Blog Explanation

This blog brings together content that is noticeable, important or otherwise interesting from a human givens point of view.

Sunday, 20 October 2013

Rumination: The danger of dwelling - By Denise Winterman BBC News Magazine

The UK's biggest ever online test into stress, undertaken by the BBC's Lab UK and the University of Liverpool, has revealed that rumination is the biggest predictor of the most common mental health problems in the country.
A bit of self-reflection can be a good thing, say psychologists. But just how serious can it get when introspection goes awry and thoughts get stuck on repeat, playing over and over in the mind?
Rumination and self-blame have long been accepted by health professionals as part of the problems that can lead to depression and anxiety - the two most common mental health problems in the UK, according to the Mental Health Foundation.
But new research has demonstrated just how significant and serious their impact on mental health can be.
The findings of a ground-breaking study, published in the journal PLOS ONE today, suggest that brooding too much on negative events is the biggest predictor of depression and anxiety and determines the level of stress people experience. The research even suggests a person's psychological response is a more important factor than what has actually happened to them.

Who took the Lab UK Stress Test?

Rodin's The Thinker
  • A total of 32,827 took part
  • Of those 12,677 were men and 20,165 women
  • They were from 172 countries
  • They were aged 18-85 years
  • The average age was 39
  • Most were working fulltime
  • Most were in stable relationships
Source: BBC Lab UK

A total of 32,827 people from 172 countries took part in the online stress test devised by the BBC's Lab UK and psychologists at the University of Liverpool, making it the biggest study of its kind ever undertaken in the UK.
"We found that people who didn't ruminate or blame themselves for their difficulties had much lower levels of depression and anxiety, even if they'd experienced many negative events in their lives," says Peter Kinderman, who led the study and is a professor of clinical psychology at the University of Liverpool.
"Dwelling on negative thoughts and self blame have previously been recognised as important when it comes to mental health, but not to the extent this study has shown.
"The findings suggest both are crucial psychological pathways to depression and anxiety."
The human mind is an extremely complex machine and it's generally accepted there is no single cause for depression and anxiety by professionals in the field. But some factors have more impact than others.
The study found traumatic life events, such as abuse or childhood bullying, were the biggest cause of anxiety and depression when dwelled upon. This is followed by family history, income and education. Next comes relationship status and social inclusion.
"But these didn't merely 'cause' depression and anxiety," he says.
"The most important way in which these things led to depression and anxiety was by leading a person to ruminate and blame themselves for the problem.
Graphic
"This shows how psychological issues are part of the routes to the development of problems, not merely that people become ill and then show changes in their psychology."
Rumination was found to be more damaging than self blame. Having thoughts stuck on replay in her head is something Teresa (not her real name), 50, from Essex, struggles with and has done for years.

Teresa's story

"I get angry with myself that negative thoughts run through my head.
"After all these years I think I should realise they're not worth worrying about. But it feels like they are always there in the background, waiting to to pop up.
"I have been to my doctor for help but was offered antidepressants. I didn't want to go down that road.
"I was offered counselling recently, but it was one hour a week over the phone. It is hard to establish any sort of connection with a person over the phone. It didn't help."
"When I don't feel on top of things in my life I start to find it harder to switch negative thoughts off," she says.
"If I'm stressed at work or home it's as if the negative thoughts swamp my mind and I can't rationalise them. I get angry with myself for allowing them to run through my head."
Teresa has been married for over 20 years and has two children. But despite having a happy home life, she says there have still been times when the negative thoughts have become overwhelming.
"There have been a couple points in my life when I have really struggled to cope. Negative thoughts and things from the past came back to haunt me.
"Both times I went to my doctor for help but was offered antidepressants. I didn't want to go down that road. I have tried to develop my own coping mechanisms over the years. I find being outside and with nature helps me a lot. It seems to calm what's in my head."
Rumination is sometimes referred to as a "silent" mental health problem because its impact is often underestimated. But it plays a big part in anything from obsessive compulsive disorder (OCD) to eating disorders.
Woman walking along shore
And the impact of mental health problems is huge. They affect one person in every four during their lifetime and are the leading cause of disability globally, according to the World Health Organization (WHO). In 2010 alone they are estimated to have cost $2.5 trillion (£1.5 trillion) globally by the World Economic Forum.
In the UK one in four people will experience some kind of mental health problem in any one year, according to the Mental Health Foundation. Anxiety and depression are the most common problems.
So what does the new study mean for people who have serious problems with ruminating and those treating them?
"Obviously it is just one study, and other people will have other important contributions, but we believe our findings are very significant," says Kinderman.
It's important to get across what the findings mean for the average person, says Dr Ellie Pontin, a clinical psychologist and research associate at the University of Liverpool, who was also involved in the study.
"It's actually a really positive message and should give people hope," she says.
"It can be very hard to be told your problems are because of what you have experienced in the past or your genetics, things you can't change. The way you think and deal with things can be changed."
Other professionals agree. They argue that such studies highlight the need to put psychological services at the heart of the health system.
"This is a positive message," says Angela Clow, professor of psychophysiology at the University of Westminster.
"And helping someone tackle negative thought processes is not something that has to be done exclusively by clinical psychologists.
"Other health professionals can be trained to deliver simple psychological help and techniques. It doesn't have to cost a lot of money."

