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Suicide in America is an epidemic, but read: The Best Way To Save People From Suicide

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Jason Cherkis writes at Huffington Post:

It was still dark outside when Amanda woke up to the sound of her alarm, got out of bed and decided to kill herself. She wasn’t going to do it then, not at 5:30 in the morning on a Friday. She told herself she would do it sometime after work.

Amanda showered. She put on khakis and a sweater. She fed Abby, her little house cat. Before walking out the door, she sent her therapist an email. “Not a good night last night, had a disturbing dream,” she wrote. “Got to try and get through the day, hope I can shift my mind enough to focus. Only plan tonight is to come home and take a nap.”

Amanda was a 29-year-old nurse, pale and thin—a quiet rule-follower. She had thought about taking a sick day, but she didn’t want to upset her co-workers or draw attention to herself. As usual, she arrived at the office earlier than just about everyone else, needing the extra time to get comfortable. She had taken a pay cut to join this clinic outside Seattle, in part because she wanted to treat low-income mothers and pregnant women. Some of her patients were in recovery, others were homeless, several had fled physically abusive men. She was inspired by their resilience and felt only slightly jealous of the ones who had found antidepressants that worked. That day, September 28, 2007, was her first shift seeing patients without a supervisor watching over her.

Amanda’s schedule was relatively light: three, maybe four patients. She measured their blood pressure, their weight. She ran through her mandated checklist of questions. Have you relapsed since your last visit? Can you afford your newborn’s car seat? Do you have a history of mental health problems? She hated those questions. There was no way she would answer them herself. Too invasive, too personal. In an email she’d sent her therapist a month earlier, she confessed that she would occasionally put on a “mask of normalcy.” Sure, patients were always commenting on how upbeat she was, but “the part they didn’t see,” she wrote, “was me turning around, me leaving the room, me getting in my car at the end of the day, taking a deep breath and me crying all the way home. I have always done what is needed to be done and when I can stop pretending I let it out.”

Her first thoughts of suicide had come shortly after her 14th birthday. Her parents were going through an ugly divorce just as her social anxiety and her perfectionism at school kicked in hard. At 20, she tried to kill herself for the first time. For about the next decade, Amanda didn’t make a few attempts. She made dozens. Most times, she would take a bunch of pills just before bedtime. That way, her roommates would think she was sleeping. In the mornings, though, she would wake up drained and spaced out, despairing that she could fail even at this. Then she would resolve not to speak of it to anyone. To her, suicide attempts weren’t cries for help but secrets to be zealously guarded.

“What in the world is it going to take for me to feel better?” Amanda asked in an exasperated diary entry from 2004. Therapy wasn’t much help—too often, her pain was met with baffling ignorance or worse. A counselor at her church suggested that her depression would go away if she prayed more. Once, a therapist refused to talk during their session unless she opened up; she never went back after that. The college where she studied nursing forced her to take a leave of absence over her depression and anxiety. The day she got the news, she made another suicide attempt.

Ursula Whiteside, Amanda’s new therapist, was different. She was just 29 years old, a graduate student working under supervision at a University of Washington lab. Amanda was one of her first clients. But Whiteside was preternaturally sensitive. She could tell how just sitting in the waiting room stoked Amanda’s social anxiety. And she made it clear that she would go to creative lengths to get Amanda talking. During one session, Whiteside stood on her head. In another, she took Amanda into a children’s playroom, thinking the absurd change of scenery would shake something loose. The rare moments when Amanda responded with a dry joke were gold.

Still, there were sessions that ended in frustration, so they agreed to email between appointments. Amanda wrote to Ursula whenever the mood hit her, late at night mostly. The emails could be short, no more than a few paragraphs, but here, more than anywhere else, she was matter-of-fact about her suicidal thinking. “I wanted to tell you what went on this weekend and I’m pretty sure I will not be able to tell you in person,” she wrote on August 26. “I survived the weekend, which I guess was the goal. … I panicked Fri. night and I took 2 extra pills. I usually just take 1, Friday night, I took 3. It was stupid, I just wanted to sleep, it was stupid because it wouldn’t do anything. … I also ended up going over to my friends house last night. She kept me safe last night, even though she doesn’t know it.”

Whiteside’s replies often teemed with exclamation points and underlined words. She knew it was important to remain upbeat. But a month later, when she received the email Amanda sent that Friday morning before work, she wrote back quickly and with little of her typical flair. They’d had a session the day before, and Amanda seemed to be hiding more than usual. Whiteside felt it was necessary to jolt her into being more forthcoming.

“If you are planning on killing yourself this evening or this weekend, I need to know,” Whiteside wrote just before 7 a.m.

