Well-known evangelical figures called for an end to the shame and secrecy that still surrounds mental illness throughout U.S. society and a greater embrace of medical treatment, particularly among evangelicals.
Archive for the ‘Mental Health’ Category
Nancy Goldstein writes in The American Prospect:
What a drag it’s been these past few weeks to watch the military brass—those kings of accountability, at least when it comes to other people’s behavior—huffing and bluffing and outright lying about what they knew and when they knew it. First we had to endure the sight of them gaping over the news that the sexual-violence crisis they’ve done nothing to squelch since the assault of 83 women and seven men at the Tailhook Air Force convention in 1991 has worsened. Now those same Pentagon officials are shocked, simply shocked, by the military’s spiking suicide rates, despite the fact that those numbers, which have been rising steadily for the past 12 years, come from their own reporting system (and some claim are still an undercount).
The only thing worse than the Pentagon’s faux surprise has been the complicity of news organizations willing to echo its talking points. Shame on The New York Times for last week’s “Baffling Rise in Suicides Plagues the U.S. Military.” Disturbing, yes. But there’s nothing “baffling” about the news that more active-duty troops killed themselves in 2012 than were killed in combat in Afghanistan in the same year, and that the number of suicides has doubled from a decade ago.
As the Government Accountability Office (GAO)—Congress’s nonpartisan investigative wing—and a variety of media outlets attest, there’s been only one thing better documented than the military’s unwillingness over the past 25 years to throw any real muscle into ending its culture of widespread sexual assault. And that’s the military’s unwillingness to acknowledge the prevalence of post-traumatic-stress-disorder (PTSD) and other mental-health issues plaguing service-members and to enact serious reforms aimed at curbing and treating mental illness in its ranks. The military’s systemic incompetence on this issue continues despite years of analysis and criticism, not only from service-member advocacy organizations, but also from within the Beltway.
Consider the drubbing administered to both the Department of Defense (DOD) and the Veteran’s Administration (VA) by the GAO last November. The report cited “a lack of leadership, oversight, resources, and collaboration” as contributing to the military’s “inability” to “address a host of problems for wounded, ill, and injured servicemembers as they navigate through the recovery care continuum.” All of those issues came under greater congressional scrutiny in the wake of the public uproar that followed the Washington Post’s 2007 Pulitzer Prize winning investigative series on conditions at Walter Reed Army Military Center, the VA’s flagship in D.C. The GAO concluded that the military had utterly failed to rectify the conditions the series had cited: Mold-stained and cockroach-filled outpatient facilities; byzantine paperwork mazes and overlong wait times to receive care; inadequate resources for soldiers with diagnoses of PTSD.
Despite the fact that Walter Reed has the largest psychiatric department in the Army, the Post’s reporters found it still lacked “enough psychiatrists and clinicians to properly treat the growing number of soldiers returning with combat stress.” Earlier that year, the head of psychiatry had “sent out an ‘SOS’ memo desperately seeking more clinical help. … Individual therapy with a trained clinician, a key element in recovery from PTSD, is infrequent, and targeted group therapy is offered only twice a week.”
But surely these are problems that money can solve. So did the $2.7 billion dollars that Congress poured into the Pentagon’s maw in the three years following thePost’s series do anything to change the way that the DOD and VA address treatment and research for “the signature wounds of the wars in Afghanistan and Iraq”—psychological health (PH) and traumatic brain injury (TBI) treatment? That’s hard to say, because the GAO’s January 2012 report found “that DOD programs supporting P.H. and TBI treatment and research are poorly coordinated, and the department has failed to provide reliable and comprehensive data on how more than $2.7 billion in funds for such programs have been used in recent years.” In other words, there’s no way of knowing what, if anything, went into patient care.
There is, by the way, no good reason why the DOD or VA should have been caught flat-footed by the waves of veterans that flooded their facilities in 2006, more than a third of whom reported symptoms of stress or other mental disorders as they returned from the wars in Iraq and Afghanistan. At least two of its own top people—the chief of psychiatry at Walter Reed and the Executive Director of the VA’s National Center for Post-Traumatic Stress Disorder—had published pieces in a 2004 edition of the New England Journal of Medicine predicting the crisis. . .
It turns out that enforced solitude can affect even physical health. Judith Shulevitch writes in The New Republic:
Sometime in the late ’50s, Frieda Fromm-Reichmann sat down to write an essay about a subject that had been mostly overlooked by other psychoanalysts up to that point. Even Freud had only touched on it in passing. She was not sure, she wrote, “what inner forces” made her struggle with the problem of loneliness, though she had a notion. It might have been the young female catatonic patient who began to communicate only when Fromm-Reichmann asked her how lonely she was. “She raised her hand with her thumb lifted, the other four fingers bent toward her palm,” Fromm-Reichmann wrote. The thumb stood alone, “isolated from the four hidden fingers.” Fromm-Reichmann responded gently, “That lonely?” And at that, the woman’s “facial expression loosened up as though in great relief and gratitude, and her fingers opened.”
Fromm-Reichmann would later become world-famous as the dumpy little therapist mistaken for a housekeeper by a new patient, a severely disturbed schizophrenic girl named Joanne Greenberg. Fromm-Reichmann cured Greenberg, who had been deemed incurable. Greenberg left the hospital, went to college, became a writer, and immortalized her beloved analyst as “Dr. Fried” in the best-selling autobiographical novel I Never Promised You a Rose Garden (later also a movie and a pop song). Among analysts, Fromm-Reichmann, who had come to the United States from Germany to escape Hitler, was known for insisting that no patient was too sick to be healed through trust and intimacy. She figured that loneliness lay at the heart of nearly all mental illness and that the lonely person was just about the most terrifying spectacle in the world. She once chastised her fellow therapists for withdrawing from emotionally unreachable patients rather than risk being contaminated by them. The uncanny specter of loneliness “touches on our own possibility of loneliness,” she said. “We evade it and feel guilty.”
Her 1959 essay, “On Loneliness,” is considered a founding document in a fast-growing area of scientific research you might call loneliness studies. Over the past half-century, academic psychologists have largely abandoned psychoanalysis and made themselves over as biologists. And as they delve deeper into the workings of cells and nerves, they are confirming that loneliness is as monstrous as Fromm-Reichmann said it was. It has now been linked with a wide array of bodily ailments as well as the old mental ones.
