A recent report from the United States has highlighted the serious problem of absenteeism facing many schools, and the serious effects this can have on young people’s achievement and later lives. The report - Absences Add Up: How School Attendance - demonstrates that students with higher absenteeism rates have lower scores on national standardized tests. Poor attendance contributes to the achievement gap for students struggling with poverty and minority ethnic groups within communities. It is hardly surprising, of course, that there is a connection between school attendance and student achievement, but the data reported is still shocking:

“students who miss more school than their peers consistently score lower on standardized tests, a result that holds true at every age, in every demographic group and in every state and city tested.”

The study also highlighted the vital importance of intervening as soon as absences begin.

This is neither surprising nor particularly new. A growing awareness of the problems of absenteeism or truancy has resulted in governmental agencies responding in increasingly frustrated and severe fashion. A popular strategy has been to shift the focus of blame on to parents. Figures from the UK reveal a five-fold increase in the number of parents found guilty of charges related to their son or daughter refusing to attend to school. In Australia, parents of truanting children risk having their welfare checks blocked.

Many people have questioned both the fairness and effectiveness of this approach. The problem is that the blame-and-punish response to absenteeism ignores the cause of the problem. It is difficult to argue with Law Professor Sally Varnham that the solution lies in creating places where young people want to go and are able to learn:

“Having significant numbers of young people disengaged from education is a serious problem, both in terms of life expectations and the future of society. Being out of school substantially increases the risk of criminal offending, and a lack of education is a firm predictor of unemployment.”

School engagement is a vital element in a successful school experience, as it is at the heart of students' participation in their education. It is not enough that they are present within the school grounds: educational success requires an active and willing connection with learning, the curriculum, and teachers. Students who are positively engaged will achieve more and be happier with the school experience than those who are disengaged. They will also, of course, be more likely to turn up to school!

Evidence suggests that sports and other physical activities can help foster school engagement.

School engagement is an umbrella concept for several different components of students’ attitudes, behaviors, and feelings. Psychological engagement, for example, refers to a feeling of belonging with the school and a sense of connection to teachers, and there is persuasive evidence that participation in activities like sports can help foster a greater sense of school belonging and satisfaction.  In fact, according to one study, time spent in organized sports significantly predicted a positive attitude to school and belonging.

Sports are not the only activities that contribute to young people’s psychological engagement to school. Similar effects have also been identified in after-school performing arts clubs, school-involvement activities or academic clubs.  Extracurricular involvement in a variety of activities has been associated with lower dropout rates and is linked to reduced problem behaviors in areas such as delinquency and substance use.

In addition, students participating in leisure activities after-school tend to express positive feelings towards their teachers and other adults.

Cognitive engagement, the second type of school engagement, relates to factors like self-regulation and appreciating the benefits of learning, which have been demonstrated to have profound and long-lasting effects of educational achievement.  Again, evidence suggests that sports and other forms of physical activity can make a contribution. Children and young people who are physically active during the school day tend to be more eager to learn, and have improved attitudes towards learning and overall discipline in schools.

Studies from a number of countries have reported positive associations between physical activity and motivation to learn, school satisfaction and school connectedness, and negative relationships with delinquent behaviors. Results indicate that schools with higher proportions of sports participants have significantly fewer serious crimes and suspensions occurring on school grounds.

Matters are not all positive. Some forms of sports participants, especially among young men, can promote precisely the opposite effect, resulting in sports taking a higher priority than academics. Some sports club cultures can even lead to an increased incident of risky behavior that may seriously undermine school success.

The final form we will consider is academic and behavioral engagement. This concerns issues like attendance and participation in school life, as well as grades and examination success.

Studies have found that students who participate in sports activities were twice as likely to attend school as opposed to those who did not. A 5-month program involving attendance monitoring, sports participation, and a moral character class found significant differences between intervention and control groups in terms of reduced absenteeism, increased educational expectations, improved attitude toward education, and general school engagement.

An Australian review examined sports and physical activity programs designed to address antisocial behaviors such as truancy and more serious crimes. Although they acknowledged that there was limited evidence, the researchers’ conclusion was that there was reasonable evidence to support the claim that these activities provide an effective vehicle through which personal and social development in young people can be positively affected.

School-sponsored sports programs can also help foster school spirit, which can translate to a greater attachment to the school. A study from the UK evaluated a four-year physical activity intervention focused on students at risk of disengaging or absenting from school. It found that students who engaged with the scheme benefited from a range of positive improvements. Including increased attendance, improved behavior, great self-confidence), and that these positive outcomes were sustained until they left school. Researchers also found that students who experienced the program were more likely to become role models for others.

Studies like these shows that sports and other physical activity programs offer a constructive solution to a serious problem that affects school systems around the world. Poor attendance and absenteeism have become international challenges, not just because of their harmful effects on educational achievement, but also because of their legacy of reduced opportunities later in life. Previous posts have demonstrated that regular physical activity can make a distinctive contribution to educational results, and that part of the story seems to be concerned with its effect on cognitive functioning and brain health. School engagement is another element, and serves to strengthen the case for regular sports and other physical activities for every student in every school in every country.

For more information on this topic see:

Bailey, R.P., Hillman, C., Arent, S., and Petitpas, A. (2013). Physical activity: an underestimated investment in human capital? Journal of Physical Activity and Health, 10(3), 289-308.

Veliz, P., and Shakib, S. (2012). Interscholastic Sports Participation and School Based Delinquency: Does Participation in Sport Foster a Positive High School Environment?  Sociological Spectrum, 32(6), 558-580.

It’s tempting to try to shake religious people’s faith. After all, religion is irrational--How could anyone find comfort in a God that would allow billions of people, including infants, to die in agony of diseases like cancer. And religion has caused so much prejudice and death--from the Crusades to Radical Islam. Plus, religion often urges disempowerment: Don’t act; wait for God. Trust God above reason. For example, consider these exhortations from the Bible:

• “Be not wise in your own eyes. God shall supply all your need.” Philippians 4:19.

• “Trust in the Lord with all your heart, and do not lean on your own understanding.” Proverbs 3:1.

• “If you have faith like a grain of mustard seed, you will say to this mountain, ‘Move from here to there,’ and it will move, and nothing will be impossible for you.” Matthew 17:20.

Even some leading liberal lights, who otherwise urge tolerance and decry prejudice, ridicule the religious, for example, Richard Dawkins, author of The God Delusion and the late Christopher Hitchens, author of God is Not Great: How Religion Poisons Everything.Hitchens, for example, wrote:

• “One must state it plainly. Religion comes from the period of human prehistory where nobody…had the smallest idea what was going on. It…is a babyish attempt to meet our inescapable demand for knowledge as well as for comfort, reassurance and other infantile needs.”

• “To choose dogma and faith over doubt and experience is to throw out the ripening vintage and to reach greedily for the Kool-Aid.”

• “We keep being told that religion, whatever its imperfections, at least instills morality. On every side, there is conclusive evidence that the contrary is the case and that faith causes people to be more mean, more selfish, and perhaps above all, more stupid.”

Criticize the religious?

Nevertheless, it often seems wrong, even malevolent, to attempt to disabuse religious people of their faith. People need a crutch, real or not. We all have imaginary crutches. For example, many people use denial to avoid facing the inevitability of death and possibly painful dying. Should we be denied our crutches? If we shouldn’t, why should we try to take away a person’s religious faith, a strong crutch for literally billions of people?

After all, many people have turned to or returned to religious faith because their life is hard. Let’s say you can’t seem to get ahead or even hold a decent job and you’re worried that you financially can’t survive. Feeling there’s a loving God and perhaps a better hereafter can be comforting. Why would any well-meaning person try to take away that crutch?

If you continually struggle with relationships: your family, romantic partner, or lack thereof, it can feel lonely, empty. Believing that God is walking by your side can mitigate depression and even prevent suicide. Why would any well-meaning person try to take away that crutch?

A serious health problem, for example, cancer, heart disease, or diabetes, can be dispiriting. It isn’t coincidence that many people find religious faith only when facing a health crisis. Why would any well-meaning person try to take away that crutch?

And then there’s existential angst. Especially if your career and family life aren’t rewarding, one may feel that life has no purpose. For religious people, following a deity's plan and feeling awe of God’s handiwork can provide a sense of meaning. Why would any well-meaning person try to take away that crutch?

When to address religiosity

Of course, there are situations in which a person’s religion is clearly doing more harm than good. The obvious example is a religion-motivated terrorist. In such a situation, a benevolent person would at least think about whether to try to encourage the person to find a more constructive way to live their life and to improve it as well as the world. Another example: the unemployed person who is doing little to find a job in the belief that God will provide. A friend might gently encourage the person to supplement his or her faith with action.

Another example of when intervention may be appropriate. It seems unfair for an adult to inculcate religion in children, who yet have limited power to reason and question. By the time s/he does, s/he may have been so influenced by religious doctrime, for example, the Christian invoked fears of an eternity in purgatory or hell, as to be unlikely to make a fair-minded choice about whether to be religious. In The God Delusion, Dawkins agrees: "Faith can be very very dangerous, and deliberately to implant it into the vulnerable mind of an innocent child is a grievous wrong.”

But, too often, someone's attempt to shake a religious person’s faith is grounded not in altruism but in a desire to show s/he's right and smarter than the religious person. Or the critic is simply oblivious to likely hurting the person.

The takeaway

Fortunately, most religious people’s faith is well-defended enough that atheists and agnostics usually fail to disabuse them of their faith. But it may be worth asking yourself, “If I’m truly  well-intentioned, should I devote my efforts to help humankind in ways other than to denigrate a person’s religiosity?”

Marty Nemko's bio is in Wikipedia.

It is popularly believed that serial killers secretly want to get caught. For the vast majority of them, however, this is simply not true. They love the act of killing too much. Serial killers gain confidence, satisfaction and are emboldened by their success, particularly at the beginning of their killing careers.

They are not experts from the start. As with all novice criminals, serial killers have no experience when they commit their first murder, although they may have fantasized about it for quite some time. The logistics involved in committing murder and disposing of the body for the very first time are complicated and require meticulous planning. Novice serial killers must learn how to target, approach, control, kill and dispose of their victims without being detected.

The learning curve for novice serial killers is very steep, indeed. Infamous and prolific serial killers such as Jeffrey Dahmer and Joel Rifkin have stated that their fist murder was by far the most difficult one for them. Serial killers gain valuable experience and confidence with each new, successful murder.

Along the way, they perfect all of their skills and techniques while minimizing problems and avoiding critical mistakes. In other words, serial killers get better and better at the business of murder with experience.

The skills and confidence gained through their experience make serial killers very difficult to apprehend. As they continue to operate and avoid capture, serial killers become increasingly emboldened and empowered. They relish their ability to kill and avoid detection and may come to believe they will never be apprehended. Such empowerment can cause serial killers to take more risks in their work.

By increasing the risk factors in their murders, such as killing during the daytime rather than at night, serial killers can enhance their excitement but such increased risk can also lead to their apprehension by law enforcement authorities if/when they make mistakes or the unexpected occurs.

Prolific serial killers who go undetected for long periods of time may begin to take shortcuts and become reckless or even careless in their work. A classic example of a veteran serial killer who became sloppy is Joel Rifkin, the most prolific serial killer of all time in the state of New York, who murdered seventeen prostitutes in the early 1990s.

Rifkin was unexpectedly and unceremoniously caught when his Mazda pickup truck was pulled over by a state trooper for having no rear license plate. Upon approaching the truck, the state trooper smelled the unmistakable stench of death and discovered the decomposing body of Rifkin’s final victim under a tarp in the back of the truck. When questioned about the corpse, Rifkin coldly replied, “She was a prostitute. I picked her up on Allen Street in Manhattan. I had sex with her. Then things went bad and I strangled her. Do you think I need a lawyer?”

