Category Archives: Mental Health

Is bullying worse than child abuse when it comes to mental health?

Anyone who has ever been nastily teased or bullied in the playground will remember how it made them feel. Now a new study shows that bullying during childhood is as harmful as abuse. For some people, it is even worse than abuse.

The research, carried out by Dieter Wolke from the University of Warwick, studied more than 4,000 children in the UK and US. The team regularly measured rates of maltreatment – assessed as physical, emotional, or sexual abuse or harsh discipline – and bullying – characterised as repetitive aggressive behaviour by someone in their peer group with more power – by interviewing the children and their parents. The researchers then assessed the children for mental health problems when they were 18-years-old.

In the UK group, maltreatment was linked to depression but this wasn’t the case in the US group. But bullying was linked to mental health problems for children in both groups.

The team worked out the odds of developing mental health problems linked to maltreatment and the odds linked to bullying. They discovered bullied children were around five times more likely to experience anxiety and nearly twice as likely to report depression and self-harm at age 18 than maltreated children.

Digging deeper

It is difficult to say whether or not the team captured the true rates of maltreatment in the study since in many cases, they relied on parents admitting child abuse. If rates of maltreatment were missed then the findings linked to maltreatment may reflect an inaccurate picture.

But even if rates of maltreatment were missed, the findings linking bullying to mental health problems remain.

The team also looked at the relationship between bullying and mental health while taking into account other factors such as family hardship and the mental health of mothers. The harmful effects of bullying remained even when controlling for these other factors, again lending support to their conclusions.

Mental health issues are related to many factors including child abuse and family hardship.

But the investigators did not assess all key factors that could explain the link between bullying and mental health problems. Childhood speech and language problems, for example, which were not assessed, are known to be linked to peer bullying in childhood and anxiety disorders in adulthood.

A study carried out by Joe Beitchman and his team at the University of Toronto followed children for 14 years. They discovered that speech and language problems at the age of five were strongly linked to anxiety problems in young adulthood. The most common anxiety problem in adulthood was social anxiety disorder.

Lasting damage

In my own clinical practice, I frequently treat people suffering from disabling social anxiety who have a history of bullying. Sometimes my clients have a history of maltreatment and bullying, but more often than not they have a history of bullying. For many people, bullying ruptures healthy self-esteem, replacing positive beliefs about oneself with beliefs linked to shame, disgust and criticism.

If a child is teased for an aspect of their appearance, they may go on to believe they look distorted and ugly. When they look in the mirror they may actually see an image of themselves encapsulating the names that bullies call them. They may develop body dysmorphic disorder, an anxiety disorder that causes people to have a distorted view of their appearance and to spend a lot of time worrying about it.

But more commonly, past bullying is linked to social anxiety disorder. People with social anxiety disorder are terrified of socialising with others, fearing harsh evaluation and rejection. They typically underachieve at school and at work and are at risk of depression and early death by suicide.

Social anxiety disorder typically starts around the time bullying starts in childhood. Many people with this disorder recover as adults when their bullying is re-visited in treatment. The therapist will help the client to transform the meaning of the bullying so that it is no longer seen as a sign of weakness but rather as evidence confirming the weakness of the bullies. Clients also learn to update their negative images with realistic images of how they really come across to other people.

Preventing bullying

In some ways knowing how bullying leads to poor mental health is less important than preventing bullying. Zero tolerance programmes are needed and government recommendations should be implemented in every school – and monitored.

For example, it would be helpful if, as part of the nationwide curriculum, students learned to spot the signs of bullying in themselves and others. Classroom discussions about the effects of bullying would help to raise awareness among children.

Children who are likely to bully need help to handle their difficult feelings and to learn positive communication skills. Their parents may need support too. Parenting classes may help or interventions that teach parents how to manage their own difficult feelings could be beneficial.

Schools should make it easy for kids to report bullying and to access immediate help. GPs should routinely ask about bullying when children visit the surgery. If teachers, health professionals, parents and children can work together to spot the signs and symptoms of bullying and stop it, there will be scope to prevent the linked mental health problems from developing.

The Conversation

This article was originally published on The Conversation.
Read the original article.

Understanding Cognitive Bias Helps Decision Making

noun: intuition
  1. the ability to understand something immediately, without the need for conscious reasoning.

People tend to trust their own intuition. Has there been much formal study about the veracity of intuition?

Brain science itself is a young field, and the terminology has yet to mature into a solid academic lexicon. To further increase your chances of being confused, modern life is rife with distractions, misinformation, and addictive escapisms, leaving the vast majority of society having no real idea what the hell is happening.

To illustrate my point, I’m going to do something kind of recursive. I am going to document my mind being changed about a deeply held belief as I explore my own cognitive bias. I am not here to tell you what’s REALLY going on or change your mind about your deeply held beliefs. This is just about methods of problem solving and how cognitive bias can become a positive aspect of critical thought.

Image: "Soft Bike" sculptiure by Mashanda Lazarus

Image: “Soft Bike” sculptiure by Mashanda Lazarus

I’m advocating what I think is the best set of decision making skills, Critical Thought. The National Council for Excellence in Critical Thinking defines critical thinking as the intellectually disciplined process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication, as a guide to belief and action. (I’m torn between the terms Critical Thinking and Critical Thought, although my complaint is purely aesthetic.)

