All posts by John pullyblank

M. Jackson Group Update – November 2019 – Neuromyths and Education

A collection of postings on a range of issues is available on our website (  This month’s post is again from Ken Pope’s listserv, where he kindly provides daily summaries of current articles in the field.  His post is as follows:
The Online Learning Consortium released a study: “Neuromyths and Evidence-Based Practices in Higher Education.”
Here’s the abstract:
[begin abstract]
Neuromyths are false beliefs, often associated with teaching and learning, that stem from misconceptions or misunderstandings about brain function. While belief in neuromyths has been established as prevalent among the general public and K-12 teachers, literature about neuromyth belief among higher education professionals (instructors, instructional designers, and administrators) has not been well-researched. This international study examined:
  • Awareness of neuromyths and general knowledge about the brain among higher education professionals across institutional types, course delivery modes, roles, and a variety of characteristics such as demographics, teaching experience, and level of education;

  • Awareness of evidence-based practices from the learning sciences and Mind (psychology), Brain (neuroscience), and Education (pedagogy and didactics; MBE) science among higher education professionals;

  • Predictors of awareness of neuromyths, general knowledge about the brain, and evidence-based practices among higher education professionals; and

  • Interest among instructors, instructional designers, and administrators in scientific knowledge about the brain and its influence on learning.
This study includes not only answers to important research questions, but practice-oriented information that is useful for pedagogy, course design, and leadership, as well as for further research on this topic.
[end abstract]
Here’s an excerpt:
[begin excerpt]
Neuromyths to which respondents were most susceptible included:

o Listening to classical music increases reasoning ability.
o A primary indicator of dyslexia is seeing letters backwards.
o Individuals learn better when they receive information in their preferred learning styles (e.g., auditory, visual, kinesthetic).
o Some of us are “left-brained” and some are “right-brained” due to hemispheric dominance, and this helps explain differences in how we learn. 
o We only use 10% of our brain. 
[end excerpt]
Another excerpt:
[begin excerpt]
Evidence-based practices to which respondents had the greatest awareness included: 
o Emotions can affect human cognitive processes, including attention, learning and memory, reasoning, and problem-solving.
o Explaining the purpose of a learning activity helps engage students in that activity.
o Maintaining a positive atmosphere in the classroom helps promote learning. Stress can impair the ability of the brain to encode and recall memories.

o Meaningful feedback accelerates learning. 
[end excerpt]
“The most erroneous stories are those we think we know best—and therefore never scrutinize or question.”
—Stephen Jay Gould, Harvard Professor of Zoology & Geology (1941-2002)
John Pullyblank, Ph.D., R.Psych. (#946)
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M. Jackson Group Update – October 2019 – Positive Childhood Experiences

This month’s post is again from Ken Pope’s listserv, where he kindly provides daily summaries of current articles in the field.  His post is as follows:
JAMA: Pediatrics includes a study: “Positive Childhood Experiences and Adult Mental and Relational Health in a Statewide Sample: Associations Across Adverse Childhood Experiences Levels.”
The authors are Christina Bethell, PhD, MBA, MPH1; Jennifer Jones, MSW2; Narangerel Gombojav, MD, PhD1; Jeff Linkenbach, EdD3; & Robert Sege, MD, PhD4.
Here’s how it opens:
[begin excerpt]
Research demonstrates that both positive and adverse experiences shape brain development and health across the life span.1-5. Understanding human development requires a model that incorporates both risks (factors that decrease the likelihood of successful development) and opportunities (factors that increase the likelihood of successful development). On the positive side, successful child development depends on secure attachment during the first years of life.6,7 As the child grows, exposure to spoken language8 and having the presence of safe, stable, nurturing relationships and environments are important factors for optimal development.9,10 On the other hand, children with adverse childhood experiences (ACEs) are at risk for observable changes in brain anatomy,11 gene expression,12,13 and delays in social, emotional, physical, and cognitive development lasting into adulthood.3-5,14-17
According to standardized measures, an estimated 61.5% of adults18 and 48% of children19 in the United States have been exposed to ACEs, with more than one-third of these having multiple exposures.18,19 The wide-ranging negative associations between exposure to multiple ACEs and diminished adult and child health are well documented.14,19-22 Most notable is the especially strong evidence linking ACEs with adult mental health problems including depression.22-28 A robust literature also exists regarding the effect of ACEs on adult relational health (often assessed by whether adults report that they get the social and emotional support they need) and how diminished adult social and emotional support contributes to poorer adult physical and mental health.29-56
Beyond the extensive and growing body of research dealing with lifelong correlates of adversity, many prior studies identify resiliency factors and adaptive skills and interventions associated with improved child development and child and adult health outcomes.2,3,16,17,25-55 For example, the Search Institute developed a list of “40 Developmental Assets” and demonstrated associations between the number of assets and both positive and negative outcomes.52 A national population-based study53 on child flourishing and resilience shows strong associations with levels of family resilience and parent-child connection for children with exposures to greater ACEs, poverty, and chronic conditions. Similar studies, such as those assessing the US Centers for Disease Control and Prevention (CDC)’s “safe, stable, and nurturing relationships” model, show similar findings.55
Despite these advances, standardized measures and the prevalence of positive childhood experiences (PCEs) at the population level for adults or children are still unknown. Yet prior studies, using data from small or nonrepresentative samples, have explored interactions between PCEs and ACEs.25,41,56 For example, 1 study,41 conducted by Kaiser Permanente and CDC investigators, analyzed a cohort of 4648 women. They found that adult reports of specific positive family experiences in childhood (including closeness, support, loyalty, protection, love, importance, and responsiveness to health needs) were associated with lower rates of adolescent pregnancy across all ACEs exposure levels.41 The protective effects of reported interpersonal PCEs against mental health problems in adulthood have also been found among pregnant women25 and young adults56 exposed to ACEs. Despite these findings, few subsequent studies on ACEs have simultaneously evaluated PCEs.
Collectively, prior studies on child development point to the importance of research focusing on PCEs, especially those associated with parent-child attachment, positive parenting (eg, parental warmth, responsiveness, and support), family health, and positive relationships with friends, in school, and in the community. Knowledge of whether retrospectively reported PCEs co-occur with ACEs and how PCEs interact with ACEs to effect adult mental and relational health is needed to inform the nation’s growing focus on addressing early life and social determinants of healthy development and lifelong health.
This study used data from the 2015 Wisconsin Behavioral Risk Factor Survey (WI BRFS), a representative, population-based survey,57 to assess the prevalence of PCEs in an adult sample and evaluate hypothesized associations with adult mental and relational health across 4 ACEs exposure levels. This study builds on a 2017 Health Outcomes of Positive Experiences report58 featuring bivariate findings from the 2015 WI BRFS associating individual PCEs with negative adult health outcomes. Here, we construct a PCEs cumulative score measure and use multivariable regression methods to assess the magnitude and significance of associations between this PCEs score and (1) adult depression and/or poor mental health (D/PMH) and (2) adults’ reported social and emotional support (ARSES). Separate assessment of associations was conducted for each of 4 ACEs exposure levels.
[end excerpt]
Another excerpt: “Positive childhood experiences demonstrate a dose-response association with adult D/PMH and ARSES after adjustment for ACEs; assessing and proactively promoting PCEs may reduce adult mental and relational health problems, even in the concurrent presence of ACEs.”
Here’s how the Discussion section opens:
[begin excerpt]
This study examined the prevalence of adult reports of both PCEs and ACEs in a statewide sample and found that PCEs both co-occur with and operate independently from ACEs in their associations with the adult health outcomes evaluated here. Findings also confirm the hypotheses that PCEs may exert their association with D/PMH through their association with ARSES. However, PCEs maintained an association with D/PMH independent from ARSES. Findings are both consistent with prior research showing that relational experiences in childhood are associated with adult social and relational skills and health3,15,56,68 and also point to enduring effects of PCEs on D/PMH separate from their influence on adult ARSES.
While PCEs associations with D/PMH were substantial and similar for adults reporting ACEs, associations were not statistically significant for those reporting no ACEs. Insignificant findings may be owing to low sample sizes for respondents with no ACEs and fewer PCEs. Results still raise questions for further exploration. We hypothesize that PCEs may have a greater influence in promoting positive health, such as getting needed social and emotional support or flourishing as an adult. In turn, these positive health attributes may reduce the burden of illness even if the illness is not eliminated. This is consistent with prior research demonstrating a dual continuum of health whereby flourishing is found to be present for many adults despite concurrent mental health conditions.69
[end excerpt]
Here’s how it concludes:
[begin excerpt]
Overall, study results demonstrate that PCEs show a dose-response association with adult mental and relational health, analogous to the cumulative effects of multiple ACEs. Findings suggest that PCEs may have lifelong consequences for mental and relational health despite co-occurring adversities such as ACEs. In this way, they support application of the World Health Organization’s definition of health emphasizing that health is more than the absence of disease or adversity.71 The World Health Organization’s positive construct of health is aligned with the proactive promotion of positive experiences in childhood because they are foundational to optimal childhood development and adult flourishing. Including PCEs as well as positive health outcomes measures in routinely collected public health surveillance systems, such as the National Survey of Children’s Health and state Behavioral Risk Factor Surveillance Surveys, may advance knowledge and allow the nation to track progress in promoting flourishing despite adversity or illness among children and adults in the United States.
Even as society continues to address remediable causes of childhood adversities such as ACEs, attention should be given to the creation of those positive experiences that both reflect and generate resilience within children, families, and communities. Success will depend on full engagement of families and communities and changes in the health care, education, and social services systems serving children and families. A joint inventory of ACEs and PCEs, such as the positive experiences assessed here, may improve efforts to assess needs, target interventions, and engage individuals in addressing the adversities they face by leveraging existing assets and strengths.72 Initiatives to conduct broad ACEs screening, such as those ensuing in California’s Medicaid program, may benefit from integrated assessments including PCEs.73
Recommendations and practice guidelines included in the National Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents74 and the CDC’s Essentials for Childhood initiative9 encourage policies and initiatives to help child-serving professionals and programs to adopt effective approaches to promote the type of PCEs evaluated in this study. The Health Outcomes of Positive Experiences framework48 and the Prioritizing Possibilities national agenda for promoting child health and addressing ACEs75 each seek to advance existing and emerging evidence-based approaches44,45,47,48,50,54,76,77 that promote a positive construct of health in clinical, public health, and human services settings. This study adds to the growing evidence that childhood experiences have profound and lifelong effects. Results hold promise for national, state, and community efforts to achieve positive child and adult health and well-being by promoting the largely untapped potential to promote positive experiences and flourishing despite adversity.53,78
[end excerpt]
“Everything should be made as simple as possible, but not simpler.”
—Albert Einstein

