In 2011, Roger Walsh published a review of the research into ways we can improve our mental health and resiliency by changing how we live. He found eight that had both solid research behind them and strong effects. As therapeutic interventions go, these lifestyle changes tend to be enjoyable, inexpensive, and carry only positive side effects such as increased physical health, self-efficacy, and longevity. Despite that, mental health professionals do not emphasize lifestyle changes. This could be due to a spin on the instrument fallacy: Clients bring in a nail and all therapists can think of to use is their hammer. Walsh suggests this failing is because therapists have unhealthy lifestyles themselves.
Exercise: 30 minutes or more of exercise has therapeutic and preventative emotional and cognitive effects.
Nutrition & Diet: Fish, vegetables and fruit in the diet have both enhancing and protective psychological effects.
Time in Nature offers cognitive and emotional benefits and stress relief.
Good relationships: Being connected in rich relationships comes with cognitive benefits, happiness, and resiliency. In fact, the quality of a therapeutic relationship may account for a large part of the benefit of therapy.
Recreation & Enjoyable Activities (AKA fun): Helps with stress, mood, and well-being.
Relaxation & Stress Management: Mindfulness practices and muscle relaxation techniques can have strong and lasting positive effects on mood management.
Religious & Spiritual Involvement is associated with good mental health, maybe especially with faiths centered on love and forgiveness.
Contribution & Service: Giving time and energy to others boosts happiness, as long as it isn’t out of a sense of obligation.
[Originally published on Nathen’s Miraculous Escape]
I just had the pleasure to attend a lecture by Dr. Bruce Perry. It was great, and if his books are as good as his lectures he may be my new hero. The topic was his “neurosequential therapeutics,” which sounds nerdy (and it is) but is much more intuitive and helpful than it is technical. The basic idea is that the developmental stage at which a client was traumatized is an important clue into what kinds of therapeutic activities will be helpful to them, and in what order and priority. Pre-verbal trauma is unlikely to be helped by cognitive therapy, for example.
Anyway, more on that when I get the time to read his books. Another thing I liked about Perry was his attitude towards the DSM, the mental health industry’s diagnostic Bible. Here’s my paraphrase of one of his tangents on the DSM:
The heart is a fairly simple organ. It’s a blood pump. Cardiologists know several hundred ways that the heart can get sick and all of them are diagnosed and named in terms of the physiology of the heart. The symptoms that bring the patient in, however, are few–often chest pain and shortness of breath.
The brain, on the other hand, is an extremely complex organ. The DSM lists several hundred psychological symptom clusters which ostensibly represent ways the brain gets sick. But none of them are diagnosed or named based on brain physiology. They are all named based on symptoms: Panic Disorder Without Agoraphobia, Major Depressive Disorder With Postpartum Onset, etc.
If cardiologists followed this protocol, they would have only a few diagnoses, along the lines of Major Chest Pain Disorder With Shortness of Breath, Major Chest Pain Disorder Without Shortness of Breath, etc.
[First published on Nathen’s Miraculous Escape]
I’ve just begun reading Antonio Damasio’s The Feeling of What Happens: Body and Emotion in the Making of Consciousness. I bought the book while I was in grad school, knowing it would be years before I could get to it, but so excited by the title! Consciousness and how it relates to the body and emotions is one of my favorite topics of inquiry. Plus, Damasio is a scientist with a (rare) good reputation as a writer.
In the introduction he describes six facts that a good theory of consciousness will have to take into account. Here are my paraphrases:
1) There will be an “anatomy of consciousness”: Elements of consciousness appear to be associated with activity in certain parts of the brain.
This may be scary to those who believe that consciousness is magical, or that its magic would be somehow diminished if it relied on the brain’s circuitry. I too used to be uneasy about that idea. After diving into brain studies a bit, though, I feel both excited and humbled by it. It’s just neatthat our brains apparently produce all the subtleties of our experience. Also, it’s a good reminder that our experiences of feeling, thinking, knowing, and of awareness itself is createdby our brains, and is not a direct line on reality.
