Psychology

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Single Mothers: Psychological Problems for Kids?

Long-held stigmas about single mothers are wrong. Posted January 17th 2021

Posted Aug 08, 2016

Dindo Jimenez/FreeImages.com

Source: Dindo Jimenez/FreeImages.com

My friend “Andrea” was at the head of the trend toward a new kind of family. In an earlier post, “On NOT Waiting for Mr. Right,” she shared her perspective as a single woman who was five months pregnant.

“This isn’t what I dreamed of,” Andrea told me. She became pregnant via sperm donor insemination, joined Single Mothers by Choice and also took childbirth and parenting classes. But she had to explain her choice to most people—even to those teaching the courses. “There is an expectation that you have a partner or spouse who will show up at some point. I have to ask if I can bring a friend,” said Andrea, who was 40 years old when her daughter was born.

During previous generations, single mothers were viewed askance. Much of the skepticism and distrust were fueled by views of teenage pregnancies and poor outcomes for the children of young, usually single teen mothers. Similarly, older, unmarried women who had babies faced criticism that was fed, in part, by those who believed how and what a family should be—you know, a mom, dad, and two children. Whatever their age or socio-economic status, single mothers struggled for legitimacy.

The 21st century has changed some, but not all tired—possibly unrealistic—attitudes about single women in general and single mothers in particular. As recently as 2010, the Pew Research Center found that 69 percent of people feel having and raising a child without a man to help raise that child is “a bad thing for society.” 

Fewer Waiting for “Mr. Right”

Yet, among women today, we have what amounts to “the invention of independent female adulthood as a norm, not an aberration, and the creation of an entirely new population: adult women who are no longer economically, socially, sexually, or reproductively dependent on or defined by the men they marry,” as Rebecca Traister described the shift in a New York Magazine article about single women’s political power.

Many of these women are parents. Single parent households in both the US and England have jumped from less than 10 percent in the 1970s to roughly 30 percent today. Some women are single parents through divorce or separation or unplanned pregnancies, but a growing number choose to have and a raise babies on their own. In other words, fewer and fewer women are waiting for Mr. Right.

Women who decide to be solo parents are in large part educated, responsible, emotionally mature, and fiscally able to support their offspring. Many of them are in their 30s and 40s and embrace advances such as sperm donation and in-vitro fertilization to become mothers.

As enlightened as we are about single women, the belief lingers that two parents are better—significantly better—than one. The concern that children raised by single mothers will have difficulties remains.

Single Mothers: Problems for Children?

Researchers studied solo mothers and two-parent families when the babies were infants. They revisited the question two years later and published their findings in the study, “Solo mothers and their donor insemination infants: follow-up at age 2 years.” Again they compared solo mothers and married women who became pregnant via donor insemination (DI). article continues after advertisement

They reported: “This route to parenthood (via DI for solo mothers) does not necessarily seem to have an adverse effect on mothers’ parenting ability or the psychological adjustment of the child.” In fact, “The solo DI mothers showed greater pleasure in their child and lower levels of anger accompanied by a perception of their child as less ‘clingy’. Fewer emotional and behavioural difficulties were shown by children of solo than married DI mothers.” The results during those typically more trying “terrible twos” were similar when studies examined the quality of parenting and children’s psychological adjustment at ages 3, 7, and 10, again with DI solo mothers and DI married parents.

In a 2016 study published in the Journal of Family Psychology, “Single mothers by choice: Mother-child relationships and children’s psychological adjustment,” children of single mothers were compared with children in two-parent households. The children ranged in age from four to nine and were all conceived by donor insemination—50 solo mothers and 51 two-parent families.

Susan Golombok and her colleagues at the University of Cambridge used a series of interviews with parents, researcher observation, teacher reports, and measurements for psychological problems such as ADHD, and autism. The findings for both family types were the same on an array of measures: warmth, conflict, stress, adjustment problems, mother’s well-being, among others. No significant differences were discovered.

Golombok noted: “The low level of psychological problems among the children of single mothers by choice in the present study suggests that lack of knowledge of the identity of their biological father does not have a negative impact on their psychological wellbeing.”

Some of the positive results might be attributed to the connection to the mother’s carrying the baby herself. One study, “Children born through reproductive donation: a longitudinal study of psychological adjustment,” looked a different means of having a baby through reproductive donation—sperm, egg or embryo donation, surrogacy. The conclusion: “The absence of a gestational connection to the mother may be more problematic for children than the absence of a genetic link.”

When thinking about the positive results of solo motherhood, especially using donor insemination, the desire to have a baby, psychological screenings, the expense and difficulties in becoming pregnant should be considered. Single women who choose motherhood often wait until they are older to start their families. Many also go to great lengths to become mothers, making children of single mothers very wanted children—all of which may help explain the optimistic outcomes. Solo mothers by choice are certainly, as Rebecca Traister wrote, not “economically, socially, sexually, or reproductively dependent on or defined by the men…” article continues after advertisement

Note: The number of unmarried women deciding to become mothers is growing, however, to date, research on single women who choose motherhood is limited and hence the children studied are young. Although donor insemination for single motherhood is in its “infancy,” future studies are bound to follow.
Copyright @2016 by Susan Newman

References

Related:On NOT Waiting for Mr. Right  Too Old to Have a Baby?  Women: Want to Make More Money? Have Babies After 30

References:

Bock, Jane D. “Doing the Right Thing? Single Mothers by Choice and the Struggle for Legitimacy.” Gender and Society 14.1 (2000): 62-86.

De Wert, G., Dondorp, W., Shenfield, F., Barri, P., Devroey, P., Diedrich,K., and Pennings, G. (2014). “ESHRE Task Force on Ethics and Law 23: “Medically assisted reproduction in singles, lesbian and gay couples, and transsexual people.” Human Reproduction, 29.9. (2014) 1859–1865. NCBI. 1   Golombok, Susan, Lucy Blake, Polly Casey, Gabriela Roman and Vasanti Jadva. “Children born through reproductive donation: a longitudinal study of psychological adjustment.” Journal of Child Psychology and Psychiatry. 54.6 (2013): 653–660. NCBI http://www.ncbi.nlm.nih.gov/pubmed/23176601 Golombok, Susan, Sophie Zadeh, Susan Imrie; Venessa Smith and Tabitha Freeman. “Single Mothers by Choice: Mother–Child Relationships and Children’s Psychological Adjustment.” Journal of Family Psychology. 30.4 (2016): 409–418. NCBI. http://www.ncbi.nlm.nih.gov/pubmed/26866836 Murray, C. and Golombok, S. “Solo mothers and their donor insemination infants: follow-up at age 2 years.” Human Reproduction. 20.6 (2005): 1655-1660. NCBI. http://www.ncbi.nlm.nih.gov/pubmed/15734751

Pew Research Center. “The Decline of Marriage And Rise of New Families.” Pew Research Center, 18 November 2010.   Traister, Rebecca. “The Single American Woman.” New York Magazine. New York Media, LLC, 22 Fe

Susan Newman, Ph.D., is a social psychologist and author. Her latest book is The Book of No: 365 Ways to Say it and Mean it—and Stop People-Pleasing Forever. Online:Susan Newman, Ph.D., Twitter, Facebook, LinkedIn

The Key to a Good Life? Lose Yourself in Something.

Whether it’s you that benefits most or someone else, don’t be afraid to go all in.

Brad Stulberg

One of the best feelings in the world is losing your attachment to yourself.

So much of our time is spent in self-focused ways. What happens if I do this? Or that? Doubt. Fear. Self-judgement. The judgement of others against ourselves. Planning. Scheming. It’s a whole lot of I, I, and I. You get the point.

Yet there’s a paradox: all of this self-focus is not very good for ourselves. Studies show that self-absorption is associated with clinical depression, personality disorders, and anxiety.

On the other hand, releasing from such a tight attachment to one’s self is a hallmark of flow, or that highly sought after state of being fully in the zone. Losing oneself is also the goal of most spiritual disciplines. (And athletic and creative ones, too.) The more you forget about yourself, the better you’ll feel, the better you’ll do, and the better you’ll be.

Unfortunately, the current ethos promotes self absorption. Examples include social media; the supposed importance of building a “personal brand”; or the self-improvement and self-esteem movements. More than ever, it seems, we’re being sold the idea of a separate self. This is a trap. And while there are a handful of ways out, I want to briefly explore two of the most dependable ones.

Pursue Mastery (In Anything)

More than 2,000 years ago, in his Aristotle wrote that integral to a meaningful life is striving for arête, or what we might today call excellence or mastery. Aristotle pointed out, however, that achieving arête — be it by throwing oneself fully into a work of art, intellect, or athletics — is not always pleasant: “A virtuous life,” he wrote, “requires exertion, and does not consist in amusement.” But he also wrote that it is in such virtuous acts — making ourselves vulnerable and giving something our all — that we lose ourselves.

Centuries later, in his wildly popular Drive, a book that at its core is about what makes people tick, author Daniel Pink makes a similar case: “Mastery,” writes Pink, “is pain.” Yet, like Aristotle, Pink also argues that mastery is meaningful, that the benefits of taking on a challenge out of one’s own volition and losing oneself in an activity are immense.

For a study published in the Journal of Personality and Social Psychology, psychologist Carol Ryff surveyed more than 300 men and women, in order to identify correlates of well-being. She found that people who had “a feeling of continued development,” and saw themselves as “growing and expanding” were more likely to score high on assessments of life satisfaction and self-esteem than those who did not. Other research shows that when people throw themselves into an activity for the sake of the activity itself — and not for some sort of external reward, like money or fame or Instagram followers — they tend to report long-term well-being and fulfillment.

Attempting to master a craft may seem inherently selfish, but that’s not the case. In interviews with over 100 highly productive scientists, artists, and other creative types, the psychologist Mihaly Csikszentmihalyi discovered that many found meaning in their lives precisely because they lost themselves in their pursuit, or because they turned themselves over to it. He coined this “vital engagement,” or a relationship to an activity that manifests when one becomes fully absorbed in it. Meaning, Csikszentmihalyi writes, “derives from the connection of the individual to a tradition, enterprise, and community of practice that lie beyond the self.”

The specific craft need not matter. For some it may be running, for others sculpting, cooking, or playing the cello. What does matter is that you respect and honor the traditions of the craft, pursue long-term progress in it, and participate not for the sake of raising yourself up (i.e., an ego boost) but for the sake of transcending the very notion of your “self” altogether. You want to express yourself in the work and lose yourself in the work at the same time.

Though some may say that pursuing this kind of mastery is self-serving, or worse, selfish, I’d argue otherwise. I’ve never met someone who is in pursuit of mastery, who pays close attention to their craft and cares deeply about it, who isn’t a good person. Plus, whatever they create tends to end up helping lots of other people anyways. (Exhibit A: Mike Posner’s recent walk across America.)

Be Kind

As meaningful as devoting oneself to mastery may be, devoting oneself directly to helping others is perhaps even more powerful. (Of course, the two aren’t exclusive.) One of the world’s foremost happiness researchers, Sonya Lyubomirsky, has told me that her research continues to show that one of the best ways to boost both happiness and meaning is to perform acts of kindness, such as volunteering, mentoring, coaching, or even just writing someone a letter of gratitude. When individuals participate in these activities, she says, they report more positive emotions, both immediately and over time.

A recent series of studies published in The Journal of Positive Psychology, “Prosociality Enhances Meaning in Life,” bears this out. The psychologist Daryl Van Tongeren and his colleagues asked over 400 participants how often they engage in altruistic endeavors. He then asked them how meaningful their lives felt. Those who were more altruistic reported more meaning in their lives.

Next, Van Tongeren conducted a case-control experiment: that is, he took a group of individuals, measured their sense of meaning at baseline, and then instructed half the participants to engage in altruistic acts and the other half not to. The participants who partook in the altruistic acts reported significantly greater increases in meaning versus those who did not, suggesting a causal relationship, or thatacts of kindness are not merely associated with but actually create meaning.

Though the exact mechanism by which performing acts of kindness enhances meaning is unknown, researchers speculate that doing so makes us feel more connected to and rooted in community. Additionally, doing nice things for others affords us a purpose that is beyond ourselves and the opportunity to contribute to a greater cause — both of which are associated with increased meaning.

Today’s world is all about quick fixes, hot takes, and outrage. Yet, according to science and the longstanding wisdom traditions, the keys to a good life are the exact opposite.

Brad Stulberg (@Bstulberg) writes about performance and wellbeing. He is the bestselling author of Peak Performance and The Passion Paradox, and co-creator of the TheGrowthEq.com.

Depression

We’ve Got Depression All Wrong. It’s Trying to Save Us.

New theories recognize depression as part of a biological survival strategy. Posted Here January 9th 2021

Posted Dec 22, 2020

THE BASICS

For generations, we have seen depression as an illness, an unnecessary deviation from normal functioning. It’s an idea that makes sense because depression causes suffering and even death. But what if we’ve got it all wrong? What if depression is not an aberration at all, but an important part of our biological defense system?

ActionVance/Unsplash

Depression is a courageous biological strategy to help us survive. Source: ActionVance/Unsplash

More and more researchers across specialties are questioning our current definitions of depression. Biological anthropologists have argued that depression is an adaptive response to adversity and not a mental disorder. In October, the British Psychological Society published a new report on depression, stating that “depression is best thought of as an experience, or set of experiences, rather than as a disease.” And neuroscientists are focusing on the role of the autonomic nervous system (ANS) in depression. According to the Polyvagal Theory of the ANS, depression is part of a biological defense strategy meant to help us survive.

The common wisdom is that depression starts in the mind with distorted thinking. That leads to “psychosomatic” symptoms like headaches, stomachaches, or fatigue. Now, models like the Polyvagal Theory suggest that we’ve got it backward. It’s the body that detects danger and initiates a defense strategy meant to help us survive. That biological strategy is called immobilization, and it manifests in the mind and the body with a set of symptoms we call depression.

When we think of depression as irrational and unnecessary suffering, we stigmatize people and rob them of hope. But when we begin to understand that depression, at least initially, happens for a good reason we lift the shame. People with depression are courageous survivors, not damaged invalids.

Laura believes that depression saved her life. Most of the time her father only hurt her with words, but it was when she stood up to him that Laura’s dad got dangerous. That’s when he’d get that vicious look in his eyes. More than once his violence had put Laura’s life at risk.

Laura’s father was so perceptive, that he could tell when she felt rebellious on the inside even when she was hiding it. And he punished her for those feelings.

It was the depression that helped Laura survive. Depression kept her head down, kept her from resisting, helped her accept the unacceptable. Depression numbed her rebellious feelings. Laura grew up at a time where there was no one to tell, nowhere for her to get help outside her home. Her only strategy was to survive in place. And she did.

Looking back, Laura does not regret her childhood depression. She values it. Going through her own healing process and working with her therapist helped her see how depression served her.

Laura’s story is stark. It’s ugly. And it helps us understand that even though depression may happen for a good reason, that does not make it a good thing. Laura suffered deeply and describes the pain of her hopelessness vividly. Her depression was a bad experience that started as the last resort of a good biological system.

Depression starts with immobilization

According to the Polyvagal Theory, discovered and articulated by neuroscientist Stephen Porges, our daily experience is based on a hierarchy of states in the autonomic nervous system. When the ANS feels safe, we experience a sense of well-being and social connection. That’s when we feel like ourselves.

But the autonomic nervous system is also constantly scanning our internal and external environment for signs of danger. If our ANS detects a threat or even a simple lack of safety, its next strategy is the fight or flight response which we often feel as anxiety.

Sometimes the threat is so bad or goes on for so long, that the nervous system decides there is no way to fight or to flee. At that point, there is only one option left: immobilization. article continues after advertisement

The immobilization response is the original biological defense in higher animals. This is the shutdown response we see in reptiles. Also known as the freeze or faint response, immobilization is mediated by the dorsal vagus nerve. It turns down the metabolism to a resting state, which often makes people feel faint or sluggish.

Owlie Harring/Unsplash

The immobilization response dulls pain. Source: Owlie Harring/Unsplash

Immobilization has an important role. It dulls pain and makes us feel disconnected. Think of a rabbit hanging limply in the fox’s mouth: that rabbit is shutting down so it won’t suffer too badly when the fox eats it. And the immobilization response also has a metabolic effect, slowing the metabolism and switching the body to ketosis. Some doctors speculate that this metabolic state could help healing in severe illness.

In humans, people often describe feeling “out of their bodies” during traumatic events, which has a defensive effect of cushioning the emotional shock. This is important because some things are so terrible, we don’t want people to be fully present when they happen.

So the immobilization response is a key part of the biological defense, but it is ideally designed to be short term. Either the metabolic shut down preserves the organism, i.e. the rabbit gets away, or the organism dies and the fox eats the rabbit.

But if the threat continues indefinitely and there is no way to fight or flee, the immobilization response continues. And since the response also changes brain activity, it impacts how people’s emotions and their ability to solve problems. People feel like they can’t get moving physically or mentally, they feel hopeless and helpless. That’s depression. article continues after advertisement

Does depression have value?

It’s easy to see why Laura’s childhood circumstances would set off the immobilization response, and even how it might have helped her survive. But why does it happen in people with less obvious adversity? Our culture tends to think of depression in the person who finds work too stressful as a sign of weakness. Self-help articles imply that they just need more mental toughness and they could lean in and solve it. Even some therapists tell them that their depression is a distorted perception of circumstances that aren’t so bad.

But that is not how the body sees it. The defense responses in the autonomic nervous system, whether fight/flight or immobilization are not about the actual nature of the trigger. They are about whether this body decides there is a threat. And that happens at a pre-conscious point. The biological threat response starts before we think about it, and then our higher-level brain makes up a story to explain it. We don’t get to choose this response; it happens before we even know it.

Studying anxiety has revealed that many modern circumstances can set off the fight or flight response. For instance, low rumbling noises from construction equipment sound to the nervous system like the growl of a large predator. Better run. Or feeling like they are being evaluated at school removes kids’ sense of safety and triggers fight or flight. Better give the teacher attitude or avoid homework. And to most of us, fight or flight feels like anxiety. article continues after advertisement

Eventually, if these modern triggers last long enough, the body decides it can’t get away. Next comes immobilization which the body triggers to defend us. According to Porges, what we call depression is the cluster of emotional and cognitive symptoms that sits on top of a physiological platform in the immobilization response. It’s a strategy meant to help us survive; the body is trying to save us. Depression happens for a fundamentally good reason.

And that changes everything. When people who are depressed learn that they are not damaged, but have a good biological system that is trying to help them survive, they begin to see themselves differently. After all, depression is notorious for the feelings of hopelessness and helplessness. But if depression is an active defense strategy, people may recognize they are not quite so helpless as they thought.

Shifting out of immobilization

If depression is the emotional expression of the immobilization response, then the solution is to move out of that state of defense. Porges believes it is not enough to simply remove the threat. Rather, the nervous system has to detect robust signals of safety to bring the social state back online. The best way to do that? Social connection. article continues after advertisement

One of the symptoms of depression is shame, a sense of having let other people down or being unworthy to be with them. When people are told that depression is an aberration, we are telling them that they are not part of the tribe. They are not right, they don’t belong. That’s when their shame deepens and they avoid social connection. We have cut them off from the path that leads them out of depression.

It is time that we start honoring the courage and strength of depressed people. It is time we start valuing the incredible capacity of our biology to find a way in hard times. And it is time that we stop pretending depressed people are any different than anyone else.

References

Porges, Stephen. (Apr 2009) The polyvagal theory: New insights into adaptive reactions of the autonomic nervous system. Cleve Clin J Med.

Porges, Stephen. (Feb 2007) The polyvagal perspective. Biol Psychology.

Suicide U.K Posted January 9th 2021 from ONS.

