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I Have Weight on my Mind and It's About 430 Pounds

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Weight has been weighing on my mind recently. We are all still trying to shed the extra pounds of Christmas cookies and fruit cake (does anyone really eat that?) Okay, so I gained a few, but that’s nothing compared to what I have coming up professionally. I am working on developing a 20-man team whose total weight will top out at about 8500. Yep, do the math. That’s over 400 pounds per person. These are to-be sumo wrestlers for a TV program. Think about this: every show on TV is about losing weight. This one is about gaining weight. The question is how do you get to be that big to begin with? No, I’m not making fun of this team. I’m in awe. I have learned that sumo wrestlers are 500 pounds of solid muscle. The amount of exercise topped by excessive healthy eating may develop pounds, but they are pounds of steel.

In Japan, the larger the sumo wrestler the more he is revered. Sumo is more of an art form than it is a sport. It is centuries old and is steeped in tradition ranging from the diaper-looking mawashi to salt purification. What does a sumo wrestler eat? A lot! You have to eat a ton to get into sumo shape. So the question is, can you take some regular overweight guys and get them into the sumo world? According to Andrew Freund, President of Sumo USA, the answer is “yes.” And it only takes a month of dedicated, intense work to get into sumo shape.

So Andrew and I are not just producing a TV show, we are producing a social experiment. If you are going to be a big guy, why not try to be a big, strong, healthy guy.

Hidden in that sumo world is Kelly Gneiting. Kelly is an Idaho family man who earns his living driving a truck and just happens to be a three time National Sumo Champ. As Kelly got larger and larger, he asked his athletic self just what to do with this weight thing. Sumo seemed to fit. Kelly has become the gold standard for stamina and “Just Do It.” He made it into the Guinness World Book of Records for the largest man to ever finish a marathon. At 9 hours, 48 minutes and 52 seconds, Kelly finished 4th to last in the 2011 LA Marathon and he was thrilled. At 430 pounds, according to the LA Times, struggling mightily for the last 5 miles, he pulled it off beating his own record of 11 hours, 52 minutes and 11 seconds and beating the former weight competitor of 275 pounds. That’s 155 pounds more than the former competitor. He’s stronger now. He’s faster now. He’s more determined than ever. And everyone cheered him on. Instead of the usual abuse overweight people suffer, Kelly got out there and maybe it was his sumo charm, but he won over the crowd.

In this country, we are brutal when it comes to overweight people. We make fun of them, we call them names, we don’t hire them thinking that if they cannot control their weights, how could they control their job. Congress amended the Americans with Disabilities Act to extend workplace disability protections to morbidly obese people, defined as those 100 percent or more above the healthy weight range for their height. In April and July of 2012, the Equal Employment Opportunity Commission (EEOC) gained settlements in its first two major cases on weight-related workplace discrimination. Peggy Howell, now on the board of the National Association to Advance Fat Acceptance, a group that promotes size acceptance for “fat people” – a term she insists upon, lost her job when she weighed 100 pounds more than her current weight having been told by her boss that her weight is an indication that her life is out of control. Make no mistake. It is a growing health hazard if not checked with a doctor and not matched with exercise to help monitor healthy heart and lungs. Some people just cannot lose weight. The point is, the world of sumo has proven you can survive as a heavy person if you maintain your health, build strength and muscle. According to Peggy, “I don’t consider myself disabled and some people don’t like ‘fat’ considered a disability.”

Neither does Kelly Kneiting, my 20 guys soon to be in training or our trainer, Byamba, or our final round competitor, Yama, the heaviest Japanese sumo wrestler ever at 600 pounds. They are big, they are absolutely revered, and they are like running up against a rock. 

So yes, I have weight on my mind. Will I train with my sumo team and gain a few hundred? I don’t think so but will I cheer them on for their effort and fortitude and for saying just what Kelly Gneiting said? “What do I do with this weight? I’m an athlete.”

Kelly has plans for one more marathon, a swim across the English Channel, for which he is currently training, wants to play for an NFL team, and would like to climb from the Dead Sea to Mt. Everest. We’ll be there with all 430 pounds of him cheering him on.


What Do We Really Know About Lethal Violence in Chimps?

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An essay in today's New York Times by James Gorman called "Lethal Violence in Chimps Occurs Naturally, Study Suggests" has resulted in a good number comments and questions arriving in my inbox. These include, "What does the study actually show?,""How robust are the data?, and "What does it mean about the enormous amount of violence in which humans engage?" The title of the Times essay is catchy and much hangs on the word "suggests", as it should.

The title of the original essay that appeared in the journal Nature is "Lethal aggression in Pan is better explained by adaptive strategies than human impacts" and was written by thirty researchers. The abstract reads as follows (the essay is available only to subscribers and the numbers refer to references that are available at the end of the abstract):

Observations of chimpanzees (Pan troglodytes) and bonobos (Pan paniscus) provide valuable comparative data for understanding the significance of conspecific killing. Two kinds of hypothesis have been proposed. Lethal violence is sometimes concluded to be the result of adaptive strategies, such that killers ultimately gain fitness benefits by increasing their access to resources such as food or mates1, 2, 3, 4, 5. Alternatively, it could be a non-adaptive result of human impacts, such as habitat change or food provisioning6, 7, 8, 9. To discriminate between these hypotheses we compiled information from 18 chimpanzee communities and 4 bonobo communities studied over five decades. Our data include 152 killings (n = 58 observed, 41 inferred, and 53 suspected killings) by chimpanzees in 15 communities and one suspected killing by bonobos. We found that males were the most frequent attackers (92% of participants) and victims (73%); most killings (66%) involved intercommunity attacks; and attackers greatly outnumbered their victims (median 8:1 ratio). Variation in killing rates was unrelated to measures of human impacts. Our results are compatible with previously proposed adaptive explanations for killing by chimpanzees, whereas the human impact hypothesis is not supported.

Note that in about 50 years of study, there were only 152 killings with which this study was concerned, 58 (38%) that were observed, 41 that were inferred (27%), and 53 (35%) that were suspected. So, 62% of the killings were not actually seen. The authors also conclude that human impacts on chimpanzees are not responsible for violent behavior. The Times essay presents different points of view on the study and its conclusions.

There has only been one known chimpanzee war

I've written about nonhuman violence before, most recently in an essay called "Animals Are Not Warmongers: An Important Media Corrective" in which I wrote on a report by Colin Barras in New Scientist magazine titled "Only known chimp war reveals how societies splinter" (the print edition version is called "Secrets of the only known chimp war"). Despite media often reporting and inferring that many nonhuman animals (animals) are typically violent, this is a misrepresentation of how they really live. Robert Sussman, an anthropologist at Washington University in St. Louis, and his colleagues Paul Garber and Jim Cheverud, reported in 2005 in The American Journal of Physical Anthropology that for many nonhuman primates, more than 90 percent of their social interactions are affiliative rather than competitive or divisive (see also for an update on what we're learning about cooperation in other animals). And, because there's only one known chimpanzee war, a point made by Duke University's Joseph Feldblum who, with a number of colleagues, analyzed this unique event, claiming we inherited our widespread destructive behavior from "them" is not a credible conclusion.

Other researchers and I have taken the position, based on available evidence, that claims about widespread violence in animals are misrepresentations and distortions of what we really know about them and we shouldn't be blaming other animals for our violent and evil ways. My earlier essay was titled "Humanlike Violence Is Not Seen In Other Animals" and to be more accurate it should have been called "Humanlike Violence Is Extremely Rare In Other Animals." In this piece I noted among other things, what world renowned primatologist Jane Goodall wrote about violence in wild chimpanzees in her book The Chimpanzees of Gombe: " . . . it is easy to get the impression that chimpanzees are more aggressive than they really are. In actuality, peaceful interactions are far more frequent than aggressive ones; mild threatening gestures are more common than vigorous ones; threats per se occur much more often than fights; and serious, wounding fights are very rare compared to brief, relatively mild ones." (p. 357, my emphasis) Dr. Goodall also noted in 2013 that chimpanzees "have a dark side just as we do. We have less excuse, because we can deliberate, so I believe only we are capable of true calculated evil." 

The above study authored by thirty prominent researchers is a very important one and understandably has attracted a lot of attention from various media because it raises all sorts of questions about who we are and who "they" (other animals) are. However, more data are badly needed concerning chimpanzee violence and I fear that some people will "pick up the ball and run" with the idea that other animals are routinely violent and that's where we got our evil ways. One of the authors of this study, world renowned primatologist Richard Wrangham who works at Harvard University, maintains that chimpanzee behavior “is a reasonable start for thinking about primitive warfare in small-scale societies.” However, he also notes, “I certainly wouldn’t want to say that chimps have anything much to say directly about what’s going on in Syria.” Dr. Sussman claims, “War has nothing to do with what chimpanzees do.”

As renowned primatologist Frans de Waal reminds us, nature offers many lessons for a kinder society (see also). We need to pay attention to what we know and push aside misleading sensationalist media that misrepresents us and other animals. At best, the jury is still out about the prevalence of intraspecific (within species) violent behavior in chimpanzees and other animals, what causes it, and what it means about our own behavior. 

So, do animals fight with one another? Yes. Do they routinely engage in cruel, violent, warlike behaviors? No. They're extremely rare when compared with positive prosocial behaviors that benefit others. Thus, we can learn a lot about who we really are from paying attention to what we are learning about the social behavior of other animals, and harness our own innate goodness, as some claim it to be, to make the world a better place for all beings. 

Reference:

Michael L. Wilson, Christophe Boesch, Barbara Fruth, Takeshi Furuichi, Ian C. Gilby, Chie Hashimoto, Catherine L. Hobaiter, Gottfried Hohmann, Noriko Itoh, Kathelijne Koops, Julia N. Lloyd, Tetsuro Matsuzawa, John C. Mitani, Deus C. Mjungu, David Morgan, Martin N. Muller, Roger Mundry, Michio Nakamura, Jill Pruetz, Anne E. Pusey, Julia Riedel, Crickette Sanz, Anne M. Schel, Nicole Simmons, Michel Waller, David P. Watts, Frances White, Roman M. Wittig, Klaus Zuberbühler, Richard W. Wrangham. Lethal aggression in Pan is better explained by adaptive strategies than human impactsNature, 2014; 513 (7518): 414 DOI: 10.1038/nature13727

Marc Bekoff's latest books are Jasper's story: Saving moon bears (with Jill Robinson; see also), Ignoring nature no more: The case for compassionate conservation (see also)and Why dogs hump and bees get depressed (see also). Rewilding our hearts: Building pathways of compassion and coexistence will be published fall 2014. (marcbekoff.com@MarcBekoff

You Can Experience Joy

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I don't believe in an afterlife but I do think I've seen heaven and hell.

We hear much talk about near-death xperiences, with many reporting a glimpse of heaven (We hear less often that some people see hell). At least when it comes to survivors of cardiac arrest, there's a scientific explanation for these experiences. In a study by Zalika Klemenc-Ketis and colleagues (which I first learned about in a PT post by Douglas Fields) gender, age, religious belief, and education made no difference in which patients emerged from cardiac arrest reporting an out-of- body experience. The common thread: a rise in carbon dioxide levels in their blood above 5.7 kPa. If doctors managed blood carbon dioxide levels better, it appears the experience could go away. 

Would that be desirable?  What do you think?

Every religion forces us to think about death. In a Christian church, people pray to an image of a man on a cross. In a Jewish service, we say Kaddish and stand with the mourners in the room. Once, when death was part of everyday life, those practices helped to console us. But now, for much of our lives, they are reminders of death, which it has become possible to forget. Women now rarely die in childbirth and we don't slaughter our own farm animals. We in the United States rarely see plagues take entire families in a night. The ordinary experience of death if you're reasonably well off might be to "put down" a pet, say goodbye to a grandparent in a hopsital room, and hear about a  classmate who died in a drug or traffic accident. Then the cancer victims come. You lose a parent and it's sad. The deaths are spread out and strange.  

But it's not clear that with less death in our daily lives we are happier or--a different question--more likely to experience joy. The ancient Greek Stoics taught that contemplating your own death and the death of your loved ones was a source of joy. It sounds weird to me, too, but it's also happenned to me. Joy came to me in the face of death on three occasions.

