Therapy News & Views

The upside of infidelity

2007-04-26T15:31:00.000-04:00

SARAH HAMPSON
From Thursday's Globe and Mail
April 26, 2007 at 9:10 AM EST
Till death do us part? Nah. It's till cheating sex do us part. Sexual fidelity is the sine qua non of marriage.
But is it all bad when an extramarital affair happens?
As a gentleman I know helpfully explained over his pinot noir in a downtown Toronto bar, "Sex is the life force, Sarah."
Indeed. And an extramarital affair is a huge life-changing event, nothing short of transformational - if, that is, you don't hide in deep guilt and denial from why you did it.
I am not a professional psychologist, although I have had what I like to call a little shrinkification. (At least therapy is no longer taboo.)
So I will say this: Once you have endured divorce and the painful examination of why you stayed for as long as you did, what the pathology of the relationship was and what you need to repair in yourself, you see the world and people with a sort of emotional X-ray vision. You see what lies beneath.
Most affairs illuminate a truth, one you may not have been ready to see.
Okay, let me go first.
In my marriage of almost 18 years, which ended in divorce 4½ years ago, I, like many, had plenty of opportunities to have affairs. Once, when I was in my late twenties and travelling on business to Sydney, Australia, a colleague, who was also married, boldly propositioned me. Never once in the Toronto office had he made a pass at me. But now he was exercising what he called "the out-of-hemisphere rule." He called my hotel room in the late evening to ask if he could come up and see me, not some time, but right then.
I said no. I was happily married at the time. But many years later, when my husband and I were in trial separation, still technically married and mulling over whether we could work it out, an affair did happen. I didn't seek it out, but I didn't stop it, either. It didn't last long. He provided comfort and tenderness, something I badly needed, but more importantly, the affair gave me clarity. I knew that if I could make that emotional transgression, my marriage was over, and it spared me further ambivalence.
Ambivalence, for anyone who is divorced or thinking about it, is an affliction that can last a long, long time before the decision to call it quits.
That's why I call it the "clarity affair." It's not why you're leaving your marriage: it tells you that you already have. A friend of mine experienced the same thing. "It made my decision about my marriage black and white."
She ended hers without revealing the affair, which was also short-lived, to her husband.
Stephen Grant, a high-profile divorce lawyer in Toronto's McCarthy Tétrault law firm, believes that both women and men often use affairs as a springboard. But he thinks that men are less likely to examine the reasons underneath the action.
"Men, to the extent that they are conscious of why they do things, think, 'I'm unhappy,' and infidelity is a response to their own bewilderment about the sense of loss in their marriage."
There's an adage at work here: Women leave their marriages for themselves, men leave for other women. "Guys, as opposed to women, typically aren't prepared to let go of one trapeze until another one is within reach," Mr. Grant says to explain the male need to have a safe (and soft) landing. Whether they stay with the new trapeze is another matter. The point is, they need it to get to the other side.
The affair is a substitute for courage.
But if affairs can be a force for social change, they can also be really good marital glue.
"I'm not making light of it," says Anne Bercht, 45, author of a 2004 book, My Husband's Affair Became the Best Thing that Ever Happened to Me, that landed her on Oprah and other television talk shows. "It's devastating. But pain is really an opportunity for personal growth. You don't develop character as a person in the good times," she says from her home in Abbotsford, B.C.
"Once an affair happens, nobody can turn back the clock and undo what has been done. But you're left with a choice: to become better or to allow bitterness to wreck the rest of your life." She and her husband, Brian, who had the affair and confessed it to her, were able to repair the damage, but not without a lot of work. Together they examined how their behaviour in their marriage had contributed to the problem. "We have much greater openness and honesty between us," she says, adding that they now run marriage therapy courses and a website, http://www.passionatelife.ca.
Affairs as marital glue can work in other ways, too, according to a woman I spoke to who uses a website that facilitates adulterous affairs between married people. Her husband of many years ignores her. The affairs she has engaged in (several over the years) are never in the hope that she can leave her marriage for another man. She claims there are different kinds of love a person can experience - a sort of fraternal-like affection for a husband of many years and then the sexual passion with a new partner.
My take? I get the thrill of sex with a new person, that life-force thing, and how valued that can make you feel. But I think the human heart longs for a big, complete love, the one where, to quote literary critic Terry Eagleton, "each realizes himself or herself through the other."
I would venture that what lies beneath this woman's behaviour is her reluctance to leave the security of her marriage. Divorce is not just frightening, it's expensive.
Put simply, divorce is a privilege. It's like a car: lots of people may need one and want one, but not everybody can afford one.
This launches Sarah Hampson's
bi-weekly column on divorce.
shampson@globeandmail.com

After Suicide, a Window on a Patient’s Other Self

2007-04-17T12:32:00.000-04:00

April 17, 2007
Cases
After Suicide, a Window on a Patient’s Other Self
By ELISSA ELY, M.D.
The death report was asking the wrong questions — whether the patient had drunk four to eight glasses of water daily, whether his diet was low in saturated fats and salt. Death had not been a result of junk food; it had been a result of suicide.
When it is your patient who has died, there is a fugitive quality to it: someone has fled, and you were unable to capture or return him alive. Diet and fluids are the least of the problem.
My patient had been an educated man, full of yearning. He wanted a mate and a job. Schizophrenia made both hard to find. I knew about his voices, and sometimes knew what his voices told him, but had come to believe that voices and patient coexisted in a delicate yet stable ecosystem. It was a false belief.
No one is immune from contemplating suicide. Demographic studies show that the population most at risk is single, urban, substance-abusing older white men with physical illness, few supports and low incomes.
We memorize the characteristics in residency training and recall them in evaluations to figure out how frightened we ought to be. The criteria are so specific it’s like putting pins in a war map. By these criteria, my patient could not be found on the map (though psychosis is also a high risk factor).
He could, however, be found on MySpace.com. In our last meeting, before he stopped coming to appointments, he told me that he had joined the site to meet friends. Finding him there during life seemed illicit; peeking into his bedroom window. Finding him there after death seemed imperative.
I typed his name into MySpace, feeling covert and slightly criminal. There was a photo of him on one side of the screen, handsome and poised, with his astrological sign, educational background and a description of his ideal mate.
On the opposite side of the screen, there were scrolls of e-mail messages that other MySpace members had sent him: friendly, uncapitalized, hallucination-free greetings. Some voiced hopes of meeting one day, some had comments about other correspondents on the site, some sent good wishes on relevant holidays.
The messages had this in common: They were all written to a correspondent who led an unquestionably normal life. They were not written to a haunted self, or someone who had failed trials of antipsychotic drugs, or someone who had been hospitalized again and again under duress. Nor, apparently, was that unseen self writing back.
I read all the messages. They were an introduction to a man I had not properly known. I had thought of him as struggling under the constant hold of hallucinations. But he had ignored his hallucinations long enough to write of a different yet equally true self here, and he had found friends who identified him not by psychiatric symptoms but by astrological sign. In this world, he was a Pisces, not a schizophrenic.
The last dozen messages on the screen were exactly the same. I had gone on the site only a day after his death, but his cyberobituary must have traveled faster. R.I.P., each message said. By now, of course, the messages had no recipient, and the friends my patient had made were writing to one another.
The unquestionably normal person, whose photograph still looked as though it were reading its e-mail messages from the opposite side of the Web page, had already fled — to find peace, or reconciliation or relief, I don’t know.
I don’t know what he found. I don’t know why he fled. I don’t know if he drank four to eight glasses of water a day.
Elissa Ely is a psychiatrist in Boston.

Up to 25% wrongly diagnosed as depressed: study

2007-04-04T19:00:00.000-04:00

Updated Wed. Apr. 4 2007 12:28 PM ET

CTV.ca News Staff

As many as one out of every four people told they have depression could, in fact, be reacting normally to some of life's more troubling times.

That's the finding of a new study this week, published in The Archives of General Psychiatry, based on a study of 8,000 people.

According to the research, 25 per cent of people diagnosed with depression were found to be simply struggling with a normal reaction to a recent emotional blow, such a death of a family member, a divorce or a job loss.

Extended periods of depression-like symptoms are common in people who have been through a life stress and don't necessarily constitute illness, the study concluded.

"Medication in these cases is unwarranted, and in the case of teenagers downright dangerous," says board-certified cognitive behavioral therapist A. B. Curtiss. People should turn instead to physical exercise and cognitive behavioral methods to build confidence and coping skills in handling life's crises.

The researchers based their findings on a national survey of 8,098 people. They found that those who had experienced a variety of stressful events frequently had prolonged periods in which they reported many symptoms of depression. Only a fraction, however, had severe symptoms that could be classified as clinical depression, the researchers said.

Patients are currently diagnosed as clinically depressed based on whether they suffer a number of identified symptoms, including fatigue, insomnia and suicidal thoughts.

The diagnostic manual used by psychiatrists says that anyone who suffers from at least five such symptoms for as little as two weeks may be clinically depressed.

Medicating many of the patients going through normal periods of grief is unnecessary, suggests the study. Supportive therapy on the other hand, can be more appropriate and helpful and might keep a person from going on to develop full-blown depression.

Lead author Dr. Jerome C.Wakefield, insists that the apparent epidemic of depression is caused by the psychiatric profession reclassifying normal human sadness as a medical illness that can be cured with drugs.

"The cost of not looking at context is you think anyone who comes under this diagnosis has a biological disorder, so should more or less automatically get antidepressant medication, and everything else is superfluous," said Wakefield, who studies the conceptual foundations of psychiatry. "There is a trend to treat people in this somewhat mechanized way."

According to the Public Health Agency of Canada, approximately eight per cent of adult Canadians will experience major depression at some time in their lives.

A recent Ipsos Reid telephone poll on depression in the workplace found that 20 per cent in Canada and 21 per cent in the U.S. believe they're either clinically depressed or they think they are but never had it properly diagnosed.

Finding Hope in Knowing the Universal Capacity for Evil

2007-04-03T13:36:00.000-04:00

April 3, 2007
A Conversation With Philip G. Zimbardo
Finding Hope in Knowing the Universal Capacity for Evil
By CLAUDIA DREIFUS
SAN FRANCISCO — At Philip G. Zimbardo’s town house here, the walls are covered with masks from Indonesia, Africa and the Pacific Northwest.
Dr. Zimbardo, a social psychologist and the past president of the American Psychological Association, has made his reputation studying how people disguise the good and bad in themselves and under what conditions either is expressed.
His Stanford Prison Experiment in 1971, known as the S.P.E. in social science textbooks, showed how anonymity, conformity and boredom can be used to induce sadistic behavior in otherwise wholesome students. More recently, Dr. Zimbardo, 74, has been studying how policy decisions and individual choices led to abuse at the Abu Ghraib prison in Iraq. The road that took him from Stanford to Abu Ghraib is described in his new book, “The Lucifer Effect: Understanding How Good People Turn Evil” (Random House).
“I’ve always been curious about the psychology of the person behind the mask,” Dr. Zimbardo said as he displayed his collection. “When someone is anonymous, it opens the door to all kinds of antisocial behavior, as seen by the Ku Klux Klan.”
Q. For those who never studied it in their freshman psychology class, can you describe the Stanford Prison Experiment?
A. In the summer of 1971, we set up a mock prison on the Stanford University campus. We took 23 volunteers and randomly divided them into two groups. These were normal young men, students. We asked them to act as “prisoners” and “guards” might in a prison environment. The experiment was to run for two weeks.
By the end of the first day, nothing much was happening. But on the second day, there was a prisoner rebellion. The guards came to me: “What do we do?”
“It’s your prison,” I said, warning them against physical violence. The guards then quickly moved to psychological punishment, though there was physical abuse, too.
In the ensuing days, the guards became ever more sadistic, denying the prisoners food, water and sleep, shooting them with fire-extinguisher spray, throwing their blankets into dirt, stripping them naked and dragging rebels across the yard.
How bad did it get? The guards ordered the prisoners to simulate sodomy. Why? Because the guards were bored. Boredom is a powerful motive for evil. I have no idea how much worse things might have gotten.
Q. Why did you pull the plug on the experiment?
A. On the fifth night, my former graduate student Christina Maslach came by. She witnessed the guards putting bags over the prisoners’ heads, chain their legs and march them around. Chris ran out in tears. “I’m not sure I want to have anything more to do with you, if this is the sort of person you are,” she said. “It’s terrible what you’re doing to those boys.” I thought, “Oh my God, she’s right.”
Q. What’s the difference between your study and the ones performed at Yale in 1961? There, social psychologist Stanley Milgram ordered his subjects to give what they thought were painful and possibly lethal shocks to complete strangers. Most complied.
A. In a lot of ways, the studies are bookends in our understanding of evil. Milgram quantified the small steps that people take when they do evil. He showed that an authority can command people to do things they believe they’d never do. I wanted to take that further. Milgram’s study only looked at one aspect of behavior, obedience to authority, in short 50-minute takes. The S.P.E., because it was slated to go for two weeks, was almost like a forerunner of reality television. You could see behavior unfolding hour by hour, day by day.
Here’s something that’s sort of funny. The first time I spoke publicly about the S.P.E., Stanley Milgram told me: “Your study is going to take all the ethical heat off of my back. People are now going to say yours is the most unethical study ever, and not mine.”
Q. From your book, I sense you feel some lingering guilt about organizing “the most unethical study” ever. Do you?
A. When I look back on it, I think, “Why didn’t you stop the cruelty earlier?” To stand back was contrary to my upbringing and nature.
When I stood back as a noninterfering experimental scientist, I was, in a sense, as drawn into the power of the situation as any prisoners and guards.
Q. What was your reaction when you first saw those photographs from Abu Ghraib?
A. I was shocked. But not surprised. I immediately flashed on similar pictures from the S.P.E. What particularly bothered me was that the Pentagon blamed the whole thing on a “few bad apples.” I knew from our experiment, if you put good apples into a bad situation, you’ll get bad apples.
That was why I was willing to be an expert witness for Sgt. Chip Frederick, who was ultimately sentenced to eight years for his role at Abu Ghraib. Frederick was the Army reservist who was put in charge of the night shift at Tier 1A, where detainees were abused. Frederick said, up front, “What I did was wrong, and I don’t understand why I did it.”
Q. Do you understand?
A. Yeah. The situation totally corrupted him. When his reserve unit was first assigned to guard Abu Ghraib, Frederick was exactly like one of our nice young men in the S.P.E. Three months later, he was exactly like one of our worst guards.
Q. Aren’t you absolving Sergeant Frederick of personal responsibility for his actions?
A. You had the C.I.A., civilian interrogators, military intelligence saying to the Army reservists, “Soften these detainees up for interrogation.”
Those kinds of vague orders were the equivalent of my saying to the S.P.E. guards, “It’s your prison.” At Abu Ghraib, you didn’t have higher-ups saying, “You must do these terrible things.” The authorities, I believe, created an environment that gave guards permission to become abusive — plus one that gave them plausible deniability.
Chip worked 40 days without a single break, 12-hour shifts. The place was overcrowded, filthy, dangerous, under constant bombardment. All of that will distort judgment, moral reasoning. The bottom line: If you’re going to have a secret interrogation center in the middle of a war zone, this is going to happen.
Q. You keep using this phrase “the situation” to describe the underlying cause of wrongdoing. What do you mean?
A. That human behavior is more influenced by things outside of us than inside. The “situation” is the external environment. The inner environment is genes, moral history, religious training. There are times when external circumstances can overwhelm us, and we do things we never thought. If you’re not aware that this can happen, you can be seduced by evil. We need inoculations against our own potential for evil. We have to acknowledge it. Then we can change it.
Q. So you disagree with Anne Frank, who wrote in her diary, “I still believe, in spite of everything, that people are truly good at heart?”
A. That’s not true. Some people can be made into monsters. And the people who abused, and killed her, were.

Personal Health:You Are Also What You Drink

2007-03-28T09:52:00.000-04:00

March 27, 2007
Personal Health
You Are Also What You Drink
By JANE E. BRODY, New York Times
What worries you most? Decaying teeth, thinning bones, heart disease, stroke, diabetes, dementia, cancer, obesity? Whatever tops your list, you may be surprised to know that all of these health problems are linked to the beverages you drink — or don’t drink.
Last year, with the support of the Unilever Health Institute in the Netherlands (Unilever owns Lipton Tea), a panel of experts on nutrition and health published a “Beverage Guidance System” in hopes of getting people to stop drinking their calories when those calories contribute little or nothing to their health and may actually detract from it.
The panel, led by Barry M. Popkin, a nutrition professor at the University of North Carolina, was distressed by the burgeoning waistlines of Americans and the contribution that popular beverages make to weight problems. But the experts also reviewed 146 published reports to find the best evidence for the effects of various beverages on nearly all of the above health problems. I looked into a few others, and what follows is a summary of what we all found.
At the head of the list of preferred drinks is — you guessed it — water. No calories, no hazards, only benefits. But the panel expressed concern about bottled water fortified with nutrients, saying that consumers may think they don’t need to eat certain nutritious foods, which contain substances like fiber and phytochemicals lacking in these waters. (You can just imagine what the panel would have to say about vitamin-fortified sodas, which Coca-Cola and Pepsi plan to introduce in the coming months.)
Sweet Liquid Calories
About 21 percent of calories consumed by Americans over the age of 2 come from beverages, predominantly soft drinks and fruit drinks with added sugars, the panel said in its report. There has been a huge increase in sugar-sweetened drinks in recent decades, primarily at the expense of milk, which has clear nutritional benefits. The calories from these sugary drinks account for half the rise in caloric intake by Americans since the late 1970s.
Not only has the number of servings of these drinks risen, but serving size has ballooned, as well, with some retail outlets offering 32 ounces and free refills.
Add the current passion for smoothies and sweetened coffee drinks (there are 240 calories in a 16-ounce Starbucks Caffe Mocha without the whipped cream), and you can see why people are drinking themselves into XXXL sizes.
But calories from sweet drinks are not the only problem. The other matter cited by the panel, in its report in The American Journal of Clinical Nutrition, is that beverages have “weak satiety properties” — they do little or nothing to curb your appetite — and people do not compensate for the calories they drink by eating less.
Furthermore, some soft drinks contribute to other health problems. The American Academy of General Dentistry says that noncola carbonated beverages and canned (sweetened) iced tea harm tooth enamel, especially when consumed apart from meals. And a study of 2,500 adults in Framingham, Mass., linked cola consumption (regular and diet) to the thinning of hip bones in women.
If you must drink something sweet, the panel suggested a no-calorie beverage like diet soda prepared with an approved sweetener, though the experts recognized a lack of long-term safety data and the possibility that these drinks “condition” people to prefer sweetness.
Fruit juices are also a sweet alternative, although not nearly as good as whole fruits, which are better at satisfying hunger.
Coffee, Tea and Caffeine
Here the news is better. Several good studies have linked regular coffee consumption to a reduced risk of developing Type 2 diabetes, colorectal cancer and, in men and in women who have not taken postmenopausal hormones, Parkinson’s disease.
Most studies have not linked a high intake of either coffee or caffeine to heart disease, even though caffeinated coffee raises blood pressure somewhat and boiled unfiltered coffee (French-pressed and espresso) raises harmful LDL and total cholesterol levels.
Caffeine itself is not thought to be a problem for health or water balance in the body, up to 400 milligrams a day (the amount in about 30 ounces of brewed coffee). But pregnant women should limit their intake because more than 300 milligrams a day might increase the risk of miscarriage and low birth weight, the panel said.
Mice prone to an Alzheimer’s-like disease were protected by drinking water spiked with caffeine equivalent to what people get from five cups of coffee a day. And a study of more than 600 men suggested that drinking three cups of coffee a day protects against age-related memory and thinking deficits.
For tea, the evidence on health benefits is mixed and sometimes conflicting. Tea lowers cancer risk in experimental animals, but the effects in people are unknown. It may benefit bone density and help prevent kidney stones and tooth decay. And four or five cups of black tea daily helps arteries expand and thus may improve blood flow to the heart.
Alcohol
Alcohol is a classic case of “a little may be better than none but a lot is worse than a little.” Moderate consumption — one drink a day for women and two for men — has been linked in many large, long-term studies to lower mortality rates, especially from heart attacks and strokes, and may also lower the risk of Type 2 diabetes and gallstones. The panel found no convincing evidence that one form of alcohol, including red wine, was better than another.
But alcohol even at moderate intakes raises the risk of birth defects and breast cancer, possibly because it interferes with folate, an essential B vitamin. And heavy alcohol consumption is associated with several lethal cancers, cirrhosis of the liver, hemorrhagic stroke, hypertension, dementia and some forms of heart disease.
Dairy and Soy Drinks
Here my reading of the evidence differs slightly from that of the panel, which rated low-fat and skim milk third, below water and coffee and tea, as a preferred drink and said dairy drinks were not essential to a healthy diet. The panel acknowledged the benefits of milk for bone density, while noting that unless people continue to drink it, the benefit to bones of the calcium and vitamin D in milk is not maintained.
Other essential nutrients in milk include magnesium, potassium, zinc, iron, vitamin A, riboflavin, folate and protein — about eight grams in an eight-ounce glass. A 10-year study of overweight individuals found that milk drinkers were less likely to develop metabolic syndrome, a constellation of coronary risk factors that includes hypertension and low levels of protective HDLs. To me, this says you may never outgrow your need for milk.
The panel emphasized the need for children and teenagers to drink more milk and fewer calorically sweetened beverages.
“Fortified soy milk is a good alternative for individuals who prefer not to consume cow milk,” the panel said, but cautioned that soy milk cannot be legally fortified with vitamin D and provides only 75 percent of the calcium the body obtains from cow’s milk.

Can You Live With the Voices in Your Head?