  • In 2019, there were 5,691 suicides registered in England and Wales, an age-standardised rate of 11.0 deaths per 100,000 population and consistent with the rate in 2018.
  • Around three-quarters of registered deaths in 2019 were among men (4,303 deaths), which follows a consistent trend back to the mid-1990s.
  • The England and Wales male suicide rate of 16.9 deaths per 100,000 is the highest since 2000 and remains in line with the rate in 2018; for females, the rate was 5.3 deaths per 100,000, consistent with 2018 and the highest since 2004.
  • Males aged 45 to 49 years had the highest age-specific suicide rate (25.5 deaths per 100,000 males); for females, the age group with the highest rate was 50 to 54 years at 7.4 deaths per 100,000.
  • Despite having a low number of deaths overall, rates among the under 25s have generally increased in recent years, particularly 10- to 24-year-old females where the rate has increased significantly since 2012 to its highest level with 3.1 deaths per 100,000 females in 2019.
  • As seen in previous years, the most common method of suicide in England and Wales was hanging, accounting for 61.7% of all suicides among males and 46.7% of all suicides among females.

Talking out loud to yourself is technology for thinking . Posted January 3rd 2021

Talking out loud to yourself is a technology for thinking | Psyche

Talking out loud to yourself is a technology for thinking

Photo by Marcos Brindicci/Reuters

Nana Arielis a writer, literary scholar and lecturer in the Faculty of Humanities at Tel Aviv University, a fellow of the Minducate Science of Learning Research and Innovation Center, and a guest lecturer at Harvard University. She specialises in theoretical and practical rhetoric and in adventurous pedagogy. She lives in Tel Aviv.

This week, a woman was strolling in my street, walking in circles and speaking out loud to herself. People were looking at her awkwardly, but she didn’t particularly mind, and continued walking vigorously and speaking.

Yes, that woman was me.

Like many of us, I talk to myself out loud, though I’m a little unusual in that I often do it in public spaces. Whenever I want to figure out an issue, develop an idea or memorise a text, I turn to this odd work routine. While it’s definitely earned me a reputation in my neighbourhood, it’s also improved my thinking and speaking skills immensely. Speaking out loud is not only a medium of communication, but a technology of thinking: it encourages the formation and processing of thoughts.

The idea that speaking out loud and thinking are closely related isn’t new. It emerged in Ancient Greece and Rome, in the work of such great orators as Marcus Tullius Cicero. But perhaps the most intriguing modern development of the idea appeared in the essay ‘On the Gradual Formation of Thoughts During Speech’ (1805) by the German writer Heinrich von Kleist. Here, Kleist describes his habit of using speech as a thinking method, and speculates that if we can’t discover something just by thinking about it, we might discover it in the process of free speech. He writes that we usually hold an abstract beginning of a thought, but active speech helps to turn the obscure thought into a whole idea. It’s not thought that produces speech but, rather, speech is a creative process that in turn generates thought. Just as ‘appetite comes with eating’, Kleist argues, ‘ideas come with speaking’.

A lot of attention has been given to the power of spoken self-affirmation as a means of self-empowerment, in the spirit of positive psychology. However, as Kleist says, talking to oneself is also a cognitive and intellectual tool that allows for a wider array of possible use cases. Contemporary theories in cognition and the science of learning reaffirm Kleist’s speculations, and show how self-talk contributes not only to motivation and emotional regulation, but also to some higher cognitive functions such as developing metacognition and reasoning.

If self-talk is so beneficial, why aren’t we talking to ourselves all the time? The dynamic between self-talk and inner speech might explain the dubious social status of the former. Self-talk is often seen as the premature equivalent of inner speech – the silent inner voice in our mind, which has prominent cognitive functions in itself. The tendency to express our inner thoughts in actual self-talk, typical of children, is internalised, and transforms to voiceless inner speech in adulthood, as the developmental psychologist Lev Vygotsky already speculated in the 1920s.

Self-talk is deemed legitimate only when done in private, by children, by people with intellectual disabilities, or in Shakespearean soliloquies

Vygotsky’s view stood in opposition to a competing one from the psychological school known as behaviourism, which saw children’s self-talk as a byproduct of (supposedly) less competent minds. But Vygotsky claimed that self-talk has an active mental role. He observed children performing tasks while speaking to themselves out loud, and reached the conclusion that their ‘private-talk’ is a crucial stage in their mental development. Gradually, a child’s interaction with others turns into an uttered conversation with the self – self-talk – until it becomes muted inner speech in adulthood. Vygotsky’s successors, such as the psychologist Charles Fernyhough, have demonstrated that inner speech goes on to facilitate an array of cognitive functions including problem solving, activating working memory and preparation for social encounters. It is inner speech rather than self-talk, then, that has been the focus of research in adults.

However, the internalisation of self-talk isn’t necessarily evidence of cognitive maturity: rather, it could represent the degeneration of an essential cognitive skill in the face of social pressure. The sociologist Erving Goffman noted that self-talk is taboo because it is a ‘threat to intersubjectivity’ and violates the social assumption that speech is communicative. As he wrote in his book Forms of Talk (1981): ‘There are no circumstances in which we can say: “I’m sorry, I can’t come right now, I’m busy talking to myself”.’ Self-talk is deemed legitimate only when done in private, by children, by people with intellectual disabilities, or in Shakespearean soliloquies.

Yet self-talk enjoys certain advantages over inner speech, even in adults. First, silent inner speech often appears in a ‘condensed’ and partial, form; as Fernyhough has shown, we often tend to speak to ourselves silently using single words and condensed sentences. Speaking out loud, by contrast, allows the retrieval of our thoughts in full, using rhythm and intonation that emphasise their pragmatic and argumentative meaning, and encourages the creation of developed, complex ideas.

Not only does speech retrieve pre-existing ideas, it also creates new information in the retrieval process, just as in the process of writing. Speaking out loud is inventive and creative – each uttered word and sentence doesn’t just bring forth an existing thought, but also triggers new mental and linguistic connections. In both cases – speech and writing – the materiality of language undergoes a transformation (to audible sounds or written signs) which in turn produces a mental shift. This transformation isn’t just about the translation of thoughts into another set of signs – rather, it adds new information to the mental process, and generates new mental cascades. That’s why the best solution for creative blocks isn’t to try to think in front of an empty page and simply wait for thoughts to arrive, but actually to continue to speak and write (anything), trusting this generative process.

Speaking out loud to yourself also increases the dialogical quality of our own speech. Although we have no visible addressee, speaking to ourselves encourages us to actively construct an image of an addressee and activate one’s ‘theory of mind’ – the ability to understand other people’s mental states, and to speak and act according to their imagined expectations. Mute inner speech can appear as an inner dialogue as well, but its truncated form encourages us to create a ‘secret’ abbreviated language and deploy mental shortcuts. By forcing us to articulate ourselves more fully, self-talk summons up the image of an imagined listener or interrogator more vividly. In this way, it allows us to question ourselves more critically by adopting an external perspective on our ideas, and so to consider shortcomings in our arguments – all while using our own speech.

You might have noticed, too, that self-talk is often intuitively performed while the person is moving or walking around. If you’ve ever paced back and forth in your room while trying to talk something out, you’ve used this technique intuitively. It’s no coincidence that we walk when we need to think: evidence shows that movement enhances thinking and learning, and both are activated in the same centre of motor control in the brain. In the influential subfield of cognitive science concerned with ‘embodied’ cognition, one prominent claim is that actions themselves are constitutive of cognitive processes. That is, activities such as playing a musical instrument, writing, speaking or dancing don’t start in the brain and then emanate out to the body as actions; rather, they entail the mind and body working in concert as a creative, integrated whole, unfolding and influencing each other in turn. It’s therefore a significant problem that many of us are trapped in work and study environments that don’t allow us to activate these intuitive cognitive muscles, and indeed often even encourage us to avoid them.

Technological developments that make speaking seemingly redundant are also an obstacle to embracing our full cognitive potential. Recently, the technology entrepreneur Elon Musk declared that we are marching towards a near future without language, in which we’ll be able to communicate directly mind-to-mind through neural links. ‘Our brain spends a lot of effort compressing a complex concept into words,’ he said in a recent interview, ‘and there’s a lot of loss of information that occurs when compressing a complex concept into words.’ However, what Musk chalks up as ‘effort’, friction and information loss also involves cognitive gain. Speech is not merely a conduit for the transmission of ideas, a replaceable medium for direct communication, but a generative activity that enhances thinking. Neural links might ease intersubjective communication, but they won’t replace the technology of thinking-while-speaking. Just as Kleist realised more than 200 years ago, there are no pre-existing ideas, but rather the heuristic process by which speech and thought co-construct each other.

So, the next time you see someone strolling and speaking to herself in your street, wait before judging her – she might just be in the middle of intensive work. She might be wishing she could say: ‘I’m sorry, I can’t chat right now, I’m busy talking to myself.’ And maybe, just maybe, you might find yourself doing the same one day.

Married to Someone Who’s Always Right?

One personality trait can be especially frustrating. Posted January 1st 2021

Posted Aug 27, 2019

THE BASICS

Relationships are rife with possible conflicts because they require the navigation of two different personalities. While there are many personality traits that can bother you in a spouse or partner, few traits elicit as strong an emotional reaction as the trait where a person acts as if they’re always right.

This trait can be frustrating in a friend but is much more difficult to bear in a romantic relationship that involves so many emotional ties and such constant close proximity. If you’re married to someone who acts as if they’re always right, there are a few things to keep in mind that can make your interactions with them less conflictual.

Before exploring the topic further, it’s important to note that research on this subject is challenging. Who, for example, wants to admit that they always need to be right? Because of the challenges in getting honest self-reports in this area, I’ll draw on my 20 years of clinical experience with men and women of various ages and social demographics. 

Acting as if one is always right reflects a pervasive psychological defense mechanism.

There isn’t one simple cause for this complex personality trait, but most individuals who have a need to always be right share one important characteristic: Their need to always be right indicates a strong and pervasive defense mechanism (including, but not limited to, a denial of their vulnerability, an inherent part of everyone’s human experience, whether one likes it or not).

The definition of a defense mechanism is: “a way in which somebody behaves without thinking about it to protect themselves from unpleasant feelings or situations” (“Defense mechanism,” 2019). Note that the part of the definition that includes “without thinking about it” is also known clinically as an unconscious process, meaning that the personality trait — always being right — has become so ingrained in the person’s thinking and personality that the person isn’t fully aware of just how right they always need to be. Though people who act as if they’re always right know that they like to be right, they would not necessarily understand consciously that they act this way because they are overcompensating for feelings of shame, a sense of insufficiency, and fear that would arise if they were wrong.

Psychologically, men and women who are never wrong would feel extremely exposed if others witnessed them being wrong. Being wrong under any circumstances in front of others reflects to them a weakness or flaw, even when most people would not consider being wrong here or there as rising to the level of a flaw! In contrast, people with good self-esteem accept that they are sometimes wrong (read: occasionally vulnerable and always imperfect) because they are human.

Why people who act as if they’re never wrong are so averse to the notion of occasionally being wrong, even in the most mundane or trivial circumstances

A history of early experiences in which being vulnerable resulted in getting emotionally hurt: Men and women who are never wrong developed this defensive personality trait many years ago, and many of them developed it because someone very important in their early life made them feel emotionally unsafe. When they were young, many of these men and women learned that it isn’t safe to let their guard down and be vulnerable, because when they let their guard down and were vulnerable in the past, they got emotionally hurt, criticized or even punished.

For example, men and women who are always right often had the experience of sharing an emotional experience with someone, and watching as information about that experience was used against them later. Other men and women with this problem were shamed at critical points during their development for “failing,” or they were made to feel stupid or even pathetic, at times, by parents or peers at school. Years ago, these individuals (unconsciously, without realizing it) began construction on a moat-like defensive response style to protect their ego from ever feeling small, insufficient, defective, or stupid again.

A lack of praise, feeling unvalued: Another factor in the life of a child that gives rise to this personality trait is a lack of feeling praised and valued enough as a child. Because these men and women weren’t praised and valued enough as boys and girls, their ego development, their self-esteem, suffered. Later in life, these men and women learned to overcompensate for self-doubt and feelings of shame for not being good enough by flipping the script. Outwardly, they learned to act as if they were strong, superior and infallible, even when logic would tell them that no such person exists. 

Growing up with a parent who was always right, too: In some cases, the person who is always right developed this orientation based on social modeling. Specifically, these individuals may have grown up with a parent who was always right, too. Children who have a parent who is never wrong and always right often feel angry and resentful, because the parent’s perspective feels rigid and unfair, and often betrays reality or objectivity.

These children often live with an underlying sense that they are inferior to the superior, always-right parent, and the children internalize the sense that they’re not inherently good enough and as valuable as they are. As a result, these children usually go through childhood feeling resentful and angry that they aren’t “heard” or valued, and that they are dismissed or discounted by those who matter. How do they cope with these feelings? They begin to operate with others using the same personality trait they fell victim to with their parent, acting with others now as if they are the ones who are always right. article continues after advertisement

What this personality trait means diagnostically

For some men and women, the never-wrong personality trait is a part of a larger problem: an entire personality organization that is distorted in crucial ways. These individuals may have what clinicians call a personality disorder, and this trait is most common among individuals who have what is known as Cluster B personality disorders (Narcissistic, Borderline, and Antisocial Personality Disorders, especially), each of which is outlined in the current edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013).

The Cluster B personalities involve distorted expectations of others, a disordered view of the self, and disordered relationships. Men and women who have a Cluster B personality disorder often have a need to feel superior to others, which often requires dismissing the thoughts and feelings of others. The thinking goes like this: What does reality really matter when my ego is on the line? I protect my ego to feel big and strong at all costs. For men and women who are never wrong, protecting their fragile ego is their number one goal.

Personality is not the only factor at work, however, in the construction and maintenance of this trait. Individuals who have the need to always be right may have this problem as a function of their cognitive (thinking) style. Specifically, they may suffer from an extremely rigid cognitive style, one with fixed ideas. Men and women who are never wrong may meet some or all of the criteria for Obsessive-Compulsive Disorder, a disorder that includes rigid, fixed ideas and behaviors. article continues after advertisement

Similarly, men and women who lie at the highly functional end of Autism Spectrum Disorder (what clinicians historically called “Aspergers Disorder”) often present rigid or fixed thoughts and behaviors. When such individuals have the thought that they are right in a particular situation, they have great difficulty “shifting sets” and seeing another person’s perspective in the very same situation.

The previous disorders are only a subset of the possible disorders that can coexist with the personality trait of always needing to be right. If you’re concerned that your spouse may present this personality type as a symptom of a larger psychological problem, the best practice is to meet with a mental health professional to discuss the issue in depth. Though such professionals can only diagnose individuals they have clinically assessed themselves, a professional can listen to your circumstances and share feedback to help you manage this relationship dynamic more effectively.

Unmet needs in the individual’s current life

While it’s helpful to understand what may be going on clinically with your spouse, it’s also helpful to reflect on what factors in your spouse’s current life could be exacerbating the problem (the need to prove how right they always are). Sigmund Freud, the revolutionary neurologist and founder of psychoanalysis, believed that a person’s primary emotional issues come out in one of two areas in life: one’s work life or romantic life. In my clinical work, I’ve found this theory to be remarkably accurate. People who act like they’re never wrong often have a strong unmet need in their personal life, whether it’s their romantic life, home life, or social life

Unmet need for recognition in one’s professional or work-contribution life: Having a sense of purpose and feeling needed are crucial to a person’s well-being. People have a driving need to feel that the work contribution they make in life is important and valued by those close to them. Whether their job is a formal one — from a cashier to a CEO — or their work life is in the home — managing a household and/or taking care of children — it’s crucial for a person’s mood and self-esteem to feel that the contribution they make is recognized and valued. If the need for recognition in one’s professional or work-contribution life is not met, the gaping unmet need will typically result in anger, resentment, sadness, and even depression.

Those who have an unmet need for recognition in their work life become defensive. They overcompensate for the unmet need by trying harder to make everyone close to them acknowledge their contribution and their overall worth and value. In other words, if one feels undervalued and unappreciated, one goes into psychological overdrive to get everyone to see their worth and value. Because men and women who are never wrong have such a deep, profound unmet need for recognition, they devote much of their energy to constructing a persona in which they are seen as the opposite of someone who is vulnerable or flawed. They start acting to the world as if they’re an authority figure, one who is gifted and superior to most others.

Unmet need for recognition in one’s personal life: To feel happy enough and to be able to socialize consistently and harmoniously with others in close proximity to them (spouses, partners, close friends, co-workers, and bosses), people need to have their basic emotional needs for respect and caring met. When people feel unnoticed, unappreciated or disrespected for too long, they start to feel bitter, angry, and even depressed. Without question, someone who acts as if they’re always right isn’t getting their basic emotional needs met for respect and recognition in their daily life.

If a person doesn’t feel sufficiently valued by those closest to them in their personal life, that person is going to become defensive and is going to take on personality characteristics and defense mechanisms that protect their ego from feeling bad or insufficient. These individuals will often adopt the I’m-never-wrong attitude as a way to overcompensate for the feelings that come up for them because crucial people in their current personal life cause them to feel invisible or unimportant.

Why their approach doesn’t work

Despite the effort, this mental approach doesn’t work. The personality orientation – always right, never wrong – isn’t authentic or rooted in reality (because it’s impossible for anyone to be superhuman, or always right), so the foundation of this belief system is faulty and maladaptive. As a result, men and women who act as if they’re never wrong don’t actually achieve their goal of making others respect and recognize them. Instead, this rigid personality style only causes conflicts, causing others to resent or dislike them even more. Sadly, the cycle continues. The person who’s never wrong gets even more triggered because they’re trying so hard to demand the respect they believe they deserve, but they’re still not getting sufficiently acknowledged. Over time, they become more bitter and angry, and are even more intent on proving their value and right-ness. The need to be respected and valued for anyone is so fundamental that people will do almost anything to get it, even if that means self-sabotaging. 

How to cope when your spouse is never wrong

You’ve heard the trope about trying to change the stripes of a tiger. Simply put, trying to change your spouse or partner’s most fundamental personality characteristics is a losing endeavor. The psychological need for these individuals to always be right and never be wrong is so strong and so many years in the making that the personality trait’s closest relative is actual titanium; it’s simply not budging. What can budge, however, is how you, their spouse or partner, react to them. How do you cope? You use a series of mental approaches.

Talk to a mental health professional to get some perspective.

First, the most effective strategy in dealing with a spouse who is never wrong is to seek out a couples therapist. Though many men and women with this personality trait won’t want to talk with a therapist because their self-esteem isn’t strong enough to withstand any constructive criticism or feedback from a therapist, it’s always a good idea to suggest therapy — even just one session — as an option. If therapy is not an option, the only other option (aside from ending the relationship, which may not be necessary) is to shift how you react to their frustrating personality trait.

Don’t take their defensive, always-right personality personally.

It feels personal when your spouse acts as if they’ve descended to from the heavens to grace you with their superior, always-right presence, but it’s most definitely not personal. Your spouse is this way with anyone with whom they are in close proximity professionally or personally. Understand that your spouse’s need to always be right isn’t a sign that they think you’re inherently inferior to them; they are simply terrified of being disrespected or unvalued by anyone — stranger, boss, spouse — and that’s why they act the way they do. Though they act superior and high-and-mighty, they actually suffer from a somewhat fragile ego. Of course, people who feel good about themselves don’t need to be right all the time; it’s the ones who battle self-doubts and low self-esteem who insist on being the smartest, wisest people in the room. Men and women who are never wrong can’t ever really be vulnerable because being vulnerable, according to their distorted thinking, would end up hurting them or being used against them. 

Choose your battles.