I have no reason to think my carbon dioxide levels were off: I think I "woke up," in the spiritual sense, though I didn't come to believe in God.

The most recent experience was when I stumbled on some pebbles while on a hike, fell down a hill and landed with a large boulder rolled over my head. I saw the boulder coming and I also saw the horrified looks on the faces of the people who stood above me on the path at the top of the hill. I thought, "So now it's happening. I'm going to die." I was suffused with joy and expectation.

Perhaps I felt loved because the faces showed such horror, but they were not people I knew well. I know I thought something good would come next. It came: The boulder's sharp edge landed on my throat, scraping it. I survived.

Does this make me suicidal? Does it mean that deep down I believe in an after-life? I'd say No to both. And none of that explains why I was so happy the rest of the week. I had no desire to die. I was thrilled that I had survived. My life had become newly valuable to me. 

The second time was when I learned that my mother had a nearly always fatal cancer.  After hours at the hospital, where my father and mother had just been walked through the news by nervous doctors, we left happily. It was a pleasant evening. My mother had always loved the small white Christmas lights strung on the bare trees in New York City, and I remember her smile when I pointed them out. We went to Carnegie Deli and shared two huge pastrami sandwiches. We made jokes and laughed.

It was perhaps the happiest time of my life. I can only compare it to moments when I felt in love--expansive, included in the web of life, grateful and expectant of good to come.

One of my most joyous afternoons came on the day I guessed my longtime lover would soon die. He had been depressed for years and unable to leave the house for the last year. He had told me he wouldn't let me in if I tried to visit him, but that day I went anyway--it took about an hour on the subway--and he didn't answer the phone when the doorman called. I left a note.

I then went midtown and spent $300 on a pair of bright green suede sandals, though I'm usually frugal. (When I told this story to a friend, she said, "Arche?""Of course!"). It was a beautiful early summer day and I felt suffused with joy. That night I finally got him on the phone and he said, weakly, "You came out here?""Yes. Why didn't you let me in?""I was sleeping.""You're going to die if you go on like this," I said. "I know.""You can't do that.""I'm sorry. Goodbye," he said, and hung up. I called his psychiatrist immediately but it didn't help. By the end of the week, he was dead.

I suppose my happiness and shopping spree could have been sparked by relief. He had been sick a long time. However, I did not feel relieved as days went by and he was still dead. I became terrified that I would die and that the people I loved would die if they were out of my sight. It was hellish. There is no better word. I felt in between life and death and wanted to die, though I feared death.  It is clear I lost my balance, which I'll have to call my "spiritual balance."

My best understanding now is that on the day I visited him I felt the preciousness of life. I also probably believed that he would make it. I think I believed my mother would make it too, although she hadn't a chance.

Those illusions helped. More importantly, for stretches of time I didn't take the people I loved, or life, for granted. If you live more joyously believing in an after-life, listen to no one who says you are wrong. But I don't think it's necessary for skeptics to convert. Meditation is also one way to see heaven, without falling down a hill.

I believe I've seen heaven and hell without any medical emergency and that I'm the better for it.

Retrain Your Anxious Brain

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The worst thing you can say to a child who is worried and voices fear is, "you have nothing to be worried about." It only drives the fears underground, unresolved, which compounds the anxiety and makes it  shameful.                                                               

Why do we need to retrain our anxious brains? Isn’t anxiety an inevitable part of life?

Yes, we all need a little anxiety to survive in the world. But when symptoms of anxiety begin to interrupt important daily living activities and impair our ability to function, our quality of life diminishes and we get overwhelmed. So like the Olympian athletes who train their bodies to stay fit, we have to train our minds to do the same.

What does anxiety do to brains and the way we think and see the world?

Chronic stress and severe anxiety can alter the brain's ability to manage stressful stimuli. Anxiety causes the brain to manifest debilitating cognitive distortions and see the world in often catastrophic ways. As a result, we may begin seeing the world with a dualistic mind as in all-or-nothing or black-and-white thinking, or we may get desperate and develop an excessive need for control, which can escalate into panic.

What is the best thing to say to a child who is worried?

The best thing not to tell a child is, “you have nothing to be afraid of.”  Or “you need to snap out of it.”

Assuring your child that you understand his/her fears and normalizing the worried thoughts as part of being human is very important. Assure children that they are safe with you and that they can count on you for unconditional support. Do not try to minimize the worry. Acknowledge it and don’t make them feel ashamed of feeling scared.

Do you think anxiety is increasing, and if so, why?

As we progress into the new millennium, the numbers of people seeking treatment for anxiety will rise exponentially. It seems there are more foreseeable stressors than ever before. For example, in post-9/11 America, we have fought two wars, we have seen terrorist acts on U.S. soil, we are living with an unstable economy, and we have experienced a host of natural disasters—earthquakes, tsunamis, floods. In addition, we are facing troubling predictions about global warming and incurable disease outbreaks, just to name a few. We also get to watch all this chaos on our smart phones, tablets, and computers. We are so plugged in and tuned into the world that it now seems people can’t afford not to stay updated on all the unrest that’s going in the world around us.

What led you to write this book?

I had my own experiences with anxiety as a child, and the excellent treatment I received inspired me to help others. Also, my personal view is that there aren’t many good books out there that really help people get to the root of their anxiety. I strongly believe my book does it very well.

What is the most surprising thing you discovered in researching/writing this book?

It forced me to revisit some of my own past experiences with anxiety that I had forgotten about. The revisiting was difficult at first, but it helped me gain new perspectives on experiences of my early years that I thought would remain unresolved. It was eye-opening, to say the least.

What is the most important point you want to get across?

Anxiety is easily diagnosed and treated with solid, evidence-based therapy that really works. No one has to endure the disorder and keep it secret anymore. Anxiety is a legitimate condition that we don’t have to be ashamed about.

Who would most benefit by reading this book?

Anyone who has experienced stress on the low end to severe anxiety on the high end will benefit from this book. It applies to everyone because anxiety is such an intrinsic part of life.

What is the most profound thing you’ve learned about yourself in writing this book?

That I am a survivor and that I am way stronger than I ever thought I was. If my anxiety episodes years ago were as bad as it gets, then I don’t have much to fear about anymore. What could be worse?

If you had one piece of advice, what would it be and who would it be for?

To anyone who’s ever crossed over to the other side of rationality and fallen into the menacing irrational cauldron of severe anxiety, you are not alone. Reach out and connect with people who are going through the same struggles as you. Read up on anxiety, stay curious, and never give up on finding ways to work on yourself.

What is it that you wished you knew when you experienced anxiety as a child?

That having anxiety does not cause sufferers to go “crazy” or to “lose their minds.”

What would you like to see happen as a result of your book?

I'd like to bring more people out of the “anxiety closet” and encourage them to seek help. I hope sufferers will learn to depathologize themselves and start accepting that anxiety is a condition that needs to be attended to. And, I want sufferers to understand that anxiety is not a condition that affects only weak-willed people or that results from a deep moral failing.

About THE AUTHOR SPEAKS: Selected authors, in their own words, reveal the story behind the story. Authors are featured thanks to promotional placement by their publishing houses.

 

To purchase this book, visit:

Retrain Your Anxious Brain

 

 

 

 

 

 

 

 

 

 

 

 

 

When a Concussion is not a Concussion

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With the dizzying array of news about sports concussions and related symptoms, we may be at risk of misinterpreting symptoms that appear to be due to a concussion. However, it is common for an athlete to experience signs and symptoms that mimic concussions but are due to other conditions. 

Here are some conditions with symptoms that mimic or can be confused with concussion injury. Remember concussions are a mild brain trauma affecting the physiology of the brain. The conditions below may stand alone, or occur simultaneously with concussion or post-concussion syndrome.

Heat Exhaustion/Dehydration— Many sports begin with practice in the summer months, and in regions where ambient temperatures on the field may be in the 90's or more. If athletes in these environments do not drink enough water before, during and after the session then heat exhaustion or dehydration may result. The heat alone may have adverse effects on brain function leading to symptoms such as fainting (loss of consciousness), dizziness, confusion, nausea, vomiting, even convulsions. These symptoms could easily be mistaken for concussion. 

Extra Cranial (outside the skull) Soft Tissue Trauma— The head often suffers injury to the tissues outside the skull, particularly in non-helmeted sports. Bruises, lacerations and other traumatic injury to these tissues are often associated with pain. Attentive care should be taken address the wound, but be careful not to refer to the pain as a “headache” even though the head may ache. 

Occipital Neuritis— A neurological condition often confused with migraines, occipital neuritis involves a pair of nerves at the back of the head below the skull that wrap upwards and around the back of the head to supply sensation to these regions. Injuries that involve "whiplash" movement or rotational forces may stretch and injure these nerves causing inflammation and nerve pain known as neuralgia. This pain is usually sharp, stabbing and radiates up the back of the head, or can be dull and aching. Often there is "referred pain" (pain perceived at a location other than the site that received the injury) that is felt behind one or both eyes. 

Migraine— Migraine is a common condition occurring equally in about 6 percent of pre-teen boys and girls. After the onset of adolescence the incidence of migraine climbs to about 18 percent in young women while remaining at around 6 percent in men. Migraines run in families. The migraine brain is an irritable brain, with unstable physiology and reactivity to many internal and environmental factors, including head trauma. There is significant evidence that having a personal or family history of migraine make one more vulnerable to concussion injury. The flip side of the coin is that head trauma may serve as a triggering factor for migraines even in individuals who have never had a migraine. Care must be taken not to label a new migraine condition as persistent post-concussion syndrome.

TMJ— This is just a variation of the extra-cranial soft tissue injury mentioned above. TMJ stands for Temporo-mandibular Joint, which is the joint between the jaw and the skull. Trauma to the jaw can result in stretching injury and inflammation to the ligaments that hold these joints together. Malocclusion (misalignment of the teeth) by dislocation of the jaw can lead to further inflammation and pain in these regions often mistaken as “headache." 

Benign Positional Vertigo— The inner ear is the balance organ that tells the brain how you are situated in space, sensing acceleration and movement. Through a complex structure of tubes filled with liquid and crystals known as otoliths, the inner ear functions much like a carpenter's level. Traumatic forces to the head can lead to displacement of the otoliths in one or both ears. This results in misinformation of balance to the brain and results in vertigo. The vertigo is typically brief, lasting seconds and less than a minute, but recurrent, brought on by further movement of the head. Recognition of this condition is very important because it is usually very easily treated with head rolling exercises such as Eppley or Sermont maneuvers.

Analgesic Overuse Headache— Also known as a "rebound headache,” this is a well-known phenomenon amongst headache specialists whereby a medication is used to treat a headache disorder (traumatic or otherwise) and the chronic use of this medication leads to a new headache pattern that would not have happened if the medication was not used. These are usually milder, more diffuse headaches with a chronic daily pattern, typically not associated with nausea, light or sound sensitivity, or provoked by exertion. 

Reactive Psychological Issues— Once concussed, life changes dramatically for the athlete. This person who has dedicated his life to physical activity is now told to go to physical and mental rest. School and work are missed. He may start falling behind in his obligations. The athlete's social structure may dramatically change. He may feel that he is letting his team, coaches and family down by not being able to participate in his sport. These stressors may contribute to depressed mood, worry, and anger apart from the physiological changes in the brain.

Reactive Sleep Issues— Similarly, because the injured athlete is at rest, with low levels of arousal, and may be sleeping during the day, or because of the emotional reactions described above, difficulty sleeping at night may occur. Night time sleep deprivation may in turn lead to daytime sleepiness and a vicious cycle of disturbed sleep ensues.

Cervical Strain/Sprain— Any time there is head injury, trauma to the neck and spine must be considered. These injuries include strain and sprain of the muscles of the neck and ligaments associated with the spine. Fractures and dislocation of the vertebrae of the spine may also occur. These conditions can lead to headaches, and even vertigo, without direct injury to the brain. 