Brene Brown gives a great talk about vulnerability - I'm still working out how to translate it to HG terms and would appreciate comments

video

Sunday, 13 October 2013

What are the Long Term Consequences of Child Sexual Abuse? (from http://www.d2l.org)

FACT: The consequences of child sexual abuse often follow victims into adulthood. Most people have no idea that the effects of child sexual abuse are so pervasive in adult life. Although survivors of child sexual abuse are negatively impacted as a whole, it is important to realize that many individual survivors do not suffer these consequences. Child sexual abuse does not necessarily sentence a victim to an impaired life.

FACT: Substance abuse problems are a common consequence for adult survivors of child sexual abuse.

  • Female adult survivors of child sexual abuse are nearly three times more likely to report substance use problems (40.5% versus 14% in general population), (Simpson and Miller, 2002).
  • Male adult CSA victims 2.6 times more likely to report substance use problems (65% versus 25% in general population), (Simpson and Miller, 2002).
  • Abused or neglected individuals 1.5 times more likely to report lifetime illicit drug use (Widom, Marmorstein, & White, 2006).

FACT: Mental health problems are a common long-term consequence of child sexual abuse.

  • Adult women who were sexually abused as a child are more than twice as likely to suffer from depression as women who were not sexually abused (Rohde, et. al., 2008).
  • Adults with a history of child sexual abuse are more than twice as likely to report a suicide attempt (Dube, et. al., 2005, Waldrop, et. al., 2007).
  • Girls who are sexually abused are 3 times more likely to develop psychiatric disorders than girls who are not sexually abused (Day, et. al., 2003; Kendler, et. al., 2000; Voeltanz, et. al., 1999).
  • Among male survivors, more than 70% seek psychological treatment for issues such as substance abuse, suicidal thoughts and attempted suicide (Walrath, et. al., 2003).

FACT: Obesity and eating disorders are more common in women who have a history of child sexual abuse.

  • 20 – 24 year-old women who were sexually abused as children were four times more likely than their non-abused peers to be diagnosed with an eating disorder (Fuemmeler, et. al., 2009).
  • Middle-aged women who were sexually abused as children were twice as likely to be obese when compared with their non-abused peers (Rohde, et. al., 2008).

FACT: Child sexual abuse is also associated with physical health problems in adulthood. It is theorized that this is a consequence of the substance abuse, mental health issues and other risks that survivors of child sexual abuse face.

  • Generally, adult victims of child sexual abuse have higher rates of health care utilization and report significantly more health complaints compared to adults without a CSA history (Arnow, 2004; Golding, Cooper, and George, 1997; Thompson, Arias, Basile and Desai, 2002). This is true for both self reported doctor’s visits and objective examination of medical records (Newman et al., 2000). These health problems represent a burden both to the survivor and the healthcare system.
  • Adult survivors of child sexual abuse are at greater risk of a wide range of conditions that are non-life threatening and are potentially psychosomatic in nature. These include fibromyalgia (Walker et al, 1997), severe premenstrual syndrome (Golding, Taylor, Menard, & King, 2000), chronic headaches (Peterlin, Ward, Lidicker, & Levin, 2007), irritable bowel syndrome and a wide range of reproductive and sexual health complaints, including excessive bleeding, amenorrhea, pain during intercourse and menstrual irregularity (Golding, 1996).
  • Not only do survivors of child sexual abuse have more minor health conditions, they are at greater risk for more serious conditions as well. Adults with a history of child sexual abuse are 30% more likely than their non-abused peers to have a serious medical condition such as diabetes, cancer, heart problems, stroke or hypertension (Sachs-Ericsson, et. al., 2005).
  • Male sexual abuse survivors have twice the HIV-infection rate of non-abused males (Zierler, et. al., 1991). In a study of HIV-infected 12-20 year olds, 41 percent reported a sexual abuse history (Dekker, et. al. 1990).

FACT: Adult survivors of child sexual abuse are more likely to become involved in crime, both as a perpetrator and as a victim. This is likely a product of a higher risk for substance abuse problems and associated lifestyle factors.

  • Adult survivors were more than twice as likely to be arrested for a property offense (9.3% versus 4.4%), (Siegel and Williams, 2003).
  • As adults, child sexual abuse victims were almost twice as likely to be arrested for a violent offense (20.4% versus 10.7%), (Siegel & Williams, 2003).
  • Males who have been sexually abused are more likely to violently victimize others (Walrath, et. al., 2003).