People who are never wrong need to win and be voted “Most Respected” at all costs. These men and women will match you note for note if you challenge them, so when the issue is not important, let them win. When the two of you are navigating an issue that is important, sit with the issue for a day or two and plan a measured, non-emotional approach to the issue. Showing these people any sort of negative feelings, like anger or frustration, will only fuel them more. The arch-enemy of these individuals is accountability, so don’t waste your energy trying to hold them accountable and asking for fairness. When these individuals’ need to be right gets triggered, they will never, ever acknowledge any vulnerability at all.

Make sure you have a long list of coping outlets when you get triggered.

You’re not crazy to expect fairness and a mutual acknowledgment of reality in a relationship. Sadly, these men and women don’t value those things. It’s not realistic to never again be bothered by this personality trait, but it is realistic to make sure that you don’t lose your mind dealing with them. You can cope well and keep the relationship working well enough as long as you have sufficient prosocial outlets. Examples: talking to a therapist, meditation, various types of physical exercise, venting to close friends, writing in a journal, talking to your minister, rabbi, preacher, etc.

The overall point

Don’t take your spouse’s need to always be right personally, but also don’t engage too emotionally when your spouse’s need to be right gets triggered. Ultimately, everyone has flaws, and it is our own job to make sure that we figure out a way to react to those closest to us in a way that makes us feel good, connected, and supported.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Defense mechanism (2019). In Oxford Learner’s Dictionaries. Retrieved from https://www.oxfordlearnersdictionaries.com/definition/english/defence-mechanism

Stigma, schizophrenia and being transgender Posted December 26th 2020

When Ashley McFord-Allister was diagnosed with schizophrenia, treatment to confirm his gender slowed to a crawl. Here he explores how you can have a mental illness and be transgender simultaneously, and why the medical community – and society in general – needs to change their definition of the ‘accepted truth’.

Words by Ashley Ford-McAllister and artwork by Olivia Twist 20 March 2020

  • Article
Illustration in black, purple and red tones, showing a person sitting in an armchair in a room. At their feet is a ruckled rug with things hidden under it. To the left is a small bookcase and house plant.

When the whole world seems convinced that being transgender is a form of madness, what does it mean to be both a transgender individual and someone with a mental illness?

I’m a transgender man, though I rarely use the ‘trans’ prefix. I completed my transition, to the extent I’m happy with, in 2011, and have been living, loving and working as your run-of-the-mill working-class guy ever since.

In 2007, I was diagnosed with schizophrenia. This slowed my transition down by almost two years, because when you’re assumed to be crazy by reason of your identity, it’s a bit rich, as far as the medical community are concerned, to have a genuine mental illness as well.

The first reaction of many people – both individuals experiencing the twists and turns of personhood, and the professionals they come into contact with – is to assume that the transgender feelings are part of the actual mental illness.

I’d expressed definitively male aspirations from the age of five. Aged nine, I cut my hair short and insisted on being called by a male name (the same name I use now, almost a quarter of a century on).

At 20, following what is recorded as my first psychotic episode (but was more likely at least my second or third), I considered mentioning that I saw myself as male, rather than female. However, I decided not to do so, and quietly hoped that the conviction that I was ‘supposed to be’ male would be resolved by whatever medication I was prescribed.

In the 1990s, there was very little representation and information about transgender people, and nobody seemed to have a problem with me ‘being a tomboy’. Had I been born in the 1990s, rather than growing up in them, I might have discussed how I saw my gender sooner; it simply wasn’t a possibility I was aware of as a child.

An either-or situation

Many people with mental illnesses avoid raising transgender feelings or experiences with consulting clinicians. It takes so long to actually get to see a professional about mental health challenges in general that people don’t want to do anything that might cause treatment to be put on hold. Meanwhile, people who are already being seen by professionals as transgender individuals can be very wary of mentioning mental health issues, as these are frequently used as a reason to discontinue hormone therapy, and put the person off the clinical pathway to transition.

The psychiatric community has, to date, been very insistent that you can either undergo gender-confirming treatment, or receive treatment to help stabilise and manage an unrelated mental health condition; doing both simultaneously is, they insist, not possible. Society at large loudly asserts that being transgender is madness, yet transgender individuals wanting to medically validate their gender are required to be sane.

But we’re not always sane, because transgender experiences don’t discriminate. Your gender does not particularly care about your neurology, or your sanity, just as it doesn’t really care about your sexuality. Psychiatrists, however, care an awful lot about both, and they let their concern about them override the requirement that they treat their patients with courtesy, and with professional compassion.

Society at large loudly asserts that being transgender is madness.

In the face of neurodivergence or mental illness, psychiatry often denies transgender people the presumption of competence. We are no longer a relatively straightforward psychosocial ‘quirk’, to be quickly popped back on the track to being as close to cisgender as possible, but an unhinged mess that can’t be neatly tidied up .

It becomes an awful lot easier, as with many stubborn stains, to throw a rug over it and forget about it. The ‘rug’, in this case, being medical professionals’ insistence that our gender identity is simply a ‘manifestation’ of our wider ‘loss of contact with accepted reality’.

Schizophrenics like me are told that “fluid interpretations of gendered experience are quite usual with schizophrenia”. The fact that the most fluid my gender has ever been is wondering whether velvet T-shirts were a good look is glossed over with an assurance that I will have been experiencing shifts in my sense of gender but may not have been fully aware of them.

Individuals on the autism spectrum, meanwhile, are regularly ‘reminded’ that they “don’t really understand the concept of gender identity”. Despite this, many individuals I know, online and as friends, who are on the spectrum, both trans and not, are as certain and understanding of their gender as anyone else.

Creating more realistic expectations

Is transgender experience, or gender dysphoria, a kind of madness? As someone who has experienced being both transgender and clinically insane, no, it isn’t. Schizophrenia means I can struggle to understand and interpret the world around me, which causes me varying degrees of distress.

Transgender identities, by contrast, result in the world around the individuals living those identities struggling to understand and interpret them, causing the people of the wider world varying degrees of distress. ‘Mental illness’ is defined, in part, as causing distress to the individual experiencing it. I was never distressed by presenting as male; people around me were.

Are there overlaps between transgender individuals and those with mental illnesses? Very often, yes. Overwhelmingly, these overlaps are positive – a shared agreement that individuals are the authorities on themselves, their experiences and their identities. A common refusal to acknowledge that what society believes to be ‘obvious’, is, or deserves to be, the accepted truth. A letting-go of unrealistic expectations, and the radical acceptance of a very simple but frequently disputed truth: that if something does not cause harm to anyone, then it really isn’t an issue.

If something does not cause harm to anyone, then it really isn’t an issue.

Other overlaps are less positive, and come not from the communities themselves, but from wider society. These include the persistent association of transgender feelings with insanity, as well as the belief that other peoples’ reactions to our lived experience and personal expression matter more than our feelings about ourselves.

It is these overlaps that continue the stigma faced by both transgender individuals and those with mental health conditions. This stigma reinforces the barriers that prevent people, whatever their personal identity and experience, from being seen and accepted as ‘normal’.

About the contributors

Photograph of Ashley Ford-McAllister

Ashley Ford-McAllister

Author

Raised working poor, diagnosed with schizophrenia in 2007; a lifelong learning curve based on these two core points. Married, with dogs. Interests mostly became obsolete at least a century ago. He/him. 

Photograph of Olivia Twist

Olivia Twist

Illustrator@yesoliviatwist on Instagram

Olivia Twist is an illustrator, arts facilitator and lecturer from east London with an MA in Visual Communication from the Royal College of Art. The key threads that can be found in her work are place, the mundane and overlooked narratives. Her striking visual language is comprised of a myriad of esoteric layers informed by a propensity for human-centered research methodologies.

Read more from Broken hearts not broken brains

Dolly Sen invited five contributors to share their experiences that reflect upon the idea that mental ill health has less to do with a broken brain and more to do with a broken heart.ArticleHappy Joy SmileDrawn from real-life experiences, this short story depicts a character negotiating the UK’s current mental health system. Discover what happens as they encounter waiting lists, sketchy healthcare and punitive government bureaucracy.Photo storyThe man who remembers everythingTilney1 can remember his life in minute detail, but can’t control the incessant intrusion of thoughts and images from the past. As cuts to mental health services isolate him more and more, a crisis approaches.

How to Get Smarter Every Day, According to Neuroscience Posted December 7th 2020

Education matters. But so does fluid intelligence. Here’s how to improve yours.

By Jeff Haden, Contributing editor, Inc.@jeff_haden

How to Get Smarter Every Day, According to Neuroscience
Getty Images

A friend of mine spends 20 to 30 minutes a day solving Sudoku puzzles. He says it improves his speed of mental processing and makes him, well, smarter.

Hold that thought.

Ask people which factor contributes the most to success and most will choose intelligence, even though science says you also have to be lucky: Right place, right time. Right person, right time. Right idea, right market, right audience at the right time. 

Yet even though there are ways to “create” your own luck, you can’t control luck.

But you can control, to some degree, how smart you are. 

Let’s Define “Smart.”

While there are a number of different forms of intelligence, let’s focus on two. Crystallized intelligence is accumulated knowledge: facts, figures. Think “educated.”

Of course we all know people who are “book smart” but not necessarily smart smart. That’s where fluid intelligence comes into play: The ability to learn and retain new information and then use it to solve a problem, to learn a new skill, to recall existing memories and modify them with new knowledge. Think “applied intelligence.”

Becoming more educated is, while not easy, certainly simple.

Improving fluid intelligence is harder, which is one reason why brain games–crossword puzzles, Sudoku, brain training apps, etc.–are fairly popular.  

But do they make you smarter? Do they improve fluid intelligence? 

Basically, No.

A 2007 study published in Behavioral and Brain Sciences assessed the impact of brain training games on fluid intelligence. After participants played Tetris–yes, Tetris–for several weeks, cortical thickness and cortical activity increased. 

Both are signs of an increase in neural connections and learned expertise. In simple terms, their brains bulked up and got smarter.

But after those first few weeks, cortical thickness and activity started to decrease, eventually returning to pre-Tetris mastery pursuit levels–even though their skill levels remained high. Participants didn’t lose brain power.

Instead, their brains became so efficient at playing Tetris those increased neural connections were no longer necessary. Using more mental energy was no longer necessary. As with most things, once they kinda figured it out, it got easy.

Unfortunately, no matter how much work it took to learn new information or gain new skills,  “easy” doesn’t help improve fluid intelligence. Once knowledge or skill is in your pocket, you certainly benefit from the increase in crystallized intelligence.

But your fluid intelligence soon returns to a more baseline level. 

That’s the problem with brain training games. Solving Sudoku puzzles, and only solving Sudoku puzzles, won’t improve my friend’s fluid intelligence in any other areas. 

It only makes him better at solving Sudoku puzzles.

Learning how to use a new inventory management system will improve your fluid intelligence, until you’ve mastered it. Setting up Quickbooks for a new business will improve your fluid intelligence, until you’ve mastered the accounting process basics.

Once you achieve a level of comfort, your brain no longer has to work as hard, and all that new mental muscle gained starts to atrophy.

So what can you do?

Stay Uncomfortable.

Easy: Once you’ve mastered a new game, a new process, a new skill, a new anything–move on to something new.

At work. At home. Anywhere. Just keep challenging yourself.

Not only will you pocket a constant flow of new information and skill, your brain will stay “bulked up” and forging new neural connections, making it easier to keep learning and growing.

And then there’s this: The more you know, the more you can leverage the power of associative learning–the process of relating something new to something you already know.

Not in a Pavlov’s dog kind of way, but by learning the relationship between seemingly unrelated things. In simple terms, whenever you say, “Oh, that makes sense: This is basically like that,” you’re using associative learning. 

The more you learn, the more likely you will be able to associate “old” knowledge to new things. Which means you only have to learn differences or nuances. And you’ll be able to apply greater context, which also helps with memory storage and retrieval, to the new information you learn.

All of which makes learning even easier, which research shows will result in your being able to learn even more quickly–and retain a lot more.

So if you like brain training games, master one and then move on to another. And another.

Better yet, keep pushing yourself to learn new things about your business, your customers, your industry, etc.

Not only will that help you become more successful, you’ll also get to improve your crystallized intelligence and fluid intelligence–which will surely help you become even more successful.

Where win-wins are concerned, that’s a tough one to beat.Inc. helps entrepreneurs change the world. Get the advice you need to start, grow, and lead your business today. Subscribe here for unlimited access.

It’s not necessarily deluded to feel in control when you’re not | Psyche

It’s not necessarily deluded to feel in control when you’re not

Daniel Yonis a cognitive neuroscientist and experimental psychologist. He is a lecturer at Goldsmiths, University of London, where he heads a research lab investigating how our brains build models of ourselves and the world around us.

A distorted awareness of our capacities and capabilities is often a sign of serious mental illness. Take ‘Sophie’, a British woman living in Oxfordshire, who – in the grips of a delusional episode – developed the bizarre belief that she was God, and so able to take flight from sheer cliff drops and walk effortlessly on water. Though this episode subsided before she came to any serious harm, she later recounted that, if she had indeed tried leaping from slightly taller heights or treading in deeper pools of water, her already unsettling story could have had a fatal ending.

Sophie’s story is so unnerving because we take for granted that our insight into our actions and their consequences is accurate. This intuition is deeply embedded in many of our formal institutions. When a jury finds a defendant guilty of a crime or a tribunal disciplines a doctor for malpractice, we tacitly assume that the blameworthy party had a good awareness of their actions and the outcomes that ensued. The same thought seems to guide our personal and social relationships. When we praise someone for a thoughtful gift or admonish them for a hurtful comment, we do so because we believe those close to us are well aware of how their actions can affect us – and perhaps that they should have known better.

However, evidence from the cognitive sciences suggests our subjective awareness of what we can and cannot control is not always reliable. This was demonstrated in a seminal set of experiments in 1979 by the psychologists Lauren Alloy and Lyn Abramson using a fiendishly simple piece of equipment – a button wired up to a light bulb. Alloy and Abramson asked student volunteers at the University of Pennsylvania to play around with the button, and to judge how much their presses influenced the flashing bulb. Unbeknown to the students, sometimes the button was disconnected from the bulb, and all the flashes were programmed to occur at random. Surprisingly, perfectly healthy volunteers still reported feeling that they could influence when the flashes would occur, even when those flashes were completely uncontrollable.

Psychologists have termed these kinds of experiences ‘illusions of control’ – where we feel a sense of agency over events in the world that we can’t truly influence. And examples of these illusions crop up in our everyday lives, if you know where to look. For instance, in the 1960s the sociologist James Henslin observed American cab drivers as they gambled away their profits on curbside games of craps. Henslin spotted that when one of the cabbies needed a higher number on the dice, he’d superstitiously throw them harder against the curb – even though this can’t possibly affect the outcome. Those of us who live in cities might often experience illusions of control, since many of the mechanical buttons we interact with – from pedestrian crossings, elevators or office thermostats – have become obsolete, with the underlying systems controlled by centralised computers and automatic timers. Nonetheless, every day, thousands of us push the ‘placebo buttons’ – not realising that they do nothing at all.

Illusions of control have led scientists to claim that human beings have a fundamentally grandiose picture of how much they can influence the world around them. Some perspectives view the problem through an evolutionary lens, and suggest that exaggerated beliefs about our actions – while false – could be a useful product of natural selection. Thinkers in this camp reason that creatures with overly optimistic beliefs about their chances of success will seize more of the opportunities that the environment offers up. On this reading, we descend from those plucky primates who were overconfident about their ability to snatch food from a rival or seduce an attractive mate, and were thus more likely to survive, multiply and pass on this disposition to us.

These evolutionary ideas are complemented by perspectives from social psychology that suggest an exaggerated sense of control is a key ingredient to healthy self-esteem. One striking demonstration of this comes from studies of people with depression – who do not experience illusions of control in the same way. This observation led Alloy and Abramson to suggest that depression gives us a ‘sadder but wiser’ view of our capabilities. On this view, the feelings of powerlessness associated with the illness arise because the scales have fallen from the patient’s eyes, and they see how little they can shape the world around them. To be healthy is to be deluded.

The idea that humans are fundamentally deluded creatures has had a wide-ranging impact on studies of the mind and brain. However, my colleagues and I have been thinking about illusions of control and if the psychological evidence really does mean we are afflicted by delusions of grandeur. We came up with a new hypothesis – maybe when people hallucinate control over some event in the world, they could be noticing something that everyone else is missing.

These hallucinations of control were linked to spurious correlations between action and outcome

This idea was partly inspired by a longstanding puzzle in studies of human perception: why do we often see or hear things that aren’t really there? For more than a century, a branch of experimental psychology called ‘psychophysics’ has investigated the limits of human perception using tightly controlled laboratory tasks. For example, a volunteer in a typical psychophysical experiment might be placed in a dark, soundproof room and asked to find degraded black-and-white patterns embedded in ‘visual noise’ – similar to the television static you see when the signal fails. Such studies reveal that observers often raise a ‘false alarm’ – seeing patterns even when the experimenter hasn’t embedded one in the noisy display.

For a long time, it was thought that these ‘false alarms’ were strategic guesses: observers know that sometimes there’ll be a pattern in the noise and, if they have a lapse of attention, they might guess and hope they’re correct. However, a study led by the cognitive neuroscientist Valentin Wyart in 2012 suggested that observers really do detect patterns in the random noise. In particular, this study revealed that false alarms were more likely to occur when (just by luck) the noise spuriously looked like the pattern they were looking for. These hallucinations were also exaggerated when observers strongly expected the pattern to be there.

With my colleagues Clare Press and Carl Bunce, we thought that the same kind of thing could explain illusions of control: it might not be that we disregard the evidence in front of our eyes and decide irrationally that we can control things that we can’t. Instead, we might just be especially sensitive to ways that changes in the world co-vary with our actions, and be able to pick up on correlations that occur just by chance. If this were true, illusions of control would be a sign that humans are sensitive – not that they are grandiose.

We recently tested this idea using some new experimental techniques. Volunteers came into the lab and completed a task where they waved their hands over an infrared motion tracker to move a virtual dot – a bit like using a mouse to move a cursor on screen. Participants were told that sometimes the movements of the dot would be yoked to the movements they were actually performing, and sometimes the trajectory would be controlled by a computer. They would have to tell us if they thought they controlled the dot or not.

Our volunteers experienced strong illusions of control – feeling that they controlled the dot even when it was objectively programmed by the computer and they had no influence over it whatsoever. However – because we tracked how the participants moved – we could see that these hallucinations of control were linked to spurious correlations between action and outcome: participants were very sensitive to times when the uncontrolled dot randomly corresponded with what they were doing, and felt control when this correspondence was strong.

To further test this idea, we constructed computational models of how these decisions might be unfolding in our volunteers’ heads. This involved simulating different artificial agents and seeing how these machines would make judgments about what they can and can’t control if we placed them in our participant’s shoes. Importantly, an artificial agent programmed only to focus on the evidence at hand, rather than a grandiose agent with built-in delusional beliefs, provided a better explanation for the illusions of control we saw in our real volunteers.

These findings put pressure on the idea that humans have hardwired delusions about their actions, ignoring the evidence in front of their eyes and instead relying on exaggerated beliefs about the kinds of things they can influence. They suggest illusions of control could arise because we are very sensitive to how the world changes when we act, and can sometimes spot spurious relationships between our behaviour and changes in the environment. While the beliefs are false (we don’t actually control things), the inference might still be a rational one in an uncertain and changeable world.

This could also give us cause to think differently about the links between feelings of control and mental health. Under our theory, illusions of control are a counterintuitive sign that we are sensitive to the relationship between actions and outcomes. The same disposition that makes us occasionally hallucinate control equips us to spot weak but genuine correlations between what we do and what we see. If this is true, the absence of illusions of control in illnesses such as depression would mean that these patients don’t necessarily have a ‘sadder but wiser’ view of their capabilities. Indeed, real insight might be knowing that our control over our environments is almost never absolute, and it is important to appreciate the slight influences we have.

