Our brains and bodies are naturally designed to express a range of emotions and
to respond to the emotions of others. The emotions of fear, shame, and anger
serve us in the most dangerous situations we may have to face. The fear and
anger not only energize us to run or fight, but also communicate our emotional
state to those close enough to respond. Our anger lets others know we are
energized to attack and they had better respect that. Fear communicates to
others that there is something dangerous nearby, and they might want to get
ready to run, too. Shame also communicates. It communicate surrender so that our
foe will not continue to attack.
We are also hardwired to express joy, distress, and surprise. The expression of joy communicates our relief at being safe among friends, while distress communicates our need for help and comfort.Surprise seems designed to help us assess the situation when something unexpected happens. It focuses our attention and opens our eyes.
We also come equipped with the ability to recognize these basic emotional states in others. Mirroring structures in the brain help us to respond to others actions and emotions automatically. Very young babies understand the difference between a smile and a frown, a lullaby and a scolding and they respond automatically.
Direct uninhibited emotional response between two people is called intimacy, and babies are natural at it, which is why we often find relationships with babies so rewarding. Babies are not ashamed to show their feelings, whether they are distress, frustration, delight, fear, or shame itself. And when we are with them, we are not ashamed to mimic them with goo goos and gah gahs of baby talk that we would be embarassed to see on video, absent the baby context. We are free to be responsive to a baby’s distress or frustration. We are rewarded by the good feelings of intimacy.
So what goes wrong later?
Somewhere along the line, we learn to try to hide our feelings because our own feelings scare us or we are ashamed of them. Expressing our feelings becomes associated with feeling vulnerablebecause others may make fun of us or try to use our feelings against us. So we work very hard to hide our feelings behind a mask of some kind, and in order to do this we work to suppress the emotions. We can get so good at this that we hide the feelings even from ourselves and feel horrified at the possibility that others could know about our distress, shame, or frustration. Some of us drink, binge, purge, or work long hours in order to numb ourselves and make it easier to suppress the emotions rather than express them. And we lose the freedom and delight of intimacy in a habit of hiding behind our mask. We substitute sex for intimacy and busy routines for friendship.
Underneath the masks, the busy routines, and the defensive habits, we are still hardwired to express our emotions and respond to others, still hardwired for intimacy if we can let go of the habits we have developed to protect ourselves. We can escape the trap of these new defensive habits, but we often have to have help to overcome the fear and shame that keep us stuck behind our masks.Read Full Post | Make a Comment ( None so far )
After every act of incomprehensible violence, the world asks whether the killer could have been identified ahead of time. It’s as automatic as the call for more gun control and better mental health services.
Psychologists and psychiatrists have been working for decades to try to figure out whether there’s a link between mental illness and violence, and if so, which people are likely to act. Using an ever-changing tool kit of theories and questionnaires, they’ve made some progress.
It’s now fairly clear, for example, that people with severe mental illness, such as schizophrenia, bipolar disorder and some personality disorders, are more likely to commit violent acts than others. But the risk is small. The vast majority of mentally ill people won’t commit assault, rape, arson or homicide, although the risk rises sharply among those who abuse drugs and alcohol.
These insights are proving useful to psychiatrists, psychologists, judges, school administrators and others who must decide whether someone seems too dangerous to be left alone. But they aren’t good enough to identify an Adam Lanza, the young man who killed 28 people, including himself, in Newtown, Conn., last month. (Lanza’s mother told friends that he had Asperger syndrome, a developmental disorder, but no evidence has emerged that Lanza was diagnosed as mentally ill.)
“There is no instrument that is specifically useful or validated for identifying potential school shooters or mass murderers,” said Stephen D. Hart, a psychologist at Simon Fraser University in Vancouver who is the co-author of a widely used evaluation tool. “There are many things in life where we have an inadequate evidence base, and this is one of them.”
Even when someone has a history of threatening behavior, the killing of innocent people can’t necessarily be prevented.
The woman accused of pushing a man to his death in front of a New York subway train on Dec. 27 had been arrested several times for assault and treated in the psychiatric wards of two hospitals. The man who fatally shot two firefighters and himself in Webster, N.Y., on Christmas Eve had killed his 92-year-old grandmother three decades earlier.
The task of identifying violence-prone individuals is even trickier with young people, who have shorter histories and whose normal development often includes a period of antisocial behavior.
The prospect that the most recent massacre, or the next one, could lead to efforts to find young men contemplating the killing of strangers worries many people. Among those expressing concern are some psychologists and former patients forcibly swept into the mental health system and treated against their will.
“I think people are going toward wanting all their kids to be screened in high school for mental illness and violence risk — and that’s a bad idea,” said Gina M. Vincent, a forensic psychologist at the University of Massachusetts Medical School. “That’s my biggest fear of what’s going to come out of this.”
“We can’t go out and lock up all the socially awkward young men in the world,” said Jeffrey W. Swanson, a professor of psychiatry and behavioral sciences at Duke University. “But we have to try to prevent the unpredicted.”
The best-known attempt to measure violence in mental patients found that mental illness by itself didn’t predict an above-average risk of being violent. People released from psychiatric wards were more violent than their neighbors only if they also had drug and alcohol problems, according to the MacArthur Violence Risk Assessment Study, which tracked almost 1,000 former patients in the early 1990s.
Other research has found a link — although not a particularly strong one — between mental illness and violence.
In a 2001 study funded by the National Institutes of Health, researchers asked 35,000 adults whether they had been diagnosed with a mental illness anytime in their lives and in the previous year. They also asked a long list of questions about the subjects’ personal histories and behaviors. Re-interviews were conducted three years later, asking about violent events in the intervening period.
People who reported that they’d had both “severe mental illness” and substance abuse problems in the year before the first interview had the highest rate of violence; 9.4 percent had committed a violent act. The next most violent were people with other types of mental illness (mostly antisocial personality disorder) accompanied by substance abuse — 7.2 percent of them reported violent behavior.
Groups with lower rates of violence included people suffering only from severe mental illness, 2.9 percent of whom reported having been violent; those only with substance abuse problems (2.5 percent); and those with other mental illnesses alone (1.4 percent). People without any of these problems had just a 0.8 percent rate of violence.
Over the years, researchers have made a particular effort to study violence and schizophrenia, a disorder that emerges in young adults and often includes paranoid thoughts.
An analysis of 20 studies published three years ago found that schizophrenia increased the risk of acting violently fourfold in men and even more in women. The risk of schizophrenics committing homicide was 0.3 percent — more than 10 times greater than the average citizen.
The evidence suggests that “there’s a modest relative risk” for violent behavior in people diagnosed with a serious mental illness, said Swanson, the Duke researcher.
If some of the mentally ill are dangerous, can they be found?
Over the years, studies have shown that psychiatrists’ accuracy in identifying patients who would become violent was slightly better than chance — “obviously not good enough, given what’s at stake for public safety as well as for civil liberties,” said John Monahan, a University of Virginia psychologist who helped direct the MacArthur study.
So Monahan and many others came up with a constellation of “risk factors” and “protective factors” for violent behavior — analogous to the risk factors for heart disease, such as age, blood pressure, smoking and cholesterol — and included them in questionnaires.
Some of those instruments rely heavily on adding up scores. Others put more emphasis on the interviewer’s clinical judgment. The most popular current strategy combines both approaches; it forces the evaluator to include any pertinent issue.