It is simply inaccurate to say that serial killers want to get caught. Most serial killers love their work far too much for that to be true. Sometimes, however, empowered and emboldened serial killers come to believe they cannot get caught and begin to take unnecessary risks in order to heighten their excitement but which can lead to their apprehension.

In other instances, highly prolific serial killers may become bored, reckless or sloppy in their work and make mistakes that can lead to their apprehension. Any serial killer, no matter how meticulous, if he operates long enough will make an error that can result in his arrest.

I present much more about the motivations, fantasies and habits of notorious serial killers, including the “Son of Sam” based on my prison interview with him, in my new book “Why We Love Serial Killers.”To order it now, click:http://www.amazon.com/dp/1629144320/ref=cm_sw_r_fa_dp_B-2Stb0D57SDB

Dr. Scott Bonn is professor of sociology and criminology at Drew University. He is available for consultation and media commentary. Follow him @DocBonn on Twitter and visit his website docbonn.com

No question: for most adolescents there are going to be times of emotional upheaval and periods of problematic functioning along the challenging road of growing up.

By themselves and often with support of parents, young people usually manage to work these troubles through. However, in some stubborn situations outside psychological help can be useful, and in extremely debilitating cases chemical intervention can be advised.

While most mental and emotional difficulties encountered navigating the adolescent passage do not warrant psychoactive (mood and mind altering) medication, there are some impacted or protracted problems that may. For example, these medications might be prescribed to moderate such conditions as intense anxiety, profound depression, extreme mood swings, frustrating compulsivity, uncontrollable emotional outbursts, or cases of high distractibility.

As a psychologist, I believe psychoactive medication works best when accompanied by some education (through counseling or therapy) that enables the young person to learn how to better understand and manage themselves around the issue of concern. In this way, the young person can reap hard-earned benefit from painful emotional experience, becoming stronger and wiser as they grow.

Of course, as with any chemical prescription, psychoactive medication, is not like a rifle bullet precisely targeting a problem. Rather, it is like a shotgun blast that impacts the whole individual system. In the case of an adolescent we are talking about drugs that may formatively affect the brain at an age when it is still maturing. What lasting influence psychoactive medication has on a developing young brain is simply unknown. Therefore, such medication should usually not be the first choice of help. Unless the young person is in life threatening crisis, it may be better to start with less dire alternatives first – educational, counseling, or therapeutic interventions, for example.

In addition, as with any drug, there are intended, known, and beneficial consequences, and there is the possibility of unintended, unknown, and costly consequences. All of this is to say that psychoactive medication should not be given to young people without serious consideration. This is a significant intervention, and parents (who I believe play a key role here) should not treat it casually or take it lightly.

Therefore, here are some suggestions for parents.

Do not depend on your prescribing physician to tell you all your need to know about the teenager’s condition and the prescribed drug. Do your homework. Use the Internet and other sources to get what seems to you reliable information about both the psychological problem being medicated and the medication itself. Have your questions in order when you meet your medical doctor. Certainly ask about any doubts or concerns, dosage and duration of treatment, interactions with recreational or other drugs, problem signs to watch for, how getting off the drug will be decided, and any cautions to be taken at that time.

Do not treat psychoactive medication as a cure for whatever mental or emotional duress afflicts the young person. This medication is primarily to help relieve the suffering. It targets symptoms; it does not address psychological causes. By itself, this medication will do nothing to teach the young person about themselves or how to better manage themselves. For this, some kind of psychological or educational help is required. As an example, psycho-stimulant medication to reduce distractibility does not teach the young person how to manage wandering attention and increase power of concentration.

Do not treat seeing a physician and getting prescribed psychoactive medication for your adolescent as a handoff, making less parenting work and responsibility for you now that a “doctor” is in charge. Quite the contrary, it will make more work and responsibility because now you stand in a Supervisory relationship to your teenager and in an Informative relationship to your physician. With your adolescent, in addition to making sure the medication is taken as prescribed, and adequately communicating with your teenager about how symptoms are responding, you must stay on the watch for problematic outcomes. For your physician, you must gather data on a regular basis that describes specific outcomes and changes, signs of improvement and setbacks, any problems, to help inform the doctor’s knowledge of how the course of treatment is proceeding. Parents are on-site; the doctor is not. Parents must work in partnership with their physician.

Finally, tell your adolescent: “Because I believe taking psychoactive medication is serious, I will be continually checking to see how it is working for you. If it’s important enough to take, it’s important enough for us to keep talking about.”

For more about parenting adolescents, see my book, “SURVIVING YOUR CHILD’S ADOLESCENCE” (Wiley, 2013.) Information at: www.carlpickhardt.com

Next week’s entry: The Two Worlds (Real and Virtual) of Parenting Adolescents

Lynne Griffin in conversation with Laurence Steinberg

Why did you write Age of Opportunity?

There were two driving forces that motivated me. The first is that if you look at statistics on the well-being of American young people, you see quite clearly that things are not going well. Our high school students lag behind teens in many other developed nations on measures of achievement. At the same time, American teenagers lead the world in a wide array of problems, like obesity, STDs, violence, and binge drinking. I wanted to write a wake-up call. The second reason is that there have been tremendous advances in our understanding of adolescence, in part because of the growth of brain science, that haven’t really influenced the way we think about the period as much as they ought to. As a scientist who has been studying adolescence for forty years, I wanted to share this exciting knowledge with the general public.

A number of books about the adolescent brain have been published in the past few years. What’s different about this one?

Yes, that’s right. And they pretty much all cover the same territory, mainly emphasizing the ways in which the development of the frontal lobe helps kids develop better self-control. And while this is certainly true, it’s only part of the story. In fact, the most exciting discovery about the adolescent brain hasn’t received any attention outside the scientific community at all. Studies are showing that adolescence is a second period of heightened brain plasticity, just like the first three years of life. This makes adolescence a really vulnerable time—because the brain can be damaged by harmful experiences—but it also makes it a time of tremendous opportunity. I want parents and educators to know this, so that they can take advantage of the opportunity and protect kids from harm. Part of my goal in writing the book was to explain how to do both.

You point out that adolescence is more than twice as long today as it was in the 1950s. Why has this happened, and why does it matter?

It’s often said that adolescence begins in biology and ends in culture—it starts with puberty and ends when people establish their own households and become financially independent. If you look at the statistics on both of these markers, you see how adolescence has grown over time. The age of puberty keeps dropping, but it has been taking longer and longer for young people to become adults.  I think of adolescence today as beginning around age ten and lasting until twenty-five or so for many people. This has led to a lot of confusion about how we should judge young people’s behavior. How should we treat a ten-year-old girl who has gone through puberty and is attracting the attention of boys who are much older? How should we view a twenty-four-year-old who is still living at home and dependent on his parents for financial support? These are challenging issues for parents who grew up during a time when adolescence started earlier and lasted longer.

Many people have raised concerns about how long it is taking for young people to move out of adolescence and into adulthood. But you argue that delaying adulthood isn’t necessarily a bad thing—and that in some respects it may even be beneficial. This will come as a surprise to lots of readers. Can you explain a bit?

I think that today’s twentysomethings have gotten a bad rap. They are being caricatured as immature and self-absorbed, and are criticized for behaving in what I think are completely rational ways given the world we now live in. But even more important is the fact that brain science is suggesting that the window of adolescent brain plasticity begins to close when we stop exposing ourselves to novel and challenging experiences. So delaying entrance into the routine and repetitive activities that are typical of most work environments (and a lot of marriages, for that matter) may actually be good for you!

Some parts of the book report findings from your own research. What has most surprised you?

There are three findings that I’ve been especially struck by. The first is that adolescents are highly susceptible to the influence of their peers in ways that are more powerful than what we usually think of as “peer pressure.” We’ve done brain imaging studies showing that simply knowing that their friends are in the next room affects adolescents’ brains in ways that make them more likely to behave recklessly. This doesn’t happen to people over twenty-five, though. The second surprising finding is that even mice seem to be susceptible to this peer effect—but only when they are in the “adolescent” phase of mouse development. And the third is that a lot of behaviors we observe in American teenagers are fairly universal. We’ve just finished a study of adolescents and young adults in eleven countries, and patterns of psychological development look far more similar than not in these markedly different contexts.

Several of your previous books have been for parents. Will parents benefit from reading this one, too? 

Very much so. One of the points that I stress throughout the book is the importance of self-regulation for adolescent success and well-being. Self-regulation has always been important, but it’s become even more so because adolescence is now so long. Pretty much any good job these days requires a college degree—or more. It takes a lot of self-control to delay gratification and stay in school that long. The good news is that we know what parents can do to help their kids develop this important ability. I devote an entire chapter to an explanation of how to parent in a way that fosters self-regulation. I also have a chapter that explains how schools can do this, too.

You argue that the lengthening of adolescence has contributed to income inequality. This isn’t a connection that is immediately obvious. What led you to this conclusion?

The delayed transition into adult roles makes life much harder on people who have weaker self-control. And the more I looked into the evidence, the more I saw that the things that contribute to poor self-control disproportionately affect children from disadvantaged families. The sorts of environments that many poor children are born into expose them to experiences that disrupt brain development in regions that are essential for self-regulation. Their parents are less likely to parent in ways that are known to build self-regulation. The factors that contribute to early puberty, which also challenges the development of self-control, are all more common among poor children in the United States. And poor families are less likely to have the resources to protect their kids from failures of self-control. When you add it all up, you see how the elongation of adolescence has really created winners and losers.

You write that we need a radically new approach to raising adolescents. What are we doing wrong, and how can we get it right?

We tend to think of adolescence as a problem waiting to happen. As a result, we have incredibly low expectations for the period—we are satisfied if our kids survive these years without something terrible happening to them. And the plasticity of the adolescent brain certainly makes it a more vulnerable time. But, as I point out, plasticity cuts both ways. During periods when the brain is malleable, people are more susceptible to positive influences, too, not just harmful ones. So instead of just trying to help our kids survive, I want parents and educators to starting thinking of adolescence as a time when we can actually help them thrive. That’s what the title of the book means—adolescence is an age of opportunity.

Lynne Griffin is the author of the family novels Sea Escape and Life Without Summer and the parenting guide Negotiation Generation. You can find her online here: www.LynneGriffin.com, and at www.twitter.com/Lynne_Griffin and on www.facebook.com/LynneGriffin.

For both women and men, so many  issues revolve around the relationship with their significant other, or the loss or lack of a significant other.  The one question we want to ask readers is: Do you really want a healthy relationship? Relationships should be a place of rest and acceptance, not a place of fear. They should be a place for us to reveal our true selves to one another and express a healthy sexuality. But many of us have been wounded, both in our upbringing from imperfect parents and in our prior relationships. How in the world, with all these obstacles in place, do we get there?
 
We have to first pat ourselves on the back and not blame ourselves for our past romances and marriages that went sour. We have grown up in a culture that pushes us into unhealthy relationships. When we were preteens and were looking for role models on TV, movies and in music to lead us to romantic success, we were given a blueprint for failure: Charlie Harper on "Two and a Half Men", Sam Malone in "Cheers", lyrics like "Do it baby", "Hello, I love can you tell me your name","Love the one you're with", "You're sixteen , you're beautiful and you're mine". All this did was teach us to base our romances on the superficial qualities of physical attraction and charm. There was no connecting of souls. We were taught to hold back on the real stuff until after we were sure we had them hooked. Then we were afraid to share because we didn't want to ruin the illusion of love.  When we made attempts to open up we were met with stony silence. This was not a place of acceptance and rest but a place of uncertainty, fear and deception.

