Mental Health Blogs

In French, that means old, healthy . . . and bilingual. I could just as well have used Google Translate to put that phrase into Finnish or Spanish or Chinese. The fact is, I don’t speak any of those languages fluently—any language except English really. Which puts me in good company: When Senator Barack Obama was campaigning for the presidency back in 2008, he told a crowd in Dayton, Ohio: “I don’t speak a foreign language. It’s embarrassing.”

It is embarrassing. But worse than that, it may be unhealthy. New research suggests that bilingualism may convey previously unrecognized cognitive benefits—benefits that appear early and last a lifetime. These benefits may go well beyond language itself. Indeed, speaking two languages may shape the mind and brain in fundamental ways, creating mental reserves that help stave off the ravages of dementia.

That’s the surprising possibility emerging from an ongoing research project at York University in Ontario. Cognitive psychologist Ellen Bialystok has for years been testing and comparing people who speak one or two languages, including children, adults and the elderly. Her overall conclusion is that bilingualism enhances the brain’s “executive control.” That’s a catchall term that encompasses the ability to pay attention, to ignore distractions, to hold information in short-term memory, to do more than one task at a time. It’s mental discipline, and it typically emerges in childhood and declines in old age.

Bialystok has tested this many different ways. Here’s one example: She had 4- and 5-year-old kids do a card sorting task. The cards show circles or triangles, some red and some blue, and the kids are told to sort the deck by color. Later they are told to switch—and sort the same cards by shape. Young children usually have great difficulty making this mental switch, but when Bialystok ran the experiment, bilingual kids were much better with the rule change. This indicates heightened executive control.

This advantage appears to persist into adulthood. Bialystok (working with various colleagues) compared bilinguals and monolinguals on various lab tests that require mental discipline. The Stroop test is one such test. That’s the one where you have the word R-E-D printed in blue, and you have to rapidly name the ink color rather than read the word. It’s hard—and again the bilinguals consistently did better than subjects who only spoke one language. Or looked at another way, monolinguals had a cognitive deficit—and this deficit appears to increase as adults get older.

Right into old age. Bialystok wanted to explore whether enhanced executive control actually has a protective effect in mental aging—specifically, whether bilingualism contributes to the “cognitive reserve” that comes from stimulating social, mental and physical activity. She studied a large group of men and women with dementia, and compared the onset of their first symptoms. The age of onset for dementia was a full four years later in bilinguals than in patients who had lived their lives speaking just one language. That’s a whopping difference. Delaying dementia four years is more than any known drug can do, and could represent a huge savings in health care costs.
Is there any downside to bilingualism? Yes. As reported on-line in the journal Current Directions in Psychological Science, Bialystok’s studies also found that bilinguals have less linguistic proficiency in either of their two languages than do those who only speak that language. They have somewhat smaller vocabularies, for example, and aren’t as rapid at retrieving word meanings. But compared to the dramatic cognitive advantages of learning a second language, that seems a small price to pay. Plus you can travel to Paris without the embarrassment of constantly thumbing through your dog-eared French for Dummies.

Wray Herbert’s “We’re Only Human” column appears regularly in the magazine Scientific American Mind. His book, On Second Thought: Outsmarting Your Mind’s Hard-Wired Habits, will be published by Crown in September.

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For today’s podcast we have guest psychiatrist Dr. Pat Barta talking about telepsychiatry, telemedicine and all things neuroimaging. We ponder how licensure works for telepsychiatry, whether or not you can get reimbursed for it, what the difference is between a face-to-face evaluation versus a telephone interview and why we don’t yet have an iPhone app to diagnose schizophrenia. All of these topics (and more) can be found on Dr. Barta’s blog Adventures in Telepsychiatry.

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Listen to our latest podcast at mythreeshrinks.com or subscribe to our rss feed. Email us at mythreeshrinks at gmail.

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You know, it’s all so fresh. I went to a conference last week, a really good one, and three-quarters into it realized my family had buried my father only two weeks past to the hour. I have no idea what happened in the third quarter of the presentation.

Later today somebody called me, left voicemail for me to call back. I totally thought it was about business, but all he wanted was to call, to see how I’m doing. That just threw me.

My dreams scare me.

I go through the usual words with people: It’s hard. I find myself crying at nothing. I have a headache. I’m cold. I have a stomach ache. (Somaticizing isn’t hard, but it is an art).

And it’s very different, not what I would have thought it would be.
You get a break and it comes back. You’re surprised every time.