FACT: Although difficult to quantify, logic tells us that the consequences of child sexual abuse (substance abuse issues, mental health problems, becoming a parent as a teen and poor physical health) result in loss of earning potential over a lifetime.

  • An average of quality-of-life court awards (primarily lost earning potential) for a survivor of child sexual abuse is $115,000 in 2010 dollars (U.S. Department of Justice, 1996).

Sunday, 6 October 2013

The Most Depressing Discovery About the Brain, Ever. Say goodnight to the dream that education, journalism, scientific evidence, or reason can provide the tools that people need in order to make good decisions. By Marty Kaplan for AlterNet

 
Yale law school professor Dan Kahan’s new research paper is called “Motivated Numeracy and Enlightened Self-Government,” but for me a better title is the headline on science writer Chris Mooney’s piece about it in Grist:  “Science Confirms: Politics Wrecks Your Ability to Do Math.”
Kahan conducted some ingenious experiments about the impact of political passion on people’s ability to think clearly.  His conclusion, in Mooney’s words: partisanship “can even undermine our very basic reasoning skills…. [People] who are otherwise very good at math may totally flunk a problem that they would otherwise probably be able to solve, simply because giving the right answer goes against their political beliefs.”
In other words, say goodnight to the dream that education, journalism, scientific evidence, media literacy or reason can provide the tools and information that people need in order to make good decisions.  It turns out that in the public realm, a lack of information isn’t the real problem.  The hurdle is how our minds work, no matter how smart we think we are.  We want to believe we’re rational, but reason turns out to be the ex post facto way we rationalize what our emotions already want to believe.  
For years my go-to source for downer studies of how our hard-wiring makes democracy hopeless has been Brendan Nyhan, an assistant professor of government at Dartmouth.
Nyan and his collaborators have been running experiments trying to answer this terrifying question about American voters: Do facts matter?
The answer, basically, is no.  When people are misinformed, giving them facts to correct those errors only makes them cling to their beliefs more tenaciously.
Here’s some of what Nyhan found:
  • People who thought WMDs were found in Iraq believed that misinformation even more strongly when they were shown a news story correcting it.
  • People who thought George W. Bush banned all stem cell research kept thinking he did that even after they were shown an article saying that only some federally funded stem cell work was stopped.
  • People who said the economy was the most important issue to them, and who disapproved of Obama’s economic record, were shown a graph of nonfarm employment over the prior year – a rising line, adding about a million jobs.  They were asked whether the number of people with jobs had gone up, down or stayed about the same.  Many, looking straight at the graph, said down.
  • But if, before they were shown the graph, they were asked to write a few sentences about an experience that made them feel good about themselves, a significant number of them changed their minds about the economy.  If you spend a few minutes affirming your self-worth, you’re more likely to say that the number of jobs increased.   
In Kahan’s experiment, some people were asked to interpret a table of numbers about whether a skin cream reduced rashes, and some people were asked to interpret a different table – containing the same numbers – about whether a law banning private citizens from carrying concealed handguns reduced crime.  Kahan found that when the numbers in the table conflicted with people’s positions on gun control, they couldn’t do the math right, though they could when the subject was skin cream.  The bleakest finding was that the more advanced that people’s math skills were, the more likely it was that their political views, whether liberal or conservative, made them less able to solve the math problem.
I hate what this implies – not only about gun control, but also about other contentious issues, like climate change.  I’m not completely ready to give up on the idea that disputes over facts can be resolved by evidence, but you have to admit that things aren’t looking so good for a reason.  I keep hoping that one more photo of an iceberg the size of Manhattan calving off of Greenland, one more stretch of record-breaking heat and drought and fires, one more graph of how atmospheric carbon dioxide has risen in the past century, will do the trick.  But what these studies of how our minds work suggest is that the political judgments we’ve already made are impervious to facts that contradict us.
Maybe climate change denial isn’t the right term; it implies a psychological disorder.  Denial is business-as-usual for our brains.  More and better facts don’t turn low-information voters into well-equipped citizens.  It just makes them more committed to their misperceptions.  In the entire history of the universe, no Fox News viewers ever changed their minds because some new data upended their thinking.  When there’s a conflict between partisan beliefs and plain evidence, it’s the beliefs that win.  The power of emotion over reason isn’t a bug in our human operating systems, it’s a feature.
Marty Kaplan, winner of the LA Press Club’s Best Columnist award, is the Norman Lear professor of entertainment, media and society at the USC Annenberg School for Communication and Journalism.  Reach him at martyk@jewishjournal.com.

