THRASHING

“If your child displays extreme irritability, anger, and frequent, intense temper outbursts, they may benefit from being screened for disruptive mood dysregulation disorder (DMDD), which is fairly new diagnosis.”

“The symptoms of DMDD resemble those of other childhood disorders, notably attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and bipolar disorder in children. DMDD first appeared as a disorder in DSM-5 in 2013. Little is known about its course or etiology.”

“DSM-5 includes several additional diagnostic criteria which describe the duration, setting, and onset of the disorder: the outbursts must be present for at least 12 months and occur in at least two settings (e.g. home or at school), and be severe in at least one setting. Symptoms appear before the age of ten, and diagnosis must be made between ages 6 and 18.  The diagnosis for DMDD should not be made for the first time before 6, or after the age of 18. This new diagnosis was implemented to help children who, although may have been diagnosed with bipolar disorder, their explosive rages were not being treated properly.”  [i.e. wrong meds.]

This is taxonomy medicine, the 19th century approach to the unknown, an impulse to make lists based on observation and subjective judgments of the variations.  It is met and encouraged by profit-linked pharmacopia, lists that match the “diagnosis” with the approved pill.

But I know of whole categories of society where the children and some of the adults, (in fact, I myself) have extreme irritability, anger, and frequent, intense temper outbursts.  I’m a hermit — the cats are the only ones who really know about my fits and their strategy is not pills — it’s avoidance.  On the reservation next to me, these kids are easy to find.  In fact, they are not well-hidden even in the little white ag towns that are supposed to be havens of normality and love.  

Nevertheless, I suggest that the treatment AND the cause is cultural and iatrogenic (at least partly caused by the present treatment).  Also, closely related to the variations among the array of things like painkillers, antacids, cough syrups, and detergents on our supermarket shelves.  The cause and cure are locked together so tightly that it’s very hard to just dump both unless one goes to the base cause: over-reliance on one-to-one understandings of symptoms and cures presenting options that are not suppression.

This morning my newsfeeds showed a Mexican woman sitting in water while being suffocated with a plastic bag.  My guess is that sitting in water has something to do with body temp extremes and something to do with electricity.  Torture is meant to take the victim to the edge of homeostasis where their survival is in doubt.  The homeostasis may include the ability of the brain to process and the damage may persist after the action stops.

But it wasn’t my mother or sister or lover being tortured so my empathy was thinned.  No intimate categories in my life look like that woman, except for all my Blackfeet, Cree, and Metis friends.  If that woman survives, my premise is that she (and her children) will suffer from extreme irritability, anger, and frequent, intense temper outbursts.  For those people there are two strategies: change their society or get the hell out.

If children in white, adequately prosperous, respectable communities are showing these symptoms, there must be something going on that we are not recognizing.  Or that we don’t know what to do about and so deny.  If we were taking a taxonomic approach, we might say:  broken families; unhappy jobs; global shifting of weather, economics; substance abuse; confrontational politics;  unwanted children.  Abuse begets abuse which makes a cycle but  there has to be a hub and a pathway — a point of attachment and a way to go.

But I’m wandering.  The subject is disruptive mood dysregulation disorder, part of a suite of trouble-making behaviors from kids who just won’t get along.   Maybe not just kids.

“On National Children’s Mental Health Awareness Day May 5, NIMH is hosting a Twitter chat on DMDD and severe irritability from 12-1 p.m. ET with expert Dr. Ellen Leibenluft. Please follow our tweets on NIMH’s Twitter page. To ask questions, you must have a Twitter account and include the hashtag #NIMHchats in every tweet. If you won't be able to make the chat, you can submit your questions in advance. You may submit questions via email NIMHpress@nih.gov, Twitter using #NIMHchats, or NIMH's Facebook page.”

This “symptom” justifies the dedication of a day, an expert, and an e-conference.  It seems aimed at parents and teachers of “nice” kids — or at least kids who should be nice, but aren’t — spotted here and there around the country.  So from my chosen vantage, I testify that there are whole classes and categories of kids where this is the norm, not the exception.  They show extreme irritability, anger, and frequent, intense temper outbursts because they are thrashing.  “Thrashing” can be a technical term, a biological description of a trapped creature who cannot find a way out and whose body, abandoning thought, has resorted to random extremes on the chance that they might accidentally trip some kind of release or tear something loose.