Orthostatic Hypotension/Tachycardia— A rare condition that may occur after head injury is post-traumatic orthostatic hypotension/tachycardia. This condition occurs when the blood pressure drops (hypotension) or the heart rate increases (tachycardia) abnormally when going from a lying to a standing position. Profound changes in these vital signs can lead to light headedness and even fainting. Low grade postural changes in these vitals can lead to a sense of chronic fatigue. 

I believe concussions are emerging as a new field of science, somewhere between neurology and sports medicine. As research continues to unfold the concussion mystery, the more we understand them and respect their dangers, the better we can provide recommendations for managing them within the context of sports. Concussions are receiving their moment in the spotlight, and for good reason. But be careful not to confuse other conditions with symptoms that appear to be concussion related.

 

Cognitive neurologist Harry Kerasidis, M.D. is the Founder of Chesapeake Neurology Associates in Maryland and XLNTbrain LLC. He also serves as the Medical Director for the Center for Neuroscience, Sleep Disorders Center and Stroke Center at Calvert Memorial Hospital. For more than 25 years, Dr. Kerasidis has studied changes of the electrophysiology of the brain as it relates to behavior, cognitive function and emotional function resulting from various brain trauma, including concussions. His work led to the establishing the first complete concussion management program, xlntbrain.com.

Why Haven’t the Pitchforks Come Yet?

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Nick Hanauer, a Seattle-based entrepreneur (and self-described “zillionaire”) recently wrote a very compelling article for Politico Magazine trying to convince his fellow rich Americans that “the pitchforks are coming." In a nutshell, Hanauer argues that all of the historical evidence clearly indicates that the current trajectory of economic inequality in the United States will eventually lead to revolt (the pitchforks) and that change is needed to boost the middle class, which will ultimately be advantageous for the rich. Pay workers more (e.g., increase the minimum wage to $15 an hour) and they will have more to spend. And their spending will boost the economy. His punch line: It is the middle class that creates jobs, not the rich.

Hanauer makes excellent points. His case is pretty convincing.  But I am not an economist or a businessman so I have little that I can intelligently say about the particulars of his argument. However, I am a psychologist and I do know something about human motivation, the psychological variables that drive our behavior. And what I know may help explain why the pitchforks have not yet come and why they may not come for some time.

Americans are not ignorant. They know that the gap between the rich and everyone else is growing. They know that CEO salaries are out of control and that wages for everyone else are standing still, barely moving, or in some cases going down. They know that they have less money to spend, that prices for just about everything are going up. They know that the job market is still very tough and that many people are settling for less than ideal positions or have given up entirely. So where are the pitchforks? Knowledge is power, right? And since people have the knowledge they should be stepping up to take the power, to demand change.

And yet, it seems like business as usual for the most part. Sure, there was Occupy Wall Street and the fast food worker strikes. We see a few pitchforks here and there. But why no mass revolt?

There have not yet been mass revolts because psychological needs are sometimes at odds with and trump financial self-interest.  Research in social psychology has long demonstrated the people gain feelings of psychological security by investing in cultural belief systems or worldviews that imbue the world with order and meaning. Cultural worldviews allow us to believe that the world is just and the people ultimately get what they deserve. And these feelings are reassuring. They comfort us and give us the motivation to move forward in life in spite of the many challenges we face.

One prominent worldview in the United States is that people are independent agents who are ultimately responsible for their own financial destinies. America is the place that people go to make it. It is a place where a good idea and hard work creates success. In other parts of the world people are limited by the class they are born into. But not in America. We pull ourselves up by our bootstraps.

In other words, part of the American capitalistic narrative is that rich people deserve to be rich and poor people deserve to be poor because we are responsible for ourselves. The system is fair and we all have a chance to make our own success.

There are, of course, people who do not buy into this worldview, but it remains quite prominent. And perhaps this should not be surprising as it is a very seductive idea and one that likely has contributed to a lot of success in our country.

The problem, however, is that people are motivated to defend this worldview even if it does not fully match reality because the worldview itself (not the potential economic consequences of it) provides psychological security.

Take, for instance, studies that consider the effect of psychological threat on support for one’s cultural worldview. Dozens of experiments indicate that when you remind people of things that have the potential to provoke anxiety (e.g., terrorism, their own mortality), they respond by more adamantly defending their cultural worldviews. For example, in one now classic set of studies led by Dr. Jeff Greenberg of the University of Arizona, research participants were asked to spend a few minutes writing about how they feel about death (a psychologically threatening topic). Participants in a control condition did not write about death. Subsequently, participants read one of two essays. One essay argued in favor of the American worldview that anyone can find financial success if they try hard enough. The other essay challenged this view. It asserted that America unfairly favors the rich. After reading one of these essays, participants were asked to evaluate the essay and the author of the essay. Do they agree with the essay? Do they think the author is intelligent? And so on.

So what did they find? Having people think about death increased positive responses to the essay and author that supported the idea that America is economically fair and anyone can make it here. And it also decreased positive reactions to the essay and author criticizing this worldview. In other words, when people felt threatened, their reaction was to more tightly cling to the idea that our country is fair and that each of us has the power to determine our own financial fate.

Other studies similarly evidence that it is often the people that are most economically or socially disadvantaged that defend the status quo most fervently. How does this work? Shouldn’t these be the people with the pitchforks, the people that would benefit most from economic change? Yes, but it is also these people that may be the most psychologically vulnerable, the most in need of clinging to a worldview that provides some sense of order and meaning. In other words, people who are struggling financially have more to be anxious about. They feel less secure. And they want to reduce their anxiety, their feelings of doubt and uncertainty. So they may be more inclined to double down on the belief, the hope, that their efforts will ultimately be rewarded, that they are part of a cultural system that is fair and just.

As some scholars have argued, it would perhaps be even more threatening to believe that the cultural system that one is participating in is unfair. This would mean not only are you facing the anxiety associated with your own economic uncertainty but you are also facing a larger, more existential, anxiety that results from feeling that you have no control over your fate. In short, to reject such a prominent cultural worldview is difficult because that worldview provides comfort and hope.

Hanauer and others who have made similar arguments are correct. Eventually, when things get bad enough, people revolt. What I would add though is that this revolt is more likely to come when people begin to more broadly invest in a different worldview or when they start to see the rich as enemies of the American worldview. Recently we saw politicians on the left attempting to take this approach by referring to American companies that were relocating overseas in order to pay lower taxes as unpatriotic and un-American. 

As I said before, everyone has the economic facts. They are reminded daily of the ever-growing wealth gap. But what everyone has yet to embrace is the idea that our collective economic worldview in this nation may be failing us. And it is when people start to truly embrace that idea and they no longer cling to such a worldview for psychological security that we will see the pitchforks really come out.

Photo: David Shankbone via Wikimedia Commons

Seeking a Balance in Feeding Children

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Is a sweet potato a vegetable? I recently had a heated discussion on this topic with a friend and fellow parent. The more I thought about it, the more I realized your answer to this seemingly innocuous question speaks volumes about your attitudes towards food. That the vegetable bona fides of the sweet potato can prompt a debate is also revealing about the food culture we inhabit today.

Eating decisions are more fraught than ever. The cornucopia of foods available to many of us is matched by the dizzying array of labels we apply to ourselves: Are you vegetarian? Vegan? Gluten free? Additive averse? Lactose intolerant? Avoiding refined sugars? Food preferences, for lack of a better name, have expanded exponentially. Once, the rules of eating derived largely from religious teaching. Kosher, Halal and Catholic statutes dictated what, how, and when foods could be prepared and consumed. Sects and communities may have adapted and interpreted those rules differently, but the basic dictates were a given, and the digressions from them were a matter of personal or familial choice.

As secularity and modern science gained traction, food rules became dictated as much or more by health concerns as by faith. Unlike religious rules, the quasi-science of nutrition is a quicksand of shifting studies and contradictory opinions. One day, a nutrient is In, and the next—to quote Project Runway—it’s Out. We can attempt to keep up with the rulings of the experts, but their authority is increasingly fragmented and multiple. To whom should we listen? Whom can we trust? Diverging from the mainstream on what’s considered “healthy” has begun to feel less like a matter of personal choice and more like a failure, while the mainstream simultaneously becomes harder to pin down.

Just like fashion, there are now entire industries predicated on these ever-fluctuating food and “health” trends; no sooner does one theory gain sway than there are business interests investing heavily in its staying power.

The ever-shifting winds of Food Fashion make feeding children especially complicated. As parents, we feel responsible for every aspect of our children’s lives; feeding, once purely a parental prerogative, now has us braving a maze of speculation, aspiration, and terror. If we feed our children the wrong things, they will be obese or malnourished. If we teach them bad eating habits, we’re kicking them down the path to illness and premature death. If they’re too thin as babies, we’ve failed. If they’re too fat at any other point of their lives, we’ve also failed. All these fears, nested in the poor state of Western food culture, have eroded parents’ competence at one of our most basic tasks: nourishing our children into healthy, happy adulthood.

The Sweet Potato Debate began with my friend’s bemoaning the lack of vegetables at a meal we were sharing. When I pointed out some roasted sweet potatoes, she said, “But a sweet potato isn’t a vegetable.” She clarified: to her, it is a starch rather than a vegetable, and as a parent she wanted some “real” vegetables for her kids. This friend is an excellent, compassionate mother, I hasten to add, and although I disagreed with her—I see a sweet potato both as a vegetable and a healthy food—the point is larger than our disagreement and more broadly applicable to parents, and ties into the confusion I see around me every day in parenting and food. How do we decide what foods and what meals are “healthy”?

While my friend and I both aim to feed our children a balanced diet, our interpretations of “balanced” differ. Her meals are carefully calibrated combinations of dishes that offer the building blocks of nutrition at every meal: proteins, starches, carbohydrates and fats in thoughtful and measured portions. She is far more likely than I to incorporate avocado into her brownies, or black-bean pasta into her mac-and-cheese. Her kids get choices of what starches or proteins they’d like, and she invests an admirable amount of time and care into thinking how best to serve their needs nutritionally.

My approach is much looser. I measure balance more on a weekly than a daily basis, and I don’t bother cooking the “healthy” foods my kids have roundly rejected (and I don’t like myself), like whole-wheat pasta. It’s likely a legacy of my older daughter’s pickiness as a baby that my main goal at any given meal is for my children to eat enough (preferably home-cooked, preferably whole) food to feel sated. That’s not to say I don’t have my own food biases: I’m definitely more excited when they try exotic flavors and global foods than I am by the health value of their meals. This is partly a selfish response—we can go out for ramen or sushi rather than just burgers or grilled cheese—but also reflects how I hope they think of food, now and as adults: as a cultural treasure trove and an opportunity for communal pleasure more than as a vehicle for either health or illness. As Laurie Colwin wrote in Home Cooking about a food craving she'd indulged, “My body may have been 
crying out for vitamins, but my spirit wanted red peppers.” 

Honestly, I can’t say whether my approach or my friend’s is superior. In truth, the two of us are more similar than not: we both consider the health consequences of what we feed our children, both favor whole foods, both have time and energy to ponder these finer points rather than having to worry whether our kids will go hungry. In many ways, ours are certainly “white people problems,” as one of my online commenters helpfully remarked. But the granularity of my friend’s nutritional thinking is quite different from my broad-brush method, and the contrast can be instructive: how do we teach thinking about food? Our children are young enough yet that we don’t know what kind of eaters they’ll be as adults, or how we will ultimately influence their choices. But if you’re wondering what kind of parent you are—or want to be—when it comes to feeding your children, I suggest you start by considering whether or not, to you, a sweet potato is a vegetable.

What I cooked this week and last:

Rings True: What’s the Role of Engagement Rings?

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If you liked it then you shoulda put a ring on it

                                                Beyonce, Single Ladies

Is Beyonce’s famous line sexist or what? What does it mean to put a ring on it? What if you put a ring on it and then wanted the ring off it?

Do you ever wonder about how certain cultural rituals developed? While marriage is a worldwide phenomenon, the customs around it vary tremendously by culture and era.  If I had another professional life to live, I could enjoy being an anthropologist studying marriage and family. Here, I want to talk about engagement rings, their history, and what is going on with the whole idea.

