Richard G. Petty, MD

Personal Mastery and the Wellness of Caregivers

Looking after aging relatives can be incredibly difficult, particularly if they have a chronic illness such as Alzheimer’s disease.

There is also evidence that the caregivers of people with Alzheimer’s disease have increased rates of cardiovascular disease and they die prematurely. It has been assumed that the cardiovascular problems are a result of stress causing overdrive of the sympathetic nervous system.

There was some interesting research (NR241) presented last month at the 2007 Annual Meeting of the American Psychiatric Association in San Diego. The investigators did not have to come far: they are from the University of California in San Diego.

The investigators looked at 70 spousal caregivers of people with Alzheimer’s disease and used an experimental task to measure the activity of their sympathetic nervous systems. They also measured the caregiver’s levels of “Mastery:” the belief that one is capable of handing one’s problems. Mastery is one of the components of resilience, a key characteristic of a person who can handle stress well.

What they found make very good sense: the caregivers with the highest levels of personal mastery had the lowest levels of sympathetic activity, suggesting that a sense of mastery may protect against the physiological effects of acute stress.

This provides us with yet more evidence that psychosocial interventions that increase mastery may reduce the risk of cardiovascular disease amongst the caregivers of people with dementia.

Choosing To Be Happy?

For the last two decades, one of the central tenets of the self-help movement has been that we can choose to experience or to be whatever we want.

Many psychologists have also said that human happiness or subjective well-being is largely independent of our life circumstances. Therefore wealthy people are no happier than people of more limited means; married people aren’t much happier than single people and healthy people aren’t much happier than sick people. The keys to happiness are supposed to lie within us, in our attitudes and perceptions.

If these theories are correct – and they are theories – we would predict that changes in our life circumstances would not have long-term effects on our happiness. This has indeed been the dominant model of subjective well-being: people adapt to major life events, both positive and negative, and our happiness stays pretty much constant through our lives, even if it is occasionally perturbed by some big gain or loss. According to the theory, winning the lottery may make you happy for a little while, but it won’t make you happier in the long run.

Not unless you have made the choice to be happy.

Similarly, while a divorce or major illness might throw your life into turmoil for a while, your happiness level will eventually return to where it was before. The idea has been that of sense of subjective well-being has a set point, and that a change in beliefs or attitudes can change the set-point.

But is this true?

New research, and reexamination of old research, is challenging some of the claims of set-point theory.

In this month’s issue of Current Directions in Psychological Science, Richard E. Lucas of Michigan State University and the German Institute for Economic Research, reviews some recent studies suggesting that adaptation to changing life circumstances only goes so far. As he says, “Happiness levels do change, adaptation is not inevitable, and life events do matter.”

To study adaptation, Lucas and his colleagues used data from two large national prospective panel studies, one in Germany and the other in Great Britain. Unlike most previous studies of adaptation, these data were able to capture levels of life satisfaction both prior to and after major life events like marriage, divorce, unemployment, and illness or disability.

Lucas found that not all of life events are created equal. For example, most people adapt quickly to marriage. They have peak in subjective well-being at the time of getting married, but within about two years, their happiness levels return to their previous levels.

People usually adapt to losing a spouse, but it takes a lot longer: on average about seven years. People who get divorced and people who become unemployed, however, do not usually return to the level of happiness that they experienced before. The same can be said about physical debilitation. Numerous recent studies have demonstrated that major illnesses and injury result in significant, lasting decreases in subjective-well being.

But Lucas also found that individual differences play an important role. There is a great deal of individual variation in the degree to which people adapt to what life throws at them. We know that life events run in families: there is a genetic predisposition to having multiple life events. People who are destined to experience certain life events differ in their subjective well-being from those who do not, even before the occurrence of those events. As an example, people who were happy 5 years before their marriage, stay married, and also stay happier than those who are destined to marry and get divorced.

Lucas stresses that his findings do not undercut the importance of adaptation processes. Some degree of adaptation necessarily protects us from prolonged emotional states that may be harmful, and helps us attune to novel threats to our well-being rather than dwell on ones we are familiar with. Adaptation also helps us detach from goals that have proven unrealistic.

So what does this mean to us personally? It is rather like the statement attributed to the German priest and scholar Martin Luther, “Pray as if everything depends on God. Then work as if everything depends on you.”