Ever since taking an introduction to Logic course at Fitchburg State college I have been convinced that Logic is a much more reliable, proven way to make decisions. Putting logic to practice when decision-making is difficult, though. Just like a math problem can be done incorrectly, Some logic can even counter-intuitive. My favorite example of intuition failing over logic is always chess. Even as I write this I can’t convince myself otherwise: I have regretted every intuitive chess move. It’s statistically impossible that all my intuitive moves have been bad moves yet logic works in the game so much better that my mind has overcompensated in favor of logic. In the microcosm of chess rules, logic really is the better decision-making tool. Often the kernel of a good move jumps out at me as intuition but then must still be thoroughly vetted with logic before I can confidently say it’s a good move.

In high school, I was an underachiever. I could pass computer science and physics classes without cracking a book. My same attempt to coast through math classes left me struggling because I could not intuitively grasp the increasingly abstract concepts. The part of my mind that controls logic was very healthy and functioning but my distrust for my own intuition was a handicap. I would be taking make up mathematics courses in the summer but getting debate team trophies during the school year.


Photograph of Marcel Duchamp and Eve Babitz posing for the photographer Julian Wasser during the Duchamp retrospective at the Pasadena Museum of Art, 1963 © 2000 Succession Marcel Duchamp, ARS, N.Y./ADAGP, Paris.

I’m not just reminiscing; everyone’s decision making process is an constantly-updating algorithm of intuitive and logical reasoning. No one’s process is exactly the same but we all want to make the best decisions possible. For me it’s easy to rely on logic and ignore even a nagging sense of intuition. Some people trust intuition strongly yet struggle to find the most logical decision; everyone is most comfortable using a specially-tailored degree of intuition and logic. People argue on behalf of their particular decisions and the methodology behind them because a different method is useful in for each paradigm.

In chess, intuition is necessary but should be used sparingly and tempered with logic. It’s my favorite example because the game can be played without any intuition. Non-AI computers are able to beat the average human at chess. Some AI can beat chess masters. So, I’m biased towards logic. Chess is just a game, though. People are always telling me I should have more faith in intuitive thinking.

“But,” you should be asking, “Isn’t there an example of reliance on intuition as the best way to decide how to proceed?”

At least that’s what I have to ask myself. The best example I found of valuable intuition is the ability to ride a bike. It is almost impossible to learn to ride a bike in one session; it takes several tries over a week or longer to create the neural pathways needed to operate this bio-mechanical device. Samurais trained to feel that their weapon was part of themselves, or an extension of their very arm.  The mechanical motion of  the human body as it drives a bicycle becomes ingrained, literally, in the physical brain. The casual, ubiquitous expression, “It’s like riding a bike”, is used to idiomatically describe anything that can be easily mastered at an intermediate level, forgotten for years, but recalled at near perfect fidelity when encountered once again.

The Backwards Brain Bicycle – Smarter Every Day episode 133

Destin at Smarter Everyday put together a video that shows the duality of intuitive thinking. It is completely possible to train the human mind with complicated algorithms of decision making that can be embrace diversification and even contradictory modes of thinking.

Cont. below…

After watching this video, I embraced a moment of doubt and realized that there are very positive and useful aspects to intuition that I often don’t acknowledge. In this case of reversed bicycle steering, a skill that seems to only work after it has been made intuitive can be “lost” and only regained with a somewhat cumbersome level of concentration.

The video demonstrates the undeniable usefulness of what essentially amounts to anecdotal proof that neural pathways can be hacked, that contradictory new skills can be learned. It also shows that a paradigm of behavior can gain a tenacious hold on the mind via intuitive skill. It casts doubt on intuition in one respect but without at least some reliance on this intuitive paradigm of behavior it seems we wouldn’t be able to ride a bike at all.

This video forced me to both acknowledge the usefulness of ingrained, intuitive behaviors while also reminding me of how strong a hold intuition can have over the mind. Paradigms can be temporarily or perhaps permanently lost.  In the video, Destin has trouble switching back and forth between the 2 seemingly over-engaging thought systems but the transition itself can be a part of a more complicated thought algorithm, allowing the mind to master and embrace contradictory paradigms by trusting the integrity of the overall algorithm.

Including Confirmation Bias in a greater algorithm.

These paradigms can be turned on and off and just as a worker might be able to get used to driving an automatic transmission car to work and operating a stick shift truck at the job site and drive home in the automatic again after the shift.

This ability to turn on and off intuitive paradigms as a controlled feature of a greater logical algorithm requires the mind to acknowledge confirmation bias. I get a feeling of smug satisfaction that logic comprises the greater framework of a possible decision making process anytime I see evidence supporting that belief. There are just as many people out there who would view intuition as the the framework of a complex decision making process, with the ability to use or not use logical thought as merely a contributing part of a superior thought process. If my personal bias of logic over intuition is erroneous in some situations, can I trust the mode of thinking I am in? Using myself as an example, my relief at realizing data confirms what I have already accepted as true is powerful.

That feeling of relief must always be noted and kept in check before it can overshadow the ability to acknowledge data that opposes the belief. Understanding confirmation bias is the key to adding that next level to the algorithm, in the video example from Smarter Everyday, steering a normal bike is so ingrained in the neural pathway that the backwards steering’s inability to confirm actually fill in the blank and the mind sends an incorrect set of instruction of the mechanical behavior to the body. Understanding the dynamics of confirmation bias would enable the mind to embrace the greater thought system that would enable the mind to go back and forth between those conflicting behavioral paradigms. I’m positing that it should be possible to master a regular bike and the “backwards bike” and be able to switch back and forth between both bikes in quick succession. The neural pathways between both behavior paradigms can be trained and made stronger than the video shows.

