Cutting and Self-injury
There’s an extremely disturbing trend: ever-increasing numbers of young people who are cutting themselves. Once rare, and something usually seen only in people with serious psychiatric illness, many school children encourage and goad each other into doing it, and there are websites dedicated to cutting, on which young people compare notes and even give each other advice on how to conceal what they are doing, by cutting themselves in places like the lower back.
We have been offered a great many explanations for this worrying development, but not much in the way of evidence. We know that most people who cut themselves are female adolescents or young adults, and apart from the obvious physical dangers, there is evidence that this behavior may lead to a more serious psychological condition called Borderline Personality Disorder. This can be a serious problem that carries a high risk of suicide. It is also of some theoretical interest, because there seem to be genuine cultural differences in borderline personality disorder. An estimated 5.8 million to 8.7 million Americans, mostly women, suffer from it, but it is far less common in most of Western Europe and Australia. Research over the last decade has indicated that the condition is becoming more common in these regions. People with the borderline personality disorder have a wide spectrum of difficulties that are marked by emotional instability, difficulty in maintaining close relationships, eating disorders, impulsivity, chronic uncertainty about life goals and addictive behaviors such as using drugs and alcohol. They also have major impact on the medical system by being among the highest users of emergency and in-patient medical services. Glen Close’s character Alex Forrest in the movie Fatal Attraction, had some of the features that we might expect in some with borderline personality disorder.
Researchers from the University of Washington in Seattle have reported that adolescent girls who engage in cutting behavior have lower levels of the chemical transmitter serotonin in their blood. They also have reduced levels of activity in the parasympathetic nervous system as measured by what is called respiratory sinus arrhythmia, a measure of the ebb and flow of heart rate as we breath. Low levels of this measure are typically found in people who are anxious or depressed. The study included 23 girls aged 14 to 18, who engaged in what psychologists call “parasuicidal” behavior. Participants were included if they had engaged in three or more self-harming behaviors in the previous six months or five or more such behaviors in their lifetime. The comparison group consisted of an equal number of girls of the same ages who did not engage in this behavior.
In line with previous research, the adolescents in the parasuicide group reported far more incidents of self-harming behavior than did their parents.
The findings of low serotonin and low parasympathetic activity support the idea that the inability to regulate emotions and impulsivity can trigger self-harming behavior. The primary problem is an inability to manage their emotions: the people who cut themselves have excessively strong emotional reactions and they have extreme difficulty in controlling those emotions. Their self-harming behavior may serve to distract them from these emotions.
A characteristic feature of borderline personality disorder is not just self-injurious behavior but also stress-induced reduction of pain perception. Reduced pain sensitivity has been experimentally confirmed in patients with the condition. The increasing incidence of the condition in Europe is attracting many European investigators and colleagues from Mannheim in Germany have recently traced the neurological circuits involved in this stress-induced reduced pain perception.
There is good evidence that people who cut themselves are more likely to have been victims of sexual abuse or violence as children, though that obviously does not mean that every person who harms themselves has had something bad happen to them in childhood. Sadly the research has become more complex because of the numbers of people who have been given false memories of abuse by well-meaning psychologists.
Treating people who cut themselves, whether or not they have borderline personality disorder can be very challenging. The first thing is to treat any underlying mood or anxiety disorder. A combination of medications and psychotherapy is normally used, with people making claims for the value of different types of therapy. Many therapists also say that they have helped people who cut themselves with tapping therapies, acupuncture, homeopathy and qigong. I’ve not been able to find any credible research evidence to support the use of those therapies, though I’ve also seen some success stories.
We also have the puzzle about why cutting and borderline personality disorder seems to have been less common in other parts of the world and are now increasing. There is research to show that it’s not just a matter of recognition or of calling the illness something else in Europe. I have a friend who is a senior academic at an Ivy League University, and an expert on borderline personality disorder. During a sabbatical in Scotland some 15 years ago, he could not find a single case. This matters, because if we can identify what’s changed, we may have some clues about treatment. There are hundreds of candidates, including environmental stress, diet and toxins.