  • Make the choice to be happy, but that choice will, on its own, achieve little unless you also work to change your life circumstances
  • The choice to be happy will not be crowned with success unless you really feel that you want it deep down inside: it has to be a core desire
  • Not everyone can make the choice because they are not wired that way
  • Do not be disheartened if you make the choice to be happy and things don’t quite work out. Some pop psychologists and gurus have told their followers that if they failed to find happiness, then they were inadequate, or did not want it enough. That kind of nonsense can cause needless guilt and suffering. Sometimes life chucks too much at you at once, and it’s okay to be unhappy. It does not mean that you are a wimp, or that you didn’t want happiness enough
  • The best way to deal with a world that throws a lot at you is to learn the art and science of resilience and acceptance

But also remember something else: the great sages have always taught that happiness is our natural state, and the art of living is to return to that natural state.

But most importantly, to help others get there as well.

“Action may not always bring happiness; but there is no happiness without action.”
–Benjamin Disraeli, 1st Earl of Beaconsfield (English Statesman, Novelist and, in 1868 and from 1874-1880, British Prime Minister, 1804-1881)

“Forgiveness is the key to happiness.”
–A Course in Miracles (Book of Spiritual Principles Scribed by Dr. Helen Schucman between 1965 and 1975, and First Published in 1976)

“Happiness is the very nature of the Self; happiness and the Self are not different. There is no happiness in any object of the world.”
–Ramana Maharshi (Indian Hindu Mystic and Spiritual Teacher, 1879-1950)


Have you ever given in to temptation? Have you ever had a moment of weakness when that jelly donut seemed just too irresistible or you felt that it was about time to tell someone what you REALLY thought?

Sad to say I am sure that we are all guilty of that at some time or other.

What we are talking about here is self-regulation, our ability to inhibit impulses, make decisions, persist at difficult tasks and to control our emotions. We know that our ability to self-regulate is highly variable. It becomes more difficult if we are tired, stressed or working with people who drain us emotionally. There is evidence that our abilities to self-regulate can fatigue in just the same way that a muscle can get tired. It’s like having a limited amount of money, and when it’s gone it’s gone. One of the main factors that help to keep self-regulating is our level of resilience.

It is interesting that when we give in to the temptation to do something unwise, we are often unaware of it at that moment. It is only later that we feel regret.

There is some interesting new research from the University of Kentucky, that was conducted by two psychologists Suzanne Segerstrom and Lise Solberg Nes. Their work suggests that there may be a biological indicator to tell us when we are working hard at resisting temptation and consequently when we are vulnerable to doing things that we hadn’t meant to.

They hypothesized that there would be a link between variations in heart rate – heart rate variability (HRV) – and self-regulation. HRV is emerging as a very interesting tool for examining the health of the autonomic nervous system, and if disturbed, it can be a harbinger of many highly undesirable health problems. The researchers’ reasoning was that many of the same brain structures involved in self-regulation are also involved in the control of HRV.

They did a two-part study to test their hypothesis. In the first experiment participants were told that they were going to take part in test on the “physiology of food preference.” They were instructed to fast for three hours before starting the procedure. Then their HRV was monitored while they were presented with a tray of cookies, candy and carrots. The “temptation” was to give in to eating the tastier but the less healthy snack of cookies and candy.

HRV was considerably higher when people were working to resist temptation (eating carrots rather than cookies and chocolate) than when they were not. This suggested that HRV was mirroring the attempt at self-regulation.

In part two of the experiment, after resisting or giving into temptation, the experimenters had the participants attempt to complete difficult anagrams, some of which were impossible to solve. The authors measured how long participants persevered at the anagrams. As predicted, those who had exerted high self-regulation by resisting the candy and cookies were more likely to give up earlier on the task. They didn’t have any more self-control to give.

People with naturally higher levels of HRV were likely to try longer at the anagram task, whether or not they had given into “temptation.”

Now the “temptation” in this study wasn’t much, but the implications are important. There are many people – particularly those with addictions and some kinds of personality disorder – who have major problems with self-regulation. HRV feedback could turn out to be a useful way of helping people realize that their self-control may be about to fail.

It is also important to know that self-regulation is finite, but can be built by building an individual’s resilience (1,2,3,4,5).

By the way, if you have never given in to temptation, would you PLEASE share your secret?