I believe that with practice, someotrciksne could alternate steering mechanism quickly and without as much awkwardness as we are seeing in the video just as my initial confirmation bias, now identified, doesn’t have to dictate my decision and I might be more open minded to an intuitive interpretation leading to the best decision in certain situations.

An inability to acknowledge that one’s own mind might be susceptible to confirmation bias paradoxically makes one more susceptible.  Critical thinking is a method of building immunity to this common trap of confidence. Identifying the experience of one’s own confirmation bias is a great way to try and understand and control this intuitive tendency.  No matter what your thoughts are regarding logic and intuition, examining one’s confirmation biases and better embracing them should lead to better decision making skills.

Jonathan Howard
Jonathan is a freelance writer living in Brooklyn, NY

When Depression And Cultural Expectations Collide

“My time is coming. It’s already time for me to die. I can’t wait. … So yeah I plan to kill myself during spring break, which by the way, starts in two days.” — Wynne Lee wrote in a March 29, 2012 journal post

Wynne Lee’s mind was at war with itself – one voice telling her to kill herself and another telling her to live. She had just turned 14.

She tried to push the thoughts away by playing video games and listening to music. Nothing worked. Then she started cutting herself. She’d pull out a razor, make a small incision on her ankle or forearm and watch the blood seep out. “Cutting was a sharp, instant relief,” she said.

Some days, that wasn’t enough. That’s when she’d think about suicide. She wrote her feelings in a journal in big loopy letters.

At first, Wynne thought she felt sad because she was having a hard 8th grade year. She and her boyfriend broke up. Girls were spreading rumors about her. A few childhood friends abandoned her. But months passed and the feelings of helplessness and loneliness wouldn’t go away.

“I was really happy as a kid and now I was feeling like this,” she said. “It was really unfamiliar and scary.”


Wynne Lee didn’t know where her despair was coming from. The words “depression” and “suicide” were not in her vocabulary. She knew, however, that she was failing — she was defying expectations of who she was supposed to be.

Growing up in the suburbs of the San Gabriel Valley, a well-known destination for Asian immigrant families with high educational and economic aspirations, she believed she was supposed work hard, get good grades and make her Taiwanese immigrant parents proud. She wasn’t doing any of that, and she didn’t know how to ask for help.

When it comes to mental health treatment, Asian Americans often get short shrift. Researchers say they are both less well-studied and less likely to seek treatment. While rates of suicide tend to be lower than national rates overall, Asian Americans are far from homogeneous and the limited research suggests depression and suicidal impulses vary significantly depending on age, gender and national origin.

For instance: Asian American college students are more likely to seriously consider suicide than white peers. According to 2007 data from the National Center for Health statistics, Asian-American females ages 15 to 24 were second only to Native Americans for suicide deaths.  In addition, researchers have found that Asian women born in the U.S. are at significantly higher risk of suicidal thoughts and attempts than others, including women immigrants and U.S.-born men.

Because they may not see depression as a brain disease or fear stigma, many Asian immigrant families don’t reach out for help until there is a crisis, experts say. “A lot of Asians avoid seeking treatment until the disease is advanced,” said MaJose Carrasco, director of the multicultural action center for the National Alliance on Mental Illness.

And even when they do reach out, they often find both medication and psychotherapy a poor fit. Patients who seek care “are telling us is that they don’t think that psychotherapy, which is designed for white Americans, really works for them,” said Hyeouk “Chris” Hahm of Boston University, who received federal funding to test a program addressing  culture and family issues among Asian American women.

There are relatively few psychologists and other mental health professionals of Asian heritage. Other therapists may use culturally biased screening tests, or fail to recognize that symptoms of depression may be different for Asian Americans. For example, these patients are more likely to report physical symptoms such as headaches than feelings of sadness, said Nolan Zane, director of the Asian American Center on Disparities Research at University of California, Davis.

Zane added that patients from immigrant families are frequently reluctant to take medications with which they are unfamiliar. They may prefer Eastern medicines or fear side effects, including fatigue, that make it harder to keep up with work or school.

Parents sometimes stand in the way of treatment, intentionally or not, because of the high standards they set. Kids can be burdened by the sacrifices their parents have made for their benefit.

“It takes a few generations before they can finally be free,” said Ranna Parekh, director of the division of diversity and health equity for the American Psychiatric Association.


I’ve missed school for almost a week now (three days). I mean I feel really bad… — Wynne Lee’s journal, 9/15/13

At the beginning of her freshman year in high school, Wynne frequently woke up feeling exhausted and unable to get out of bed. She would curl up and go back to sleep under the red blanket she’d had since she was a toddler.

Wynne’s mom, Maggie Huang, begged her daughter to go to school. She yelled at her and took away her phone. Wynne still refused to go. “I thought she was just being lazy,” Huang said.

Altogether, Wynne missed 47 days in 9th grade — more than a quarter of the school year. She arrived late 21 days. The next year, she missed 39 days and was tardy 63 times.

