Isabella Mori – Brain Blogger http://brainblogger.com Health and Science Blog Covering Brain Topics Wed, 23 May 2018 14:00:26 +0000 en-US hourly 1 https://wordpress.org/?v=4.9.6 Peace and Conflict, Part 3 – Conflict Resolution http://brainblogger.com/2010/08/27/peace-and-conflict-part-3-conflict-resolution/ http://brainblogger.com/2010/08/27/peace-and-conflict-part-3-conflict-resolution/#comments Fri, 27 Aug 2010 19:31:30 +0000 http://brainblogger.com/?p=5333 In the last of this series on peace and conflict, we are looking at the question, How can an intractable conflict be resolved or at least transformed into a benign conflict? The attempt here is to use dynamical systems theory or chaos theory to look at the question of intractable conflicts. As mentioned before, an important part of chaos theory is the notion of attractors. Imagine rolling a marble down the schoolyard until it lands in an indentation. The marble will roll around a bit and then finally come to a stop at the lowest point of the indentation. The indentation is an attractor for the marble.

The authors of the article discussed here argue that there are certain processes in long-standing conflicts that act as attractors, which then prolong and deepen the conflict. Because of the almost magnetic gravitational effect of the attractor, external influences tend to have little long-lasting influence. The authors use this example:

Imagine, for instance, one’s reaction to an acquaintance who takes it upon himself or herself to explain to one in detail why one’s pro-choice (or pro-life) position on abortion is erroneous. Odds are, one will likely tune this person out, confront him or her, or move away and avoid him or her in the future.

Attempts to challenge a “belief attractor” like this are typically as unsuccessful as challenging gravity. However, there can be exceptions.

Interrupting the Feedback Loop Through “Reverse Engineering”

Attractors consist of elements such as events, beliefs, information, conversations, habits etc. that reinforce each other, even if they are only loosely related. (“What? Joe has 12 unpaid parking tickets? I KNEW he was a no-good jerk! There’s no way I’ll give him a break now!”). In reverse engineering, one carefully looks at these elements and separates them from each other, thus interrupting the reinforcing feedback loops (feedback, by the way, is also an important element of chaos theory). For example, a mediator can help the conflicting parties set aside less relevant factors (like Joe’s parking tickets that really have nothing to do with his dispute with his neighbor).

Finding Commonalities – Moving to Alternative Attractors

Here, the idea is to move the conflict and its stakeholders to a “latent attractor” that is more benign, maybe even engenders positive thoughts, actions, and relationships. An example is Virginia Satir, one of North America’s most influential family therapists, who suggested to start some therapy sessions with “warring” couples by asking them about their courtship and why they got married in the first place. There are situations where commonalities such as positive common dreams, goals or memories can provide such an alternative attractor (imagine nudging the marble out of the current indentation into an even deeper one).

Such latent attractors almost always exist. Unfortunately, change, including change for the better, is typically unpredictable (“nonlinear”), complex and unfathomable. To keep with our example, there is no GPS for the schoolyard where our marble game takes place, and it’s dark and foggy. All we know is that there are “better” attractors but we don’t know where. However, this also provides hope. Seemingly useless attempts at resolution can suddenly bear fruit. The authors explain

Thus, although peacekeeping missions, conflict resolution initiatives, reconciliation processes, and trust-building activities often appear to be largely ineffective in situations with groups locked in a protracted struggle, they may be acting to establish or bolster a sufficiently wide and deep attractor basin for moral, humane forms of intergroup interactions that provide the foundation for a stable, peaceful future. The gradual and long-term construction of a new attractor may be imperceptible.

The Butterfly Effect

Each human interaction comprises of myriads of elements. While the first suggestion was to separate these elements from one another (perhaps in a “stop and think” fashion), the third suggestion is to make small changes (the Butterfly Effect). These small changes create what is referred to in chaos theory as “bifurcations” – basically decision points at an intersection. In order to keep the conflict going, a certain pattern must be followed. Even a slight alteration in the pattern can make a difference. Of course it is hard to say which alteration will make a crucial difference. Thorough analysis, while often a daunting, painstaking task, can help in determining which small changes are more likely to make a large difference. In Tipping Point, Malcolm Gladwell wrote a whole book about a topic similar to the Butterfly Effect. He describes a number of situations where painstaking attention to dealing with small elements of a problem makes a large-scale difference, for example in an area of New York that has changed from being a dangerous place to live to a relatively peaceful place:

[The police] has a team of officers who go around and break up the groups of young men who congregate on street corners, drinking, getting high, and playing dice-and so remove what was once a frequent source of violent confrontations. He says that he has stepped up random ‘safety checks’ on the streets, looking for drunk drivers or stolen cars. And he says that streamlined internal procedures mean that he can now move against drug-selling sites in a matter of days, where it used to take weeks. ‘It’s aggressive policing,’ he says. ‘It’s a no-nonsense attitude. Persistence is not just a word, it’s a way of life.’

In some ways, all of the above could be referred to as “changing the dance of conflict.” The old adage that it “takes two to Tango” applies world-threatening conflicts as much as to harmless disagreements between friends.

Reference

Vallacher, R., Coleman, P., Nowak, A., & Bui-Wrzosinska, L. (2010). Rethinking intractable conflict: The perspective of dynamical systems. American Psychologist, 65 (4), 262-278 DOI: 10.1037/a0019290

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Peace and Conflict, Part 2 – The Role of Religion http://brainblogger.com/2010/08/08/peace-and-conflict-part-2-the-role-of-religion/ http://brainblogger.com/2010/08/08/peace-and-conflict-part-2-the-role-of-religion/#comments Sun, 08 Aug 2010 16:40:44 +0000 http://brainblogger.com/?p=5253 This is second post in a series on peace and conflict. Specifically, we are looking at an article entitled Rethinking intractable conflict: The perspective of dynamical systems by psychologists Vallacher, Coleman, Nowak and Bui-Wrzosinska. In the first post, we introduced the reasons for examining peace and conflict from a dynamical systems or chaos theory point of view, and examined the question of why intractable conflicts are so persistent despite the fact that they only seem to bring misery to all involved. Today, we follow the authors’ question about religion:

What is the role of religion in the origin, maintenance, and resolution of conflict?