Thrashing can also refer to beating someone at a drastic level to punish them or force obedience, usually accompanied by a high level of incoherent emotion.

“In computer science, thrashing occurs when a computer's virtual memory subsystem is in a constant state of paging, rapidly exchanging data in memory for data on disk, to the exclusion of most application-level processing. This causes the performance of the computer to degrade or collapse. The situation may continue indefinitely until the underlying cause is addressed. The term is also used for various similar phenomena, particularly movement between other levels of the memory hierarchy, where a process progresses slowly because significant time is being spent acquiring resources.”  

https://en.wikipedia.org/wiki/Thrashing_(computer_science)

If I were confronted with a kid with extreme irritability, anger, and frequent, intense temper outbursts, my first strategy would be to look for what is trapping him or her.  If there is nothing that can be seen by an outsider, I would look for the inside traps, using empathy to discover why the kid believes he or she is trapped.  Is it memory, illusion, too much television?  Loss of identity?  Fear?  In my case it is most often having my identity and existence questioned, blocked, and belittled that makes me rave and smash and drive all cats under the bed.  I think a lot of nice people are doing it to their kids.

I also think the world is doing it to whole classes of kids so that they never feel safe, lose touch with who they are, and can’t see which way to go.  I see several relevant image tropes on television, repeat and repeat.  One is the little phalanx of heavily armed, dressed-in-black, SWAT teams moving as a unit to find and destroy.  Another is the corresponding small group of fleeing kids: hoodies, tennies, jeans, wheels.  And a third is a long machine-polished hallway with identical doors down both sides: hospital, school, jail.  The fourth is the infrastructure labyrinth of pipes and circuits with the occasional metal ladder leading up and — presumably — out.

It’s enough to make an alligator thrash.  Unless he can climb ladders.

DESPERATE THRASHING

When I looked for the formal definitions of “thrashing” I did not expect to find a computer term, although many things have become metaphors for something technical in the computer world.

“When referring to a computer, thrashing or disk thrashing is a term used to describe when the hard drive is being overworked by moving information between the system memory and virtual memory excessively. Thrashing is often caused when the system does not have enough memory, the system swap file is not properly configured, or too much is running on the computer and it has low system resources. . .

"When thrashing occurs, a user will notice the computer hard drive always working and a decrease in system performance. Thrashing is bad on a hard drive because of the amount of work the hard drive has to do and if is left unfixed will likely cause an early failure of the hard drive.”

The original word, which has an onomatopoeia element (sounds like what it means) is about separating wheat from chaff by beating on the grain stalks, forcing the meat of the seed out of the husk.  Since grain harvest is done by machinery now generally -- people use the word to mean beating or fighting.  They also use it to describe violent punishment, like a parent beating a child to an extreme, presumably beating out bad traits.

Shark. Thrashing attracts them.

The meaning I want is psychological, but I don’t see it in the definitions.  Maybe it’s local but my friend the psychiatric nurse recognized it.  I mean a situation when all hope is lost and the body goes into a state of wild random energy, throwing the body around, pulling and pushing -- because there’s no rational way out and there’s nothing left to lose.  Once in a while it works.  The first time I set my cat trap, the cat I caught (which I never saw, only heard) thrashed around enough to pop the door open and escape.

But decades ago we visited the scene where a grizzly had been trapped and had thrashed but didn’t escape.  It had plowed the ground around the point of entrapment to a depth of two feet, it had torn up trees six inches across, it had thrown logs, and bellowed loudly enough to make the sheepherder some distance away cower in his flimsy wagon.  The bear did not escape.  It is dangerous to approach a thrashing animal to rescue it.  When daylight came, they shot the bear.

We're just trying to help you.

So people, when trapped in some circumstances with no way out, will throw themselves emotionally against the “walls” of the people around them, especially those with whom they have a strong pre-existing connection.  The thrashing brain will see ghosts of all the most feared forces of their lives: oppression, blame, lack of success, punishment instead of love, injustice, on and on and on.  The people who are the walls can suffer because cause-and-effect have been disconnected.  If they are lucky walls, there won’t be physical violence or only ineffective physical violence -- just verbal attack.  If they are not lucky and if the thrasher is armed, the consequences might be in the newspaper.  But usually a thrasher is too disorganized to plan.  Shooters are deluded but not out of control.  They are over-controlling.