All of the approaches consider the presence of a mental disorder as only a small contributor to risk, outweighed by other factors such as age, previous violent acts, alcohol use, impulsivity, gang membership and lack of family support.
There have been numerous efforts to test these violence-predicting tools in recent decades. For example, Monahan and his colleagues incorporated 106 risk factors into a software interview program and administered it to patients being discharged from psychiatric units in Massachusetts and Pennsylvania. Of those judged to be low-risk by this tool, 90 percent committed no violence over the next six months. Of those judged to be high-risk, 49 percent committed violent acts.
“From our research, we could quickly distinguish between a patient whose chance of being violent was 1-in-10 from one whose was 1-in-2,” he said.
Last summer, a large study published in the British Medical Journal found much the same thing.
It analyzed the findings of 68 studies that involved about 25,000 people in psychiatric hospitals, prisons or court-ordered detention. (The studies used a variety of assessment tools.) Of the people predicted to “violently offend,” 41 percent did. Of those predicted to be nonviolent, 91 percent were. In practical terms, that meant that if authorities used the tools for the purposes of public health, they’d have to detain two people to prevent one from becoming violent.
The authors of the analysis concluded that “risk assessment tools in their current form can only be used to roughly classify individuals at the group level, and not to safely determine criminal prognosis in an individual case.”
Most of this research has been conducted on populations already “enriched” with the potential for violence: psychiatric patients, drug users, binge drinkers, people who have been arrested. But some mass shooters don’t fall into any of those categories.
For the general public, there’s no screening tool for violence, and nobody expects that there ever will be.
Is what’s known about the relationship between mental illness and violence of any use after events like the mass shooting in Connecticut?
People who study and provide mental health treatment generally say, “Yes.” However, that’s not because people prone to violence can be found and stopped. It’s because if psychiatrists, psychologists and judges become more aware of the relationship between social circumstance, behavior and risk factors for violence, then they might be able to exert influence long before a killer’s plans are made.
At least that’s the current thinking.
“Most people who are thinking about violence are ambivalent about it,” said Hart of Simon Fraser University. “Our job is to find people who are ambivalent and convince them that violence is a bad idea.”
He cited the recent case in Vancouver of a college student who told a friend she was thinking of killing a homeless man. The friend notified authorities; the student was detained and evaluated with an assessment tool called the HCR-20. She had a “death kit” of tools in her possession and had killed a cat and dog for pleasure. She was convicted of animal cruelty but will soon be released on probation, with close supervision.
But some people warn that a more aggressive mental health system would pose its own dangers.
James B. Gottstein, a lawyer in Anchorage and head of the Law Project for Psychiatric Rights, has won four cases in his state’s Supreme Court supporting patients’ rights to refuse to take psychiatric medicines, limiting conditions for involuntary commitment and other issues. He learned firsthand what it’s like to be forcibly drugged and stigmatized by psychiatric treatment.
In June 1982, he had a manic episode that he attributes to sleep deprivation. He was working hard, suffering from jet lag after returning from Europe and living in a place where the sun didn’t set at night. He was taken by the police to a mental hospital, where he spent a month.
“One of the problems that happens when you become a psychiatric patient is that everything that you do or say can be labeled as a psychiatric symptom,” said Gottstein, 59, a graduate of Harvard Law School.
“If the police knock down your door and haul you off and you get upset, you get labeled as ‘hostile’ and ‘labile.’ If you decide that you’re not going to react to these provocations, you get labeled as having ‘a flat affect.’ If you think something is funny and you laugh to yourself, then they write down ‘responding to internal stimuli,’ ” he said.
It’s not that people don’t want help, Gottstein said, but that “the system basically forces things on them that they don’t want.” He thinks it is “entirely possible to create a system where things are voluntary.”
Essential are peer counselors — people once similarly diagnosed who might be able to connect with the mentally ill when the professionals can’t. There’s a largely unknown movement trying that approach. But he’s quite sure that’s not what people calling for “greater access to mental health services” these days are talking about.
And that worries him.Read Full Post | Make a Comment ( None so far )
Everyone is familiar with the concept of a periodic medical checkup — some sort of scheduled doctor’s visit to check your blood pressure, weight and other physical benchmarks.
The notion of a regular mental health checkup is less established, perhaps because of the historical stigma about mental illness. But taking periodic stock of your emotional well-being can help identify warning signs of common ailments like depression or anxiety. Such illnesses are highly treatable, especially when they are identified in their early stages, before they get so severe that they precipitate some sort of personal — and perhaps financial — crisis.
“Absolutely, people should have a mental health checkup,” said Jeffrey Borenstein, editor in chief of Psychiatric News, published by the American Psychiatric Association. “It’s just as important as having a physical checkup.”
About a quarter of American adults suffer from some type of mental health problem each year, according to the National Institute of Mental Health, and 6 percent suffer severe ailments, like schizophrenia or major depression. When left untreated, mental health illnesses are more likely to lead to hospitalization — something that could mean time lost from work.
Ideally, doctors should ask patients about their moods as part of a regular wellness visit, Dr. Borenstein said — there doesn’t necessarily need to be a special visit to gauge mental health. But if the doctor doesn’t bring it up, patients can educate themselves and start the conversation with their physicians.
Jeffrey Cain, president of the American Academy of Family Physicians, said family doctors were trained to spot symptoms of mental illness, like depression, and he encouraged patients to bring in questions or concerns for discussion. But people don’t necessarily go to their family doctor and say they are depressed, he said. Rather, they say they’re tired, or that they lack energy, that they’re having trouble concentrating or that their body aches — all of which can be symptoms of depression or anxiety.
There are some well-known screening tools that patients can use as a starting point to assess themselves, to help prompt a conversation with their doctor. Dr. Borenstein mentioned a common tool used by doctors to assess patients for depression: a “P.H.Q.,” for “patient health questionnaire” He cautioned that the idea here was not to self-diagnose using such forms — there are several versions, varying by number of questions — but rather to self-assess, and then discuss your concerns with a professional.
The P.H.Q.-9, which asks nine questions, was developed by researchers at Columbia University and Indiana University, with help from a grant from Pfizer Inc. The form is available on several Web sites, including (phqscreeners.com/pdfs/02_PHQ-9/English.pdf).
It asks about the patient’s outlook and health habits over the previous two weeks. The first question, for instance, asks patients whether they have had “little interest or pleasure” in doing things and asks them to check a box ranging from “not at all,” which scores a zero, to “nearly every day,” which scores a 3. A professional computes a total score, which gives more weight to frequent symptoms; the higher the score, the greater the likelihood of significant depression.
Another set of screening tools for depression and other mental health disorders were developed by Screening for Mental Health, a Boston-area nonprofit that creates assessment tools for use by health plans, colleges, the military and the general public. Founded by Douglas Jacobs, an associate clinical professor of psychiatry at Harvard Medical School, the organization grew out of the first National Depression Screening Day, which is held annually each October during Mental Illness Awareness Week.
Mental illnesses have specific signs and symptoms, much as a disease like diabetes does, Dr. Jacobs said, and those symptoms can be identified and treated. Take depression, again, as an example. It’s normal to be sad for a while after a personal loss or a traumatic event. But when the effects linger and begin to affect your self-esteem, or interfere with your ability to do your job or handle other responsibilities, he said, you may want to consider if you are suffering from a more serious depression that should be treated professionally — with behavioral therapy, medication or both.