In a way, these discoveries are as consequential as the germ theory of disease. Just as we once knew that infectious diseases killed, but didn’t know that germs spread them, we’ve known intuitively that loneliness hastens death, but haven’t been able to explain how. Psychobiologists can now show that loneliness sends misleading hormonal signals, rejiggers the molecules on genes that govern behavior, and wrenches a slew of other systems out of whack. They have proved that long-lasting loneliness not only makes you sick; it can kill you. Emotional isolation is ranked as high a risk factor for mortality as smoking. A partial list of the physical diseases thought to be caused or exacerbated by loneliness would include Alzheimer’s, obesity, diabetes, high blood pressure, heart disease, neurodegenerative diseases, and even cancer—tumors can metastasize faster in lonely people.The psychological definition of loneliness hasn’t changed much since Fromm-Reichmann laid it out. “Real loneliness,” as she called it, is not what the philosopher Søren Kierkegaard characterized as the “shut-upness” and solitariness of the civilized. Nor is “real loneliness” the happy solitude of the productive artist or the passing irritation of being cooped up with the flu while all your friends go off on some adventure. It’s not being dissatisfied with your companion of the moment—your friend or lover or even spouse— unless you chronically find yourself in that situation, in which case you may in fact be a lonely person. Fromm-Reichmann even distinguished “real loneliness” from mourning, since the well-adjusted eventually get over that, and from depression, which may be a symptom of loneliness but is rarely the cause. Loneliness, she said—and this will surprise no one—is the want of intimacy.
Today’s psychologists accept Fromm-Reichmann’s inventory of all the things that loneliness isn’t and add a wrinkle she would surely have approved of. They insist that loneliness must be seen as an interior, subjective experience, not an external, objective condition. Loneliness “is not synonymous with being alone, nor does being with others guarantee protection from feelings of loneliness,” writes John Cacioppo, the leading psychologist on the subject. Cacioppo privileges the emotion over the social fact because—remarkably—he’s sure that it’s the feeling that wreaks havoc on the body and brain. Not everyone agrees with him, of course. Another school of thought insists that loneliness is a failure of social networks. The lonely get sicker than the non-lonely, because they don’t have people to take care of them; they don’t have social support. . .
In shaving, I quickly learned of two mindsets: explorers, who look for any excuse to try a new product or technique, and settlers, who look for any excuse to stick with what they have. “If it ain’t broke, don’t fix it” is the slogan of the settler, and many in this mindset are completely unwilling to try (say) a new shaving soap: “The one I have now works fine, so why should I try something different?” The answer, “Because it could be a whole lot better” doesn’t seem to have much impact—as evidenced by the many millions who continue to use cartridge razors and canned foam in preference to trying DE shaving, which offers better shaves at (substantially) lower cost. Settlers tend to settle—thus the name.
But explorers and settlers—also termed “bold” and “shy” respectively—are found throughout the animal kingdom: some minnows will hide back in the reeds while others dart out in search of food. Have both mindsets in a species aids survival: the bold can find new grazing grounds, new foods, and so on, while the shy can preserve the species when an innovative locale or food proves deadly.
Don Cossins in The Scientist has an interesting finding on the two modes:
When a group of genetically identical mice lived in the same complex enclosure for 3 months, individuals that explored the environment more broadly grew more new neurons than less adventurous mice, according to a study published today (May 9) in Science. This link between exploratory behavior and adult neurogenesis shows that brain plasticity can be shaped by experience and suggests that the process may promote individuality, even among genetically identical organisms.
“This is a clear and quantitative demonstration that individual differences in behavior can be reflected in individual differences in brain plasticity,” said Fred Gage of the Salk Institute for Biological Studies in La Jolla, California, who was not involved the study. “I don’t know of another clear example of that . . . and it tells me that there is a tighter relationship between [individual] experiences and neurogenesis than we had previously thought.”
Scientists have often tried to tackle the question of how individual differences in behavior and personality develop in terms of the interactions between genes and environment. “But there is next to nothing [known] about the neurobiological mechanisms underlying individuality,” said Gerd Kempermann of the German Center for Neurodegenerative Diseases in Dresden.
One logical way to study this phenomenon is to look at brain plasticity, or how the brain’s structure and function change over time. Plasticity is hard to study, however, because it mostly takes place at the synaptic level, so Kempermann and his colleagues decided to look at the growth of new neurons in the adult hippocampus, which can easily be quantified. Earlier studies have demonstrated that activity—both physical and cognitive—increases adult neurogenesis in groups of genetically identical mice, but there were differences between individuals in the amount of neuron growth.
To understand why, Kempermann and his colleagues housed 40 genetically identical female inbred mice in a complex 5-square-meter, 5-level enclosure filled with all kinds of objects designed to encourage activity and exploration. The mice were tagged with radio-frequency infer-red (RFIR) transponders, and 20 antennas placed around the enclosure tracked their every movement. After 3 months, the researchers assessed adult neurogenesis in the mice by counting proliferating precursor cells, which had been labeled before the study began.
The researchers found that . . .
Full disclosure: In terms of ideas and foods and the like, I am an explorer; in terms of sports and travel, I am a settler. Most people are a mix.
Laurie Jo Reynolds and Stephen F. Eisenman report at CreativeTimeReports.org:
In 1998, Illinois opened a prison without a yard, cafeteria, classrooms or chapel. Tamms Supermax was designed for just one purpose: sensory deprivation. No phone calls, communal activities or contact visits were allowed. Men could only leave their cells to shower or exercise alone in a concrete pen. Food was pushed through a slot in the door. The consequences of isolation were predictable: many men fell into severe depression, experienced hallucinations, compulsively cut their bodies or attempted suicide.
The first men at Tamms were transferred there from other prisons around the state for a one-year shock treatment intended to break down disruptive prisoners and make them more compliant. But the Illinois Department of Corrections (IDOC) left them there indefinitely. A decade later, more than a third of the men at Tamms had been there since it opened, and for no apparent reason.