 For Jane, a 45 year old nurse,  relationships with men were a place of fear.  There was no mutual sharing with her emotionally indifferent partners. First there was  John, an insurance agent, who used the food and prescription narcotics to numb himself instead of dealing with his issues in the relationship.  Then there  was Mike, a advertising executive,  who became emotionally frozen and sought solace with others  after the loss of their 4 year old daughter.  Finally there was Tom, a web site designer of whom she knew absolutely nothing. She certainly had no role models with her parents own tortured marriage. Eventually Jane realized she was going nowhere in life, became despondent and hit rock bottom. Then she heard about the 12 step tradition, attended meetings dealing with codependency and  changed her life. She began the slow but steady journey from deceptive living to health.
 
One aspect of our journey from deception to health is to get in touch with our spirituality. We define spirituality as our relationship with Creation, our Higher Power if we have one, and to the creative process. It is in our spirituality that we find meaning to life and our purpose in the tribe we call the human race. Through our spirituality we have contentment in what we are apart from our actions.

 We experience so much anger, fear and despair in our youth as we struggle to find purpose and value to life.  Writer Henri Nouwen observed that  it starts early: “The word ‘school’ …comes from ‘schola’,  meaning free time, remind[ing] us that schools were originally meant to interrupt a busy existence and create some space to contemplate the mysteries of life. Today they have become an arena for a hectic race to accomplish as much as possible, and to acquire in a short period the necessary tools to survive the great battle of human life.”

 Former Yale English professor William Deresiewicz's  new book, "Excellent Sheep",  describes this  place of fear.  He quotes a Stanford University student who said, "For many students, rising to the absolute top means being consumed by the system. I've seen my peers sacrifice health, relationships, exploration, activities that can't be quantified and are essential for developing souls and hearts, for grades and resume building. "  No wonder so many of us grow up fearful, either producing the good grades or giving up.

 Because of damage in our childhood from the school system of fear as well as parents who weren't there for us due to their own character flaws and addictions, many of us can't accept just being and must fill our lives with doing. Some of us even lose ourselves in religious activities, thinking it will solve the problem. But eventually the busyness isn't enough and the emptiness leads to acting out and lashing out, or even considering suicide when things fall apart as they eventually do. Instead of being busy, we may even go to the opposite extreme and become aimless and burned out. Often women in their late 30s hit the wall and face this “midlife crisis” as their biological clock strikes midnight or their kids leave the nest. Many couples hit the midlife wall when they discover they have nothing in common except shared alienation  after two decades of busyness raising a family.It's a cliche that some men fill the midlife crisis void by buying a sports car.  But that is wasting a great opportunity.

 This crisis can be a life-altering moment to explore and consider new ways of thinking and living, leave the old failed lifestyle patterns behind and  finally enjoy true intimacy, defined by psychologist Harriet Lerner of the Menninger Clinic as "a relationship where one can be one's self  and provide space for someone else to do the same, where we deepen and refine the truths we  tell each other, where we hear each other and talk to each other about sensitive information."  It is frightening to leave the comfortable sickness and numbing behaviors that served us like an old ratty security blanket. But the rewards are definitely worth the risk.

We all know by now that the Islamic State, formerly known as ISIS, has beheaded two American journalists, and that, routinely, its soldiers execute village men and put their severed heads on sticks. What fewer of us have paid attention to is how women are faring in ISIS territory.

The Wall Street Journal covered the women’s side of the story earlier this month.  Their reporting began with mention of women tied to trees and offered as sexual rewards to fighters. The report also spoke of a line of women shrouded in black being led by rope to a slave market. Girls still young enough to play with dolls are being forcibly married to jihadists. And the Islamic State has asked jihadists in other countries to kidnap virgins and send them to Syria.

Meanwhile, Islamic State propaganda proclaims the importance of women’s modesty. Why, then, would its soldiers engage in sexual crimes against women?

Work by psychologists at the Chinese University of Hong Kong and at China’s Hebei University suggests an answer. We tend to think of raped women and girls as the unfortunate collateral damage of war. But these scientists suggest that, from an evolutionary perspective, what’s happening to women may be war’s whole point.

The fundamental question the researchers set out to address was “Why has war proven to be absolutely ineradicable?” The data they collected from experiments with young men suggest that it has much to do with a Darwinian compulsion among young men to spread their seed.

For example: Citing the work of other researchers, the Chinese team noted that men play a meaner hand of blackjack after seeing a picture of a pretty woman. With a real-life pretty woman watching, a man is more likely to cross traffic against a red light. From evidence like that, the Chinese researchers came to suspect that men’s everyday exhibitions of agility and daring-do are the behavioral equivalent of plumage on a rooster or big antlers on a stag —or of the ornamentation of military uniforms. Wearing a uniform or carrying a weapon, according to these researchers, can have the same effect on females as shouting, "My seed makes hearty progeny, and I can protect my family. Mate with me!"

To test the idea of a connection between being willing to go to war and an evolutionary imperative to procreate, the researchers showed young heterosexual men pictures of women. Some of those women were conventionally attractive. Some were not. After showing a picture, the researchers asked men to rate their agreement with some war-supporting statements. Seeing pictures of attractive women prompted significantly more agreement than seeing pictures of unattractive women. And in a separate experiment, men shown pictures of attractive women responded more quickly to warlike imagery. Even pictures of a national flag failed to turn men into the hair triggers that a picture of a pretty face did.

Which is all to say that attractive women real or imagined have the potential to make men more belligerent and more rash.

By the way, the researchers also tested women. Their attitudes towards war and their quickness to act were unaffected by pictures of attractive men.

Now, if you ask a modern soldier what he's fighting for, he's unlikely to salute and shout, "To make babies, SIR!" It's not surprising, then, that according to the researchers, any role in war-making of the biological imperative to spread seed is probably hidden from soldiers' awareness. But that doesn’t necessarily mean much. Ignorance was apparently blissful enough for one infamous warrior. DNA survey data show that about 8% of the adult men in the region of the former Mongol empire descend directly from Genghis Kahn.

I believe that children should be well behaved. 

Most parents, of course, want more for their children than just good behavior. We want them to become caring and responsible adults.

Still, more often than not, children who are cooperative and respect adult authority are also happy and confident children. They are able to bounce back from disappointments and frustrations, sustain effort on difficult tasks and get along with their peers. And the parents of well-behaved children are, undoubtedly, happier parents.

By all accounts, modern American children are very poorly behaved. Why is this so? And what can we do about it?

Many parents (and some parent advisors) believe that our children behave badly because we allow them to - that we are afraid to insist on obedience and respect. Critics of contemporary family life argue that we have turned our homes into “little democracies” in which children “determine their own upbringing” and have the right to argue about everything. As a group, the critics concur: Parents should be less afraid to say “No.”

For some families, this is sound advice. In my experience, for most families, it is not. Saying no, although necessary, is a small part of successful discipline.

Every week, parents tell me, “I’ve taken away all his privileges and things are just getting worse. He’s even more rude and disrespectful” or “I tell him ‘No’ all the time, but he still doesn’t listen.”

These families are locked in vicious cycles of negative interactions. Then, as these cycles escalate, parents feel increasingly justified in their criticism and disapproval. And kids, for their part, feel increasingly justified in their resentment and defiance.

Of course, we will often have to say no. When we are at our wit’s end, we may even have to count to three. (This worked with my kids, like a charm: “If you guys do not stop fighting by the time I count to three, you will not be able to watch The Cosby Show tonight.”)  But it takes more than saying no or counting to three to produce a well-behaved child.

Disciplinarians believe that children will behave well when they know what is expected of them and when they come to understand the consequences of their actions. This idea has obvious, intuitive appeal. Everyday experience and behavioral research teach us, however, that often, this is not true. Angry and discouraged children do not behave well, regardless of the consequences of their behavior.

We now know that frequent references to rules and consequences - even strict enforcement of rules and consequences - is simply not the best way to foster good behavior in young children.

There is a Better Way

If we want our children to be well behaved, we should play (and work) with them often, repair moments of anger and criticism, engage them in problem solving, and let them know that we are proud of them, especially for the good things they do for others.

Then, we can set limits.

We can let them know when their demands or their behavior, including their language, is “over the line.” (The line is clear: We do not allow behavior that is dangerous or hurtful to others.) When necessary, we can institute a simple system of earning rewards and privileges in return for cooperation with basic tasks.

Ultimately, good behavior depends on the development of a moral identity – a child’s inner sense of him or her self as a good and helpful person. (The developmental psychologist Grazyna Kochanska refers to this as “committed” - in contrast to merely “situational” – compliance.) Children will behave well when they are able to regulate their emotions, when they come to value empathy and kindness and when they understand that the real reason to cooperate with adults is not “because I said so” but consideration for the needs and feelings of others.

It is always important, in thinking about children, to keep in mind that kids are different, and one size does not fit all. Children who are impulsive and strong-willed will require more firmness and more patience, more opportunities to practice self-restraint, more frequent praise for every increment of effort and helpfulness and more moments of repair.

Our goal is to help children develop self-discipline, or discipline in the best sense - the ability to forgo immediate pleasure and to endure frustration in the service of long-term goals. The word discipline (like the word parent) is a noun before it is a verb.

In my next post, I will discuss these recommendations in greater detail and offer 15 Rules to foster good behavior in children of all ages.

Copyright Kenneth Barish, Ph.D.

Kenneth Barish is the author of Pride and Joy: A Guide to Understanding Your Child's Emotions and Solving Family Problems.  Pride and Joy is winner of the 2013 International Book Award.

At some point, most people ask themselves, “What’s it all mean?” And sometimes, their answer is, “Not much.”

Here’s a dialogue between two hypothetical people. One believes that nearly anyone can have a meaningful life. I’ll call that person “Max.” The other believes life has minimal meaning. I’ll call that person “Minnie.”

Perhaps their exchange might help you in your search for meaning or in accepting life’s limitations.

MAX: All of us have the potential to make a difference.

MINNIE: With 7.7 billion people on the planet, you can’t begin to move the needle.

MAX: You do what you can. That’s better than doing nothing.

MINNIE: I have trouble just getting everything done every day to survive, let alone change the world.

MAX: It doesn’t take time. It’s as little as smiling at someone.

MINNIE: I don’t feel like smiling when my world is going to pot: my parents are getting old, my job is feeling empty, and my relationships aren’t much better.

MAX: The answer of course is to try to make little fixes, one at a time so you don’t get overwhelmed. When you make a little progress, you’ll have more bandwidth to give to others.

MINNIE: But when life feels like crap, you don’t have the energy, the desire, to fix anything. I do my job, come home make some crappy dinner, and collapse in front of the TV—if my kids will let me.

MAX: Take a step back. Just look your daughter or husband in the eye, be reminded of the good in them, the positive feelings for them, even if now dormant. Then, if you can,  say you love them and then do the smallest thing—put a little note in her lunchbox, brush lint from his collar. You’re making a difference. Over a lifetime, you can easily do thousands of those things. That adds up to a meaningful life.

MINNIE: The benefit seems trivial given the amount of effort it takes to just get through the day., without forcing myself to smile and be nice. And to this point, I’m healthy. What happens when the inevitable shit hits the fan: I develop a bad back or I get some horrible disease that most of us die from?

MAX: Looking ahead to a bad future only poisons the good you have now. I know it’s a cliché but you must live in the moment and try to do the most you can for others.

MINNIE: What about me?

MAX: Ironically, the more you do for others, the better you’ll feel about your own life--I swear. I’m an atheist but the Bible isn’t wrong when it says it’s better to give than to receive.