Monday, 8 July 2013

The Science of Sleep: Dreaming, Depression, and How REM Sleep Regulates Negative Emotions by Maria Popova

For the past half-century, sleep researcher Rosalind D. Cartwright has produced some of the most compelling and influential work in the field, enlisting modern science in revising and expanding the theories of Jung and Freud about the role of sleep and dreams in our lives. In The Twenty-four Hour Mind: The Role of Sleep and Dreaming in Our Emotional Lives (public library), Cartwright offers an absorbing history of sleep research, at once revealing how far we’ve come in understanding this vital third of our lives and how much still remains outside our grasp.
One particularly fascinating aspect of her research deals with dreaming as a mechanism for regulating negative emotion and the relationship between REM sleep and depression:
The more severe the depression, the earlier the first REM begins. Sometimes it starts as early as 45 minutes into sleep. That means these sleepers’ first cycle of NREM sleep amounts to about half the usual length of time. This early REM displaces the initial deep sleep, which is not fully recovered later in the night. This displacement of the first deep sleep is accompanied by an absence of the usual large outflow of growth hormone. The timing of the greatest release of human growth hormone (HGH) is in the first deep sleep cycle. The depressed have very little SWS [slow-wave sleep, Stages 3 and 4 of the sleep cycle] and no big pulse of HGH; and in addition to growth, HGH is related to physical repair. If we do not get enough deep sleep, our bodies take longer to heal and grow. The absence of the large spurt of HGH during the first deep sleep continues in many depressed patients even when they are no longer depressed (in remission).
The first REM sleep period not only begins too early in the night in people who are clinically depressed, it is also often abnormally long. Instead of the usual 10 minutes or so, this REM may last twice that. The eye movements too are abnormal — either too sparse or too dense. In fact, they are sometimes so frequent that they are called eye movement storms.
But what has perplexed researchers is that when these depressed patients are awakened 5 minutes into the first REM sleep episode, they’re unable to explain what they are experiencing. This complete lack of dream recall in depression has showed up in study after study, but it’s been unclear whether it’s due to patients’ reluctance to talk with researchers or to truly not forming and experiencing any dreams. That’s where recent technology has helped shed light:
Brain imaging technology has helped to shed light on this mystery. Scanning depressed patients while they sleep has shown that the emotion areas of the brain, the limbic and paralimbic systems, are activated at a higher level in REM than when these patients are awake. High activity in these areas is also common in REM sleep in nondepressed sleepers, but the depressed have even higher activity in these areas than do healthy control subjects. This might be expected — after all, while in REM these individuals also show higher activity in the executive cortex areas, those associated with rational thought and decision making. Nondepressed controls do not exhibit this activity in their REM brain imaging studies. This finding has been tentatively interpreted… as perhaps a response to the excessive activity in the areas responsible for emotions.

Cartwright spent nearly three decades investigating “how a mood disorder that affects cognition, motivation, and most of all the emotional state during waking shows itself in dreams.” What proved particularly difficult was understanding the basis for this poor dream recall during REM sleep, since anti-depressants suppress that stage of the sleep cycle, but early research suggested that this very suppression of REM might be the mechanism responsible for reinvigorating the depressed.
This brings us to the regulatory purpose of dreaming. Cartwright explains:
Despite differences in terminology, all the contemporary theories of dreaming have a common thread — they all emphasize that dreams are not about prosaic themes, not about reading, writing, and arithmetic, but about emotion, or what psychologists refer to as affect. What is carried forward from waking hours into sleep are recent experiences that have an emotional component, often those that were negative in tone but not noticed at the time or not fully resolved. One proposed purpose of dreaming, of what dreaming accomplishes (known as the mood regulatory function of dreams theory) is that dreaming modulates disturbances in emotion, regulating those that are troublesome. My research, as well as that of other investigators in this country and abroad, supports this theory. Studies show that negative mood is down-regulated overnight. How this is accomplished has had less attention.
I propose that when some disturbing waking experience is reactivated in sleep and carried forward into REM, where it is matched by similarity in feeling to earlier memories, a network of older associations is stimulated and is displayed as a sequence of compound images that we experience as dreams. This melding of new and old memory fragments modifies the network of emotional self-defining memories, and thus updates the organizational picture we hold of ‘who I am and what is good for me and what is not.’ In this way, dreaming diffuses the emotional charge of the event and so prepares the sleeper to wake ready to see things in a more positive light, to make a fresh start. This does not always happen over a single night; sometimes a big reorganization of the emotional perspective of our self-concept must be made — from wife to widow or married to single, say, and this may take many nights. We must look for dream changes within the night and over time across nights to detect whether a productive change is under way. In very broad strokes, this is the definition of the mood-regulatory function of dreaming, one basic to the new model of the twenty-four hour mind I am proposing.

