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The Spirit Level. Why equality is better for everyone – Richard Wilkinson and Kate Pickett.

“For the first time in history, the poor are on average fatter than the rich.”
How is it that we have created so much mental and emotional suffering despite levels of wealth and comfort unprecedented in human history? The luxury and extravagance of our lives is so great that it threatens the planet.

At the pinnacle of human material and technical achievement, we find ourselves anxiety-ridden, prone to depression, worried about how others see us, unsure of our friendships, driven to consume and with little or no community life. Our societies are, despite their material success, increasingly burdened by their social failings.

If we are to gain further improvements in the real quality of life, we need to shift attention from material standards and economic growth to ways of improving the psychological and social wellbeing of whole societies. It is possible to improve the quality of life for everyone. We shall set out the evidence and our reasons for interpreting it the way we do, so that you can judge for yourself.

Social theories are partly theories about ourselves; indeed, they might almost be regarded as part of our selfawareness or self-consciousness of societies. The knowledge that we cannot carry on as we have, that change is necessary, is perhaps grounds for optimism: maybe we do, at last, have the chance to make a better world.

The truth is that both our broken society and broken economy resulted from the growth of inequality. The problems in rich countries are not caused by the society not being rich enough (or even by being too rich) but by the scale of material differences between people within each society being too big. What matters is where we stand in relation to others in our own society.

Why do we mistrust people more in the UK than in Japan? Why do Americans have higher rates of teenage pregnancy than the French? What makes the Swedish thinner than the Greeks? The answer: inequality.

This groundbreaking book, based on years of research, provides hard evidence to show:

  • How almost everything from life expectancy to depression levels, violence to illiteracy is affected not by how wealthy a society is, but how equal it is.
  • That societies with a bigger gap between rich and poor are bad for everyone in them including the well-off.
  • How we can flnd positive solutions and move towards a happier, fairer future.

Urgent, provocative and genuinely uplifting, The Spirit Level has been heralded as providing a new way of thinking about ourselves and our communities, and could change the way you see the world.

Richard Wilkinson has played a formative role in international research on the social determinants of health. He studied economic history at the London School of Economics before training in epidemiology and is Professor Emeritus at the University of Nottingham Medical School, Honorary Professor at University College London and Visiting Professor at the University of York.

Kate Pickett is Professor of Epidemiology at the University of York and a National Institute for Health Research Career Scientist. She studied physical anthropology at Cambridge, nutritional sciences at Cornell and epidemiology at the University of California Berkeley.

People usually exaggerate the importance of their own work and we worry about claiming too much. But this book is not just another set of nostrums and prejudices about how to put the world to rights. The work we describe here comes out of a very long period of research (over fifty person-years between us) devoted, initially, to trying to understand the causes of the big differences in life expectancy, the ‘health inequalities’ between people at different levels in the social hierarchy in modern societies. The focal problem initially was to understand why health gets worse at every step down the social ladder, so that the poor are less healthy than those in the middle, who in turn are less healthy than those further up.

Like others who work on the social determinants of health, our training in epidemiology means that our methods are those used to trace the causes of diseases in populations, trying to find out why one group of people gets a particular disease while another group doesn’t, or to explain why some disease is becoming more common. The same methods can, however, also be used to understand the causes of other kinds of problems, not just health.

Epidemiology is the study and analysis of the distribution (who, when, and where) and determinants of health and disease conditions in defined populations.

Just as the term ‘evidence-based medicine’ is used to describe current efforts to ensure that medical treatment is based on the best scientific evidence of what works and what does not, we thought of calling this book ‘Evidence-based Politics’. The research which underpins what we describe comes from a great many research teams in different universities and research organizations. Replicable methods have been used to study observable and objective outcomes, and peer-reviewed research reports have been published in academic, scientific journals.

This does not mean that there is no guesswork. Results always have to be interpreted, but there are usually good reasons for favouring one interpretation over another. Initial theories and expectations are often called into question by later research findings which make it necessary to think again. We would like to take you on the journey we have travelled, signposted by crucial bits of evidence and leaving out only the various culs-de-sac and wrong turnings that wasted so much time, to arrive at a better understanding of how we believe it is possible to improve the quality of life for everyone in modern societies. We shall set out the evidence and our reasons for interpreting it the way we do, so that you can judge for yourself.

At an intuitive level people have always recognized that inequality is socially corrosive. But there seemed little reason to think that levels of inequality in developed societies differed enough to expect any measurable effects. The reasons which first led one of us to look for effects seem now largely irrelevant to the striking picture which has emerged. Many discoveries owe as much to luck as judgement.

The reason why the picture we present has not been put together until now is probably that much of the data has only become available in recent years. With internationally comparable information not only on incomes and income distribution but also on different health and social problems, it could only have been a matter of time before someone came up with findings like ours. The emerging data have allowed us, and other researchers, to analyse how societies differ, to discover how one factor is related to another, and to test theories more rigorously.

It is easy to imagine that discoveries are more rapidly accepted in the natural than in the social sciences, as if physical theories are somehow less controversial than theories about the social world. But the history of the natural sciences is littered with painful personal disputes, which started off as theoretical disagreements but often lasted for the rest of people’s lives. Controversies in the natural sciences are usually confined to the experts: most people do not have strong views on rival theories in particle physics. But they do have views on how society works. Social theories are partly theories about ourselves; indeed, they might almost be regarded as part of our selfawareness or self-consciousness of societies. While natural scientists do not have to convince individual cells or atoms to accept their theories, social theorists are up against a plethora of individual views and powerful vested interests.

In 1847, Ignaz Semmelweiss discovered that if doctors washed their hands before attending women in childbirth it dramatically reduced deaths from puerperal fever. But before his work could have much benefit he had to persuade people, principally his medical colleagues to change their behaviour. His real battle was not his initial discovery but what followed from it. His views were ridiculed and he was driven eventually to insanity and suicide. Much of the medical profession did not take his work seriously until Louis Pasteur and Joseph Lister had developed the germ theory of disease, which explained why hygiene was important.

We live in a pessimistic period. As well as being worried by the likely consequences of global warming, it is easy to feel that many societies are, despite their material success, increasingly burdened by their social failings. And now, as if to add to our woes, we have the economic recession and its aftermath of high unemployment. But the knowledge that we cannot carry on as we have, that change is necessary, is perhaps grounds for optimism: maybe we do, at last, have the chance to make a better world. The extraordinarily positive reception of the hardback editon of this book confirms that there is a widespread appetite for change and a desire to find positive solutions to our problems.

We have made only minor changes to this edition. Details of the statistical sources, methods and results, from which we thought most readers would want to be spared, are now provided in an appendix for those with a taste for data. Chapter 13, which is substantially about causation, has been slightly reorganized and strengthened. We have also expanded our discussion of what has made societies substantially more or less equal in the past. Because we conclude that these changes have been driven by changes in political attitudes, we think it is a mistake to discuss policy as if it were a matter of finding the right technical fix. As there are really hundreds of ways that societies can become more equal if they choose to, we have not nailed our colours to one or other set of policies. What we need is not so much a clever solution as a society which recognizes the benefits of greater equality.

If correct, the theory and evidence set out in this book tells us how to make substantial improvements in the quality of life for the vast majority of the population. Yet unless it is possible to change the way most people see the societies they live in, the theory will be stillborn. Public opinion will only support the necessary political changes if something like the perspective we outline in this book permeates the public mind.

We have therefore set up a not-for-profit organization called The Equality Trust (described at the end of this book) to make the kind of evidence set out in the following pages better known and to suggest that there is a way out of the woods for us all.

PART ONE

Material Success, Social Failure

1 The end of an era

“I care for riches, to make gifts to friends, or lead a sick man back to health with ease and plenty. Else small aid is wealth for daily gladness; once a man be done with hunger, rich and poor are all as one.” Euripides, Electra

It is a remarkable paradox that, at the pinnacle of human material and technical achievement, we find ourselves anxiety-ridden, prone to depression, worried about how others see us, unsure of our friendships, driven to consume and with little or no community life. Lacking the relaxed social contact and emotional satisfaction we all need, we seek comfort in overeating, obsessive shopping and spending, or become prey to excessive alcohol, psychoactive medicines and illegal drugs.

How is it that we have created so much mental and emotional suffering despite levels of wealth and comfort unprecedented in human history? Often what we feel is missing is little more than time enjoying the company of friends, yet even that can seem beyond us. We talk as if our lives were a constant battle for psychological survival, struggling against stress and emotional exhaustion, but the truth is that the luxury and extravagance of our lives is so great that it threatens the planet.

Research from the Harwood Institute for Public Innovation (commissioned by the Merck Family Foundation) in the USA shows that people feel that ‘materialism’ somehow comes between them and the satisfaction of their social needs. A report entitled Yearning for Balance, based on a nationwide survey of Americans, concluded that they were ‘deeply ambivalent about wealth and material gain’. A large majority of people wanted society to ‘move away from greed and excess toward a way of life more centred on values, community, and family’. But they also felt that these priorities were not shared by most of their fellow Americans, who, they believed, had become ‘increasingly atomized, selfish, and irresponsible’. As a result they often felt isolated. However, the report says, that when brought together in focus groups to discuss these issues, people were ‘surprised and excited to find that others share[d] their views’. Rather than uniting us with others in a common cause, the unease we feel about the loss of social values and the way we are drawn into the pursuit of material gain is often experienced as if it were a purely private ambivalence which cuts us off from others.

Mainstream politics no longer taps into these issues and has abandoned the attempt to provide a shared vision capable of inspiring us to create a better society. As voters, we have lost sight of any collective belief that society could be different.

Instead of a better society, the only thing almost everyone strives for is to better their own position as individuals within the existing society.

The contrast between the material success and social failure of many rich countries is an important signpost. It suggests that, if we are to gain further improvements in the real quality of life, we need to shift attention from material standards and economic growth to ways of improving the psychological and social wellbeing of whole societies. However, as soon as anything psychological is mentioned, discussion tends to focus almost exclusively on individual remedies and treatments. Political thinking seems to run into the sand.

It is now possible to piece together a new, compelling and coherent picture of how we can release societies from the grip of so much dysfunctional behaviour. A proper understanding of what is going on could transform politics and the quality of life for all of us. It would change our experience of the world around us, change what we vote for, and change what we demand from our politicians.

In this book we show that the quality of social relations in a society is built on material foundations. The scale of income differences has a powerful effect on how we relate to each other. Rather than blaming parents, religion, values, education or the penal system, we will show that the scale of inequality provides a powerful policy lever on the psychological wellbeing of all of us. Just as it once took studies of weight gain in babies to show that interacting with a loving care-giver is crucial to child development, so it has taken studies of death rates and of income distribution to show the social needs of adults and to demonstrate how societies can meet them.

Long before the financial crisis which gathered pace in the later part of 2008, British politicians commenting on the decline of community or the rise of various forms of anti-social behaviour, would sometimes refer to our ‘broken society’. The financial collapse shifted attention to the broken economy, and while the broken society was sometimes blamed on the behaviour of the poor, the broken economy was widely attributed to the rich.

Stimulated by the prospects of ever bigger salaries and bonuses, those in charge of some of the most trusted financial institutions threw caution to the wind and built houses of cards which could stand only within the protection of a thin speculative bubble. But the truth is that both the broken society and the broken economy resulted from the growth of inequality.

WHERE THE EVIDENCE LEADS

We shall start by outlining the evidence which shows that we have got close to the end of what economic growth can do for us. For thousands of years the best way of improving the quality of human life was to raise material living standards. When the wolf was never far from the door, good times were simply times of plenty. But for the vast majority of people in affluent countries the difficulties of life are no longer about filling our stomachs, having clean water and keeping warm. Most of us now wish we could eat less rather than more. And, for the first time in history, the poor are on average fatter than the rich.

Economic growth, for so long the great engine of progress, has, in the rich countries, largely finished its work. Not only have measures of wellbeing and happiness ceased to rise with economic growth but, as affluent societies have grown richer, there have been long-term rises in rates of anxiety, depression and numerous other social problems. The populations of rich countries have got to the end of a long historical journey.

Figure 1.1 Only in its early stages does economic development boost life expectancy.
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The course of the journey we have made can be seen in Figure 1.1. It shows the trends in life expectancy in relation to Gross National Income per head in countries at various stages of economic development. Among poorer countries, life expectancy increases rapidly during the early stages of economic development, but then, starting among the middle-income countries, the rate of improvement slows down. As living standards rise and countries get richer and richer, the relationship between economic growth and life expectancy weakens. Eventually it disappears entirely and the rising curve in Figure 1.1 becomes horizontal showing that for rich countries to get richer adds nothing further to their life expectancy. That has already happened in the richest thirty or so countries nearest the top righthand corner of Figure 1.1.

The reason why the curve in Figure 1.1 levels out is not because we have reached the limits of life expectancy. Even the richest countries go on enjoying substantial improvements in health as time goes by. What has changed is that the improvements have ceased to be related to average living standards. With every ten years that passes, life expectancy among the rich countries increases by between two and three years. This happens regardless of economic growth, so that a country as rich as the USA no longer does better than Greece or New Zealand, although they are not much more than half as rich. Rather than moving out along the curve in Figure 1.1, what happens as time goes by is that the curve shifts upwards: the same levels of income are associated with higher life expectancy. Looking at the data, you cannot help but conclude that as countries get richer, further increases in average living standards do less and less for health.

While good health and longevity are important, there are other components of the quality of life. But just as the relationship between health and economic growth has levelled off, so too has the relationship with happiness. Like health, how happy people are rises in the early stages of economic growth and then levels off. This is a point made strongly by the economist Richard Layard, in his book on happiness.

Figure 1.2 Happiness and average incomes (data for UK unavailable).
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Figures on happiness in different countries are probably strongly affected by culture. In some societies not saying you are happy may sound like an admission of failure, while in another claiming to be happy may sound selfsatisfied and smug. But, despite the difficulties, Figure 1.2 shows the ‘happiness curve’ levelling off in the richest countries in much the same way as life expectancy. In both cases the important gains are made in the earlier stages of economic growth, but the richer a country gets, the less getting still richer adds to the population’s happiness. In these graphs the curves for both happiness and life expectancy flatten off at around $25,000 per capita, but there is some evidence that the income level at which this occurs may rise over time.

The evidence that happiness levels fail to rise further as rich countries get still richer does not come only from comparisons of different countries at a single point in time (as shown in Figure 1.2). In a few countries, such as Japan, the USA and Britain, it is possible to look at changes in happiness over sufficiently long periods of time to see whether they rise as a country gets richer. The evidence shows that happiness has not increased even over periods long enough for real incomes to have doubled. The same pattern has also been found by researchers using other indicators of wellbeing such as the ‘measure of economic welfare’ or the ‘genuine progress indicator’, which try to calculate net benefits of growth after removing costs like traffic congestion and pollution.

So whether we look at health, happiness or other measures of wellbeing there is a consistent picture. In poorer countries, economic development continues to be very important for human wellbeing. Increases in their material living standards result in substantial improvements both in objective measures of wellbeing like life expectancy, and in subjective ones like happiness. But as nations join the ranks of the affluent developed countries, further rises in income count for less and less.

This is a predictable pattern. As you get more and more of anything, each addition to what you have, whether loaves of bread or cars, contributes less and less to your wellbeing. If you are hungry, a loaf of bread is everything, but when your hunger is satisfied, many more loaves don’t particularly help you and might become a nuisance as they go stale.

Sooner or later in the long history of economic growth, countries inevitably reach a level of affluence where ‘diminishing returns’ set in and additional income buys less and less additional health, happiness or wellbeing. A number of developed countries have now had almost continuous rises in average incomes for over 150 years and additional wealth is not as beneficial as it once was.

The trends in different causes of death confirm this interpretation. It is the diseases of poverty which first decline as countries start to get richer. The great infectious diseases such as tuberculosis, cholera or measles which are still common in the poorest countries today, gradually cease to be the most important causes of death. As they disappear, we are left with the so-called diseases of affluence, the degenerative cardiovascuiar diseases and cancers. While the infectious diseases of poverty are particularly common in childhood and frequently kill even in the prime of life, the diseases of affluence are very largely diseases of later life.

One other piece of evidence confirms that the reason why the curves in Figures 1.1 and 1.2 level off is because countries have reached a threshold of material living standards after which the benefits of further economic growth are less substantial. It is that the diseases which used to be called the ‘diseases of affluence’ became the diseases of the poor in affluent societies. Diseases like heart disease, stroke and obesity used to be more common among the rich. Heart disease was regarded as a businessman’s disease and it used to be the rich who were fat and the poor who were thin. But from about the 1950s onwards, in one developed country after another, these patterns reversed. Diseases which had been most common among the better-off in each society reversed their social distribution to become more common among the poor.

THE ENVIRONMENTAL LIMITS TO GROWTH

At the same time as the rich countries reach the end of the real benefits of economic growth, we have also had to recognize the problems of global warming and the environmental limits to growth. The dramatic reductions in carbon emissions needed to prevent runaway climate change and rises in sea levels may mean that even present levels of consumption are unsustainable particularly if living standards in the poorer, developing, world are to rise as they need to. In Chapter 15 we shall discuss the ways in which the perspective outlined in this book fits in with policies designed to reduce global warming.