MINNIE: In the past, I have given and given and most people don’t give back. It feels crappy.

MAX: You can’t give in the hopes of reciprocity. People are generally selfish. You must give for its own sake. Take pleasure in the act of giving itself.

MINNIE: Max, I’m resisting your pontification.

MAX:  I’m sorry. Is there anything in our discussion of possible value?

MINNIE: I guess it can’t hurt to try those tiny things—like the smile and the lint.

MAX: And that will build momentum. The more you give, the more you’ll want to give.

MINNIE: Again with the pontification?!

MAX: I’m sorry.

Marty Nemko's bio is in Wikipedia.

"Every time I go to the store I have to buy a [chewing gum called] ‘Big Red’. I chew three packs every day. I love the taste, and it's sweet. I started chewing gum excessively when she couldn't find a job after graduation. I became depressed because I thought that with my qualifications I would find a job immediately but I did not. Since I've been chewing gum I have had to make visits to the dentist more than once due to tooth pain" (Tamika Wilbourn, 22-year old US college graduate).

“I used to have an addiction problem. No, I was not addicted to drugs, alcohol, gambling, video games or any other typical vice that you can think of. I was addicted to chewing gum. A lot of you are probably thinking, ‘I have the same problem!’ or ‘I chew a lot of gum too!’ but I’ve yet to meet someone who chews as much gum as I once did. Some might argue that using the word ‘addiction’ in this context is going a little too far; I beg to differ. I used to NEED gum. I would chew so much gum that even when my jaw started to hurt, I kept chewing. I chewed in the morning, I chewed at night, I chewed when I was bored, stressed and nervous. I needed gum more than coffee; I was a chain chewer for about 7 whole years…I always carried at least 2 packs of gum with me at all times, and made it a point to stop and buy some if I was running low. I often went through 1-2 packs per day, maybe more. I would chew a piece for 5 minutes, spit it out and chew another. No matter what I did, I could convince myself that chewing just one piece of gum was enough…After a while I didn’t even like the taste anymore. Sure I liked the initial burst of minty sweetness, but what I really craved was the chewing motion. After a while the chain chewing did not feel good anymore, it felt necessary” (Stellina Saia, US business graduate).

A few months ago, I was contacted by a researcher from an American television production company. I was told that the company was planning to make a documentary film on people that were allegedly addicted to chewing gum. They had come across my personal blog and wanted to know if I thought chewing gum could be addictive. I had never come across a study that had examined the chewing of gum as an addiction but added that I thought it was theoretically possible. As an occasional gum chewer myself, I answered all the questions from a personal and anecdotal perspective but was unable to respond to any of the questions from an empirical standpoint (i.e., I had no data to support a single thing that I said. Everything I said was pure speculation.

I remember being asked about why people chew gum and I said there were multiple reasons. I know that I only ever chew gum after I have eaten – using it as a way to clean my teeth and remove food that may have stuck to my teeth. Occasionally I will chew mint gum to help freshen my breath or because I like the taste of a particular gum. I also made reference to English soccer managers (most notably Alex Ferguson and Sam Allardyce) that appear to chew gum as a stress relieving activity. In fact, there appear to appear to be many cognitive benefits to mastication (i.e., chewing). A recent (2013) review by Dr. Kin-ya Kubo and colleagues in the book Senescence and Senescence-Related Disorders noted that chewing helps improve learning and memory, may help people suffering from dementia, and provide stress relief:

“Although mastication is primarily involved in food intake and digestion, it also promotes and preserves general health, including cognitive function. Functional magnetic resonance imaging (fMRI) and positron emission topography studies recently revealed that mastication leads to increases in cortical blood flow and activates the somatosensory, supplementary motor, and insular cortices, as well as the striatum, thalamus, and cerebellum. Masticating immediately before performing a cognitive task increases blood oxygen levels in the prefrontal cortex and hippocampus, important structures involved in learning and memory, thereby improving task performance. Thus, mastication may be a drug-free and simple method of attenuating the development of senile dementia and stress-related disorders that are often associated with cognitive dysfunction. Previous epidemiologic studies demonstrated that a decreased number of residual teeth, decreased denture use, and a small maximal biting force are directly related to the development of dementia, further supporting the notion that mastication contributes to maintain cognitive function”.

A study by Dr. Yoshiyuki Hirano and colleagues in a 2013 issue of Brain and Cognition showed that chewing boosts thinking and alertness and that reaction times among chewers were 10% faster than non-chewers. The research team also reported that up to eight areas of the brain are affected by chewing (most notably the areas concerning attention and movement). It has been claimed that chewing increases arousal levels and that this increased arousal causes increased temporary blood flow to the brain. Commenting on these findings to the Daily Mail, Professor Andy Smith of Cardiff University, said that: “The effects of chewing on reaction time are profound. Perhaps football managers arrived at the idea of chewing gum by accident, but they seem to be on the right track”.

There are dozens and dozens of academic papers all showing the many benefits of mastication but I didn’t come across a single one that looked at whether chewing gum can be addictive. (If you type in ‘chewing gum’ and ‘addiction’ into any academic database you simply get loads of papers about the effectiveness of chewing nicotine gum in helping smoking cessation). However, as the opening quote highlights, there are online self-confessions of ‘chewing gum addiction’. Although the benefits of chewing gum appear to greatly outweigh the disadvantages, there are a number of online articles that take great pride in pointing out the negatives.

In a 2011 article on the Organic Authority website, Jill Ettinger provided a list of reasons of why people should give up chewing gum including jaw aches (accompanied by headaches), intestinal pressure for irritable bowel syndrome sufferers, over-production of saliva, and her assertion that “most of the sugar-free chewing gum on the market is sweetened with aspartame, which has been linked to cancer, diabetes, neurological disorders, tinnitus and birth defects”. For those people that don’t chew sugar-free gum, she added that “the rest of the gum out there is typically sweetened with high fructose corn syrup, which in addition to a number of health issues (obesity, diabetes, cancer), is also one of the main causes of tooth decay”. An article in The Delphian by Valgina Cooper also claims chewing gum can be hazardous to your health (and partly based on her own chewing gum experiences). She reported:

“Did you know you could get addicted to gum? Jaws hurt. Teeth hurt because you have been popping gum all day. Millions of people chew gun but could it be an addiction? A person can be addicted to just about anything. People may buy 20 packs of gum a day because chewing gum can calm your nerves…But the taste can get you. Once you pop you can't stop. Gum addiction can happen to you if you don't know how to control yourself. First, you start chewing gum because you like the taste. Then you realize that you're chewing gum when nervous or bored. It can be used to pacify you so it seems like you have something to concentrate on. Therefore the amount of gum chewed within a day increases. After this stage your body comes to a point where it needs gum all the time to feel comfortable…While many people chew gum, few realize that it can become an addiction that can leave you with serious health risks. How do you know you've become addicted to gum chewing? When you feel like you have to chew gum to function through the day - as I learned through my own experience”.

From what I have read on the topic, there is little in the empirical literature to suggest chewing gum can be an addiction. There is loads of anecdotal evidence that a minority of individuals chew gum excessively but little evidence among these individuals that it could be classed as an addiction. While I don’t rule out the theoretical possibility of becoming addicted to chewing gum, I have yet to see or read about a case that would fulfil my own criteria for addiction.

References and further reading

Brook, C. (2013). Chewing over a problem? Chomping on gum can boost alertness by 10%. Daily Mail, February 4. Located at: http://www.dailymail.co.uk/news/article-2272800/Chewing-gum-GOOD-...

Cooper, V. (2003). Warning! Chewing gum can be hazardous to your health. The Delphian, December 10. Located at: http://students.adelphi.edu/delphian/2003.12.10/articles/q.shtml 

Ettinger, J. (2011). Hate to burst your bubble but…9 reasons to stop chewing gum. Organic Authority, September 16. Located at: http://www.organicauthority.com/health/bubble-gums-reasons-to-sto...

Griffiths, M.D. (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, 191-197. 

Hirano, Y., Obata, T., Takahashi, H., Tachibana, A., Kuroiwa, D., Takahashi, T., ... & Onozuka, M. (2013). Effects of chewing on cognitive processing speed. Brain and Cognition, 81(3), 376-381.

Kubo, K. Y., Chen, H., & Onozuka, M. (2013). The relationship between mastication and cognition. In Wang, Z. & Inuzuka (Eds.), Senescence and Senescence-Related Disorders. InTech. Located at: http://www.intechopen.com/books/senescence-and-senescence-related...

Saia S. (2013). How I stopped chewing gum. My Yoghurt Addiction, February 25. Located at: http://myyogurtaddiction.com/2013/02/25/how-i-stopped-chewing-gum/

In so many ways, my daughter Julia is a young soon-to-be 12-year-old. Though she’s in middle school, she’s unconcerned with fashion, boys or other pre-pubescent experimenting. Julia, adopted from a Siberian orphanage at 8 months old, is on track intellectually but is still catching up emotionally. She is a wonderful violinist and artist and an honor student, but she hasn’t yet learned how to make a BFF, nor (and I suppose I should be thankful) has she attached herself to a clique. My husband and I are her whole world.

The other day, Julia and I were in the car waiting for my husband to pick up cat food and chicken feed. Her mood had grown stormy, and I was restlessly impatient. I honestly can’t remember what we were bickering about, but I had said “no” to something, and she replied by telling me she didn’t have to listen to me. “You are not my real mom,” she said defiantly.

I knew this day would come. I can’t say I was prepared for it. I wish I had handled it with aplomb. I didn’t. I snapped back by saying, “Oh yeah, then who is?”

I regretted these words as they catapulted from my mouth. Judging from Julia’s reaction, I could see she also felt very sad about the exchange. “That’s so mean,” she said.

I knew it was. We sat silently. I was choking back tears. She managed to be the bigger one and said she was sorry. I was sorry, too. I asked her to never say that again. Finally allowing tears to flow, I told her being her mother was the most important thing in the world to me. She reached toward me from the back seat and threw her hands around my neck and shoulders. I clutched her wrists.

Mothers and daughters clash, especially when young girls are entering puberty. Tweens are hormone-addled and gaining confidence about their place in the world. Julia is experimenting with a range of new behaviors lately, maybe taking a swear word or two for a test drive. Asking more-incisive questions about why people do the things they do. Taking greater notice, too, of my life.

But those four words “you’re not my mother” are this adoptive mother’s nightmare, especially because it took more than a few years for my child to attach. In the early months after we adopted Julia, she would not let me hold her without recoiling and she wouldn’t make eye contact. Her “terrible twos” were indeed terrible, and confusing. She was constantly oppositional and distant. During this time, I assumed I was deeply flawed and not fit to be a mother. I certainly didn’t feel like Julia’s mother.

Clues along the way led us to a syndrome called Reactive Attachment Disorder, which is a serious condition suffered by some children who have experienced early neglect or abuse. With concerted effort, a host of counter-intuitive parenting techniques and all the love we could muster, Julia released her armor and began to bond and trust us. It was slow and steady progress, and when I look back, I think of us as survivors. Like a former alcoholic counts his sober years, I ponder seven years bonded, and I’m so grateful that we’ve never looked back.

Julia is my daughter, in all the ways that mothers and daughters love and hate, push and pull, know they belong to one another. Yes, the words “you are not my mother” are just words, but they are true in one sense, and they are words a birth mother is not likely to hear. They hurt.

As parents, birth or adopted, we steel ourselves for moments when our child turns mean or hateful. I should have been better prepared to hear those words. Unfortunately, they seared my heart,and, caught unaware, I responded in kind.