Religion plays an important role in many conflicts. Usually we think of places such as the Middle East or Ireland when the topic of conflict arises but there is much more. Just to name some examples, religion is a major player in the political conflicts in the United States, interfaith marriage is still very controversial in many parts of the world, and the effects of religion’s part in oppressing minorities (such as in Canada’s residential schools for First Nations) can still be painfully felt, both on an individual psychological level and on a societal level.

On the other hand, there are the beneficial effects of religion on conflict. Religion can provide constraints on selfish actions and promote those that are conducive to peaceful and cooperative relations with other people. In Christianity, the Quakers and Mennonites are good examples of that; there is Engaged Buddhism such as exemplified by Thich Nhat Hanh; and in the Islam the Ismailis are instances of groups that actively work towards peace and cooperation. Apart from that, most religions stress moral codes that incorporate impulse control and a concern for the welfare of others.

However, many religions also emphasize — subtly or strongly — a division of the world into good and evil, which often ends up meaning “our religion is good, yours is evil.” This divides the world into ingroup and outgroup, a phenomenon that was recognized as early as 1906 by pioneering sociologist William Graham Sumner and then elaborated on in psychology by Gordon Allport and, famously, by Muzafer and Carolyn Sherif in the 1950s and 1960s. In these situations, religion can intensify conflict. Perceiving others as members of an outgroup typically leads to seeing others as less worthy or human, and to loosening any moral codes regarding aggression or violence. The loosening, or disinhibition will, under certain circumstances, outweigh any religious rules against killing. The genocide in Rwanda is a famous example, where Hutu called the Tutsi “cockroaches” and proceeded to slaughter them wholesale.

The authors return to the idea of attractors – in psychology, points in a system that attract and hold ideas, beliefs, emotions, etc. (see my previous post on more information on attractors). They go on to say

Religion captures the defining properties of an attractor. A religious faith provides certainty: a coherent view of the world, both with respect to moral values and cosmological truth, and a stable platform for personal and collective action. Information or events that are inconsistent with the religious worldview represent potential threats to the validity of that view and thus can promote intense defensive reactions (as seen in the current debates between creationism and the theory of evolution). The cognitive biases observed when personal attitudes are contradicted are on full display when information or events challenge a group’s religious beliefs. Indeed, because religion by definition reflects faith rather than reason or empirical evidence, discrepant information or events are likely to be experienced as especially threatening and to promote very intense reactions in the service of reinstating the mental and social system at its attractor.

Seen from the point of view of chaos or dynamical systems theory, there is yet another crucial element, however. Clearly, not every system (country, family, workplace, etc.) with a diversity of religions breeds conflict. To the contrary, countries like Canada pride themselves in embracing a wide variety of religious views, from Islam to Christianity to Paganism to atheism.

What needs to be factored in are other aspects, most of them related to availability of resources — financial resources, land, etc. When these resources are steadily available, the system’s patterns can remain stable for a long time — imagine a garden going through the seasons in a mild, temperate climate. When the resources are not available, however, patterns change and can become chaotic (e.g. with lack of rain, the roses in our garden might wither and thistles might start growing). It is exactly in an effort to change this chaos, to re-stabilize it, that people look for attractors like religion or charismatic leaders.

This perspective on religion and conflict can also be supplemented by Freud’s idea of regression, which proposes that when faced with a real or perceived threat, individuals tend to regress to feelings, thoughts and behaviours associated with a younger age. This can be applied to groups, as well, and is sometimes referred to as societal regression. Let’s take Rwanda as an example again: faced with the threat of diminishing grazing lands, the Hutu literally listened (over the radio) to the voice of an authority figure who exhorted them to go out and kill the Tutsi. In the presence of this threat, more rational, adult “voices” were squashed.

Having looked at the problem of intractable conflicts in these two posts, in the following post we will examine what psychologists say about solutions to intractable conflicts.

Reference

Vallacher, R., Coleman, P., Nowak, A., & Bui-Wrzosinska, L. (2010). Rethinking intractable conflict: The perspective of dynamical systems. American Psychologist, 65 (4), 262-278 DOI: 10.1037/a0019290

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Peace and Conflict, Part 1 – The Research http://brainblogger.com/2010/07/24/peace-and-conflict-part-1-the-research/ http://brainblogger.com/2010/07/24/peace-and-conflict-part-1-the-research/#comments Sat, 24 Jul 2010 12:00:05 +0000 http://brainblogger.com/?p=5196 Over the next little while, I’d like to explore with you research on peace and conflict. In this part, I will base most of my observations on an article entitled Rethinking intractable conflict: The perspective of dynamical systems, by psychologists Vallacher, Coleman, Nowak and Bui-Wrzosinska, researchers from the US and from Poland.

Intractable conflicts develop their own cognitive, affective, and social mechanisms. They are self-perpetuating processes of thinking, feeling and dealing with relationships that end up distorting the reasons why a conflict started in the first place. Intractable conflicts literally have a demoralizing effect; just think of Rwanda, where normal citizens turned into rabid killers. Through this demoralization and other processes, the groups involved in the conflicts — from married couples to families, workplaces, political parties, countries, etc. — are destabilized and plunge into a downwards spiral of misery and hate.

The authors propose that the perspective of dynamical systems can integrate the various factors and already existing theories about intractable conflicts, which can then help to design a coherent overview, and to find ways to predict and resolve conflict.

Dynamical systems theory (sometimes alternatively referred to as chaos theory) is used to study, describe and even derive predictions for processes that are in motion, often unpredictable motion. It is frequently used in studying stock market movement and meteorology, and more and more also in psychology.

As a serious conflict progresses, the parties involved spend increasingly more time, thoughts and feelings on it. Even irrelevant issues become a part of and drawn, almost sucked into the conflict. The conflict attracts more and more of the surrounding mental, behavioral, and social landscape (this type of attraction is a typical part chaos theory). After a while, everyone is trapped inside a deep well of conflict and escape seems impossible.

The authors build their paper around a set of eleven questions. Many of them are probably too theoretical to easily digest here. A few of them, however, might be of interest to you. Today I’ll present one of them:

Intractable conflicts are undesirable and destructive to all parties, yet they are maintained for very long periods of time and resist attempts at resolution. Why?