There’s an important new study in which 13 children with autism showed marked improvement in some of their challenging behaviors when they were given 1.5gms of omega-3 fatty acids each day. This was only a six week study, but it needs to be replicated using larger numbers. It is also important to be alert to the possibility that some makes of omega-3 fatty acids on the market contain mercury. The one that we have found best so far has been OmegaBrite. http://www.omegabrite.com/ It will also be useful to see if dietary supplementation will help self-injurious behavior in other types of people.
Here is a list of some of the better information sites about self-harm.
The key to success with helping complex problems, as I point out in great detail in Healing, Meaning and Purpose, is a comprehensive approach:
Combinations are Key
Our Unique Brains
One of the fundamental tenets of the old self-help movement is that we all have the same brains and so we all have the potential to become a Leonardo da Vinci, Albert Einstein or Michelangelo.
But is this really true?
I’ve talked a lot about the way in which genes in the brain do not so much determine your behavior, but instead predispose you to respond to the environment in certain ways. If asked the question, “Why has she got depression? Was it because of the abuse as a child, or because her grandmother had depression?” The answer is “Yes.” All of the above.
I’ve examined many hundreds of brain scans, and one of the most striking features of them is their variability. It’s a strange paradox: when we look at the nerves running to your fingers or your toes, they are pretty much in the same place in everyone. The veins and arteries are often in different places, but those peripheral nerves tend to stay put.
Yet when we get to the brain, things are very different. I’ve never seen two brain that look the same. This has been a big problem in research: how do you compare the brain of someone with depression with a healthy volunteer? We usually end up doing all sorts of sophisticated computer modeling to be able to compare two very different brains. This is also why we are a bit skeptical about people who claim to be able to diagnose illnesses based on brain scans. There is just so much variability.
This came up last week, when Grigory Perelman turned down a prestigious honor for his extraordinary work in mathematics. Here we have someone who’s brain works quite differently from other people. He has a very remarkable gift, but I doubt that anyone else could simulate what he has achieved.
I knew a woman who was employed as an air traffic controller by the Royal Air Force. Like all air traffic controllers, she had to have an amazing ability: to be able to tell – without instruments – where every plane was in the sky. With planes flying in different directions at 300-500 knots, the variables are staggering. Yet Veronica and her co-controllers could do it easily.
One of the reasons that I landed in the United States was that I was given a problem to solve. It had to do with measuring an inaccessible region of the brain that is mind-bogglingly important. World class investigators had been trying to solve the problem for four years. After years of playing chess, I have a reasonable ability to visualize things in three dimensions. That was all that it took to solve the problem. Within three weeks we started cranking out data that changed the way in which we think about major mental illness.
Could anyone model Grigory Perelman, or Veronica the air traffic controller or my modest efforts in brain imaging? Is that something that everyone can do?
The answer is almost certainly not.
Although we are forever being told that we can each be whatever we want to, that is not what the evidence says.
I am in no doubt that most people have the potential to perform far above their accustomed level.
But I’m just as sure that not everyone can do everything.
There is often a subtle subtext here: if you have not achieved everything that you want, it is because you have failed. And that’s wrong. Human potential is magnificent, but there are almost certainly some neurological constraints on what each of us can achieve. The key to much of our work is to see how we can expand beyond those neurological limitations.
There’s a terrific discussion of some of these issues by Steven Pinker from Harvard.
Cultural Competence
One of the problems about so many self-help articles is not only that their authors have often not done their homework, neglecting research and sometimes ignoring the dictates of common sense, but they also tend to be culturally myopic.
I’ve spent a great deal of time in different cultures and some of the advice proffered by a few American business experts would quickly get you shown the door in Japan or Germany!
I’ve just learned that Wal-Mart is pulling out of Germany, writing off a loss of around $1 billion. Part of the problem was that this super successful American company failed to understand German culture. It attempted to introduce the “greeters,” that are a familiar sight in the United States. Germans found it offensive to be confronted by someone ordered to smile at every customer. To a German, a broad toothy grin may be seen as intrusive and an invasion of privacy.
My personal background, extensive travels and work with people from every corner of the world, have made me very sensitive to these differences, and I’m often asked for advice before people head off to do teach, speak or to do business overseas. I was very pleased to find out about a company that specializes in training executives to be culturally competent, and one of the tools that they use is cultural profiling.
