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Asking the Right Questions

  • Posted on February 10, 2010 at 2:55 PM

Alex, who is predominantly nonverbal, has been behaving in a way that indicates that bi-polar disorder or mania may be an appropriate co-label to apply to him.  While Alex’s behavior is very different from Mark’s, who has a diagnosis of bi-polar disorder, there are certain similarities.  After discussing the matter with one of the few psychologists whose opinion I value and trust, I decided that a mental health assessment may provide useful insights and possible strategies for helping Alex be more comfortable with himself and his environment.

In pursuit of this assessment, I recently filled out a series of mental health questionnaires.  Clearly these questions were not designed to address a child who is nonverbal at the age of ten, which makes me wonder how effective this assessment process will be.  Furthermore, a lot of the questions involved internal mental processes, which there is no way for me (or the doctors) to really observe.  While I understand there is a certain statistical validity and thoroughness to a set of generic questionnaires, there is also a de-humanizing element to this process.  Considering that I had to go through a thorough series of questionnaires to even get this appointment, it seems somehow inappropriate for their data collection efforts to continue to involve questions that are so poorly tailored to my son.  It makes me wary.  Are they prepared to assess Alex at all, let alone provide me with actionable information in response to that assessment?

Then again, when it comes to psychologists, I worry about that in a more generalized fashion.  My interactions with psychology have left me with a deeply in-grained belief that much of psychology is based on unquestioned, unquestionable biases.  One bias is that “different=bad,” which I reject wholly.  A more subtle bias is that observation of behaviors equips psychologists to explain internal mental processes.  Yet, there is something inherently absurd about this bias.  First, mental processes cannot be observed, unless you’re observing the brain at the time—in which case the issue is separating the many mental processes one is observing in relation to the many behaviors that are occurring.  Second, observation is by its nature subjective.  Most of us only observe what we look for, and sometimes we see things we’re looking for when they’re not really there.  Ironically, this absurdity is made apparent through the study of psychology.

Allow me to illustrate:  If someone were to look at my hands, they might think I’m afraid of germs.  This is a logical conclusion from a psychological perspective, because my hands have sustained (and continue to sustain) physical damage from excessive hand-washing.  I have open crevices in my skin which sometimes bleed.  I have scabs over partially healed crevices.  My hands look far older than their 30 years.  Sometimes my skin is so dry and stiff that it looks like arthritis has stolen their mobility.  A common explanation for such a destructive behavior is a phobia, especially when that behavior coincides with obsessive-compulsive disorder (a diagnosis I have).

And yet, my behaviors have nothing to do with germs.  Unless you’re looking for germ-o-phobia you won’t find any real evidence of it.  In reality, as subjective as my personal reality may be, the damage to my hands is the result of a combination of raising young children and having tactile sensitivities that makes touching anything sticky, tacky, slime, gritty, sandy, flaky—well, the list could go on, but I think you get the point—an adverse experience.  So, sure I wash my hands every time I change a diaper or touch the garbage can or sort dirty clothes or pick up miscellaneous things from the floor.  Sure, I wash my hands whenever I sneeze or blow my nose or go to the bathroom or take out the trash.  These are basic sanitary actions.  What makes it excessive is when I have to wash both my hands all over because the side of my finger touched something tacky, like the glue left behind by a sticker that was stuck one too many times.  Or when I do the same thing, because my hand brushed up against something sticky, like the ring left behind by a juice cup.

Perhaps my behavior isn’t rational.  Perhaps it is compulsive.  But, far too many people have tried to label my behavior, both officially and casually, without understanding it.  Yet, when it comes to people doing this to me, I’m prepared.  I’m a highly introspective person and tend to understand myself quite well.  I know why I wash my hands until they literally bleed.  When others throw their baseless speculations at me, I can flick them off with the little regard they deserve.

I’m much more wary when it comes to my children.  While I think I understand my boys fairly well, I’m also insightful enough to recognize that there is far more I don’t understand.  I don’t know how Brandon really feels about being shuffled between two very different households.  I don’t know why Willy feels so comfortable walking up to complete strangers and starting a conversation.  I don’t know what Alex is trying to do when he colors the same drawing furiously for a half an hour, discarding page after page after page and starting again.  I don’t know why Ben closes a book or stops a video at the same part over and over again, yet seems to like that same book or video so very much.  I don’t know these things, and I don’t think their behavior alone can provide genuine insights into the behaviors themselves.  To truly understand these emotions and these actions and all that goes on in-between you have to understand the experience of the individual.  The only way I really know to do that is through communication, but even that is imperfect.  What the other says and what I interpret are and always will be two entirely different things, and this isn’t because I am specifically flawed—all of humankind faces the same limitation.  What I understand and what is meant may be close; my understanding may be sufficient, but these two separate experiences are always going to be at least slightly different.  More importantly, they can be substantially different.

So, as I prepare myself for this meeting I have tomorrow, I remind myself that they may have a greater understanding of the discipline of psychology than I, but I have a better understanding of my child and an appreciation of the limits of that understanding.  For a child who struggles so much to communicate, it may seem natural to rely on interpreting his behaviors to gain insights to his internal processes.  But, these insights are far from perfect and that must never be forgotten.  Last, but not least, as we seek to understand Alex and to help him, we must remember to ask the right questions, because the questions we ask color the experience for each of us.