In Reinhold Niebuhr’s Serenity Prayer, the supplicant asks for the serenity to accept the things they cannot change, the courage to change the things they can, and the wisdom to know the difference. It has been tempting for scientists to think that illusions of control mean the human mind is rich on courage and lean on wisdom. But this might be premature, and new tools will allow scientists to reveal how our beliefs about our abilities are calibrated to the world around us – and whether the illusion of control is an illusion after all.

Pills Given to selected victims of exempted criminals and abusers are not an answer, they are just more abuse along with all the psycho babble and official bull-hit. R.J Cook Posted December 3rd 2020

Trauma unmakes the world of the self. Can stories repair it? | Psyche

Trauma unmakes the world of the self. Can stories repair it?

Anna Gotlibis an associate professor of philosophy at Brooklyn College in New York, specialising in bioethics, moral psychology and philosophy of law. She is the editor of The Moral Psychology of Sadness (2018) and The Moral Psychology of Regret (2020). In January 2020, she was a Fulbright Specialist Scholar at the University of Iceland.

Edited by Sam Dresser

Human beings are storytelling creatures: we spin narratives in order to construct our world. Whether on the cave walls of Lascaux or the golden record stored on the Voyager spacecraft, we want to share our selves and what matters to us through words, actions, even silence. Self-making narratives create the maps of the totality of our physical reality and experiences – or, as philosophers sometimes say, of the lifeworlds that we inhabit. And just as narratives can create worlds, they can also destroy them.

Trauma, in its many guises, has been part of these narratives since time immemorial, often by shattering the topographies of our lifeworlds. Breaking our most fundamental, most taken-for-granted means of self-understanding, it replaces our familiar narratives with something dreadful, something uncanny, sometimes something unspeakable.

What is trauma? Rather than just fear or guilt or unwanted memories, trauma is a totalising force that unmakes our worlds, leading to a kind of world-loss. It draws sharp lines marked ‘before’ and ‘after’: the ‘before’ demarcates the prelapsarian world, the self that we knew; the ‘after’ is the devastation of a broken lifeworld that remains.

Because we are natural storytellers, we turn to narratives in order to try to make sense of trauma. Our stories can vary as widely as human experience itself. Sometimes, while trauma breaks down our sense of who we are, it also shocks us into greater clarity about alternative, perhaps better, versions of ourselves. And so, while the Epic of Gilgamesh (c1800 BCE) offers a glimpse of the pain of trauma, it also explores its transformative effects. Through his grief over losing his beloved friend Enkidu, the arrogant Gilgamesh, touched by personal tragedy, becomes more connected to the mortal and the temporary – indeed, he becomes more human.

Trauma can be something that we choose to do to each other

Alternatively, in the ‘after’, we might find ourselves in the difficult liminal spaces that trauma makes for us. Sigmund Freud argued that we can be traumatised by a contradictory sense of what he called the ‘uncanny’: the almost-recognisable, forgotten or repressed thing that frightens us. We can remember the horror in pieces and parts, in vivid flashes and in opaque memorylessness. For this, too, we need narratives by which to navigate these borderlands of memory. And so Toni Morrison, in her novel Beloved (1987), writes narratives born of what she calls the ‘rememory’ of the survivors of slavery who confront the uncanny by recollecting and reassembling their histories, their families, their communities, their very selves. Trauma fuels the narratives, and the narratives themselves become the loci of trauma, the battlegrounds where suffering and memory meet.

Fictionalised narratives offer a kind of reckoning with our collective traumas. But understanding and responding to trauma also calls for personal stories that take us into singular experiences of lifeworld loss. What we need, then, is a more direct way to glimpse what trauma is like, and how we might go on in its wake.

These personal narratives can emerge against the background of world-historical tragedies. For instance, the Italian writer and Holocaust survivor Primo Levi describes his arrival at Auschwitz:

Driven by thirst, I eyed a fine icicle outside the window, within hand’s reach. I opened the window and broke off the icicle, but at once a large, heavy guard prowling outside brutally snatched it away from me. ‘Warum?’ [Why?] I asked him in my poor German. ‘Hier ist kein warum,’ (there is no why here) he replied, pushing me inside with a shove.

Levi’s words transport us into his world, into his trauma – what it looks like, feels like, sounds like. We see a man dehumanised not only by the brutality of the camp itself, but by the attitudes of his tormentors that make such traumatisation possible. What Levi’s narrative makes clear is that how (or whether) we traumatise each other depends on what Ludwig Wittgenstein calls our ‘attitude towards a soul’: the role that our actions and words play in recognising another as human. Levi’s Nazi captors saw no such humanity in him. It is this dehumanisation that reveals to us how trauma can be something that we choose to do to each other. But it also suggests how it might be resisted: in the harshest of circumstances, such as a war, our attitudes toward another soul matter.

Does trauma have to be understood, expressed, and confronted narratively? For many, not at all. Instead, it might be viewed as an illness, reified by the psychiatric handbook the DSM‐III (1980), leading directly to the psychiatrist’s office for medication, to the psychologist for therapy, or else to the local bookstore for self-help literature. This medicalisation of trauma positions it as a disease, as an alien within that must be treated as one would treat a virus: identify the culprit, find the appropriate tool for combat, and destroy the enemy.

Yet because trauma’s complexities so often elude purely medicalised solutions, this is at best incomplete. Let’s then return to trauma as a felt, existentially threatening experience. A brush with serious illness in the intensive care unit leaves one with paralysing fear at the possibility of returning there during the pandemic. A victim of violence suffers from post-traumatic stress disorder, her world forevermore unsafe. In the traumatic ‘after’, we’re not simply facing negative emotions that can be medicated away. We lack the means of more permanent repair – the kind that doesn’t merely blunt the pain, but re-establishes meaningful lifeworlds. We are emotionally, narratively and psychologically adrift, having ‘outlived’ ourselves, as the philosopher and trauma survivor Susan Brison notes in Aftermath: Violence and the Remaking of a Self (2001), without a way back. What, then, is left to remake?

In the midst of despair, we can still find – indeed, create – meaning by embracing ‘tragic optimism’

When all else fails, we might remake the story itself. Because most of us can’t do much about the conditions in which we find ourselves, we can begin by repairing the stories about who we are.

How we proceed partly depends on what we want these narratives to do for us – after all, not all stories are reliable, or good, or restorative. Some narratives might insist on impenetrable hopelessness in the wake of suffering. Others might counsel forgetting of the trauma in favour of epistemic lacunas. But as the former lovers in the film Eternal Sunshine of the Spotless Mind (2004) discover, no amount of wilful forgetting fully erases our deepest, most unwanted recollections.

What also fails is a kind of magical thinking. Those who embrace the largely American tendencies toward triumphant, happiness-centred narratives offer stories of what the political activist Barbara Ehrenreich calls ‘reckless optimism’ in her book Bright-sided (2009), or Smile or Die as it’s titled in Britain. As Ehrenreich notes:

[W]e cannot levitate ourselves into that blessed condition by wishing it. We need to brace ourselves for a struggle against terrifying obstacles, both of our own making and imposed by the natural world.

None of these options, it seems to me, get us any closer to world-repair.

So what does? Surprisingly, a kind of optimism – but not the reckless variety. Viktor Frankl, the Austrian neurologist, psychiatrist and Holocaust survivor, argued in a postscript to his memoir Man’s Search for Meaning (1946) that in the midst of despair, tragedy and suffering we can still find – indeed, create – meaning by embracing what he called ‘tragic optimism’. This odd kind of optimism allows us to remake ourselves and our worlds, despite what Frankl calls the ‘tragic triad’ of pain, guilt and death.

It is to Frankl’s ‘tragic optimism’ that we might turn in the midst of trauma. Tragic optimism is found in the story of the Brooklyn ICU nurse who chooses to stay by the bedside of a dying COVID-19 patient, bearing witness to his suffering. Fully cognizant of the trauma of death in isolation, she offers a counternarrative by taking an attitude towards his soul that restores his lifeworld, and her own, even if a little. She bears witness in silence and in spoken narratives – ‘You are not alone.’ Her actions remake the trauma into something more meaningful: the isolation of human suffering and death is no longer unintelligible, but shared through a profound experience of compassion. And while her actions might not be life-saving in that most basic sense, they are world-saving for the patient, for whatever time remains.

So tragic optimism calls for letting go of our happiness-seeking tendencies. We face the difficult process of world-repair through the restoration of meaning – through our work, our relationships, and through engaging with suffering itself. And what this requires is not a denial of trauma’s existence, of its destructive powers, but the deliberate decision to act in ways that affirm our shared humanity by sustaining each other’s lifeworlds.

Trauma is not a virus to be medicated away, nor a tale to be forgotten, nor a deep sadness to be replaced with reckless optimism. What it can be is a catalyst for different stories – better stories – about who we are, what we value, and how we might live in the ‘after’. And these stories are not happiness-seeking – they are meaning-making, meaning-remaking. They are the narratives of tragic optimism that don’t fall prey to comfortable amnesias or myths of human invulnerability. They harbour no illusions about the indestructibility of our worlds. Perhaps if we engage with our traumas less reluctantly and open up to the possibilities of narrative world-remaking, we might integrate some of our worst experiences into the ever-evolving stories about who we are. However uneasily, we just might coexist with, and even flourish in, their glare. Because trauma can, and will, unmake our worlds again.

Write to Reward Your Reader

November 18, 2020

Illustration by Asia Pietrzyk

Chances are that every time you sit down to write — whether it’s a report or a speech or a white paper or an op-ed — you hear a little voice. It’s your high-school teacher or college professor reciting the rules of writing: Use the active voice. Choose strong verbs and nouns. Show don’t tell.

But are these the right rules? Do they put the focus on what most matters? Is there another — even better — approach?

Research by scientists today shows there is. Thanks to the work of psychologists and neuroscientists using MRIs, EEGs, PETs and other tools, we can observe in never-before-seen detail what entices readers to read and listeners to listen. We now know how readers respond to simple words (versus complex), to specific language (versus abstract), to aesthetic features (versus literal ones), to metaphor (versus plain language), and more.

All of the research points to a single principle: You can actually write in a way that rewards our primal learning needs, prompting the release of pleasing chemicals in the reader’s “reward circuit,” a cluster of midbrain regions that drive desire and behavior. The first chemical out of the gate is dopamine, released when your neurons sense a cue for a likely reward. If the reward pays off, eventually a half dozen pleasure hotspots may glow.

You can craft a winning communication strategy that specifically taps the reward circuit embedded within our hunter-gatherer brains.  Here are five tactics:

Keep it simple: People may say they love complexity, but they’re usually praising wine, not prose. So favor simple words, simple sentences, and above all, distilling simple concepts from complex ones.

Princeton University scientist Daniel Oppenheimer researched how readers viewed complexity. He asked 71 Stanford University students to assess two written passages. One was composed of simple words, the other, complex. Both said the same thing. The students, quizzed later, consistently said the authors of the complex passage were less intelligent.

Research has even shown that it literally pays to keep your writing simple:  Researchers Byoung-Hyoun Hwang and Hugh Hoikwang Kim used a computer to rank the readability of shareholder reports from closed-end investment companies. Their findings: Companies that issue reports that are hard to read traded at a 2.5% discount to competitors.

So divide your big sentences in two, omit unnecessary adjectives and adverbs, cut useless transitions, and omit caveats that clutter your message. Make your writing accessible.

Keep it specific: Concrete details light up neurons that process smell, sight, sound, and motion. Your brain, as it turns out, yearns for full-bodied stimuli — and then it runs an internal multimedia show.

Scientists have shown that when people in MRI scanners read words like garlic, cinnamon, and jasmine, their olfactory circuits light up.  The same thing happens with sight, sound, and motion. So write as if you’re scripting lines for readers’ internal cinema.

Keep it stirring: You may think you persuade people with logic, not emotion, but our brains process emotions much faster than thoughts. Each emotion also comes programmed with reflexive reactions and motivations — fear, for example, prompting dry mouth and the urge to run, which served our hunter-gatherer ancestors who needed to outrun fires and snakes.

The lesson is that how your words make people feel shapes what they understand. Emotion and language deliver meaning together. The leaner you are on emotion, the slower readers are on comprehension.

Jonah Berger and Katherine Milkman tracked the virality of 7,000 New York Times articles. Stories carrying emotions — anger, awe, anxiety, surprise — got 34% more shares, and those with positive emotions did best of all. So at least pair your logic with some zeal. And favor metaphors as a potent way to do so.

Keep it social: Even hints of connection count.  Experiments with poems, for example, show that a social signal as slight as a quotation mark — to indicate someone speaking — engages people’s reward circuitry. We are driven to seek out social cues as hungrily as any other.

So flavor your writing with your voice, character, and experience. Self-revelation — measured and apt — connects readers to you and turns on rewards.

An overlooked way to keep it more social is to write in the second person, (i.e. “you”). Research on song lyrics and poems found that people preferred those that spoke directly to the audience. No other pronoun, “he,” “she,” or “they,” has the same power to create a sense of social connection.

Keep it story-driven: Evolutionarily, stories are believed to have served as a primary vehicle for sharing lessons. We’re wired to ask, “What did she do next?” And “what happened?” So play to your readers’ thirst with whodunnit or how-did-it narratives.

Telling stories can literally pay off. For example, researchers who looked at two kinds of business crowdfunding campaigns found that those with richer narratives earned higher marks for entrepreneur credibility, legitimacy, and intentions of people to invest and share. The implication: No stories, no funding!

Tastes vary, of course, but we’re all affected by basic evolutionary drives. Ultimately readers don’t listen to what you say because they like your style. They listen because they love how you reward them in the ancient midbrain. That principle ties all the rules of great communication together.

So, the next time you’re struggling for the right words, turn not just to your teachers’ advice. Turn inward as well to your ancient muse and ask, “What would a hunter-gatherer read?”


Bill Birchard is a business author and book-writing coach. His book Eight Secrets from Science for Aspiring Writers is in progress. His previous books include Merchants of Virtue, Stairway to Earth, Nature’s Keepers, Counting What Counts, and others. For more tips, see his website: https://billbirchard.com/craft.html.

A Johns Hopkins Study Reveals the Scientific Secret to Double How Fast You Learn November 25th 2020

Making one small change to the way you practice can make a huge difference in how quickly you gain new skills.

Inc.

  • Jeff Haden

Read when you’ve got time to spare.

Photo from Getty Images.

When you’re trying to learn something new — like, say, making that new sales demo really sing — you need to practice. When you’re trying to gain expertise, how much you practice is definitely important.

But even more important is the way you practice.

Most people simply repeat the same moves. Like playing scales on the piano, over and over again. Or going through the same list of vocabulary words, over and over again. Or, well, repeating anything over and over again in the hopes you will master that task.

Not only will your skills not improve as quickly as they could, in some cases, they may actually get worse.

According to research from Johns Hopkins, “What we found is if you practice a slightly modified version of a task you want to master, you actually learn more and faster than if you just keep practicing the exact same thing multiple times in a row.”

Why? The most likely cause is reconsolidation, a process where existing memories are recalled and modified with new knowledge.

Here’s a simple example: trying to get better at shooting free throws in basketball. The conditions are fixed. The rim is always 10 feet above the floor. The free throw line is always 15 feet from the basket.

In theory, shooting from the same spot, over and over again, will help you ingrain the right motions into your muscle memory so your accuracy and consistency will improve.

And, of course, that does happen — but a better, faster way to improve is to slightly adjust the conditions in subsequent practice sessions.

Maybe one time you’ll stand a few inches closer. Another time you might stand a few inches to one side. Another time you might use a slightly heavier, or lighter, ball.

In short, each time you practice, you make the conditions a little different. That primes the reconsolidation pump — and helps you learn much more quickly.

But Not Too Different — or Too Soon

But you can’t adjust the conditions more than slightly. Do something too different and you’ll simply create new memories — not reconsolidated ones.

“If you make the altered task too different, people do not get the gain we observed during reconsolidation,” the researchers say. “The modification between sessions needs to be subtle.”

And you’ll also need to space out your practice sessions appropriately.

The researchers gave the participants a six-hour gap between training sessions, because neurological research indicates it takes that long for new memories to reconsolidate.

Practice differently too soon and you haven’t given yourself enough time to “internalize” what you’ve learned. You won’t be able to modify old memories — and therefore improve your skills — because those memories haven’t had the chance to become old memories.

So if you want to dramatically improve how quickly you learn a new skill, try this.

How to Learn a New Skill

The key to improvement is making small, smart changes, evaluating the results, discarding what doesn’t work, and further refining what does work.

When you constantly modify and refine something you already do well, you can do it even better.

Say you want to improve a skill; to make things simple, we’ll pretend you want to master a new presentation.

1. Rehearse the basic skill. Run through your presentation a couple of times under the same conditions you’ll eventually face when you do it live. Naturally, the second time through will be better than the first; that’s how practice works. But then, instead of going through it a third time …

2. Wait. Give yourself at least six hours so your memory can consolidate. (Which probably means waiting until tomorrow before you practice again, which is just fine.)

3. Practice again, but this time …

  • Go a little faster. Speak a little — just a little — faster than you normally do. Run through your slides slightly faster. Increasing your speed means you’ll make more mistakes, but that’s OK — in the process, you’ll modify old knowledge with new knowledge — and lay the groundwork for improvement. Or …
  • Go a little slower. The same thing will happen. (Plus, you can experiment with new techniques — including the use of silence for effect — that aren’t apparent when you present at your normal speed.) Or …
  • Break your presentation into smaller parts. Almost every task includes a series of discrete steps. That’s definitely true for presentations. Pick one section of your presentation. Deconstruct it. Master it. Then put the whole presentation back together. Or …
  • Use a different projector. Or a different remote. Or a lavaliere instead of a headset mic. Switch up the conditions slightly; not only will that help you modify an existing memory, it will also make you better prepared for the unexpected.

4. And then, next time, slightly modify another condition.

Keep in mind you can extend this process to almost anything. While it’s clearly effective for improving motor skills, the process can also be applied to nearly any skill.

Don’t do the same thing over and over again in hopes you’ll improve. You will, but not nearly as quickly as when you slightly modify the conditions in subsequent practice sessions — and then give yourself the time to consolidate the new memories you’ve made.

Keep modifying and refining a skill you already do well and you can do it even better.

And a lot more quickly.

That’s the fastest path to expertise. Inc.

More from Inc.

A Math Theory for Why People Hallucinate Posted November 23rd 2020

Psychedelic drugs can trigger characteristic hallucinations, which have long been thought to hold clues about the brain’s circuitry. After nearly a century of study, a possible explanation is crystallizing.

Quanta Magazine

  • Jennifer Ouellette

Read when you’ve got time to spare.Hallucination_2880_v2.jpg

Credit: aeforia and Olena Shmahalo / Quanta Magazine.

In the 1920s, decades before counterculture guru Timothy Leary made waves self-experimenting with LSD and other psychedelic drugs at Harvard University, a young perceptual psychologist named Heinrich Klüver used himself as a guinea pig in an ongoing study into visual hallucinations. One day in his laboratory at the University of Minnesota, he ingested a peyote button, the dried top of the cactus Lophophora williamsii, and carefully documented how his visual field changed under its influence. He noted recurring patterns that bore a striking resemblance to shapes commonly found in ancient cave drawings and in the paintings of Joan Miró, and he speculated that perhaps they were innate to human vision. He classified the patterns into four distinct types that he dubbed “form constants”: lattices (including checkerboards, honeycombs and triangles), tunnels, spirals and cobwebs.

Some 50 years later, Jack Cowan of the University of Chicago set out to reproduce those hallucinatory form constants mathematically, in the belief that they could provide clues to the brain’s circuitry. In a seminal 1979 paper, Cowan and his graduate student Bard Ermentrout reported that the electrical activity of neurons in the first layer of the visual cortex could be directly translated into the geometric shapes people typically see when under the influence of psychedelics. “The math of the way the cortex is wired, it produces only these kinds of patterns,” Cowan explained recently. In that sense, what we see when we hallucinate reflects the architecture of the brain’s neural network.