Research has shown that supermax prisons don’t reduce prison violence or rehabilitate prisoners. On the contrary, isolation induces or exacerbates mental illness, creates stress and tension, worsens behavior and undermines the ability of people to function once they get out.
Despite its uselessness as a form of correction, Tamms had many strong supporters: the powerful union to which the prison guards belonged, the nearby towns that welcomed the well-paid jobs, and state officials who thrived on tough-on-crime politics. They all deployed a single phrase meant to paralyze any possible dissenters: the worst of the worst. This slogan was applied to the men at Tamms to suggest they deserved the worst possible treatment—long-term solitary confinement that human rights monitors uniformly describe as cruel, inhuman and degrading, if not outright torture. Challenging this label and this punishment became the project of Tamms Year Ten, a campaign launched in 2008, a decade after the supermax opened.
Punching Above Our Weight
Two years earlier, a group of Chicago artists, poets and musicians formed the Tamms Poetry Committee. Two of them, Laurie Jo Reynolds included, had been members of a group that had protested plans to construct the supermax. Following the practice of two women who sent holiday cards to the prison, we sent letters and poems to every man at Tamms to provide them with some social contact. Their replies demonstrated the necessity of this project: “Hi Committee, is this for real? I can’t believe someone cares enough to send a pick-me-up to the worst-of-the-worst. Well, if nobody else has said it, I will: THANK YOU.” But we quickly found ourselves deluged with pleas for help: “Hey, this poetry is great, but could you please tell the governor what they’re doing to us down here?”
By 2008, we had connected with men on the outside who had spent years in Tamms and family members of current prisoners. Together, we launched the Tamms Year Ten campaign. Our goal was to educate the public about Tamms and hold the IDOC, legislators and then-Governor Blagojevich accountable for the use of long-term isolation. Prison reform is hard enough, but getting people to stand up for “the worst of the worst” was considered hopeless. Attorneys and veteran prisoner advocates warned that this campaign could endanger the men and increase support for the prison. But we believed that recent controversy over solitary confinement and torture at Guantanamo Bay and Abu Ghraib opened a new space for debate. And in any case, after a decade of isolation with no end in sight, the men in Tamms didn’t have much to lose.
Outrage Properly Directed
It was hard to know where to begin. Not many people had even heard of Tamms, located at the southern tip of Illinois, 360 miles from Chicago. Our members consulted with legislators from all over the state and sought advice from every quarter. A turning point was . . .
Given the description of the prison, what conclusions would you draw about a nation that not only allows it but seems to approve of it? This prison seems evil and totalitarian—beyond inhumane. Do you think that the prisoners, once released, are prepared to find constructive roles in society?
For a social animal—such as humans—solitary confinement is torture.
So far, the only therapy that has been demonstrated to work is CBT. At Mother Jones Kevin Drum points to a new example of its effectiveness:
Harold Pollack draws my attention today to the results of a large-scale study he conducted recently with several other researchers in low-income Chicago schools. The study design was fairly simple: first, they chose several thousand teenage boys with horrible risk profiles. Their group was 70 percent black and 30 percent Hispanic; had an average GPA of 1.7; and had missed 40 out of 170 days of school the previous year. Over a third of them had been arrested at least once prior to the study.
They randomly assigned these boys to a control group or a treatment group. The randomization was done beforehand to avoid choosing a treatment group that differed in some unknown way from the control group. The treatment group was offered a chance to participate in a program called “Becoming a Man,” which focused strongly on improving poor judgment and decision making. Here’s an example:
At 3pm on Saturday, June 2, 2012, in the South Shore neighborhood just a few miles from the University of Chicago, two groups of teens were arguing in the street about a stolen bicycle. As the groups began to separate, someone pulled out a handgun and fired….Two weeks later, prosecutors filed first-degree murder charges against the alleged shooter, Kalvin Carter — 17 years old.
…. In Chicago, the site of our study, police believe that roughly 70 percent of homicides stem from “altercations,” compared to only about 10 percent from drug-related gang conflicts….At 3pm on June 2 on the south side of Chicago, is Kalvin Carter thinking about 3:01 — or even consciously thinking at all, for that matter? Automatic, intuitive decision-making is also susceptible to systematic biases, partly because the brain’s automatic “system” tends to emphasize explanations that are coherent rather than necessarily correct. Examples of such errors include hostile attribution bias….confirmation bias….or catastrophizing.
The intervention in the study was not really all that intense: the kids all skipped one regular class and attended 27 one-hour weekly sessions during the school year. In addition, some of the kids also attended after-school sessions. The primary purpose of the sessions was to teach cognitive behavioral therapy—”thinking about thinking”—in an effort to get the participants to change the way they interact with the rest of the world. The results were pretty stunning: . . .
The GOP strongly and explicitly opposes teaching critical thinking skills, in school or out. And in looking at the GOP, you can see that they follow their own advice.
Timothy Leary famously used psychedelics with prisoners to try to encourage a positive change in worldview, the measure being the rate of recidivism of treated vs. untreated prisoners. (More here on that experiment.) Now a proposal is being made to the Pentagon to use MDMA (Ecstasy) to help treat PTSD. Greg Miller reports in Wired Science:
For Rick Doblin, being invited to the Pentagon was an emotional experience. Growing up in the 60s, Doblinembraced the counterculture and protested the Vietnam war and the military-industrial complex behind it.
Yesterday he was at the Pentagon trying to persuade military medical officials to permit a clinical trial that would test MDMA, the active ingredient in the party drug Ecstasy, in conjunction with psychotherapy, in active duty soldiers with post-traumatic stress disorder.
“There’s been this history of conflict between psychedelics and the military, and we’re trying to say that’s not the only vision,” Doblin said. “There’s a way for us to come together.”
Doblin is the founder and director of the non-profit Multidisciplinary Association for Psychedelic Studies(MAPS), which is trying to get drugs like psilocybin, LSD, and MDMA approved for medical use. MAPS has already sponsored small clinical trials of MDMA-assisted psychotherapy for PTSD, first in survivors of sexual abuse and assault, and now in military veterans, police, and firefighters.
