Using Digital To Address The Mental Health ‘Silent Epidemic’

Digital tools and platforms are a natural fit for overcoming the top barriers to getting mental healthcare: accessibility, cost and social stigma, says Emily Thayer, a Senior Consultant within Cognizant Consulting’s Healthcare Practice.

Untreated mental health conditions have long been a top healthcare concern. In 2019, fewer than half of Americans with a diagnosed mental illness received treatment for that condition, according to the US National Institute of Mental Health.

Not only is untreated mental illness detrimental to patients’ health — it’s also a strain on national healthcare costs. In fact, mental health disorders cost the US economy an estimated $4.6 billion per year in unnecessary ER visits and $300 billion in lost workplace productivity, making mental health disorders among the most costly untreated conditions in the US.

The pandemic has only accelerated the need for care — according to a Kaiser Family Foundation study, over 40% of US adults reported symptoms of anxiety or depression in January 2021, compared with 11% in the first six months of 2019. Given the well-documented therapist shortages that have resulted, the concern of connecting patients with care has only grown more acute.

It’s no wonder, then, that interest and investment are growing in digitally oriented mental healthcare, from platforms that match therapists with patients, to chatbots, to online cognitive behavioral therapy tools. Although emerging digital solutions are nascent and will inevitably encounter friction, virtual remedies show great promise in lowering the barriers that both practitioners and patients face.

Consider how digital tools can address the top three factors that have historically kept patients from seeking mental health care: accessibility, cost and social stigma.

Improving accessibility to mental health treatment

As of May 2021, over 125 million Americans live in a behavioral or mental health professional shortage area. This gap will continue to widen as the pandemic exacerbates the therapist shortage.

To expand accessibility to behavioral health services, companies like Quartet and Talkspace are using telehealth platforms to connect patients and therapists. By leveraging clinical algorithms, these platforms identify available therapists based on the patient’s symptoms, state of residence (due to cross-state licensing restrictions), insurance carrier, preferred mode of communication (synchronous video or audio and asynchronous text messaging) and desired appointment cadence.

In other words, if you have a connected device, you can receive on-demand care for your behavioral health condition. Digital accessibility also addresses physician shortages and burnout on a national scale.

As these entities are still relatively new to the market, challenges and questions remain, such as the fundamental disconnect between virtual treatment and physician intervention in a clinical setting. As patient adoption grows, enough accurate data will be generated to prompt when physician intervention is necessary.

Additionally, these telehealth platforms are more geared toward mild cases, as these services do not replace the necessary stages of the care continuum that may be needed for more serious mental health conditions such as schizophrenia and bipolar disorder.

Lowering behavioral healthcare costs

An estimated 47% of US adults with an untreated behavioral or mental health illness do not seek treatment due to high costs.

Many entities in the private and public sectors are turning to virtual services to help patients better afford behavioral and mental health services. For instance, traditional in-person therapy ranges from $64 to $250 per hour, depending on patient insurance, whereas digital solutions can cost under $32 per hour.

Accordingly, many workplaces are incorporating digital solutions into their employee-sponsored health plans through health platforms like Ginger, which offers 24×7 access to behavioral health coaches via asynchronous texting for low-acuity conditions like anxiety and depression.

Recent moves by the federal government further bolster the effort to make behavioral healthcare affordable. In addition to the US Department of Health and Human Services announcing an additional $3 billion in funding to address pandemic-related behavioral and mental health issues, the Biden administration has signaled commitment to expanding access to telehealth services for underserved communities. Such efforts will need to be combined with further work in the private sector to ensure mental healthcare affordability through virtual means.

Overcoming negative social stigma

Perceived social stigma is an additional barrier for many people seeking mental health treatment. In a study of patients with schizophrenia, 86% of respondents reported concealing their illness due to fears of prejudice or discrimination.

To circumvent these challenges, some mental health providers have embraced artificial intelligence (AI) chatbots and online cognitive behavioral therapy (CBT) tools. Although chatting with a bot may seem counterintuitive to the “high-touch” nature of the healthcare industry, the anonymity of this approach can ease patient anxiety about opening up to another potentially judgmental human.

In a randomized control trial with a conversational agent that delivers CBT treatment, patients reported a 22% reduction in depression and anxiety within the first two weeks. This study shows promise for the effectiveness of chatbot-based therapy, particularly for younger generations, many of whom already share many intimate details of their lives on digital forums and hence have a higher level of acceptance of these tools. Older generations may view the adoption of this new behavioral care model with more incredulity and hesitancy.

A virtual future for behavioral healthcare

It is clear that the virtual care industry is poised for future growth, as there is a clear correlation between our understanding of behavioral healthcare challenges and the evolution of treatment modalities to bridge those gaps.

While digital services may not be a cure-all remedy for behavioral health, they certainly offer a promising long-term solution to one of the country’s most prominent and costly diseases.

To learn more, visit our Healthcare solutions section or contact us.

Emily Thayer is a Senior Consultant within Cognizant Consulting’s Healthcare Practice, who specializes in driving digital transformation. Emily has a proven track record in both the private and public sectors, most notably in health plan strategy and operations, business development and project management. Emily earned her bachelor’s degree in business management and psychology from the University of Nebraska-Lincoln and University of Oxford, and an MBA from Washington University in St. Louis. She can be reached at Emily.Thayer@cognizant.com

Source: Using Digital To Address The Mental Health ‘Silent Epidemic’

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Neuroscientist: Do These 6 Exercises Everyday To Build Resilience and Mental Strength

When I first began researching anxiety in my lab as a neuroscientist, I never thought of myself as an anxious person. That is, until I started noticing the words used by my subjects, colleagues, friends and even myself to describe how we were feeling — “worried,” “on edge,” stressed out,” “distracted,” “nervous,” “ready to give up.”

But what I’ve found over the years is that the most powerful way to combat anxiety is to consistently work on building your resilience and mental strength. Along the way, you’ll learn to appreciate or even welcome certain kinds of mistakes for all the new information they bring you.

Here are six daily exercises I use to build my resilience and mental strength:

1. Visualize positive outcomes

At the beginning or at the end of each day, think through all those uncertain situations currently in your life — both big and small. Will I get a good performance review? Will my kid settle well in his new school? Will I hear back after my job interview?

Now take each of those and visualize the most optimistic and amazing outcome to the situation. Not just the “okay” outcome, but the best possible one you could imagine.

This isn’t to set you up for an even bigger disappointment if you don’t end up getting the job offer. Instead, it should build the muscle of expecting the positive outcome and might even open up ideas for what more you might do to create that outcome of your dreams.

2. Turn anxiety into progress

Our brain’s plasticity is what enables us to be resilient during challenging times — to learn how to calm down, reassess situations, reframe our thoughts and make smarter decisions.

And it’s easier to take advantage of this when we remind ourselves that anxiety doesn’t always have to be bad. Consider the below:

  • Anger could block your attention and ability to perform, OR it could fuel and motivate you; sharpen your attention; and serve as a reminder of what’s important.
  • Fear could trigger memories of past failures; rob your attention and focus; and undermine your performance, OR it could make you more careful about your decisions; deepen your reflection; and create opportunities for changing direction.
  • Sadness could flatten out your mood and demotivate you, OR it could help you reprioritize and motivate you to change your environment, circumstances and behavior.
  • Worry could make you procrastinate and get in the way of accomplishing goals, OR it could help you fine-tune your plans; adjust your expectations; and become more realistic and goal-oriented.
  • Frustration could stymie your progress and steal your motivation, OR it could innervate and challenge you to do more or better.

These comparisons may seem simplistic, but they point to powerful choices that produce tangible outcomes.

3. Try something new

These days, it’s easier than ever to take a new online class, join a local sports club or participate in a virtual event.

Not too long ago, I joined Wimbledon champ Venus Williams in an Instagram Live workout, where she was using Prosecco bottles as her weights. I’d never done something like that before. It turned out to be a fantastic and memorable experience.

My point is that for free (or only a small fee) you can push your brain and body to try something you never would have considered before. It doesn’t have to be a workout, and it doesn’t have to be hard — it can be something right above your level or just slightly outside of your comfort zone.

4. Reach out

Being able to ask for help, staying connected to friends and family, and actively nurturing supportive, encouraging relationships not only enables you to keep anxiety at bay, but also shores up the sense that you’re not alone.

It isn’t easy to cultivate, but the belief and feeling that you are surrounded by people who care about you is crucial during times of enormous stress — when you need to fall back on your own resilience in order to persevere and maintain your well-being.

When we are suffering from loss or other forms of distress, it’s natural to withdraw. We even see this kind of behavior in animals who are mourning. Yet you also have the power to push yourself into the loving embrace of those who can help take care of you.

5. Practice positive self-tweeting

Lin-Manual Miranda published a book about the tweets he sends out at the beginning and end of each day. In it, he shares what are essentially upbeat little messages that are funny, singsongy and generally delightful.

If you watch him in his interviews, you’ll see an inherently mentally strong and optimistic person. How do you get to be that resilient, productive and creative?

Clearly, part of the answer is coming up with positive reminders. You don’t necessarily need to share them with the public. The idea is to boost yourself up at the beginning and at the end of the day.

This can be difficult for those of us who automatically beat ourselves up at the drop of a hat. Instead, think about what your biggest supporter in life — a partner, sibling, friend, mentor or parent — would tell you, and then tweet or say it to yourself.

6. Immerse yourself in nature

Science has shown again and again that spending time in nature has positive effects on our mental health. A 2015 study, for example, found that it can significantly increased your emotional well-being and resilience.

You don’t need live next to a forest to immerse yourself in nature. A nearby park or any quiet environment with greenery where there aren’t that many people around will work just fine.

Breathe, relax and become aware of the sounds, smells and sights. Use all your senses to create a heightened awareness of the natural world. This exercise boosts your overall resilience as it acts as a kind of restoration of energy and reset to your equilibrium.

 

By: Wendy Suzuki, Contributor

 

Wendy Suzuki, PhD, is a neuroscientist and professor of Neural Science and Psychology in the Center for Neural Science at New York University. She is also the author of “Good Anxiety: Harnessing the Power of the Most Misunderstood Emotion.” Follow her on Twitter @wasuzuki.

Source: Neuroscientist: Do these 6 exercises every day to build resilience and mental strength

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Neurodiversity is Not Enough. We Should Embrace Psydiversity

The concept of ‘neurodiversity’ has gained enormous cultural influence in recent years. Computer scientists and ‘techies’ wear the ‘neurodiverse’ label with pride; businesses are building ‘neurodiverse’ workforces; scriptwriters strive to represent and cast ‘neurodivergent’ people. Those framed as ‘different’ have been given a remarkable new lens through which to reimagine that variance.

The sociologist Judy Singer coined the term ‘neurodiversity’ in the late 1990s. Inspired by other emancipatory social movements based on race and gender, Singer used her standing as an autistic person to rally together neurodivergent people. This was partly a response to what Singer called the ‘social constructivist’ view of autism, where the condition was seen as having no solid biological basis.

This denied the reality of neurological difference, according to Singer. In reply, she offered up ‘neurodiversity’ in the spirit of biodiversity, in that it recognized and respected natural variance among humans. The movement quickly gained support via online forums and new social networks. Since Singer’s first use of the term, neurodiversity has widened beyond autism to include people who identify with categories such as attention deficit hyperactivity disorder (ADHD), dyslexia, bipolar disorder, depression and more.