Then she waited. 10 a.m. Noon. No reply. By 1:30 p.m., Whiteside called her supervisor to discuss strategy. If Whiteside’s instincts were correct, and she asked the police to do a welfare check, she could save Amanda’s life. If she was wrong, she could destroy the trust they had built over their months together, and Amanda might not return for another session. Whiteside started typing up notes. “I’m glad that she is telling me something,” she wrote. “But something is getting in the way of her being completely forthright. … As good as I am, I can not magically help someone feel better. … So terrifying that she is going to go all the way to the bottom.”

Amanda left work at 4:30 p.m. and stopped at a local pharmacy to refill a prescription. She wanted to make sure she had enough antidepressants to successfully overdose. She then went home and gathered up other sleeping meds so that she could mix them together with the new pills. She never replied to Whiteside. She didn’t write a suicide note. After dark, she put on her pajamas and brushed her teeth. She took a deep breath, methodically swallowed one pill after another, dozens and dozens of them, laid down on her bed and drifted off to sleep.

Meanwhile, Whiteside had a lot of work to do, but her mind kept returning to Amanda. She was so worried that she forgot that she had driven to the university that morning and took a bus home. She kept leaving voicemails and texts, telling Amanda that she cared about her, that she was confident the therapy could work. That night, she finally called the police. She knew the risks; she just didn’t care anymore.

But when the cops arrived, Amanda was nowhere to be found: The address Whiteside had was out of date. Helpfully, an old neighbor gave the police the number of one of Amanda’s friends. The friend, though, insisted on meeting the police in person, eating up valuable time. By the time she took them to Amanda’s studio apartment, it was late, maybe five or six hours after Amanda had ingested the pills. They found Amanda in bed, alive but clearly out of it. There were empty pill bottles nearby, cat toys underfoot. Her friend shook her awake. In a sleepy whisper, Amanda confirmed what she had done.

Several hours later, Amanda came to in the emergency room. She had an IV drip in her arm. An oxygen mask covered her face. Medical personnel monitored her extremely low blood pressure and x-rayed her chest. She could hardly speak, but the staff got enough information to describe her in their medical records as “a 29-year-old previously healthy, except for her psychiatric history.”

In time, Amanda was transferred to another part of the hospital, where a “sitter” was assigned to observe her in case she tried to harm herself. During a psychological assessment, she frequently dozed off. She couldn’t believe she was here again. She didn’t call any friends or family members. Her state of mind was exactly the same as it was when she started downing the pills. Amanda still wanted to die.

Over the last two decades, suicide has slowly and then very suddenly announced itself as a full-blown national emergency. Its victims accompany factory closings and the cutting of government assistance. They haunt post-9/11 military bases and hollow the promise of Silicon Valley high schools. Just about everywhere, psychiatric units and crisis hotlines are maxed out. According to the most recent figures from the Centers for Disease Control and Prevention, there are now more than twice as many suicides in the U.S. (45,000) as homicides; they are the 10th leading cause of death. You have to go all the way back to the dawn of the Great Depression to find a similar increase in the suicide rate. Meanwhile, in many other industrialized Western countries, suicides have been flat or steadily decreasing.

What makes these numbers so scary is that they can’t be explained away by any sort of demographic logic. Black women, white men, teenagers, 60-somethings, Hispanics, Native Americans, the rich, the poor—they are all struggling. Suicide rates have spiked in every state but one (Nevada) since 1999. Kate Spade’s and Anthony Bourdain’s deaths were shocking to everybody but the epidemiologists who track the data.

And these are just the reported cases. None of the numbers above account for the thousands of drug overdose deaths that are just suicides by another name. If you widen the lens a bit to include those contemplating suicide, the problem starts to take on the contours of an epidemic. In 2014, the federal government estimated that 9.4 million American adults had seriously considered the idea.

There’s an inherent lack of closure to suicide. Even when people write notes, they can reveal so little. Suicides often leave loved ones, acquaintances and co-workers to question themselves for the rest of their lives. And in their own grief, they, too, can entertain dangerous thoughts. “With suicide you have that added trauma to it,” said Julie Cerel, the president of the American Association of Suicidology. “The ‘why’ question of trying to search for meaning when there’s no meaning available—If I only had a note. If I only talked to the last person that they talked to. The ‘onlys’ can be torturous.’” Last year, Cerel published a study examining the consequences of suicide and found that each one could affect as many as 135 other people.

The fundamental mystery of suicide has long made it an object of fear and contempt within the medical establishment. Since the 1950s, public health officials have tried hotlines, individual therapy, group therapy, shock therapy and forced hospitalizations. Doctors have taken away people’s shoelaces and belts and checked in on attempt survivors every 15 minutes to make sure they are still safe. They have coerced patients into signing contracts swearing that they would not kill themselves. They have piled on psychiatric medications with ever-more invasive side effects, only to watch the number of suicides continue to climb.