2) Consciousness is more than wakefulness or attentiveness. Humans can be awake and attentive without being conscious.
Damasio describes patients who are clearly awake and attentive, but not conscious, and promises to devote two chapters to the significance of this phenomenon.
3) You cannot have consciousness without emotion.
I am excited about this point because I’ve thought it both crucial and little recognized since reading The Mind’s I many years ago. It had an essay which convinced me that real artificial intelligence would not be possible without emotion. Without emotion all you have is processing power. And in human intelligence at least, emotion brings in the body. Emotions are not just mental phenomenon. I can’t wait to see how Damasio deals with this.
4) There is a distinction between “core consciousness,” producing a sense of moment-to-moment “core self,” and “extended consciousness,” producing a story-making “autobiographical self.”
This distinction could bring clarity to the debates about consciousness in infants and non-human animals. Core consciousness may be the kind that everyone has, and extended consciousness the kind that we develop as our experience becomes more and more intertwined with language and concepts.
Core consciousness sounds to me like the experience that meditators work to remain in. We live most of our lives in the useful but problematic realm of extended consciousness, judging experiences as good or bad, right or wrong, safe or unsafe, and other ways they relate to the story we have of ourselves. Once we are living this way it is difficult to escape. Meditators find that maintaining awareness of core consciousness can be a welcome rest from all that. This practice may help the autobiographical self have an easier time as well.
5) Consciousness cannot be wholly described by other mental activities. Things like language and memory are necessary but not sufficient for full consciousness.
You can’t leave consciousness out of the discussion. It is more than its parts. I like this because I think a lot of scientists are squeamish of even using the word “consciousness.” It makes you sound like a hippy. Prepare to hear a lot of scientists trying to talk about consciousness without sounding like a hippy.
6) Consciousness also cannot be described wholly by describing how the brain creates our experiences out of sensory and mental data.
I read some famous scientist saying that if he were to be at the beginning of his career, he would be looking into creation of qualia, the “particles” of experience, that this was the next holy grail of psychology. That’s a good one, for sure, but I think an explanation of consciousness is a better holy grail than an explanation of qualia.
(First published on Nathen’s Miraculous Escape, July 28, 2012)
A few weeks ago, one of my blog posts received a comment that was worth a whole post:
“I am also a therapist (though I’m still in training). I’m wondering if you would be willing/able to recommend some family therapy books you’ve found helpful. My program is very focused on the individual and I’m trying to fill in some gaps and find your perspective on therapy to be very resonant with my own.”
I’d love to recommend some family therapy books! My program was extremely family-systems focused, which I’ve been grateful for since leaving school. If you want to see an exhaustive reading list (I can’t remember having been assigned a real dud), you can see reverse-order lists of everything I read in my first year here and my second year here.
I’ll try to create a bare-bones list for you here—much more useful for you and a good exercise for me. I should warn you before I begin that I am super nerdy when it comes to family therapy reading and I can imagine many in my cohort rolling their eyes at my “must-read” list. If you are nerdy like me, though, here goes:
Pragmatics of Human Communication: A classic and profound book by Bateson’s MRI team, the first and probably still the best attempt to apply system theory to human relationships.
Susan Johnson’s books The Practice of Emotionally Focused Couple Therapy and Emotionally Focused Couple Therapy for Trauma Survivors. Johnson combines system-thinking, Rogers-style experiential therapy, and attachment theory, creating one of my most-used therapy models.
John Gottman’s books, especially The Marriage Clinic and The Science of Trust. Gottman has taken up the project started with Pragmatics, largely abandoned by family therapy, and is doing it in fine style, with solid science.
Metaframeworks: This book presents my favorite meta-model of family therapy, combining the best parts of the many family therapy models.
