Wednesday, December 17, 2014

In the Blogs: The Real Connection Between Ambition And Mental Health

By Carolyn Gregoire for The Huffington Post

We're a culture that tends to define success in terms of money and power. But finding other ways to measure self-worth isn’t just intrinsically worthwhile -- it could help prevent a troubling mental health diagnosis.

How one views social status, including financial status, can predict mental health problems including bipolar disorder, narcissistic personality disorder, anxiety and depression, according to a new study from the University of California at Berkeley.

The research, which was published this month in the journal Psychology and Psychotherapy: Theory, Research and Practice, applied the “dominance behavioral system" -- a model used to explain how humans and animals assess their position in social hierarchies -- to 600 young men and women, particularly focusing on their motivation to achieve wealth and power.

Whether they achieved success by these definitions or not, the outcome was dim: A deflated sense of power or disappointment in social standing was associated with a higher risk of depression and anxiety, while excessive striving and ambition meant a higher risk of bipolar disorder and narcissistic personality disorder.

Previous research supports this connection: A 2010 study found that people who live in developed countries with very high levels of income inequality are three times more likely to suffer from depression or anxiety disorders than people living in developed nations that are more economically uniform. Countries with particularly large gaps between rich and poor, the new research suggests, may foster cultures of intense striving for wealth and power, in which it's easy for an individual's self-worth to become deeply intertwined with their social status.

The Huffington Post spoke to Berkeley psychologist Sheri Johnson, the study's lead author to learn more about the role social status plays in mental health.

Why did you decide to apply an animal behavioral model to humans?

Most of us are used to the idea that we live within a system of social dominance, or that there's some sort of rank order or sense of hierarchy among people. That's interesting to me because it's got some deep roots -- most animals who live in packs have a sense of hierarchy. There are a lot of scientists who study this in animal models. What we've been working on, a long with a lot of other researchers, is the idea that there are a lot of pieces in how to think about our social hierarchy.

How do people conceive of power?

First, you can think about the level of power you have within any one hierarchy. Do you feel like you have the power to influence people? Second on the list might be how important it is for you to have that power -- so motivation for power, and comfort with having power. Some people really want to get to the top and others are happy in the middle, and others are just trying to avoid being at the bottom. Then, we also look at the strategies people use to attain power.

Finally, it's a question of, how do you feel emotionally when the power has been attained? There, we draw on the work of Jessica Tracey, who's shown that pride is an emotion that's triggered when you have a sense of having attained power.

What kind of differences have you observed in how people judge the importance of achieving high levels of wealth and power?

Research shows that we're really varied in how much we put our investments into attaining power and the admiration of other people. There are some people who are really motivated to make sure that other people are admiring them and respecting them because that's one form of attaining a sense of social dominance. So their ambitions might have more to do with being recognized by other people than by their own intrinsically satisfying activities.

Psychologists talk about the idea that you can pursue either extrinsically-oriented life motivations or intrinsically-oriented life motivations. Intrinsic motivations might be "I want to be very close to people," "I want to feel like my life has meaning," "I want to feel like I'm doing something good for the universe." Extrinsic ambitions might be things like "I want to make sure that I'm wealthier than other people," "I want to be viewed by others as having influence and power."

As you can imagine, people set very different priorities on those two broad levels of organizing their lives. What they've shown is that for college seniors who put their focus on these extrinsically oriented life goals, that's going to predict less life satisfaction over time. It's an unhappy way to set your life goals.

Are people who are more invested in power more likely to suffer from mental health problems?

Certainly that story holds for people with anxiety and depression. People who put their value on a set of goals related to attaining power -- and then experience profound sense of subordination and not making it to those goals -- are at high risk for anxiety and depression.

For narcissism, we're not as sure which direction it plays out. We don't have the longitudinal evidence. We do know that this is a group where it seems very important to people to attain power. They've put their focus on this, and there's a kind of steadfast over-pursuit of this. Which came first, we don't really know. And with people with bipolar disorder, we know that if they really value the pursuit of fame and money, they are more likely to have worse symptoms over time. It's not a good focus for them.