Her grades fell. Administrators at Diamond Bar High School warned her that things had to change. The Los Angeles County district attorney’s office threatened her parents with prosecution because of the absences.

Huang said she and her husband believed they were doing everything they could for their three children. They didn’t know where they had gone wrong with Wynne.

They lived in a middle-class community east of Los Angeles, in a beautiful two-story home. Wynne’s father works for a mattress company. Huang stays home with Wynne and her younger brothers, helping them do homework and taking them to after-school activities and to museums and parks on weekends.

As a young girl, Wynne was good-natured and energetic, her mother said. She loved swimming and drawing; she excelled at hip hop and modern dance.  Now, Wynne was sullen and crying all the time. “I just worried,” Huang said. “I was so worried.”

But Huang didn’t know what to do.

Wynne was just finishing middle school when Huang went into her room, read her journal and saw the threats of suicide. Scared, Huang told the school counselor. A social worker came to the house to talk to the family about getting help.

Huang enrolled in a parenting class and tried to talk to her daughter more about her feelings. She asked for advice from her sister, a high school counselor in Taiwan. “She said it was a stage and that I needed to be patient,” Huang said.

But things only got worse. One afternoon Wynne asked for a ride to see a friend. She had skipped school that day and her mom said no. They argued. “I couldn’t do it anymore,” Huang said. She called the police.

Wynne ran downstairs and grabbed a bottle of prescription pills. She swallowed as many as she could.

Paramedics rushed Wynne to an emergency room; then she landed in a psychiatric facility.  She remembers sitting in a room with a huge window, coloring pictures.  Doctors told her she had depression.

Finally, Wynne had a name for what was wrong.

At the hospital, Wynne was glad to meet other girls like her. It made her feel less alone. But when she got home, her depression didn’t lift.

“The suicidal thoughts are seeping back here and there by droplets. … Therapy and counseling are so not … helping me either. All we do in these sessions is chat. I’m not feeling any better. I’m still not able to handle this at all. I’m not healing.” — Wynne Lee’s journal, 5/18/14

After the hospital, Wynne went into outpatient therapy at Pacific Clinics, a counseling and treatment agency based in Arcadia.

Maribel Contreras, the program director, said Wynne’s suicide attempt – along with the school absences, irregular sleeping and angry outbursts at her parents – made it very clear that her case was “very serious,” she said.

Wynne saw a few different therapists but didn’t feel a strong connection with any of them. She said one didn’t even take her depression seriously. The therapist treated her like “a little kid upset someone took my candy,” she said.

In art therapy, she drew her greatest fear – loneliness – as a swirl of dark colors.

Some days she came away feeling better. “There were bursts of healing,” she said. But other days, she still felt urges to hurt or kill herself. “That was the only thing I could control – whether to end my life.”

A psychiatrist suggested she take antidepressants, but Wynne rejected the idea. “I just wanted to get better on my own,” she said.

Wynne felt she made little progress in therapy and ultimately quit late last year.

At home, she rarely came downstairs to eat with her family. She feared being a burden to her family. Her 11-year-old brother, Kevin, said she often locked herself in her room. He could hear her crying. “It was hard to watch her like that,” he said.

After her grades dropped, she started on an independent study program. Being away from the drama of high school helped, Wynne said. But it also made her feel more isolated.

Huang, too, felt alone. Other Asian moms were always asking about Wynne and how she was doing in school. She felt they blamed her for Wynne’s lack of motivation.

“To them, grades are everything,” she said.

For Wynne, school wasn’t all that slipped. She started skipping practices for her hip hop team and showed up late for competitions. Unaware of Wynne’s depression, the owner of the dance studio was upset by Wynne’s lack of commitment, especially after she’d worked so hard to make the team.

“Once she achieved that goal, it seemed it meant so little to her,” the owner, Bobbi Dellos, said. “And she was so talented.”

In the end, Dellos asked Wynne to leave the team.


“‘And even when you’re ready to let go. When you’re ready to break free. When you’re ready to be brand-new. Lonliness is an old friend standing beside you in the mirror. … Loneliness is a bitter, wretched companion.’” — Wynne Lee’s journal, quoting author Tahereh Mafi, 4/6/14

Near the end of her sophomore year in high school, Wynne’s mother took her out to dinner. Sitting across from her daughter at the Cheesecake Factory, Huang told her that she loved her. She said she believed that Wynne would succeed — no matter what.

“That’s when I started to open up to her,” Wynne said.

Wynne’s feelings were beginning to shift – she didn’t know exactly why. But it helped to talk to her mom that night. She wrote in her journal afterward: “This is going to be the best summer ever.”

That fall, Pacific Clinics invited her to participate in a panel for Hollywood screenwriters and producers about mental health. “I was nervous,” Wynne said, but the experience gave her confidence. Talking to others about her depression, in general, seemed to help.

In the last few months, she said, it has been easier to control intrusive, chaotic thoughts. “I can keep them on a leash,” she said. “Before, they were everywhere.”

Although she stopped therapy, she now believes she got something from it. “I used to be hotheaded and had tough times resolving conflicts,” she wrote in her journal. “But that’s before counseling.”

Her energy returned. She took a test to graduate early from high school and enrolled in community college, where she is taking a drawing class. She started dancing again.