“Watch and pray, that ye enter not into temptation: the spirit indeed is willing, but the flesh is weak.”
–The Bible: Matthew 26:41

“A silly idea is current that good people do not know what temptation means. This is an obvious lie. Only those who try to resist temptation know how strong it is…. A man who gives in to temptation after five minutes simply does not know what it would have been like an hour later. That is why bad people, in one sense, know very little about badness. They have lived a sheltered life by always giving in.”
–C. S. Lewis (British Scholar and Novelist, 1898-1963)

“What makes resisting temptation difficult for many people is they don’t want to discourage it completely.”

–Franklin P. Jones (American Businessman, 1887-1929)

“Temptation is an irresistible force at work on a moveable body.”

Henry Louis (H.L.) Mencken (American Writer and Editor, 1880-1956)

Psychological Problems, Stigma and Success

I do a lot of work to try and de-stigmatize mental illness, and to emphasize that all of my experience and all the scientific evidence makes it very clear that most psychological and psychiatric problems lie on a spectrum. We define something as an “illness” only if it is causing suffering or distress.

Because of my work I know about the physical and psychological problems of a great many people in the public eye, but I will obviously not talk about people unless they decide to say something themselves.

When I am speaking to politicians or the media I often show them a list of some of the people with psychological problems who have gone public.

I just found this long list of Deborah Serani’s blog. There were a number of names of people whom I did not know had revealed that they had suffered from problems. I am pleased that Deborah offered some references. I have also added a few names from my own research.

If there are any mistakes, please let me know and I shall correct them.

I would like to make three points:

  1. Psychological problems and psychiatric illnesses are common and usually treatable
  2. Having been diagnosed with one of these problems does not preclude you from outstanding success
  3. This list does not include people with substance abuse problems, though these problems are usually as physical as any other

I do hope that you will find it helpful to see just how many terrific people have had their downs as well as their ups!