How can we create a healthy self-image that isn't based on extrinsic factors like our perceived social status or levels of power?

There really are these two forms of pride. Beyond hubris, there's something that Tracey calls "authentic pride," which is more carefully rooted in what you've accomplished and what things about yourself are important treasure. So instead of just the fight to make sure that you feel like you're superior to other people, authentic pride would involve nurturing along a set of beliefs about why you genuinely do have value, and that there are things about yourself you want to value.

Is there a measurable correlation between our cultural obsession with achieving ever-higher levels of money and power, on the one hand, and the well-documented rise of mental illness on the other?

Countries with extreme levels of income inequality have worse mental health, and that seems well-documented even after you take into account the level of overall level wealth or poverty in the country. It's the disparity that seems particularly toxic to mental health. That's very consistent with the idea that in countries where there are greater levels of striving for money in an individualist way, that's probably bad for mental health. That's one piece that certainly points in that direction, and it's a piece that's well-studied.

We've done a little bit of work on the level of individualistic striving in a country, and we've seen that rates of mania are higher in countries whose cultural values emphasize more individualistic striving. There's some evidence on the table that this is really a concern on a cross-cultural level.

What does your data suggest in terms of possible solutions, or at least different ways of looking at these mental health problems?

We haven't tackled treatment yet, but there's a man in England named Paul Gilbert who does a lot of treatment work. He has designed something called self-compassion therapy, which looks very promising here. It's an attempt to help people learn to provide themselves with more compassion and acceptance.

One way to think about this is that you're paying too much attention to trying to gain other people's admiration, and to have enough power and enough social rank. Sometimes, you're not giving yourself enough compassion and enough room to pursue the things that are really intrinsically meaningful to you. His therapies seem to help people re-anchor themselves in those sort of internally driven ways. It's been shown to work really nicely for depression and anxiety.

Saturday, December 13, 2014

In the Blogs: The Downside Of Treating Mental Illness Like A Physical Problem

By Lindsay Holmes  

One of the most established arguments in the fight against mental health stigma is a biological one. Those struggling with mental illness deserve the same level of empathy as those struggling with physical illness, the narrative goes. To accomplish this, many highlight the underlying neurological and chemical explanations for their disorders.

But according to a new study, this may be a losing strategy: A team of researchers from Yale University found that doctors were less compassionate toward mental health patients when their illnesses were described by biological rather than emotional terms.

"Biological explanations are like a double-edged sword," Matthew Lebowitz, lead study author, said in a statement. "They tend to make patients appear less blameworthy but the overemphasis on biology to explain psychopathology can be dehumanizing by reducing people to mere biological mechanisms."

Researchers asked therapists and psychiatrists to review mental health patients' symptoms, which were explained either through genetics and neurobiology or by childhood experiences and stressful life circumstances. Despite common wisdom that biological explanations for mental health issues should reduce the shame patients receive for their condition, clinicians in the study reported feeling less compassionate toward patients whose symptoms were explained by biological factors.

The clinicians also viewed psychotherapy as a less viable treatment option when reviewing the patients' biological explanations, which the authors note is quite problematic. According to previous research, psychotherapy is one of the most effective ways to treat mental health disorders.

The study provides a surprising perspective to the challenge of fighting stigma associated with mental health issues. Only 25 percent of people with mental health disorders feel that others are caring and understanding about their condition. Experts stress that mental illness is not something under a patient's control, reaffirming the notion that biological reasoning for psychiatric conditions should bring out more empathy from others -- not less.

Instead, it seems, doctors are as subject as the rest of us to the power of personal narrative. "We're certainly not saying that people should ignore biological factors when studying mental disorders, but it's crucial to understand biology as something that's part of all human experience, rather than something that separates so-called mentally ill people from everyone else," Woo-kyoung Ahn, Yale professor of psychology and study co-author, wrote in the report.

The research was published in the Proceedings of the National Academy of Sciences.

Need help? In the U.S., call 1-800-273-8255 for the National Suicide Prevention Lifeline.

