psychology

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Silent Wars: Helping Vets Fight Mental Health Battles At Home

By Evan Bick
Guest Contributor

The movies have it wrong. Combat, at least in my experience, was not non-stop or action-packed. Those who have experienced it know that modern warfare usually involves a lot of starting and stopping. Long stretches of quiet, even boredom, can be broken in an instant.

I was deployed to Iraq as an infantry platoon leader in 2008-2009. During that time, there may not have been constant action but there was tension — my fellow soldiers and I were on edge most of time, soldiers among civilians, going on patrols in the northwest corner of Baghdad.

Evan Bick, a veteran of the Iraq war, now works with other vets struggling with mental health problems. (Courtesy)

Evan Bick, a veteran of the Iraq war, now works with other vets struggling with mental health problems. (Courtesy)

On our first day in the city, the leaders from the unit we were replacing took us on a walk through their area of responsibility. We saw the sidelong glances from civilians as Americans walked through their streets, hidden behind rifles and sunglasses, and weighed down by cumbersome body armor. We also saw an area filled with stark contrasts — stucco houses with gated courtyards in one neighborhood, and refugee camps for Iraqis displaced by ethnic violence in the next.

Deployment is a challenging experience even when it’s boring. Whether you are patrolling ‘outside the wire’ or working behind the scenes, the sense of danger is real and omnipresent. While deployed, soldiers typically work far longer hours, and with less opportunity for relaxation than they experience at their home station. Isolation from loved ones, of course, is an important challenge both for the deployed soldier and family members back home.

Even with all those challenges, the bigger battle for many veterans begins when they return home. Without a unit that shared in your experience of war, you can feel lost — more lost than you would ever feel on patrol. It’s easy to get trapped inside your own head, and to dwell on what did not go well, and what you should have done differently. The quick reflexes and adrenaline that may have helped keep you alive overseas are probably no longer helpful.

Strategies that kept you and your fellow soldiers safe, like driving fast and straight down the middle of a road, become dangerous, and loud noises or crowds may make some part of you feel like you’re back in the desert. Continue reading

Studies: It May Be Better For Kids Who Are Overweight Not To Know It

feetonscale

According to the scale, the 18-year-old girl is severely obese. But she doesn’t think so.

“I know I’m big, but I’m not obese,” she says. “I don’t take up three seats. My weight is high, but no higher than lots of people’s. It’s no problem.”

If you’re her doctor or school nurse or parent, what do you do? Do you bombard her with Body Mass Index charts and warnings of the health risks she faces? Knowledge is power, right? Certainly, that’s the principle behind the “BMI report cards” — colloquially known as “fat letters” — that schools send home in some states.

But research just presented at ObesityWeek, a major conference on obesity, suggests that it may not be wise to persuade that young woman that she has a problem.

One study found that overweight teens who “misperceive” their weight as normal end up gaining less weight over the next decade or so than teens who are overweight and know it. Another study found that those “misperceivers” blind to their extra pounds were also less likely to become depressed in later years.

The findings are at odds with the basic assumption behind BMI report cards, that it is helpful to inform kids and their families of their weight status, says researcher Kendrin Sonneville, an assistant professor at the University of Michigan School of Public Health who is also affiliated with Harvard and the Division of Adolescent/Young Adult Medicine at Boston Children’s Hospital.

Kendrin and IdiaXXX

Dr. Kendrin Sonneville and Dr. Idia Thurston at the Obesity Week conference, where they presented studies that found that weight “report cards” may backfire. (Carey Goldberg/WBUR)

“I think we can say the jury is still out,” she says. “Weight misperception is not something we should assume is harmful, and in the spirit of doing no harm, I think we need to proceed with caution on any type of programming that involves correcting weight misperception.”

The study she led, which followed more than 2700 young people beginning in high school, found that after about a decade, the overweight teens who had perceived their weight accurately gained more than one BMI unit — very roughly about 10 pounds — more than those overweight teens who had falsely believed their weight to be normal.

Why might this be? That’s one of the next avenues of research that need to be explored, but clinical psychologist Idia Thurston, an assistant professor at the University of Memphis, says the key could be the emotional baggage that comes with being told you’re overweight or obese.

More accurate weight perception may translate into more feelings of stigma and lower satisfaction with your own body, she says, “and that could affect your ability to cope — hence, depressive symptoms or hence, engaging in harmful eating behaviors.”