2007-03-26T15:30:00.000-04:00

March 25, 2007
Can You Live With the Voices in Your Head?
By DANIEL B. SMITH, New York Times Magazine
Angelo, a London-born scientist in his early 30s with sandy brown hair, round wire-frame glasses and a slight, unobtrusive stammer, vividly recalls the day he began to hear voices. It was Jan. 7, 2001, and he had recently passed his Ph.D. oral exams in chemistry at an American university, where, for the previous four and a half years, he conducted research into infrared electromagnetism. Angelo was walking home from the laboratory when, all of a sudden, he heard two voices in his head. “It was like hearing thoughts in my mind that were not mine,” he explained recently. “They identified themselves as Andrew and Oliver, two angels. In my mind’s eye, I could see an image of a bald, middle-aged man dressed in white against a white background. This, I was told, was Oliver.” What the angels said, to Angelo’s horror, was that in the coming days, he would die of a brain hemorrhage. Terrified, Angelo hurried home and locked himself into his apartment. For three long days he waited out his fate, at which time his supervisor drove him to a local hospital, where Angelo was admitted to the psychiatric ward. It was his first time under psychiatric care. He had never heard voices before. His diagnosis was schizophrenia with depressive overtones.
Angelo remembers his time at the hospital as the deepening of a nightmare. On top of his natural confusion and fear over the shattering of his psychological stability, Angelo did not react well to the antipsychotic he’d been prescribed, risperidone, which is meant to alleviate the symptoms of schizophrenia by reducing the level of dopamine in the brain. In Angelo’s case, the pills had a predominantly negative effect. His voices remained strong and disturbing — an unshakable presence, quiet only in sleep — while he grew sluggish and enervated. “If you think of the mind as a flowing river of thoughts,” he told me in an e-mail message, “the drug made my mind feel like a slow-moving river of treacle.” Several days into his stay, Angelo’s parents flew to the United States from London and took him back home.
More than six years later, Angelo still lives at his parents’ house. He currently takes a cocktail of antidepressants and antipsychotics, with tolerable side effects, and sees a psychologist every two months to monitor his medication. The pills help Angelo to manage his voices, but they have not been able to eradicate them. Shortly after his return to London, he made an attempt to resume his career, accepting a research position at the university where he had received his undergraduate degree. He lasted eight months (his neighbors heard him screaming at his voices and called the police), checked himself into the hospital for six weeks and returned home. Despite these setbacks, Angelo has maintained his optimism. He is eager to discover new ways to combat his voices. Not long ago, he found one. In November, his psychologist informed him of a local support group for people who hear voices, from which he thought Angelo might benefit. Angelo began to attend the group late last year.
I first met Angelo at a meeting of the group in mid-January. (I was given permission to sit in on the condition that I not divulge the participants’ last names.) The meeting took place in the bright, cheerfully decorated back room of a community mental-health center in North Finchley, an affluent, grassy suburb in the northern reaches of London. The gathering was small but eclectic. In addition to the group’s facilitators — Jo Kutchinsky, an occupational therapist, and Liana Kaiser, a social-work student — five men and women assembled in a circle of bulky wool-knit chairs around a worn coffee table. Besides Angelo, there was Stewart, a young, working-class Londoner with a shaved head and a hoop earring; Jenny, an affable woman in her 50s who spoke of her fondness for arts and crafts; Michelle, a heavyset woman who dominated the session with her forceful opinions; and David, a 60-something man with a thick gray beard and a pageboy haircut who slumped in his seat and dozed throughout much of the meeting.
Angelo was the newest member of this group — it was his third visit — and he did not seem inclined to participate fully. When Kutchinsky opened the meeting by asking each member to discuss the previous week’s experience hearing voices, he softly mentioned that his voices made it difficult to read, then quickly ceded the floor. What followed was sometimes painful. Stewart in particular was visibly agitated. His hallucinatory life, as he described it, was chaotic and irrepressible. He heard voices pleading to him for help; he heard the voices of strangers; he heard the voice of his father. Sometimes he heard the voices of military commandos, who offered to defend him against this confusion. “I haven’t been well for a long time,” he said glumly. Yet most of the members spoke of their voices in the way that comedians speak of mothers-in-law: burdensome and irritating, but an inescapable part of life that you might as well learn to deal with. When David’s name was called, he lifted his head and discussed his struggle to accept his voices as part of his consciousness. “I’ve learned over time that my voices can’t be rejected,” he said. “No matter what I do, they won’t go away. I have to find a way to live with them.” Jenny discussed how keeping busy quieted her voices; she seemed to have taken a remarkable number of adult-education courses. Michelle expressed her belief that her voices were nothing more exotic than powerfully negative thoughts. “Negative thoughts are universal,” she said. “Everyone has them. Everyone. What matters is how you cope with them: that’s what counts.”
I had trouble gauging Angelo’s reaction throughout these testimonies, so afterward I pulled him aside and asked him what he thought. “It’s interesting to hear people’s stories,” he said. “Before I started coming, I hadn’t realized just how long some people have suffered. I’ve heard voices for six years. Some people have heard them for 15 or 20. It’s amazing.” I asked him if this knowledge reassured or frightened him. “It’s a bit scary, in a way. I think, I could be this way for a long time.” Still, he appeared to appreciate the camaraderie. For years, he had been socially isolated. He spends most of his time with his parents and a sympathetic older sister. His neighbors know only that he is “off work.” It was comforting, he said, to speak at last with people who understood.
The meeting that I attended in London is one of dozens like it affiliated with a small but influential grass-roots organization known as Hearing Voices Network. Based in Manchester, Hearing Voices Network (H.V.N.) has since its inception, in 1991, developed a range of services related to the phenomenon known as auditory hallucination: a hot line for people who suffer from the experience, a series of educational workshops for mental-health professionals and 170 support groups across Britain, with more in development. H.V.N., which openly challenges the standard psychiatric relationship of expert physician and psychotic patient, might be said to take the consumer movement in mental health care to its logical endpoint. Although H.V.N. groups meet in a variety of settings — from psychiatric wards to churches to the organization’s headquarters — all must be run by, or there must be active plans for them to be run by, voice-hearers themselves. What’s more, H.V.N. groups must accept all interpretations of auditory hallucinations as equally valid. If an individual comes to a group claiming that he is hearing the voice of the queen of England, and he finds this belief useful, no attempt is made to divest him of it, but rather to figure out what it means to him.
H.V.N.’s ecumenical approach makes it a difficult organization to pin down. I have met members who believed that their voices were a result of a biochemical glitch, requiring all the tools modern pharmacology has to offer; I have met those who believed their voices were signs from the spirit realm — a cherished gift. Yet the organization’s clearest rhetorical note is oppositional and antipsychiatric.
For more than a half-century, auditory hallucinations have primarily been studied and discussed in terms of severe mental illness, most notably schizophrenia, and linked to bizarre delusions, disordered thought and emotional dissociation. Approximately 75 percent of patients diagnosed with schizophrenia hear voices, and for the majority the experience is overwhelmingly negative. Those voices may issue commands, comment sarcastically on everyday actions or berate, curse and insult the hearer. As many as one-third of people with schizophrenia attempt suicide; as many as one-fifth hear voices that command them to do so. H.V.N. does not dispute that auditory hallucinations are frequently painful: many of the organization’s leading members have endured harrowing voices themselves and, at one time or another, sought psychiatric help.
What H.V.N. does dispute is that the psychological anguish caused by hearing voices is indicative of an overarching mental illness. This argument, disseminated through a quarterly newsletter, numerous pamphlets and speeches and alternative mental-health journals, are as voluminous and diverse as its membership. But H.V.N.’s brief against psychiatry can be boiled down to two core positions. The first is that many more people hear voices, and hear many more kinds of voices, than is usually assumed. The second is that auditory hallucination — or “voice-hearing,” H.V.N.’s more neutral preference — should be thought of not as a pathological phenomenon in need of eradication but as a meaningful, interpretable experience, intimately linked to a hearer’s life story and, more commonly than not, to unresolved personal traumas. In 2005, Louise Pembroke, a prominent member of H.V.N., proposed a World Hearing Voices Day (held the next year) that would “challenge negative attitudes toward people who hear voices on the incorrect assumption that this is in itself a sign of illness, an assumption made about them that is not based on their own experiences, is stigmatizing, isolating and makes people ill.”
H.V.N.’s insistence that it is not just the psychotic who hear voices does not, in fact, contradict psychiatric orthodoxy. According to the Diagnostic and Statistical Manual of Mental Disorders, the so-called bible of psychiatry, auditory hallucinations are only a potential symptom of mental illness — they must appear with other symptoms, persist for a specified length of time and impede day-to-day functioning in order to become part of a diagnosable syndrome. In a 2001 debate on whether voices are by definition pathological, Tony David, a neuropsychiatrist at the Institute of Psychiatry in London, noted that a “voice-hearer who is not in any distress, who lives a fruitful and productive life according to commonsense criteria, would never enter the arena in which the possibility of mental illness was up for discussion.” Nor does psychiatry insist that the syndrome in question when a voice-hearer is in distress is invariably schizophrenia. Approximately 20 percent of patients suffering from mania and 10 percent of patients suffering from depression hear voices. Auditory hallucinations can also be caused by “organic” conditions, like Parkinson’s, Alzheimer’s, temporal-lobe epilepsy, hyperthyroidism and migraine headaches, and have long been known to occur in the twilight consciousness between wakefulness and sleep.
That said, H.V.N.’s insistence that voice-hearers should attend carefully to what their hallucinations say is far from traditional. Prolonged exposure to untreated psychosis is held by many experts to be damaging to an individual’s ability to hold down a job or to maintain a meaningful relationship and by others to be damaging to brain function — what clinicians refer to as “psychosocial toxicity” and “neurotoxicity,” respectively. And though psychiatrists acknowledge that almost anyone is capable of hallucinating a voice under certain circumstances, they maintain that the hallucinations that occur with psychoses are qualitatively different. “One shouldn’t place too much emphasis on the content of hallucinations,” says Jeffrey Lieberman, chairman of the psychiatry department at Columbia University. “When establishing a correct diagnosis, it’s important to focus on the signs or symptoms” of a particular disorder. That is, it’s crucial to determine how the voices manifest themselves. Voices that speak in the third person, echo a patient’s thoughts or provide a running commentary on his actions are considered classically indicative of schizophrenia.
Interpreting voices in relation to a patient’s past has a checkered history in the treatment of psychosis. Though Freud discouraged the application of psychoanalysis to psychotic patients, it nonetheless became, for 25 years after World War II, a widespread treatment for schizophrenia in the English-speaking world. This episode in psychiatry is now widely acknowledged to have been a medical and moral disaster; crippling psychoses were routinely blamed on insufficiently nurturing and “schizophrenogenic” mothers. “The psychoanalytic approach to psychosis was toxic,” says Peter Weiden, a professor of psychiatry at SUNY Downstate Medical Center in Brooklyn. “Clinicians of that time were often highly antagonistic toward family members. They blamed the parents, left them out of the treatment process and isolated the patient from his family.” Over the past 30 years, the biomedical model displaced the psychoanalytic one, bolstered by advances in pharmacology, modern genetic and neurological research and the completion of large-scale empirical studies that concluded that psychoanalysis was useless at best and actively destructive at worst. Today, medication is typically prescribed to extinguish, or at least mitigate, voices (about 80 percent of patients experience a reduction in voices, Weiden says, from medication alone, though this does not always translate into an equal improvement in day-to-day functioning); psychotherapy is usually admitted as an adjunct, to deal with issues of social functioning and stigma.
There are signs, however, that psychotherapy is again encroaching on the biomedical paradigm in the treatment of psychoses. Since the 1990s, a growing number of researchers and clinicians, predominantly based in England, have been comparing voice-hearing in psychotic patients with voice-hearing in nonpatients, measuring the incidence of hallucinations in the general population, and using cognitive behavioral therapy (C.B.T.), a popular, short-term treatment for depression and anxiety, to help them manage their responses to the voices they continue to hear. C.B.T. typically asks patients to scrutinize how they interpret their symptoms rather than focusing on an illness as an underlying cause. “The matter of whether it’s effective, and to what extent,” Lieberman says, is still being investigated. So far, the use of C.B.T. in the treatment of psychoses is much more prevalent in the U.K. than in the U.S. In large part, Lieberman says, this is because “the motivation to research the treatment has mostly come from investigators in England.” But, he added, “you could also read into the situation the influence of a strong antipsychiatry or antimedication movement in England — there’s more of an interest in getting nonmedication treatments into clinical use.”
In England, this new cognitive approach to psychosis and the efforts of Hearing Voices Network are independent of each other, and are sometimes at odds. H.V.N.’s leading members, for instance, frequently criticize even sympathetic academic researchers for being insufficiently political. Yet both approaches share a similar purpose in seeking to place voice-hearing within the continuum of normal human experience — one, in order to better treat patients, the other, out of a firm conviction that hearing voices need not interfere with leading an otherwise “normal” life. Over the years, they have forged something of an alliance; psychologists, though they may not embrace H.V.N.’s more polemical views, frequently refer their patients to H.V.N. groups, while H.V.N. frequently cites the research of psychologists. And both H.V.N. and the cognitive approach to psychosis can be traced, to varying degrees, to the same radical figure.
When H.V.N. is accused of being hostile to psychiatry, its members sometimes point out that the organization was, in effect, founded by a psychiatrist — albeit a singularly unorthodox one. In 1986, Marius Romme, a professor of psychiatry at Maastricht University in the Netherlands, was referred a patient, Patsy Hage, who suffered from chronic auditory hallucinations and fell into a deep, suicidal depression. Hage took comfort only from reading “The Origin of Consciousness in the Breakdown of the Bicameral Mind,” an eccentric book, published in 1976, by Julian Jaynes, a Princeton psychologist, in which he argues that before around 2,000 B.C., all humans were guided by hallucinated verbal commands caused by a physical split between the right and left hemispheres of the brain.
Romme wondered whether Hage might benefit from communicating this theory with other voice-hearers and arranged to appear with his patient on a popular Dutch television program. They invited people who heard voices to contact them: 450 people called in, one-third of whom claimed they were able to live alongside their voices without much difficulty. It struck Romme that this smaller group, the existence of which surprised him, might serve as a therapeutic resource. He asked 20 men and women who had learned to manage their voices to serve as speakers at a conference for voice-hearers. The governing principle of the meeting was that all interpretations of voice-hearing, no matter how unusual, would be accepted.
Today, H.V.N.’s members speak of that first conference as the birthplace of their organization — and, indeed, of a worldwide Hearing Voices movement. There are currently self-help organizations for people who hear voices in more than 15 countries, including Germany, Japan and Australia. (The group has only recently begun to make inroads in the U.S.) Meanwhile, Romme has emerged as a spirited leader-activist, increasingly speaking of psychiatry in terms of cultural and personal oppression. People who hear voices, he has declared, “are like homosexuals in the 1950s — in need of liberation, not cure.” H.V.N. often echoes this protesting stance. Its annual conferences, held in Manchester, project an antiestablishment tenor. Ron Coleman, a prominent member, sports a tattoo that reads “Psychotic and Proud” and looks forward to a day when he can “walk the streets talking to his voices and not be denied his freedom.”
In its publicly disseminated material, however, H.V.N. tends to focus less on Romme’s rhetoric than on his research. In an article published with a group of colleagues in The Journal of Nervous and Mental Disease in 1998, Romme reported on the hallucinations of three groups: patients with schizophrenia, patients with dissociative disorder and nonpatients. All three groups heard a mixture of positive and negative voices (though the patients heard more negative voices than nonpatients), reported traumatic experiences in their past and heard both external and internal voices. What for Romme distinguished the voices of the patients most from those of the nonpatients was that the latter felt that they had control over their voices; they rarely sought to eradicate or ignore them and devised ways of coping with and understanding them. “Helping the patient to accept the voices and actively developing effective coping strategies with the patient,” Romme had noted earlier, “may well prove an effective adjunct to psychiatric rehabilitation.”
The concept of “coping” is central to H.V.N., based on its belief that people feel better not when their voices are extinguished but when the person hearing voices learns to listen to his hallucinations without anguish. Jacqui Dillon, the national chairwoman of H.V.N., embraces this credo based on personal experience. Dillon, a mother of two, has heard voices for more than 30 years and has never taken medication for them. Mostly, she says, her voices are supportive and even witty, though occasionally they are cruel — they swear and tell her to harm herself. But she no longer heeds their commands or allows them to bother her. Instead, she takes them as symbols of her unconscious thoughts. “Sometimes voices carry messages that you don’t want to hear,” she told me. “Nevertheless, you don’t shoot the messenger. You listen to him.”
When Romme’s gospel of hallucinatory “acceptance” emerged in the early 1990s, it sparked a notably sharp rebuke in the mainstream British Medical Journal. Reviewing “Accepting Voices” (1993) — a hodgepodge of research findings, coping strategies and firsthand testimonies edited by Romme and his wife and colleague, Sandra Escher — Raymond Cochrane, a professor of psychology at the University of Birmingham, wrote, “Anything that may encourage people to accept the reality of delusional beliefs, and even attribute to these beliefs some mystical supernatural power, can only prolong the existence of these beliefs and make recovery from schizophrenia more protracted and more uncertain.”
But Romme’s work influenced a number of researchers and clinicians, even those not inclined to agitate for the liberation of voice-hearers. “By the late 1980s, hearing voices had become such a stigmatized experience, people had forgotten that it is not just the insane who hear voices,” says Douglas Turkington, a psychiatrist at the Royal Victoria Infirmary, in Newcastle. “The standard line was: ‘Don’t talk to patients about the experience. It’ll only make it worse.’ ” Romme’s report that there existed numerous people living in the community who heard voices and were not distressed, Turkington says, provided ballast for a psychotherapeutic approach to schizophrenia that he and a colleague, David Kingdon, a professor of psychiatry at the University of Southampton, had already embarked on. Adapting the techniques of cognitive behavior therapy, they started in the late 1980s to lead patients, through Socratic-style questioning, toward an understanding of their hallucinations as coming from their own minds. The therapy included mitigating patients’ fears of madness by pointing out that even “normal” people can hear voices. Turkington and Kingdon’s efforts are now widely credited with helping to reopen the door to psychotherapeutic approaches to psychotic symptoms.
Richard Bentall, a professor of psychology at the University of Manchester, embraced not only the clinical implications of Romme’s research but also some of his political activism. Over the past 15 years, Bentall has garnered a reputation as an opponent of traditional psychiatric diagnostics and as an enthusiastic supporter of consumer-based therapies. In the early 1990s, as a professor at the University of Liverpool, Bentall supported the first H.V.N. group in that city, and last August he joined Romme and H.V.N. at a news conference held to announce the Campaign for the Abolition of the Schizophrenia Label, which they billed as “the last great civil rights movement.”
For Bentall, schizophrenia is the diagnostic equivalent of a circus tent, sheltering a heterogeneous crowd of experiences and serving to stigmatize patients. Clinicians, he maintains, should be treating individual symptoms, not syndromes. He is not merely indulging in the kind of rhetoric favored by the antipsychiatrists of the 1960s and 1970s, with whom he is sometimes compared. Questioning the validity of schizophrenia as a label is not new — even the architects of the DSM acknowledge that it is useful only insofar as it guides research and treatment. And while Bentall’s argument that specific psychotic symptoms should be studied in relation to the psychological mechanisms that give rise to them places him outside the mainstream, he publishes frequently in leading peer-reviewed journals and is often cited by psychologists (who are more inclined than their psychiatric counterparts to place auditory hallucinations on a continuum of everyday experience). He has also received support from the British government for his clinical work, most recently a $2.9 million grant from the U.K. Medical Research Council to investigate whether C.B.T. can prevent people who exhibit early signs of psychosis from developing a full-blown disorder.
In his 2003 book, “Madness Explained,” Bentall draws on the theory that auditory hallucinations may have their roots in what psychologists call “inner speech.” All of us, every day, produce a steady stream of silent, inward-directed speech: plans, thoughts, quotations, memories. People hear voices, Bentall argues, when they make faulty judgments about whether this inner speech is the product of their own consciousness or of something alien to their consciousness. Lapses in what researchers call “source monitoring” may occur for a number of reasons — because an individual is primed to expect a perception to occur, because the level of background noise makes it difficult to separate what is internal from what is external, because he or she is in a state of emotional arousal. But whatever the cause, Bentall writes, there is evidence to suggest that hallucinating “can be explained in terms of the same kinds of mental processes that affect normal perceptual judgments.”
This theory raises the critical question of why making source-monitoring errors results in psychosis: why, when people mistake their private speech for someone else’s, does it cause them to grow so distressed that they seek professional help? The answer Bentall gives echoes Romme’s observation that a fundamental difference between voice-hearers in the community and voice-hearers under psychiatric care is that the latter think negatively about their experience. According to Bentall, how patients perceive auditory hallucinations can have a significant impact on how those hallucinations are experienced. Bentall cites a landmark 1994 study by Max Birchwood, at the University of Birmingham, and Paul Chadwick, of the Royal South Hants Hospital in Southampton, to support this view. Published in The British Journal of Psychiatry, it proposes that the anguish experienced by patients who hear voices is directly related to their beliefs in the malevolence and power of the voices. A more recent study, published in 2004 and led by Anthony Morrison, a colleague of Bentall’s at the University of Manchester, also found that negative beliefs about voices are associated with an increase in the distress of the experience, and often these negative beliefs are reinforced by both mental-health services and the media.
According to Louise Johns, a psychologist at the Institute of Psychiatry in London, cognitive models of psychosis have had a significant impact on mental-health practice in Britain. Few psychologists trumpet C.B.T. as a panacea; it is considered an adjunct to, not a replacement for, standard medical intervention, most frequently in cases where patients do not respond well to medication or are chronically ill. Since the early 1990s, more than 20 randomized clinical trials have been conducted with C.B.T. for psychosis, showing that C.B.T. can be useful in helping patients cope with psychotic symptoms, increasing insight into psychosis and promoting compliance with medication. Based on the findings of these studies, the National Institute for Health and Clinical Excellence — the advisory body of the British National Health Service — in 2002 announced that all “individuals with schizophrenia who are experiencing persistent psychotic symptoms should be offered C.B.T.”
Members of H.V.N. express a wary appreciation of these developments. Many are glad that the mental-health professions are taking a psychological approach to psychosis seriously (their literature even notes the increasing availability of cognitive behavioral therapy), but they worry that the organization’s more radical, populist message is being obscured. As always, said Jacqui Dillon, the chairwoman of Hearing Voices Network, the mainstream is attending to what scientists have to say about how to treat voice-hearing rather than what nonscientists like her have to say about how to accept the phenomenon.
It was just before noon on a mild Friday in January when the North Finchley hearing-voices group reconvened after a 15-minute coffee break. A sixth participant had joined the group: Chris, light-haired, overweight and audibly short of breath, who has been a member for four years. He seemed completely at ease.
Earlier in the day, Kutchinsky and Kaiser printed out a list of coping strategies that another group’s members had found useful, cutting each description into thin rectangles, which they now spread across the table, facedown. The participants were asked to choose one and discuss. Angelo picked first: “Hobbies.” He cleared his throat, and in a gentle, measured voice, began: “Collecting, day or evening classes, visiting a library, computer skills, reading and sport. All these activities are not only fun and relaxing; they can fill voids in our lives and help to occupy us during the day or evening. They can improve concentration and reduce isolation. They can also boost our morale and confidence and give us a feel-good factor.” Finished, Angelo lifted his head from the paper and looked around.
“Well, do you have any hobbies, Angelo?” Kutchinsky asked.
“I like to play chess,” he said. “And, as I’ve said, I like to read. But it’s difficult. I can really only handle something light or humorous. Like Dave Barry.”
“I see. Does reading help to block the voices at all?”
Angelo’s eyes seemed to darken. “No. I’m afraid nothing at all blocks the voices. Even if I play music really loud, it doesn’t help at all.”
The coping strategies that followed were within the same vein as the first — commonsensical lifestyle suggestions geared toward improving one’s frame of mind, or sanding down the edges of the experience’s effects. Liana chose “Exercise”; Jenny chose “Religious Activities”; David chose “Pamper Yourself” (“Put nice music on in the next room, put some scented candles around the room. You could even have a bath with your partner!”). The most novel strategy, and the only one that seemed to cause the group’s members to perk up, came under the heading of “Mobile Phones.” If you have the temptation to yell at your voices in public, one suggestion went, you should do so with a phone to your ear. That way you can feel free to let loose, and no one who sees you will think you’re crazy. Chris in particular seemed to cozy to the suggestion. “I sometimes talk to my voices in public,” he said matter-of-factly. “It’s very upsetting. I have to bite my knuckles to suppress the urge.”
Participants in H.V.N.’s self-help groups take comfort from strategies like these not least because they approach voices as you would approach any other painful but normal experience, like anxiety or stress. Many of the members of the North Finchley group, however, pursue pharmaceutical treatment in addition to coping strategies: they talk at the same time that they are on pills. Indeed, as Kutchinsky told me, they sometimes talk about their pills. They talk about the best dosage and about how to deal with the anxiety and sluggishness and impotence that pills sometimes cause. There is, of course, nothing wrong with this combination. It might even be ideal: who better to talk to about medication than people who are actually on it? And if you were struggling from an experience as complicated as hearing voices, why wouldn’t you use every means at your disposal to deal with it?
As for Angelo, his concern is not to choose one option over another — but only to recover. “I have found the group interesting,” Angelo wrote via e-mail three weeks after we met. “It has made me realize that many voice-hearers have had the problem for many years, and that many never stop hearing the voices, though some are successful in that regard. One lady has recently quit the group as she no longer hears voices. I also see that some hearers are quite high-functioning and are able to hold down a job despite the voices. I hope to do this myself. Perhaps the right combination of drugs will make this possible.”
Daniel B. Smith is the author of “Muses, Madmen and Prophets: Rethinking the History, Science and Meaning of Auditory Hallucination,” just published by the Penguin Press and from which this article is in part adapted.

Attraction 'determined by walk'

2007-03-13T10:46:00.000-04:00

From the BBC

There really is something in the way she moves, according to researchers.
An hourglass figure has long been perceived to be the ideal figure for a woman to have.
But New York University researchers have found that to be found attractive, a woman had to move in a feminine way - swaying her hips.
Men, the Proceedings of the National Academy of Sciences paper found, were more attractive if they moved with a "shoulder swagger".
The waist-hip ratio has long been thought to be key to Western perceptions of attractiveness, with a small waist and bigger hips the ideal combination.
Marilyn Monroe, and now Beyonce and Jennifer Lopez are famous examples of women with that figure.
Its popularity may be down to media images, or because Western women do not need to have strong and muscular bodies in order to carry out manual labour, unlike women in developing countries.
But the US research suggests they would never have achieved their sex symbol status if they did not move in the right way.
Not just measurements
The team carried out a series of studies involving over 700 participants who were shown a variety of animations and videos of people moving.
Some showed shadow figures, where it was not possible to see if it was a man or a woman, while others obviously showed a man or a woman.
No matter which format was being used, the participants rated women or "female" figures as more attractive if their hips swayed as they walked, while men were more attractive if they had the characteristic shoulder movement.
The research also confirmed the waist-hip ratio assumption, with women's attractiveness being rated higher if their waist-hip ratio was small and men's being higher if their ratio was large.
But Kerri Johnson and Louis Tassinary who led the research, say their work shows attractiveness is not as simple as the difference between two measurements.
Writing in PNAS, the researchers said: "The body's shape and motion provoke basic social perceptions, biological sex and gender - ie masculinity or femininity respectively.
"The compatibility of these basic precepts predicts perceived attractiveness."
The team say their findings only apply to Western cultures, and other societies will judge attractiveness depending on their most prized feminine and masculine traits.
Dr George Fieldman, principal lecturer in psychology at Buckinghamshire Chilterns University College said: "This is quite plausible.
"It's the movement which attracts, and not just the waist-hip ratio per se."
He added: "It would be interesting to see what the ideal combination of measurements and wiggle is."
Story from BBC NEWS:http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/6444851.stmPublished: 2007/03/13 10:08:20 GMT© BBC MMVII

Sex cues ruin men's decisiveness

2007-03-10T09:01:00.000-05:00

Catching sight of a pretty woman really is enough to throw a man's decision-making skills into disarray, a study suggests.
The more testosterone he has, the stronger the effect, according to work by Belgian researchers.
Men about to play a financial game were shown images of sexy women or lingerie.
The Proceedings of the Royal Society B study found they were more likely to accept unfair offers than men not been exposed to the alluring images.
The suggestion is that the sexual cues distract the men's thoughts, preventing them from focusing on their task - particularly among those with high natural testosterone levels.
The University of Leuven researchers gave 176 heterosexual male student volunteers aged 18 to 28 financial games to test their fair play.

But first, half of the men were shown sexual cues of some kind.
One group of 44 men were given pictures to rate; some were shown landscapes while the rest were shown attractive women.
Another group, of 37 men, were either asked to assess the quality, texture and colour of a bra or a t-shirt.
And a third group of 95 were shown either pictures of elderly women or young models.
Each group was then paired up to play a game where the men had $10, a proposer had to suggest a split, and the other man accepted or rejected the offer.
If the second man accepted the offer, the money was distributed in agreement with the offer. If he rejected it, neither partner got anything.
The game is designed as a lab model of hunting or food sharing situations.
'Vulnerable'
The men's performance in the tests showed those who had been exposed to the "sexual cues" were more likely to accept an unfair offer than those who were not.
The men's testosterone levels were also tested - by comparing the length of the men's index finger compared to their ring finger.
If the ring finger is longer, it indicates a high testosterone level.
The researchers found that men in the study who had the highest levels performed worst in the test, and suggest that is because they are particularly sensitive to sexual images.
Dr Siegfried DeWitte, one of the researchers who worked on the study, said: "We like to think we are all rational beings, but our research suggests ... that people with high testosterone levels are very vulnerable to sexual cues.
"If there are no cues around, they behave normally.
"But if they see sexual images they become impulsive."
He added: "It's a tendency, but these people are not powerless to fight it.
"Hormone levels are one thing, but we can learn to deal with it."
The researchers are conducting similar tests with women. But so far, they have failed to find a visual stimulus which will affect their behaviour."
Dr George Fieldman, principal lecturer in psychology at Buckinghamshire Chilterns University College, told the BBC News website: "The fact men are distracted by sexual cues fits in to evolutionary experience. It's what they are expected to do.
"They are looking for opportunities to pass on their genes."
He said the study confirmed what had been suspected by many.
"If a man is being asked to choose between something being presented by an attractive woman and an ugly man, they might not be as dispassionate as they could be."
Story from BBC NEWS:http://news.bbc.co.uk/go/pr/fr/-/1/hi/health/4921690.stmPublished: 2006/04/19 11:14:22 GMT© BBC MMVII

Canadians rage, rage against dying of the light

2007-03-08T12:40:00.000-05:00

Sleep experts expect U.S.-led time shift to take its toll on the seasonally depressed
HAYLEY MICK
Globe and Mail Update
TORONTO — If rising before the sun leaves you feeling blue after daylight time kicks in on Sunday, blame the Americans.
Daylight time begins three weeks early this year and lasts one week longer. Most of Canada has agreed to adopt the new schedule pushed through by the U.S. Congress two years ago in its bid to save energy costs.
But mental-health experts warn that extension, which begins March 11, could make people feel sad for a longer period of time. People with seasonal affective disorder – or its milder version, the so-called winter blahs – could be thrust back into depression-inducing darkness during a month when they might normally be seeing the light.
"So you've got a double whammy," said Michael Terman, director of Columbia University's Center for Light Treatment and Biological Rhythms in New York. "Not only is the winter forcing the sun to rise later, but we are now pushing it back artificially. It's analogous to shifting our circadian clock back into its February mode."
When most of Canada, except Nunavut and Saskatchewan, the only large jurisdictions not using daylight time moves the clock ahead on Sunday, an hour of daylight will be taken from the morning and tacked onto the evening. In Thunder Bay, the sun rose yesterday at 7:28. On Sunday, the city will be in darkness until past 8 a.m.
While an extra hour of afternoon sun may make gardeners and joggers happy, experts say waking up in darkness is what really messes with the body's natural cycles that regulate appetite, sleep and mood.
"There's a biological clock in the brain . . . and that clock is affected by light," says Raymond Lam, director of the Mood Disorder Clinic at the University of British Columbia. "It looks like the dawn signal is more important than the dusk signal for that synchronization."
Between 1 and 3 per cent of Canadians suffer from seasonal affective disorder, or SAD, a clinical illness with symptoms ranging from extreme lethargy to depression. Another 15 per cent suffer from the milder winter blahs, Dr. Lam said.
"March is that time when they would ordinarily be starting to feel better," he said, adding most patients feel like themselves from May through October. "This will make it tougher for them."
But some sufferers are looking forward to the switch. Heather Stevenson, 45, is a mother of three who has had seasonal affective disorder since moving to Ontario from South Africa six years ago. It forced her to quit her job as a high-school math teacher, and from November to May she's in bed by 8 p.m. Some days she can barely move her limbs.
"I'm very glad to hear that the time's going back because it's lighter at the end of the day," she said from her Barrie home. "The worst time of day for me is in the evening with the sun setting at 5."
Researchers will be keeping a close eye on how this new shift in daylight time affects people with seasonal mood disorders, said Anthony Levitt, a professor of psychiatry at the University of Toronto and an expert in seasonal affective disorder. "We've got this huge natural experiment and we'll see what happens. Will it be better for them or will it in fact be more difficult? . . . We're going to inquire with our patients whether there's been any difference."

Insufferable Clinginess, or Healthy Dependence?

2007-03-08T09:39:00.000-05:00

By BENEDICT CAREY, New York Times
The domestic scenes that would slowly suffocate the marriage were not scenes at all, in the usual sense, but silences, imagined slights, private fears that went unspoken. She would ask him to do the dishes after dinner and feel a shudder when he put off the chore, as if it were a rejection.
Or she would dress up to go out, and then struggle against a growing dread as the moments passed and he did not comment on how good she looked.
“I never once said anything, but I had this need for approval, this terrible dependence that he had no way to understand,” Ronni Weinstein, 61, a therapist living near Chicago, said about her former husband. Indeed, she added, she has since learned that her dependent urges might have been used to bind the marriage rather than undermine it.
“That’s what healthy couples learn to do,” she said, “to voluntarily depend on one another and decide who is doing what for the relationship.”
Neediness has a familiar face: the close friend who is continually asking for reassurance, for advice, for help with the wireless connection. The accomplished adult who lurches from one relationship to another, playing geisha for each new partner. The abused spouse who is afraid to walk out.
Yet only in recent years have researchers begun to realize that while in some guises dependence can undermine mental health, in others it can provide valuable social support.
At one extreme is an ingrained, helpless need to be cared for — a stubborn problem that psychiatrists diagnose as dependent personality disorder. In milder forms, dependency can come across as an annoying clinginess. But it can also be a protective warmth that cements romantic relationships in times of stress. It is the way people manage dependent urges, researchers are finding, that determines the effect of needy behavior on relationships.
“There are the dependent people who panic easily, who are calling a friend or spouse 15 times a day, undermining the relationship, and then there are those who have learned to modulate their impulses,” said Dr. Robert F. Bornstein, a psychologist at Adelphi University in Garden City, N.Y., and co-author, with his wife, Mary A. Languirand, of “Healthy Dependency” (Newmarket Press, 2003).“These people may have dependency needs that are very intense,” he continued, “but they have developed social skills, learned to make others feel good about helping them. That makes all the difference.”
A tug-of-war between headstrong independence and needy vulnerability is visible as early as infancy. In so-called attachment studies, young children or primates who are confident in their mother’s affections tend to be confident when exploring an unfamiliar room or meeting a stranger. Those who are less secure often cling to their mothers in new situations, noticeably fearful.
“This is an absolutely fundamental dynamic that underlies all of our interpersonal relations, as well as psychiatric diagnoses,” said Dr. Sydney Blatt, a professor of psychology and psychiatry at Yale University.
Researchers measure the strength of dependency traits by having people rate how highly they endorse certain beliefs, like, “After a fight with a friend, I must make amends as soon as possible”; “I am very sensitive to others for signs of rejection”; or “I have a lot of trouble making decisions for myself.”
In studies, people who score highly on these tests also tend to rate their parents as either authoritarian or overly protective (or one of each). “The message growing up is: You’re fragile, you’re weak, you need someone powerful to look after you,” Dr. Bornstein said.
That upbringing primes many people, as they grow, to seek similarly dependent pairings, with friends, colleagues and romantic partners. The pattern persists at least in part because it is frequently rewarded.
In one recent study, psychologists rated 48 men and women attending Gettysburg College in Pennsylvania on measures of dependency, and calculated their grade-point averages. After controlling for the students’ SAT scores and the difficulty of their course schedules, among other factors, the researchers found, to their surprise, that those students who scored highly on measures of dependency were doing significantly better, on average, than those who were more self-sufficient.
One likely reason, the authors found, was that dependent students were much more likely to say they sought help with course work from their professors.
In another experiment, presented in January at the American Psychoanalytic Association’s annual meeting, psychologists at the University of Leuven in Belgium measured dependency traits, relationship satisfaction and levels of conflict in 266 adults in long-term relationships. The researchers found that dependent partners scored significantly higher on satisfaction than more self-sufficient ones — but only when couples were struggling.
At least in the short run, dependent traits seemed to buffer the relationships in times of crisis, the authors suggest. Afraid of losing the relationship, “individuals high on dependency may actually behave in a more positive way to their partner, like being more complying, being more loving,” said Bénédicte Lowyck, the psychologist who led the study.
In the long run, Ms. Lowyck said, it is not at all clear whether such protective instincts nourish a relationship or smother it. The answer will depend on the couple, experts say, and likely on the content of a partner’s dependence: how it is expressed, whether the person is generous as well as needy, flexible as well as anxious.
To distinguish different shades, or varieties, of dependency, two psychologists, Aaron L. Pincus of Pennsylvania State and Michael B. Gurtman of the University of Wisconsin, Parkside, administered an exhaustive battery of dependency-related questionnaires to 654 psychology students. The scales rated everything from social confidence to preference for solitude to urges to please others. The psychologists’ analysis of the answers suggested that there were three distinct varieties of dependent behavior patterns.
One was defined predominantly by submissiveness (“I don’t have what it takes to be a good leader” or “I am easily downed in an argument”). Another was characterized principally by exploitability (“I am afraid of hurting people’s feelings” or “I do things that are not in my best interest in order to please others”). And a third, which the psychologists call love dependency, was based on a longing for social connection (“Being isolated from others is bound to lead to unhappiness” or “After a fight with a friend, I must make amends as soon as possible”).
People who struggle with an exaggerated need for the comfort of others may show flashes of all three types. “But it is this love dependency that is the most adaptive,” Dr. Pincus said. “These are people that form very strong attachments, who are not happy unless surrounded by friends and family” and least likely to stumble over their own anxieties.
Dr. Weinstein, the Chicago-area therapist, said that in more than 30 years of practice she had seen dozens of couples in which submission and exploitation have ended marriages. And studies now suggest that in severely troubled, abusive relationships, the aggressor, as well as the victim, often have a dependent fear of losing the relationship.
“This is the kind of couple where maybe the husband says: ‘You’re going to the store by yourself? You’re going to leave me here alone? You can’t do that — here, I’ll drive you,’ ” Dr. Weinstein said.
“And this kind of trivial-sounding exchange can turn very demanding and even violent, because of this unreasonable fear of abandonment.”
Skilled therapists can help people manage such fears, but there is little research to guide treatment. In one approach, people learn to identify, and alter, some of the conversation habits that make their interactions with others so volatile.
For example, they learn to reduce the number of times they seek reassurance in a conversation — “You’re not just saying that, right?” “Do you really mean that?” — and, eventually, to shift the focus of the conversation to the other person.
The patient can also learn to defuse his or her fears of losing a relationship by taking some of the hard evidence of a partner’s commitment at face value: flowers, romantic dinners, back rubs.
The partner can help, too, at least in cases of garden-variety neediness. Psychiatrists often advise a kind of sympathetic distancing: acknowledge the person’s fears; offer some reassurance; but nudge (or push) the person to at least experiment with interests, hobbies or habits that don’t revolve around the relationship.
And then turn off the cellphone for a few hours.

Psychiatry Can Do Only So Much

2007-02-06T10:07:00.000-05:00

Essay

About That Mean Streak of Yours: Psychiatry Can Do Only So Much

By RICHARD A. FRIEDMAN, M.D.

When have you ever heard of a therapist telling a patient that he is mean or bad? Probably never.

It’s not fashionable in our therapy-friendly nation, where people who behave obnoxiously are assumed to have a treatable psychiatric problem until proven otherwise. Nothing in the human experience is beyond the power of psychiatry to diagnose or fix, it seems.

But even for me, an optimist and a proponent of therapy, things have gotten a little out of hand.

Not long ago, one of my psychiatric residents called in distress about a patient who was demanding a different therapist. “This guy is in my office shouting at me and telling me how bad I am,” the resident said.

Sure enough, the patient in question was very hostile and demeaning in talking about this young doctor. Jabbing his finger in the air, he told me how unsympathetic my resident was and how rude the staff at the front desk had been.

“This kid doesn’t know the first thing about treating patients,” he said with derision. He clearly meant to hurt and humiliate his new doctor in front of a supervisor.

I listened for a while to his litany of complaints and found it easy to understand why people didn’t like him. “It’s no surprise to me that people aren’t nice to you if this is a sample of how you behave in the world,” I said to him.

This remark did not go over well.

“I’m basically a nice guy who has a terrible problem with anxiety,” the patient said resentfully.

He in fact did have a major psychiatric disorder; he had been struggling with obsessive-compulsive disorder for the last decade but had shown a pretty good response to antidepressant medication.

There was something else about him, however, that could not be neatly explained by psychiatry: he was simply mean-spirited.

At this point, most therapists might go in search of a cause for the patient’s behavior. Was there something in this patient’s life experience that might explain his nastiness? Not really. Life had not been too unkind to him; he’d suffered no major deprivation or trauma, and he had had all the benefits of an upper-middle-class upbringing.

Many of my colleagues would argue that he could have a personality disorder, a category that is broad enough to encompass nearly every variety of human misbehavior. Of course, everyone has personality traits, but when they cause major problems in relationships and work, they cross the line into disorder.

On the other hand, maybe he was mean by nature, a concept that may sound heretical coming from a psychiatrist because it seems dangerously close to rendering a moral judgment on a patient’s soul, something doctors should doubtless leave to theologians and philosophers.

But if some people turn out happy and good despite a lifetime of withering hardships, why can’t some people be mean or bad for no discernible reason?

There can be a relationship between nastiness and mental illness, and many therapists assume that when patients are mentally ill and mean, the illness is probably the cause of the ill temper.

But human meanness is far more common than all the mental illness in the population combined, so the contribution of mental illness to this essential human trait must be very small indeed.

Don’t get me wrong. There is plenty of undesirable human behavior that falls well within the rightful domain of psychiatry to understand and treat. But must we turn everything we don’t like about our fellow humans into a form of psychopathology?