INCOME DIFFERENCES WITHIN AND BETWEEN SOCIETIES

We are the first generation to have to find new answers to the question of how we can make further improvements to the real quality of human life. What should we turn to if not to economic growth? One of the most powerful clues to the answer to this question comes from the fact that we are affected very differently by the income differences within our own society from the way we are affected by the differences in average income between one rich society and another.

In Chapters 4-12 we focus on a series of health and social problems like violence, mental illness, teenage births and educational failure, which within each country are all more common among the poor than the rich. As a result, it often looks as if the effect of higher incomes and living standards is to lift people out of these problems. However, when we make comparisons between different societies, we find that these social problems have little or no relation to levels of average incomes in a society.

Take health as an example. Instead of looking at life expectancy across both rich and poor countries as in Figure 1.1, look just at the richest countries. Figure 1.3 shows just the rich countries and confirms that among them some countries can be almost twice as rich as others without any benefit to life expectancy. Yet within any of them death rates are closely and systematically related to income.

Figure 1.3 Life expectancy is unrelated to differences in average income between rich countries.
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Figure 1.4 shows the relation between death rates and income levels within the USA. The death rates are for people in zip code areas classified by the typical household income of the area in which they live. On the right are the richer zip code areas with lower death rates, and on the left are the poorer ones with higher death rates. Although we use American data to illustrate this, similar health gradients, of varying steepness, run across almost every society. Higher incomes are related to lower death rates at every level in society.

Figure 1.4 Death rates are closely related to differences in income within societies.
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Note that this is not simply a matter of the poor having worse health than everyone else. What is so striking about Figure 1.4 is how regular the health gradient is right across society it is a qradient which affects us all.

Within each country, people’s health and happiness are related to their incomes. Richer people tend, on average, to be healthier and happier than poorer people in the same society. But comparing rich countries it makes no difference whether on average people in one society are almost twice as rich as people in another.

What sense can we make of this paradox that differences in average income or living standards between whole populations or countries don’t matter at all, but income differences within those same populations matter very much indeed? There are two plausible explanations. One is that what matters in rich countries may not be your actual income level and living standard, but how you compare with other people in the same society. Perhaps average standards don’t matter and what does is simply whether you are doing better or worse than other people, where you come in the social pecking order.

The other possibility is that the social gradient in health shown in Figure 1.4 results not from the effects of relative income or social status on health, but from the effects of social mobility, sorting the healthy from the unhealthy. Perhaps the healthy tend to move up the social ladder and the unhealthy end up at the bottom.

This issue will be resolved in the next chapter. We shall see whether compressing, or stretching out, the income differences in a society matters. Do more and less equal societies suffer the same overall burden of health and social problems?

2 Poverty or inequality?

“Poverty is not a certain small amount of goods, nor is it just a relation between means and ends; above all it is a relation between people. Poverty is a social status It has grown as an invidious distinction between classes”

Marshall Sahlins, Stone Age Economics

HOW MUCH INEQUALITY?

In the last chapter we saw that economic growth and increases in average incomes have ceased to contribute much to wellbeing in the rich countries. But we also saw that within societies health and social problems remain strongly associated with incomes. In this chapter we will see whether the amount of income inequality in a society makes any difference.

Figure 2.1 How much richer are the richest 20 per cent than the poorest 20 per cent in each country?
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Figure 2.1 shows how the size of income differences varies from one developed country to another. At the top are the most equal countries and at the bottom are the most unequal. The length of the horizontal bars shows how much richer the richest 20 per cent of the population is in each country compared to the poorest 20 per cent.

Within countries such as Japan and some of the Scandinavian countries at the top of the chart, the richest 20 per cent are less than four times as rich as the poorest 20 per cent. At the bottom of the chart are countries in which these differences are at least twice as big, including two in which the richest 20 per cent get about nine times as much as the poorest. Among the most unequal are Singapore, USA, Portugal and the United Kingdom. (The figures are for household income, after taxes and benefits, adjusted for the number of people in each household.)

There are lots of ways of measuring income inequality and they are all so closely related to each other that it doesn’t usually make much difference which you use. Instead of the top and bottom 20 per cent, we could compare the top and bottom 10 or 30 per cent. Or we could have looked at the proportion of all incomes which go to the poorer half of the population. Typically, the poorest half of the population get something like 20 or 25 per cent of all incomes and the richest half get the remaining 75 or 80 per cent.

Other more sophisticated measures include one called the Gini coefficient. It measures inequality across the whole society rather than simply comparing the extremes. If all income went to one person (maximum inequality) and everyone else got nothing, the Gini coefficient would be equal to 1. If income was shared equally and everyone got exactly the same (perfect equality), the Gini would equal 0. The lower its value, the more equal a society is. The most common values tend to be between 0.3 and 0.5. Another measure of inequality is called the Robin Hood Index because it tells you what proportion of a society’s income would have to be taken from the rich and given to the poor to get complete equality.

To avoid being accused of picking and choosing our measures, our approach in this book has been to take measures provided by official agencies rather than calculating our own. We use the ratio of the income received by the top to the bottom 20 per cent whenever we are comparing inequality in different countries: it is easy to understand and it is one of the measures provided ready-made by the United Nations. When comparing inequality in US states, we use the Gini coefficient: it is the most common measure, it is favoured by economists and it is available from the US Census Bureau. In many academic research papers we and others have used two different inequality measures in order to show that the choice of measures rarely has a significant effect on results.

DOES THE AMOUNT OF INEQUALITY MAKE A DIFFERENCE?

Having got to the end of what economic growth can do for the quality of life and facing the problems of environmental damage, what difference do the inequalities shown in Figure 2.1 make?

It has been known for some years that poor health and violence are more common in more unequal societies. However, in the course of our research we became aware that almost all problems which are more common at the bottom of the social ladder are more common in more unequal societies. It is not just ill-health and violence, but also, as we will show in later chapters, a host of other social problems. Almost all of them contribute to the widespread concern that modern societies are, despite their affluence, social failures.

To see whether these problems were more common in more unequal countries, we collected internationally comparable data on health and as many social problems as we could find reliable figures for.

The list we ended up with included:

  • level of trust
  • mental illness (including drug and alcohol addiction)
  • life expectancy and infant mortality
  • obesity
  • children’s educational performance
  • teenage births
  • homicides
  • imprisonment rates
  • social mobility (not available for US states)

Occasionally what appear to be relationships between different things may arise spuriously or by chance. In order to be confident that our findings were sound we also collected data for the same health and social problems or as near as we could get to the same for each of the fifty states of the USA. This allowed us to check whether or not problems were consistently related to inequality in these two independent settings. As Lyndon Johnson said, ‘America is not merely a nation, but a nation of nations.’

To present the overall picture, we have combined all the health and social problem data for each country, and separately for each US state, to form an Index of Heaith and Social Problems for each country and US state. Each item in the indexes carries the same weight so, for example, the score for mental health has as much influence on a society’s overall score as the homicide rate or the teenage birth rate. The result is an index showing how common all these health and social problems are in each country and each US state. Things such as life expectancy are reverse scored, so that on every measure higher scores reflect worse outcomes. When looking at the Figures, the higher the score on the Index of Health and Social Problems, the worse things are. (For information on how we selected countries shown in the graphs we present in this book, please see the Appendix.)

Figure 2.2 Health and social problems are closely related to inequality among rich countries.
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We start by showing, in Figure 2.2, that there is a very strong tendency for ill-health and social problems to occur less frequently in the more equal countries. With increasing inequality (to the right on the horizontal axis), the higher is the score on our Index of Health and Social Problems. Health and social problems are indeed more common in countries with bigger income inequalities. The two are extraordinarily closely related, chance alone would almost never produce a scatter in which countries lined up like this.

Figure 2.3 Health and social problems are only weakly related to national average income among rich countries.
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To emphasize that the prevalence of poor health and social problems in whole societies really is related to inequality rather than to average living standards, we show in Figure 2.3 the same index of health and social problems but this time in relation to average incomes (National Income per person). It shows that there is no similarly clear trend towards better outcomes in richer countries. This confirms what we saw in Figures 1.1 and 1.2 in the first chapter. However, as well as knowing that health and social problems are more common among the less well-off within each society (as shown in Figure 1.4), we now know that the overall burden of these problems is much higher in more unequal societies.

To check whether these results are not just some odd fluke, let us see whether similar patterns also occur when we look at the fifty states of the USA. We were able to find data on almost exactly the same health and social problems for US states as we used in our international index.

Figure 2.4 Health and social problems are related to inequality in US states.
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Figure 2.4 shows that the Index of Health and Social Problems is strongly related to the amount of inequality in each state, while Figure 2.5 shows that there is no clear relation between it and average income levels.

Figure 2.5 Health and social problems are only weakly related to average income in US states.
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The evidence from the USA confirms the international picture. The position of the US in the international graph (Figure 2.2) shows that the high average income level in the US as a whole does nothing to reduce its health and social problems relative to other countries.

We should note that part of the reason why our index combining data for ten different health and social problems is so closely related to inequality is that combining them tends to emphasize what they have in common and downplays what they do not. In Chapters 4-12 we will examine whether each problem taken on its own is related to inequality and will discuss the various reasons why they might be caused by inequality.

This evidence cannot be dismissed as some statistical trick done with smoke and mirrors. What the close fit shown in Figure 2.2 suggests is that a common element related to the prevalence of all these health and social problems is indeed the amount of inequality in each country. All the data come from the most reputable sources from the World Bank, the World Health Organization, the United Nations and the Organization for Economic Cooperation and Development (OECD), and others.

Could these relationships be the result of some unrepresentative selection of problems? To answer this we also used the ‘Index of child wellbeing in rich countries’ compiled by the United Nations Children’s Fund (UNICEF). It combines forty different indicators covering many different aspects of child wellbeing. (We removed the measure of child relative poverty from it because it is, by definition, closely related to inequality.)

Figurer 2.6 The UNICEF index of child wellbeing in rich countries is related to inequality.
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Figure 2.6 shows that child wellbeing is strongly related to inequality, and Figure 2.7 shows that it is not at all related to average income in each country.

Figure 2.7 The UNICEF index of child wellbeing is not related to Gross National Income per head in rich countries.
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SOCIAL GRADIENTS

As we mentioned at the end of the last chapter, there are perhaps two widespread assumptions as to why people nearer the bottom of society suffer more problems. Either the circumstances people live in cause their problems, or people end up nearer the bottom of society because they are prone to problems which drag them down. The evidence we have seen in this chapter puts these issues in a new light.

Let’s first consider the view that society is a great sorting system with people moving up or down the social ladder according to their personal characteristics and vulnerabilities. While things such as having poor health, doing badly at school or having a baby when still a teenager all load the dice against your chances of getting up the social ladder, sorting alone does nothing to explain why more unequal societies have more of all these problems than less unequal ones. Social mobility may partly explain whether problems congregate at the bottom, but not why more unequal societies have more problems overall.

The view that social problems are caused directly by poor material conditions such as bad housing, poor diets, lack of educational opportunities and so on implies that richer developed societies would do better than the others. But this is a long way from the truth: some of the richest countries do worst.

It is remarkable that these measures of health and social problems in the two different settings, and of child wellbeing among rich countries, all tell so much the same story.

The problems in rich countries are not caused by the society not being rich enough (or even by being too rich) but by the scale of material differences between people within each society being too big. What matters is where we stand in relation to others in our own society.

Of course a small proportion of the least well-off people even in the richest countries sometimes find themselves without enough money for food. However, surveys of the 12.6 per cent of Americans living below the federal poverty line (an absolute income level rather than a relative standard such as half the average income) show that 80 per cent of them have airconditioning, almost 75 per cent own at least one car or truck and around 33 per cent have a computer, a dishwasher or a second car.

What this means is that when people lack money for essentials such as food, it is usually a reflection of the strength of their desire to live up to the prevailing standards. You may, for instance, feel it more important to maintain appearances by spending on clothes while stinting on food. We knew of a young man who was unemployed and had spent a month’s income on a new mobile phone because he said girls ignored people who hadn’t got the right stuff. As Adam Smith emphasized, it is important to be able to present oneself creditably in society without the shame and stigma of apparent poverty.

However, just as the gradient in health ran right across society from top to bottom, the pressures of inequality and of wanting to keep up are not confined to a small minority who are poor. Instead, the effects are as we shall see widespread in the population.

. . .

from

The Spirit Level. Why equality is better for everyone

by Richard Wilkinson and Kate Pickett

get it at Amazon.com

DARK NIGHTS OF THE SOUL. Kidnapped by Depression – Dale M. Kushner * The Emotional Life of Your Brain – Richard J. Davidson, Ph.D. and Sharon Begley.

“We do not see things as they are, we see them as we are. Emotions, far from being the neurological fluff that mainstream science once believed them to be, are central to the functions of the brain and to the life of the mind.”

Why and how do people differ so widely in their emotional responses to the ups and the downs of life? How myths and neuroscience can illuminate the darkness of depression.

Imagine a black sack thrown over your head. Imagine your arms and legs bound, your body injected with a drug that wipes out thoughts, flattens feelings, and numbs senses. This is depression.

Depression is called the dark night of the soul for good reason. Depression leads us into the night world, a world of shadows, emptiness, and blurry vision. You feel lost, lonely and alone, mired in the quicksand of sadness, vulnerable to thoughts of failure and unworthiness.

During depression, we yearn for a lost part of ourselves, for it seems that our spirited aliveness has deserted us, our appetite for living kidnapped and dragged down into the house of death.

Depression may feel as if parts of us have died, and yet is it possible depression opens us to another level of deep experience, one that matures us and brings new wisdom?

We are more than our genetic predisposition and our biochemistry; we are conscious creatures capable of discovering light in the darkness.

“We do not see things as they are, we see them as we are,” says a Talmudic expression. Through the lens of depression, the world is saturated with gloom.

One way to understand the lived experience of depression is to see it acted out symbolically in story form. Myths and fairytales show us the collective (and archetypal) universal patterns of the human psyche. I may have “my depression” and you, “yours,” but throughout the ages, worldwide, depression has plagued the human race.

The Rape of Proserpina (1621-22), white marble sculpture, by Gian Lorenzo Bernini (1598-1680).
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One of the Greek Homeric hymns, the “Hymn to Demeter,” gives an early and vivid picture of depression. It tells the story of Persephone, Demeter and Zeus’s daughter, whom Hades, god of the underworld and brother of Zeus, falls in love with. When Hades asks Zeus’ leave to marry her, Zeus knows Demeter would never agree and says he will neither give nor withhold his consent. So, one day, while Persephone is gathering flowers in a meadow, the ground splits open and Hades springs forth and abducts her, dragging her down into his kingdom against her will. The unwilling bride screams to Zeus, her father, to save her, but he ignores her pleas. Demeter, a goddess herself, hears her daughter’s cries and also begs Zeus for aid, but he refuses to intervene.

Separated from her daughter, Demeter rages at the gods for allowing Persephone’s capture and rape. Her grief is “terrible and savage.” Disguised as an old woman, she roams the earth, neither eating, drinking, nor bathing while she searches for her child. During her time of mourning, the earth lies fallow.

“Then she caused a most dreadful and cruel year for mankind over the all-nourishing earth: the ground would not make the seed sprout, for rich-crowned Demeter kept it hid. In the fields the oxen drew many a curved plough in vain, and much white barley was cast upon the land without avail. So she would have destroyed the whole race of man with cruel famine.” “Hymn to Demeter,” translated from Greek by Hugh G. Evelyn-White.

Ceres Begging for Jupiter’s Help after the Kidnapping of Her Daughter Proserpine (1777) by Antoine-Frangois Callet (1741-1823).
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As Demeter pines for her daughter, so too, during depression, do we yearn for a lost part of ourselves, for it seems that our spirited aliveness has deserted us, our appetite for living kidnapped and dragged down into the house of death. With our instincts blunted, we sink into darkness, and experience the desolation of barren landscape. Like the grieving Demeter, our enthusiasm lost, our life-giving energy depleted, we fall into despair.

This feeling of isolation is a signature of depression and runs deep in those who try to articulate their condition and reach out for help.

As the story continues, Zeus’s mounting fear that if he does not reunite mother and daughter nothing will ever grow again on the land finally propels his intervention. He orders Hermes, messenger of the gods, into the underworld to bring Persephone back. Hades is surprisingly gracious in agreeing to her return. Inconsolable during her stay in the underworld, Persephone has yet to eat anything. Before she leaves, Hades urges her to eat at least three pomegranate seeds. Distracted by her joy at leaving, Persephone does so – and thereby consigns herself to return to Hades for three months every year. Had she not eaten the fruit of the underworld, she would have been able to stay with her mother forever.

When we enter the space of depression, it seems we will never “get out,” but as the myth reveals, nature is cyclic. The myth of Demeter and Persephone originates in ancient fertility cults and women’s mysteries, and is associated with harvest and the annual vegetation cycles. Symbolically, for a quarter of the year, while Persephone is in the underworld, lifeless winter prevails. When she returns to earth, spring advances, a time of rebirth.