“So when we think about weight report cards and telling kids, ‘This is what your weight status is,’ you really need to think about how that information is being disseminated, and what kinds of protections are put into place, rather than just sending report cards home to kids and not knowing how kids will act on that information.”

Dr. Thurston’s study, also presented at ObesityWeek, found that overweight high-school-aged boys who accurately perceived their own weight as high were significantly more likely to develop depressive symptoms over the next decade or so. (The findings in girls were not statistically significant.) Once again, a false sense of being a normal weight appeared to be protective for overweight young people.

The idea of having schools screen kids for obesity began in 2003 in Arkansas during then-Gov. Mike Huckabee’s anti-obesity efforts, Dr. Sonneville says, and spread around the country without ever having a solid research base on what its effects might actually be.

About one-fourth of states track schoolchildren’s height and weight, and last year U.S. News reported that nine sent weight “report cards” home, including Massachusetts. But last October, facing pushback from nurses, parents and others, the state’s Public Health Council voted to stop sending the letters home, though the schools still gather the information. U.S. News reported that decision under the headline “Massachusetts Schools To Stop Sending ‘Fat Letters:'” Continue reading

After A Death, Should We Get A Dog? Brain Study Signals ‘Yes’

(Greg Westfall/Flickr)

(Greg Westfall/Flickr)

Let’s be clear: I need a dog like a hole in the head.

I’m a recently widowed working mother with a small house, no trust fund and two extremely active young daughters: if it’s Thursday, it must be rock-climbing, piano and Taekwondo before track practice across town. You get the picture.

Still, lately I’ve been thinking the unthinkable: a Maltipoo, Goldendoodle or some other ridiculously named, hypoallergenic, low-maintenance (does that exist?), cute-as hell puppy for my daughters — and for me — to love.

I know full well this is a risky prospect. “There is no rational reason to get a dog,” says my Basset Hound-owner friend. “They are work, expense and add to the list of beings in your home who have needs to be attended to. It is sort of like deciding to have a kid — no rational reason to do that either but big pay off on love, general hilarity and a constant reminder of the joy in everyday small things.” Or, as another friend put it: “What have dogs done for me? They make me more human.”

“What have dogs done for me? They make me more human.”
– A dog-loving friend

It’s that truly profound, but tricky to pinpoint, human-pet bond that drives Lori Palley’s research. She’s assistant director of veterinary services at Massachusetts General Hospital’s Center for Comparative Medicine and has recently become fascinated by why people’s relationships with their dogs can be so very significant.

Her latest research, published in the medical journal PLOS ONE, involved scanning the brains of mothers while they were looking at images of their own children and their dogs. Surprise: similar areas of the brain were activated — regions involved in emotion and reward — whether it was the kids or dogs on view.

It was a small study using fMRI: only 14 mothers (dog owners) who had at least one young child. And in case you jump to some conclusion about moms loving their dogs as much as, or more than, their kids, wait: the research also found that in other areas of the brain involved in attachment and bonding, the mother’s brains were more activated when viewing their children.

In a small study, mothers viewed images of their own children and their dog. Similar areas of the brain involved in emotion and reward were activated. Source: PLOS ONE: "Brain Activation when Mothers View Their Own Child and Dog: An fMRI Study

In a small study, mothers viewed images of their own children and their dog. Similar areas of the brain involved in emotion and reward were activated. (Source: PLOS ONE: “Brain Activation when Mothers View Their Own Child and Dog: An fMRI Study”)

Continue reading

Beyond Good And Evil: New Science Casts Light On Morality In The Brain

Harvard brain scientist Joshua Buckholtz has never forgotten a convict he met back when he was an undergrad conducting psychological tests in prisons. The man had beaten another man nearly to death for stepping on his foot in a dance club.

“I wanted to ask him,” he recalls, “‘In what world was the reward of beating this person so severely, for this — to me — minor infraction, worth having terrible food and barbed wire around you?’ ”

But over the years, Buckholtz became convinced that this bad deed was a result of faulty brain processing, perhaps in a circuit called the frontostriatal dopamine system. In an impulsive person’s brain, he says, attention just gets so narrowly focused on an immediate reward that, in effect, the future disappears.