A major work by each family therapy model-builder is also important reading: Haley, Madanes, Satir, Whitaker, Minuchin, Bowen, Selvini-Palazolli/Milan group, Weakland/Fisch/MRI group, deShazer/Insoo-Berg, Epson/White, and Hubble/Duncan/Miller. Keep in mind that their books are presentations of informed opinion, not science. Every one of these folks have got some things right and some wrong. They have also advanced the field significantly, and are the largest part the conversation on how to think about families.
Finally, a couple things that I was not assigned in school, but I found extremely helpful in making sense of the flood of information. First, a grounding in systems/complexity theory: Family therapists think of themselves as system-theory experts and throw around a lot of lingo that they may or may not really understand. It’s easy to get confused in this situation. The best introduction to modern system thinking is still Capra’s The Web of Life (though we’re overdue for an update). Also, check out Bateson’s books Steps to an Ecology of Mind and Mind and Nature.Second, familiarity with Wilber’s integral theory really helped me navigate the heated arguments about modernism vs. post-modernism and intervention at the level of individuals vs. family systems vs. larger systems. Check out Integral Psychology or A Theory of Everything.
(Originally published as “Family Therapy Books I Recommend to Individual Therapists,” on Nathen’s Miraculous Escape.)
Sometimes I imagine being able to visit myself in the past, usually my anxious or sad teenaged self, and wonder how I could be the most helpful to him and the rest of his-future/my-past selves. One thing I like about this fantasy is that it reminds me how lucky I am. There are people who would probably want to tell their young selves something like, “It’s very important that you do not use X drug because it will ruin your life,” or “It is never OK for a romantic partner to hit you. Dump them and go immediately to the authorities.”
I usually imagine delivering a convincing version of, “If you are scared or sad, it’s because scary or sad stuff is happening, and that’s the way life is. Know, though that this all works out. Your next several decades are much better than you can imagine. Yes, there will be scary and painful stuff, but remember that it works out great.” I can vividly imagine beaming at my young self, delivering this message.
There is something comforting about this fantasy, like my young, internal Nathen benefits from hearing it. This led me to taking the question a step further: Given my life so far, what might my 80-year-old self want me to know now? I like to imagine my old, wrinkly self beaming at me, saying, “This works out even better than you can imagine…” As far as I can tell it is likely true, and it is quite calming to imagine.
It strikes me that this is something like what I do in my therapy work. Yes, there is the occasional need for advice, but the biggest part of what I do is let clients know with my mind, body, and soul that their current struggle is a small, if poignant, part of their life story. I welcome their sadness, anger, and anxiety as appropriate, given the circumstances, and I have confidence in their goodness, their strength, their resourcefulness. I try to know and show that this works out for them. It can and they deserve it.
Some of my oldest memories are of lying in bed, late at night, wishing I was asleep: sleep-onset insomnia. I’m happy to say that I have largely overcome this malady. I have a sizeable bag of tricks to help me out with it (read about them here), the most important of which is having gotten over my fear of insomnia, which had become the primary source of sleeplessness. For the last several years I’ve had trouble getting to sleep just a few times a year.
For the last couple months, though, I’ve been experiencing “terminal insomnia,” AKA waking up too early and failing to fall back asleep. Most of my tricks don’t apply here. It sometimes helps to stay in bed until my alarm goes off–occasionally I will fall back asleep. Sometimes cuddling helps, too, but I’ve found nothing consistent so far. It’s become a problem: I’m getting married next week and sleep debt tends to make me clumsy, grouchy, and stupid–not the way I’d like to show up for this event!
So I complained about it to my therapist today and he gave me his hypothesis: I am chronically and habitually productive. Productivity is a way of life for me and it’s infiltrated my groggy, should-be-going-back-to-sleep mind. He is right. I am on the go all day. It never occurs to me to slow down, much less take a nap, and that was exactly his prescription:
“I wonder what would happen if you cultivated a habit of trying, even to a ridiculous degree, whenever you noticed being really tired , just saying, ‘OK, I’m just going to lie down. I’m just going to quit what I’m doing and lie down.’ Even if it seems indulgent or inconvenient. Just ‘F*** it. I’m lying down, I’m closing my eyes, I’m relaxing. If I sleep, I sleep–it doesn’t matter. I’m just going to relax.’ Look at your tiredness as a sort of enlightened messenger, giving you the gift of saying, “Stop it! Stop working so hard. Just lie down right now and be irresponsibly lazy. Just lay out.’