M. Jackson Group Update – September 2019 – What to Do When You’ve Said the Wrong Thing

This month’s post is again from Ken Pope’s listserv, where he kindly provides daily summaries of current articles in the field.  His post is as follows:
The New York Times includes an article: “What to Do When You’ve Said the Wrong Thing” by Anna Goldfarb.
Here are some excerpts:
[begin excerpts]
Apologizing for saying the wrong thing requires a different kind of apology than, say, spilling coffee on a stranger’s purse or running late to work. When you make an inappropriate comment or insensitive joke, the wound is internal, which can make patching things up more fraught.
Humans are designed to operate in a community. When social rejection occurs, the exclusion can feel physically painful. A recent study in the Clinical Journal of Pain found that the same neural pathways that process social distress are also involved in the pathways of physical pain.
Here’s how to bounce back from a verbal slip-up and heal those bruised feelings.
Before you apologize
Assess the harm. “Be open and vulnerable with yourself about perhaps the damage that has been done,” said Andrea Bonior, a licensed clinical psychologist. You might think you need to apologize for one throwaway comment, but to this other person, this might be part of a larger pattern of thoughtlessness on your part. In fact, they could be angrier than you thought, especially if your remark touched a nerve.
“When we find out we’ve hurt someone, we have these instincts that pop in to want to restore balance,” said Ijeoma Oluo, author of “So You Want to Talk About Race.” If you aren’t clear on what you said that was hurtful, Ms. Oluo recommends reaching out and saying, “It would help make this right if you could explain what I did that harmed you.” 
Don’t frame it as, “Tell me why you’re mad,” but ask, “What did I do?”
Don’t “catastrophize.” People who are prone to guilty thoughts tend to be harder on themselves. They’ll say things like: “I can’t believe I said that. I’m a terrible person.” If you find yourself in a shame spiral, Dr. Bonior suggests reframing your internal narrative about the event into something more realistic, supportive and helpful, like: “This situation touches a chord. I’m feeling ashamed, but I can make this better. Everyone makes mistakes.”
Don’t let it fester. You might be tempted to put the issue on the back burner, but that’d be a mistake, experts said. Not only will you spend more time worrying about the situation, but the longer you delay bringing up the gaffe, the more awkward it will be. Dr. Bonior suggests setting a period of time to lick your wounds (an hour, a day), but try to make amends as soon as possible. Sometimes when we procrastinate on having a difficult conversation, we end up not having the talk at all, which is what actually causes irreparable damage to the relationship. “It’s not the initial offense,” she said. “It’s how it was handled.”
During the apology
Take responsibility. Resist the urge to get defensive or make excuses, like, “Well, I didn’t mean it,” or, “Why are you so sensitive? It was clearly a joke.” Avoid quibbling over specifics, and just let the other person have their feelings, Dr. Bonior said. Make it clear that you don’t take what you did lightly. Studies show that labeling your feelings can help manage anxiety and depression. So saying things like, “I’m ashamed I said that,” or “I’m appalled I hurt you,” might alleviate some of your anguish over the situation. However, you don’t want to make yourself the victim, so don’t lay it on too thick, Dr. Bonior said.
Validate their pain. It’s tempting to use this time to clarify your intent — you might be feeling under attack, and it’s understandable to want to clear your name. But unless the person asked what you meant by your comment or joke, don’t go there. What you intended to say is irrelevant in a conversation centered on the negative impact of your words. It’s also not productive to argue whose version of events is correct….  Accept that what the person heard and felt was real: “My comment was inappropriate and I understand why you’re upset.”
Be genuine. Make sure your apology comes from your heart. Avoid canned phrases like, “I’m sorry if you were hurt.” That language distances yourself from your actions and can feel hollow to the recipient. Body language, facial signals and vocal pitch are all lost in written communication, which makes email and text messages less than ideal when broaching sensitive topics like an apology. Experts said it’s best to deliver an apology face-to-face if possible. Speaking over the phone is the next best option.
Explain how it won’t happen again. Sharing what the situation taught you will reassure this person that you’ve learned from your mistake. Furthermore, educating yourself and making an effort to correct your behavior shows you’re operating in good faith. For instance, if you keep mispronouncing a co-worker’s name, own up to your mistake. Don’t bicker or say, “Well, it’s a really tricky name and I’ve never heard it before,” Alison Green said. As publisher of the career advice blog Ask a Manager and author of the book with the same name, Ms. Green recommends saying, “Hey, I’m really sorry I did that. I’m glad you told me and I will work on getting it right.”
After the apology
Reset. It can be especially important to have an uneventful interaction after a blunder in case the other person is wondering what the relationship will look like moving forward. Put their fears to rest. “If you then come in half an hour later and you’re talking to them about some normal work thing, often that will really put them at ease,” Ms. Green said. This will help to recalibrate the relationship and reassure them that all is well.
Let it go. If after giving it your best effort the other person isn’t able to move past the transgression, disengage. You can offer a sincere apology and own up to your mistakes, but you cannot make somebody accept it, Dr. Cole said. Sometimes words do irreparable harm.
No one owes you a relationship. “If you’ve harmed someone, there’s only so much you can attempt to repair. But if they don’t want to,” Ms. Oluo said, “they don’t have to.”
Still, try to embrace the opportunity to understand the other person’s lived experience and identify with their pain, even if you played a part in causing it. Not only will you be a more considerate friend and colleague, but by looking at the world through their eyes, you’ll be more likely to make the other person feel safe, heard and understood.
[end excerpts]
“Things falling apart is a kind of testing and also a kind of healing.  We think that the point is to pass the test or to overcome the problem, but the truth is that things don’t really get solved.  They come together again and fall apart again. It’s just like that.  The healing comes from letting there be room for all of this to happen: room for grief, for relief, for misery, for joy.”
—Pema Chodron, 1st American-born woman to be ordained as a bhiksuni in Tibetan Buddhism