Not long ago, we had a patient in the hospital who was psychotic and frightening to the staff. After several weeks, his psychosis cleared beautifully with antipsychotic medication, and we all thought he was ready for discharge.

Then early one morning, he used the pay phone to call one of my female residents at home, threatening her and talking in a sexually provocative way.

When I confronted him, it was quickly obvious that he was no longer psychotic or manic. In fact, he was cheeky and unrepentant about his behavior. And he left no doubt in my mind that psychiatry had done all it could for him.

He said it better than all the clinicians who had treated him on the inpatient unit: “I’m not crazy now, but I guess I’ve never been a nice guy.”

To put it another way, some mentally ill patients can be mean or bad just like anyone else, and this is not a problem for psychiatry to fix.

Do You Believe in Magic?

2007-01-23T10:21:00.000-05:00

January 23, 2007, NEW YORK TIMES
Do You Believe in Magic?
By BENEDICT CAREY
A graduate school application can go sour in as many ways as a blind date. The personal essay might seem too eager, the references too casual. The admissions officer on duty might be nursing a grudge. Or a hangover.
Rachel Riskind of Austin, Tex., nonetheless has a good feeling about her chances for admittance to the University of Michigan’s exclusive graduate program in psychology, and it’s not just a matter of her qualifications.
On a recent afternoon, as she was working on the admissions application, she went out for lunch with co-workers. Walking from the car to the restaurant in a misting rain, she saw a woman stroll by with a Michigan umbrella.
“I felt it was a sign; you almost never see Michigan stuff here,” said Ms. Riskind, 22. “And I guess I think that has given me a kind of confidence. Even if it’s a false confidence, I know that that in itself can help people do well.”
Psychologists and anthropologists have typically turned to faith healers, tribal cultures or New Age spiritualists to study the underpinnings of belief in superstition or magical powers. Yet they could just as well have examined their own neighbors, lab assistants or even some fellow scientists. New research demonstrates that habits of so-called magical thinking — the belief, for instance, that wishing harm on a loathed colleague or relative might make him sick — are far more common than people acknowledge.
These habits have little to do with religious faith, which is much more complex because it involves large questions of morality, community and history. But magical thinking underlies a vast, often unseen universe of small rituals that accompany people through every waking hour of a day.
The appetite for such beliefs appears to be rooted in the circuitry of the brain, and for good reason. The sense of having special powers buoys people in threatening situations, and helps soothe everyday fears and ward off mental distress. In excess, it can lead to compulsive or delusional behavior. This emerging portrait of magical thinking helps explain why people who fashion themselves skeptics cling to odd rituals that seem to make no sense, and how apparently harmless superstition may become disabling.
The brain seems to have networks that are specialized to produce an explicit, magical explanation in some circumstances, said Pascal Boyer, a professor of psychology and anthropology at Washington University in St. Louis. In an e-mail message, he said such thinking was “only one domain where a relevant interpretation that connects all the dots, so to speak, is preferred to a rational one.”
Children exhibit a form of magical thinking by about 18 months, when they begin to create imaginary worlds while playing. By age 3, most know the difference between fantasy and reality, though they usually still believe (with adult encouragement) in Santa Claus and the Tooth Fairy. By age 8, and sometimes earlier, they have mostly pruned away these beliefs, and the line between magic and reality is about as clear to them as it is for adults.
It is no coincidence, some social scientists believe, that youngsters begin learning about faith around the time they begin to give up on wishing. “The point at which the culture withdraws support for belief in Santa and the Tooth Fairy is about the same time it introduces children to prayer,” said Jacqueline Woolley, a professor of psychology at the University of Texas. “The mechanism is already there, kids have already spent time believing that wishing can make things come true, and they’re just losing faith in the efficacy of that.”
If the tendency to think magically were no more than self-defeating superstition, then over the pitiless history of human evolution it should have all but disappeared in intellectually mature adults.
Yet in a series of experiments published last summer, psychologists at Princeton and Harvard showed how easy it was to elicit magical thinking in well-educated young adults. In one instance, the researchers had participants watch a blindfolded person play an arcade basketball game, and visualize success for the player. The game, unknown to the subjects, was rigged: the shooter could see through the blindfold, had practiced extensively and made most of the shots.
On questionnaires, the spectators said later that they had probably had some role in the shooter’s success. A comparison group of participants, who had been instructed to visualize the player lifting dumbbells, was far less likely to claim such credit.
In another experiment, the researchers demonstrated that young men and women instructed on how to use a voodoo doll suspected that they might have put a curse on a study partner who feigned a headache. And they found, similarly, that devoted fans who watched the 2005 Super Bowl felt somewhat responsible for the outcome, whether their team won or lost. Millions in Chicago and Indianapolis are currently trying to channel the winning magic.
“The question is why do people create this illusion of magical power?” said the lead author, Emily Pronin, an assistant professor of psychology and public affairs at Princeton. “I think in part it’s because we are constantly exposed to our own thoughts, they are most salient to us” — and thus we are likely to overestimate their connection to outside events.
The brain, moreover, has evolved to make snap judgments about causation, and will leap to conclusions well before logic can be applied. In an experiment presented last fall at the Society for Neuroscience meeting, Ben Parris of the University of Exeter in England presented magnetic resonance imaging scans taken from the brains of people watching magic tricks. In one, the magician performed a simple sleight of hand: he placed a coin in his palm, closed his fingers over it, then opened his hand to reveal that the coin was gone.
Dr. Parris and his colleagues found spikes of activity in regions of the left hemisphere of the brain that usually become engaged when people form hypotheses in uncertain situations.
These activations occur so quickly, other researchers say, that they often link two events based on nothing more than coincidence: “I was just thinking about looking up my high school girlfriend when out of the blue she called me,” or, “The day after I began praying for a quick recovery, she emerged from the coma.”
For people who are generally uncertain of their own abilities, or slow to act because of feelings of inadequacy, this kind of thinking can be an antidote, a needed activator, said Daniel M. Wegner, a professor of psychology at Harvard. (Dr. Wegner was a co-author of the voodoo study, with Kimberly McCarthy of Harvard and Sylvia Rodriguez of Princeton.)
“I deal with students like this all the time and I say, ‘Let’s get you overconfident,’ ” Dr. Wegner said. “This feeling that your thoughts can somehow control things can be a needed feeling” — the polar opposite of the helplessness, he added, that so often accompanies depression.
Magical thinking is most evident precisely when people feel most helpless. Giora Keinan, a professor at Tel Aviv University, sent questionnaires to 174 Israelis after the Iraqi Scud missile attacks of the 1991 gulf war. Those who reported the highest level of stress were also the most likely to endorse magical beliefs, like “I have the feeling that the chances of being hit during a missile attack are greater if a person whose house was attacked is present in the sealed room,” or “To be on the safe side, it is best to step into the sealed room right foot first.”
“It is of interest to note,” Dr. Keinan concluded, “that persons who hold magical beliefs or engage in magical rituals are often aware that their thoughts, actions or both are unreasonable and irrational. Despite this awareness, they are unable to rid themselves of such behavior.”
On athletic fields, at the craps table or out sailing in the open ocean, magical thinking is a way of life. Elaborate, entirely nonsensical rituals are performed with solemn deliberation, complete with theories of magical causation.
“I am hoping I do not change my clothes for the rest of the season, that I really start to stink,” said Tom Livatino, head basketball coach at Lincoln Park High School in Chicago, who wears the same outfit as long as his team is winning. (And it usually does.)
The idea, Mr. Livatino said, is to do as much as possible to recreate the environment that surrounds his team’s good play. He doesn’t change his socks; he doesn’t empty his pockets; and he works the sideline with the sense he has done everything possible to win. “The full commitment,” he explained. “I’ll do anything to give us an edge.”
Only in extreme doses can magical thinking increase the likelihood of mental distress, studies suggest. People with obsessive-compulsive disorder are often nearly paralyzed by the convictions that they must perform elaborate rituals, like hand washing or special prayers, to ward off contamination or disaster. The superstitions, perhaps harmless at the outset, can grow into disabling defense mechanisms.
Those whose magical thoughts can blossom into full-blown delusion and psychosis appear to be a fundamentally different group in their own right, said Mark Lenzenweger, a professor of clinical science, neuroscience and cognitive psychology at Binghamton, part of the State University of New York. “These are people for whom magical thinking is a central part of how they view the world,” not a vague sense of having special powers, he said. “Whereas with most people, if you were to confront them about their magical beliefs, they would back down.”
Reality is the most potent check on runaway magical thoughts, and in the vast majority of people it prevents the beliefs from becoming anything more than comforting — and disposable — private rituals. When something important is at stake, a test or a performance or a relationship, people don’t simply perform their private rituals: they prepare. And if their rituals start getting in the way, they adapt quickly.
Mr. Livatino lives and breathes basketball, but he also recently was engaged to be married.
“I can tell you she doesn’t like the clothes superstition,” he said. “She has made that pretty clear.”

Help, I’m Surrounded by Jerks

2007-01-20T10:13:00.000-05:00

By STEPHANIE ROSENBLOOM, NEW YORK TIMES
CERTAIN mortals have the power to sink hearts and sour moods with lightning speed. The hysterical colleague. The meddlesome neighbor. The crazy in-law. The explosive boss. A mélange of cantankerous individuals, they are united by a single achievement: They make life miserable.
You call them jerks, dolts and nitwits. Psychologists call them “difficult people.” In fact they are difficult in so many ways that they have been classified into species like the Complainer, the Whiner and the Sniper, to name but three.
But in an age when no problem goes unacknowledged or unaddressed, living with such people is no longer the only choice. Instead, an industry of books and seminars has sprung up, not to help the difficult change their maddening ways, but to help the rest of us cope with them.
Two decades ago there were only a handful of books offering advice on how to defang the dears. Today there are scores of seminars, workbooks and multimedia tools to help people co-exist with those they wish did not exist.
In the spring, Career Press is to publish “151 Quick Ideas to Deal With Difficult People” by Carrie Mason-Draffen. But numerous resources are already on the market, including the succinctly titled “Since Strangling Isn’t an Option” by Sandra A. Crowe.
Next month the Career and Professional Development Center at Duke Law School will for the first time offer a workshop called Dealing With Conflict and Difficult People. In September the negotiation program in Harvard Law School’s executive education series will present a seminar called Dealing With Difficult People and Difficult Situations. And the Graduate School, United States Department of Agriculture, which offers continuing education classes, has scheduled more than half a dozen seminars entitled Positive Approaches to Difficult People for this year.
The lessons include common sense (talk it out and put yourself in their shoes), character by character tactical road maps and something that the victims of the difficult don’t want to hear: they might be the problem.
Nan Harrison, the vice president of training resources and publication sales for CareerTrack, which every month presents more than 50 public “difficult people” seminars across the country, attributes the increased popularity of such workshops to a desire to improve workplace skills in a time of corporate downsizing and a more competitive job market. “I think the stakes have gotten higher for everyone,” she said.
Other conflict-resolution specialists suggested an unexpected reason for the increasing interest: A post-9/11 desire to make peace, even if it is merely with the wet blanket in the adjoining cubicle.
Whatever the reason, “difficult people” gurus are in demand. That is perhaps because everyone knows at least one person who can set the blood boiling. They can be found in corporate offices, on co-op boards, in church choirs and on university faculties. They are the office Cassandra who predicts doom for every project her team initiates, the intimidating boss for whom nothing is ever good enough and the unreasonable receptionist at the motor vehicles office.
“They’re very disruptive, these people,” said Brook Zelcer, a tennis pro and an English teacher in Westwood, N.J.
On the tennis court, Mr. Zelcer has been served up his share of overbearing and impatient parents. One stood out as truly difficult: The father who gave his wife play-by-plays of his daughter’s matches on his cellphone, disrupted games by shouting from the stand, encouraged his daughter to cheat during matches and drove her to tears.
Mr. Zelcer tried to control the father, but all he got was a phone call from the man insisting he loved his child. “That’s one of the reasons I quit coaching,” Mr. Zelcer said. “I couldn’t deal with these people.”
For Ann Rothman, a Manhattan real estate agent, her difficult person is a know-it-all friend who simply cannot be pleased.
“She’s a superior human being, and she comes from a superior area — Berkeley, Calif.,” Ms. Rothman said. “She has told me many times that there are only two places to get good food. One of them is Berkeley, and one of them is France. And France is only second to Berkeley.”
Difficult people are not harmless. The impact of slowing productivity or creating unhappy customers and vendors is immeasurable, unknowable and often a company’s biggest cost, said Ms. Harrison of CareerTrack, paraphrasing W. Edwards Deming, a management consultant.
Yet, some scholars say, the problem is not the difficult people themselves. It is you.
“There’s a good quote from the Talmud,” said Bruce Elvin, an associate dean and the director of the Career and Professional Development Center at Duke Law School. “ ‘We do not see the world as it is. We see the world as we are.’ That really in my view sums this topic up.”
He and others say that rather than seeing the office curmudgeon or the post office nitpicker as the sum of their most wretched behavior, it is better to think of them as full people, even to empathize with them, if only to maintain some sense of control.
Easier said than done. But psychologists say people exhibit difficult behavior because they have a need that is not being met. Understanding that need — a colleague may be snappish, for instance, because his personal life is in turmoil — helps take the sting out of his or her actions, they say.
“Some people really are bad people,” said Mark I. Rosen, a social scientist at Brandeis and the author of “Thank You for Being Such a Pain: Spiritual Guidance for Dealing With Difficult People,” “but I don’t think the percentage is as high as people think it is.” Instead, he said, “most people fall into the category of incompetent or oblivious.”
Several authors think it is useful to characterize infuriating people into types and prescribe ways to deal with them, as Robert M. Bramson did in 1981 in “Coping With Difficult People,” one of the first popular books on the topic. Its overarching lesson is to find a way to communicate with these people because they are not going away. Dr. Bramson lists seven difficult behavior types: Hostile-Aggressives, Complainers, Silent and Unresponsives, Super-Agreeables, Know-It-All Experts, Negativists and Indecisives.
These authors say that after categorizing the difficult behavior, you can take steps to rein it in. For example, Dr. Rick Brinkman, a seminar leader and an author of “Dealing With People You Can’t Stand: How to Bring Out the Best in People at Their Worst,” calls one category Whiners. These people rattle off an endless loop of complaints and must be coaxed into problem solving.
He suggests listening to them and letting them vent. Chances are, he said, their complaints will be vague and exaggerated. When they begin to repeat their gripes, summarize for them what they have said. Then begin asking specific questions.
“You have to keep asking them what they think they should do,” Dr. Brinkman said, to press for resolutions. You might finally say something outrageous, like “What if we were to kill everyone in the other department?”
The literature on difficult people often focuses on the workplace, but business scholars say that neither your department nor “the other department” has a corner on the difficult people market. Rather, as Richard Freedman, the distinguished service professor of management at the Leonard N. Stern School of Business of New York University, put it, “Difficult people are distributed evenly throughout society.”
“How many mother-in-law stories have you heard?” he asked. “It’s not disproportionate in the workplace, but often what it is, is that the stakes are so big for people. Career is at the center of people’s lives.”
Workplaces are competitive environments comprising individuals with disparate styles of working and communicating. With so many temperaments thrown together, every office is a powder keg.
For instance, there are those who think they are powerless, that their ideas go unheard or are dismissed and who believe they are not valued, feelings that can turn into chronically difficult behavior.
In the end, the specialists say, we cannot control other people, only our response to them. Then again, we can always let nature take its course.
“Having somebody who is really difficult can actually be good for the workplace,” said Jo-Ellen Pozner, a researcher in the Kellogg School of Management at Northwestern. “If everyone really hates this one person, it becomes the basis of social bonding for the rest of the group.”

Saying Yes to Mess

2006-12-23T17:15:00.000-05:00

December 21, 2006, NEW YORK TIMES
Saying Yes to Mess
By PENELOPE GREEN
IT is a truism of American life that we’re too darn messy, or we think we are, and we feel really bad about it. Our desks and dining room tables are awash with paper; our closets are bursting with clothes and sports equipment and old files; our laundry areas boil; our basements and garages seethe. And so do our partners — or our parents, if we happen to be teenagers.
This is why sales of home-organizing products, like accordion files and labelmakers and plastic tubs, keep going up and up, from $5.9 billion last year to a projected $7.6 billion by 2009, as do the revenues of companies that make closet organizing systems, an industry that is pulling in $3 billion a year, according to Closets magazine.
This is why January is now Get Organized Month, thanks also to the efforts of the National Association of Professional Organizers, whose 4,000 clutter-busting members will be poised, clipboards and trash bags at the ready, to minister to the 10,000 clutter victims the association estimates will be calling for its members’ services just after the new year.
But contrarian voices can be heard in the wilderness. An anti-anticlutter movement is afoot, one that says yes to mess and urges you to embrace your disorder. Studies are piling up that show that messy desks are the vivid signatures of people with creative, limber minds (who reap higher salaries than those with neat “office landscapes”) and that messy closet owners are probably better parents and nicer and cooler than their tidier counterparts. It’s a movement that confirms what you have known, deep down, all along: really neat people are not avatars of the good life; they are humorless and inflexible prigs, and have way too much time on their hands.
“It’s chasing an illusion to think that any organization — be it a family unit or a corporation — can be completely rid of disorder on any consistent basis,” said Jerrold Pollak, a neuropsychologist at Seacoast Mental Health Center in Portsmouth, N.H., whose work involves helping people tolerate the inherent disorder in their lives. “And if it could, should it be? Total organization is a futile attempt to deny and control the unpredictability of life. I live in a world of total clutter, advising on cases where you’d think from all the paper it’s the F.B.I. files on the Unabomber,” when, in fact, he said, it’s only “a person with a stiff neck.”
“My wife has threatened divorce over all the piles,” continued Dr. Pollack, who has an office at home, too. “If we had kids the health department would have to be alerted. But what can I do?”
Stop feeling bad, say the mess apologists. There are more urgent things to worry about. Irwin Kula is a rabbi based in Manhattan and author of “Yearnings: Embracing the Sacred Messiness of Life,” which was published by Hyperion in September. “Order can be profane and life-diminishing,” he said the other day. “It’s a flippant remark, but if you’ve never had a messy kitchen, you’ve probably never had a home-cooked meal. Real life is very messy, but we need to have models about how that messiness works.”
His favorite example? His 15-year-old daughter Talia’s bedroom, a picture of utter disorder — and individuality, he said.
“One day I’m standing in front of the door,” he said, “and it’s out of control and my wife, Dana, is freaking out, and suddenly I see in all the piles the dress she wore to her first dance and an earring she wore to her bat mitzvah. She’s so trusting her journal is wide open on the floor, and there are photo-booth pictures of her friends strewn everywhere. I said, ‘Omigod, her cup overflows!’ And we started to laugh.”
The room was an invitation, he said, to search for a deeper meaning under the scurf.
Last week David H. Freedman, another amiable mess analyst (and science journalist), stood bemused in front of the heathery tweed collapsible storage boxes with clear panels ($29.99) at the Container Store in Natick, Mass., and suggested that the main thing most people’s closets are brimming with is unused organizing equipment. “This is another wonderful trend,” Mr. Freedman said dryly, referring to the clear panels. “We’re going to lose the ability to put clutter away. Inside your storage box, you’d better be organized.”
Mr. Freedman is co-author, with Eric Abrahamson, of “A Perfect Mess: The Hidden Benefits of Disorder,” out in two weeks from Little, Brown & Company. The book is a meandering, engaging tour of beneficial mess and the systems and individuals reaping those benefits, like Gov. Arnold Schwarzenegger, whose mess-for-success tips include never making a daily schedule.
As a corollary, the book’s authors examine the high cost of neatness — measured in shame, mostly, and family fights, as well as wasted dollars — and generally have a fine time tipping over orthodoxies and poking fun at clutter busters and their ilk, and at the self-help tips they live or die by. They wonder: Why is it better to pack more activities into one day? By whose standards are procrastinators less effective than their well-scheduled peers? Why should children have to do chores to earn back their possessions if they leave them on the floor, as many professional organizers suggest?
In their book Mr. Freedman and Mr. Abrahamson describe the properties of mess in loving terms. Mess has resonance, they write, which means it can vibrate beyond its own confines and connect to the larger world. It was the overall scumminess of Alexander Fleming’s laboratory that led to his discovery of penicillin, from a moldy bloom in a petri dish he had forgotten on his desk.
Mess is robust and adaptable, like Mr. Schwarzenegger’s open calendar, as opposed to brittle, like a parent’s rigid schedule that doesn’t allow for a small child’s wool-gathering or balkiness. Mess is complete, in that it embraces all sorts of random elements. Mess tells a story: you can learn a lot about people from their detritus, whereas neat — well, neat is a closed book. Neat has no narrative and no personality (as any cover of Real Simple magazine will demonstrate). Mess is also natural, as Mr. Freedman and Mr. Abrahamson point out, and a real time-saver. “It takes extra effort to neaten up a system,” they write. “Things don’t generally neaten themselves.”
Indeed, the most valuable dividend of living with mess may be time. Mr. Freedman, who has three children and a hard-working spouse, Laurie Tobey-Freedman, a preschool special-needs coordinator, is studying Mandarin in his precious spare moments. Perusing a four-door stainless steel shoe cabinet ($149) at the Container Store, and imagining gussying up a shoe collection, he shook his head and said, “I don’t get the appeal of this, which may be a huge defect on my part in terms of higher forms of entertainment.”
The success of the Container Store notwithstanding, there is indeed something messy — and not in a good way — about so many organizing options. “When I think about this urge to organize, it reminds me of how it was when Americans began to take more and more control of their weight: they got fatter,” said Marian Salzman, chief marketing officer of J. Walter Thompson and co-author, with Ira Matathia, of “Next Now: Trends for the Future,” which is about to be published by Palgrave Macmillan. “I never gained weight until I went on a diet,” she said, adding that she has a room in which she hides a treadmill and, now, two bags of organizing supplies.
“I got sick of looking at them so I bought plastic tubs and stuffed the bags in the tubs and put the tubs in the room.” Right now, she said, “we are emotionally overloaded, and so what this is about is that we are getting better and better at living superficially.”
“Superficial is the new intimate,” Ms. Salzman said, gaining steam, “and these boxes, these organizing supplies, are the containers for all our superficial selves. ‘I will be a neater mom, a hipper mom, a mom that gets more done.’ Do I sound cynical?”
Nah.
In the semiotics of mess, desks may be the richest texts. Messy-desk research borrows from cognitive ergonomics, a field of study dealing with how a work environment supports productivity. Consider that desks, our work landscapes, are stand-ins for our brains, and so the piles we array on them are “cognitive artifacts,” or data cues, of our thoughts as we work.
To a professional organizer brandishing colored files and stackable trays, cluttered horizontal surfaces are a horror; to cognitive psychologists like Jay Brand, who works in the Ideation Group of Haworth Inc., the huge office furniture company, their peaks and valleys glow with intellectual intent and showcase a mind whirring away: sorting, linking, producing. (By extension, a clean desk can be seen as a dormant area, an indication that no thought or work is being undertaken.)
His studies and others, like a survey conducted last year by Ajilon Professional Staffing, in Saddle Brook, N.J., which linked messy desks to higher salaries (and neat ones to salaries under $35,000), answer Einstein’s oft-quoted remark, “If a cluttered desk is a sign of a cluttered mind, of what, then, is an empty desk?”
Don Springer, 61, is an information technology project manager and the winner of the Type O-No! contest sponsored by Dymo, the labelmaker manufacturer, in October. The contest offered $5,000 worth of clutter management — for the tools (the boxes, the bins and the systems, as well as a labelmaker) and the services of a professional organizer — to the best example of a “clutter nightmare,” as expressed by contestants in a photograph and a 100-word essay. “Type O-Nos,” reads a definition on the Dymo Web site, are “outlaws on the tidy trail, clutter criminals twice over.”
Mr. Springer, who in a phone interview spoke softly, precisely and with great humor, professed deep shame over the contents of what he calls his oh-by-the-way room, a library/junk room that his wife would like cleaned to make a nursery for a new grandchild. With a full-time job and membership in various clubs and organizations, and a desire to spend his free time seeing a movie with his wife instead of “expending the emotional energy it would take to sort through all the stuff,” Mr. Springer said, he is unable to prune the piles to his wife’s satisfaction. “There are emotional treasures buried in there, and I don’t want to part with them,” he said.
So, why bother?
“Because I love my wife and I want to make her happy,” he said.
According to a small survey that Mr. Freedman and Mr. Abrahamson conducted for their book — 160 adults representing a cross section of genders, races and incomes, Mr. Freedman said — of those who had split up with a partner, one in 12 had done so over a struggle involving one partner’s idea of mess. Happy partnerships turn out not necessarily to be those in which products from Staples figure largely. Mr. Freedman and his wife, for example, have been married for over two decades, and live in an offhandedly messy house with a violently messy basement — the latter area, where their three children hang out, decorated (though that’s not quite the right word) in a pre-1990s Tompkins Square Park lean-to style.
The room’s chaos is an example of one of Mr. Freedman and Mr. Abrahamson’s mess strategies, which is to create a mess-free DMZ (in this case, the basement stairs) and acknowledge areas of complementary mess. Cherish your mess management strategies, suggested Mr. Freedman, speaking approvingly of the pile builders and the under-the-bed stuffers; of those who let their messes wax and wane — the cyclers, he called them; and those who create satellite messes (in storage units off-site). “Most people don’t realize their own efficiency or effectiveness,” he said with a grin.
It’s also nice to remember, as Mr. Freedman pointed out, that almost anything looks pretty neat if it’s shuffled into a pile.

Do You Believe in Surnits?

2006-12-23T17:12:00.000-05:00

December 23, 2006
New York Times Op-Ed Contributor
Do You Believe in Surnits?
By JACQUELINE WOOLLEY
Austin, Tex.
WE delight in our children’s belief in reindeer that can fly and a fat man who fits through chimneys and travels the whole world in a single night. Many children believe fiercely not only in Santa Claus but also in other fantastical beings like the Easter Bunny and the Tooth Fairy from the time they are about 3 until they are 7 or 8.
Their eager belief contributes to the common view, shared by psychologists and other scientists, that young children are credulous (and conversely, that adults are not). Children believe everything they are told, we assume, with little regard for logic, a sense of the real world or any of the other criteria adults use to debunk such fictions as the Loch Ness monster or Sasquatch.
But are children really that different from us? A study that my colleagues and I conducted at the Children’s Research Laboratory at the University of Texas suggests not. We found that, in fact, children use many of the same cues adults use to distinguish fantasy from reality.
Our experiment was designed to investigate how a young child, upon encountering a fantastical being like a unicorn in a storybook, decides whether it is real or imaginary. Adults often make the call based on context. If, for example, we encounter a weird and unfamiliar insect at a science museum, we are more likely to think it is something real than if we find it in a joke store.
To see if children could also use context in this way, we described “surnits” and other made-up things to our study group. To some of the children, we put surnits in a fantastical context: “Ghosts try to catch surnits when they fly around at night.” To others, we characterized them in scientific terms: “Doctors use surnits to help them in the hospital.”
The 4- to 6-year-olds who heard the medical description were much more likely to think surnits were real than children who were told they had something to do with ghosts. The children demonstrated that they do not indiscriminately believe everything they’re told, but use some pretty high-level tools to distinguish between fantasy and reality.
If children are so smart, why do they believe in Santa Claus? My view is that they are exhibiting their very rational and scientific cognitive abilities. The adults they count on to provide reliable information about the world introduce them to Santa. Then his existence is affirmed by friends, books, TV and movies. It is also validated by hard evidence: the half-eaten cookies and empty milk glasses by the tree on Christmas morning.
In other words, children do a great job of scientifically evaluating Santa. And adults do a great job of duping them. As we gradually withdraw our support for the myth, and children piece together the truth, their view of Santa aligns with ours. Perhaps it is this kinship with the adult world that prevents children from feeling anger over having been misled.
So maybe this holiday season, when the children come rushing in to see what Santa brought, we should revel not in their wide-eyed wonder, but in how sophisticated and clever their young minds really are.
Jacqueline Woolley is a professor of psychology at the University of Texas at Austin.

Questions Couples Should Ask (Or Wish They Had) Before Marrying

2006-12-23T17:08:00.000-05:00

Relationship experts report that too many couples fail to ask each other critical questions before marrying. Here are a few key ones that couples should consider asking:
1) Have we discussed whether or not to have children, and if the answer is yes, who is going to be the primary care giver?
2) Do we have a clear idea of each other’s financial obligations and goals, and do our ideas about spending and saving mesh?
3) Have we discussed our expectations for how the household will be maintained, and are we in agreement on who will manage the chores?
4) Have we fully disclosed our health histories, both physical and mental?
5) Is my partner affectionate to the degree that I expect?
6) Can we comfortably and openly discuss our sexual needs, preferences and fears?
7) Will there be a television in the bedroom?
8) Do we truly listen to each other and fairly consider one another’s ideas and complaints?
9) Have we reached a clear understanding of each other’s spiritual beliefs and needs, and have we discussed when and how our children will be exposed to religious/moral education?
10) Do we like and respect each other’s friends?
11) Do we value and respect each other’s parents, and is either of us concerned about whether the parents will interfere with the relationship?
12) What does my family do that annoys you?
13) Are there some things that you and I are NOT prepared to give up in the marriage?
14) If one of us were to be offered a career opportunity in a location far from the other’s family, are we prepared to move?
15) Does each of us feel fully confident in the other’s commitment to the marriage and believe that the bond can survive whatever challenges we may face?