While engagement ring customs are not universal, there are universal aspects of marriage that include similar customs that govern courtship, rules about betrothal, and, of course, rules about how a promise to marry can be ended. The customs vary but they often have a lot to do with assuring true intention to follow-through.  

In an era where marriages are founded around the principles of intimacy and deeper connection, I believe that a central role that commitment is to secure romantic attachment. When there is intense attachment to another but unclear commitment, it makes most people anxious about the potential loss of the partner. When commitment is clear and mutual, commitment promotes a sense of safety in the connection and the future of the relationship. People relax and invest when there is a sense of both present and future safety. (And when there is not, they buy gold without diamonds in it, at least, economically.)

Some customs around romantic relationships represent the giving and receiving of emblems of commitment. These emblems serve the purpose of signaling security in commitment.  Enter the ritual of engagement rings. 

Matthew O’Brien, who usually writes about business and economics, wrote a piece awhile for the Atlantic about engagement rings: The Strange (and Formerly Sexist) Economics of Engagement Rings.  It’s an excellent piece. O’Brien notes how this custom is relatively recent, taking hold after a marketing campaign by N. W. Ayers on behalf of De Beers (a big diamond company).  This is fascinating, though it makes me feel about as warm and fuzzy as knowing that greeting card companies started some commemorative days I am emotionally attached to and celebrate. By the way, did I tell you when World Commitment-Related-Blog Day is? It’s coming up, but I have not set the exact date. I have to design a line of digital cards, first, that you can send to friends, for a fee, of course. If you’d rather just keep your schedule free from another day where something is celebrated, just send me 5 bucks and forget the card. US funds are preferred. Old diamond rings, no longer being used, are acceptable as well.

O’Brien points out that there used to be laws about the breach of a promise to marry (similar to how their used to be laws about the breach of promises made in marriage).  These laws allowed women to sue men for failing to follow through on marriage plans. Apparently, since even many decades ago, it was not uncommon for a couple to have sex before marriage, and virginity was highly prized when one became married, males could be forced to compensate females for reducing their value by having sex with them but failing to follow through on the promised marriage. Note the logic here. Women were more likely to give something of value to men in the context of the male promising commitment to the future.

You may have noticed that times have changed in a few respects here. O’Brien cites work by a legal scholar Margaret Brinig that supports the idea that the engagement ring (expensive engagement rings—with Diamonds, thanks to DeBeers’) became an actual custom performing the same function as the breach of promise laws just as those laws started to disappear. So, the legal obligation was replaced in some parts of society with an economic promise of forfeiture should a male not fulfill a promise about marriage he had made. Hence began the custom of the woman keeping the ring if the man bailed. These days, you’ll see plenty of debates in advice columns about if and when a ring should be returned based on how a marriage has been called off.  O’Brien seems to think this debate is over, but I’m not so sure it is. He considers it somewhat obvious that the woman would give the ring back to a man who did not follow-through on a promise to marry. I’m not so sure.  I know some people hate the gender stereotype stuff—and often for good reasons—but this is an area where there has been some rationale historically related to differences in men and women. In the rest of this post I want to raise some questions, explicitly, and then give an example of something that seems complex to me.

Q:  Why don’t women, historically, give something expensive to the man in case she changes her mind? Is this sexist in the pejorative sense of sexist = bad or is it sex-difference based in some rationale sense, whether one wants to think it good or bad, because of differences between men and women?  (I’ll come back to that question next time.)

Q: In the following vignette, should Tyra give the ring back to Sam? 

Sam and Tyra started dating when they met at age 26. They got engaged at age 27, and he gave her a really nice ring at that time.  Now they are 32. So, the engagement has gone on for 5 years.  I think this is a new trend, by the way, long engagements. For some, endless engagements reflect a desire to tell others they, as a couple, are more committed than average. That is, for some, it’s not as much a plan to marry as a way to signal this higher level of commitment to others—“we’re off the market but we may never really walk the aisle.” But for others, like Sam and Tyra, engagement meant they shared a serious intention to marry.  

Moving ahead. Now Sam and Tyra are 32, have been cohabiting for 4 years, and they are still engaged. Sam starts to fall for a woman at work, and the gravitational pull toward this new woman just grows and grows.  After some anguish and a lot of effort to work through untangling their lives, he achieves enough escape velocity to move on. There is a lot of inertia to cohabiting (and even more so with engagement), so it can take a lot of energy to move on.

Tyra is feeling VERY burned. Of course, the burning could have happened just as easily either direction, but in this case, Tyra felt that the engagement and the cohabiting were sure signs they were going to get married. As I’ve written in various places, the former is a lot stronger signal of commitment than the latter. Anyway, Tyra plans to keep the ring and she wishes it were bigger still.  Way bigger.

In his article, O’Brien suggest that women should generally give rings back in this day and age because they are increasingly likely to be the ones with the good jobs, and therefore, do not really need the collateral of the ring. While not stated, I would imagine he and many others would also not consider Tyra to have given anything more away than Sam has by them having sex and no longer being virgins.

At any rate, Tyra doesn’t feel like Sam owes her for her no longer being a virgin. She feels that this aspect of their relationship was mutual and not something to blame him about. And, while she's deeply hurt about him leaving her for another woman, that's not the biggest reason she feels he owes here, either. What she realizes she is most upset about is that Sam has, in her view, wasted years on biological clock. You might say she is "ticked" off. Tyra wants children and Tyra wants a nuclear family to raise those children in. Tyra has read a great deal about the biological clock and knows well what her odds are and how they have already changed. Thus, Tyra does believe she has lost something of value because she’s lost some of her window on one of her most deeply held life goals. So, does Tyra keep the ring? Should they have talked about the meaning of the ring in the first place, and what happens if things don’t go according to plan?

Next time, let’s look at the sex difference thing a bit more. If I have your number, I’ll give you a ring when I post it.  

 


Educational Accommodations for LD and Mental Illness

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For parents of children struggling with mental illnesses or learning disabilities, the return to school can be cause for panic. Parents of children with special needs frequently find that standard classrooms aren't equipped to meet those needs. This is where parents come in. It's your job to be a strong advocate for your child's rights, and understanding the basics of the various laws that protect children with special needs is a prerequisite to being a strong advocate for your child. Schools don't always do a good job of educating parents about their children's rights, and a few schools may even actively ignore the law. Knowledge is power, and if you are the parent of a special needs child, you need to know that your child is entitled to a quality education and reasonable disability accommodations.

Who Is Entitled to Accommodations?

Most disability laws are federal statutes, which means every disabled child is entitled to accommodations regardless of where in the United States he or she lives. Federal laws don't list a specific list of conditions that count as disabilities, and they make no distinction between physical and mental health disabilities. Instead, a disability is any condition that interferes with daily functioning, so the test of whether your child qualifies is not whether she has a specific condition, but how that condition affects her life. A child whose ADHD is well-controlled under medication and who experiences no academic difficulties might not qualify for accommodations, but that same child could qualify if her ADHD interfered with her ability to take tests or take notes in class.

What Accommodations Can My Child Get?

Children with mental health disabilities are entitled to three key rights:

• Freedom from disability discrimination – This right covers your child's right to freedom from discrimination, as well as her right to privacy. Children and their parents aren't required to disclose a disability, and students can't treat children differently by virtue of their disability. For example, excluding a child from recess based on her disability or requiring her to move to a different class would be discrimination. Schools can make accommodations—such as special classes—designed to help students who need it. But isolating a student purely based on her diagnosis, and not her need for help, is illegal. Courts have repeatedly ruled that children with disabilities have the right to unrestrictive educational settings, just like other children.

• Reasonable disability accommodations – Your child's school, under the Americans With Disabilities Act, is required to make “reasonable” accommodations that make it possible for your child to learn without fundamentally altering the educational experience. Examples of reasonable accommodations include a note-taker, extended test-taking time, a sign language interpreter, or a quiet room in which to take tests.

• An Individualized Education Program – Students with disabilities are entitled, under the Individuals With Disabilities in Education Act (IDEA) to an Individualized Education Program, usually just called an IEP. This document establishes specific educational objectives for your child and devises a program and list of disability accommodations designed to help your child learn.

The Procedure for Getting Accommodations

Many schools provide specific procedures for children seeking accommodations to receive them. You might have to provide specific documentation to the disability services coordinator at your child's school, for example. Generally speaking, schools can't limit disability accommodations. For example, your child's teacher can't refuse to provide accommodations just because you requested them in the middle of the year instead of the beginning. Schools can, however, request specific documentation from medical professionals. You'll generally have to show proof of your child's disability, and may have to provide information about his or her prognosis. The school cannot require your child to undergo specific treatment; that decision is up to you and to your child's medical provider.

If your school doesn't establish specific procedures for obtaining disability accommodations, you're still entitled to accommodations. Try contacting the guidance counselor or social worker at your child's school, or talking directly to your child's teacher. The National Alliance on Mental Illness publishes a helpful guide for parents seeking an IEP for their child. You can access that guide here.

Enforcing Your Child's Individualized Education Program

Receiving authorization for disability accommodations and implementing your child's IEP are just the beginning. Some parents find that schools don't always follow a child's IEP, or teachers ignore the accommodations to which a child is entitled. Some steps you can take to protect your child's rights include:

• Talking to your child in an age-appropriate way about his rights, and encouraging him to be a good advocate for himself.

• Planning a teacher-parent conference early in the year so you can review your child's IEP and clear up any misconceptions or address any disagreements.

• Carefully monitoring your child's grades and intervening early if you notice any problems.

• Documenting any and all challenges you encounter. Communicate in writing whenever possible, and save voice mails and other communications.

• Remaining friendly, but forceful. If your child's school ignores your requests, follow up and remind them of their obligations under the ADA and IEP.

If your child's school remains uncooperative, you may need to seek legal help. Disabled children are entitled to file lawsuits if their rights are violated, so consider contacting a lawyer who specializes in disability or mental health law if you experience difficulties enforcing your child's rights. Sometimes a strongly worded letter from an attorney is sufficient to get a school to cooperate.

References:

ADA overview. (n.d.). Retrieved from http://www.mentalhealthadvocacyinc.org/ada-overview

Americans With Disabilities Act and mental illness. (n.d.). Retrieved from http://www.womenshealth.gov/mental-health/your-rights/americans-d...

Archived: Guide to the Individualized Education Program. (n.d.). Retrieved from http://www2.ed.gov/parents/needs/speced/iepguide/index.html

Tudisco, R. (n.d.). ADD and your legal rights. Retrieved from http://www.additudemag.com/adhd/article/3611.html

Can You Ever Fully Recover From an Eating Disorder?

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A student came to interview me about my job and research interests the other day. She asked me to be her interviewee because she knew I was a disordered eating researcher and she herself was in recovery.

When she asked me why I got into disordered eating research, I went to the safe answer and told her about a former student athlete who came to my office in tears because she was being pressured by her coach to lose weight from her virtually fat-free body. This student’s experience motivated me to begin studying disordered eating in athletes. I branched out into general college and adult populations from there.

All of that was certainly true. But it’s not the only reason. The more we talked and the more my student interviewer discussed her struggles with her recovery, the more I understood I needed to come clean. I told her I had suffered from an eating disorder for 23 years. I told her about my denial of my problems for the majority of that 23-year period. About my justifications that I couldn’t suffer from an eating disorder – I was the researcher, not the subject, not the victim. That I had been lying to myself.

Then she asked me the hardest question for any ED patient to answer: Are you recovered?

Are you ever?

I’ve had this conversation with several professionals and ED sufferers. Everyone seems to agree that you can be “in recovery,” but are you ever really recovered? That’s a tough question to answer; and that’s what I told her.

Do I restrict calories anymore? Not very often.

Do I think about it? Yes. Every time I experience something that feels like a whopping error in judgment or a big mistake on my part sets off the “you screwed up and must punish yourself” alarm. My m.o. for the past 23 years when that alarm goes off has been to restrict calories and/or increase my exercise.

Do I restrict food groups? As of late, yes. When the stress piles on, my digestive system is much less tolerant of the foods I used to restrict when I was at the height of my eating disorder. So foods I had been able to work back into my diet (like cheese) are back out. It’s either I restrict those foods or I bloat and have stomach cramps. Then the voice in my head wonders: is this a real thing (e.g., is this food really a problem for you) or is this my eating disorder in disguise? It’s hard to tell sometimes.

