It is suggested that we divide the world into them (out-group) and us (in-group), by placing people into social groups. The Wendes study suggests that individuals are more sensitive to discrimination by out-group members than in-group members. In-group discrimination leads to feelings of threat and shame, whereas discrimination by out-group members is perceived as a challenge situation, leading instead to anger. In-group discrimination is also linked to cortisol increase, short term memory impairments, and increased vascular resistance which, if experienced over the long-term, can lead to disorders with severe cognitive impairments. However, the study reports that out-group discrimination has more immediate results: expressions of anger, increased vigilance for danger, and more risk-taking behaviors. So, out-group discrimination is more likely to lead to dangerous behavior patterns compared to in-group discrimination.

Discrimination seems to be a very powerful social weapon. The effects described above do not necessarily need a face-to-face situation. In the study by Mendes and colleagues, participants at the receiving end of social rejection showed distinct emotional and physiological profiles when merely informed that their on-line negative interaction was with either an in-group or an out-group member. Social rejection from an out-group partner — even in an on-line interaction — is enough to trigger anger and risk-taking behaviors.

The research described above focused only on racial discrimination. The participants were simply told that the person spewing negativity through chat was either a person of the same race or from a different race as the participant. Despite the anonymity and one-off interaction, the effect of social rejection was strong enough to elicit both affective and physiological responses.

The effects could possibly be much stronger if the interactions are prolonged or with known ‘friends’. It is also highly possible that the strong and negative reaction to discrimination is not limited to racial discrimination alone. People form out-groups and in-groups based on the current social situation they are in. Affective and physiological responses similar to that observed in the study discussed above could be triggered in reaction to any form of out-group discrimination.

Hate blogs, discriminatory social networking groups and posts may therefore have a tremendous impact on our social lives. Consider how many times we run across discriminatory posts while on a random scrawl through our news feeds. This study might be reason enough to stop you sharing apparently harmless, but potentially discriminatory messages on your Facebook wall.

Reference

Jamieson JP, Koslov K, Nock MK, & Mendes WB (2013). Experiencing discrimination increases risk taking. Psychological science, 24 (2), 131-9 PMID: 23257767

Image via Mary_L / Shutterstock.

Related Articles:

• Why So Serious About The Self?
• Smell Your Age
• Cults and Terrorism, Part 5 – Features of Destructive Cults
• Genotypes, Stress and Emotions. Oh My!
• Social Isolation and Mental Illness
• The Brain Rejects Inequality
• Motivation for Mental Health Care – All it Takes is a Phone Call

While a story as complex as this will admittedly take some time to unfold, the emerging tidbits are beginning to point to a familiar picture. The perpetrator is often a victim of abuse himself: in a 2004 suicidal note, Ariel Castro had detailed his own history of sexual abuse as a child. Women prone to sexual victimization usually have prior history of abuse: Michelle was sexually assaulted after dropping out of the school at 17 and lived in an abusive relationship with a man who was abusive to both her and her son. The perpetrator is usually familiar with the victim: Gina was best friends with Ariel Castro’s daughter prior to her abduction and had met her just an hour before the perpetrator lured Gina into his home. The perpetrator is not a readily identifiable sociopath living in isolation: Ariel Castro played music with several Latin bands in Cleveland and loved his collection of base guitars. He even entertained other musicians in his 1,400 square feet house while he had the three captive women locked away in adjoining rooms. In fact, he helped organize a benefit concert to aid the community search efforts to locate these three missing women!

These are good things to learn. They tell us that we have well substantiated touch-points for intervention and prevention. The question is: do our communities have the resources and inclinations to intervene? The Seymour Avenue events will tell us a lot in the coming months. They will also tell us whether the sex education that some of our young children receive in schools, lowers the motivation for escaping should they find themselves in similar unfortunate circumstances. Elizabeth Smart, herself tormented sexually by her captor over many years, thinks it does. Ms. Smart remembers feeling, “Who will want me now after sexual assault; I am worthless.” This feeling, combined with what is known as ‘Stockholm Syndrome’— a victim’s life depends on the perpetrator, can create a hopeless cycle of dependence for a captive child. Recalling her sex education at school prior to her abduction, Ms. Smart remembers the teacher likening those girls who engage in frequent sex, to an over-chewed piece of gum that is ready to be rejected. I hope the Seymour Avenue events will teach our sex educators to find better metaphors.

Then there is our hero Charles Ramsey. TV coverage has shown that the man clearly has a penchant for performance… both on and off camera. Sadly, the social media is focusing on getting chuckles out of the mannerism and speech of this brave, spontaneous African American. When Ramey said, “Bro, I knew something was wrong when a little pretty white girl ran into a black man’s arms,” it was no laughing matter. It was a telling commentary on how stereotypically fearful we are of black men. This is the same man who told Anderson Cooper that he did not want to receive the monetary award associated with locating the three women. Ramsey wants the money to be used for the care of these rescued women.

The Seymour events will provide many teaching moments and America will be better for all of them.

Image via Henryk Sadura / Shutterstock.

Related Articles:

• Societal Assumptions on Abuse and the Victim’s Perspective
• Diagnosing Child Abuse
• Women After Sex
• Genetic Discrimination: A Real Threat?
• Estrogen Reduces Risk of Alzheimer’s in Women
• Good Health Equals Good Sex
• Domestic Violence – Understanding is Getting More Nuanced

The researchers recruited two groups of participants: students from the University of Toronto who were between the ages of 17 and 27 and older adults who lived in the community who were between the ages of 60-78 years old. All the participants were asked to take three tests. The first was to memorize a list of words and recall those words after only a few minutes. After this first test, there was a fifteen minute period during which the participants worked on an attention task that involved looking at pictures. While they were working on this task, half of the list of words they studied appeared as distractors across the screen they were viewing. The effect was similar to watching television and then suddenly seeing weather information about an upcoming storm streamed across the bottom of the screen. In some instances the words were appeared during the 15 minutes assigned for the picture task and in other instances they appeared at the end of the 15 minute interval. After the picture task was complete, the researchers surprised the participants by asking them to recall the words on that original list.

What the researchers observed during that second recall test was quite amazing. Repeating the words as distractors did not affect how well the young people remembered the words on the list. However,  older adults rarely or never forgot the words that had appeared as distractors. These seniors were 30% more likely to remember the distractor words compared to the words that were not used as distractors. The seniors used hyperbinding, linking the words to the pictures, as a way to remember.

What do these findings mean in terms of improving the quality of life for senior citizens? These results can be used to develop learning techniques for older adults that can help them remember important information like when to take medication or if they are supposed to be somewhere. The most significant aspect to all of this is that the seniors do not even have to be consciously paying attention to the distractors that will act as cues to remembering.

References

Biss RK, Ngo KW, Hasher L, Campbell KL, & Rowe G (2013). Distraction Can Reduce Age-Related Forgetting. Psychological science PMID: 23426890

Image via d13 / Shutterstock.