Parenting as Therapy for Child’s Mental Disorders

2006-12-23T11:26:00.000-05:00

By BENEDICT CAREY , NEW YORK TIMES
Correction Appended
BUFFALO — In school he was as floppy and good-natured as a puppy, a boy who bear-hugged his friends, who was always in motion, who could fall off his chair repeatedly, as if he had no idea how to use one.
But at home, after run-ins with his parents, his exuberance could turn feral. From the exile of his room, Peter Popczynski would throw anything that could be launched — books, pencils, lamps, clothes, toys — scarring the walls of the family’s brick bungalow, and leaving some items to rattle down the hallway, like flotsam from a storm.
The Popczynskis soon received a diagnosis for their son, attention-deficit hyperactivity disorder, or A.D.H.D., and were told that they could turn to a stimulant medication like Ritalin. Doctors have ample evidence that stimulants not only calm children physically but may also improve their school performance, at least for as long as they are on medication.
But like most other parents, the couple preferred to avoid drug treatment, if possible. Instead, with the guidance of psychologists at the University at Buffalo, they altered the way they interacted with Peter and his younger brother, Scott. And over the course of a difficult year, they brought about a transformation in their son. He still has days when he gets into trouble, like any other 10-year-old, but he no longer exhibits the level of restless distractibility that earned him a psychiatric diagnosis.
“People are so stressed out, and it’s so much easier to say, ‘Here, take this pill and go to your room; leave me alone,’ ” Lisa Popczynski said on a recent Monday after work. Peter sat on the couch, hunched over his homework, while her husband, Roman, occupied Scott, 8.
“But what I would say is that if you are willing to take on the responsibility of extra parenting, you can make a big difference,” said Ms. Popczynski, an interior designer. “I compare parenting to driving. We all learn pretty quickly how to drive a car. But if you have to drive a Mack truck, you’re going to need some training.”
In recent decades, psychiatry has come to understand mental disorders as a matter of biology, of brain abnormalities rooted in genetic variation. This consensus helped discredit theories from the 1960s that blamed the parents — usually the mother — for problems like neurosis, schizophrenia and autism.
By defining mental disorders as primarily problems of brain chemicals, the emphasis on biology also led to an increasing dependence on psychiatric drugs, especially those that entered the market in the 1980s and 1990s.
But the science behind nondrug treatments is getting stronger. And now, some researchers and doctors are looking again at how inconsistent, overly permissive or uncertain child-rearing styles might worsen children’s problems, and how certain therapies might help resolve those problems, in combination with drug therapy or without drugs.
The psychotherapy techniques intended for the improvement of interactions between parents and children have been used mostly for children who suffer from attention disorders or who exhibit aggressive or defiant behavior. But recently, mental health professionals have been studying their use for families whose children suffer from depression or other mood problems.
In a comprehensive review, the American Psychological Association urged in August that for childhood mental disorders, “in most cases,” nondrug treatment “be considered first,” including techniques that focus on parents’ skills, as well as enlisting teachers’ help.
And in its just-completed guidelines, even the American Academy of Child and Adolescent Psychiatry, an organization whose members strongly favor drug treatment, recommends that children receive some form of talk therapy before being given drugs for moderate depression, a very common complaint.
“We are at a point where families who bring in a child ought to get a Chinese menu of treatments that are backed by some evidence, including not only medication but psychosocial or family interventions,” said Dr. John March, a child psychiatrist at Duke University. “Not to do so when we know some of these therapies work is, in my opinion, simply unethical. Then let the family choose which one they want.”
The argument over which is better, medication or psychotherapy intended to change the behavior of parents and children, is irrelevant in many cases. A child paralyzed by feelings of severe despair or anxiety, for example, often cannot begin to engage in any type of therapy without a period on medication to break the disabling mood. And many studies suggest that the combination of medication and talk therapy is significantly more effective, and safer, than either alone.
Drugs, Therapy or Both?
“It’s obvious that medication has been more effective than behavioral modification in treating the core symptoms of A.D.H.D., but behavioral treatments can produce real improvement, and for certain kids the combination of the two treatment appears to be best,” said Dr. Oscar Bukstein, a child psychiatrist at the University of Pittsburgh School of Medicine who is helping the American Academy of Child and Adolescent Psychiatry write treatment guidelines. “Children with other behavior problems in addition to A.D.H.D., for instance, seem to do best with both treatments.”
The Popczynskis found that a brand of family therapy by itself was sufficient to put Peter on track at school and at home. Their experience helps illustrate how a family can, in effect, treat a child’s psychiatric disorder — and for whom such an approach can be practical.
One thing the family had going for it was location. When Peter’s mother began scouring the Internet for resources in the spring of 2003, she quickly learned that they lived only a few miles from the University of Buffalo, which runs one of the country’s most comprehensive behavioral modification programs.
In a study involving 128 families, psychologists at the university had found that about a third of parents who completed the program saw enough improvement in their children that they had decided that medication was unnecessary. The other two-thirds put their children on stimulant medication at school but at doses significantly lower those typically prescribed, said William Pelham, a psychologist who is director of the Center for Children and Families at Buffalo and the senior author of the study. Eighty percent of the families who participated in the program, with follow-up parent training, decided that their children did not need medication at home.
“Most parents seeking help for a child with a psychiatric disorder never hear about programs like this,” Dr. Pelham said. “The only option they’re given is medication. Now, it may be that the best treatment for that child is medication. But how do you know if you never try anything else?”
Behavior modification for A.D.H.D. and for related problems, like habitually disruptive or defiant behavior, is based on a straightforward system of rewards and consequences. Parents reward every good or cooperative act they see: small things, like simply paying attention for a few moments, earn an “attaboy.” Completing homework without complaint might earn time on a Gameboy. Parents remove privileges, like television and playtime, or impose a “time out,” in response to defiance and other misbehavior.
And they learn to ignore annoying but harmless attempts to win attention, like making weird noises, tapping or acting like a baby.
Tracking Behavior
These skills are hardly unknown to seasoned parents. But most also know that stress or anger, even when dealing with a child who has no serious problems, can sour the best instincts. That is why family-based programs insist that parents try to maintain a clear, neutral tone when instructing their children, or penalizing them.
Bluntness, for example, is a virtue. Saying to a child, “Would you put your toys back in the box, please?” turns a command into a question. Saying, “Let’s put your toys back in the box,” implies collaboration. An unadorned “Put your toys back in the box” is clearer for everyone, psychologists say, especially so for a child who is highly distractible.
However it is dressed up, family therapy like this teaches parents to provide what many critics say children these days are missing — discipline. But therapists make a careful distinction between corrective action and cruelty, between firmness and frostiness. Overly punitive parents increase the likelihood that a child will develop mood problems, some studies suggest. So parents learn not to become scolds, but to bring their children into line without demeaning them.
In some programs, parents play-act situations in front of their peers, who critique the performance for emotional tone and the clarity of parents’ statements. As a result, the parents say, they become immediately more deliberate at home. “You end up constantly saying things like, ‘That’s not an appropriate behavior,’ using this unnatural language,” said Ms. Popczynski. “But the point is you don’t get into it with them. The first thing I noticed was that I wasn’t yelling all the time. The house got a lot quieter right away.”
Their instructions to Peter and Scott became more precise, as well. Saying “Clean your room” is too vague and covers a half-dozen tasks, Roman Popczynski, the boys’ father, said. Peter might wonder where to start, or just decide it was too much to worry about, and give up, his father said. “Put your laundry in the hamper” is much more likely to get results, he said, and lead to the next clear step, like “Put your toys where they belong.”
Multiple commands are also confounding: “Put away your crayons, clear away the table, and organize your homework, please” leaves a child wondering which to do first, and whether it is too much work to finish. “It overloads a kid, and then he feels like he’s failing, which only makes it worse,” said Mr. Popczynski, who is a UPS driver.
Starting Slowly
Like most who try to use behavior modification techniques, the Popczynskis relied on a daily report card to keep a running tally of Peter’s specific problem behaviors, like wandering attention, ignoring commands or defiance, and his efforts to correct them.
For instance, at the beginning, Peter, then 7, would get a check mark every time he ignored more than two commands to do his homework, put away his toys or brush his teeth, but he would earn immediate praise if he got started. He received check marks when he slid off his chair at dinner, and earned approval if he stayed seated.
At bedtime he accumulated marks if hepulled delay tactics. A tantrum resulted in instant punishment: a timeout of 5 to 10 minutes, shortened for good behavior. The report card was posted on the refrigerator.
The Popczynskis started slowly. They measured how many marks Peter recorded in a normal day, and at first rewarded him if he reduced the number by even one: with an extra 15 minutes on Game Cube, for example. If he had more good days than bad ones over the course of a week, he got to choose from a bag of toys from the $1 store.
Mr. and Ms. Popczynski continued to raise the standard, one checkmark at a time, until Peter hit zero consistently.
“You want them to be able to succeed,” Mr. Popczynski said. “If you make it too hard, they’ll just give up, and so will you.”
The Buffalo program is more comprehensive than most: psychologists run a summer camp here, employing the same principles, and, during the school year, regularly visit the teachers of every child in the program. Those teachers who agree to cooperate — most do — keep daily behavior report cards for the child too, in effect providing full coverage for a child’s every waking hour.
Even then, the therapy is far from a silver bullet or an automatic replacement for treatment with Ritalin or other drugs that are routinely prescribed for attention disorder based on many studies showing their effectiveness. The constant tallying and reminding is too exhausting for some parents, especially those raising children on their own and juggling outside jobs. The Popczynskis did well in part because Peter’s difficulties were not severe, he was a capable student and his most disruptive behavior came out at home, Mr. Popczynski said. And the couple were able to share the many duties.
Yet most parents in the program have found that their children do best with a combination of the medication and family treatment, albeit with significantly lower doses of the drugs than typically prescribed.
Dawn Van de Wal, a single mother of three in Buffalo, said that over the last six months she has learned to contain and redirect the behavior of her exuberant 9-year-old, TJ, who has received a diagnosis of attention-deficit disorder. TJ can still become extremely frustrated when required to sit for long periods and concentrate on schoolwork, in the absence of his mother.
“I still give him medication for school, because the fact is that right now he needs it to get through the day, but it’s a low dose,” Ms. Van de Wal said while TJ practiced headstands on the couch. “He doesn’t take it at home, though, and I plan to reduce the dosage in time as much as I can.”
She added, “I don’t want him to look back and think the successes he’s had are all due to a drug.”
In surveys and in dozens of interviews, most parents of children with psychiatric diagnoses say that they prefer to avoid using medications, if possible. It is not so easy to do. Insurers as a rule do not fully cover behavior modification therapies because they cost substantially more than drugs.
The therapies require an enormous commitment from already overloaded parents, and some children are too severely troubled to respond. Many clinics do not even offer the programs.
Psychiatrists, pediatricians and family doctors also tend to be more comfortable writing prescriptions for psychological reasons.
Shifting Perceptions
“It’s a tremendous relief for the physician to prescribe something, because these kids are very tough, and it feels horrible to sit there and not be able to help,” said Dr. Jennifer Mary Harris, a child psychiatrist practicing in Arlington, Mass., who has argued for more caution in using medication. At every level, she said, the mental health system strongly favors drug treatment.
Yet the increasing number of studies that support family-based behavioral treatment is shifting perceptions. The largest study comparing medication with behavioral modification therapy for attention deficit problems, released in 1999, found that drugs were more effective in improving children’s ability to focus and keep still. But more than three-fourths of those treated without medication did well enough that their parents were able to keep them off drugs. And behavior therapy significantly improved children’s reading performance and their relations with parents and teachers when combined with medication, the study found.
Researchers have also studied a different approach to behavior treatment, called cognitive behavior therapy. This approach engages children directly, and signs up parents as helpers. The children meet in groups to speak with a therapist, and learn elementary ways to identify and manage their anger, frustration and hopelessness. The parents learn in sessions how to reinforce those lessons at home.
Studies find that up to three quarters of children who suffer from depression, anxiety or obsessive-compulsive disorder find relief of their symptoms with the help of this kind of therapy, which usually involves once-a-week sessions for a few months or so.
Alicia Brzycki, a freelance editor who lives in Lawrenceville, N.J., said she noticed several years ago that her son was struggling more than usual with Tourette’s syndrome, a neurological disorder that causes involuntary facial tics and limb movements.
The condition did not stop him from making friends or doing well in school, Ms. Brzycki said, “but I think it was first grade, I realized that he was stifling the tics at school, and it created this boomerang effect, and they came out like mad at home.”
At the urging of a doctor, she took the boy, by then 9, to a program at Temple University in Philadelphia that specializes in treating childhood anxiety, which can exacerbate Tourette’s. Therapists teach children to identify the thoughts that amplify their worries, and then defuse or moderate them. Ms. Brzycki and her husband attended sessions, too, and Ms. Brzycki learned she was unwittingly contributing to her son’s anxiety. “The main thing that came out for me was that I was being overprotective,” she said.
She added: “As a parent you want to protect a child from stressful situations, but by doing that you’re creating an avoidance mechanism that can turn a minuscule anxiety into the big, bad wolf. I had to loosen my grip” and let him face his fears.
Now in fourth grade, her son has helped make a DVD about Tourette’s syndrome that he has shown to classmates. He has a close circle of friends, his mother said, and his tics seem to have diminished lately. But he sometimes still feels self-conscious and will talk himself through it, with his parents’ help if needed.
Family-based therapy for a difficult childhood disorder is in almost all cases a way of life, not a weeks-long or months-long cure. If parents are serious about finding alternatives to drug treatments, experts say, they have to be willing to make difficult, and long lasting, changes to their behavior and the home environment, and to allow the child to progress at his or her own pace.
“You can’t let your foot off the accelerator with something like behavioral modification for A.D.H.D., for example,” said Dr. Gabrielle Carlson, director of child and adolescent psychiatry at Stony Brook University School of Medicine, who used the treatment for her own son. “It’s like making changes in diet and exercise to lose weight: you don’t lose 20 pounds and then you’re home free and can eat ice cream and cake again. No, it’s a complete lifestyle change, and when you have a child with any of these psychiatric difficulties you have to stay on the program, for as long as it takes.”
Correction: December 23, 2006
A front-page article yesterday about parents’ influence in helping their children overcome psychiatric disorders misstated the age of TJ Van de Wal, whose attention problems have improved in response to parental techniques. He is 7, not 9.

Atheists Agonistes

2006-11-28T14:52:00.000-05:00

NEW YORK TIMES, OP-ED

By RICHARD A. SHWEDER

Chicago

ONE of the surest ways to bring a certain type of dinner party to a halt is to speak piously about “God.” Earnest reference to sinners, apostates or blasphemers, or to the promise of salvation offered in evangelical churches, is likely to produce the same effect. Among the cosmopolites who live in secular enclaves, religion is automatically associated with darkness, superstition, irrationality and an antique or pre-modern cast of mind. It has long been assumed that religion is opposed to science, reason and human progress; and the death of gods is simply taken for granted as a deeply ingrained Darwinian article of faith.

Why, then, are the enlightened so conspicuously up in arms these days, reiterating every possible argument against the existence of God? Why are they indulging in books — Daniel Dennett’s “Breaking the Spell,” Sam Harris’s “Letter to a Christian Nation,” and Richard Dawkins’s “God Delusion” — in which authors lampoon religion or rail against the devout under the banner of a crusading atheism? Books dictated or co-written by God sell quite well among the 2.1 billion self-declared Christians and 1.3 billion self-declared Muslims of the world. What explains the current interest among secularists in absolutely, positively establishing that the author is a fraud?

The most obvious answer is that the armies of disbelief have been provoked. Articulate secularists may be merely reacting to the many recent incitements from religious zealots at home and abroad, as fanatics and infidels have their ways of keeping each other in business.

A deeper and far more unsettling answer, however, is that the popularity of the current counterattack on religion cloaks a renewed and intense anxiety within secular society that it is not the story of religion but rather the story of the Enlightenment that may be more illusory than real.

The Enlightenment story has its own version of Genesis, and the themes are well known: The world woke up from the slumber of the “dark ages,” finally got in touch with the truth and became good about 300 years ago in Northern and Western Europe.

As people opened their eyes, religion (equated with ignorance and superstition) gave way to science (equated with fact and reason). Parochialism and tribal allegiances gave way to ecumenism, cosmopolitanism and individualism. Top-down command systems gave way to
the separation of church from state, of politics from science. The story provides a blueprint for how to remake and better the world in the image and interests of the West’s secular elites.

Unfortunately, as a theory of history, that story has had a predictive utility of approximately zero. At the turn of the millennium it was pretty hard not to notice that the 20th century was probably the worst one yet, and that the big causes of all the death and destruction had rather little to do with religion. Much to everyone’s surprise, that great dance on the Berlin Wall back in 1989 turned out not to be the apotheosis of the Enlightenment.

Science has not replaced religion; group loyalties have intensified, not eroded. The collapse of the cold war’s balance of power has not resulted in the end of collective faiths or a rush to democracy and individualism. In Iraq, the “West is best” default (and its discourse about universal human rights) has provided a foundation for chaos.

Even some children within the enclave are retreating from the Enlightenment in their quest for a spiritual revival; one discovers perfectly rational and devout Jews or Hindus in one’s own family, or living down the block. If religion is a delusion, it is a delusion with a future, which it may be hazardous for us to deny. A shared conception of the soul, the sacred and transcendental values may be a prerequisite for any viable society.

John Locke, who was almost everyone’s favorite political philosopher at the time of the founding of our nation, was a very tolerant man. In his 1689 “Letter Concerning Toleration,” he advocated a policy of live and let live for believers in many faiths, even heretics. But he drew
the line at atheists. He wrote: “Lastly, those are not at all to be tolerated who deny the being of God. Promises, covenants and oaths, which are the bonds of human societies, can have no hold upon an atheist. The taking away of God, though but even in thought, dissolves all.”

Instead of waging intellectual battles over the existence of god(s), those of us who live in secular society might profit by being slower to judge others and by trying very hard to understand how it is possible for John Locke and our many atheist friends to continue to gaze at each other in such a state of mutual misunderstanding.

Richard A. Shweder is a professor of comparative human development at the University of Chicago and a co-editor of “Engaging Cultural Differences.”

A Free-for-All on Science and Religion

2006-11-22T13:30:00.000-05:00

NEW YORK TIMES

By GEORGE JOHNSON

Maybe the pivotal moment came when Steven Weinberg, a Nobel laureate in physics, warned that “the world needs to wake up from its long nightmare of religious belief,” or when a Nobelist in chemistry, Sir Harold Kroto, called for the John Templeton Foundation to give its next $1.5 million prize for “progress in spiritual discoveries” to an atheist — Richard Dawkins, the Oxford evolutionary biologist whose book “The God Delusion” is a national best-seller.

Or perhaps the turning point occurred at a more solemn moment, when Neil deGrasse Tyson, director of the Hayden Planetarium in New York City and an adviser to the Bush administration on space exploration, hushed the audience with heartbreaking photographs of newborns misshapen by birth defects — testimony, he suggested, that blind nature, not an intelligent overseer, is in control.

Somewhere along the way, a forum this month at the Salk Institute for Biological Studies in La Jolla, Calif., which might have been one more polite dialogue between science and religion, began to resemble the founding convention for a political party built on a single plank: in a world dangerously charged with ideology, science needs to take on an evangelical role, vying with religion as teller of the greatest story ever told.

Carolyn Porco, a senior research scientist at the Space Science Institute in Boulder, Colo., called, half in jest, for the establishment of an alternative church, with Dr. Tyson, whose powerful celebration of scientific discovery had the force and cadence of a good sermon, as its first minister.

She was not entirely kidding. “We should let the success of the religious formula guide us,” Dr. Porco said. “Let’s teach our children from a very young age about the story of the universe and its incredible richness and beauty. It is already so much more glorious and awesome — and even comforting — than anything offered by any scripture or God concept I know.”

She displayed a picture taken by the Cassini spacecraft of Saturn and its glowing rings eclipsing the Sun, revealing in the shadow a barely noticeable speck called Earth.

There has been no shortage of conferences in recent years, commonly organized by the Templeton Foundation, seeking to smooth over the differences between science and religion and ending in a metaphysical draw. Sponsored instead by the Science Network, an educational
organization based in California, and underwritten by a San Diego investor, Robert Zeps (who acknowledged his role as a kind of “anti-Templeton”), the La Jolla meeting, “Beyond Belief: Science, Religion, Reason and Survival,” rapidly escalated into an invigorating intellectual free-for-all. (Unedited video of the proceedings will be posted on the Web at tsntv.org.)

A presentation by Joan Roughgarden, a Stanford University biologist, on using biblical metaphor to ease her fellow Christians into accepting evolution (a mutation is “a mustard seed of DNA”) was dismissed by Dr. Dawkins as “bad poetry,” while his own take-no-prisoners approach (religious education is “brainwashing” and “child abuse”) was condemned by the anthropologist Melvin J. Konner, who said he had “not a flicker” of religious faith, as simplistic and uninformed.

After enduring two days of talks in which the Templeton Foundation came under the gun as smudging the line between science and faith, Charles L. Harper Jr., its senior vice president, lashed back, denouncing what he called “pop conflict books” like Dr. Dawkins’s “God Delusion,” as “commercialized ideological scientism” — promoting for profit the philosophy that science has a monopoly on truth.

That brought an angry rejoinder from Richard P. Sloan, a professor of behavioral medicine at Columbia University Medical Center, who said his own book, “Blind Faith: The Unholy Alliance of Religion and Medicine,” was written to counter “garbage research” financed by Templeton on, for example, the healing effects of prayer.

With atheists and agnostics outnumbering the faithful (a few believing scientists, like Francis S. Collins, author of “The Language of God: A Scientist Presents Evidence for Belief,” were invited but could not attend), one speaker after another called on their colleagues to be less timid in challenging teachings about nature based only on scripture and belief. “The core of science is not a mathematical model; it is intellectual honesty,” said Sam Harris, a doctoral student in neuroscience and the author of “The End of Faith: Religion, Terror and the Future of Reason” and “Letter to a Christian Nation.”

“Every religion is making claims about the way the world is,” he said. “These are claims about the divine origin of certain books, about the virgin birth of certain people, about the survival of the human personality after death. These claims purport to be about reality.”

By shying away from questioning people’s deeply felt beliefs, even the skeptics, Mr. Harris said, are providing safe harbor for ideas that are at best mistaken and at worst dangerous. “I don’t know how many more engineers and architects need to fly planes into our buildings before we realize that this is not merely a matter of lack of education or economic despair,” he said.

Dr. Weinberg, who famously wrote toward the end of his 1977 book on cosmology, “The First Three Minutes,” that “the more the universe seems comprehensible, the more it also seems pointless,” went a step further: “Anything that we scientists can do to weaken the hold of religion should be done and may in the end be our greatest contribution to civilization.”

With a rough consensus that the grand stories of evolution by natural selection and the blossoming of the universe from the Big Bang are losing out in the intellectual marketplace, most of the discussion came down to strategy. How can science fight back without appearing to be just one more ideology?

“There are six billion people in the world,” said Francisco J. Ayala, an evolutionary biologist at the University of California, Irvine, and a former Roman Catholic priest. “If we think that we are
going to persuade them to live a rational life based on scientific knowledge, we are not only dreaming — it is like believing in the fairy godmother.”

“People need to find meaning and purpose in life,” he said. “I don’t think we want to take that away from them.” Lawrence M. Krauss, a physicist at Case Western Reserve University known for his staunch opposition to teaching creationism, found himself in the unfamiliar role of playing the moderate. “I think we need to respect people’s philosophical notions unless those notions are wrong,” he said.

“The Earth isn’t 6,000 years old,” he said. “The Kennewick man was not a Umatilla Indian.” But whether there really is some kind of supernatural being — Dr. Krauss said he was a nonbeliever — is a question unanswerable by theology, philosophy or even science. “Science does not make it impossible to believe in God,” Dr. Krauss insisted. “We should recognize that fact and live with it and stop being so pompous about it.”

That was just the kind of accommodating attitude that drove Dr. Dawkins up the wall. “I am utterly fed up with the respect that we —all of us, including the secular among us — are brainwashed into bestowing on religion,” he said. “Children are systematically taught that there is a higher kind of knowledge which comes from faith, which comes from revelation, which comes from scripture, which comes from tradition, and that it is the equal if not the superior of knowledge that comes from real evidence.”

By the third day, the arguments had become so heated that Dr. Konner was reminded of “a den of vipers.”

“With a few notable exceptions,” he said, “the viewpoints have run the gamut from A to B. Should we bash religion with a crowbar or only with a baseball bat?”

His response to Mr. Harris and Dr. Dawkins was scathing. “I think that you and Richard are remarkably apt mirror images of the extremists on the other side,” he said, “and that you generate more fear and hatred of science.”

Dr. Tyson put it more gently. “Persuasion isn’t always ‘Here are the facts — you’re an idiot or you are not,’ ” he said. “I worry that your methods” — he turned toward Dr. Dawkins — “how articulately barbed you can be, end up simply being ineffective, when you have much more power of influence.”

Chastened for a millisecond, Dr. Dawkins replied, “I gratefully accept the rebuke.” In the end it was Dr. Tyson’s celebration of discovery that stole the show. Scientists may scoff at people who fall back on explanations involving an intelligent designer, he said, but history shows that “the most brilliant people who ever walked this earth were doing the same thing.” When Isaac Newton’s “Principia Mathematica” failed to account for the stability of the solar system — why the planets tugging at one another’s orbits have not collapsed into the Sun — Newton proposed that propping up the mathematical mobile was “an intelligent and powerful being.”

It was left to Pierre Simon Laplace, a century later, to take the next step. Hautily telling Napoleon that he had no need for the God hypothesis, Laplace extended Newton’s mathematics and opened the way to a purely physical theory.

“What concerns me now is that even if you’re as brilliant as Newton, you reach a point where you start basking in the majesty of God and then your discovery stops — it just stops,” Dr. Tyson said. “You’re no good anymore for advancing that frontier, waiting for somebody else to come behind you who doesn’t have God on the brain and who says: ‘That’s a really cool problem. I want to solve it.’ ”

“Science is a philosophy of discovery; intelligent design is a philosophy of ignorance,” he said. “Something fundamental is going on in people’s minds when they confront things they don’t understand.”

He told of a time, more than a millennium ago, when Baghdad reigned as the intellectual center of the world, a history fossilized in the night sky. The names of the constellations are Greek and Roman, Dr. Tyson said, but two-thirds of the stars have Arabic names. The words “algebra” and “algorithm” are Arabic.

But sometime around 1100, a dark age descended. Mathematics became seen as the work of the devil, as Dr. Tyson put it. “Revelation replaced investigation,” he said, and the intellectual foundation collapsed.

He did not have to say so, but the implication was that maybe a century, maybe a millennium from now, the names of new planets, stars and galaxies might be Chinese. Or there may be no one to name them at all.

Before he left to fly back home to Austin, Dr. Weinberg seemed to soften for a moment, describing religion a bit fondly as a crazy old aunt.

“She tells lies, and she stirs up all sorts of mischief and she’s getting on, and she may not have that much life left in her, but she was beautiful once,” he lamented. “When she’s gone, we may miss her.”

Dr. Dawkins wasn’t buying it. “I won't miss her at all,” he said. “Not a scrap. Not a smidgen.”

Essay: When Young Doctors Strut Too Much of Their Stuff

2006-11-22T10:23:00.000-05:00

NEW YORK TIMES

By ERIN N. MARCUS, M.D.

MIAMI, Nov. 20 — When I was a new faculty physician, I worked with a resident doctor who was smart and energetic and took excellent care of her patients.

There was just one problem. As she delivered her thoughtful patient presentations to me and the other attending doctors, it was hard not to notice her low-cut dress.

“You two have to say something to her,” one of my male colleagues said to me and another female doctor one afternoon. But while none of us would have hesitated to intervene had she prescribed the wrong drug for a patient, we felt weird saying something to her about her clothes.

So we didn’t.

Nearly a decade later, my impression is that more young physicians and students are dressing like that resident. Every day, it seems, I see a bit of midriff here, a plunging neckline there. Open-toed sandals, displaying brightly manicured toes, seem ubiquitous. My observations may partly reflect the city in which I work, Miami, a subtropical place known for its racy clothes. But colleagues who practice elsewhere report that they, too, have seen medical students and young doctors show up for clinical work in less-than-professional attire.

“Poor choice is not regional — I’ve seen it everywhere,” said Dr. Pamela A. Rowland, a behavioral scientist and director of the office of professional development at Dartmouth Medical School, who has studied the impact of physician clothing on patient confidence. “It always surprises me when there are dress codes for staff but not for physicians.”

Among older and middle-aged physicians (like myself), tales of salacious and sloppy trainee attire abound. One colleague commented that a particularly statuesque student “must have thought all her male patients were having strokes” when she walked in their exam room wearing a low-cut top and a miniskirt. Another complained about a male student who came to class unshaven, even though he hadn’t been on call the night before. One Midwestern medical school dean reported that her school instituted a formal dress policy after administrators noticed students revealing too much flesh while sunbathing on a small patch of grass outside the school building, directly below patients’ hospital room windows.

Patients and colleagues may dismiss a young doctor’s skills and knowledge or feel their concerns aren’t being taken seriously when the doctor is dressed in a manner more suitable for the gym or a night on the town. There are also hygiene considerations: open-toed shoes don’t protect against the spills that commonly occur in patient care, and long, flowing hair can potentially carry harmful bacteria.

“Patients don’t have your c.v. in front of them, and appearance is all they have to go by,” Dr. Rowland said. “If you don’t meet their expectations, their anxiety level increases.”

In a study published last year in The American Journal of Medicine, patients surveyed in one outpatient clinic overwhelmingly preferred doctors photographed in formal attire with a white coat to photos of doctors in scrubs, business suits and informal clothes — jeans and a T-shirt for men, an above-the-knee skirt for women. The patients also said they were more likely to divulge their social, sexual and psychological worries to the clinicians in the white coats than to the other doctors.

Plaintiffs’ attorneys sometimes ask about a doctor’s attire in malpractice depositions, Dr. Rowland said. Her research has also found that physician clothing can influence scores on board certification oral exams, in which a senior doctor assesses a younger doctor’s medical knowledge.

“You don’t want to look too attractive to be serious,” she said, adding that “a certain amount of the nerd factor” can help a doctor’s performance.

Historically, doctors have dressed differently from the rest of the population, and the doctor’s uniform in the Western world continues to evolve. Hippocrates advised doctors to be “clean in person” and “well dressed” but also recommended that they be “plump” and anoint themselves with “sweet-smelling unguents.” The white coat itself became a staple for Western doctors in the early 20th century. More recently, the British Medical Association recommended that doctors on hospital wards not wear ties, because they are seldom washed and can carry antibiotic-resistant bacteria.

Many medical schools have dress codes (my employer, the University of Miami, specifies that students have hair “of a natural human color,” among other things). But enforcement is often left up to faculty members and thus can be haphazard.

Last year, I sent home an otherwise excellent student because her feet were clad in shoes that looked like flip-flops (though she claimed they were expensive leather sandals). I felt guilty about it at the time, since it meant she missed an afternoon of clinic. But I doubtshe’ll ever wear them in front of patients again.

And I wonder about that resident with whom I worked many years ago. Do patients and colleagues underestimate her abilities? Ultimately, we didn’t do her a favor by pretending to ignore her clothes.

Dr. Erin N. Marcus is a general internist and assistant professor of clinical medicine at the
University of Miami Miller School of Medicine.

Young people in developed countries unhappy: survey

2006-11-20T15:29:00.000-05:00

Sun Nov 19, 2006 7:08 PM ET

By Kate Holton

LONDON
(Reuters) - Young people in developing nations are at least twice as likely to feel happy about their lives than their richer counterparts, a survey says.

Indians are the happiest overall and Japanese the most miserable.

According to an MTV Networks International (MTVNI) global survey that covered more than 5,400 young people in 14 countries, only 43 percent of the world's 16- to 34-year-olds say they are happy with their lives.

MTVNI said this figure was dragged down by young people in the developed world, including those in the United States and Britain where fewer than 30 percent of young people said they were happy with the way things were.

Only eight percent in Japan said they were happy.

Reasons for unhappiness across the developed world included a lack of optimism, concern over jobs and pressure to succeed.

In developing countries a majority in the same age group expected their lives to be more enjoyable in the future, led by China with 84 percent.

"The happier young people of the developing world are also the most religious," the survey said.

The MTVNI survey took six months to complete and resulted in the Wellbeing Index which compared the feelings of young people, based on their perceptions of how they feel about safety, where they fit into society and how they see their future.

Young people from Argentina and South Africa came joint top in the list of how happy they were at 75 percent.

The overall Wellbeing Index was more mixed between rich and poor. India came top followed by Sweden and Brazil came last.

"In developing countries, economic growth is on the go ... so you could see that logically there should be optimism and a positive feeling," Bill Roedy, the President of MTVNI, told Reuters.

Developed countries were particularly pessimistic about globalization, with 95 percent of young Germans thinking it is ruining their culture, while developing countries which tended to be more receptive to globalization were also more optimistic about their economic future and more proud of their nationality.

MTVNI said one of the trends they spotted was that young people with access to mass media tended to feel less safe as they did not have the cognitive skills to interpret real risk.

In the UK, more than 80 percent of 16- to 34-year-olds said they were as afraid of terrorism as they were of the getting cancer -- though the latter was far more likely to hurt them.

The 14 countries included in the survey were Argentina, Brazil, China, Denmark, France, Germany, India, Indonesia, Japan, Mexico, South Africa, Sweden, the UK and the U.S.

Health Disparities Persist for Men, and Doctors Ask Why

2006-11-15T11:38:00.000-05:00

By RONI RABIN, NEW YORK TIMES

In recent years, women’s health has been a national priority. Pink ribbons warn of breast cancer. Pins shaped like red dresses raise awareness about heart disease.

Offices of women’s health have sprung up at every level of government to offer information and free screenings, and one of the largest government studies on hormones and diet in aging focused entirely on older women.

Yet statistics show that men are more likely than women to suffer an early death.

Now some advocates and medical scientists are beginning to ask a question that in some circles might be considered politically incorrect: Is men’s health getting short shrift?

The idea, they say, is not to denigrate the importance of women’s health but to focus public attention on the ways in which men may be uniquely at risk — and on what a growing men’s health movement has termed the “health disparity” between the sexes and its most glaring example, a persistent longevity gap that has narrowed but still shortchanges men of five years of life compared with women.

“We’ve got men dying at higher rates of just about every disease, and we don’t know why,” said Dr. Demetrius J. Porche, an associate dean at Louisiana State University’s Health Sciences Center School of Nursing in New Orleans, and the editor of a new quarterly, American
Journal of Men’s Health, that will publish its first issue next March.

The Men’s Health Network, a not-for-profit educational foundation based in Washington, has called for creating a federal office of men’s health to mirror the office on women’s health within the Health and Human Services Department, and it is backing a bill sponsored by Senator Mike Crapo, Republican of Idaho, and Representative Vito Fossella, Republican of New York, to do so.

Several federal offices on women’s health were recently established to compensate for years in which women were often excluded from medical research, but there is no federal office of men’s health.

Men’s health advocates say that men are silently suffering through what may be a serious health crisis. “We keep throwing out lifestyle as an explanation for the differences in longevity, saying that men come in later for care and have unhealthy behaviors, but I’m not sure we
really know the reason,” Dr. Porche said. “And we haven’t answered the question: Is there a biological determinant for why men die earlier than women?”

