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Douglas Berger – Tokyo Psychiatrist

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Doug Berger – Tokyo Psychiatrist Discusses Anger Management

Dr. Doug Berger, a psychiatrist in Tokyo Japan discusses anger and anger management for us.

1. How large of a role does stress play in anger?

We could look at anger as a so-called, “stress-diathesis model” wherein persons have differing levels of tolerance or a threshold to where they will feel but not show, or feel and then show anger to others. Diathesis means the predisposition or sensitivity someone may have to a certain feeling state or behavior. So, depending on the type of stress, and the intensity of the stress, some persons may be prone to feel and/or exhibit angry feelings. Regarding the type of stress, someone may for example get angry when they are ignored, but not when they are criticized or vice-versa. It all depends on the mix of an individual’s psychological issues and how they are wired neurologically.

2. Is society angrier than it used to be?

I can only really answer this regarding the two countries I am familiar with, Japan and the United States. Japanese society in general is not outwardly an angry country like the U.S. There are of course angry individuals anywhere, and certain groups with a specific political agenda, that are and have been angry for a long time. There is also considerable discrimination against non-Japanese but this has not led to many protests or incidents, is tolerated as “matter-of-fact” by the Japanese population, and the non-Japanese population as a whole seems to quietly accept and/or not fully understand the situation for various reasons perhaps too complex to discuss in this forum.

Regarding the U.S., specific social changes and demographics can inflame resentments and anger segments of the population. Lately racial tensions are at the forefront, however, each generation has its own memory and it can be easy to forget that tensions and anger were also very high during the civil rights era and other times past. The advent of radio, TV, and now the internet and mobile social media has allowed the fire of resent and anger to spread quickly through the population. I am not sure this means that society is inherently angrier than it used to be, although the spread of firearms in the population has probably led to an ease of expressing anger in a larger proportion of the population and in more dramatic ways.

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3. What is the difference between mild anger and serious anger management issues?

The outcome of a serious instance of anger may be to become more aggressive, but the underlying reasons may be the same whether mild or serious. Besides the social issues discussed above, personal social stress can also lead to anger. Work stress and relationship stress are the most common causes. Resentment in these and other social situations are a common cause of angry feelings. Certain psychiatric conditions may also show irritability and anger as an expression of this irritability. Hyperactivity disorder, depression, manic or hypomanic states, certain personality tendencies, and drug use and withdrawal can show irritability.

4. How does one combat, alleviate anger in adults? In children and adolescents?

This naturally depends on the cause. Removing a specific stressor or conclusion of a stressful social situation can alleviate anger in any age group. If one suffers from a psychiatric condition such as those described above than specific treatment targeted at that condition is necessary. This may mean psychotherapy, medication, social environment changes, or some combination of these. We should not conclude that it is just “normal” for young persons to be angry in a persistent or intense manner.

5. Anger is often a sign of deeper problems can you explain how anger manifests in relation to mental illness, physical illness and situational stress?

In addition to mental illness and the situational issues covered above, persons with physical illness are also prone to become angry. Failure of medical care to alleviate pain and suffering, frustration with serious illness, medication side-effects, and family/caretaker stress are all common reasons for persons with physical illness to become angry. In addition, patients may become angry if a clinic or hospital is not run well or if the “bedside manner” of the medical staff is curt, rude, or negligent in some way.

There is no specific way to provide “anger management” in a “one size fits all” method. First the causality should be delineated, and then specific counseling, psychotherapeutic, family intervention, treatment of substance abuse, and care for psychiatric or medical conditions can be initiated as appropriate.

Read more on Dr. Doug Berger‘s comments as it relates to anger management here: http://www.megurocounseling.com/TF/2016/Feb_2016.pdf

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Doug Berger – Tokyo Psychiatrist on Single-Parent Homes

Dr. Doug Berger, a psychiatrist in Tokyo, has written before on marriage and divorce in Japan. Here we ask him to elaborate on a few questions.