But depressive cycles are not nearly as predictable as the seasons, and yet we might consider our time in the underworld as periods of incubation. While winter’s colorless landscape may suggest death, beneath the ground roots, seeds, and bulbs are dormant, not dead. They are busy with the business of storing nutrients for the coming season.

The Return of Persephone (1891), oil on canvas, by Frederic Leighton (1830-1896) shows Hermes returning Persephone to Demeter.
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For plants, winter’s stillness is necessary before spring’s renewal. Depression, too, can be viewed as a time of going inward and down into the depths, and can be a generative and creative interlude during which the psyche renews itself in the slower rhythms of dark days. Many artists attest to depressive episodes that prefigure a creative breakthrough. An astonishing number of famous artists, writers, and statesmen as diverse as Charles Darwin, Friedrich Nietzsche, Winston Churchill, Hans Christian Andersen, Abraham Lincoln, and Georgia O’Keefe have described experiencing depression.

Little is written about Persephone’s life in the underworld, but one thing is clear, she does not die. Quite the opposite. She is given the honorific title Queen of the Underworld. This suggests her movement “to below” is one of transformation and the acquisition of special gifts and powers. Depression may feel as if parts of us have died, and yet is it possible depression opens us to another level of deep experience, one that matures us and brings new wisdom?

When depression drags us away from the lively day world, we might remember Persephone. The darkness of the underworld may provide a special quality of illumination not possible in the glaring, horn-honking, digitally-frenzied daylight. To consider depression as an expression of loss, grief, mourning, and inevitability of mortality is to bring it into the realm of the human heart.

We are more than our genetic predisposition and our biochemistry; we are conscious creatures capable of discovering light in the darkness.

If myths allow us to look into “the heart of the matter,” then neuroscience allows us to peer into the actual matter of our brains. Dr. Richard J. Davidson, founder of the Center for Healthy Minds at the University of Wisconsin, Madison, has made it his life’s work to investigate brain (neuro)plasticity, and how we can improve our wellbeing through the development of certain skills, including meditation.

In his groundbreaking book, The Emotional Life of Your Brain: How Its Unique Patterns Affect the Way You Think, Feel, and Live—and How You Can Change Them, Dr. Davidson and his co-author Sharon Begley offer an in-depth view of how our brains respond to different emotions and provide strategies to help balance or strengthen specific areas of brain circuitry.

Schematic of brain regions that showed significantly different association with amygdala in control versus depressed individuals.
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The experience of depression differs from person to person. With the aid of fMRI imaging, Dr. Davidson has been able to pinpoint dysfunctional areas of the brain and correlate them with patient’s symptoms. Under the subheading “A Brain Taxonomy of Depression,”

Dr. Davidson identifies three subcategories of depression. One group of depressed patients had difficulty recovering from adversity while another group had difficulty regulating their emotions in a context-appropriate way. The third group was unable to sustain positive emotions. Different patterns of brain activity were noted for each group.

Dr. Davidson is optimistic. His book offers a questionnaire to help readers figure out their emotional “style” and gives exercises that build skills to improve brain functioning. Sufferers of depression need hope. Dr. Davidson’s excitement about what he is learning in the laboratory is palpable and his hope contagious.

Archetypal myths and brain science may seem disconnected, but each presents its own form of wisdom, one through images and story, the other through investigatory science. Demeter’s suffering, the barren land, Persephone’s descent into darkness lodge in our imagination and dreams and recommend that we look into our own lives to discover the source of our grief. Neuroscience advances our knowledge of brain anatomy and its relationship to our feelings and emotions. Each perspective provides a potentially valuable way to examine and understand our experience of depression.

Psychology Today

THE EMOTIONAL LIFE OF YOUR BRAIN. How Its Unique Patterns Affect the Way You Think, Feel and Live. And how You can Change Them.

Richard J. Davidson, Ph.D. with Sharon Begley

INTRODUCTION

A Scientific Quest

This book describes a personal and professional journey to understand why and how people differ in their emotional responses to what life throws at them, motivated by my desire to help people lead healthier, more fulfilling lives.

The “professional” thread in this tapestry describes the development of the hybrid discipline called affective neuroscience, the study of the brain mechanisms that underlie our emotions and the search for ways to enhance people’s sense of well-being and promote positive qualities of mind.

The “personal” thread is my own story. Spurred by the conviction that, as Hamlet said to Horatio, “there are more things in heaven and earth than are dreamt of” in the standard account of the mind provided by mainstream psychology and neuroscience, I have ventured outside the boundaries enclosing these disciplines, sometimes getting struck down, but in the end, I hope, achieving at least some of what I set out to do: to show through rigorous research that emotions, far from being the neurological fluff that mainstream science once believed them to be, are central to the functions of the brain and to the life of the mind.

My thirty years of research in affective neuroscience has produced hundreds of findings, from the brain mechanisms that underlie empathy and the differences between the autistic brain and the normally developing brain to how the brain’s seat of rationality can plunge us into the roiling emotional depths of depression.

I hope that these results have contributed to our understanding of what it means to be human, of what it means to have an emotional life. But as these findings accumulated, I found myself stepping back from the day-to-day life of my laboratory at the University of Wisconsin, Madison, which has grown over the years to something resembling a small company: As I write this in the spring of 2011, I have eleven graduate students, ten postdoctoral fellows, four computer programmers, twenty-one additional research and administrative staff members, and some twenty million dollars in research grants from the National Institutes of Health and other funders.

Since May 2010, I have also served as director of the university’s Center for Investigating Healthy Minds, a research complex dedicated to learning how the qualities of mind that humankind has valued since before the dawn of civilization, compassion, wellbeing, charity, altruism, kindness, love, and other noble aspects of the human condition, arise in the brain and how they can be nurtured.

One of the great virtues of the center is that we do not confine our work to research alone. We very much want to get the results of that research out into the world, where it can make a real difference in the lives of real people. To that end, we have developed a preschool and elementary school curriculum designed to cultivate kindness and mindfulness, and we are evaluating the impact of this training on academic achievement as well as on attention, empathy, and cooperation. Another project investigates whether training in breathing and meditation can help veterans returning from Afghanistan and Iraq cope with stress and anxiety.

I love all of this, both the basic science and the extension of our findings into the real world. But it is way too easy to get consumed by it. (I often joke that I have several full-time jobs, from overseeing grant applications to negotiating with the university bioethics committees for permission to do research on human volunteers.) I did not want that to happen.

About ten years ago, I therefore began to take stock of my research and that of other labs pursuing affective neuroscience, not the interesting individual findings but the larger picture. And I saw that our decades of work had revealed something fundamental about the emotional life of the brain: that each of us is characterized by what I have come to call Emotional Style.

Before I briefly describe the components of Emotional Style, let me quickly explain how it relates to other classification systems that try to illuminate the vast diversity of ways to be human: emotional states, emotional traits, personality, and temperament.

The smallest, most fleeting unit of emotion is an emotional state. Typically lasting only a few seconds, it tends to be triggered by an experience, the spike of joy you feel at the macaroni collage your child made you for Mother’s Day, the sense of accomplishment you feel upon finishing a big project at work, the anger you feel over having to work all three days of a holiday weekend, the sadness you feel when your child is the only one in her class not invited to a party. Emotional states can also arise from purely mental activity, such as daydreaming, or introspection, or anticipating the future. But whether they are triggered by real-world experiences or mental ones, emotional states tend to dissipate, each giving way to the next.

A feeling that does persist, and that remains consistent over minutes or hours or even days, is a mood, of the “he’s in a bad mood” variety. And a feeling that characterizes you not for days but for years is an emotional trait. We think of someone who seems perpetually annoyed as grumpy, and someone who always seems to be mad at the world as angry. An emotional trait (chronic, just-about-to-boil-over anger) increases the likelihood that you will experience a particular emotional state (fury) because it lowers the threshold needed to feel such an emotional state.

Emotional Style is a consistent way of responding to the experiences of our lives. It is governed by specific, identifiable brain circuits and can be measured using objective laboratory methods. Emotional Style influences the likelihood of feeling particular emotional states, traits, and moods.

Because Emotional Styles are much closer to underlying brain systems than emotional states or traits, they can be considered the atoms of our emotional lives, their fundamental building blocks.

In contrast, personality, a more familiar way of describing people, is neither fundamental in this sense nor grounded in identifiable neurological mechanisms. Personality consists of a set of high-level qualities that comprise particular emotional traits and Emotional Styles. Take, for instance, the well-studied personality trait of agreeableness.

People who are extremely agreeable, as measured by standard psychological assessments (as well as their own and that of people who know them well), are empathic, considerate, friendly, generous, and helpful. But each of these emotional traits is itself the product of different aspects of Emotional Style. Unlike personality, Emotional Style can be traced to a specific, characteristic brain signature. To understand the brain basis of agreeableness, then, we need to probe more deeply into the underlying Emotional Styles that comprise it.

Psychology has been churning out classification schemes with gusto lately, asserting that there are four kinds of temperament or five components of personality or Lord-knows-how-many character types. While perfectly interesting and even fun the popular media have had a field day describing which character types make good romantic matches, business leaders, or psychopaths, these schemes are light on scientific validity because they are not based on any rigorous analysis of underlying brain mechanisms. Anything having to do with human behavior, feelings, and ways of thinking arises from the brain, so any valid classification scheme must also be based on the brain. Which brings me back to Emotional Style.

Emotional Style comprises six dimensions. Neither conventional aspects of personality nor simple emotional traits or moods, let alone diagnostic criteria for mental illness, these six dimensions reflect the discoveries of modern neuroscientiflc research:

Resilience: how slowly or quickly you recover from adversity.

Outlook: how long you are able to sustain positive emotion.

Social Intuition: how adept you are at picking up social signals from the people around you.

Self-Awareness: how well you perceive bodily feelings that reflect emotions.

Sensitivity to Context: how good you are at regulating your emotional responses to take into account the context you fmd yourself in.

Attention: how sharp and clear your focus is.

These are probably not the six dimensions you would come up with if you sat down and thought about your emotions and how they might differ from those of others. By the same measure, the Bohr model of the atom is probably not the model you would come up with if you sat down and thought about the structure of matter. I don’t mean to equate my work with that of the founders of modern physics, only to make a general point: It is rare that the human mind can determine the truths of nature, or even of ourselves, by intuition or casual observation. That’s why we have science. Only by methodical, rigorous experiments, and lots of them, can we figure out how the world works, and how we ourselves work.

These six dimensions arose from my research in affective neuroscience, complemented and strengthened by the discoveries of colleagues around the world. They reflect properties of and patterns in the brain, the sine qua non of any model of human behavior and emotion.

If the six dimensions don’t resonate with your understanding of yourself or of those close to you, that is likely because several of them operate on levels that are not always immediately apparent. For example, we tend not to be consciously aware of where we fall on the Resilience dimension. With few exceptions, we do not pay attention to how quickly we recover from a stressful event. (An exception would be something extremely traumatic, such as the death of a child; in that case, you are all too aware that you have remained a basket case for months and months.) But we experience its consequences. For instance, if you have an argument with your significant other in the morning, you might feel irritable for the entire day, yet not realize that the reason you are snappish and grouchy and churlish is that you have not regained your emotional equilibrium, which is the mark of the Slow to Recover style. I will show you in chapter 3 how you can become more aware of your Emotional Styles, which is the first and most important step in any attempt to either gracefully accept who you are or transform it.

A rule of thumb in science is that any new theory that hopes to supplant what came before must explain the same phenomena that the old theory did, as well as new ones. In order to be accepted as a more accurate and all-encompassing theory of gravity than what Isaac Newton had proposed after he saw the apple fall from the tree (or not), Einstein’s general theory of relativity had to explain all of the gravitational phenomena that Newton’s did, such as the orbits of the planets around the sun and the rate at which objects fell to earth, and new ones, too, such as the bending of celestial light around a large star. Let me show, then, that Emotional Style has sufficient explanatory power to account for well-established personality traits and temperament types; later, particularly in chapter 4, we will see that it has a solid foundation in the brain, something other classification schemes do not.

I believe that every individual personality and temperament reflects a different combination of the six dimensions of Emotional Style.

Take the “big five” personality traits, one of the standard classification systems in psychology: openness to new experience, conscientiousness, extraversion, agreeableness, and neuroticism:

– Someone high in openness to new experience has strong Social Intuition. She is also very self-aware and tends to be focused in her Attention style.

– A conscientious person has well-developed Social Intuition, a focused style of Attention, and acute Sensitivity to Context.

– An extraverted person bounces back rapidly from adversity and thus is at the Fast to Recover end of the Resilience spectrum. She maintains a positive Outlook.

– An agreeable person has a highly attuned Sensitivity to Context and strong Resilience; he also tends to maintain a positive Outlook.

– Someone high in neuroticism is slow to recover from adversity. He has a gloomy, negative Outlook, is relatively insensitive to context, and tends to be unfocused in his Attention style.

While the combinations of Emotional Styles that add up to each of the big five personality traits generally hold true, there will always be exceptions. Not everyone with a given personality will have all the dimensions of Emotional Style that I describe, but they will invariably have at least one of them.

Moving beyond the Big Five, we can look at traits that all of us think of when we describe ourselves or someone we know well. Each of these, too, can be understood as a combination of different dimensions of Emotional Style, though, again, not everyone with the trait will possess each dimension. However, most people will have most of them:

– Impulsive: a combination of unfocused Attention and low Self-Awareness.

– Patient: a combination of high Self-Awareness and high Sensitivity to Context. Knowing that when context changes, other things will change, too, helps to facilitate patience.

– Shy: a combination of being Slow to Recover on the Resilience dimension and having low Sensitivity to Context. As a result of the insensitivity to context, shyness and wariness extend beyond contexts in which they might be normal.

– Anxious: a combination of being Slow to Recover, having a negative Outlook, having high levels of Self-Awareness, and being unfocused (Attention).

– Optimistic: a combination of being Fast to Recover and having a positive Outlook.

– Chronically unhappy: a combination of being Slow to Recover and having a negative Outlook, with the result that a person cannot sustain positive emotions and becomes mired in negative ones after setbacks.

As you can see, these common trait descriptors comprise different permutations of Emotional Styles. This formulation provides a way of describing what the brain bases for these common traits are likely to be.

If you read original scientific papers, it is easy to get the impression that the researchers thought of a question, designed a clever experiment to answer it, and carried out the study with nary a dead end or setback between them and the answer. It’s not like that. I suspect you realized as much, but what is not as widely known, even among people who gobble up popular accounts of scientific research, is how difficult it is to challenge a prevailing paradigm.

That was the position I found myself in during the early 1980s. At that time, academic psychology relegated the study of emotions mostly to social and personality psychology rather than to neurobiology; few psychology researchers were interested in studying the brain basis of emotion. What little interest there was supported research on the socalled emotion centers of the brain, which were then thought to be exclusively in the limbic system.

I had a very different idea: that higher cortical functions, particularly those located in the evolutionarily advanced prefrontal cortex, are critical to emotion. When I first suggested that the prefrontal cortex is involved in emotion, I was met with an endless stream of skeptics. The prefrontal cortex, they insisted, is the site of reason, the antithesis of emotion. It certainly could not play a role in emotion, too. It was very lonely trying to carve out a scientific career when the prevailing winds blew strongly in the other direction. My search for bases of emotion in the brain’s seat of reason was viewed as quixotic, to say the least, the neuroscientific equivalent of hunting elephants in Alaska. There were more than a few times, especially when I struggled to get funding early on, when my skepticism about the classic division between thought (in the highly evolved neocortex) and feeling (in the subcortical limbic system) seemed like a good way to end a scientific career, not begin one.

If my scientific leanings were a less-than-savvy career move, so were some of my personal interests. Soon after I entered graduate school at Harvard in the 1970s, I met a remarkable group of kind and compassionate people who, I soon learned, had something in common: They all practiced meditation. This discovery catalyzed my then rudimentary interest in meditation to such an extent that, after my second year of grad school, I went off to India and Sri Lanka for three months to learn more about this ancient tradition and experience what intensive meditation might bring. I had a second motive as well, I wanted to see whether meditation might be a suitable subject for scientific research.

Studying emotions was controversial enough. Practicing meditation was practically heretical, and studying it was a scientific nonstarter. Just as academic psychologists and neuroscientists believed that there are brain regions for reason and brain regions for emotions, and never the two shall meet, so they believed that there is rigorous, empirical science and there is woo-woo meditation, and if you practiced the latter, your bona fides for the former were highly suspect.

This was the period of The Tao of Physics (1975), The Dancing Wu Li Masters (1979), and other books arguing that there are strong complementarities between the findings of modern Western science and the insights of ancient Eastern philosophies. Most academic scientists dismissed this as trash; being a meditator in their midst was not, shall we say, the most direct path to academic success. It was made very clear to me by my Harvard mentors that if I wanted a successful scientific career, studying meditation was not a very good place to start. While I dabbled in research on meditation in the early part of my career, once I saw how deep the resistance was, I set it aside. I remained a closet meditator, though, and eventually, once I had been granted tenure at the University of Wisconsin, and had a long list of scientific publications and honors to my credit, returned to meditation as a subject of scientific study.