He explains: “If you had asked this person, ‘What will happen if you beat someone nearly to death?’, they will tell you, ‘Oh, I’ll be put away.’ It’s not that these people who commit crimes are dumb, but what happens is, in the moment, that information about costs and consequences can’t get in to their decision-making.”

For two decades, researchers have scanned and analyzed the brains of psychopaths and murderers, but they haven’t pinpointed any single source of evil in the brain. What they’ve found instead, as Buckholtz puts it, “is that our folk concepts of good and evil are much more complicated, and multi-faceted, and riven with uncertainty than we ever thought possible before.”

In other words, so much for the old idea that we have an angel on one shoulder and a devil on the other, and that morality is simply a battle between the two. Using new technology, brain researchers are beginning to tease apart the biology that underlies our decisions to behave badly or do good deeds. They’re even experimenting with ways to alter our judgments of what is right and wrong, and our deep gut feelings of moral conviction.

One thing is certain: We may think in simple terms of “good” and “evil,” but that’s not how it looks in the brain at all.

In past years, as neuroscientists and psychologists began to delve into morality, “Many of us were after a moral center of the brain, or a particular system or circuit that was responsible for all of morality,” says assistant professor Liane Young, who runs The Morality Lab at Boston College. But “it turns out that morality can’t be located in any one area, or even set of areas — that it’s all over, that it colors all aspects of our life, and that’s why it takes up so much space in the brain.”

So there’s no “root of all evil.” Rather, says Buckholtz, “When we do brain studies of moral decision-making, what we are led into is an understanding that there are many different paths to antisocial behavior.”

If we wanted to build antisocial offenders, he says, brain science knows some of the recipe: They’d be hyper-responsive to rewards like drugs, sex and status — and the more immediate, the better. “Another thing we would build in is an inability to maintain representations of consequences and costs,” he says. “We would certainly short-circuit their empathic response to other people. We would absolutely limit their ability to regulate their emotions, particularly negative emotions like anger and fear.”

At his Harvard lab, Buckholtz is currently studying the key ability that long-ago convict lacked — to weigh future consequence against immediate gratification. In one ongoing experiment (see the video above), he’s testing whether he can use electrical stimulation to alter people’s choices. Continue reading

‘Did You Ever Kill Anyone?’ 5 Things Not To Say To A Veteran

U.S. Soldiers depart Forward Operating Base Baylough, Afghanistan, June 16, 2010, to conduct a patrol.  (Photo: Staff Sgt. William Tremblay, U.S. Army/Released)

U.S. Soldiers depart Forward Operating Base Baylough, Afghanistan, June 16, 2010, to conduct a patrol. (Photo: Staff Sgt. William Tremblay, U.S. Army/Released)

By Tommy Furlong and Dr. Paula K. Rauch
Guest contributors

“So, did you ever kill anyone?”

It’s not a question you would ask a police officer, but it’s one that many veterans get all the time. Most people have good intentions, but that doesn’t seem to be enough to guide people in what to say and what not to say to a returning veteran. It has become commonplace to say, “Thank you for your service,” but then what?

So here, in advance of our most patriotic holiday, is a brief guide for speaking with post-9/11 veterans and their families. We begin with five things not to say, and end with five that maybe you should:

1. I can’t understand why anyone would join the military.

Oftentimes, people hear the word “military” and immediately think of warfare. In reality, that is just one of the components. The military puts a lot of its resources toward humanitarian efforts. And if you list almost any civilian job, that same position can be found in the military.

So why would someone join the military? They might enjoy the structure. The job security is alluring, as are the benefits. Many young people also choose to serve for educational or economic opportunity, family tradition, seeking a challenge or as a path out of a difficult situation.

Serving our nation is an intense and rewarding career choice. So is being a firefighter, a nurse or a surgeon. Different individuals are drawn to different vocations. Choosing military service is one choice — and it’s not a crazy one.

Family members often hear “Why did you let him (or her) enlist?” or “I would never let one of my kids join the military.” The suggestion is that loving parents don’t let their children serve in the armed forces. These types of comments leave parents and spouses of veterans feeling isolated and unappreciated because, as any military family knows, when one member serves, the entire family serves. Family members have pride in their service member, but they also live with anxiety during the years of service. But all that aside, most parents don’t get to choose their adult child’s life path — and that includes career, partner and place to live.