I just read an excellent article in the Telegraph by Michael Gates, in which he describes a moment in Finland, when he asked someone how they were, to get the response, “You asked me that last week.” Ask a German how they are, and they will probably spend the next ten minutes telling you.
Different cultures have very different ideas and attitudes toward time, space, truth, privacy, authority, individuality, and, of course, gender. The glass ceiling is still alive and well in many cultures. Children are raised quite differently in different cultures: I knew a British doctor working in the pharmaceutical industry. Her company sent her to the United States for three years, but in less than two she and her family were back in England: she did not like the effects of American education on her children.
The Expat Telegraph website has also launched a series of “National Cultural Profiles.” This is a terrific resource to help us understand the thinking patterns of the world’s major cultures. The resource has been taken from the CultureActive cultural web program that is used throughout the world by governments, non-governmental organizations and corporations. It is also the core of a project (InterCulturalEdge) based at Duke University’s Fuqua Business School in North Carolina.
CultureActive is based on the work of Richard D. Lewis, the author of When Cultures Collide, a book that I recommend highly. He is the chairman of Richard Lewis Communications. Lewis has developed a theory, known as the Lewis Model of Culture. He classifies cultures into three main types:
- Linear-active
- Multi-active
- Reactive
These National Cultural Profiles are different from typical country profiles that you find in the Encyclopedia Britannica or the CIA website that detail economic or political data. These profiles concentrate on key cultural questions such as values, beliefs and communication.
There are free mini-introductions available at the Expat Telegraph website, and there are much more detailed profiles available for subscribers.
CultureActive also allows you to complete your own Personal Cultural Profile by filling in an online questionnaire.
Learning how to communicate with people from different cultures is essential if you hope to expand your own personal horizons, as well as developing your business.
“Civilization is the order and freedom promoting cultural activity.”
–Will Durant (American Historian, 1885-1981)
Optimism and Pessimism
It is sometimes very disheartening to read articles that are probably well intentioned, but in which the writer hasn’t done the most basic research.
I was just sent an article on optimism and pessimism, in which the writer extols the benefits of developing an optimistic outlook on life. And yes, it’s nice to be optimistic, but he – at least I think that it’s a he – makes several significant errors.
He gives examples of several well-known people who were supposed to have attained great things by being optimistic rather than realistic. He has clearly not studied the lives Thomas Edison or Henry Ford in any detail. Or Winston Churchill, Mother Teresa or Ted Turner.
He then says that optimism cannot be measured. Yes it can, there are many validated rating instruments. There is also a lot of research on the relationship between optimism, pessimism, temperament and cognitive and personality styles.
He goes on to say that you can learn to have an optimistic outlook on life. That is only half true. There are well-known genetic predispositions to optimism and pessimism. I’ve also written about recent work from Finland that makes it clear that it is very difficult to develop an optimistic mind set if you spent your childhood in a low socioeconomic status family. Special techniques may be needed to help people who were disadvantaged in childhood.
The idea that you can achieve anything by just “thinking it,” is not just wrong but it leads to some people feeling inadequate because they cannot generate enthusiasm and optimism. I have seen countless people feel guilty because they could not feel happy and optimistic the way that the motivational speaker told them to!
An un-researched and unbalanced article does more harm than good. It’s no good saying that it wasn’t meant to be scientific: you, as a reader, deserve better than some generalized nostrums based on wishful thinking. If someone recommends something, you need to know whether you can rely on what you are being told, or if it is just an unsubstantiated opinion. If it’s just an opinion, that’s fine, but you need to be told that, and why you can rely on that opinion, or why the writer has chosen to disregard research and previous experience.
So are you stuck with you genes and your upbringing? No you are not. But it is important to know if you are one of the people who do better with negative cognitions. It is well known in psychology that some people do much better with a constant negative outlook on life. In fact a psychologist – Julie Norem – wrote a first rate book on the subject entitled The Positive Power of Negative Thinking: Using Defensive Pessimism to Harness Anxiety and Perform at Your Peak.
There are techniques from cognitive therapy that can help change a person’s outlook and the newer technique – Attachment and Commitment Therapy – teaches ways of detaching from negative and pessimistic cognitions, rather than trying to stick a smiley face on them.