A big reason I did so was a transformative meeting I had with the Dalai Lama in 1992, which completely changed the course of both my career and my personal life. As I describe in chapter 9, the encounter was the spark that made me decide to bring my interests in meditation and other forms of mental training out of the closet.

It is breathtaking to see how much has changed in the short period of time that I’ve been at this. In less than twenty years, the scientific and medical communities have become much more receptive to research on mental training. Thousands of new articles are now published on the subject in top scientific journals each year (I was tickled that the first such paper ever to appear in the august Proceedings of the National Academy of Sciences was by my colleagues and me, in 2004), and the National Institutes of Health now provides substantial funding for research on meditation. A decade ago that would have been unthinkable.

I believe this change is a very good thing, and not because of any sense of personal vindication (though I admit it’s been gratifying to see a scientific outcast of a topic receive the respect it deserves). I made two promises to the Dalai Lama in 1992: I would personally study meditation, and I would try to make research on positive emotions, such as compassion and well-being, as central a focus of psychology as research on negative emotions had long been.

Now those two promises have converged, and with them my tilting-at-windmills conviction that the seat of reason and higher-order cognitive function in the brain plays as important a role in emotion as the limbic system does. My research on meditators has shown that mental training can alter patterns of activity in the brain to strengthen empathy, compassion, optimism, and a sense of well-being, the culmination of my promise to study meditation as well as positive emotions. And my research in the mainstream of affective neuroscience has shown that it is these sites of higher-order reasoning that hold the key to altering these patterns of brain activity.

So while this book is a story of my personal and scientific transformation, I hope it offers you a guide for your own transformation. In Sanskrit, the word for meditation also means “familiarization.” Becoming more familiar with your Emotional Style is the first and most important step in transforming it. If this book does nothing more than increase your awareness of your own Emotional Style and that of others around you, I would consider it a success.

CHAPTER 1

One Brain Does Not Fit All

If you believe most self-help books, pop-psychology articles, and television therapists, then you probably assume that how people respond to significant life events is pretty predictable. Most of us, according to the “experts,” are affected in just about the same way by a given experience, there is a grieving process that everyone goes through, there is a sequence of events that happens when we fall in love, there is a standard response to being jilted, and there are fairly standard ways almost every normal person reacts to the birth of a child, to being unappreciated at one’s job, to having an unbearable workload, to the challenges of raising teenagers, and to the inevitable changes that occur with aging. These same experts confidently recommend steps we can all take to regain our emotional footing, weather a setback in life or in love, become more (or less) sensitive, handle anxiety with aplomb . . . and otherwise become the kind of people we would like to be.

But my thirty-plus years of research have shown that these one-size-fits-all assumptions are even less valid in the realm of emotion than they are in medicine. There, scientists are discovering that people’s DNA shapes how they will respond to prescription drugs (among other things), ushering in an age of personalized medicine in which the treatments one patient receives for a certain illness will be different from what another patient receives for that same illness, for the fundamental reason that no two patients’ genes are identical. (One important example of this: The amount of the blood thinner warfarin a patient can safely take to prevent blood clots depends on how quickly the patient’s genes metabolize the drug.)

When it comes to how people respond to what life throws at them, and how they can develop and nurture their capacity to feel joy, to form loving relationships, to withstand setbacks, and in general to lead a meaningful life, the prescription must be just as personalized. In this case, the reason is not just that our DNA differs, though of course it does, and DNA definitely influences our emotional traits, but that our patterns of brain activity do. Just as the medicine of tomorrow will be shaped by deciphering patients’ DNA, so the psychology of today can be shaped by understanding the characteristic patterns of brain activity underlying the emotional traits and states that define each of us.

Over the course of my career as a neuroscientist, I’ve seen thousands of people who share similar backgrounds respond in dramatically different ways to the same life event. Some are resilient in the face of stress, for instance, while others fall apart. The latter become anxious, depressed, or unable to function when they encounter adversity. Resilient people are somehow able not only to withstand but to benefit from certain kinds of stressful events and to turn adversity into advantage.

This, in a nutshell, is the puzzle that has driven my research. I’ve wanted to know what determines how someone reacts to a divorce, to the death of a loved one, to the loss of a job, or to any other setback, and, equally, what determines how people react to a career triumph, to winning the heart of their true love, to realizing that a friend will walk over hot coals for them, or to other sources of happiness. Why and how do people differ so widely in their emotional responses to the ups and the downs of life?

The answer that has emerged from my own work is that different people have different Emotional Styles. These are constellations of emotional reactions and coping responses that differ in kind, intensity, and duration.

Just as each person has a unique fingerprint and a unique face, each of us has a unique emotional profile, one that is so much a part of who we are that those who know us well can often predict how we will respond to an emotional challenge.

My own Emotional Style, for instance, is fairly optimistic and upbeat, eager to take on challenges, quick to recover from adversity, but sometimes prone to worry about things that are beyond my control. (My mother, struck by my sunny disposition, used to call me her “joy boy.”)

Emotional Style is why one person recovers fairly quickly from a painful divorce while another remains mired in self-recrimination and despair. It is why one sibling bounces back from a job loss while another feels worthless for years afterward. It is why one father shrugs off the botched call of a Little League umpire who called out his (clearly safe!) daughter at second base while another leaps out of his seat and screams at the ump until his face turns purple.

Emotional Style is why one friend serves as a wellspring of solace to everyone in her circle while another makes herself scarce, emotionally and literally, whenever her friends or family need sympathy and support. It is why some people can read body language and tone of voice as clearly as a billboard while to others these nonverbal cues are a foreign language.

And it is why some people have insight into their own states of mind, heart, and body that others do not even realize is possible.

Every day presents countless opportunities to observe Emotional Styles in action. I spend a lot of time at airports, and it is a rare trip that doesn’t offer the chance for a little field research. As we all know, there seem to be more ways for a flight schedule to go awry than there are flights departing O’Hare on a Friday evening: bad weather, waiting for a flight crew whose connection is late, mechanical problems, cockpit warning lights that no one can decipher . . . the list goes on. So I’ve had countless chances to watch the reaction of passengers (as well as myself!) who, waiting to take off, hear the dreaded announcement that the flight has been delayed for one hour, or for two hours, or indefinitely, or canceled.

The collective groan is audible. But if you look carefully at individual passengers, you’ll see a wide range of emotional reactions. There’s the college student in his hoodie, bobbing his head to the music coming in through his earbuds, who barely glances up before getting lost again in his iPad. There’s the young mother traveling alone with a squirmy toddler who mutters, “Oh great,” before grabbing her child and stalking off toward the food court. There’s the corporate-looking woman in the tailored suit who briskly walks up to the gate agent and calmly but firmly demands to be rerouted immediately through anywhere this side of Kathmandu, just get her to her meeting! There’s the silver-haired, bespoke-suited man who storms up to the agent and, loud enough for everyone to hear, demands to know if she realizes how important it is for him to get to his destination, insists on seeing her superior, and-red-faced by now-screams that the situation is completely intolerable.

Okay, I’m prepared to believe that delays are worse for some people than for others. Failing to make it to the bedside of your dying mother is definitely up there, and missing a business meeting that means life or death to the company your grandfather founded is a lot worse than a student arriving home for winter break half a day later than planned. But I strongly suspect that the differences in how people react to an exasperating flight delay have less to do with the external circumstances and more to do with their Emotional Style.

The existence of Emotional Style raises a number of related questions. The most obvious is, when does Emotional Style first appear, in early adulthood, when we settle into the patterns that describe the people we will be, or, as genetic determinists would have it, before birth? Do these patterns of emotional response remain constant and stable throughout our lives? A less obvious question, but one that arose in the course of my research, is whether Emotional Style influences physical health. (One reason to suspect it does is that people who suffer from clinical depression are much more prone to certain physical disorders such as heart attack and asthma than are people with no history of depression.)

Perhaps most fundamentally, how does the brain produce the different Emotional Styles, and are they hardwired into our neural circuitry, or is there anything we can do to change them and thus alter how we deal with and respond to the pleasures and vicissitudes of life? And if we are able to somehow change our Emotional Style (in chapter 11 I will suggest some methods for doing so), does it also produce measureable changes in the brain?

The Six Dimensions of Emotional Style

So as not to leave you in suspense, and to make specific what I mean by “Emotional Style”, let me lay out its bare bones. There are six dimensions of Emotional Style. The existence of the six did not just suddenly occur to me, nor did they emerge early on in my research, let alone result from a command decision that six would be a nice number. Instead, they arose from systematic studies of the neural bases of emotion. Each of the six dimensions has a specific, identifiable neural signature, a good indication that they are real and not merely a theoretical construct. It is conceivable that there are more than six dimensions, but it’s unlikely: The major emotion circuits in the brain are now well understood, and if we believe that the only aspects of emotion that have scientific validity are those that can be traced to events in the brain, then six dimensions completely describe Emotional Style.

Each dimension describes a continuum. Some people fall at one or the other extreme of that continuum, while others fall somewhere in the middle. The combination of where you fall on each dimension adds up to your overall Emotional Style.

Your Resilience style: Can you usually shake off setbacks, or do you suffer a meltdown? When faced with an emotional or other challenge, can you muster the tenacity and determination to soldier on, or do you feel so helpless that you simply surrender? If you have an argument with your significant other, does it cast a pall on the remainder of your day, or are you able to recover quickly and put it behind you? When you’re knocked back on your heels, do you bounce back and throw yourself into the ring of life again, or do you melt into a puddle of depression and resignation? Do you respond to setbacks with energy and determination, or do you give up?

People at one extreme of this dimension are Fast to Recover from adversity; those at the other extreme are Slow to Recover, crippled by adversity.

Your Outlook style: Do you seldom let emotional clouds darken your sunny outlook on life? Do you maintain a high level of energy and engagement even when things don’t go your way? Or do you tend toward cynicism and pessimism, struggling to see anything positive? People at one extreme of the Outlook spectrum can be described as Positive types; those at the other, as Negative.

Your Social Intuition style: Can you read people’s body language and tone of voice like a book, inferring whether they want to talk or be alone, whether they are stressed to the breaking point or feeling mellow? Or are you puzzled by, even blind to, the outward indications of people’s mental and emotional states? Those at one extreme on this spectrum are Socially Intuitive types; those at the other, Puzzled.

Your Self-Awareness style: Are you aware of your own thoughts and feelings and attuned to the messages your body sends you? Or do you act and react without knowing why you do what you do, because your inner self is opaque to your conscious mind? Do those closest to you ask why you never engage in introspection and wonder why you seem oblivious to the fact that you are anxious, jealous, impatient, or threatened? At one extreme of this spectrum are people who are Self-Aware; at the other, those who are Self-Opaque.

Your Sensitivity to Context style: Are you able to pick up the conventional rules of social interaction so that you do not tell your boss the same dirty joke you told your husband or try to pick up a date at a funeral? Or are you baffled when people tell you that your behavior is inappropriate? If you are at one extreme of the Sensitivity to Context style, you are Tuned In; at the other end, Tuned Out.

. . .

from

The Emotional Life of Your Brain. How Its Unique Patterns Affect the Way You Think, Feel and Live. And how You can Change Them.

by Richard J. Davidson, Ph.D. and Sharon Begley

get it at Amazon.com

Global warming will drive up suicide rates, study warns – Sharon Kirkey * How Climate Change Affects Mental Health – Katherine Schreiber * Mental Health and our Changing Climate, A Primer – APA.

The health, economic, political, and environmental implications of climate change affect all of us. The tolls on our mental health are far reaching. They induce stress, depression, and anxiety; strain social and community relationships; and have been linked to increases in aggression, violence, and crime.

Heat profoundly affects the human mind. The more neurotransmitters needed to cool the body, the less available to suppress emotions like aggression, impatience or violence. Heat increases circulating levels of the stress hormone, cortisol. Psychiatric hospital visits increase during hotter weather.

Virtually everywhere around the world we’re facing warmer temperatures, and there is a lot of evidence of direct effects of warming on mental health.

Although the psychological impacts of climate change may not be obvious, they are no less serious because they can lead to disorders, such as depression, antisocial behavior, and suicide. Therefore, these disorders must be considered impacts of climate change as are disease, hunger, and other physical health consequences.

Of the 36% of Americans who are personally concerned a great deal about climate issues, 72% are Democrats, and 27% are Republicans (PEW Research).

Sharon Kirkey

It was Raymond Chandler who wrote of nights with a hot wind blowing into Los Angeles, a wind that makes “your nerves jump.”

“On nights like that every booze party ends in a fight,” he wrote. “Meek little wives feel the edge of the carving knife and study their husbands’ necks. Anything can happen.”

Now there’s research that says climate change may damage our mental health, just like Chandler’s hot wind from the Santa Ana Mountains.

Last week, a team of 28 specialists convened by the Lancet medical journal listed climate change among the greatest threats to mental health globally.

Ferocious storms and more frequent weather extremes will affect the human psyche in costly ways, some scientists predict, from more depression and anxiety to increased suicide rates.

One working theory is that some of the same neurotransmitters used by the brain to regulate the body’s temperature are also used to control emotions. The more neurotransmitters needed to cool the body, the less available to suppress emotions like aggression, impatience or violence.

. . . National Post

How Climate Change Affects Mental Health.

A new report shows global warming affects our psyches just as much as our earth.

Katherine Schreiber

When we talk about climate change, we tend to think about its effects on our environment, melting polar ice caps, extreme swings in weather, more frequent droughts, flooding, and higher incidences of natural disasters. But what about the effect on our moods, thoughts, and feelings? A new report written by the American Psychological Association, Climate for Health, and ecoAmerica argues that our mental wellbeing is just as vulnerable to global warming as is our earth.

. . . Psychology Today

MENTAL HEALTH AND OUR CHANGING CLIMATE:

IMPACTS IMPLICATIONS, AND GUIDANCE

WHY WE OFFER THIS REPORT

When you think about climate change, mental health might not be the first thing that comes to mind. Americans are beginning to grow familiar with climate change and its health impacts: worsening asthma and allergies; heat-related stress: foodborne, waterborne, and vector-borne diseases; illness and injury related to storms; and floods and droughts. However, the connections with mental health are not often part of the discussion.

It is time to expand information and action on climate and health, including mental health. The health, economic, political, and environmental implications of climate change affect all of us. The tolls on our mental health are far reaching. They induce stress, depression, and anxiety; strain social and community relationships; and have been linked to increases in aggression, violence, and crime. Children and communities with few resources to deal with the impacts of climate change are those most impacted.

To compound the issue, the psychological responses to climate change, such as conflict avoidance, fatalism, fear, helplessness, and resignation are growing. These responses are keeping us, and our nation, from properly addressing the core causes of and solutions for our changing climate, and from building and supporting psychological resiliency.

To help increase awareness of these challenges and to address them, the American Psychological Association and ecoAmerica sponsored this report, Mental Health and Our Changing Climate: Impacts, Implications, and Guidance. This is an updated and expanded version of our 2014 report, Beyond Storms & Droughts: The Psychological Impacts of Climate Change, which explored how climate change can impact mental health and provided guidance to engage the public. This updated report is intended to further inform and empower health and medical professionals, community and elected leaders, and the public. Our websites offer webinars and other resources to supplement this report.

On behalf of the authors, the many professionals who contributed directly and indirectly to this work, and all those involved in expanding awareness of and action on climate and mental health, thank you for taking the time to review and share this important resource.

We invite your feedback, and as the field continues to grow, we’ll continue to update this work.

EXECUTIVE SUMMARY

Thus far, most research and communications on the impacts of climate change have emphasized the physical health effects, while mental health has been secondary. Building upon Beyond Storms and Droughts: The Psychological Impacts of Climate Change, the goal of this updated report is to increase awareness of the psychological impacts of climate change on human mental health and well-being. The report provides climate communicators, planners, policymakers, public health professionals, and other leaders the tools and tips needed to respond to these impacts and bolster public engagement on climate solutions.

The impacts of climate change on people’s physical, mental, and community health arise directly and indirectly. Some human health effects stem directly from natural disasters exacerbated by climate change, like floods, storms, wildfires, and heatwaves. Other effects surface more gradually from changing temperatures and rising sea levels that cause forced migration. Weakened infrastructure and less secure food systems are examples of indirect climate impacts on society‘s physical and mental health.

Some communities and populations are more vulnerable to the health-related impacts of climate change. Factors that may increase sensitivity to the mental health impacts include geographic location. presence of pre-existing disabilities or chronic illnesses, and socioeconomic and demographic inequalities, such as education level, income, and age.

In particular, stress from climate impacts can cause children to experience changes in behavior, development, memory, executive function, decision-making, and scholastic achievement.