2. How could you leave your children? Continue reading

Falling Into The Postpartum Mood Disorder Abyss: A Personal Story

By Deb Wachenheim
Guest Contributor

Over the past two days, The New York Times published a series of articles about postpartum depression and other related mood disorders. The first article looked at the science and policy on this topic and highlights a few women’s stories.

Today’s article is about my sister, Cindy Wachenheim, who took her own life in March of 2013 after struggling for six months with postpartum mood disorders. I say mood disorders because it was not just depression (and the fact that there are other postpartum mood disorders in addition to postpartum depression was something about which I was previously completely unaware). She had extreme anxiety about, and obsession with, her baby’s health and she was depressed because she believed she caused him to have serious health problems. Also, according to what I have been told by experts, she may have been psychotic: she was so convinced that something was seriously wrong with her baby — despite doctors telling her otherwise — that she strapped him to her chest when she jumped out of her apartment window, believing, I can only assume, that this was what was best for him. Thank goodness, he survived and is thriving.

Beyond what is written in the article, I think it is important to give more detail and information on some resources and policy activities in Massachusetts, in the hope that this could possibly help others who are facing similar struggles. As is mentioned in the article, I reached out to Cindy’s son’s pediatrician after Cindy had gone to see her multiple times about her concerns.

Pediatricians are key to screening for postpartum mood disorders and making referrals for needed treatment. Most women see their OB a few weeks after giving birth and if everything seems okay at that point then they are sent on their way until the following year’s annual exam.

However, woman bring their infants to see the pediatrician many times over that first year. It is pediatricians who could notice if something seems to not be right with the mother. Continue reading

Can Brain Science Help Lift People Out Of Poverty?

Five years ago Lauretta Brennan was a single mom on welfare with a pack-a-day smoking habit, stuck in a “bad” relationship and living in the South Boston projects where she grew up.

Now, she’s still living in the projects with her young son, but the bad boyfriend is gone and Brennan’s got a job as an administrative assistant after receiving a business management degree. And she quit smoking.

Her childhood in the projects was marked by alcoholism and violence all around, Brennan said; “having no adult role model was the norm, being with a man who’s ignorant, that was the norm.”

Lauretta Brennan graduated from Bunker Hill Community College with an Associates Degree in Business Management in June 2013 (Courtesy)

Lauretta Brennan graduated from Bunker Hill Community College with an Associates Degree in Business Management in June 2013 (Courtesy)

But now, thanks to a novel program that uses the latest neuroscience research to help women dig themselves out of poverty, Brennan says: “I don’t want to live off welfare. I want to make money and be around people who work and go to school. In five years, the program got me to think more like an executive — I have goals, I’m an organizer managing my family well. I’m not scared anymore.”

This shift in thinking — from chaotic, stressed-out, oppressed and overwhelmed to purposeful and goal-oriented — may not sound like brain science. But it fits into an emerging body of research that suggests that the stress of living in poverty can profoundly change the brain: it can undermine development and erode important mental processes including executive function, working memory, impulse-control and other cognitive skills.

To fix that damage, the new thinking goes, people must engage in activities and practices that strengthen this diminished functionality and, exploiting the brain’s ability to change (plasticity in neuroscience lingo) re-train themselves to think more critically and strategically.

“Poverty whacks executive function and executive function is precisely what’s needed to move people out of poverty,” says Elisabeth Babcock, chief executive of the nonprofit Crittenton Women’s Union, a Boston-based group that draws on the latest brain research to help families achieve economic success. “What the new brain science says is that the stresses created by living in poverty often work against us, make it harder for our brains to find the best solutions to our problems. This is a part of the reason why poverty is so ‘sticky.'”

In a recent paper, “Using Brain Science To Design New Pathways Out Of Poverty,” Babcock makes the case that living in an impoverished environment “has the capacity to negatively impact the decision-making processes involved in problem-solving, goal-setting and goal attainment.” In other words, this type of stress can “hijack” the brain.

