Wednesday, November 30, 2022

Antisemitism, Inglourious Basterds, and Hate Crimes

Honestly, I don’t like Thanksgiving, I know, sacrilege but the holiday has always seemed so hard on my patients and frankly it isn't a blast for me, either, sitting around the table for hours.  Tough on the back. And I eat more and more and more, which I realize is the point, but still.  

This one was wonderful. in fact I don’t remember a better one in decades. FD and I enjoyed it pretty much because we hadn’t seen this branch of the tree in six months, which is a long time not to see your kids and grandkids if you have a relatively functional family. I know that during Covid folks have had it worse. 


In Chicago few people mask anymore, I don't, yet I sported an ugly white N-95 in the airport and on the plane to avoid the triple threat, Covid, flu, and RSD. As predicted the airport was MOBBED Sunday night, crazy full of over-stuffed humans ready-to-get-home. Exhausted, wide-eyed, very well behaved children pointed to puppies in purses. 

 

Over the weekend my son brought up the movie Inglourious Basterds, which I had never seen but found on Delta’s entertainment interface. Too long to finish, but still worth the time, Christoph Waltz is absolutely chilling as a Jew hunter colonel in France doing his Nazi thing, eliminating Jews from Europe, seeking out those hiding places. I believe that here in America there may be like-minded people, still, like the fictional colonel's, adults who want to do this, rid the world of the people who brought you all of the following and much, much more


Brought to you by Jews--a very, very, very short list:   


the polio vaccine, antibiotics, first Big Bang Theory and quantum physics, gasoline fueled cars (Sigfried Marcus), the cardiac pacemaker, ballpoint pens, fertilizer, color photography, the film industry, condoms (yes, condoms), the first reactors for NASA rockets, remote control pacemakers, the first laser, LED technology, Duracells, videotape, no, most of us don’t use that anymore but we did play the first videogames on the first Jewish conceived/developed game consoles, USB memory (an Israeli company, ScanDisk), microprocessors to prevent our computers from overheating, Facebook, WhatsApp, GettyImages, Nivea cream (that one is important), Heineken’s beer yeast formula, Mattel and Toys “R” Us, Sears, Macy’s, Marks & Spenser, the first Mercedes-Benz cars, Estee Lauder, Revlon, Faberge, Helen Rubinstein, Ralph Lauren, Haagen Dazs, Dunkin’ Donuts, Proust, Kafka, Joseph Roth, Arthur Miller, Saul Bellow, Billy Wilder, Fritz Lang, Kubrick, Spielberg, the Coen brothers and hundreds more, Mahler, Dylan, Leonard Cohen, Lou Reed, Mark Knofler, Jascha Heifetz, Yehudi Menuhin, Amy Winehouse, Billy Joel, hundreds of Nobel prizes, the creation of the Pulitzer Prize, UNICEF, the NBA, the AHL (American Hockey League), the Universal Declaration of Human Rights of 1948 written by Rene Cassin, Abraham, Moses, Jesus, and of course, Marvel. 


Feel free to add contributions in the comments. 


I didn't scratch the surface when we talk about the Yiddin. But enough about stuff we take for granted, i.e, all the good that most everyone gives and wants to give, let's get back to hate and violence. 

 

Inglourious Basterds  (spelling intentional) is arguably Quentin Tarantino’s most popular film. Apropos of something, perhaps, Mr. Tarantino is not Jewish but did marry in and lives in Israel. His popular 2009 film is a fictional alternative to historically correct events in World War II. Many of the main characters in the film are based upon real people. Not Brad Pitt, who leads an American squadron of scalping (literally) Nazi hunters. His band of basterds terrify Hitler, the Germans. 

A lovely scene, that..

Brad Pitt as a Nazi hunter

 

It is a violent film which means I covered my eyes during violent scenes making it hard to read closed captions. But that behavior, trauma avoidance, is worth 20 of exposure therapy when you're me. (Although I spend a good chunk of my life teaching exposure therapy). But not to have bloody flashbacks, that is the key for me watching film. And really, who doesn’t love a good war movie? I do. 

 

The story behind Tarantino's alternative script, the true one, is that there did exist vigilante Jewish volunteers during the war, men who sought out Nazis to torture and kill them. A secret British intelligence unit, X-Troop (like X-Men, hmm, which came first?) organized D-Day. Volunteers for X-Troop had already experienced the horrors of antisemitism in Europe and they didn't intend to let the Nazis win the war.  X-Troop soldiers did not glorify themselves with nicknames like Bear Jew in the movie, Bear Jew is memorable for mercilessly beating a Nazi to death with a bat (I only saw the first blow and still I think about it. In the war, not the alternative, fighters with no claim to fame at all did request to be dropped over enemy lines from airplanes to carry out their missions of vengeance. 