Even now, most mental health professionals have no idea what to do when a suicidal person walks through their door. They’re untrained, they’re under-resourced and, not surprisingly, their responses can be remarkably callous. In an emergency room, an attempt survivor might be cuffed to a bed and made to wait hours to be officially admitted, sometimes days. Finding help beyond the ER can be harder yet.

“You take someone who is not doing well, shutting down, and throw them in a system that requires them to have the highest problem-solving abilities and emotional regulation,” said Jeff Sung, a psychiatrist colleague of Whiteside’s who works with high-risk clients and trains others to do so. According to federal data, the majority of those in need of mental health services do not receive it.

When confronted with the coldness of her colleagues, Whiteside grows exasperated. Because while the dead are invisible to most, she knows them. She gets how suicidal thoughts have their own seductive logic, how there is comfort in the notion that there is a surefire way to end one’s pain. She sees why people might turn to these thoughts when they hit a crisis, even a minor one like missing a bus to work or accidently bending the corner of a favorite book. That’s why suicidal urges are so much more dangerous than depression—people can view death as an answer to a problem. And she knows that many patients of hers will always feel vulnerable to these thoughts. She has described her job as an endless war.

Whiteside was born in Colville, Washington, 40 years ago, the first child of parents drawn to adventurous work wherever they could find it: building an oil pipeline in Alaska, raising cattle and conducting child health screenings in rural Washington, driving trucks through the Midwest. By the time she attended junior high, in Minnesota, Whiteside had enrolled in six different schools in three different states. But instead of turning her bitter or shy, all the moving seemed to sharpen her empathic powers. She became one of those canny little people who could intuit when those around her were in pain.

And she could be impulsive in her efforts to help. When she was in eighth grade, one of her best friends called her frantic and in tears. The friend didn’t go into detail, but said that she needed to escape her house immediately. So Whiteside planned a rescue. Shortly after midnight, Whiteside snuck out of a window in her family’s basement apartment and stole her mother’s sedan. She didn’t think about the fact that she couldn’t drive legally or that her friend’s house was 8 miles away or that the roads were icy and covered in snow. She didn’t care that she weighed only 80 pounds and could barely see over the steering wheel. She made it past the McDonald’s, down the hill, to the one-lane country road where her friend lived before crashing the car into a ditch in front of the house.

The older Whiteside got, the clearer it became that she was better at looking after others than herself. In high school, she struggled with her body image along with depression and anxiety. Like her future clients, she found it excruciatingly difficult to talk about what she was experiencing. The idea of asking for help was “the scariest thing I could imagine,” she said. During one point in college, she sent her mother, who had lost her own brother to suicide, a lengthy letter detailing her ups and downs. “I’m writing you this letter because I often have a hard time saying out loud what I mean,” she confessed. “I am just chicken.”

She wanted so badly to understand the mechanics of despair, including her own. “Everything I do has to be extreme,” she wrote in her diary. “I go through phases where I absolutely love myself—I go through others where all I can think about is knives and bridges.” At the University of Minnesota-Duluth, she read mental health textbooks and academic journals in her spare time. She was drawn to the field as a practical way of untangling life’s most intractable problems. “I took my first psychology class and I was like, ‘Oh my God, you can actually change things,’” she said. “It’s not magic.”

Before her junior year, Whiteside transferred to the University of Washington so she could learn from Marsha Linehan, a legend in the field of suicide research. Linehan had pioneered a powerful form of treatment called dialectical behavior therapy, or DBT, which trains patients how to reroute their suicidal impulses. It can be grueling, emotionally exhausting work that requires people to spend several hours a week in individual and group therapy, and therapists to do check-in calls as needed throughout the week. Linehan had a principle for all of her students: Clients came first, your own life came second.

It couldn’t have suited Whiteside better. “I’ve found some semblance of passion,” she wrote in her diary at the time. “I have to think of myself and I have to think of my soul and I have to remember those in most need, those experiencing suffering beyond my imagination.” In a letter of recommendation, Linehan wrote that Whiteside had “become unflappable.”

And then Whiteside sprinted nose-first into the wall of the modern-day behavioral health care system. She took a clinical internship in the psychiatric department of Harborview Medical Center in downtown Seattle, an under-resourced, grim institution. The main goal, she kept hearing, was triage. She was there to stabilize suicidal patients, nothing more, because no one had the time to do more.