At the site helpyourselfhelpothers.org, which is sponsored by Screening for Mental Health, you can find locations near you that offer mental health services. Or, you can use a free online screening tool that can help you gauge if you might be at risk for various illnesses including depression, anxiety, bipolar disorder, eating disorders and post-traumatic stress disorder.
You can choose a specific screening or answer questions to help narrow your choice. For instance, the tool asks you to complete the sentence “I have been…” with phrases like “feeling sad or empty,” or “drinking more than planned.”
The depression screening tool asks questions about how you have been feeling during the last two weeks, like whether you have been “blaming yourself for things” some of the time, all of the time, or most of the time.
The questionnaire concludes with a finding based on your answers. For instance, it might tell you that “Your screening results are consistent with symptoms of an eating disorder,” along with a recommendation to seek a professional evaluation. Gina N. Duncan, an assistant professor of psychiatry at the Medical College of Georgia at Georgia Health Sciences University in Augusta, who has blogged about the notion of a personal mental health checkup, said sleep disruptions were often a sign of stress. If you’re sleeping much more or less than usual, or having difficulty falling asleep, that can be a warning signal.
Many large employers include mental health coverage as part of their health benefits packages, and recent federal rules on benefits “parity” mean such benefits at large plans should not have higher have co-payments and deductibles or stricter limits on treatment than benefits for other medical or surgical needs. Also, most large companies currently offer employee assistance plans, which provide counseling and referrals — both over the phone and in person — to workers and members of their families who are suffering from personal crises.
Helen B. Darling, president of the National Business Group on Health, a consortium of large employers, said employee assistance plans were an important way to screen for mental health problems. Help through them is generally provided free of charge outside of the main health insurance plan, so using the service does not generate an insurance claim.
Over all, however, 15 percent of employers in the United States do not offer mental health coverage to employees, according to the Society for Human Resource Management. Such benefits may become more widely available in 2014, when many provisions of the Affordable Care Act take effect. Mental health benefits will be part of the “essential package” that must be offered by many insurance plans, including the new state-sponsored insurance exchanges.Read Full Post | Make a Comment ( None so far )
Over the past 30 years, I’ve spent nearly 25,000 hours counseling angry men, and until about two years ago, my enthusiasm was beginning to wane. If you’ve worked with angry male clients, you can understand why. These men are generally highly reluctant clients, who are often in your office only because they’ve gotten “the ultimatum” from their wives or girlfriends or bosses or sometimes court judges: “Get therapy for your anger or get out / you’re fired / you’ll go to jail.” Many, considered by everyone who knows them to have an “anger problem,” arrive in your office convinced that they don’t have an anger problem: the real problem is their stupid coworkers, annoying girlfriends, demanding spouses, spoiled kids, or unfair probation officers. However, they arrive at your office with a shotgun at their backs, so to speak, and know they have no choice. They hate the entire situation because it makes them feel powerless.
No wonder they feel powerless: they’re being coerced to lay down their anger, the only weapon they’ve ever had against feelings of powerlessness. They often trace their reliance upon anger to a childhood history of danger, trauma, shaming, and pain. Anger is the emotion they can trust, the one that might keep danger at bay. As they grew up, they continued to use anger to make people they regard as dangerous back away. By the time you see them, they regard just about every person in their lives as “dangerous,” including loved ones. These men have become habitually angry. I liken their condition to the default option on a computer: their anger goes on automatically unless they consciously turn it off.
Of course, it isn’t easy to turn off the default option when the way to do so is hidden deep within the machine’s (our brain’s) control panel. Furthermore, men for whom anger is a default emotional response to life’s vicissitudes are often relatively untrained in experiencing and communicating other emotions. For example, one of my clients “went off”–screaming and threatening bodily harm against his father’s doctors–when his father died, to the point the police had to be summoned, because he couldn’t handle his grief. Anger was the only emotion he could call upon in time of need. Not surprisingly, when these men come to therapy, whether as individuals or in couples or groups, they’re frequently defensive, argumentative, passive-aggressive, protective of their right to be angry, and doubtful about my competence to understand or help them in any way.
It’d be misleading to say that my most difficult clients are unmotivated. More accurately, they’re antimotivated, committed to undermining any behavioral programs or specific anger management tactics I offer. Meaningful change takes many repetitions: “Practice, practice, practice” is a hallmark of anger-management training. For example, taking the time to put a problem into perspective (“On a 1-10 point scale, Joe, how important is it for your teenage daughter to get home every night by 8 p.m.?”) works well, but only if the client is motivated enough to practice putting things into proper perspective perhaps as often as several times a day. It stands to reason that trying to argue such men out of their commitment to anger is pointless. I long ago realized I couldn’t beat them in face-to-face combat; they’re better at in-your-face challenges and making contemptuous remarks than I’ll ever be. I needed a tool that allowed me to sidestep their oppositionality and create a therapeutic alliance.
At a deeper level, chronically angry people have become lifelong victims of what’s sometimes called negative neuroplasticity. They’ve unintentionally trained their brains so well, through countless repetitions of undesired behavior (at least, undesired by the rest of the world), that they’re primed to think, feel, and say things that increase their own anger. For example, Joe may well think that if his daughter gets home after 8 p.m. it means she’s probably having sex with some male punk. That kind of thought pattern is automatic.
So now we have two major concerns. First, some of my clients enter treatment antimotivated. Second, their brains have been programmed to react automatically with anger and hostility to a wide variety of situations. What kind of therapeutic intervention can address these issues?
Focusing on the Brain to Increase Motivation
About six years ago, I stumbled across the answer when I attended a session about the brain at the Networker Symposium in Washington, D.C. The controversial brain researcher Daniel Amen was just beginning his lecture when he mentioned in passing that he’d been browsing through the books on anger in the sales area. “None of them said anything about the brain,” he noted somewhat dismissively. Now many of those anger books he was trashing were my books, so at first I was defensive. But by the end of the talk, I realized he was right, at least about the books I’d authored. I hadn’t mentioned anything about brain processes for a simple reason: I didn’t know anything about them. That led me to immerse myself in the subject of the brain, and as I did so, my enthusiasm for working with angry clients increased exponentially.
How can learning about the brain–particularly the angry brain and how it got that way–possibly influence clients who have a hard time taking in therapy or sticking with anger-management techniques? Aren’t concepts drawn from brain research simply too abstruse, too abstract, and apparently unrelated to daily life to make much difference to them? In fact, what I’ve found is just the reverse: these men are fascinated by information about how anger develops in the brain and why it’s so hard to control, and they consider it far more relevant to their lives than many standard therapy concepts. Getting to understand a bit of what happens “inside their heads” when they get angry resonates deeply with them. In one way, they can cling to their defensiveness and denial systems, since they certainly can’t be accused of deliberately messing up their minds. Sidestepping their defensiveness and emphasizing their opportunity to do something right that will retrain their brains gives them a positive direction and a possible source for well-earned personal pride. Furthermore, hearing me explain how, by regular, committed behavioral practice of various anger-management techniques, they can literally change their own brain circuits, stimulates both hope that they can change and desire to begin. For the first time in their lives, they feel they might be capable of literally using their own brains tochange their brains. It is a real revelation to many angry men.