It is a question that has piqued the interest of some medical scientists, including Dr. Marianne J. Legato, founder of the Partnership for Gender-Specific Medicine at Columbia University.

Five states — Maryland, Georgia, New Hampshire, Louisiana and Oklahoma— have either established or plan to establish offices or commissions on men’s health, and the Nov. 15 issue of JAMA, The Journal of the American Medical Association, is entirely devoted to studies on the topic.

But the mere suggestion that men need their own health bureau or that they must advocate for their rights like a victimized minority rankles some women’s health advocates, and some politicians are reluctant to take men’s health on as a cause, for fear of alienating women.

“Saying we need an office of men’s health ignores the fact that men’s health always was the main focus of medical research,” said Cynthia Pearson, executive director of the National Women’s Health Network in Washington, a membership organization for improving women’s
health.

“During the first half-century of our nation’s investment in medical research, the majority of resources went to studying men and the conditions that affected men disproportionately,” she said. “Is their health perfect? No. But they don’t need a movement.”

Still, by just about any measure, men’s health is abysmal. American men have an average life expectancy of 75.2 years, and even less — 69.8 years — for black men, compared with 80.4 years for women over all.

Men die of just about every one of the leading causes of death at younger ages than women, from lung cancer to influenza and pneumonia, chronic liver disease, diabetes and AIDS. One notable exception is Alzheimer’s disease: more women than men die of it.

Topping the list for both sexes is heart disease.

But while the American Heart Association has been conducting an aggressive public education campaign to raise awareness about heart disease among women, called Go Red for Women and featuring pins in the shape of dresses, progress among men has been slipping, said Dr. Steven Nissen, the chairman of the department of cardiovascular medicine at the Cleveland Clinic and president of the American College of Cardiology. Yet, he added, the illness exacts a disproportionate toll on men.

Although heart disease occurs in women in their 30s and 40s, he said, it is “extremely unusual,” while severe heart disease in men that age is “not exceptionally rare.” Heart disease in women increases as they age, he noted.

“We’ve got to put it all in perspective,” Dr. Nissen said. “Coronary heart disease has a devastating impact on men, particularly on men who are in the prime of life — 45-year-old men with major heart attacks, who may never work another day in their life, who may have children.”

Cancer also strikes men disproportionately: one in three women at some point in life; one in two men. In part, that is a result of the fact that more men than women smoke, and possibly of occupational exposures.

But experts and advocates say that when it comes to government financing for the most common sex-specific reproductive cancers, breast cancer financing exceeds prostate cancer financing by more than 40 percent, with prostate cancer research receiving $394 million in 2005, and breast cancer receiving $710 million. The figures, for financing by the National Cancer Institute and Defense Department, were provided by the not-for-profit Prostate Cancer Foundation.

More women die of breast cancer than men do of prostate cancer: some 40,970 women will die of breast cancer this year, compared with 27,350 deaths of men from prostate cancer, according to the American Cancer Society.

Breast cancer also strikes young people more often. But men’s chances of receiving a prostate cancer diagnosis at some point in their lifetimes are high, with about 234,460 new cases expected to be diagnosed this year, compared with 212,920 new cases of breast cancer.

Nevertheless, said Dr. Peter Scardino, a prostate cancer surgeon and chairman of the department of surgery at Memorial Sloan-Kettering Cancer Center in New York, “there are still more people doing research on breast cancer than on prostate cancer, there’s more industry support for research on breast cancer drugs, there’s been more attention to the quality of life effects of breast cancer and we have more-effective chemotherapy agents for breast cancer because more trials have been done.”

Men’s vulnerability appears to start quite early. More male fetuses are conceived, but they are at greater risk of stillbirth and miscarriage, scientists find. Even as infants, mortality is higher among newborn boys and premature baby boys.

As children, boys are at higher risk for developmental disabilities and autism. Boys and men are more likely to be colorblind, suffer higher rates of hearing loss and are believed to have weaker immune systems than women. They may also recover more slowly from illnesses.

“It’s not that we ‘could be’ the weaker sex — we are the weaker sex,” said Dr. Robert Tan, a geriatrics specialist in Houston who is on the advisory board of the Men’s Health Network. “Even when men and women have the same disease, we often find that men are more likely todie. Hip fractures stand out, for instance: women seem more likely to recover, while men are more likely to die afterward.”

Behavior plays a role in some of the extra deaths and illnesses among men: they tend to be more aggressive than women and to take more risks. Men smoke at higher rates than women, drink more alcohol and are less likely to wear seat belts or use sunscreen. Men also suffer more
accidental deaths and serious injuries and are more likely to die of injuries and car accidents. They are three times as likely to be victims of murder, four times as likely to commit suicide and, as teenagers, 11 times as likely to drown.

Some experts think that depression contributes to these reckless and self-destructive behaviors, but that just as heart disease was initially defined by men’s experiences and therefore ignored or missed in women, depression may have been framed by women’s experiences and therefore may be missed and go untreated in men.

In any case, as a result, even though more baby boys are born, among people in their mid-30s, women outnumber men. Among people age 100, women outnumber men by 8 to one.

Among the questions research might explore, Dr. Legato said, are: “Why are there more miscarriages of boy fetuses? What is it about the sexing of the fetus that makes a male more vulnerable? What makes a boy less mature in terms of lung function after he’s born? And what is this propensity for risk-taking?”

One theory is that males are vulnerable because of their chromosomal makeup: where women have two X chromosomes, men have an X chromosome and a Y chromosome. “It is said that even before implantation in the wall of the uterus, the newly fertilized XX entity has a leg up,” Dr. Legato said, “because it can use that extra X to combat mutations in the chromosome that might be lethal or detrimental. And that might be a reason why females have a more sturdy constitution.”

Scientists and advocates who are concerned about men’s health are encouraging men themselves to take the first steps by accepting responsibility for their health status, seeking preventive care and making changes in habits, if necessary. New drugs for erectile
dysfunction have helped bring men into doctors’ offices in recent years, experts say, but that is not enough.

“Men need to take as good care of their bodies as they do of their cars and trucks, and they don’t,” said Dr. Ken Goldberg, a urologist and the author of “How Men Can Live as Long as Women,” among other books. “We need men to come in” to the doctor’s office, he said, adding, “A lot of men think they’re bulletproof and invincible.”

Research based on a 2000 survey by the Commonwealth Fund found that almost a quarter of all men had not seen a doctor during the previous year, compared with only 8 percent of women, and that one in three men had no regular doctor, compared with one in five women. More than half of men had not gone in for a routine checkup or cholesterol test during the previous year.

Even if something was bothering them, the survey found, men often expressed reluctance to seek medical help. Nearly 40 percent said they would delay care for a few days, and 17 percent said they would wait at least a week.

Strangely, some insights into men’s behavior in regard to their health have been gleaned from studies intended to yield information about women. A 2001 national study on ambulatory care found that women, who are in the habit of seeing doctors regularly if only because they
need reproductive services, had double the number of annual exams that men had. Other studies have found that because poor women with children may qualify for Medicaid, poor men are more likely to lack health insurance.

Advocates say that research must be directed at how specific diseases develop in men, but that studies should also be done to explore the underlying reasons that men do not take better care of themselves.

Many psychologists think the problems are rooted in how boys are raised.

“We’ve socialized men from the time they are boys that ‘You have to stand on your own two feet,’ ‘If you have a problem, handle it by yourself,’ ‘Be a man, take one for the team,’ ” said Dr. William Pollack, director of the Center for Men at McLean Hospital in Belmont, Mass., affiliated with Harvard Medical School. “All of which means, ‘Don’t complain, don’t ask for help and solve the problem by yourself.’”

He added: “Men think that being vulnerable is the worst thing. But to recognize there might be something wrong with you, you have to acknowledge: you’re vulnerable.”

A Chronicle of Descent, and a Stark Reflection

2006-11-14T14:05:00.000-05:00

By LARRY ZAROFF, M.D.

The creative process is therapeutic for many of us. If we are writers, we wrench out poetry,
prose, a play about our pain, about our mistakes in life.

We explain ourselves to ourselves, and generally feel better. A cousin of mine, who was made miserable by his mother, wrote her a long letter after she died. Afterward, he felt relief, unburdened.

But writing is not the only way for people to unveil their troubles. Some compose music, a few paint, others choreograph or dance. Chris Furbee is making a documentary of his mother’s life, a film that powerfully reveals her gradual deterioration — physical and mental —from Huntington’s disease.

In the video — some still frames from it are shown above — we see Mr. Furbee’s mother early on, before the onset of Huntington’s. She is a beautiful young woman, a fine artist. Then she is 40, in the writhing, uncooperative movements typical of Huntington’s, a personal plague like no other. Finally she is on the floor, her mental capacity gone, few words remaining.

Mr. Furbee, too, has the single dominant gene for Huntington’s in every part of his body, every cell. The disease is a criminal that wants to steal his brain. It is the worst of the dementias, with its early onset and its inevitability. There is no return, no recovery.

I met Mr. Furbee, now 40, three years ago when he came to my class with his genetic counselor, Andrea Zanko. He was there to provide the medical students with a view of Huntington’s and of the “medical interview” process in a complex and difficult disease.

As a young man, Mr. Furbee saw his mother decline and thought that it could be him. He turned 18, ran away, was on the road for five years. Eventually, he came back, picked up his guts and made the film, chronicling everything he had dreaded. It is more than a record. Making the film, he can face his mother, accept her and move on with his life. And if people see the film, he reasons, they must respond and support research on Huntington’s disease.

Mr. Furbee remains relatively well, but in the film he must also see himself. In seeing, he accepts the worst, and by doing so, accepts himself.

The New York Times Company

3D system 'moves' phantom limbs

2006-11-14T11:26:00.000-05:00

From the BBC

A computer program has been designed to allow amputees to see and move a 3D "phantom limb".

A small study by researchers at the University of Manchester found the device could help people with phantom limb pain.

Previous research showed that if a person's brain is "tricked" into
believing they can see and move a "phantom limb", pain can decrease.

The researchers say one patient saw her pain ease after just one session.

It is suggested that phantom limb pain is caused by signals from nerve endings on the amputated limb being amplified.

'Positive impact'

People with phantom limb pain are currently treated using a "mirror
box" where they move their remaining arm, but their brain perceives it
is their amputated limb is actually the one moving.

However, it is easy for the illusion to be broken and the benefit to be lost.

The Manchester researchers created a virtual reality world where patients can see both "limbs" moving at once.

Upper-limb amputees were fitted with a special data glove and had sensors attached to the elbow and wrist joints.

Sensors were fitted to the knee and ankle joints of lower-limb amputees.

Patients can use their remaining limb to control the movements of the computer-generated limb which appears in the 3D computer-generated "virtual world".

They are able to move fingers, arms, hand, arms, feet and legs. They are even able to play ball games.

Three men and two women aged 56-65 took part in the study.

There were three arm amputees and two leg amputees, who had lost limbs between the ages of one and 40.

Each used the system between seven and 10 times over two to three months.

Four out of the five reported improvement in their phantom limb pain, sometimes almost immediately.

Dr Craig Murray, of the School of Psychological Sciences who led the research, said: "Although there isn't compete agreement on how phantom limb pain is helped by the mirror box or our virtual reality system, one theory is that the brain is being tricked."

He added: "One patient felt that the fingers of her amputated hand were continually clenched into her palm, which was very painful for her.

"However, after just one session using the virtual system she began to feel movement in her fingers and the pain began to ease."

Dr Stephen Pettifer, of the University's School of Computer Science, said: "Most people know about 3D graphics and virtual reality from their use in the entertainment industry, in computer games and special effects in films.

"It's very satisfying being able apply the same technology to something that may have a real positive impact on someone's health and well-being."

Academics now hope to carry out a larger study to identify people most likely to benefit from the research.

Story from BBC NEWS:

http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/6146136.stm

Too Close for Comfort

2006-11-07T13:29:00.000-05:00

Op-Ed Contributor

Too Close for Comfort

By STEPHANIE COONTZ

Olympia, Wash.

EVER since the Census Bureau released figures last month showing
that married-couple households are now a minority, my phone has been
ringing off the hook with calls from people asking: “How can we save
marriage? How can we make Americans understand that marriage is the
most significant emotional connection they will ever make, the one
place to find social support and personal fulfillment?”

I think these are the wrong questions — indeed, such questions would
have been almost unimaginable through most of history. It has only been
in the last century that Americans have put all their emotional eggs in
the basket of coupled love. Because of this change, many of us have
found joys in marriage our great-great-grandparents never did. But we
have also neglected our other relationships, placing too many burdens
on a fragile institution and making social life poorer in the process.

A study released this year showed just how dependent we’ve become
on marriage. Three sociologists at the University of Arizona and Duke
University found that from 1985 to 2004 Americans reported a marked
decline in the number of people with whom they discussed meaningful
matters. People reported fewer close relationships with co-workers,
extended family members, neighbors and friends. The only close
relationship where more people said they discussed important matters in
2004 than in 1985 was marriage.

In fact, the number of people who depended totally on a spouse for
important conversations, with no other person to turn to, almost
doubled, to 9.4 percent from 5 percent. Not surprisingly, the number of
people saying they didn’t have anyone in whom they confided nearly tripled.

The solution to this isolation is not to ramp up our emotional
dependence on marriage. Until 100 years ago, most societies agreed that
it was dangerously antisocial, even pathologically self-absorbed, to
elevate marital affection and nuclear-family ties above commitments to
neighbors, extended kin, civic duty and religion.

St. Paul complained that married men were more concerned with
pleasing their wives than pleasing God. In John Adams’s view, a
“passion for the public good” was “superior to all private passions.”
In both England and America, moralists bewailed “excessive” married
love, which encouraged “men and women to be always taken up with each
other.”

From medieval days until the early 19th century, diaries and
letters more often used the word love to refer to neighbors, cousins
and fellow church members than to spouses. When honeymoons first gained
favor in the 19th century, couples often took along relatives or
friends for company. Victorian novels and diaries were as passionate
about brother-sister relationships and same-sex friendships as about
marital ties.

The Victorian refusal to acknowledge strong sexual desires among
respectable men and women gave people a wider outlet for intense
emotions, including physical touch, than we see today. Men wrote
matter-of-factly about retiring to bed with a male roommate, “and in
each other’s arms did friendship sink peacefully to sleep.” Upright
Victorian matrons thought nothing of kicking their husbands out of bed
when a female friend came to visit. They spent the night kissing,
hugging and pouring out their innermost thoughts.

By the early 20th century, though, the sea change in the culture
wrought by the industrial economy had loosened social obligations to
neighbors and kin, giving rise to the idea that individuals could meet
their deepest needs only through romantic love, culminating in
marriage. Under the influence of Freudianism, society began to view
intense same-sex ties with suspicion and people were urged to reject
the emotional claims of friends and relatives who might compete with a
spouse for time and affection.

The insistence that marriage and parenthood could satisfy all an
individual’s needs reached a peak in the cult of “togetherness” among
middle-class suburban Americans in the 1950s. Women were told that
marriage and motherhood offered them complete fulfillment. Men were
encouraged to let their wives take care of their social lives.

But many men and women found these prescriptions stifling. Women who
entered the work force in the 1960s joyfully rediscovered social
contacts and friendships outside the home.

“It was so stimulating to have real conversations with other
people,” a woman who lived through this period told me, “to go out
after work with friends from the office or to have people over other
than my husband’s boss or our parents.”

And women’s lead in overturning the cult of 1950s marriage inspired
many men to rediscover what earlier generations of men had taken for
granted — that men need deep emotional connections with other men, not
just their wives. Researchers soon found that men and women with
confidants beyond the nuclear family were mentally and physically
healthier than people who relied on just one other individual for
emotional intimacy and support.

So why do we seem to be slipping back in this regard? It is not
because most people have voluntarily embraced nuclear-family isolation.
Indeed, the spread of “virtual” communities on the Internet speaks to a
deep hunger to reach out to others.

Instead, it’s the expansion of the post-industrial economy that
seems to be driving us back to a new dependence on marriage. According
to the researchers Kathleen Gerson and Jerry Jacobs, 60 percent of
American married couples have both partners in the work force, up from
36 percent in 1970, and the average two-earner couple now works 82
hours a week.

This is probably why the time Americans spend socializing with
others off the job has declined by almost 25 percent since 1965. Their
free hours are spent with spouses, and as a study by Suzanne Bianchi of
the University of Maryland released last month showed, with their
children — mothers and fathers today spend even more time with their
youngsters than parents did 40 years ago.

As Americans lose the wider face-to-face ties that build social
trust, they become more dependent on romantic relationships for
intimacy and deep communication, and more vulnerable to isolation if a
relationship breaks down. In some cases we even cause the breakdown by
loading the relationship with too many expectations. Marriage is
generally based on more equality and deeper friendship than in the
past, but even so, it is hard for it to compensate for the way that
work has devoured time once spent cultivating friendships.

The solution is not to revive the failed marital experiment of the
1950s, as so many commentators noting the decline in married-couple
households seem to want. Nor is it to lower our expectations that we’ll
find fulfillment and friendship in marriage.

Instead, we should raise our expectations for, and commitment to,
other relationships, especially since so many people now live so much
of their lives outside marriage. Paradoxically, we can strengthen our
marriages the most by not expecting them to be our sole refuge from the
pressures of the modern work force. Instead we need to restructure both
work and social life so we can reach out and build ties with others,
including people who are single or divorced. That indeed would be a
return to marital tradition — not the 1950s model, but the
pre-20th-century model that has a much more enduring pedi- gree.

Stephanie Coontz, a
history professor at Evergreen State College, is the author of
“Marriage, a History: How Love Conquered Marriage.”

An Evolutionary Theory of Right and Wrong

2006-11-01T09:30:00.000-05:00

New York Times

By NICHOLAS WADE

Who doesn’t know the difference
between right and wrong? Yet that essential knowledge, generally
assumed to come from parental teaching or religious or legal
instruction, could turn out to have a quite different origin.

Primatologists like Frans de Waal have long argued that the roots of
human morality are evident in social animals like apes and monkeys. The
animals’ feelings of empathy and expectations of reciprocity are
essential behaviors for mammalian group living and can be regarded as a
counterpart of human morality.

Marc D. Hauser, a Harvard
biologist, has built on this idea to propose that people are born with
a moral grammar wired into their neural circuits by evolution. In a new
book, “Moral Minds” (HarperCollins 2006), he argues that the grammar
generates instant moral judgments which, in part because of the quick
decisions that must be made in life-or-death situations, are
inaccessible to the conscious mind.

People are generally unaware of this process because the mind is
adept at coming up with plausible rationalizations for why it arrived
at a decision generated subconsciously.

Dr. Hauser presents his argument as a hypothesis to be proved, not
as an established fact. But it is an idea that he roots in solid
ground, including his own and others’ work with primates and in
empirical results derived by moral philosophers.

The proposal, if true, would have far-reaching consequences. It
implies that parents and teachers are not teaching children the rules
of correct behavior from scratch but are, at best, giving shape to an
innate behavior. And it suggests that religions are not the source of
moral codes but, rather, social enforcers of instinctive moral behavior.

Both atheists and people belonging to a wide range of faiths make
the same moral judgments, Dr. Hauser writes, implying “that the system
that unconsciously generates moral judgments is immune to religious
doctrine.” Dr. Hauser argues that the moral grammar operates in much
the same way as the universal grammar proposed by the linguist Noam Chomsky
as the innate neural machinery for language. The universal grammar is a
system of rules for generating syntax and vocabulary but does not
specify any particular language. That is supplied by the culture in
which a child grows up.

The moral grammar too, in Dr. Hauser’s view, is a system for
generating moral behavior and not a list of specific rules. It
constrains human behavior so tightly that many rules are in fact the
same or very similar in every society — do as you would be done by;
care for children and the weak; don’t kill; avoid adultery and incest;
don’t cheat, steal or lie.

But it also allows for variations, since cultures can assign
different weights to the elements of the grammar’s calculations. Thus
one society may ban abortion,
another may see infanticide as a moral duty in certain circumstances.
Or as Kipling observed, “The wildest dreams of Kew are the facts of
Katmandu, and the crimes of Clapham chaste in Martaban.”

Matters of right and wrong have long been the province of moral
philosophers and ethicists. Dr. Hauser’s proposal is an attempt to
claim the subject for science, in particular for evolutionary biology.
The moral grammar evolved, he believes, because restraints on behavior
are required for social living and have been favored by natural
selection because of their survival value.

Much of the present evidence for the moral grammar is indirect. Some
of it comes from psychological tests of children, showing that they
have an innate sense of fairness that starts to unfold at age 4. Some
comes from ingenious dilemmas devised to show a subconscious moral
judgment generator at work. These are known by the moral philosophers
who developed them as “trolley problems.”

Suppose you are standing by a railroad track. Ahead, in a deep
cutting from which no escape is possible, five people are walking on
the track. You hear a train approaching. Beside you is a lever with
which you can switch the train to a sidetrack. One person is walking on
the sidetrack. Is it O.K. to pull the lever and save the five people,
though one will die?

Most people say it is.

Assume now you are on a bridge overlooking the track. Ahead, five
people on the track are at risk. You can save them by throwing down a
heavy object into the path of the approaching train. One is available
beside you, in the form of a fat man. Is it O.K. to push him to save
the five?

Most people say no, although lives saved and lost are the same as in the first problem.

Why does the moral grammar generate such different judgments in
apparently similar situations? It makes a distinction, Dr. Hauser
writes, between a foreseen harm (the train killing the person on the
track) and an intended harm (throwing the person in front of the
train), despite the fact that the consequences are the same in either
case. It also rates killing an animal as more acceptable than killing a
person.

Many people cannot articulate the foreseen/intended distinction, Dr.
Hauser says, a sign that it is being made at inaccessible levels of the
mind. This inability challenges the general belief that moral behavior
is learned. For if people cannot articulate the foreseen/intended
distinction, how can they teach it?

Dr. Hauser began his research career in animal communication,
working with vervet monkeys in Kenya and with birds. He is the author
of a standard textbook on the subject, “The Evolution of
Communication.” He began to take an interest in the human animal in
1992 after psychologists devised experiments that allowed one to infer
what babies are thinking. He found he could repeat many of these
experiments in cotton-top tamarins, allowing the cognitive capacities
of infants to be set in an evolutionary framework.

His proposal of a moral grammar emerges from a collaboration with
Dr. Chomsky, who had taken an interest in Dr. Hauser’s ideas about
animal communication. In 2002 they wrote, with Dr. Tecumseh Fitch, an
unusual article arguing that the faculty of language must have
developed as an adaptation of some neural system possessed by animals,
perhaps one used in navigation. From this interaction Dr. Hauser
developed the idea that moral behavior, like language behavior, is
acquired with the help of an innate set of rules that unfolds early in
a child’s development.

Social animals, he believes, possess the rudiments of a moral system
in that they can recognize cheating or deviations from expected
behavior. But they generally lack the psychological mechanisms on which
the pervasive reciprocity of human society is based, like the ability
to remember bad behavior, quantify its costs, recall prior interactions
with an individual and punish offenders. “Lions cooperate on the hunt,
but there is no punishment for laggards,” Dr. Hauser said.

The moral grammar now universal among people presumably evolved to
its final shape during the hunter-gatherer phase of the human past,
before the dispersal from the ancestral homeland in northeast Africa
some 50,000 years ago. This may be why events before our eyes carry far
greater moral weight than happenings far away, Dr. Hauser believes,
since in those days one never had to care about people remote from
one’s environment.

Dr. Hauser believes that the moral grammar may have evolved through
the evolutionary mechanism known as group selection. A group bound by
altruism toward its members and rigorous discouragement of cheaters
would be more likely to prevail over a less cohesive society, so genes
for moral grammar would become more common.

Many evolutionary biologists frown on the idea of group selection,
noting that genes cannot become more frequent unless they benefit the
individual who carries them, and a person who contributes
altruistically to people not related to him will reduce his own fitness
and leave fewer offspring.

But though group selection has not been proved to occur in animals,
Dr. Hauser believes that it may have operated in people because of
their greater social conformity and willingness to punish or ostracize
those who disobey moral codes.

“That permits strong group cohesion you don’t see in other animals, which may make for group selection,” he said.

His proposal for an innate moral grammar, if people pay attention to
it, could ruffle many feathers. His fellow biologists may raise
eyebrows at proposing such a big idea when much of the supporting
evidence has yet to be acquired. Moral philosophers may not welcome a
biologist’s bid to annex their turf, despite Dr. Hauser’s expressed
desire to collaborate with them.

Nevertheless, researchers’ idea of a good hypothesis is one that
generates interesting and testable predictions. By this criterion, the
proposal of an innate moral grammar seems unlikely to disappoint.

For a World of Woes, We Blame Cookie Monsters

2006-11-01T09:28:00.000-05:00

NEW YORK TIMES
By GINA KOLATA

FIRST we said they were ruining their health with their bad habit, and they should just quit.

Then we said they were repulsive and we didn’t want to be around
them. Then we said they were costing us loads of money — maybe they
should pay extra taxes. Other Americans, after all, do not share their
dissolute ways.

Cigarette smokers? No, the obese.

Last week the list of ills attributable to obesity grew: fat people cause global warming.

This latest contribution to the obesity debate comes in an article by Sheldon H. Jacobson of the University of Illinois
at Champaign-Urbana and his doctoral student, Laura McLay. Their paper,
published in the current issue of The Engineering Economist, calculates
how much extra gasoline is used to transport Americans now that they
have grown fatter. The answer, they said, is a billion gallons a year.

Their conclusion is in the same vein as a letter published last year
in The American Journal of Public Health. Its authors, from the Centers for Disease Control and Prevention,
did a sort of back-of-the-envelope calculation of how much extra fuel
airlines spend hauling around fatter Americans. The answer, they wrote,
based on the extra 10 pounds the average American gained in the 1990’s,
is 350 million gallons, which means an extra 3.8 million tons of carbon
dioxide.

“People are out scouring the landscape for things that make obese
people look bad,” said Kelly Brownell, director of the Rudd Center for
Food Policy and Obesity at Yale.

And is that a bad thing? Dr. Jacobson doesn’t think so. “We felt
that beyond public health, being overweight has many other
socioeconomic implications,” he said, which was why he was drawn to
calculating the gasoline costs of added weight.

The idea of using economic incentives to help people shed pounds
comes up in the periodic calls for taxes on junk food. Martin B.
Schmidt, an economist at the College of William and Mary, suggests a
tax on food bought at drive-through windows. Describing his theory in a
recent Op-Ed article in The New York Times, Dr. Schmidt said people
would expend more calories if they had to get out of their cars to pick
up their food.

“We tax cigarettes in part because of their health cost,” he wrote.
“Similarly, the individual’s decision to lead a sedentary lifestyle
will end up costing taxpayers.”

Eric Oliver, a political scientist at the University of Chicago,
said his first instinct was to laugh at the gas and drive-through
arguments. But such claims often get wide attention, he says, and take
on a life of their own.

“This is like, let’s find another reason to scapegoat fat people,” Dr. Oliver says.

At an annual meeting of the Obesity Society, one talk correlated
obesity with deaths in car accidents, and another correlated obesity
with suicides.
Dr. Oliver, who attended, said no one in the crowd of at least 200
questioned whether the correlations were really cause and effect. “The
funny thing was that everyone took it seriously,” he said.

Katherine Flegal of the Centers for Disease Control and Prevention
also wryly cautions against being quick to link cause and effect. “Yes,
obesity is to blame for all the evils of modern life, except somehow,
weirdly, it is not killing people enough,” she said. “In fact that’s
why there are all these fat people around. They just won’t die.”

The message in the blame-obesity approach, said James Marone, a political science professor at Brown University, is that it is so important to persuade fat people to lose weight that common sense disappears.

“Anything we can say to persuade you, we will say,” Dr. Marone added.

So is it working?

It doesn’t seem to be. Fat people are more reviled than ever,
researchers find, even as more people become fat. When smokers and
heavy drinkers turned pariah, rates of smoking and drinking went down. Won’t fat people, in time, follow suit?

Research suggests that the stigma of being fat leads to more
eating, not less. And if reducing the stigma suggests a solution,
that’s not working either.

“One hypothesis about getting rid of stigma is having more contact
with the stigmatized group,” Dr. Brownell says. But with obesity, the
stigma seems to be growing along with the national girth.

He cites a famous study in the 1960’s in which children were shown
drawings of children with and without disabilities, as well as a
drawing of a fat child. Who, they were asked, would you want for your
friend? The fat child was picked last.

Now, three researchers have repeated the study, this time with
college students. Once again, almost no one, not even fat people, liked
the fat person. “Obesity was highly stigmatized,” wrote the
researchers, Janet D. Latner of the University of Canterbury in New
Zealand, Albert J. Stunkard of the University of Pennsylvania and C. Terence Wilson of Rutgers University, in the July 2005 issue of Obesity Research.

One problem with blaming people for being fat, obesity researchers
say, is that getting thin is not like quitting smoking. People struggle
to stop smoking, but many, in the end, succeed. Obesity is different.
It’s not that the obese don’t care. Instead, as science has shown over
and over, they have limited personal control over their weight. Genes
play a significant role, the science says.

That is not a popular message, Dr. Brownell says. And the notion
that anyone can be thin with a little effort has consequences. “Once
weight is due to a personal failing, a lot of things follow,” he said.
There’s the attitude that if you are fat, you deserve to be
stigmatized. Maybe it will motivate you to lose weight. The opposite
happens.

In a paper published Oct. 10 in Obesity, Dr. Brownell and his
colleagues studied more than 3,000 fat people, asking them about their
experiences of stigmatization and discrimination and how they
responded.

Almost everyone said they ate more.

Model bailed again over 'assault'. Alleged victim is model's counsellor

2006-10-26T10:40:00.000-04:00

From: BBC
Supermodel Naomi Campbell has been released on bail following her arrest for allegedly assaulting another woman.

Ms Campbell, 36, was taken to a central London police station on Wednesday and returned on Thursday morning for further questioning.

Police said she had been bailed until a future date, thought to be in December.

Ms Campbell was arrested at an address in Westminster where the woman, believed to be the model's counsellor, claimed an assault had taken place.

Earlier, Ms Campbell's spokesman said he thought there had been a "misunderstanding".

"We are sure it will all be sorted out when the police investigate," he said.

The model, from Streatham in south London, shot to fame after being discovered in London at the age of 15.

She became the first black model to appear on the covers of Time magazine and French and British Vogue.

Short men thrive in spite of bias, author says

2006-10-25T09:40:00.000-04:00

Updated Mon. Oct. 23 2006 3:16 PM ET
Mary Nersessian, CTV.ca News
The world clearly prefers tall to small, the author of a new book argues. But being short has its advantages, particularly for adults who grappled with discrimination as children, he explains.
"There is a long history of both positive qualities like moral rectitude that's been associated with tallness," award-winning journalist Stephen Hall told CTV.ca in a phone interview from Brooklyn, NY.

"There is a longstanding social association of tallness with gifts like strength. I think it's much less important now, but I think there's probably a cultural and evolutionary carryover from the early importance of physical size," said Hall, author of "Size Matters."

Hall argues in his book that the experiences men have as children and adolescents help shape their emotional growth.

Drawing on his own experiences, Hall traces the history of society's past and present bias against shortness and reveals how vertically challenged people thrive in spite of this widespread heightist discrimination.

Hall, who was shorter than 99 per cent of boys his age in the first year of high school, says he was very far behind the curve and "intensely" aware of it.

"I found it intensely frustrating. At that time, it seemed like most the miserable set of circumstances," he said.

But Hall argues that while one child's small stature may lead to torment another short child could well develop an emotional resilience that will carry him through life.

"In the process of writing this book, I came to realize I probably cultivated a lot of social skills -- I guess what passes now for social intelligence or emotional intelligence -- during adolescence because it was a way for me to compensate for the fact that I was not as big," he said.
"In retrospect, a little bit of adversity during adolescence may have been a great deal of help in adulthood," he said.

When asked by Playboy magazine in 1984 about the impact being short had on his upbringing, songwriter Paul Simon had this to say: "I think it had the most significant single effect on my existence, aside from my brain. In fact, it's part of an inferior-superior syndrome. I think I have a superior brain and an inferior stature, if you really want to get brutal about it."

Children realize very early on that there are distinct social advantages to being tall, he said, adding that he noticed this even with his own son.