As I thought about her words, I wondered whether Julia was just experimenting with a spectacular way to push my buttons, or whether she was trying to tell me something deeper and more complicated. I must keep my antennae up. Over the years, she’s asked briefly about her birth and her origins, and we’ve told her everything we know, which is practically nothing. If this should truly preoccupy her down the road, I will do anything necessary to meet her needs. Of course I would. I’m her mother.

There has been surprisingly little research on the nonverbal communication of seduction. Which nonverbal cues are interpreted by others as seductive? How good are people at communicating seduction to others? These were some of the questions that Howard Friedman and I addressed in a study of the nonverbal expression of seduction.

We had college students to try to express “complex emotional expressions,” which included sympathy, pride, and seduction, while saying the same standard sentences (e.g., “I hope you don’t mind if I tell you, I really like you a lot.”). We videotaped their faces, and showed these to groups of judges who tried to identify which emotion they were trying to convey.

Overall, our participants, or “senders,” had a hard time looking seductive. There doesn’t seem to be any particular facial cues that are clearly seductive, so we looked only at the very best and very worst senders of seduction. Here are the findings: Clearly, the successful senders of seduction looked more positive in their facial expressions than the poor senders. In fact, when poor senders tried to look seductive, their facial expressions looked more like negative emotions (angry, sad, etc.). We also found that women were better at conveying seduction than men.

We also explored personality differences in ability to look seductive. We found that dominant, emotionally expressive and extraverted participants were better at conveying seduction than were non-expressive and introverted individuals. In addition, we found that persons who were skilled at sending basic emotional expressions (i.e., happiness, surprise, anger) were better at sending complex emotions such as seduction.

What are the implications of this research?

Perhaps the most interesting findings were from the poor senders of seduction. Although they were trying to look seductive, their facial expressions came off as negative (angry, sad, even disgusted) when viewed by judges who had no idea which emotion they were trying to convey. Submissive and introverted persons were also less able to look seductive. The fact that skilled senders were better at it suggests that practicing looking seductive, as actors and actresses do, should lead to improvement.

Although we only focused on facial expressions, there are other known cues of seduction. A light touch of the hand, a gaze that is held a bit longer than usual, these can also be cues of seduction.

Reference

Friedman, Howard S., & Riggio, Ronald E. (1999). Individual differences in ability to encode complex affects. Personality and Individual Differences, 27, 181-194.

Follow me on Twitter:

http://twitter.com/#!/ronriggio

The tragic shooting death of Michael Brown and chokehold death of Eric Garner by police has brought into sharp focus the fact that many Americans simply do not trust law enforcement. Recent polls suggest that the majority of Americans do not feel that police are adequately held accountable for their actions, treat racial groups equally or use the right amount of force. This lack of trust undermines the legitimacy of law enforcement and creates an unequal society in which some feel comforted by law enforcement while others feel suspicious and distrustful. Members of the community are more likely to feel safe and cooperate in investigations if they trust law enforcement; thus, it is in the best interest of all stakeholders to understand and build trust in law enforcement.

Trust can be defined as the "belief that someone or something is reliable, good, honest, effective." High levels of trust promote healthy interactions, whereas low levels of trust undermine constructive relationships. Trust in law enforcement is essential for the belief in the legitimacy of law enforcement, or feeling of obligation to obey the law and defer to decisions made by legal authorities.   

Research shows that perceived legitimacy of law enforcement is crucial to effective law enforcement. One study of 830 New York City residents who were predominantly either white, Hispanic or African-American examined whether perceived legitimacy of police, which included measures of trust, obligation and confidence in police produced increased cooperation with police in law enforcement efforts (e.g., reporting a crime, assisting law enforcement officers) over time. The results show that trust was significantly related to not only cooperation with the police but also — to a lesser extent — cooperation with others in the community. These findings have been replicated in other samples. In a study of 300 Muslim-Americans, it was found that perceived legitimacy was associated with willingness to cooperate with police on terrorism investigations. Further work suggests that it is trust that drives this effect. One study of 638 high school students ages 18 and older in Slovenia found that of the various factors that make up "legitimacy" it is trust in police that most predicts cooperation.

Research demonstrates that minority groups consistently show less trust in law enforcement.  This difference in trust appears to be based on two things. First, minority groups report having more direct negative personal experiences with law enforcement. Further, there is evidence of discrepancies in procedural justice outcomes. Research shows that minority groups are disproportionately incarcerated; as an example, African-Americans comprise 14 percent of drug users but 37 percent of those arrested for drug offenses. Despite the fact that minority groups make up a large percentage of people subjected to "stop and frisk,"white people are more likely to have drugs or weapons. 

In the most extreme cases, when lack of trust is so severe, perceived discrimination can be associated not only with poor cooperation with police, but also negative mental and physical health consequences. One recent meta-analysis of 134 studies found that perceived discrimination has a significant negative effect on both mental and physical health. Perceived discrimination also produces significantly heightened stress responses and is related to participation in unhealthy behaviors and non-participation in healthy behaviors. And there has been a call for looking at the public health effects of witnessing police misconduct and brutality.

So what can be done?

Across the board, various entities have suggested that increased transparency is one of the best ways to build trust. There are several concrete ways that transparency could be increased.  Perhaps most strikingly is the important need for data to be aggregated, organized and shared across law enforcement and community agencies. For example, research suggests that currently it is unknown how many people are killed by police each year. There have been similar calls for transparency in the results of evaluating rape kits. 

These recent tragic deaths have ignited particular interest in whether police should be videotaped during interactions with the public. The debate has included calls for more flexibility allowing journalists and citizens to videotape police officers. Current state laws do not explicitly say whether this behavior is legal even though courts have upheld a person's First Amendment right to record public events such as protests or traffic stops. More, evidence suggests that if police wear video cameras so that their behavior is recorded, everyone wins; studies suggest that complaints are radically reduced, and in the case of complaints police are exonerated far more often than if no recording existed.

There is a compelling need for more communication between law enforcement agencies and community organizations. This type of approach includes regular meetings with community leaders and law enforcement. Initial research suggests positive results in involving community leaders with cooperation, even for the smallest infractions. There is also evidence suggesting that diversity training for police can improve relations with the community. Further, on a policy level, there must be examination of laws that result in unequal treatment.

Law enforcement agencies and the people that serve deserve our respect for putting their lives on the line to protect us. Similarly, our community deserves to exist in a context where everyone receives the same benefit from the legal system. One of the best ways that we can show that respect is by being honest with ourselves and with others when trust has broken down and seeking ways to rebuild.

Because when trust is broken, everyone loses.

Dr. Mike Friedman is a clinical psychologist in Manhattan and a member of EHE International’s Medical Advisory Board. Follow Dr. Friedman on Twitter @DrMikeFriedman and EHE @EHEintl 

Novelist Paul Auster wrote a memoir, Hand to Mouth: A Chronicle of Early Failure.

He writes, “By the end of 1977, I was feeling trapped, desperate to find a solution. I had spent my whole life avoiding the subject of money, and now, suddenly, I could think of nothing else.”

This reminded me of a thought-provoking interview I did with personal finance expert Zac Bissonnette a few years ago. I’ve never forgotten a story he told:

A few years ago – when I was in high school — my dad was going through a ton of financial problems that culminated in him living at a friend’s house.

My dad was born in 1948 and is a classic hippie; He lived in a tree-house in a state park for a while in the early 1970s, he’s a carpenter, and he is probably the coolest, most loving person I know.

But he’s never really given much thought to money. He always said that it wasn’t important to him and that it didn’t matter. So I was sitting on the couch with him at his friend’s house watching the Red Sox…and I asked him, just off the top of my head: “Who do you think thinks about money more? You or Bill Gates?”

And I’ll never forget his response: “Without a doubt, me. I spent my whole life thinking I was above money and that it didn’t matter and now it dominates my life and is all I think about. It’s like money is exacting its cruel revenge on me.”

I interviewed you [meaning me, Gretchen] once for a piece and you told me that “Money affects happiness primarily in the negative” and that’s exactly right. When it comes to happiness, the less money matters to you, the more careful you need to be with it. If you don’t like thinking about money and don’t pay enough attention to it, it will one day become all you think about.

I think this is true about money, and I think it’s true about habits. All too often, the areas of our lives that we decide to ignore can become the areas that dominate our lives, later. And not in a good way.

Perhaps this happens most with health.

Habits allow us to put a behavior on automatic, so we don’t have to think about it or make decisions related to it anymore. In this way, habits can free us from the things we don’t want to think about.

For instance, if you hate to think about money, you might decide to follow the habit of never carrying credit cards, so that you can’t impulsively buy things that you can’t really afford.

My sister told me, “Now I’m free from French fries.” Not everyone would use habits the way she did, to get free from French fries — the Strategy of Abstaining doesn’t work for everyone — but habits can bring freedom.

This idea, of how habits can be confining but how we can use them to feel free, is a big theme in my forthcoming book about habit formation, Better Than Before. If you want to hear when it goes on sale, sign up here.

Also ...

Would you like a free, personalized, signed bookplate for your copy of The Happiness Project or Happier at Home? Or, if you have the e-book or the audio-book, a signature card? One card is "Paradoxes of Happiness," the other is "Tips for Happiness in Your New Home." Or would you like these for a friend? Request as many as you want (within reason), here. Alas, because of mailing costs, I can now mail only to the U.S. and Canada--so sorry about that.

Other posts you might be interested in...

Why I’ve Grown Wary Of Accepting Anything That’s Free.

Abstainers And Moderators, I’d Love To Hear Your Answers To A Few Questions.

Do You Fall For Any Of These 5 Common Mistakes About Habits?

When Facing Temptation, Are You An All-Or-Nothing Person? A Quiz.

Do You Want The Tenth Bite Of Ice Cream More Than The First Bite, Or Less?

When Robin Williams killed himself, it was a loss that felt so personal to so many people who never really knew him. It provoked a flood of grief all around the world. Film director Chris Colombus who worked with him in Mrs. Doubtfire said “His performances were unlike anything any of us had ever seen, they came from some spiritual and otherworldly place. He truly was one of the few people who deserved the title of ‘genius.’ Why should people who never knew Robin Williams feel this loss so personally?

Robin Williams brought the joy of laughter into so many people’s lives and to them, it felt as if they were laughing with him. When people laugh together, an attachment bond is formed. But it did not feel this way to him. The response of his audience made him feel like a million dollars, and he literally could not get enough of it. He called it therapy, “a relief from that shit,” meaning all the things that would get him down, “celebrity and all that other crazy shit.” Very down, as he also candidly explained, speaking at length . . . about his depression and even his past suicidal thoughts.His audience's response was not therapy. Like the cocaine and alcohol he consumed, it was not therapy. It was his “drug of choice”.

He once told an interviewer that he struggled with depression, but hadn't been diagnosed with either "clinical depression" or bipolar disorder. : "No clinical depression, no. No. I get bummed, like I think a lot of us do at certain times. You look at the world and go, 'Whoa.' Other moments you look and go, 'Oh, things are okay.'" In an interview with Diane Sawyer of ABC News, he said that just after his two-month treatment at Hazeldon, his falling back into the addiction was gradual. In another interview, Williams acknowledged that for much of his career he didn’t plumb personal depths in the way that Richard Pryor or Chris Rock did.

According to his own public statements, he quit drugs and alcohol cold turkey in the mid-eighties after the suicide of his friend, comedian John Belushi. He managed to have two decades of sobriety under his belt before relapsing in 2006 relapsed. His family held an intervention to force him to rehab again. In 2009 he had heart surgery. Less than two months before his suicide, he had checked himself into Hazelden, a rehab center.