Heck, I had four months to get used to the idea that my father was living on borrowed time, and we had some very intimate moments. Dying is very intimate if you share it, and it occurs to me that maybe some people have an extended dying just so they can be intimate.

Probably we can never be prepared, can never predict what it will be like, no matter the type of relationship we have had with a parent. If you take a hit, you shouldn’t be surprised, and if you don’t, it’s okay. The books on death and dying recommend that if possible, grieve as a family. Discuss your different trajectories, mark important days, discuss memories. Let the emotions roll. And spread it out, talk to all kinds of people if you feel like it.

Meanwhile, here I am at work as if nothing has happened and it really feels this way at the moment. Gotta’ love the brain.

A follow-up on eulogies:

I started out mine about my father admitting that before writing the eulogy I looked up the rules of eulogies in one of the rule books. There, in black and white and a little Hebrew, it said:

You can exaggerate. Not that much, but if there’s a question, you can. You can err on the side of the positive.

Now this is incredibly important information. I don’t know anyone who can’t stand to be idealized a little bit in life or death, do you?

A story:

A man was dying. He had lived a full life but was clearly, undoubtedly, beleaguered with not one personality disorder, but with features of several. He hoarded, he was narcissistic, he stole on occasion, and his jealousy was completely, totally irrational, bordered on psychotic at times.

His son, let’s call him Eugene, went to the funeral of a friend’s father. His friend spoke glowingly of the deceased, tearfully, and as Eugene listened, he panicked.

“I’m ____ed,” he moaned. “What in the world am I going to say about my father? My father was such a nothing compared to this guy. So selfish! And he’s not going to make it through the year! He could die any day now!”

Eugene went home and quickly wrote a eulogy emphasizing whatever good he could find in his father’s life. The focus was entirely on his father’s good qualities, and he made some of the bad sound comical, not dysfunctional.

When the time came, when his father died, Eugene stood up in front of the crowd at the chapel and delivered a wonderful eulogy, had people in tears of laughter and love, and everyone said what a wonderful man his father must have been.

Eugene didn’t know what to do, didn’t want to correct anyone who said, Your father sounds like he was such a wonderful man. You were so lucky to have had him; what a wonderful family it must have been to grow up in. So he would disclose just a little now and then.

“My father was difficult,” he might say. Or, “You couldn’t correct my father, if you did he would call you stupid.”

But this bothered him, made him feel guilty, besmirching the name of the dead, his father, the man who gave him life, for better or for worse. So he stopped it and let the positives of his dad’s life eclipse the negatives. He could talk about the truth with his wife and his mother, for they knew this man. They grieved who he hadn’t been, too, and their emotions were plenty rich. With others, however, he took one for the team.

He found that he was really angry and his anger wouldn’t quit. Unable to shake it, he went to therapy. Here he learned that this is normal, being angry at someone who didn’t treat you well, who could be irresponsible, difficult. Eventually he would be able to let it go, who his father really was, even forgive.

Perhaps it’s not much of a story. But let me tell you how some of us would work a therapy like this, thanks, in part, to what we know about mental illness.

For sure we’d aim for acceptance while working through the full range of grieving, the sadness, the anger, the guilt, the denial, the shame– the Kubler-Ross stages of grief. And some of us might even bring in other family members.

Family therapists will sketch out at an emotional family tree, inquire about the suicides, the mental illness, the infamous experiences in the extended family, reaching back in time. We want to know who left town and never came back, what became of the black sheep, what the norms are in the family about differentiation, and why. We inquire about how anger is expressed, and sadness, and who set these rules, and why. We want to know the meaning of success to those who are no longer living, and the meaning of failure.

To investigate, to get more of the story, patients are encouraged to interview living elderly relatives, to find photographs, letters. The job is to uncover, if possible, the good in the family, but also the mental or behavioral disorders, too, and the quirky, if not always so pleasant, personalities.

Based upon this, some of us will proffer a tentative individual diagnosis or three, defining, psychologically, members of the family who may have long since passed away, at least labeling the features. This may or may not make people feel better, but it is what it is and it’s something to consider, something important to talk about, something to grieve.

“Is it genetic?” patients ask about a particular diagnosis.

We’ll say yes, if we think so, or admit we don’t know. Maybe, maybe not, depending upon who is fertilizing whose egg. But it’s a good thing to know, isn’t it, that if an ancestor has features of a disorder, that descendants might have these features as well?

For whether or not things are genetic, everything behavioral can be learned and passed down. All of us struggle with our nature, and we fight how we’ve been nurtured, too. Both are likely to be transgenerational, even dysfunctional in some way.