M. Jackson Group Update – August 2019 – Resilience is Complicated

This month’s post is again from Ken Pope’s listserv, where he kindly provides daily summaries of current articles in the field.  His post is as follows:
The Toronto Globe & Mail includes an article: “Put down the self-help books. Resilience is not a DIY endeavour” by Michael Unger.
Here’s the author note: “Michael Ungar is the Canada Research Chair in Child, Family and Community Resilience, a professor of social work at Dalhousie University and a family therapist. He is the author of more than a dozen books, including Change Your World: The Science of Resilience and the True Path to Success, from which this essay is adapted.”
Here are some excerpts:
[begin excerpts]
At a conference about resilience in Brisbane, Australia, I shared a stage with a charismatic speaker named Todd Sampson, who calls himself a “bodyhacker.” He had recently travelled the world training his very ordinary brain to be extraordinary, filming his miraculous acts of courage, endurance and mind control for a television series. People sat spellbound as he described, among other feats, climbing Mount Everest without an oxygen tank. “Our brains are powerful tools,” he told us. “Anyone with a little motivation can train themselves to do great things.”
Posing as an everyman in low-rise jeans and T-shirt, Mr. Sampson told us how we, too, could remake our minds, improve our resilience and perform heroic physical acts such as climbing a 120-metre chimney in the desert surrounding Moab, Utah, even leaping between two ledges – blindfolded.
Like everyone at the conference, I wanted to be inspired by Mr. Sampson, but watching his film crew document his astonishing feats, I knew that not one of us had a hope in hell of climbing a mountain blindfolded. 
It was all a bad misrepresentation of what scientists know about resilience.
While Mr. Sampson was certainly brave to climb blindfolded, he was already an accomplished mountaineer before he tried this stunt. He was also led up that 120-metre climb by someone he described as one of the best mountaineers in the world, with a crew of technical experts. The camera was focused on Mr. Sampson while the people who were coaching him were on the periphery. Mr. Sampson has more courage than I ever will, but saying, as he did, that he got up that mountain by rewiring his brain is like saying that the airplane I took to Australia got me there on its own, when in reality it needed a worldwide network of airports, satellites, government treaties, integrated businesses and the many professionals who design and build planes and who train to be pilots.
Mindfulness, neuroplasticity, trauma-informed cognitive behavioural therapy, psychoanalysis, career coaching, Kripalu yoga – the list of “cures” for our lack of resilience and related problems is endless. 
If you are overweight, alone, miserable at work or crippled by stress or anxiety or depression, there are hordes of gurus and experts chasing you with books and quick fixes. With their advice, guidance, motivation or inspiration, you can fix your problems.
But make no mistake: They are always your problems. You alone are responsible for them. It follows that failing to fix your problems will always be your failure, your lack of will, motivation or strength.
Galen, the second-century physician who ministered to Roman emperors, believed his medical treatments were effective. “All who drink of this treatment recover in a short time,” he wrote, “except those whom it does not help, who all die. It is obvious, therefore, that it fails only in incurable cases.” This is the way of the billion-dollar self-help industry: You are to blame when the guru’s advice does not produce the expected outcome, and by now, we are all familiar enough with self-help to know that expected outcomes are elusive.
We take upon ourselves the task of becoming motivated and subject ourselves to the heavy lifting of personal transformation. We mostly fail. We gain back the weight that we lost. Our next relationship is just as bad as the one we left. Our attitudes improve, but the boss is still a jerk.
I enjoy an inspiring TED Talk as much as anyone. I love that “Ah ha!” moment when I gain some new insight into myself or, at the very least, better understand why everyone else is so dysfunctional. I want to believe that attainments as complex as success, happiness, love and meaning can be attributed to a short list of personal traits such as virtue, faith, perseverance, self-control, grit and positive thinking; that if I just listen to the right podcasts or sign up for the right courses, I will discover hidden strengths and the happy life that is waiting to burst from inside me.
But stories such as this are misleading, if not dishonest. Personal explanations for success actually set us up for failure. TED Talks and talk shows full of advice on what to eat, what to think and how to live seldom work. 
Self-help fixes are like empty calories: The effects are fleeting and often detrimental in the long term.
Worse, they promote victim blaming.  
The notion that your resilience is your problem alone is ideology, not science.
We have been giving people the wrong message. Resilience is not a DIY endeavour. Self-help fails because the stresses that put our lives in jeopardy in the first place remain in the world around us even after we’ve taken the “cures.” The fact is that people who can find the resources they require for success in their environments are far more likely to succeed than individuals with positive thoughts and the latest power poses.
What kind of resources? The kind that get you through the inevitable crises that life throws our way. A bank of sick days. Some savings or an extended family who can take you in. Neighbours or a congregation willing to bring over a casserole, shovel your driveway or help care for your children while you are doing whatever you need to do to get through the moment. Communities with police, social workers, home-care workers, fire departments, ambulances and food banks. Employment insurance, pension plans or financial advisers to help you through a layoff.
Striving for personal transformation will not make us better when our families, workplaces, communities, health-care providers and governments fail to provide us with sufficient care and support. 
The science shows that all the internal resources we can muster are seldom of much use without a nurturing environment. Furthermore, if those resources are not immediately at hand, we are better off trying to change our world to gain those resources than we are trying to change ourselves.
For more than 20 years, I have been a family therapist working with hard-to-reach young people while also holding a research chair that has let me to study resilience around the world. 
The Resilience Research Centre at Dalhousie University, which I lead, investigates why some people “beat the odds” and do far better than expected. Unlike many other research centres, our team is focused not on personal traits but on social and physical ecologies – the natural environments in which we live – and how these create well-resourced individuals who make success look easy.
Our research shows that even the worst problems are not beyond the control of individuals if we think about changing environments more than changing ourselves. Here’s an example from someone you will never see in a TED Talk.
Akiko had just turned 18 a week before March 11, 2011. That was the day a 9.1-magnitude earthquake shook the seabed off the northeastern coast of Japan at a depth of more than 20,000 metres below the ocean surface. The result was a towering wave that destroyed the town of Yamada, where Akiko (I’ve changed her name to preserve her identity) lived with her parents. She was in a car with a friend on her way to school when she heard the tsunami alarm. Stuck in traffic, the car was tossed like a rubber dinghy until it became submerged. Akiko’s friend was knocked unconscious and drowned. Akiko managed to break the window and swim up through the debris, gasping for air as she dodged floating cars and pieces of concrete falling around her. She was the only one in her immediate family to survive.
A photographer who happened to be on a nearby hillside caught several pictures of Akiko swimming in the very chilly water until she was able to hoist herself onto the roof of a four-storey building that had miraculously remained standing. Akiko remembers cutting her hands on the sharp metal of a drainage pipe before she was able to break free of the eddies that kept pulling her under. Once on the roof, she braced herself against a ventilation fan and waited 12 shivering hours for the water to recede and rescue crews to arrive. She recalls being lifted by helicopter through a haze of acrid smoke from the dozens of fires that had started when natural gas pipes ruptured.
By every measure of risk, Akiko should have been traumatized by her experience. When I met her, a year and a half later, she was still having nightmares but she was attending school, completing her high-school credits and considering her options for postsecondary education. She was housed with an aunt who had lost her husband. Together they occupied a small temporary home fashioned from portable trailers. Long rows of squat, steel-sided units had been placed end to end on a soccer field next to the high school. Each home had its own hot plate and toilet. Akiko did not have much good to say about her aunt but she also knew she did not have many other options for housing. At least she had been resettled in her community and was back in high school. That meant she could spend time with her friends, who all had tales of their own harrowing survival from the day their world had drowned.
A number of non-governmental organizations had arrived in Yamada in the months following the disaster. It was at an NGO that Akiko and I were introduced. Its program provided evening and Saturday tutoring for students whose families could no longer afford to send their children to regular after-school classes. For most Japanese youth, I was told, the normal school day provides them with only a small portion of their lessons. Additional instruction is a part of most children’s lives, especially for students whose parents expect their kids to go on to college.
How had Akiko managed to keep going, to avoid the debilitating, paralyzing effects of living in such a chaotic situation for so many months? Why had the deaths of her friend and immediate family, and her own near drowning, not left her with more evident emotional scars? Listening to Akiko tell her story, I learned how she and other children and adults such as her could be protected from the more damaging effects of extreme loss and a cascade of potentially traumatizing events.
While Akiko was not exuberant or deeply insightful, she spoke clearly about the routines she had in her life and the continuity she experienced between who she was before the tsunami and who she was 18 months later. There was also the sameness of her peer group and school environment. Placement with her aunt, though far from wonderful, meant a sense of identity as a member of a family and a culture. The interventions of government agencies and non-governmental service providers had also given Akiko a sense of hope for the future. No one, it seemed, was providing individual psychotherapy or masking the trauma with sports and other forms of play. Not that these things would have been bad – they just did not seem necessary.
As a colleague of mine, Keiji Akiyama, explained to me when I puzzled over Akiko’s success, her life still resembled that of many other young Japanese, regardless of the tsunami that had destroyed their town. It was a simple lesson in resilience.
Obliterate the world around us, and one person in a thousand might maintain an optimistic outlook in life, more by chance than design. Put in place the resources needed by an entire population of displaced, traumatized individuals, and the majority will regain normal functioning in a short period of time, so long as those resources are culturally and contextually relevant.
No wonder, then, that when I asked Mr. Akiyama why the service providers were only offering tutoring programs instead of recreation and psychosocial programming, he looked at me confused, cocking his head to the side. “Why would we want our children wasting their time playing?” he asked. It was a revelation for me. We cannot separate culture from the resources people need to cope with traumatic experiences. As long as Akiko and her peers were being treated like “normal” kids, they were being protected from the dangerous consequences of extreme loss: the physical, emotional and neurological damage typical in people who fail to cope.
Akiko’s simple story of survival is not as captivating as blind mountaineering or finding a treasure chest, but most of the things that genuinely improve people’s lives are quite mundane. I built an international program of research that at one point included a five-country, six-year study with colleagues from New Zealand, South Africa, Colombia and China who replicated the work of my team in Canada. Together, we examined how 13-to-24-year-olds with complex needs living in stressed environments (such as economically depressed neighbourhoods and homes with family violence) make use of the health and social services available to them, and whether their patterns of service use are associated with their resilience over time. The point of the study was to explore a seldom discussed aspect of resilience: the services we receive from health, social welfare and educational systems, as well as the informal supports we sometimes need from our families and communities. Rather than focusing our attention on individual factors such as grit or mindset, we wanted to understand whether an investment in services could be a better way to nurture well-being in sub-optimal environments. Remarkably few studies to date have asked the obvious question: Does resilience depend on the services we receive?
For our sample, we purposefully selected adolescents and young adults who were using multiple services. These were young people needing special educational supports at the same time that they were under the supervision of a child-welfare worker because of exposure to family violence. Or they were youth with severe mental-health problems such as attention-deficit disorder and conduct disorder who were also under a probation order because they had been caught selling drugs or committing a violent act. Some of our participants had learning challenges, others anxiety disorders. Some were homeless because they had run away from abusive parents. When data collection was completed, we methodically churned out statistics.
Finally, on a warm spring day after years of work, a senior statistician on the team came to me with a one-page graphic representation of a structural equation model that focused on Canadian youth. The math was daunting, but what it showed was the relationship between risk exposure, resilience and behavioural outcomes for almost 500 young people, all of them facing serious challenges. We later verified these results with more than 7,000 young people around the world, but this was the first proof that let us say with certainty that resilience depends more on what we receive than what we have within us. These resources, more than individual talent or positive attitude, accounted for the difference between youths who did well and those who slid into drug addiction, truancy and high-risk sexual activity.
I have to admit it, the diagram made me tear up. We had proved that resourced individuals do far better than individuals without resources, no matter how rugged the latter might be. We also discovered that the reason many young people who need help do not take advantage of what is offered is because service providers seldom tailor their programs to the clients’ needs. For example, we heard stories of school guidance counsellors who insisted that parents take time off from minimum-wage jobs to attend case conferences because guidance counsellors and psychometricians do not work evenings. It should come as no surprise that the most vulnerable families did not show up because they could not afford the lost time at work. It was their children, doubly disadvantaged by learning difficulties and poverty, who wound up untreated and who eventually dropped out of school.
There were many more findings of that nature. We learned that if kids were not responding to treatment, it was not the kids’ fault but a failure of the services to meet their needs. Shape the right environment for a troubled child, and the child changes for the better. Put in front of a child the necessary help, and he or she will take advantage of it. This is true even with children who are not initially motivated to make something of their lives.
A positive attitude, encouraged by those around us, helps us heal and cope with the continuing stress of adjustment. But it has also been found that the single biggest predictor of adjustment after a crisis has nothing to do with prayer, relationships or a positive attitude. Sometimes recovery depends on much more mundane things – such as how quickly insurance adjusters settle claims after a natural disaster.
Colleagues of mine who work as social workers discovered that after major flooding destroyed towns at the base of the Rocky Mountains, people who had their claims settled within a year recovered quicker and showed far less stress than those who had to live in hotels and cope with being away from their community for longer periods of time. As a resilience-promoting factor, a quick claims settlement means people can start rebuilding their homes. It gives them purpose and focus. It rejoins them with their communities and gives their children the chance to return to their schools. It also decreases the daily stress of living and the worry associated with an uncertain financial future.
The banks and insurance companies must have taken note. When wildfires destroyed Fort McMurray, Alta., in the summer of 2016, residents were scattered across nearby towns and cities and packed into community centres. Financial institutions loaded their staff onto large buses, the kind that touring rock bands use, and on each bus were bank machines, loans officers and insurance adjusters. The bankers travelled to the shelters, sleeping on the buses so they would not burden the scarce local resources. By travelling to people who had been forcibly displaced, the bankers were able to give their customers access to cash and an opportunity to start the paperwork required to submit a claim for compensation. The effort must have expedited payouts, because people were back in Fort McMurray and rebuilding within months. Not everyone was fortunate enough to have his insurance paid out quickly, but for those who had a friendly banker and an insurance adjuster make a visit, emotional outcomes were likely better than expected.
In a major disaster, the first responders should be the fire department and paramedics. Second should be insurance adjusters and bankers. A distant third should be psychologists, and only if financial claims cannot be settled quickly. Mental-health professionals, such as me, are sometimes needed – just not as much as we think.
None of this is entirely new. We have known for at least half a century that certain things about our communities make them likely to prevent mental illness. Socially integrated communities are better for us: They have fewer single-parent households, stronger relationships between neighbours, good leaders, recreational facilities and spaces, less hostility, fewer disasters, lower levels of poverty and a shared culture. Healthy communities do not depend on the internal messages people tell themselves, or even on the number of psychotherapists and yoga teachers. These communities are largely a consequence of good governance and progressive taxation, housing and social-welfare policies.
We know that those closest to us within our environments – our families, friends, and colleagues at work – have an enormous effect on our collective capacity to thrive. Improve the functioning of the family, peer group or work team, and individuals are more likely to show resilience, even if their larger world is seeming to become more volatile, uncertain, complex and ambiguous.
That is just as true in the workplace, where no amount of personal development is going to help you succeed if your employer offers no support. As long as mountains of memos and paperwork accumulate, unrealistic deadlines are imposed, projects are understaffed, jobs are insecure, facilities are poorly maintained and administrators are incompetent, workers will burn out and fail, whatever their individual beliefs or behaviours. Every serious look at workplace stress has found that when we try to influence workers’ problems in isolation, little change happens.
In all aspects of life, social justice is important to resilience, too. Decades of research have shown that people who are treated justly do better physically and mentally than those who are not, and we also know that people who are in better health tend to be more productive and happier.
The science of resilience is clear: The social, political and natural environments in which we live are far more important to our health, fitness, finances and time management than our individual thoughts, feelings or behaviours. When it comes to maintaining well-being and finding success, environments matter. In fact, they may matter just as much, and likely much more, than individual thoughts, feelings or behaviours. A positive attitude may be required to take advantage of opportunities as you find them, but no amount of positive thinking on its own is going to help you survive a natural disaster, a bad workplace or childhood abuse. 
Change your world first by finding the relationships that nurture you, the opportunities to use your talents and the places where you experience community and governmental support and social justice. Once you have these, your world will help you succeed more than you could ever help yourself.
[end excerpts]
“I play what we can play, not me.  I never play what I can play.  I’m always playing way over and above what I can play.”
—Miles Davis