“And you’ll have to deal with the resistance in you too. The well-trained hard, hard worker in you will say “Now’s not a good time… maybe later,” and the challenge is to say “F*** you. I’m not buying it. I’m lying down. For at least five minutes I’m going to lie down, deep breath, deep relax, and invite myself to doze if it happens.
“It’s the next logical progression of getting over the fear of insomnia: The next step is getting over the fear of being tired. OK, I’m building into my lifestyle being tired and loving myself in my tiredness. If I’m tired, I lie down. Why the hell not?
“I want you to take it on as a spiritual practice. Seriously. A spiritual practice of just interrupting productivity as often as possible in order to be lazy and relaxed and tired and just let the earth hold you up. When you lay down, experience the earth holding you up and receive that kind of support. You are a very diligent, principled and hard-working fellow, Nathen, and we have noticed. We got the message. You’ve got that covered. You’ve acheived that already and can let your pendulum swing back in the other direction.”
He’s right that it won’t be easy. As I’ve been writing, I can feel the familiar tiredness in my face and arms, weighing me down, and I’m choosing to write instead of lie down. Well, maybe I willgo lie down and finish this later…
Jim Berkland seemed to predict a large earthquake in mid- to late- March 2011 somewhere in North America. Watch the footage here. (The Fox commentator is pretty funny. At one point he says to pay attention because “he is a pretty good geologist.”)
There was no large earthquake during that time, but we can’t really know if Berkland was technically wrong, because what he actually predicted was a “high probability” of a large earthquake in North America. If you want to know how accurate a predictor who uses language like this is, you have to track outcomes of a whole bunch of their predictions, not just one. This is what Philip Tetlock does in his research on prediction accuracy–track the outcomes of hundreds of predictions of political experts. He also had to force the experts make specific enough predictions that they would either be true or false, not ambiguous–not always an easy task. Berkland, while casting a wide net, was fairly precise with “large earthquake” and “North America,” though we must wonder whether he would have claimed success if there had been a large earthquake, say, in the northern Pacific.
I’m not sure how many earthquake predictions Berkland has made, but if there have been enough, we could judge his rough accuracy: When he predicts a high probability of an earthquake, does it happen most of the time? When he predicts a low probability of an earthquake does it usually not happen? How about a medium probability?
The point is, if your prediction is of a probability, rather than a certainty of an event, we need to do some statistics to figure out if you’re a good predictor. And this is the form that careful people make their predictions. If, on the other hand, you tend to make predictions about certainties–100% or 0% probability events, it’s quite a bit easier to check your accuracy–as long as you make sufficiently specific, falsifiable predictions. Most prediction by ideologues, for example, set up what Tetlock calls an “outcome-irrelevant learning situation,” a situation in which the predictor can claim they were right no matter what actually happens. Every ideologue, therefore, is in the position to explain what happened, using their own ideology.
An example of that may be the Mayan-calendar predictions. Here is Graham Hancock on Art Bell’s radio show, seeming to predict something happening on December 21, 2012. It is full of talk of cataclysms, the end of the world, tumult, a ball of fire hitting the earth, etc. (And lots of talk about how accurate the Mayan calendar was, as if having a really accurate way to measure time lends credence to your predictions. Better ask the guy who invented the atomic clock!) I bet these guys will be patting themselves on the back on 12/21/2012 if a ball of fire does hit the earth. But if nothing particularly tumultuous happens, will they be wrong about anything? No. They are not precise at all, and they attach no probability to their “prediction.” There are plenty of “just mights” and “maybes” and “a window of about 40 years.” They even say that if humanity gets their act together in some vague way, we might avert what may or may not have been coming. This is a perfect setup for an outcome-irrelevant learning situation.