The connection between changes in the climate and impacts on a person can be difficult to grasp. Although people’s understanding and knowledge of climate change can increase by experiencing the effects directly, perception, politics, and uncertainty can complicate this link. Psychological factors (like psychological distance), a political divide, uncertainty, helplessness, and denial influence the way people comprehend information and form their beliefs on climate change. Research on the impacts of climate change on human well-being is particularly important given the relationship among understanding, experiencing, and comprehending climate change. People’s willingness to support and engage in climate solutions is likely to increase if they can relate them to local experiences or if they see the relevance to their own health and well-being. Additionally, individuals who have higher perceived environmental self-efficacy, or the sense of being able to positively contribute, are more motivated to act on climate solutions.

Climate solutions are available now, are widespread, and support psychological health. Increasing adoption of active commuting, public transportation, green spaces, and clean energy are all solutions that people can choose to support and integrate into their daily lives. These climate solutions, among others, can help to curb the stress, anxiety, and other mental illnesses incurred from the decline of economies, infrastructure, and social identity that comes from damage to the climate.

Major acute mental health impacts include increases in trauma and shock, posttraumatic stress disorder (PTSD), compounded stress, anxiety, substance abuse, and depression. Climate change induced extreme weather, changing weather patterns, damaged food and water resources, and polluted air impact human mental health. Increased levels of stress and distress from these factors can also put strains on social relationships and even have impacts on physical health, such as memory loss, sleep disorders, immune suppression, and changes in digestion.

Major chronic mental health impacts include higher rates of aggression and violence, more mental health emergencies, an increased sense of helplessness, hopelessness, or fatalism, and intense feelings of loss. These feelings of loss may be due to profound changes in a personally important place (such as one’s home) and/or a sense that one has lost control over events in one’s life due to disturbances from climate change. Additionally, a sense of loss regarding one’s personal or occupational identity can arise when treasured objects are destroyed by a disaster or place-based occupations are disrupted by climate change.

Personal relationships and the ways in which people interact in communities and with each other are affected by a changing climate. Compounded stress from a changing environment, ecomigration, and/or ecoanxiety can affect community mental well-being through the loss of social identity and cohesion, hostility, violence, and interpersonal and intergroup aggression.

Psychological well-being includes positive emotions, a sense of meaning and purpose, and strong social connections. Although the psychological impacts of climate change may not be obvious, they are no less serious because they can lead to disorders, such as depression, antisocial behavior, and suicide. Therefore, these disorders must be considered impacts of climate change as are disease, hunger, and other physical health consequences.

Building resilience is essential to address the physical and mental health impacts of climate change. Many local governments within the United States and in other countries have created plans to protect and enhance infrastructure, but these plans tend to overlook the support needed to ensure thriving psychological well-being. There is an opportunity to include the resilience capacity of individuals and communities in the development of preparedness plans.

OUR CHANGING CLIMATE: A PRIMER

Our climate is changing at an accelerated rate and continues to have profound impacts on human health. This change jeopardizes not only physical health but also mental health.

ACCELERATION

From wildfires and drought in California to severe flooding in Maryland to Alaskan communities threatened by rising seas, we are clearly living through some of the most severe weather events in US. history as a result of damage to our climate. Thes impacts on our environment will, in turn, affect human health and community well-being.

CHANGES WORLDWIDE

Climate change is creating visible impacts worldwide, including many here in America. As seen in the tripling of heat waves between 2011 and 2012, weather patterns introduce lasting impacts, such as food insecurity. Similarly, rising sea-surface temperatures have been connected to increasing rates of disease for marine life and humans. Sea levels are estimated to increase anywhere from 8 inches to 6.6 feet due to warmer temperatures by 2100, putting 8 million Americans living in coastal areas at risk for flooding. In terms of our economy, Hurricane Sandy cost the United States around $68 billion in total. Droughts caused by increases in temperature and changing weather patterns cost California $2.7 billion in 2015 and Texas $7.62 billion in 2011. As these climate disturbances become more dramatic and persistent, we must prepare for these climate conditions.

COMMUNITIES ARE IMPACTED

Our communities’ health, infrastructure, and economy are directly connected to our climate. As temperatures increase, we experience higher levels of pollution, allergens, and diseases. Severe weather events threaten our businesses and vulnerable communities. Pollution and drought undermine our food and water supplies, and the latter increases the prevalence of wildfires that can destroy homes and communities. Although all Americans are affected, certain populations of concern will feel the impacts more severely. Together, communities can build resilience to a changing climate.

HEALTH IS IMPACTED

As severe weather events, poorer air quality, degraded food and water systems, and physical illnesses increase, the direct and indirect impacts on health must be understood. The next section highlights the physical health impacts of climate change, and the following sections delve deeper into the mental health impacts, and what can be done to protect human well-being.

THE CLIMATE AND HEALTH IMPACTS ON HUMANS

Health is more than the absence of disease. Health includes mental health, as well as physical well-being, and communities that fail to provide basic services and social support challenge both. As we think about the impacts of climate change on our communities, we need to recognize not only the direct effects but also the indirect consequences for human health based on damage to the physical and social community infrastructure. Regardless of how these impacts surface, whether they occur within a matter of hours or over several decades, the outcomes of climate change are interconnected to all facets of our health.

ACUTE IMPACTS:

DlSASTER-RELATED EFFECTS

Recent increases in natural disasters illustrate the relationship between the acceleration of climate change and severe weather.

Areas that endure a natural disaster face a number of risks and difficulties. Direct physical impacts range from brute physical trauma to more pernicious effects, like increased incidence of infectious disease, asthma, heart disease, and lung problems. These physical health impacts interact with mental health impacts.

Major and minor acute physical injury

Natural disasters lead to increased rates of death and injury. The most common causes of mortality during floods are drowning and acute physical trauma. This past year alone, deaths from flash floods have more than doubled the 10-year average. Many people sustain non-fatal injuries, such as cuts and broken bones.

Infrastructure, food, and water

The direct effect of a natural disaster is often exacerbated by a cascade of indirect consequences that follow. Natural disasters can lead to technological disasters (such as power outages), breakdowns in the water, sewer, and other infrastructure, or urban fires. For instance, the risk of carbon monoxide poisoning related to power outages increases as a result of climate change-induced disasters. Disruptions to medical infrastructure, including the provision of medical supplies, can transform minor issues into major and even fatal problems. In addition, disruptions in other types of services (e.g., cell phone communication, transportation, or waste management) add stress and difficulty during the aftermath of a disaster. These disruptions may impact people’s physical health by making it more difficult to access health care or by potentially increasing exposure to pests or hazardous substances (e.g., when there is no garbage pick-up. Loss of income while businesses are closed due to natural disasters can be a major threat to food security, especially for non-professionals or small business owners.

After effects

Additional health threats follow in the wake of a disaster. Floodwater has been shown to introduce toxic materials, water-borne diseases (e.g., respiratory illnesses, skin infections, and neurologic and gastrointestinal illness where there are poor hygiene resources), and vector-borne illnesses (e.g., West Nile). Other after effects of flooding include heart attack, heat stroke, dehydration, and stroke, particularly when the affected areas lack the necessary medical supplies. In addition, post-flood mold due to fungal growth inside houses can worsen allergy or asthma symptoms.

MORE GRADUAL HEALTH EFFECTS

Ongoing effects of climate change include rising sea levels, increases in temperature, and changes in precipitation that will affect agricultural conditions. The impacts on human health are less dramatic in the short term but in the long run can affect more people and have a fundamental impact on society.

Severe and changing weather

Periods of higher-than-normal heat result in higher rates of heat exhaustion, heat cramps, heat stroke, hospital admission for heart-related illnesses, and death.

It’s estimated that the average American citizen will experience between 4 and 8 times as many days above 95 degrees Fahrenheit each year as he or she does now by the end of the century. This increase will likely push Arizona’s above-95-degree days from 116 today to as many as 205 by 2099. In contrast, extreme winter storms can expose people to hypothermia and frostbite. Altered growing seasons and ocean temperatures change the timing and occurrence of diarrhea, fever, and abdominal cramps from pathogen transmissions in raw food. Additionally, changing weather patterns influence the expansion of the migration patterns of animals and insects. This expansion has already begun to result in the spread of vector-borne illness, such as Lyme disease, malaria, dengue fever, plague, and Zika virus to new U.S. geographic areas. For example, vector-borne illnesses carried by mosquitoes can capitalize on receding floodwater for mosquito breeding.

Respiratory issues and allergens

People exposed to ozone air pollution, which is emitted mostly by cars and industrial facilities and is intensified by warmer temperatures, are more likely to visit the hospital for respiratory issues, suffer from asthma, and die prematurely of strokes or heart attacks. Hotter and drier summers increase the frequency and intensity of large wildfires that contribute to smoke inhalation. Pollution contributes to higher levels of pollen and translates into longer and more prevalent allergy seasons.

Fetal and child development

CIimate-driven physical stress on mothers can cause adverse birth outcomes, such as preterm birth and low birth weight. Scientific research shows that children and developing fetuses are at particular risk from air pollution, heat, malnutrition, infectious diseases, allergies, and mental illnesses, which have detrimental impacts on development.

Water and food supply

Nutrition and food safety can be affected because climate change can lower crop yields, reduce the nutritional quality of food, interrupt distribution chains, and reduce access to food because families lose income. For example, higher C02 concentrations lower the levels of protein and essential minerals of widely consumed crops such as wheat, rice, and potatoes. Barriers to food transport, such as damage to infrastructure and displacement of employees, affect food markets by increasing food costs. Droughts, floods, and changes in the availability of fertile land lead to hunger and malnutrition, though these changes are less likely in wealthy countries, such as the United States. Nevertheless, there will be an increased likelihood of a global food market crisis as climate change accelerates. A two-degree Celsius increase in temperature places 100-400 million people at risk of hunger, according to the World Bank.

General fitness

Increased average temperatures and decreased air quality also lead to changes in the type of activities that people engage in, particularly outdoor activities and recreation. These changes, in turn, may be associated with increased rates of obesity and cardiovascular disease. Although people may compensate by exercising in indoor environments, reduced access to the restorative potential of outdoor environments may indirectly increase stress and bypass the long-term emotional benefits of taking physical activity outdoors.

LINKING PHYSICAL IMPACTS, MENTAL HEALTH, AND COMMUNITY WELL-BEING

MENTAL HEALTH

The ability to process information and make decisions without being disabled by extreme emotional responses is threatened by climate change. Some emotional response is normal, and even negative emotions are a necessary part of a fulfilling life. In the extreme case, however, they can interfere with our ablllty to think rationally, plan our behavior, and consider alternative actions. An extreme weather event can be a source of trauma, and the experience can cause disabling emotions. More subtle and indirect effects of climate change can add stress to people’s lives in varying degrees. Whether experienced indirectly or directly, stressors to our climate translate into impaired mental health that can result in depression and anxiety. Although everyone is able to cope with a certain amount of stress, the accumulated effects of compound stress can tip a person from mentally healthy to mentally ill. Even uncertalnty can be a source of stress and a risk factor for psychological distress. People can be negatively affected by hearing about the negative experiences of others, and by fears, founded or unfounded, about their own potential vulnerability.

PHYSICAL HEALTH AND MENTAL HEALTH

Compromised physical health can be a source of stress that threatens psychological well being. Conversely mental health problems can also threaten physical health, for example, by changing patterns of sleep, eating, or exercise and by reducung immune system function.

COMMUNITY HEALTH

Although resndents‘ mental and physical health affect communlties, the impacts of climate on community health can have a particularly strong effect on community fabric and interpersonal relationships. Altered environmental condtions due to climate change can shift the opportunities people have for social interaction, the ways in which they relate to each other. and their connectlons to the natural world.

COMPREHENDING CLIMATE CHANGE

Witnessing the visible impacts of climate change may help people overcome barriers to grasping the problem; however, comprehension has many facets.

PERCEPTION IS DIFFICULT

Although most people are generally aware that climate change is occurring, it continues to seem distant: something that will happen to others, in another place, at some unspecified future date. Psychologists refer to this idea as psychological distance. Terms such as “climate change” and “global warming” draw attention to the global scale rather than the personal impacts. Additionally, the signal of climate change is obscured by the noise of daily and seasonal weather variation. All this makes the issue easier for people to push aside, particularly when faced with other pressing life issues. When people learn about and experience local climate impacts, their understanding increases. Local effects of climate change are often more personally relevant than the general phenomenon of a warming climate, and particularly when knowledge of direct effects is combined with news stories of the imminent risks of climate change. Perceived experience of impacts is associated with increased concern and awareness about climate change, direct experience also increases people’s understanding of climate change. However, direct experience does not necessarily lead to behavior change. For example, experiencing water shortages may increase behavior changes in water use but not encourage other sustainable behavior. Similarly, research suggests experiencing temperature change has no impact on water use behavior.

A PARTISAN ISSUE

Politically polarized in the United States, climate change is perceived as an issue that belongs with the political left, which can suppress belief and concern and discussions about solutions. For example, of the 36% of Americans who are personally concerned a great deal about climate issues, 72% are Democrats, and 27% are Republicans. Political orientation can make open conversations about climate impacts and solutions difficult, and make those who are concerned about climate change feel isolated or paranoid in some circles.

Concerns about health impacts provide common ground for discussion with both ends of the political spectrum. Describing the health-related impacts of climate change and the relevant benefits of taking action to address the impacts can inspire hope among those who dismiss climate change. For instance, conservatives showed decreased support for climate action when the negative health effects were described as affecting people in a faraway country as opposed to people who live in the United States. Listing several health impacts is overwhelming, causing fatalism and diminished engagement.

UNCERTAINTY AND DENIAL

People feel uncertain about the threat of climate change and how to minimize the damage. The media have been criticized for promoting an inaccurate perception of climate change: for example, that there is more scientific controversy about climate change than actually exists. In some cases, information that increases perceptions of the reality of climate change may feel so frightening that it leads to denial and thus a reduction in concern and support for action. In addition, communicating scientific information is not easy; this complexity itself may be a problem. One study showed that people who received more complex information on environmental problems 1) felt more helpless and more inclined to leave the problem to the government; and 2) those who felt ignorant about the topic were more likely to want to avoid hearing about more negative information.

Worldviews and ideologies act as filters to help increase or decrease concern about climate change and motivate action toward solutions. People do not perceive the world neutraly. Instead, through directionally motivated cognition, individuals strive to maintain a world consistent with the ideology and values of their social groups. Because of this, individuals whose worldviews conflict with climate change realities actually may not perceive certain climate effects. Myers, Maibach, Roser-Renouf, Akerlof, and Leiserowitz (2012) found that individuals who were 1) either very concerned about or skeptical of climate change tended to report personal experience with climate change (or lack thereof) based on their pre-existing beliefs about its existence; and 2) individuals less engaged with the issue of climate change changed their beliefs about the existence of climate change based on perceived personal experience with its impacts. Ideologies of climate change and action may also contribute to widespread psychological denial. The distress of climate change can manifest in negative reactions to climate activism. These reactions are reflected in outlets such as social media, and researchers believe this behavior shifts others to denial.

CLIMATE SOLUTIONS BENEFIT MENTAL HEALTH

Physical commuting enhances a sense of well-being. Choosing to bike and/or walk (assuming it is safe and practical to do so) is one individual step that can help reduce the use of climate change-driving fossil fuels. Physical commuting also directly impacts depression, anxiety, PTSD, and other mental illnesses. People who bike and walk to work, school, appointments, and other activities not only reduce emissions and improve their physical health but also experience lower stress levels than car commuters. For instance, individuals who utilized the Washington DC. bikeshare program reported reduced stress levels and weight loss. Similarly, adolescents who actively commute to school show not only lower levels of perceived stress but also increased cardiovascular fitness, improved cognitive performance, and higher academic achievement.

Public transportation invigorates community mental health. Moving people from individual cars to public transit also results in lower greenhouse gas emissions. In addition, several studies have shown that using public transportation leads to an increase in community cohesion, recreational activities, neighborhood walkability, and reduced symptoms of depression and stress associated with less driving and more exercise. Meanwhile, traffic driving worsens air quality and contributes to reduced productivity and increased healthcare costs. Sound transportation systems and urban planning should be expanded as they lead to beneficial mental health and climate outcomes. Green spaces diminish stress. Parks and green corridors have been connected to improved air quality and can increase mental well-being. For example, trees sequester carbon, and green spaces absorb less heat than paved surfaces and buildings. More time spent interacting with nature has been shown to significantly lower stress levels and reduce stress-related illness. Interestingly, this evidence is supported across socioeconomic status, age, and gender. Likewise, individuals who move to areas with access to more green space showed sustained mental health improvements, while individuals who moved to areas with less access to green space experienced substantial negative mental health impacts. However, although a person’s physical and mental health is determined to a large degree by the neighborhood in which he or she lives, relocating to a greener neighborhood isn’t always an option. As planners and policymakers make decisions that will reshape the landscapes of our cities and communities, it is important to recognize the significance and role green areas have in improving air quality, reducing stress, and ensuring a healthy living environment for everyone.