Tuesday, December 9, 2014

From the BrainPickings newsletter: Lynda Barry’s Syllabus: An Illustrated Field Guide to Keeping a Visual Diary and Cultivating the Capacity for Creative Observation


How to master the infinitely rewarding art of “being present and seeing what’s there.”

“It gives me such a sense of peace to draw; more than prayer, walks, anything,” Sylvia Plath wrote in her diary when she first began working on her little-known drawings“The great benefit of drawing … is that when you look at something, you see it for the first time,” the great Milton Glaser observed in sharing his wisdom on life“And you can spend your life without ever seeing anything.”

Hardly anyone has explored this delicate relationship between drawing and looking, drawing and experiencing, drawing and thinking with more rigor, wit, and insight than Lynda Barry, one of the greatest visual artists of our time. In 2011, Barry joined the faculty at the University of Wisconsin to teach a class titled “The Unthinkable Mind” — a wonderfully unusual interdisciplinary course exploring the biological function of the arts and the psychological mechanisms of the creative impulse by blending cognitive science, visual art, and writing. Barry’s magnificently illustrated syllabus notes and class assignments, many of which she had released on her Tumblr throughout each semester, are now collected inSyllabus: Notes from an Accidental Professor (public library | IndieBound) — a slim but infinitely invigorating compendium of illustrated exercises, instructions, and meditations on everything from how to keep a diary (because, as we know, the creative benefits of doing so are vast) to memorizing things effectively to navigating the psychological phases of the creative process to why art exists in the first place.

Echoing Joan Didion’s unforgettable reflections on keeping a notebook, Barry traces her own journey and what is to be gained by those endeavoring to master this simple, powerful practice:

I began keeping a notebook in a serious way when I met my teacher Marilyn Frasca in 1975 at the Evergreen State College in Olympia, Washington.

She showed me ways of using these simple things — our hands, a pen, and some paper — as both a navigation and expedition device, one that could reliably carry me into my past, deeper into my present, or farther into a place I have come to call “the image world” — a place we all know, even if we don’t notice this knowing until someone reminds us of its ever-present existence.

I wasn’t quite 20 years old when I started my first notebook. I had no idea that nearly 40 years later, I would not only still be using it as the most reliable route to the thing I’ve come to call my work, but I’d also be showing others how to use it too, as a place to practice a physical activity — in this case writing and drawing by hand — with a certain state of mind.

This practice can result in … a wonderful side effect: a visual or written image we can call “a work of art”; although a work of art is not what I’m after when I’m practicing this activity.

What am I after? I’m after what Marilyn Frasca called “being present and seeing what’s there.”

While Barry’s exercises are decidedly and refreshingly practical, they don’t shy away from the philosophical — she explores subjects like the eternal question of what makes good art and how drawing can change our already elastic perception of time. Along the way, she illuminates these questions by assigning readings as diverse as Emily Dickinson’s poetry and Iain McGilchrist’s The Master and His Emissary: The Divided Brain and the Making of the Western World.

All in all, Barry’s Syllabus makes not only tangible but also practically attainable the deep intuition that some of history’s greatest minds have articulated — the idea that keeping a notebook or a diary, whether visual or otherwise, is one of the most consciousness-expanding ways of bearing witness to our experience and our journey through this world.

In the Blogs: Has a Harvard Neurologist Discovered the Cure for Insomnia?

By John Cloud

The night before I met Patrick Fuller, a 39-year-old neurologist at Harvard Medical School who just discovered an area in the brain that could unlock the mysteries of sleep, I stayed in a hotel that offered a bedside remedy called “Dream Water.” About the size of a 5-Hour Energy drink, it was fortified with melatonin (a hormone often used as a sleep aid) and, more important, gamma-hydroxybutyrate, or GABA, the neurochemical that makes us sleep. While GABA’s importance has been understood for decades, doctors and drugmakers have only been able to make use of it in relatively crude ways. The existence of a product like Dream Water is a testament to the fact that we are a nation still struggling desperately to get its Zs.