At the least, protracted conflicts are extremely unpleasant. They rarely have happy or even satisfactory endings; often they tear apart families and communities and destroy lives. Theories of motivation are not helpful in explaining the persistence of such conflicts. For example, neither hedonism (seeking pleasure/pleasantness) nor motivational theories that revolve around enlightened self-interest or achievement are useful.

The authors propose two “attractors” that override the aversion to self-destruction inherent in protracted conflicts. In dynamical systems theory, an attractor is something on which objects, processes, people or ideas almost inevitably settle, much like a rolling marble will eventually come to settle in an indentation on the sidewalk.

The first attractor is that an entrenched conflict provides a coherent view of the problem, thus satisfying humans’ deep-seated hunger for meaning and explanation. Humans prefer simple explanations over complex ones, especially when they feel threatened. It is easier to think about a situation where “our” group is “good” and the “other” group is “bad” than to deal with the complex and often paradoxical reasons for conflict. For example, some of you may remember the great success former US President Ronald Reagan had with characterizing Russia as the “evil empire.” When attempts are made to correct these simplistic views, they usually meet a great amount of resistance. One could say, then, that the hunger for simplistic explanations acts as a sort of attractor.

The authors propose that the greatest potential for a sudden eruption of violence exists when the coherent (if oversimplified, likely incorrect and difficult to verify) view of the conflict is threatened. This is substantiated by research that suggests that people who think highly of themselves but cannot easily provide objective information on why they think that way, tend to be extremely defensive when faced with unflattering feedback and can even resort to violence (cf. Baumeister, Smart, & Boden, 1996).

The second attractor, related to the first, is a stable platform for action, enabling unequivocal, quick responses to any provocation, perceived or otherwise. Just as humans are averse to complex explanations, they dislike hesitation, ambivalence and uncertainty.

Certain forms of family violence come to mind which illustrate how these attractors work. If a parent has established criteria according to which a child is “good” or “bad” (the simplistic view), it is easy to react with a beating (the platform for action). The situation typically becomes even more entrenched when the child “talks back” by questioning the parent’s reasoning.

In future posts about this topic, we will look at

What is the role of religion in the origin, maintenance, and resolution of conflict?

How can an intractable conflict be resolved or at least transformed into a benign conflict?

Reference

Vallacher, R., Coleman, P., Nowak, A., & Bui-Wrzosinska, L. (2010). Rethinking intractable conflict: The perspective of dynamical systems. American Psychologist, 65 (4), 262-278 DOI: 10.1037/a0019290

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Social Media and Mental Health http://brainblogger.com/2010/07/06/social-media-and-mental-health/ http://brainblogger.com/2010/07/06/social-media-and-mental-health/#comments Tue, 06 Jul 2010 12:00:32 +0000 http://brainblogger.com/?p=5146 In a few days (July 10), the third Mental Health Camp will be held in Vancouver, Canada. Mental Health Camp is an (un)conference that addresses the intersection between mental health and social media (e.g. blogging, Facebook, Twitter). The organizers, Dr. Raul Pacheco-Vega and myself, believe that social media can be used as a force for good to help with mental health issues. First and foremost, we have seen how social media can help decrease stigma. For example, there are many people who formerly were quiet about their mental illness. Through social media and its relative anonymity they can explore being more open about mental illness. This in turn makes it easier for others to speak out.

However, in the interest of providing balanced information, it’s also good to look at how social media can impair mental health. A while ago, ThoughtPick posted an article about just that. Let’s look at some of the issues the writer addresses, and whether there are rebuttals.

Insomnia & Sleep Disorders: insomnia is “difficulty initiating or maintaining sleep, or both”.

… social media can cause it as well as [?] insomnia at a more advanced stage. I take myself here as an example. I use social media from morning till after midnight and I confess Twitter has kept me up for early morning hours on several occasions.

While there is a difference between deciding not to sleep and not being able to sleep, it’s clear that overuse of social media that results in things like tweeting into the wee hours of the morning can’t help with already existing insomnia. It’s interesting, though, how social media is often immediately equated with excessive use of it.

ADHD: ADHA [?] is primarily characterized by “the co-existence of attentional problems and hyperactivity, with each behavior occurring infrequently alone.”

In such a fast moving environment that we live in, we are becoming like goldfish; with a rather limited attention span… I think that the use of social media and the many distractions the various channels, tools and sites cause [?] actually help promote ADHD for all of us!

As far as I know, the causes of ADHD are not yet known. For example, in a recent study at Texas Tech University on the connection between ADHD and TV, a phenomenon similar to social media, the researchers could not find that TV watching caused ADHD in children. Checking the web site of Dr. Ned Hallowell, a well-known expert on AHDH  did return anything on the connection between social media and ADHD. On the other hand, Pete Quily, another well-known blogger on the topic of ADHD, often talks quite favourably about social media, for example here, where he discusses the advantages of having ADD when working in the tech industry.

However, it would be unrealistic to claim that social media is only a boon to people with ADD/ADHD. Even people who don’t officially suffer from such a clinical condition are often adversely affected by the fragmented attention that social media tends to promote. Tony Schwartz quotes Dr. Hallowell as saying “In the world we live in, there’s an increasingly thin line between what’s viewed as necessary and even optimal when it comes to paying attention and what is literally pathological.”

Addiction: is a ‘term used to is used in many contexts to describe an obsession, compulsion, or excessive psychological dependence’.

There are alcohol addicts, drug addicts, cigarette addicts and there are social media addicts! … Social media provides a well-prepared platform for weak people who can’t organize their time and control their social media use.

While I have a problem with the writer referring to “weak people” – addiction is a mental health condition, not a weakness — there is definitely some truth to what she says. Having thousands of social media sites available at one’s fingertips, from Facebook to Twitter to YouTube to MySpace, is like planting a casino right beside a gambler’s house.

There is still some debate among academics as to whether there is actually such a thing as internet addiction. My stance on addiction is that it is primarily a behavioural problem, not a problem associated with a specific substance/thing — thus, one can develop an addiction to just about anything.

Just like the situation with ADHD, an interesting question is whether problematic internet use, as it is sometimes referred to, is a personal problem or a problem that pervades all of society.