Clean energy reduces health burdens. Wind, solar, hydro, and other clean energy as well as energy efficiency are not only climate-friendly; they also reduce particulates and pollution in the air. Studies on air quality and children’s lung development have shown that as air pollution is reduced, children display significant lung function improvements. Further research revealed that children exposed to higher levels of urban pollution are more likely to develop attention problems and symptoms of anxiety and depression, as well as lower academic performance and brain function. Clean energy provides an opportunity to protect populations of concern, such as children, who experience these impacts more severely.

Although the co-benefits are clear, more comprehensive research on the positive mental health outcomes of climate solutions is needed to bolster support. Research can further promote dynamic solutions as opportunities to improve our health. It is important to increase awareness of the daily choices we make, from how to get to work to the sources of energy to, the more climate-friendly behaviors become mainstreamed, the more they help populations of concern: children, elderly, sick, low income, etc. Fortunately, tangible and effective climate solutions are available today to implement and build upon.

MENTAL HEALTH IMPACTS

The mental health effects of Climate change are gaining public attention. A 2071 government report (US. Global Change Research Program) reviewed a large body of research to summarize the current state of knowledge. This report builds on that knowledge, and considers the direct and indirect effects of Climate change on mental health.

We start by describing the mental health effects on individuals, both short and long term, acute and chronic, the stressors that accumulate in the aftermath of a disaster, and the impacts that natural disasters have on social relationships, with consequences for health and well-being. We move on to discussing the individual-level impacts of more gradual changes in climate, including impacts on aggression and violence, identity, and the long-term emotional impacts of Climate change. Next, we discuss the impacts of climate change on communities and on intergroup and international relationships. Finally, we address the problem of inequity, the fact that certain populations are relatively more vulnerable to these mental health impacts compared to others.

IMPACTS ON INDIVIDUALS

Climate change has acute and chronic impacts, directly and indirectly, on individual well-being. Acute impacts result from natural disasters or extreme weather events. Chronic impacts result from longer term changes in climate. This discussion emphasizes the impacts experienced directly by individuals; however, it also touches on indirect impacts (witnessing others being impacted), which have profound implications for mental health.

ACUTE IMPACTS

Trauma and shock

Climate change-induced disasters have a high potential for immediate and severe psychological trauma from personal injury, injury or death of a loved one, damage to or loss of personal property (e.g., home) and pets, and disruption in or loss of livelihood. An early meta-analysis of studies on the relationship between disasters and mental health impacts found that between 7% and 40% of all subjects in 36 studies showed some form of psychopathology. General anxiety was the type of psychopathology with the highest prevalence rate, followed by phobic, somatic, and alcohol impairment, and then depression and drug impairment, which were all elevated relative to prevalence in the general population. More recent reviews concluded that acute traumatic stress is the most common mental health problem after a disaster. Terror, anger, shock, and other intense negative emotions are likely to dominate people’s initial response. Interview participants in a study about flooding conducted by Carroll, Morbey, Balogh, and Araoz (2009) used words such as “horrifying,” “panic stricken,” and “petrified“ to describe their experience during the flood

Post-traumatic stress disorder (PTSD)

For most people, acute symptoms of trauma and shock are reduced after conditions of security have been restored. However, many continue to experience problems as PTSD manifests as a chronic disorder. PTSD, depression, general anxiety, and suicide all tend to increase after a disaster.

For example, among a sample of people living in areas affected by Hurricane Katrina, suicide and suicidal ideation more than doubled, one in six people met the diagnostic criteria for PTSD, and 49% of people living in an affected area developed an anxiety or mood disorder such as depression. Similarly, 14.5% showed symptoms of PTSD from Hurricane Sandy, and 15.6% of a highly affected community showed symptoms of PTSD several years after experiencing extreme bushfire. PTSD is often linked to a host of other mental health problems, including higher levels of suicide, substance abuse, depression, anxiety, violence, aggresson, interpersonal difficulties, and job-related difficulties.

Incidence of PTSD is more likely among those who have lost close family members or property. Individuals who experience muitiple or long-lasting acute events, such as more than one disaster or multiple years of drought, are likely to experience more severe trauma and may be even more susceptible to PTSD and the other types of psychiatric symptoms described above. For example, a study showed that refugees exposed to multiple traumatic events experienced a higher rate of immediate and lifetime PTSD and had a lower probability of remission than refugees who had experienced few traumatic events. The likelihood of suicide is higher among those who have been exposed to more severe disasters.

Compounded stress

In general, climate change can be considered an additional source of stress to our everyday concerns, which may be tolerable for someone with many sources of support but can be enough to serve as a tipping point for those who have fewer resources or who are already experiencing other stressors. Stress manifests as a subjective feeling and a physiological response that occur when a person feels that he or she does not have the capacity to respond and adapt to a given situation. Thus, climate-related stress is likely to lead to increases in stress-related problems, such as substance abuse, anxiety disorders, and depression. These problems often carry economic costs incurred by lost work days, increased use of medical services, etc, which, in turn, create additional stress for individuals and society and have their own impacts on mental and physical health. Stress can also be accompanied by worry about future disasters and feelings of vulnerability, helplessness, mourning, grief, and despair. Following disasters, increased stress can also make people more likely to engage in behavior that has a negative impact on their health (e.g., smoking, risky behavior, and unhealthy eating habits; e.g. Stain et al. (2011) found that people living in a drought-affected area who had also recently experienced some other adverse life event were more likely to express a high degree of worry about the ongoing drought conditions. Although not as dramatic and acute a disaster as a hurricane, drought is associated with psychological distress, and one study found increased rates of suicide among male farmers in Australia during periods of prolonged drought. Several studies have found that many victims of a flood disaster express psychological distress even years after the flood.

Impacts of stress on physical health

High levels of stress and anxiety also appear to be linked to physical health effects.

For example, chronic distress results in a lowered immune system response, leaving people more vulnerable to pathogens in the air and water and at greater risk for a number of physical ailments. Sleep disorders also increase in response to chronic distress. Doppelt (2016) has described potential physiological responses to the stress of climate change, such as increased levels of the stress hormone cortisol, which, if prolonged, can affect digestion, lead to memory loss, and suppress the immune system. The World Heart Federation (2016) lists stress as a serious risk factor in developing cardiovascular disease.

Strains on social relationships

Particularly in home environments, disasters precipitate a set of stressors that can strain interpersonal interactions. A review of research on the impacts of natural disasters identified problems with family and interpersonal relations, as well as social disruption, concerns about the wider community, and feelings of obligation to provide support to others. Families whose homes are damaged by a flood, storm, or wildfire may need to be relocated, sometimes multiple times, before settling permanently. Family relationships may suffer. Separation from one another and from their systems of social support may occur. Children may have to attend a new school or miss school altogether; parents may find themselves less able to be effective caregivers. In addition, even those who are able to remain in their own home may still lose a sense of their home as a safe and secure environment. This has implications for interpersonal connections, as a home provides the context for social relationships. When the physical home is damaged, it changes the dynamic of the social relationships, often negatively. Domestic abuse, for example, including child abuse, often increases among families who have experienced disasters, such as Hurricane Katrina or the Exxon Valdez oil spill.

CHRONIC IMPACTS

Aggression and violence

The psychological impacts of warmer weather on aggression and violence have been extensively studied. Lab-based experiments and field-based surveys have demonstrated a causal relationship between heat and aggression. In other words, as the temperature goes up, so does aggression. This influenced researcher Craig Anderson (2012) to predict a demonstrable increase in violence associated with increased average temperatures. The relationship between heat and violence may be due to the impacts of heat on arousal, which results in decreases in attention and self-regulation, as well as an increase in the availability of negative and hostile thought, effect on cognitive function, which may reduce the ability to resolve a conflict without violence. Although this impact can manifest as an acute impact (e.g., as a result of a heat wave), due to the pervasive warming trends, and the shifting of climate zones, it is listed under chronic impacts.

Mental health emergencies

There is evidence that increases in mean temperature are associated with increased use of emergency mental health services. This is true not only in hot countries, like Israel and Australia, and in parts of the United States but also in relatively cooler countries, such as France and Canada. Higher temperatures have been linked to increased levels of suicide. It appears that the distress of feeling too hot can overwhelm coping ability for people who are already psychologically fragile. Climate emergencies can also exacerbate preexisting symptoms and lead to more serious mental health problems.

Loss of personally important places

Perhaps one of the best ways to characterize the impacts of climate change on perceptions is the sense of loss. Loss of relationship to place is a substantial part of this. As climate change irrevocably changes people‘s lived landscapes, large numbers are likely to experience a feeling that they are losing a place that is important to them, a phenomenon called solastalgia. This psychological phenomenon is characterized by a sense of desolation and loss similar to that experienced by people forced to migrate from their home environment. Solastalgia may have a more gradual beginning due to the slow onset of changes in one’s local environment. Silver and Grek-Martin (2015) described the emotional pain and disorientation associated with changes in the physical environment that were expressed by residents of a town damaged by tornadoes, even by residents who had not experienced personal loss.

Loss of place is not a trivial experience. Many people form a strong attachment to the place where they live, finding it to provide a sense of stability, security, and personal identity. People who are strongly attached to their local communities report greater happiness, life satisfaction, and optimism; whereas work performance, interpersonal relationships, and physical health can all be negatively affected by disruption to place attachment. For instance, Scannell and Gifford (2016) found that people who visualized a place to which they were attached showed improved self-esteem and sense of belonging relative to those who visualized a place to which they were not attached.

Climate change is likely to have a significant effect on human well-being by increasing migration. When people lose their home to rising sea levels, or when a home becomes unsuitable for human habitation due to its inability to support food crops, they must find another place to live. Although it is difficult to identify climate change as the causal factor in a complex sequence of events affecting migration, a common prediction is that 200 million people will be displaced due to climate change by 2050. Migration in and of itself constitutes a health risk. Immigrants are vulnerable to mental health problems, probably due to the accumulated stressors associated with the move, as well as with the condition of being in exile. Adger, Barnett, Brown, Marshall, and O‘Brien (2013) found being forced to leave one‘s home territory can threaten one’s sense of continuity and belonging. Because of the importance of connection to place in personal identity, such displacement can leave people literally alienated, with a diminished sense of self and increased vulnerability to stress. Although empirical research on the psychological impacts of migration is rare, Tschakert, Tutu, and Alcaro (2013) studied the emotional experience among residents of Ghana who were forced to move from the northern region of the country to the capital, Accra, because local conditions no longer supported their farming practices. Also, respondents expressed nostalgia and sadness for the home left behind and helplessness due to changes in their environments, such as deforestation, that were described as sad and scary.

Loss of autonomy and control

Climate change will intensify certain daily life inconveniences, which can have psychological impacts on individuals’ sense of autonomy and control. The desire to be able to accomplish basic tasks independently is a core psychological need, central to human well-being, and basic services may be threatened due to dangerous conditions. This may make mobility a challenge, particularly for the elderly and those with disabilities. Exposure to unwanted change in one’s environment can also reduce one’s sense of control over one’s life, which, in turn, has negative impacts on mental health.

Loss of personal and occupational identity

A more fundamental loss is the loss of personal identity tied to mundane aspects of daily life. Losing treasured objects when a home is damaged or destroyed is one way in which climate change can significantly impair an individual’s sense of self and identity. This is because objects help provide a continuing sense of who we are, particularly objects that represent important moments in life (e.g., journals), relationships (e.g., gifts or photographs), or personal family history (e.g., family heirlooms). Interviewees in a study conducted by Carroll et al. (2009) indicated that flood victims were particularly troubled by the loss of personal possessions, such as things they had made themselves or special things they had spent time and effort to procure or maintain. Although this may seem acute, the losses are permanent; the impacts are persistent and therefore become chronic.

A loss of identity associated with climate change is also sometimes attributable to its effect on place-bound occupations. This is likely due to the close relationship between identity and place-based occupations, like farming and fishing. Because severe storms and high temperatures disrupt economic activity climate change may have an effect on occupational identity in general. Loss of occupation has been associated with increased risk of depression following natural disaster.

Helplessness, depression, fear, fatalism, resignation, and ecoanxiety

Gradual, long-term changes in climate can also surface a number of different emotions, including fear, anger, feelings of powerlessness, or exhaustion. A review by Coyle and Van Susteren (2011) described cases in which fear of extreme weather approaches the level of phobia and the “unrelenting day-by-day despair” that can be experienced during a drought. Watching the slow and seemingly irrevocable impacts of climate change unfold, and worrying about the future for oneself, children, and later generations, may be an additional source of stress. Albrecht (2011) and others have termed this anxiety ecoanxiety. Qualitative research provides evidence that some people are deeply affected by feelings of loss, helplessness, and frustration due to their inability to feel like they are making a difference in stopping climate change. Some writers stress the possible detrimental impact of guilt, as people contemplate the impact of their own behavior on future generations. Although the impacts of climate change are not always visible, they perpetuate a delayed destruction that, like the damage to climate, are incremental and can be just as damaging as acute climate impacts.

IMPACTS ON COMMUNITY AND SOCIETY

In addition to the effects on individual health and wellbeing, climate change affects how individuals interact in communities and relate to each other. For example, natural disasters can have a negative impact on community bonds. A changing climate will likely affect aspects of community wellbeing, including social cohesion, aggression, and social relationships.

SOCIAL COHESION AND COMMUNITY CONTINUITY

Compounded stress from climate change has been observed among various communities. For example, CunsoLo Willox et al. (2013) examined the impacts of climate change on a small Inuit COMMUNITY. Members of the community, who all reported a strong attachment to the land, said they had noticed changes in the local climate and that these changes contributed to negative effects on themselves. As a result of altered interactions with the environment, community members reported food insecurity, sadness, anger, increased family stress, and a belief that their sense of self-worth and community cohesion had decreased. Elders expressed specific concern for the preservation of Inuit language and culture as they directly influence mental wellbeing and social cohesion.

Social cohesion and social capital can protect communities against mental and physical health impacts during a climate related disaster. Regardless of socioeconomic or cultural backgrounds, communities with high levels of social capital and community leadership experience the quickest recoveries after a disaster and the highest satisfaction with community rebuilding.

When locaI conditions become practically uninhabitable, ecomigration, leading to environmental refugees, can result. Such migrations erode social networks, as communities disperse in different directions. Because social networks provide important practical and emotional resources that are associated with health and wellbeing, the loss of such networks places people’s sense of continuity and belonging at risk. The current Syrian conflict, which has resulted in mass migration, may partially stem from climate change driven precipitation changes, rising mean sea levels, and a decrease in soil moisture. These climate impacts were exacerbated during the drought from 2007 to 2010 due to human disruptions within natural systems, leading to crop failure and large-scale conflict, hunger, and desperation. Although such civil unrest cannot be attributed to a single cause, recent evidence suggests climate-change caused drought may have played a significant role in the unraveling of an already vulnerable political and ecological climate.

AGGRESSION

Heightened anxiety and uncertainty about one’s own future can reduce the ability to focus on the needs of others, negatively impacting social relationships with friends and co-workers, as well as attitudes toward other people in general.

Interpersonal violence

High temperatures associated with climate change may increase people‘s aggressive tendencies. Aggression can also be exacerbated by decreased access to stress reducing green spaces and supportive social networks. Rising levels of frustration in society consequently lead to interpersonal aggression (such as domestic violence, assault, and rape). Ranson (2012) calculated that between 2010 and 2099, climate change would cause an estimated additional 30,000 murders, 200,000 cases of rape, and 3.2 million burglaries due to increased average temperatures.

Intergroup aggression

Climate change may increase conflict through several mechanisms. Violence may increase when competition for scarce natural resources increases or when ecomigration brings formerly separate communities into contact and they compete for resources, like jobs and land. In a recent metaanalysis, Hsiang, Burke, and Miguel (2013) found evidence that climate change can contribute to the frequency of intergroup violence (ie. political conflict and war). For example, in Houston, Texas, crime rates increased significantly following Hurricane Katrina, although Katrina migrants have not been definitively sourced as the cause. Meanwhile, restraints on crime weaken when existing social institutions are disrupted, thus increasing the probability of criminal behavior. For example, when government resources are devoted to damaged infrastructure from natural disasters, those resources may be diverted away from criminal justice systems, mental health agencies, and educational institutions, all of which tend to help mitigate crime. Agnew (2012) further pointed out that the effects of climate chanqe are likely to promote crime by “increasing strain, reducing social control, and weakening social support.”

Intergroup attitudes can also be negatively impacted by climate change. In a recent study, survey respondents displayed more negative attitudes toward policies to support minorities and immigrants when temperatures were high. An experimental study showed that people who were thinking about climate change became more hostile to individuals outside their social group (that is, people they consider to be unlike them) and more likely to support the status quo and its accompanying social inequities. Hostility toward individuals outside one’s social group can be a way of affirming one’s own group identity in the face of a perceived threat. In a vicious cycle, lower levels of social cohesion and connectedness, greater social inequalities, lack of trust between community members and for institutions, and other factors that inhibit community members from working together are associated with intergroup aggression.

THE PROBLEM OF INEQUITY

The impacts of climate change are not distributed equally. Some people will experience natural disasters firsthand, some will be affected more gradually over time, and some will experience only indirect impacts. This section describes some of the populations that are more vulnerable to the mental health impacts of climate change, including people who live in risk-prone areas, indigenous communities, low-income groups, certain communities of color, women, children, older adults, and people with disabilities or chronic illnesses. A thorough review of demographic differences in vulnerability to climate change can be found in Dodqen et al. (2016).