For me, waking up at 2 a.m. and never falling back asleep is pretty normal. I can’t remember the last time I woke up feeling well-rested. In that respect, I'm far from alone. According to the Centers for Disease Control, approximately 30 million Americans 16 years and older have endured at least 30 consecutive days of “insufficient rest.” In the South, the nation's tiredest region, one in five people has a sleep disorder. 

The next morning, I woke up at 4:45 a.m. Not the 7:30 I’d been shooting for, but not too bad by my standards. As I prepared for the day, I was curious whether Fuller would give me hope that I’ll rest better in the years ahead.

Since the 1970s, millions of studies around the globe have focused on human sleep. During the same period, pharmaceutical companies have created myriad products to address insomnia, including plenty of blockbusters. Americans spend billions of dollars every year on sleep drugs, but a well-understood and regrettable secret of the pharma industry is that none is very good. We can knock you out, but you may not feel right for a day or so. We can softly sedate you, but you may spring wide awake four hours later. The best-known drugs in the category -- including barbiturates, benzodiazepines, and z-class hypnotics like Ambien and Lunesta -- work by manipulating the behavior of GABA in the upper part of the brain. But many neurologists have long suspected that there is probably a better way to induce deep sleep.

The research Fuller and his team published in the journal Nature Neuroscience in October could be the solution. It's possible that the cure to insomnia lies in the tiny region they recently discovered in the brain stem -- the part of the brain that, among other things, helps controls the basic functions of our hearts and lungs. They even named this new neurological nook: the parafacial zone.  

Fuller has neatly cropped salt-and-pepper hair and the air of a man who knows what shirt he will wear in the morning. He was disarmingly polite when I arrived, even though, clumsily, I had shown up on the wrong floor. (Clearly, the man was at ease dealing with sleep-deprived people.) We were meeting at a gleaming new medical research center in Boston, an 18-story, 700,000-square-foot scientist's dream, that houses facilities for Harvard, Dana-Farber Cancer Institute, and Children's Hospital of Boston. 

In his quest to solve the neurological mysteries of sleep, Fuller went all the way back to scientific research from the 1950s. Even then, many believed there must be a localized center of neurons, probably in the lower part of the brain, that played a central role in deep sleep. Although the upper-brain structures crucial to “slow-wave sleep” -- the dreamless kind of slumber that is thought to consolidate memories, encourage the immune system, and provide a sense of wakefulness in the morning — had been known for years, they account for only about half of the deep sleep we get. Modern pharmaceuticals let us push around all the GABA we want up there in the cerebral cortex, but with very different results for different people. Why?

"What people forget," Fuller told me, "is that almost the entire brain stem is wake-promoting." 

Fuller and his team at Harvard (and the University at Buffalo) spent more than three years searching for the hypothetical little node of brain-stem neurons in the brain stem that might counteract that effect. One of their methods was to introduce a virus into various areas of the mouse brains. (He showed me a refrigerated mouse brain encased in solution; it looked precisely like a tiny sculpture of a human brain. In fact, the two organs are remarkably similar, and brain studies in mice tend to carry over well to humans.)

Among his investigators is a French scientist, Christelle Anaclet, whose job was to watch videos of mice sleeping for hours on end, stopping every ten seconds to see whether a note was required. One day in 2011, she happened to notice that mice who had been infected with the harmless virus in a largely unexplored lower-brain area adjacent to the facial nerve (which partly controls your face) were staying awake far longer than those who hadn’t been infected in the same area. So Fuller, a straightforward man, dubbed it the “parafacial zone.”

More important, the team also found that they could induce deep sleep by tinkering with the same region: They could turn it on like a switch any time of day by using a virus that instructed those lower-brain cells to gush GABA. The animals fell into a slumber despite the fact that they were not given any drugs, and the process caused no harm to cells.