But no one could figure out precisely how the intrinsic circuitry of the brain’s visual cortex generates the patterns of activity that underlie the hallucinations. FormConstants_560.jpg

Heinrich Klüver classified the shapes he saw while under the influence of hallucinogenic drugs into four categories, known as “form constants.” Credit: Lucy Reading-Ikkanda / Quanta Magazine.

An emerging hypothesis points to a variation of the mechanism that produces so-called “Turing patterns.” In a 1952 paper, the British mathematician and code-breaker Alan Turing proposed a mathematical mechanism for generating many of the repeating patterns commonly seen in biology — the stripes of tigers or zebra fish, for example, or a leopard’s spots. Scientists have known for some time that the classic Turing mechanism probably can’t occur in a system as noisy and complicated as the brain. But a collaborator of Cowan’s, the physicist Nigel Goldenfeld of the University of Illinois, Urbana-Champaign, has proposed a twist on the original idea that factors in noise. Experimental evidence reported in two recent papers has bolstered the theory that this “stochastic Turing mechanism” is behind the geometric form constants people see when they hallucinate.

Sweaty Grasshoppers

Images we “see” are essentially the patterns of excited neurons in the visual cortex. Light reflecting off the objects in our field of view enters the eye and comes to a focus on the retina, which is lined with photoreceptor cells that convert that light into electrochemical signals. These signals travel to the brain and stimulate neurons in the visual cortex in patterns that, under normal circumstances, mimic the patterns of light reflecting off objects in your field of view. But sometimes patterns can arise spontaneously from the random firing of neurons in the cortex — internal background noise, as opposed to external stimuli — or when a psychoactive drug or other influencing factor disrupts normal brain function and boosts the random firing of neurons. This is believed to be what happens when we hallucinate.

But why do we see the particular shapes that Klüver so meticulously classified? The widely accepted explanation proposed by Cowan, Ermentrout and their collaborators is that these patterns result from how the visual field is represented in the first visual area of the visual cortex. “If you opened up someone’s head and looked at the activity of the nerve cells, you would not see an image of the world as through a lens,” said Peter Thomas, a collaborator of Cowan’s who is now at Case Western Reserve University. Instead, Thomas explained, the image undergoes a transformation of coordinates as it is mapped onto the cortex. If neuronal activity takes the form of alternating stripes of firing and non-firing neurons, you perceive different things depending on the stripes’ orientation. You see concentric rings if the stripes are oriented one way. You see rays or funnel shapes emanating from a central point — the proverbial light at the end of the tunnel common in near-death experiences — if the stripes are perpendicular to that. And you see spiral patterns if the stripes have a diagonal orientation.

But if geometric visual hallucinations like Klüver’s form constants are a direct consequence of neural activity in the visual cortex, the question is why this activity spontaneously occurs — and why, in that case, it doesn’t cause us to hallucinate all the time. The stochastic Turing mechanism potentially addresses both questions.

Alan Turing’s original paper suggested that patterns like spots result from the interactions between two chemicals spreading through a system. Instead of diffusing evenly like a gas in a room until the density is uniform throughout, the two chemicals diffuse at different rates, which causes them to form distinct patches with differing chemical compositions. One of the chemicals serves as an activator that expresses a unique characteristic, such as the pigmentation of a spot or stripe, while the other acts as an inhibitor, disrupting the activator’s expression. Imagine, for example, a field of dry grass dotted with grasshoppers. If you start a fire at several random points, with no moisture present, the entire field will burn. But if the heat from the flames causes the fleeing grasshoppers to sweat, and that sweat dampens the grass around them, you’ll be left with periodic spots of unburned grass throughout the otherwise charred field. This fanciful analogy, invented by the mathematical biologist James Murray, illustrates the classic Turing mechanism.

Turing acknowledged that this was a greatly simplified toy model for how actual patterns arise, and he never applied it to a real biological problem. But it offers a framework to build on. In the case of the brain, Cowan and Ermentrout pointed out in their 1979 paper that neurons can be described as activators or inhibitors. Activator neurons encourage nearby cells to also fire, amplifying electrical signals, while inhibitory neurons shut down their nearest neighbors, dampening signals. The researchers noticed that activator neurons in the visual cortex were mostly connected to nearby activator neurons, while inhibitory neurons tended to connect to inhibitory neurons farther away, forming a wider network. This is reminiscent of the two different chemical diffusion rates required in the classic Turing mechanism, and in theory, it could spontaneously give rise to stripes or spots of active neurons scattered throughout a sea of low neuronal activity. These stripes or spots, depending on their orientation, could be what generates perceptions of lattices, tunnels, spirals and cobwebs.

While Cowan recognized that there could be some kind of Turing mechanism at work in the visual cortex, his model didn’t account for noise — the random, bursty firing of neurons — which seemed likely to interfere with the formation of Turing patterns. Meanwhile, Goldenfeld and other researchers had been applying Turing’s ideas in ecology, as a model for predator-prey dynamics. In that scenario, the prey serve as activators, seeking to reproduce and increase their numbers, while predators serve as inhibitors, keeping the prey population in check with their kills. Thus, together they form Turing-like spatial patterns. Goldenfeld was studying how random fluctuations in predator and prey populations affect these patterns. He knew about Cowan’s work in neuroscience and soon realized his insights could apply there as well.

Houses With Eyes and Jaws

A condensed matter physicist by training, Goldenfeld gravitates toward interdisciplinary research, applying concepts and techniques from physics and math to biology and evolutionary ecology. Roughly 10 years ago, he and his then graduate student Tom Butler were pondering how the spatial distribution of predators and prey changes in response to random local fluctuations in their populations, for instance if a herd of sheep is attacked by wolves. Goldenfeld and Butler found that when a herd’s population is relatively low, random fluctuations can have big effects, even leading to extinction. It became clear that ecological models need to take random fluctuations into account rather than just describe the average behavior of populations. “Once I knew how to do the fluctuation calculation for pattern formation,” Goldenfeld said, “it was an obvious next step to apply this to the hallucination problem.”

In the brain, it’s the number of neurons that are on or off that randomly fluctuates rather than sheep and wolf populations. If an activator neuron randomly switches on, it can cause other nearby neurons to also switch on. Conversely, when an inhibitory neuron randomly switches on, it causes nearby neurons to switch off. Because the connections between inhibitory neurons are long-range, any inhibitory signals that randomly arise spread faster than random excitatory signals — exactly what’s needed for a Turing-like mechanism. Goldenfeld’s models suggested that stripes of active and inactive neurons will form in a Turing-like pattern. He dubbed these stochastic Turing patterns.

However, to function properly, the visual cortex must be primarily driven by external stimuli, not by its own internal noisy fluctuations. What keeps stochastic Turing patterns from constantly forming and causing us to constantly hallucinate? Goldenfeld and colleagues argue that even though the firing of neurons can be random, their connections are not. Whereas short-range connections between excitatory neurons are common, long-range connections between inhibitory neurons are sparse, and Goldenfeld thinks this helps suppress the spread of random signals. He and his cohorts tested this hypothesis by creating two separate neural network models. One was based on the actual wiring of the visual cortex, and the other was a generic network with random connections. In the generic model, normal visual function was substantially degraded because the random firing of neurons served to amplify the Turing effect. “A generically wired visual cortex would be contaminated by hallucinations,” Goldenfeld said. In the realistic model of the cortex, however, internal noise was effectively dampened. Goldenfeld_2K.jpg

Nigel Goldenfeld, a physicist at the University of Illinois, Urbana-Champaign, hypothesizes that the stochastic Turing mechanism underlies visual hallucinations. Credit: Seth Lowe for Quanta Magazine.

Goldenfeld suggests that evolution has selected for a particular network structure that inhibits hallucinatory patterns: The sparseness of connections between inhibitory neurons prevents inhibitory signals from traveling long distances, disrupting the stochastic Turing mechanism and the perception of funnels, cobwebs, spirals and so forth. The dominant patterns that spread through the network will be based on external stimuli — a very good thing for survival, since you want to be able to spot a snake and not be distracted by a pretty spiral shape.

“If the cortex had been built with these long-range inhibitory connections all over the place, then the tendency to form these patterns would be stronger than the tendency to process the visual input coming in. It would be a disaster and we would never have survived,” Thomas said. Because long-range inhibitory connections are sparse, “the models don’t produce spontaneous patterns unless you force them to, by simulating the effects of hallucinogenic drugs.”

Experiments have shown that hallucinogens like LSD appear to disrupt the normal filtering mechanisms the brain employs, perhaps boosting long-range inhibitory connections and therefore permitting random signals to amplify in a stochastic Turing effect.

Goldenfeld and collaborators have not yet tested their theory of visual hallucinations experimentally, but hard evidence that stochastic Turing patterns do arise in biological systems has emerged in the last few years. Around 2010, Goldenfeld heard about work done by Ronald Weiss, a synthetic biologist at the Massachusetts Institute of Technology who had been struggling for years to find the appropriate theoretical framework to explain some intriguing experimental results.

Years earlier, Weiss and his team had grown bacterial biofilms that were genetically engineered to express one of two different signaling molecules. In an effort to demonstrate the growth of a classic Turing pattern, they tagged the signaling molecules with fluorescent markers so that the activators glowed red and the inhibitors glowed green. Although the experiment started out with a homogenous biofilm, over time a Turing-like pattern emerged, with red polka dots scattered throughout a swath of green. However, the red dots were much more haphazardly located than, say, leopards’ spots. Additional experiments also failed to yield the desired results.

When Goldenfeld heard about these experiments, he suspected that Weiss’ data could be viewed from a stochastic point of view. “Rather than trying to make the patterns more regular and less noisy,” Weiss said, “we realized through our collaboration with Nigel that these are really stochastic Turing patterns.” Weiss, Goldenfeld and collaborators finally published their paper in the Proceedings of the National Academy of Sciences last month, 17 years after the research began.

The biofilms formed stochastic Turing patterns because gene expression is a noisy process. According to Joel Stavans of the Weizmann Institute of Science in Israel, that noise is responsible for disparities among cells, which can have the same genetic information yet behave differently. In recently published work, Stavans and his colleagues investigated how noise in gene expression can lead to stochastic Turing patterns in cyanobacteria, ancient organisms that produce a large proportion of the oxygen on Earth. The researchers studied Anabaena, a type of cyanobacteria with a simple structure of cells attached to one another in a long train. An Anabaena’s cells can specialize to perform one of two activities: photosynthesis, or converting nitrogen in the atmosphere into proteins. An Anabaena might have, for instance, one nitrogen-fixing cell, then 10 or 15 photosynthesis cells, then another nitrogen-fixing cell, and so on, in what appears to be a stochastic Turing pattern. The activator, in this case, is a protein that creates a positive feedback loop to produce more such proteins. At the same time, the protein may also produce other proteins that diffuse to neighboring cells and inhibit the first protein’s production. This is the primary feature of a Turing mechanism: an activator and an inhibitor fighting against each other. In Anabaena, noise drives the competition.

Researchers say the fact that stochastic Turing processes appear to be at work in these two biological contexts adds plausibility to the theory that the same mechanism occurs in the visual cortex. The findings also demonstrate how noise plays a pivotal role in biological organisms. “There is not a direct correlation between how we program computers” and how biological systems work, Weiss said. “Biology requires different frameworks and design principles. Noise is one of them.”

There is still much more to understand about hallucinations. Jean-Paul Sartre experimented with mescaline in Paris in 1935 and found it distorted his visual perception for weeks. Houses appeared to have “leering faces, all eyes and jaws,” clock faces looked like owls, and he saw crabs following him around all the time. These are much higher-level hallucinations than Klüver’s simple form constants. “The early stages of visual hallucination are very simple — these geometric patterns,” Ermentrout said. But when higher cognitive functions kick in, such as memory, he said, “you start to see more complex hallucinations and you try and make sense of them. I believe that all you’re seeing is the spontaneous emergence of [stored memories] as the higher brain areas become more excited.”

Back in the ’20s, Klüver also worked with subjects who reported tactile hallucinations, such as cobwebs crawling across their skin. Ermentrout thinks this is consistent with a cobweb-like form constant mapped onto the somatosensory cortex. Similar processes might play out in the auditory cortex, which could account not only for auditory hallucinations but for phenomena like tinnitus. Cowan agrees, noting that the brain has similar wiring throughout, so if a theory of hallucinations “works for vision, it’s going to work for all the other senses.”

Jennifer Ouellette is a freelance writer and an author of popular science books, including “Me, Myself, and Why: Searching for the Science of Self.”

How is paranoid personality disorder treated?

People with PPD often do not seek treatment on their own because they do not see themselves as having a problem. The distrust of others felt by people with PPD also poses a challenge for health care professionals because trust is an important factor of psychotherapy (a form of counseling). As a result, many people with PPD do not follow their treatment plan and may even question the motives of the therapist.

When a patient seeks treatment for PPD, psychotherapy is the treatment of choice. Treatment likely will focus on increasing general coping skills, especially trust and empathy, as well as on improving social interaction, communication, and self-esteem.

Medication generally is not used to treat PPD. However, medications—such as anti-anxiety, antidepressant, or anti-psychotic drugs—might be prescribed if the person’s symptoms are extreme, or if he or she also suffers from an associated psychological problem, such as anxiety or depression.

What are the complications of paranoid personality disorder?

The thinking and behaviors associated with PPD can interfere with a person’s ability to form and maintain relationships, as well as their ability to function socially and in work situations. In many cases, people with PPD become involved in legal battles, suing people or companies they believe are “out to get them.”Previous: Diagnosis and TestsNext: Prevention

Comment This is a catch all for anyone criticising the state and its public services. It is incredibly convenient in an age where so many are apparently , for no specific reason, labelled mentally ill. R.J Cook

WHAT YOU NEED TO KNOW:

What is paranoid personality disorder? Posted November 19th 2020

Paranoid personality disorder (PPD) is a long-term, mental health condition. PPD causes you to be suspicious, distrusting, and hostile toward others. This is because you think they want to hurt you or take advantage of you. You may have trouble trusting or getting along with others. These thoughts and behaviors can cause problems with your relationships and daily activities.

What causes PPD?

The cause may not be known. Your risk for PPD is increased if you have a family history of the disorder. You are also at risk if you were abused or neglected as a child.

What are the symptoms of PPD?

  • You think other people will harm, trick, or take advantage of you
  • You think that your friends might not be loyal. You may think about how they have let you down. You may search for proof that they cannot be trusted.
  • You are nervous about talking to other people because you are afraid they will use the information against you.
  • You often hold grudges against people who you believe have done something bad to you. You believe that the actions were done to hurt you, and you cannot forgive the people who did them. You may see people as your enemies, and want to get back at them.
  • You think that others are trying to insult you. You may hear a person say one thing, but you think that they mean something else.
  • You suspect that your partner has been unfaithful.
  • You think that certain people are trying to make you look bad to others. You may react by getting angry or attacking them back. You may also believe that your reputation is being threatened.

What other behaviors might I have with PPD?

  • Depression
  • Obsessive-compulsive disorder
  • Agoraphobia
  • Alcohol or substance abuse

How is PPD diagnosed?

Your healthcare provider will ask about your history and if you want to hurt yourself or others. He will ask about your behaviors, feelings, and relationships with others.

How is PPD treated?

Medicines can help decrease anxiety or depression and make you feel more stable.

How can I manage my symptoms?

Go to individual or group therapy. You may need any of the following types of therapy:

  • Supportive psychotherapy helps you understand your behaviors and actions. This can help you cope with your disorder so you can have positive relationships.
  • Family therapy helps you and your family communicate and teaches your family how they can best support you.

When should I contact my healthcare provider?

  • You are depressed.
  • You feel anxious or worried.
  • You do not want to leave your house.
  • You begin to drink alcohol, or you drink more than usual.
  • You take illegal drugs.
  • You take medicines that are not prescribed to you.
  • You have questions or concerns about your condition or care.

When should I seek immediate care or call 911?

  • You have severe depression.
  • You want to hurt yourself or others.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© Copyright IBM Corporation 2020 Information is for End User’s use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or IBM Watson Health

Brain Fog November 14th 2020

Mental fog is often described as a “cloudy-headed” feeling.

Common conditions of brain fog include poor memory, difficulty focusing or concentrating, and struggling with articulation.

Imagine if you could concentrate your brain power into one bright beam and focus it like a laser on whatever you wish to accomplish.

Many people struggle to concentrate. And when you can’t concentrate, everything you do is harder and takes longer than you’d like.

Give Up the Clutter

Mess creates stress.

There’s a strong link between your physical space and your mental space.

Clutter is bad for your mind and health. It can create long-term, low-level anxiety.

When the book, The Life-Changing Magic of Tidying Up: The Japanese Art of Decluttering and Organizing, by Marie Kondo became a best-seller, it wasn’t too surprising.

We are all looking for ways to create more meaningful lives with less to distract us.

Get rid of clutter at your office, on your desk, in your room, and you will send a clear message of calm directly to your brain.

Start decluttering today in small, focused bursts. You’re not going to clean up your entire space in a day, so start small to make it a daily habit that sticks.

Set yourself up for success by making a plan and targeting specific areas you’re going to declutter, clean up, and organize over a prolonged period of time.

Multi-Tasking Doesn’t Work

The ability to multi-task is a false badge of honor.

Task switching has a severe cost.

Your concentration suffers when you multitask.

It compromises how much actual time you spend doing productive work, because you’re continually unloading and reloading the hippocampus/short term memory.

Research shows that task switching actually burns more calories and fatigues your brain – reducing your overall capacity for productive thought and work.

Commit to completing one task at a time.

Remove potential distractions (like silencing your mobile, turning off email alerts) before you start deep work to avoid the temptation to switch between tasks.

Use the 3-to-1 method!

Narrow down your most important tasks to 3, and then give one task your undivided attention for a period of time.

Allow yourself to rotate between the three, giving yourself a good balance of singular focus and variety.

Give Up the Urgent Distraction

Disconnect. Your productivity, creativity and next big idea depends on it.

Urgency wrecks productivity. Urgent but unimportant tasks are major distractions.

Last-minute distractions are not necessarily priorities.

Sometimes important tasks stare you right in the face, but you neglect them and respond to urgent but unimportant things.

You need to reverse that. It’s one the only ways to master your time.

Your ability to distinguish urgent and important tasks has a lot to do with your success.

Important tasks are things that contribute to your long-term mission, values, and goals. Separating these differences is simple enough to do once, but doing so continually can be tough.

Stop Feeding Your Comfort

Comfort provides a state of mental security.

When you’re comfortable and life is good, your brain can release chemicals like dopamine and serotonin, which lead to happy feelings.

But in the long-term, comfort is bad for your brain.

Without mental stimulation dendrites, connections between brain neurons that keep information flowing, shrink or disappear altogether.

An active life increases dendrite networks and also increase the brain’s regenerating capacity, known as plasticity.

“Neglect of intense learning leads plasticity systems to waste away,” says Norman Doidge in his book, The Brain That Changes Itself.

Michael Merzenich, a pioneer of plasticity research, and author of Soft-wired: How the New Science of Brain Plasticity Can Change Your Life says that going beyond the familiar is essential to brain health.

“It’s the willingness to leave the comfort zone that is the key to keeping the brain new,” he says.

Seeking new experiences, learning new skills, and opening the door to new ideas inspire us and educate us in a way improves mental clarity.

Don’t Sit Still

Sitting still all day, every day, is dangerous.

Love it or hate it, physical activity can have potent effects on your brain and mood.

The brain is often described as being “like a muscle”. Its needs to be exercised for better performance.