John Quincy Adams (US President)
Alvin Ailey (Choreographer)
Lionel Aldridge (Football Star)
Buzz Aldrin (Astronaut)
Adam Ant A.K.A. Stuart Goddard (Singer)
Ann-Margaret (Actor)
Louie Anderson (Comedian Actor)
Gillian Anderson (Actress)
Fiona Apple (Musician)
Diane Arbus (Photographer)
Isaac Asimov (Author)
Drew Barrymore (Actor/Producer)
Daniel Boorstin (Former Us Presidential Adviser)
Zach Braff (Actor)
Art Buchwald (Columnist)
Oksana Baiul (Skating Star)
Kim Basinger (Actress)
Ned Beatty (Actor)
Syd Barrett (Musician)
Ludwig Van Beethoven (Composer)
Maurice Bernard (Actor)
Irving Berlin (Composer)
Danny Bonaduce (Actor/Radio DJ)
Halle Berry (Actor)
Kjell Magne Bondevik (Prime Minister of Norway)
Steve Blass (Baseball Star)
Charles “Buddy” Bolden (Musician)
Robert Borrstin (Political Advisor)
David Bowie (Singer)
Marlon Brando (Actor)
Jeremy Brett (Actor)
Charlotte Bronte (Author)
Robert Burns (Poet)
Willie Burton (Athlete)
Barbara Bush (Former First Lady – U.S.)
Delta Burke (Actor)
Carol Burnett (Actress/Comedian)
Lord Byron (Poet)
Cher (Singer/Actress)
Dick Clark (Producer/Music Magnate)
John Candy (Comedian)
Ray Charles (Musician)
Deanna Carter (Singer)
Helen Caldicott (Activist/Writer)
Dean Cain (Actor)
Drew Carey (Actor/ Comedian)
Earl Campbell (Football Star)
Eric Clapton (Musician)
Jim Carrey (Actor/Comedian)
Melanie Chisholm (Singer)
Naomi Campbell (Model)
Rosemary Clooney(Singer)
Jose Canseco (Baseball Star)
Shawn Colvin (Musician)
Mary Jo Codey (First Lady Of New Jersey)
Judy Collins (Musician)
Dick Cavett (TV Host/Writer)
Courtney Cox (Actor)
Margaret Cho (Actor/Comedian)
Natalie Cole (Singer)
Michael Crichton (Writer)
Francis Ford Coppola (Director)
Sheryl Crow (Musician)
Winston Churchill (English Prime Minister)
Nicolas Cage (Actor)
Sandra Cisneros (Writer)
Patricia Cornwell (Writer)
John Cleese (Comedian/Actor)
Leonard Cohen (Musician)
Paula Cole (Actor)
Shayne Corson (Hockey Star)
Judy Collins (Musician)
Shawn Colvin (Musician)
Jeff Conaway (Actor)
Ty Cobb (Baseball Star)
Pat Conroy (Writer)
Billy Corgan (Musician)
Calvin Coolidge (US President)
Bill Dana (Comedian)
John Daly (Golf Star)
Rodney Dangerfield (Comedian/ Actor)
Charles Darwin (Scientist)
Jefferson Davis (President Of The Confederate States Of America)
Jonathan Davis (Musician)
Sandra Dee (Actor)
Gaetano Donizetti (Opera Singer)
Mike Douglas (TV Host)
Walt Disney (Entrepreneur)
John Denver (Musician)
Dame Edna Everage a.k.a. Barry Humphries (Comedian)
Ellen Degeneres (Comedian/Actor)
Richard Dreyfuss (Actor)
Johnny Depp (Actor)
Paolo Dicanio (Soccer Star)
Eric Douglas (Actor)
Charles Dickens (Author)
Patty Duke (Actress)
Scott Donie (Olympic Star)
Kitty Dukakis (Former First Lady Of Massachusetts)
Michael English (Singer)
Jim Eisenreich (Baseball Star)
Thomas Edison (Inventor)
Ralph Waldo Emerson (Writer)
Robert Evans (Film Producer)
Jules Feiffer (Cartoonist)
James Farmer (Civil Rights Leader)
Edie Falco (Actress)
Betty Ford (Former US First Lady)
Carrie Fisher (Actress)
James Forrestal (Undersecretary Of US)
Eddie Fisher (Singer)
Aretha Franklin (Singer)
Harrison Ford (Actor)
Albert French (Writer)
Sally Field (Actress)
Connie Francis (Singer)
Sarah Ferguson (Duchess Of York)
Sigmund Freud (Psychoanalyst)
Stephen Fry (Actor)
Shecky Greene (Comedian)
Barbara Gordon (Filmmaker)
Phil Graham (Washington Post)
James Gandolfini (Actor)
James Garner (Actor)
Peter Gabriel (Musician)
Kendall Gill (Basketball Star)
Ruth Graham (Writer)
John Gibson (Pianist)
Danny Glover (Actor)
Dwight Gooden (Baseball Star)
Tipper Gore (Former US First Lady)
Galileo (Scientist)
Carey Grant (Actor)
Mariette Hartley (Actor/Activist)
Tim Howard (Soccer Star)
Juliana Hatfield (Musician)
Ernest Hemingway (Writer/ Nobel Laureate)
Margaux Hemingway (Actor)
Audrey Hepburn (Actor/Activist)
Olivia Hussey (Actress)
Pete Harnisch (Baseball Star)
Linda Hamilton (Actor)
Stephen Hawking (Physicist)
Sir Anthony Hopkins (Actor)
Marty Ingels (Comedian)
Janet Jackson (Musician)
Kay Redfield Jamison (Psychologist/Author)
Richard Jeni (Comedian)
Jim Jenson (Newscaster)
Billy Joel (Musician)
Beverly Johnson (Supermodel)