On a recent night, she stood in the front row at a studio in a grey tank top, picking up the routine quickly and flipping her long hair to the music. During a quick break, she caught her breath. “I feel really, really good,” she said.

Wynne said she knows that the depression, and the loneliness, may return. “I’ve accepted it as part of who I am,” she said.

But as she ran back toward the blaring music, it seemed the last thing on her mind.

Image of Brain under the influence of LSD

Lysergic acid diethylamide, AKA, LSD is probably the most famous hallucinogen. Despite the anecdotes of scary and beautiful trips, and the new age rumors of psychotropic medicinal potential, little is known about the actual, physical effects of LSD on the brain.  The drug has been under-researched, regardless of your stance on it, and in this day and age of legalization and the waning era of a completely ineffectual drug war it is hard to trust public opinion on any recreational mind altering substance. Timothy Leary’s 1960s-era writings and studies of the drug are the last true exploration – until now.

Last Summer, Carhart-Harris presented his findings after being the first UK Scientist to legally administer LSD to  human volunteers. The Misuse of Drugs Act of 1971 outlawed it for public use of any kind, including science. His presentation included a slide showing still unpublished cross-sectional brain images of a volunteer chilling in an fMRI scanner, tripping on acid. This kind of pro-LSD presentation is one of a handful from the worldwide science community that spurred the recent work of British medical researchers, lead by Imperial College London Neuropsychopharmacology Professors David Nutt and Dr Robin Carhart-Harris, who are  recording data as the drug interacts with regular healthy brains with MEG and fMRI brain scans.  It’s England’s first large-scale study of LSD in fifty years, and the first-ever study of this kind with a scientifically respectable sample size.

The study is being performed by The Beckley Foundation Psychedelic Research Programme, after crowdfunding on the website Walacea was extremely successful. The Walacea page says the money help to complete the research study which will present published results later in 2015. The crowdfunding is an important part of the story because university science budgets and government money have been slow to cover the costs of something so stigmatized by negative anecdotes.

‘Despite the incredible potential of this drug to further our understanding of the brain, political stigma has silenced research. We must not play politics with promising science that has so much potential for good’., said Prof. Nutt (Yes, that is his real name.)

LSD is in a restricted class of drugs in England where it is considered a Schedule-1 narcotic. There were a lot of legal requirements to meet before the team could get a license to use LSD on test subjects. They also needed approval from a science ethics committee to administer LSD to human subjects. After jumping through all the hoops, the researchers realized why LSD has gone so understudied. It was expensive, and they found they often had to convince people they were actually doing real science before they could get the paperwork to be taken seriously. The entire process has been slow and well-monitored, as a result.

The relatively sophisticated brain images the study hopes to produce of their subjects tripping on LSD could lead to new treatments for psychological disorders, most likely including obsessive compulsion and depression.

Jonathan Howard
Jonathan is a freelance writer living in Brooklyn, NY

Battle For Mental Health Parity Produces Mixed Results

By law, many U.S. insurance providers that offer mental health care are required to cover it just as they would cancer or diabetes treatment. But advocates say achieving this mental health parity can be a challenge. A report released last week by the National Alliance on Mental Illness found that “health insurance plans are falling short in coverage of mental health and substance abuse conditions.”

Jenny Gold of Kaiser Health News spoke with NPR’s Arun Rath over the weekend about the issue. She noted that many patients have trouble getting their mental health care covered, and she outlined some of the issues confronting both patients and the insurance industry. Here is an edited transcript of her comments.

Mental Health Parity

Where does parity stand?

It’s been a mixed bag so far. Insurance companies often used to have a separate deductible or a higher copay for mental health and substance abuse visits.  Right now, that usually isn’t the case. In that way, insurers really have complied.

But in more subtle ways , advocates are saying they’re really not complying. For example, insurance companies, in order to keep down costs, will do things called “medical necessity” reviews. Basically, they look at someone’s care and ask is it really medically necessary. Advocates say they’re applying those sorts of cost-control techniques more stringently on the mental health side and the substance abuse side than they are on the physical health side. So people are still having trouble getting their care covered.

For insurers, isn’t it legitimate to say that it’s more difficult to say something is medically necessary when we’re talking about mental health?

Insurance companies are arguing this is a really hard law to implement. Clare Krusing, a spokeswoman for America’s Health Insurance Plans, the insurance industry’s main trade group, says the plans are doing their best to make this work.

“The plans have made tremendous steps since the final rules have come out to implement these changes and requirements in a way that is affordable for patients,” Krusing said. “And again this goes back to the fact that we are at a point where health care costs continue to go up.”

She also said that it’s hard to compare mental and physical health care, that those are two really different things, sort of apples and oranges. It’s hard to make them exactly equal when treatment often doesn’t line up, she said, and success can be harder to measure on the mental health side.

How are things going for patients?

Advocates, patients and lawyers say it’s not going well for patients and that we’ve got something that looks like mental health parity in name only. A National Alliance on Mental Illness poll found that consumers said they were twice as likely to get their mental health care denied than their medical care, which suggests that insurance companies still aren’t equating the two.

Carol McDaid, an advocate who runs the Parity Implementation Coalition, noted that her group has a helpline to take complaints from people who are having trouble getting their care covered. “They end up with this perception that they have access to care, but when they’re in a crisis for themselves or their loved one, lo and behold, the care’s not available because of these cost-control techniques,” McDaid said.

Do patients know what their rights are?