1. How are children affected by living in a single parent home?
This will necessarily depend on a number of factors, the age of the child, the time and quality of the ability of the parent to provide love, affection, and a protective environment, the socioeconomic environment of the family, and the ability of the parent and child to be flexible and reasonable with this situation.

Naturally, the more time and quality of the parent’s ability to provide love and security, and the more inherent mental stability both the child and parent have, the better off they will be. The age of the child when the single-parent home was created, and the circumstances around this creation will be of importance, more on that below.

2. Are abandonment issues more prevalent in children from single parent homes?

I don’t think it is a valid use of statistics to make a blanket statement and say yes or no. For each home, there is either more or less time alone on the part of the child. One could argue that the chances of having a difficult parent are 50% less than a 2-parent home, and while being alone seems better than being with a difficult parent, we would not advocate single parent homes over 2-parent homes of course.

If there is a child that is alone or feels abandoned then we need to engage some kind of social intervention and help this child integrate with some social activities. If the community the family lives in has good infrastructure and a close-knit community with families that participate in many activities where many same-age friendships can be grown then this may be enough in of itself to make a child from a single-parent household feel social and happy. If it is not a community like this, then social services need to have a bigger role to provide some alternative.

3. Are children raised in single parent homes from birth less affected than children whose parents divorced in their teens?

It is common to meet children raised in single parent homes from birth who state they did not know any other kind of family structure so that the single parent situation seemed entirely normal to them and they had no problem with it.

Divorce of one’s parents in adolescence is usually not a great thing, but might be worse for a child who is between 5 and 12 years-old because they usually more connected to their parents then teenagers. However, this all depends on how bitter the divorce, how many friends the teen has, the inherent mental stability of the child and parents, and the ability of the parents to be reasonable in ensuring that divorce will lead to a smooth transition for the child to continue the same lifestyle and with frequent visits and access to each parent, and this is more important for young teens than older teens.

4. What are some tips for children that may blame themselves for their parents’ separation or divorce?

This is not easy to clear up and sometimes takes years to run its course because a course of events has already unfolded once the child has started to think like this. Coaching and psychotherapy may help these children, but probably the best way is to avoid this happening to begin with.

Reasonable parents who can continue to work together as parents and a family will help decrease the risk of this outcome. Sometimes, we recommend that the parents move to a partial separation where one of the spouses has a separate living space, but where the family is together often, or at least one parent is visiting the child’s living space regularly.

The partial separation may be enough to give the parents space but allow them to continue the family in some way. Then the parents can actually be divorced on paper without telling the children-depending on their age or the parents can go to full divorce in stages as the children get older. It may be easier to acclimate to stressful events unfolding in slow stages.

5. How can parents ease the transition into a single parent household for children?

Continuing the ideas presented in question 4, I would say that if for example the father is moving out, he can present the idea to his children that he is getting an “office” to stay in so that he can do work in a quiet place, but he will still spend time at the home and that the children can also visit him. The wife may take the opportunity to have her own social life on days the husband, or ex-husband if they have signed divorce papers, is at the home watching the children.

For many couples in conflict, one partner having a separate living space can be enough to decrease the stress in the relationship enough to the point where they can be reasonable with each other. As the children get older, they will not need both parents around so often and the parents can begin to build their lives independently from the ex-spouse both socially and occupationally.

Read more on Dr. Doug Berger‘s comments as it relates to single-parent households here: http://www.tokyofamilies.net/2011/06/single-parent-households/.

Doug Berger, M.D., Ph.D. – Tokyo Psychiatrist: How the economy impacts mental health

We know you have written about the economy and mental health before, perhaps we can ask you to elaborate on a few questions.

1.  How is mental health linked to economic success and failure?

One’s ability to be stable economically may be closely related to one’s personality and/or other mental health issues. First here is the issue of getting on a career path, and next is the issue of how one spends and invests their income.