Related Articles:

• Bilingualism May Be Neuroprotective
• The Science Behind Impulse Buying
• Love Can Alleviate Pain
• Anti-Smoking Campaign Doesn’t Mess Around
• James Parkinson’s Disease
• March’s Match Day
• Exercise to Keep Your Brain Healthy and Increase Cerebral Blood Flow

Carl Rogers created a theory and therapy indicated by the terms “umanistic theory” and “person-centered therapy”. This theoretical perspective postulates many important ideas, and several of these ideas are pertinent to this discussion. The first of these is the idea of “conditions of worth”, and the idea of “the actualizing tendency.” Rogers asserts that our society applies to us “conditions of worth”. This means that we must behave in certain ways in order to receive rewards, and receipt of these rewards imply that we are worthy if we behave in ways that are acceptable. As an example, in our society, we are rewarded with money when we do work that is represented by employment.

In terms of the life of a schizophrenic, these conditions of worth are that from which stigmatization proceeds. The psychotic individuals in our society, without intentionality, do not behave in ways that produce rewards. Perhaps some people believe that schizophrenics are parasites in relation to our society. This estimation of the worth of these individuals serves only to compound their suffering. The mentally ill and psychotic individuals, in particular, are destitute in social, personal and financial spheres.

Carl Roger’s disapproved of conditions of worth, and, in fact, he believed that human beings and other organisms strive to fulfill their potential. This striving represents what Roger’s termed “the actualizing tendency” and the “force of life.” This growth enhancing aspect of life motivates all life forms to develop fully their own potential. Rogers believed that mental illness reflects distortions of the actualizing tendency, based upon faulty conditions of worth. It is clear that psychotic people deal with negatively skewed conditions of worth.

It is an evident reality that the mentally ill could more successfully exist in the world if stigmas were not applied to them. The mentally ill engage in self-denigration and self-laceration that culminate in the destruction of selfhood. This psychological violence toward the mentally ill is supported by non-mentally ill others. The type of self-abuse by psychotic individuals would certainly abate if the normative dismissal of the mentally ill as worthless is not perpetuated.

In spite of a prevalent view that psychotic individuals are unsuccessful in the context of psychotherapy, Roger’s theory and therapy of compassion cannot be assumed to be unhelpful to the mentally ill. The key components of Rogers’ approach to psychotherapy include unconditional positive regard, accurate empathy and genuineness. Unconditional positive regard, accurate empathy and genuineness are considered to be qualities of the therapist enacted in relation to the client in terms of humanistic therapy. These qualities are essential to the process of humanistic therapy.

In terms of these qualities, unconditional positive regard is a view of a person or client that is accepting and warm, no matter what that person in therapy reveals in terms of his or her emotional problems or experiences. This means that an individual in the context of humanistic psychotherapy, or in therapy with a humanistic psychologist or therapist, should expect the therapist to be accepting of whatever that individual reveals to the therapist. In this context, the therapist will be accepting and understanding regardless of what one tells the therapist.

Accurate empathy is represented as understanding a client from that person’s own perspective. This means that the humanistic psychologist or therapist will be able to perceive you as you perceive yourself, and that he will feel sympathy for you on the basis of the knowledge of your reality. He will know you in terms of knowing your thoughts and feelings toward yourself, and he will feel empathy and compassion for you based on that fact. .

As another quality enacted by the humanistic therapist, genuineness is truthfulness in one’s presentation toward the client; it is integrity or a self-representation that is real. To be genuine with a client reflects qualities in a therapist that entail more than simply being a therapist. It has to do with being an authentic person with one’s client. Carl Rogers believed that, as a therapist, one could be authentic and deliberate simultaneously. This means that the therapist can be a “real” person, even while he is intentionally saying and doing what is required to help you.

The goal of therapy from the humanistic orientation is to allow the client to achieve congruence in term of his real self and his ideal self. This means that what a person is and what he wants to be should become the same as therapy progresses. Self-esteem that is achieved in therapy will allow the client to elevate his sense of what he is, and self-esteem will also lessen his need to be better than what he is. Essentially, as the real self is more accepted by the client, and his raised self-esteem will allow him to be less than some kind of “ideal” self that he feels he is compelled to be. It is the qualities of unconditional positive regard, accurate empathy and genuineness in the humanistic therapist that allow the therapist to assist the client in cultivating congruence between the real self and the ideal self from that client’s perspective.

What the schizophrenic experiences can be confusing. It is clear that most therapists, psychiatrists and clinicians cannot understand the perspectives of the chronically mentally ill. Perhaps if they could understand what it is to feel oneself to be in a solitary prison of one’s skin and a visceral isolation within one’s mind, with hallucinations clamoring, then the clinicians who treat mental illness would be able to better empathize with the mentally ill. The problem with clinicians’ empathy for the mentally ill is that the views of mentally ill people are remote and unthinkable to them. Perhaps the solitariness within the minds of schizophrenics is the most painful aspect of being schizophrenics, even while auditory hallucinations can form what seems to be a mental populace.

Based upon standards that make them feel inadequate, the mentally ill respond to stigma by internalizing it. If the mentally ill person can achieve the goal of congruence between the real self and the ideal self, their expectations regarding who “they should be” may be reconciled with an acceptance of “who they are”. As they lower their high standards regarding who they should be, their acceptance of their real selves may follow naturally.

Carl Rogers said, “As I accept myself as I am, only then can I change.” In humanistic therapy, the therapist can help even a schizophrenic accept who they are by reflecting acceptance of the psychotic individual. This may culminate in curativeness, although perhaps not a complete cure. However, when the schizophrenic becomes more able to accept who they are, they can then change. Social acceptance is crucial for coping with schizophrenia, and social acceptance leads to self-acceptance by the schizophrenic. The accepting therapist can be a key component in reducing the negative consequences of stigma as it has affected the mental ill patient client.

This, then, relates to conditions of worth and the actualizing tendency. “Conditions of worth” affect the mentally ill more severely than other people. Simple acceptance and empathy by a clinician may be curative to some extent, even for the chronically mentally ill. If the schizophrenic individual is released from conditions of worth that are entailed by stigmatization, then perhaps the actualizing tendency would assert itself in them in a positive way, lacking distortion.

In the tradition of person-centered therapy, the client is allowed to lead the conversation or the dialogue of the therapy sessions. This is ideal for the psychotic individual, provided he believes he is being heard by his therapist. Clearly, the therapist’s mind will have to stretch as they seek to understand the client’s subjective perspective. In terms of humanistic therapy, this theory would seem to apply to all individuals, as it is based upon the psychology of all human beings, each uniquely able to benefit from this approach by through the growth potential that is inherent in them. In terms of the amelioration of psychosis by means of this therapy, Rogers offers hope.

Image via Kheng Guan Toh / Shutterstock.