WIlliams did not know most of these people who felt so connected to him.. They were simply a source of affirmation, and Williams was a man whose worth needed to be constantly affirmed. His sense of himself was so depleted that he needed others to boost it for him continuously. And he got that from working constantly to get it. He worked relentlessly to keep those laughs coming. When he was not on stage, working desperately for this affirmation, he was depressed and anxious, so much so that he used cocaine and alcohol to medicate himself. One newspaper article called drugs, alcohol, and depression his longtime companions. As with coke and alcohol , Williams developed a tolerance to his audience's affirmative response and required greater and greater doses of it. When huge doses of the drug of choice do not produce the desired effect, this is when the risk for suicide is the greatest. Robin Williams was sober but was struggling with depression, anxiety and the early stages of Parkinson's disease when he died, his widow said. Williams used exercise and cycling to manage his stress and depression, and the prospect that Parkinson'smight prevent him from doing that was extremely upsetting, adding to the depression someone familiar with his family said.

What most people do not know is that most addiction rehab facilities do not diagnose or treat patients for anything other than a substance abuse problem. And that even for these, they are not very good at it. Most of their counselors are not professionally trained, and all counseling is in a group setting, not individualized.Most people who have a problem with alcohol or drugs use them as a means of self-medication for an underlying psychiatric disorder. It appeared that Williams never got much in the way of adequate mental health diagnosis and treatment. Perhaps if he had known to check himself into a hospital-based dual diagnosis treatment program, he might have begun getting the real help that he needed. Anne Fletcher (2013) elaborates on this difficulty in her book Inside Rehab: The Surprising Truth About Addiction Treatment-and How to Get Help That Works, as do Lance and Zachary Dodes (2014) in The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry

. Comedians understand what Robin Williams was going through because they go through it themselves. Severe depression seems to be an occupational hazard for comedians, whose major energy goes into honing their sense of comedy to ward off the darkness that is always there, lurking inside. Their humor serves as a manic defense, to keep their depression at bay. We all experience some depressive anxiety from time to time, but the manic defense plays a prominent role, however, in the lives of those who are terrified of grief and sadness. But all defenses have their limits, and like drugs and alcohol, stop providing their magic.

Richard Jeni used to be one of my favorite comedians. I laughed my head off at his HBO performances, I was stunned when I heard that he killed himself. He had been diagnosed with severe depression and paranoid schizophrenia shortly before. After his suicide a group called Comedians for Suicide Prevention held comedy benefits for suicide prevention in major cities. Roy Johnson age 44, said that comedians committing suicide “is just part of this business that you get used to. , “It’s a thing. It’s a real issue in the business because part of what drives people to do (comedy) for a living is some kind of deficiency inside you. It kills a lot of people.” Johnson said he has lost good friends in the comedy business, including Richard Jeni to suicide and Greg Giraldo to a drug overdose. Johnson said he once had a stand-up career that was on the rise, but he left the business because, in a span of nine months, he became a basket case and wound up in what he called a “very bad place.”“It took me a good year-and-a-half to really get over,” he said. “You know how they say there are extremes? You have that deficiency and you go on stage and you get 300 people to love you, just love the (crap) out of you and then they go home. And so you go right back down to that desperate need. And you either do a lot of drugs and drinking or sleeping around, or you go back to your hotel room and you sit there for 23 hours just curled up in a ball. I’m not the only one that lived like that. I know a lot of friends that live like that.” Johnson suggested there is danger in getting up on stage and asking people to love you at all costs.“We want desperately for everybody to think that when we walk in the room, the fun starts,” he said. “What they don’t understand is a lot of guys, they need that just because when they walk out of that room, there’s just this black emptiness that they are born with. Some guys self-medicate it with drugs and end up killing themselves that way.” For more about this, go to Youtube, The Tragic Side of Comedy.

Mental health experts are hoping that the apparent suicide of actor-comedian Robin Williams will turn a national spotlight on depression, and help others find treatment for this devastating disease. Nationally known psychotherapist Fran Sherman said “Robin Williams was a true genius. People loved the manic side of him, and it was what made him. But when he took on serious roles, the depth of his sadness was real,”

 When someone wants to kill himself, he cannot think about it. He is in a tunnel vision trance and nothing else matters.So many who have made suicide attempts that failed have been able to take hold of life once again, and live. Richard Heckler wrote about this in Waking Up Alive: The Descent, The uicide Attempt & The Return to Life.

In my last blog post, I talked about “precision medicine” and finding out if a particular antidepressant medication is going to make you achieve remission. I talked about that at the end of the big study sponsored by the National Institutes of Mental Health, STAR*D, about 50% of the patients achieve remission—their symptoms have improved to such a degree that they no longer qualify for a diagnosis of major depressive disorder. Another 30-40% of patients achieve what is called a “response”, which means that their symptoms improved quite significantly, though not quite enough to meet the threshold for remission.

That leaves us with another 10%.

Lifetime prevalence of depression in the US is about 20%. 10% of 20% is about 2%. 2% of people in the US have what we call Treatment Resistant Depression, which is a nasty condition that we have very few treatments for. The main remaining options are (1) Electroconvulsive Therapy (ECT) (2) Transcranial Magnetic Stimulation (TMS), which is expensive and not particularly effective (3) Ketamine infusion (4) Deep Brain Stimulation (DBS) (5) intensive psychotherapy of some kind.

The most effective treatment and one that has the most empirical support is ECT, which has a response rate of up to 80%, although in patients with “real” Treatment Resistant Depression, the response rate even for ECT tends to be lower—and of course ECT has its well-known undesirable effects. DBS was a technique pioneered by Helen Mayberg, who has had tremendous press coverage and got many people very excited. Here is the problem: although there are a few dramatic cases, it turns out that it doesn’t work for everyone and that the responses often do not sustain itself. The very much anticipated BROADEN trial from St. Jude’s Medical failed early this year in a whimper. For further coverage see here.

“At NYU, Mayberg admitted that she has to wonder why her implant studies show better results than the BROADEN trial apparently did. “Do my patients want to please me?” she asked.”

Large, double blind, randomized controlled trial is our best defense against hype. Perhaps Mayberg was being slightly glib--not as facile with psychodynamics as a neurologist, she probably didn’t see the pretty obvious transference-countertransference slipping through that comment. Those of us who often treat these patients see a lot of co-morbid personality disorders, and many psychodynamic theories posit depression as some kind of “resistance”, and the dramatic response can be a manifestation of “narcissism” to please a famous researcher in a cutting-edge clinical trial. This is of course all conjecture. The enemies of the psychodynamics theory in my head can and will immediately come back and retort, “how could you blame the victim for what is clearly a brain disease!”

Here is where “precision medicine” should come in.

What is and isn’t a “brain disease” isn’t well defined and this “debate”, just like the debate over efficacy of antidepressants, is trivial. Here is what we know and can define and measure: DBS works for some people. Some patients have genuine “resistance” or have “subconscious primary gain”. Every investigator thinks he/she is right because he/she only sees that small number of patients, and some of these patients get better with whatever treatment they received in the study that they got into. What should be obvious to everyone is that Treatment Resistant Depression is highly heterogeneous, but what is being sold is that a specific treatment works for everyone. The reality is messy: some people might do better with DBS; others might need confrontations from a therapist in a treatment like Transference Focused Psychotherapy. Some of these patients might even just remit without any of these treatments.

Is that possible? I looked for it in a cursory search: it turns out there are very few quality longitudinal studies on Treatment Resistant Depression [1]. The largest naturalistic study, following Treatment Resistant Depression patients through 2 years [2] (no DBS or any fancy psychotherapy) reports this shocker: at the end of 24-months, 20% of these patients achieve a “response” and 10% achieve a remission. 

It seems that patients who have Treatment Resistant Depression come in and out of depression just like the other patients. They just come out of it less frequently, and for not as long, and their symptoms more severe. These patients don’t just always stay depressed, as we might assume. Treatment Resistant Depression is not just heterogeneous for different patients; it’s also heterogeneous in time for the same patient!

We don’t know very much about this condition, and given the relative high prevalence (twice as common as bipolar and schizophrenia) it’s really a travesty. I propose to create a national de-identified registry so that all Treatment Resistant Depression patients, defined by some clear NIMH established criteria, are reportable and tracked in time and in space. We gather large, quality longitudinal data on these patients and use machine learning to figure out which of them get better and which of them do not, and who got better with ECT, and who went and had a ketamine infusion. Will you, my reader, be willing to write this grant?

Reference 

[1] Fekaddu A et. al, 2009 What happens to patients with treatment-resistant depression? A systematic review of medium to long term outcome studies, J. Affective Disorders, 116: 4-11

[2] Dunner DL et. al 2006 Prospective, long-term, multicenter study of the naturalistic outcomes of patients with treatment-resistant depression, Journal of Clinical Psychiatry 67: 688-695

Genetic studies by Cynthia Kenyon—at the Hillblom Center for the Biology of Aging at the University of California San Francisco—with flatworms and Richard Miller—at the Geriatrics Center of the Medical School, University of Michigan—with mice show that having a diminished growth hormone production (or reception) seems to increase longevity. Having stunted growth increases longevity. The body seems to know that it needs to live longer to pass on its genes since its growth is stunted.

Which is exactly what happens with Michael Rose’ s experiments—at the Department of Ecology and Evolutionary Biology at the University of California, Irvine—with flies. Collecting eggs produced by older mothers produces offspring that lived longer.

There seems to be an expiration date stamped on our genes.  If we are stunted in growth or our parents delayed producing us, then our body seems to know that it needs to live longer in order to pass on its genes.  The best way to explain this is through the disposable soma theory. This theory which was first developed in 1977 by a biologist named Thomas Kirkwood—who now heads The Institute for Ageing and Health in its School of Clinical Medical Sciences, at Newcastle University—states that the body protects itself just enough so that we are able to pass on our genes.

What if we cheated our body? As in these experiments they cheated the body into thinking that they are developing really slow and therefore needed more time. What if we castrated ourselves? The Cumming Manuscript Collection of the New York Academy of Medicine Library contains more than 1200 references, abstracts, and documents concerning the early history of human castration.

But the first time that eunuchs—boys who had their testicles and sometimes their penis removed surgically—featured in longevity debates was with the observation by Serge Abrahamovitch Voronoff in the early 1900s.  And it was not a positive observation.

Voronoff—a French surgeon of Russian—worked at a hospital in Cairo from 1896 to 1910 where he had the opportunity to observe eunuchs. He noted their obesity, lack of body hair, and broad pelvises, as well as their flaccid muscles, lethargic movements, memory problems, and lowered intelligence. He concluded that the absence of testicles was responsible for aging and that their presence should prompt bone, muscle, nerve, and psychological development. He saw aging as the result of the lack of substance from the testicles and ovaries. This is all before we knew about hormones. Voronoff gained fame for his technique of grafting monkey testicle tissue on to the scrotum of men for anti-aging purposes. Voronoff and his predecessor and mentor Charles-Édouard Brown-Séquard—although ridiculed at the time—developed the field of endocrinology, the study of hormones. 

Coming back to the observation about eunuchs, Voronoff observations was that castration had retarding effects.

But then a new study in 2012 by Kyung-Jin Min from the Inha University, and his Korean colleagues, reversed this finding. In their study the authors reported that during Chosun Dynasty between 14th to early 20th centuries Korean eunuchs lived 14 to 19 years longer than other (intact) men. Researchers were able to identify 81 eunuchs, who were castrated as boys, and determined that they lived to an average age of 70, significantly longer than other men of similar social status. Three of the eunuchs lived to 100. This is a centenarian rate that's far higher than would be expected today.