Do I exercise excessively? Sometimes. Not like I used to. Gone are the days of 20-something mile runs. The heel that I broke twice in a year can’t handle them anymore. Do I work out a lot? Compared to most people, yes. Do my workouts increase in frequency or duration as the stress piles on? Yes. I call it a coping mechanism rather than eating disordered mentality. But then that’s what an eating disorder is, isn’t it? A coping mechanism gone awry?

My student interviewer and I chatted about how eating disorders are perceived by the general public. Like many other mental health issues, people often believe you should be able to stop. Just like that. Flip a switch and turn off your eating disorder or depression or whatever it is you struggle with. She confessed that her parents still didn’t understand that this wasn’t a choice she had made. That being mired in the depths of her eating disorder wasn’t something she really wanted to do. They didn’t understand why she couldn’t stop.

A colleague of mine, Becky Henry, wrote a fabulous book called Just Tell Her to Stop– a tongue-in-cheek title alluding to the fact that many friends, family, and significant others really don’t understand that eating disorders are a coping mechanism. Like those who choose smoking or alcohol as a way to cope with their stressors, eating disorder sufferers have a difficult time quitting. When your eating disorder has been your primary coping mechanism for 10 or 20 years, you can’t simply stop. How will you cope with the stress of ‘quitting’ your eating disorder if the eating disorder has been the way you cope?

As I tell my students, when you’re trying to replace a not-so-healthy habit with a healthier one, you have to have a plan B. If alcohol or smoking or eating disordered thinking is your coping mechanism of choice, you’d better replace that with something else before you try to give it up. Otherwise, the first time a stressor arises after you’ve ‘quit’ you’re likely going to go back to what you know.

I have certainly been my own example of this the past two weeks. As the stress of being back in school full time and major household repairs keep piling on, the ED voice in my head has increased its whispers. And yes, I took my own advice and came up with a Plan B and C and D! ED is nothing if not a persistent little bugger, despite my attempts to cope in other, more healthy, ways.

This is why I wonder if you can ever truly be recovered from an eating disorder. I’d love to hear your thoughts on this. Has anyone ever been able to say, “Yes, I had an eating disorder and I am fully recovered?” Or is it more of, “I had an eating disorder and I am in recovery and always will be?” What do you think? Please share your thoughts in the comments below.          

 

 

Awakening to Ourselves As We Are

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The renowned psychologist Carl Rogers famously said, “The curious paradox is that when I can accept myself just as I am, then I can change.”

This statement is as simple as it is profound, but not easy to implement. Yet it embodies a principle that is a key to both psychological health and spiritual growth.

Mindfulness practice is a well-researched method that derives from Buddhism; it is now used widely in hospitals and secular settings to reduce stress and improve immune functioning. The essence of mindfulness is to be present to our experience just as it is without judging ourselves. This echoes Rogers’s wisdom that we need to accept ourselves as we are rather than try to fix and change ourselves.

Our conditioning prompts the struggle to eliminate our flaws, jettison uncomfortable feelings, and muscle our way into a place we deem more pleasant and less disruptive to our flattering self-image or where we’d like to be. Our instinctual fight, flight, freeze response orients us to avoid real or imagined threats to our safety and well-being. This neurological wiring has ensured mammalian survival — and eventually us — over millions of years. It operates on autopilot in ways that propel us toward safety, but left unchecked it may undermine the more soulful aspects of our humanity.

Mindfulness offers a specific and helpful way to accept, know, and value ourselves by inviting us to pause, go inside, and notice what we’re experiencing from moment to moment. As I explain in Dancing with Fire:

Mindfulness practice means gently attending to our experience and inquiring deeply into ourselves. We meet life as it presents itself from moment to moment. We vividly experience what is alive now — the play of breath as it enters the nostrils, the melodic chorus of birds in the distance, a tightness in our stomach as we remember an awkward moment, a shudder of apprehension regarding a health issue. We make space for the full range of what is, rather than how we’d like things to be. We bring a gentle presence to the ever-changing stream of sensations, feelings, thoughts, sounds, sights, or whatever happens to present itself. In short, we become intimate with this ever-changing precious moment.

Rather than conclude that something is wrong with us for having troubling thoughts or feelings, we simply acknowledge and attend to whatever we happen to notice. Psychologist and meditation teacher Tara Brach calls this attitude, radical acceptance. This attitude is enormously freeing. We pause long enough to meet and greet our experience as it is.

Accepting ourselves includes accepting and embracing our experience as it is. Expanding our tolerance for our experience just as it is, we may observe how things come and go. Whatever we happen to be experiencing, including unpleasant feelings, tend to pass as we relate to them in an accepting, friendly way. We may then notice a settling of our experience.

Things calm down inside as we no longer succumb to the reactive mode of fighting or fleeing from our experience — that is, from ourselves. The path forward is awakening to ourselves as we are. This includes opening to both and unpleasant feelings and sensations that are a part of being human.

As such experiences arise and pass away, we may tap into a deep pool of stillness that has been long neglected. Some spiritual teachers call this our “true nature” — a deeper and truer sense of who we really are, which exists below the daily dramas and trials of our lives.

Being with the full range of ourselves experience without clinging to anything or pushing anything away is a path toward loving ourselves. Also, as we awaken to ourselves as we are, we then have a more true and authentic self to show others, which creates a foundation for love and intimacy in our lives.

© John Amodeo

For more on bringing mindfulness to all aspects of relationships, please see Dancing with Fire: A Mindful Way to Loving Relationships.

Flickr image by Hans-Peter

 

Internet Trolls Are Narcissists, Psychopaths, & Sadists.

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In this month's issue of Personality and Individual Differences, a study was published that confirms what we all suspected: internet trolls are horrible people. 

Let's start by getting our definitions straight. An internet troll is someone who comes into a discussion and posts comments designed to upset or disrupt the conversation. Often, it seems like there is no real purpose behind their comments except to upset everyone else involved. Trolls will lie, exaggerate, and offend to get a response. 

What kind of person would do this?

Canadian researchers decided to find out. They conducted two internet studies with over 1,200 people. They gave personality tests to each subject along with a survey about their internet commenting behavior. They were looking for evidence that linked trolling with the Dark Tetrad of personality: narcissism, Machiavellianism, psychopathy, and sadistic personality. 

They found that Dark Tetrad scores were highest among people who said trolling was their favorite internet activity. To get an idea of how much more prevalent these traits were among internet trolls, check out this figure from the paper:

 

 

 Look at how low the scores are for everyone except the internet trolls! Their scores for all four terrible personality traits soar on the chart. The relationship between this Dark Tetrad and trolling is so significant, that the authors write the following in their paper:

"... the associations between sadism and GAIT (General Assessment of Internet Trolling) scores were so strong that it might be said that online trolls are prototypical everyday sadists." [emphasis added]

Trolls truly enjoy making you feel bad. To quote the authors once more (because this is a truly quotable article):

"Both trolls and sadists feel sadistic glee at the distress of others. Sadists just want to have fun ... and the Internet is their playground!"

So next time you encounter a troll online, remember a few things. (1) These trolls are some truly messed up people and (2) it is your suffering that brings them pleasure, so the best thing you can do is ignore them. 

References

Buckels, Erin E., Paul D. Trapnell, and Delroy L. Paulhus. "Trolls just want to have fun."Personality and Individual Differences67 (2014): 97-102.

Photo adapted from original by Kevin Dooley

Why Addicts Relapse After Going to Treatment

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Ignoring the most important part of aftercare:

I am amazed by the number of people who spend a month or more in either an inpatient or an intensive outpatient treatment setting but then, after all that time and money spent, fail to follow-up with recommended aftercare. Aftercare plans, usually several carefully prepared pages, are written, disseminated, and discussed with recovering addicts for a very good reason - they outline the path to continued sobriety and a healthy, happy life. Ignoring any element of an aftercare is never a good idea.

These highly individualized plans typically include personalized information about coping skills and support resources addicts can utilize when they are back in the “real world” and triggered toward relapse. Nearly always there are recommendations for group support, as it is well-known that addicts don’t heal well in a vacuum. Instead, addicts need ongoing advice, feedback, and support from their peers (fellow addicts) if they hope to maintain the sobriety established in formalized treatment. Unfortunately, this critical element of the healing process is the aftercare recommendation addicts are most likely to skip. Usually recovering addicts are perfectly willing to continue with individual therapy and take medications (if any have been prescribed), but outpatient group therapy, twelve step recovery groups, and other peer-to-peer support networks are often ignored, even though these milieus provide much needed empathy, support, and day-to-day advice and assistance.

The importance of a supportive peer-to-peer healing environment:

For long-term sobriety and emotional healing, recovering addicts must overcome shame about their early-life traumas and their adult addictive behaviors. This best occurs in peer support settings, where addicts learn that their early-life issues and their maladaptive adult coping responses (including but not limited to addiction) are not unique. Knowing they are not alone in their battle is incredibly helpful in terms of reducing the guilt, shame, and remorse they often feel (all of which can be triggers for relapse).

Peer support groups are also an ideal setting for confronting the rationalizations, minimizations, and justifications (the denial) that addicts use to make their addictive behaviors okay (in their own minds). Peer confrontations about denial are powerful not only for the individual being confronted, but for the addicts doing the confronting. These interactions let everyone present see how rationalizations and justifications sustain active addiction and potentially lead to relapse. Perhaps most importantly, these supportive settings are where addicts talk and learn about the interventions and coping skills that work best in specific situations.

Typically, aftercare plans recommend peer support settings with the following elements:

  • Emotional safety and stability among the members
  • Peer similarity with addictive issues and, if possible, life circumstances
  • Consistent gatherings in a safe, stable environment
  • A focused, goal-oriented agenda related to sobriety and finding ways to enjoy life
  • High levels of behavioral accountability
  • The option to find a specific person with whom the recovering addict can share intimately (but not romantically) about whatever is going on in his or her life

These support settings may include “smart recovery” programs at treatment facilities, outpatient addiction-focused therapy groups, twelve step support groups, online support groups, and various other support environments, including church-sponsored support groups. Many peer support settings are facilitated by therapists or clergy members; others are simply structured groups run by the members. The recovering addict is usually accountable to the group itself, and also to either the facilitator or a specific member of the group (such as a sponsor in a twelve step group). Ultimately, these groups help addicts to not only maintain their sobriety, but to live life on life’s terms. In other words, these settings are where addicts committed to healing develop emotional maturity and stability, which helps them to become more functional in life and to find both serenity and joy.

Among the choices for peer support in recovery, twelve step groups are among the most useful, readily available, and affordable. These groups have helped millions of willing people recover from alcoholism, drug addiction, gambling addiction, compulsive spending, eating disorders, sex and love addiction, and other addictive and/or compulsive disorders. Even chronic mental health clients can find twelve step assistance in Emotions Anonymous.

Why do addicts resist peer-to-peer healing?

Recovering addicts resist and avoid the healing potential of peer support groups, facilitated or otherwise, for an almost infinite number of reasons. A few of the most common include:

  • Fear of getting pulled in with no control (like joining a cult)
  • Fear of or negative feelings about religion (not wanting to be part of a group where “God” is part of the healing process
  • Lack of religious direction (not wanting to be part of a group where religion is not a strong element, or where the word “God” can be interpreted by the individual)
  • Social anxiety and/or social avoidance
  • Fear of being seen and then talked about later, outside the group, as a person who has a particular problem
  • It is a reminder of “being sick” and therefore it reinforces shame
  • Fear of being “hit on” sexually at meetings
  • Fear of being affiliated with or becoming like the “losers” and “criminals” and “degenerates” who attend such groups
  • Fear of failing in a public/group setting
  • Fear of switching one addiction for another (going to meetings all the time)

You may have noticed that the main reasons for not attending peer support groups boil down to religious distaste, fears about the lack of privacy, and various forms of social anxiety.