RISK-PRONE AREAS

Communities in which people’s livelihoods are directly tied to the natural environment, through agriculture, fishing, or tourism, are at greater risk. Some parts of the world are geologically more vulnerable to storms, rising seas, wildfires, or drought. There are detailed reports of farmers in Australia who have been negatively affected by prolonged periods of drought caused by changing weather patterns. Additionally, communities in low-lying areas, such as coastal Louisiana and islands in the Chesapeake Bay, are losing their land to erosion and rising seas. This past year, residents of Isle de Jean Charles, Louisiana, became the first climate refugees in the United States; a $48 million budget was allocated to relocate residents to a less flood-prone area, inhabitants of indigenous communities often depend on natural resources for their livelihoods and are located in geographically vulnerable regions.

Communities that lack resources, both physical and financial, can experience climate impacts more severely. This can be demonstrated by higher incidents of extreme weather within impoverished communities. In disasters, socioeconomically disadvantaged communities often suffer the most. For example, following Hurricane Sandy, lower income residents reported weak or absent social support networks and had the greatest percentages of severe mental distress and diagnosis of depression or anxiety after the hurricane. Furthermore, 35% of children living in a household that earns less than $20,000 annually experienced feelings of sadness, depression, fear, or nervousness following the hurricane.

INDIGENOUS COMMUNITIES

Indigenous communities are at risk of losing their cultural heritage, as well as their homes. Imperiled indigenous communities are found around the world, including the United States. In Alaska, for example, some native Alaskans have seen their villages literally vanish due to the thawing permafrost, and others are facing a similar outcome in the near future. For indigenous communities, climate change may threaten not oniy their physical home but also their lifestyle, including access to traditional food and culturally meaningful practices. Chief Albert Naquin of a Louisiana tribal community threatened by climate change stated, ”We’re going to lose all our heritage, all our culture”. Cunsolo, Willox et al. (2013) reviewed case studies of several Inuit communities and reported weakening social networks, increased levels of conflict, and significant stress associated with relocation or even thinking about relocation. In evocative language, Inuit community members interviewed by Durkalec et al. (2015) reported that an inability to go out on the sea ice (due to a changing climate) would make them feel like they “have no health” and ”can’t breathe,“ and they would ”be very sad,” “be lost,” or ”go crazy”.

The loss of any community is tragic, but the impact on native communities is particularly notable because it diminishes the cultural heritage and because indigenous communities are often defined by a special connection to the natural environment. This connection includes traditional patterns of behavior and environmental knowledge about the specific local ecosystem, knowledge that is disappearing, and about how to adapt to changing environments that could help us as a broader society as we adapt to the consequences of climate change.

CHILDREN AND INFANTS

Climate change has a big impact on young people. Children are more vulnerable to many of the effects due to their small size, developing organs and nervous systems, and rapid metabolisms. Children are more sensitive to temperature, because their physiological regulatory systems may be less effective (e.g., they sweat less) and because they are more likely to depend on others to help them regulate their behavior. Their small size makes very young children more susceptible to dehydration, and children under age five living in poverty represent 80% of victims of sanitation-related illnesses and diarrheal disease.

Climate impacts may have long-term and even permanent effects, such as changing the developmental potential and trajectory of a child. Currie and Almond (2011) reviewed evidence that even minor disturbances during childhood may have effects on health and earning potential that last into adulthood. Studies have shown that children who experience a flood or a drought during key developmental periods are shorter, on average, as adults. Fetuses are vulnerable to heat waves, with research shows that exposure to heat waves especially during the second and third trimesters of pregnancy leads to a lower average birth weight and possibly a greater incidence of preterm birth. Malnourishment or severe threat to health during the early years is associated with fewer years of schooling and reduced economic activity as adults, as well as with behavioral and motor problems and reduced IQ. Additionally, early exposure to disease provoked by climate change can have a major and permanent impact on neurological development, as can be dramatically seen in children exposed prenatally to the Zika virus.

Children can experience PTSD and depression following traumatic or stressful experiences with more severity and prevalence than adults. After climate events, children typically demonstrate more severe distress than adults. Furthermore, the prevalence of distress is also higher; higher rates of PTSD were found in children two years after a flood. Children’s mental health can also be affected not only by their experiences of stressors, such as natural disasters, extreme weather, and ecomigration, but also by the mental health of their caregivers. Children also have the potential to be emotionally affected if they become separated from their primary caregivers. Similar to physical experiences, traumatic mental experiences can have lifelong effects. Of course, early childhood is critical for brain development. Studies have documented that high levels of stress during childhood can affect the development of neural pathways, in ways that impair memory, executive function, and decision-making in later life.

Children are also at increased risk from disruptions to the educational system. Natural disasters, in particular can damage or destroy schools or make them inaccessible to teachers and students. After Hurricane Katrina, for example, 196,000 public school students had to change schools, and many of them missed a month or more of schooling. In this case, because the hardest-hit school districts were also some of the worst-performing ones, some students benefitted by transferring to better schools. However the effects on school achievement were negative.

Disasters may cause children to lose their social support networks to a greater extent. During adversity, people draw upon all of their personal resources, emotional and material. Although social networks can fill the gaps when individual resources become depleted during extreme trauma, the resources available from a tight-knit community may not go far, especially if the network is small or the community is poor. When disasters hit an area, they affect everyone and put entire neighborhoods in need of help. A study of children impacted by Hurricane Katrina found that those who were hit hardest by the storm also experienced less social support, likely because people in their immediate support network were themselves suffering.

DISADVANTAGED COMMUNITIES

Some communities of color are prone to experience increased impacts. A persistent reality in American culture is the existence of environmental injustice: Some racial and ethnic groups tend to be more exposed to environmental risks and to have fewer financial and political resources to buffer the impact. This is partly, but not completely, explained by economic status. Communities with fewer resources and greater exposure, for example, in Phoenix, Arizona, are likely to experience greater rates of high temperature impacts than majority groups. Lower-income communities are more likely to have outdated infrastructure, such as a lack of extreme weather warning systems, inadequate storm surge preparedness, and clogged or inadequate storm sewer systems, which places these communities at greater risk for the impacts of climate change. Areas with a high number of residents who lack access to health care or health insurance, or already experience poor health are more likely to be affected by climate change. Communities are also less resilient when they are weakened by social stressors, such as racism, economic inequality, and environmental injustices. Many of the communities in New Orleans that were affected by Hurricane Katrina possessed all of these characteristics, and the effects of racial disparities were clearly visible in the aftermath of the storm.

OCCUPATIONAL GROUPS

Certain lines and fields of work are more directly exposed to the impact of climate change. These occupations may include but not be limited to first responders, construction workers, health care workers, farmers, farm workers, fishermen, transportation workers, and utility workers. Inequitable health outcomes may arise directly through workers’ exposure to increased temperatures, air pollution, and extreme weather, and indirectly through vector-borne diseases, increased use of pesticides, and many other elements. According to the US Environmental Protection Agency, outdoor workers will be the first to endure the effects of climate change, as they will be exposed to extreme heat, which can cause heat stroke, exhaustion, and fatigue. As natural disasters occur more frequently, such as wildfires and flooding, firefighters and paramedics face increased safety risks. Agricultural workers face increased vulnerability to allergens, insects carrying diseases, such as West Nile, and pesticide exposure that are increased by changing weather and insect migration patterns.

ADDITIONAL POPULATIONS OF CONCERN

Individuals of all ages with disabilities or chronic mental or physical health issues may experience climate-related impacts at a greater extent. Often, people living with disabilities have disproportionately far lower access to aid during and after climate-related disasters. Those with mental health disorders can also experience exacerbated symptoms due to natural disasters. Degraded infrastructure creates barriers for people with mental illnesses to receive proper medical attention, leading to additional negative mental and physical health outcomes. For instance, following the 2012 Wisconsin heat wave, 52% of all heat-related deaths were among individuals with at least one mental illness. Half of those suffering from mental illness were taking psychotropic medications, which impede one’s ability to regulate one’s body temperature. These medications that treat mental illness are one of the main underlying causes of heat-related deaths. Additionally, those suffering from ongoing asthma and respiratory illnesses, like chronic obstructive pulmonary disease (COPD), are more sensitive to reduced air quality. Moreover, inequalities in the incidence of those who are chronically ill arise as a result of several socioeconomic factors.

Due to increased health and mobility challenges, the elderly are very susceptible to the risks of climate impacts. Higher rates of untreated depression and other physical illnesses reported among seniors contribute to this increased vulnerability. Research suggests the elderly, in particular, experience declines in cognitive ability when exposed to air pollution over the long ter. A study by Dominelii (2013) found that when infrastructure broke down (e.g., roads were impassable) due to floods. heat waves, or freeze-thaw events (all potentially climate-driven), formal care services were not available to vulnerable people, such as the elderly. They could not get to the services, and their normal services could not come through. Heat can have a particuIarly severe impact on the elderly and on people with pre-existing mental health problems; some of the medications associated with mental illness make people more susceptible to the effects of heat. Extreme temperatures or pollution can also make it more difficult for seniors to engage in regular outdoor activities, thus depriving them of the associated physical and mental benefits.

The stress directly related to supporting a child makes women more affected by climate change. Because of a mother’s frequent caregiver role, and because, on average, women have fewer economic resources than men, women may also be more affected, in general, by the stress and trauma of natural disasters. Possible loss of resources, such as food, water, shelter, and energy, may also contribute to personal stress. Epidemiological studies of post-disaster cohorts and the general population, suggest that women are more likely to experience mental health problems as a result of trauma. For example, the prevalence of PTSD in the general population is reported to be approximately twofold greater in women than in men.

BUILDING RESILIENCE

Developing plans to adapt and cope is critical in addressing the physical and psychological impacts of climate change. Resilience can be defined as the ability of a person (or a community) to cope with, grow through, and transcend adversity.

Climate change is no longer a distant, unimaginable threat; it is a growing reality for communities across the globe. Recognizing the risk, many local governments in the United States (as well as other places around the world) have created preparation or adaptation plans for shoring up physical infrastructure to withstand new weather and temperature extremes. These plans, while an important step, generally overlook the psycho-social impacts of a changing climate and do little to create or support the soft infrastructure needed for community psychological wellbeing. How can communities prepare themselves to minimize suffering and promote resilience in the face of the challenging impacts of climate change? Resilient communities can create the physical and social infrastructure that makes them less susceptible to negative effects.

On an individual level, resilience is built internally and externally through strategies, such as coping and self-regulation, and community social support networks. Most people come through adversity with positive adjustment and without psychopathology. In fact, some individuals may even experience what is called post-traumatic growth and come through a significant disruption with the feeling of having gained something positive, such as stronger social relationships or spectfic skills.

Even so, much can be done to increase the resilience capacity of individuals and communities, particularly in response to climate change.

Download the full report here.

MIT Creates AI that Predicts Depression from Speech – Cami Rosso.

Depression is one of the most common disorders globally that impacts the lives of over 300 million people, and nearly 800,000 suicides annually.

For a mental health professional, asking the right questions and interpreting the answers is a key factor in the diagnosis. But what if a diagnosis could be achieved through natural conversation, versus requiring context from question and answer?

An innovative Massachusetts Institute of Technology (MIT) research team has discovered a way for AI to detect depression in individuals through identifying patterns in natural conversation.

Psychology Today

Lost Connections. Uncovering the Real Causes of Depression and the Unexpected Solutions – Johann Hari.

“Even when the tears didn’t come, I had an almost constant anxious monologue thrumming through my mind. Then I would chide myself: It’s all in your head. Get over it. Stop being so weak.”

As she was speaking, I started to experience something strange. Her voice seemed to be coming from very far away, and the room appeared to be moving around me uncontrollably. Then, quite unexpectedly, I started to explode, all over her hut, like a bomb of vomit and faeces. When, some time later, I became aware of my surroundings again, the old woman was looking at me with what seemed to be sad eyes. “This boy needs to go to a hospital,” she said. “He is very sick.

Although I couldn’t understand why, all through the time I was working on this book, I kept thinking of something that doctor said to me that day, during my unglamorous hour of poisoning.

“You need your nausea. It is a message. It will tell us what is wrong with you.”

It only became clear to me why in a very different place, thousands of miles away, at the end of my journey into what really causes depression and anxiety, and how we can find our way back.
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In every book about depression or severe anxiety by someone who has been through it, there is a long stretch of pain-porn in which the author describes, in ever more heightened language, the depth of the distress they felt. We needed that once, when other people didn’t know what depression or severe anxiety felt like. Thanks to the people who have been breaking this taboo for decades now, I don’t have to write that book all over again. That is not what I am going to write about here. Take it from me, though: it hurts.

Prologue: The Apple

One evening in the spring of 2014, I was walking down a small side street in central Hanoi when, on a stall by the side of the road, I saw an apple. It was freakishly large and red and inviting. I’m terrible at haggling, so I paid three dollars for this single piece of fruit, and carried it into my room in the Very Charming Hanoi Hotel. Like any good foreigner who’s read his health warnings, I washed the apple diligently with bottled water, but as I bit into it, I felt a bitter, chemical taste fill my mouth. It was the flavor I imagined, back when I was a kid, that all food was going to have after a nuclear war. I knew I should stop, but I was too tired to go out for any other food, so I ate half, and then set it aside, repelled.

Two hours later, the stomach pains began. For two days, I sat in my room as it began to spin around me faster and faster, but I wasn’t worried: I had been through food poisoning before. I knew the script. You just have to drink water and let it pass through you.

On the third day, I realized my time in Vietnam was slipping away in this sickness-blur. I was there to track down some survivors of the war for another book project I’m working on, so I called my translator, Dang Hoang Linh, and told him we should drive deep into the countryside in the south as we had planned all along. As we traveled around, a trashed hamlet here, an Agent Orange victim there, I was starting to feel steadier on my feet.

The next morning, he took me to the hut of a tiny eighty-seven-year-old woman. Her lips were dyed bright red from the herb she was chewing, and she pulled herself toward me across the floor on a wooden plank that somebody had managed to attach some wheels to. Throughout the war, she explained, she had spent nine years wandering from bomb to bomb, trying to keep her kids alive. They were the only survivors from her village.

As she was speaking, I started to experience something strange. Her voice seemed to be coming from very far away, and the room appeared to be moving around me uncontrollably. Then-quite unexpectedly, I started to explode, all over her hut, like a bomb of vomit and faeces. When, some time later, I became aware of my surroundings again, the old woman was looking at me with what seemed to be sad eyes. “This boy needs to go to a hospital,” she said. “He is very sick.”

No, no, I insisted. I had lived in East London on a staple diet of fried chicken for years, so this wasn’t my first time at the E.coli rodeo. I told Dang to drive me back to Hanoi so I could recover in my hotel room in front of CNN and the contents of my own stomach for a few more days.

“No,” the old woman said firmly. “The hospital.”

“Look, Johann,” Dang said to me, “this is the only person, with her kids, who survived nine years of American bombs in her village. I am going to listen to her health advice over yours.” He dragged me into his car, and I heaved and convulsed all the way to a sparse building that I learned later had been built by the Soviets decades before. I was the first foreigner ever to be treated there. From inside, a group of nurses, half excited, half baffled, rushed to me and carried me to a table, where they immediately started shouting. Dang was yelling back at the nurses, and they were shrieking now, in a language that had no words I could recognize. I noticed then that they had put something tight around my arm.

I also noticed that in the corner, there was a little girl with her nose in plaster, alone. She looked at me. I looked back. We were the only patients in the room.

As soon as they got the results of my blood pressure, dangerously low, the nurse said, as Dang translated, they started jabbing needles into me. Later, Dang told me that he had falsely said that I was a Very Important Person from the West, and that if I died there, it would be a source of shame for the people of Vietnam. This went on for ten minutes, as my arm got heavy with tubes and track marks. Then they started to shout questions at me about my symptoms through Dang. It was a seemingly endless list about the nature of my pain.

As all this was unfolding, I felt strangely split. Part of me was consumed with nausea, everything was spinning so fast, and I kept thinking: stop moving, stop moving, stop moving. But another part of me, below or beneath or beyond this, was conducting a quite rational little monologue. Oh. You are close to death. Felled by a poisoned apple. You are like Eve, or Snow White, or Alan Turing.

Then I thought, is your last thought really going to be that pretentious?

Then I thought, if eating half an apple did this to you, what do these chemicals do to the farmers who work in the fields with them day in, day out, for years? That’d be a good story, some day.

Then I thought, you shouldn’t be thinking like this if you are on the brink of death. You should be thinking of profound moments in your life. You should be having flashbacks. When have you been truly happy? I pictured myself as a small boy, lying on the bed in our old house with my grandmother, cuddling up to her and watching the British soap opera Coronation Street. I pictured myself years later when I was looking after my little nephew, and he woke me up at seven in the morning and lay next to me on the bed and asked me long and serious questions about life. I pictured myself lying on another bed, when I was seventeen, with the first person I ever fell in love with. It wasn’t a sexual memory, just lying there, being held.