Historically, and as recent as the 19th century, eunuchs were common across the world. Castrati boys—castrated before puberty—were among the most prized singers especially in catholic churches in Italy (the Sistine Chapel retained the last of the castrati singers) and Opera houses in Vienna. Elsewhere eunuchs were hired staff in harems and imperial palaces in China, Korea, Japan, and the rest of Asia and the Middle East. As well as in Europe and Russia.

In the 18th century there was a Christian sect called the Skoptzy, also called the White Doves, whose male members—in order to attain their ideal of sanctity—subjected themselves to castration. They believed that the Messiah would not come until the Skoptsy numbered 144,000 (Rev. 14:1,4).

Further East, in China, eunuchs played a more central role in government The emperor maintained approximately 2,000 in his service, the imperial princes and princesses each had about 30, and various family members were allowed 10 or so eunuchs each. Although in this context, castration was mostly as a punishment, some subjected themselves to the procedure in order to gain employment. At the same time, during the Ottoman period, especially from the 16th century on, black eunuchs from Ethiopia or Sudan were in charge of the harem in the Ottoman court. Many of these boys were castrated at a monastery in Upper Egypt by Coptic priests. The practice was pervasive and endemic.

In 1999 Jean Wilson and Claus Roehrborn investigated the long-term effects of castration. These included the enlargement of the pituitary gland, especially among those with an earlier castration. Skeletal changes included thinning of the bones of the skull and decreased bone mineral density. Although an increased incidence of fractures does not appear to have been reported in the eunuchs. Some reported growth of breasts in the Ottoman court eunuchs, which is also evident in photographs of Skoptzy men and Chinese eunuchs. Shrinkage of the prostate was common among eunuchs. However the authors could not resolve whether life span differed in their study.

A study on life span difference was done earlier in 1969, by James Hamilton and Gordon Mestler from the Department of Anatomy, State University of New York College of Medicine. They studied the mortality of patients in a mental institution with a population of 735 intact White males, 883 intact White females, and 297 White eunuchs. It was common practice to castrate mentally challenged children at the turn of the century, part of the eugenics movement. They reported that survival was significantly better in eunuchs than in intact males and females. This survival advantage started at age 25 years and continued throughout their life. The life expectancy for eunuchs was 69.3 years compared to 55.7 years in intact males. Males castrated at 8-14 years of age—before sexual maturation—were longer lived than males castrated at 20-39 years of age—after sexual maturation. Castration reduced the age of death by 0.28 years for every year of castration from age 39 and younger.

There are many changes that happen as a result of castration. The world was very different 600 years ago, or even 100 years age. In most cases it was a very violent world where men suffered early mortality through wars, famine, and daily trauma.  Eunuchs, because of their demeanor might have escaped all of that onslaught of violence. They might also have had more nurturing qualities that extended to looking after themselves better. We will never know.

Pragmatically we know that sex, and the activity surrounding sex, increases longevity. Howard Friedman and Leslie Martin in the Longevity Project longitudinal study provided our first glimpse into female orgasms and longevity. The study which was begun by Lewis Terman of Stanford University, California in 1921 on 1548 children with high intelligence born around 1910 was continued after his death in 1958. Now in their nineties, the study morphed into a gerontological study. One of the interesting and pertinent findings was that women who had a higher frequency of orgasm tended to live longer than their less fulfilled sisters.

No data on men was collected from this study. But a separate study in in the town of Caerphilly in South Wales, England, provided evidence for males as well.  George Davey Smith from Department of Social Medicine, University of Bristol,, England, and his colleagues interviewed nearly 1,000 men in six small villages about their sexual frequency,, then followed up on their death records ten years later. The authors determined that men who had two or more orgasms a week had died at a rate half that of the men who had orgasms less than once a month. And importantly there was a dose effect, where the more times these men had orgasms the longer they lived. 

These observations have been replicated in Sweden and in the USA for both male and female.

The most conclusive evidence however comes from the masters of longevity themselves—centenarians. In the Blue Zones the cluster of centenarians teach us about the pragmatisms of living longer and sexual activity is a significant part of their life. In some cases they also carried out extra marital affairs.

Perhaps there are better ways to cheat the body to tell it that it is not quite finished yet. Perhaps if you behave like you are still sowing seeds, the body will still support your endeavors. It is likely then that you do not need to cheat the body. It seems that enjoying its great capacity, in all it wondrous glory, is enough to increase longevity. Castration might cheat the body to stay around longer, but sex will make it want to stay longer.  

There is a strategy to writing a popular Psychology Today article. Describe 5 ways to feel happier right now, add images of scantily clad women with curvaceous bodies, and include references to Beyonce, atheists, porn addiction, and techniques for spotting and derailing psychopaths.

In this blog post, I am going to take a risk and write about something of profound importance. War veterans suffering from post-traumatic stress disorder (PTSD). Don't leave just yet as I am bringing in a guest expert...

Thousands of civilians risk their lives in the United States military to protect the freedom of characters such as myself who can write, debate, research, and talk about nearly anything, regardless of the ensuing controversy. The psychological and physical well-being of every human being is important. But I am going to argue that is particularly important to care for those who get injured while protecting the innocents among us. Unfortunately, there are numerous problems in our current system of getting help to those people who need it most. To tackle the topic of combat veterans with PTSD seeking treatment, I have invited a guest author for this blog post, my mentor and collaborator, B. Christopher Frueh, Ph.D.

He is going to argue that the VA's vast disability system is utterly broken and cannot do what it is intended to do - and in the process wastes precious resources and irreparably harms veterans and their families.

But I will leave it to Chris to tell his own narrative. If you are a military veteran, know one, or care about their well-being, read on. 

In this commentary I outline my view of the case for symptom misrepresentation among veterans seeking post-traumatic stress disorder (PTSD) services with the Veteran Administration Hospital system.  My perspective is based on 15 years of clinical experience as a psychologist in a VA PTSD clinic (1991-2006) and 23 years of research with veterans and other populations seeking PTSD care (1991-present) in VA, prisons, community mental health centers, primary care settings, and inpatient psychiatric hospitals.  I believe PTSD is a real psychiatric disorder and that veterans who suffer from it deserve all the appropriate treatment and safety net help that they need.  That said, current VA policies encourage misrepresentation and invalidism, rather than recovery and reentry into the workforce.

The issue is extremely nuanced, with different forms and levels of misrepresentation and many veterans start at one place and then move to another.  Among those seeking PTSD services (treatment/benefits) from the VA, there are some who misrepresent or exaggerate their combat experience, some who malinger symptoms they do not have, some who exaggerate symptoms they have, some of misrepresent symptoms of other psychiatric disorders as PTSD, some who do not admit to treatment benefits they experience – and some who are reporting it like it is.  There are many veterans who misrepresent perhaps without even realizing it, and many veterans whose behaviors and recovery efforts are influenced by the contingencies the VA has set up (see McNally & Frueh, 2012).

My overarching concerns about the VA’s disability policies are that they are countertherapeutic and harmful to veterans’ recovery efforts and lead to misallocation of resources.  Others have noted this concern going back many years (e.g., Mossman, 1996).  Recently I co-authored a commentary with Dr. Sally Satel in The National Review, which explains this concern:  https://www.nationalreview.com/nrd/articles/384821/other-va-scandal

Below are the reasons I think we have a serious systemic problem with symptom misrepresentation among veterans seeking PTSD services with the VA.  Please note, this is not intended to be an exhaustive literature review.

1. My own clinical experience: My own clinical experience over 15 years in the VA was that a large percentage (> 50%) of veterans appeared to be misrepresenting their symptoms and did not appear to be very invested in their treatment.  This was the consensus opinion of most mental health clinicians I worked with, and of most of the VA mental health clinicians I talk with to this day – across disciplines.  Also, the treatment response I have observed from PTSD patients treated outside the VA or inside the VA who have disavowed disability, has been markedly different from PTSD patients seeking disability.  When I started seeing patients in a community mental health clinic I was shocked at how quickly and significantly they responded to PTSD treatment.
2. Validity profiles of MMPI:  In the 1980s and 1990s there was a wide body of evidence from many different VAs consistently showing the mean validity profile on the Minnesota Multiphasic Personality Inventory (MMPI) was one of a malingering (“faking bad”), especially among disability seekers.  We summarized this research in a review paper (Frueh et al., 2000).  Eventually most clinicians stopped using the MMPI with this population because the profiles were so rarely valid.
3. Clinician and expert perspectives:  At least one national survey of VA mental health clinicians found that a majority viewed malingering of PTSD in the VA as a significant concern (Sayer & Thuras, 2002). Also, a consensus opinion of top PTSD experts in the 1990s wrote an opinion piece suggesting that disability seeking veterans should not be included in research studies because of the potential distortions of cash disability incentives (Charney et al., 1998), though this suggestion has been virtually ignored by the entire field – in part because the percentage of treatment-seeking veterans also seeking disability or on disability rose to virtually 100%.
4. Malingering studies:  Several small sample studies have produced results directly suggestive of malingering.  Our Freedom of Information Act study of military personnel records found many discrepancies with veterans reported military experiences (Frueh et al., 2005).  A study by another group used a labor intensive forensic interview developed to identify malingerers and found 25% were clearly responding honestly, 50% were in the range of possible malingering, and 25% were clearly malingering (Freeman et al., 2008).  These are relatively small studies, but they may represent the tip of the iceberg.  It is notable that the VA has never organized large-scale study to investigate.
5. Economic research:  Large economic studies shows that employment consequences of PTSD have as much to do with VA disability cash incentives as with a medical inability to work – and that exposure to combat (and by implication, PTSD) cannot plausibly be the driver of the massive increase in recent Vietnam-era claims (Angrist, Chen, Frandsen, 2010).
6. The VA’s POW issue:  In the early 2000s, I conducted DOD-funded research with POWs and found overall they had relatively low rates of PTSD and high rates of functioning.  In meeting and talking with Vietnam POWs (e.g., Mike McGrath, then President of NAM-POWs) I learned they were very concerned about fake Vietnam POWs using the VA system.  Although there were fewer than 800 Vietnam POWs, extrapolating data from two VA systems indicated the VA had over 10,000 on their roles.  McGrath wrote to then VA Secretary Principi, and did not get much if any response (McGrath & Frueh, 2002).
7. Clinical trial data:  The published clinical trial literature on the treatment of PTSD among civilians (e.g., rape victims) shows substantial treatment gains, with about 50% of patients showing full remission from the disorder; the published literature on treatment of PTSD in combat veterans shows almost no treatment benefits, with almost 0% in full remission (see review by Bradley et al., 2005).  There are a few current small open trial studies published showing treatment benefits with OIF/OEF veterans (e.g., Tuerk et al. 2011) – however, these are non-controlled studies that seem to have carefully selected the patients they accepted.  Most studies, including recent studies, show no or very little treatment benefit. Several other concerns with the clinical trial studies:  (1) Since negative trials are often not published, it’s hard to know about the failure studies, especially in pharmacotherapy trials. I’ve talked with several psychiatrist who do industry sponsored research and they have offered the opinion that we would have more FDA approved meds for PTSD if veterans had been left out of the trials. (2) Across the country right now, many million dollar clinical trials for PTSD in combat veterans (funded by VA and DOD) are struggling to meet their recruitment goals.  They simply cannot recruit sufficient numbers of OIF/OEF veterans with PTSD.  (3) Another open secret among clinical trial investigators is that veterans often acknowledge to researchers that the treatment has helped them, but ask them not to document in the record for fear of losing disability.  We’re currently experiencing this in a large DOD-funded trial we are conducting outside of the VA.
8. Lack of VA administrative data to support treatment effectiveness:  To date, the VA system nationally has provided no data to support the efficacy of their vast treatment programs nationally.  None.  How can this be?  The Institute of Medicine report released June 20, 2014 scolded the VA for not having such systematic data.  However, what the IOM missed somehow is that for about five years the VA has mandated collection of PTSD symptom severity via a checklist (the “PCL”) at 90-day intervals for every veteran diagnosed with PTSD in the VA system nationally (see Frueh, 2013).  It is a performance measure.  What do these data show?  As far as I can tell the VA has never disseminated these data.  Why not?  What might they tell us?
9. Administrative data that raise concerns:  VA administrative data raises concerns, much of it noted in the OIG report (2005), which we have described and synthesized elsewhere (Frueh et al., 2007).  For example, OIG found that most veterans’ self-reported symptoms of PTSD become worse over time until they reach 100% disability, at which point an 82% decline in use of VA mental health services occurs; with no change in use of other VA medical services.  While virtually 100% of treatment seeking veterans apply for disability; of those applying for PTSD disability only about 50% are seeking treatment.  According to Alan Zarembo (LA Times, August 3, 2014, http://www.latimes.com/local/la-me-ptsd-disability-20140804-story.html#page=1 ) of the 572,612 veterans on the disability rolls for PTSD at the end of 2012, 1,868 — a third of 1% — saw a reduction in their ratings the next year, according to statistics provided by the VA. This is despite strong evidence that PTSD can be effectively treated in other populations.  Why are there almost no veterans benefiting from the VA’s vast PTSD treatment services and coming off disability?
10. Data from epidemiological studies:  Rates of applications and service connections far exceed what epidemiological studies indicate is the actual prevalence of the disorder.  Point prevalence of PTSD for Vietnam veterans was 9% in the 1980s and for OIF/OEF veterans was 8% (Richardson, Acierno, Frueh, 2010).  Moreover, 30-50% of those meeting criteria for PTSD had mild symptom severity.  Set these against the number of veterans now receiving and/or applying for PTSD disability.  One report suggests that 35% of OIF/OEF veterans have already applied for PTSD disability – a war with lower KIA/WIA rates than other US wars of the 20th Century (as reported in McNally & Frueh, 2013).  Also, the rates of PTSD in US veterans of OIF/OEF are higher than UK veterans, and UK veterans have different disability contingencies. It is also worrisome that OIF/OEF veterans are seeking disability from VA (for PTSD and many other conditions) at historically unprecedented rates – much higher than Vietnam, Korea, and WWII cohorts (McNally & Frueh, 2012), though other factors could also account for this.
11. VA's resistance to studying the issue:   A national study conducted by the congressionally funded VA National Centers for PTSD found that although the system’s mental health clinicians are not using standardized diagnostic procedures (e.g., clinical interviews, self-report measures) or standardized forensic measures to detect malingering or symptom exaggeration (Jackson et al., 2011), there is somehow no reason to worry because the malingering rate is estimated to be so low as to be irrelevant.  The VA National Centers for PTSD leaders vigorously defend their view that there is virtually no malingering of PTSD in the system.  Yet, they have essentially ignored all the evidence to the contrary and failed to conduct the type of rigorous research it would take the address the concern.  Some of these senior leaders in the field were co-authors on the Charney et al consensus statement (1998) urging exclusion of veterans seeking disability connection from clinical trials, yet now they seem to have changed their minds.  Why did they once worry about apparent malingering and now dismiss it as a non-problem?  Finally and anecdotally, there is evidence that PTSD evaluators are heavily discouraged from using forensic measures that might identify symptom misrepresentation (e.g., Poyner, 2010). 