Tarantino had plenty of history to draw upon. The movie took 10 years to make.  (Read Quinn Hough at ScreenRant for more).

 

Which brings me to why I am writing about this now, other than I saw the film on an 8" x 6" screen on an airplane, a perk of Delta. Yay Delta for finding good films.  


The date November 9-10, 1938 marks a stepping up of the regime of terror against the Jews, Kristallnacht, the Night of Broken Glass. In those terrifying, horrifying 24-hours the Nazis smashed storefronts of Jewish owners, violently stormed Jewish homes, and ransacked synagogues. We call this a POGROM in my parts.


The day to commemorate that, a German pogrom, a day set aside to never forget it, always precedes Thanksgiving. 

Kristallnacht pogrom, the Aron Kodesh

Kristallnacht pogrom a terrorist attack


The world watched, certainly heard, about how what the Nazis did, how they planned extermination of an entire people. The world said nothing. We didn’t have Twitter. 

 

FAST FORWARD: 


From the Anti-defamation League: 


In 2021, ADL counted a total of 2,717 antisemitic incidents across the U.S. This represents a 34 percent increase from the 2,026 incidents recorded in 2020 and is the highest number on record since ADL began tracking antisemitic incidents in 1979. 

 

Not in every neighborhood, not in every city, not yet, but antisemitism is revving up in many a Jewish local. We want to think that it is the squeaky wheel that gets the press and that this is a very tiny group of Ungrateful Idiots, but it isn’t so small, and negative attitudes freely expressed on campuses across the nation about Israel on campus have added to anti-Jewish sentiment in America. (I am not good at debate so when anyone tells me that Israel should be more open to Palestinians freely living/visiting Israel proper, I tell them that in Gaza, where they chose to live, which they destroyed to create a military zone instead of the thriving agricultural economy it was when they 'occupied' it as their own (I was there. Gaza was gorgeous and rich, lush with vegetation, thriving), children are taught that the only good Jew is a dead Jew. This sounds so familiar. Never forget. Children are taught this message in school, earlier even. It is in the mothers milk, we say. Do we grant visas to seekers who say that the only good American is a dead American? I don't know, actually, but think not.

 

This blog is not about politics but it is about the seeds of fear and appropriate caution versus panic. When we hear stories like I'm about to tell you, true stories, Jews grieve immediately and some of us panic. We have children in Israel. We have children in the army. But this is life in Israel. In the back of the mind there is anticipatory anxiety, rational, the mind waiting for the next explosion, 


(1) November 23, 2022, terrorists exploded bombs (nails in a backpack I think I read). Two buses at two different bus stops in Jerusalem killed at least one teen, Aryeh Schupak, 16 years old, of Canadian-Israeli citizenship, leaving 22 injured. 



Aryeh Schupak


Soldiers in Jerusalem following a terrorist attack





And 










(2) Yesterday: A female IDF soldier in her 20s was struck by a car at the Migron-Kochav Yaakov intersection in the West Bank in a terror attack on Tuesday morning.  The alleged attacker: identified as 45-year-old Rani Mamoun Faiz Abu Ali from Beitounia. Married and the father of five children, he had an Israeli work permit and was employed at the Rami Levy supermarket at the Sha’ar Binyamin industrial zone.

 

So we have that to put a damper on our happiness, the relentless hatred of cousins. 


But back to antisemitism in America, the home of freedom and free speech, and a good deal of hate, too. Psychologically people who are down, depressed, desperate and hopeless find that hate feels okay, The negative thinking summons the negativity emotion to leave the brain, come out of the mouth. Look, look what I am doing. Thoughts in my brain, a bit on the negative side, coming out of my mouth via my keyboard. Do I feel better? A little. I want antisemitism to be out of the closet. I want people to know that there are haters and these people have to be stopped, put behind bars when they commit hate crimes. That is the purpose of this post. Writing, like this is not a crime. Swastikas on synagogues are a whole other level.


But back to hate. Hating others, hating the self, is a sign of a negative affective state. We talk in therapy about hate and how it doesn’t change anything, only makes the hater feel worse, ultimately because it is not a positive identity, being a hater. Unfortunately, those who are spewing antisemitism so they can bring themselves up by putting other people down, are not getting psych consults. They are just out there creatively spewing hate just like the Nazis did in the twentieth century.