Research shows that moving your body can improve your cognitive function.

30–45 minutes of brisk walking, three times a week, can help fend off the mental wear and tear.

What you do with your body impinges on your mental faculties.

Find something you enjoy, then get up and do it. And most importantly, make it a habit.

Stop Consuming Media and Start Creating Instead

It’s extremely easy to consume content.

You are passive. Even relaxed.

But for each piece of unlimited content you consume, it stops a piece of content you could have created.

Limit your mass media consumption.

Embrace the creation habit.

Start paying attention to the noise that you let seep into your eyes and ears.

Ask, Is this benefitting my life in any way?

Does all this information make me more prone to act?

Does it really make me more efficient? Does it move me forward in any significant way?

Let creation determine consumption.

Allow curiosity to lead you to discover and pursue something you deepy care about. Make time to create something unique.

The point is to get lost in awe and wonder like you did when you were a child. When you achieve that feeling from a certain activity, keep doing it!

Share your authentic self with the rest of us.

Thomas Oppong is the founder of AllTopStartups and writes on science-based answers to problems in life about creativity, productivity, and self-improvement.

The Amazing Psychology of Japanese Train Stations

The nation’s famed mastery of rail travel has been aided by some subtle behavioral tricks. Posted November 10th 2020

CityLab

  • Allan Richarz

Read when you’ve got time to spare.940....jpg

Passengers line up for a bullet train at a platform in Tokyo Station. Photo by Yuya Shino/Reuters

It is a scene that plays out each weekday morning across Tokyo. Suit-clad office workers, gaggles of schoolchildren, and other travelers gamely wend their way through the city’s sprawling rail stations.

To the casual observer, it is chaos; commuters packed shoulder-to-shoulder amid the constant clatter of arriving and departing trains. But a closer look reveals something more beneath the surface: A station may be packed, yet commuters move smoothly along concourses and platforms. Platforms are a whirl of noisy activity, yet trains maintain remarkable on-time performance. Indeed, the staggering punctuality of the Japanese rail system occasionally becomes the focus of international headlines—as on May 11, when West Japan Railways issued a florid apology after one of its commuter trains left the station 25 seconds early.

Tokyo is home to the world’s busiest train stations, with the capital’s rail operators handling a combined 13 billion passenger trips annually. Ridership of that volume requires a deft blend of engineering, planning, and psychology. Beneath the bustle, unobtrusive features are designed to unconsciously manipulate passenger behavior, via light, sound, and other means. Japan’s boundless creativity in this realm reflects the deep consideration given to public transportation in the country.

Passengers wait for a train at a platform of a station in Kawasaki. Photo by Kim Kyung-Hoon/Reuters

Rail stations, whether in Japan or elsewhere, are also great places to see “nudge theory” at work. Pioneered by behavioral economist Richard Thaler, who was awarded the 2017 Nobel Memorial Prize for his work, and Harvard Law School professor Cass Sunstein, the theory posits that gentle nudges can subtly influence people towards decisions in their own (or society’s) best interests, such as signing up for private pension schemes or organ donation. In the U.K., there’s a government office devoted to the idea, the Behavioural Insights Team (or “nudge unit”), and their work often shows up in the transit realm.

In 2016, for instance, London Underground operator Transport for London partnered with the behavioral science department at the London School of Economics to develop ways of encouraging riders to queue on both sides of station escalators as a means of increasing their capacity in the capital’s Holborn Station. Among other measures, simple hand and footprints were also painted on each side of the “up” escalators. In Australia, researchers conducted an experiment with lighted directional arrows on signposts to improve flows of departing passengers. Using a camera system designed to recognize and distinguish brisk-walking businesspeople from dawdling tourists, for example—green arrows would flash to direct commuters in an efficient route towards the exit.

When it come to passenger manipulation, what sets the stations of Japan apart from their counterparts is both the ingenuity behind their nudges and the imperceptible manner in which they are implemented. Japan’s nudges reflect a higher order of thinking. The orderliness of society is taken as a given—Japanese commuters know how to queue on an escalator and can easily navigate the confusing, but wide-open, spaces of Tokyo’s rail stations without assistance. This allows rail operators to instead focus on deeper psychological manipulation.

The Ultimate in Mood Lighting

Japan has one of the highest suicide rates among OECD nations, and often, those taking their own lives do so by leaping from station platforms into the path of oncoming trains, with Japan averaging one such instance each day. It is a brutal, disruptive end that can also wreak havoc across the transit system.

To address the issue, stations across Tokyo and the rest of Japan installed chest-high barriers as a means of preventing suicide attempts. But platform barriers are expensive, and about 70 percent of Japan’s largest and most-travelled stations do not have the platform space or structural strength to accommodate them. While there are hopes to have platform barriers installed in all 243 of Tokyo’s train stations by 2032 (at a cost of $4.7 billion), rail operators in the interim have come up alternative approaches.

Standing at either end of a platform in Tokyo’s labyrinthine Shinjuku Station, one might detect a small square LED panel emitting a pleasant, deep-blue glow. Nestled among vending machines and safety posters, the panel might be dismissed as a bug zapper. But these simple blue panels are designed to save lives.

A blue-light panel in a Japanese train station, designed to calm agitated passengers. Photo by Allan Richaz/CityLab

Operating on the theory that exposure to blue light has a calming effect on one’s mood, rail stations in Japan began installing these LED panels as a suicide-prevention measure in 2009. They are strategically located at the ends of each platform—typically the most-isolated and least-trafficked area, and accordingly, the point from which most platform jumps occur. Some stations, such as Shin-Koiwa Station in Tokyo, bolster their LED regime with colored roof panels, allowing blue-tinted sunlight to filter down on to platforms.

It is an approach that has proven to be surprisingly effective. According to a study by researchers at the University of Tokyo published in the Journal of Affective Disorders in 2013, data analyzed over a 10-year period shows an 84 percent decline in the number of suicide attempts at stations where blue lights are installed. A subsequent study revealed no corresponding increase in suicide attempts at neighboring stations lacking such lights.

The idea has been picked up in the U.K.: Several stations in England now emulate the Japanese approach, with blue LED light panels on station platforms.

A Song for a More Peaceful Departure

Commuting during rush hour in Japan is not for the faint of heart. The trains are jam-packed at as much as 200 percent capacity during the height of rush hour, and razor-thin connection times to transfer from one train to another leave little margin for error. Compounding the stressful nature of the commute in years past was the nerve-grating tone—a harsh buzzer used to signal a train’s imminent departure. The departing train buzzer was punctuated by sharp blasts of station attendants’ whistles, as harried salarymen raced down stairs and across platforms to beat the train’s closing doors.

To calm this stressful audio environment, in 1989 the major rail operator JR East commissioned Yamaha and composer Hiroaki Ide to create hassha melodies—short, ear-pleasing jingles to replace the traditional departure buzzer.

Also known as departure or train melodies, hassha tunes are brief, calming and distinct; their aim is to notify commuters of a train’s imminent departure without inducing anxiety. To that end, most melodies are composed to an optimal length of 7 seconds, owing to research showing that shorter-duration melodies work best at reducing passenger stress and rushing incidents, as well as taking into account the time needed for a train to arrive and depart.

The tunes feature whimsical titles like “Seaside Boulevard” and range from the wistful to the jaunty. Most stations have their own melodies, forming de facto theme songs that become part of a station’s identity. Tokyo’s Ebisu Station, for example, is known for its departure melody—a short, stylized version of the theme from The Third Man.

As more stations have added melodies over the years, the original thesis has proven correct. A study conducted in October 2008 at Tokyo Station, for instance, found a 25 percent reduction in the number of passenger injuries attributable to rushing after the introduction of hassha melodies on certain platforms.

The use of these jingles is not without controversy, however. Shortly after their introduction, residents living near open-air rail stations, weary of hearing endless repetitions of the same jingles all day, complained of noise pollution.

Teenager-Be-Gone

Despite, or perhaps because of, its reputation as a remarkably safe country, Japan is nonetheless vigilant in combatting youth delinquency. Train stations are particularly sensitive in that regard, since large congregations of young people pass through stations at all hours of the day.

To address the Japanese fear of loitering and vandalism by young riders, some train stations deploy ultrasonic deterrents—small, unobtrusive devices that emit a high-frequency tone. The particular frequency used—17 kilohertz*—can generally only be heard by those under the age of 25. (Older people can’t detect such frequencies, thanks to the age-related hearing loss known as presbycusis.) These devices—the brainchild of a Welsh inventor and also used to fend off loitering teens in the U.S. and Europe—have been enthusiastically adopted in Japan.

Standing outside one of Tokyo Station’s numerous exits on a recent summer day, it was easy to see the effectiveness of this deterrent in action. Weary salarymen and aged obaachan passed under the sonic deterrent without changing pace. Among uniform-clad students, however, the reactions were evident—a suddenly quickened pace, a look of confusion or discomfort, and often a cry of urusai! (Loud!) None appeared to connect the noise to the deterrents placed almost flush in the ceiling panels above.

Pointing the Best Way Forward

Rail employees are not exempt from the behavioral hacks of their employers. Perhaps most famously, Japanese train conductors, drivers, and platform attendants are mandated to use the “point and call” method—called shisa kanko—in executing tasks. By physically pointing at an object, and then verbalizing one’s intended action, a greater portion of the brain is engaged, providing improved situational awareness and accuracy. Studies have repeatedly shown that this technique reduces human error by as much as 85 percent. Pointing-and-calling is now a major workplace safety feature in industries throughout Japan.

So, why don’t train workers everywhere do this? Like so many aspects of Japanese transit culture, shisa kanko has proved resistant to export (though pointing-and-calling has been adopted in modified form by New York City’s transit authority). In this, as in so many things, Japan’s rail system stands largely alone.

Allan Richarz is a privacy lawyer and writer based in Tokyo, Japan.CityLab

More from CityLab

‘It Feels Like a Derangement’: Menopause, Depression, & Me

Estrogen is more powerful and more wide-ranging than is assumed, and its removal or diminishment brings effects ludicrously understated by “the change.” Posted November 9th 2020

The New York Review of Books

  • Rose George

Read when you’ve got time to spare.hammershoi-rest.jpg

Vilhelm Hammershøi: Rest, 1905. Credit: René-Gabriel Ojéda / Google Arts & Culture.

Menopause: the ceasing of menstruation or the period in a woman’s life (typically between forty-five and fifty-five).

I stare stupidly at it. It’s nothing much to look at. It’s only a small pile of clothing: the shorts and tank top that I wear in bed, which I have thrown onto the floor before getting into the shower. I stare stupidly at the clump because I can’t pick it up. It’s astonishing I managed to shower, because I know already that this is a bad day, one when I feel assaulted by my hormones, which I picture as small pilots in those huge Star Wars armored beasts that turn me this way and that, implacable. On this morning, I wake up with fear in my stomach—fear of nothing—and I know it will be a bad day.

For a while, I thought I could predict these days. I have had practice. This is my second menopause: the first was chemically induced seven years ago to treat my endometriosis, a condition that has riddled my insides with adhesions of endometrial tissue, and stuck my organs together. The adhesions are exacerbated by estrogen; the drug switched it off. (The same drug can block other hormones and is also used to treat pedophilia and prostate cancer.) I hated that menopause; it was a crash off a cliff into sudden insomnia and depression and a complete eradication of sexual desire. “The symptoms will last six months,” said the male ob-gyn, with a voice he thought was kind but that sounded only casual. They lasted far longer. The nurse giving me the first injection said, “He keeps prescribing this stuff, but women hate it.”

This menopause is the natural one. I’m two years in. It doesn’t feel natural. It feels like a derangement. With each menopause, I have chosen to take hormone replacement therapy (HRT). The first time because I wanted my sleep back. This time because I spent a year researching menopause for a magazine article, and because I have weighed the risks and judged them acceptable, and because I know what happened last time, when I was broken. The two occasions when I asked for HRT are the only two on which I have cried in a doctor’s office.

Every Wednesday and Saturday, I take two 100mg transdermal patches of estradiol (a form of estrogen). I fix them to my abdomen, swapping sides each time. They never fall off, though I go running for hours at a time and sweat. This is the maximum dose of estrogen, and it took about a year for me to understand I needed this amount, a year of peeling skin, sore tendons, poor sleep, awful sadness, inexplicable weeping, and various other “symptoms” of menopause that you can find listed if you look beyond the hot flashes and insomnia. (I don’t know why Americans say “flash” instead of “flush”; I prefer the British-English word, less fleeting than a flash, a better fit for that rise in temperature, violently sudden and overwhelming, that makes you feel as if you had never been cool or would be again.) Estrogen is more powerful and more wide-ranging than is assumed, and its removal or diminishment brings effects ludicrously understated by “the change.”

A friend gave me access to her university library and I start to swim among papers, sometimes floundering. I learn that estrogen is a gonadal steroid produced by the ovaries and essential to female reproduction. It is a sex hormone but—it is now known—far more besides. There are receptors for estrogen all over the body. In the brain, the densest amounts are in the amygdala, the hippocampus, and the hypothalamus. Estrogen influences serotonin, dopamine, glutamate, and noradrenaline. It is involved in cognitive function. Its diminishment can impair verbal dexterity, memory, and clarity of thought. Recently, scientists discovered that estrogen is also produced in the adrenal glands, breasts, adipose tissue, and brain. This is astonishing. But so is the extent of the unknown.

Peri-menopausal women (whose periods may be irregular, who have symptoms, but who are not yet post-menopausal) are twice as likely to have depressive symptoms or depression than pre-menopausal women. Peri-menopausal women who were vulnerable to depression during the menstrual cycle are more susceptible to depression when they enter menopause or its hinterlands. This is accepted, but there is disagreement about how to fix it. Antidepressants often don’t work. Studies show both success and failure when women are given estrogen to counter depression. Controversy exists over whether the menopausal transition is a risk factor for the development of depression, I read. And, I think, the person who wrote that has probably never been on a menopause forum, where women’s stories and pain would make me weep, if I didn’t feel like weeping already, from menopause.

Because I have a womb—though it is likely of no use for fertility, thanks to the endometriosis—I also take progesterone for ten days a month. This induces the womb to shed its endometrium, which may otherwise thicken to cancer-risky proportions. So I still bleed, and choose to. I knew from my research that the gentlest version of progesterone is micronized, something that my doctor had to look up. I didn’t know that taking it orally, as I had for many months, would bring me profound sadness, fatigue, weight gain, awfulness. That wasn’t something I discovered in my research, and no one told me.


I can’t pick up the clothes. I can’t explain the granite of that “can’t” to anyone else, the way it feels impossible to beat. Look at me looking at the pile and you will think, Just pick it up. For fuck’s sake. But I don’t. I look at it, and the thought of accomplishing anything makes my fear and despair grow. Every thought brings on another and that prospect is frightening. All those thoughts. I write that down and I feel stupid and maudlin and dramatic. A privileged freelance writer who does not have a full-time job that requires her presence in an office and can be indulgent of what the medical profession calls “low moods.” In fact, plenty of menopausal women leave their jobs, endure wrecked relationships, suffer, and cope. Or don’t. But I don’t feel maudlin and dramatic in the bathroom, or on any other of a hundred occasions over the past two years. I feel terrified. I have no reason to feel fear. But my body acts as though I do: the blood rushing from my gut to my limbs in case I need to flee, leaving the fluttering emptiness that is called “butterflies,” though that is too pretty a description.

Still, I set off on my bicycle to my writing studio. I hope I can overcome the day. I always hope, and I am always wrong. A few hours later, I find myself cowering in my workspace, a studio I rent in a complex of artists’ studios, scared to go downstairs to the kitchen because I can’t bear to talk to anyone I might find there. I have done nothing of use all day. Every now and then, I stop doing nothing and put my head in my hands because it feels safe and comfortable, like a refuge. I look underneath my desk and think I might sit there. There is no logic to this except that it is out of sight of the door and no one will find me.

Even so, when the phone rings I answer it. I shouldn’t, but I am hopeful that I can manage it and mask it, and I haven’t spoken to my mother for a few days and would like to. It goes well for a few minutes, because I’m not doing the talking. Then she asks me whether I want to accompany her to a posh dinner, several weeks hence. She doesn’t understand when I ask to be given some time to think about it. “Why can’t you decide now?” I say it’s one of the bad days, but I know this is a mixed message: If it’s that bad, how am I talking on the phone and sounding all right? Because I am a duck: talking serenely above, churning below, the weight on my chest, the catch in my throat, the inexplicable distress. I try to explain but I’m also trying hard not to weep, and so I explain it badly.

She doesn’t understand. This is not her fault. She is a compassionate woman, but she had an easy menopause, so easy that she can say, “Oh, I barely remember it.” One of those women: the lucky ones. She doesn’t understand depression, though both her children experience it, because she has never had it. “But you sounded well,” she says, “I thought you were all right.” Now she says, “I don’t understand how your not being well is stopping you deciding whether you want to go to dinner.” Because it is a decision, and a decision is too hard, requiring many things to happen in my brain and my brain is too busy being filled with fear and panic and tears and black numbness. There is no room to spare.

I hang up because I can’t explain this. I stay there for a while, sitting on my couch, wondering how to face cycling home or leaving my studio or opening the door. All these actions seem equally impossible.

It takes a while but finally I set off. I know where I’m going. I have learned. On days like this, there are only two places to be. One is in my darkened bedroom with my cat lying next to me. On days like this, she takes care to lie closer to me than usual because she knows and because she loves me. Maybe my darkness has a smell.

The other place to be is in unconsciousness.

These are the safe places because everything is quiet. On days like this, I wonder if this is what autism feels like, when sensation is overwhelming. Not just noise, but thoughts, sights, all input. It is on the bad days that I realize what a cacophony of impressions we walk through every day, and how good we are at receiving and deflecting, as required. Every day, we filter and sieve; on the bad days, my filters fail.

I sometimes call these bridge days, after a footbridge near my studio that goes at a great height over the busy A64 road. On days like this, that bridge is a danger for me. I am not suicidal, but I have always had the urge to jump. This is a thing with a name. HPP: high places phenomenon. The French call it “l’appel du vide.” So very Sartre of them: the call of emptiness. The A64 is the opposite of emptiness, but still, it is a danger. Today I don’t have the filter that we must all have to function: the one that stops us stepping into traffic or fearing the cars or buses that can kill us at any time. The one that mutes the call of the HPP.

I avoid the bridge. I cycle home, trying not to rage at drivers who cut me off and ignore me. I have no room for rage along with everything else. Thoughts that would normally flow now snag. Every observation immediately triggers a negative thread, a spiral, and a worsening. On a good day, I can pass a child and a mother and think, How nice. Nothing more. Fleeting. Unimportant. On a bad day, I see the same and think of my own infertility, how I have surely disappointed my mother by not giving her grandchildren; how it is all too late, and what have I done with my life, and my book will be a failure and today is lost and I can’t afford to lose the time. It goes on and on. Snagging thoughts that drag me down, that are relentless.

When I get inside my house, I cry. I try to watch something or read, but nothing interests me. This is called anhedonia and is a symptom of depression: the forgetting how to take pleasure. The best thing to do is sleep away the day, as much as I can.

Toward evening, I begin to feel a faint foolishness. This is my sign. Embarrassment. Shame at the day and at my management of it. When I am able to feel that and see that, I am getting better. Now I manage to watch TV, though only foreign-language dramas. Without the filmmaking industries of northern Europe, my menopause would be even bleaker. Foreign words go somewhere shallower in the brain; they are less heavy. But soon I switch it off. I don’t care about the plot. I don’t care about anything. I take a sleeping pill to get the day over with, so the better next day can begin.

Twenty-four hours earlier, I had been wearing a Santa hat, running for five miles through icy bogs on a Yorkshire moor, happy to be doing that for fun, happy to be alive.