Whiteside was tasked with probing patients for their treatment history and state of mind. There was the man who killed his dog and shot himself in the stomach. The immigrant who set himself on fire. The college student who had been found walking in the middle of a street clutching a teddy bear. Each one, she felt, was desperate for any form of help or kindness.

“I was absolutely insane, completely unconcerned with life,” one former patient from that era said. “They had no idea what to do with me. But Ursula was looking at me in a way where she was actually waiting for me to respond. … It wasn’t, ‘What are your symptoms? What medications are you on?’ It was, ‘Tell me a little bit about your story.’” Whiteside knew that people who leave the hospital after a suicide attempt are at a greater risk of harming themselves again within 90 days. And yet the doctors at Harborview were only providing referrals for clinics most patients would never visit or putting patients on waiting lists for therapists who might not be right for them. “These patients were basically at this critical juncture,” Whiteside said, “and we were fucking blowing it.”

After her patients left the hospital, she couldn’t stop thinking about them. So she began tracking them down, calling to see if they needed help or just to let them know they were on her mind. She handed out her phone number to patients before they left the hospital. On the back, she’d also leave a personal note. Anything to keep them tethered to the world. For six months, she called a woman who had made an attempt after a breakup. The woman took Whiteside’s calls for a while, until she didn’t. Whiteside still doesn’t know what happened to her. . .

Continue reading. There’s much more.

Written by LeisureGuy

15 November 2018 at 2:07 pm

Study finds major traumatic injury increases risk of mental-health diagnoses, suicide

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Wency Leung reports in the Globe & Mail:

Patients seriously injured in car accidents, violence and falls are at greater risk of developing a mental illness or dying by suicide, according to a new study that suggests those patients need better mental-health support.

The study, published on Monday in the Canadian Medical Association Journal, found that patients were 40 per cent more likely to be hospitalized with a mental-health diagnosis, such as depression, anxiety or alcohol-abuse disorder, after a major trauma than they were before being injured.

The rate of suicide among post-trauma patients was also significantly higher, at 70 suicides per 100,000 people per year, compared with 11.5 suicides per 100,000 among the general population.

“Anyone involved in the acute management of these patients needs to be thinking about mental health as importantly as we think about the physical injuries that someone has suffered,” says lead author Christopher Evans, director of trauma at the Kingston Health Sciences Centre.

As an emergency physician, Dr. Evans says he has cared for trauma patients who have made remarkable physical recoveries, but struggled with depression, anxiety and self-harm in the months and years afterward. While hospitals and health-care providers generally do offer mental-health services to trauma patients, he says, they are not always provided in a co-ordinated, systematic way.

“There’s a need for offering [mental-health] supports to every patient so that it becomes standard practice,” he says.

He and his team analyzed Ontario administrative health data, held at the Institute for Clinical Evaluative Sciences, for more than 19,300 patients treated for major trauma in Ontario, between 2005 and 2010. The most common type of injury was blunt trauma, and the causes of injury varied, including traffic accidents, unintentional falls, assault and exposure to smoke or fire.

The researchers examined how many of the patients were admitted to hospital for a mental-health diagnosis in the five years prior to their traumatic injury, compared with in the five years post-injury. They found hospital admissions, particularly for alcohol abuse, drug abuse and major depressive disorders, were higher during the post-injury period.

The study did not examine the reasons for the increase. However, Dr. Evans suggests there may be multiple factors involved. It is possible some individuals with mental illnesses may not actually be diagnosed until they come into contact with health professionals when they experience major trauma, he says. But, he explains, people who have experienced major injuries often struggle with chronic pain and financial difficulties, and they may lose their ability to function independently, which can affect their mental health.

The latest findings echo a 2014 study by researchers from the University of Manitoba that showed individuals across Canada who had experienced major traumatic injuries were at greater risk of suicide than a matched control group. The authors of that earlier study noted that advancements in medical and intensive care over the past 30 years have led to more people surviving physical injuries, and as a result, patients are also having to deal with the consequences of their injuries, including pain, disability and financial issues.

Sarvesh Logsetty, one of the authors of the 2014 study, says health professionals are now paying more attention to patients’ needs beyond treating their physical injuries.

“Now it’s not acceptable just to say, ‘Okay, great, we saved your life, see you later,’” says

Continue reading.

Written by LeisureGuy

12 November 2018 at 3:41 pm

Is Something Neurologically Wrong With Donald Trump?

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James Hamblin writes in the Atlantic:

resident donald trump’s decision to brag in a tweet about the size of his “nuclear button” compared with North Korea’s was widely condemned as bellicose and reckless. The comments are also part of a larger pattern of odd and often alarming behavior for a person in the nation’s highest office.