Towards the end of the book, Cartwright explores the role of sleep and dreaming in consolidating what we call “the self,” with another admonition against memory’s self-editing capacity:
[In] good sleepers, the mind is continuously active, reviewing experience from yesterday, sorting which new information is relevant and important to save due to its emotional saliency. Dreams are not without sense, nor are they best understood to be expressions of infantile wishes. They are the result of the interconnectedness of new experience with that already stored in memory networks. But memory is never a precise duplicate of the original; instead, it is a continuing act of creation. Dream images are the product of that creation. They are formed by pattern recognition between some current emotionally valued experience matching the condensed representation of similarly toned memories. Networks of these become our familiar style of thinking, which gives our behavior continuity and us a coherent sense of who we are. Thus, dream dimensions are elements of the schemas, and both represent accumulated experience and serve to filter and evaluate the new day’s input.
Sleep is a busy time, interweaving streams of thought with emotional values attached, as they fit or challenge the organizational structure that represents our identity. One function of all this action, I believe, is to regulate disturbing emotion in order to keep it from disrupting our sleep and subsequent waking functioning.
The rest of The Twenty-four Hour Mind goes on to explore, through specific research case studies and sweeping syntheses of decades worth of research, everything from disorders like sleepwalking and insomnia to the role of sleep in knowledge retention, ideation, and problem-solving.

Sunday, 2 June 2013

Some interesting observations about the current state of mental health care.


The Paradox of Mental Health: Over-Treatment and Under-Recognition



Among all the conditions in the world of health, mental health occupies a unique and paradoxical place.
On the one hand is over-treatment and over-medicalization of mental health issues, often fueled by a pharmaceutical industry interested in the broadening of the boundaries of “illness” and in the creation of more and wider diagnostic categories and thus markets for “selling sickness.” On the other hand exists profound under-recognition of the suffering and breadth of mental health issues affecting millions of people across geographies, which is a global problem.
As a journal, PLOS Medicine has covered both sides of the mental health “coin,” and we continue to make mental health in general a priority area. We recognize that the whole of the field of mental health research is relatively underdeveloped, and that a particular scarcity of clinical trials exists from outside high-income settings and for non-drug interventions. As a result, we also support efforts to improve capacity in mental health research whilst committing to the publication of the state of the art in research and commentary [1],[2].
Over-treatment, especially when it results from “disease mongering,” is a persistent and troubling issue. The harms of over-treatment arise from situations where normal life experiences (such as menopause, shyness, grief, etc.) are deemed illnesses [3] or when diseases are “created” from mild problems and symptoms (such as restless legs syndrome or female sexual dysfunction) [4],[5]. In both situations, people become patients, and their problems are deemed to need medical treatment when they may not need it or could be harmed by it, or when nonmedical options are available. Over-diagnosis and over-treatment have been shown for a range of human conditions [3], but this phenomenon as it relates to mental health is particularly powerful [6]. For example, the widespread over-diagnosis of conditions such as bipolar disorder, autism spectrum disorder, and attention deficit hyperactivity disorders (ADHD), especially among children, is now being documented—the US Centers for Disease Control recently estimated that 6.4 million children aged 4 to 17 had received an ADHD diagnosis at some point in their lives (amounting to 11% of all US children)—a 41% increase in the last decade that has been met with alarm and concern by many doctors and parents [7]. Two thirds of these children are said to be on medication for the condition. Recent Canadian data [8] reaffirm the concerns with excessive labeling of normal child behavior as pathological. Over-diagnosis in mental health risks unnecessary tests and treatment, the stigma associated with being labeled mentally ill, and the considerable costs of testing, treatment, and wasting resources that could be better utilized elsewhere [3],[5].
The recent DSM-5 process is a lightning rod for these concerns: this month's update of the psychiatric diagnostic manual has been widely criticized for continuing the tradition of broadening diagnostic categories and adding new conditions that redefine more people as having mental illness and in need of pharmaceutical treatment [9],[10]. That decisions about DSM-5 categories are made by experts with financial ties to the industry that benefits most from a widened patient population [11],[12], is particularly worrying.