Best of all are the techniques of Integrated Medicine, that help attitudinal problems with a combination of highly individualized physical, psychological, social, subtle and spiritual techniques.
“If wishes were horses, then beggars would ride.”–Unknown Author
Psychological Reslience and Adult Support
Most of us would agree that it is very difficult to try to reduce human behavior to genes alone: one of the most important breakthroughs in our understanding of many genes is the way in which they interact constantly with the environment. This has been known for years with the genes involved in metabolism, but we now also know that the main function of genes in the brain is not to determine behavior, but to predispose us to the way in which we handle the environment.
There is a good discussion of this distinction in a paper posted by someone whom I am sorry to say that I do not know, called R.J. O’Hara, that endorses our point: even if you have genes that could predispose you to a bad long-term outcome, if you had strong, positive support from an adult, it could significantly reduce the impact of "bad" genes.
It leaves us with an important question: how late in life can strong social supports and a positive mental attitude cancel out some of our genetic predispositions?
My answer? "Biology is not destiny, and we can help people make a new start at any age or at any time in life."
Technorati tags: Psychological resilience Genetic predisposition Biology is not destiny
Mel's Madness
In the midst of all the furor about Mel Gibson and his self-admittedly foul behavior while under the influence of alcohol, an important point has been missed: when someone is drunk or brain damaged, is their behavior just disinhibition? Are they behaving this way because they’ve lost the cerebral censor that normally maintains our social demeanor? The Romans certainly thought so: in banqueting halls they would have roses carved into columns and the ceiling. The rose – the symbol of secrets – was a reminder to be discrete when alcohol might begin to lossen the tongue.
When the frontal lobes are on strike, does our “true” personality emerge? Or can alcohol, drugs and brain injury produce brand new behaviors that are not just totally out of character, but predictable by the drug or type of injury?
The answer is a mixture of the two. I know a man who is in the running for the Nobel Prize in medicine. But a couple of years ago it was all over the press when he shattered the arm of an innocent man in the middle of an alcohol-fueled frenzy. Was it the alcohol? Yes, I’m sure that it was. But the scientist has had a very long history of anger problems and of bullying younger colleagues. The alcohol was the catalyst to behavior that he normally keeps in check, but which was just waiting to come out of its cage. I’ve treated hundreds of alcohol abusing people, and the amiable ones far outnumber the violent ones. And the majority of the violent ones had also been violent when not drinking.
Some drugs and chronic alcohol abuse can produce stereotyped hallucinations and behaviors. Some alcoholic people really do see bugs and pink elephants, and there are many other examples of predictable perceptual and behavioral disturbances with drugs and with brain injuries.
Students of the healing arts learn that damage to certain regions of the brain is associated with specific behavioral and emotional consequences. This teaching goes back more than a century, and generations of students have been told that, “Damage here causes depression, and damage here causes mania, and over there a lesions will damage one type of language.” Yet for three decades we have known that much of this teaching is fictitious. I was taught brain localization by some of the finest neurologists in the world, and yet each would admit the inaccuracy of their methods. A new study from Brisbane, Australia supports that nihilism. The investigators examined 61 consecutive people admitted to a stroke unit. “Strokes” are either vascular blockage or bleeds affecting the brain.
They could find no significant relationship between the side or location of a lesion and the development of post-stroke depression. But the kinds of people that they were before the stroke had a big impact: pre-morbid neuroticism and a past history of mental disorder were important predictors of depression following stroke.
So why all the fuss about Mel? Because people are asking if deep down inside he really has been harboring some of the dark, mean spirited thoughts that he expressed to the police, and that the alcohol was the catalyst and not the creator of his diatribe.
“The intoxication of anger, like that of the grape, shows us to others, but hides us from ourselves. We injure our own cause in the opinion of the world when we too passionately defend it.”
— Charles Caleb Colton (English Clergyman and Author, c.1780-1832)
Technorati tags: Mel Gibson Alcohol abuse Pre-morbid personality Brain
Video Games and Violence
For years now, there has been a vigorous debate on both sides of the Atlantic about the impact of violence in the media and the behavior of young people. I’ve seen various statistics indicating that the average teenager, by the time he or she graduates from high school, will have seen thousands of people killed on television. Most professionals have seen young people who no longer have any concept of death: they assume that if someone is killed they will simply get up and play another scene. As bizarre as this sounds, there have been multiple reports of this happening with young people involved in some of the most notorious acts of violence seen in schools.