My own enthusiasm for brain science and my belief in angry men’s inherent capacity to reorganize their own neural circuitry are probably another key to revving up their motivation to try. My “brain talk” to them isn’t just a lecture about applied neurophysiology, but in truth a kind of triggering mechanism arousing their own curiosity and interest. Clearly, my enthusiasm evokes–in their brains–a mirroring enthusiasm for this process. It may well be that my sheer enthusiasm for this endeavor, my joy and excitement about the brain, triggers left-hemisphere mirror neuronal activity that bypasses right-hemisphere negativity and cynicism.
Devron Johnson is a 40-year-old male who’s been divorced for 10 years, partly because of his anger problems. An intelligent but not highly educated man, he works as a heating and cooling technician. He has two adolescent sons, with whom he barely converses and seldom visits. He’s now in a new relationship with Sheila, a 36-year-old mother of three younger children who live with them. Although Devron has never been physically violent with the children, he often frightens them with his angry outbursts.
This man grew up in a tough part of Detroit, where survival was the name of the game. His parents separated and reconnected several times during his childhood. The family atmosphere was markedly hostile–full of negativity, accusations, and occasional violence. Devron said he hated his father because he was never there for him, not even when he became a star athlete on his high school’s baseball team.
Devron sought therapy because Sheila had threatened to end their relationship unless he became much nicer to her kids. He added that he was also in trouble at work because “I gave the finger to my boss once too often.”
Here’s how Devron described his anger: “Man, I had a bad attitude in school. I beat people up if they looked at me wrong. But I gave that up. I don’t hit nobody anymore. But Sheila says I still have a bad attitude. She says I look for problems with her kids. Then I blow because I have a really short fuse. And I have a hard time letting go of my anger, too. Once I get pissed at someone, they stay my enemy forever.” Still, Devron does want to change. He loves Sheila and even grudgingly admits he likes her children. He doesn’t want to lose them. However, he doubts whether I, or anybody else, can help him. A few years ago, he attended an anger-management program for about 10 weeks, but says, “I didn’t get nothing useful from it.”
Like many angry clients, Devron came to counseling under duress–the “get help, or get out” final call. This isn’t a formula for success, since such clients often arrive for counseling thinking that they’ll more or less passively go through the motions to get the wife/boss/law off their backs, and then they’ll be free to revert to previous behavior. By contrast, Devron was directly skeptical and dismissive–derisive, in fact. Instead of pretending to buy the package, he openly challenged me to prove I had something new to offer. It’s uncomfortable to be sneered at by your client, but I’ve learned to recognize an open challenge as a positive indicator for success. Devron’s disdain was a sign of energy that might be used in counseling, if I could develop an alliance with him.
“Actually, Devron, I do have something to offer you that you probably haven’t run into before,” I told him, “I can help you change your brain.” I proceeded to explain with the enthusiasm and energy I usually feel when talking about the brain that he was actually capable of making fundamental, long-term changes in the way he thinks. “Devron, all it takes is commitment and persistence. I know you’re capable of both of those things because you’ve told me how much you love Sheila and the kids–that’s commitment–and how you’ve stuck it out with them when it would have been easier to walk away–that’s persistence.” I emphasized to him that he’d developed lifelong habits of anger that had become deeply rooted in his brain. But I assured him that he and he alone could make changes in those habits if he so desired. However, I cautioned him that real brain change doesn’t come easy. I said he’d need to make a strong commitment to practice new behavior for at least several months, so he could build, improve, and expand new circuitry inside his brain while reducing the power of his negative brain circuits. I briefly mentioned such concepts as neuroplasticity and myleinization, but only as a tactical move, to assure him that I did, in fact, know what I was talking about. I told him I didn’t just believe this brain stuff might work, I was absolutely convinced because I’ve seen many other angry people change their brains in just this way, and because I myself had changed my brain to become much more optimistic and generous.
As I spoke, I watched Devron’s “show me” expression change to hope and wonder. “You mean I can really change the way I think?” he asked. It turned out that Devron’s oppositionality obscured a deep sense of pessimism and hopelessness. He’d believed that change was impossible, in effect dooming him to a lifelong anger career. But now, maybe because of my own sense of conviction, he began to see possibilities. We talked a little more before the hour ended, and I asked him to think about how much he wanted to change his brain and in which ways. I also asked him what positive goals he wanted to pursue–for example, what other emotions he might be willing to experience if his brain wasn’t dominated by anger. A positive goal is important with all clients, of course, but especially with angry clients, who often mistakenly set only the negative goal of being less angry. I explained to Devron that only setting a negative goal like quitting being angry was like deciding that a car that currently could only go in reverse would be just fine if you could get it to stay in neutral. The idea is to move forward in life, to get that car moving ahead. Of course this same idea applies to only quitting drinking (instead of leading a sober lifestyle) or stopping being critical (instead of giving praise).
Finally, I cautioned Devron again that real brain change doesn’t come easy. I told him he’d need to make a strong commitment to practice new behavior for at least several months so he could build, improve, and expand new circuitry inside his brain while reducing the power of his negative brain circuits. I then sent him home with two pages of examples of possible brain change plans he could implement. One example was converting criticism and pessimism to praise and optimism. Another was to convert resentment into forgiveness. A third was to look for the good in people (and himself) instead of the bad.
When Devron returned a week later, he said he’d thought a lot about changing his brain and his life. He’d discussed it with Sheila, who’d told him she’d stick around for a while if she saw him really working to change his behavior. Now he was eager to make a six-month commitment to brain change. I then gave him some handouts I’ve created to help him name his brain-change plan. A person with a good brain plan has given it a name that means something at an emotional level, includes specific initial behaviors to maximize the opportunity for immediate success, and at least speculates about longer-term improvements and additions, and how achieving these changes might affect him or her. I also gave Devron the chapter on neuroplastic change from my book to reinforce the idea that changing his brain was realistic, if and only if he’d make a strong commitment to it.
Devron returned the next week in a quandary. He told me that he and Sheila had had a big disagreement about what his brain-change plan should include. She wanted him to be nicer to her children. Devron told me that he wanted to be nicer to them, but that his first concern was quitting thinking so pessimistically about the world. “If I can’t quit thinking that everyone is out to screw me over, I don’t think my changes will last,” he said. I thought Devron had hit upon a clear understanding of how he needed to change at an existential level. Brain-change plans aren’t simple behavioral alterations: they really change your brain, and in doing so, ultimately affect your connections with yourself, those you love, and the universe. So I affirmed Devron’s insight. However, I did point out that his goal and Sheila’s weren’t contradictory. Being nicer to the kids could well become one way that he altered his mindset of hostility and suspiciousness. After all, deeply held beliefs don’t change completely on their own. Devron needed to try out new behavior and receive positive rewards for doing so in order to give his brain the opportunity to be transformed.
I’d like to offer a side comment here. We often expect our angry clients to act as if they were living in a safe world, a world in which people are pleasant, trustworthy, loving, and consistent. This false belief on our part sets clients up to fail. Devron’s siblings, for instance, regularly engaged in felonious behaviors, such as drug dealing and robbery, and expected him to join them as he often had in the past. He told me during therapy that he’d begun declining these invitations. When I asked him if he’d practiced being assertive with them, he laughed. “I guess if telling my brother to go to hell when he attacked me for not going along with some scam he was into, then yes, I was very assertive.” The result of his new “good” behavior was that his family ostracized him for several months. Fortunately though, Sheila and her children were dependably in his corner, so that Devron could practice new, prosocial behavior around them without being criticized or ridiculed.