It’s hard for people to bring a complaint. To prove there’s been a violation, you have to look at how an insurance company makes decisions on the mental health side and then compare that to how they make determinations for medical and surgical treatments. And insurance companies often won’t give up those documents to be analyzed.

In addition, for a consumer to make a complaint, it means coming forward and acknowledging that they have a mental illness. There’s still a lot of stigma about these conditions. Sometimes it’s hard for people to step forward, especially when it means telling their employers.

How are states and groups reacting?

There are a handful of states that are taking some enforcement actions, including New York, which has reached settlements with some insurance companies, and California. Also, there are many individual and class action lawsuits against insurance companies alleging that they are violating mental health and substance abuse parity law. And so that may end up being the way it starts getting enforced.

Awe May Be A Natural Anti-Inflammatory

The beauty of a night sky or painting may lower risk for inflammation, found a study published in the journal Emotion. Researchers conducted two experiments designed to measure the affect positive emotions, such as amusement, awe, compassion, contentment, joy, love, and pride, have on the cytokine Interleukin-6 (IL-6), a marker for inflammation. More than 200 young… Continue reading

Steroids Almost Drove One Woman to Suicide

This is the story of Jane. A healthy, stable woman in her twenties who, only weeks after moving from a rural town in Wisconsin landed the job of her dreams in the Big Apple, otherwise known as the city that never sleeps. I mention that, because it runs parallel to Jane’s initial experiences in New York: for the first couple of weeks after her uprooting, Jane wasn’t sleeping either. Not only that, Jane was facing a dangerous depression. A meloncholoy that got worse and worse every day, to the the point she found herself spending her days on the couch, immobile to the point she could not even muster up the emotional strength to answer the phone. It wasn’t long before Jane became suicidal and found herself in a hospital after spending an hour or so on the ledge of her building, ready to jump and end it all.


Of course, the big question here is why. Why would a woman who had already undergone the stress of moving from a little town to the most threatening city of them all and on top of that, land her dream job in a well-known advertising company want to end her life? There is one notable glitch: since the move, Jane had developed asthma, an extrememly common occurence among transplants to an urban environment with poor air quality. After multiple attempts at treating her new breathing ailment with inhalers all of which proved ineffective, her doctor prescribed an oral steroid – et voila! it worked.

But that’s when the weird stuff started happening. Just a week or two after beginning the medication, Jane woke up one morning to a sudden rush of overwhelming and heavy sadness – nothing, she explained, like she had ever encountered before. She could not think of anything that would explain this very sudden and very intense despair. Within a day, the funk got bluer. She sat on the couch and didn’t move, and when it was time to go to bed, she couldn’t sleep and therefore resumed her intitial position on the couch. Jane stopped eating and drinking, cried uncontrollably and remained there in a catatonic state, and by the next day, the suicidal thoughts came creeping in. While the idea was a surprise to normal Jane, to depressed Jane, it seemed awfully alluring and relieving. Depressed Jane won over, and before she knew it, she found herself teeterng on the edge of her window sill deciding whether or not to take the plunge. Thankfully, in a sudden state of terror, Jane pulled herself back into her apartment and called 911.


When confronted with Jane’s story, the doctor in the ER was perplexed. Most suicide attempts, as you can imagine, are usually triggered by traumatic events such as a bad break-up, a death in the family, and so on. But in Jane’s case, just the opposite was true. While Jane’s doctor first thought of bi-polar disorder or some type of mania, the diagnosis didn’t seem to fit her case. Although she descried herself as feeling “euphoric” prior to the depressive episode, the euphoria was mild and not accompanied by the disorganized thoughts and behavior that go hand-in-hand with such a diagnosis. Further, her functioning was normal up to the episode, and she had no history of psychiatric illness at all. Jane was then asked what type of medications she’d been on, to which she replied “none”. She explained that she had been prescribed asthma medication but that she was “done with it”. Because asthma is a chronic condition, Jane’s doctor thought her answer to be a little off the mark. With a little more research including a call to her pharmacy, it was discovered that she had in fact been prescribed a high dose of oral steroids for a week along with a second prescription for a tapering dose of the same medication – but Jane never picked up that second prescription.

The medication that Jane had been prescribed was a corticosteroid, alternately known simply as a steroid. Corticosteroids are very powerful hormones produced by our adrenal glands  and physicians are known to prescribe them as inti-inflammatory drugs, in this case to reduce the inflammation in Jane’s lungs that was happening due to her asthma. Steroids have an array of physiological effects, including regulating the immune system and metabolism. When a person is on steroids, her adrenal glands don’t function as diligently as they would were she not on them. The body recognizes these drugs and in response, cuts back on the amount of steroids it would normally produce. Sometimes, it stops producing these hormones altogether. If a person stops taking these steroids, the adrenal glands will wake up, but this waking up process is sort of like trying to get an adolescent out of bed – it takes time, and sometimes, lots of time. Most high-dose steroids need to be tapered over weeks or months to give the adrenal glands time to “get out of bed” and start functioning again. In the case of Jane, it’s safe to say that when she stopped taking her steroids, her adrenal glands got all wonky and needed way more time than was allowed to wake up.