Related Articles:

• The Human Condition and the Mentally Ill
• Psychosis and Psychological Theory
• Cognitive Dissonance and Psychosis – Understanding Inconsistency
• Tackling Schizophrenia Using the Eriksonian Stages
• Joy to the World – Empathy and Positive Emotions
• Reduced Empathy Following Traumatic Brain Injury
• Impaired Awareness of Mental Illness

Based upon my review of the professional literature, I find at least six subtypes noted: predatory, anti-predatory, impulsive, defensive, affiliative, and dominant. Predatory aggression targets those we find to be the most threatening to our well-being. Anti-predatory aggression is aimed at anyone we have an issue with. Road rage is often thought of as impulsive. Parents or coaches behaving badly at youth soccer matches, that I referee, are another example. Some refer to these events as “crimes of passion”. When any of us are threatened personally, we may resort to defensive actions. Affiliative aggression is aimed to protect others dear to us who are being threatened. And finally, males across most cultures are expected to show dominance.

In response to real or perceived threats to our well-being, we can react in three ways: fight, flight, and freeze. We also engage in a thinking process referred to as primary cognitive appraisals. That is, does the event pose a possible harm, a possible loss, or an opportunity of challenge? At a genetic level, we are programmed with a threat alarm, often generated in the part of the brain called limbic. I refer to the limbic brain as are “immediate reactive brain”. From an evolutionary perspective we need to quickly size-up friend or foe.

As a species, we humans cannot be absolutely passive in our environments as it would not bode well based on survival of the fittest. Males especially, are expected to show degrees of aggression and dominance. We are far more likely than females to cross the line and become sexually aggressive, and commit homicide in far greater numbers than our female counterparts. When stressed, males tend to externalize and act out our emotions and blame others. Women tend to internalize difficult emotions and blame themselves. We are far more likely to also kill ourselves. By far, firearms are our chosen tools of action. And in the US, we have plenty of them! In fact, our Constitution protects our right to defend ourselves from threats in this manner. Testosterone, in my clinical opinion, affords males a significant risk. Until, we age into our 40’s and 50’s, we are far more likely to die in accidents than from diseases.

Being raised in dysfunctional and toxic psychosocial environments posses another large risk. Having an anti-social global personality orientation also ups the ante. And of course, over use of psychoactive substances, especially, alcohol, puts us over the top. Though the events at Sandy Hook are having us reconsider care of the mentally ill, the fact is that less than 5% of crimes are committed by our clients!

Sadly, we clinicians are poor predictors of dangerousness. However, ethically, we are charged with 4 simultaneous actions in regard to client dangerousness: protect, warn, predict, and prevent. This is true only when our clients are actively involved in our care. Prevention and reduction of undue aggression and violence is likely to be a multi-faceted endeavor. But, for the sake of all victims of violence, we must give this our very best effort!

References

White, J. M., and Porth, C. M. (2000). Evolution of a model of stress, coping and discrete emotions. In, Handbook of stress, coping and health. Thousand Oaks, CA. Sage.

Lazarus, R. S. (1999). Stress and emotion. New York: Springer.

Lazarus, R. S. (2000). In Handbook of stress, coping and health. Thousand Oaks, CA. Sage.

Bower B. (2006a, May 27). Violent developments. Disruptive kids grow into their behavior. Science News. 169, 328~329.

Stokstad E (2002). Psychology. Violent effects of abuse tied to gene. Science (New York, N.Y.), 297 (5582) PMID: 12161621

Snyder, H. N. 7 Sickmund, M. (2006). Juvenile Offenders and Victims: 2006 national report. Office of Juvenile Justice and Delinquency Prevention.

Burns, G. L. et al. (1997). Disruptive behavior disorder symptoms: Implications. Journal of Abnormal Child Psychology, 110, 516~525.

Rosenthal, Martha S. Human Sexuality: From Cells to Society. Wadsworth Cengage Learning. 2013.

Odeh, M., Zeiss, R., and Huss, M. (2006). Cues they use: clinicians’ endorsement of risk cues in predictions of dangerousness Behavioral Sciences and the Law, 24 (2), 147-156 DOI: 10.1002/bsl.672

Image via val lawless / Shutterstock.

Related Articles:

• Sex, Violence and The Male Warrior Hypothesis
• Gender Competency Principles in Clinical Practice
• Subconscious Mind and the Limbic System
• Media Violence Leads to Real Violence
• Emotions and the Brain
• Woman Comparable to Men in Domestic Violence: Stereotypes and their Consequences
• A Unique Struggle Against Juvenile Huntington’s Disease

In previous studies of personality and health outcomes, neuroticism has been associated with depression, increased chronic disease, high levels of substance abuse, overeating, smoking, and an increased risk of mortality. But, when coupled with high levels of conscientiousness, the conscientiousness mitigates the negative effects of neuroticism. According to the authors, people with high levels of both neuroticism and conscientiousness likely weigh the consequences of their actions and decisions carefully and are unlikely to engage in risky behavior. They also likely strive to prevent and treat illness and chronic disease. No other combination of personality traits revealed the same association with markers of inflammation and chronic disease.

Many nature- and nurture-based factors influence personality, risk taking, and health behaviors. There is likely a genetic component to personality, but that doesn’t explain all the neurotic and conscientious people in the world. But, regardless of why people are the way they are, many can now appreciate that their nervousness and Type-A organizational skills are improving their health. Just when, and if, a personality assessment will be included in medical questionnaires or annual physicals is still up for debate.

References

Majima S, Wada T, & Ikeda M (2012). Pharmacological profiles and results of clinical studies of denosumab (RANMARK®), a human anti-RANKL antibody. Nihon yakurigaku zasshi. Folia pharmacologica Japonica, 140 (6), 295-302 PMID: 23229637

Sutin AR, Terracciano A, Deiana B, Naitza S, Ferrucci L, Uda M, Schlessinger D, & Costa PT Jr (2010). High neuroticism and low conscientiousness are associated with interleukin-6. Psychological medicine, 40 (9), 1485-93 PMID: 19995479

Turiano NA, Mroczek DK, Moynihan J, & Chapman BP (2013). Big 5 personality traits and interleukin-6: Evidence for “healthy Neuroticism” in a US population sample. Brain, behavior, and immunity, 28, 83-9 PMID: 23123863

Image via ktsdesign / Shutterstock.

Related Articles:

• The Personality of Chronic Fatigue
• Are You Depressed Because You’re Introverted?
• Inflammatory Markers Altered in Depression and Suicide
• The Bold and the Beautiful
• The Parkinsonian Personality: A Habit of Highly Successful People?
• Chronic Fatigue Syndrome – A Medical Mystery
• The Beauty of First Impressions

Psychology researchers used functional magnetic resonance imaging to evaluate the neural networks of 21 adults in response to positive and negative emotional stimuli. The participants had an average age of 29 years and had no history of neurological or psychiatric disorders or psychoactive drug use. The participants were given short stories describing a fictional character who shared the same gender and some demographic and trait characteristics as the participant. The participants then underwent neuroimaging while reading sentences that described positive and negative emotional states of themselves and the previously-introduced fictional character. They ranked the level or joy or distress they felt on a 10-point scale.