Tetlock says that when predictors are wrong, they generally either claim to be right in some way, based on the fuzziness of their prediction, or they use one of several “belief system defenses.” The most common of these is “Just off on timing.” The other two major defenses are the upward counterfactual defense, or “you think this is bad?” and the downward counterfactual defense, or “you think this is good?”
If nothing particularly tumultuous happens on 12/21/2011, and we ask Bell and his guest about it, how will they respond? They might use “just off on timing,” and blame our modern, inaccurate calendars. More likely they would claim to have been right, something like, “All the war and bad stuff happening on the earth–this is what we were talking about. It’s just a lot more slow and drawn out than we thought.” There is some, small, chance that they might cop to being wrong. I haven’t listened to Bell in over a decade, and I can’t remember how he handles his predictors being wrong, or if he even addresses it.
Berkland could also claim to be right: “Well, there was a high probability of a large earthquake, but not everything with a high probability happens every time.” A “just off on timing” defense would be pretty weak for him, since timing is everything in earthquake prediction.
The third predictor I’ve been thinking about, though, has given himself very little wiggle room. It takes guts to make a prediction like this. According to Harold Camping, next Saturday, May 21, 2011:
“A great earthquake will occur the Bible describes it as “such as was not since men were upon the earth, so mighty an earthquake, and so great.” This earthquake will be so powerful it will throw open all graves. The remains of the all the believers who have ever lived will be instantly transformed into glorified spiritual bodies to be forever with God.
“On the other hand the bodies of all unsaved people will be thrown out upon the ground to be shamed.
“The inhabitants who survive this terrible earthquake will exist in a world of horror and chaos beyond description. Each day people will die until October 21, 2011 when God will completely destroy this earth and its surviving inhabitants.”
That’s from his website, which you can see here. I have also heard Camping say that millions of people are certain to die on May 21, 2011, and every day thereafter until the very end, October 21, 2011. I have heard him say “It is going to happen.” I have heard him say “It is absolutely certain.” I was disappointed when I heard him back down from that, recently, saying he can’t be absolutely certain, but he has stuck with “going to happen” and “there is no doubt.”
I wonder how Camping will react if his predictions are wrong. The counterfactual defenses won’t apply at all. It will be very difficult to argue that he was right in some way if there is not at least the largest earthquake ever recorded (that would be at least a 9.6), that all buried bodies are somehow exposed (ideally as the result of the earthquake), that millions of people will die on May 21, and that approximately 7 billion people will die by October 21.
So my prediction is that he will use “Just off on timing” and go back to calculating the real day of judgment. Based on social psychology research, I will also predict that in general, this event will increase believers conviction, rather than decrease it. And if I am wrong, I will do my best to just admit it.
(First published as “Three Predictions,” May 14, 2011 on Nathen’s Miraculous Escape.)
I read Whitaker’s Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America as a counterpoint assignment in one of the diagnosis classes in my Couples & Family Therapy program. It is an excellent book about the history and science of several psychological problems, both as phenomena and diagnoses, including depression, depression, bipolar disorder, ADHD, and schizophrenia. As a university student, I had the opportunity to check out, for free, any of the many academic citations in the book that piqued my interest; each one that I looked at seemed indeed to provide the evidence he claimed. I haven’t read anything like all of them (there are nearly 700 citations), but enough to satisfy myself that Whitaker has done some good journalism here, and that his hypotheses are credible.
Two of these hypotheses is about childhood bipolar disorder, the first of which he calls the “ADHD to bipolar pathway.” The side effects of stimulants such as those used to treat ADHD are substantially similar to bipolar symptoms, as shown in the table below, from p. 238. (The formatting here is slightly different than Whitaker’s, thanks to an Open Office/Wordpress interaction.) Multiplying the estimated rate of stimulant-induced bipolar-like symptoms by the 3,500,000 children and teens taking those medications, Whitaker estimates we should see approximately 400,000 “bipolar youth” as a result.