April 4. Sleep mostly OK; a few days of melatonin after stopping progesterone. Last night I was exhausted but slept badly. Mood difficult but not dreadful. Angry and irritated. No bleed after progesterone. Peeling skin. Weepy and panic now. Can I face people?

Depression, wrote William Styron, is a noun “with a bland tonality and lacking any magisterial presence, used indifferently to describe an economic decline or a rut in the ground, a true wimp of a word for such a major illness.” It was pioneered by a Swiss psychiatrist who, Styron thought, perhaps had a “tin ear” and “therefore was unaware of the semantic damage he had inflicted by offering ‘depression’ as a descriptive noun for such a dreadful and raging disease.”

Black dog. Walking through treacle. Low moods. Nothing I have read of depression has conveyed the crippling weight of it, that is a weight made out of nothing.

I do not have depression according to most authoritative clinical definitions of the condition. Depression is a long-term chronic illness. Mine is unpredictable, and before I got my HRT dose right, it lasted weeks at a time; but usually, these days, it lasts no more than twenty-four hours. My now-and-thens do not qualify as a disease. I do not count as depressed. Instead, I am one of the women of menopause, who struggle to understand why we feel such despair, why now we cry when before we didn’t, why understanding what is left and what is right takes a fraction longer than it used to: all this is “low mood” or “brain fog.” These diminishing phrases, which convey nothing of the force of the anguish or grief that assaults us, are reserved for women and usually relate to menstrual cycles or hormones.

I have never been sunny. People who can rise from their beds and see joy without working at it, they have always been a mystery. I still feel guilty for once asking a cheery person, cheery very early in the morning, why he was so happy—I made it sound like an accusation not praise—and I watched as his face fell and his warmth iced over. I’m still sorry. Cheeriness always seems like an enviable gift. I have always been susceptible to premenstrual upheaval: two days a month when things feel awful as though they have never been anything else. I endured them. Now and then, there have been therapists sometimes and antidepressants now and then, and, for the last few years, running, in whatever wilds I can find. The best therapy. I have managed.

Then I became what I am. A menopausal woman. In the eyes of evolution, that makes me a pointless person. I can no longer reproduce, if I ever could. The grandmother theory of menopause—that women live beyond their reproductive utility in order to care for grandchildren—doesn’t persuade me. Also, I have no grandchildren. I cannot account for how awful menopause can be, unless I think that we were not meant to survive it. A useless evolutionary blip.


Thursday 14. Removed old patch, added half a new one. Mood immediately plunged. Awful: anhedonia, anxiety, panic, weepiness. I still ran but stopped to cry in the middle. So sick of this, and I can’t work.

For months, I resisted HRT. I endured as my periods got erratic, as I lost my ability to sleep through the night, as my temperature rose furiously and intolerably at unpredictable moments, all the time. I had forgotten from the first time what it was like to stink, to carry around a fan, to wear so much black so the sweat didn’t show. I had forgotten what a hot flash—such an innocent phrase—felt like; what the night sweats—such an innocent phrase—felt like. I woke up in the night boiling hot and pouring sweat. I use “pouring” deliberately because I was drenched. Sometimes, I woke up freezing because I was covered in cold sweat. Every athlete knows to change clothes as soon as possible because sweat chills so fast. Every night, it was as though I was running several races. I woke up fatigued, stinking, and angry that something so common, something that affects millions of women, is still such a medical mystery. Why do we get hot flashes? We don’t know. Why is sleep broken? We don’t know. Why are we the only creatures to get menopause apart from two types of whales? We don’t know.

I saw my doctor, who prescribed a low dose of HRT and a visit to a specialized menopause clinic, of which there are far too few. The symptoms continued, and were far more numerous than the hot flashes and insomnia to which menopause is usually reduced in common perception. I made a list: at various points, my skin peeled, my ears rang with tinnitus, my posterior tibial tendon swelled, my lubrication disappeared, my eyes dried so it felt as if I had grit in them, my jaw locked. My menopause doctor prescribed a higher dose of HRT, but the troubles continued; I got a higher one still and still they came. Finally, I sat in her office and said I couldn’t think straight. I felt like I was going mad. I became clumsier, dropping things. I forgot everything: names, events, appointments. My partner began to say, carefully, too often, “Yes, you’ve mentioned that,” in the same way I used to say it to my dad when he had dementia. The menopause doctor said, “This is just your age.” I never went back. The year before, aged forty-six, I had had no brain confusion. Forty-seven, and menopausal, I did. And she was a specialist.

I paid to see a private menopause specialist who immediately said I could be on the maximum dose of estrogen, that she couldn’t understand why no one had told me that taking progesterone orally causes many women troubles such as profound fatigue and depression, or that I could take it vaginally in half the dose for less of the time, which would be better (it is). She also prescribed testosterone, a clinical decision that is controversial in the small circle of medical professionals who take an interest in menopause. It is unnecessary, say skeptics, because the ovaries produce enough testosterone, and mine are still there, though sputtering into dysfunction. But it can help, say others, because, in the same way that estrogen is far more than a sex hormone, testosterone can lift energy, mood, life. Perhaps I would get a libido back. Perhaps I would remember what desire feels like, rather than looking at my partner and thinking how lovely he is, but distantly, through a glass pane, as if someone else were thinking it, as if that thought had nothing to do with me.

I took my new boxes of patches, a pump gel of estrogen to top up with on the bad days, my precious testosterone, and went home with hope. It took months, but things stabilized. Now, there is never more than one bad day at a time of these “low moods.” The phrase is belittling. My depression is not simply feeling miserable or glum. I know what that feels like. I know that that can be fixed by fresh air or effort. This depression is dysfunction, derangement. I hate myself so hard. And I miss myself, the woman who didn’t feel like this. The woman who felt uncomplicated sexual desire, whose skin healed quickly and didn’t scar so easily, whose hands did not dry and flake, whose ears didn’t ring; whose bladder didn’t leak. On the good days, I am at peace with my age, with what I have done, with who I am, menopausal or not. I delight in what I can do, and when I run, I hurtle headlong down a steep descent with the joy of a child, aged nearly fifty. But on other days, that woman seems like someone else.


Monday 25. First morning I haven’t felt dread and weepiness. Not giddy like before, but like things are possible. But also scared of mood flipping—and it did. Horribly. Weepy, panicking, total anhedonia. I haven’t left the house. At 3:30 I went to bed and woke up at 6. I feel profoundly sad, black, AWFUL. Did it all change after I drank coffee?

Tuesday 26. No coffee. Panic, dread, weepy. Can’t focus, can’t wash up.

I grasp for reason. I look for patterns. I keep a diary for eighteen months. If I can understand the patterns, I can predict the bad days and allow for them. I can plan for them. Tom Cruise in Minority Reporthad “pre-crime” to prevent and disrupt future criminal threats. Perhaps I can have pre-depression. For many months, I think that the bad days come when my estrogen dips on the last day before I get new patches. I stop scheduling things on Mondays and Fridays. But then the pattern changes so that I know it never was a pattern. Sometimes, it’s a Tuesday. Sometimes, a Sunday. I can’t tell. I give up the diary.

I try to take control by being less embarrassed. Once, when I still had flashes and was out at dinner, I got out my fan and a relative said, “Must you?” I don’t understand this reaction. People are not mortified by cancer patients on chemo who sweat and use fans. Is it because menopause is to do with periods? Is it because women’s health must be hidden and quiet? Is it because women do hide it? I can’t think why the irregularities of the hypothalamus should be socially unacceptable. I kept using my fan for as long as I needed to, though I felt faintly uneasy.

The only acceptable place for menopause is in menopause jokes. The humor that masks distress and shame. The woman in a meeting who laughs off her sweating, who talks of “power surges.” The comedians and their mothers-in-law and their flushes or flashes. What if it came out of jokes and into accepted conversation?

For many months, I told people I was “unwell.” Not crippled, not weeping, not disabled. “Unwell.” The implication: that there is something physically wrong. A proper illness, not depression. A definition of depression is heartache, but it is my head that aches. What if I told everyone I had a severe headache? A broken ankle not brain? They would understand better. Then, one day, as I sit at my computer and think of the writing deadline that is today and feel despair, and I try to read serious medical literature and instead put my head in my hands again, I decide to write to the commissioning editor, even though she is new and this may form her opinion of me, and say: I can’t function today. I can’t write. And it is because of depression. Please give me leeway. It shames me to write it, but I do. And I do it again, when needed. So far, every response has been profoundly kind. I should have done it sooner.

Mental illness. Such an odd concept. How strange to put a division between mental and physical illness, as if the brain is not in the body. As if emotions are not regulated by the brain. As if feelings are not linked to hormones. As if all maladies are not of the body. And still mental illness is put in its place, which is in a different category. Not “real” illness. Not physical. Easier to fix, to underfund, to sweep into the dark corner of the unspoken. Imagine the contrary. Have you broken your ankle? Cheer up. Do you have third-degree burns? Chin up. Think yourself better, you with your chronic lymphocytic leukemia. Smile.


May 4. Finally felt better yesterday. Tweeted fury about BBC menopause doc and all its “low moods.” Messaged with a doctor who thinks 50mg of estradiol is too low and particularly for someone who was prone to PMT. She also thought I should try testosterone. I immediately went downstairs and put another patch on. Retroactively furious with Dr. X for sticking so firmly to dose, but maybe I played down the depression. Today I slept well. Mood good. A feeling in my stomach that is positivity, like I can do things.

In London, at an event: clever people all around me, and I am on a panel discussing clever things. But I do not feel clever. I feel like a dolt, that when my mouth opens stupidity and cotton wool come out. I meet people I know and like from social media, and am happy to learn that I like them in real life, too. We go for a drink, but I want to leave. There is no reason for me to feel this way: the people are nice, the place is great, the cocktails look tasty. I mostly drink water and leave early and walk through the quietening streets of London and feel so numb I can’t even be bothered to loathe myself. The next morning, I wake gloomy, my head foggy apparently from just one glass of prosecco. The room is hot, the city noises are infuriating. I put new estrogen patches on my abdomen. I smear testosterone gel, two pea-sized globs, on my inner thighs. I go through the motions of other activities and wait. Half an hour later, as I am walking to the station, I feel a quiet flood of good mood. It feels as though the estrogen is lifting me slightly. I picture a tide floating buoys higher and higher in a harbor. Estrogen is hefting and hauling me out of depression, for today.

This is my theory. It is unproven, according to the literature. I wish the urge to better understand the extent of estrogen’s reach, and the devastation its fluctuation can bring, had happened decades ago. There has been more research in recent years, but I doubt that the driver for this knowledge is how poorly menopause is treated or understood; it’s probably that estrogen is implicated in higher rates of Alzheimer’s disease in postmenopausal women. There is money in Alzheimer’s, but not in making women’s lives better.


Friday 22. Woke up at 10. Awful, awful, awful. Got up at 12 and ran 10 miles, got back and burst into tears. Profound sadness, depression, weepiness. One of the worst yet. Panic at night.

My mother says, the day after another bad day, “I feel so awful for you. Why can’t they fix it?” They are doing all they can, I say. I don’t really believe this. If women’s health were taken as seriously as men’s, this probably would have been solved a while ago.

The trouble with women is we cope. We always do.

I keep fit. I gave up alcohol for months, reasoning that it plunges me into depression the next day—and I can produce those days all on my own without paying money to make them happen. Over the years, I have taken citalopram, sertraline, black cohosh, red clover, omega 3, magnesium, iron, vitamin D. For a while, I saw a serene herbalist, who mixed dark potions and told me I should eat chickpeas and tofu to get their phyto-estrogens to bind to the receptors all over my body, that these are good estrogens and binding them is something I want to do. But I don’t understand her explanation and imagine only battalions of chickpeas marching around my body seeking docking stations. Many peri-menopausal women with depression are prescribed antidepressants. I hope theirs work, as mine did nothing. I know the iron helps, and I think the magnesium does, too, because when I forget to take it, I start to feel stupider.

In scientific papers, researchers argue about whether women feeling depressed in menopause (pre-, peri-, post-) are actually just experiencing the ups and downs of life. We are brought low, they reason, by the hot flashes and sleeplessness, not by hormonal fluctuations. Or we are diminished by life. At that age, I read, women may have aging parents to care for; grown children and an empty house; empty marriages. Their depressive symptoms are a mourning for who they were and what is to come. They have what is called “the redundancy syndrome.” It’s just coincidence that they are also menopausal. “Research has found,” I read, “that depressed mood and depressive disorder in middle-aged women are related less to menopause than to the vicissitudes of life.”

I bristle at this. Although I wonder. I remember a month away in France when I had not a single bad day. I notice that my mood lifts once my book is written and its huge pressure is also lifted. I wonder: Is my problem not menopause-specific depression, but that the removal of estrogen leaves me less protected against my natural lows? This theory lasts until the next bad day when I remember how elemental it feels. There is no choice involved. I would not choose to feel the way I do. Who the hell would?


May 2. I slept fine and took no pills but today was the same. Sad, weepy, furious. I can interact with people but in-between is awful. I went home at 3 and went to bed until 6. I hate this.

Today. Today is a decent day. It has taken me months to write this essay because when I am bad, I can’t write, and when I am not, I don’t want to remember. Tomorrow? My menopausal status is being masked by HRT, so I won’t know when I become post-menopausal until I dare to stop my artificial bolster of hormones. My post-menopausal friends tell me everything is better on the other side. I want to believe them and ask my doctor, a young woman half my age, when I can stop taking HRT and what will happen if I do. She says, “Four years? That’s about right.” Stay on HRT for four years, wean yourself off it, and then see. She doesn’t say that this means I have to plan for a period of life when I can risk being brutalized by depression and insomnia for weeks at a time, not days. When I can crash to the bottom again. Even on a good day, I think that time will be never.

Rose George is a British-based journalist and writer who has contributed to The Guardian, the Financial Times, Details, and Condé Nast Traveler, among other publications. She is also the author of “A Life Removed,” “The Big Necessity: the Unmentionable World of Human Waste and Why it Matters,” “Ninety Percent of Everything,” and, most recently, “Nine Pints.” Follow her on Twitter: @rosegeorge3.The New York Review of Books

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Why Do We See Dead People?

Humans have always sensed the ghosts of loved ones. It’s only in the last century that we convinced ourselves this was a problem by Patricia Pearson
Illustration by Megan Kyak-Monteith Updated 19:38, Nov. 6, 2020 | Published 15:54, Oct. 27, 2020

In the late spring of 2015, my brother-in-law paid a visit to my sister’s grave, in a lush meadow cemetery amid the Gatineau Hills of southern Quebec. My sister had been dead, at this point, for seven years, and the couple had been separated for twelve. Doug sat in the grass among planted geraniums for half an hour or so, musing about the rise and fall of their marriage. He told Katharine, or her grave, that he was sorry for the part he had played in the dissolution. Then, plucking up and tossing a handful of grass, desultory, he began his two-and-a-half-hour motorcycle journey back to Montreal.

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“The landscape is open there, with a big wide sky, but it was overcast and had started to rain—just barely, but it made me a bit nervous,” Doug later told me. Even fit riders in their fifties experience the occasional lapse in confidence. “It wasn’t until I was maybe halfway home that I felt her presence.”

“The sense wasn’t physical at first,” he went on, “just this really nice, strong awareness of her. And then I had the distinct sensation of her arms around me and her leaning in close against my back. It was tactile and fantastic. I felt warm. I was completely calm and happy, smiling from ear to ear. That hardly ever happens to me.” His nervousness about the rain ebbed, and it occurred to him that Katharine was there to keep him safe on behalf of their two sons. She—her presence, her spirit—rode behind him for twenty minutes or so. “What I know is that it did not feel at all like a product of my imagination,” he said. “It felt external to me. It felt real.”

He wasn’t prepared to name what the experience pointed to: that he had been visited by my sister’s ghost. Like other secular North Americans, he is aware that we must uphold a certain paradigm and say “this cannot be.” After all, Doug considers himself a rationalist: the son of an engineer, himself an amateur astronomer. Nevertheless, the sensed presence mattered deeply to him. “It was,” he said, “a remarkable, indelible experience.”

Sigmund Freud was the first to articulate the concept of “wishful psychosis” in grief, a notion of temporary madness featuring wilfully conjured visions of the dead. A person who’s lost someone might see the face of their beloved, hear their voice, notice the smell of their pipe or perfume, or simply be struck by a feeling of their presence. Such ghostly apparitions were diagnosed as fanciful yearnings by Freud—warning signs of some lingering dependency. In his 1917 essay “Mourning and Melancholia,” he urged his patients toward recovery by severing bonds with the dead: move on and let go, lest sorrow bedevil and sink you. For decades, this was one of the counselling profession’s central models for grief recovery: a sort of tacit agreement played out between therapist and patient that what the latter sensed, no matter how comforting it may be or how real it may seem, dwelled in their head and would best be forgotten. When the physician W. Dewi Rees uncovered the prevalence rate of these hallucinations in a 1972 study of Welsh widows and widowers—about 50 percent—he also found that three-quarters of them had never spoken of the experience before being asked in his survey. Unsurprisingly, these people didn’t wish to be pathologized. They also didn’t want to move on.

In 1970, English author Sylvia Townsend Warner, a frequent contributor of short stories to The New Yorker, had an unexpected visit from her dead lover, Valentine Ackland, lost the previous year to breast cancer. Roused one night at three, Warner found, as she later wrote in her diary, that Ackland had followed her to bed. “Not remembered,” she clarified, “not evoked, not a sense of presence. Actual.” In the dark quiet of their British cottage, this “actual” Ackland, solid yet ephemeral, engaged in a reuniting embrace. Then she was gone. “I held her again,” Warner noted with deep satisfaction. “It was. It is.”

Ought anyone to have argued with her? Death and its accompanying grief are often shrouded by awkward silences, but the unwavering prevalence of these apparitions, whether viewed as grief hallucinations or as ghosts, lays bare a metaphysical crisis at the heart of our common model of mourning: for there to be efficacy in recovery, these experiences must be respected as real. As counselling psychologist Edith Maria Steffen notes in her book, Continuing Bonds in Bereavement, there is a “controversial reality status” at play that can erode the trusting relationship between therapist and bereaved person if not handled with care and nuance. The same can be said for family and friends. The question is not whether these apparitions are real, it’s why the first impulse of many is to stifle these stories and dismiss the experiences as impossible.

Pulling power

Women find a man more attractive once they learn he has a wife or girlfriend, study suggests Posted November 8th 2020

They think he is more likely to be kind and faithful and, therefore, a good dad

  • 30 Jan 2018, 0:53
  • Updated: 30 Jan 2018, 3:54

WOMEN find a man more attractive once they learn he has a wife or girlfriend, a study suggests.

They think he is more likely to be kind and faithful and, therefore, a good dad, psychologists believe.

 A study has revealed that having a partner gives men an 'attractiveness boost'
A study has revealed that having a partner gives men an ‘attractiveness boost’Credit: Alamy

Having a partner gives men an “attractiveness boost”, they say.

But women may just be swayed by the opinions of others — and are as likely to up their rating of artworks which others like.

The findings come from an experiment testing the notion of “mate-choice copying”, which is seen in female birds and fish.

It can offer an evolutionary advantage by boosting their chances of finding a good sexual partner.

Researchers asked 49 female volunteers to rate men’s faces, men’s hands and a piece of art.

But when they were shown others’ ratings and asked again, they moved 13 per cent closer to the average facial score and 14 per cent closer to the average art rating.

Research leader Dr Kate Cross, from the University of St Andrews, said: “Women appear to copy the mate preferences of other women but this might simply be because humans have a general tendency to be influenced by the opinions of others.”