It’s come to mean any real mental differences – neither choices nor simply illnesses – that aren’t problems to solve so much as enrichments for society. Neurodiversity has done brilliant work in breaking down social barriers, challenging stigmas, and raising awareness. But it also contains limitations, and these are becoming increasingly prominent as the concept expands into new domains.

The main premise of the neurodiversity movement is that society should be robust enough to embrace and celebrate all people, no matter how their brains are ‘wired’. That’s a laudable goal and shouldn’t be tricky for anyone to wrap their head around. Yet since the beginning, critics of neurodiversity have claimed that its mantra of radical acceptance could hinder treatments and interventions for those who are suffering. Embracing neurodivergent thought too enthusiastically, they say, risks distracting from genuine physical, emotional or social needs that require attention.

This debate quickly descends into unhelpful recriminations. But it also distracts from a deeper philosophical problem that neurodiversity must confront as it expands into new territory. Neurodiversity’s vision of inclusion, alluring as it is, tends to rely on the idea that neural wiring is at the root of all differences in how humans relate to the world. But reducing diversity to brain-based distinctions can stand in the way of more sensitive and potentially fruitful ways of understanding mental life.

In fact, the success of neurodiversity has exposed the glaring lack of any shared vision or sense of solidarity around mental difference that isn’t anchored in brain-based accounts. So while we can applaud neurodiversity’s ethos of acceptance, we should question its commitment to achieving legitimacy through false ‘neuro’ certainties.

There is a different way forward, in which we fashion our political advocacy and scientific reasoning not on the brain but the ‘mind’. I call this programme ‘psydiversity’. Psydiversity rejects the claim that mental states can be cleanly and predictably mapped on to the brain. Instead, it augments the valuable work of neurodiversity by demonstrating that mental processes and the way we understand them change and evolve through history.

Indeed, psydiversity holds that the mind and ‘human nature’ are not unitary things, but are profoundly embedded and even constituted by the society and context in which they appear. That isn’t to deny the reality of difference, but rather to situate this reality as part of an unfolding social and historical process.

If there’s one aspect of neurodiversity that’s core to its agenda, it’s the ‘neuro’ prefix. The term ‘neuro’ actually stems from the ancient Greek ‘neûron’ or the Latin ‘nervus’, defining nerves or the nervous system. Contemporary neuroscientific approaches have their origins in the early 19th century, when physiologists such as Franz Joseph Gall, Charles Bell, and François Magendie used a combination of human anatomical studies and terrifying animal vivisections to identify the relation between brain, spinal cord and nervous system.

By the early 20th century, neurologists had created detailed maps of the brain and nervous system, and had named many distinct conditions such as cerebral palsy and hemiplegia. It wasn’t until the 1990s, though, that the brain sciences began to really assert themselves in other branches of human knowledge. Via new imaging and genomic testing technologies, evidence emerged that differences in human emotion and behaviour could be traced to differences within people’s brains.

This spawned a number of ‘neuro-’ prefixes that could be attached to subjects as disparate as ‘neuroeducation’, ‘neuroethics’, ‘neuroanthroplogy’, ‘neuroaesthetics’ and ‘neurolaw’. The former US president George Bush called the 1990s the ‘decade of the brain’, while the philosophers Fernando Vidal and Francisco Ortega declared that the neurosciences were leading us to believe that ‘we are our brains’.

Once a treatment or medical tool exists, social, financial and political forces tend to push up diagnoses. All this fervour sprang from the belief that brain-based sciences and genetic research could transform society for the better. When the Dutch geneticist Han Brunner claimed that deficiencies in the MAOA gene could be responsible for an increased propensity to violence, this inspired hopes that moral judgments about ‘good’ and ‘bad’ behaviour could be transformed into progressive scientific research and treatment.

There would be no more ‘evil’ people, merely malfunctioning brains. If human motivation could be identified at the molecular level, it could also be changed. From the 1990s, the neuroscientific dream was that unique behaviours and ‘mental disorders’ could be correlated with brain states and treated accordingly. In reality, though, most psychiatric diagnoses or conditions are not stable or static, don’t have simple ‘watermarks’ in the brain, and are often very difficult to treat.

What’s more, drug developments have often preceded the refinement of psychiatric categories and, disturbingly, treatments tend to lead to increased diagnosis – the opposite of the neuroscientific fantasy. This was the case with ADHD, where the development of amphetamine treatments coincided with large increases in diagnosis, while rates of depression moved in line with the production of Prozac and other antidepressant drugs.

The disquieting truth is that, once a treatment or medical tool exists, social, financial and political forces tend to push up diagnoses. The Diagnostic and Statistical Manual of Mental Disorders (DSM) – the medical textbook that serves as the basis for most real-world psychiatric diagnoses but also most neuroscientific laboratory studies – is by no means an impeccable diagnostic tool, as the psychiatrist Allen Frances and others have argued.

Drug companies might tout theories that brain- and drug-based theories will be a panacea for all forms of mental suffering, but we are a long, long way from that becoming a reality. While this ‘neuro’ revolution didn’t ever come to fruition, it still opened the door for new dreams and aspirations. It was in this context that ‘neurodiversity’ came into being. While neurodiversity advocates can be critical of mainstream neuroscience and psychiatry, they have also created a curious alliance with these same disciplines.

Starting with its reframing of autism, the neurodiversity movement latched on to the scientific legitimacy of both the neurosciences and the DSM, without really acknowledging the critiques and other, competing interpretations of human mental life. It’s striking that autism itself is unique in the DSM. No other diagnosis spread so rapidly throughout the 1980s and ’90s. Most importantly, its expansion had nothing to do with the production of drugs, as in the cases of ADHD and depression.

The autism category is something of an anomaly, yet ironically it’s this anomaly that sparked the entire neurodiversity movement, which is now growing to encompass an increasing number of other DSM diagnoses. When neurodiversity originated, its dismissal of earlier psychological sciences was very much intentional. As an autistic woman in the 1990s, Singer understandably wanted a clean slate when it came to defining her identity. The dominant discourse around autism often involved blaming mothers for creating the condition in their children, drawing on the work of a number of postwar male psychologists such as Bruno Bettelheim.

By the 1970s, a new generation of psychologists argued that these claims were outlandish, because they did not even contain a clear definition of what autism was. Lorna Wing, a psychologist and the mother of an autistic child, then worked tirelessly to correct the conceptual drift by creating a standardized definition of autism as a kind of social and communication ‘impairment’. This was the definition that was solidified in the DSM in the 1980s, and which in turn invited genetic explanations.

Autism diagnoses shot up in line with the destruction of the postwar welfare state. Coming across all these descriptions and definitions in the 1990s, Singer was well placed to make her own claims of the development of her own identity. She didn’t want to adopt former models of psychological development that pathologised mothers and benign psychological differences. Yet she also didn’t want to adopt the label of ‘impaired’. The neurodiversity movement allowed for a new form of identity that was psychologically distinct, but didn’t see its members as lacking in some way.

Political categories are always a response to the conditions in which they arise. Singer sensed that her personal identity was under threat, and so rapidly set up a new framework on which to build a fresh one. As I have argued before, the diagnosis of autism slotted neatly into a neoliberal model of social welfare in the 1990s, where only those with defined social disabilities or ‘impairments’ received any social support.

In the UK, the US, Australia and elsewhere, these two factors combined such that autism diagnoses shot up in line with the destruction of the postwar welfare state. So when Singer advocated for political representation for autistic people in the 1990s, she could do so only because autistic people had already become a political class. Singer merely rallied the crowds, and she did so under the banner of neurodiversity.

What’s so wrong with brain-based or ‘neuro’ accounts anyway? All explanations of this sort rest on the premise that the brain gives us access to a scientific reality that can then be projected out on to the world to explain the immensity and range of human experience. This satisfies our craving for absolutes and certainties, and can even be the foundation of solidarity and meaningful identities. Yet human categories are almost always contingent, messy, uncertain affairs.

In fact, there are a number of other scientific models and working hypotheses that could help us get a handle on psychological development, although Singer relegated them to the bottom of the class. These are the ‘psy’ sciences we know today – psychology, psychoanalysis, psychiatry, psychotherapy. Just as ‘neuro’ has its origins in the Greek for ‘nerves’, ‘psy’ has its origins in the Greek for ‘psyche’, meaning the soul, mind or life.

The ‘psy’ sciences as we know them today sprang up in the decades either side of 1900, fuelled by Sigmund Freud’s ‘discovery’ of the unconscious. Freud exploded comfortable Western notions of the rational minds steering human history on an upward path to progress Enlightenment. Instead, he posited a theory of unconscious motivation, in which human beings were driven by ingrained, instinctual urges. These principles had a profound influence on educators, bureaucrats and governments across the world.

A strong adherence to ‘neuro’ explanations leaves scant room for wider theories of unconscious motivation. For most of the 20th century, ‘psy’ sciences dominated theorisations of the brain and nervous system. The creation of IQ testing in France in 1905 set the scene for the massive expansion of psychological sciences. In the early 1900s, psychological laboratories, institutions and departments began to be established, and psychologists distinguished themselves as a professional group.

Compulsory education and the growth of new communication technologies such as film, radio and TV in modern democracies supported this spread. ‘Psy’ sciences made huge contributions to all theorisations of the self, and of identity, and continue to be influential in the governance of everyday life via social, medical and legal services. For example, the creation of the juvenile court in the UK in 1908 united ‘psy’ and legal professionals to reframe juvenile crime in terms of psychological motivation rather than moral failing. It encouraged psychological programmes in schools, health centres and social service departments, a model that many other industrialised nations soon followed.

Crucially, earlier ‘psy’ sciences paid particular attention to how the mind adapted instinctual urges to cope with demands placed upon them by ‘civilisation’, offering new perspectives on the pressures of industrialisation and modernity. So when neurodiversity advocates turned their back on psychological theories in the 1990s, they turned away from much more than Bettelheim’s badly formulated theories of maternal love.

A strong adherence to ‘neuro’ explanations also leaves scant room for wider theories of unconscious motivation – and, in many ways, the social sciences as a whole, to the extent that these seek to identify underlying systems of thought and ideologies that guide human action. The development of new neuroscientific models in the 1990s, together with the internet and social media technologies, has catalysed new identity politics that destabilise prior ‘psy’ professional networks and created new models for identity.

These are vital developments to be sure, but it would be naive to think that they could replace some of the fundamental principles that have shaped wider understandings of human thought for more than 100 years. It’s essential to recognise the value of what the neurodiversity movement has achieved without unwittingly submitting to the rigid aspects of a wholly brain-based ‘neuro’ society.

Historically, both ‘psy’ and neurosciences have been mobilised to justify large-scale social injustices in democratic countries, from confinement to forced sterilisation and hormone treatments to ‘cure’ aberrant sexualities. We must be under no illusions here. However, it doesn’t make sense to denigrate one and eulogise the other. Indeed, often it’s psychologists taking a ‘softer’ approach to human motivation that’s served to ward off more draconian approaches to brain-based difference.