 

Camaraderie in depression, camaraderie in failure, violent goal-oriented behavior directed towards a target that has everything they do not.  

 

Will there be a time—in my lifetime— I can’t help but wonder— when strong, young, Jewish men, men who already have weapons (what do you think, Jews don’t carry?) will see the need to use them here in America? Will we be forming cells like Inglorious Basterds, like those we see in the movies? 

 

Because Never Again really does mean Never Again

 

therapydoc

Tuesday, November 22, 2022

DSM-5-TR

The DSM-5-TR


I'm not even sure how long the DSM-5-TR has been out (some of us haven't been paying attention) and honestly for me that's embarrassing. But the copyright is 2022 so if you're just tuning in, like me, you aren't that far behind. My copy is in the mail so I'll be referring to the TR in future posts beginning with a refresh of yesterday's (yesterday?) discussion about defining pedophilia. Over time we will review other disorders, too.

Usually TR means text revised and implies important changes. Why bother otherwise? The last DSM-5 is only 9 years old but academians have been busy, apparently. 

The American Psychiatric Association lists changes to the DSM. A glance tells me that those of us who have to diagnose had best go shopping. Totally rewritten there are, of course, even new codes. The APA boasts the following : 

  • Fully revised text for each disorder with updated sections on associated features, prevalence, development and course, risk and prognostic factors, culture, diagnostic markers, suicide, differential diagnosis, and more.
  • Addition of Prolonged Grief Disorder (PGD) to Section II—a new disorder for diagnosis
  • Over 70 modified criteria sets with helpful clarifications since publication of DSM-5
  • Fully updated Introduction and Use of the Manual to guide usage and provide context for important terminology
  • Considerations of the impact of racism and discrimination on mental disorders integrated into the text
  • New codes to flag and monitor suicidal behavior, available to all clinicians of any discipline and without the requirement of any other diagnosis
  • Fully updated ICD-10-CM codes implemented since 2013, including over 50 coding updates new to DSM-5-TR for substance intoxication and withdrawal and other disorders
  • Updated and redesigned Diagnostic Classification

therapydoc

Monday, November 21, 2022

Pedophilia--The Definition

 

REPORT SUSPECTED CHILD ABUSE


A few weeks ago I wrote something about this (no, not the Praying Mantis post, something more serious) and took it down within the hour. I wasn’t in a good place, wasn't thinking like an academic, relied upon my memory for definitions and realize that's probably not a great idea. 

So I thought I’d take the topic in small, manageable bites, differentiate between sociopathy and pedophilia. Because a person can assault a child sexually and have no sexual interest in children at all, and a person can have intense sexual interest in children and never act upon his or her desires. 


Health professionals rely upon ICD 10 and 11 and the ICD relies upon the DSM-5 for mental health codes, so this discussion will stay within those parameters excepting the World Health Organization


The ICD-10-11 defines pedophilia as a "sustained, focused, and intense pattern of sexual arousal—as manifested by persistent sexual thoughts, fantasies, urges, or behaviours—involving pre-pubertal children.' 

The DSM-5 goes on to require that harm to the self or others is implicit in pedophilia as a disorder, but not as a condition or a state. But before we go over the DSM-5 criterion note that the World Health Organization's definition includes wider social ramifications:


Pedophilia refers to the sexual preference for children and poses a primary motivator for child molestation, which can incur great emotional and financial burdens on victims and on society, as well as on the pedophilic individuals themselves.  


Let's look at a bit of history, why don't we.

For over seventy years pedophilia has been classified as a mental disorder in the Diagnostic and Statistical Manual of Mental Disorders of by the American Psychiatric Associations. The DSM is upgraded every few decades and pedophilia has traditionally been classified as either a Psychosexual Disorder or a Paraphilic Disorder. The latest version of the DSM, the DSM-5, classifies it as a paraphilic disorder. There are dozens of these, but only 8 are chosen for the DSM primarily ‘because they are relatively common and some also entail actions for their satisfaction that, because of their noxiousness or potential harm to others, are classed as criminal offenses.’