Steroids are also known to alter mood and behavior, sometimes creating extreme happiness, other times creating severe depression – which is what happened to Jane. These medications are so powerful in fact, that they can even trigger psychosis, extreme anger – and yes, thoughts of suicide. It is more than likely that this is what happened to Jane. She had been on the medication long enough to supress her adrenal glands, and when she stopped taking them, the sudden and severe drop in her blood steroid levels was catastrophic enough to cause her to spiral into a deep dpression that led to suicidal behavior.

Jane was monitored by psychiatrists for a couple of days, and when they restarted her on the steroids, it was like night and day. The depressed, desheveled Jane that had been rolled into the ER after a suicide attempt had transformed into a cheerful (nonetheless unnerved), articulate woman who clearly did not belong on a psychiatric ward. She was discharged within a short period of time, after a slow steroid taper to allow her adrenal glands to start working on their own again.

The story of Jane ends here. It is a not only a clear illustration of how a quick analysis of her symptoms could have led to a misdiagnosis of a primary psychiatric disorder, but a lesson about  the danger of medication when not taken appropriately. There are lots of close calls when it comes to medications and their effects – but this one comes a little too close to the ledge.

How music helps resolve our deepest inner conflicts

Billions of people enjoy music; many feel that they can’t live without it.


It’s a question that has puzzled scientists and philosophers for centuries. 2,400 years ago Aristotle wondered, “Why does music, being just sounds, remind us of the states of our soul?”

In the 19th century Darwin tried to decipher if our ability to create music evolved by natural selection. Of all human faculties, only music seemed beyond understanding; flummoxed, he came to the conclusion that “music is the greatest mystery.”

More than 200 years ago, Kant declared music useless. And near the end of the 20th century, celebrated psychologist Steven Pinker – also unable to comprehend its purpose – called music “auditory cheesecake.”

A few years ago, the respected journal Nature published a series of essays about music. Their conclusion? That it’s impossible to explain what music is and why it affects us so strongly – and that it’s not even clear if music can serve “an obvious adaptive function.”

But my recent research suggests otherwise: music is an evolutionary adaptation, one that helps us navigate a world rife with contradictions.

The crippling effect of cognitive dissonance

Music’s effect on our brains is closely related to what’s been dubbed “the greatest discovery in social psychology” of the 20th century: cognitive dissonance. Cognitive dissonance is the idea that people experience unpleasant feelings when they either possess contradictory knowledge, or are confronted with new information that opposes existing beliefs.

One way we alleviate dissonance is through suppressing or rejecting this contradictory knowledge.

Aesop’s fable “The Fox and the Grapes” illustrates this common human response. In the tale, the fox is distressed over the fact that he can’t reach a bunch of grapes. Even more unpleasant is the dissonance he experiences: the grapes are so tempting and so close – yet unattainable.

‘If I can’t have it, I don’t want it’: the fable ‘The Fox and the Grapes’ illustrates cognitive dissonance, a core human response to conflicting information.
Wikimedia Commons

As a result, the fox attempts to alleviate the dissonance by rationalizing, “Oh, you aren’t even ripe yet! I don’t need any sour grapes.”

During the 20th century hundreds of experiments confirmed this common psychological response. When faced with dissonant thoughts, children, teens and adults all responded the same way: if I can’t have it, then I don’t need it.

A manifestation of cognitive dissonance is the rejection of new knowledge. Even some great scientific discoveries have had to wait decades for recognition and acceptance, because they contradicted existing beliefs that people didn’t want to surrender. For example, Einstein didn’t receive a Nobel Prize for his Theory of Relativity – now considered one of the greatest discoveries in the history of mankind – because it contradicted our core beliefs about space and time.

Music helps us grapple with dissonance

So if people are willing to deceive themselves or ignore new information, how has human culture evolved? After all, the foundation of culture is the accumulation of new knowledge – much of which contradicts existing knowledge.

Consider language: when language emerged in our species, every new word was a nugget of new information that contradicted an existing idea or belief. A powerful mechanism of the mind must have evolved to enable our ancestors to overcome these unpleasant dissonances that split their world, and allowed them to keep contradictory knowledge – to absorb new words rather than immediately discarding them.

Could it be that this ability was enabled by music?
While language splits the world into detailed, distinct pieces, music unifies the world into a whole. Our psyche requires both.

Several experiments have proven music’s ability to help us overcome cognitive dissonances and retain contradictory knowledge.

For example, in one experiment, an experimenter gave a group of four-year-old boys five popular Pokemon toys. Playing with each boy individually, she had them rank, one by one, their preferences for the five toys. Then the experimenter told each subject that she needed to leave for few minutes, and asked him not to play with his second-ranked toy. When she returned, she re-initiated play and found that the formerly second-ranked toy was entirely ignored. When confronted with conflicting information (“I like this toy, but I shouldn’t play with it”), each boy apparently rejected his initial preference for it.

But when the experimenter turned on music when leaving, the toy retained its original value. The contradictory knowledge didn’t lead the boys to simply discard the toy.

In another experiment, we gave a group of fifteen-year-old students a typical multiple choice exam, and asked them to record the difficulty of each question, along with how much time it took them to answer each one.

It turned out that more difficult questions were answered faster (and grades suffered), because students didn’t want to prolong unpleasant dissonance of choosing between difficult options. However when Mozart’s music played in the background, they spent more time on the difficult questions. Their scores improved.