Doblin spoke with Wired about his military mission and what it says about shifting attitudes towards psychedelic drugs.
Wired: What were you doing at the Pentagon?
Rick Doblin: I am hoping to convince them to back a study with active duty soldiers with PTSD. But I’m not asking them to fund it. MAPS will fund a demonstration project. If it works, I’d hope they will fund future studies. This was our second meeting to talk about some sort of collaboration, and the meeting went really well.
Wired: Was it strange for you to be there?
Doblin: Just walking into the Pentagon and being invited to the Pentagon is a healing process for me personally, and I hope more broadly for society. In the 60s, society went in two directions: There was psychedelics and marijuana and anti-war protestors, and there was alcohol and beer and pro-Vietnam supporters. But now the war on drugs is losing steam, and the culture is coming together again after 45 years.
But I don’t want to underestimate the resistance. When Michael Mithoefer [a South Carolina psychiatrist who has led two PTSD trials sponsored by MAPS] came to the Pentagon with me the first time, he shaved his ponytail off. The last time he did that was when he did his residency interviews after medical school. So we’re trying to do our part not to create countercultural flak, and I think that’s really key.
Wired: The fact that they’re even considering this seems like an indication of how things have changed.
Doblin: For so long the only story that’s been told has been exclusively one of risk. It’s been told for marijuana, MDMA, LSD, and psilocybin, and the risk has been exaggerated. Now that we’ve been able to start getting some evidence on the benefits, it changes people’s calculus. And the benefits are coming in areas that people are more worried about than they are about drugs, like end of life anxiety [in terminal cancer patients] and PTSD in veterans. We’re purposely choosing conditions that will resonate with people.
Wired: What benefits have you seen so far in the study with veterans? . . .
And here’s another article by Greg Miller on psychedelic medicine.
Certainly SDD would be easier to fix. Vatsal Thakkar writes in the NY Times:
IN the spring of 2010, a new patient came to see me to find out if he had attention-deficit hyperactivity disorder. He had all the classic symptoms: procrastination, forgetfulness, a propensity to lose things and, of course, the inability to pay attention consistently. But one thing was unusual. His symptoms had started only two years earlier, when he was 31.
Though I treat a lot of adults for attention-deficit hyperactivity disorder, the presentation of this case was a violation of an important diagnostic criterion: symptoms must date back to childhood. It turned out he first started having these problems the month he began his most recent job, one that required him to rise at 5 a.m., despite the fact that he was a night owl.
The patient didn’t have A.D.H.D., I realized, but a chronic sleep deficit. I suggested some techniques to help him fall asleep at night, like relaxing for 90 minutes before getting in bed at 10 p.m. If necessary, he could take a small amount of melatonin. When he returned to see me two weeks later, his symptoms were almost gone. I suggested he call if they recurred. I never heard from him again.
Many theories are thrown around to explain the rise in the diagnosis and treatment of A.D.H.D. in children and adults. According to the Centers for Disease Control and Prevention, 11 percent of school-age children have now received a diagnosis of the condition. I don’t doubt that many people do, in fact, have A.D.H.D.; I regularly diagnose and treat it in adults. But what if a substantial proportion of cases are really sleep disorders in disguise?
For some people — especially children — sleep deprivation does not necessarily cause lethargy; instead they become hyperactive and unfocused. Researchers and reporters are increasingly seeing connections between dysfunctional sleep and what looks like A.D.H.D., but those links are taking a long time to be understood by parents and doctors.
We all get less sleep than we used to. The number of adults who reported sleeping fewer than seven hours each night went from some 2 percent in 1960 to more than 35 percent in 2011. Sleep is even more crucial for children, who need delta sleep — the deep, rejuvenating, slow-wave kind — for proper growth and development. Yet today’s youngsters sleep more than an hour less than they did a hundred years ago. And for all ages, contemporary daytime activities — marked by nonstop 14-hour schedules and inescapable melatonin-inhibiting iDevices — often impair sleep. It might just be a coincidence, but this sleep-restricting lifestyle began getting more extreme in the 1990s, the decade with the explosion in A.D.H.D. diagnoses.
A number of studies have shown that a huge proportion of children with an A.D.H.D. diagnosis also have sleep-disordered breathing like apnea or snoring, restless leg syndrome or non-restorative sleep, in which delta sleep is frequently interrupted.
One study, published in 2004 in the journal Sleep, . . ..
Full transcript at the link (a tab you click).
Read this column for a view of three men who were true daily heroes. The focus on what you have, not what you lack, and what is available to you, not what is denied to you, is a good route to a happy life: true mental health.
Bullying has aftereffects. Adam Lanza reportedly was bullied:
Adam Lanza was bullied while he attended Sandy Hook Elementary and his mother Nancy considered suing the school for turning a blind eye to the abuse, an unnamed Lanza family member told the New York Daily News.
“Adam would come home with bruises all over his body,” the relative told the Daily News. “His mom would ask him what was wrong, and he wouldn’t say anything. He would just sit there.”
The family member went on to say that Lanza’s mother was distressed by the abuse, and didn’t believe school officials were protecting her son: “Nancy felt fiercely protective of him. She was convinced the school wasn’t doing enough to protect Adam. It made her irate.”
The relative also appears to attribute Lanza’s emotional and mental health problems to the experience, telling the Daily News that he never “seemed right” after his time in Sandy Hook.
“He was a sick boy,” the relative said.
Howard Bess takes a look at bullying in America at ConsortiumNews.com:
Bullying is now a major reason that American teenagers give for skipping school and eventually dropping out of high school. Students get bullied over race, sexual orientation, clothes, looks, handicaps, intelligence and economic class.
Yet, where can we find a voice of sanity that will publicly call for a halt in the practice of bullying? It is not the Christian churches. Indeed, many Christian pastors and fundamentalists practice the art of bullying themselves, demanding obedience to holy books and creeds.
Michelangelo’s depiction of God on the ceiling of the Sistine Chapel in the Vatican.
I cringe every time I hear preachers and devout Christians declare “The Bible says…” Rarely do they identify the author or the circumstance of the passage to which they refer. “The Bible says…”is the sledge hammer of Protestant Christianity.