The brain scans of the participants showed that areas of the brain known to participate in empathy reacted more to negative emotions of others than positive ones. Overall, the authors concluded that humans have a remarkable ability to share the pain and suffering of others, but do not share happiness with the same intensity.

Empathy is fundamental to human emotion and social experience and it has strong evolutionary roots. Empathy provides information about peoples’ actions and about the environment; empathy provides motivation for pro-social behavior, cooperation, and communication — all important survival skills for many species. Understanding and responding to negative emotions allows more of these benefits than reacting to positive emotions. Selfishly, sharing joy has little benefit for an individual, according to the authors of the current study.

Still, happiness and positive emotions are associated with an overall improved well-being, and, while it may be easier for the brain to experience the pain of others, constantly feeling distress carries negative physical consequences for the empathetic individual. Evolution may dictate that negative emotions have more to do with self-preservation and perpetuating the life span of a species than positive ones, but, socially, mentally, and physically, positive emotions are the ones that make life worth living. So, in this joy-filled time of year, challenge your brain to share some cheer, spread some glad tidings, and delight in other’s pleasures and treasures.

References

Bernhardt BC, & Singer T (2012). The neural basis of empathy. Annual review of neuroscience, 35, 1-23 PMID: 22715878

Danziger N, Faillenot I, & Peyron R (2009). Can we share a pain we never felt? Neural correlates of empathy in patients with congenital insensitivity to pain. Neuron, 61 (2), 203-12 PMID: 19186163

de Vignemont F, & Singer T (2006). The empathic brain: how, when and why? Trends in cognitive sciences, 10 (10), 435-41 PMID: 16949331

Perry D, Hendler T, & Shamay-Tsoory SG (2012). Can we share the joy of others? Empathic neural responses to distress vs joy. Social cognitive and affective neuroscience, 7 (8), 909-16 PMID: 22156723

Image via iko / Shutterstock.

Related Articles:

• Empathy – How Much is Too Much?
• Is Happiness Always a Good Thing?
• Social and Physical Pain Share Neural Architecture
• “I Feel Your Pain” – The Neural Basis of Empathy
• Feel Good Foods
• School Bullies – Is the Amygdala to Blame?
• Reduced Empathy Following Traumatic Brain Injury

Self-actualization has been described by Maslow as the ability to transcend levels of physiological, psychological and social needs, to obtain fulfillment of personal needs in terms of life’s meaning. He stated this type of growth to be a linear escalation of fulfillment that is represented by a pyramidal hierarchy. The levels that he describes express these needs and their order of hierarchical transcendence. These needs in order of hierarchical ascension are as follow:

1. Physiological needs represented by hunger, thirst, air and sleep;
2. Safety needs, reflecting the needs for security and protection; (Note that safety needs become prominent in situations of social or political instability);
3. The needs for belongingness and love; these needs can take two forms: (a) The drive to fulfill deficiency-based needs for others in a selfish way by taking instead of giving, and (b) The need for non-possessive and unselfish love based upon growth rather than deficiency;
4. The next level is described by self-esteem needs or the needs for self-respect and positive feelings consequent to admiration; and
5. Lastly, the final stage of self-actualization is reflected by the “being” needs, indicated by the needs for creative self-development in terms of one’s potential toward a goal and a sense of meaning in life.

According to Maslow, creativity is a prominent quality in self-actualizers. It should be noted that self-actualizing people and the needs depicted on his pyramidal hierarchy are descriptively explained by Maslow, as opposed to a explicitly stated in terms of how the fulfillment of them emerges.

Maslow contends that the hierarchical needs must be fulfilled in order of more basic needs to the highest level of needs, or being values, stated to be needs associated with personal meaning in life. The needs within this hierarchy, according to Maslow, must be obtained in a stepwise fashion, such that each level, from survival needs to being values, must be fulfilled at a prior level in order to be fulfilled at the subsequent, higher level. Maslow additionally states, however, that one’s needs may be met only partially at any given moment. It is the contention within this essay that such needs may be fulfilled in any order, given that needs relating to survival may be compromised in a long-term situation even while an individual may be more or less fulfilled in terms of needs for meaning. Additionally, confrontation with life and death may represent a dichotomy that the individual at this point in life is trying to resolve. Seen in this sense, the self-actualized or self-actualizing person may find meaning in confrontation with death and the dialectical contrast between life and death, in particular.

As might be the case if one was faced with the Eriksonian stage of ego integrity versus despair, “being” values or fulfillment regarding life’s meaning may then be actualized even when a person is in a long-term situation of deficiency regarding other needs. Erikson postulated the “ego integrity” versus “despair” stage as feasibly culminating in a sense of meaning in life. A confrontation with life and death may represent a dichotomy that the individual at this point in life is trying to resolve.

Seen in this sense, the self-actualized or self-actualizing person may find meaning in confrontation with death, when safety or physiological needs are threatened. This may be the case regarding the needs of a person who is imprisoned, who finds meaning in his life in spite of incarceration, even while his life may be threatened. Such may have been true of Nelson Mandela, for example, who maintained a sense of meaning and values in the context of imprisonment. Likewise, the individual, Viktor Frankl, was a Holocaust survivor who never relinquished his search that culminated in meaning. Gandhi can be compared with the self-actualizing individual postulated by Maslow. Through non-violent civil disobedience, Gandhi moved India to independence, and he inspired movements for non-violence, civil rights and freedom across the world, in spite of whatever difficulties he endured in terms of satisfying his more basic needs. Personal needs for meaning, such as spiritual needs, may be fulfilled in any circumstance of life. The fact that apparently self-actualized people do find meaning in dire life circumstances for long periods of time lessens support of Maslow’s ideas regarding stepwise fulfillment of the need hierarchy. It is evident that people can find “being values” regarding meaning when they are situated, at least in part, at the lower levels of Maslow’s hierarchy. It should be noted that Maslow would certainly agree that these individuals were self-actualized.

Maslow’s goal was to describe psychologically healthy rather than psychologically or mentally unwell individuals. Maslow contended that the “being” needs or needs for personal meaning allow persons who have obtained the highest level in terms of Maslow’s hierarchy to find meaning in life, and they are able to resolve dichotomies such as the “free-will versus determinism”, “good versus evil” and “subject versus object.” Maslow’s understanding of self-actualization, as indicated, is descriptive, and it has been, to an extent, overlooked as a subjectively based composition of ideas, rather then an empirical science, perhaps largely because self-actualization occurs in the mental realm of the self instead of allowing for observation by the five senses. Additionally and prominently, psychology’s focus on mentally unhealthy people results from an effort to solve the problems associated with mental illness, as opposed to Maslow’s focus on postulations regarding psychologically healthy individuals.