M. Jackson Group Update – July 2019 – Finding More Happiness at Work

This month’s post is again from Ken Pope’s listserv, where he kindly provides daily summaries of current articles in the field.  His post is as follows:
The New York Times includes an article: “A Deceptively Simple Way to Find More Happiness at Work” by By Tim Herrera.
Here are some excerpts:
[begin excerpts]
Do you like what you do?
Now, I don’t mean that in the broad sense of wondering whether you’re on the right career path. I mean on a day-to-day basis, if you thought about every single task your job entails, could you name the parts that give you genuine joy? What about the tasks you hate?
We don’t often step back to ask whether the small, individual components of our job actually make us happy.
But maybe we should. 
As many as a third of United States workers say they don’t feel engaged at work. The reasons vary widely, and everyone’s relationship with work is unique. But there are small ways to improve any job, and those incremental improvements can add up to major increases in job satisfaction.
A study from the Mayo Clinic found that physicians who spend about 20 percent of their time doing “work they find most meaningful are at dramatically lower risk for burnout.” 
But here’s what’s fascinating: Anything beyond that 20 percent has a marginal impact, as “spending 50 percent of your time in the most meaningful area is associated with similar rates of burnout as 20 percent.”
In other words: You don’t need to change everything about your job to see substantial benefits. A few changes here and there can be all you need.
“When you look at people who are thriving in their jobs, you notice that they didn’t find them, they made them,” said Ashley Goodall, senior vice president of leadership and team intelligence at Cisco and co-author of the book “Nine Lies About Work.”
“We’re told in every commencement speech that if you find a job you love you’ll never work a day in your life. But the verb is wrong,” he said, adding that successful people who love their jobs take “the job that was there at the beginning and then over time they transform the contents of that job.”
To be sure, transforming your job isn’t easy. But you have to start somewhere, and there’s a wonderfully simple but surprisingly revealing trick that can help.
For a full week, carry a notepad at all times. Draw a line down the center of a page and label one column “Love” and the other column “Loathe.” Whenever you perform a task, no matter how small, be mindful of how it makes you feel. Are you excited about it? Do you look forward to it? Does time fly when you’re doing it? Or did you procrastinate, dreading every moment and feeling drained by the time you’re done?
[T]his exercise — which Mr. Goodall and his co-author, Marcus Buckingham, co-head and talent expert at the A.D.P. Research Institute, write about in their book and practice in their lives — can show you hidden clues and nuances about work.
“It’s a beautifully simple way to inventory your emotional reactions to the reality of your day or week at work,” Mr. Buckingham said. “Understand what it is that lights you up. Understand what you run toward. Understand where you are at your most energetic, your most creative, your most alive, and then volunteer for that more and more and more,” he added.
This is, of course, just a starting point. You won’t instantly be happier at work once you have a list of things you dislike about your job. But this exercise gives you a road map about how to focus your time and energy on the things that get you excited. Rather than trying to get better at things you hate doing and know you’re not great at, reframe the issue and try to do more things that energize you and that you excel at. 
No one can tell you what those things are, and discovering them can be transformative.
“If you don’t know what you’re like when you’re in love with your work, no one can do that for you,” Mr. Buckingham said. “This has always been in your hands, and it cannot be in anyone else’s.”
[end excerpts]
The article is online at:
Ken Pope
Print—Kindle—Nook—eBook—Apple iBook—Google Book
“We’re all going to die, all of us, what a circus!  That alone should make us love each other but it doesn’t. We are terrorized and flattened by trivialities, we are eaten up by nothing.”
—Charles Bukowski

M. Jackson Group Update – June 2019 – Failings of the Biological Model of Mental Illness

This month’s post is again from Ken Pope’s listserv, where he kindly provides daily summaries of current articles in the field.  His post is as follows:
Next month’s issue of The Atlantic includes an article: “Psychiatry’s Incurable Hubris: The biology of mental illness is still a mystery, but practitioners don’t want to admit it” by Gary Greenberg.
Here’s the author note: “Gary Greenberg, a practicing psychotherapist, is the author of The Book of Woe: The DSM and the Unmaking of Psychiatry.”
Here are some excerpts:
[begin excerpts]
In 1886, Clark Bell, the editor of the journal of the Medico-Legal Society of New York, relayed to a physician named Pliny Earle a query bound to be of interest to his journal’s readers: Exactly what mental illnesses can be said to exist? In his 50-year career as a psychiatrist, Earle had developed curricula to teach medical students about mental disorders, co-founded the first professional organization of psychiatrists, and opened one of the first private psychiatric practices in the country. He had also run a couple of asylums, where he instituted novel treatment strategies such as providing education to the mentally ill. If any American doctor was in a position to answer Bell’s query, it was Pliny Earle.
Earle responded with a letter unlikely to satisfy Bell. “In the present state of our knowledge,” he wrote, “no classification can be erected upon a pathological basis, for the simple reason that, with slight exceptions, the pathology of the disease is unknown.” Earle’s demurral was also a lament. During his career, he had watched with excitement as medicine, once a discipline rooted in experience and tradition, became a practice based on science. Doctors had treated vaguely named diseases like ague and dropsy with therapies like bloodletting and mustard plasters. Now they deployed chemical agents like vaccines to target diseases identified by their biological causes. But, as Earle knew, psychiatrists could not peer into a microscope to see the biological source of their patients’ suffering, which arose, they assumed, from the brain. They were stuck in the premodern past, dependent on “the apparent mental condition [his emphasis], as judged from the outward manifestations,” to devise diagnoses and treatments.
The protracted attempt to usher psychiatry into medicine’s modern era is the subject of Anne Harrington’s Mind Fixers: Psychiatry’s Troubled Search for the Biology of Mental Illness. As her subtitle indicates, this is not a story of steady progress. Rather, it’s a tale of promising roads that turned out to be dead ends, of treatments that seemed miraculous in their day but barbaric in retrospect, of public-health policies that were born in hope but destined for disaster.
Some of the episodes Harrington recounts are familiar, such as Egas Moniz’s invention of the lobotomy, which garnered him a Nobel Prize in 1949, at just about the same time that the psychiatrist Walter Freeman was traveling the United States using a surgical tool modeled on an ice pick to perform the operation on hapless asylum inmates. She has retrieved others from history’s dustbin. In the 1930s, for example, insulin was used to render mental patients comatose in hopes that they would wake up relieved of their psychoses. 
And in at least one case—the deinstitutionalization of mental patients in the 1960s and ’70s—she has given an old story a new twist. That movement, she argues convincingly, was spearheaded not by pill-happy psychiatrists convinced that a bit of Thorazine would restore their patients to full functioning, but by Freudians. They saw the antipsychotic drugs invented in the 1950s as a way to render patients suitable for the outpatient treatment that psychoanalysts were equipped to provide.
From ice baths to Prozac, each development Harrington describes was touted by its originators and adherents as the next great thing—and not without reason. Some people really did emerge from an insulin coma without their delusions; some people really are roused from profound and disabling depressions by a round of electroconvulsive therapy or by antidepressant drugs. But in every case, the treatment came first, often by accident, and the explanation never came at all. The pathological basis of almost all mental disorders remains as unknown today as it was in 1886—unsurprising, given that the brain turns out to be one of the most complex objects in the universe. Even as psychiatrists prescribe a widening variety of treatments, none of them can say exactly why any of these biological therapies work.
It follows that psychiatrists also cannot precisely predict for whom and under what conditions their treatments will work. That is why antipsychotic drugs are routinely prescribed to depressed people, for example, and antidepressants to people with anxiety disorders. Psychiatry remains an empirical discipline, its practitioners as dependent on their (and their colleagues’) experience to figure out what will be effective as Pliny Earle and his colleagues were. Little wonder that the history of such a field—reliant on the authority of scientific medicine even in the absence of scientific findings—is a record not only of promise and setback, but of hubris.
That word does not appear in Mind Fixers, despite its repeated accounts of overreach by enthusiastic doctors who are often the last to recognize the failure of their theories. As Harrington tells us at the outset, she is committed to restraint. “Heroic origin stories and polemical counterstories may give us momentary emotional satisfaction,” she writes. But the result—“tunnel vision, mutual recrimination, and stalemate”—is not very useful. By presenting a just-the-facts narrative of the attempt to find biological sources of mental suffering, particularly in the brain, she hopes to get the “fraught” enterprise of psychiatry back on the path to progress.
Harrington is right to sigh over what has too often proved to be a yelling match between equally deaf opponents—members of an ambitious profession convinced that psychiatry is making strides toward understanding mental illness, and critics who believe it is at best a misguided attempt to help suffering people and at worst a pseudoscience enabling social control at the expense of human dignity. Indeed, since the sides first squared off, more than half a century ago, they seem to have learned little from each other.
As Harrington ably documents, a series of fiascoes highlighted the profession’s continued inability to answer Clark Bell’s question. Among them was the 1973 vote by the American Psychiatric Association declaring that homosexuality was no longer a mental illness. The obvious question—how scientific is a discipline that settles so momentous a problem at the ballot box?—was raised by the usual critics. This time, insurers and government bureaucrats joined in, wondering, often out loud, whether psychiatry warranted their confidence, and the money that went along with it.
The association’s response was to purge its Diagnostic and Statistical Manual of Mental Disorders (DSM) of the Freudian theory that had led it to include homosexuality in the first place. When the third edition of the DSM came out, in 1980, its authors claimed that they had come up with an accurate list of mental illnesses: Shedding the preconceptions that had dominated previous taxonomies, they relied instead on atheoretical descriptions of symptoms.
But as Harrington points out, they did have a theory—that mental illness was no more or less than a pathology of the brain. In claiming not to, she argues,

they were being disingenuous. They believed that biological … markers and causes would eventually be discovered for all the true mental disorders. They intended the new descriptive categories to be a prelude to the research that would discover them. The DSM-3’s gesture at science proved sufficient to restore the reputation of the profession, but those discoveries never followed. Indeed, even as the DSM (now in its fifth edition) remains the backbone of clinical psychiatry—and becomes the everyday glossary of our psychic suffering—knowledge about the biology of the disorders it lists has proved so elusive that the head of the National Institute of Mental Health, in 2013, announced that it would be “re-orienting its research away from DSM categories.”