The VA has the data available and/or could easily gather the data to address this concern and many of the other angles of it definitively.  Why has it not done so?

A final thought:  The real problem is not so much veterans misrepresenting to the VA – though this is a large cost driver for the system – but misrepresenting to themselves, and in the process irreparably harming their mental well-being by accepting a life as a psychiatric invalid - rather than engaged, productive members of society who have conquered their emotional troubles.  The VA’s disability policies are well-intentioned, but they are hugely wasteful and destructive to the lives of veterans and their families.  It should reconsider its outdated and iatrogenic disability policies. 

B. Christopher Frueh, Ph.D. is a Professor of Psychology at the University of Hawaii, Hilo, HI and directs research at The Menninger Clinic, Houston, TX.  He is author of over 250 scientific publications, and of “They Die Alone” and five other crime novels writing under the pseudonym Christopher Bartley.

OTHER NEWS:Our new book, The Upside of Your Darkside, has been recently honored as one of 14 books to read this fall.Pre-order here to get a bonus chapter emailed to you!

Read here on where to send your electronic receipt to get this bonus chapter.

Dr. Todd B. Kashdan is a public speaker, psychologist, and professor of psychology and senior scientist at the Center for the Advancement of Well-Being at George Mason University.  His new book, The upside of your dark side: Why being your whole self - not just your “good” self - drives success and fulfillment is available from Amazon , Barnes & Noble , Booksamillion , Powell's or Indie Bound. If you're interested in speaking engagements or workshops, go to: toddkashdan.com

Readers who follow me regularly know that I am an avid Redskins fan, and by extension, a huge fan of football more generally. However, I find myself questioning my fandom of the NFL with yet another violent scandal that raises the complicity of the league in turning a blind eye to criminal behavior of its players until it becomes a PR nightmare.

For those of you who have somehow managed to miss this recent headline, here is a brief summary: renowned Ravens running back Ray Rice was implicated back in February for violence against his then-fiance (they are married now) in an elevator at the Revel casino in Atlantic City. At the time, the public had only had access to grainy video footage of the altercation outside of the elevator doors that shows a clearly passed out Janay Palmer being dragged callously by Rice. In the aftermath of the altercation becoming public, Rice admitted to having assaulted his wife inside the elevator (effectively rendering her unconscious), and was indicted on an aggravated assault charge. The commissioner of the NFL, Roger Goodell, suspended Rice for two games as disciplinary action for this violation of the league’s conduct policy.

To put Rice’s initial slap of the wrist in perspective, a player that is consuming marijuana, and thus violates the substance abuse policy of the NFL, will face much more significant penalties and fines and could potentially miss a third of the regular season, if not longer. Or, more recently, strong safety Brandon Meriweather of the Washington Redskins was penalized for an illegal hit (leading with the helmet) during a preseason game against the Ravens, and was suspended for two games during the regular season. Yup, that’s right, folks, the NFL is so concerned with violence against women instigated by their players that the penalty is akin to tackling an opponent too aggressively on the field.

Not only was the initial handling of the violent altercation poorly bungled by both the league and the Ravens, public comments by both the commissioner and the Ravens put the blame squarely on both parties in the elevator. In fact, when Goodell questioned Palmer about the incident, it was in the presence of Ray Rice. In what other scenario after a victim has been brutalized are they questioned about what they endured in the presence of the perpetrator? The narrative that the league and team put forth, and that by and large the media and general public swallowed whole, was that this was just a mistaken “moment” instigated by Rice, and that quite probably, Palmer had in some way contributed to the altercation. The classic psychological phenomenon of blame the victim was at play—as is often the case with domestic violence the female victim was perceived as having in some way contributed to her victimization.

For instance, the Ravens tweeted that, “Janay Rice says she deeply regrets the role that she played the night of the incident” in the aftermath of the altercation (Jenkins, 2014, para 5). What role, exactly, did Palmer play in the incident, other than being the target of Rice’s aim? Of course, the implicit message here being, she had it coming.

But wait a minute—all the sudden the NFL turned course yesterday, as did the Ravens, and saw the error in theirs and Rice’s way because of additional grainy footage that couldn’t justify complicity any longer. Just yesterday, TMZ leaked the footage from what happened before Palmer was unconscious, where inside the elevator Rice punches Palmer so violently that her head hits the railing of the elevator and she swiftly hits the ground. The carefully scripted narrative that the commissioner and the Ravens and the rest of the sports media had constructed started to unravel, and suddenly outrage poured from every side—the public, the Raven's head coach, the sports media, social media, even NFL players were tweeting their disgust at what was exposed.

So this is what it takes, ladies, for domestic violence to be taken seriously by this league—just make sure that there is a tape leaked to the public that will foment enough outrage, and now the perpetrator will be characterized as the villain. But what about the league itself? Rice had never denied or tried to misrepresent what happened in the elevator, so is he now suspended indefinitely by the league and released by the Ravens because of his actions that night, or in reaction to public outrage so that the NFL can attempt to restore some sense of order and credibility to their brand?

Firstly, I find it suspect that the NFL did not have access to this footage prior to the initial sentencing of Rice, particularly given that various credible journalists within sports, and employees at Revel, have reported that the league was given access to the tapes. As Sally Jenkins (2014), a prominent sports writer for the Washington Post bemoans:

“The NFL claims in a statement that no one in the league office had previously seen the tape. That is almost surely not the truth, unless the NFL wanted it that way. This is a league that works with Homeland Security, confers with the Drug Enforcement Agency, collaborates with law enforcement and has its own highly equipped and secretive private security arm. You’re telling me it couldn’t get a hold of a grainy tape from an Atlantic City casino elevator? But TMZ could?” (para 3)

This then leads to two possibilities: 1) that the league had access to the videotape all along, but wasn’t concerned about what was exposed in the footage until it became public or 2) the league willfully turned a blind eye and preferred not to dig too deep into what transpired between one of the most prominent players in the league and his partner. Either way, the message being sent is that this league doesn’t care about how their players treat women, unless that treatment is video recorded and leaked to the general public.

The complicity behind this act of violence runs through every phase of the investigation—from the prosecutor who decided to allow Rice a pre-trial diversion to the reaction of the decision makers of the NFL and Baltimore Ravens, to the sports media that ignored this story for too long until the video footage was released.

The reality is that domestic violence is pervasive in American society, and most women who are its victims do not have the luxury of a tape that documents the extent of the brutality that is being waged against them. Moreover, the uproar that ensued in the aftermath of the leaked tape clearly demonstrates that it wasn’t until the visual evidence of Rice’s act was exposed that this incident was actually taken seriously.

Rice is the perpetrator in this case, however turning him into a monster now without also holding the larger institution of the NFL and its key policymakers and coaches involved with the Ravens also accountable is short sighted. A culture of entitlement pervades male dominated professional sports, in the case of football in particular, the reverence and elevation of status that players achieve even starting in high school sets the stage for a mentality that the player is entitled to whatever he wants off the field—with women oftentimes being just another commodity. This sentiment is even more pervasive in college when athletes are not being paid, so their rewards include lavish attention and possession of other spoils on campus, namely, women to be used and then discarded when they are no longer useful or serving a purpose.

Such a mentality then continues into the NFL, particularly when these large sports institutions do little to deter or counter such misogynistic attitudes. Witness, for instance, that, “while the general conviction rate for domestic-violence cases is 77 percent, it is only 36 among athletes” (Calkins, 2014, p. 2). Other research suggests that athletes may have higher incidence of domestic violence than the general population, so it isn’t that these violent incidents aren’t occurring in the male-dominated sports world, it is that the perpetrators aren’t being held accountable, which then further enables such acts of brutality to persist. This brings up perhaps the most disturbing question of all, namely, what happens in all those domestic violence cases when there isn’t video footage?

Calkins, M. (2014, September 8). We only condemn domestic violence when we see it. U-T, San Diego, Sports. Retrieved on September 9 from: http://www.utsandiego.com/news/2014/sep/08/domestic-violence-ray-...

Jenkins, S. (2014, September 8). Roger Goodell’s willful blindness and need to maintain plausible deniability. The Washington Post: Sports. Retrieved on September 9, 2014 from: http://www.washingtonpost.com/sports/redskins/roger-goodells-hand...

Copyright Azadeh Aalai 2014