  • Religious distaste: Many peer support groups do have a spiritual component. For instance, twelve step recovery groups use phrases like “higher power” and “a power greater than ourselves” to help addicts put their faith in something beyond their own best (i.e., worst) thinking. The word “God” is used as well, usually followed by the words “as we understand God,” creating a lot of leeway for those who struggle with organized religion and the “God of their childhood.” Importantly, these references to higher power and God are not in any way directed toward a specific religious or belief system. In twelve step groups, recovering addicts are free to believe (or not believe) whatever they want. This, of course, can be a turn-off for some recovering addicts, particularly those with strong religious beliefs. The good news here is that many churches have addiction support groups that incorporate their specific religion. There are even peer support groups for atheists and agnostics.
  • Lack of privacy: It’s a bit ironic that the same people who stumble drunkenly through bars and parties, get arrested for drunk driving or possession of illicit drugs, post nude pictures of themselves on dating sites and smartphone hookup apps, and engage in other similarly public behaviors will balk at the idea of walking into an addiction support group, worried that someone might see them and therefore know they have a problem. While it is true that peer support meetings are typically not bound to the same level of confidentiality as individual therapy, the vast majority of participants are nonetheless committed to anonymity as a part of their own healing process. Sometimes it helps to remember that if someone sees you at a peer support group, he or she almost certainly has the exact same problem and doesn’t want to be gossiped about any more than you do.
  • Social anxiety: This is an equally invalid excuse for avoiding peer support. Usually, other than introducing yourself by your first name only (and perhaps self-identifying as an addict who “qualifies” for the group), participation is entirely voluntary. No one will make you talk about anything you don’t wish to divulge. Usually, over time, as you develop trust and empathy with fellow group members, this fear of sharing and “being known” goes away.

Sadly, avoiding peer support, which is perhaps the most essential portion of aftercare planning, often leads to relapse. I can’t even begin to tell you how many times I’ve heard a client say, “I can’t believe I relapsed. I’ve been doing everything I’m supposed to be doing except I’m not going to those meetings.” I also can’t begin to tell you how many times the clients who don’t want to attend peer support groups but do so anyway end up saying, “What was I so afraid of? Going to my support group is the best part of my week. I actually look forward to it. And now that I’ve made friends with people who are dealing with the same issues, it’s much easier and a lot more fun to stay sober.”

 

Robert Weiss LCSW, CSAT-S is Senior Vice President of Clinical Development with Elements Behavioral Health. He has developed clinical programs for The Ranch outside Nashville, Tennessee, Promises Treatment Centers in Malibu, and The Sexual Recovery Institute in Los Angeles, among others.An author and subject expert on the relationship between digital technology and human sexuality, he has served as a media specialist for CNN, The Oprah Winfrey Network, the New York Times, the Los Angeles Times, and the Today Show, among others. For more information you can visit his website, www.robertweissmsw.com.

Have We Become Addicted to Violence?

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A young woman knocks at the door one night asking for help because she’d been in a car accident--shot to death by the man inside, who says he was afraid. A troubled young man walks into a movie theater, shooting everyone in sight. Our nation’s colleges, high schools, and elementary schools from Columbine to Virginia Tech to Sandy Hook are scenes of violent mass murders.

Beneath much of this violence is fear: fear of one another, fear of not getting our needs met, fear of losing control in an increasingly unstable, dangerous world.

With remarkable prescience, community action lawyer Allan Luks wrote of the “growing, unprecedented level of fear and tension that now prevails among residents of American cities—and is spreading from our cities to all areas of the country. This increasing violence among us may well be the most severe test ever of our strength and even of our ability to hold together as a nation” (1991, p. 204).

For Luks, one way to heal this violent epidemic is by rebuilding trust and community. We have become a nation of strangers. Most of us don’t know our neighbors, subsisting on an artificial diet of celebrity gossip and sitcoms, tweets, texts, and the alarming news of the day.

In their riveting new book, Stop Teaching our Kids to Kill, Gloria DeGaetano and Lt. Col. David Grossman connect this epidemic with our daily diet of media violence. They point out that America’s children spend 40 hours a week—the equivalent of a full-time job—watching violent entertainment on TV, in movies, and actively participating in violent video games. “Media violence primes children to see killing as acceptable,” they explain (2014, pp. 2-3). In a process known as “social modeling,” psychologist Albert Bandura found that we learn our values and behavior from the people around us (2003). Social modeling includes our cultural memes: what we watch and read, even the games we play.

Our technological gadgets are ingenious, ubiquitous--and incredibly addictive, according to neuroscientist Robert Numan (2014). Many of them model behavior on screen that would be diagnosed as pathological. With alarming evidence, Grossman and DeGaetano (2014) describe how grisly scenes from recent violent films, TV programs, and video games have led children to imitate in real life the sadism they see on screen.

Research has shown that the first step in effective change is becoming aware of the problem (Prochaska, Norcross, & Diclemente, 2002).  Grossman and DeGaetano’s book not only points out a root cause of this violence, it offers practical advice for parents: age-appropriate media literacy activities for children to counter media violence and a set of resources for protecting our children online.

Now it’s your turn. What are you doing and what do you recommend to help heal our national epidemic of violence?

References

Bandura, A. (2003). On the psychosocial impact and mechanisms of spiritual modeling.    International Journal for the Psychology of Religion, 13, 167-173.

Grossman, D. & DeGaetano, G. (2014). Stop teaching our kids to kill (Rev. Ed). New York, NY: Harmony Books.

Luks, A. (1991). The healing power of doing good: The health and spiritual benefits of helping others.  New York, NY: Fawcett Columbine.

Numan, Robert (September 12, 2014). Personal communication, Santa Clara University, Santa Clara, California.

Prochaska, J. O., Norcross, J. C., & Diclemente, C. C.(2002). Changing for good. New York, NY: HarperCollins.

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Diane Dreher is a best-selling author, personal coach, and professor at Santa Clara University. Her latest book is Your Personal Renaissance: 12 Steps to Finding Your Life’s True Calling.

Follow Diane on Twitter: Diane Dreher (@dianedreher) on Twitter

Like Diane on Facebook: Diane Dreher | Facebook

 

Say and Mean These Three Words To Fall Back in Love

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To fall back in love, you and your partner really need to truly know and understand each other. Doing this rebuilds trust and emotional safety. 

When we show empathy to our intimate partners, we are saying (and demonstrating) three powerful words: "I Understand You."

Empathy is not something that drains or depletes us or our partners. Sympathy can be draining, but not empathy. Sympathy leads us to feel we have to do something. Empathy empowers us by a special sense of togetherness and connection that is formed by powerful mutual shared identification for the one you love.

So loving someone automatically means being empathetic with them, right?

Not necessarily. According to the Merriam-Webster dictionary, the term, "love" can mean: 1) strong affection, 2) warm attachment, 3) attraction based on sexual desire, 4) a beloved person, 5) unselfish benevolent concern for others, and, last but not least, 6) a score of zero in tennis.

Based on these definitions and my own experience working with couples, love does not necessarily include empathy. Think about how some divorced people may still love one another, but never could understand each other!

When it comes to intimate relationships, no matter how much love there is between you and your partner, there’s no guarantee that you both will be able to empathize—even if you think you’re "soulmates." So unless you want to end up in your intimate relationship, with "love" as in tennis—one big zero—I am asking you to carefully pay attention to what I share about how crucial empathy is for relationships to thrive.

I have never had someone come into my office and say, "My problem is that my partner understands me too much." Developing empathy for your partner means really understanding what life has been and is like for him or her. Empathy is not some mystical power. It is not magic, intuition, or just the "warm fuzzies." And make no mistake, empathy is not mind-reading. But, it may just be the next best thing to mind reading in relationships.

Bridge the Gaps of Understanding in Your Relationship

We've all been on the receiving end of empathy. It feels really good, doesn't it? Think of the teachers and bosses you worked hardest for. Chances are, you felt that they connected with you and powerfully understood you. We feel motivated when we feel understood. Our intimate partners, especially, since these are our most powerful emotional bonds, feel motivated when they perceive that they are understood, as well. Empathy, the ability to powerfully understand another person, is invaluable, for that matter, in every human relationship. I have seen incredible positive changes occur between fathers and sons, mothers and daughters, siblings, and, of course, intimate partners who learn and apply this critical skill.

I describe in my book, Why Can't You Read My Mind?, how empathy as “emotional glue” for couples. I also think of empathy as a bridge that connects one partner to the other. Each of you as partners grew up with their own unique experiences and expectations. Being empathetic is the best way to bridge the gap of your differences. This bridge, when strong, can withstand the inevitable pounding forces of stresses on the relationship, including the demands of children, time, work, financial, and other pressures. In a truly mutual intimate relationship, which means a partnership of shared understanding, partners are stimulated and energized by genuinely empathizing with one another.

 

Dr. Jeffrey Bernstein is a psychologist with over twenty years experience specializing in child, adolescent, couples, and family therapy. He holds a Ph.D. in Counseling Psychology from the State University of New York at Albany and completed his post-doctoral internship at the University of Pennsylvania Counseling Center. He has appeared on the Today Show, Court TV as an expert advisor, CBS eyewitness news Philadelphia, 10! Philadelphia—NBC and public radio. Dr. Bernstein has authored four books, including the highly popular, Why Can't You Read My Mind? (Perseus Books, 2003) 10 Days to a Less Defiant Child(Perseus Books, 2006) and 10 Days to Less Distracted Child (Perseus Books 2007). 

 


Domestic Violence and Child Abuse in the NFL

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“This is bigger than a football game.”

-Al Franken

Currently, there are four players in the NFL who have been charged with either domestic violence or child abuse. While there are many important issues related to these cases, including how the NFL handled the situation, in this article I am going to focus on but two aspects: 1) how they highlight the fact that shame is at the core of abusive behavior, and 2) how a lack of compassion for self and others is one of the many long-term effects of having suffered abuse in childhood. I will use the cases of Adrian Peterson and Ray Rice to illustrate my points.

Professional therapists and trauma experts know that those who were abused in childhood often repeat the cycle of abuse by becoming abusive themselves. About 30 percent of abused and neglected children will later abuse their own children (U.S. Department of Health and Human Services 2013). And many who work with those who abuse others are finding that these clients are typically filled with shame. In fact, experts such as myself are now realizing that former victims who become abusive do not need “anger management” as much as they need “shame management.”

Shame is the source of cruelty, violence, and destructive relationships, and is at the core of many addictions. It can damage a person’s self-image in ways no other emotion can, causing him to feel deeply flawed, inferior, worthless, unlovable. If someone experiences enough shame he can become so self-loathing that he becomes self-destructive or even suicidal. He can also become abusive.

Shame is a natural reaction to abuse. This is because abuse is by nature humiliating and dehumanizing. There is a feeling of being invaded and defiled, and the indignity of being helpless and at the mercy of another person. This feeling occurs most profoundly in the case of child sexual abuse, but it occurs with all forms of abuse. For example, physical abuse is not only an assault on the body, it is an insult to the victim’s integrity. No one has the right to attack our body—it is a violation. Emotional abuse has been described as “soul murder” (Hirigoyen 2000). Constant criticism, name-calling, belittling, unreasonable expectations, and other forms of emotional abuse can be just as harmful and just as shame-inducing as physical or sexual attacks; some experts, including myself, believe that the negative effects of emotional abuse can last longer and have more far-reaching consequences than other forms of abuse. Neglect can also create shame in a child, causing her to think, “If my own mother doesn’t love me enough to take care of me, I must be worthless.” How else can a child interpret being neglected or abandoned by a parent?

Victims of childhood abuse also tend to feel shame because, as human beings, we want to believe that we have control over what happens to us. When that is challenged by a victimization of any kind, we feel humiliated. We believe we should have been able to defend ourselves. This is particularly true of male victims. And because we weren’t able to do so, we feel helpless and powerless. This powerlessness leads to humiliation and to shame. 

A person who was deeply shamed in childhood, especially if he was shamed by being abused by a parent, can become so full of shame that it is overwhelming and even unbearable. Therefore, he looks for ways to rid himself of this debilitating shame. A common way to accomplish this is to project shame onto someone else. This can take the form of viewing others in a critical, contemptuous way or by becoming emotionally, physically, or sexually abusive.