Fuller’s research couldn’t come at a more important time for people who have serious sleep problems. For a while, Ambien seemed like the answer. But when so-called z-class drugs move gobs of GABA around the prefrontal cortex in order to convince you that you’re asleep, upper-brain urges for food and sex also get activated. In many users, this results in disturbing patterns of behavior. By 2010, doctors had begun to write fewer prescriptions for Ambien and its siblings. Just last year, the Federal Drug Administration issued an unusual recommendation saying that women should take half the prescribed dosage.

By contrast, targeting the parafacial zone offers the possibility of a treatment that turns you out like a light in a matter of seconds without creating a secondary set of problems.

Too good to be true? Possibly. But now that we know about the parafacial zone, we should be able to engineer drugs that initiate a GABA response in the brain stem. It will take years to identify something unique about the receptors those cells express or the transmitters they release. According to Fuller, if this proves too difficult, there are other options. One is a more mechanical process already well understood in patients with Parkinson’s: deep brain stimulation, which implants a thin wire into the brain. Another would be to use electromagnetic induction, which is noninvasive and painless.

If all this sounds like it’s going to take 40 years, it won’t. Let’s call it five to ten. Thanks to Fuller and his team, we know that sleep can be controlled with the precision and minimal harm of other brain-stem procedures -- similar to, say, those that help modify reflexes like blinking too often. My husband sometimes says, “Just fall asleep!” I desperately wish I could. I'll be dreaming of the day it's actually as easy as it sounds.

Monday, December 1, 2014

In the Blogs: Some Statistics That May Show Mental Illness Touches More People Than You Might Think

By Lindsay Holmes for The Huffington Post 

Whether you're aware of it or not, chances are you know someone who has been personally affected by a mental health disorder.

Depression is one of the leading causes of disability worldwide and other mental health disorders are growing in numbers.

And while mental illness is starting to be considered the serious medical condition that it is, when it comes to healthcare, we still have a long way to go before mental health patients are treated with the respect afforded physical health patients. Research shows there's still stigma surrounding these disorders.

Below are some statistics that show these disorders touch more people than you might think.

61,500,000 - The approximate number of Americans who experience a mental health disorder in a given year. That's one in four adults.

$100,000,000,000 - The estimated economic cost of untreated mental illness in the U.S. This includes unemployment, unnecessary disability, substance abuse and more.

70 - 90% - The percentage of individuals with mental illness who saw improvement in their symptoms and quality of life after participating in some form of treatment.

800,000 - The estimated number of people globally who die by suicide each year.

25% - The approximate amount of people with a mental illness who feel that others are not compassionate or understanding toward those suffering from one of the disorders.

350,000,000 - The number of people worldwide who are affected by depression.

79% - The percentage of suicides that are completed by men.

40,000,000 - The number of adults who suffer from anxiety disorders in the U.S.

30% - The number of college students who reported feeling depressed to the point where it negatively impacted their ability to function. Approximately 7.5 percent of college students also reported earlier this year that they seriously considered suicide in the last 12 months.

22 - The (potentially underestimated) number of veterans who die by suicide each day, according to a 2013 report by researchers at the Department of Veterans Affairs.

10% - The percentage of children and adolescents whose mental and emotional disorders disrupt their day-to-day lives.

3,500,000 - The number of Americans who suffer from schizophrenia. The disorder usually develops between ages 16 to 25.

60% - The percentage of adults who didn't receive mental health treatment in 2012.

6,100,000 - The number of individuals in the U.S. who suffer from some form of bipolar disorder.

21% - The percentage of mothers polled in a recent BabyCenter survey who stated they have been diagnosed with postpartum depression. Approximately 40 percent of them did not seek medical treatment.

5,200,000 - The estimated number of adults who suffer from post-traumatic stress disorder in a given year.

7 - The number of people who die by suicide per hour in the Americas.

11% - The percentage of adolescents who have a depressive disorder before the age of 18.

90% -The percentage of people who die by suicide who also had a mental health disorder.

CORRECTION: A previous version of this article stated 31 percent of college students have considered suicide, when it is 7.5 percent. The statistic has been updated.

Need help? In the US, call 1-800-273-8255 for the National Suicide Prevention Lifeline.