While some persons make a reasonable living no matter what path they study or train for, persons who have a plan and obtain some kind of recognized credential tend to be more stable and thrive better than those that do not. Persistence, drive, and focus are important qualities here. In addition, while it is favorable to be affable and friendly no matter what occupation one is in, some occupations are more dependent on one’s charisma in terms of their ability to exude trust, likeability, and collect a set of followers.

Regarding saving and spending, planning and organization is a crucial quality for success. Persons who spend out of their means and/or wish to have a lifestyle that is out of their income level without thinking of the consequences will naturally have financial trouble.

For investing, it is always more adaptive to live within one’s means and invest with minimal risk. Investing companies will recommend to take some risk with a proportion of one’s assets. This may be more of a function of an investing company’s desire to make commission from the turnover of brokering stocks than the success of the investor. Small amounts of assets invested in higher risk stocks might be ok, but one would need to assume the monies invested in this fashion may likely be lost or risk the possibility of considerable mental stress related to loss. Persons who feel they must “get rich” from investing are at high risk for loss and the mental anguish associated with loss.

2.  What can investors do to safeguard their mental health during a trying economic time?

This is really a function of what persons have done with their careers and finances before the trying economic time comes around. The more flexibility persons have in the work they can do, the more economic redundancies a family has, i.e., both partners in a marriage have jobs that are less vulnerable to economic downturns, the more they have some stable income from safe investments, and the less they have over extended themselves in loans and purchases, the less chance of having unstable mental states.

3.  Do you recommend regular vacations or digital holidays to recharge the mental battery and decompress?

Yes, both of these are good ideas. Weekend trips and taking at least a few days every few months to be in a new environment and see new things is very important to stay excited about life. Knowing when to get away and turn off your PC or phone is a good thing.

If you can’t turn off your phone regularly, then having an old mobile phone just for calls is one way to avoid the kind of “phone addiction” we see in so many people recently. Of course the digital age comes with many conveniences and efficiencies, however, looking at a small screen (or any lit-up screen) for hours is a strain on one’s eyes, and time spent reading content or seeing videos with minimal intrinsic value can keep people from normal social interaction or using their mind in more valuable stimulating ways.

4. After the stock market crash in the 30s, there were lots of mental health issues. Similarly in 2008, after the financial crisis, there was a rise in suicides.  Why are we not getting better at separating our emotions from the economy?

This is an interesting question. Unfortunately, I don’t think so. People are still hooked on making quick and easy income and tend to focus on the stories that they hear about big winners. In this sense, the stock market is similar to a gambling casino in giving the promise of reward. If you look at a slot machine, there are usually images of lots of money or happy people, and investment groups usually put out graphs of increased earnings.

It is rare to see a slot machine or investment graph that emphasizes loss and grief. The average person is also not aware of the influence government, large investment banks, and other entities have on pumping up stock prices into a bubble that eventually leads to a fizzle-out, or worse, a bust. Humans evolved to get the next meal as soon as possible, not to look at nuanced and complicated things. The best thing we can do is educate the public, unfortunately, there are few entities willing to spend the resources for an education campaign. Perhaps the best way to do this is to make a lecture series on this topic mandatory for high school students.

Read more on Dr. Doug Berger’s comments as it relates to mental health and the economy here: http://www.megurocounseling.com/TF/2013/May_2013.pdf.

Dr. Doug Berger: Advice for Interracial Couples

We know you frequently see couples having trouble, many of whom are mixed-cultural couples, and that you have written on this topic before.

1. For couples who come from distinct, separate backgrounds, what are some tips for them to make their relationship work?

Of course mutual respect and interest in the culture of one’s partner is crucial. Mutual participation in culturally significant events and enjoyment of this participation is important. Even if learning the language of the partner is a daunting task, some effort in this regards shows that one values the other’s culture. If people are flexible and loving, then there should be little trouble to make the relationship work.