The need to dispel widespread public doubt haunts another debacle that Harrington chronicles: the rise of the “chemical imbalance” theory of mental illness, especially depression. The idea was first advanced in the early 1950s, after scientists demonstrated the principles of chemical neurotransmission; it was supported by the discovery that consciousness-altering drugs such as LSD targeted serotonin and other neurotransmitters. The idea exploded into public view in the 1990s with the advent of direct-to-consumer advertising of prescription drugs, antidepressants in particular. Harrington documents ad campaigns for Prozac and Zoloft that assured wary customers the new medications were not simply treating patients’ symptoms by altering their consciousness, as recreational drugs might. Instead, the medications were billed as repairing an underlying biological problem.
The strategy worked brilliantly in the marketplace. But there was a catch.
 “Ironically, just as the public was embracing the ‘serotonin imbalance’ theory of depression,” Harrington writes, “researchers were forming a new consensus” about the idea behind that theory: It was “deeply flawed and probably outright wrong.” Stymied, drug companies have for now abandoned attempts to find new treatments for mental illness, continuing to peddle the old ones with the same claims. And the news has yet to reach, or at any rate affect, consumers. At last count, more than 12 percent of Americans ages 12 and older were taking antidepressants. The chemical-imbalance theory, like the revamped DSM, may fail as science, but as rhetoric it has turned out to be a wild success.
Harrington’s dispassion as she chronicles the rise and fall of various biological theories of mental illness will make this book of value to historians of medicine. It may even allow critics and advocates of biological psychiatry alike to gain a deeper appreciation of the historical stream in which they are swimming, and to stop trying to drown one another.
But her restraint carries a risk: that she will underplay the significance of the troubles she is reporting.
Modern medicine pivots on the promise that portraying human suffering as biological disease will lead to insight and cures. Inescapably, this enterprise has a sociopolitical dimension. To say which of our travails can (and should) come under medicine’s purview is, implicitly if not explicitly, to present a vision of human agency, of the nature of the good life, of who deserves precious social resources like money and compassion. 
By virtue of its focus on our mental lives, and especially on our subjective experience of the world and ourselves, psychiatry, far more directly than other medical specialties, implicates our conception of who we are and how our lives should be lived. 
It raises, in short, moral questions. If you convince people that their moods are merely electrochemical noise, you are also telling them what it means to be human, even if you only intend to ease their pain.
In this sense, the attempt to work out the biology of mental illness is different from the attempt to work out the biology of cancer or cardiovascular disease. The fact that the brain is necessary to consciousness, added to the fact that the brain is a chunk of meat bathing in a chemical broth, does not yield the fact that conscious suffering is purely biological, or even that this is the best way to approach mental illness. 

Those unresolved, and perhaps unanswerable, moral questions loom over the history that Harrington traces here. The path she has chosen may require her to steer clear of such knotty concerns as the relationship of mind to brain or the relationship of political order to mental illness. But her account doesn’t just skirt the polemics she decries. It also overlooks the consequences of psychiatrists’ ignoring those questions, or using scientific rhetoric to conceal them.
At the risk of being polemical, let me suggest that Harrington’s word disingenuous fails to describe the cynicism of Robert Spitzer, the editor of the DSM-3, who acknowledged to me that he was responding to the fact that “psychiatry was regarded as bogus,” and who told me that the book was a success because it “looks very scientific. If you open it up, it looks like they must know something.” 
Nor does ironic accurately describe the actions of an industry that touts its products’ power to cure biochemical imbalances that it no longer believes are the culprit. Plain bad faith is what’s on display, sometimes of outrageous proportion. And like all bad faith, it serves more than one master: not only the wish to help people, but also the wish to preserve and increase power and profits.
Harrington ends her book with a plea that psychiatry become “more modest in focus” and train its attention on the severe mental illnesses, such as schizophrenia, that are currently treated largely in prisons and homeless shelters—an enterprise that she thinks would require the field “to overcome its persistent reductionist habits and commit to an ongoing dialogue with … the social sciences and even the humanities.” 
This is a reasonable proposal, and it suggests avenues other than medication, such as a renewed effort to create humane and effective long-term asylum treatment. 
But no matter how evenhandedly she frames this laudable proposal, an industry that has refused to reckon with the full implications of its ambitions or the extent of its failures is unlikely to heed it.
[end excerpts]
The article is online at:
Ken Pope
Print—Kindle—Nook—eBook—Apple iBook—Google Book
“It is not the answer that enlightens, but the question.”
—Eugene Ionesco (1912-1994) 

M. Jackson Group Update – May 2019 – Responding to Suicide Risk

This month’s post is again from Ken Pope’s listserv, where he kindly provides daily summaries of current articles in the field.  His post is as follows:
NPR released an article: “Reach Out: Ways To Help A Loved One At Risk Of Suicide” by Rhjitu Chatterjee.
Here are some excerpts:

[begin excerpts]
If you or someone you know may be considering suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (En Español: 1-888-628-9454; Deaf and Hard of Hearing: 1-800-799-4889) or the Crisis Text Line by texting HOME to 741741.
If you know someone struggling with despair, depression or thoughts of suicide, you may be wondering how to help.
You don’t have to be a trained professional to help, says Doreen Marshall, a psychologist and vice president of programs at the AFSP.
“Everyone has a role to play in suicide prevention,” she says. But “most people hold back. We often say, ‘Trust your gut. If you’re worried about someone, take that step.’ “
And that first step starts with simply reaching out, says Marshall. It may seem like a small thing, but survivors of suicide attempts and suicide experts say, it can go long way.
Simple acts of connection are powerful, says Ursula Whiteside, a psychologist and a faculty member at the University of Washington.
“Looking out for each other in general reduces [suicide] risk,” says Whiteside. “Because people who feel connected are less likely to kill themselves.”
And “the earlier you catch someone,” she adds, “the less they have to suffer.”
Here are nine things you can do that can make a difference.

1. Recognize the warning signs

Signs of suicide risk to watch for include changes in mood and behavior, Marshall says.
“For example, someone who is usually part of a group or activity and you notice that they stop showing up,” explains Marshall. “Someone who is usually pretty even-tempered, and you see they are easily frustrated or angry.”

Other signs include feeling depressed, anxious, irritable or losing interest in things.
Pay attention to a person’s words, too.
“They may talk about wanting to end their lives or seeing no purpose or wanting to go to sleep and never wake up,” says Marshall. “Those are signs that they may be thinking about [suicide]. It may be couched as a need to get away from, or escape the pain.”
According to the AFSP, people who take their own lives often show a combination of these warning signs.
And the signs can be different for different individuals, says Madelyn Gould, a professor of epidemiology in psychiatry at Columbia University who studies suicide and suicide prevention.
“For some people, it might be starting to have difficulty sleeping,” she says. Someone else might easily feel humiliated or rejected.
“Each one of these things can put [someone] more at risk,” explains Gould, “Until at some point, [they’re] not in control anymore.”

2. Reach out and ask, “Are you OK?”

So, what do you do when you notice someone is struggling and you fear they may be considering suicide?
Reach out, check in and show you care, say suicide prevention experts.
“The very nature of someone struggling with suicide and depression, [is that] they’re not likely to reach out,” says Marshall. “They feel like a burden to others.”
People who are having thoughts of suicide often feel trapped and alone, explains DeQuincy Lezine, a psychologist and a member of the board of directors of the American Association of Suicidology. He is also a survivor of suicide attempts.
When someone reaches out and offers support, it reduces a person’s sense of isolation, he explains.
“Even if you can’t find the exact words [to say], the aspect that somebody cares makes a big difference,”says Lezine.
Questions like “Are you doing OK?” and statements like “If you need anything, let me know” are simple supportive gestures that can have a big impact on someone who’s in emotional pain, explains Julie DeGolier, a medical assistant in Seattle and a survivor of suicide attempts. It can interrupt the negative spiral that can lead to crisis.
The website for the National Suicide Prevention Lifeline has a list of do’s and don’ts when trying to help someone at risk.

3. Be direct: Ask about suicide

“Most people are afraid to ask about suicide, because they [think they] don’t want to put the thought in their head,” says Marshall. “But there’s no research to support that.”
Instead, she and other suicide prevention experts say discussing suicide directly and compassionately with a person at risk is key to preventing it.
One can ask a direct question like, “Have you ever had thoughts of suicide?” says Marshall.
More general questions like, “What do you think of people who kill themselves?” can also open up a conversation about suicide, says Gould. 
“Now they are talking about it, when you might not have had the conversation before.”

4. Assess risk and don’t panic: Suicidal feelings aren’t always an emergency

Say a loved one confides in you that they have been thinking about suicide. What do you do then?
“Don’t let yourself panic,” says Whiteside.
People often believe that a person considering suicide needs to be rushed to the hospital. But “not everyone who expressed these thoughts needs to be hospitalized immediately,” says Marshall.
But how do you know whether your loved one’s situation is an immediate crisis?
Whiteside suggests asking direct questions like: “Are you thinking of killing yourself in the next day or so?” and “How strong are those urges?”
For help with this conversation, psychiatrists at Columbia University have developed the Columbia Protocol, which is a risk-assessment tool drawn from their research-based suicide severity rating scale. It walks you through six questions to ask your loved one about whether they’ve had thoughts about suicide and about the means of suicide and whether they have worked out the details of how they would carry out their plan.
Someone who has a plan at hand is at a high risk of acting on it — according to the Suicide Prevention Resource Center, about 38 percent of people who have made a plan go on to make an attempt.

5. If it’s a crisis, stick around

So what if you’ve assessed risk and you fear your loved one is in immediate crisis? First, request them to hold off for a day or so, says Whiteside, at the same time being “validating and gentle.”
The kind of intense emotions that might make someone act on an impulse, “usually resolve or become manageable in less than 24 or 48 hours,” she says. If you can, offer to stay with them during that time period, she adds. Otherwise, help them find other immediate social support or medical help. They shouldn’t be alone at these times of crisis.
Ask whether they have any means of harming themselves at hand and work with them to remove those things from their environment. Research shows that removing or limiting access to means reduces suicide deaths.
The National Suicide Prevention Lifeline offers this guide to the five action steps to take if someone you know is imminent danger.
If you don’t feel confident about helping someone through a crisis period, call the National Suicide Prevention Lifeline, says Gould.