If a parent was deeply shamed as a child due to physical abuse by a parent he may unconsciously project that shame onto his own child and justify this by telling himself that the child needs to be punished or “taught a lesson.” This punishment tends to be extreme and severe, having little relationship to what the child actually did.

Shame can also manifest itself by a parent having unreasonable expectations of his or her child—unreasonable in the sense of him expecting behavior or knowledge that are beyond the child’s ability, skill, or emotional maturity.

In cases where a simple correction might be in order, a parent who is full of shame is likely to go overboard by strongly chastising the child, humiliating the child, or physically abusing him. In Adrian Peterson’s case, one has to wonder what a four-year-old could possibly have done to warrant the severe beating he received—a beating that caused visible cuts, lacerations and bruises.

 “There is no more humiliating experience than to have another person who is clearly the stronger and more powerful take advantage of that power and give us a beating.”

-Gershen Kaufman, Ph.D.

It is especially shaming to a child when a parent abuses him, violating his body and integrity. Physical abuse in particular sends the message that the child is “bad” and therefore “unlovable.” Children want to feel loved and accepted by their parents more than anything. And because parental love is so important, children will make up all kinds of excuses for a parent’s behavior—even abusive behavior. Most often the child ends up blaming himself for “causing” his parent to abuse him, thinking, “If I had just done what she asked me to she wouldn’t have gotten so mad,” or, “I know I’m a disappointment to my father—no wonder he has to get on me all the time.”

Victims of physical abuse often feel they disappointed their parent or other authority figure and thus deserved to be chastised or even beaten. Many of my clients who were severely physically abused argue with me when I call what happened to them “abuse.” I’ve heard everything from “You don’t know what a terror I was. My mother could only control me by hitting me with that cord” to “I deserved every beating I got. My father was just trying to teach me to be a man.”

In addition to the shame perpetuated by believing the abuse was their fault there is the shame associated with the violation itself. This is the shame that comes from feeling rejected and abandoned by an adult who one loves and desperately wants to be loved by. Facing up to the truth—that they were powerless and helpless or that they were abandoned by someone they loved—is so painful and frightening that many simply refuse to do it.

There are certain tendencies that those with a history of having been abused have when it comes to how they view and treat their children, including: an inability to have compassion toward their child, a tendency to take things too personally (causing them to overreact to their children’s behavior), being overly invested in their children looking good (and themselves looking good as their parent) because of a lack of self-confidence, and an insistence on their children “minding” or respecting them to compensate for their own shame or lack of confidence.

And there is another reason, not often discussed, that can cause a parent to become abusive: seeing their own weakness or vulnerability in their child. Those with a history of having been victimized may respond by hating or despising weakness. If they see weakness in their child, they may have been reminded of their own vulnerability and victimization and this may have ignited self-hatred, causing them to lash out at their child. (This phenomena can be likened to what causes bullies to attack other children).

When Adrian Peterson stated that he was just doing to his son what was done to him he was no doubt telling us the truth. We know that child abuse, especially physical abuse, gets passed down from one generation to another. But when he stated he didn’t intend to hurt his son, but only wanted to discipline him, he probably wasn’t telling the whole truth. I’m not saying he was lying to us—it is far more likely that he was lying to himself. Although I don’t believe he was consciously trying to hurt his son, on an unconscious level I believe he was taking his anger and rage out on his child—the repressed anger he likely felt because of his own abuse. Like so many victims of child abuse, he was passing onto a weaker person the abuse he had suffered. As the one who was now in power, he was trying to rid himself of the shame and humiliation he had felt at the hands of his parent.

Rage comes naturally and spontaneously when someone is shamed. It serves as a self-protective measure to protect the self against further experiences of shame. It also serves as a way to actively keep others away. But whether held inside or expressed openly, rage serves the purposes of defending and may also, secondarily, transfer shame to another—in other words, making someone else feel shame in order to reduce our own shame.

In his masterpiece on shame, Shame: The Power of Caring (1992), Gershen Kaufman, Ph.D., an expert on shame, conceptualized a variety of shame-based syndromes rooted in, and organized around the effect of shame. One such disorder, caused by physical abuse, is rooted in powerlessness and humiliation.

“Repetitive beatings are a recurring source of shame for children whose parents cannot control and otherwise safely discharge their own mounting rage. Parental rage, which triggers the enactment of a scenario involving physical abuse, itself is a part of the unfolding drama. Parents who physically abuse their own children were typically themselves abused when young. They felt equally humiliated, and continue to live with unresolved shame in their lives. Children of shame-based parents will inevitably activate their parents’ shame, and the cycle repeats itself with shame passed from generation to generation” (p. 181).

“Parents who are about to abuse their own children are simultaneously reliving scenes in which they were also beaten, but they relive the scene from the perspective of their own parents as well. They now play their parents’ role, thereby recasting the scene. The internal image of the abusive parent mediates the process” (p. 182).

Denial Leads to Lack of Compassion

As those who work with victims of child abuse can attest, victims of child abuse typically deny they were abused and repeatedly defend their abusive parent’s actions. These behaviors serve the function of preserving the child’s primary attachment to his parents, even in the face of daily evidence of malice or indifference. According to trauma expert Judith Herman, M.D., the abuse is either walled off from conscious awareness and memory, so that it did not really happen, or minimized, rationalized, and excused. Unable to escape or alter the unbearable reality in fact, the child alters this in his mind.  

But not all abused children have the ability to alter reality through denial, minimization or dissociation. As Judith Herman explained in her book, Trauma and Recovery:

“When it is impossible to avoid the reality of the abuse, the child must construct some system of meaning that justifies it. Inevitably, the child concludes that her innate badness is the cause. The child seizes upon this explanation early and clings to it tenaciously, for it enables her to preserve a sense of meaning, hope, and power. If she is bad, then her parents are good. If she is bad, then she can try to be good. If, somehow, she has brought this fate upon herself, then somehow she has the power to change it” (p. 103).

In all likelihood, Adrian Peterson wouldn’t have beaten his son with a switch if he had not been in denial about his own abusive experiences and if he had been able to have some compassion for himself about how he had suffered.

He wouldn’t have wanted to beat his son if he had been able to admit to himself how the beatings he experienced had left him feeling humiliated, inadequate and worthless. He wouldn’t have felt compelled to pass on the shame to his son if he had the ability to empathize and feel another’s pain. Instead, he did what so many victims do. In order to protect his dignity and prevent himself from ever being shamed again, he built up a defensive wall. He hid his feelings of vulnerability and weakness and pain and closed off his heart in order to avoid any further emotional wounding.

Instead of defending his father and fooling himself into believing that the beatings he suffered kept him on the straight and narrow and helped him to become a successful football player, Adrian’s salvation lies in admitting that while his anger and rage may have made him hard enough and tough enough to tackle other men, it also made him too hard to have compassion for his 4-year-old son, even as he cried out in pain, even as his tender little body began to tear and bleed.

And while we don’t know Ray Rice’s history, we can surmise that he, too, has closed his heart and built up a defensive wall to keep his pain and vulnerability safely hidden, most likely due to experiences of childhood abuse or trauma. We can assume this, not just because he knocked his then fianceé out cold but because at that moment, when he realized he had really hurt her—possibly critically—he didn’t kneel down to say, “I’m sorry honey,” or even, “Are you okay?” He didn’t lift her up in his arms to take her to get help or even to put her on a comfortable couch or bed. He bent down and grabbed her legs and dragged her halfway out of the elevator. He didn’t even show her enough respect to pull her dress down. Instead he let her lie on the ground while he talked to someone else. What kind of a person does that to anyone—much less someone he supposedly loves? What kind of a man not only hits his fianceé so hard that he knocks her out but doesn’t show any concern for her or any remorse? The answer: someone who had closed off his heart, someone who has no empathy or compassion for the suffering of others.  

Carrying around debilitating shame is like being weighed down by a heavy burden. And defending against the shame doesn’t make it disappear—it continues to fester like a wound that won’t heal. So how does one heal debilitating shame from childhood abuse? By facing their shame, not running from it. As much as it hurts to come out of denial and face the truth about the abuse and their abuser, it hurts even more to keep carrying the shame caused by blaming themselves. 

Those who have become abusive need counseling to help them through the process of coming out of denial, expressing their anger and rage in appropriate ways, and perhaps most importantly, learning to have compassion for their own suffering.

 

As their ability to be self-compassionate continues to grow, they will discover that their compassion for others will grow as well. When they stop ignoring their own pain and suffering and begin comforting and soothing themselves in times of trouble, they will find that their capacity to care for the suffering of others will increase. .

 

Those who have become abusive are notorious for not having empathy or compassion for others, especially their victims. But once they no longer have to work as hard to defend against their shame, they will be able to take their blinders off and actually see other people’s pain and suffering—including the pain and suffering they have caused.

 

This increased capacity to have compassion for others will, in turn, make them far less likely to re-offend. Once much of their shame has been eliminated, they can afford to face themselves much more honestly, including admitting when they have been abusive in the past and catching themselves when they start to become abusive in the present.

 

 

I have written a book that will be coming out in January entitled, It’s Not Your Fault: Healing the Shame of Childhood Abuse through Self-Compassion. In it I help those who were abused in childhood to stop blaming themselves for their abuse and to learn how to have compassion for their suffering. In Part II of this article I will share with you how teaching self-compassion to those who have become abusive (as well as those who have become self-abusive or established a victim pattern) can not only help former victims to heal but help them to break the cycle of abuse.

You—Yes, You—Can Save a Life

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It's been the summer from hell, and if it were up to me I'd be dead twenty times over.  But to my amazement I'm still here.  My survival is the result of several extraordinary kindnesses, which I think deserve to be noted.  We can all learn from what happened to me:  not only is suicide preventable, but it's within the reach of every one of us to change the course of a life.

For several years, I've been struggling financially—it's a painfully long time between book advances if you really want to write a decent book.  The burden of trying to make ends meet without any income finally overwhelmed me in April, and I was diagnosed with a severe peptic ulcer.  It felt like my own body was attacking me—exploding incendiary bombs in my stomach that peppered my insides with molten shrapnel.  "You have to reduce your stress," my doctor said.  I just nodded.

Shortly after the ulcer my dermatologist found skin cancer on my face, which required reconstructive surgery and left a nasty, jagged scar.  All of which was enough to upset even the most balanced mind.  But the worst was yet to come:  right after I was diagnosed with the cancer, the man I'd loved for thirty-five years left me—without a word, without any warning.  One minute he was reassuring me via voicemail that he was still in my life; the next he was refusing to answer my calls.  Or my emails.  Or my texts.  To this day, I haven't heard a word from him.

This combination of events was just too much for me:  I spiraled down into a vicious depression, so profound I could barely move.  I replayed my relationship over and over, trying to make sense out of incomprehension.  The more I thought about it, the deeper my despair became.  It boiled down to this:  If the world could be so heartless and cruel, I didn't want to be a part of it anymore.

My support team did what they could.  My therapist phoned me every day.  My psychopharmacologist prescribed drug after drug.  My best friend listened to me moan.  But I was so shocked by the savage nature of the universe that I couldn't understand why anyone who loved me wouldn't let me die.

Life doesn't care if you're suicidal.  The gas bill needs to be paid regardless; the body still needs to be fed.  In my writing group, I casually wrote about a dilemma I was facing at the time:  I could either buy food or medication, but not both.  I didn't write this seeking help, I was just cataloguing a fact of my life.

To my astonishment, a couple of days later I received a card in the mail from my group, with a check large enough to get me past my dilemma.  I didn't have the slightest idea what to do:  I was shocked and perplexed and deeply touched.  I wasn't sure what the proper protocol was for taking money from friends.  But desperation trumps protocol every time, and I quickly cashed the check.

A week later there was a knock at my door.  I opened it to a delivery man bearing a glorious bunch of white lilies.  They were from a young man who knew I was severely depressed, because I kept postponing lunch with him.  He and his family had surprised me by their frequent emails voicing their concern; but nothing had prepared me for this.  Getting flowers is always great, but these were extraordinary because there was no special occasion, and they were a custom bouquet:  the young man knew from reading my book Manic that white lilies mean the world to me.  Every day I inhaled that lovely fragrance I felt a little farther from death.