As other researchers, including Jack Shonkoff, director of the Center on the Developing Child at Harvard, have noted, this chronic vise of pressure — to pay the bills, function at work, raise the kids, and simply survive in an atmosphere rife with social bias and harsh living conditions — “places extraordinary demands on cognitive bandwidth.” Babcock writes:

“The prefrontal cortex of the brain — the area of the brain that is associated with any of the analytic processes necessary to solve problems, set goals and optimally execute chosen strategies — works in tandem with the limbic system, which processes and triggers emotional reactions to environmental stimuli…When the limbic brain is overactive and sending out too many powerful signals of desire, stress, or fear, the prefrontal brain can get swamped and the wave of emotion can drown out clear focus and judgement…”

How does this play out in real life? Chuck Carter, senior VP of research at Crittenton Women’s Union, explains:

“One of the things the brain science brings is something of an ‘aha’ in terms of why things are sometimes harder than we expect them to be. When you’re looking at a family that is struggling and making decisions that you don’t really understand, having that research helps you reassess…it adds another perspective. A lot of nonprofit organizations look at the social determinants [of poverty] but not a lot look at the science that says, ‘What else is at play?’

“I think that, on the ground, it gives us creative ways to think about the work and how we might approach it…Often families are in a lot of crises…and they feel they need to do things ‘right now.’ So, for instance, we’ve got a family, and they’re in a hallway and they’ll have to talk to the case manager ‘right now.’ And we ask whether it’s a true emergency, and if not, can we talk about this the next morning, and not in the hallway. It’s a problem with executive function and poor impulse control, but we can help them slow down and figure out the right time to figure this out and what information do they need. It’s about not responding so impulsively in other parts of their lives. So, in thinking about what to do with money, it can be a question of, ‘Do I buy cigarettes now or save the money for some new furniture when I move?'”

So how do you begin to fix all of this?

I asked Babcock a bit about the science behind her organization’s Mobility Mentoring program, in which low-income — mostly single — mothers apply to get training, professional mentoring, financial and other support for three to five years, in hopes of attaining economic independence.

Here, edited, is our discussion:

RZ: What does the research say about how poverty changes the brain? And how does a “hijacked” brain function compared to a brain not experiencing intense, chronic stress?

EB: Poverty hits what scientists call our executive functioning skills: our ability to problem-solve, set priorities and goals, juggle and multi-task, focus and stick to things. And it does this in at least two very important ways. First, the stress of dealing with new problems every day and never having enough to make ends meet overwhelms our heads and swamps us. It overloads the circuits in our brains and compromises our decision-making in the moment. Continue reading

When Your Writing Is Part of Your Healing

We recently ran an essay by Sarah Baker, exploring the links between her childhood asthma, her mother’s early death, the family chaos that followed and how it all played out physically and psychologically into adulthood.

Sarah told me the response to her post, which also raised the question of whether becoming a mother herself helped alleviate her asthma, was overwhelming and gratifying. Now, Dr. Annie Brewster, a Boston internist and frequent CommonHealth contributor who uses storytelling therapeutically, as a path toward healing, followed up with Sarah in a revealing audio interview. (For more on Brewster’s approach to personal storytelling for health, listen to her recent TedX Talk above).

Sarah Baker, around age 3, before her mother was diagnosed with a brain tumor.

Sarah Baker, around age 3, before her mother was diagnosed with a brain tumor.

Here’s a snippet from the interview, which you can listen to in full on Brewster’s website, Health Story Collaborative:

Annie Brewster: I’m really interested in what you said about that you never really consciously thought about this until you started to write about it. I’m really fascinated with the process of storytelling and how that sort of helps move somebody from one place or another. So, can you speak to the process that you went through in writing this and how that helped you and what it meant then to put it out there in a public way and get feedback on it; what that was like for you and what did it take to get to a place where you felt ready to take that on as a writing project?

Sarah Baker: I remember a number of years ago when I started writing, a friend of mine who is a successful writer said, “write what’s raw” so I always try to write what hits a chord in my heart. So writing about my childhood and writing about my mother’s death is what I tend to write about. This was the first time I wrote about my asthma and it was hard to write about it because I don’t have a lot of memory. I had to interview my Dad, I had to do some research, and I had to relive the trauma. I just kept working at [the story] and sometimes felt a little sick after writing but I just kept working. I usually write ten drafts before I show it to any one. I showed it to my husband and he reacted positively. I showed it to a class that I was in and to my teacher and they responded positively. I thought maybe I’ve struck something here. Then the story sat in my computer for a year; it did. And it was after I started taking a class about the book I’m working on that I decided to send it out. Maybe the year allowed it to percolate so it didn’t feel as scary. Continue reading

Weather Sexism: Female-Named Storms Deadlier, Seen As Less Threatening

Forget the brouhaha over Jill Abramson’s firing and questions about sexism running rampant in America’s newsrooms: here’s some really hard-core sexism that could kill you.