Trump’s grandiosity and impulsivity has made him a constant subject of speculation among those concerned with his mental health. But after more than a year of talking to doctors and researchers about whether and how the cognitive sciences could offer a lens to explain Trump’s behavior, I’ve come to believe there should be a role for professional evaluation beyond speculating from afar.

I’m not alone. Viewers of Trump’s recent speeches have begun noticing minor abnormalities in his movements. In November, he used his free hand to steady a small Fiji bottle as he brought it to his mouth. Onlookers described the movement as “awkward” and made jokes about hand size. Some called out Trump for doing the exact thing he had mocked Senator Marco Rubio for during the presidential primary—conspicuously drinking water during a speech. [photos of the awkward drinking in the article at the link – LG]

By comparison, Rubio’s movement was smooth, effortless. The Senator noticed that Trump had stared at the Fiji bottle as he slowly brought it to his lips, jokingly chiding that Trump “needs work on his form. Has to be done in one single motion, and eyes should never leave the camera.”

Then in December, speaking about his national-security plan in Washington, D.C., Trump reached under his podium and grabbed a glass with both hands. This time he kept them on the glass the entire time he drank, and as he put the glass down. This drew even more attention. The gesture was like that of an extremely cold person cradling a mug of cocoa. Some viewers likened him to a child just learning to handle a cup.

Then there was an incident of slurred speech. Announcing the relocation of the American embassy in Israel from Tel Aviv to Jerusalem—a dramatic foreign-policy move—Trump became difficult to understand at a phonetic level, which did little to reassure many observers of the soundness of his decision.

Experts compelled to offer opinions on the nature of the episode were vague: The neurosurgeon Sanjay Gupta described it as “clearly some abnormalities of his speech.” This sort of slurring could result from anything from a dry mouth to a displaced denture to an acute stroke.

Though these moments could be inconsequential, they call attention to the alarming absence of a system to evaluate elected officials’ fitness for office—to reassure concerned citizens that the “leader of the free world” is not cognitively impaired, and on a path of continuous decline.

Proposals for such a system have been made in the past, but never implemented. The job of the presidency is not what it used to be. For most of America’s history, it was not possible for the commander in chief to unilaterally destroy a continent, or the entire planet, with one quick decision. Today, even the country’s missileers—whose job is to sit in bunkers and await a signal—are tested three times per month on their ability to execute protocols. They are required to score at least 90 percent. Testing is not required for their commander in chief to be able to execute a protocol, much less testing to execute the sort of high-level decision that would set this process in motion.

The lack of a system to evaluate presidential fitness only stands to become more consequential as the average age of leaders increases. The Constitution sets finite lower limits on age but gives no hint of an upper limit. At the time of its writing, septuagenarians were relatively rare, and having survived so long was a sign of hardiness and cautiousness. Now it is the norm. In 2016 the top three presidential candidates turned 69, 70, and 75. By the time of the 2021 inauguration, a President Joe Biden would be 78.

After age 40, the brain decreases in volume by about 5 percent every decade. The most noticeable loss is in the frontal lobes. These control motor functioning of the sort that would direct a hand to a cup and a cup to the mouth in one fluid motion—in most cases without even looking at the cup

These lobes also control much more important processes, from language to judgment to impulsivity. Everyone experiences at least some degree of cognitive and motor decline over time, and some 8.8 percent of Americans over 65 now have dementia. An annual presidential physical exam at Walter Reed National Military Medical Center is customary, and Trump’s is set for January 12. But the utility of a standard physical exam—knowing a president’s blood pressure and weight and the like—is meager compared with the value of comprehensive neurologic, psychological, and psychiatric evaluation. These are not part of a standard physical.

Even if they were voluntarily undertaken, there would be no requirement to disclose the results. A president could be actively hallucinating, threatening to launch a nuclear attack based on intelligence he had just obtained from David Bowie, and the medical community could be relegated to speculation from afar.

Even if the country’s psychiatrists were to make a unanimous statement regarding the president’s mental health, their words may be written off as partisan in today’s political environment. With declining support for fact-based discourse and trust in expert assessments, would there be any way of convincing Americans that these doctors weren’t simply lying, treasonous “liberals”—globalist snowflakes who got triggered?

The downplaying of a president’s compromised neurologic status would not be without precedent. Franklin Delano Roosevelt famously disguised his paralysis from polio to avoid appearing “weak or helpless.” He staged public appearances to give the impression that he could walk, leaning on aides and concealing a crutch. Instead of a traditional wheelchair, he used an inconspicuous dining chair with wheels attached. According to the FDR Presidential Library, “The Secret Service was assigned to purposely interfere with anyone who tried to snap a photo of FDR in a ‘disabled or weak’ state.” . . .