Devron named his plan “Learning to Trust.” I was tempted to add “and take in love,” but Devron would have labeled that phrase unmanly. When I asked him how he planned to begin this plan, he suggested he could go to his father to see if he could learn to trust the man he most distrusted in the world. Needless to say, this was a palpably rotten idea: in all likelihood, his father would once again have demonstrated his complete untrustworthiness, potentially undermining everything Devron was trying to do. I talked him out of it with some difficulty by pointing out that he was betting his whole stake on one roll of the dice. “Besides, it’s a bad bet,” I said. “You’d be better off investing in a smaller stake, like letting yourself trust Sheila more.” That reminded him of his real priorities.
He decided to open up emotionally a little more to both his family and a few trusted coworkers. For example, he told some of his history to two of his coworkers, the ones he felt most comfortable with, and they responded positively with their own self-disclosures. Then he took a bigger chance by admitting to Sheila that he had cheated on his first wife. Much to his shock, she told him she’d known about it for a long time–his ex-wife had thoughtfully given Sheila that information when she’d begun dating Devron–but she’d chosen not to mention it and trust that he’d be faithful to her.
Shiela’s disclosure and assertion of trust brought him to tears. At that very moment, his brain-change plan spontaneously expanded to include being trustworthy to others. Since Devron had a long history of lying by omission (“Oh, I must have forgotten to tell you that”) this expansion was quite significant. It had proved harder for him than the initial goal because he’d had to retrain himself not to leave out some of the truth “so nobody could pin me down.” He kept expanding from his core commitment to develop trust. He realized along the way that he’d been mean to Sheila’s children because he didn’t want to get close to them and then lose them. But Sheila came through by rewarding his obvious changes with reassurance that she’d stay with him.
I regularly review a client’s brain-change plan with him or her, rather than just assume it’s working fine. It’s important to challenge clients quickly if they’re letting their plan drift.
The final addition to Devron’s plan was learning how to be more empathetic. Devron acknowledged that empathy was strange territory for him: “Frankly, I never gave a damn what anybody else felt.” But now that he felt safer, he could do what safe people do: care about and take a real interest in others. Like many angry people, he has some difficulty being empathic. Empathy partly depends on automatic attunement processes usually learned in infancy through parent–infant synchronic movement. He experienced few such experiences as a child. We talked together about this deficit, a deficit he was determined to challenge. He immediately made a real effort to put himself in the shoes of others. It’s just that he had trouble first taking off his own shoes. For instance, he told his 12-year-old daughter, Amy, who was being teased by classmates, that he knew exactly how she felt, even though he’d been the bully, not the victim, when he’d been in school. But here again, the principles of neuroplasticity apply. Devron realized he’d misunderstood the situation when his daughter got mad at his reply. He then consciously took the time to listen better. Gradually, this behavior was becoming faster, smoother, and more automatic.
Devron’s plan, then, began with developing some basic trust in the world, which led to being trustworthy himself, which morphed into increased empathy and actually caring about others. He quit working with me after approximately nine months. Our last session included Sheila, who affirmed that Devron had become much less angry, more caring, and far more present in their lives. She’d previously doubted his changes would endure, “But he’s only becoming nicer,” she admitted. “I don’t doubt him any longer.” Devron added that he now felt deep inside his soul that he could trust Sheila. He felt safe in a relationship for the first time in his life. “So now I have no reason to be mad all the time.” Of course, he and Sheila still argue from time to time, as do almost all couples. But Devron controls his initial burst of anger far better than before, calms down quicker, and lets go of his anger sooner.Read Full Post | Make a Comment ( 1 so far )
It first showed up in my Facebook feed early Saturday morning, and then I saw it everywhere—in my email inbox, my texts, all over the internet: Asperger’s … Asperger’s … Did you hear???? … Asperger’s. Twenty-year-old Adam Lanza, who had killed 26 people at Sandy Hook Elementary School the day before, was allegedly on the autism spectrum. Advocates rushed to respond; many groups, including Autism Speaks, GRASP (the Global and Regional Asperger Syndrome Partnership) and Autism Rights Watch issued statements expressing sympathy for the victims while reminding a spooked public not to “scapegoat” the disorder or further “stigmatize … autistic persons and their families.”
Although Lanza’s diagnosis has yet to be confirmed, he is only the latest mass murderer whose autism-spectrum status has been speculated about, including Colorado movie shooter James Holmes and Anders Behring Breivik, the Norwegian who killed 77 people in 2011. Even serial killer Jeffrey Dahmer and Unabomber Ted Kaczynski have been retroactively labeled autistic, with the same diagnosis-happy fervor that has caused other activists to claim Albert Einstein and Thomas Edison as members of the Asperger’s nation. But the legitimacy of these diagnoses is less interesting than the question they imply: Did autism make them do it?
As president of EASI Foundation: Ending Aggression and Self-Injury in the Developmentally Disabled, I work with many families struggling to manage their autistic children’s dangerous behaviors. There was a time when my own son Jonah, now 13, was prone to such violent rages that I feared I might end up like Trudy Steuernagel, who was bludgeoned in 2009 by her 19-year-old autistic son Sky Walker, or Linda Foley, who was also beaten to death by her 18-year-old stepson, Henry Cozad. But I was never afraid Jonah would massacre 20 kids with a semi-automatic rifle.
Researchers distinguish between two types of aggression: affective and predatory. Affective aggression is the most common; it occurs when an individual reacts to stimuli in the environment—or, as was the case for my son, internal neuropsychiatric events. These are short but very emotional episodes, accompanied by the increased heart rate and flushed skin of autonomic system arousal. The vast majority of violent crimes committed by individuals with an autism spectrum diagnosis fall in this category, and the details reveal a marked lack of premeditation. A 2006 Swedish study comparing autistic murderers with those who had been diagnosed with antisocial personality disorder found that more than 70 percent of antisocial killers used a weapon, whereas only 25 percent of the autistic killers did—and, I should note, this group was very small, consisting of eight autistic individuals who had been convicted of homicide or manslaughter in Sweden from 1996 to 2001, compared with 27 who had been diagnosed with anti-social personality disorder. As many autism advocates have pointed out over this past weekend, the autistic population has a lower rate of criminal activity than that of neurotypicals; in all likelihood this is because those who are prone to the most violent rages—like Sky Walker and Henry Cozad—are identified at a very young age. In the best-case scenario, they respond, as Jonah did, to psychiatric intervention. But this population is notoriously difficult to treat. Many end up in residential treatment facilities.
Predatory aggression is very different. Cool, detached, and controlled, it is primarily a cognitive experience of planning and execution. When Adam Lanza donned black fatigues and a military vest, drove to Sandy Hook Elementary School with three of his mother’s guns, and ruthlessly gunned down everyone he found—this was an example of predatory aggression that is generally not seen in the autistic population.