If one is the thrasher, like a little kid at that stage of development when the brain storms and the child beats itself howling against the floor, there’s not much to do in the way of intervention except physical restraint or chemical restraint.  The wall must protect itself and wait for the tantrum to pass.  Even an adult person who is in the grip of the storm cannot get a hold on the situation.  

Psychology Today, always ready to offer pop ideas, suggests there are two kinds of tantrum, as follows.  (Neither is flattering to the person in the storm.)  http://www.psychologytoday.com/blog/stop-walking-eggshells/201111/blame-storms-and-rage-attacks-common-borderlines-narcissists

"Both borderlines and narcissists get into rages in which they blame and criticize others. However, the rages are slightly different and are motivated by different things. . . . Keeping these differences in mind will help you anticipate the rage and respond when it happens.

"As you know, people with Borderline Personality Disorder are emotionally unstable. . .  Their intense and annihilating anger comes from believing that others don't care about them, are not listening to them, or are not meeting their core needs. Their pain is your punishment. You're still, though, the equal in the relationship.

"The anger of narcissists, on the other hand, can be more demeaning. Their criticism evolves from their conviction that others don't meet their lofty standards--or worse, aren't letting them get their own way. "Narcissistic injuries," or wounds to the ego, often pave the way for narcissistic rages, which can be passive-aggressive or planned out, as well as sudden. They are above you and you have displeased them and probably deserve punishment they will dole out."

Neither of these ideas addresses the desperation of someone fighting for survival.  Nor do they consider how much a person who is desperate is exploited by other people who can passively and “innocently” deny help, thereby adding more insult and entrapment.  They see a person “in the stocks” -- that old punishment of trapping someone’s head and hands so that they are vulnerable -- and can’t resist throwing rotten objects at them.

Most of the advice in Psychology Today is meant for young adults in relationships or raising children.  I don’t read it often.  This recent study is more helpful.

“A study, published in the March 2014 issue of Psychology and Aging, examined 1,315 men — mostly military veterans who participated in a 15-year survey — between the ages of 53 and 85. Some 80 percent said that at age 50, life became easier.”  But then at seventy things get rough: people die, health declines, money runs out, people are no longer listening, past accomplishments are forgotten.  Then there’s the added element of Post Traumatic Stress Syndrome, having been in life-threatening circumstances that demanded extreme reaction:  killing, extreme exertion, high risk, major loss.  More than one veteran has told me that it is a truism that when a person has no idea what to do, that all indications are gone but the danger is extreme, it is much better to do anything than nothing.  Even if all you can do is thrash people with your cane.  You might accidentally strike the one holding a gun and knock it to the ground.

When I was working at a nursing home, one of the patients had been an aide in that same place.  She was much admired and loved by everyone.  When she became a patient, she lost her mind and began thrashing:  that is, screaming, throwing herself around, striking people, in what looked like self-destruction and is called “acting out.”  Finally she was sedated into unconsciousness for the sake of the people around her.  If her sane and healthy self had known, she would have been mortified.  But one couldn’t help but speculate (Freudian-style) about whether she had been repressing irritation and impatience all along and now that the restraints were weakened, they were bursting out.  I think that’s putting a psych layer onto something that was purely physical -- not even spiritual, but merely (!!)  the desperate attempt of a body to find some way out.  

In the days with Bob Scriver we shot a gopher every summer morning in order to feed the eagle.  A raptor that doesn’t get roughage (fur and bones) will die.  I got pretty handy with a .22 and there was usually a choice between shooting the critter in the head or the heart.  If you shot them in the head, there were enough reflexes left in the spine so that they thrashed and often the thrashing took them down their hole.  No breakfast for the eagle.  If you shot them in the heart, that was it -- they dropped.  Things are simpler with ground squirrels.  

But even a grumpy old man who “acts out” is trying to survive with the resources at hand.  If he has a lot of "backbone," it will be hard for everyone.  "The system does not have enough memory, the system swap file is not properly configured, or too much is running on the computer and it has low system resources."