complained:

Our adolescents now seem to love luxury. They have bad manners and contempt for authority. They show disrespect for adults and spend their time hanging around places gossiping with one another. . . . They are ready to contradict their parents, monopolize the conversation in company, eat gluttonously, and tyrannize their teachers.

Even Shakespeare (1610) is often quoted: "I would there were no age between ten and three and twenty, or that youth would sleep out the rest for there is nothing in the between but getting wenches with child, wronging the ancientry, stealing and fighting" (A Winter's Tale, Act 2, Scene 2).

Thus, adolescents have long been seen as inevitably tormented, wanton, selfish, and irresponsible. Nevertheless, longitudinal studies in different cultures have confirmed that most adolescents go through those years with fairly smooth and stable trajectories. It is an unfortunate myth that is disrespectful to that entire age group, the vast majority of whom progress relatively seamlessly and remarkably productively (Offer and Sabshin, 1984; Levine, 2000). It is also a dangerous belief: it is a self-fulfilling prophecy, an example of how expectations can and do shape behavior. Adolescents, expected to get into trouble, are more likely to use drugs, explode, act out, get pregnant, and so on by way of fulfilling their parents' and society's expectations. In addition, not only does this purview enable some behaviors to be ignored or excused as merely stage-related, but it can minimize pathological symptomatology. If it is expected that adolescents are by definition troubled beings, how is one to discern serious symptomatology and disorders?

Early Destitution Inevitably Leads to Later and Permanent Emotional Scarring and Disability

Prevailing conventional wisdom has been that early life deprivation can predict later adult suffering and scarring with absolute certainty. That this is not, in fact, the case has become abundantly clear via a variety of new research studies (Skeels, 1966; Garmezy, 1991; Richters and Martinez, 1993). Although early trauma can be a severe impediment, there are myriad accounts of people who have been born into lives of abject destitution, yet who have grown into mature, stable, productive, and generative adults (Brown, 1965).

Even children who were born into circumstances of tragic loss, war, brutality, forces majeurs, abuse, disease, disfigurement, and severe deprivation have developed and evolved into productive, generative, fulfilled and optimistic adults (Werner and Smith, 1992; Levine and Ion, 2001). There are known personal and social risk factors, to be sure, which can contribute to the more likely occurrence of psychological problems and obstacles, potentially leading to frailty and failure. But the obverse is equally valid, and, in fact, has much more valence in eventual maturation: human beings are remarkably resilient. Personal and social resources (both internal and external) are extremely influential in enhancing one's life and overcoming adversity (Rutter, 1990).