6. Listen and offer hope

If the person is not in immediate risk, it is still important to listen to them, say survivors of suicide attempts like Lezine and DeGolier.
“The biggest thing is listening in an open-minded way, to not be judgmental,” says DeGolier.
“Don’t tell a person what to do. They’re looking to be heard, to have their feelings acknowledged.”
The next step is to offer hope, says Whiteside. It helps to say things like, “I know how strong you are. I’ve seen you get through hard things. I think we can get through this together,” she explains.
One of Lezine’s closest friends in college did just that during his suicidal phases, he says.
“For one thing, she never lost faith in me,” says Lezine. “She always believed I have a positive life possible and I would achieve good things.”
He says her faith in him kept him from giving in to his despair completely.
“Having somebody, a confidante who absolutely believed as a person in [my] ability to do something meaningful in life” was instrumental in his recovery, he says.

7. Help your loved one make a safety plan

When a person is not in immediate risk of attempting suicide, it’s a good time to think about preventing a future crisis.
“That’s where we want to make help-seeking and adaptive coping strategies a practice,” says Gould.
Suicide prevention experts advise people develop what’s known as a safety plan, which research has shown can help reduce suicide risk. It’s a simple plan for how to cope and get help when a crisis hits, and typically, an at-risk person and their mental health provider create it together, but a family member or friend can also help.
The American Foundation for Suicide Prevention has a template for creating a safety plan. It includes making a list of the person’s triggers and warning signs of a coming crisis, people they feel comfortable reaching out to for help and activities they can do to distract themselves during those times — it can be something simple as watching a funny movie.
Safety planning includes helping your loved one make their environment safer. This is one of the most important steps to preventing suicide, says Marshall. That involves a conversation about lethal means.
“If you ask what kinds of thoughts you’re having, they may tell you the means,” she says.
If they don’t volunteer that information, it’s worth asking them directly, she adds. Once they say what means they have thought of using, one can discuss with them how to limit their access to it.
“The more time and space you can put between the person and harming themselves, the better,” says Marshall. “If this is someone who is a firearm owner, you may talk with them to make sure they don’t have ready access to firearm in moments of crisis.”

8. Help them tackle the mental health care system

When someone is in urgent crisis mode, it’s often not the best time to try to navigate the mental health care system, says DeGolier. But to prevent a future crisis, offer to help your loved one connect with a mental health professional to find out whether medications can help them and to learn ways to manage their mood and suicidal thinking.
A kind of talk therapy calleddialectical behavior therapy, or DBT, has been shown to be effective in reducing risk of suicide. It teaches people strategies to calm their minds and distract themselves when the suicidal thoughts surface.
It can be hard for someone who’s struggling with negative emotions to get and keep a mental health appointment. Family members and friends can help, notes Whiteside.
“Know that it takes persistence,” she says. “You don’t stop until you have an appointment for them. That may mean you call 30 people until you find someone who has an availability. You take the day off from work, go with them.”
Lezine says he was fortunate to have had that kind of help and support from his college friend when he was struggling.
“One of the things that was helpful … was she went with me [to my appointment],” he says. “When you’re feeling really down and feeling like you don’t matter as much, you might not want to take time, or think that it’s worth the time, or feel like I don’t want to go through this.”
Many people don’t make it to their first appointment, or don’t follow up, he says. Having a person hold your hand through the process, accompany you to your appointments can prevent that.
“If somebody is sitting there with you, you can have eye contact, touch contact,” says Lezine. “It does make a difference, making you feel like you have another person who cares.”

9. Explore tools and support online

For those struggling to access mental health care there are some evidence-based digital tools that can also help.
For example, there’s a smartphone app called Virtual Hope Box, which is modeled on cognitive behavioral therapy techniques. Research shows that veterans who were feeling suicidal and used the app were able to cope better with negative emotions. 
Whiteside and her colleagues started a website called Now Matters Now, which offers videos with personal stories of suicide survivors talking about their own struggles and how they have overcome their suicidal thoughts. Stories of survival and coping with suicidal thoughts have been shown to have a positive effect on people at risk of suicide.
The website also has videos that teach some simple skills that are otherwise taught by a therapist trained to offer DBT.
Those skills include mindfulness and paced breathing, which involves breathing with exhales that last longer than the inhales. Whiteside explains that this can calm the nervous system. Similarly, a cold shower or splashing ice water on one’s face or making eye contact with someone can distract and/or calm the person who is at immediate risk of taking their own life.
Surveys show that people who visit the website and watch the videos have a short-term reduction in their suicidal thoughts, she says.
[end excerpts]
The article is online at:
Ken Pope
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“We are all in the same boat, in a stormy sea, and we owe each other a terrible loyalty.”
—G. K. Chesterton (1874-1936)

M. Jackson Group Update – April 2019 – The Placebo Effect

This month’s post is again from Ken Pope’s listserv, where he kindly provides daily summaries of current articles in the field.  His post is as follows:
The British Psychological Society’s Research Digest includes an article: “The Placebo Effect, Digested – 10 Amazing Findings” by Christian Jarrett.
Here are some excerpts:
[begin excerpts]
The placebo effect usually triggers an eye-brow raise or two among even the most hard-nosed of skeptics. We may not be able to forecast the future or move physical objects with our minds, but the placebo effect is nearly as marvellous (Ben Goldacre once called it the “coolest, strangest thing in medicine”).
The term “placebo effect” is short-hand for how our mere beliefs about the effectiveness of an inert treatment or intervention can lead to demonstrable health benefits and cognitive changes – an apparently incontrovertible demonstration of the near-magical power of mind over matter. 
Our beliefs are the subjective echo of physical processes in the brain – and it’s this constellation of neurochemical and electrical events , and their downstream effects, that underlies the placebo phenomenon (in some cases the placebo effect can also be interpreted as a form of conditioned response, in which a learned physiological reaction occurs in the absence of the original trigger).

Here, in a celebration of the mysterious and maddening placebo effect, and to help inspire future research into this most fascinating aspect of human (and animal) psychology, we digest 10 amazing placebo-related findings:
The Placebo Effect Works Even When You Know It’s A Placebo
For the placebo effect to occur, it’s usually considered that deception is required – tricking the patient into thinking that an inert treatment is actually a powerful drug or similar. It’s this need for trickery that has long meant the deliberate inducement of placebo effects in mainstream medicine is seen as unethical. Nearly ten years ago, however, researchers showed that people with irritable bowel syndrome showed greater improvement after being given a so-called “open placebo” that they were told was completely inert, as compared to receiving no treatment. Presumably some residual belief and expectation of an effect survives being told that the treatment is physically impotent (or there is a condition response to the placebo that does not require positive beliefs). More recent research has since shown benefits of open placebos for many other conditions including back pain and hay fever. Open placebos “bypass at least some of the conventional ethical barriers” to the clinical use of placebos, according to some experts. Others however have highlighted the lack of suitably robust research in this area, and it’s worth noting there have been some null findings – for instance, open placebos failed to speed up wound healing.
Branding, Colours and Medical Paraphernalia Can All Boost The Placebo Effect
Putting aside open placebos, there’s evidence that different forms of deceptive placebo vary in their effectiveness. The more powerful we imagine their effect will be, the larger the benefit. This means that four placebo pills have a larger effect than two; and placebo injections (filled with nothing other than saline solution) are more powerful than pills (in fact, in the context of osteoarthritis, a placebo injection was found to be more effective than a real drug). Also – depending on the condition being treated – pills of certain colours and descriptions are more effective than others, such as blue placebo pills making better sedatives than pink ones, and branded placebo pills being more effective than those without any labelling. The influence of the credibility of a given placebo on its subsequent effectiveness may help explain one of the most astonishing demonstrations of the placebo effect that I’ve come across. It involved “placebo brain surgery” – and what could elicit a greater hope for a treatment effect than the elaborate paraphernalia and protocols involved in experts operating on your brain? Specifically, the research showed that patients with Parkinson’s Disease who undertook a form of placebo brain surgery (supposedly, but not really, involving the injection of stem cells) showed greater symptom improvements than those patients who received the stem cell treatment, but didn’t think they had. “The placebo effect was very strong in this study,” the researchers said, “demonstrating the value of placebo-controlled surgical trials.”
Some People Are More Prone To The Placebo Effect Than Others
Certain personality traits are associated with it being more likely that a person will experience the placebo effect. This is logical since the placebo effect depends on our beliefs and expectations, which some of us may subscribe to more readily and enthusiastically than others. Among the results in this area, optimists are more responsive to analgesic placebos, as are people who score higher for emotional resilience and friendliness (this last finding may relate to the social dynamic involved in the elicitation of the placebo effect by physicians). 
Some Doctors Are Better At Inducing The Placebo Effect Than Others
As placebo effects depend on the patient believing in the power of the treatment being given to them, it follows that some doctors will be better placed to reinforce this hope and expectation than others. Research backs this up: a study that involved a placebo injection for the treatment of an allergic reaction found that symptom improvement was greater when the injection was given by a doctor conveying warmth and confidence. Feelings of similarity toward one’s doctor may also be relevant: another study found that subjective pain was lower after a medical procedure when participants thought they’d been paired with a doctor who shared the same values and personal beliefs as them.
The Placebo Effect Isn’t Just About Pain Reduction – It Can Boost Creativity And Cognitive Performance Too
We usually think of the placebo effect in the context of medical interventions and especially pain relief. However, there is growing evidence that the effect can also work in other ways, including enhancing our physical and mental performance. In terms athletic abilities, various studies have shown placebo effects on speed, strength and endurance (in one placebo-like study, researchers asked cyclists to train to complete exhaustion and found they were able to persist significantly longer when their clocks had been secretly tampered with to make them run slow).
In relation to creativity, one study found that people who smelt an odour that they were told boosts creativity went on to excel at tests of their creative performance as compared with a control group who smelled the same odour but weren’t told it had any special benefits. Another experiment involved participants receiving placebo non-invasive brain stimulation and performing a learning task. The placebo group thought their brains had been stimulated by a mild electrical current – in reality they hadn’t – and they were led to believe that this stimulation would boost their mental function. The placebo participants were subsequently more accurate in the learning task, and showed steeper reductions in their reaction times than control participants. 
There’s Even Such A Thing As Placebo Sleep
There is almost no end to the ways that the placebo phenomenon can manifest. In one particularly novel instance researchers tricked participants into thinking they’d had more sleep than they actually had, and then observed how this affected their performance the next day. The researchers achieved this deception by wiring their participants up to various physiological measures and then giving some of them false feedback on how much REM sleep they’d had. After hearing that they’d had an impressive amount of sleep, participants performed better on tests of language and arithmetic. 
Animals Seem To Experience The Placebo Effect Too
It is common in drug trials involving animals to compare an active treatment against a placebo, similar to the procedure in human drug trials. And when this is done, researchers have often observed that a significant number of animals in the placebo group show a treatment response, such as happened in a trial of an anti-seizure medication for dogs, and in a dietary intervention for muscle stiffness in horses. The problem with interpreting these kind of findings is that it’s possible the placebo effect really lies with the owners, who may interact with their animals differently when they believe they are receiving medial care or nutritional supplements.
The Placebo Effect Has An Evil Twin
If the placebo effect occurs simply because you believe a given treatment will be beneficial, it follows that if you have negative expectations, this could result in a worsening of your symptoms. That’s exactly what researchers have found and they’ve called this the “nocebo effect”. The placebo effect’s twin is not to be sniffed at either. A meta-analysis in the context of analgesia (in which some participants are told that an inert cream or pill leads to increased pain in some people) found that the nocebo effect is roughly similar in size to positive placebo effects.
Intriguingly, nocebo effects can even occur in the presence of real pain-relieving medications, not just inert treatments – in one study, participants were told that their pain would increase after an analgesia treatment was stopped. The physiological effect of the analgesia would normally persist, however in these participants it ended abruptly, as if the negative expectations had cancelled out the genuine analgesic effect. The real-life implications of these kind of findings are obvious – if nothing else, it’s probably worth taking care when you read the side-effects leaflet that came with your latest prescription.
The Placebo Effect Is A Bit Of A Pain For Many Psychology Researchers
The placebo effect is fascinating in its own right, but for researchers interested in establishing the efficacy of psychological interventions, it can be maddening. The influence of expectations on our thoughts, feelings and behavior is so powerful and pervasive that it complicates the interpretation of many studies, unless they are very carefully designed. In their 2013 paper titled “The Pervasive Problem With Placebos In Psychology“, a team led by Walter Boot at Florida State University argued that in fact many psychology studies (on things like brain training, expressive writing and internet therapy) do not do enough to match participants’ expectations across different conditions. They explain that simply having an active control condition is not adequate if participants in the control group do not expect it to have as beneficial or powerful an effect as participants in the intervention condition expect of their experience. The way around this, Boot and his colleagues explained, is to measure participants’ expectations and take steps to try to match them across control and intervention conditions as much as possible. “‘We are hopeful that, with better designs and better checks on placebo effects, future research will provide more compelling evidence for the effectiveness of interventions,’ they concluded.
The Placebo Effect Appears To Be Getting Stronger
Curiously, it’s become apparent in recent years that the placebo effect is getting stronger – this has been shown for placebo antipsychotic medications, placebo anti-depressants, and – in the US only – for placebo analgesics. With regards to that last finding, research team leader Jeffrey Mogil told Nature News, “We were absolutely floored when we found out”. Specifically, in the 90s, they found that participants receiving an active drug reported 27 per cent greater pain relief than participants receiving placebo, but by 2013, the difference was just 9 per cent. One explanation is that drug trials have become larger and more elaborate, especially in the US, thus increasing the drama and intensity of the experience for participants only receiving placebo.
Another possibility is that the general public has become more aware of the placebo effect – and of the idea that its impact on symptoms can be real (as reflected in less pain-related brain activity, for instance) and not merely illusory. That was the argument put forward by anesthesiologist Gary Bennett in the journal Pain last year. In fact, Bennett goes so far as to suggest that, because the term placebo now elicits such a strong placebo effect, its use should be dropped from drug trials. “The word ‘placebo’ should be avoided in all information and instructions given to the patients,” he advises. “Patient instructions should have the goal of forcing the patient’s expectations to the form: ‘I may receive pain relief’ vs. ‘I will not obtain pain relief’.”
[end excerpts]
The article is online at:
Ken Pope
Print—Kindle—Nook—eBook—Apple iBook—Google Book
“[Danish physicist Niel Bohr, recipient of the Nobel Prize for Physics] used to tell the story of a visitor to his country home who noticed a horseshoe hanging over the entrance door.  Puzzled, he asked Bohr if he really believed that this brought luck.  Bohr replied: ‘Of course not!  But I’m told you don’t have to believe in it for it to work.'”
—Daniel R. Bes in Quantum Mechanics: A Modern and Concise Introductory Course, Second, Revised Edition 