Anxiety & Depression: refers to ‘a state of low mood and aversion to activity’ which is highly correlated with anxiety.

Sometimes, locking yourself inside, staying in solitude and keeping away from face-to-face interaction can cause depression and anxiety. I believe social media encourages people to spend more time alone, on their computers, rather than with others.

Again, the writer’s description of depression and anxiety leaves a bit to be desired. The question of isolation is an interesting one. First of all, there is no question that isolation is extremely detrimental to mental health, and is particularly harmful for people who experience depression. The question, though, is whether social media actually does increase isolation. It is, after all, “social.” Many people report deeply meaningful connections online, and often these connections turn into face-to-face connections (as is the case in Mental Health Camp). Social media is detrimental only insofar as it specifically prevents meaningful and/or face-to-face connections.

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Goal Setting – Pitfalls and Benefits http://brainblogger.com/2010/06/22/goal-setting-pitfalls-and-benefits/ http://brainblogger.com/2010/06/22/goal-setting-pitfalls-and-benefits/#comments Tue, 22 Jun 2010 14:54:21 +0000 http://brainblogger.com/?p=5100 Goal setting is a funny thing. Like many of you, I’m sure, I’ve had a long and checkered relationship with it. I’ve gone back and forth, was a big fan, hated it, went back to goal setting again. What is it that fascinates and repels about goal setting? I set out to look at some of the research and found a great meta study by Latham and Locke in 2006. They say

more than 1,000 studies conducted by behavioral scientists on more than 88 different tasks, involving more than 40,000 male and female participants in Asia, Australia, Europe and North America, show that specific high goals are effective in significantly increasing a person’s performance – regardless of the method by which they are set. Assigned goals by a manager, for example, are as effective as self-set or participatively set goals if they are accompanied by logic or a rationale from a manager.

Sounds pretty good, doesn’t it? Except the title of the research article where these words appear is “Enhancing the Benefits and Overcoming the Pitfalls of Goal Setting.”

So there are pitfalls, too, and they often do not get talked about. What are some, according to Latham and Locke?

  • When people lack the knowledge and skill to attain a goal, giving them a difficult goal sometimes leads to poorer performance than telling them to do their best
  • A goal can have a detrimental effect on a group’s performance if there is conflict among group members
  • A goal can be detrimental if it is viewed as a threat rather than a challenge
  • Goals can have an adverse effect on risk taking, if failure to attain a specific high goal is punished
  • Paradoxically, goal attainment can become problematic. Past successes quite naturally increase satisfaction. This satisfaction can lead to (a) too much reliance on previously successful strategies and (b) increasingly high self-confidence and the setting of goals that are too high
  • Tying goal attainment to self-esteem can result in a desperate over-commitment
  • Goals can increase a person’s stress, especially if they are challenging and there are 37 goals rather than a reasonable number, such as 3 to 7
  • Employees who reach or exceed challenging goals may be assigned goals for the following year that are impossible to attain

Researchers at Harvard, too, have found that goal setting can become problematic. Specifically, they refer to “stretch goals” — goals that are difficult to attain. On the other hand, they mention that goals that foster learning and mastery can be beneficial. My professional and personal experience certainly bears that out; in fact, I am a big fan of the opposite of stretch goals — small (or even tiny) goals.

What is your experience with goal setting?

Reference

LATHAM, G., & LOCKE, E. (2006). Enhancing the Benefits and Overcoming the Pitfalls of Goal Setting Organizational Dynamics, 35 (4), 332-340 DOI: 10.1016/j.orgdyn.2006.08.008

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Exercise – It Works For Depression http://brainblogger.com/2010/06/03/exercise-it-works-for-depression/ http://brainblogger.com/2010/06/03/exercise-it-works-for-depression/#comments Thu, 03 Jun 2010 12:00:37 +0000 http://brainblogger.com/?p=5021 I’m currently reading with great pleasure Tony Schwartz’s new book, The Way We’re Working Isn’t Working – The Four Forgotten Needs That Energize Great Performance. Schwartz’s main premise is that we need balance — between activity and rest on the physical level, between performance and renewal on the emotional level, between left and right brain on the mental level, and between inner and outer work on the spiritual level. If we don’t have this balance, we tread water — we may look like we’re high performers but compared to what we are capable of when we have balance, we don’t produce much, are not very creative, and don’t have as much fun, or as much impact, as we could have.

One chapter of the book is dedicated to movement. Schwartz cites an important study in it — the SMILE study (Standard Medical Intervention and Long-term Exercise, conducted at Duke University), which found that vigorous exercise three times a week for half an hour or forty-five minutes reduced symptoms of depression as effectively as antidepressants.

Figure from Psychosomatic Medicine 62:633-638 (2000)What Schwartz does not mention is that a follow-up study went even further. In the initial study, participants exercised for 16 weeks and were then given a depression test four months later. When participants were investigated another two months later, those that had kept up with the exercise were doing extremely well. When they were interviewed about depression symptoms, according to the Diagnostic and Statistical Manual (DSM IV) and the Hamilton Rating Scale for Depression, those who had exercised were more likely to be partially or fully recovered or were less likely to have relapsed than the group that had only taken medication (Zoloft) or taken medication and exercised. In fact, an illustration shows that there were approximately 60% more in the exercise group than those in the medication group who had recovered, and there were about six times more in the medication group who had relapsed compared to the exercise group.

Is exercise the solution to depression, then? Of course not. While the findings are truly impressive, there were many who had recovered with medication alone or with a combination of the two. There is always a tendency to take the main finding of a study and proclaim it to be the new truth – but neither life nor science is that simple. However, the study is something that we need to seriously think about, or better yet, try out ourselves. One thing is for certain: the benefits of exercise far outweigh its drawbacks.

The heading under which Schwartz talks about the initial SMILE study is “Move and Thrive”. For someone who is in the depths of a major depression, these two may seem far off, and getting oneself motivated to exercise can seem next to impossible. However, starting an exercise routine — or let’s call it a movement ritual, as Schwartz would (“exercise routine” always sounds so serious, doesn’t it?) — when one is not currently in the grips of depression may just be the thing that forestalls or at least alleviates the next bout.