The ADHD to Bipolar Pathway
|Stimulant-Induced Symptoms||Bipolar Symptoms|
|Increased lethargyIntensified focusHyperalertnessEuphoriaAgitation, anxietyInsomniaIrritability
|SomnolenceFatigue, lethargySocial withdrawal, isolationDecreased spontaneityReduced curiosityConstriction of affectDepression
|Increased energyIntensified goal-directed activityDecreased need for sleepSevere mood changeIrritabilityAgitationDestructive outbursts
|Sad moodLoss of energyLoss of interest in activitiesSocial isolationPoor communicationFeelings of worthlessnessUnexplained crying|
The second part of Whitaker’s thinking on childhood bipolar disorder is an SSRI to bipolar pathway. Estimates of the rate of the well-know SSRI side effect of mania, multiplied by 2,000,000 children and adolescents on the medications, give us the possibility of producing at least 500,000 SSRI-induced bipolar disorders in young people.
If true, these hypotheses could go a long way to explain the skyrocketing rates of childhood bipolar disorder diagnoses, as most diagnoses of childhood bipolar disorder are made on children who are already taking stimulants and/or SSRIs. The primary alternative, and more mainstream, hypothesis is not that stimulants and SSRIs are iatrogenic, but that since those medications solve the problems of ADHD and depression, the symptoms of bipolar disorder that emerge show that the diagnostician had initially guessed wrong, and that bipolar disorder was the previously-existing and underlying cause of the ADHD and/or depression. This, of course, may be true, but it seems very important to discover for certain whether it is!
As a family therapist, when I am presented with a child exhibiting symptoms of ADHD, I am trained to look at the child’s environment and history, especially their family relationships. How is it that these behaviors might be a response to the stresses that the child is experiencing? The point is that I do not just assume that the child has been genetically programmed to disrupt their classroom. I came across this study last year, though, that was a good reminder that “environment and history” are bigger than what happens in-between family members.
It found that children with higher levels of polyfluoroalkyl chemicals (PFCs) in their blood were more likely to have been diagnosed with ADHD. PFCs are long-lasting industrial substances that we accidentally eat and breath into our bodies from various coatings, foams, emulsifiers, and cleaning and personal products. Almost all of us have detectable levels of them in our bloodstreams. They are known to be toxic in other animals to the liver, immune and reproductive systems, and fetal development. It is also starting to look like they are neurotoxins as well.
The study was of correlations, so whether the PFCs caused the children to get ADHD diagnoses remains to be seen. ADHD may turn out to be a PFC-toxity-induced syndrome. Or it could be that PFC levels in mothers correlates with that of children, and that it is in-utero PFC levels that are critical. Or perhaps having an ADHD diagnosis causes children to eat and/or breath more coatings, foams, and emulsifiers. Or who knows what else?
Until the scientists know for sure, here are some ways to limit your PFC exposure, from Environmental Working Group:
Forgo the optional stain treatment on new carpets and furniture.
Find products that haven’t been pre-treated, and if the couch you own is treated, get a cover for it.
Choose clothing that doesn’t carry Teflon® or ScotchgardTM tags.
This includes fabric labeled stain- or water-repellent. When possible, opt for untreated cotton and wool.
Avoid non-stick pans and kitchen utensils.
Opt for stainless steel or cast iron instead.
Cut back on greasy packaged and fast foods.
These foods often come in treated wrappers.
Use real plates instead of paper.
Pop popcorn the old-fashioned way on the stovetop.
Microwaveable popcorn bags are often coated with PFCs on the inside.
Choose personal care products without “PTFE” or “perfluoro” in the ingredients.
Use EWG’s Skin Deep at cosmeticsdatabase.com to find safer choices.