M. Jackson Group Update – March 2019 – How To Be a Better Talker

This month’s post is again from Ken Pope’s listserv, where he kindly provides daily summaries of current articles in the field.  His post is as follows:
The Wall Street Journal includes an article: “No One Listening? Maybe You’re the Problem; Listeners typically shoulder the blame for disconnected conversations, distracted by screens and multitasking. But communication experts say talkers should examine their own actions, too” by Elizabeth Bernstein.
Here are some excerpts:
[begin excerpts]
A good friend called me recently to say hello. We chatted about his kids, a problem he was having at work, and his recent vacation.  When he asked how I was doing, I mentioned a big work project.  “The deadline is bearing down on me and I am stressed,” I said.
There was more silence.  Then my friend—who had woken me up at 6 a.m. to talk—blurted out: “Oh darn, I missed one!  I’m taking this online training course for work and just messed up the last answer.”
Ever feel like someone you’re talking to isn’t listening?  You’re not alone.  Listeners estimate that they tune out during conversations about 30% of the time, according to research from Harvard Business School, presented in its preliminary stage earlier this month at the annual conference for the Society for Personality and Social Psychology.
The blame is usually placed on the shoulders of the listener, distracted in the smartphone era by multiple screens and multitasking.  Solutions have concentrated on how to listen better: Put down your phone.  Make eye contact.  Ask open-ended questions.  Encourage the other person to elaborate.
But now communication experts say we need to focus on what the talker is doing wrong, too.  Often, they say, talkers engage in a monologue rather than a dialogue.  They drone on and ignore the listener’s cues that he or she is disengaged.  They sometimes accuse the listener of spacing out, causing hurt feelings or starting an argument.  They don’t let the listener get a word in.
“Usually, talkers are too active,” says Traci Ruble, a couples therapist and communication consultant in San Francisco, who is the founder of Sidewalk Talk, a nonprofit that sends groups of trained volunteers into the streets to talk with strangers.  
“The talker starts on a roll and never checks to see if they are being listened to, and the listener starts to feel objectified and thinks: ‘Do you even notice that I am here or are you just anxiously pouring out all your thoughts?’”
Ms. Ruble, who estimates that she’s trained about 8,000 people to communicate, says that talkers need to engage in “connected talking.” 
Connected talkers focus on four actions, she says.  They are aware of the listener and value what that person brings to the conversation.  They pay attention to what it feels like to be listened to and don’t get lost in their own head.  They feel gratitude for the listener.  And they are aware of the well-being of the listener, asking: “Am I overwhelming or losing the person?”
How do you put this into practice? Don’t just launch in. Ask the other person if they have time to chat. Then give them a hint of the emotional tenor of the conversation. You can say: “Hey, I’ve got some good news to share,” or “I’m falling apart, I could use some advice.” “Maybe people have time for a happy story but don’t have time to console you…,” Ms. Ruble says.
Next, be clear about what you need. Do you want advice, empathy, someone to hold your hand and just listen? Being open about what you want will help both you and the listener stay focused.
It’s important to pay attention to how much you appreciate the listener. Doing this will help the talker feel more heard.
You’ll also need to slow down your talking, make eye contact, pay attention to the other person’s responses and let the other person talk. Be aware of “anxious talking,” when you’re rambling on about anything that comes into your head. If that happens, ask yourself why you’re anxious. Sharing your worry can help the person feel more connected, too.
If the other person seems distracted or disengaged, don’t take it personally. Politely ask if there is something wrong or if they prefer to talk another time. And accept the answer. “If your listener doesn’t feel strong-armed into listening, then when they are listening they are really with you,” says Ms. Ruble.
How to Be a Better Talker
Here are some tips from Traci Ruble, a couples therapist in San Francisco and founder of Sidewalk Talk, a nonprofit that sends groups of trained volunteers into the streets to talk with strangers.
Don’t just launch in. Ask the other person if it’s a good time to chat.
Be clear about what you need from your listener—advice, empathy, an ear or a hug. Explain this.
Don’t take it personally if the listener can’t talk at that moment. Ask to chat at a better time.
Slow down. Breathe. Make eye contact. Let the other person talk, too.
Don’t ramble. If you do, get yourself back on track by saying: “My intention for sharing this with you right now is…” “It’s the ultimate gut check so you can be clear why you are sharing,” Ms. Ruble says.
If you sense the other person isn’t listening, politely ask what is going on or if there is a better time to talk. You may need to switch environments—move to another room, say—to remove distractions. If not listening is a pattern, discuss that and explain how this makes you feel.
Practice appreciating the listener more. This will help you feel more heard.
[end excerpts]
The article is online at:
Ken Pope
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Hardbound—Kindle—Nook—eBook—Google Book
“We’re all just walking each other home”  
—Harvard Psychologist Richard Alpert, later aka Ram Dass 