Life’s big choices become more informed

Beyond multiple choice tests, we’re constantly confronted with choices in our day-to-day lives – from the mundane (what to buy for lunch), to the major (whether or not to accept a job offer). We often use both intuition and pragmatism when evaluating complex situations, but we also incorporate emotion.

And then there are choices related to two universal themes of our existence – love and death – which are inherently steeped in contradictions.

With love, we’d like to fully trust it. But we know that to fully trust is dangerous – that we can be betrayed and disappointed. With death, one of the most difficult contradictions of all is our longing to believe in spiritual eternity and our knowledge that our time on Earth is finite.

Is it any coincidence, then, that there are so many songs about love and betrayal? Or that we are drawn to sorrowful songs in times of mourning?

The idea is that music – which can convey an array of nuanced emotions – helps us reconcile our own conflicted emotions when making choices. And the more diverse, differentiated emotions we possess, the more well-founded our decisions become. Whether it’s choosing to play with a toy or deciding to propose to a boyfriend or girlfriend, our research shows that music can enhance our cognitive abilities.

Thus, because we constantly grapple with cognitive dissonances, we created music, in part, to help us tolerate – and overcome – them.

And this is the universal purpose of music.

The Conversation

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Why anti-vaxxers just ‘know’ they’re right

Anti-vaccination beliefs can cause real, substantive harm, as shown by the recent outbreak of measles in the US. These developments are as shocking and distressing as their consequences are predictable. But if the consequences are so predictable, why do the beliefs persist?

It is not simply that anti-vaxxers don’t understand how vaccines work (some of them may not, but not all of them). Neither are anti-vaxxers simply resistant to all of modern medicine (I’m sure that many of them still take pain killers when they need to). So the matter is not as simple as plain stupidity. Some anti-vaxxers are not that stupid, and some stupid people are not anti-vaxxers. There is something more subtle going on.

Naïve theories

We all have what psychologists call “folk” theories, or “naïve” theories, of how the world works. You do not need to learn Newton’s laws to believe that an object will fall to the floor if there is nothing to support it. This is just something you “know” by virtue of being human. It is part of our naïve physics, and it gives us good predictions of what will happen to medium-sized objects on planet earth.

Naïve physics is not such a good guide outside of this environment. Academic physics, which deals with very large and very small objects, and with the universe beyond our own planet, often produces findings that are an affront to common sense.

A life force.
Food by Shutterstock

As well as physics, we also have naïve theories about the natural world (naïve biology) and the social world (naïve psychology). An example of naïve biology is “vitalistic causality” – the intuitive belief that a vital power or life force, acquired from food and water, is what makes humans active, prevents them from being taken ill, and enables them to grow. Children have this belief from a very young age.

Naïve theories of all kinds tend to persist even in the face of contradictory arguments and evidence. Interestingly, they persist even in the minds of those who, at a more reflexive level of understanding, know them to be false.

In one study, adults were asked to determine, as quickly as possible, whether a statement was scientifically true or false. These statements were either scientifically true and naïvely true (“A moving bullet loses speed”), scientifically true but naïvely false (“A moving bullet loses height”), scientifically false but naïvely true (“A moving bullet loses force”), or scientifically false and naïvely false (“A moving bullet loses weight”).

Adults with a high degree of science education got the questions right, but were significantly slower to answer when the naïve theory contradicted their scientific understanding. Scientific understanding does not replace naïve theories, it just suppresses them.

Sticky ideas

As ideas spread through a population, some stick and become common, while others do not. The science of how and why ideas spread through populations is called cultural epidemiology. More and more results in this area are showing how naïve theories play a major role in making some ideas stickier than others. Just as we have a natural biological vulnerability to some bacteria and not others, we have a natural psychological vulnerability to some ideas and not others. Some beliefs, good and bad, are just plain infectious.

Here is an example. Bloodletting persisted in the West for centuries, even though it was more often than not harmful to the patient. A recent survey of the ethnographic data showed that bloodletting has been practiced in one form or another in many unrelated cultures, across the whole world.

Peter Merholz, CC BY-SA

A follow-up experiment showed how stories that do not originally have any mention of bloodletting (for instance, about an accidental cut) can, when repeated over and over again, become stories about bloodletting, even among individuals with no cultural experience of bloodletting.

These results cannot be explained by bloodletting’s medical efficiency (since it is harmful), or by the perceived prestige of western physicians (since many of the populations surveyed had no exposure to them). Instead, the cultural success of bloodletting is due to the fact that it chimes with our naïve biology, and in particular with our intuitive ideas of vitalistic causality.

Bloodletting is a natural response to a naïve belief that the individual’s life force has been polluted in some way, and that this pollution must be removed. Anti-vaccination beliefs are a natural complement to this: vaccinations are a potential poison that must be kept from the body at all costs.

At an intuitive, naïve level we can all identify with these beliefs. That is why they can satirised in mainstream entertainment.

In Stanley Kubrick’s great comedy Dr. Strangelove, the American general Jack D. Ripper explains to Lionel Mandrake, a group captain in the Royal Air Force, that he only drinks “distilled water, or rainwater, and only pure grain alcohol”, because, he believes, tap water is being deliberately infected by Communists to “sap and impurify all of our precious bodily fluids”. The joke works because Ripper’s paranoia is directed at something we all recognise: the need to keep our bodies free from harmful, alien substances. Anti-vaxxers think they are doing the same.

The Conversation

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