Elton John (Musician)
Angelina Jolie (Actor/Activist)
Daniel Johns (Musician)
Ashley Judd (Actor)
Naomi Judd (Singer)
Al Kasha (Songwriter)
Danny Kaye (Actor)
Leila Kenzle (Actress)
John Keats (Poet)
Franz Kafka (Writer)
Gelsey Kirkland (Dancer)
Margot Kidder (Actress)
Nicole Kidman (Actress)
Joey Kramer (Musician)
Julie Krone (Star Athlete)
Pat Lafontaine (Hockey Star)
Jessica Lange (Actor)
Robert E. Lee (US General)
Jacob Lawrence (Artist)
Vivien Leigh (Actress)
Peter Nolan Lawrence (Writer)
Primo Levi (Writer)
John Lennon (Musician)
Meriwether Lewis (Explorer)
Courtney Love (Singer)
Allie Light (Director)
Abraham Lincoln (American President)
Rick London (Cartoonist)
Mary Todd Lincoln (Former US First Lady)
Salvador Luria (Scientist/Nobel Laureate)
John Madden (Football Star)
Meat Loaf (Musician/Actor)
Camryn Manheim (Actor)
Martha Manning (Psychologist)
Gustav Mahler (Composer)
Alanis Morisette (Singer)
Howie Mandel (Comic)
Bette Midler (Singer/Actress)
Dave Matthews (Musician)
Gary Mcdonald (Actor)
A.J. Mclean (Musician)
Burgess Meredith (Actor)
Sir Paul Mccartney (Musician)
Robert Mcfarlane (Security Advisor)
Sarah Mclachlan (Musician)
Rod Mckuen (Writer)
Gary Mcdonald (Actor)
Les Murray (Poet)
John Stuart Mill (Philosopher)
J.P. Morgan (Industrialist)
Edvard Munch (Artist)
John Mellencamp (Musician)
Paul Merton (Comedian)
Kate Millet (Writer/Feminist)
Carmen Miranda (Dancer)
Claude Monet (Artist)
Many Moore (Singer)
Michelangelo (Artist)
V.S. Naipaul (Writer/Nobel Laureate)
John Nash (Mathematician /Nobel Prize)
Ralph Nader (Consumer Rights Advocate)
Stevie Nicks (Musician)
Vaclav Nijinsky (Dancer)
Sir Isaac Newton (Scientist)
Deborah Norville (Journalist)
Marie Osmond (Entertainer)
Sir Laurence Olivier (Actor)
Rosie O’Donnell (Comedian/Actress)
Georgia O’Keefe (Artist)
Donny Osmond (Entertainer)
Lani O’Grady (Actress)
Eugene O’Neill (Playwright)
Dolly Parton (Musician)
Meera Popkin (Broadway Star)
Charley Pell (Football Coach)
George Patton (US General)
Jane Pauley (Journalist)
Teddy Pendergrass (Musician)
Edgar Allan Poe (Writer)
Elvis Presley (Entertainer)
Ezra Pound (Poet)
Jason Pollock (Artist)
Cole Porter (Composer)
Jimmy Piersall (Baseball Star)
Alma Powell (Wife Of General Colin Powell)
Susan Powter (Motivational Speaker)
Freddie Prinze Jr. (Actor)
Roseanne (Comedian/Actress)
Bonnie Raitt (Musician)
Burt Reynolds (Actor)
Lou Reed (Musician)
Norman Rockwell (Artist)
Theodore Roosevelt ( President Of The United States)
Joan Rivers (Comedian Actress)
Mac Rebennack A.K.A. Dr. John (Musician)
Alex Rodriguez (Baseball Star)
Alys Robi (Vocalist)
Axel Rose (Singer)
Winona Ryder (Actress)
Yves Saint Laurent (Fashion Designer)
Sam Shepard (Playwright)
Tom Snyder (TV Host)
Monica Seles (Tennis Star)
Linda Sexton (Writer)
Neil Simon (Playwright)
William T. Sherman (US General)
Marc Summers (TV Host)
Diana Spencer (Princess Of Wales)
John Steinbeck (Author)
Paul Simon (Musician)
Lauren Slater (Writer)
Willard Scott (Star Weatherman)
William Shakespeare (Writer)
Carly Simon (Singer)
Jose Solano (Actor)
Rick Springfield (Musician/Actor)
Brooke Shields (Model/Actress)
Rod Steiger (Actor)
George Stephanopoulos (Political Advisor)
Barbra Streisand (Singer/Actress)
William Styron (Writer)
Charles Schulz (Cartoonist)
Teresa Stratas (Opera Singer)
Sissy Spacek (Actress),
Dave Stewart (Singer)
Darryl Strawberry (Baseball Star)
Lori Schiller (Writer)
Francis Sherwood (Writer)
Scott Simmie (Journalist)
Earl Simmons A.K.A. DMX (Musician/Actor)
Alonzo Spellman (Football Star)
Nikola Tesla (Inventor)
Spencer Tracy (Actor)
Hunter Tylo (Actor)
Leo Tolstoy (Author)
Ted Turner (Entrepreneur)
Henri De Toulouse-Lautrec (Artist)
Mark Twain (Author)
Peter Illyich Tchaikovsky (Composer)
Anne Tyler (Author)
Tracy Ullman (Actor)
Dimitrius Underwood (Football Star)
Vivian Vance (Actor)
Kurt Vonnegut (Writer)
Tom Waits (Musician)
Mike Wallace (Journalist)
Michael Warren (Editor Canada Post)
George Washington (US President)
Evelyn Waugh (Novelist)
Damon Wayans (Comedian/Actor)
Tennessee Williams (Writer)
Dar Williams (Musician)
Robin Williams (Comedian/Actor)