This month see the publication of an important report from Iowa State University, where a research team has been examining the effects of violence in the media for several years now.
This latest report, "The Effects of Video Game Violence on Physiological Desensitization to Real-Life Violence," was published in the current issue of the Journal of Experimental Social Psychology. Previous research has come to the intuitively sensible conclusion that exposure to violent video games increases aggressive thoughts, angry feelings, physiological arousal and aggressive behaviors and at the same time decreases helpful behaviors. This is very worrying when we discover that more than 85 percent of video games contain some violence, and approximately half of video games include serious violent actions.
The latest research involved 257 college students (124 men and 133 women). First, the investigators made some baseline physiological measurements of heart rate and galvanic skin response, which reflects sweating and blood flow in the skin. They then asked questions to control for the students’ preference for violent video games and general aggression. The participants then played one of eight randomly assigned violent or non-violent video games for 20 minutes.
When viewing real violence, participants who had played a violent video game experienced skin response measurements significantly lower than those who had played a non-violent video game. The participants in the violent video game group also had lower heart rates while viewing the real-life violence compared with the nonviolent video game group.
This research shows that people who play these violent video games get so used to violence that they become desensitized to it: it no longer affects them. Given the numbers of games and the enormous numbers of people playing them, the results are shocking: it could be said that modern entertainment media are systematically desensitizing millions of young people to violence.
Are you happy about that?
Shouldn’t we – both individually and collectively – be doing something about this?
Technorati tags: Violence Video games Desensitization
Gender, Culture and Communication
Regular readers will know that I’m very interested in gender differences. More and more evidence is confirming what most of us have always known: men and women tend to think and behave differently. Some of the differences are clearly neurological and some social. It is sometimes difficult to sort out which is more important: some research findings on gender differences have produced mixed results because of some of the assumptions of male investigators!
But notice that I emphasize the word “tend” to think differently. We are always dealing with statistical differences. My Y-chromosome should enable me to navigate from A to B without difficulty. In fact, I am seriously directionally challenged: I should probably have a GPS system with me when I go down to the shops!
I have spoken about my admiration for the work of Deborah Tannen, and I have also written about Christina Robb’s marvelous book, in which she charts the development of new insights into gender differences in psychology.
This weekend I was at the annual meeting of the National Speakers Association in Orlando, and I learned something very interesting that fits in with all of our previous discussions. I learned it from one of the speakers, named Julia Hubbel. I already knew that women tend to be more relational in their interactions and men are more transactional. Most women tend to spend a lot more time on the maintenance and development of relationships and most men are more interested in the bottom line: What is the solution? What’s the deal going to be? What I did not know is that there is some data to indicate that non-White males tend also to emphasize relationships over transaction. As soon as I heard that, I was sure that it was right: I have had a lot of dealings with people from the Indian subcontinent, and most would consider it very rude to get straight down to business before we had taken tea or eaten something while discussing family and other personal matters. Julia teaches networking skills that integrate gender and ethnic considerations.
As she was explaining her insights and methods, I was reminded of the work of the anthropologist and cross-cultural researcher Edward T. Hall, who wrote a series of excellent books on cultural factors and thought.
Gender and cultural differences in communication are of such importance that I plan to return to the topic in the near future. In the meantime, you might be interested in a book by Richard Nisbett, entitled The Geography of Thought: How Asians and Westerners Think Differently and Why. After multiple trips to Japan, during which I learned a lot about cultural differences, I gave a copy to a friend who is a Canadian in a senior management position in the Japanese affiliate of a US-based company. He told me that he was astonished by the accuracy of the insights.
Some of the political misunderstandings that you see on the news every morning are often a consequence of different thinking styles. Learning how men and women and people in different cultures think and operate is not just interesting.
It is essential.
“Skill in the art of communication is crucial to a leader’s success. He can accomplish nothing unless he can communicate effectively.”