For example, when eugenicists such as Carlos Blacker in the UK equated ‘mental deficiency’ with social and economic redundancy after the Second World War in order to advocate for sterilisation, it was psychologists such as Neil O’Connor and Beate Hermelin who argued that psychological and social intervention was always preferable.

It’s striking that previous critics of ‘psy’ sciences rarely sought to radically dispose of all psychological knowledge. Take forerunners to the neurodiversity movement, such as the ‘anti-psychiatry’ and ‘psychiatric survivors’ movements that developed in the 1950s and ’60s. They were critical of how the psychiatric system had pathologised and damaged them, yet remained resolutely opposed to all brain-based or ‘neuro’ explanations for mental states.

This opposition was partly due to a postwar backlash against eugenic or hereditary understandings of mental illness or disability, which were bound up with the Nazis – a pushback that contributed to the proliferation of ‘social constructivist’ theories of mental states in the late 1970s and ’80s via charities, universities and a booming publishing industry.

It’s testament to how far we have come that neurodiversity advocates such as Singer can embrace even small aspects of neuroscience and genetics as part of a new social movement, let alone radically advocate for brain-based theories. The mind is always a historically situated object, regardless of its ‘neuro’ states

Anti-psychiatrists knew that the ‘psy’ sciences served an important role in empowering people, even if they’d been employed poorly in the past. In many ways, the anti-psychiatry movement integrated key psychoanalytic principles by employing historical knowledge to empower and galvanise populations to criticise the practices of psychologists. This was a psychoanalytically and historically informed kind of activism.

Instead of discrediting psychological sciences, the philosopher Michel Foucault and others played psychologists at their own game: ‘If you’re going to analyse where my identity “problems” came from,’ they might have said, ‘then I will analyse where your identity, legitimacy and power also came from.’ This was shrewd because it not only unchained the shackles that ‘psy’ professionals had placed on their own individuality: it also revealed how the psychological sciences wielded power through psychological experts, institutions and policies.

What Foucault called ‘historical ontology’ – the study of what makes being or becoming possible – asserted the importance of history, and of collective thought, to understanding contemporary minds. In some ways, this was just a highly refined form of self-reflective psychology. What it showed was that the mind is always a historically situated object, regardless of its ‘neuro’ states.

Psydiversity accepts that minds are entangled with the societies around them, and can’t be moored to neuroscientific verities – which are, in any event, a byproduct of the time as well. Psydiversity would move us beyond an unhealthy reliance on the knowledge monopoly of the neurosciences, and address the difficulties of stretching neurodiversity to cover all human differences.

None of this is to say the ‘psy’ sciences are perfect, and retooling them to fit our current needs should also involve critically assessing their influence on democracy and society. That influence cannot be overstated. In many ways, the ‘psy’ sciences are the cornerstones of modern democracies. Thinkers such as Jean Piaget, Maria Montessori, Susan Sutherland Isaacs, Edward Glover and Anna Freud gave shape to many ideas that have become fundamental to democratic functioning, such as the principles of early education and attempts to understand rather than punish children’s misbehaviour.

Today, psychiatrists, psychologists, psychoanalysts and psychotherapists have become the footsoldiers of liberal, economically prosperous nations. Through psychological theories, individuals and policymakers alike have learnt to harness human motivations, balancing citizens’ democratic freedoms against the necessity of laws and social norms.

Psydiversity aims to rehabilitate the positive features of such methods, without shying away from where they’ve hit walls in the past. The major problem with ‘psy’ disciplines isn’t necessarily the theories themselves, but their potential to be used as cudgels on behalf of narrow, controlled and regulated versions of the family, society or nation. One of the neurodiversity movement’s key achievements has been to expose the illogical nature of many such approaches.

Activists such as Steven Kapp and Damian Milton have pointed out, for example, that preventing behaviours such as tics and ‘stimming’ isn’t usually done for the benefit of the individual concerned but to maintain social norms and structures. This is correct, and there’s no doubt that the reach of psychological sciences must constantly be kept in check – but psydiversity also makes this possible by internalising a historical self-critique, maintaining a constant awareness of how and for whom knowledge is developed, employed and granted legitimacy.

Psydiversity conceives of our minds as being structured by science, yes, but also by law, society and history. Yet ‘psydiversity’ doesn’t simply skip along to the tune of prior ‘psy’ models. Rather, it aims to reclaim psychological knowledge for the populations it’s supposed to serve. It encourages a radical reframing of the psychological sciences, such that they are both historicised and variegated.

Instead of holding them out as seers or sages, psydiversity encourages psychological professionals to acknowledge the scientific foundations of their approaches and to make this clear at every point of practice: from the statistical sciences that support the DSM; the remnants of Darwinism and instinct theory that support psychoanalysis; and the computing metaphors that support the cognitive sciences. It is only by having an understanding of this history that we can hope to change it. Psychology has had, and continues to have, a role in shaping our understandings of ourselves that can’t simply be dismissed as we now stand in thrall to the new neurosciences.

In short, psydiversity creates a space for psychology to mediate the dogmatic aspects of contemporary neurosciences. It greatly values neurodiverse perspectives, but recognises that we live in a world that needs to move beyond identity politics and develop new models of the mind. Instead of grounding ‘the self’ in ‘the brain’, psydiversity conceives of our minds as being structured by science, yes, but also by law, society and history.

Crucially, it acknowledges that psychological and mental suffering is real, exists in many different forms, and often stems from stigmas or threats to one’s existence with deep historical origins. It’s fruitless to expect neuroscience alone to come to our aid here. The ‘neurodiverse’ tag is becoming more common and widely applied. Many contemporary psychological scientists such as the autism researcher Francesca Happé talk casually about the distinction between ‘neurotypical’ and ‘neurodivergent’ brains.

This has encouraged many debates and discussions about which conditions do or don’t qualify as ‘neurodivergent’. In turn, this makes researchers such as the former neurobiologist Mo Costandi worry that the legitimising power of the ‘neurodiverse’ label might encourage people to avoid treatment or engage in damaging thoughts and behaviours, such as anorexic aspirations. While this has nothing to do with the stated aims of the neurodiversity movement per se, the fact that it has put so much store in locating conditions in the brain clearly affects these narratives.

None of this is to deny the profound sense of solidarity that’s developed within the autism community via neurodiversity, which Steve Silberman eloquently described in his book Neurotribes (2015). The fact that the law has changed to provide specific protections for autistic people was absolutely necessary and correct. However, I question whether we really want to see a society in which DSM-based ‘neurotribes’ become the new political and social classes. It seems to me there’s a limit to the value that such categories can provide in terms of enhancing all human flourishing.

As the neurodiversity movement has shown, threats to identity often provoke unifying political responses. However, history teaches us that these threats shift over time, and that both ‘neuro’ and ‘psy’ categories react and change in turn. Nothing is certain now and for all time, not even a brain-based model of autism. Psydiversity encourages us to think about how to support people regardless of their individual or ‘neuro’ identity.

It offers another perspective from which to understand differences among people, and to celebrate them too. For a child recently diagnosed with ADHD, or an adult diagnosed with bipolar disorder, psydiversity will offer another dimension of understanding as to how they arrived at that point. Just as legal scholars recognise that it’s citizens who ultimately enforce any law via the legal system, psydiversity recognises that it’s individuals who ultimately interpret and implement information deriving from the neurosciences.

That can happen only via the involvement of ‘psy’ knowledge. If we are to genuinely acknowledge the value of all human life, we must first see the human mind in all its fluidity and complexity as our mediating instrument, rather than a detached, ahistorical object that neuroscience allows us to stand outside of. Psydiversity holds that the first step towards understanding the mind must be self-criticism and self-enquiry. This requires a psychology that’s aware of its own history, a psychology that recognises diversity, and a psychology that doesn’t just latch on to existing neuroscientific categories. After neurodiversity, we have a responsibility to explore the wider implications of how humans think. The challenge is to do so without losing our minds.

By: Bonnie Evans

Source: Neurodiversity is not enough. We should embrace psydiversity | Aeon Essays

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When Your Child Is Newly Diagnosed With ADHD

Why Can’t I Focus?

Adult ADHD: Find The Right Therapy

Explore Our ADHD Health Center

Things That Don’t Mix With Your Medication

Is ADHD Real?

How ADHD Affects Teens

What’s Causing My Mood Swings?

Lithium for Bipolar Disorder

Lithium to Treat Bipolar Disorder  

Treatment-Resistant Depression

Tips to Help Fight Heart Failure

The Story of “Eczema Warrior”

Metastatic NSCLC: How to Live Well

Effective Sleep Aids

Penis Curved When Erect

Treat HR+, HER2- MBC

Lung Cancer Treatment

COVID-19 Did Not Affect Mental Health the Way You Think

You’ve probably heard that the coronavirus pandemic triggered a worldwide mental-health crisis. This narrative took hold almost as quickly as the virus itself. In the spring of 2020, article after article—even an op-ed by one of us—warned of a looming psychological epidemic.

As clinical scientists and research psychologists have pointed out, the coronavirus pandemic has created many conditions that might lead to psychological distress: sudden, widespread disruptions to people’s livelihoods and social connections; millions bereaved; and the most vulnerable subjected to long-lasting hardship. A global collapse in well-being has seemed inevitable.

We joined a mental-health task force, commissioned by The Lancet, in order to quantify the pandemic’s psychological effects. When we reviewed the best available data, we saw that some groups—including people facing financial stress—have experienced substantial, life-changing suffering. However, looking at the global population on the whole, we were surprised not to find the prolonged misery we had expected.

We combed through close to 1,000 studies that examined hundreds of thousands of people from nearly 100 countries. This research measured many variables related to mental health—including anxiety, depression, and deaths by suicide—as well as life satisfaction. We focused on two complementary types of evidence:

Surveys that examined comparable groups of people before and during the pandemic and studies tracking the same individuals over time. Neither type of study is perfect, but when the same conclusions emerged from both sets of evidence, we gained confidence that we were seeing something real.

Early in the pandemic, our team observed in these studies what the media was reporting: Average levels of anxiety and depression—as well as broader psychological distress—climbed dramatically, as did the number of people experiencing clinically significant forms of these conditions.

For example, in both the U.S. and Norway, reports of depression rose three-fold during March and April of 2020 compared with averages collected in previous years. And in a study of more than 50,000 people across the United Kingdom, 27 percent showed clinically significant levels of distress early in the pandemic, compared with 19 percent before the pandemic.

But as spring turned to summer, something remarkable happened: Average levels of depression, anxiety, and distress began to fall. Some data sets even suggested that overall psychological distress returned to near-pre-pandemic levels by early summer 2020. We share what we learned in a paper that is forthcoming in Perspective on Psychological Science.

We kept digging into the data to account for any anomalies. For example, some of the data sets came disproportionately from wealthy countries, so we expanded our geographic lens. We also considered that even if the pandemic didn’t produce intense, long-term distress, it might have undercut people’s overall life satisfaction. So, members from our team examined the largest data set available on that topic, from the Gallup World Poll.

This survey asks people to evaluate their life on a 10-point scale, with 10 being the best possible life and zero being the worst. Representative samples of people from most of the world’s countries answer this question every year, allowing us to compare results from 2020 with preceding years. Looking at the world as a whole, we saw no trace of a decline in life satisfaction: People in 2020 rated their lives at 5.75 on average, identical to the average in previous years.