Ann Wilson (Singer)
Bill Wilson (Founder Of Alcoholics Anonymous)
Brian Wilson (Musician)
Oprah Winfrey (TV Host)
Jonathan Winters (Comedian)
Ed Wood (Director)
Tom Wolfe (Writer)
Lewis Wolpert (Scientist)
Hugo Wolf (Composer)
Virginia Woolf (Novelist)
Luther Wright (Basketball Star)
W.B. Yeats (Poet)
Robert Young (Actor)
Bert Yancey (Golf Star)
William Zeckendorf (Industrialist)
Renee Zellweger (Actor)


Buchwald, A. (1999). Famous, important people who have suffered depression. Psychology Today.

Fonda, J. (2005). My life, so far. New York: Random House.

Jamison, K.R. (1993). Touched with fire. Manic depressive illness and artistic temperment. New York: Free Press.

Shepard, S. (1999). Mrs. gore breaks the ice on mental illness. Wahsington Bureau: The Palm Beach Post.

Shields, B. (2005). Down came the rain: My journey through post partum depression.
New York: Hyperion Books.

______(2005). Health: Celebrities who have admitted suffering from depression. England: Burmingham Post.

People with Mental Illness Enrich Our Lives

Celebrity with Anxiety Disorders

Famous People Who Have Battled Depression

People Watching

For the eighth time in a week your humble reporter found himself at the Atlanta airport. Ahem, I should say, of course, the Hartsfield-Jackson Atlanta International Airport.

It’s a perfect place for people watching. New statistics out today have shown that in 2006 it held its position as the world’s busiest airport, followed by O’Hare in Chicago and London’s Heathrow.

I was chastened to realize that I have been in every one of the top ten airports in the last year or so. For people who like such things, here’s the list of the top ten busiest airports with the number of millions passengers who’ve been through each:

  1. Atlanta    84.8
  2. O’Hare    76.2
  3. Heathrow   67.5
  4. Tokyo’s Haneda    65.2
  5. Los Angeles International    61
  6. Dallas/Fort Worth    60
  7. Paris, Charles de Gaulle    56.8
  8. Frankfurt    52.8
  9. Beijing Capital International Airport    48.5
  10. Denver International    47.3

Spending a lot of time in airports can stress the physical, psychological and subtle systems of the body, as well as making it easy to lose touch with your spirituality.

I’m going to let you in on a secret: for over two decades I had learned and then taught methods for building resilience and bouncing back from adversity. But it wasn’t until I started flying a quarter of a million miles a year that I got the chance to test and refine the methods under the most extreme conditions. Engineers often talk about taking their constructions and “testing them to destruction.” I did the same thing with the methods I teach. If they couldn’t help people cope with flights, illness or job loss, then I discarded them and looked for something else. And if they didn’t also have another piece – a way to grow in response to adversity, they were out too.

The result has been a whole raft of techniques and methods that have been tried and tested again and again. Over the next year I shall be rolling out a great many of these techniques in a novel format.

Watch this space!

“Every adversity carries with it the seed of equal or greater benefit.”
–Napoleon Hill (American Founder of Personal Success Literature, 1883-1970)

“From the withered tree, a flower blooms.”
–Zen Buddhist Saying

“How you handle adversity in the workplace tends to have much more impact on your career than how you handle the good stuff. The people who know how to overcome adversity are the ones who rise to the top of the organization."
— Martin E. P. Seligman (American Psychologist, Professor at the University of Pennsylvania and Former President of the American Psychological Association, 1941-)

“Adversity is the diamond dust with which Heaven polishes its jewels.”
— Robert Leighton (Scottish Presbyterian Bishop and Classical Scholar, 1611-1684)

“Adversity has the effect of eliciting talents which in prosperous times would have lain dormant.”
–Horace (a.k.a. Quintus Horatius Flaccus, Roman Poet and Satirist, 65-8 B.C.E.)