 The 8 DSM-5 paraphilic disorders: 


voyeuristic disorder (spying on others in private activities)


exhibitionistic disorder (exposing the genitals)


frotteuristic disorder (touching or rubbing against a nonconsenting individual) 


sexual masochism disorder (undergoing humiliation, bondage, or suffering)


sexual sadism disorder (inflicting humiliation, bondage, or suffering)


pedophilic disorder (sexual focus on children)

 

fetishistic disorder (using nonliving objects or having a highly specific focus on nongenital parts of the body, and 


transvestic disorder (engaging in sexually arousing cross-dressing).  


Pedophilic disorder is considered an anomalous target preference disorder. Anomalous means that it deviates from the norm, from what is expected.


The label paraphilia denotes any intense or persistent  sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners. The DSM takes into accountability that the interest may be less intense or persistent as among the very ill or elderly. 


Note: children cannot legally consent to sexual relationships


For a paraphilia to be a disorder it must cause intense distress to the one who has it or personal harm or risk of harm to the target. Having a paraphilia, according to the manual, does not justify or require treatment. 


The DSM-5* criterion for Pedophilic Disorder F65.4 (302.2)   

A.     A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children (generally age 13 years or younger)

B.     B. The individual has acted on these sexual urges, or the sexual urges or fantasies cause marked distress or interpersonal difficulty

C.     C. The individual is at least 16 years old and at least 5 years older than the child or children in Criterion A.

Note: Do not include an individual in late adolescence involved in an ongoing sexual relationship with a 12 or 13 year old. 

Specify whether:

Exclusive type (attracted only to children)

Nonexclusive type

Specify if: 

Sexually attracted to males

Sexually attracted to females

Sexually attracted to both

 

Pedophilic sexual orientation is not the same thing, according the DSM—5. Here: the individual is not distressed or suffering any guilt, shame or anxiety about a sexual attraction to children, reports never having acted upon these impulses, and is not otherwise functionally limited by the paraphilic impulses and has not acted upon them.


 A person with pedophilia has an attraction to children that begins at puberty and doesn’t abate over time. What might change over time are feelings of distress, i.e. guilt and shame, feelings of isolation, or the propensity to act upon the desire. 


 The prevalence is not known, but is estimated to be approximately between 3-5% of the male population, unknown for females at the time the DSM-5 published in 2013. There is new data on women and I am waiting for the research to be delivered to my mailbox, hopefully soon. It suggests there is no difference between males and females.


 One is more likely to act on sexual impulses if diagnosed with antisocial personality disorder so the personality disorder is a risk factor. This explains my vitriol in the post that I took down, my screaming that a school pedophile who likely harmed a dozen or so children should be reported to police because this is NOT A NICE GUY, rather is a sociopath and should be in jail. 


So I wasn’t so off the mark on that one. 


But to be clear. One not have a diagnosable antisocial personality disorder to be a pedophile who acts upon his impulses. Pedophilia itself is the risk factor, a condition, a disorder that can cause emotional, psychological, social and financial harm to children.


One not have a diagnosable antisocial personality disorder to commit sexual crimes with children, nor need one be a pedophile to commit sexual crimes against children. 


 When we refer to the association between antisocial personality disorder and child sexual assault, it is about an adult with the personality disorder using the child for sex on the basis of accessibility. The child is available. A pedophile who works in a school and seduces children is harming them. He may not have antisocial personality disorder but intentionally harming children is sociopathy, a legal parlance. This is why I so strongly suggest that law enforcement be the judge regarding criminality, not school authorities. 


That and all school personnel are mandated reporters in most states. They must report to state departments of protective services. In Illinois, for example, mandated reporters must call the Department of Child and Family Services Child Abuse Hotline.


24-hours 800-25-ABUSE (800-252-2873)    Mandated means that if you have a suspicion of child abuse of any kind, you are required by law to call that number.  Mandated reporters include:
  • physicians
  • physician assistants
  • psychiatrists, surgeons
  • residents
  • interns
  • dentists
  • dental hygienists
  • medical examiners
  • pathologists
  • osteopaths
  • coroners
  • Christian Science practitioners
  • chiropractors
  • podiatrists
  • registered and licensed practical nurses
  • emergency medical technicians
  • hospital administrators and other personnel involved in the examination care or treatment of patients
  • teachers
  • school personnel
  • educational advocates assigned to a child pursuant to the School Code
  • directors and staff assistants of day care centers and nursery schools
  • child care workers
  • truant officers
  • probation officers
  • law enforcement officers
  • animal control officers
  • field personnel of the Departments of Children and Family Services, Public Health, Public Aid, Human Services (acting as successor to the Department of Mental Health and Developmental Disabilities Rehabilitation Services, or Public Aid), Corrections and Human Rights

Bottom line: Not everyone who assaults children sexually is a pedophile, and not every individual diagnosed with pedophilia is dangerous to children. 