"In my son's case, at least as early as first grade when they start lining up kids by height, it's a very routine and traditional way of organizing children and so they notice it. They are very much aware of it then," Hall said.

Hall cited research from one of the leading authorities on physical aggression, Canada Research Chair in Child Development Richard Tremblay, which suggests children are aware of their size even in pre-school.

"He makes the point that physically larger kids are very much aware of superiority even then and begin to use it their way ... some children realize very early they can get their way by exerting their physical superiority," he said.

Even after children leave elementary-school bullies behind and move on to high school, size seems to matter a great deal, he said.

But as they "move beyond gym glass and the high school cafeteria, and all these dreadful places where boys act out without too much supervision, size does not matter nearly as much because all these adult qualities that we culturally prize come much more into play."

Still, studies show that society continues to favour the tall over the small.

"Over the last 30 years there have been a number of studies that show taller people on average are compensated better in terms of income than shorter people," he said.

A 1995 article in The Economist, entitled "Short Guys Finish Last" cited a 1980 survey that showed more than half of the chief executive officers at Fortune 500 companies were six feet or taller.

A 2004 study by a group of economists at the University of Pennsylvania and the University of Michigan found that the strongest correlation between the highest income was not among the tallest adults, but among those who had been tallest between the ages of 11 and 16.

"The notion is that being tall -- during roughly the high school years and certainly around the time of puberty -- probably confers some sense of social confidence and self esteem that carries over into adult life and adult-earning power," Hall said.

But it's not all doom and gloom for men of diminutive height.

Citing recent findings from the fields of animal behaviour, psychology, and evolutionary biology, Hall argues that the role of physical size in mating success is given too much weight.

"Everyone assumes women tend to seek taller males for mating because tallness is seen as factor that suggest reproductive fitness in the male," Hall said.

"I think part of is a sort of comfort level thinking the male should be taller and bigger than the female," he said.

But he cites research from Rutgers University that casts doubt on this prevailing belief.
One of the factors that makes a man attractive to a woman is how he moves, the study suggests.

"Specifically, how they dance. And it makes sense from an evolutionary point of view, because to be able to dance reflects a sense of balance and symmetry that probably also suggest normal development and normal cognition and mental ability and agility."

Hall, who is measured at 5 feet 5 ¾ inches, and whose wife is 5 feet 9 inches tall, says the height difference does not bother either of them -- but the taboo prevails.

"I don't think it really makes a difference at all. And I think if you asked her she would probably say the same thing -- she still wears high heels," he said.

Excerpt from "Size Matters"

"Stature" is one of those beautiful words that has a narrow meaning - in this case referring to physical height - but that easily expands to much larger, even metaphoric, dimensions when it refers to less quantifiable but more important human qualities that we admire, aspire to, and devote so much life energy to attaining. Turning the concept inward, "stature" also refers to how we view ourselves in the mirror as well as in that private chamber of self-identity where we really undress our hopes, fears, vanities, insecurities, and self-appraisals.

If Garrison Keillor's Lake Wobegon is that mythical place where "all the children are above average," I have lived most of my life way south of Wobegon. At any stage of physical development and growth, from infancy to adulthood, in any country on the planet - and we could be talking here about the Netherlands, where the average Dutch citizen is taller than the average height anywhere else on earth, or those parts of equatorial Africa where pygmies still gather and hunt - about half of us are, by definition, below average in height for our particular tribe. That's not to suggest that this half of the population is abnormal. But in a social context that focuses on physical appearance and celebrates physical performance, size is an aspect of our identity on which we are constantly measured throughout life, even though the quantity measured lies almost totally outside our control. In ways subtle and blunt, physical stature affects who we are and who we become: the way people treat us, the activities we pursue, the games we play, the spouses we choose, the respect we command, even the salaries we receive.
Although many men who were small as children or adolescents reach average or above-average height, the fear of remaining forever below average carves one of the deepest furrows in the otherwise hardscrabble surface of a man's emotional and psychological life. From a parent's point of view, size becomes one of the earliest areas in which we compare, as we all do, our own children against other children. They're all beautiful, of course, but we carry around in our heads our children's percentile positions on the growth chart just as proudly as we carry their photos in our wallets. Their height represents the signature of our genes scribbled, however briefly, on the unfurling scroll of human events. During adolescence, a child's deep emotional frustration about being short can yank parents down into the disturbing world of teenage anguish and pain and remind us of our own limitations as parents. Trudeau recalls the night he fell sobbing into his father's arms: "We both knew," he writes, "it was one problem he couldn't fix." The inability of parents to fix the "problem" of small stature, and the sense of betrayal that helplessness incurs in their offspring, can color, often darkly, the relations between parents and children.
Having lived this experiment, I know the feeling. Of all the childhood terms of endearment I endured - shrimp, runt, peewee, pip-squeak, punk, peanut, bug, mouse, gnat, midget, Mr. Peabody - I had a particular favorite: squirt. It might seem odd to embrace an insult, but I loved the short, explosive burst of energy the word captured. Though intended to diminish me, it was at the same time subversive, irrepressible, and relentless, perhaps even avenging. Nonetheless, all the nicknames were diminutives; on the phylogenetic ladder of adolescence, I was down there with mice and mascots. When I was a high school freshman, my height placed me in what would be the first percentile on today's standard growth chart. I didn't need a chart, however, to be reminded that 99 percent of my male peers were taller than I was. They reminded me every day, with teasing, taunts, and occasionally physical assault.
Since then I've inched upward to a fairly respectable smaller-than-average adult size. However, physical size was the most consuming emotional issue of my youth, especially during adolescence - more consuming than, but not unrelated to, peer acceptance, dating, bullying, classroom performance, sexual maturation, and almost anything else considered essential to adolescent self-image, not to say self-loathing. And I gather I'm not alone. I've been surprised at how widespread and intense this lingering obsession about developmental size is among perfectly normal, seemingly well-adjusted adults whenever the topic comes up. I think we never entirely outgrow the sensation of being small, of being different, of being physically vulnerable. The emotional impulses we learn, usually as a matter of day-to-day survival in the difficult, formative times of adolescence, are like the reptilian brain, deep inside, surrounded by more civilized tissue but never totally disconnected, just waiting for the right conditions - perhaps a sufficiently stressful situation - to emerge.

The human life cycle relentlessly reinforces the dominant role of physical size in our personal development. I have been in the delivery room when a ruler was first laid against the fat, writhing masses of my newborn children. I've been the last boy picked for sports games. I sent away for my Charles Atlas booklet when I was a scrawny twelve-year-old. As an adolescent with delayed puberty, I stood in front of the mirror searching - even praying - for the first visible hint of sexual maturity. I stood on tiptoes to kiss a high school date. And I grew increasingly impatient with and distrustful of my parents' repeated assurances that I would undergo a growth spurt - which, when it finally arrived, seemed too little and too late. I have spent a lifetime being asked by photographers to sit in the front row - except the photographer at my own wedding, who nonchalantly asked my wife to sit in a chair while I stood behind her, so that the disparity between my height and hers (about three inches) would not be so apparent.

Copyright © 2006 by Stephen S. Hall. Reprinted by permission of Houghton Mifflin Company.

Alarm raised on teen alcohol abuse

2006-10-25T09:31:00.000-04:00

Globe and Mail

When Rebekah Grant was 11 years old, it took only a sip of wine with her parents for her to feel a buzz. By 13, she found herself needing more like a couple of glasses to get the same result.

Now, the 15-year-old says she can tolerate alcohol better than her parents can.

"I would get pissed [drunk] with just one sip back then," said the teen, who is visiting Toronto from Scotland. "I wish it was still the same now."

A new study has found that Rebekah isn't alone in experiencing this condition: Teenagers, as a whole, are naturally less sensitive to the effects of alcohol than are adults, and need more drinks per occasion to reach the same level of intoxication.

But the findings hardly merit a toast -- this so-called "safeguarding effect" is linked to potential damage in the brain and a strong dependence on alcohol later in life.

The study by Binghamton University researchers in New York shows that teens are physiologically able to compensate for the impairing effects of alcohol because their brains are built to handle stressful events better than adults.

"What I find really interesting is that they are also less sensitive than adults to hangover-related effects," said Elena Varlinskaya, a research professor of psychology at Binghamton and lead author of the study published in the November issue of Alcoholism: Clinical & Experimental Research.

The results of the study could explain why adults often say they can't hold their alcohol as well as they used to, said Anh Le, a senior scientist at the Centre for Addiction and Mental Health in Toronto.

The teenage brain is under a lot of stress and can adapt quickly when new substances are introduced to the body. This "plasticity" of the brain decreases with age and the brain becomes fully developed.

But, he warns, the implications of teens being less sensitive to alcohol has major setbacks.

"Because the brain is still developing, taking [in] more alcohol can lead to a lot of damage, even memory impairment," Dr. Le said. "And we know that 70 to 80 per cent of people who are alcohol-dependent in adult life started off with heavy alcohol consumption in adolescence."

These results are backed by a study published earlier this year in the journal Archives of Pediatric & Adolescent Medicine, which found that 14- to 19-year-olds who drink are 45 per cent more likely to become alcohol-dependent later in life than those who start drinking after the age of 20.

Binge drinking, or having five or more drinks on one occasion, has been a serious issue in Canada.

In 2001, more than one-quarter (27.5 per cent) of Ontario students in Grade 7 to OAC reported binge drinking at least once during the four weeks before the Ontario Student Drug Use Survey. Among all students surveyed, 6.2 per cent reported binge drinking at least four times during the four weeks before the survey. Among university students aged 19-24, 72 per cent binged at least once in the 12 months before the 1998 Canadian Campus Survey.

Because testing the effects of alcohol on teenagers cannot be done for legal and ethical reasons, the researchers used rat models. Adolescent rats are similar to human adolescents because they spend more time in social interactions than the younger and the older animals, Prof. Varlinskaya said.

Job Lost to Injury, and a Struggle for a Home

2006-10-24T13:52:00.000-04:00

NEW YORK TIMES
By ELISSA ELY, M.D.
He lost his apartment two years ago, after losing his job. He lost his job after falling off scaffolding in an unacknowledged industrial accident. The company lawyer does not answer his phone calls. Now he has chronic pain, a hand like a claw and a bed in the homeless shelter.
My patient likes to talk about the apartment he used to have, and the honest satisfactions of a home. He liked taking his shower after work, watching his TV. He had a girlfriend who tidied the place from time to time. He took the bus to and from work and said that whenever someone was missing bus fare, he would reach into a pocket and supply it. It felt good, like buying everyone a round. He was not a drinker, but altruism was something he enjoyed.
He especially liked his apartment key. But no job, no key. At first, he slept in a condemned building; it gave comfort, and the illusion of a home: there were doors to walk through. After the building was demolished, he came to the mental health clinic. He had all the profound symptoms of depression one would expect. He understood that antidepressants take weeks to work, and dutifully accepted that fact. He was willing to be patient.
By then, he had a permanent bed in a shelter, which is as close to security and keys as homelessness gets. There was a locker for his clothes, a washer and dryer, the same sheets each night, mostly the same neighbors — a regimen to count on.
He was inconvenienced, but not bested. Homelessness, as he saw it, was a temporary state. Sleeping in an assigned bed would do while he waited for public housing. Because of his years of work, he qualified for Social Security disability payments, and he had no reason to believe that the monthly stipend would not cover an apartment. He got himself on a list.
The list was long. After a year or so, he found himself drinking. It was a comfort he could not resist. Six months later, he got into a fight at the shelter — not his fault, he argues — and lost his permanent bed. He was barred from the shelter, and descended into the rougher layer of shelters, where drinking and drugs are commonplace, there is no daily shower and residents have to stand in line for a different bed each night.
He began to look blunted, blank. This is what two years without a key will do to a man. The medication was no help. You can’t live in an antidepressant bottle.
That was when he decided to build himself a house. He came on some land deep in the woods, not too far from the shelter where he had started out. He was still handy, if no longer employable. Using tree stumps and branches, and his one good arm, he fashioned a kind of lean-to.
He says he lies in it and can see the stars in the roofless sky. There is no heat or electricity, of course, and the house is not structurally safe, but he doesn’t mind. He looks up, and hours pass. In the dark, lying on the floor looking up, he begins to feel the absence of grief, of anger. He feels the blessing of no feelings at all.
The medication is still not working. It won’t work, when his need is for a key. He has begun to talk about train tracks and the uselessness of life. He says one day he may not return to the clinic. He won’t tell me where his house in the woods is, though for now he continues to visit it. It offers respite from the anxiety, rage and heartbreak he faces in the shelter.
Feeling nothing, he says thoughtfully, is almost like feeling peace.

Troubled Children: Living With Love, Chaos and Haley

2006-10-22T10:48:00.000-04:00

NEW YORK TIMES
By PAM BELLUCK

PLYMOUTH, Mass. — When Haley Abaspour started seeing things that were not there — bugs and mice crawling on her parents’ bed, imaginary friends sitting next to her on the couch, dead people at a church that housed her preschool — her parents were unsure what to think. After all, she was a little girl.

“I thought for a long time, ‘She’s just gifted,’ ” said her father, Bejan Abaspour. “ ‘This is good. Don’t worry about it.’ ”

But as Haley got older, things got worse. She developed tics — dolphin squeaks, throat-clearing, clenching her face and body as if moving her bowels. She heard voices, banging, cymbals in her head. She became anxiety-ridden over run-of-the-mill things: ambulance sirens, train rides. Her mood switched suddenly from excitedly chatty to inconsolably distraught.

“It’s like watching ‘The Sound of Music’ and ‘The Exorcist’ all at the same time,” Mr. Abaspour said.

For her family, life with Haley, now 10, has been a turbulent stream of symptoms, diagnoses, medications, unrealized expectations. Diagnosed as a combination of bipolar disorder with psychotic features, obsessive-compulsive disorder, generalized anxiety disorder and Tourette’s syndrome, her illness dominates every moment, every relationship, every decision.

Haley’s fears, moods and obsessions seep into her family’s most pedestrian routines — dinnertime, bedtime, getting ready for school. Excruciating worries permeate her parents’ sleep; unanswerable questions end in frustrated hopes.

“The first time we took Haley to the hospital, I guess I expected that they would put it all back together,” said her mother, Christine Abaspour. “But it’s never all back together.”

At least six million American children have difficulties that are diagnosed as serious mental disorders, according to government surveys — a number that has tripled since the early 1990’s. Most are treated with psychiatric medications and therapy. The children sometimes attend special schools.

But while these measures can help, they often do not help enough, and the families of such children are left on their own to sort through a cacophony of conflicting advice.

The illness, and sometimes the treatment, can strain marriages, jobs, finances. Parents must monitor medications, navigate therapy sessions, arrange special school services. Some families must switch neighborhoods or schools to escape unhealthy situations or to find support and services. Some keep friends and relatives away.

Parents can feel guilt, anger, helplessness. Siblings can feel neglected, resentful or pressure to be problem-free themselves.

“It kind of ricochets to other family members,” said Dr. Robert L. Hendren, president-elect of the American Academy of Child and Adolescent Psychiatry. “I see so many parents who just hurt badly for their children and then, in a sense, start hurting for themselves.”

Ms. Abaspour, 39, struggles to master the details of Haley’s illness, to answer her obsessive questions, to keep her occupied. Mr. Abaspour, 50, who long believed that “Haley was going to grow out of it,” has been gripped by anxious thoughts and intrusive images that rattle him to tears on the hourlong commute to his job as an anesthesia engineer at a Boston hospital. He imagines people being crushed by trucks, someone hurting Haley, his own death.

Haley’s sister, Megan, 13, has been so focused on Haley and determined not to add to her family’s burden that in June, after a quarrel with her parents, she tied a T-shirt around her neck in a suicidal gesture.

“I feel like she gets all the problems and I feel like I have to take some of that off of her,” Megan said. “It’s really difficult a lot to try to stay away from babying her and helping her. I try to stay still but it just hurts, it hurts inside.”

Haley, with her shy smile and obsidian eyes, is increasingly aware of her own problems, although she cannot always express exactly what is going on inside. “My mind says I need some help” is the way she explained it recently.

Her illness has caused great financial strain; although the Abaspours have health insurance, they have been forced to draw on their savings and lean heavily on their credit cards for living expenses. Still, they have bought a trailer in a New Hampshire campground because there Haley finds occasional solace, and relatives nearby understand the family’s ordeal.

The family wrestles with deciding whom to tell about Haley’s illness, and what to say. Her worst symptoms are most visible at home and less apparent at the public school and the state-financed therapeutic after-school program she attends. Her parents say she works hard to hold herself together during the day and then later, feeling more comfortable with her family, falls apart.

This disparity in behavior is not uncommon, said Dr. Joseph A. Jackson IV, Haley’s psychiatrist, and “parents often get the brunt.”

Because of the contrast in Haley’s public and private behavior, her parents are wary of telling people that she is mentally ill, as they might not notice.

“I don’t want anybody to pity her,” Mr. Abaspour said. But they also get frustrated when teachers or relatives play down the seriousness of Haley’s illness, or conclude that she is being manipulative or that another child-rearing approach would help.

In the middle of last year, for example, a teacher did not understand Haley’s need to leave the classroom to quiet the voices or relieve anxiety. Haley grew so frustrated that she “would sit there in her chair and cry,” her father said. The parents pressed school officials to switch her to another class.

“We’re sick and tired of trying to prove it to people,” Ms. Abaspour said.

Her husband added, “Everybody thinks they have the solution. When Joe Schmo comes over for a drink, he says, ‘Try this, this will work.’ No, it won’t.”

Visions and Voices

From birth, it was clear that “I was dealing with something different,” Ms. Abaspour said. Displaying a photo album with picture after picture of Megan all smiles and Haley “crying, crying, crying,” she added, “We just thought we had a very difficult child.”

Yet exactly what was wrong puzzled them for years, and even now, Ms. Abaspour said, “Every day it’s something new, I swear.”

While increasing awareness of childhood mental illness has helped many children and families, it can also create a misimpression that everything can be treated, said Dr. Glen R. Elliott, chief psychiatrist at the Children’s Health Council, a community mental health service in Palo Alto, Calif., and the author of “Medicating Young Minds: How to Know if Psychiatric Drugs Will Help or Hurt Your Child.” That can make families with complex cases feel “either genuine confusion or pretend certainty,” Dr. Elliott said.

The Abaspours decided to speak with a reporter about Haley’s illness and its impact on their family because they hoped it would help other families and make society more hospitable for children like their daughter. Talking about it was sometimes emotional, especially for Mr. Abaspour, whose eyes often clouded with tears. But they also said they found it useful to articulate their feelings.

When Haley was 3 or 4, a pediatrician blamed tonsillitis-induced sleep apnea, predicting that after her tonsils were removed, “ ‘you’ll see a totally different child,’ ” Ms. Abaspour recalled.

“We thought, ‘This is what is wrong with our child. This is our answer,’ ” she said. Preschool teachers suggested a learning disability. Later, Haley repeated first grade. The Abaspours consulted therapists about the visions of friends in the liner of the family’s pool and riding with Haley on her bike, and the voices criticizing her or telling her to touch a certain table. When a neurologist ruled out medical causes like Lyme disease, Ms. Abaspour recalled, her husband said, “I think we should just give her a placebo — it’s all in her head.”

They got a cat, “though we weren’t cat people,” Ms. Abaspour said. Then they got another because the first was “not the type of cat that Haley could throw over her shoulder and squeeze.”

New symptoms kept emerging. For a while, when she was about 7, the voices “were telling her she was a boy,” Ms. Abaspour said. “She had to constantly prove to them that she wasn’t.”

Haley became obsessed with penises, which she called “bums.” She claimed to see them though she was looking at fully clothed men and boys, her mother said. “Then she felt guilty. She would come up to me and whisper, ‘I saw his bum, I saw his bum.’ The bus driver or the little boy, anyone. It was constant.”

To halt the whispering, Ms. Abaspour suggested that they share a private signal: Haley could flash a thumbs-up after a sighting. Haley also seemed preoccupied with death, and on a highway would say that voices told her, “If that license plate didn’t say such and such, she was going to die,” her mother said.

Once, Mr. Abaspour recalled, Haley “kept yelling that she wants to start over.”

The Treatment Puzzle

When she was almost 8, Haley visited Dr. Jackson at his office at the Cambridge Health Alliance. He was struck by the results of a screening: Haley met full criteria for virtually every mental disorder listed.

“Her symptoms,” he said, “suggested anxiety, morbid thoughts, obsessions possibly of a sexual nature, frequent fluctuations in mood, periods of euphoria, giddiness, irritability, rapid speech, auditory and visual hallucinations, thought disorganization, vocal tics, distractibility, poor socialization in school, sensory integration issues, attention impulse disorder, manic behavior, sleep disturbance.”

Dr. Jackson wondered if the voices and the friends, which Haley told him were “nowhere but everywhere,” were schizophrenic-like hallucinations or milder thought distortions.

He also saw Haley’s mood swing from anxiety about a “disturbing dream in which her mother was killed” to euphoria, as she gleefully drew a large, brightly colored butterfly and a self-portrait with a too-big smile and a skirt that ballooned as if she were floating. The pictures, he said, “scream” manic sensibility, suggesting bipolar disorder.

Dr. Jackson prescribed an antipsychotic, Risperdal, one of a dozen drugs Haley would try. Some helped initially, but the voices returned or side effects developed.

Huge pills or bad-tasting liquid made Haley gag or throw fits.

“It was horrible, horrible, horrible,” her mother said, “and she’d pull us into it because we had to make her take it.”

Lithium caused weight gain: clothes that fit her one day no longer did the next.

When Haley was 81/2, Mr. Abaspour said, “Let’s drop all of these medications and see what happens.” He said, “I wanted to see her true self.”

The results chastened them. “You see her fine one day,” Mr. Abaspour said. “The second day comes and she’s fine and you say, ‘You see, honey, there’s nothing wrong with her.’ Then it’s the third day and she goes crazy and you feel like an idiot.”

Haley resumed taking Risperdal. Then, abruptly, her condition worsened.

“She couldn’t function, she couldn’t go to school,” said Ms. Abaspour, who took Haley to a hospital; she had to handle the crisis with her husband away in London.

In the emergency room, Haley was manic and hyperarticulate, Ms. Abaspour recalled. “I was a basket case.”

When Mr. Abaspour returned and saw Haley “like a zombie” in a hospital full of out-of-control children, his first reaction was, “She can’t be in here.”

But the eight-day hospital stay made him grasp the severity of her illness.

“You look at an X-ray and you say it’s a fracture,” he said. “But this thing. ... Before then, there wasn’t solid evidence.”

A year later, school halls “would get scary because the voices would get louder,” so Haley constantly visited the school’s nurse and psychologist, her mother said. “She was going out of her mind.”

Haley was hospitalized again, and another antipsychotic drug, Abilify, muffled the voices.

“I remember thinking, ‘Am I supposed to be happy about this?,’ ” Ms. Abaspour said. She was grateful that something helped but distressed at the suggestion that Haley was psychotic. The Abilify has not soothed Haley’s anxiety or stopped her outbursts. And despite increases in the dosage, back are the voices (four boys and a girl), the tics (eye squinting and hand clenching) and the “bums.”

Dr. Jackson, her psychiatrist, said Haley’s biggest asset was her “very caring family” that was “seeking ways to shore themselves up” to better help her.

Ms. Abaspour said: “We ask ourselves sometimes, ‘Why? Why did it happen to us?’ Other times we see a child bald, going through chemotherapy. That’s the thing about this — it’s on the inside, you can’t see it.”

Megan’s Heartache

I pretend no one is around me when my sister is there.

I feel a constant hurt inside.

I touch a rainbow of joyfulness in my mind when my sister and I are FINALLY having a fun laugh together.

I worry that when one day I die, I won’t be there to help my sister.

I cry to the stars, pleading them to take me away from this madness at mind.

Megan’s sixth-grade writing assignment was to write a poem called “I Am.”

Virtually every line was about Haley.

Megan wrote of love, frustration, obligation, pain, embarrassment. Eighteen months later, those feelings erupted.

Told to do dishes before calling a friend, Megan felt that the chore should be Haley’s and stormed to her room. When her father said it was Megan’s responsibility, “I really got mad and slammed the door,” she recalled. “He came and ripped my phone right out of the wall.”

That was unusual for Mr. Abaspour, usually gentle or quietly humorous.

“I tried not to say something that would hurt her,” he said. “And definitely not to touch her. So I took it out on the phone.”

Megan said her reaction was, “Why should I live?”

“I took a T-shirt and I put it around my neck,” she said. “Then I said, ‘No I shouldn’t do this. I want to live but I don’t know another way out.’ ”

Siblings of mentally ill children often have such feelings, experts said.

Ten days of treatment helped Megan understand that “I felt pretty much like I was another mom for Haley,” she said.

The Abaspours, who always gave Megan positive attention, were stunned. But Ms. Abaspour said she might have unconsciously been relieved that Megan could get Haley to laugh, or in other ways “take a little attention off me.”

For Megan, a doctor prescribed Prozac, but she became edgy and the suicidal thoughts continued.

“When I’m doing dishes and I see a knife there, my mind’s like, ‘Pick up the knife and kill yourself,’ ” Megan said. “I kind of just think, ‘Would things be easier without me?’ ”

Now she has stopped taking medication and is seeing a psychiatrist. Her parents are encouraging her to focus more on herself. She realizes, she said, “I’m important.”

Still, trying not to help Haley is hard. “I don’t really feel the pain that she feels,” Megan said, “but I feel that I should to make it even between us.”

Haley’s mother calls it “the ongoing search” — Haley’s obsessive quest for novelty and for objects to hold or to stroke over her touch-sensitive skin.

“I need something to calm me down so I can learn how to end my frustration,” Haley said. “I just get, like, sometimes, mad. I need to, like, hold it or hug it or just play with it.”

She and her family search through stores, scavenge through her crawlspace storage area and her bedroom full of Beanie Babies, toy cars, dolls. Megan said she sometimes offered her own belongings for Haley, thinking, “if I get excited about it she’ll decide it’s the right thing.”

But, Ms. Abaspour said, “she’s never satisfied.” Because her parents sometimes brush the hair on her arm with a surgical brush from Mr. Abaspour’s hospital, the family’s therapist recently suggested getting a soft lambskin.

Haley fixated on buying one, always asking as if it were a new thought: “Oh my God, you know what just came to mind? If I get that animal fur...”

Megan found her a faux shearling vest to stroke instead, but Haley exploded.

“I wanted Megan to find something like that animal fur,” she wailed, convulsing and weeping.

Anguished as he watched her, Mr. Abaspour said: “This is the point of no return. She’ll scream and cry and kick. If the neighbors could hear, they would think we were abusing the kid.”

Haley refuses to be consoled or touched, all the while saying, “Please help me, please make it stop, please make it go away,” her mother said. The Abaspours look on helplessly or send her to another room.

Haley’s eruptions, often 20 minutes long, occur almost daily, especially in the evenings. They often begin with Haley revved up.

Before the lambskin incident, for example, she marched around, chatting giddily about camp: “Today, today, today, we, um, instead of two periods of the game thingies, they call it sessions, periods, each session or whatever, we went to the picnic tables and we all went to the picnic tables and it was really fun.”

Haley’s parents struggled to track her unspooling sentences and scrambled thoughts.

“Did you follow the bouncing ball?” Ms. Abaspour asked her husband, who replied, “I don’t even see the ball, honey.”

Haley sighs, frowns and fidgets, eyes drooping before she falls apart. Sometimes she hyperventilates or crawls under a table. It always ends with crying, but sometimes she will start to laugh through her tears, becoming “all chipper again, like manic,” Mr. Abaspour said.

Adds Ms. Abaspour: Later, “she says, ‘I’m sorry, I’m sorry,’ apologizing for who she is.” Her father said: “It’s not like a hurt that you can kiss better. It comes from within, and she doesn’t know why, and you can’t do anything about it.”

A Mother’s Stoicism

Christine Abaspour, the youngest of four girls raised by a divorced mother, knew what she wanted early in life. At 19, she left Massachusetts, joined a sister in Florida and became a waitress. At 25, she met her husband-to-be, who was 11 years older. She was engaged in two weeks, married in nine months and a mother a year later.

“We both wanted to have children right away, like you wouldn’t believe,” she recalled.

Ms. Abaspour said that she had no regrets, and that Haley “was given to us for some reason, and I keep waiting for the day when I realize why.”

Still, the experience has tested her stamina, and she avoids capitulating to Haley’s whims and outbursts by imposing structure, consistency, even distance.

“I’m her mother,” Ms. Abaspour said. “I try to make it a better world for her, a more comfortable world. I stay very strong for her and very encouraging for her. If she comes out of a meltdown, I’ll say, ‘I knew that you could.’ I don’t make her feel totally hopeless. It doesn’t give me any satisfaction, though, because I still feel helpless. Unfortunately it just bites you in the face all day long.”

Ms. Abaspour’s stoic approach, which her husband appreciates but cannot always emulate, is “a good coping skill for parents,” Dr. Elliott, of the Children’s Health Council, said. “It’s what happens to a family system when you’ve got a source of chaos in the middle of it.”

After getting Haley ready for school, Ms. Abaspour feels she has already lived an entire day. In the afternoon, “Haley walks in the door and I just want to hold her and give her a big kiss like most kids,” Ms. Abaspour said. “Instead I get a frown and tears and ‘Ooh, I had such a stressful day.’ ”

She said that every evening, a distraught Haley will “say to me her same 12 questions: ‘What’s going to happen when I need to go to school and I can’t leave the classroom?’ or ‘What do I have to look forward to today?’ ”

By bedtime, Ms. Abaspour said, “your heart’s just breaking.”

To slake Haley’s thirst for “something to do,” Ms. Abaspour keeps her involved in activities outside of school. Otherwise, the family ends up stopping for ice cream or concocting other outings, because unstructured time allows Haley to focus on the voices and anxiety. “Staying home is not an option,” Ms. Abaspour said. “Honestly I could not keep her busy. Sometimes being around here on a Saturday or Sunday, it’s almost toxic. She has multiple episodes — it’s like living hell.”

Haley’s fears of noises, crowded streets and surprises force the Abaspours to forgo amusement parks, apple picking or other traditional family activities. When relatives visit “and you think it’s going to be relaxing and we’ll watch movies and eat popcorn — that doesn’t happen in this family,” Ms. Abaspour said.

Instead, there are mood cycles, as when Haley marched around announcing, “I’m going to make a really great art project,” then fell apart, wailing, “I don’t know what to do.”

Ms. Abaspour stays unflustered. When Haley bawled, “I don’t have any markers,” her mother replied, “Oh, don’t tell me you don’t have.”

But she found Haley a T-shirt to cut up and draw on, saying, “If I can get her to do that kind of chop, chop, chop, mark, mark, mark, it kind of brings her back.”

Ms. Abaspour said she had watched “everyone else in the family rush over to her, and I won’t become a part of that. I make her be responsible for her own feelings because I can’t be responsible for those. You still have to be a regular parent. Honestly, she has to learn to soothe herself.”

But Ms. Abaspour doggedly monitors Haley’s progress. This summer, she visited Haley at day camp and was dismayed that the child frequently declined to participate, asking for the nurse.

Sitting out the swim period one day, Haley, wearing a “Keep It Cool” T-shirt, listed her feelings on a worksheet: “stressed, axxouis, sick, shacky.”

At lunch, she mostly licked salt off pretzels. Asked to choose a word-card matching her emotions, she picked “overwhelmed.”

Ms. Abaspour worries that as Haley becomes a teenager, her poor social skills might get her “mixed up with the wrong kids” or lead her to use illegal drugs. So she arranges play dates, but if friends are unavailable “it’s the end of the world,” she said. If they are available, she said, Haley anxiously asks, “What do I say, Mommy?”

Ms. Abaspour was recently laid off from a medical assistant’s job. Her former co-workers understood her need to interrupt work to deal with Haley’s needs, she said, and “didn’t look at me and say, ‘Her child’s crazy.’ ” Now she fears she will not find an employer who is as tolerant, though the family needs the income. Haley’s illness, the Abaspours were dismayed to discover, does not qualify for disability assistance.

In August, Ms. Abaspour arranged an elaborate 50th-birthday surprise party for her husband. They were “not always on the same page” about Haley at first, she said, but their strong marriage helps her handle the strain.

So do bright spots, she said, like the day Haley “really kissed me.”

Still, she can get overwhelmed.