Still, this distinction doesn’t explain why so many autistics are prone to aggression of any kind. Studies have found that up to a staggering 30 percent suffer from aggressive and/or self-injurious behaviors of varying degrees. But it turns out this might not have much to do with autism at all—the primary impairments of which, according to the Diagnostic and Statistical Manual of Mental Disorders, involve socialization and communication, not violence. The violence has and more to do with psychiatric conditions that many people on the spectrum suffer from. One 2008 study by scientists at King’s College London found that 70 percent of their young autistic subjects had at least one co-morbid disorder, such as childhood anxiety disorder, depressive disorder, oppositional defiant and conduct disorder, or ADHD. Forty-one percent had two or more co-morbid disorders.
It is this combination of developmental delay and psychiatric disorders that pops up again and again in the literature on autism and violent crime. A 2008 review by Stewart S. Newman and Mohammad Ghaziuddin reported that “an overwhelming number of violent cases had co-existing psychiatric disorders at the time of committing the offence”—84 percent, to be precise. And Newman and Ghaziuddin couldn’t rule out personality disorders, such as anti-social personality disorder, in the remaining subjects. They conclude, “co-existing mental disorders raise the risk of offending behavior in this group, as it does in the general population.” This academic paper echoes the practical experience of those working with autistic youth; Roma Vasa, child psychiatrist in Kennedy Krieger Institute’s Center for Autism & Related Disorders, states that children with Asperger’s “usually only exhibit intense anger if they have additional psychiatric disorders.” Even then, “their anger does not typically result in these types of massive violent attacks [like the Sandy Hook shooting].”
It’s no surprise to find the real culprit is mental illness, not autism. As Katherine S. Newman, author of the 2004 book Rampage: The Social Roots of School Shootings observed in a CNN editorial Monday morning, school shooters such as Adam Lanza “are almost always mentally or emotionally ill.” Still, there is a lesson for those of us who care for a person on the autism spectrum: We need to watch for those secondary psychiatric disorders our loved ones are vulnerable to. Often, parents and clinicians assume that patients are anxious or depressed or manic or aggressive because of their autism, when in fact those symptoms may have a different etiology. It isn’t easy to tease them apart, especially in lower-functioning individuals who can’t articulate their feelings well. But it was only once my son was diagnosed with bipolar disorder and treated accordingly that the frequent, unpredictable, and intense rages that characterized his childhood finally subsided.
Going forward, we may or may not find out more about Adam Lanza’s alleged Asperger’s diagnosis. But his social awkwardness, his genius IQ, his ability to build a computer from parts—these are all red herrings, reasons why autistic individuals are more likely to be victims of crime. These factors are not even remotely relevant explanations of why Lanza committed this crime. And every time we conflate his developmental disorder with whatever psychiatric or personality disorders he may also have suffered from, we harm the entire autism community.Read Full Post | Make a Comment ( None so far )
Human empathy depends on the ability to share the emotions of others—to “feel” what other people feel. It is regarded by many people as the foundation of moral behavior. But to some, the concept seems rather airy-fairy. What does it mean to say “I feel your pain”? Isn’t that just a fanciful flight of the imagination?
Well, not really. For one thing, it turns out nonhuman animals—-even rodents-—show evidence of empathy. For another, it appears that empathy has a neurological basis.
The same brain regions that process our first-hand experiences of pain are also activated when we observe other people in pain. Moreover, when we observe the emotional signals of others, we recruit brain regions associated with theory of mind, the mechanism that permits us to take the perspective of another person. This theory of mind mechanism-—along with the ability to keep our own emotional reactions under control-—may be of crucial importance for showing empathic concern, or sympathy.
A person who lacked theory of mind or the ability to self-regulate emotions might focus solely on her own emotional reactions to another person’s plight. She might respond aversively to the victim, or–absorbed by her own emotional agitation–she might even become aggressive. Empathy, then, involves a package of abilities. Here’s a quick guide to the biology of empathy, including information about the development of empathy in children.
In one experiment, 15 rhesus monkeys were trained to get food by pulling chains. Monkeys quickly learned that one chain delivered twice as much food than the other. But then the rules changed. If a monkey pulled the chain associated with the bigger reward, another “bystander” monkey received an electric shock. After seeing their conspecific get a shock, 10 of the monkeys switched their preferences to the chain associated with the lesser food reward. Two other monkeys stopped pulling either chain—preferring to starve rather than see another monkey in pain.
Mice, too, respond to the display of pain by their companions. Researchers at McGill University put pairs of mice together and injected one or both of them with a substance that induces mild stomach ache. Mice reacted to the pain by wriggling and stretching their legs. But the intensity of the reaction depended on social cues. Mice wriggled and stretched more when their companions were also in pain. Moreover, mice exposed to the sight of a suffering cage mate were quicker to back away from an unpleasant heat source—suggesting that witnessing their companion’s discomfort made mice more sensitive to their own pain.
So there is nothing particularly human about finding the painful experiences of others unpleasant. But why is “second-hand” pain unpleasant or upsetting?
New research by neuroscientist Jean Decety suggests a fascinating neurological link between our own, first-hand experience of pain and our perception of pain in other people. When typically developing kids (aged 7 to 12 years) were presented with images of people getting hurt, the kids experienced more activity in the same neural circuits that process first-hand experiences of pain. This automatic response–termed “mirroring”—has also been documented in adults. The phenomenon may reflect the activation of mirror neurons, nerve cells that fire both when a person performs an action and he sees that action being performed by others. To date, researchers have identified specific neurons involved in the mirroring of hand movements. No one yet has isolated specific mirror neurons for pain or emotion.
Mirror neurons may explain how we can experience “second-hand” pain or emotion. But to respond with empathic concern, we need other information, too. We need to understand the perspectives of other people. We also need to overcome our own negative reactions to the display of another person’s pain or distress.
Brain-imaging research seems to confirm this link between theory of mind and empathy. For instance, when people have been asked to evaluate the emotional facial expressions of others, they showed activation in the brain regions associated with theory of mind tasks. And theory of mind is probably important in other ways. For instance, Jean Decety and his colleagues have investigated how the brain distinguishes between the victims of accidents and victims of aggression.
To better understand how theory of mind contributes to the perception of “second hand” pain, Decety’s team showed kids two sets of images. One set depicted people experiencing painful accidents. The other set showed people who were being victimized by aggressors. In both scenarios, functional magnetic resonance imaging (fMRI) revealed that merely looking at images activated brain regions associated with the first-hand experience of pain. But when kids watched images of one person deliberately inflicting pain on another person, additional brain regions (in the orbital medial frontal cortex and the paracingulate cortex) were activated.
Brain imaging research and studies of brain-damaged patients suggest that these regions are associated with social interaction, emotional self-control, and moral reasoning. Were the additional brain regions activated because the kids were engaged in social and moral thinking? It seems very plausible.
The activation wasn’t caused by the mere presence of multiple people in the images, because researchers controlled for that. And, when kids were debriefed at the end of the experiment, most of them commented on the unfairness with which the victims had been treated.
The study mentioned above measured the responses of normally-developing kids. What about kids who show a cruel streak? Decety’s group conducted a similar fMRI study on teenage boys with conduct disorder, or CD.
This disorder is a serious psychiatric condition linked with behaviors like physical aggression, manipulative lying, sexual assault, cruelty to animals, vandalism, and bullying. It’s also a precursor to antisocial personality disorder in adulthood (Lahey et al 2005). Researchers screened boys (aged 16-18) for CD, and showed them the same types of images of accidents and assaults mentioned above.
The results were very interesting. I feel your pain…and it makes me lash out
In some respects, the boys with CD responded like boys in the control group. In particular, the mirror neuron system for pain was activated in both groups.