Persons of evident psychopathology, such as Sylvia Plath, might be recognized to be among self-actualizing individuals. Plath’s poem about the birth of her child demonstrated an aspect of her own peak experience in giving birth. In her poem, “Morning Song”, she expresses this experience:

I’m no more your mother
Than the cloud that distills a mirror to reflect its own slow
Effacement at the wind’s hand.

In this, Plath realized personal meaning of what it is to be a mother. Although she had definite indications of mental illness, this did not prevent her from demonstrating creativity in the sense of Maslow’s self-actualizers, and she obviously had moments of insight or epiphanies during her life, in spite of having a mental illness, as well. The abundance of creativity that Maslow said to characterize self-actualizing people is quite strong in the mentally ill, who, as a group, demonstrate creativity to a greater extent than is the norm.

As indicated, Maslow stated that the self-actualized person might love creative pursuits, such a reading or writing poetry and enjoying art. In terms of resolution of paradox, a theory of creativity might be postulated as a basis for understanding self-actualization. Creativity may reflect transcendence in terms of self-actualization that relies on reification of the self through experienced self-awareness. This may burgeon from creative activity as experienced by the self-actualized or self-actualizing person. Creativity is both a conscious and an unconscious process; it is both intentional and unintentional. It results, at least in part, from fortuitous accidents that are built upon and therefore utilized in terms of creativity. Art and its appreciation may lead to “peak experiences”, as described by Maslow to characterize self-actualizers. Embedded within poetry, for example, are graphic illustrations that may allow a perceptive reader to find transformation on the level of the self by means understanding of metaphor and allegory, and such understanding then could be said to be fundamentally “alive” within the individual, as opposed to dogmatically received by the individual. It is the experience of art both by the artist and the reader, seer or hearer that allows for this type of experience.

Creativity unifies the dichotomy of free-will and determinism, if only in the sense that art relies on both causal and freely willed activity, on the part of both the artist and the receiver of artistic expression. Creativity also allows for unification of subject and object, the self and the other, due to the at least somewhat extant bonding of subject or poet and object or appreciator of art. Conscious and unconscious awareness are to some extent unified through artistic expression and reception, as well. Creativity may reside within the essence of dialectical transcendence.

Clearly, poetry, as only one example of art, is both an intrapersonal and an interpersonal activity for both those who express and those who receive poetic expression. Poetry enhances a recapitulation of the psychological self, thought and emotion, serving a communicative function for the poet and the consequent enactment of self-realization by the audience. Deconstruction and reconstruction of the self becomes possible through poetic expression and recognition of an evolving self. Metaphor and allegory, as used in poetic expression, can be represented as a means of creating permeable boundaries that are nevertheless intact, for both the poet and his audience. Self-actualization through poetic expression and reception, or reflective communication, enhances the psychological health of the individual. Moreover, self-actualization becomes possible for both the poet and his audience, as both of these entities will find self-recognition through poetic expression, whether through the process of becoming conscious of the meaning of one’s own words or the words of others. These same processes are apparent in terms of all forms of art.

Ultimately, self-actualization is defined by creativity. Clearly, people may find transcendence through dialectical processes that allow for anyone to find meaning, as opposed to strictly self-actualizers who may have escalated Maslow’s levels of need fulfillment. The merging of thesis and antithesis, culminating in a synthesis of self-realization by means of a personal illumination is expressed at all levels of need fulfillment, even when one’s needs remain unfulfilled because of dire circumstances. Spiritual epiphanies find us at markedly difficult times and when needs are compromised severely. This may represent an aspect of the conscious and the unconscious, the intentional and the unintentional creative aspects of self, mind and existence. In contrast to Maslow’s contention, any creative individual may have an avenue to being values and meaning. More or less, we are all creative individuals.

Image via Pixelbliss / Shutterstock.

Related Articles:

• What is in a Brand Name which Appeals to the Brain?
• Humanistic Theory and Therapy, Applied to the Psychotic Individual
• Tackling Schizophrenia Using the Eriksonian Stages
• Cults and Terrorism, Part 6 – Leader-Follower Traits
• What is Creativity? Art as a Symptom of Brain Disease
• The Art of Medicine
• Psychosis and Psychological Theory

You said I got something to say. Then you got that look in your eye.

You can hear Brad Arnold of the band 3 Doors Down singing “behind those eyes you hide.” The eyes tell a lot about our physical and emotional well-being. You may have heard that the eyes are the window to the soul. Now scientists believe that the eyes can also tell if someone has schizophrenia. Schizophrenia is a complicated disorder that affects the way a person thinks, acts, expresses emotions, and perceives reality. This disabling condition leaves its victim frightened and withdrawn. A recent research publication in Biological Psychiatry informs us that eye movements are associated with schizophrenia. Simple viewing patterns can detect abnormalities of eye movement that allow doctors to discriminate schizophrenia from control subjects with surprising precision.

Behind those eyes you lie and there’s nothing I can say.

Psychiatrists have been researching impaired eye movements as they related to schizophrenia for over a hundred years. Experts already knew that people with schizophrenia had established deficits in their ability to follow slow-moving objects with their eyes. When they attempted this, their eye movements did not match the trajectory of the moving object, and the result was a rapid eye movement. Now, lead researchers Drs. Benson and St. Clair report that by using a series of simple viewing tests, schizophrenics can be distinguished from other people. These doctors devised a model to test eye movement that has an impressive 98% accuracy rate for diagnosing schizophrenia.

As you turned to walk away I saw another look in your eye.

The study involved 88 people with schizophrenia and 88 control subjects. Benson, St. Clair, and colleagues assessed eye movements during smooth pursuit, fixation stability, and free-viewing tasks. The group differences regarding performance measures were evaluated by multivariate and univariate methods. The results showed that, as a group, the schizophrenia cases differed from the control subjects in many ways. The eye movement tests included the Lissajous pursuit, the horizontal pursuit, and the visual scanpath. The effects were found to be consistent over time and to have no correlation with medication, cigarette smoking, or gender.

Behind those eyes you lie, behind those eyes you hide…

Benson and St. Clair report that a predictive model with such accuracy could possibly be used in hospitals and mental health centers to assist physicians by enhancing and appending other symptom-based diagnostic criteria. Because the experts devised a model that has 98% precision, it can be a useful tool in the diagnosis of schizophrenia.  The authors reported that they also have unpublished information showing that eye movement pattern abnormalities are specific to other psychiatric subgroups. They plan to continue their research in hopes of using these findings for routine clinical practice.

References

Benson PJ, Beedie SA, Shephard E, Giegling I, Rujescu D, & St Clair D (2012). Simple viewing tests can detect eye movement abnormalities that distinguish schizophrenia cases from controls with exceptional accuracy. Biological psychiatry, 72 (9), 716-24 PMID: 22621999

Pedersen, T. (2012). Eye test identifies people with schizophrenia. PsychCentral.com.