I like to think that we can fight both, that much of personality can be shaped and confronted in a nice way, and that most mental illness can be treated. We may have to change how we define success and failure.

The kicker, the part that is most difficult for many patients to buy in this psycho-educational family therapy, is that it’s good to “out” our mentally ill, personality disordered, addicted relatives. Out them to the children, mainly, expose those who, dead or alive, have or had issues, or were perhaps differently-abled.

Certainly when it comes to mental illness, rather than attempt to erase a person from the family tree, own the mishigas, (rhymes with wish-ih-moss, Yiddish for craziness) and vaccinate the kids, empower them.

It’s so funny. When you tell your kids about the colorful people in the family, they get it right away. And no, they don’t want to be just like them. The research on self-fulfilling prophesies has always been a little light.

All that said, you don’t have to roast anyone at a funeral, not unless you know your crowd.

therapydoc

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Paperdoll commented that ?she (?he– do paperdolls have gender?) likes posts about “normal.”

The quick answer is: No, you’re not normal! Normal people don’t call themselves “paper doll.” Normal people also don’t write blogs called “Shrink Rap” or post photos of their feet all over the internet.

I’m a psychiatrist and people ask me all the time “Is that normal?” or worse, “Am I normal?”
And we start with a semantic disconnect here: I equate “Normal” with “Booooring!” and would gladly wear a pin that says “Why Be Normal?” Like Why? What is normal? Why would anyone aspired to that. Normal is an IQ of 100, corn flakes for break fast and tuna fish for lunch (ok, I like tuna)..normal entails conforming to some exact mediocre standard. Why would you want to be Normal. Please don’t call me normal (I think I don’t have too worry too much here).

To my patients, however, “Am I normal?” doesn’t mean Am I normal, it means “Please tell me I’m not crazy.” You’re not crazy. Okay, Paperdoll, I don’t know you, and I don’t know what crazy means to you, but there’s probably a good shot you’re not crazy. And I am definitely not crazy. Oh, yeah, I’m a psychiatrist and I’m not supposed to use the word crazy. Okay, you’re normal.

So sometimes I’m told that I’m too normal to be a psychiatrist. Oh, all the Shrink Rappers—believe it or not— kind of “look” normal….except for ClinkShrink who has started acting like Spiderman while she repels off steep cliffs. Apparently– or so I’m told– psychiatrists don’t look normal.

Where am I going with this? And why? Is this kind of bloggy discourse normal?

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Louis Brandeis was already one of America’s most famous lawyers when Woodrow Wilson appointed him to the Supreme Court in 1916. He was a tireless and prescient critic of big investment banks—including bankers’ excessive bonuses—an argument he spelled out in his influential book of essays, Other People’s Money and How Bankers Use It. His solution for the problem of concentrated financial power was unfettered public scrutiny, a belief he summarized in his famous statement: “Sunlight is said to be the best of disinfectants; electric light the most efficient policeman.”

Justice Brandeis was an intuitive psychologist. When he said that the “broad light of day” would purify men’s actions, he was anticipating a field of research that is just now beginning to illuminate the intricate interplay of the mind, the body, and morality. Light, it appears, does much more than distinguish day from night; it takes away our illusion of anonymity and, in doing so, literally keeps us honest.

This seems obvious on one level. Streetlights were most likely invented to deter crime, and big power outages are almost inevitably followed by looting. But darkness in that sense is actual cover for criminals, like a mask. The new research suggests that even non-criminals may be influenced by the metaphorical meaning of light and darkness, becoming more dishonest and self-centered as light diminishes.

Here’s the science. Three psychologists—Chen-Bo Zhong and Vanessa Bohns of the University of Toronto and Francesca Gino of the University of North Carolina—wanted to explore the idea that metaphorical darkness leads to illusory anonymity, and in turn to moral transgression. In one experiment, they had a group of volunteers perform a complicated mathematical task—so complicated that it was impossible to complete in the time allotted. When they ran out of time, the volunteers were told to pay themselves only for the work they were able to finish. This was all done anonymously, although secretly the scientists were monitoring the volunteers’ actions.

Half the volunteers did this sham exercise is a brightly lit room, with twelve overhead light bulbs, while the others did it in a room dimly lit by just four bulbs. The idea was to see if those in the darker room were more likely to cheat than those working in bright light. And they were, indisputably. They not only lied about their performance on the difficult task, they also paid themselves more cash for work they had failed to do. In short, they lied, cheated and stole money.