Sometimes she bolts awake at night, but she declines medication.

“I can’t climb in a shell and stay there forever,” she said, “although it seems like some days where I’d want to be.”

A Father’s Anxiety

As a young man, Bejan Abaspour worried, especially about family.

Twenty years ago, for example, when his sister’s son was born, “I pictured my nephew getting Super Glue in his eyes and I was calling my sister saying, ‘Make sure you keep Super Glue away from him.’ ”

But the worries were not that intense — until Haley’s illness. After that, the intrusive thoughts and images got worse, horrific scenes in which he imagines himself as bystander or thwarted rescuer. “I’ll be driving next to a semi tractor-trailer truck and all of a sudden I will picture someone getting crushed by the wheel,” he said. “It’s usually an older lady or a kid. You get them out from under the truck, but it doesn’t stop. I’m in the emergency room, trying to help. I’m at the funeral. Then very easily, the tears come.”

Mr. Abaspour said he sometimes pictured Haley “getting lost somewhere, or someone’s going to hurt her. I’m involved and trying to get the guy who did it to stop. Sometimes I kill him. Sometimes it doesn’t get that far.”

Other times, he said, he imagines his death, seeing his family “at the funeral home and I’m laying there. I try to see what’s going on at home, how Meggie’s reacting to my death, how Haley’s reacting, what Christine is going through.”

He rehashes things Haley has said, like wanting to “start over” or her question: “When I get really old, can I come back home? Will you be there?”

He wonders if his worrying laid genetic groundwork for Haley’s illness, “if I’m the cause of what Haley’s going through.”

Until recently, Mr. Abaspour, who also has trouble sleeping, told no one about his agonizing thoughts, not even his wife.

“I didn’t want to burden her,” he said. “I can handle it. So what if I’m driving to work and I cry? So what if I only sleep for four hours?”

But last spring, the family’s therapist noticed “I had certain problems,” he recalled. She encouraged him to tell his wife whenever he had disturbing thoughts. Mr. Abaspour said he hoped that confronting his own anxiety would help “get to the bottom of what Haley’s going through.”

He added, “It doesn’t matter for me, but for Haley.”

Families once kept illnesses like Haley’s quiet, afraid of being shunned or disparaged.

Public acceptance has grown, but some misperceptions and prejudice remain, and families feel conflicted: they want people to understand so the child can get appropriate help, but they also fear that Haley will be mocked or ostracized.

“If they keep it a secret then they’re bad parents,” Dr. Elliott said. “If they start spewing diagnoses, they’re subject to criticism because they’re not taking responsibility, just laying it on the illness. Or they’re social pariahs because there are some people who think that mental illness is contagious.”

Like other families, the Abaspours sometimes hesitate to publicly label their daughter mentally ill. But they also want people to know, and they get frustrated if people do not fully accept or understand it, or see her symptoms “as a manipulative thing, or they feel like they can fix it themselves, maybe by distracting her,” Ms. Abaspour said.

Her own family now understands and is very supportive, but it took some convincing, she said.

“My mother would say, ‘She’ll be fine, she’ll be fine, there’s nothing wrong with her,’ ” Ms. Abaspour said. “My sister says, ‘Well, she didn’t act like that when she was over here.’ ”

Mr. Abaspour has not told most of his family, who live in England, because they might worry excessively or not understand.

He told his sister, but “she was like I was when I first encountered the situation — disbelief or denial,” he said. His sister, he said, has not told her husband or her 20-year-old son, which created an odd atmosphere when they visited the Abaspours in August. “When Haley did have one of her little episodes, they were all like, ‘oh, oh,’ and they wondered why we weren’t running over to her,” Ms. Abaspour said. “I would like to talk to them more about it. If she had diabetes, they’d know she had diabetes.”

When, after reading a book for children with bipolar disorder, Haley said, “I can’t wait to go to school and tell everybody I’m bipolar,” the Abaspours were torn.

They discouraged her from announcing the diagnosis. But Haley did tell her classmates, “ ‘I have a lot of noise going on in my head and sometimes I feel anxious and sometimes I have to take a walk.’ ”

Some day, the Abaspours hope, Haley will have more effective drugs and better coping skills, and society will be more tolerant, so she can lead an independent life. But they have no illusions.

“This is not going away,” Ms. Abaspour said. Not for Haley or her family. “The overflow of what Haley has is what has made all of us what we are today.”

From soul catcher to adventurer

2006-10-20T12:59:00.000-04:00

By Patrick Noonan
From The Tablet

The modern missionary is someone who steeps him- or herself in new cultures and enters sympathetically in the lives of others. It is a process that is demanding and poses major psychological challenges

Missionaries are shadowy people. Hundreds of them still descend on Europe every year from the far corners of the earth. They look like anyone else emerging from airports, though their dress code probably leaves something to be desired. They have travelled from remote parts where style does not count and materialism is unknown. They bring this experience with them to home cultures they have been distanced from and homes they may not recognise. And back where they came from, few people have an accurate grasp of what their work involves.

Part of the reason for this is that so little is known about missionary history. Missionaries thumbed lifts on colonial ships. Some blessed slave ships leaving Angola. Others, later, educated indigenous populations in non-violent resistance to oppression. But the documented accounts are relatively thin on the ground. Describing his experiences in the jungle in Liberia in 1935, the missionary Thomas O'Shaughnessy (who later published Rest Your Head in Your Hand detailing his experiences) wrote, "We knew that if yellow fever happened to be raging when we arrived, our immediate death was practically certain ... It was a six-day walk to the village ... the carriers asked in each village for the path to the next town ... the whole journey lasted two weeks ... [how could this be] that I should be listening to night crickets and wading through swamps in an African forest to help a dying human being I had never known? One reflected on one's loneliness, one's exile and tried to find a remedy for gloom. Why the longing for one's country? I had few books other than the complete works of Shakespeare and G.B. Shaw. Every two or three months, the mail brought some magazines and papers that might be six months old. We had no music or radio."

That is a classic description of missionary life in the early part of the last century. At home, we knew that these were people who set out to bring salvation to the world; they established the Church in unlikely places. There was a mystique about them. Some were given missionary crosses in a public ceremony before they went. They were acclaimed minor heroes, riding into the unknown bringing the good news of Christianity. But there was another, a more negative image. Earlier missionaries were sometimes referred to as "soul catchers" and accused of hunting and baptising poor heathen children and their parents. Many appeared in a mission area all too often as "benefactors" (sometimes they still do) always handing out things. It was a feel-good experience. I felt it myself. And at times missionaries, both lay and clerical, didn't notice that their behaviour was seen as arrogant, especially when they believed that they had a duty to bring "civilisation" to Africa, Asia or South America. This was the model of mission before the Second Vatican Council, that is, before the Sixties.

Thirty-five years ago some missionaries stopped attending Irish cultural gatherings on St Patrick's Day in South Africa when we found Irish immigrants to be too insular and European in their perspective. It was difficult to cope with their acceptance of apartheid. Empowering people to savour the life and words of Jesus, we now know, is a multifaceted learning process. It is a long journey to Emmaus dotted with many breaking revelations of God.

Serious missionaries today read the novels and newspapers of the local peoples and steep themselves in their lore when possible. They learn the local language, and know in advance that their insensitivity to local cultures will be remembered and often criticised in future. This is the lot of any missionary, from St Paul's encounter with the philosophers of Athens or the first Franciscan martyrs who really didn't get it right in Morocco. They went with naive zeal to convert the Muslim infidels, who turned on them.

The long-term missionary (man or woman) prayerfully invites the faithful to interpret the presence of God in their situations and through their cultures. Softly penetrating another culture, trying to understand its beliefs and even trying out its slang language has always been rewarding for a missionary. Cross-cultural experiences change people willing to be changed. A person is drawn into questioning his own assumptions and ways of seeing things as he enters sympathetically into the lives of others.

Passing over to the wonderland of another culture can be the most profound spiritual experience of a missionary's life, a spiritual adventure. It is a continuation of Incarnation. And it includes the transforming of cultures where they might lack the love of God. And when he comes back to Europe he is not the same person. His viewpoints and insights may well have changed, broadened and become more objective.

The serious missionary learns that the people of the host culture will accept him when they are ready, once he has opened and disclosed himself sufficiently and with empathy to their world view. There is a powerful lesson in listening here - learned, typically, from people's stories as we sit crouched around a table with one flickering candle long into the African night. The missionary has a sense of being pulled emotionally in different directions by his home country and the country he has chosen to serve in. Sometimes he feels closer to the soul of his adopted country than his own country of birth. Meanwhile, responding to local needs, he is trying to be a car mechanic, carpenter, plumber, painter, electrician, accountant, motivator, problem-solver, peacemaker, organiser, secretary, pastoral priest, brother or sister all in one.

He begins to find the Christ of other cultures - "the hidden traces of God" - in other cultures. This is a hugely rewarding encounter, an experience of God in action. Previously unrecognised presences of God progressively and gradually materialise before him. This exposure to the diversity of the divinity slowly becomes his frame of reference in life. When many of his "non-missionised" colleagues, friends and family at home encounter his changed perspectives they are sometimes mystified and uncomprehending.

When a missionary returns on holidays, he must reconnect with his life story before he left. This he does through his extended family and friends and colleagues. He connects too with his sending congregation or organisation. Some religious congregations have debriefing mechanisms in place to assist their missionaries to readjust to their own culture as soon as possible after arriving home. If he is coming from a stressful situation of social or political conflict he would be advised to seek help. Here I speak from experience. I remember (with others) returning to Ireland in the Eighties for three-month holiday periods during the uprisings in South Africa. I was stressed but at the time didn't realise it. By the end of the holidays, when I prepared to return, the stress had barely dissipated.

Again - with growing exceptions - missionaries are struck by the rigid, lifeless, spiritless liturgies they so often see in Europe. The missionary, lay or clerical, like the African immigrant, notes that church life tends to have a quality which unconsciously prevents it from wanting to learn from the vibrant life of the Church in other parts of the world. It seems to have lost contact with the innovative, spontaneous energy of the Holy Spirit or ushered the life-giving Spirit to the sidelines.

While Europe has rightly given much to the younger Churches of the world, and continues to do so, missionary experience has a lot to contribute to the mother Church in Europe, and Europe has something to learn from the Churches of Africa, South America and Asia. Globally, in the area of cultural gifts and belief, the West loves to expound truth, doctrine and order; Asia still offers us the gift of prayer and meditation; Latin America preaches liberation and solidarity with the poor, and Africa knows all about community and liturgical celebration. And St Paul says these gifts are for all.

Today the African Church is booming. Thousands of lay leaders conduct priestless services every Sunday all over the continent. They have worked with married and unmarried deacons, with parish pastoral councils and finance committees. Perhaps the time has come for the Church in the southern hemisphere to come to the aid of the northern churches, and for the North to listen more keenly, more searchingly and more openly, to the Christian voices from the South.

The early Franciscans missionaries in Morocco 800 years ago learned from their experience. They changed their ways. Recently an Arab commentator said this about Franciscans in the Middle East:"Instead of engaging us [with apologetics], they quietly go about our cities, serving everyone. Once people are served they become interested in Christianity, and the next thing you know they've become followers of Jesus. Those Franciscan Christians don't fight fair with us."

Patrick Noonan OFM has worked in South Africa as a Franciscan missionary, mostly in the formerly black townships, for 35 years. He is the author of They're Burning the Churches (Jacana, 2003).

Eating addictive as sex, drugs: Study

2006-10-20T08:46:00.000-04:00

Sex and drugs and guacamole.

According to a new study by Yale University, food can be just as addictive as recreational drugs or sex.
The hormone most associated with making you hungry affects the same pleasure-inducing, addictive area of the brain that marijuana or cocaine do, said Dr. Tamas Horvath, chair of comparative medicine at Yale University's school of medicine, in New Haven, Conn.

"And if you think about it, you need to be addicted to eating. It's a must," Horvath said."It has to be (addictive) if you consider it, because without that you would die."

The study, partially sponsored by the National Science and Engineering Research Council of Canada, will appear today in an online edition of the Journal of Clinical Investigation.

What Horvath found in rats was that the hormone ghrelin — produced in the stomach to promote eating — is actually acting on a part of the brain, the ventral tegmental area (VTA), that has long been associated with the pleasurable effects of things like drugs and sexual activity.

Horvath, a veterinarian and neuroscientist, says an addiction mechanism to promote eating would have evolved naturally in our brains to ensure we took the trouble to find food.

"Not necessarily today, when you can open the refrigerator, but when you consider us as animals, you'd need to go out and be interested in seeking the food and to go and get it," Horvath said."Therefore, it makes sense that it has this type of reward value. It emerged to make you more efficient at survival."

The newly discovered neural pathway could lead to treatments for addictive eating, or even to "curb the munchies," said Carlton University psychologist Alfonso Abizaid, who contributed to the study.

Abizaid said that knowledge of the neurological mechanism could spur the development of drugs that would interfere with it, adding one more weapon to the arsenal against obesity.Horvath said a new diet drug, known as Rimonabant and available in Europe as an obesity treatment, works on the brain's VTA region.

1M Canadians dissatisfied with jobs, many depressed: studies

2006-10-17T14:04:00.000-04:00

Last Updated: Tuesday, October 17, 2006 12:50 PM ET
CBC News
About one in 12 Canadians, or more than one million people, said they were unhappy on the job in 2002, and depression is a major occupational health issue, Statistics Canada reported Tuesday.

The study used data from the 2002 Canadian Community Health Survey and the 2002/2003 National Population Health Survey to describe stress levels among people 18 to 75 who were employed, and looked at the links between stress and depression.

"For workers of both sexes, high stress on and off the job was associated with depression. However, the mental health of male workers was more vulnerable to stress arising from the work environment," the report's authors wrote.
Levels of stress and depression differed between industries. For example, job strain among men in processing, manufacturing or utilities was 30 per cent compared with a low of 13 per cent for men working in management.

Employers will need to think about how to deal with the high proportion of men who are not happy in traditionally male-dominated industries, said Eilenna Denisoff, a clinical psychologist at the Centre for Addiction and Mental Health in Toronto.

Reducing stress, depression on the job
In a second study, just over one million adults, 70 per cent who were employed, reported a "major depressive episode" in the year before they were interviewed.

In 2000, the World Health Organization ranked depression as the leading cause of disability worldwide.

For women, low supervisor support was linked with depression, while low support from co-workers was linked with higher prevalence of the condition for both sexes, the study's authors found.

Enlightened employers are recognizing the costs of chronic job stress and depression in higher absenteeism and lower productivity and are trying to reduce stress for employees, said Judith Berg, a therapist in Vancouver.

In her practice, Berg said common factors among her stressed-out clients included:High demand jobs. Low control at work. Little input in decisions. Little recognition. Lack of training or poor job skills. Mismatch with the culture of the organization. Lack of communication with senior management or within the workplace.

Long commutes and communication technologies that tie people to their jobs also contribute to stress levels, Berg said. "Everyone as an adult usually knows what to do to de-stress themselves," Berg told CBC Newsworld. "That could be just having a warm bath, if you've had a bad day. It could be jogging, it could be exercise, it could be listening to music. Knitting, gardening, going for a walk, talking to a friend. It's the chronic stress that employers should be concerned about."

Job strain a factor in depression
About 27 per cent of female workers and 19 per cent of male workers reported high job strain — when the demands of work outweigh the freedom to make decisions or apply skills.
"Men in high-strain jobs were 2.5 times more likely than their counterparts in low-strain jobs to have experienced depression; women were 1.6 times more likely," the report said.

There was also a clear link between perceptions of job stress and job satisfaction. One in four workers who found most days extremely stressful were dissatisfied with their jobs. But among those for whom stress was not really an issue, only one in 15 was dissatisfied.

People who were unhappy at work also tended to take more disability days. The average number of days taken by workers who were dissatisfied was almost three times that for workerswho were very satisfied with their jobs.

Income also seemed to make a difference. About 15 per cent of men with annual incomes of less than $20,000 were dissatisfied with their jobs, while only five per cent with incomes of at least $60,000 were dissatisfied.

Seduced by Snacks? No, Not You

2006-10-16T10:15:00.000-04:00

New York Times
By KIM SEVERSON
Ithaca, N.Y.
PEOPLE almost always think they are too smart for Prof. Brian Wansink’s quirky experiments in the psychology of overindulgence.
When it comes to the slippery issues of snacking and portion control, no one thinks he or she is the schmo who digs deep into the snack bowl without thinking, or orders dessert just because a restaurant plays a certain kind of music.
“To a person, people will swear they aren’t influenced by the size of a package or how much variety there is on a buffet or the fancy name on a can of beans, but they are,” Dr. Wansink said. “Every time.”
He has the data to prove it. Dr. Wansink, who holds a doctorate in marketing from Stanford University and directs the Cornell University Food and Brand Lab, probably knows more about why we put things in our mouths than anybody else. His experiments examine the cues that make us eat the way we do. The size of an ice cream scoop, the way something is packaged and whom we sit next to all influence how much we eat. His research doesn’t pave a clear path out of the obesity epidemic, but it does show the significant effect one’s eating environment has on slow and steady weight gain.
In an eight-seat lab designed to look like a cozy kitchen, Dr. Wansink offers free lunches in exchange for hard data. He opened the lab at Cornell in April, after he moved it from the University of Illinois at Urbana-Champaign, where he spent eight years conducting experiments in cafeterias, grocery stores and movie theaters. Dr. Wansink presents his work to dieticians, food executives and medical professionals. They use it to get people to eat differently.
His research on how package size accelerates consumption led, in a roundabout way, to the popular 100-calorie bags of versions of Wheat Thins and Oreos, which are promoted for weight management. Although food companies have long used packaging and marketing techniques to get people to buy more food, Dr. Wansink predicts companies will increasingly use some of his research to help people eat less or eat better, even if it means not selling as much food. He reasons that companies will make up the difference by charging more for new packaging that might slow down consumption or that put seemingly healthful twists on existing brands. And they get to wear a halo for appearing to do their part to prevent obesity.
To his mind, the 65 percent of Americans who are overweight or obese got that way, in part, because they didn’t realize how much they were eating.
“We don’t have any idea what the normal amount to eat is, so we look around for clues or signals,” he said. “When all you see is that big portions of food cost less than small ones, it can be confusing.”
Although people think they make 15 food decisions a day on average, his research shows the number is well over 200. Some are obvious, some are subtle. The bigger the plate, the larger the spoon, the deeper the bag, the more we eat. But sometimes we decide how much to eat based on how much the person next to us is eating, sometimes moderating our intake by more than 20 percent up or down to match our dining companion.
Much of his work is outlined in the book “Mindless Eating: Why We Eat More Than We Think” (Bantam), which will be published on Tuesday. The book is his fourth over all, but his first directed at a general audience. It is peppered with his goofy, appealing Midwestern humor and practical diet tips. But the most fascinating material is directly from his studies on university campuses and in test kitchens for institutions like the United States Army.
An appalling example of our mindless approach to eating involved an experiment with tubs of five-day-old popcorn. Moviegoers in a Chicago suburb were given free stale popcorn, some in medium-size buckets, some in large buckets. What was left in the buckets was weighed at the end of the movie. The people with larger buckets ate 53 percent more than people with smaller buckets. And people didn’t eat the popcorn because they liked it, he said. They were driven by hidden persuaders: the distraction of the movie, the sound of other people eating popcorn and the Pavlovian popcorn trigger that is activated when we step into a movie theater.
Dr. Wansink is particularly proud of his bottomless soup bowl, which he and some undergraduates devised with insulated tubing, plastic dinnerware and a pot of hot tomato soup rigged to keep the bowl about half full. The idea was to test which would make people stop eating: visual cues, or a feeling of fullness.
People using normal soup bowls ate about nine ounces. The typical bottomless soup bowl diner ate 15 ounces. Some of those ate more than a quart, and didn’t stop until the 20-minute experiment was over. When asked to estimate how many calories they had consumed, both groups thought they had eaten about the same amount, and 113 fewer calories on average than they actually had.
Last week in his lab seven people were finishing lunch while watching a big-screen TV. Cartoons on the TV served as a distraction so participants would not be influenced by what and how much those nearby ate.
Because he does not take money from food companies and is a newcomer at the university, the lab runs on the cheap. The menus, like the one on this day, are often built from Beefaroni, applesauce, M&M’s and Chex Mix: simple, inexpensive food that subjects are familiar with and that can be easily manipulated.
He prefers to experiment on graduate students or office workers, whom he sometimes lures with the promise of a drawing for an iPod. “It’s easy to find undergraduates to participate, but with the guys nothing makes sense because they all eat like animals,” he said.
On this day he is testing how much people eat depending on whether they have exercised. Over the past several weeks they have sent subjects, some who have exercised and some who have not, through an unlimited buffet line. By measuring the difference between how much and what people eat depending on whether they have exercised, Dr. Wansink hopes to prove that even moderate exercise makes us think we are entitled to many more calories than we actually burned.
“Geez Louise, you can’t believe how much people eat to overcompensate,” he said.
Those kinds of things — intuitive bits we know about food but think we are either immune to or don’t think about — are the spine of “Mindless Eating.” In it he outlines an eating plan based on simple awareness. Employ a few tricks and you can take in 100 to 300 fewer calories a day. At the end of a year you could be 10 to 30 pounds lighter.
For example, sit next to the person you think will be the slowest eater when you go to a restaurant, and be the last one to start eating. Plate high-calorie foods in the kitchen but serve vegetables family style. Never eat directly from a package. Wrap tempting food in foil so you don’t see it. At a buffet put only two items on your plate at a time.
His dieting methods aren’t as fast as the Atkins plan or even Weight Watchers, and have little to do with matters that consume nutrition researchers or even culinarians. Dr. Wansink is not that guy. Although he has studied to be a sommelier and keeps a mental list of his 100 best meals, he drinks vats of Diet Coke and will inhale a box of Burger King Cini-mini rolls with no apologies. He doesn’t think that his work will solve the obesity problem, but it’s a start.
“It’s like a big pyramid,” he said. “The people at 30,000 feet can look down and say we need a wholesale change in our food system, in school lunches, in the way we farm.” At the bottom of the pyramid, he said, are the nutritionists and the diet fanatics who think the problem will be solved by examining every nutrient and calorie.
Dr. Wansink does his research for the person in the middle, the guy on the sofa who can appreciate a good meal, whether it is from Le Bernardin or Le Burger King.
“Will being more mindful about how we eat make everyone 100 pounds lighter next year?” he said. “No, but it might make them 10 pounds lighter.”
And the best part, he promises, is that you won’t even notice.

De Nile Ain't Just A River in Egypt

2006-10-10T17:18:00.000-04:00

Tuesday, October 10, 2006

As part of my research for a seminar on Death and Dying that I am presenting at Home Based Spiritual Care today, I was looking for some of the euphemisms we use to avoid the "D" word.

Without getting into the debate over whether the use of euphemisms is an effective coping skill or a form of denial which interferes with the grieving process, I was amazed to discover the plethora of words or expressions often used instead of the words death or dead. (I suspect they are sometimes beneficial coping methods and sometimes denial.) Here is the list I discovered:

This collection contains more than 200 euphemisms, metaphors used in place of the words dying, death or dead, and some of the often amusing slang expressions that people use when talking about death or dying.

A - C Terms:

A long sleep, A race well run, Angels carried him/her away, Annihilated, Asleep in Christ, Ate it, Be all over with one, Be no more, Be taken, Bills of mortality, Bit the dust, Blew him/herself away, Bought the farm, Break one's neck, Breathe one's last, Breathed the last, Buy the farm, Called home, Came to an end, Cashed in, Catch one's death, Cease to breathe, Cease to live, Cessation of life, Changed form, Chant du cygne (French for swansong), Checked out, Close one's eyes, Come to an untimely end, Come to dust, Consigned to earth, Croaked, Cross the bar, Cross the Stygian ferry, Crossed over Jordan, Curtains.

D - E Terms:

Dead drop, Death doom, Death knocks at the door, Death song, Death stares one in the face, Debt of nature, Definitely Done Dancing, Depart this life, Departed, Departure, Die, Die a natural death, Die a violent death, Down dead, Drop dead, Drop into the grave, Drop off, Dropped the body, Dust to dust, Dying agonies, Dying breath, Dying day, Ebb of life, End of life, End one's days, End one's earthly career, End one's life, Ended it all, Eternal rest, Expire, Expired, Extinction of life.

F - H Terms:

Fall, Fall dead, Fall down, Feeling no pain, Fell asleep in the arms of Jesus,Final chapter, Final curtain call, For whom the bell tolls, Found everlasting peace, Gave it up, Gave up the ghost, Getting Bagged, Give up the ghost, Go off, Go off the hooks, Go out like the snuff of a candle, Go the way of all flesh, Go to Davy Jones's locker, Go to one's last home, Go to one's long account, Go to the wall, God took him/her, Goes to his/her heavenly father, Gone to heaven, Gone to his/her reward, Hand in one's checks, Hand in one's chips, Hand of death, Hell's grim Tyrant, His/her time was up, Hop the twig.

I - L Terms:

Iced,” I’m comin', Elizabeth”, In adamantine chains shall death be bound, In the arms of the Father, In the great beyond, It was curtains, Jaws of death, Join the greater number, Join the majority, Kick the bucket, Kicked the bucket, King Death, King of terrors, Knocking on heaven's door, Laid to rest, Last agonies, Last, breath, Last gasp, Lay down one's life, Left this world, Left us, Life ebbs, Life fails, Life hangs by a thread, Liquidated, Lose one's life, Loss, Loss of life, Lost.

M - O Terms:

Made the change, Make one's will, Meet one's death, Meet one's end, Met his/her Maker, No longer with us, Offed himself/herself, On the heavenly shores, On the other side, On ice, One’s days are numbered, One’s doom is sealed, One’s hour is come, One’s race is run, Out of his/her misery.

P - S Terms:

Pass away, Pass in one's checks, Pass in one's chips [U.S.] ,Passed away ,Passed on, Passing, Pay the debt to nature, Perish, Perished, Pop off, Post mortem, Pushing up daisies, Quietus, Reached the finish line, Receive one's death warrant, Release, Relinquish one's life, Resign one's being, Resign one's breath, Resign one's life, Rest, Resting in peace, Returned to dust, Returned to the source, Rigor mortis, Rubbed out, Shadow of the Valley of Death, Shuffle off this mortal coil, Sink into the grave, Six feet under, Snuffed, Spake the grisly Terror, Step out, Stygian shore ,Succumbed, Surrender one's life ,Swan song.

T - Z Terms:

Take one's last sleep, Taking the dirt nap, Terminated, That was all she wrote,The breath is out of the body, The grave closes over one, The lone couch of this everlasting sleep, Transcended, Translated into glory, Turn to dust, Turn up one's toes, Untimely end, Valley of death, Was a goner, Was done in, Wasted, Watery grave, Went to a new life, Went to his/her eternal reward, With the angels, Withered away, Yield one's breath, Yield up the ghost.

Twenty-first-century human beings live in a culture in which "dead" is a four-letter word. Because four-letter words have a reputation for being obscene, death is obscene to modern sensibilities; that is, to those in modern death-denying cultures who rarely have firsthand experiences with the dying and the dead. Modernity has afforded people the ability to hide the dying process from public view; and often people see the dead body of a loved one to be so polluting that they pay strangers to dispose of "it" properly. The modern mind can abstract death, further buffering itself from death's horror, through the use of metaphor and euphemism when describing the dead. In daily conversations the deceased tend to pass or fade away, embark on a desired trip to meet their eternal reward or loved ones ("Grandpa is back with Grandma"), or merely fall asleep ("She earned her rest").

Some scholars argue that our circumlocutions should be understood as evidence of death denial, as should such colorful expressions as "buying the farm," "pushing up daisies," or "kicking the bucket." On the other hand, euphemism has a long tradition of use when dealing with the topic of death, and the use of metaphor is often inevitable when trying to explain certain facets of the human condition, particularly death.

Humans are symbolic creatures, perceiving and experiencing their social worlds largely through their symbols, many of which are figurative and metaphoric. Instead of understanding metaphors as embellishments of facts, they are better conceived as ways in which these facts are experienced, filtering and shaping apprehensions of social reality and understandings of things about which they are unfamiliar—like death.

Distinctive metaphors and euphemisms have emerged from the various social institutions directly involved with death. The more powerful the institution, the more likely its metaphors leak into everyday parlance and produce common world-views. Over the twentieth century, these have included the military, medical, and political orders— the social institutions primarily responsible for death control.

Twentieth-century militarism had a powerful effect on death's metaphoric framings. In George Orwell's futuristic novel Nineteen Eighty-four(1949), the Ministry of Truth proclaimed "War is peace." In the twenty-first century war is "pacification." The military sanitizes its lethal activities through benign labels (e.g., the Nazis assigning carloads of concentration camp–bound to Sonderbehandlung, meaning "special treatment") or by dehumanizing its enemies (who are "fumigated," "exterminated," or "wasted" like cockroaches and rats). In Doublespeak (1989), William Lutz distinguishes euphemism, which covers the unpleasant, from doublespeak, whose purpose is to deceive and mislead. To illustrate the latter, he noted how the U.S. State Department replaced "killing" with "unlawful deprivation of life." Dead enemy soldiers are "decommissioned aggressor quantum." Deaths of innocent civilians are referred to as "collateral damage." When commandos parachuted in the early 1980s American invasion of Grenada, the Pentagon referred to the action as a "predawn vertical insertion."

In Illness As Metaphor (1978), Susan Sontag describes the military metaphors applied to disease, the alien invaders that breach bodily defense systems necessitating surgical, chemical, or radiation counterattacks. The frontline in the cultural war against death is the medical establishment. Here death has long been viewed as failure, giving rise to a host of clinically detached euphemisms. Patients "go sour," their respirations cease, or they are simply "no longer with us." Emergency room nurses make references to someone being "DDD" ("definitely done dancing") or "getting bagged."

The euphemisms extend to those most likely to die—those who have lived the longest lives. The most death prone are not "old people" but rather "senior citizens," "Golden Agers," or simply "the mature." They die in "homes"—rest homes, nursing homes, retirement homes—where they are too often deindividualized and victimized by under-paid staff.

In the political arena, heated battles on the moralities of abortion and euthanasia have produced a new language for death-related matters. In the contest between social movements supporting or opposing legalized abortion and euthanasia has emerged the self-referencing "pro-choice" and "pro-life" labels. For those opposing assisted or accelerated death, "active euthanasia" is a euphemism for murder. For proponents, the practice of keeping the terminally ill alive on hi-tech life supports is "technological torturing" of the dying.

Crisp mortality references often enter into American parlance when referring to nonthanatological matters. People often "die" symbolically, as when failing in their social performances. One certainly does not want to be "dead wrong," an office "deadwood," a "deadbeat" father, or within a "dead-end" job. Companies may adopt a "poison pill" defense against a hostile takeover attempt, leaving workers worried about being "axed" or appearing on "Schindler's List." The symbolic potency of such death metaphors rise with increases in the centrality of work roles to the identities of men and women. Studies have shown that when a business facility shuts down workers often go through the deathlike stages described by the death expert Elisabeth Kübler-Ross. A late 1980s survey of Richmond, Virginia, entrepreneurs published in the Wall Street Journal cited nearly six in ten saying failure was the incident they feared most, with fear of death being but a distant third for both sexes. And when the worker actually does die, he or she dies metaphorically in occupationally unique ways: Deceased soldiers "answer their last roll call," chefs "lay down their knife and fork," actors "make a final exit," and boxers "take the last count."

Among those whose job it is to deal with the dead, death professionals as scholar Michael Lesy calls them, metaphors arising from their humor produce the death desensitizations required for them to cope with society's "dirty work." Among themselves, funeral directors, for instance, refer to embalming as "pickling" or "curing the ham," cremation as "shake and bake," and coffins as "tin cans." When dealing with the public, the "patient" (not the corpse) is "interred" (not buried) within a "casket" (not coffin) beneath a "monument" (not tombstone).

So what do all of these colorful, humorous, consoling, deceptive, demeaning, and frightful framings of death mean? Are they useful? The metaphors and euphemisms that people apply to the dying and the dead shape the way the living now see their connection with the dead. They can sanitize the profound pollution posed by a decaying corpse and assuage the profound moral guilt of collective murder during times of war. They can reaffirm the meaningfulness of the deceased's life ("He lives with us all") or degrade their very existence ("The vermin were whacked").