“Adversity is not undesirable. Because, it is only when you are down and out in life that you can realize its true value.”
–Swami Ramdas (a.k.a. Papa Ramdas, Indian Spiritual Teacher, 1884-1963)

Personality Style, Coping and Posttraumatic Stress Disorder

I have written a fair amount about posttraumatic stress disorder (PTSD) not only because it can be such a nasty problem, but also because it is beginning to give up many of its secrets, and it is one of the illnesses that can really show the benefits of Integrated Medicine.

There is new research just published in the journal Psychosomatic Medicine. The report is a prospective study that was done in Israel.

180 undergraduate students at the University of Haifa were coincidentally evaluated 2 weeks before a terrorist explosion in a bus heading toward their university and reevaluated 1 week, 1 month, and 6 months after the explosion.

The findings were that there were premorbid personality characteristics that predicted the development of PTSD. This is in line with the research showing both genetic and neurological predispositions to developing PTSD. The research also indicated that
some people have more robust coping styles than others. And finally, as
expected, there is a relationship to how close people were to the

This is all useful information, and once again shows the futility of trying to psychological reactions to only genes, only the brain, only past experience or only the environment.

Any comprehensive understanding needs us to incorporate all of those factors.

Leg Length and Cognitive Reserve

I recently mentioned the "Barker Hypothesis" which says that fetal malnutrition is associated with many physical problems later in life.

Well the difficulties may not only be physical.

I would like to tell you about an important concept that we call "Cognitive reserve." This can be thought of as our cognitive resilience. This first came to light almost twenty years ago when a post-mortem study of 137 elderly people was published in the Annals of Neurology, and confirmed something that we had suspected for years: there was a large discrepancy between the degree of Alzheimer’s disease neuropathology and the clinical manifestations of the disease. Some people had extensive pathology but they  clinically had no or very little manifestations of the disease. The investigators also showed that these people had higher brain
weights and greater number of neurons compared with age-matched
controls. This lead to the idea that they had a greater "reserve." This is why building your brain throughout life is thought to reduce the ce of cognitive impaitrment later on.

Studies have shown that childhood cognition, educational attainment and adult occupation all independently contribute to cognitive reserve, and more recently it has been confirmed that education and the complexity of a person’s occupation may both slow the rate of decline in people who already have Alzheimer’s disease.

Although height is in part genetically determined, shorter leg length has been found to be associated with an adverse environment in early childhood. In a recent study of older Afro-Caribbean people living in London, shorter leg length was significantly associated with cognitive impairment, leading to the suggestion that shorter leg length may be a marker of early life stressors that then result in reduced cognitive reserve.

It is also worth recalling our discussion about the association between growth hormone and intelligence in children and between intelligence and head size.

And nutrition is one of the determinants of growth hormone synthesis and release.

Naturally this does not mean that less tall people will all get Alzheimer’s disease. But these observations have a number of practical consequences. They re-emphasize the importance of good nutrition during pregnancy: something that is simply not available to over a third of the world’s population. They also help us to identify some of the people who would most benefit from strategies to increase their cognitive reserve and to avoid some of the things that can strip it away from them.

Wishing You Great Learning Opportunities in the New Year!

“The world is the great gymnasium where we come to make ourself strong.”
–Swami Vivekananda (Indian Hindu Mystic and Spiritual Teacher, 1863-1902)

A lot of people tell me that they are pleased to see the back of 2006, and we certainly had more than our fair share of challenges during the year, having lost four members of our family in just a few months. The fact that they were not all human didn’t change the impact one bit.

But for all the people who have told me about their negative thoughts about the year I’ve said the same thing: the year has actually been a terrific learning experience. That’s not to say that we should slap a big smiley face on every pain, hardship and adversity, but it does mean that it is essential for all of us to try and find the meaning in the events that have happened in our lives.

When Nietzsche said “That which does not kill me makes me stronger,” he was giving voice to a peculiarly Germanic ideal of the time: that people need to be tested and tempered like steel. That’s not what I mean at all.

The three best and most effective ways of dealing with adversity are first to extract meaning from the event or situation: “Why is this happening?” “Is it just dumb bad luck or is there more to it?”

The second essential is to learn to detach from an event, so that it no longer has its emotional claws in you.

And the third is to accept a situation. Not in some passive way of letting life bowl you over, but of being able to acknowledge an experience and then using it as the basis for wise action.

Each of these can take a lifetime to learn the hard way, but you can actually master them very quickly with a series of simple steps.