And anyone who suspects a child is being abused or sexually assaulted, molested, should report it. You don't need a mandate. 



therapydoc


*Note: The DSM-5 TR (text revised) is out and mine is due to arrive in early December. This post will have a refresh after that. 



 

Wednesday, November 16, 2022

Preying Mantis, Child Abuse, Child Sexual Assault


No, that's not a typo in the title

It’s a lazy, cold, rainy morning and I’m catching up on Facebook, wondering if there’s an actual date that the world will melt from global warming or some similar event to spoil my Zen. Masochistic, I know. But Donald is running in 2024! People in power, more than one, are outed for sexually abusing children. Oh, that works. 

But wait. Before getting to anything substantial, maybe in lieu of getting to anything substantial, let’s play a game! A language game. 


Is child sexual abuse the same as child sexual assault


When it comes to kids people are always using the word abuse as in child abuse, but in my studies of sexual assault, and there were several years devoted to this, I learned that no matter the spot on the continuum from molestation to rape, or even murder before or after the rape, it is the legal word assault that we use. So why, if we are talking about kids, is it abuse that gets prime time? Nobody says, A child was sexually assaulted in a classroom. They say, there’s a case of child sexual abuse in such and such a school. Just an example, apropos of nothing. Let’s look a little deeper.


I was not even sure what abuse meant so I Googled it and found the definition of abuse to be improper treatment. Abuse is softer, it is code for assault, less in your face.  


By this definition we might say that abuse is what happens while I am behind the wheel of a car with a manual transmission. I will abuse the clutch. You can count on it. The clutch is likely to be an ex-clutch when I get through with it but it isn’t something intentionally cruel, I don’t mean it, I do not set out to wreck the clutch or its future. 

 

Abuse might also be applied to shoes, or linens, too. You wear a pair of suede shoes out in the rain. Or you take a tablecloth, one that should have been dry-cleaned, and throw it in the wash. Textile abuse. Always accidental but the consequences are lasting. 

 

But you see, nobody cares if I ruin my shoes. Nobody cares about my table cloth, except maybe my mother and she is in Heaven. In Heaven there must be better things to do. Perhaps golf.

 

Assault, on the other hand, implies more energy, more intention, even violence. It is what I’ve done to more than one cockroach. I admit to assaulting small, defenseless creatures, midges, flies, mosquitoes. Maybe a spider or two. This points to a severe empathy deficit when it comes to insects. Is the deficit genetic or learned? It is learned, for sure. This one is learned. I suffered a trauma and I need to talk about it. Talking about trauma can be therapeutic. It is can be exposure therapy.


A Relevant Story About the Praying Mantis


Once I loved these insects—so elegant, so delicate, filigree green—until on a summer night at the pool, about to hop in, I see a praying mantis merrily prancing in the water. The green sticklike creature is hopping up onto the blue and white plastic rope cordoning off the lap lane. Not believing my eyes and good fortune, because again, I had once loved these insects and had never seen one in a swimming pool, I jump in to get a closer look. 

 

A correct call! This is a mantis pacing back and forth on a plastic rope. I watch for a bit then swim a few laps, checking once or twice to see if it is still there. At one point I stop to observe, stand up for a better view. Within seconds the mantis’ persona seems to change. The creature appears to be summoning up insect serotonin, readying itself for an attack. Posture forward, legs in front. No longer praying. 

 

Stunned, I do not move. Why this sudden confrontation, I wonder? Perhaps it thinks I invaded its  space, turf. He, she, they got there first. (Let’s go with she). I’m not usually in the pool after dark. Or maybe this evolved creature, clearly a favorite of the Old Mighty by design, feels objectified. I had been watching, admiring. She jumps back in, treads water a moment while glaring at me, bug-eyed, threatening.  


I’m about four feet away. We have a little staring contest for a few confusing seconds before she makes her move, darts at me, paddling at top speed! True story! I back off, swim away fast, terrified, and when I look back, she is gone.

 

The moral of the story? 

 

Do not trust all insects, especially if they feign to be religious. 

 

Game over. 


There is more to be said about why child sexual assault within schools tends to be washed, bleached, softened as child abuse or even no abuse at all. So this subject is 


To be continued.


therapydoc




 

T

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