Continue reading. There’s much more—and it’s both important and somewhat urgent.

Written by LeisureGuy

12 November 2018 at 2:47 pm

Spanking Is Still Really Common and Still Really Bad for Kids

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On the whole, adults hitting little children actually seems to be bad—not totally surprising. Joe Pinsker writes in the Atlantic:

The good news about spanking is that parents today are less likely to do it to their children than parents in the past. The bad news is that parents today still spank their kids—a lot.

“Some estimates are that by the time a child reaches the fifth grade [in the United States], 80 percent of children have been spanked,” says George Holden, a professor of psychology at Southern Methodist University who studies parenting and corporal punishment. Spanking is also widespread worldwide.

Perhaps parents are quick to spank their children because it can bring about immediate acquiescence, but the benefits, a consensus of scholars and doctors agree, end there. On Monday, the American Academy of Pediatrics (AAP), which represents 67,000 doctors, came out strongly against the practice, saying that it “harms children,” doesn’t change their behavior for the better, and may make them more aggressive later in life.

The first time the AAP, which publishes recommendations on everything from bullying to teens’ sleep schedules, issued guidelines on spanking was in 1998. Those guidelines said that pediatricians should encourage parents to seek out other punitive measures, which remained the organization’s stance until this week. “Now, with the accumulation of two more decades of research, it’s much more clear that parents should not spank their children,” says Robert Sege, a pediatrician at Tufts Medical Center who helped write the AAP’s latest statement. Other research has indicated that spanking is linked to an increased likelihood of anxiety, diminished cognitive abilities, and lower self-esteem, among other things.

Holden says it’s difficult to say exactly how common spanking is, because some surveys measure parents’ beliefs about whether spanking is acceptable (which don’t always line up with their actual behavior) and others tally up parents’ reports of their behavior (which … don’t always line up with their actual behavior). He says it’s clear, though, that “the majority of [American] children at some point in their childhood are hit”—a word Holden uses interchangeably with spanked because, he says, the term spanking can “normalize the act of hitting children.” (The peak years of spanking, he says, are from ages 2 to 5.) Holden also said that academic research points to spanking being more common among those who live in the South, those who have fundamentalist religious beliefs, and those who have less education.

Still, the ubiquity of spanking today represents an improvement over the past. According to the General Social Survey, as of 2014, 70 percent of American adults agreed that a “good, hard spanking is sometimes necessary to discipline a child.” In the mid-1980s, the percentage was in the mid-80s. Holden attributes this decline to the mounting evidence against spanking, and pediatricians who advise parents not to spank.

The AAP’s new guidelines also note “the harm associated with verbal punishment, such as shaming or humiliation,” and indeed, many parenting experts and psychologists have promoted positivity as a way of changing kids’ behavior. Alan Kazdin, the director of the Yale Parenting Center and a former president of the American Psychological Association, has called spanking “a horrible thing that does not work,” and says that what does work is enthusiastic approval of good conduct. “When you get compliance, if that’s the behavior you want,” he told my colleague Olga Khazan in 2016, “now you go over and praise it … very effusively.” The idea is that such praise will encourage better behavior in the future.

One reason it may be difficult to adjust from punishment to praise is that spanking and yelling are, to many parents, cathartic in frustrating moments.  . .

Continue reading.

Other articles that look interesting:

No Spanking, No Time-Out, No Problems
Olga Khazan

How Spanking Affects Later Relationships
James Hamblin

The Strong Evidence Against Spanking
Julie Beck

What ‘Go to Your Room’ Teaches Kids About Dealing With Emotions
Joe Pinsker

Written by LeisureGuy

10 November 2018 at 7:39 am

How Dad’s Stresses Get Passed Along to Offspring

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Environmental influences range broader than we thought. Esther Landhuis writes in Scientific American:

A stressed-out and traumatized father can leave scars in his children. New research suggests this happens because sperm “learn” paternal experiences via a mysterious mode of intercellular communication in which small blebs break off one cell and fuse with another.

Carrying proteins, lipids and nucleic acids, these particles ejected from a cell act like a postal system that extends to all parts of the body, releasing little packages known as extracellular vesicles. Their contents seem carefully chosen. “The cargo inside the vesicle determines not just where it came from but where it’s going and what it’s doing when it gets there,” says Tracy Bale, a neurobiologist at the University of Maryland School of Medicine.

Preliminary research Bale and others, announced this week at the annual meeting of the Society for Neuroscience in San Diego, shows how extracellular vesicles can regulate brain circuits and help diagnose neurodegenerative diseases—in addition to altering sperm to disrupt the brain health of resulting offspring.