But there were dramatic differences.
First, the boys with conduct disorder experienced less activation in brain regions associated with self-regulation, theory of mind, and moral reasoning.
Second, the boys with CD actually exhibited a stronger “mirror” response to accidentally-caused pain.
And, unlike controls, the boys with conduct disorder experienced strong, bilateral activation in the amygdala and striatum.
What does this mean? It’s not clear. The amygdala processes emotion. And the striatum is activated by strong stimuli—both pleasurable and aversive. So there are at least two possibilities.
The aggressive boys might have gotten a pleasurable “kick” out of viewing the pain of others.
But given that their own pain centers were strongly activated, it’s also possible that observing second-hand pain triggered negative emotions—emotions that make the boys behave more aggressively. As Decety and his colleagues point out, negative emotions—particularly in people with poor emotional control—can cause agitation and outbursts of aggression (Berkowitz 2003). This effect may be magnified in kids who have trouble distinguishing their own first-hand pain from the pain of others.
Decety and colleagues speculate that boys with conduct disorder may experience high levels of agitation or distress when they experience second-hand pain. When this distress is combined with poor self-regulation of emotion, they lash out. But whether second-hand pain makes aggressive kids feel good or irritable, one thing seems pretty certain:
The brains of boys with conduct disorder responded more intensely to images of other people experiencing pain. And this intensity was linked with the boys’ aggressive tendencies. The more strongly a boy’s brain responded to second-hand pain, the more highly he scored on measures of daring and sadism.
Animal studies and brain scan research might make us wonder if feeling empathy is a purely automatic process. But, as noted above, empathy is really a package of abilities, and there is evidence that empathy and empathic concern can be shaped by experience.Read Full Post | Make a Comment ( None so far )
We need only to do something once to know we are capable of doing it, the more we do it the better we get, each time we do it, we gain confidence and are more capable, less fearful. The doubts we possess prevent us from trying and push our comfort zone, to step beyond what we are capable of achieving. What is familiar is comfortable, and we like to stick with what provides us comfort, but what is familiar is not always what’s better. Anything worth having in life takes some degree of effort, change is inevitable and what was once novel soon becomes familiar. We adapt to just about anything and are able to endure. We grow accustomed to what is familiar and in it we find security. We cannot necessarily control what is happening but we can adjust to the world around us, we are great at dealing with change we change our clothes, our hair, as you read this the hand on the clock are moving, the lights grow dimmer the sun sets, we cannot control the wind but we can adjust our sails. Yet we feel as powerless as a car without an engine to alter our environment, but we can be a role model to others to be an example of how we would like to be treated. If what I’m doing isn’t working, I need to change direction and find what I can alter, that being yourself, rather then fight what I cannot control.Read Full Post | Make a Comment ( None so far )
I like to say that the heart is where emotions come from. Yet, the heart has no judgment at all. We are all born as emotional beings, which we use to help us survive. Our brains are not fully developed, so our logic is not always logical or rationally based on facts. We seek to avoid pain and cry out for pleasure. When an infant hears his parent’s arguing and yelling he will cry. Infants are emotional being that use their emotional radar to pick up on the feelings of those around them to survive. Historically, teenagers have always seemed to make illogical and irrational decisions. This is partly due to the limitations in their logic and reliance upon their emotions. Adolescents seek out pleasure, are unable to delay gratification, and pursue impulsive actions. As we age our brain fully develops and our logic takes over. Yet our emotional memories are strong and trump our rational decisions. Can we logically explain all the things we do for love? The time and money we invest in caring for others, beyond evolutionary theories, there is no logical explanation other then it feels good to love. Emotional memories become emotional reflexes as we age. We no longer even think of these motivations, we just react. Yet, below the surface our fears of pain lead us to defend ourselves to avoid the misery we once were exposed to. This pain may be from our own direct experience or it may be vicariously through witnessing another’s pain. Still these emotional memories were so strong and even traumatic that we have spent a great deal of our lives acting in ways to avoid reliving them. The longer we act to avoid these experiences the more these emotional memories turn into strong emotional reflexes. Eventually reaching the point where we no longer question where they come from but feel obliged to act in accordance with them out of internal discomfort. Emotions cause us physical discomfort in the form of headaches, muscle tension, nausea, sweating, shortness of breath, or an increased heartbeat just to name a few. These are ways our body communicates with us and lets us know that we are neglecting ourselves. So we seek to release this pain by lashing out with exaggerated emotional reactions and dump our pain onto someone else. Typically these are safe targets, who are people that love us because we know that they will forgive us and tolerant our outbursts.Read Full Post | Make a Comment ( None so far )
New research on posttraumatic stress disorder (PTSD) in soldiers challenges popular assumptions about the origins and trajectory of PTSD, providing evidence that traumatic experiences in childhood — not combat — may predict which soldiers develop the disorder.
Psychological scientist Dorthe Berntsen of Aarhus University in Denmark and a team of Danish and American researchers wanted to understand why some soldiers develop PTSD but others don’t. They also wanted to develop a clearer understanding of how the symptoms of the disorder progress.
“Most studies on PTSD in soldiers following service in war zones do not include measures of PTSD symptoms prior to deployment and thus suffer from a baseline problem. Only a few studies have examined pre- to post-deployment changes in PTSD symptoms, and most only use a single before-and-after measure,” says Berntsen.
The team aimed to address these methodological issues by studying a group of 746 Danish soldiers and evaluating their symptoms of PTSD at five different timepoints. Their study is published in Psychological Science, a journal of the Association for Psychological Science.
Five weeks before the soldiers were scheduled to leave for Afghanistan, they completed a battery of tests including a PTSD inventory and a test for depression. They also completed a questionnaire about traumatic life events, including childhood experiences of family violence, physical punishment, and spousal abuse.
During their deployment, the soldiers completed measures related to the direct experience of war: perceptions of war zone stress, actual life-threatening war experiences, battlefield wounds, and the experience of actually killing an enemy.
The researchers continued to follow the soldiers after their return home to Denmark, assessing them a couple weeks after their return, two to four months after their return, and seven to eight months after their return.
What Berntsen and her colleagues found challenges several widely held assumptions about the nature of PTSD.
Rather than following some sort of “typical” pattern in which symptoms emerge soon after a particularly traumatic event and persist over time, Berntsen and colleagues found wide variation in the development of PTSD among the soldiers.
The vast majority of the soldiers (84%) were resilient, showing no PTSD symptoms at all or recovering quickly from mild symptoms.
The rest of the soldiers showed distinct and unexpected patterns of symptoms. About 4% showed evidence of “new-onset” trajectory, with symptoms starting low and showing a marked increase across the five timepoints. Their symptoms did not appear to follow any specific traumatic event.
Most notably, about 13% of the soldiers in the study actually showed temporary improvement in symptoms during deployment. These soldiers reported significant symptoms of stress prior to leaving for Afghanistan that seemed to ease in the first months of deployment only to increase again upon their return home.
What could account for this unexpected pattern of symptoms?
Compared to the resilient soldiers, the soldiers who developed PTSD were much more likely to have suffered emotional problems and traumatic events prior to deployment. Childhood experiences of violence, especially punishment severe enough to cause bruises, cuts, burns, and broken bones actually predicted the onset of PTSD in these soldiers. Those who showed symptoms of PTSD were more likely to have witnessed family violence, and to have experienced physical attacks, stalking or death threats by a spouse. They were also more likely to have past experiences that they could not, or would not, talk about. And they were less educated than the resilient soldiers.