Perhaps another way to think about the matter is to ask how many words there are that solely capture the single fact that this person or creature is no more. "He died" is the simplest way English speakers can make the point. From there on, everything is an elaboration of a phenomenon of which none of the living has any direct knowledge. The military borrows from the medical when it conducts its surgical operations to remove "the cancer"; the medical from the military in its "wars against enemy diseases." In sum, metaphors and euphemisms for death are employed as both shields and weapons, to cover the unpleasant or distasteful aspects of mortality, or to apply the power of death to reinforce the significance of certain events among the living.

Friends for Life: An Emerging Biology of Emotional Healing

2006-10-10T16:54:00.000-04:00

October 10, 2006, New York Times

Essay

By DANIEL GOLEMAN

A dear friend has been battling cancer for a decade or more. Through a grinding mix of chemotherapy, radiation and all the other necessary indignities of oncology, he has lived on, despite dire prognoses to the contrary.

My friend was the sort of college professor students remember fondly: not just inspiring in class but taking a genuine interest in them — in their studies, their progress through life, their fears and hopes. A wide circle of former students count themselves among his lifelong friends; he and his wife have always welcomed a steady stream of visitors to their home.

Though no one could ever prove it, I suspect that one of many ingredients in his longevity has been this flow of people who love him.

Research on the link between relationships and physical health has established that people with rich personal networks — who are married, have close family and friends, are active in social and religious groups — recover more quickly from disease and live longer. But now the emerging field of social neuroscience, the study of how people’s brains entrain as they interact, adds a missing piece to that data.

The most significant finding was the discovery of “mirror neurons,” a widely dispersed class of brain cells that operate like neural WiFi. Mirror neurons track the emotional flow, movement and even intentions of the person we are with, and replicate this sensed state in our own brain by stirring in our brain the same areas active in the other person.

Mirror neurons offer a neural mechanism that explains emotional contagion, the tendency of one person to catch the feelings of another, particularly if strongly expressed. This brain-to-brain link may also account for feelings of rapport, which research finds depend in part on extremely rapid synchronization of people’s posture, vocal pacing and movements as they interact. In short, these brain cells seem to allow the interpersonal orchestration of shifts in physiology.

Such coordination of emotions, cardiovascular reactions or brain states between two people has been studied in mothers with their infants, marital partners arguing and even among people in meetings. Reviewing decades of such data, Lisa M. Diamond and Lisa G. Aspinwall, psychologists at the University of Utah, offer the infelicitous term “a mutually regulating psychobiological unit” to describe the merging of two discrete physiologies into a connected circuit. To the degree that this occurs, Dr. Diamond and Dr. Aspinwall argue, emotional closeness allows the biology of one person to influence that of the other.

John T. Cacioppo, director of the Center for Cognitive and Social Neuroscience at the University of Chicago, makes a parallel proposal: the emotional status of our main relationships has a significant impact on our overall pattern of cardiovascular and neuroendocrine activity. This radically expands the scope of biology and neuroscience from focusing on a single body or brain to looking at the interplay between two at a time. In short, my hostility bumps up your blood pressure, your nurturing love lowers mine. Potentially, we are each other’s biological enemies or allies.

Even remotely suggesting health benefits from these interconnections will, no doubt, raise hackles in medical circles. No one can claim solid data showing a medically significant effect from the intermingling of physiologies.

At the same time, there is now no doubt that this same connectivity can offer a biologically grounded emotional solace. Physical suffering aside, a healing presence can relieve emotional suffering. A case in point is a functional magnetic resonance imaging study of women awaiting an electric shock. When the women endured their apprehension alone, activity in neural regions that incite stress hormones and anxiety was heightened. As James A. Coan reported last year in an article in Psychophysiology, when a stranger held the subject’s hand as she waited, she found little relief. When her husband held her hand, she not only felt calm, but her brain circuitry quieted, revealing the biology of emotional rescue.

But as all too many people with severe chronic diseases know, loved ones can disappear, leaving them to bear their difficulties in lonely isolation. Social rejection activates the very zones of the brain that generate, among other things, the sting of physical pain. Matthew D. Lieberman and Naomi Eisenberg of U.C.L.A. (writing in a chapter in “Social Neuroscience: People Thinking About People,” M.I.T. Press, 2005) have proposed that the brain’s pain centers may have taken on a hypersensitivity to social banishment because exclusion was a death sentence in human prehistory. They note that in many languages the words that describe a “broken heart” from rejection borrow the lexicon of physical hurt.

So when the people who care about a patient fail to show up, it may be a double blow: the pain of rejection and the deprivation of the benefits of loving contact. Sheldon Cohen, a psychologist at Carnegie-Mellon University who studies the effects of personal connections on health, emphasizes that a hospital patient’s family and friends help just by visiting, whether or not they quite know what to say.

My friend has reached that point where doctors see nothing else to try. On my last visit, he and his wife told me that he was starting hospice care.

One challenge, he told me, will be channeling the river of people who want to visit into the narrow range of hours in a week when he still has the energy to engage them.

As he said this, I felt myself tearing up, and responded: “You know, at least it’s better to have this problem. So many people go through this all alone.”

He was silent for a moment, thoughtful. Then he answered softly, “You’re right.”

Daniel Goleman is the author of “Social Intelligence: The New Science of Human Relationships.”

Dead Bachelors in Remote China Still Find Wives

2006-10-06T13:22:00.000-04:00

October 5, 2006
By JIM YARDLEY
CHENJIAYUAN, China — For many Chinese, an ancestor is someone to honor, but also someone whose needs must be maintained. Families burn offerings of fake money or paper models of luxury cars in case an ancestor might need pocket change or a stylish ride in the netherworld.
But here in the parched canyons along the Yellow River known as the Loess Plateau, some parents with dead bachelor sons will go a step further. To ensure a son’s contentment in the afterlife, some grieving parents will search for a dead woman to be his bride and, once a corpse is obtained, bury the pair together as a married couple.
“They happen pretty often, especially when teenagers or younger people die,” said Yang Husheng, 48, a traveling funeral director in the region who said he last attended such a funeral in the spring. “It’s quite common. I’ve been in the business for seven or eight years, and I’ve seen all sorts of things.”
The rural folk custom, startling to Western sensibilities, is known as minghun, or afterlife marriage. Scholars who have studied it say it is rooted in the Chinese form of ancestor worship, which holds that people continue to exist after death and that the living are obligated to tend to their wants — or risk the consequences. Traditional Chinese beliefs also hold that an unmarried life is incomplete, which is why some parents worry that an unmarried dead son may be an unhappy one.
In random interviews in different villages across the Loess Plateau, which spreads across parts of Shanxi and Shaanxi Provinces, everyone acknowledged the custom. People say parents of a dead son depend on an informal network of friends or family, or even a well-connected fixer, to locate a family that has recently lost a single daughter. Selling or buying corpses for commercial purposes is illegal in China, but these individual transactions, usually for cash, seem to fall into a fuzzier category and are quietly arranged between families.
In some villages, a son is eligible for such a spouse if he is 12 or older when he dies. None of the people interviewed considered the custom shameful or overly macabre. Instead, it was described as a parental duty to a lost child that reflected Confucian values about loyalty to family.
“Parents have a sense of responsibility for their son,” said one woman, Li Yinlan. She said she had attended ceremonies where the coffins were placed side by side and musicians played a dirge. “They have this custom everywhere,” she said of her region.
The Communist Party has tried, with mixed success, to stamp out beliefs it considers to be superstition. But the continued practice of the ancient custom in the Loess Plateau is a testament to the region’s extreme isolation. In other parts of rural China, it is difficult to know how often, if at all, the custom is followed.
The Loess Plateau, a dense warren of eroding canyons where some villages are unreachable by roads, is separated from much of the change stirring up China. Many young people have fled the arid hills, while those left behind struggle to raise a crop. Many of the men left behind also struggle to find a wife.
The reason is that many women have left for work in cities, never to return, while those women who remain can afford to be picky. No family would approve of a daughter marrying a man too poor to afford a dowry and a decent future. Families of the poorest bachelor sons sometimes pool their savings to buy a wife from bride sellers, the traveling brokers who lure, trick or sometimes kidnap women from other regions and then illegally sell them into marriage.
In the tiny village of Chenjiayuan, a farmer named Chen Xingwu, 57, stabbed a spade into his field overlooking the Yellow River and said minghun represented the final effort by parents to find a bride for a son. He said the parents of a local disabled man were so worried their son would die before finding a spouse that they recently gave a gold ring and earrings to a woman’s family to secure her as a bride.
Mr. Chen said his own marriage, at 35, was a lucky stroke, coming after he lobbied the family of a younger woman in another village. It allowed him to have three children and carry on his family name. But he said the pool of available brides was limited, a scarcity that increased their value — an irony, given that some rural families, conscious of China’s one-child policy, abort female fetuses before birth or abandon newborn girls.
“For girls, it doesn’t matter about their minds, whether they are an idiot or not,” he said. “They are still wanted as brides.” Dead or alive, he added, as he peered at the river.
“There are girls who have drowned in the river down there,” he said. “When their bodies have washed up, their families could get a couple of thousand yuan for them.”
Villagers and Mr. Yang, the funeral director, said a family searching for a female corpse typically must pay more than 10,000 yuan, or about $1,200, almost four years of income for an average farmer. Families of the bride regard the money as the dowry they would have received had death not intervened.
The existence of such a market for brides has led to scattered reports of grave robbing. This year, a man in Shaanxi Province captured two men trying to dig up the body of his wife, according to a local news account. In February, a woman from Yangquan tried to buy the remains of a dead 15-year-old girl, abandoned at a hospital in another city, to satisfy her unmarried deceased brother. She said the brother’s ghost was invading her dreams and demanding a wife, according to a news account.
Guo Yuhua, a sociology professor at Qinghua University in Beijing, an expert on folk traditions and burial customs in the Loess Plateau, said the minghun custom stemmed from both dread and sympathy for the dead. She said parents with dead daughters, like those with dead sons, were also carrying out an obligation to their child. They will sell their bodies as a way of finding them a place in a Chinese society where tradition dictates that a daughter has no place on her father’s family tree.
“China is a paternal clan culture,” said Professor Guo, who did postdoctoral work in anthropology at Harvard. “A woman does not belong to her parents. She must marry and have children of her own before she has a place among her husband’s lineage. A woman who dies unmarried has no place in this world.”
Pinpointing the origins of minghun is difficult, but scholars have found allusions to the practice in different ancient texts, including the Rites of Zhou, a guidebook of appropriate Confucian behavior written around the third century B.C. Commentators on the Confucian classics have argued that the ancient educated elite disapproved of the custom.
Yet Professor Guo emphasized that the values of Confucianism, later blended with Buddhism and Taoism, are the basis of folk customs like minghun, which share a reverence for family.
In the village of Qinjiagelao, where roughly one in four eligible men are unmarried, Qin Yuxing, 80, is a genial grandfather unashamed of the minghun practice or the fact that he bought living brides for both his sons.
His younger son, now 40, had tried to find a spouse but the family was too poor. The elder Mr. Qin saved his money and bought a bride from a man who showed up at a local market offering a woman for $500. The woman bore Mr. Qin’s son a child and then left three years ago to visit her family — and never came back.
“People aren’t willing to come here,” the elder Mr. Qin said to explain why he was willing to purchase a woman for his son. His village is perched atop a cliff and had no road until last year. Women often face backbreaking work. Mr. Qin said similar pressures weighed on a neighboring family after their unmarried son died in a gas explosion more than a decade ago. That family spent $500 for an afterlife marriage, he said. Mr. Qin’s wife, Cao Guoxiang, 76, recalled another case involving parents buying a dead bride for their unmarried son, a trucker who died in an accident.
She said the size of afterlife ceremonies depended on a family’s wealth. “Poor people just bring the bodies over and put them in the earth,” she said. “People with money will have a reception and slaughter a pig or a sheep for friends.”
She added: “It’s superstition and religion. People live as couples. If they die, they should live as a couple, too.”
And that is why families too poor to afford a minghun bride also follow a similar custom in some villages: They make a figure of straw and bury it beside a dead son as the spouse he never had.
Jake Hooker contributed reporting.

Women Face Greatest Threat of Violence at Home, Study Finds

2006-10-06T09:35:00.000-04:00

October 6, 2006

By ELIZABETH ROSENTHAL, International Herald Tribune
Violence against women by their live-in spouses or partners is a widespread phenomenon, both in the developed and developing world, as well as in rural and urban areas, the most comprehensive and scientific international study on the topic has confirmed.
In interviews with nearly 25,000 women at 15 sites in 10 countries, researchers from the World Health Organization found that rates of partner violence ranged from a low of 15 percent in Yokohama, Japan, to a high of 71 percent in rural Ethiopia.
At six of the sites, at least 50 percent of women said that they had been subjected to moderate or severe violence in the home at some point. At 13 sites, more than a quarter of all women said they had suffered such violence in the past year.
“Violence by an intimate partner is a common experience worldwide,” the authors wrote of the findings, which are being published today in The Lancet, a medical journal in London. “In all but one setting, women were at far greater risk of physical or sexual violence by a partner than from violence by other people.”
The report says that rural areas tend to have higher rates of abuse than cities. But no area was immune.
While researchers and women’s groups have long known that domestic violence was widespread — and other, smaller surveys have supported that notion — the W.H.O. study adds an important dimension to the topic because it provides an unusual amount of quantitative, scientific data on the subject.
Previous studies had focused mostly on developed countries, indeed mostly on the United States, said Claudia García-Moreno, a researcher with the W.H.O. in Geneva who coordinated the study.
Because of a lack of scientific data on the magnitude of such violence, particularly in poorer countries, “there had been a lot of skepticism about whether it was a serious problem” or just a pet peeve of the women’s groups, Dr. García-Moreno said.
Most partner abuse is hidden, and only a tiny fraction is reported to the authorities.
“We have always known that violence is part of women’s lives,” said Adrienne Germain, director of the International Women’s Health Coalition in New York, “but when we’ve talked about it before we were mostly dismissed. In the past we’ve often heard: ‘Prove it. Prove that it’s happening in our country.’ ”
The researchers used meticulously designed surveys and statistical techniques. Their work took root more than a decade ago, after organizers of the 1995 International Women’s Conference in Beijing rued the lack of hard data on the issue and asked the W.H.O. for help.
For the study, 1,500 interviews were conducted in each country at sites in Bangladesh, Brazil, Ethiopia, Japan, Namibia, Peru, Samoa, Serbia, Thailand and Tanzania. In a few countries, researchers selected urban and rural sites for comparison.
The rate of abuse by partners is estimated to be around 20 percent to 25 percent in the European Union, smaller studies have found, although the problem is reported to the police in only a tiny fraction of cases.
In the United States, national surveys by the federal Centers for Disease Control and Prevention have found that about 25 percent of women said that they had been physically or sexually assaulted by a spouse, partner or date.
In the World Health Organization survey, one-fifth to two-thirds of women interviewed said that it was the first time they had ever spoken of the abuse to anyone, Dr. García-Moreno said.
The next step is to determine what puts women at risk for violence, the researchers said.

Black tea 'soothes away stress'

2006-10-05T16:04:00.000-04:00

Scientists have evidence behind what many tea drinkers already know - a regular cuppa can help you recover more quickly from everyday life stresses.

The study of black tea - instead of green or herbal varieties - found it helps cut levels of the stress hormone cortisol circulating in the blood.

They found people who drank tea were able to de-stress more quickly than those who drank a tea substitute.

The University College London study is in the journal Psychopharmacology.

In the study, 75 young male regular tea drinkers were split into two groups and monitored for six weeks.

They all gave up their normal tea, coffee and caffeinated beverages, and then one group was given a fruit-flavoured caffeinated tea mixture made up of the constituents of an average cup of black tea.

The other group was given a caffeinated placebo identical in taste, but devoid of the active tea ingredients.

Stressful tasks

All drinks were tea-coloured, but were designed to mask some of the normal sensory cues associated with tea drinking (such as smell, taste and familiarity of the brew).

This was designed to eliminate confounding factors such as the 'comforting' effect of drinking a cup of tea.

Both groups were subjected to challenging tasks, while their cortisol, blood pressure, blood platelet and self-rated levels of stress were measured.

In one task, volunteers were exposed to one of three stressful situations (threat of unemployment, a shop-lifting accusation or an incident in a nursing home), where they had to prepare a verbal response and argue their case in front of a camera.

The tasks triggered substantial increases in blood pressure, heart rate and subjective stress ratings in both of the groups.

However, 50 minutes after the task, cortisol levels had dropped by an average of 47% in the tea-drinking group compared with 27% in the fake tea group.

Blood platelet activation - linked to blood clotting and the risk of heart attacks - was also lower in the tea drinkers.

In addition, this group reported a greater degree of relaxation in the recovery period after the task.

Complex drink

Researcher Professor Andrew Steptoe said: "Drinking tea has traditionally been associated with stress relief, and many people believe that drinking tea helps them relax after facing the stresses of everyday life.

"However, scientific evidence for the relaxing properties of tea is quite limited."

Professor Steptoe said it was unclear what ingredients in tea were responsible.

He said it was very complex, and ingredients such as catechins, polyphenols, flavonoids and amino acids had all been found to affect neurotransmitters in the brain.

Nevertheless, the study suggests that drinking black tea may speed up our recovery from the daily stresses in life.

"Although it does not appear to reduce the actual levels of stress we experience, tea does seem to have a greater effect in bringing stress hormone levels back to normal.

"This has important health implications because slow recovery following acute stress has been associated with a greater risk of chronic illnesses such as coronary heart disease."

Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/5405686.stm

Published: 2006/10/04 23:21:24 GMT

© BBC MMVI

A Simple Show of Hands

2006-10-05T09:08:00.000-04:00

By STEPHANIE ROSENBLOOM, New York Times

ON a brisk autumn afternoon, in the shadow of the marble arch in Washington Square Park, a couple visiting from Ohio walked along holding hands like two teenagers going steady, decades after “going steady” went out of vogue.
When a stranger asked why they had chosen to join hands during their stroll, the man, Dave Findlay, looked at his wife of seven years and answered in a word: “Connection.”
Or as the Beatles sang back in 1963: “When I’ll feel that something, I want to hold your hand.”
Those simple lyrics turned an expression of teenage longing and first romantic steps into a No. 1 hit. Yet today, when Justin Timberlake is at the top of the charts with “SexyBack” and the digital airwaves are filled with steamy lyrical declarations (“I’m into havin’ sex, I ain’t into makin’ love” sang 50 Cent in “In da Club”), couples like Dave and Carey Findlay still intertwine fingers, kiss palms and link pinkies as they meander through parks, cross streets and snake through crowds.
“Hand-holding is the one aspect that’s not been affected by the sexual revolution,” said Dalton Conley, a professor and chairman of the department of sociology at New York University. “It’s less about sex than about a public demonstration about coupledom.”
Nowadays hand-holding has attracted the interest of scientists who are studying its effects on the body and mind. And sexual health educators say it is a much-discussed topic among gay students who now publicly hold hands more than ever before but still must consider whether they want to declare their sexuality.
“I think it remains more important in an era of perhaps more liberal sexual norms,” Dr. Conley said. “It remains this thing to be doled out.”
To hold someone’s hand is to offer them affection, protection or comfort. It is a way to communicate that you are off the market. Practically speaking, it is an efficient way to squeeze through a crowd without losing your partner. People do it during vigils, marches, weddings and funerals.
Usually it connotes something innocuous and sweet about a couple and their relationship. In rare instances, it takes on added potency, such as when President George W. Bush held the hand of Crown Prince Abdullah of Saudi Arabia in Crawford, Tex., last year — an act of respect and affection in Arab countries — reminding some people of the film “Fahrenheit 9/11,” which depicted the Bush family’s close business ties to Saudi leaders and which ignited conspiracy theories.
But, over all, few things are more innocent than a child grabbing the hand of a parent, for protection, direction and, as Mr. Findlay put it, connection. And with many children these days closer and more outwardly affectionate to their parents, chances are you have spotted a mother and her teenage daughter and perhaps even a father and his adolescent son ambling through a mall, scurrying through a crosswalk or strolling along, hand in hand.
Adult children and their elderly parents also hold hands, for balance, support and as a sign of love.
As for romantic couples, the opinions about hand-holding are as varied as fingerprints. But most people agree that it has merely changed, not lost favor.
“I think that for sure college students hold hands just like the old days,” said Sandra L. Caron, a professor of family relations and human sexuality at the University of Maine in Orono.
If they do, it is likely only after they are deep into a relationship — not in those early days of budding romance, when a touch of hands was the first act of intimacy between a couple. That was the hand-holding that the Beatles wrote about. (Followed swiftly by the sexual revolution, whose equivalent anthem might be The Rolling Stones’ “Let’s Spend the Night Together.”)
Among more than a half-dozen students at the University of Maine, there seemed to be two universal truths: that hand-holding is the least nauseating public display of affection and that holding hands has become more significant than other seemingly deeper expressions of love and romance.
“It is a lot more intimate to hold hands nowadays than to kiss,” said Joel Kershner, 23. Because of that, he said, reaching for someone’s hand these days has more potential for rejection than leaning in for a smooch at a party where alcohol is flowing.
Libby Tyler, 20, said it was “weird that hand-holding is more serious,” but true. “It’s something that you lead up to,” she said.
There is nothing casual about it any more, said Rachel Peters, 22. “Hand-holding is something that usually people do once they’ve confirmed they’re a couple,” she said.
But if that is not complicated enough, where you choose to hold hands also has meaning, the students said.
Drew Fitzherbert, 21, said that public hand-holding “shows that commitment not only to you and your partner but everyone else in the community.”
Dr. Conley of N.Y.U. agreed. “In the dark movie theater, in the dorm room, that’s a very different social act,” he said.
Are people holding hands as much as they once did? That’s impossible to quantify. But Gregory T. Eells, the director of counseling and psychological services at Cornell University in Ithaca, said he didn’t think so.
“I see more people on their cellphone than holding hands,” he said, adding, “To some extent we are trading real face-to-face relationships, where there’s touch and body language, for electronic ones.”
Peter Shawn Bearman, a professor of sociology and the director of the Institute for Social and Economic Research and Policy at Columbia University, said that hand-holding in crowded cities like New York may simply be impractical.
“Maybe if the proportion of hand-holders has indeed gone down it has more to do with density (of humans) than the devaluing of hand-holding as a romantic signal,” he wrote in an e-mail message.
Whatever degree of hand-holding may be happening, there are good reasons to cultivate the habit — reasons would-be hand-graspers may wish to pass along to their hands-in-pockets partners.
“Based on what we’ve seen, when we get more physical intimacy we get better relationships, whether a mother and an infant or a couple,” said Tiffany Field, the director of the Touch Research Institute at the University of Miami School of Medicine.
Even monkeys understand the importance of a hand squeeze every now and then. In “Good Natured: The Origins of Right and Wrong in Humans and Other Animals,” Dr. Frans B. M. de Waal, a primatologist at Emory University, wrote that some monkeys hold hands in reconciliation after a fight.
James Coan, an assistant professor of psychology and the neuroscience graduate program at the University of Virginia, has studied the impact of human touch, particularly how it affects the neural response to threatening situations, and said the results of a recent study were more dramatic than he expected.
“We found that holding the hand of really anyone, it made your brain work a little less hard in coping,” Dr. Coan said, adding that any sort of hand-holding relaxes the body.
The study, which will be published this year in the journal Psychological Science, involved 16 couples who were rated happily married based on the answers in a detailed questionnaire. The wives were put inside an M.R.I. machine and were told they were to receive mild electric shocks to an ankle. Brain images showed that regions of the women’s brains that had been activated in anticipation of pain and that were associated with negative emotions decreased when their husbands reached into the machine.
“With spouse hand-holding you also stop looking for other signs of danger and you start feeling more secure,” said Dr. Coan, who led the study. “If you’re in a really strong relationship, you may be protected against pain and stress hormones that may have a damaging effect on your immune system.”
Perhaps it is why so many people crave it.
Blogs and online forums are rife with complaints of those who say their significant other does not want to hold hands. “When we go out, we always have a blast, but the one thing that bothers me is that he never holds my hand in public,” writes a woman on a “love advice” forum on www.lovingyou.com.
For older couples, letting go of hand-holding may be one more sign that they are pressed for time and too swamped for little acts of intimacy.
“When do we make time to hold hands?,” said Dr. Eells of Cornell, talking about his own marriage of 15 years. “Not very often.”
The couple is often busy shuttling children to and from school and extracurricular activities, not strolling through parks like characters in a Georges Seurat painting.
Sometimes, though, even errands provide opportunities. Recently, Dr. Eells said, he and his 9-year-old daughter were caught in a downpour after her cheerleading practice. The two grabbed hands and raced off into the rain together. When they finally splashed over to the car, the damp girl turned her face to her father. “That was awesome,” she sighed.

Out-of-Body Experience? Your Brain Is to Blame

2006-10-05T09:01:00.000-04:00

By SANDRA BLAKESLEE , New York Times

They are eerie sensations, more common than one might think: A man describes feeling a shadowy figure standing behind him, then turning around to find no one there. A woman feels herself leaving her body and floating in space, looking down on her corporeal self.
Such experiences are often attributed by those who have them to paranormal forces.
But according to recent work by neuroscientists, they can be induced by delivering mild electric current to specific spots in the brain. In one woman, for example, a zap to a brain region called the angular gyrus resulted in a sensation that she was hanging from the ceiling, looking down at her body. In another woman, electrical current delivered to the angular gyrus produced an uncanny feeling that someone was behind her, intent on interfering with her actions.
The two women were being evaluated for epilepsy surgery at University Hospital in Geneva, where doctors implanted dozens of electrodes into their brains to pinpoint the abnormal tissue causing the seizures and to identify adjacent areas involved in language, hearing or other essential functions that should be avoided in the surgery. As each electrode was activated, stimulating a different patch of brain tissue, the patient was asked to say what she was experiencing.
Dr. Olaf Blanke, a neurologist at the École Polytechnique Fédérale de Lausanne in Switzerland who carried out the procedures, said that the women had normal psychiatric histories and that they were stunned by the bizarre nature of their experiences.
The Sept. 21 issue of Nature magazine includes an account by Dr. Blanke and his colleagues of the woman who sensed a shadow person behind her. They described the out-of-body experiences in the February 2004 issue of the journal Brain.
There is nothing mystical about these ghostly experiences, said Peter Brugger, a neuroscientist at University Hospital in Zurich, who was not involved in the experiments but is an expert on phantom limbs, the sensation of still feeling a limb that has been amputated, and other mind-bending phenomena.
“The research shows that the self can be detached from the body and can live a phantom existence on its own, as in an out-of-body experience, or it can be felt outside of personal space, as in a sense of a presence,” Dr. Brugger said.
Scientists have gained new understanding of these odd bodily sensations as they have learned more about how the brain works, Dr. Blanke said. For example, researchers have discovered that some areas of the brain combine information from several senses. Vision, hearing and touch are initially processed in the primary sensory regions. But then they flow together, like tributaries into a river, to create the wholeness of a person’s perceptions. A dog is visually recognized far more quickly if it is simultaneously accompanied by the sound of its bark.
These multisensory processing regions also build up perceptions of the body as it moves through the world, Dr. Blanke said. Sensors in the skin provide information about pressure, pain, heat, cold and similar sensations. Sensors in the joints, tendons and bones tell the brain where the body is positioned in space. Sensors in the ears track the sense of balance. And sensors in the internal organs, including the heart, liver and intestines, provide a readout of a person’s emotional state.
Real-time information from the body, the space around the body and the subjective feelings from the body are also represented in multisensory regions, Dr. Blanke said. And if these regions are directly simulated by an electric current, as in the cases of the two women he studied, the integrity of the sense of body can be altered.
As an example, Dr. Blanke described the case of a 22-year-old student who had electrodes implanted into the left side of her brain in 2004.
“We were checking language areas,” Dr. Blanke said, when the woman turned her head to the right. That made no sense, he said, because the electrode was nowhere near areas involved in the control of movement. Instead, the current was stimulating a multisensory area called the angular gyrus.
Dr. Blanke applied the current again. Again, the woman turned her head to the right. “Why are you doing this?” he asked.
The woman replied that she had a weird sensation that another person was lying beneath her on the bed. The figure, she said, felt like a “shadow” that did not speak or move; it was young, more like a man than a woman, and it wanted to interfere with her.
When Dr. Blanke turned off the current, the woman stopped looking to the right, and said the strange presence had gone away. Each time he reapplied the current, she once again turned her head to try to see the shadow figure.
When the woman sat up, leaned forward and hugged her knees, she said that she felt as if the shadow man was also sitting and that he was clasping her in his arms. She said it felt unpleasant. When she held a card in her right hand, she reported that the shadow figure tried to take it from her. “He doesn’t want me to read,” she said.
Because the presence closely mimicked the patient’s body posture and position, Dr. Blanke concluded that the patient was experiencing an unusual perception of her own body, as a double. But for reasons that scientists have not been able to explain, he said, she did not recognize that it was her own body she was sensing.
The feeling of a shadowy presence can occur without electrical stimulation to the brain, Dr. Brugger said. It has been described by people who undergo sensory deprivation, as in mountaineers trekking at high altitude or sailors crossing the ocean alone, and by people who have suffered minor strokes or other disruptions in blood flow to the brain.
Six years ago, another of Dr. Blanke’s patients underwent brain stimulation to a different multisensory area, the angular gyrus, which blends vision with the body sense. The patient experienced a complete out-of-body experience.
When the current flowed, she said: “I am at the ceiling. I am looking down at my legs.”
When the current ceased, she said: “I’m back on the table now. What happened?”
Further applications of the current returned the woman to the ceiling, causing her to feel as if she were outside of her body, floating, her legs dangling below her. When she closed her eyes, she had the sensation of doing sit-ups, with her upper body approaching her legs.
Because the woman’s felt position in space and her actual position in space did not match, her mind cast about for the best way to turn her confusion into a coherent experience, Dr. Blanke said. She concluded that she must be floating up and away while looking downward.
Some schizophrenics, Dr. Blanke said, experience paranoid delusions and the sense that someone is following them. They also sometimes confuse their own actions with the actions of other people. While the cause of these symptoms is not known, he said, multisensory processing areas may be involved.
When otherwise normal people experience bodily delusions, Dr. Blanke said, they are often flummoxed. The felt sensation of the body is so seamless, so familiar, that people do not realize it is a creation of the brain, even when something goes wrong and the brain is perturbed.
Yet the sense of body integrity is rather easily duped, Dr. Blanke said.
And while it may be tempting to invoke the supernatural when this body sense goes awry, he said the true explanation is a very natural one, the brain’s attempt to make sense of conflicting information.

Educated women have more orgasms, says survey

2006-10-04T16:29:00.000-04:00

Updated Wed. Oct. 4 2006 2:22 PM ET

CTV.ca News Staff

Women with graduate degrees are more likely to reach orgasm than their less educated counterparts, a new Australian study suggests.

The survey, which interviewed more than 9,000 women, claims that higher levels of education and income are associated with a greater prevalence for orgasm among women.

"The association between orgasm and demographic characteristics suggest a social-effect, with better-educated, non-immigrant women more likely to have orgasms," the researchers wrote in their report.

Researchers said factors such as becoming sexually active before the age of 16, the number of past sexual partners and looking at porn had little association with a woman's ability to have an orgasm.

However, the study said women were more likely to reach orgasm if they used sex toys, or had sex more than twice a week in the month before they were surveyed.

"Use of sex toys and orgasm in women may indicate a link between orgasm and sexual interest or adventurousness."

The research also found that men were far more likely than women to experience an orgasm during their last sexual encounter -- 98.4 per cent and 68.9 per cent respectively.

And while men in their late teens were less likely to report having an orgasm during their last sexual encounter, women were substantially less likely to have an orgasm if they were in their late teens or in their 50s.

Aside from age, researchers said there was no significant association between a man's ability to climax and his income, occupation, education or religion.

Men were less likely to have an orgasm if they had been sexually active for two years or less, were uptight about sex or if they were engaging in casual sex, rather than with a regular partner.

The telephone survey was conducted by researchers from Sussex University, England, and the universities of Sydney and Melbourne, Australia.

More than 10,100 men and 9,100 women aged 16-59 across Australia participated in the survey.

The study, "Sexual Practices at Last Heterosexual Encounter and Occurrence of Orgasm in a National Survey," asked respondents what practices they engaged in during their last sexual encounter and whether they had an orgasm as a result.