Striking evidence that harsh conditions affect a man’s children came from crop failures and war ravaging Europe more than a century ago. In those unplanned human experiments, prolonged famine appeared to set off a host of health changes in future generations, including higher cholesterol levels and increased rates of obesity and diabetes. To probe the inheritance of such changes at the cellular level, Bale and co-workers performed a series of mouse experiments.

It is pretty easy to stress out a mouse. Stick one into a tube it cannot wriggle out of, soak its bedding or blast white noise—and stress hormone levels shoot up, much as they do in people worrying about finances or facing incessant pressure at work. Remarkably, the way a mouse physiologically responds to stress looks noticeably different if—months before conception—its father endured a period of stress. Somehow “their brain develops differently than if their dad hadn’t experienced that stress,” says Chris Morgan, a postdoc in Bale’s lab who helped create the mouse model.

The big question is how information about the paternal environment reaches the womb in the first place. After all, Morgan says, the “dad is only in there for one night, perhaps just a few hours.” Could his sperm carry memories of prior trauma? The idea seemed reasonable yet controversial. Because DNA is packed so tightly in the nucleus of a sperm cell, “the thought that [the cell] would respond to anything in the environment really boggled people’s minds,” says Jennifer Chan, a former PhD student in Bale’s lab who’s now a postdoc at Icahn School of Medicine at Mount Sinai in New York City.

Rather, there must be some other kind of cell whose DNA does react to environmental changes—and that cell, she reasoned, could then relay that information to sperm cells to transmit at fertilization. She focused on a population of cells that interact with developing sperm by releasing molecules that help sperm grow and mature. They also secrete extracellular vesicles—and Chan showed it is these vesicles whose contents fuse with sperm cells, instilling memories of dad’s prior stress.

In one set of experiments Chan stressed a group of male mice, let them mate and looked at stress responses in the pups. The clincher was  . . .

Continue reading.

Written by LeisureGuy

8 November 2018 at 9:41 pm

To be happier, focus on what’s within your control

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Massimo Pigliucci, a professor of philosophy at City College and at the Graduate Center of the City University of New York and author of How to Be a Stoic: Ancient Wisdom for Modern Living, writes in Aeon:

God, grant me the serenity to accept the things I cannot change,
Courage to change the things I can,
And wisdom to know the difference.

This is the Serenity Prayer, originally written by the American theologian Reinhold Niebuhr around 1934, and commonly used by Alcoholics Anonymous and similar organisations. It is not just a key step toward recovery from addiction, it is a recipe for a happy life, meaning a life of serenity arrived at by consciously taking what life throws at us with equanimity.

The sentiment behind the prayer is very old, found in 8th-century Buddhist manuscripts, as well as in 11th-century Jewish philosophy. The oldest version I can think of, however, goes back to the Stoic philosopher Epictetus. Active in the 2nd century in Rome and then Nicopolis, in western Greece, Epictetus argued that:

We are responsible for some things, while there are others for which we cannot be held responsible. The former include our judgment, our impulse, our desire, aversion and our mental faculties in general; the latter include the body, material possessions, our reputation, status – in a word, anything not in our power to control. … [I]f you have the right idea about what really belongs to you and what does not, you will never be subject to force or hindrance, you will never blame or criticise anyone, and everything you do will be done willingly. You won’t have a single rival, no one to hurt you, because you will be proof against harm of any kind.

I call this Epictetus’ promise: if you truly understand the difference between what is and what is not under your control, and act accordingly, you will become psychologically invincible, impervious to the ups and downs of fortune.

Of course, this is far easier said than done. It requires a lot of mindful practice. But I can assure you from personal experience that it works. For instance, last year I was in Rome, working, as it happened, on a book on Stoicism. One late afternoon I headed to the subway stop near the Colosseum. As soon as I entered the crowded subway car, I felt an unusually strong resistance to moving forward. A young fellow right in front of me was blocking my way, and I couldn’t understand why. Then the realisation hit, a second too late. While my attention was focused on him, his confederate had slipped his hand in my left front pocket, seized my wallet, and was now stepping outside of the car, immediately followed by his accomplice. The doors closed, the train moved on, and I found myself with no cash, no driver’s licence, and a couple of credit cards to cancel and replace.

Before I started practising Stoicism, this would have been a pretty bad experience, and I would not have reacted well. I would have been upset, irritated and angry. This foul mood would have spilled over the rest of the evening. Moreover, the shock of the episode, as relatively mild as the attack had been, would have probably lasted for days, with a destructive alternation of anger and regret.