 Extremely bizarre compilation of Russian online dating profile pics

Antipsychotic Medicines Posted October 27th 2020

Authored by Dr Laurence Knott, Reviewed by Dr Hannah Gronow | Last edited 29 Jun 2018 | Meets Patient’s editorial guidelines 

In this series: Schizophrenia Psychosis

Antipsychotics are medicines that are mainly used to treat schizophrenia or mania caused by bipolar disorder. There are two main types of antipsychotics: atypical antipsychotics and older antipsychotics. Both types are thought to work as well as each other. Side-effects are common with antipsychotics. You will need regular tests to monitor for side-effects while you take these medicines.

In this article

What are antipsychotics?

Antipsychotics are a group of medicines that are mainly used to treat mental health illnesses such as schizophrenia, or mania (where you feel high or elated) caused by bipolar disorder. They can also be used to treat severe depression and severe anxiety. Antipsychotics are sometimes also called major tranquillisers.

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There are two main types of antipsychotics:

Antipsychotics are available as tablets, capsules, liquids and depot injections (long-acting). They come in various different brand names.

Older antipsychotics have been used since the 1950s and are still prescribed today. Newer antipsychotics were developed in the 1970s onwards. It was originally thought that these medicines would have fewer side-effects than the older type of antipsychotics. However, we now know that they can also cause quite a few side-effects.

How do antipsychotics work?

Antipsychotics are thought to work by altering the effect of certain chemicals in the brain, called dopamine, serotonin, noradrenaline and acetylcholine. These chemicals have the effect of changing your behaviour, mood and emotions. Dopamine is the main chemical that these medicines have an effect on.

By altering the effects of these chemicals in the brain they can suppress or prevent you from experiencing:

  • Hallucinations (such as hearing voices).
  • Delusions (having ideas not based on reality).
  • Thought disorder.
  • Extreme mood swings that are associated with bipolar disorder.

When are antipsychotics usually prescribed?

As discussed above, antipsychotics are usually prescribed to help ease the symptoms of schizophrenia, mania (caused by bipolar disorder), severe depression or severe anxiety. Normally they are started by a specialist in psychiatry, or your GP will ask a specialist for advice on when to start them.

Also, for many years antipsychotics were used to calm elderly people who had dementia. However, this use is no longer recommended. This is because these medicines are thought to increase the risk of stroke and early death – by a small amount. Risperidone is the only antipsychotic recommended for use in these people. Even then, it should only be used for a short period of time (less than six weeks) and for severe symptoms.

Which antipsychotic is usually prescribed?

The choice of antipsychotic prescribed depends upon what is being treated, how severe your symptoms are and if you have any other health problems. There are a number of differences between the various antipsychotic medicines. For example, some are more sedating than others. Therefore, one may be better for one individual than for another. A specialist in psychiatry usually advises on which to use in each case. It is difficult to tell which antipsychotic will work well for you. If one does not work so well, a different one is often tried and may work well. Your doctor will advise.

It is thought that the older and newer types of antipsychotics work as well as each other. The exception to this is clozapine – it is the only antipsychotic that is thought to work better than the others. Unfortunately, clozapine has a number of possible serious side-effects, especially on your blood cells. This means that people who take clozapine have to have regular blood tests. See below.

In some cases, an injection of a long-acting antipsychotic medicine (depot injection) is used once symptoms have eased. The medicine from a depot injection is slowly released into the body and is given every 2-4 weeks. This aims to prevent recurrences of symptoms (relapses). The main advantage of depot injections is that you do not have to remember to take tablets every day.

How well do antipsychotics work?

It is thought that for every 10 people who take these medicines, 8 will experience an improvement in their symptoms. Unfortunately, antipsychotics do not always make the symptoms go away completely, or for ever. A lot of people need to take them in the long term even if they feel well. This is in order to stop their symptoms from coming back. Even if you take these medicines on a long-term basis and they are helping, sometimes your symptoms can come back.

Symptoms may take 2-4 weeks to ease after starting medication and it can take several weeks for full improvement. The dose of the medicine is usually built up gradually to help to prevent side-effects (including weight gain).

What is the usual length of treatment?

This depends on various things. Some people may only need to take them for a few weeks but others may need to take them long-term (for example, for schizophrenia). Even when symptoms ease, antipsychotic medication is normally continued long-term if you have schizophrenia. This aims to prevent relapses, or to limit the number and severity of relapses. However, if you only have one episode of symptoms of schizophrenia that clears completely with treatment, one option is to try coming off medication after 1-2 years. Your doctor will advise.

Stopping antipsychotics

If you want to stop taking an antipsychotic you should always talk to your doctor first. This is in order to help you decide if stopping is the best thing for you and how you should stop taking your medicine. These medicines are usually stopped slowly over a number of weeks. If you stop taking an antipsychotic medicine suddenly, you may become unwell quite quickly. Your doctor will usually advise you to reduce the dose slowly to see what effect the lower dose has on your symptoms.

What about side-effects from antipsychotics?

Side-effects can sometimes be troublesome. There is often a trade-off between easing symptoms and having to put up with some side-effects from treatment. The different antipsychotic medicines can have different types of side-effects. Also, sometimes one medicine causes side-effects in some people and not in others. Therefore, it is not unusual to try two or more different medicines before one is found that is best suited to an individual.

The following are the main side-effects that sometimes occur. However, you should read the information leaflet that comes in each medicine packet for a full list of possible side-effects.

Common side-effects include:

  • Dry mouth, blurred vision, flushing and constipation. These may ease off when you become used to the medicine.
  • Drowsiness (sedation), which is also common but may be an indication that the dose is too high. A reduced dose may be an option.
  • Weight gain which some people develop. Weight gain may increase the risk of developing diabetes and heart problems in the longer term. This appears to be a particular problem with the atypical antipsychotics – notably, clozapine and olanzapine.
  • Movement disorders which develop in some cases. These include:
    • Parkinsonism – this can cause symptoms similar to those that occur in people with Parkinson’s disease – for example, tremor and muscle stiffness.
    • Akathisia – this is like a restlessness of the legs.
    • Dystonia – this means abnormal movements of the face and body.
    • Tardive dyskinesia (TD) – this is a movement disorder that can occur if you take antipsychotics for several years. It causes rhythmical, involuntary movements. These are usually lip-smacking and tongue-rotating movements, although it can affect the arms and legs too. About 1 in 5 people treated with typical antipsychotics eventually develop TD.

Atypical antipsychotic medicines are thought to be less likely to cause movement disorder side-effects than typical antipsychotic medicines. This reduced incidence of movement disorder is the main reason why an atypical antipsychotic is often used first-line. Atypicals do, however, have their own risks – in particular, the risk of weight gain. If movement disorder side-effects occur then other medicines may be used to try to counteract them.

Will I need any tests while taking an antipsychotic?

Your doctor will want to monitor you regularly for side-effects if you take an antipsychotic. The tests needed and how often you will need to have them depend on which antipsychotic you are taking.

In general, your doctor will take a sample of blood for certain tests before you start treatment. The tests look at:

  • How many blood cells you have.
  • How well your kidneys and liver are working.
  • How much lipid (fat) is in your blood.
  • Whether you have diabetes.

When you take clozapine your white blood cell (leukocyte) and differential blood counts must be normal before treatment is started. After beginning treatment, a full blood count should be taken every week for 18 weeks, then at least every two weeks after that. If clozapine is continued, and the blood count is stable after one year, then monitoring should occur at least every four weeks, and for four weeks after finishing. These tests may be repeated in the first three or four months of treatment. After this they are normally done every year. However, your doctor may advise you to have these tests more often.

Your weight and blood pressure are usually measured before you start treatment and every few weeks after this for the first few months. After this they are normally measured every year.

The blood level of prolactin (a hormone) may also be measured before starting treatment and six months later. Usually it is then measured every year after this. The prolactin level is measured because sometimes antipsychotics can make you produce too much of this hormone. If you make too much prolactin it can lead to your breasts growing bigger and breast milk being produced.

Who cannot take antipsychotics?

Antipsychotics are usually not prescribed for people who are in a coma (comatose), have depression of their central nervous system, or who have a tumour on the adrenal gland (phaeochromocytoma).

Can I buy antipsychotics?

No – they are only available from your pharmacist, with a doctor’s prescription.

How to use the Yellow Card Scheme

If you think you have had a side-effect to one of your medicines you can report this on the Yellow Card Scheme. You can do this online at www.mhra.gov.uk/yellowcard.

The Yellow Card Scheme is used to make pharmacists, doctors and nurses aware of any new side-effects that medicines or any other healthcare products may have caused. If you wish to report a side-effect, you will need to provide basic information about:

  • The side-effect.
  • The name of the medicine which you think caused it.
  • The person who had the side-effect.
  • Your contact details as the reporter of the side-effect.

It is helpful if you have your medication – and/or the leaflet that came with it – with you while you fill out the report.

Previous article

Antipsychotic Medicines

Authored by Dr Laurence Knott, Reviewed by Dr Hannah Gronow | Last edited 29 Jun 2018 | Meets Patient’s editorial guidelines 

In this series: Schizophrenia Psychosis

Antipsychotics are medicines that are mainly used to treat schizophrenia or mania caused by bipolar disorder. There are two main types of antipsychotics: atypical antipsychotics and older antipsychotics. Both types are thought to work as well as each other. Side-effects are common with antipsychotics. You will need regular tests to monitor for side-effects while you take these medicines.

In this article

What are antipsychotics?

Antipsychotics are a group of medicines that are mainly used to treat mental health illnesses such as schizophrenia, or mania (where you feel high or elated) caused by bipolar disorder. They can also be used to treat severe depression and severe anxiety. Antipsychotics are sometimes also called major tranquillisers.

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There are two main types of antipsychotics:

Antipsychotics are available as tablets, capsules, liquids and depot injections (long-acting). They come in various different brand names.

Older antipsychotics have been used since the 1950s and are still prescribed today. Newer antipsychotics were developed in the 1970s onwards. It was originally thought that these medicines would have fewer side-effects than the older type of antipsychotics. However, we now know that they can also cause quite a few side-effects.

How do antipsychotics work?

Antipsychotics are thought to work by altering the effect of certain chemicals in the brain, called dopamine, serotonin, noradrenaline and acetylcholine. These chemicals have the effect of changing your behaviour, mood and emotions. Dopamine is the main chemical that these medicines have an effect on.

By altering the effects of these chemicals in the brain they can suppress or prevent you from experiencing:

  • Hallucinations (such as hearing voices).
  • Delusions (having ideas not based on reality).
  • Thought disorder.
  • Extreme mood swings that are associated with bipolar disorder.

When are antipsychotics usually prescribed?

As discussed above, antipsychotics are usually prescribed to help ease the symptoms of schizophrenia, mania (caused by bipolar disorder), severe depression or severe anxiety. Normally they are started by a specialist in psychiatry, or your GP will ask a specialist for advice on when to start them.

Also, for many years antipsychotics were used to calm elderly people who had dementia. However, this use is no longer recommended. This is because these medicines are thought to increase the risk of stroke and early death – by a small amount. Risperidone is the only antipsychotic recommended for use in these people. Even then, it should only be used for a short period of time (less than six weeks) and for severe symptoms.

Which antipsychotic is usually prescribed?

The choice of antipsychotic prescribed depends upon what is being treated, how severe your symptoms are and if you have any other health problems. There are a number of differences between the various antipsychotic medicines. For example, some are more sedating than others. Therefore, one may be better for one individual than for another. A specialist in psychiatry usually advises on which to use in each case. It is difficult to tell which antipsychotic will work well for you. If one does not work so well, a different one is often tried and may work well. Your doctor will advise.

It is thought that the older and newer types of antipsychotics work as well as each other. The exception to this is clozapine – it is the only antipsychotic that is thought to work better than the others. Unfortunately, clozapine has a number of possible serious side-effects, especially on your blood cells. This means that people who take clozapine have to have regular blood tests. See below.

In some cases, an injection of a long-acting antipsychotic medicine (depot injection) is used once symptoms have eased. The medicine from a depot injection is slowly released into the body and is given every 2-4 weeks. This aims to prevent recurrences of symptoms (relapses). The main advantage of depot injections is that you do not have to remember to take tablets every day.

How well do antipsychotics work?

Symptoms may take 2-4 weeks to ease after starting medication and it can take several weeks for full improvement. The dose of the medicine is usually built up gradually to help to pIt is thought that for every 10 people who take these medicines, 8 will experience an improvement in their symptoms. Unfortunately, antipsychotics do not always make the symptoms go away completely, or for ever. A lot of people need to take them in the long term even if they feel well. This is in order to stop their symptoms from coming back. Even if you take these medicines on a long-term basis and they are helping, sometimes your symptoms can come back.

revent side-effects (including weight gain).

What is the usual length of treatment?

This depends on various things. Some people may only need to take them for a few weeks but others may need to take them long-term (for example, for schizophrenia). Even when symptoms ease, antipsychotic medication is normally continued long-term if you have schizophrenia. This aims to prevent relapses, or to limit the number and severity of relapses. However, if you only have one episode of symptoms of schizophrenia that clears completely with treatment, one option is to try coming off medication after 1-2 years. Your doctor will advise.

Stopping antipsychotics

If you want to stop taking an antipsychotic you should always talk to your doctor first. This is in order to help you decide if stopping is the best thing for you and how you should stop taking your medicine. These medicines are usually stopped slowly over a number of weeks. If you stop taking an antipsychotic medicine suddenly, you may become unwell quite quickly. Your doctor will usually advise you to reduce the dose slowly to see what effect the lower dose has on your symptoms.

What about side-effects from antipsychotics?

Side-effects can sometimes be troublesome. There is often a trade-off between easing symptoms and having to put up with some side-effects from treatment. The different antipsychotic medicines can have different types of side-effects. Also, sometimes one medicine causes side-effects in some people and not in others. Therefore, it is not unusual to try two or more different medicines before one is found that is best suited to an individual.

The following are the main side-effects that sometimes occur. However, you should read the information leaflet that comes in each medicine packet for a full list of possible side-effects.

Common side-effects include:

  • Dry mouth, blurred vision, flushing and constipation. These may ease off when you become used to the medicine.
  • Drowsiness (sedation), which is also common but may be an indication that the dose is too high. A reduced dose may be an option.
  • Weight gain which some people develop. Weight gain may increase the risk of developing diabetes and heart problems in the longer term. This appears to be a particular problem with the atypical antipsychotics – notably, clozapine and olanzapine.
  • Movement disorders which develop in some cases. These include:
    • Parkinsonism – this can cause symptoms similar to those that occur in people with Parkinson’s disease – for example, tremor and muscle stiffness.
    • Akathisia – this is like a restlessness of the legs.
    • Dystonia – this means abnormal movements of the face and body.
    • Tardive dyskinesia (TD) – this is a movement disorder that can occur if you take antipsychotics for several years. It causes rhythmical, involuntary movements. These are usually lip-smacking and tongue-rotating movements, although it can affect the arms and legs too. About 1 in 5 people treated with typical antipsychotics eventually develop TD.

Atypical antipsychotic medicines are thought to be less likely to cause movement disorder side-effects than typical antipsychotic medicines. This reduced incidence of movement disorder is the main reason why an atypical antipsychotic is often used first-line. Atypicals do, however, have their own risks – in particular, the risk of weight gain. If movement disorder side-effects occur then other medicines may be used to try to counteract them.

Will I need any tests while taking an antipsychotic?

Your doctor will want to monitor you regularly for side-effects if you take an antipsychotic. The tests needed and how often you will need to have them depend on which antipsychotic you are taking.

In general, your doctor will take a sample of blood for certain tests before you start treatment. The tests look at:

  • How many blood cells you have.
  • How well your kidneys and liver are working.
  • How much lipid (fat) is in your blood.
  • Whether you have diabetes.

When you take clozapine your white blood cell (leukocyte) and differential blood counts must be normal before treatment is started. After beginning treatment, a full blood count should be taken every week for 18 weeks, then at least every two weeks after that. If clozapine is continued, and the blood count is stable after one year, then monitoring should occur at least every four weeks, and for four weeks after finishing. These tests may be repeated in the first three or four months of treatment. After this they are normally done every year. However, your doctor may advise you to have these tests more often.

Your weight and blood pressure are usually measured before you start treatment and every few weeks after this for the first few months. After this they are normally measured every year.

The blood level of prolactin (a hormone) may also be measured before starting treatment and six months later. Usually it is then measured every year after this. The prolactin level is measured because sometimes antipsychotics can make you produce too much of this hormone. If you make too much prolactin it can lead to your breasts growing bigger and breast milk being produced.

Who cannot take antipsychotics?

Antipsychotics are usually not prescribed for people who are in a coma (comatose), have depression of their central nervous system, or who have a tumour on the adrenal gland (phaeochromocytoma).

Can I buy antipsychotics?

No – they are only available from your pharmacist, with a doctor’s prescription.

How to use the Yellow Card Scheme

If you think you have had a side-effect to one of your medicines you can report this on the Yellow Card Scheme. You can do this online at www.mhra.gov.uk/yellowcard.

The Yellow Card Scheme is used to make pharmacists, doctors and nurses aware of any new side-effects that medicines or any other healthcare products may have caused. If you wish to report a side-effect, you will need to provide basic information about:

  • The side-effect.
  • The name of the medicine which you think caused it.
  • The person who had the side-effect.
  • Your contact details as the reporter of the side-effect.

It is helpful if you have your medication – and/or the leaflet that came with it – with you while you fill out the report.

Comment

This is astonishing stuff. Following my very serious criminal allegations, over nearly 13 years, against two police forces command and control, and their many efforts to have me tried and jailed, my doctor et al were contacted. They first tried this in 2013, when a senior forensic psychiatrist concluded that I was not suffering from any known mental illness. The police and my GP ignored this report. It was not in disclosures, redacted and sent to me at my request after a year of arguing with them,

In March 2018, two psychiatrists and a mental health nurse turned up at my home, making three 40 minute calls in total, concluding that I do not have normal psychology, have a paranoid personality disorder and should be subject to a multi agency approach.

Their report said that I would be upset if I saw all of the combined Police/NHS records on my case, but I did not need hospital at the moment but should take anti psychotic drugs, as detailed, with side effects, above. Another report, based on me being persuaded to attend the Gender Identity Clinic, concluded that I have ‘ a secure female identity .’

The police still refuse to disclose records of their alleged investigations into my criminal behaviour and alleged domestic violence – the first of which I heard while in court being prosecuted for repeating criminal allegations against individuals including senior police officers.

I spent another 12 hours in police custody on August 24th, in a cold dark dirty cell, before nearly succeeding in strangling myself. I was then transferred to a secure mental health facility, kept for 12 hours, went before a panel of two senior doctors and a senior mental health worker. I was judged sane and fit to leave.

Interestingly, the police, who have a very big axe to grind with me, informed my GP that I am a violent mentally ill alcoholic, advising them to inform a consultant urologist dealing with other aspects of my medical care. This GP, Dr Roger Dickson Principal of Norden House Surgery Avenue Rd, acted accordingly.

The urologist informed me, along with Dr Ramasamay of the same surgery putting me in a position where I could copy a letter from Reading Police Station, off of his VDU, informing Norden House that I am, in their opinion, mentally ill. It is a very serious matter when police can make these allegation as if fact. meanwhile Dickson seemed to have forgotten that he regularly passed me fit to drive HGVs, which I had been doing for the 12 years leading up to lockdown. There is something very rotten about our public services, particularly the police.

This is life in a very dangerous police state today. I have worked in a wide range of occupations, including teaching, journalism, engineering, truck driving, construction and writing many books. No one apart from the little Police and NHS clique seem to have noticed how mad I am. Praise be to our wonderful police and NHS ( sic ). The situation is ongoing. R.J Cook

NHS incompetence killed both my parents and is working with police in what they call ‘ a multi agnecy approach’ to have me take anti psychotics, and ultimately to section me.
R.J Cook
There will never be real reform of the British police because the British Elite’s Dictatorship needs them, they are essential to oppression and elite privilege.