We also wondered if the surveys weren’t reaching the people who were struggling the most. If you’re barely holding things together, you might not answer calls from a researcher. However, real-time data from official government sources in 21 countries showed no detectable increase in instances of suicide from April to July 2020, relative to previous years; in fact, suicide rates actually declined slightly within some countries, including the U.S. For example, California expected to see 1,429 deaths by suicide during this period, based on data from prior years; instead, 1,280 occurred.

We were surprised by how well many people weathered the pandemic’s psychological challenges. In order to make sense of these patterns, we looked back to a classic psychology finding: People are more resilient than they themselves realize. We imagine that negative life events—losing a job or a romantic partner—will be devastating for months or years. When people actually experience these losses, however, their misery tends to fade far faster than they imagined it would.

The capacity to withstand difficult events also applies to traumas such as living through war or sustaining serious injury. These incidents can produce considerable anguish, and we don’t want to minimize the pain that so many suffer. But study after study demonstrates that a majority of survivors either bounce back quickly or never show a substantial decline in mental health.

Human beings possess what some researchers call a psychological immune system, a host of cognitive abilities that enable us to make the best of even the worst situation. For example, after breaking up with a romantic partner, people may focus on the ex’s annoying habits or relish their newfound free time.

The pandemic has been a test of the global psychological immune system, which appears more robust than we would have guessed. When familiar sources of enjoyment evaporated in the spring of 2020, people got creative. They participated in drive-by birthday parties, mutual-assistance groups, virtual cocktail evenings with old friends, and nightly cheers for health-care workers.

Some people got really good at baking. Many found a way to reweave their social tapestry. Indeed, across multiple large data sets, levels of loneliness showed only a modest increase, with 13.8 percent of adults in the U.S. reporting always or often feeling lonely in April 2020, compared with 11 percent in spring 2018.

But these broad trends and averages shouldn’t erase the real struggles—immense pain, overwhelming loss, financial hardships—that so many people have faced over the past 17 months. For example, that 2.8 percent increase in the number of Americans reporting loneliness last spring represents 7 million people. Like so many aspects of the pandemic, the coronavirus’s mental-health toll was not distributed evenly.

Early on, some segments of the population—including women and parents of young children—exhibited an especially pronounced increase in overall psychological distress. As the pandemic progressed, lasting mental-health challenges disproportionately affected people who were facing financial issues, individuals who got sick with COVID-19, and those who had been struggling with physical and mental-health disorders prior to the pandemic.

The resilience of the population as a whole does not relieve leaders of their responsibility to provide tangible support and access to mental-health services to those people who have endured the most intense distress and who are at the greatest ongoing risk.

But the astonishing resilience that most people have exhibited in the face of the sudden changes brought on by the pandemic holds its own lessons. We learned that people can handle temporary changes to their lifestyle—such as working from home, giving up travel, or even going into isolation—better than some policy makers seemed to assume.

As we look ahead to the world’s next great challenges—including a future pandemic—we need to remember this hard-won lesson: Human beings are not passive victims of change but active stewards of our own well-being. This knowledge should empower us to make the disruptive changes our societies may require, even as we support the individuals and communities that have been hit hardest.

By: Lara Aknin, Jamil Zaki, and Elizabeth Dunn

Lara Aknin is a psychology professor at Simon Fraser University and the chair of the Mental Health and Wellbeing Task Force for The Lancet’s COVID-19 Commission. Jamil Zaki is a professor of psychology at Stanford University and the director of the Stanford Social Neuroscience Laboratory. He is the author of The War For Kindness: Building Empathy in a Fractured World. Elizabeth Dunn is a psychology professor at the University of British Columbia and a co-author of Happy Money: The Science of Happier Spending.

Source: COVID-19 Did Not Affect Mental Health the Way You Think – The Atlantic

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Critics:

The COVID-19 pandemic has impacted the mental health of people around the world. Similar to the past respiratory viral epidemics, such as the SARS-CoV, MERS-CoV, and the influenza epidemics, the COVID-19 pandemic has caused anxiety, depression, and post-traumatic stress disorder symptoms in different population groups, including the healthcare workers, general public, and the patients and quarantined individuals.

The Guidelines on Mental Health and Psychosocial Support of the Inter-Agency Standing Committee of the United Nations recommends that the core principles of mental health support during an emergency are “do no harm, promote human rights and equality, use participatory approaches, build on existing resources and capacities, adopt multi-layered interventions and work with integrated support systems.”COVID-19 is affecting people’s social connectedness, their trust in people and institutions, their jobs and incomes, as well as imposing a huge toll in terms of anxiety and worry.

COVID-19 also adds to the complexity of substance use disorders (SUDs) as it disproportionately affects people with SUD due to accumulated social, economic, and health inequities. The health consequences of SUDs (for example, cardiovascular diseases, respiratory diseases, type 2 diabetes, immunosuppression and central nervous system depression, and psychiatric disorders) and the associated environmental challenges (e.g., housing instability, unemployment, and criminal justice involvement) increase risk for COVID-19.

References

The Invisible Addiction: Is It Time To Give Up Caffeine?

After years of starting the day with a tall morning coffee, followed by several glasses of green tea at intervals, and the occasional cappuccino after lunch, I quit caffeine, cold turkey. It was not something that I particularly wanted to do, but I had come to the reluctant conclusion that the story I was writing demanded it. Several of the experts I was interviewing had suggested that I really couldn’t understand the role of caffeine in my life – its invisible yet pervasive power – without getting off it and then, presumably, getting back on.

Roland Griffiths, one of the world’s leading researchers of mood-altering drugs, and the man most responsible for getting the diagnosis of “caffeine withdrawal” included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the bible of psychiatric diagnoses, told me he hadn’t begun to understand his own relationship with caffeine until he stopped using it and conducted a series of self-experiments. He urged me to do the same.

For most of us, to be caffeinated to one degree or another has simply become baseline human consciousness. Something like 90% of humans ingest caffeine regularly, making it the most widely used psychoactive drug in the world, and the only one we routinely give to children (commonly in the form of fizzy drinks). Few of us even think of it as a drug, much less our daily use of it as an addiction. It’s so pervasive that it’s easy to overlook the fact that to be caffeinated is not baseline consciousness but, in fact, an altered state. It just happens to be a state that virtually all of us share, rendering it invisible.

The scientists have spelled out, and I had duly noted, the predictable symptoms of caffeine withdrawal: headache, fatigue, lethargy, difficulty concentrating, decreased motivation, irritability, intense distress, loss of confidence and dysphoria. But beneath that deceptively mild rubric of “difficulty concentrating” hides nothing short of an existential threat to the work of the writer. How can you possibly expect to write anything when you can’t concentrate?

I postponed it as long as I could, but finally the dark day arrived. According to the researchers I’d interviewed, the process of withdrawal had actually begun overnight, while I was sleeping, during the “trough” in the graph of caffeine’s diurnal effects. The day’s first cup of tea or coffee acquires most of its power – its joy! – not so much from its euphoric and stimulating properties than from the fact that it is suppressing the emerging symptoms of withdrawal.

This is part of the insidiousness of caffeine. Its mode of action, or “pharmacodynamics”, mesh so perfectly with the rhythms of the human body that the morning cup of coffee arrives just in time to head off the looming mental distress set in motion by yesterday’s cup of coffee. Daily, caffeine proposes itself as the optimal solution to the problem caffeine creates.

At the coffee shop, instead of my usual “half caff”, I ordered a cup of mint tea. And on this morning, that lovely dispersal of the mental fog that the first hit of caffeine ushers into consciousness never arrived. The fog settled over me and would not budge. It’s not that I felt terrible – I never got a serious headache – but all day long I felt a certain muzziness, as if a veil had descended in the space between me and reality, a kind of filter that absorbed certain wavelengths of light and sound.

I was able to do some work, but distractedly. “I feel like an unsharpened pencil,” I wrote in my notebook. “Things on the periphery intrude, and won’t be ignored. I can’t focus for more than a minute.”

Over the course of the next few days, I began to feel better, the veil lifted, yet I was still not quite myself, and neither, quite, was the world. In this new normal, the world seemed duller to me. I seemed duller, too. Mornings were the worst. I came to see how integral caffeine is to the daily work of knitting ourselves back together after the fraying of consciousness during sleep. That reconsolidation of self took much longer than usual, and never quite felt complete.


Humanity’s acquaintance with caffeine is surprisingly recent. But it is hardly an exaggeration to say that this molecule remade the world. The changes wrought by coffee and tea occurred at a fundamental level – the level of the human mind. Coffee and tea ushered in a shift in the mental weather, sharpening minds that had been fogged by alcohol, freeing people from the natural rhythms of the body and the sun, thus making possible whole new kinds of work and, arguably, new kinds of thought, too.

By the 15th century, coffee was being cultivated in east Africa and traded across the Arabian peninsula. Initially, the new drink was regarded as an aide to concentration and used by Sufis in Yemen to keep them from dozing off during their religious observances. (Tea, too, started out as a little helper for Buddhist monks striving to stay awake through long stretches of meditation.) Within a century, coffeehouses had sprung up in cities across the Arab world. In 1570 there were more than 600 of them in Constantinople alone, and they spread north and west with the Ottoman empire.

The Islamic world at this time was in many respects more advanced than Europe, in science and technology, and in learning. Whether this mental flourishing had anything to do with the prevalence of coffee (and prohibition of alcohol) is difficult to prove, but as the German historian Wolfgang Schivelbusch has argued, the beverage “seemed to be tailor-​made for a culture that forbade alcohol consumption and gave birth to modern mathematics”.

In 1629 the first coffeehouses in Europe, styled on Arab and Turkish models, popped up in Venice, and the first such establishment in England was opened in Oxford in 1650 by a Jewish immigrant. They arrived in London shortly thereafter, and proliferated: within a few decades there were thousands of coffeehouses in London; at their peak, one for every 200 Londoners.

To call the English coffeehouse a new kind of public space doesn’t quite do it justice. You paid a penny for the coffee, but the information – in the form of newspapers, books, magazines and conversation – was free. (Coffeehouses were often referred to as “penny universities”.) After visiting London coffeehouses, a French writer named Maximilien Misson wrote, “You have all Manner of News there; You have a good fire, which you may sit by as long as you please: You have a Dish of Coffee; you meet your Friends for the Transaction of Business, and all for a Penny, if you don’t care to spend more.”

London’s coffeehouses were distinguished one from another by the professional or intellectual interests of their patrons, which eventually gave them specific institutional identities. So, for example, merchants and men with interests in shipping gathered at Lloyd’s Coffee House. Here you could learn what ships were arriving and departing, and buy an insurance policy on your cargo. Lloyd’s Coffee House eventually became the insurance brokerage Lloyd’s of London. Learned types and scientists – known then as “natural philosophers” – gathered at the Grecian, which became closely associated with the Royal Society; Isaac Newton and Edmond Halley debated physics and mathematics here, and supposedly once dissected a dolphin on the premises.