M. Jackson Group Update – February 2019 – Limits on Self-Care

This month’s post is again from Ken Pope’s listserv, where he kindly provides daily summaries of current articles in the field.  His post is as follows:
Current Affairs includes an article: “Self-Care Won’t Save Us” by Aisling McCrea.
Here are some excerpts:
[begin excerpts]
They’re usually painted in comforting primary colors or pastels, featuring simple illustrations, accompanied by text in a non-threatening font. They invite you to practice “self-care”, a term that has been prominent in healthcare theory for many decades but has recently increased in visibility online. The term generally refers to a variety of techniques and habits that are supposed to help with one’s physical and mental well-being, reduce stress, and lead to a more balanced lifestyle. “It’s like if you were walking outside in a thunderstorm, umbrella-less, and you walked into a café filled with plush armchairs, wicker baskets full of flowers, and needlepoints on the walls that say things like ‘Be kind to yourself’ and ‘You are enough,’” says the Atlantic. 
Though the term has a medical tinge to it, the language used in the world of self-care is more aligned with the world of self-help, and much of the advice commonly given in the guise of self-care will be familiar to anyone who has browsed the pop-psychology shelves of a bookstore or listened to the counsel of a kindly coworker—take breaks from work and step outside for fresh air, take walks in the countryside, call a friend for a chat, have a lavender bath, get a good night’s sleep. Light a candle. Stop being so hard on yourself. Take time off if you’re not feeling so well and snuggle under the comforter with a DVD set and a herbal tea. 
Few people would argue with these tips in isolation….  We should all be making sure we are well-fed, rested, and filling our lives with things that we enjoy.
In a time where people—especially millennials, at whom this particular brand of self-care is aimed—are increasingly talking about their struggles with depression, anxiety and insecurities, it’s no wonder that “practicing self-care” is an appealing prospect, even if it does sometimes seem like a fancy way to say “do things you like.” 
What is concerning is the way that this advice appears to be perfectly designed to fit in with a society that appears to be the cause of so much of the depression, anxiety, and insecurities. By finding the solution to young people’s mental ill-health (be it a diagnosed mental health problem or simply the day-to-day stresses of life) in do-it-yourself fixes, and putting the burden on the target audience to find a way to cope, the framework of self-care avoids having to think about issues on a societal level. 
In the world of self-care, mental health is not political, it’s individual. Self-care is mental health care for the neoliberal era.
As I write, the U.K. Prime Minister, Theresa May, is tweeting about World Mental Health Day and suicide prevention. She is not the only one; scrolling through the trending hashtags (there are several) one can find lots of comforting words about taking care of yourself, about opening up, confiding in a friend, keeping active, taking a breath. One such tweet is a picture of an arts-and-craftsy cut-out of a bright yellow circle behind dull green paper, designed to look like a cheerful sun. Printed on the sun are the words “everything will be so good so soon just hang in there & don’t worry about it too much.” All of us have probably seen some variation of these words at many points in our lives, and probably found at least a little bit of momentary relief in them. 
But looking through other tweets about World Mental Health Day reveals a different side of the issue. People talk about the times they did try to seek help, and were left to languish on waiting lists for therapy. 
They talk about the cuts to their local services (if they’re from somewhere with universal healthcare) or the insurance policies that wouldn’t cover them (if they’re in the United States). 
They talk about the illnesses left cold and untouched by campaigns that claim to reduce stigma—personality disorders, bipolar disorder, schizophrenia. 
They talk about homelessness and insecure housing and jobs that leave them exhausted. 
They talk about loneliness. 
These are deep material and societal issues that all of us are touched by, to at least some degree. We know it when we see people begging in the streets, when we read yet another report that tells us our planet is dying, when we try to figure out why we feel sad and afraid and put it down to an “off day”, trying not to think about just how many “off days” we seem to have. We turn to our TVs, to our meditation apps, and hope we can paper over the cracks. 
We are in darkness, and when we cry out for light, we are handed a scented candle.
A common sentiment expressed in the world of self-care is that anyone can suffer from mental ill-health. This is true, but it’s not the entire story. 
In fact, mental health problems are strongly correlated with poverty, vulnerability, and physical health conditions (with the causation going both ways). 
Furthermore, there is a big difference between those of us who are fortunate enough to be able to take time off work for doctor’s appointments and mental health days, and those who can’t; those of us who have children or other dependents to take care of, and those who don’t; those of us who have the financial independence to take a break from our obligations when we need to, and those who don’t. 
Not all people have the same access to help, or even access to their own free time—employers increasingly expect workers to be available whenever they are needed, both in white-collar jobs and precarious shift work. 
Add in the (heavily gendered) responsibilities of being a parent, studying, a night-time Uber gig to cover the bills, or a long commute from the only affordable area in the city, and the stress of life will pile on even as it soaks up the time you’re supposed to set aside to relieve that stress.  
Funding cuts are in fashion across a plethora of Western countries, both to healthcare and to other services that indirectly affect our health, especially the health of people who need additional support to lead the lives they wish to live, or even just to survive. 
The rhetoric around self-care is flattering but flattening, treating its audience as though the solution to their problems is believing in themselves and investing in themselves. 
This picture glosses over the question of what happens when society does not believe or invest in us.
Even for those of us who are relatively lucky in life, self-care does not solve our problems. “It’s okay if all you did today was breathe,” promises a widely-shared image macro of a gentle talking pair of lungs. Well, I hate to break it to you, talking lungs, but it’s 2018. We’re supposed to be walking powerhouses of productivity, using every minute of our time to its best effect. In an economic environment where careers are precarious and competitive, young people are increasingly pressured to give up their free time to take on extracurriculars and unpaid projects “for their resume,” produce creative content “for exposure,” learn skills such as coding, scout for jobs on LinkedIn, write self-promoting posts about their personal qualities, and perhaps worst of all, attend godawful networking events, some of which don’t even have free canapés. Taking part in all this sounds unfair and exploitative, but you’re in a world where solidarity is just the name of a song from the Billy Elliot musical; if you won’t go along with it, there’s a line of brilliant, hungry graduates from top-name schools right behind you who will. 
It doesn’t stop with work either. This way of thinking about ourselves—constantly in need of self-improvement, constantly aware of our need to market ourselves as premium humans—seeps into our personal lives as much as our professional lives. On your way home from the office, perhaps you’ll flick through the apps on your smartphone, doing all the tasks you’ve assigned to yourself so you can be stronger, smarter, more attractive. Have you walked the 10,000 steps today mandated by your Fitbit? Have you done your Duolingo practice? You’re falling behind with learning French. Learning French will make you more appealing to employers, and might also make you look sexy and mysterious on dates. Have you responded to that Tinder message? It wasn’t very interesting, but you can’t remember the last time you met a romantic prospect organically so you should really get around to responding. You need to think of a good joke first, though; if you come off as too generic they’ll be on to the next candidate. Have you finished that book for your book club? You’ll look like an idiot if you don’t know how it ends. Did you play the guitar today? Creativity is important. Have you checked the news? What if someone asks you about the situation in Myanmar? How’s your posture? Is it upright? Check your reflection in the window. Why are you slouching? Why are you so pale? Why are you so tired? Who is this person?
It’s harder, too, if you’re a woman. (Copy and paste this sentence and stick it into any article you like, it’ll work.) 
The standard pressures from the advertising industry have only ramped up as we’ve turned away from traditional media, insinuating their way into social media under the same guise of aspirational content, but this time smiling with the face of a friend. Youtube and Instagram stars draw you in with viral content and enviable abs, promising you that if you drink the juice, do the workout routine, learn how to use a hairdryer with perfect salon technique (and if you’re finding it difficult this new product makes it SO much easier, use my code for a 15 percent discount!) you can be the best version of yourself you can be. 
This is a lie, of course—the goal is not to be you, it’s to be them.  You know this, and know it isn’t what you should think, but you cannot help how you feel. The insecurities burrowing deep under your skin and planting the desire to be someone else don’t even have to be internally consistent. 
Being a woman means you can stand in front of a mirror and simultaneously be upset that you’re not as skinny as a sportswear model and as curvaceous as a 1950s pinup girl. Your phone is filled with updates from the lives of beautiful women you do not know. Flick to the next image in your feed, past the girl with the Photoshopped manicure (perhaps in reality, her nails, like yours, are bitten down). The next post is about self-care. There’s a link to buy bath oils in the description.
On social media sites such as Instagram and Pinterest, pictures exhorting us to set aside an evening to relax sit alongside images of gorgeous people we will never look like (but will spend hundreds of dollars and hours trying to emulate), images of locations we will never travel to (but will keep for years on our bucket lists), images of top 10 tips from successful entrepreneurs (whose life advantages and luck cannot be guaranteed, but who we will continue to hold up as experts in how they attained their position in life). 
Ironically, in telling us to take the pressure off ourselves, self-care discourse can feel as though it’s doing the exact opposite—adding “taking care of our mental health” as yet another task to put onto our plates, alongside finding a fulfilling, well-paid career, doing overtime to prove our worth, networking to maximize our chance of success, getting to the gym five times a week, finding the perfect skincare routine, practicing an interesting and resume-friendly hobby, seeing friends in a variety of glamorous locales, finding a partner, and creating an original yet classic décor theme for our homes. 
If it’s too hard, and you need something easier for a little bit, you are invited to seek solace in consumption. Watch Netflix, watch Amazon Prime—put a little more change in the pocket of the world’s richest man, in exchange for a couple of hours’ distraction. Get delivery food from an app that uses poorly-paid “independent contractors”, the bulk of them time-poor, cash-poor millennials like you. Squash down the wave of guilt—guilt at spending too much money, at using services you don’t support, at ordering the chicken when you swore you’d go vegan months ago. You’re feeling constantly guilty about something or other anyway, so one more thing to feel guilty about barely registers. After eating, you curl up on the couch, hugging your knees with your arms, small. You are taking up the most minimal space; even in our darker moments, we feel a need to exist in the most efficient way possible.
Why are these feelings familiar to so many of us, yet we feel so alone? We are atomized, individualized, struggling under the same system but struggling inwardly and separately. Self-care slots in neatly with capitalism, treating mental ill-health as an individual problem divorced from material and political context, to be solved by pulling ourselves up by our bootstraps and maybe spending a little money on the way. We are invited to draw inwards, shut our curtains; pull ourselves into movies and food and warm water and blankets as a means of escaping our problems without solving them. We are encouraged to “reach out” to others, if we feel able to, but our relationships to others in the language of self-care appears to be as mutual conduits for pressure relief; “reaching out” always seems to mean drawing someone into the blanket with you rather than throwing the blanket off.
But what if there was an alternative? What if you didn’t have to worry about your insurance covering a therapist, because everyone had universal coverage? What if you weren’t exhausted from balancing your job and your family, because you had affordable daycare, decent parental leave, and six weeks’ paid vacation? What if you didn’t have to spend every waking moment optimizing yourself for the job market, because we had built an economy that did not put disproportionate power in the hands of employers? 
What if we stopped thinking of ourselves as being constantly in competition with each other, because we realized it was more a source of misery than success? What if we didn’t feel a nagging sense of doom every time we looked at the news, because we were actually on the road to making things better? What if we built something different? What if we did it together?
All of us need to take pleasure in things we enjoy. It’s important to take care of our needs and smell flowers and eat cheesecake. But if our deeper anxieties are at least in part caused by our conditions, then maybe our solution lies in fixing our conditions. 
Instead of commiserating with coworkers on a poor working environment, imagine organizing with them. Imagine connecting with other people in your community over things that matter to all of you; whether that’s saving a treasured park or bringing attention to a local crisis. Going door-to-door, meeting people you’ve been living next to this whole time, hearing their voices, hearing your collective voice get a little louder every time someone joins you. Imagine what putting faith in solidarity could do at a local level, or a national level. How would it feel to take back power, to have agency? Developing bonds with people over something that matters can be electrifying, and of course if you win, that’s a real change to the world you live in, for you and the people around you! 
Even if you don’t win, all is not lost, because you created a possibility—the possibility that future victories might come, that other people might be inspired by what you did, that you could return to try again, that there’s a better thing to be created. Most importantly of all, there’s hope, perhaps the most powerful force in life. No bubble bath can give us that. Maybe that’s a gift we give ourselves.
[end excerpts]
The article is online at:
Ken Pope
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“I’ve coined the word stressism to describe the current belief that the tensions of contemporary life are primarily individual lifestyle problems to be solved through managing stress, as opposed to the belief that these tensions are linked to social forces and need to be resolved primarily through social and political means. Analysis of stressism brings into sharp focus significant polarities in Western thought, principally the sharp divisions between mind and body, health and illness, public and private, social responsibility and individual self-actualization. Examining stress brings to light many of our cherished cultural preoccupations and predispositions, exposing existing tensions and inequities related to class and gender; and our increasing dependence on stress to explain our lives has consequences for the way we see ourselves and the world, the way we act, and the world we create as a consequence of that vision and those actions.”
—Dana Becker in One Nation Under Stress: The Trouble with Stress as an Idea