2. What are some of the challenges that interracial couples face?

Here in Japan, common challenges might be broken down into, 1. the logistics of the expatriate partner’s ability to socialize, work, and thrive in the foreign culture, and 2. mutual tolerance of each other’s different cultural and language challenges when dealing with the culture of the other side.

The occupational choices available to an expatriate in Japan will necessarily be limited compared to their country of origin, except of course the ability to teach English if the expatriate is a native English speaker. Non-Japanese persons tend to be transient or eventually move to another country such that long-standing social ties are hard to maintain if one is in a foreign country.

Mutual tolerance will always be necessary because one’s ideas about the world may be colored by the culture and educational background one grew up in. Just to reiterate from the answer in question 1, flexible and loving persons will usually do well in cross-cultural relationships.

3. Can couples counseling help reconcile some of the issues these couples face?

Yes, brainstorming and coaching can help to overcome the logistic challenges noted on question 2. Some persons, however, get negative and pessimistic easily. I try to have them take the challenges at hand as a chance to do something they may not have been able to do before. For example, learn Japanese, take up a sport or martial art not available in their home country, enjoy the chance to meet expatriates from many countries, see new things etc. Of course there are always persons whose career and/or life style does not really fit into living in Japan at a specific point in time. For those persons, the flexibility they need is to accept is that they and/or their family will function better if they move back to their country of origin. They can always consider moving back to Japan at some future time when the logistics are a better fit.

If the problem a couple faces is more complex than what help coaching can provide, then the same kinds of evaluation and problems these couples face need to be addressed just as any individual or couple, be they personality problems, depression, attention-deficit hyperactivity disorder, substance abuse, etc., that are common problems seen in the population as a whole. Our default position is to try keep families together, however, there are always couples who have come to see us who are really already well on the way to splitting up, for these persons we try to help this process unfold amicably.

What are some exercises or activities that couples can engage in together to better understand each others’ perspective?

Here in Japan, the answer is language and etiquette study on the part of the expatriate. Simple things like how to properly take off one’s shoes in a Japanese house, how to do simple greetings, participate in the yearly ceremonies that Japanese families tend to do together, etc. These are generally easy enough to do and can be fun in and of themselves.
Japanese persons need to be tolerant that their partner’s family and country of origin is not likely to behave or function like Japan does. As long as each side can respect each other and see that there is something to gain by the fusion of culture in the relationship, then things should go well. This is a principal that should be applicable to an international couple anyplace.

For more information on this topic, please visit the discussion with Dr. Doug Berger that appeared in Tokyo Families Magazine, seen here: http://www.tokyofamilies.net/2011/11/do-japanese-western-relationships-work/.

Doug Berger, Tokyo Psychiatrist Speaks on Parenting Children with ADD/ADHD (Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder).

Dr. Doug Berger is actively treating children and adults with ADD/ADHD and has written about this kind of treatment before. Here we ask Dr. Berger to elaborate on some questions.

1. What should parents of children with ADD/ADHD know about the way they learn?
Parents should first be educated on whether their child is predominantly inattentive, predominantly hyperactive, or combined type. It is not necessary to be hyper to have ADD, and it is not necessary to be inattentive to have ADHD.

The inattentive children generally need longer times to study and take tests. They do not have an intelligence problem, they only need to be given enough time to focus on the study and test materials.

Hyperactive children should be given frequent breaks in their study or test times because they do not have the patience to sit still for long periods of time.

For either type, including the combined type, it is probably better to have them study in shorter modules where they can focus on targeted material they need to learn and reply on, and where they do not get completely discouraged with study altogether and drop-out which is not an infrequent consequence of serious inattention and/or hyperactivity.