But I had been practicing Stoicism for a couple of years. So my first thought was of Epictetus’ promise. I couldn’t control the thieves in Rome, and I couldn’t go back and change what had happened. I could, however, accept what had happened and file it away for future reference, focusing instead on having a nice time during the rest of my stay. After all, nothing tragic had happened. I thought about this. And it worked. I joined my evening company, related what happened, and proceeded to enjoy the movie, the dinner, and the conversation. My brother was amazed that I took things with such equanimity and that I was so calm about it. But that’s precisely the power of internalising the Stoic dichotomy of control.

And its efficacy is not limited to minor life inconveniences, as in the episode just described. James Stockdale, a fighter-jet pilot during the Vietnam War, was shot down and spent seven and a half years in Hoa Lo prison, where he was tortured and often put in isolation. He credits Epictetus for surviving the ordeal by immediately applying the dichotomy of control to his extreme situation as a captive, which not only saved his life, but also allowed him to coordinate the resistance from inside the prison, in his position as senior ranking officer.

Most of us don’t find ourselves in Stockdale’s predicament, but once you begin paying attention, the dichotomy of control has countless applications to everyday life, and all of them have to do with one crucial move: shifting your goals from external outcomes to internal achievements.

For example, let’s say that you are preparing your résumé for a possible job promotion. If your goal is to get the promotion, you are setting yourself up for a possible disappointment. There is no guarantee that you will get it, because the outcome is not (entirely) under your control. Sure, you can influence it, but it also depends on a number of variables that are independent of your efforts, including possible competition from other employees, or perhaps the fact that your boss, for whatever unfathomable reason, really doesn’t like you.

That’s why your goal should be internal: if you adopt the Stoic way, you would conscientiously put together the best résumé that you can, and then mentally prepare to accept whatever outcome with equanimity, knowing that sometimes the universe will favour you, and other times it will not. What do you gain by being anxious over something you don’t control? Or angry at a result that was not your doing? You are simply adding a self-inflicted injury to the situation, compromising your happiness and serenity.

This is no counsel for passive acceptance of whatever happens. After all, . . .

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Written by LeisureGuy

3 November 2018 at 10:11 am

Posted in Books, Daily life, Mental Health

Tagged with ,

Dear Therapist: Is It Possible to Apologize for a Sexual Assault?

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Lori Gottleib has a special column now in the Atlantic:

Editor’s Note: This special installment of Dear Therapist diverges from the normal format, in that the question addressed does not come from an individual reader. Rather, it’s one that various men have asked our columnist Lori Gottlieb, in her inbox and in her own therapy practice: Is it possible to apologize for a sexual assault? And if so, how?

Dear Men Who Have Asked,

There are so many reasons that men might be reluctant to come forward and ask this question, much less to reflect on what they’ve done, so I admire the courage it takes to do so. I worry, too, that some people will take issue with this question and attack those who ask it, and I would hate for that to happen because your intentions are good, and attacking people who come forward shuts down the very conversations that #MeToo has worked so hard to start.

While there’s no one way to handle this—your options range from a genuine, heartfelt apology to the woman you assaulted to attempts at making things right for women more broadly—I can help you think through what might be the best way to take responsibility for a sexual assault committed in the past.

Some of you have said that you’d like to tell the woman you assaulted that you’re remorseful and that you’ve changed as a person. So first, let’s separate what you’re seeking for yourself from what this woman might herself be seeking. You’re essentially asking two questions—one about you, and one about her. The question related to you is about forgiveness: You’re seeking something from her so that you feel less pain (shame, horror, anxiety about whether she’ll come forward). The question related to her is what you can do so that she feels less pain.

I’d suggest that you get clear about your motivations so that if you do approach her, it’s to help her and not yourself. Your needs are important, too, but as I’ll get to in a moment, those needs are for you to work through without bringing her into it. Right now, the focus should be solely on her.

First, you’ll want to consider what it might be like for her to hear from you. She might find it upsetting to be contacted by the person who assaulted her, and you’ll need to honor and respect whatever her reaction is—refusing to speak with you, not responding to a letter you send, expressing anger, etc. On the other hand, she might welcome an apology because it validates her experience and makes her feel less dehumanized, which is a common reaction to being sexually assaulted—she’s finally being acknowledged as a human being with feelings: I’m not crazy. My memories are real. I’m not the only one who witnessed my assault. I felt utterly invisible then but I’m not invisible now. He couldn’t see my pain then, but he sees it now.

When planning what you’ll say, think about how to phrase your apology so that she knows you aren’t asking anything from her—forgiveness, reassurance, absolution, a clean slate. After all, if this is being done for your benefit, it might feel like just another violation.

With that in mind, it will be important to . . .

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Written by LeisureGuy

2 November 2018 at 6:42 pm

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