I am going to be sharing some of them with you in the coming months. I am also going to be publishing an eBook on the topic of resilience, because detachment and acceptance come much more easily to the person with robust resilience.

Having recently had to make a number of unexpected trips overseas has delayed our publication schedule by three months, but we shall be back on track by the end of January.

And here’s a final thought for you from Healing, Meaning and Purpose: adversity is an invitation to grow. If approached in the right way, apparently negative events can lead to a shift in your consciousness and rapid spiritual development.

In fact the majority of my own teachers could trace their spiritual maturation to major life events that at the time seemed to be the end of the world.

Remember that what the caterpillar thinks to be the end of the world, is, for the butterfly, just a new beginning!

“Trials, temptations, disappointments — all these are helps instead of hindrances, if one uses them rightly. They not only test the fiber of character but strengthen it. Every conquering temptation represents a new fund of moral energy. Every trial endured and weathered in the right spirit makes a soul nobler and stronger than it was before.”
James Buckham (American Naturalist and Writer)

“The most spiritual human beings, assuming they are the most courageous, also experience by far the most painful tragedies: but it is precisely for this reason that they honor life, because it brings against them its most formidable weapons.”
–Friedrich Wilhelm Nietzsche (German Philosopher, 1844-1900)

“Out of confusion, you invent something permanent – the Absolute, the Brahman or God.”

–Jiddu Krishnamurti (Indian Spiritual Teacher, 1895-1986)

Social Adversity and Schizophrenia

People who are interested in the interaction of genes, environment, brain and mental illness might be interested to look at a brief article posted over at the Psychiatric Resource Forum.

The article summarizes some very important new data on social adversity and the subsequent dvelopment of major mental illness. The research has been looking at a huge puzzle: why are serious mental illnesses so much more common in Afro-Caribbeans and Africans living in England and other parts of Western Europe? It was initially thought that it might all be due to over-diagnosis, but with deatialed work done in England, the Caribbean and Africa it has now become clear that that isn’t it.

There may be a contribution from vitamin D deficiency: dark skinned people who are recent immigrants cannot make as much in their skin as they need. But that is not a cause but a potential contrbutor. That being said I am going to have something more to say about causality in medicine in a post in the next day or two.

A second line of research has identified some key brain structures that if abnormal, dramatically increase the change that a "high risk" person will develop schizophrenia. By "high risk" we mean a significant family history of the illness.

This is important material and represents a major step forward in our understanding of major mental illness and a move away from the medical model that has dominated so much of psychiatry over the last 30 years.

A New Understanding of Mood Medicines and Cells

We are in the midst of a revolution in our understanding of how many medicines work. Most students are still taught that the key to their actions is simply a matter of binding to a receptor, and then some magic occurs in the cell. But over the last few years there has been a sea change in how we see the actions of many medicines. In many ways the focus on receptor pharmacology is so 1990s.

Several years ago our group and others began to speculate that one of the ways of modulating the interaction of insulin with cells was to modify the characteristics of the cell membrane in which the insulin receptors sit. If we could change the fluidity of the cell membrane, then we could change the sensitivity of the insulin receptor. We also went a bit further and wondered whether high cholesterol levels might be associated with coronary artery disease because it changed the way in which growth factors interacted with cells in the vessel walls.

One of the reasons that fish oils may yet turn out to be helpful in some mood disorders is because they may change the behavior of cell membranes and therefore the behavior of receptors.

I have admired the work that has bee done by Husseini Manji and his group that is now at the National Institute of Mental Health in Bethesda, Maryland. Their interest is in bipolar disorder and there is a very nice update on the group’s work in the journal Biological Psychiatry.

The group is unraveling the ways in which effective medicines work at the cellular level and what actually goes wrong in bipolar disorder. We know that people with severe mood disorders may experience regional impairments of what we call structural plasticity and cellular resilience. This means that the cells find it more difficult to learn and respond to environmental changes. We think that this is why some people with severe mood problems fail to benefit from many medicines and also have so many long-term cognitive problems. So the search is on for strategies that may enhance and maintain the normal connections between neurons. The good news is that there are several new strategies on the horizon.

This notion of impairment in the normal plasticity and resilience of the brain is also why psychosocial approaches are an essential component of successful treatment. When they are coupled to the right medicine as well as the strategies that we employ in Integrated Medicine, the effects can often be very gratifying.

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