The conversation in London’s coffee houses frequently turned to politics, in vigorous exercises of free speech that drew the ire of the government, especially after the monarchy was restored in 1660. Charles II, worried that plots were being hatched in coffeehouses, decided that the places were dangerous fomenters of rebellion that the crown needed to suppress. In 1675 the king moved to close down the coffeehouses, on the grounds that the “false, malicious and scandalous Reports” emanating therefrom were a “Disturbance of the Quiet and Peace of the Realm”. Like so many other compounds that change the qualities of consciousness in individuals, caffeine was regarded as a threat to institutional power, which moved to suppress it, in a foreshadowing of the wars against drugs to come.

But the king’s war against coffee lasted only 11 days. Charles discovered that it was too late to turn back the tide of caffeine. By then the coffeehouse was such a fixture of English culture and daily life – and so many eminent Londoners had become addicted to caffeine – that everyone simply ignored the king’s order and blithely went on drinking coffee. Afraid to test his authority and find it lacking, the king quietly backed down, issuing a second proclamation rolling back the first “out of princely consideration and royal compassion”.

It’s hard to imagine that the sort of political, cultural and intellectual ferment that bubbled up in the coffeehouses of both France and England in the 17th century would ever have developed in a tavern. The kind of magical thinking that alcohol sponsored in the medieval mind began to yield to a new spirit of rationalism and, a bit later, Enlightenment thinking.

French historian Jules Michelet wrote: “Coffee, the sober drink, the mighty nourishment of the brain, which unlike other spirits, heightens purity and lucidity; coffee, which clears the clouds of the imagination and their gloomy weight; which illumines the reality of things suddenly with the flash of truth.”

To see, lucidly, “the reality of things”: this was, in a nutshell, the rationalist project. Coffee became, along with the microscope, telescope and the pen, one of its indispensable tools.


After a few weeks, the mental impairments of withdrawal had subsided, and I could once again think in a straight line, hold an abstraction in my head for more than two minutes, and shut peripheral thoughts out of my field of attention. Yet I continued to feel as though I was mentally just slightly behind the curve, especially when in the company of drinkers of coffee and tea, which, of course, was all the time and everywhere.

Here’s what I was missing: I missed the way caffeine and its rituals used to order my day, especially in the morning. Herbal teas – which are barely, if at all, psychoactive – lack the power of coffee and tea to organize the day into a rhythm of energetic peaks and valleys, as the mental tide of caffeine ebbs and flows. The morning surge is a blessing, obviously, but there is also something comforting in the ebb tide of afternoon, which a cup of tea can gently reverse.

At some point I began to wonder if perhaps it was all in my head, this sense that I had lost a mental step since getting off coffee and tea. So I decided to look at the science, to learn what, if any, cognitive enhancement can actually be attributed to caffeine. I found numerous studies conducted over the years reporting that caffeine improves performance on a range of cognitive measures – of memory, focus, alertness, vigilance, attention and learning.

An experiment done in the 1930s found that chess players on caffeine performed significantly better than players who abstained. In another study, caffeine users completed a variety of mental tasks more quickly, though they made more errors; as one paper put it in its title, people on caffeine are “faster, but not smarter”. In a 2014 experiment, subjects given caffeine immediately after learning new material remembered it better than subjects who received a placebo. Tests of psychomotor abilities also suggest that caffeine gives us an edge: in simulated driving exercises, caffeine improves performance, especially when the subject is tired. It also enhances physical performance on such metrics as time trials, muscle strength and endurance.

True, there is reason to take these findings with a pinch of salt, if only because this kind of research is difficult to do well. The problem is finding a good control group in a society in which virtually everyone is addicted to caffeine. But the consensus seems to be that caffeine does improve mental (and physical) performance to some degree.

Whether caffeine also enhances creativity is a different question, however, and there’s some reason to doubt that it does. Caffeine improves our focus and ability to concentrate, which surely enhances linear and abstract thinking, but creativity works very differently. It may depend on the loss of a certain kind of focus, and the freedom to let the mind off the leash of linear thought.

Cognitive psychologists sometimes talk in terms of two distinct types of consciousness: spotlight consciousness, which illuminates a single focal point of attention, making it very good for reasoning, and lantern consciousness, in which attention is less focused yet illuminates a broader field of attention. Young children tend to exhibit lantern consciousness; so do many people on psychedelics.

This more diffuse form of attention lends itself to mind wandering, free association, and the making of novel connections – all of which can nourish creativity. By comparison, caffeine’s big contribution to human progress has been to intensify spotlight consciousness – the focused, linear, abstract and efficient cognitive processing more closely associated with mental work than play. This, more than anything else, is what made caffeine the perfect drug not only for the age of reason and the Enlightenment, but for the rise of capitalism, too.

The power of caffeine to keep us awake and alert, to stem the natural tide of exhaustion, freed us from the circadian rhythms of our biology and so, along with the advent of artificial light, opened the frontier of night to the possibilities of work.

What coffee did for clerks and intellectuals, tea would soon do for the English working class. Indeed, it was tea from the East Indies – heavily sweetened with sugar from the West Indies – that fuelled the Industrial Revolution. We think of England as a tea culture, but coffee, initially the cheaper beverage by far, dominated at first.

Soon after the British East India Company began trading with China, cheap tea flooded England. A beverage that only the well-to-do could afford to drink in 1700 was by 1800 consumed by virtually everyone, from the society matron to the factory worker.

To supply this demand required an imperialist enterprise of enormous scale and brutality, especially after the British decided it would be more profitable to turn India, its colony, into a tea producer, than to buy tea from the Chinese. This required first stealing the secrets of tea production from the Chinese (a mission accomplished by the renowned Scots botanist and plant explorer Robert Fortune, disguised as a mandarin); seizing land from peasant farmers in Assam (where tea grew wild), and then forcing the farmers into servitude, picking tea leaves from dawn to dusk.

The introduction of tea to the west was all about exploitation – the extraction of surplus value from labor, not only in its production in India, but in its consumption by the British as well. Tea allowed the British working class to endure long shifts, brutal working conditions and more or less constant hunger; the caffeine helped quiet the hunger pangs, and the sugar in it became a crucial source of calories. (From a strictly nutritional standpoint, workers would have been better off sticking with beer.) The caffeine in tea helped create a new kind of worker, one better adapted to the rule of the machine. It is difficult to imagine an Industrial Revolution without it.


So how exactly does coffee, and caffeine more generally, make us more energetic, efficient and faster? How could this little molecule possibly supply the human body energy without calories? Could caffeine be the proverbial free lunch, or do we pay a price for the mental and physical energy – the alertness, focus and stamina – that caffeine gives us?

Alas, there is no free lunch. It turns out that caffeine only appears to give us energy. Caffeine works by blocking the action of adenosine, a molecule that gradually accumulates in the brain over the course of the day, preparing the body to rest. Caffeine molecules interfere with this process, keeping adenosine from doing its job – and keeping us feeling alert. But adenosine levels continue to rise, so that when the caffeine is eventually metabolized, the adenosine floods the body’s receptors and tiredness returns. So the energy that caffeine gives us is borrowed, in effect, and eventually the debt must be paid back.

For as long as people have been drinking coffee and tea, medical authorities have warned about the dangers of caffeine. But until now, caffeine has been cleared of the most serious charges against it. The current scientific consensus is more than reassuring – in fact, the research suggests that coffee and tea, far from being deleterious to our health, may offer some important benefits, as long as they aren’t consumed to excess.

Regular coffee consumption is associated with a decreased risk of several cancers (including breast, prostate, colorectal and endometrial), cardiovascular disease, type 2 diabetes, Parkinson’s disease, dementia and possibly depression and suicide. (Though high doses can produce nervousness and anxiety, and rates of suicide climb among those who drink eight or more cups a day.)

My review of the medical literature on coffee and tea made me wonder if my abstention might be compromising not only my mental function but my physical health, as well. However, that was before I spoke to Matt Walker.

An English neuroscientist on the faculty at University of California, Berkeley, Walker, author of Why We Sleep, is single-minded in his mission: to alert the world to an invisible public-health crisis, which is that we are not getting nearly enough sleep, the sleep we are getting is of poor quality, and a principal culprit in this crime against body and mind is caffeine. Caffeine itself might not be bad for you, but the sleep it’s stealing from you may have a price.

According to Walker, research suggests that insufficient sleep may be a key factor in the development of Alzheimer’s disease, arteriosclerosis, stroke, heart failure, depression, anxiety, suicide and obesity. “The shorter you sleep,” he bluntly concludes, “the shorter your lifespan.”

Walker grew up in England drinking copious amounts of black tea, morning, noon and night. He no longer consumes caffeine, save for the small amounts in his occasional cup of decaf. In fact, none of the sleep researchers or experts on circadian rhythms I interviewed for this story use caffeine.

Walker explained that, for most people, the “quarter life” of caffeine is usually about 12 hours, meaning that 25% of the caffeine in a cup of coffee consumed at noon is still circulating in your brain when you go to bed at midnight. That could well be enough to completely wreck your deep sleep.

I thought of myself as a pretty good sleeper before I met Walker. At lunch he probed me about my sleep habits. I told him I usually get a solid seven hours, fall asleep easily, dream most nights. “How many times a night do you wake up?” he asked. I’m up three or four times a night (usually to pee), but I almost always fall right back to sleep.

He nodded gravely. “That’s really not good, all those interruptions. Sleep quality is just as important as sleep quantity.” The interruptions were undermining the amount of “deep” or “slow wave” sleep I was getting, something above and beyond the REM sleep I had always thought was the measure of a good night’s rest. But it seems that deep sleep is just as important to our health, and the amount we get tends to decline with age.

Caffeine is not the sole cause of our sleep crisis; screens, alcohol (which is as hard on REM sleep as caffeine is on deep sleep), pharmaceuticals, work schedules, noise and light pollution, and anxiety can all play a role in undermining both the duration and quality of our sleep. But here’s what’s uniquely insidious about caffeine: the drug is not only a leading cause of our sleep deprivation; it is also the principal tool we rely on to remedy the problem. Most of the caffeine consumed today is being used to compensate for the lousy sleep that caffeine causes – which means that caffeine is helping to hide from our awareness the very problem that caffeine creates.


The time came to wrap up my experiment in caffeine deprivation. I was eager to see what a body that had been innocent of caffeine for three months would experience when subjected to a couple of shots of espresso. I had thought long and hard about what kind of coffee I would get, and where. I opted for a “special”, my local coffee shop’s term for a double-​shot espresso made with less steamed milk than a typical cappuccino; it’s more commonly known as a flat white.

My special was unbelievably good, a ringing reminder of what a poor counterfeit decaf is; here were whole dimensions and depths of flavour that I had completely forgotten about. Everything in my visual field seemed pleasantly italicised, filmic, and I wondered if all these people with their cardboard-sleeve-swaddled cups had any idea what a powerful drug they were sipping. But how could they?

They had long ago become habituated to caffeine, and were now using it for another purpose entirely. Baseline maintenance, that is, plus a welcome little lift. I felt lucky that this more powerful experience was available to me. This – along with the stellar sleeps – was the wonderful dividend of my investment in abstention.

And yet in a few days’ time I would be them, caffeine-tolerant and addicted all over again. I wondered: was there any way to preserve the power of this drug? Could I devise a new relationship with caffeine? Maybe treat it more like a psychedelic – say, something to be taken only on occasion, and with a greater degree of ceremony and intention. Maybe just drink coffee on Saturdays? Just the one.