The message is all too plain: Get in line or you are headed for punishment, rejection or even Hell. It is the ultimate bullying tool because it is difficult for a parishioner to out-gun a holy god who has spoken with finality and without error. Dynamic and authoritarian preachers are especially good at Bible rhetoric that is calculated intimidation. Preachers may be the most skilled persons in our society in the practice of bullying.
And then there are the creeds, which were originally devised to force conformity to Christian belief. The creeds of Christianity have been and are regularly used as the club for bullying. Again, the message is clear: Agree or be denied ordination; agree or be silenced; agree or be censored; disagree and be labeled a heretic and be excommunicated.
Bullying also is practiced at the highest level of American civil society, with bullying a front-line tool of U.S. foreign policy. One could say that America in its world leadership role has refined and redefined the art of bullying.
We constantly send messages to the nations of the world: Behave and we will send you money; misbehave and we will place sanctions against you; get out of line too much and we have the power to crush you; dare rattle your own sword and we will station our battleships off your coast.
None of these public practices teaches our children the ways of peace. Then we seem surprised when we find bullying prevalent among our school children. Teenage gangs are simply another manifestation of a bully system that pervades many of the most respected institutions of society.
While details change, the dynamics of bullying never change. The story line repeats itself over and over. A bully finds ways to intimidate others to establish control over them. The person who is the object of the bullying has three choices: submit, run away, or fight back. None of these standard responses produce good results.
I had a chance to reflect on the dynamics of bullying when . . .
In New Scientist Michael Bond has an interesting review of two books on stress:
See more: An illustrated version of this article will be published within the next two weeks on our CultureLab books and arts blog
One Nation Under Stress: The trouble with stress as an idea, by Dana Becker
Published by: Oxford University Press
Your Survival Instinct is Killing You: Retrain your brain to conquer fear, make better decisions, and thrive in the 21st century, by Marc Schoen
Published by: Hudson Street Press
Two opposing strategies for dealing with the stress of modern life have been put forward by Dana Becker and Marc Shoen, but which is better?
STRESS is the epidemic of our age, or so it seems: a disfiguring consequence of modern life that we all succumb to from time to time. Yet it is hard to know what it really is, other than a miscellany of physical and psychological symptoms covering everything from anxiety to hypertension. The original medical definition, which, as its derivation from mechanics suggests, is concerned specifically with an organism’s response to external pressures, has all but vanished from view.
The effect of the external environment is central to some of the most telling scientific studies on stress, such as those exploring links between wealth inequalities and brain development. But this is not how most of us – or indeed most scientists – talk about stress. The focus has now turned inward, from environmental causes to medical solutions and what individuals should do to cope.
The result of this recalibration, initiated partly by the discovery that stressful experiences affect people’s immune systems in different ways, is a vast market for biomedical and psychological interventions. In the scramble for drugs and therapy, the social and developmental context of stress and stress-related disease is conveniently ignored. Children with chronic behavioural issues, for example, are diagnosed with “conduct disorder”, a label that pathologises their shortcomings and disregards the deficiencies in care and upbringing that are likely to have contributed to them.
In One Nation Under Stress, Dana Becker argues that the medicalisation of stress and the current infatuation with neurobiology is a disaster for societies, and particularly for women. The problems women face daily in balancing work and family, for example, are so strongly shaped by social attitudes that they have most to lose when social conditions are ignored.
Ignoring the social background to stress, she says, puts the burden of responsibility on vulnerable people to change themselves – to solve their own problems – and it condones the external conditions that lead to their suffering. It allows us to avoid the larger problems. The upshot, writes Becker, is that it becomes “far easier to talk about the ‘stressed’ African American single mother, say, than to think about the effects of de facto school segregation in our cities, or the effects of discrimination on employment opportunities, or the shortage of affordable childcare”.
Becker is a family therapy specialist at Bryn Mawr College in Pennsylvania with a long interest in cultural and historical attitudes to illness. She is a sharp observer of the social and cultural implications of modern attitudes to stress, such as the tendency of researchers and the media to exaggerate the incidence of post-traumatic stress disorder among both civilians and soldiers.
One Nation Under Stress reads like a manifesto against the current order, and few areas of medicine emerge unscathed. Becker sounds angry and occasionally bitter, which can make for a difficult read. She is convincing but also frustrating, for she offers few solutions, short of the need to “make substantive structural changes in our society”, such as reducing inequalities.
Here, she makes the radical and clever suggestion that poverty should be viewed (by researchers and funders presumably) as a direct cause of illness and death, since it is well established that poverty leads to a greater risk of hypertension, depression, heart disease and other life-threatening conditions. But she fails to show how that could affect how science is carried out. Does she want money diverted from biomedicine to social sciences? Should we just give up on trying to discern individual differences in the way people deal with environmental and social pressures?
Marc Schoen’s Your Survival Instinct is Killing You, on the other hand, offers to “retrain your brain” to better cope with the stresses of modern living. It looks like just the kind of approach Becker hopes to banish. . .
The Washington Post has an interesting article by Michelle Boorstein on how the suicide of Pastor Rick Warren’s son has encouraged a reappraisal of how to approach and treat mental illness in the context of religious beliefs.
n the days after the suicide of California megachurch pastor Rick Warren’s son, evangelical Christian leaders have begun a national conversation about how their beliefs might sometimes stigmatize those who struggle with mental illness. “Part of our belief system is that God changes everything, and that because Christ lives in us, everything in our hearts and minds should be fixed,” said Ed Stetzer, a prominent pastor and writer who advises evangelical churches. “But that doesn’t mean we don’t sometimes need medical help and community help to do those things.”
The death of Matthew Warren, 27, who shot himself Friday, stunned evangelical Christians. Most were unaware that Rick Warren, the best-selling author of “The Purpose Driven Life” and a pastor known for frank talk on subjects including politics, marriage and sex, was struggling with such a serious family problem. Rick Warren wrote to his congregation at Saddleback Church in Lake Forest, Calif., that “only those closest” knew that his son had long been suicidal, despite receiving the best of spiritual and medical care.