According to Berntsen and colleages, all of these factors together suggest that army life — despite the fact that it involved combat — offered more in the way of social support and life satisfaction than these particular soldiers had at home. The mental health benefits of being valued and experiencing camaraderie thus diminished when the soldiers had to return to civilian life.
The findings challenge the notion that exposure to combat and other war atrocities is the main cause of PTSD.
“We were surprised that stressful experiences during childhood seemed to play such a central role in discriminating the resilient versus non-resilient groups,” says Berntsen. “These results should make psychologists question prevailing assumptions about PTSD and its development.”
D. Berntsen, K. B. Johannessen, Y. D. Thomsen, M. Bertelsen, R. H. Hoyle, D. C. Rubin. Peace and War: Trajectories of Posttraumatic Stress Disorder Symptoms Before, During, and After Military Deployment in Afghanistan. Psychological Science, 2012;
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Like a compulsive crack user desperately sucking on a broken pipe, we can’t get enough of addiction. We got hooked on the concept a few centuries back, originally to describe the compulsive intake of alcohol and, later, the excessive use of drugs like heroin and cocaine. Now it seems like we’re using it every chance we can get—applying the concept to any behavior that seems troublesome or ill-advised. Take overuse of technology, for example: Over the summer, a flurry of media reports touted the services of the RESTART clinic in Washington state—apparently the first “Internet addiction” recovery center in the United States. For $15,000, you can enroll in a 45-day course designed to rid you of a dangerous or unhealthy fascination with, say, the online role-playing game World of Warcraft. So-called Internet addiction is just one of many new behavioral addictions to break into the mainstream: there’s also shopping addiction, sex addiction, eating addiction, love addiction, and others.
This creeping medicalization of everyday life means that almost any problem of excess can now be portrayed as an individual falling foul of a major mental illness. While drug addiction is a serious concern and a well-researched condition, many of the new behavioral addictions lack even the most basic foundations of scientific reliability. In light of Tiger Woods’ extramarital trysts, “sex addiction” has been widely touted by the global media despite the fact it lacks official recognition and scientific support. Perhaps the most widely publicized of these new diagnoses, Internet addiction, is flawed even on its own terms: A 2009 study published in the journal CyberPsychology and Behavior revealed that it has been classified in numerous, inconsistent ways in published research. Most studies of the “disorder” rely on self-selecting samples of college computer users and are otherwise subject to significant bias.
Despite the scientific implausibility of the same disease—addiction—underlying both damaging heroin use and overenthusiasm for World of Warcraft, the concept has run wild in the popular imagination. Our enthusiasm for labeling new forms of addictions seems to have arisen from a perfect storm of pop medicine, pseudo-neuroscience, and misplaced sympathy for the miserable.
You might assume that we’ve always known about addiction, but it’s a relatively recent idea—and one that has almost always been championed by people with a political and moral agenda. The modern concept was invented in the 18th century by physician Benjamin Rush, who, with his fellow temperance campaigners, promoted it as an explanation for, and warning against, the dangers of the demon drink. In this early formulation, the booze itself caused a “disease of the will.”
Later, the theory of “degeneracy” became popular among medical men with the assumption that mental illness could be explained by an inherited tendency to be mentally defective and socially disadvantaged. The devastating effects of alcohol on supposedly inferior native people led colony psychiatrists in the 19th century to conclude that the two conditions—drunkenness and degeneracy—went hand in hand. Slowly the concept of addiction began to shift from poisonous drugs to a biological weakness among certain people. Addicts were to be pitied but not blamed. “Degeneration,” along with eugenics, died a long-overdue death in the 1950s, but the idea that addiction is a vulnerability that exists before someone has even taken his first hit lives on. It seems to have reached its pinnacle in 2004, when a report from the World Health Organization called substance dependence “as much a disorder of the brain as any other neurological or psychiatric illness.”
This reframing of addiction carries its own risks. We know that describing a problem solely from a medical perspective changes how we understand it, which may explain why addiction has become such a popular label for human troubles. Recent work by psychologist Meredith Young and colleagues at McMaster University in Canada has shown that if we replace a common name for an illness with a medical term—pharyngitis for sore throat, e.g.—people tend to perceive the illness as being more serious. Several other studies have found that when mental disorders are described solely in biological terms, those with the diagnosis are perceived as having less control over their actions. This approach aims to be sympathetic to sufferers—but it may come at the cost of portraying the miserable as slaves to their damaged brains.
The idea that all these behavioral problems can be reduced to brain chemistry is also linked to a vacuous piece of pseudo-neuroscience. According to many popular discussions of the topic, dopamine equals addiction. That fallacy is often touted by mental health professionals as a substantive explanation when it is nothing of the sort. The popular myth goes something like this: Dopamine levels increase when we do something pleasurable, and this is what causes the addiction. When anyone wants to convince you that something should really count as an addiction, they’ll quote the fact that it “raises dopamine levels.”
The myth does have some basis in fact: We know that dopamine is involved in pleasure and desire, and that drug addiction causes long-term changes to the dopamine system that likely weaken our impulse control and draw our attention to reminders of drugs and drug-taking. There are subtle but important differences between these two statements, though. The former refers to an instant reaction to any pleasurable activity, while the latter indicates a possibly permanent change in how the brain reacts to the world owing to the use of substances which artificially alter it. There’s no direct one-to-one relationship between dopamine and addiction, and knowing that this particular brain chemical is released during an activity predicts nothing about how problematic the activity might be. As the dopamine system starts working when we encounter anything pleasurable, the popular myth would suggest everything we like could be addictive: reading books, scratching an itch, building model steamships out of matchsticks, whatever floats your boat. A recent article on extended and unresolved grieving for the New York Times cited a study on how dopamine is released when affected people looked at a picture of their late family member, suggesting that even thoughts of the deceased could be addictive.
The fact that the dopamine fallacy is used to prop up our dubious assumptions rather than test them can be seen in how some pleasurable, repetitive, and likely dopamine-fueled behaviors are never described as an addiction. A study by psychologists Kirk Wakefield and Daniel Wann found that while most sports fans are well-adjusted, others are preoccupied with their fandom, excessively motivated to follow their team, and abusive in response to outcomes on the field. What’s more, sports fandom has a clear and well-researched link to violence, social disorder, and alcohol abuse. But despite the fact that following a sports team could have serious personal and social consequences, and seems to fulfill all the criteria for a diagnosis of behavioral addiction, it is never considered as such. Being a fan of an online computer game, however, can get you placed in an expensive private clinic for “addiction therapy.”
Currently, we are concerned about young people using the Internet, eating too much, spending irresponsibly, and being promiscuous, and these worries are being expressed in the language of addiction. The medical terminology helps us to believe we’re avoiding moralization or blame, and popular science has given us a sound bite of pseudo-neurology to support our prejudices. For these problems, addiction is little more than a fig leaf for a realistic understanding that would address why people return to unhelpful ways of coping with isolation, stress, and depression. Instead, we prefer to rely on a trite and unhelpful catch-all label that prevents people from getting appropriate help for their difficulties. We need to break the addiction habit, before it breaks us.
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