2. What can parents do to promote learning in a fun way?
Topics should have interesting dialog to them. For example, math can be numbers and dry, or it can be used as an exciting adventure to explain how rockets travel thru air and space, and how time is warped near massive objects. Age-appropriate study material can be tailored to a student’s needs. Perhaps most importantly, children with ADD/ADHD need to be given praise that they will succeed even if they need to go at a slower pace than their peers.

3. What should parents tell teachers or the school?
If a student is obviously impaired, then teachers may need to know the child has specific learning needs and for teachers to try to flexibly teach them using some of the principals I described above.

Regarding giving a teacher or school a diagnostic name that a mental health worker labeled their child as is another story because that diagnostic name, true or not, may follow that child’s educational record up through college. Diagnoses in psychiatry are unproven entities, and at the end of the day only a provisional way to steer the directionality of what the problem may be and what to do about it.

Questionnaires, symptom checklists, and psychological testing, only provide data to help solidify the provisional diagnosis which is usually determined in a psychiatric interview that focuses on symptoms and history. “Tests” in mental health do not have the same reliability as a blood test or chest x-ray etc., that can basically prove the existence of a medical illness (i.e., diabetes, heart attack, stroke, etc.) in many instances, so that giving labels to schools etc. may not be necessary to promote a child’s special educational needs.

4. What about extracurricular activities?

Extracurricular activities are generally a good thing for everyone including ADD/ADHD children. These activities should probably be physical activities rather than any kind of book or computer activities that can just be another kind of activity that stresses the child’s trouble focusing and/or ability to sit quietly.

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5. If the child gets frustrated, what are some tips parents can deploy?

There are usually common patterns of what frustrates these children. Inattentive children often “zone-into” activities they like but don’t to activities they do not like, i.e., the internet, video games etc. If a parent tries to move them away from this activity the child may get very frustrated. Better to try to distract them with a reward like a sweet treat or other activity they really like and move from there.

Hyperactive children are frequently impatient and easily upset with small things. These children need a mixture of agreement and understanding, distraction to other less aggressive high-action activities like sports, and loving soothing. Depending on the child’s age and symptom severity psychopharmacology-integrated behavioral therapy may be indicated and effective.

Feel free to read more about Dr. Doug Berger‘s comments on this topic here: http://www.megurocounseling.com/TF/2013/Jan_2013.pdf

Dr. Douglas Berger in Tokyo Comments on “The Interplay of Mood Disorders and Eating Disorders” by Blair Uniacke, MD and Allegra Broft, MD

Tokyo psychiatrist, Dr. Douglas Berger, comments on “The Interplay of Mood Disorders and Eating Disorders” by Blair Uniacke, MD and Allegra Broft, MD, May 26, 2016 issue of the Psychiatric Times:

The authors state that CBT is a “well established” evidence-based treatment” for mood disorders, however, there has never been a single-(=which is defined as patient blind) or double-blind, and thus no blind-placebo, controlled clinical trial of CBT for any indication.

This is one reference, however, regardless of this study no CBT trial has ever had more than masked assessment which just records the subjective reports of the subject-treater system, bias can not be filtered by an unblinded study, and conclusive efficacy statements should be tempered:

Psychol Med. 2010 Jan;40(1):9-24. doi: 10.1017/S003329170900590X.

Cognitive behavioural therapy for major psychiatric disorder: does it really work? A meta-analytical review of well-controlled trials. Lynch D, Laws KR, McKenna PJ.

Doug Berger, M.D., Ph.D.
US Board Certified Psychiatrist
Tokyo, Japan

For more information about Dr. Doug Berger visit the following resources:

http://www.theglobaldispatch.com/toky…

http://www.groundreport.com/doug-berg…

http://spiritualityhealth.com/article…

http://usdailyreview.com/treating-dep…

http://feelgoodstyle.com/2016/09/01/d…

https://dougbergertokyopsychiatrist.w…

https://about.me/dougbergertokyopsych…

http://dougbergerpsychiatristtokyo.br…

http://www.tokyofamilies.net/author/d…

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