Rebekah Lyons, a blogger and wife of the popular pastor Gabe Lyons, wrote this week that “anxiety and panic are my nemesis” and urged Christians not to link mental illness with spiritual weakness.
“As Christians, we believe this side of heaven all disease, sickness and pain is rooted in a world broken by sin. But there are real consequences to living amidst the mess. To oversimplify these complexities would be naive at best, negligent at worst,” she wrote.
The revelation has spurred discussion within church communities about how a fervent belief among evangelicals in the power of prayer and dependence on God and Jesus for healing might stifle congregants from talking about mental illness or seeking help for themselves or family members.
For Christians who believe in turning to a divine source for emotional help, even defining a prayerful request can be fraught, some leaders and congregants pointed out. For example, is depression the result of sinful behavior for which one should seek forgiveness? And if prayer does not bring relief, what might God be saying?
When people suffer despite prayer and consider therapy, “people think: ‘Is this a knock against my faith? Am I not believing in God enough? Now I have to resort to this?’ ”said Henry Davis, leader of the evangelical First Baptist Church of Highland Park. “I believe God is in therapy. I believe God can be in medicine. If someone says, ‘I’m just going to pray,’ you have to do more.” . . .
An intriguing approach described by Susan Dominus in the NY Times:
Just after noon on a Wednesday in November, Adam Grant wrapped up a lecture at the Wharton School and headed toward his office, a six-minute speed walk away. Several students trailed him, as often happens; at conferences, Grant attracts something more like a swarm. Grant chatted calmly with them but kept up the pace. He knew there would be more students waiting outside his office, and he said, more than once, “I really don’t like to keep students waiting.”
Grant, 31, is the youngest-tenured and highest-rated professor at Wharton. He is also one of the most prolific academics in his field, organizational psychology, the study of workplace dynamics. Grant took three years to get his Ph.D., and in the seven years since, he has published more papers in his field’s top-tier journals than colleagues who have won lifetime-achievement awards. His influence extends beyond academia. He regularly advises companies about how to get the most out of their employees and how to help their employees get the most out of their jobs. It is Grant whom Google calls when “we are thinking about big problems we are trying to solve,” says Prasad Setty, who heads Google’s people analytics group. Plenty of people have made piles of money by promising the secrets to getting things done or working a four-hour week or figuring out what color your parachute is or how to be a brilliant one-minute manager. But in an academic field that is preoccupied with the study of efficiency and productivity, Grant would seem to be the most efficient and productive.
When we arrived at Grant’s office on the Philadelphia campus, five students were waiting outside. The first was a student trying to decide between Teach for America and a human-resources job at Google. Grant walked her through some other possibilities, testing her theories about potential outcomes. Although she was aware of the crowd, she seemed to be in no hurry to leave, in part because Grant was so clearly engaged. A second student came in. Then a third. Someone dropped off a bottle of wine to say thank you; another asked for a contact (Grant pledges to introduce his students to anyone he knows or has met, and they shop his LinkedIn profile for just that purpose). For every one of them, Grant seemed to have not only relevant but also scientifically tested, peer-reviewed advice: Studies show you shouldn’t move for location, since what you do is more important than where you do it. Studies show that people who take jobs with too rosy a picture get dissatisfied and quit. If you truly can’t make a decision, consider delegating it to someone who knows you well and cares about you. Is there anything else I can help you with? How else can I help? He was like some kind of robo-rabbi.
Grant might not seem so different from any number of accessible and devoted professors on any number of campuses, and yet when you witness over time the sheer volume of Grant’s commitments, and the way in which he is able to follow through on all of them, you start to sense that something profoundly different is at work. Helpfulness is Grant’s credo. He is the colleague who is always nominating another for an award or taking the time to offer a thoughtful critique or writing a lengthy letter of recommendation for a student — something he does approximately 100 times a year. His largess extends to people he doesn’t even know. A student at Warwick Business School in England recently wrote to express his admiration and to ask Grant how he manages to publish so often, and in such top-tier journals. Grant did not think, upon reading that e-mail, I cannot possibly answer in full every such query and still publish so often, and in such top-tier journals. Instead, Grant, who often returns home after a day of teaching to an in-box of 200 e-mails, responded, “I’m happy to set up a phone call if you want to discuss!” He attached handouts and slides from the presentation on productivity he gave to the Academy of Management annual conference a few years earlier.
For Grant, helping is not the enemy of productivity, a time-sapping diversion from the actual work at hand; it is the mother lode, the motivator that spurs increased productivity and creativity. In some sense, he has built a career in professional motivation by trying to unpack the puzzle of his own success. He has always helped; he has always been productive. How, he has wondered for most of his professional life, does the interplay of those two factors work for everyone else?
Organizational psychology has long concerned itself with how to design work so that people will enjoy it and want to keep doing it. Traditionally the thinking has been that employers should appeal to workers’ more obvious forms of self-interest: financial incentives, yes, but also work that is inherently interesting or offers the possibility for career advancement. Grant’s research, which has generated broad interest in the study of relationships at work and will be published for the first time for a popular audience in his new book, “Give and Take,” starts with a premise that turns the thinking behind those theories on its head. The greatest untapped source of motivation, he argues, is a sense of service to others; focusing on the contribution of our work to other peoples’ lives has the potential to make us more productive than thinking about helping ourselves.
“Give and Take” incorporates scores of studies and personal case histories that suggest the benefits of an attitude of extreme giving at work. . .
You’d have to do some serious looking: many therapists avoid treatment that works. Read this article and note in particular the questions you should ask any prospective therapist:
. . . Need to find a therapist well-grounded in the latest research? Experts recommend interviewing prospective providers before starting therapy, especially if you are looking for a specific type of treatment. Useful questions include:
¶ What kind of trainings have you done, and with whom?
¶ What professional associations do you belong to? (If you’re looking for a C.B.T. therapist, for instance, ask whether the therapist belongs to the Association for Behavioral and Cognitive Therapies, where most top C.B.T. researchers are members.)
¶ What do you do to keep up on the research for treating my condition?
¶ How do you know that what you do in treatment works?
¶ Do you consider yourself and your approach eclectic? (Therapists who subscribe to an eclectic approach are less likely to adhere to evidence-based treatments.)