References

Babyak M, Blumenthal JA, Herman S, Khatri P, Doraiswamy M, Moore K, Craighead WE, Baldewicz TT, & Krishnan KR (2000). Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months. Psychosomatic medicine, 62 (5), 633-8 PMID: 11020092

Blumenthal JA, Babyak MA, Moore KA, Craighead WE, Herman S, Khatri P, Waugh R, Napolitano MA, Forman LM, Appelbaum M, Doraiswamy PM, & Krishnan KR (1999). Effects of exercise training on older patients with major depression. Archives of internal medicine, 159 (19), 2349-56 PMID: 10547175

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Clinical Psychologists’ Perceptions of Persons with Mental Illness http://brainblogger.com/2010/05/20/clinical-psychologists-perceptions-of-persons-with-mental-illness/ http://brainblogger.com/2010/05/20/clinical-psychologists-perceptions-of-persons-with-mental-illness/#comments Thu, 20 May 2010 12:00:17 +0000 http://brainblogger.com/?p=4964 Many people have fabulous relationships with their psychologists. They feel supported, understood, well-liked. But there are also those who feel a little uneasy. Research by Lynn Servais and Stephen Saunders of Marquette University in Milwaukee, Wisconsin may have unearthed one of the reasons why.

Some psychologists have a hard time connecting with people with mental illness, especially when they have diagnoses of borderline personality disorder or schizophrenia.

Most psychologists start off by evaluating people — that’s what a diagnosis is. Diagnoses, by their very nature, look at what’s not working. Most would agree that’s a good thing — if you don’t know where the problem is, it’s hard to fix it.

On the other hand, psychologists are people. Like you and me, they have personal likes and dislikes; perhaps they are even not so different from the employer who, research has shown, often decides who to hire within the first few minutes of meeting a prospective employee.

What Servais and Saunders looked at specifically was the concept of “disidentification” which

involves the process of characterizing persons with mental illness as easily recognizable and different from “normal” individuals while characterizing oneself as normal and not susceptible to mental illness (Cumming & Cumming, 1957; Mahatane & Johnston, 1989).

This is similar to the concept of othering you may have heard of and which often comes up when people talk about ethnocentrism (e.g. “I don’t know that I want to live in Surrey; there are so many East Indians there. They are just… different.”)

Disidentification can help boost a person’s self esteem; from my research in chronic pain, I have also formed the hypothesis that it goes even further — there may be a very primitive sense that by distancing oneself from someone who is “afflicted”, one could avoid “catching” an illness. (Of course this goes on at an unconscious level; very few psychologists would consciously hold such an irrational thought.)

The researchers analyzed surveys returned by 306 psychologists. It’s interesting to note that 95% of them were Caucasian; 83% saw mostly mildly or moderately “disturbed” clients.

Psychologists tended to see themselves as quite dissimilar to persons with borderline features and persons with schizophrenia. Borderlines tended to be experienced as quite dangerous and as least desirable of the five classes of people psychologists were asked to rate (themselves, a member of the public, a person with moderate depression, a person with borderline features, and a person with schizophrenia.

What is the effect of such disidentification? The researchers speculate (and find some basis for it in already existing research) that such perceptions detract from the therapist-patient relationship; could dissuade people in need of psychological services from seeking help; make it difficult for the therapist to feel and express empathy and genuine concern; could decrease the therapist’s belief in their clients’ recovery; and may model inappropriate behaviour.

Where does all of this come from? The need to keep up one’s self esteem and a fear of “infection” were already mentioned. Other sources are professional training, especially when it overemphasizes the psychologist as an expert. Personally, I also think that a focus on diagnosis which, as I mentioned earlier on, focuses on what’s wrong, is unhelpful. Additionally, I wonder whether the fact that 95% of those surveyed were Caucasian had something to do with it; conceivably, non-Caucasians may be more sensitive to the detrimental effects of disidentification.

Lastly, and most importantly, how can psychologists be helped to see clients with mental illness as more like themselves, less “other”?

  • Psychologists could take a more holistic view of their patients and focus not only on their problems but also on their strengths. Solution focused approaches such as advocated by Scott Miller de-emphasize diagnosis and concentrate on concrete, future-oriented solutions, with great success.
  • Universities and other training bodies need to a) specifically address stigmatization and stereotyping; and b) help psychologists form the belief that individuals who have a mental illness can indeed recover.
  • Persons with mental illness could be used as trainers for psychologists.

Reference

Servais, L., & Saunders, S. (2007). Clinical psychologists’ perceptions of persons with mental illness. Professional Psychology: Research and Practice, 38 (2), 214-219 DOI: 10.1037/0735-7028.38.2.214

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Research on Psychology and Cancer: Still in its Infancy? http://brainblogger.com/2008/04/18/research-on-psychology-and-cancer-still-in-its-infancy/ http://brainblogger.com/2008/04/18/research-on-psychology-and-cancer-still-in-its-infancy/#comments Fri, 18 Apr 2008 13:27:36 +0000 http://brainblogger.com/?p=865 BioPsychoSocial_Health2.jpgHow do thoughts, emotions and social environment influence people diagnosed with breast cancer?

A report by Falagas and his colleagues looked at and compared 46 studies investigating psychological and social factors that affect breast cancer survival rates. The results are not entirely conclusive. The most promising parameters associated with better breast cancer prognosis were social support, minimizing and to some degree being married.

Social Support

Think PinkAn example of the role of social support is a study by Reynolds and her team. The absence of close ties and perceived sources of emotional support were associated significantly with an increased breast cancer death rate. Women reporting few sources of emotional support had a higher death rate from their disease during the 5-year period of follow-up.

Marital Status

When taking a close look at Falagas’ study, I was not able to see the evidence of the benefit of marriage for breast cancer survival they claimed. Interestingly, a study in 1987 by Goodwin et al. has this to say about the connection between marital status and any kind of cancer:

The effects of marital status on the diagnosis, treatment, and survival of patients with cancer were examined in population-based data on 27,779 cancer cases. Unmarried persons with cancer had decreased overall survival … We identified three complementary explanations for the poorer survival of the unmarried persons. Unmarried persons were more likely to be diagnosed at a regional or distant stage [and were] more likely to be untreated for cancer… Previous studies have demonstrated that unmarried persons have decreased overall mortality. For cancer, our results suggest that the favorable consequence of being married on overall survival is secondary to the beneficial effects at several steps in the diagnosis, choice of treatment, and response to treatment.