When I got home I tackled my to-do list with unaccustomed fervour, harnessing the surge of energy – of focus! – coursing through me, and put it to good use. I compulsively cleared and decluttered – on the computer, in my closet, in the garden and the shed. I raked, I weeded, I put things in order, as if I were possessed. Whatever I focused on, I focused on zealously and single-mindedly.

Around noon, my compulsiveness began to subside, and I felt ready for a change of scene. I had yanked a few plants out of the vegetable garden that were not pulling their weight, and decided to go to the garden centre to buy some replacements. It was during the drive that I realised the true reason I was heading to this particular garden centre: it had this Airstream trailer parked out front that served really good espresso.

This article was amended on 8 July 2021 to include mention of the Turkish influence on early European coffeehouses.

This is an edited extract from This Is Your Mind on Plants: Opium-Caffeine-Mescaline by Michael Pollan, published by Allen Lane on 8 July and available at guardianbookshop.co.uk

By

Source: The invisible addiction: is it time to give up caffeine? | Coffee | The Guardian

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Critics:

Caffeine is a central nervous system (CNS) stimulant of the methylxanthine class. It is the world’s most widely consumed psychoactive drug. Unlike many other psychoactive substances, it is legal and unregulated in nearly all parts of the world. There are several known mechanisms of action to explain the effects of caffeine. The most prominent is that it reversibly blocks the action of adenosine on its receptors and consequently prevents the onset of drowsiness induced by adenosine. Caffeine also stimulates certain portions of the autonomic nervous system.

Caffeine is a bitter, white crystalline purine, a methylxanthine alkaloid, and is chemically related to the adenine and guanine bases of deoxyribonucleic acid (DNA) and ribonucleic acid (RNA). It is found in the seeds, fruits, nuts, or leaves of a number of plants native to Africa, East Asia and South America, and helps to protect them against herbivores and from competition by preventing the germination of nearby seeds, as well as encouraging consumption by select animals such as honey bees. The best-known source of caffeine is the coffee bean, the seed of the Coffea plant.

Caffeine is used in:

  • Bronchopulmonary dysplasia in premature infants for both prevention and treatment. It may improve weight gain during therapy and reduce the incidence of cerebral palsy as well as reduce language and cognitive delay. On the other hand, subtle long-term side effects are possible.
  • Apnea of prematurity as a primary treatment, but not prevention.
  • Orthostatic hypotension treatment.
  • Some people use caffeine-containing beverages such as coffee or tea to try to treat their asthma. Evidence to support this practice, however, is poor. It appears that caffeine in low doses improves airway function in people with asthma, increasing forced expiratory volume (FEV1) by 5% to 18%, with this effect lasting for up to four hours.
  • The addition of caffeine (100–130 mg) to commonly prescribed pain relievers such as paracetamol or ibuprofen modestly improves the proportion of people who achieve pain relief

Supporting a Friend or Family Member with a Mental Illness

It can be scary when someone you love is sick. It can be especially scary if they’re diagnosed with a mental illness. It’s hard to see someone you love in pain and it’s confusing when someone you know well is not acting like themselves. You know how you would take care of them if they had a cold or flu, but what do you do for a mental illness? Like any other health problem, someone with a mental illness needs extra love and support. You may not be able to see the illness, but it doesn’t mean that you’re powerless to help.

How can I help?

Research confirms that support from family and friends is a key part of helping someone who is going through a mental illness. This support provides a network of practical and emotional help. These networks can be made up of parents, children, siblings, spouses or partners, extended families, close friends and others who care about us like neighbours, coworkers, coaches and teachers. Some people have larger networks than others, but most of us have at least a few people who are there for us when we need them.

There are a number of major ways that family and friends can help in someone’s journey of recovery from a mental illness:

Knowing when something is wrong—or right: Getting help early is an important part of treating mental illness. Family and friends are often the first ones to notice that something is wrong. See “How do I know when to help?” on the next page for signs to watch for. Finding a treatment that works is often a process of trial and error, so family members may also be the first to see signs of improvement.

How do I do this?

  • TIP: Learn more about the signs and symptoms of different mental illnesses. Also learn more about how treatments work so that you know what side effects you may see, when to look for improvements and which ones to look for first. A recent review found that when the family is educated about the illness, the rates of relapse in their loved ones were reduced by half in the first year.

Seeking help: Families and friends can be important advocates to help loved ones get through those hard, early stages of having a mental illness. They can help their loved one find out what treatment is best for them. They can also be key in letting professionals know what’s going on, filling in parts of the picture that the person who’s ill may not be well enough to describe on their own.

How do I do this?

  • TIP: Offer to make those first appointments with a family doctor to find out what’s wrong or accompany your loved one to the doctor—these steps can be hard if your loved one doesn’t have much energy or experiences problems with concentration. If you do accompany the person, work with them to write down any notes or questions either of you have in advance so that you cover all the major points. If your loved one wants to do it on their own, show them your support and ask them if there’s anything you could do to help.
  • TIP: You can’t always prevent a mental health crisis from happening. If your loved one needs to go to hospital, try and encourage them to go on their own. If you’re concerned that your loved one is at risk of harm, they may receive treatment under BC’s Mental Health Act. It may be necessary in certain cases, but involuntary treatment can be complicated and traumatic for everyone. To learn more about the Mental Health Act, see the “Coping with Mental Health Crises and Emergencies” info sheet.

Helping with medications, appointments and treatments: If you spend a lot of time around your loved ones, you can help them remember to take their medications. You may also be able to help tell a doctor why medications aren’t being taken as they should be. Similarly, you may be involved in reminding your loved one to do their counselling homework or use their light therapy treatment each morning, or reminding your loved one to make or keep appointments for treatment.

How do I do this?

  • TIP: If you notice that your loved one is having trouble taking their medication, you can encourage them to talk to their doctor or pharmacist. They can suggest ways to make pill taking easier. If there are other problems with taking medicine, such as side effects, encourage your loved one to write down their concerns and questions and talk to their doctor. If they don’t have a good relationship with their doctor, help them find a new one. If cost is a barrier, learn about BC’s no-charge psychiatric medication coverage called Plan G.

Supporting a healthy lifestyle: Families can also help with day-to-day factors such as finances, problem solving, housing, nutrition, recreation and exercise, and proper sleeping habits.

How do I do this?

  • TIP: See our Wellness Modules at http://www.heretohelp.bc.ca for practical tips on how to have a healthy lifestyle for both you and your loved one. Case managers and peer support workers at mental health centres in your community may be able to help with life skills training as well as connections to income and housing.

Providing emotional support: You can play an important role in helping someone who’s not feeling well feel less alone and ashamed. They are not to blame for their illness, but they may feel that they are, or may be getting that message from others. You can help encourage hope.

How do I do this?

  • TIP: Try to be as supportive, understanding and patient as possible. See our “Where do I go from here?” section for resources on how to be a good communicator.
  • TIP: Taking care of an ill family member or friend can be stressful. Remember that you need emotional support, too. Consider joining a support group for family members of people with mental illness. There, you can connect with other people going through the same things and they can help you work through your own emotions. It’s very important to make sure you are taking care of your own mental health as well.

“Tom’s recovery has been an exercise in patience, love and understanding. We take one step forward and stumble two steps back; baby steps—small increments of success, tiny improvements of things we would ordinarily take for granted—are things we celebrate. When Tom smiles, cracks a joke or declares that he wants to go for a run, they are positive, encouraging signs: baby steps forward.”
—Family member from Family Toolkit

“The most important thing [families] have to do is accept you completely, with all your faults. Families can help by saying ‘You’re okay, we love you, and you’ll get better”
—Mariam, 31 in recovery from clinical depression 

If you need advice on how to get your loved one the help they need, there are a number of resources available to you.

Other helpful resources are:

BC Partners for Mental Health and Addictions Information
Visit www.heretohelp.bc.ca for info sheets and personal stories on supporting loved ones. You’ll also find more information, tips and self-tests to help you understand many different mental health problems.

Alzheimer Society of BC
Visit www.alzheimerbc.org or call 1-800-936-6033 (toll-free in BC) for information and community resources for individuals and families with dementia.

AnxietyBC
Visit www.anxietybc.com or call 604-525-7566 for information, tools, and community resources on anxiety.

British Columbia Schizophrenia Society
Visit www.bcss.org or call 1-888-888-0029 (toll-free in BC) or 604-270-7841 (in Greater Vancouver) for information and community resources on schizophrenia and other major mental illnesses and support for families.

Canadian Mental Health Association, BC Division
Visit www.cmha.bc.ca or call 1-800-555-8222 (toll-free in BC) or 604-688-3234 (in Greater Vancouver) for information and community resources on mental health and mental illnesses.

FORCE Society for Kids’ Mental Health
Visit.www.forcesociety.com or call 1-855-887-8004 (toll-free in BC) or 604-878-3400 (in the Lower Mainland) for information and resources that support parents of a young person with mental illness.

Jessie’s Legacy at Family Services of the North Shore
Visit www.familyservices.bc.ca or call 1-888-988-5281 ext. 204 (toll-free in BC)  or 604-988-5281 ext. 204 (in Greater Vancouver) for information and resources on body image and prevention of eating disorders.

Kelty Mental Health
Contact Kelty Mental Health at www.keltymentalhealth.ca or 1-800-665-1822 (toll-free in BC) or 604-875-2084 (in Greater Vancouver) for information, referrals and support for children, youth and their families in all areas of mental health and addictions.

Mood Disorders Association of BC
Visit www.mdabc.net or call 604-873-0103 (in the Lower Mainland) or 1-855-282-7979 (in the rest of BC) for resources and information on mood disorders. You’ll also find more information on support groups around the province.

Resources available in many languages:
*For each service below, if English is not your first language, say the name of your preferred language in English to be connected to an interpreter. More than 100 languages are available.

1-800-SUICIDE
If you are in distress or are worried about someone in distress who may hurt themselves, call 1-800-SUICIDE 24 hours a day to connect to a BC crisis line, without a wait or busy signal.

Source: Supporting a Friend or Family Member with a Mental Illness | Here to Help

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References

Long Working Hours Killing 745,000 People a Year, Study Finds

 

The first global study of its kind showed 745,000 people died in 2016 from stroke and heart disease due to long hours.The report found that people living in South East Asia and the Western Pacific region were the most affected.

The WHO also said the trend may worsen due to the coronavirus pandemic.

The research found that working 55 hours or more a week was associated with a 35% higher risk of stroke and a 17% higher risk of dying from heart disease, compared with a working week of 35 to 40 hours.

The study, conducted with the International Labour Organization (ILO), also showed almost three quarters of those that died as a result of working long hours were middle-aged or older men.

Often, the deaths occurred much later in life, sometimes decades later, than the long hours were worked.Five weeks ago, a post on LinkedIn from 45-year-old Jonathan Frostick gained widespread publicity as he described how he’d had a wake-up call over long working hours.

The regulatory program manager working for HSBC had just sat down on a Sunday afternoon to prepare for the working week ahead when he felt a tightness in his chest, a throbbing in his throat, jawline and arm, and difficulty breathing.