¶ What manuals do you use?
¶ What data can you show me about your own outcomes?
“A clinician who can’t tell you how many patients get well isn’t going to care that much whether you get well,” said Dr. Waller.
Probably good as a preventive measure as well: some minimum optimal daily amount. Gretchen Reynolds writes in the NY Times:
Scientists have known for some time that the human brain’s ability to stay calm and focused is limited and can be overwhelmed by the constant noise and hectic, jangling demands of city living, sometimes resulting in a condition informally known as brain fatigue.
With brain fatigue, you are easily distracted, forgetful and mentally flighty — or, in other words, me.
But an innovative new study from Scotland suggests that you can ease brain fatigue simply by strolling through a leafy park.
The idea that visiting green spaces like parks or tree-filled plazas lessens stress and improves concentration is not new. Researchers have long theorized that green spaces are calming, requiring less of our so-called directed mental attention than busy, urban streets do. Instead, natural settings invoke “soft fascination,” a beguiling term for quiet contemplation, during which directed attention is barely called upon and the brain can reset those overstretched resources and reduce mental fatigue.
But this theory, while agreeable, has been difficult to put to the test. Previous studies have found that people who live near trees and parks have lower levels of cortisol, a stress hormone, in their saliva than those who live primarily amid concrete, and that children with attention deficits tend to concentrate and perform better on cognitive tests after walking through parks or arboretums. More directly, scientists have brought volunteers into a lab, attached electrodes to their heads and shown them photographs of natural or urban scenes, and found that the brain wave readouts show that the volunteers are more calm and meditative when they view the natural scenes.
But it had not been possible to study the brains of people while they were actually outside, moving through the city and the parks. Or it wasn’t, until the recent development of a lightweight, portable version of the electroencephalogram, a technology that studies brain wave patterns.
For the new study, . . .
This reminds me of the Artist’s Dates described in Julia Cameron’s The Artist’s Way.
In my view, the most damaging aspect of any organization, religious or not, is an insistence that certain ideas must never be questioned. This (in my view) damages the spirit of inquiry by crippling (sometimes permanently) curiosity, speculation, investigation, experimentation, and, in general, the ability to learn and grow. Organizations that encourage open inquiry and open debate are, in general, much more healthy (and much more cognizant of reality) than those that cordon off certain areas of thought as never to be investigated or questioned. These authoritarian organizations may or may not be religious: some religions certainly are authoritarian, others not so much—same with businesses, political parties, governments, hospitals, colleges, and any other human organization. The problems that any organization typically encounters are human problems, and these crop up in all contexts. Not all religions are authoritarian, and not all authoritarian organizations are religions. This entire article, though interested, could stand to be generalized to be an article about authoritarian organizations, with this situation as an example.
Valerie Tarico writes for AlterNet:
At age sixteen I began what would be a four year struggle with bulimia. When the symptoms started, I turned in desperation to adults who knew more than I did about how to stop shameful behavior—my Bible study leader and a visiting youth minister. “If you ask anything in faith, believing,” they said. “It will be done.” I knew they were quoting  the Word of God. We prayed together, and I went home confident that God had heard my prayers. But my horrible compulsions didn’t go away. By the fall of my sophomore year in college, I was desperate and depressed enough that I made a suicide attempt. The problem wasn’t just the bulimia. I was convinced by then that I was a complete spiritual failure. My college counseling department had offered to get me real help (which they later did). But to my mind, at that point, such help couldn’t fix the core problem: I was a failure in the eyes of God. It would be years before I understood that my inability to heal bulimia through the mechanisms offered by biblical Christianity was not a function of my own spiritual deficiency but deficiencies in Evangelical religion itself.
Dr. Marlene Winell is a human development consultant in the San Francisco Area. She is also the daughter of Pentecostal missionaries. This combination has given her work an unusual focus. For the past twenty years she has counseled men and women in recovery from various forms of fundamentalist religion including the Assemblies of God denomination in which she was raised. Winell is the author ofLeaving the Fold – A Guide for Former Fundamentalists and Others Leaving their Religion , written during her years of private practice in psychology. Over the years, Winell has provided assistance to clients whose religious experiences were even more damaging than mine. Some of them are people whose psychological symptoms weren’t just exacerbated by their religion, but actually caused by it.
Two years ago, Winell made waves by formally labeling what she calls “Religious Trauma Syndrome” (RTS) and beginning to write  and speak on the subject for professional audiences. When the British Association of Behavioral and Cognitive Psychologists published a series of articles on the topic, members of a Christian counseling association protested  what they called excessive attention to a “relatively niche topic.” One commenter  said, “A religion, faith or book cannot be abuse but the people interpreting can make anything abusive.”
Is toxic religion simply misinterpretation? What is religious trauma? Why does Winell believe religious trauma merits its own diagnostic label?
Let’s start with the basics. What exactly is religious trauma syndrome?
Religious trauma syndrome (RTS) is a set of symptoms and characteristics that tend to go together and which are related to harmful experiences with religion. They are the result of two things: immersion in a controlling religion and the secondary impact of leaving a religious group. The RTS label provides a name and description that affected people often recognize immediately. Many other people are surprised by the idea of RTS, because in our culture it is generally assumed that religion is benign or good for you. Just like telling kids about Santa Claus and letting them work out their beliefs later, people see no harm in teaching religion to children.
But in reality, religious teachings and practices sometimes cause serious mental health damage. The public is somewhat familiar with sexual and physical abuse in a religious context. As Journalist Janet Heimlich has documented in, Breaking Their Will , Bible-based religious groups that emphasize patriarchal authority in family structure and use harsh parenting methods can be destructive.
But the problem isn’t just physical and sexual abuse. Emotional and mental treatment in authoritarian religious groups also can be damaging because of 1) toxic teachings like eternal damnation or original sin 2) religious practices or mindset, such as punishment, black and white thinking, or sexual guilt, and 3) neglect that prevents a person from having the information or opportunities to develop normally.
Can you give me an example of RTS from your consulting practice? . . .
Yes, outright lies that conservatives continually and explicitly push. Amanda Marcotte counts them off for Salon. The first few:
Lie No. 1: Racism has barely been an issue in U.S. history and slavery wasn’t that big a deal.