In perhaps the most dedicated venue for discussions of this topic, the Selling Sickness conferences (http://www.sellingsickness.com), which PLOS Medicine has been instrumental in shaping, have brought together academic researchers, medical reformers, consumer advocates, and health journalists with shared interests in examining the problem of disease mongering and developing strategies and coalitions for change. The inaugural conference in 2006 coincided with our launch of the PLOS Medicine Disease Mongering Collection (http://bit.ly/18i6j6h) that to this day remains astonishingly relevant. In February 2013 we participated again, this time in a roundtable on the role of the medical media where we outlined our responsibility as editors to avoid the spin in published articles and the journal's press releases that can fuel hype about new disease categories and treatment [13]; we also highlighted another important role of journals in fighting disease mongering: to require that all clinical trials be registered and data be reported and shared, so that the full picture of the benefits and harms of tested interventions can be seen (see, for example, http://www.alltrials.net). The conference's Call to Action petition (http://sellingsickness.com/final-stateme​nt/) is available for readers to view and sign. Later in 2013, two comrade conferences, PharmedOut (http://www.pharmedout.org/) and Avoiding Overdiagnosis (http://www.preventingoverdiagnosis.net/), will continue the conversation about both the extent and the prevention of over-diagnosis, and will undoubtedly provide new insights into the problems associated with over-treatment of mental health.
Equally important, however, is the vast under-recognition of mental health conditions, especially in the developing world. This neglect has occurred at multiple levels including at the national level, where many countries have failed to establish adequate mental health policy. At the level of global health agendas, mental health was essentially ignored in the Millennium Development Goal program and failed to elevate to prominence at the recent United Nations special assembly on non-communicable disease.
As many others have noted [14][16], this neglect makes little sense: more than 13% of the global burden of disease is attributable to neuropsychiatric disorders, and over 70% of this burden lies in low- and middle-income countries (LMICs). Almost a quarter of the world's disability burden is now attributable to mental and behavioral disorders (including depression, anxiety, Alzheimer disease, and schizophrenia) [17]. And yet mental health has failed thus far to receive the political priority and international funding commensurate with its global toll [14]. There are signs this tide is shifting, and several prominent groups and organizations are working to raise the profile of global mental health. PLOS Medicine has provided a forum for that effort over the last few years, publishing packages of care for mental health disorders in LMICs [18] and an ongoing series on mental health interventions in practice [2]. And this week we conclude a five-part series that sets out an agenda for integrating mental health care into primary care, maternal health, non-communicable disease, and HIV interventions in the developing world [19]. All of these analyses were done by researchers free of financial links to manufacturers with a stake in expanded markets, thus providing the necessary independent opinion.
In addition, we've recently published high-quality research on a range of topics within mental health that contributes to improved clinical practice, policy, and action. This includes definitive evidence on the long-term health consequences of sexual abuse [20] and trafficking [21], a genome-wide analysis establishing the limited ability of genetic data to predict antidepressant response [22], and a meta-analysis reporting the relative benefits and harms of adjunctive antipsychotic medications in depression [23]. These studies add to a growing evidence base, and signal a growing recognition of the importance of mental health.
Still, our understanding of all aspects of mental health is relatively underdeveloped. As others have acknowledged [3],[24], the research base for over-diagnosis and harm from over-treatment remains limited, and so the new initiatives and calls for action are welcomed. So too is growing recognition and research on genuine mental health issues and the best ways to address and prevent mental health problems, especially in terms of policy and human rights action and in a global context. To the extent that these two areas (over-treatment on one hand, under-recognition on the other hand) represent the paradox of mental health, where's the balance point? We don't have all the answers, but as a journal we reaffirm our commitment to publishing rigorous, insightful research and commentary on the breadth of issues around global mental health, and we welcome continued debate on the challenges this paradox represents. The largest challenge may be to recognize and prioritize mental health globally—with the requisite political visibility, funding, research, and attention—without reducing it to an object for disease mongering, pathologizing, and harmful over-treatment.