Image via Inga Dudkina / Shutterstock.

Related Articles:

• Vulnerability-Stress-Coping Model for Schizophrenia
• Are Physicians Spending Too Much Time Diagnosing Patients?
• My Nephew and his Brain, Part 1 – Introduction
• Integration of the Biopsychosocial Model in Contemporary Psychiatry
• Free Will is NOT An Illusion
• The Anti-Psychiatry Movement
• Schizophrenia and Bipolar Disorder Share Genetic Links

The latest research, conducted by Italian gastroenterology experts, explains that lactose intolerance, a subjective experience, is often attributed to lactose malabsorption, an objective, diagnosed condition. However, the relationship is far from proven, and the presentation of lactose intolerance symptoms varies with the type and amount of dairy product ingested. For the study, 102 patients underwent a lactose hydrogen breath test — the most reliable method for diagnosing lactose malabsorption. The patients also reported symptoms of lactose intolerance on a subjective scale and they completed a psychological symptom checklist and a health-related quality of life survey.

Lactose malabsorption was diagnosed in 18% of the patients, while lactose intolerance was reported in 25% of patients. The two conditions were not associated with each other. Interestingly, the severity of intolerance symptoms was the lowest among patients with malabsorption. Somatization (the presence of clinically relevant symptoms with no identifiable cause) is blamed for the intolerance-related complaints. Patients with a high level of somatization reported the lowest quality of life. Patients with malabsorption did not report poor quality of life.

Lactose malabsorption is the inability of the body to completely digest lactose due to a deficiency of the enzyme lactase. This condition may occur as a primary disorder or secondary to a gastrointestinal disease. Lactase activity may also decline with age, resulting in nearly 75% of the world’s adults losing the ability to digest lactose at some point during their lives. However, not all of these people will experience symptoms consistent with lactose intolerance such as bloating, abdominal pain, diarrhea, and vomiting. A lactose-restricted diet often leads to decreased symptoms of intolerance, but it also carries the nutritional disadvantages of reduced calcium and vitamin intake.

True lactose malabsorption is difficult to diagnose, and, as new research points out, symptoms are not a reliable indicator of absorption ability. Symptoms associated with lactose intolerance may be little more than psychological manifestations that can lead to impaired quality of life. Subjective, non-pathological health complaints are common among the general population, and gastrointestinal symptoms account for many of these complaints. Somatization disorders are often difficult to identify and the authors of the current study do not recommend a therapeutic approach for patients complaining of lactose intolerance. But, they suggest that a cognitive approach may prove more useful than a medical or pharmacological approach.

References

Mattar R, de Campos Mazo DF, & Carrilho FJ (2012). Lactose intolerance: diagnosis, genetic, and clinical factors. Clinical and experimental gastroenterology, 5, 113-21 PMID: 22826639

Olivier CE, Lorena SL, Pavan CR, Dos Santos RA, Dos Santos Lima RP, Pinto DG, da Silva MD, & de Lima Zollner R (2012). Is it just lactose intolerance? Allergy and asthma proceedings : the official journal of regional and state allergy societies, 33 (5), 432-6 PMID: 23026186

Tomba C, Baldassarri A, Coletta M, Cesana BM, & Basilisco G (2012). Is the subjective perception of lactose intolerance influenced by the psychological profile? Alimentary pharmacology & therapeutics, 36 (7), 660-9 PMID: 22860690

Usai-Satta P, Scarpa M, Oppia F, & Cabras F (2012). Lactose malabsorption and intolerance: What should be the best clinical management? World journal of gastrointestinal pharmacology and therapeutics, 3 (3), 29-33 PMID: 22966480

Image via Gayvoronskaya_Yana / Shutterstock.

Related Articles:

• Hypnosis and Chronic Pain
• If You’re Happy and You Know It, You Must Be Over 50
• Spirituality Improves Mental Health
• Caring for Our Greatest Generations
• Take Two of These… And You Still Might Have Pain
• Gender Affects Treatment Delays for Heart Disease
• Eating Disorders in the Emergency Department

The study was conducted at the University of Michigan Medical Center in Ann Arbor. Patients aged 14 to 20 years who presented to the ED were screened for behavior consistent with disordered eating by completing a 20-minute computerized survey. The survey evaluated the presence of eating disorders, depressive symptoms, and risky drinking behavior. In all, 942 patients, with an average age of 17.7 years, completed the survey. A total of 16% of the patients screened positive for an eating disorder; nearly three-quarters of these patients were female. There was no difference in the prevalence of eating disorders among different economic or ethnic groups.

The body mass index (BMI) was higher for patients with eating disorders than those without, and eating disorder patients were 3 times as likely to be obese. Patients with an eating disorder were also 3 times more likely to have symptoms of depression and 2 times as likely to engage in risky drinking behavior, smoke cigarettes and marijuana, and abuse stimulants and other drugs. Patients with an eating disorder were also 1.6 times more likely to use the ED compared to those without an eating disorder; the most common complaints on presentation to the ED were abdominal pain and gastrointestinal problems.

While descriptions of waif-like supermodels dominate the eating disorder conversation, the results of this study confirm the fact that, today, eating disorders associated with too little caloric intake (such as anorexia nervosa) represent a minority of disordered eating behaviors. Binge eating is the most common eating disorder, which causes weight gain and related physical and psychiatric comorbidities.

Eating disorders are complex and difficult for a physician — or even, sometimes, a patient — to recognize. And, in general, ED physicians provide incomplete and inconsistent documentation of mental health issues, particularly in younger patients. However, with the increasing prevalence of eating disorders, and associated mortality rates, every physician should be aware of the signs and symptoms of disordered eating and be prepared to offer further evaluation, screening, and treatment options.

References

Cappelli M, Glennie JE, Cloutier P, Kennedy A, Vloet M, Newton A, Zemek R, & Gray C (2012). Physician management of pediatric mental health patients in the emergency department: assessment, charting, and disposition. Pediatric emergency care, 28 (9), 835-41 PMID: 22929135

Crow SJ, Peterson CB, Swanson SA, Raymond NC, Specker S, Eckert ED, & Mitchell JE (2009). Increased mortality in bulimia nervosa and other eating disorders. The American journal of psychiatry, 166 (12), 1342-6 PMID: 19833789

Dooley-Hash S, Banker JD, Walton MA, Ginsburg Y, & Cunningham RM (2012). The prevalence and correlates of eating disorders among emergency department patients aged 14-20 years. The International journal of eating disorders, 45 (7), 883-90 PMID: 22570093

Dooley-Hash S, Lipson SK, Walton MA, & Cunningham RM (2012). Increased emergency department use by adolescents and young adults with eating disorders. The International journal of eating disorders PMID: 23044650

Grover CA, Robin JK, & Gharahbaghian L (2012). Anorexia nervosa: a case report of a teenager presenting with bradycardia, general fatigue, and weakness. Pediatric emergency care, 28 (2), 174-7 PMID: 22307188

Mascolo M, Trent S, Colwell C, & Mehler PS (2012). What the emergency department needs to know when caring for your patients with eating disorders. The International journal of eating disorders, 45 (8), 977-81 PMID: 22707235

Image via SeanPavonePhoto / Shutterstock.