Shortly after that I forced myself to go to a birthday party for a friend I love.  I swore I'd just make an appearance and leave.  But as soon as I arrived, I ran into a man that I hadn't seen in years.  He asked me how I was, and I didn't have the energy to edit.  I told him my woes.  It turned out he was suffering too, and by unspoken consensus we stepped away from the party and spent the next two hours commiserating.  For once, I got to say everything I wanted and someone listened and gave a damn.  As the day slipped tranquilly into night, I could feel my heart begin to heal.

Money, flowers, and an open ear:  random acts of kindness performed not for gain or advantage, but simply because someone cared enough to make the effort.  And in the doing, save a life.  It made me realize something essential:  The man who left me may have been cruel, but he was only one man.  The world itself is capable of great compassion, and that's a world I want to live in.

So find a need.  Surprise someone with your benevolence.  You'll not only reap the karma, you may just rewrite a life.

 

 

 

Pediatricians as Mental Health Doctors

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Pediatricians and other primary care physicians (PCPs) are finding themselves as providers of child mental health care more than ever. Whether it be screening toddlers for autism, starting medications for conditions such as ADHD or depression, or dispensing parental advice to manage oppositional children, your PCP is now finding him or herself on the front lines of treating childhood emotional-behavioral problems, like it or not. While there was once the opportunity for PCPs to outsource mental health problems in their patients to therapists and child psychiatrists, national shortages are making this practice a dim memory in many parts of the country. Some pediatricians welcome the challenge, others find it quite uncomfortable, given the lack of specific training most of them receive in medical school and residency.  

New initiatives in public health are working towards the idea of the primary care office as the central “medical home” equipped with ever more resources to handle things in house. At the same time, more traditional models in which children with significant emotional-behavioral problems are sent to people like child psychiatrists with the idea that the psychiatrist will simply take over the mental health care for an indefinite period of time are slowly being replaced with more consultative models in which psychiatrists provide advice and recommendations to the PCP, who remains the direct provider of that care. 

Are these changes positive and welcome? To get some perspective, I talked to Dr. Joseph Hagan, a pediatrician from Burlington, Vermont. Dr. Hagan has been involved in shaping pediatric mental health care policy for years as the former chair of the American Academy of Pediatrics’ (AAP) Committee on the Psychosocial Aspects of Child and Family Health and current member of the Bright Futures Steering Committee. He is also running this year to be the President-Elect of the AAP nationally. 

 Q:  What do you see as some of the key issues affecting child mental health care?

A: One of the things I haven’t heard a lot about is that there are not enough therapists to see kids. The system has traditionally been based upon procedures and not on time and that’s a problem. Therapists get paid less than the shop rate of your local auto mechanic, and of course, anyone who sees kids has to talk to schools and parents outside of the session. That’s non-billable, and we wonder why nobody will see kids. Mental health is part of health, and the earlier we invest, the bigger the return. Since our practice was certified as a Family Centered Medical Home and now has access to a Community Health Team, my life has changed because we now have services that we didn’t have before. The problem with screening in the past has been “What if you find something?”  Now we have so much more to offer.

Q:  How much should a pediatrician really be expected to know and do when it comes to child behavioral problems? Is there a floor of knowledge and skills when it comes to mental health that all pediatricians should attain?

A: I think there definitely is. Behavioral and mental health problems can be managed in our offices and everyone ought to be able to manage the majority of kids not only with ADHD, but also with oppositional defiant disorder, anxiety and depression. I mean, there are certain mental health problems that are part of pediatrics. To refer a standard ADHD child is absurd because it really is a day to day problem that needs to be managed in your primary care medical home. Everybody needs to know how to do that and do it well.  It is a chronic illness and you need to hang in there with these kids.  

Q: Psychiatric medications certainly have become even more controversial lately.  What advice do you have for pediatricians when they prescribe them?

A: Tell families the expected effects and potential side effects. If you don’t, Dr. Google will. Start low and go slow, but titrate until desired effect of recovery. Remember if you are 100% anxious and miserable, you’ll look and feel great when your only 50% anxious, but you’re still only halfway better! It’s also important to discuss with your patient when you start meds how long you are going to continue them, lest they feel good and stop prematurely.

Q:  There are a lot of efforts these days to extend the education of pediatricians and provide consulting back up while the patient remains directly in the care of the pediatrician. Do you think those efforts are enough or should we be more focused on providing more psychiatrists and other mental health clinicians that pediatricians can refer to?

A:  We need to be able to do this (mental health) work. But part of being successful is having someone to consult with and someone to refer to. Just like with cardiac or GI problems, there are cases we can take care of all by ourselves, cases where we will need to reach out to a consultant for help, and cases that need referral. Yes we need more child psychiatrists. Co-located and collaborative care are best-case scenarios.

More information about mental health care can be found from the American Academy of Pediatrics. More information about Dr. Hagan can be found here

@copyright by David Rettew, MD

David Rettew is author of Child Temperament: New Thinking About the Boundary Between Traits and Illnessand a child psychiatrist in the psychiatry and pediatrics departments at the University of Vermont College of Medicine.

Follow him at @PediPsych and like PediPsych on Facebook.

Are You an Internet Troll?

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Yesterday I posted about a study that describes internet trolls as narcissistic, sadistic, and psychopathic. A lot of people commented about their own internet behavior, wondering if their provocative comments count as "trolling." (And judging by the comments that article received, some readers certainly qualify as trolls). Some people questioned if simply making a disruptive comment counted as trolling. 

Fortunately, there is a technical answer to those questions!

In the same study from yesterday, the authors introduced a measure of someone's trolliness (that's my term, not theirs). They call it the Global Assessment of Internet Trolling (GAIT). Subjects in their study were shown these four statements: 

  1. I have sent people to shock websites for the lulz.
  2. I like to troll people in forums or the comments section of websites.
  3. I enjoy griefing other players in multiplayer games.
  4. The more beautiful and pure a thing is, the more satisfying it is to corrupt.

The first three statements measure enjoyment and experience with trolling, and the last one measures how closely someone identifies with the trolling "culture."

Subjects were asked to rate how well each statement described them on a five-point scale from 1 (strongly disagree) to 5 (strongly agree). The average of a person's ratings for these four statements became their GAIT, or trolliness, score.

The main idea is that trolls are people who make comments to upset others because they find joy in upsetting people. It's not just that the comments are disruptive or provocative - it is that the poster makes them with the intent of enjoying the suffering of others. 

I talked to one of the authors of the study, and she gave me some data you can use for comparison. Among people who make online comments, the mean GAIT score in their data was 1.47 (on a 1-5 scale),  with a standard deviation of 0.78. Among everyone in their study (commenters and non-commenters alike), the mean GAIT score was 1.54 (basically the same).

Remember - 1 is the lowest possible score a person could get, since people are rating those statements on a 1-5 scale. Thus, most people are scoring quite low. According to the author, if your score is over 2.25 (roughly one standard deviation above the mean), that would be pretty high.

She also sent me one more interesting insights. When people had a GAIT score under 3, there was a mix of sadists and non-sadists. Once the GAIT score climbed above 3.5, everyone in that range was highly sadistic (according to other tests they administered).

So - want to know if you're a troll? Rate yourself honestly on those 4 statements, average your ratings, and you have a trolliness score. If it's over 2.25, you're trollier than a lot of people in the original study, and if it's much over 3, you're probably solidly in troll category.

References

[1] Buckels, Erin E., Paul D. Trapnell, and Delroy L. Paulhus. "Trolls just want to have fun."Personality and Individual Differences 67 (2014): 97-102.

Photo adapted from original by Kevin Dooley

Good Resources for Dealing With Narcissism

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Earlier today I recorded a live webinar for therapists on Narcissistic Habits: Couples Therapy Treatment  [note: the webinar can be accessed after Sept 29 from the goodtherapy.org  webinar archives].  One of my initial points was that individual therapy, in general, has a low success rate for bringing changes in narcissistic behavior patterns.  While one-on-one sessions with a therapist can help narcissistic individuals feel less depressed, anxious or angry, to break out of self-defeating and relationship-destroying narcissism however, couples therapy is a far more potent treatment modality. 

At the same time, what about self-help?

Reading about narcissism enhances awareness.  Awareness can bring relief.  "Oh, so that's why I did x, even though afterwards I regretted it!"  Awareness also motivates change, and can even lead to building new habits. 

These benefits hold true both for narcissistic individuals themselves and for "co-dependents" who struggle to cope  with a lover, parent, friend or work colleague who interacts in narcissistic ways.

I very much enjoyed, as part of preparing for the webinar, looking over some of the relatively recently published books on narcissism.  Here's several that I found particularly insightful, well-written and likely to be helpful to narcissists and those who live or work with them.

1. Running on Empty: Overcome Your Childhood Emotional Neglect

This book by Jonice Webb details in engagingly written language what happens in adulthood to children raised by narcissisitc parents.  They couldn't see or hear you--they just wanted you to be what they wanted you to be.  They also probably were excessively critical, so you developed a false self to hide from them, and from yourself as well, your actual feelings, thoughts and preferences. 

Folks with this kind of upbringing are at risk for developing either narcissistic "all about me" or enabling "all about you" patterns in adulthood. 


2. The Wizard of Oz and Other Narcissists: Coping with the One-Way Relationship in Work, Love, and Family.

One reason, besides its excellent insights, that this book makes it to my top choices list is because the author, Eleanor Payson, agrees with me about therapy for people with narcissistic habits:

"You will want to find a relationship therapist who has skills in teaching more effective communication as as as training and talent in the important process of insight development.  In other words, the therapist needs to be experienced in working with both partners together (not separately) .... (p. 125).

Payson also emphasizes the importance of "elevating your ability to handle conflict together" ..."using some form of structured dialogue that inserts ground rules into the process" ..research indicates that the number one predictor for the long-term success of any relationship is how well the couple is able to handle conflict ...this is usuallly the first order of business for relationship work... (p. 126)."


3. Narcissistic Lovers: How to Cope, Recover and Move On

The authors of this book, Cynthia Zayn and Kevin Dibble, focus on the more severely narcissistic, more set-in-their-ways and more unwilling-to-change individuals with narcissistic patterns, the ones who meet the criteria for a full-blown narcissistic personality disorder (NPD).  That's why their emphasis is on leaving rather than fixing the relationship. 

At the same time, even for partners whose goal is to fix rather than flee the problem, the book is full of insights, both regarding the narcissistic individual and his/her partner.  For the partner, for instance, "if you find yourself jumping through hoops to please your partner on a daily baiss, chances are something is not right...(p. 112)"

Got it.  What next? How do you build new and healthier habits?

While there's lots of good relationship skill-building books out there, I can't help but favor my own Power of Twobook, workbook, CD/free podcast, video and interactive online course (see below).   I've also written a batch of PT posts on narcissism, as well as on its first cousin, borderline personality disorder. They're listed here.

The main point though that I want to make here is that seeing what's wrong builds awareness of the narcissistic habits that are causing needless distress.  Awareness is a huge first step toward change.  The problem won't be fixed though until you also build new, more emotional healthy, ways of interacting.

And then?

The following may be platitudes, and at the same time they are true and good news.  Where there is a will there is a way.  If you want to, you can change.  Others in your lifespace, if they want to let go of just blaming and instead to build their own self-awareness, can change as well. 

Everyone, you included, has potential, if you decide you want to learn and grow, to emerge as a happy and emotionally healthy individual who enjoys wholly collaborative, side-by-side and fully gratifying relationships.  A sense of personal well-being, goodwill in relationships--these are life's ultimate blessings.

Go for it!

-----------------------------------

Denver clinical psychologist Susan Heitler, Ph.D, a graduate of Harvard and NYU, is author of Power of Two, a book, a workbook, and a website that teach the communication skills that sustain positive relationships.  

Click here for a free Power of Two relationship quiz. 

Click the Power of Two logo to learn the skills for a strong, emotionally healthy and loving marriage.

 

 

 

 

 

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