Minimization

We're thinking of youMinimization is a coping mechanism that involves strategies such as not thinking about a problem too deeply, trying to forget one’s feelings, or downplaying risks. In a study by Butow, Coates and Dunn, the risk of dying was reduced by 7% for each unit increase in minimization, and survival time was increased by a median of 5.2 months after study entry for those scoring higher than average on minimization.

Emotional Wellbeing

Lastly, you may remember that recently, there was quite a bit of talk about a study involving neck and head cancer. In the large-scale study conducted over nine years, Coyne and colleagues used baseline quality-of-life questionnaires to assess the well-being of 1,093 cancer patients. All participants were involved in clinical trials, which ensured uniformity of treatment and ruled out substantial health disparities in the sample. During the study, 646 patients died, and the research team found no relationship between their emotional well-being and cancer progression and death.

***

It seems that this area of cancer research is still in its infancy; indeed, a recent gap analysis states that the psychosocial aspects of cancer — the use of appropriate psychosocial interventions, and the personal impact of all stages of the disease among patients from a range of ethnic and demographic backgrounds — still needs a lot more attention.

This is part of the Frozen Pea series — a series of blog posts on cancer by Vancouver therapist Isabella Mori, in support of internet personality’s Susan Reynold’s struggle with breast cancer.
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Mind-Brain Connection: PTSD and Concussions http://brainblogger.com/2008/02/05/mind-brain-connection-ptsd-and-concussions/ http://brainblogger.com/2008/02/05/mind-brain-connection-ptsd-and-concussions/#comments Tue, 05 Feb 2008 16:53:12 +0000 http://brainblogger.com/2008/02/05/mind-brain-connection-ptsd-and-concussions/ BioPsychoSocial_Health.jpgThe February 1st edition of the New England Journal of Medicine reports that suffering a concussion in Iraq after a bomb attack was strongly associated with post-traumatic stress disorder (PTSD).

Three to four months after returning home from Iraq, [2,525] soldiers completed an anonymous survey about their combat experiences, injuries, symptoms of PTSD, depression, and physical health problems.
Almost 15% of the soldiers had suffered a concussion in Iraq, including 5% who lost consciousness and 10% who were dazed and confused or saw stars. An additional 17% reported other injuries that didn’t involve concussions.
Nearly 44% of soldiers who lost consciousness were diagnosed with PTSD, compared with 27% of those who had concussions but remained conscious, 16% of soldiers with other injuries, and 9% of uninjured soldiers. Depression also often accompanied loss-of-consciousness concussions.
Soldiers who had suffered concussions also reported worse health and missed more days of work.

In a radio interview with CBC on January 31st, the lead researcher, Dr. Christian Hoge, pointed out that concussion, or mild traumatic brain injury, as it is often referred to these days, is not always associated with PTSD — for example, there is nothing pointing to sports-related concussions increasing the risk of PTSD. It is when the concussion occurs in connection with a life-threatening event that it is associated with PTSD.

It is going to be interesting to see what further research is spawned by this. For example, what are the implications for PTSD associated with sexual assault?

A quick review of internet and of the first “bible” on PTSD, Herman’s Trauma and Recovery, does not indicate any mention of this connection (maybe on closer reading it’s somewhere in there; I have to confess it’s been quite a while since I last read it).

In general, I always had the impression that traditional research does not pay much attention to the connection between physical and mental/emotional events, so I think Hoge’s project is an important and exciting movement towards recognizing that we need to look at the totality of the human experience, and not act as if what happens in our mind and in our bodies is completely separate.

(This is a contribution by guest blogger Isabella Mori, a psychotherapist in Vancouver, Canada).

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Body Image Research http://brainblogger.com/2007/11/19/body-image-research/ http://brainblogger.com/2007/11/19/body-image-research/#comments Mon, 19 Nov 2007 20:17:42 +0000 http://brainblogger.com/2007/11/19/body-image-research/ Psychiatry_Psychology2.jpgBack in September, Sudip Ghosh offered a review at Brain Blogger of a new book on anorexia, Perfect Girls, Starving Daughters.

One of the many aspects of the complex problem of eating disorders is body image. It was informative, then to come across an article summarizing a wide variety of research findings on body image. I’ve picked out a few of the more interesting and perhaps less well-known ones:

* In court, “attractive” people (whatever that means) have distinct advantages in our society. They are found guilty less often and when found guilty, receive less severe sentences.

* While concern with appearance is not just part of modern Western culture, there is a difference in degree of concern. With advances in technology and the rise of the mass media, normal considerations regarding our looks have turned to obsessions. Standards of “beauty” are becoming harder and harder to attain, particularly for women. The current media ideal of thinness for women is achievable by less than 5% of the female population.

* Reactions to mirror reflections vary according to species, age, gender, ethnic group, mood, sexual orientation, marital status, childhood experiences, menstrual cycle, whether a person has an eating disorder, what they’ve been watching on TV, what magazines they’ve been reading, where they shop, whether they take part in sports and whether they are pregnant, and even what they’ve had for lunch.

* If you were a mouse, a cat or a dog, you wouldn’t realize that the image was a reflection of yourself. Most animals think they are face to face with another member of their species. The great apes are an exception — chimps, gorillas, orangutans, and the naked apes (humans) are capable of recognizing themselves in the mirror.

* However, other great apes use mirrors to groom themselves, pick food out of their teeth and make faces at themselves for entertainment. But I’d be interested so know whether they also use mirrors to criticize themselves, like we do? It would be interesting to follow up on that.

* Female dissatisfaction with appearance and poor body-image begin at a very early age. Human infants begin to recognize themselves in mirrors at about 2 years of age. Girls can start disliking what they see only a few years later. In one US survey, 81% of ten-year-old girls had already dieted at least once.

* The main focus of dissatisfaction for most women looking in the mirror is the size and shape of their bodies, particularly their hips, waists and thighs. Men unhappy with their bodies focus on height, stomachs, chests and hair loss (and penis size, according to this study).