Author Contributions

Wrote the first draft of the manuscript: JC. Contributed to the writing of the manuscript: JC PS MW LC AR. ICMJE criteria for authorship read and met: JC PS MW LC AR. Agree with manuscript results and conclusions: JC PS MW LC AR.


Saturday, 11 May 2013

This Guardian piece warns of the dangers of the current attitudes towards groups in our society

Benefit claimants are now seen as other – less than fully human

Research suggests many of us regard people on benefits as part of an 'outgroup' who don't feel the same emotions. This is scary
A Job Centre Plus
'There are only a few groups considered to be both threatening and incompetent. These include poor people, homeless people, drug addicts and (you’ve guessed it) welfare claimants.' Photograph: Mark Richardson/Alamy
The government's cuts to welfare benefits are causing real harm to a lot of innocent people. Nevertheless, remarkable numbers seem willing to support them, and all too ready to justify them with extreme aberrations. You can probably put some of this down to our straitened times. People struggling to get by in their own lives will find it hard to sympathise with those they feel are getting a free ride. However, at bottom, a lot of the bad feeling towards people on benefits comes from the way we now see them as a distinct, separate social group. Different from the rest of us. Worse than.
On the face of it this doesn't make a lot of sense. People move on and off benefits throughout their lives (with most claiming only for short periods), and lots of us will have claimed at one point or another. Yet we still have this idea of benefit claimants as a separate, special sort of person.
This is crucial if we want to understand people's antipathy towards the benefits system. Decades of findings in sociology and psychology tell us that as soon as a group can be defined as separate, as an "outgroup", people will start to view them differently. We're all familiar with the negative characteristics people seem to identify with benefit claimants. They're lazy, dishonest, stupid, "scroungers", and so on. But there are also deeper, largely unconscious beliefs that likely have even more profound and insidious effects. These have to do with whether benefit claimants are even felt to be truly, properly human in the same way that "we" are.
This idea comes from a relatively new body of work in psychology on something called "infrahumanisation". The infra just stands for "below", as in below or less than fully human. The term was coined by a researcher at the University of Louvain called Jacque-Philippe Leyens to distinguish this milder form of everyday dehumanisation from more extreme kind associated with genocide.
This is a fascinating (and quite scary) process whereby certain groups are not felt to have the same range of emotional experiences as everybody else. Specifically, while people are fine imagining them feeling basic emotions like anger, pleasure or sadness, they have trouble picturing them experiencing more complex feelings like awe, hope, mournfulness or admiration. The subtle sentiments that make us uniquely human.
There has been plenty of work with ethnic groups that shows this to be a real phenomenon. But crucially this tendency to deny people the full range of human emotions is strongest for low social status groups; particularly those groups that are both disliked and disrespected.
Not all low status groups are in this invidious position. Some – for example disabled people and the elderly – tend to be disrespected, but are also felt to be warm and unthreatening. There are only a few groups that have the dubious honour of being considered to be both threatening and incompetent. These include poor people, homeless people, drug addicts and (you've guessed it) welfare claimants. It is these most stigmatised groups that people have the most trouble imagining having the same uniquely human qualities as the rest of us.
You can try it for yourself. Imagine the most stereotypical "chav" you can. Imagine their clothes, their surroundings, their posture, their attitude. Now imagine them feeling surprise, anger, or fear. Easy right? Well now imagine them experiencing reverence, melancholy, or fascination. If you found that just as easy, congratulations. But I'd bet for a few of you it was just that bit harder. I'm ashamed to admit it was for me.
The reason this is scary is that it takes the "infrahumanised" group out of the warm circle of our moral community. If we don't think of them as experiencing the same rich inner life that we do; don't imagine them feeling things in the same way that we do, then we lose some measure of our empathy for them, and consequently our sense of ethical obligation. This would explain why people are so tolerant of the cuts – on an unconscious level, the people being hurt aren't real, full people. If this is true then fighting the cuts is going to be much, much harder than just fighting myths and misapprehensions.

Monday, 22 April 2013

Dreaming Takes the Sting out of Painful Memories, Research Shows



ScienceDaily (Nov. 23, 2011) — They say time heals all wounds, and new research from the University of California, Berkeley, indicates that time spent in dream sleep can help us overcome painful ordeals.
UC Berkeley researchers have found that during the dream phase of sleep, also known as REM sleep, our stress chemistry shuts down and the brain processes emotional experiences and takes the edge off difficult memories.
The findings offer a compelling explanation for why people with post-traumatic stress disorder (PTSD), such as war veterans, have a hard time recovering from distressing experiences and suffer reoccurring nightmares. They also offer clues into why we dream.
"The dream stage of sleep, based on its unique neurochemical composition, provides us with a form of overnight therapy, a soothing balm that removes the sharp edges from the prior day's emotional experiences," said Matthew Walker, associate professor of psychology and neuroscience at UC Berkeley and senior author of the study to be published on Nov. 23, in the journal Current Biology.
For people with PTSD, Walker said, this overnight therapy may not be working effectively, so when a "flashback is triggered by, say, a car backfiring, they relive the whole visceral experience once again because the emotion has not been properly stripped away from the memory during sleep."
The results offer some of the first insights into the emotional function of Rapid Eye Movement (REM) sleep, which typically takes up 20 percent of a healthy human's sleeping hours. Previous brain studies indicate that sleep patterns are disrupted in people with mood disorders such as PTSD and depression.
While humans spend one-third of their lives sleeping, there is no scientific consensus on the function of sleep. However, Walker and his research team have unlocked many of these mysteries linking sleep to learning, memory and mood regulation. The latest study shows the importance of the REM dream state.
"During REM sleep, memories are being reactivated, put in perspective and connected and integrated, but in a state where stress neurochemicals are beneficially suppressed," said Els van der Helm, a doctoral student in psychology at UC Berkeley and lead author of the study.
Thirty-five healthy young adults participated in the study. They were divided into two groups, each of whose members viewed 150 emotional images, twice and 12 hours apart, while an MRI scanner measured their brain activity.
Half of the participants viewed the images in the morning and again in the evening, staying awake between the two viewings. The remaining half viewed the images in the evening and again the next morning after a full night of sleep.
Those who slept in between image viewings reported a significant decrease in their emotional reaction to the images. In addition, MRI scans showed a dramatic reduction in reactivity in the amygdala, a part of the brain that processes emotions, allowing the brain's "rational" prefrontal cortex to regain control of the participants' emotional reactions.
In addition, the researchers recorded the electrical brain activity of the participants while they slept, using electroencephalograms. They found that during REM dream sleep, certain electrical activity patterns decreased, showing that reduced levels of stress neurochemicals in the brain soothed emotional reactions to the previous day's experiences.
"We know that during REM sleep there is a sharp decrease in levels of norepinephrine, a brain chemical associated with stress," Walker said. "By reprocessing previous emotional experiences in this neuro-chemically safe environment of low norepinephrine during REM sleep, we wake up the next day, and those experiences have been softened in their emotional strength. We feel better about them, we feel we can cope."
Walker said he was tipped off to the possible beneficial effects of REM sleep on PTSD patients when a physician at a U.S. Department of Veterans Affairs hospital in the Seattle area told him of a blood pressure drug that was inadvertently preventing reoccurring nightmares in PTSD patients.
It turns out that the generic blood pressure drug had a side effect of suppressing norepinephrine in the brain, thereby creating a more stress-free brain during REM, reducing nightmares and promoting a better quality of sleep. This suggested a link between PTSD and REM sleep, Walker said.
"This study can help explain the mysteries of why these medications help some PTSD patients and their symptoms as well as their sleep," Walker said. "It may also unlock new treatment avenues regarding sleep and mental illness."
Other co-authors of the study are UC Berkeley sleep researchers Justin Yao, Shubir Dutt, Vikram Rao and Jared Saletin.