Related Articles:

• Dying To Be A Good Mom – Eating Disorders In Pregnancy
• BED-head and Obesity – Food for Thought
• Barriers to Emergency Contraception
• Self-Injury and the Internet
• Cognitive Behavioral Therapy for Bulimia Nervosa – A Success Story
• Problem Eating Behavior in Preschool Children
• Mental Health Disorders Prevalent Among Youth Worldwide

The authors of the new study evaluated the effects of a nature walk on 20 adults with major depressive disorder. The individuals completed baseline assessments of mood and memory span. At the participant’s first encounter, they were asked to ruminate about an unresolved negative experience in their own lives. They were then assigned to take a 50-minute walk, either in a natural setting or an urban one. After the walks, mood and memory were reassessed. One week later, the participants repeated the entire procedure, but walked in the location that they did not in the first session.

Significant improvements in mood and memory span were observed after the nature walks compared to the urban walks. Overall, the authors report that nature-based exercise could be considered a viable treatment for depressive disorders. The study is published in a recent issue of Journal of Affective Disorders.

Numerous studies have shown positive associations between green environments and physical and mental health. Exercising in nature is related to a feeling of revitalization, positive social engagement, increased energy, and decreased anxiety, confusion and depression. People who engage in outdoor activities report greater joy, satisfaction, and self-esteem compared to those who complete indoor activities, and natural environments promote exercise adherence more than indoor environments.

The restorative effects of natural environments are difficult to quantify, but the great outdoors is definitely calling. With an obesity epidemic and a generation of youngsters who barely know how to ride a bike or throw a ball, encouraging outdoor activities should be a top public health initiative of every physician, teacher, parent, and neighbor. Take a hike, stop and smell the roses, listen to the song of a bird or the babble of a brook. Go to nature to be soothed and healed.

References

Barton J, Griffin M, & Pretty J (2012). Exercise-, nature- and socially interactive-based initiatives improve mood and self-esteem in the clinical population. Perspectives in public health, 132 (2), 89-96 PMID: 22616429

Barton J, & Pretty J (2010). What is the best dose of nature and green exercise for improving mental health? A multi-study analysis. Environmental science & technology, 44 (10), 3947-55 PMID: 20337470

Berman MG, Kross E, Krpan KM, Askren MK, Burson A, Deldin PJ, Kaplan S, Sherdell L, Gotlib IH, & Jonides J (2012). Interacting with nature improves cognition and affect for individuals with depression. Journal of affective disorders, 140 (3), 300-5 PMID: 22464936

Pretty J, Peacock J, Sellens M, & Griffin M (2005). The mental and physical health outcomes of green exercise. International journal of environmental health research, 15 (5), 319-37 PMID: 16416750

Sugiyama T, Leslie E, Giles-Corti B, & Owen N (2008). Associations of neighbourhood greenness with physical and mental health: do walking, social coherence and local social interaction explain the relationships? Journal of epidemiology and community health, 62 (5) PMID: 18431834

Thompson Coon J, Boddy K, Stein K, Whear R, Barton J, & Depledge MH (2011). Does participating in physical activity in outdoor natural environments have a greater effect on physical and mental wellbeing than physical activity indoors? A systematic review. Environmental science & technology, 45 (5), 1761-72 PMID: 21291246

Image via robert_s / Shutterstock.

Related Articles:

• Going Green for Health Inequality
• The Right Amount of Exercise for Improved Mental Health
• Games to Prevent Alzheimer’s Disease
• Mental Healthcare on the Go – There’s an App for That
• Sleep Is Important for Next Day Memory Formation
• Exercise for Depression – A Gold Standard Therapy
• Strike a Pose to Reduce Anxiety

Researchers assembled a sample of 62 parents of children aged 2-3 years. They assessed the parents’ knowledge of child development processes and milestones, as well as effective parenting strategies. The parents also self-reported parenting dysfunction, nurturing, confidence, affective states, and child behavior. In-home observations assessed parent-child interactions and negative or problematic child behavior.

Not all that surprising, the authors of the study concluded that the more parents understood effective parenting strategies, the less dysfunction, anxiety, and problem behavior they reported. Similarly, a higher level of parenting knowledge was associated with observed positive parenting competence. Limiting the general applicability of the results is the fact that the parents in the study were mostly white, with a middle-to-high socioeconomic status.

The American Psychological Association, the US Centers for Disease Control and Prevention, the World Health Organization, and the Institute of Medicine have all recommended implementing training programs to teach evidence-based parenting in order to reduce the prevalence of child maltreatment, inadequate parenting, and behavioral and emotional problems in children. But, while “evidence-based” is common medical vernacular, most parents would shy away from turning child-rearing into an outcomes-based science experiment. (And, it would ruin the American learn-as-you-go parenting style!)

Still, public health interventions focusing on high-risk parent groups have shown promising results in reducing adverse childhood outcomes. But, is it even possible to teach entire populations to follow evidence-based parenting strategies?  Programs that are effective and appropriate will offer education and support to parents, but each group of parents – whether divided by age, socioeconomic status, or even geography – needs different information and support, and universal programs would likely leave parents who need the most help unserved.

Good parents need knowledge and confidence, and a few special talents, to raise healthy, happy, and well-functioning children. Just when to start building these skills and who should teach the skills, though, are larger questions.

References

Arria AM, Mericle AA, Rallo D, Moe J, White WL, Winters KC, & O?connor G (2012). Integration of Parenting Skills Education and Interventions in Addiction Treatment. Journal of addiction medicine PMID: 23079483

Maguire ER (2012). Exploring Family Risk and Protective Factors for Adolescent Problem Behaviors in the Caribbean. Maternal and child health journal PMID: 23054459

Bjørknes R, & Manger T (2012). Can Parent Training Alter Parent Practice and Reduce Conduct Problems in Ethnic Minority Children? A Randomized Controlled Trial. Prevention science : the official journal of the Society for Prevention Research PMID: 23135877

Morawska A, Winter L, & Sanders MR (2009). Parenting knowledge and its role in the prediction of dysfunctional parenting and disruptive child behaviour. Child: care, health and development, 35 (2), 217-26 PMID: 19134009

Winter L, Morawska A, & Sanders M (2012). The Knowledge of Effective Parenting Scale (KEPS): a tool for public health approaches to universal parenting programs. The journal of primary prevention, 33 (2-3), 85-97 PMID: 22528199

Image via hartphotography / Shutterstock.