Researchers from the University of Illinois and Arizona State report that female hurricanes have proven to be more deadly than male hurricanes. Why? The researchers theorize that hurricanes with girly names like Alexandra aren’t taken as seriously as male-named storms, like Alexander; so, faced with a female storm, people don’t prepare as fully, or heed evacuation orders as intently.  

As USA Today notes: “The paper claimed that a masculine-named storm would kill about 15 people, but a hurricane of the same strength with a female name would kill about 42.”

Hurricane Katrina, 2005 (News Muse/flickr)

Hurricane Katrina, 2005 (News Muse/flickr)

Here’s more from the study, published in the Proceedings of the National Academy of Sciences:

[Researchers] use more than six decades of death rates from U.S hurricanes to show that feminine-named hurricanes cause significantly more deaths than do masculine-named hurricanes. Laboratory experiments indicate that this is because hurricane names lead to gender-based expectations about severity and this, in turn, guides respondents’ preparedness to take protective action.

And in conclusion, the authors write:

…these findings suggest the value of considering a new system for hurricane naming to reduce the influence of biases on hurricane risk assessments and to motivate optimal preparedness. For media practitioners, the pervasive media practice of giving gendered descriptions of hurricanes should prompt a reconsideration of the use of “he” or “she” when communicating about hurricanes. Finally, making members of the general public aware of the impact of gender biases on subjective risk perceptions may improve preparedness in the face of the next Hurricane Fay or Laura. Continue reading

P.S. To Jill Abramson: Grads, You Must Learn The Word ‘Fungible’

Jill Abramson, former executive editor of The New York Times, speaks at the commencement ceremony at Wake Forest University on Monday. (Neil Redmond/AP)

Jill Abramson, former executive editor of The New York Times, speaks at the commencement ceremony at Wake Forest University on Monday. (Neil Redmond/AP)

On Monday, ousted New York Times editor Jill Abramson began her post-firing public life by speaking at the Wake Forest University commencement, and shared her father’s buck-up maxim for when you’re dumped or disappointed: “Show what you’re made of.” Here, I add one other bit of advice: Learn the word “fungible.”

Dear soon-to-be-college grads:

I regret to inform you that at the last minute, we at the University of Hard Knocks have added one additional graduation requirement: You must learn the meaning of the word ‘fungible.’

But not to worry. We’ll help you out with the dictionary definition:

fun·gi·ble [fuhn-juh-buhl]: adjective.
(especially of goods) being of such nature or kind as to be freely exchangeable or replaceable, in whole or in part, for another of like nature or kind.

And here’s the deeper meaning: When you enter the working world, you will almost certainly be fungible. That is, no matter how hard you work, you will remain, at base, replaceable. Disposable.

This is not a cynical-making thing. It’s just a hard fact that it’s important to know as you plan your life and make decisions along the way. You might love your work as much as Jill Abramson loved hers, to the point that you wear your love not just on your sleeve but in a tattoo on your shoulder. But your work may not — cannot — love you back the same way.

The fact of her presence before a gigantic crowd said — indeed, shouted — ‘I am not ashamed. I soldier on.’

I use “work” here as a collective noun, and your working-world fate will likely rest in collective hands, just as Jill Abramson’s firing stemmed from rejection not only by the publisher but by the “masthead” — the newspaper equivalent of nobility. You’ll never know all the structural constraints and financial challenges and personal machinations that could converge into a pink slip for you. You just need to know, deep down, that it’s possible.

What to do with that knowledge?

First, you need to watch for the signs. Is your industry in trouble? Is your company hemorrhaging cash or known as a brutal shucker of staff? Have you noticed that you have no higher-level manager who seems invested in you, who has your back?

Second, live your life accordingly. There are some people for whom you are not fungible. Your parents. Your partner, if you’re lucky. Most of all, your children, if and when you have them. “The currency of love is time,” they say. Work can suck you in and make you forget that. But there are unpaid tasks that only you can perform. Continue reading