* Black women with high self-esteem and a strong sense of racial identity rated themselves more attractive than pictures of supposedly ‘beautiful’ Caucasian fashion models.

* People become significantly more dissatisfied with their own appearance after being shown TV ads featuring exceptionally slim and beautiful people or reading fashion magazines.

* Those who suffer from extreme body-image disturbance (body dysmorphic disorder) report a lack of holding and hugging as children.

* When in the pre-menstrual phase of their cycle, women experience higher levels of body-dissatisfaction than at other times.

* The mental well-being of obese women can be worse to than that of the chronically ill or even severely disabled. These problems are not caused by obesity itself — in cultures without fat-phobia or where fat is admired, obese people show no signs of these effects — but by social pressure and the association of beauty with thinness.

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World Mental Health Day: A Cultural Round-Up http://brainblogger.com/2007/10/12/world-mental-health-day-a-cultural-round-up/ http://brainblogger.com/2007/10/12/world-mental-health-day-a-cultural-round-up/#comments Fri, 12 Oct 2007 22:16:13 +0000 http://brainblogger.com/2007/10/12/world-mental-health-day-a-cultural-round-up/ BioPsychoSocial_Health2.jpgOctober 10th was World Mental Health day. This year, the focus was on the interplay between culture and mental health. Let’s see what we can learn on the topic:

Mental health among black and Latino GLBT

Blacks and Hispanics who identify themselves as either gay, lesbian or bisexual report significantly fewer mental health issues than their white counterparts, according to a report conducted at Columbia University’s Mailman School of Public Health…
The finding counters the theory that the opposite would be true. The report’s researchers hypothesized that black and Hispanic gays, lesbians and bisexuals might have additional stress related to racism and homophobia. Lead researcher Ilan Meyer: “These findings suggest that black lesbians, gay men and bisexuals have effective ways to cope with prejudice related to racism and homophobia.”

Mental health in India

The truth remains that it is the lack of awareness and therefore the abundance of prejudice not just at the workplace but also in the immediate and extended family, that keeps the incidence of mental health well hidden in India. Now and then there comes a film, which tries hard to bring up the issue, such as Aparna Sen’s “15 Park Avenue” or Mahesh Bhatt’s “Woh Lamhe,” albeit not without enforcing the same stereotypes of violence, aggression, suicide and such like and then, nothing. Silence.
Things may be changing, if ever so slowly, as you can see from this blog by an Indian mother chronicling her daughter’s schizophrenia. Even so, by and large, the management of mental health issues remains a dominantly NGO activity in India, as captured wonderfully in this book.

Worldwide suicide rates

Speaking of India, as I searched around for an article on suicide, initially sparked by this one about the drop in suicide rates in Finland, I noticed that quite a few people from India seem to be interested in this topic, like Nita, who gives an overview of suicide rates the world over.

She speculates on the reason for the differences between the various countries (Lithuania: 43 per 100,000 versus UK: 6.9) and discusses gender differences as it relates to suicide. Like so many, she makes the connection between suicide and depression. This is what John Banmen, an international expert on suicide prevention, says about it:

Although many suicides have a mental illness component, only a very small number assessed as mentally ill actually kill themselves. Some studies indicate that mental illness, such as depression, schizophrenia, alcohol abuse, and personality disorder are found in only 25 percent of suicides.

As an aside, Banmen sees suicide as the end result of an inability to cope. He points to the fact that generally, people on low incomes have a lower suicide rate. Poor people tend to have a high ability to cope, simply because they have to. Perhaps the well-exercised coping skills that come with being a minority also explain why black and Latino gay men have fewer mental health problems?

Mental health among First Nations

Back from the aside – now we’ve gone to the US, India, Finland and all over the world to look for a cultural perspective on mental health. I’d like to return to my home, Canada, for a look at mental health among our First Nations:

Michael McIsaac, who has years of experience providing therapeutic intervention for First Nations, and who has roots in the Ojibway, Cree, Mohawk, and Algonquin cultures, points out:

The problems with urban-based approaches to mental disorders are discussed in a Washington Post article… Carl Bell, a psychiatrist at the University of Illinois in Chicago, says, “This thing called psychiatry—it is a European-American invention, and it largely has no respect for non-white philosophies of mental health and how people function.”
And Dr Marcello Maviglia, a psychiatrist who has worked extensively with Native Americans in New Mexico, agrees, saying, “A lot of minority groups perceive psychiatric interventions as an ideological approach that discounts their own cultures. A lot of people wouldn’t be able to verbalize this, but patients know when you are discounting them, their traditions.”

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Mental Illness: Writing Our Own Scripts http://brainblogger.com/2007/09/19/mental-illness-writing-our-own-scripts/ http://brainblogger.com/2007/09/19/mental-illness-writing-our-own-scripts/#comments Wed, 19 Sep 2007 15:02:44 +0000 http://brainblogger.com/2007/09/19/mental-illness-writing-our-own-scripts/ Anti_Stigmatization2.jpgEarlier this week, I attended the annual general meeting at the Canadian Mental Health Association (Vancouver – Burnaby branch). As always, people who have used the CMHA’s services over the years stood up and told their stories. What remained most with me was one person mentioning that at a certain age, he “experienced symptoms associated with paranoid schizophrenia.” How different that sounded from saying “I am a paranoid schizophrenic.”

The space between who that person was and those symptoms was palpable, airy, freeing. He did not identify with his mental illness. It sounded like one among many things in his life — perhaps one that at times becomes pretty big and in need of a lot of attention but by far not the defining characteristic of who he is.

Listening to the other speakers, I heard the same theme. They were stories of success and vitality, about how they’re volunteering, working, spending time with other people. Not one of them belabored their mental illness, and every one of them had an almost casual way of referring to it, as something definitely worth mentioning but nothing extraordinarily important.

One person, who is now part of a very successful team that teaches government agencies and the public about “mental health first aid” briefly touched on a diagnosis of multiple personality disorder “associated with experiencing severe trauma in childhood.” The message I heard was not that there was some horrible illness but that a condition like that could easily be expected after this trauma, just like a broken bone could easily be expected after falling from a tree.