Related Articles:

• Does Having ADHD Mean Doing Poorly in School?
• Prevention of Adolescent Depression
• Careful with that Axe – The Effects of Criticism on Autistic Symptoms
• Problem Eating Behavior in Preschool Children
• How To Talk To Kids About Sex
• ADHD – A Very Incomplete Puzzle
• Public Health Needs a Shot in the Arm

The study, conducted by psychologists at the University of Wisconsin, included three separate investigations that evaluated pacifier use and emotional health. For the first study, parents of 106 first- and second-grade children in France completed a questionnaire about their child’s pacifier use and thumb-sucking as babies and infants. The children were independently asked to watch a video of different emotions and mimic those expressions. (Facial mimicry is a component of emotional development.) For the second and third studies, college students from across the United States and France were asked to self-report pacifier use and thumb-sucking during their own childhoods, as well as complete surveys of emotional intelligence and reactivity and attachment to other people.

Each investigation led to the same conclusion: boys who used pacifiers frequently had lower emotional competence than other groups. According to the authors, boys who used a pacifier during the day had a difficult time mimicking the facial expressions and emotions of others, which makes it harder to express their own emotions.

While the study cannot draw definite cause-and-effects conclusions, the authors do report that the results remained consistent, regardless of other factors such as demographics, education levels, personalities and temperaments, and environment. Across all the investigations, a longer duration of pacifier use was associated with a greater degree of emotional incompetence. Thumb-sucking did not lead to the same effects, nor did girls who used a pacifier show emotional deficits. Night-time only pacifier use was not associated with negative consequences, either.

Pacifier use is controversial, with different organizations making different recommendations. The World Health Organization recommends limiting the use of pacifiers to reduce dental abnormalities and the incidence of ear infections. But, the American Academy of Pediatrics recommends pacifiers as a protective measure against Sudden Infant Death Syndrome for children under one year old. However, pacifiers have proven beneficial in analgesia for newborns and infants and reducing hospitalizations in preterm infants.

The study, published in Basic and Applied Social Psychology, cautions parents to consider limiting pacifier use in order to encourage emotional health. Many parents (and children) are reluctant to take away a pacifier, relying on it for comfort, security, and a little bit of quiet. Like everything else in parenthood, the decision to use a pacifier is a balancing act. Parents should consider the risks and benefits of a pacifier with their child’s physician and dentist and limit its use when the time is right.

References

Hauck FR, Omojokun OO, & Siadaty MS (2005). Do pacifiers reduce the risk of sudden infant death syndrome? A meta-analysis. Pediatrics, 116 (5) PMID: 16216900

Keim SA, Fletcher EN, TePoel MR, & McKenzie LB (2012). Injuries associated with bottles, pacifiers, and sippy cups in the United States, 1991-2010. Pediatrics, 129 (6), 1104-10 PMID: 22585773

Niedenthal PM, Augustinova M, Rychlowska M, et al. Negative relations between pacifier use and emotional competence. Basic and Applied Social Psychology. 2012; 34:387-394. DOI: 10.1080/01973533.2012.712019

Sexton S, & Natale R (2009). Risks and benefits of pacifiers. American family physician, 79 (8), 681-5 PMID: 19405412

Soxman JA (2007). Non-nutritive sucking with a pacifier: pros and cons. General dentistry, 55 (1) PMID: 17333970

Image via Nomad_Soul / Shutterstock.

Related Articles:

• Sibling Risk of Autism
• Colic and Probiotics – A Cure for the Crying?
• Emotions and the Brain
• Female Teachers’ Math Anxiety Negatively Affects Female Students
• The Curbside Consult
• Who Should Decide the Survivability of Newborns?
• Stimulants May Offer Protection in ADHD

Psychopharmacology is in crisis. The data are in, and it is clear that a massive experiment has failed: despite decades of research and billions of dollars invested, not a single mechanistically novel drug has reached the psychiatric market in more than 30 years. Indeed, despite enormous effort, the field has not been able to escape the “me too/me (questionably) better” straightjacket. In recent years, the appreciation of this reality has had profound consequences for innovation in psychopharmacology because nearly every major pharmaceutical company has either reduced greatly or abandoned research and development of mechanistically novel psychiatric drugs. This decision is understandable because pharmaceutical and biotechnology executives see less risky opportunities in other therapeutic areas, cancer and immunology being the current pipeline favorites. Indeed, in retrospect, one can wonder why it took so long for industry to abandon psychiatry therapeutics. So how did we get here and more importantly, what do we need to do to find a way forward?

The discovery of all three major classes of psychiatric drugs, antidepressants, antipsychotics, and anxiolytics, came about on the basis of serendipitous clinical observation. At the time of their discoveries, the mechanisms by which these molecules produce their effects were unknown, and it was only later that antipsychotics were shown to be D2 receptor antagonists, antidepressants monoamine reuptake inhibitors, and anxiolytics GABA receptor modulators. It is interesting and perhaps instructive to consider whether any of these classes of drugs could have been discovered by current drug discovery strategies. For example, what genetic or preclinical data exist that point to the D2 dopamine receptor as a likely target for antipsychotic activity? Presently there are no genetic data that suggest that this receptor is expressed or functions abnormally in psychotic disorders (emphasis added). And without the benefit of the prior clinical validation, it is difficult to see how preclinical data alone would point to the D2 receptor as an interesting potential target for the treatment of psychotic disorders. The same can be said for monoamine transporters with respect to depression where, like psychosis, there are no animal models based on disease pathophysiology and no compelling preclinical data pointing to these as potential targets for antidepressant drugs. This raises a troubling question: if in retrospect the three major classes of currently prescribed psychiatric drugs would likely never have been discovered using current drug discovery strategies, why should we believe that such strategies are likely to bear fruit now or in the future?

Given that there cannot be a coherent biology for syndromes as heterogeneous as schizophrenia, it is not surprising that the field has failed to validate distinct molecular targets for the purpose of developing mechanistically novel therapeutics. Although it has taken our field too long to gain this insight, we seem to be getting there. For example, at the 2011 meeting of the American College of Neuropsychopharmacology, the need for change and the need for new strategies were predominant themes.

In summation the excitement in the past two decades about the “Decades of the Brain” are fading to realism. Our human genome is much more complex than we can imagine. Half of our genes are devoted to brain form and function. The interaction between geneotype and phenotype is also more complex that we realize. Thus, we are approaching this science with more skepticism and realism.

Reference

Fibiger HC (2012). Psychiatry, the pharmaceutical industry, and the road to better therapeutics. Schizophrenia bulletin, 38 (4), 649-50 PMID: 22837348

Image via Kuzmin Andrey / Shutterstock.

Related Articles:

• Fatty Acids and Suicide Risk
• Are Generic Drugs Really Equivalent to Brand Name Drugs?
• New Antipsychotic Agent in the US Market
• Salvia Divinorum – DEA Control over Magic in the Mint
• The Ethics of Selling Prescription Data
• Preventing Schizophrenia, Part 1 – Overview
• Off-Label Use of Psychiatric Medications Common for Veterans