Lie No. 2: Joe McCarthy was right.
Lie No. 3: Climate change is a massive hoax scientists have perpetuated on the public.
Lie No. 4: . . .
Take, for example, this article by Sandra Boodman in the Washington Post:
At a critical point in a complex abdominal operation, a surgeon was handed a device that didn’t work because it had been loaded incorrectly by a surgical technician. Furious that she couldn’t use it, the surgeon slammed it down, accidentally breaking the technician’s finger. “I felt pushed beyond my limits,” recalled the surgeon, who was suspended for two weeks and told to attend an anger management course for doctors.
The 2011 incident illuminates a long-festering problem that many hospitals have been reluctant to address: disruptive and often angry behavior by doctors. Experts estimate that 3 to 5 percent of physicians engage in such behavior, berating nurses who call them in the middle of the night about a patient, flinging scalpels at trainees who aren’t moving fast enough, demeaning co-workers they consider incompetent or cutting off patients who ask a lot of questions.
“We’re talking about a very small number of physicians, but the ripple effect is profound,” said Charles Samenow, an assistant professor of psychiatry at George Washington University School of Medicine, who evaluates doctors with behavioral problems.
For generations, bad behavior by doctors has been explained away as an inevitable product of stress or tacitly accepted by administrators reluctant to take action and risk alienating the medical staff, particularly if the offending doctors generate a lot of revenue. Recently at one Virginia hospital, according to University of Virginia School of Nursing dean Dorrie Fontaine, a veteran operating-room nurse with 30 years’ experience walked into her supervisor’s office and quit after a surgeon screamed at her — his usual reaction to unwelcome news — when she told him that a routine count revealed that an instrument was missing. Hospital administrators shrugged off the episode, saying, “Well, that’s the way he is.”
But that time-honored tolerance is waning, Samenow and other experts say, as a result of regulations imposed in 2009 by the Joint Commission, the group that accredits hospitals. These rules require hospitals to institute procedures for dealing with disruptive behavior, which can take passive forms such as refusing to answer pages or attend meetings. The commission has called for a “zero tolerance” approach. Such behavior is not unique to doctors; researchers have found that nurses act out, too, mostly to other nurses, but that their behavior is less likely to affect patients.
Growing attention to the problem, which appears to be most common among surgeons and other specialists who do procedures, has spawned a cottage industry of therapists who provide anger management counseling, which is sometimes billed as “executive coaching.” Programs are flourishing at Vanderbilt, the University of Virginia, the University of California at San Diego and, most recently, GWU.
Most doctors who enroll are middle-aged men sent by hospitals or state medical boards that have ordered them to shape up. . .
Kate Miller wisely distinguishes need and abuse in this column in the NY Times:
The first time I took Adderall I didn’t think twice. It was 2007. I was in my last year at UCLA, where I had come down with a bad case of senioritis, and found myself cramming for finals. I bought it from a gangly kid with yellow skin and bags under his eyes who lived in the dorms. His hair was stringy. There were papers on the floor and piles of clothes on all the furniture in the room. Above his desk was a poster of John Belushi from “Animal House,” chugging a bottle of Jack Daniels and wearing a sweatshirt that read COLLEGE.
I had gone to his room with a friend. He told us the pills were $5 each. We asked where he’d got it. “I’ve been taking this stuff since I was five,” he said and took out an orange prescription bottle and gave us each two small, round blue pills. He smelled sour. “It makes me feel like a zombie. But that’s only because I have ADD,” he quickly added. He didn’t want to scare away his customers.
I started taking Adderall and things changed fast. I focused in the library for hours without distraction. I cranked out a 15-page research paper in one night, without wanting to take a break. I could shut out the world. Any immediate distractions were rendered powerless. It was just me and the paper in front of me. No broken heart, best friend drama or money woes were big enough to penetrate the tunnel vision Adderall provided. Sure, the desire to smoke cigarettes was uncontrollable. It also suppressed my appetite, so I was forgetting to eat as well, but when I lost a few pounds in that first week, I felt it was a net gain. Plus everyone was trying it, like Pinkberry and Sufjan Stevens.
A week after I graduated with my fellow English majors, I packed up my life and headed to New York, where I thought I’d find mature, motivated, sophisticated peers and a pace and degree of structure absent in my artistic, hippie upbringing. I couldn’t get there fast enough to start adulthood as the new me. With my sleepy beach town a speck in the rearview, I found a position at a law firm as a paralegal, which suited my talents for writing, editing, and researching, without having to follow in the footsteps of the rest of my artistic family. I fancied myself a serious person, someone on the verge of making a real difference. I was 23. . .
That finding surprises me, though I can see how it’s possible—well, given that it’s true, it’s obviously possible. I mean I can just about see how it might work: very slight differences resulting in different expressions, like being threat-tolerant or not sets in motion a chain of outcomes and influences that result in totally different political outlooks. Gina Kolata writes in the NY Times:
The psychiatric illnesses seem very different – schizophrenia, bipolar disorder, autism, major depression and attention deficit hyperactivity disorder. Yet they share several genetic glitches that can nudge the brain along a path to mental illness, researchers report. Which disease, if any, develops is thought to depend on other genetic or environmental factors.
Their study, published online Wednesday in the Lancet, was based on an examination of genetic data from more than 60,000 people world-wide. Its authors say it is the largest genetic study yet of psychiatric disorders. The findings strengthen an emerging view of mental illness that aims to make diagnoses based on the genetic aberrations underlying diseases instead of on the disease symptoms.
Two of the aberrations discovered in the new study were in genes used in a major signaling system in the brain, giving clues to processes that might go awry and suggestions of how to treat the diseases.
“What we identified here is probably just the tip of an iceberg,” said Dr. Jordan Smoller, lead author of the paper and a professor of psychiatry at Harvard Medical School and Massachusetts General Hospital. “As these studies grow we expect to find additional genes that might overlap.”
The new study does not mean that the genetics of psychiatric disorders are simple. Researchers say there seem to be hundreds of genes involved and the gene variations discovered in the new study only confer a small risk of psychiatric disease. . .