“I got to the bedroom so I could lie down, and got the attention of my wife who phoned 999,” he said.While recovering from his heart-attack, Mr Frostick decided to restructure his approach to work. “I’m not spending all day on Zoom anymore,” he said.

His post struck a chord with hundreds of readers, who shared their experiences of overwork and the impact on their health.Mr Frostick doesn’t blame his employer for the long hours he was putting in, but one respondent said: “Companies continue to push people to their limits without concern for your personal well-being.”

HSBC said everyone at the bank wished Mr Frostick a full and speedy recovery.”We also recognise the importance of personal health and wellbeing and a good work-life balance. Over the last year we have redoubled our efforts on health and wellbeing.

“The response to this topic shows how much this is on people’s minds and we are encouraging everyone to make their health and wellbeing a top priority.”

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While the WHO study did not cover the period of the pandemic, WHO officials said the recent jump in remote working and the economic slowdown may have increased the risks associated with long working hours.

“We have some evidence that shows that when countries go into national lockdown, the number of hours worked increase by about 10%,” WHO technical officer Frank Pega said.

The report said working long hours was estimated to be responsible for about a third of all work-related disease, making it the largest occupational disease burden.

The researchers said that there were two ways longer working hours led to poor health outcomes: firstly through direct physiological responses to stress, and secondly because longer hours meant workers were more likely to adopt health-harming behaviours such as tobacco and alcohol use, less sleep and exercise, and an unhealthy diet.

Andrew Falls, 32, a service engineer based in Leeds, says the long hours at his previous employer took a toll on his mental and physical health.”Fifty to 55 hour weeks were the norm. I was also away from home for weeks on end.”

“Stress, depression, anxiety, it was a cauldron of bad feedback loops,” he says. “I was in a constant state of being run down.”After five years he left the job to retrain as a software engineer. The number of people working long hours was increasing before the pandemic struck, according to the WHO, and was around 9% of the total global population.

In the UK, the Office for National Statistics (ONS) found that people working from home during the pandemic were putting in an average of six hours of unpaid overtime a week. People who did not work from home put in an average of 3.6 hours a week overtime, the ONS said.

The WHO suggests that employers should now take this into account when assessing the occupational health risks of their workers. Capping hours would be beneficial for employers as that had been shown to increase productivity, Mr Pega said. “It’s really a smart choice to not increase long working hours in an economic crisis.”

Source: Long working hours killing 745,000 people a year, study finds – BBC News

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References

“Spain introduces new working hours law requiring employees to clock in and out”. Idealista. Retrieved 30 April 2020.

Dementia and sleep deprivation linked in recent study – The Washington Post

Sleep deprivation has been linked to hypertension, obesity and diabetes and has long been suspected of having a connection to dementia. Now, a large new study has more clearly established that association by concluding that people who sleep less than six hours a night in midlife have a greater risk of developing late-onset dementia.

That doesn’t mean middle-aged short sleepers should panic, according to experts. Although the study is an important step forward, much about the connection between sleep and dementia remains unknown, they said. Still, it can’t hurt to work on your sleep habits while research continues, and you’ll find some strategies listed below.

In the study, European researchers followed nearly 8,000 people in Britain for 25 years, starting when subjects were 50. They found that those who consistently got six hours of sleep or less per night in their 50s and 60s were about 30 percent more likely to develop dementia later in life, compared to those who logged seven hours of sleep per night. That was independent of “sociodemographic, behavioural, cardiometabolic, and mental health factors,” the study authors wrote. Findings were published in the journal Nature Communications in late April.

“This is just another example of the importance of appropriate sleep for brain health,” said Michael V. Vitiello, a professor of psychiatry and behavioral sciences at the University of Washington at Seattle and member of the SleepFoundation.org medical advisory board, who wasn’t involved in the study. “It’s really important for people to be conscious of making sure that they sleep well. It’s not trivial, and it shouldn’t be the last thing you think about. It shouldn’t be the thing you sacrifice.”

Lack of sleep might increase dementia risk by impairing learning and memory development, said study author Andrew Sommerlad, an old-age psychiatrist at University College London, or it could affect the brain’s ability to clear harmful protein waste products.

Researchers have spent years trying to understand the sleep-dementia connection, a quest that becomes more urgent as the number of people with Alzheimer’s disease balloons. More than 6 million Americans are living with the disease, according to the Alzheimer’s Association, and by 2050, that number is expected to reach nearly 13 million. Yet, it’s a difficult area in which to draw conclusions.

Earlier this year, Charles Czeisler, chief of the sleep and circadian disorders division at Brigham and Women’s Hospital in Boston, co-authored a similar study that found that adults age 65 and older who got five hours or less of sleep per night had double the risk of dementia than those who clocked seven or eight hours per night. Results were published in the journal Aging.

“At this point, it’s too early to say that behavior X leads to Y,” Czeisler said. “But the association certainly reveals the importance of continuing to study the relationship.”

One of the challenges to studying the link between sleep and cognitive decline is that it’s difficult to determine what happens first: Is too little sleep a symptom of the brain changes that often begin decades before cognitive problems appear? Or does it cause those changes? So far, that’s still unclear, said Claire Sexton, director of scientific programs and outreach with the Alzheimer’s Association.

“There’s mounting evidence pointing toward the relationship between sleep and dementia,” she said. “But there are a lot of unanswered questions. There’s no one factor that would guarantee someone will develop dementia, and there’s no one factor that will guarantee someone won’t.”

Vitiello lauded the new study’s lengthy follow-up period and examination of people in their 50s (most similar research focuses on those 65 and older). But he emphasized that the findings estimate increased risk for the entire population, not for any one individual. “These are predictions,” he said. “On average, if you have this kind of disturbed sleep, your odds go up this percentage. It doesn’t mean that just because you’re a 55-year-old sleeping under six hours a night, you’re guaranteed to have an increased Alzheimer’s risk of 30 percent.”

Exactly why someone is a short sleeper — for example, if they have insomnia, hold multiple jobs that require odd hours or naturally need less sleep — likely plays a role in their unique risk, he added. The study didn’t account for those factors.

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Source: Dementia and sleep deprivation linked in recent study – The Washington Post

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Health Anxiety: The Fear of Illness Making People Quit Jobs and Move Home

People who obsessively worry about their health have often been dismissed as hypochondriacs. But for some, coronavirus has fuelled a rise in a debilitating mental health condition known as health anxiety. As Andrew Kersley explores, it can lead to job losses and even suicidal thoughts.

In March 2020, Ben quit his job as a bus driver. Whenever he was off shift he couldn’t stop thinking about how one of his passengers must have had Covid-19 and infected him. Even though he was young and healthy and his chances of serious illness were low, he was fixated on the idea he would become infected and die.

Within a fortnight, Ben had moved out of his family home in Birmingham and into in an empty student house that his friends had left. “I kept thinking about being in a place where no-one was going in or out,” he says.

Despite leaving home and quitting his job, his anxiety about getting infected still dominated his thoughts. “I would wake up and check to see if my body was okay,” he says.

“I gave myself symptoms all the time – if I was tired I’d be completely convinced I had it. I was scared to go to the shops. I just avoided going out and seeing any people at all. It’s all about the ‘what if’ rather than the reality… and no-one can ever tell you that you’ll be fine.”

Ben was experiencing health anxiety.

‘It almost took my life’

While we all sometimes worry about our health, or google symptoms, health anxiety is recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) – known as the bible of psychiatry – as a condition in which obsessive fears about health become excessive.

It is defined by compulsively checking for symptoms, researching diseases, obsessing over normal bodily sensations or avoiding anything that could potentially lead to you being exposed to disease.

This little-known, yet widespread condition, has hit more people this year in the wake of the pandemic.

Many have been unable to leave their house or even open windows for fear of infection. Some, like Ben, have quit jobs. Others bleach their house for hours a day. Almost all have been plagued by uncontrollable thoughts about dying from Covid.

“When people say it’s just light anxiety – it almost took my life,” says Cherelle Farrugia, from Cardiff, who runs a YouTube channel about living with health anxiety.

She first developed it three-and-half years ago after finding a small bump and convincing herself she had lymphoma. Once that was ruled out she spiralled through breast cancer, brain tumours and more. She wasn’t just worried about being sick, but certain she was dying and no-one was listening.

“I’m a relatively logical and intelligent person but health anxiety took all logic away from me,” she explains. The constant fixation got so bad she repeatedly ended up at her local mental health crisis centre as it increasingly left her unable to function.

“I became suicidal, which is strange because I was trying to avoid death,” she says. “But it got so bad that I couldn’t live with the thought process anymore. Nothing I did would calm me down.” And the pandemic made things worse.

My partner would do the food shopping and I would sit there on the floor for an hour washing it. There was a real ritual over it
Cherelle Farrugia

“When we first got told about this virus, it was just my worst nightmare,” the 28-year-old says. “I know everybody was inside but I couldn’t even open my window. My partner would do the food shopping and I would sit there on the floor for an hour washing it. There was a real ritual over it.

“It makes you feel like an attention-seeker,” says Cherelle. “It really destroyed my life and I feel very lucky just to be here.”

Cherelle says her anxiety eased over the year because Covid started to feel more “real” and visible to her than the hypothetical illnesses she had previously convinced herself of having, but many others can’t say the same.

‘Enemy you can’t see’

Health anxiety generally covers two areas – fear that you are already sick or fear that you could become sick. During the pandemic, the latter impacted everyone. But like most mental illness, it is a spectrum.

While some people rarely think about it, for others it is all they think about. Yet the number of those experiencing health anxiety has skyrocketed.

Dr Rob Willson, a London-based cognitive behavioural therapist and health anxiety expert, says he has “never had more enquiries” about health anxiety. Another specialist told the BBC he was fully booked for the next few months.

But seeking medical attention doesn’t always ease the anxiety. “Reassurance never reassures, that’s what we always say,” explains clinical psychologist Dr Marianne Trent, who runs a private mental health practice in Coventry. “Their world gets very small, but their distress is still very high.”

When you’re dealing with an enemy that you can’t see it’s hard to turn that threat radar down
Dr Marianne Trent
Clinical psychologist

Coronavirus in particular poses problems for those with health anxiety. Symptoms like shortness of breath can be symptomatic of both anxiety and Covid, and the two can create a vicious cycle. The more anxious you become the more “evidence” you have that you are sick.

Plus there’s the uncertainty over infection. “When you’re dealing with an enemy that you can’t see it’s hard to turn that threat radar down,” says Dr Trent. For Myra Ali, in north London, the past 12 months have felt very long. “I haven’t really been out the house for a year,” she says. “All we’ve heard is how easily you can catch Covid, so it’s embedded in your mind.”

The 33-year-old is low risk, but an intense fear about getting hospitalized with Covid controlled her thoughts. She even put off surgery for a chronic condition as a result. Just ordering a takeaway one night was enough to trigger an episode. “The next day I had to phone a doctor because I kept thinking ‘what if I’m getting symptoms?’.”

The way we talk about health anxiety in society only makes it worse. Terms like hypochondriac can dismiss those who worry too much about their health, and few people are aware that health anxiety is a genuine condition.

That attitude even filters into the medical community and Dr Willson says it can be difficult to get help from doctors due to their own negative perception of it. The condition was previously called hypochondriasis, but the stigma drove professionals to call it health anxiety instead.