It’s important to note that, while one room was darker than the other, neither room was actually dark. That is, the lack of illumination was not enabling the cheating; and indeed, the task was (ostensibly) anonymous anyway, so there was nothing really to hide. It’s not like they were tip-toeing out of the room with cash. Yet the dim lighting gave volunteers the psychological license to behave unethically.

These findings were bizarre enough that the scientists wanted to double-check them. So in a second experiment, instead of dimming the room, they had only some of the volunteers wear sunglasses to dim their view. Then all the volunteers participated in a laboratory exercise called the dictator’s game. The dictator’s game is a test of fairness and greed; one volunteer (the initiator) has a given pot of cash, and is allowed to give away all, some or none of it to another, who can accept or reject it. In this experiment, all the volunteers were initiators; the scientists simply wanted to see how generous or stingy they were, depending on whether they were wearing sunglasses or not.

Shades corrupt. As reported on-line in the journal Psychological Science, those with a slightly darkened view of the world gave away considerably less money—less than what’s fair and less than the volunteers not wearing shades. Darkness gave them the sensation that they were more concealed, and that in turn made them greedier people.

Think about this for a minute. The researchers were not manipulating light and darkness so that some actually had more cover. They were the ones perceiving a darker world, and that perception was enough to license their transgressions. What’s going on here? Well, the researchers believe that dimming the lights or wearing sunglasses is a kind of egocentric mental “anchor”; because they see the world as somewhat darkened, they assume that others have an obscured view of them as well. They act not as if they have sunglasses on, but as if there has been a widespread power outage that has darkened everyone’s world.

Kids are notoriously egocentric in this way. They’ll close their eyes when they play hide-and-seek, thinking that they can’t be seen if they themselves can’t see. Apparently, adults don’t outgrow this egocentrism entirely. But what’s cute in a childhood game of hide-and-seek isn’t nearly so cute in grownup games with other people’s money.

For more insights into the quirks of human nature, visit the “Full Frontal Psychology” blog as True/Slant. Excerpts from “We’re Only Human” appear regularly in the magazine Scientific American Mind. Wray Herbert’s book, On Second Thought: Outsmarting Your Mind’s Hard-Wired Habits, will be published by Crown in September.

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Imagine this scenario: You lost your job at the lumber yard early in 2009. Nobody is building new homes these days, and this slowdown has trickled down to suppliers all over the country. What’s worse, you’re dipping into savings just to make your own mortgage payments—on a house that has lost a big chunk of its value. In short, your American dream is in shambles.

It’s a dreary but all too familiar scenario. Now imagine further how you feel about this. Is worry your primary emotion? Are you anxious about your wife’s health, and the possibility of an expensive hospitalization? Are you fearful about depleting your kids’ college funds? Where will you all live if you lose the house?

Or are you mostly angry? After all, this situation is totally unfair, given how hard you have worked all these years. Who’s to blame? Those fat cat bankers are still drawing their obscene bonuses, while working guys like you are barely eking out a living. Someone’s got to pay for this mess.

Both fear and anger are understandable under these dire circumstances. But what are you going to do? Well, there‘s an election coming up later this year. Here’s your chance to at least take some action, to raise your citizen’s voice and be heard. How will you exercise this civic responsibility when you go to the polls in November?

We like to think that our democracy is rational, that as voters we educate ourselves on the issues and choose the candidate who best represents our views. Emotions, while natural, would seem to undermine this civic ideal, leading to cynicism and confused thinking and wrongheaded choices. But is it so simple? New research suggests that emotions can indeed skew voting behavior—but in surprising and nuanced ways.

University of Massachusetts scientists Michael Parker and Linda Isbell rigged an election to explore the interplay of specific emotions and voting. Not a real election, of course, but a hypothetical Democratic primary election for the Massachusetts state senate. They created two candidates, John Clarkson and Tom Richards, each with detailed positions on a dozen important public issues. The candidates’ positions are spelled out on the candidates’ Web sites, along with general information on each aspiring senator.

The researchers recruited a large number of volunteers, all Massachusetts residents, to act as voters in this election. They were directed to the Web sites, and told to peruse as much information as they liked, in any manner they wanted—and to consider whatever they needed to make an informed voting decision. Clarkson and Richards actually agreed on most of the issues, though they stated their views differently. The general information was vague, but made clear that each candidate was well qualified.

But here’s the rub: Before the voters started researching the issues and candidates, some were primed for fear and others for anger—much like the scenarios above. The idea was to see if these two basic human emotions shaped civic behavior in different ways. That is, did angry citizens size up candidates one way, and anxious voters a different way? And did these thinking styles translate into different behavior at the polls?