'In praise of ...REM'



The Guardian, 25 November 2011 referred to the article in Current Biology

No, not the late-lamented band, whom we praised a few weeks ago. We refer to the state in which the twitch of the closed eye betrays the unshackling of the imagination. REM is something shared with many animals. Humans can't even claim to do more than the rest – a glance at the REM league table suggests armadillos dream far bigger dreams. The unlikely connection between the flittering iris and the unconscious mind's eye was first discerned in the 1950s, and was established fact before long. Ever since, we have known we owe our nightly flights of fancy to this distinctive sleep phase which features a complex chemistry and irregular breathing as well as the rapid eye movement itself. We owe to it, too, the whole cultural story of dreaming which stretches from Sumerian myths to Freudian speculation by way of the Bible itself. Throughout, there's been speculation as to why we dream in the first place, and yet most of the myriad "theories" advanced remain just that. Now a paper in Current Biology sheds a little light on what happens in the dark hours. The researchers showed subjects images that pulled on the heartstrings before allowing half – and depriving the rest – of a proper sleep. The next day they saw the images again, and scans revealed that while the raw emotional centres non-sleepers brains still buzzed in response, the sleepers' reasoning apparatus kicked in. Sleep seems to lay demons to rest, or at least allow them to be approached in a dispassionate spirit. Sweet dreams indeed.

Perhaps an example of the process whereby  an idea which starts off being ignored,  then controversial and rejected  finally becomes mainstream and part of the background with no one quite sure where it came from but just obvious when you think about it. Joe's theory links the mystery of dreaming as the leader article says with a rational EXPLANATION so joining two pars of our conscious lives - wondering and digesting satisfying answers.

But as it’s well past midnight I'd better get some rem in myself

Harold

If you go to The Guardian web site and search 'In praise of rem' there is a  link to the Current Biology
reference:

REM Sleep Depotentiates Amygdala Activity to Previous Emotional Experiences
Authors
Els van der Helm, Justin Yao, Shubir Dutt, Vikram Rao, Jared M. Saletin, Matthew P. Walker

 See Affiliations

  • Highlights
► Sleep decreases amygdala activity to prior waking emotional experiences ►The amygdala decrease is associated with reestablished prefrontal connectivity ►These neural changes are accompanied by overnight reductions in subjective reactivity ►Reductions in both brain and behavioral reactivity are associated with REM physiology
Summary
Clinical evidence suggests a potentially causal interaction between sleep and affective brain function; nearly all mood disorders display co-occurring sleep abnormalities, commonly involving rapid-eye movement (REM) sleep [1,2,3,4]. Building on this clinical evidence, recent neurobiological frameworks have hypothesized a benefit of REM sleep in palliatively decreasing next-day brain reactivity to recent waking emotional experiences [5,6]. Specifically, the marked suppression of central adrenergic neurotransmitters during REM (commonly implicated in arousal and stress), coupled with activation in amygdala-hippocampal networks that encode salient events, is proposed to (re)process and depotentiate previous affective experiences, decreasing their emotional intensity [3]. In contrast, the failure of such adrenergic reduction during REM sleep has been described in anxiety disorders, indexed by persistent high-frequency electroencephalographic (EEG) activity (>30 Hz) [7,8,9,10]; a candidate factor contributing to hyperarousal and exaggerated amygdala reactivity [3,11,12,13]. Despite these neurobiological frameworks, and their predictions, the proposed benefit of REM sleep physiology in depotentiating neural and behavioral responsivity to prior emotional events remains unknown. Here, we demonstrate that REM sleep physiology is associated with an overnight dissipation of amygdala activity in response to previous emotional experiences, altering functional connectivity and reducing next-day subjective emotionality.