Another person referred to her illness simply in terms of “hospitalizations.” Even though it looked like these moments had severely disrupted her life, I was again left with the impression that this was not what her life was all about. It’s so much bigger than that.

We all have varying degrees of abilities and health. What counts is what we make of it. And what we make of it depends so much on what story we tell ourselves and others about our experiences. We can concentrate on talking about what doesn’t work — or on what does and will work; we can use labels for ourselves and others — or we can find our very own words to describe what’s going on.

We can write our own scripts.

And I sure liked those scripts yesterday.

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Brain Implants: Become a Borg or Get Healthy? http://brainblogger.com/2007/02/27/brain-implants-become-a-borg-or-get-healthy/ http://brainblogger.com/2007/02/27/brain-implants-become-a-borg-or-get-healthy/#comments Tue, 27 Feb 2007 19:18:09 +0000 http://brainblogger.com/2007/02/27/brain-implants-become-a-borg-or-get-healthy/ Neuroscience and Neurology CategoryBrain implants, or neural implants, have been around since the 1940’s. They can allow people who are paralyzed, deaf or blind to function again. Such an implant is a type of biomedical prosthesis that circumvents areas in the brain which are dysfunctional, perhaps as a result of a stroke or head injuries. Brain implants create a bridge between neural systems and computer chips. Other medical research involves drug delivery via neural implants.

Brain implants also have the capacity to be used in more sinister ways.

Why is that?

Neural implants are used to remotely control the brain, and at least theoretically, they could be implanted without someone’s knowledge. Of course that is a remote possibility in countries that have tight controls on operations; I would not be too surprised, however, if it turned out that neural implants are being experimented with in countries that are much looser about patients’ rights.

The New Scientist reports that brain implants have been used to “mind read” monkeys. Supposedly, the implants were able to accurately predict 67% of the time where in their visual field trained monkeys were planning to reach.

In another study, a young man was able to move video icons just by using his imagination.

According to one source, controversial Finnish doctor Rauni-Leena Luukanen, the Washington Post reported that Prince William of England received an implant at the age of 12 so that if he were ever kidnapped, he could be traced. Of course, this does not sound unlikely; however, I was not able to find confirmation of that report.

What the Washington Post did report is that CityWatcher.com, a Cincinnati company that stores surveillance camera footage, implanted two of its employees and its chief executive with a microchip (on a voluntary basis) so they can enter a secure building that no one else can enter.

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Mental Illness – It’s Not Talked About http://brainblogger.com/2007/01/22/mental-illness-its-not-talked-about/ http://brainblogger.com/2007/01/22/mental-illness-its-not-talked-about/#comments Mon, 22 Jan 2007 21:28:10 +0000 http://brainblogger.com/2007/01/22/mental-illness-its-not-talked-about/ Anti_Stigmatization.jpgAre you reading this at work during your lunch break? Has anyone come into the lunchroom to tell you about the cold they had lately, or their children’s chicken pox, or their aging father’s hip replacement?

I bet this happens quite a bit. Just about everyone talks about these maladies, small and large, fleeting or chronic.

When’s the last time you tossed a “How ya doin’?” at a co-worker, and instead of talking about that flu that just doesn’t seem to go away, she mentioned casually, “Ah, well, I’m going through another depression, don’t you just hate that?”

Now I bet that this has just about never happened to you. And if it did, chances are you’d be startled and wouldn’t know what to say.

According to the Canadian Mental Health Association, in Canada, one in five of us will experience a mental health problem during our lifetime. One in eight will be hospitalized due to a mental illness. A University of Toronto study in 2004 estimated that 8%, or one out of twelve employees, were dealing with diagnosable mental health issues. (Note: while this is written from a Canadian perspective, very similar statistics hold true for the U.S.)

That means that if you, like the average Canadian, work at a place that employs 45 employees, between three and four are likely to be struggling with issues such as depression, anxiety, schizophrenia or an eating disorder.

In other words, mental illness is not uncommon.

So why does nobody talk about it?

Most of us know very little about mental illness, and ignorance breeds fear. Fear breeds avoidance. Avoidance breeds more ignorance. It’s a vicious cycle. And vicious cycles breed more vicious cycles: The ignorance that prevents us from learning more about mental illness does not only create more fear and avoidance in us, but also prevents people who have a mental illness from talking about it. This makes them more afraid, and therefore more prone to isolate from people who they feel don’t understand them – and that exacerbates the symptoms of mental illness.

Some think that it is not the mental illness itself that creates suffering but how we think about it and react to it. There is a difference between pain and suffering. Pain is the immediate feeling of dis-ease in the body or mind, our neurons firing in such a way as to tell us that there is something wrong, that we must pay attention and react to set things right. Suffering comes in the aftermath of immediate pain, or in the anticipation of pain.

Here’s an example. Have you stubbed your toe lately? It really hurts, doesn’t it? The pain is intense, it lasts for a minute or so, and then it’s over, and you completely forget about it. If you can, you move the obstacle that made you stub your toe. Period. That’s acute pain. Now compare that to, say, an abscessed tooth. The pain itself is probably not as intense as the stubbed toe. But it doesn’t go away. You don’t really want to eat anything. When you reach the point where you’re so grouchy that you snap at your spouse, and when the pain gets so insistent that you’re ready to sell your Grandmother’s soul to make it go away, that’s the beginning of suffering. It’s the emotional reaction to the pain.

Most mental “pain” is like the abscessed tooth. It can quickly tip over into suffering. Can you imagine having an abscessed tooth but you can’t really tell anyone that’s why you need a day off and you’re expected to munch on the peanuts that everyone else is eating (because nobody is supposed to have problems with their teeth)? Would that make you feel angry, inferior, isolated? That is suffering, it’s not pain. And that’s what happens to the close to two million Canadian workers who experience mental illness.

When our co-workers suffer, it’ll eventually impact all of us. It definitely impacts the bottom-line: A recent estimate of the cost of mental illness in Canada was set at $16 billion. The cost has only increased since then.

If you want to be on the forefront of those who want to stop the viscous cycle around mental health, all you have to do is inform yourself. The Canadian Mental Health Association, the Government of British Columbia site on mental health or Mental Health Works might be a place to start.

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