Dr Willson, who co-authored a book on the condition, says there is a shortage of doctors specializing in it even though the condition can have a life-changing impact. Two of his patients have taken their own lives and he says it dominates the lives of many others.

But he, along with Dr Trent, agreed health anxiety could be managed through cognitive behavioural therapy (CBT), a talking therapy which helps change the way you think and behave as well as exposure therapy, where, with professional support, people slowly expose themselves to the things making them anxious – like going outside – in small doses.

Dr Trent says she appreciates the detrimental impact it can have. “It’s real life and death stuff. It can definitely be as debilitating as any other mental health condition.”As society opens up, life may resume for many, but for those with health anxiety a full return to normality is unlikely. It is thought the number of health anxiety patients will continue to rise long after the pandemic ends.

Dr Willson says: “It has been long enough for them to develop habits of checking for symptoms, googling and obsessing. The brain is not quick to give up those kind of habits.” If you need any advice about health anxiety, the NHS has a dedicated page containing tips and guidance, or you can contact charities including Anxiety UK, Mind or Rethink Mental Illness.

Source: Health anxiety: The fear of illness making people quit jobs and move home – BBC News

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Brain Fog: How Trauma, Uncertainty and Isolation Have Affected Our Minds and Memory

After a year of lockdown, many of us are finding it hard to think clearly, or remember what happened when. Neuroscientists and behavioural experts explain why

Before the pandemic, psychoanalyst Josh Cohen’s patients might come into his consulting room, lie down on the couch and talk about the traffic or the weather, or the rude person on the tube. Now they appear on his computer screen and tell him about brain fog. They talk with urgency of feeling unable to concentrate in meetings, to read, to follow intricately plotted television programms.

“There’s this sense of debilitation, of losing ordinary facility with everyday life; a forgetfulness and a kind of deskilling,” says Cohen, author of the self-help book How to Live. What to Do. Although restrictions are now easing across the UK, with greater freedom to circulate and socialize, he says lockdown for many of us has been “a contraction of life, and an almost parallel contraction of mental capacity”.

This dulled, useless state of mind – epitomized by the act of going into a room and then forgetting why we are there – is so boring, so lifeless. But researchers believe it is far more interesting than it feels: even that this common experience can be explained by cutting-edge neuroscience theories, and that studying it could further scientific understanding of the brain and how it changes.

I ask Jon Simons, professor of cognitive neuroscience at the University of Cambridge, could it really be something “science”? “Yes, it’s definitely something science – and it’s helpful to understand that this feeling isn’t unusual or weird,” he says. “There isn’t something wrong with us. It’s a completely normal reaction to this quite traumatic experience we’ve collectively had over the last 12 months or so.”

What we call brain fog, Catherine Loveday, professor of cognitive neuroscience at the University of Westminster, calls poor “cognitive function”. That covers “everything from our memory, our attention and our ability to problem-solve to our capacity to be creative. Essentially, it’s thinking.” And recently, she’s heard a lot of complaints about it: “Because I’m a memory scientist, so many people are telling me their memory is really poor, and reporting this cognitive fog,” she says.

She knows of only two studies exploring the phenomenon as it relates to lockdown (as opposed to what some people report as a symptom of Covid-19, or long Covid): one from Italy, in which participants subjectively reported these sorts of problems with attention, time perception and organisation; another in Scotland which objectively measured participants’ cognitive function across a range of tasks at particular times during the first lockdown and into the summer. Results showed that people performed worse when lockdown started, but improved as restrictions loosened, with those who continued shielding improving more slowly than those who went out more.

Loveday and Simons are not surprised. Given the isolation and stasis we have had to endure until very recently, these complaints are exactly what they expected – and they provide the opportunity to test their theories as to why such brain fog might come about. There is no one explanation, no single source, Simons says: “There are bound to be a lot of different factors that are coming together, interacting with each other, to cause these memory impairments, attentional deficits and other processing difficulties.”

One powerful factor could be the fact that everything is so samey. Loveday explains that the brain is stimulated by the new, the different, and this is known as the orienting response: “From the minute we’re born – in fact, from before we’re born – when there is a new stimulus, a baby will turn its head towards it. And if as adults we are watching a boring lecture and someone walks into the room, it will stir our brain back into action.”

Most of us are likely to feel that nobody new has walked into our room for quite some time, which might help to explain this sluggish feeling neurologically: “We have effectively evolved to stop paying attention when nothing changes, but to pay particular attention when things do change,” she says.

Loveday suggests that if we can attend a work meeting by phone while walking in a park, we might find we are more awake and better able to concentrate, thanks to the changing scenery and the exercise; she is recording some lectures as podcasts, rather than videos, so students can walk while listening.

She also suggests spending time in different rooms at home – or if you only have one room, try “changing what the room looks like. I’m not saying redecorate – but you could change the pictures on the walls or move things around for variety, even in the smallest space.”

The blending of one day into the next with no commute, no change of scene, no change of cast, could also have an important impact on the way the brain processes memories, Simons explains. Experiences under lockdown lack “distinctiveness” – a crucial factor in “pattern separation”. This process, which takes place in the hippocampus, at the centre of the brain, allows individual memories to be successfully encoded, ensuring there are few overlapping features, so we can distinguish one memory from another and retrieve them efficiently.

The fuggy, confused sensation that many of us will recognize, of not being able to remember whether something happened last week or last month, may well be with us for a while, Simons says: “Our memories are going to be so difficult to differentiate. It’s highly likely that in a year or two, we’re still going to look back on some particular event from this last year and say, when on earth did that happen?”

Perhaps one of the most important features of this period for brain fog has been what Loveday calls the “degraded social interaction” we have endured. “It’s not the same as natural social interaction that we would have,” she says. “Our brains wake up in the presence of other people – being with others is stimulating.”

We each have our own optimum level of stimulation – some might feel better able to function in lockdown with less socialising; others are left feeling dozy, deadened. Loveday is investigating the science of how levels of social interaction, among other factors, have affected memory function in lockdown. She also wonders if our alternative to face-to-face communication – platforms such as Zoom – could have an impact on concentration and attention.

She theorises – and is conducting a study to explore this – that the lower audio-visual quality could “create a bigger cognitive load for the brain, which has to fill in the gaps, so you have to concentrate much harder.” If this is more cognitively demanding, as she thinks, we could be left feeling foggier, with “less brain space available to actually listen to what people are saying and process it, or to concentrate on anything else.”

Carmine Pariante, professor of biological psychiatry at King’s College London, is also intrigued by brain fog. “It’s a common experience, but it’s very complex,” he says. “I think it is the cognitive equivalent of feeling emotionally distressed; it’s almost the way the brain expresses sadness, beyond the emotion.” He takes a psycho-neuro-immuno-endocrinological approach to the phenomenon – which is even more fascinating than it is difficult to say. He believes we need to think about the mind, the brain, the immune and the hormonal systems to understand the various mental and physical processes that might underlie this lockdown haze, which he sees as a consequence of stress.

We might all agree that the uncertainty of the last year has been quite stressful – more so for some than for others. When our mind appraises a situation as stressful, Pariante explains, our brain immediately transmits the message to our immune and endocrine systems. These systems respond in exactly the same way they did in early humans two million years ago on the African savannah, when stress did not relate to home schooling, but to fear of being eaten by a large animal.

The heart beats faster so we can run away, inflammation is initiated by the immune system to protect against bacterial infection in case we are bitten, the hormone cortisol is released to focus our attention on the predator in front of us and nothing else. Studies have demonstrated that a dose of cortisol will lower a person’s attention, concentration and memory for their immediate environment. Pariante explains: “This fog that people feel is just one manifestation of this mechanism. We’ve lost the function of these mechanisms, but they are still there.” Useful for fighting a lion – not for remembering where we put our glasses.

When I have experienced brain fog, I have seen it as a distraction, a kind of laziness, and tried to push through, to force myself to concentrate. But listening to Loveday, Simons and Pariante, I’m starting to think about it differently; perhaps brain fog is a signal we should listen to. “Absolutely, I think it’s exactly that,” says Pariante. “It’s our body and our brain telling us that we’re pushing it too much at the moment. It’s definitely a signal – an alarm bell.” When we hear this alarm, he says, we should stop and ask ourselves, “Why is my brain fog worse today than yesterday?” – and take as much time off as we can, rather than pushing ourselves harder and risking further emotional suffering, and even burnout.

For Cohen, the phenomenon of brain fog is an experience of one of the most disturbing aspects of the unconscious. He talks of Freud’s theory of drives – the idea that we have one force inside us that propels us towards life; another that pulls us towards death. The life drive, Cohen explains, impels us to create, make connections with others, seek “the expansion of life”. The death drive, by contrast, urges “a kind of contraction. It’s a move away from life and into a kind of stasis or entropy”. Lockdown – which, paradoxically, has done so much to preserve life – is like the death drive made lifestyle.

With brain fog, he says, we are seeing “an atrophy of liveliness. People are finding themselves to be more sluggish, that their physical and mental weight is somehow heavier, it’s hard to carry around – to drag.” Freud has a word for this: trägheit – translated as a “sluggishness”, but which Cohen says literally translates as “draggyness”. We could understand brain fog as an encounter with our death drive – with the part of us which, in Cohen’s words, is “going in the opposite direction of awareness and sparkiness, and in the direction of inanimacy and shutting down”.

This brings to mind another psychoanalyst: Wilfred Bion. He theorised that we have – at some moments – a will to know something about ourselves and our lives, even when that knowledge is profoundly painful. This, he called being in “K”. But there is also a powerful will not to know, a wish to defend against this awareness so that we can continue to live cosseted by lies; this is to be in “–K” (spoken as “minus K”).

I wonder if the pandemic has been a reality some of us feel is too horrific to bear. The uncertainty, the deaths, the trauma, the precarity; perhaps we have unconsciously chosen to live in the misty, murky brain fog of –K rather than to face, to suffer, the true pain and horror of our situation. Perhaps we are having problems with our thinking because the truth of the experience, for many of us, is simply unthinkable.

I ask Simons if, after the pandemic, he thinks the structure of our brains will look different on a brain scan: “Probably not,” he says. For some of us, brain fog will be a temporary state, and will clear as we begin to live more varied lives. But, he says, “It’s possible for some people – and we are particularly concerned about older adults – that where there is natural neurological decline, it will be accelerated.”

Simons and a team of colleagues are running a study to investigate the impact of lockdown on memory in people aged over 65 – participants from a memory study that took place shortly before the pandemic, who have now agreed to sit the same tests a year on, and answer questions about life in the interim.

One aim of this study is to test the hypothesis of cognitive reserve – the idea that having a rich and varied social life, filled with intellectual stimulation, challenging, novel experiences and fulfilling relationships, might help to keep the brain stimulated and protect against age-related cognitive decline. Simons’ advice to us all is to get out into the world, to have as rich and varied experiences and interactions as we can, to maximize our cognitive reserve within the remaining restrictions.

The more we do, the more the brain fog should clear, he says: “We all experience grief, times in our lives where we feel like we can’t function at all,” he says. “These things are mercifully temporary, and we do recover.”

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Source: Brain fog: how trauma, uncertainty and isolation have affected our minds and memory | Health & wellbeing | The Guardian

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