The answer is a resounding yea. As reported on-line in the journal Psychological Science, the worried voters were much more deliberate and organized in their thinking than were the angry voters, spending significantly more time exploring the candidates’ Web sites. What’s more, the anxious citizens actually voted for the candidates whose positions they agreed with; in other words, democracy worked the way it’s supposed to work. This may seem obvious, but it wasn’t to the angry citizens, for whom there was no apparent connection among issues and positions and ballot-box choices.

So what was influencing the angry voters, if not the issues of the day and the candidates promises? Apparently it was the vague general information that guided their choices. In the real world, that means things like basic name recognition, party loyalty, and simplistic political labels. The angry voters didn’t take the time to really concentrate on the issues and positions, and instead let these skimpy generalities guide them. It appears their anger was switching their brain from deliberate mode to automatic mode—to gut feelings more than rational analysis. The worried citizens had too much at stake to trust their gut.

For more insights into the quirks of human nature, visit the “Full Frontal Psychology” blog at True/Slant. Excerpts from “We’re Only Human” appear regularly in the magazine Scientific American Mind. Wray Herbert’s book, On Second Thought: Outsmarting Your Mind’s Hard-Wired Habits, will be published by Crown in September.

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I watched the movie, “The Wanted” this past weekend and was horrified at what I saw. I’d read rumors that Angelina Jolie struggled with anorexia, but withheld judgment since it was only Hollywood rumor. Then I saw the movie. Angelina Jolie was so emaciated I couldn’t believe it. She was scary thin.

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Allan Frances chaired the APA task force that created DSM-IV. On Monday, he had an editorial in the Los Angeles Times called “It’s Not Too Late to Save Normal.”

Dr. Frances writes:

The first draft of the next edition of the DSM, posted for comment with much fanfare last month, is filled with suggestions that would multiply our mistakes and extend the reach of psychiatry dramatically deeper into the ever-shrinking domain of the normal. This wholesale medical imperialization of normality could potentially create tens of millions of innocent bystanders who would be mislabeled as having a mental disorder. The pharmaceutical industry would have a field day — despite the lack of solid evidence of any effective treatments for these newly proposed diagnoses.

The manual, prepared by the American Psychiatric Assn., is psychiatry’s only official way of deciding who has a “mental disorder” and who is “normal.” The quotes are necessary because this distinction is very hard to make at the fuzzy boundary between the two. If requirements for diagnosing a mental disorder are too stringent, some who need help will be left out; but if they are too loose, normal people will receive unnecessary, expensive and sometimes quite harmful treatment.

Okay, I have a confession to make here: I don’t keep a copy of the DSM in my office. I own an edition which I’ve opened a couple of times while writing our book. I don’t care what the precise diagnostic criteria are: mostly I know them, but I’m left with the fact that if you wander into my office saying you’re tormented and suffering or having trouble functioning, I’m going to treat you. And if I prescribe medications, it’s mostly based on symptoms. Totally? No, because if there’s history of mania (I know those symptoms) or any sense that the diagnosis might be bipolar disorder, I’m going to go pretty gently with the antidepressants, just because I’ve notice that people with tendencies towards mood instability (whether or not it meets criteria for full mania) do better if the antidepressants are kept to a minimum. I hear we over-diagnose, but I’m going to comment that absolutely no one has ever come to see me for simple, uncomplicated grief or a normal reaction to a stressor– people just don’t define this (and let’s hope it stays that way) as a reason to run to a psychiatrist. And everyone’s favorite diagnostic complaint: Shyness vs. Social Anxiety Disorder. 18 years of practice and how many patients have come with a chief complaint of isolated social anxiety? Zero. And how many patients in my practice carry the diagnosis of Social Anxiety Disorder? Zero. Over-diagnosis of mood and anxiety disorders in general? Of course– maybe we’re treating people who previously would have just suffered. Or maybe we’re forced to assign a reimbursable diagnosis because V Codes (phase of life and relational disorders) can’t be reimbursed. It all gets to be circular reasoning.

So who’s placing bets on whether I purchase the DSM-V?

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I really have a problem with the recent surge in diagnosing children with Bipolar Disorder. The children I see with this diagnosis are often the victims of serious issues at home, issues which may even include abuse. Some struggle with PTSD and the mood swings which are inherent in a traumatized individual are attributed to “Bipolar Disorder” and medicated.

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I’m talked out on the subject of whether or not psychiatric illnesses exist and whether or not psychiatric treatments work. I went to work today. I think I’ll go again.
For the sake of completion, here’s Louis Menand writing in The New Yorker, “Head Case.” Click the link and read away.

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