— Norman Allen (American Playwright, Recipient of a Charles MacArthur Award for Outstanding New Play)
Technorati tags: Communication Gender differences Deborah Tannen Cross-cultural communication
Growing Your Brain
Several years ago we learned that London taxi drivers grew a small part of their hippocampus while learning “The Knowledge,” a detailed map of the streets of the city. Unlike most American cities, London is like a rabbit warren that has been growing organically for two thousand years. Despite the Great Fire of 1666, and the best efforts of Hitler’s Luftwaffe, the basic illogical structure has just become more complex over the centuries. The hippocampus is intimately involved in memory, navigation and in constructing a map of your surroundings. It has also been established that professional musicians and people who use Braille, all have increases in the size and complexity of a specific region of the brain.
We now learn from researchers in Germany that medical students show an increase in the amount of grey matter in the posterior part of the hippocampus and also in regions of the parietal lobes while studying for their exams. It is calculated that a medical student learns around 6,000 new words during his or her training, so it is no surprise that the brain changes to accommodate all this new information.
This new finding just adds to our knowledge about the plasticity of the brain. Even if you do not have to learn 6,000 new words and innumerable new concepts and practical techniques, it is worth knowing that learning any new knowledge or skills will likely grow specific regions of your brain.
So make a resolution to learn at least one new thing each day, and to work on developing a new skill. It doesn’t matter whether it is learning to knit or how to play chess. Each will likely help you.
Later this year we will be bringing out a book that teaches brain stretching skills based on the latest advances in brain science.
Watch this space!
Technorati tags: Hippocampus Parietal lobe Learning Medical students Neurogenesis
Motivation
“Motivation is everything. You can do the work of two people, but you can’t be two people. Instead, you have to inspire the next guy down the line and get him to inspire his people."
–Lee Iacocca (American Businessman and Former CEO of Chrysler, 1924-)
I am always on the look out for tips or techniques that might help my clients and students. But sometimes I come away scratching my head, after reading about some “new” technique or hearing someone discussing a life principle or healing method. So often I wonder why the author or he speaker hasn’t checked his or her facts.
I’ve recently seen an entire self-help system based upon a discredited psychological model of a disease. There’s a book and a website and loads of glowing testimonials. Maybe the methods work, and maybe they don’t. But if the basic principle is wrong, it’s impossible to apply the methods in a new situation. One of the fruits of the Chinese Cultural Revolution was the creation of the “barefoot doctors” – peasants who provided basic medical care throughout much of rural China. They had little training but had a set of manuals that told them exactly what to do with most common ailments. And when they came up against something that was in the book, they were fine. But because the practitioners had not been trained on the basic principles of anatomy, physiology or subtle systems, the system had no flexibility. If you had a chest infection, and the same signs and symptoms that they had in the book, then everything was fine. But if you had symptoms or an illness not in the book, you were out of luck.
In recent years a lot of people have gone back to talking about pleasure and pain as the principle motivators of human behavior. Of course, these two factors play some part in our behavior. And the idea that they are the key drivers is simple, easy to understand and easy to explain.
And dead wrong.
Eighty-six years ago Sigmund Freud published a short essay entitled Jenseits des Lustprinzips, which was eventually translated into English as Beyond the Pleasure Principle. All those years ago he had already come to the conclusion that there were other equally important drives, and that to try and reduce human motivation and behavior to pleasure and pain is very misleading.
We have a very large scientific literature on some of the factors involved in human motivation, how to achieve change and improvement in our lives and how to motivate others. Let me give just a few of the more important ones that cannot be reduced to pain and pleasure, and for which we have good empirical data:
1. Clarity of vision
2. Encouragement
3. Personal engagement
4. Recognition
5. Pride
6. Free flow of energy and information
7. Appropriate reward systems (money is often not the best one!)
8. Personal and group expectations
9. Creating shared goals
10. Transpersonal motivation: Inspiration and leaving a legacy
There are others, like emotional congruence, that can, perhaps, be reduced to the pleasure/pain axis. But it is the last of these that I am going to spend more time on in the near future: the differences between motivation and inspiration, and how combining the two together may have an important impact upon your life.
Technorati tags: Motivation Inspiration Reward Personal engagement