Wait, I thought. Have you only ever been happy lying in bed? What does this reveal about you? Then this internal monologue was eclipsed by a heave. I begged the doctors to give me something that would switch off this extreme nausea. Dang talked animatedly with the doctors. Then he told me finally: “The doctor says you need your nausea. It is a message, and we must listen to the message. It will tell us what is wrong with you.”

And with that, I began to vomit again.

Many hours later, a doctor, a man in his forties came into my field of vision and said: “We have learned that your kidneys have stopped working. You are extremely dehydrated. Because of the vomiting and diarrhea, you have not absorbed any water for a very long time, so you are like a man who has been wandering in the desert for days.” Dang interjected: “He says if we had driven you back to Hanoi, you would have died on the journey.”

The doctor told me to list everything I had eaten for three days. It was a short list. An apple. He looked at me quizzically. “Was it a clean apple?” Yes, I said, I washed it in bottled water. Everybody burst out laughing, as if I had served up a killer Chris Rock punch line. it turns out that you can’t just wash an apple in Vietnam. They are covered in pesticides so they can stand for months without rotting. You need to cut off the peel entirely, or this can happen to you.

Although I couldn’t understand why, all through the time I was working on this book, I kept thinking of something that doctor said to me that day, during my unglamorous hour of poisoning.

“You need your nausea. It is a message. It will tell us what is wrong with you.”

It only became clear to me why in a very different place, thousands of miles away, at the end of my journey into what really causes depression and anxiety, and how we can find our way back.

“When I flushed away my final packs of Paxil, I found these mysteries waiting for me, like children on a train platform, waiting to be collected, trying to catch my eye. Why was I still depressed? Why were there so many people like me?”

Introduction: A Mystery

I was eighteen years old when I swallowed my first antidepressant. I was standing in the weak English sunshine, outside a pharmacy in a shopping center in London. The tablet was white and small, and as I swallowed, it felt like a chemical kiss.

That morning I had gone to see my doctor. I struggled, I explained to him, to remember a day when I hadn’t felt a long crying jag judder its way out of me. Ever since I was a small child, at school, at college, at home, with friends, I would often have to absent myself, shut myself away, and cry. They were not a few tears. They were proper sobs. And even when the tears didn’t come, I had an almost constant anxious monologue thrumming through my mind. Then I would chide myself: It’s all in your head. Get over it. Stop being so weak.

I was embarrassed to say it then; I am embarrassed to type it now.

In every book about depression or severe anxiety by someone who has been through it, there is a long stretch of pain-porn in which the author describes, in ever more heightened language, the depth of the distress they felt. We needed that once, when other people didn’t know what depression or severe anxiety felt like. Thanks to the people who have been breaking this taboo for decades now, I don’t have to write that book all over again. That is not what I am going to write about here. Take it from me, though: it hurts.

A month before I walked into that doctor’s office, I found myself on a beach in Barcelona, crying as the waves washed into me, when, quite suddenly, the explanation, for why this was happening, and how to find my way back, came to me. I was in the middle of traveling across Europe with a friend, in the summer before I became the first person in my family to go to a fancy university. We had bought cheap student rail passes, which meant for a month we could travel on any train in Europe for free, staying in youth hostels along the way. I had visions of yellow beaches and high culture, the Louvre, a spliff, hot Italians. But just before we left, I had been rejected by the first person I had ever really been in love with, and I felt emotion leaking out of me, even more than usual, like an embarrassing smell.

The trip did not go as I planned. I burst into tears on a gondola in Venice. I howled on the Matterhorn. I started to shake in Kafka’s house in Prague.

For me, it was unusual, but not that unusual. I’d had periods in my life like this before, when pain seemed unmanageable and I wanted to excuse myself from the world. But then in Barcelona, when I couldn’t stop crying, my friend said to me, “You realize most people don’t do this, don’t you?”

And then I experienced one of the very few epiphanies of my life. I turned to her and said: “I am depressed! It’s not all in my head! I’m not unhappy, I’m not weak, I’m depressed!”

This will sound odd, but what I experienced at that moment was a happy jolt, like unexpectedly finding a pile of money down the back of your sofa.

There is a term for feeling like this! It is a medical condition, like diabetes or irritable bowel syndrome! I had been hearing this, as a message bouncing through the culture, for years, of course, but now it clicked into place. They meant me! And there is, I suddenly recalled in that moment, a solution to depression: antidepressants. So that’s what I need! As soon as I get home, I will get these tablets, and I will be normal, and all the parts of me that are not depressed will be unshackled. I had always had drives that have nothing to do with depression, to meet people, to learn, to understand the world. They will be set free, I said, and soon.

The next day, we went to the Parc Güell, in the center of Barcelona. It’s a park designed by the architect Antoni Gaudi to be profoundly strange, everything is out of perspective, as if you have stepped into a funhouse mirror. At one point you walk through a tunnel in which everything is at a rippling angle, as though it has been hit by a wave. At another point, dragons rise close to buildings made of ripped iron that almost appears to be in motion. Nothing looks like the world should. As I stumbled around it, I thought, this is what my head is like: misshapen, wrong. And soon it’s going to be fixed.

Like all epiphanies, it seemed to come in a flash, but it had in fact been a long time coming. I knew what depression was. I had seen it play out in soap operas, and had read about it in books. I had heard my own mother talking about depression and anxiety, and seen her swallowing pills for it. And I knew about the cure, because it had been announced by the global media just a few years before. My teenage years coincided with the Age of Prozac the dawn of new drugs that promised, for the first time, to be able to cure depression without crippling side effects. One of the bestselling books of the decade explained that these drugs actually make you “better than well”, they make you stronger and healthier than ordinary people.

I had soaked all this up, without ever really stopping to think about it. There was a lot of talk like that in the late 1990s; it was everywhere. And now I saw, at last that it applied to me.

My doctor, it was clear on the afternoon when I went to see him, had absorbed all this, too. In his little office, he explained patiently to me why I felt this way. There are some people who naturally have depleted levels of a chemical named serotonin in their brains, he said, and this is what causes depression, that weird, persistent, misfiring unhappiness that won’t go away. Fortunately, just in time for my adulthood, there was a new generation of drugs, Selective Serotonin Reuptake Inhibitors (SSRIs), that restore your serotonin to the level of a normal person’s. Depression is a brain disease, he said, and this is the cure. He took out a picture of a brain and talked to me about it.

He was saying that depression was indeed all in my head, but in a very different way. It’s not imaginary. It’s very real, and it’s a brain malfunction.

He didn’t have to push. It was a story I was already sold on. I left within ten minutes with my script for Seroxat (or Paxil, as it’s known in the United States).

It was only years later, in the course of writing this book, that somebody pointed out to me all the questions my doctor didn’t ask that day. Like: Is there any reason you might feel so distressed? What’s been happening in your life? Is there anything hurting you that we might want to change? Even if he had asked, I don’t think I would have been able to answer him. I suspect I would have looked at him blankly. My life, I would have said, was good. Sure, I’d had some problems; but I had no reason to be unhappy, certainly not this unhappy.

In any case, he didn’t ask, and I didn’t wonder why. Over the next thirteen years, doctors kept writing me prescriptions for this drug, and none of them asked either. If they had, I suspect I would have been indignant, and said, If you have a broken brain that can’t generate the right happiness, producing chemicals, what’s the point of asking such questions?

Isn’t it cruel? You don’t ask a dementia patient why they can’t remember where they left their keys. What a stupid thing to ask me. Haven’t you been to medical school?

The doctor had told me it would take two weeks for me to feel the effect of the drugs, but that night, after collecting my prescription, I felt a warm surge running through me, a light thrumming that I was sure consisted of my brain synapses groaning and creaking into the correct configuration. I lay on my bed listening to a worn-out mix tape, and I knew I wasn’t going to be crying again for a long time.

I left for the university a few weeks later. With my new chemical armor, I wasn’t afraid. There, I became an evangelist for antidepressants. Whenever a friend was sad, I would offer them some of my pills to try, and I’d tell them to get some from the doctor. I became convinced that I was not merely nondepressed, but in some better state, I thought of it as “antidepression.” I was, I told myself, unusually resilient and energetic. I could feel some physical side effects from the drug, it was true, I was putting on a lot of weight, and I would find myself sweating unexpectedly. But that was a small price to pay to stop hemorrhaging sadness on the people around me. And-look! I could do anything now.

Within a few months, I started to notice that there were moments of welling sadness that would come back to me unexpectedly. They seemed inexplicable, and manifestly irrational. I returned to my doctor, and we agreed that I needed a higher dose. So my 20 milligrams a day was upped to 30 milligrams a day; my white pills became blue pills.

And so it continued, all through my late teens, and all through my twenties. I would preach the benefits of these drugs; after a while, the sadness would return; so I would be given a higher dose; 30 milligrams became 40; 40 became 50; until finally I was taking two big blue pills a day, at 60 milligrams. Every time, I got fatter; every time, I sweated more; every time, I knew it was a price worth paying.

I explained to anyone who asked that depression is a disease of the brain, and SSRis are the cure. When I became a journalist, I wrote articles in newspapers explaining this patiently to the public. I described the sadness returning to me as a medical process, clearly there was a running down of chemicals in my brain, beyond my control or comprehension. Thank God these drugs are remarkably powerful, I explained, and they work. Look at me. I’m the proof. Every now and then, I would hear a doubt in my head, but I would swiftly dismiss it by swallowing an extra pill or two that day.

I had my story. In fact, I realize now, it came in two parts. The first was about what causes depression: it’s a malfunction in the brain, caused by serotonin deficiency or some other glitch in your mental hardware. The second was about what solves depression: drugs, which repair your brain chemistry.

I liked this story. It made sense to me. It guided me through life.

I only ever heard one other possible explanation for why I might feel this way. It didn’t come from my doctor, but I read it in books and saw it discussed on TV. It said depression and anxiety were carried in your genes. I knew my mother had been depressed and highly anxious before I was born (and after), and that we had these problems in my family running further back than that. They seemed to me to be parallel stories. They both said, it’s something innate, in your flesh.

I started work on this book three years ago because I was puzzled by some mysteries, weird things that I couldn’t explain with the stories I had preached for so long, and that I wanted to find answers to.

Here’s the first mystery. One day, years after I started taking these drugs, I was sitting in my therapist’s office talking about how grateful I was that antidepressants exist and were making me better. “That’s strange,” he said. “Because to me, it seems you are still really quite depressed.” I was perplexed. What could he possibly mean? “Well,” he said, “you are emotionally distressed a lot of the time. And it doesn’t sound very different, to me, from how you describe being before you took the drugs.”

I explained to him, patiently, that he didn’t understand: depression is caused by low levels of serotonin, and I was having my serotonin levels boosted. What sort of training do these therapists get, I wondered?

Every now and then, as the years passed, he would gently make this point again. He would point out that my belief that an increased dose of the drugs was solving my problem didn’t seem to match the facts, since I remained down and depressed and anxious a lot of the time. I would recoil, with a mixture of anger and prissy superiority.

“No matter how high a dose I jacked up my antidepressants to, the sadness would always outrun it.”

It was years before I finally heard what he was saying. By the time I was in my early thirties, I had a kind of negative epiphany, the opposite of the one I had that day on a beach in Barcelona so many years before. No matter how high a dose I jacked up my antidepressants to, the sadness would always outrun it. There would be a bubble of apparently chemical relief, and then that sense of prickling unhappiness would return. I would start once again to have strong recurring thoughts that said: life is pointless; everything you’re doing is pointless; this whole thing is a fucking waste of time. It would be a thrum of unending anxiety.

So the first mystery I wanted to understand was: How could I still be depressed when I was taking antidepressants? I was doing everything right, and yet something was still wrong. Why?

“Addictions to legal and illegal drugs are now so widespread that the life expectancy of white men is declining for the first time in the entire peacetime history of the United States.”

A curious thing has happened to my family over the past few decades.

From when I was a little kid, I have memories of bottles of pills laid out on the kitchen table, waiting, with inscrutable white medical labels on them. I’ve written before about the drug addiction in my family, and how one of my earliest memories was of trying to wake up one of my relatives and not being able to. But when I was very young, it wasn’t the banned drugs that were dominant in our lives, it was the ones handed out by doctors: old-style antidepressants and tranquilizers like Valium, the chemical tweaks and alterations that got us through the day.

That’s not the curious thing that happened to us. The curious thing is that as I grew up, Western civilization caught up with my family. When I was small and I stayed with friends, I noticed that nobody in their families swallowed pills with their breakfast, lunch, or dinner. Nobody was sedated or amped up or antidepressed. My family was, I realized, unusual.

And then gradually, as the years passed, I noticed the pills appearing in more and more people’s lives, prescribed, approved, recommended. Today they are all around us. Some one in five US. adults is taking at least one drug for a psychiatric problem; nearly one in four middle-aged women in the United States is taking antidepressants at any given time; around one in ten boys at American high schools is being given a powerful stimulant to make them focus; and addictions to legal and illegal drugs are now so widespread that the life expectancy of white men is declining for the first time in the entire peacetime history of the United States.

These effects have radiated out across the Western world: for example, as you read this, one in three French people is taking a legal psychotropic drug such as an antidepressant, while the UK has almost the highest use in all of Europe. You can’t escape it: when scientists test the water supply of Western countries, they always find it is laced with antidepressants, because so many of us are taking them and excreting them that they simply can’t be filtered out of the water we drink every day. We are literally awash in these drugs.

What once seemed startling has become normal. Without talking about it much, we’ve accepted that a huge number of the people around us are so distressed that they feel they need to take a powerful chemical every day to keep themselves together.

So the second mystery that puzzled me was: Why were so many more people apparently feeling depressed and severely anxious? What changed?

“We’ve accepted that a huge number of the people around us are so distressed that they feel they need to take a powerful chemical every day to keep themselves together.”

Then, when I was thirty-one years old, I found myself chemically naked for the first time in my adult life. For almost a decade, I had been ignoring my therapist’s gentle reminders that I was still depressed despite my drugs. It was only after a crisis in my life, when I felt unequivocally terrible and couldn’t shake it off, that I decided to listen to him. What I had been trying for so long wasn’t, it seemed, working. And so, when I flushed away my final packs of Paxil, I found these mysteries waiting for me, like children on a train platform, waiting to be collected, trying to catch my eye. Why was I still depressed? Why were there so many people like me?

And I realized there was a third mystery, hanging over all of it. Could something other than bad brain chemistry have been causing depression and anxiety in me, and in so many people all around me? If so-what could it be?

Still, I put off looking into it. Once you settle into a story about your pain, you are extremely reluctant to challenge it. It was like a leash I had put on my distress to keep it under some control. I feared that if I messed with the story I had lived with for so long, the pain would be like an unchained animal, and would savage me.

Over a period of several years, I fell into a pattern. I would begin to research these mysteries, by reading scientific papers, and talking to some of the scientists who wrote them, but I always backed away, because what they said made me feel disoriented, and more anxious than I had been at the start. I focused on the work for another book, Chasing the Scream: The First and Last Days of the War on Drugs, instead. It sounds ridiculous to say I found it easier to interview hit men for the Mexican drug cartels than to look into what causes depression and anxiety, but messing with my story about my emotions, what I felt, and why I felt it, seemed more dangerous, to me, than that.

And then, finally, I decided I couldn’t ignore it any longer. So, over a period of three years, I went on a journey of over forty thousand miles. I conducted more than two hundred interviews across the world, with some of the most important social scientists in the world, with people who had been through the depths of depression and anxiety, and with people who had recovered. I ended up in all sorts of places I couldn’t have guessed at in the beginning, an Amish village in Indiana, a Berlin housing project rising up in rebellion, a Brazilian city that had banned advertising, a Baltimore laboratory taking people back through their traumas in a totally unexpected way. What I learned forced me to radically revise my story, about myself, and about the distress spreading like tar over our culture.

“Everything that causes an increase in depression also causes an increase in anxiety, and the other way around. They rise and fall together.”

I want to flag up, right at the start, two things that shape the language I am going to use all through the book. Both were surprising to me.

I was told by my doctor that I was suffering from both depression and acute anxiety. I had believed that those were separate problems, and that is how they were discussed for the thirteen years I received medical care for them. But I noticed something odd as I did my research. Everything that causes an increase in depression also causes an increase in anxiety, and the other way around. They rise and fall together.

It seemed curious, and I began to understand it only when, in Canada, I sat down with Robert Kohlenberg, a professor of psychology. He, too, once thought that depression and anxiety were different things. But as he studied it, for over twenty years now, he discovered, he says, that “the data are indicating they’re not that distinct.” In practice, “the diagnoses, particularly depression and anxiety, overlap.” Sometimes one part is more pronounced than the other, you might have panic attacks this month and be crying a lot the next month. But the idea that they are separate in the way that (say) having pneumonia and having a broken leg are separate isn’t borne out by the evidence. It’s “messy,” he has proved.

Robert’s side of the argument has been prevailing in the scientific debate. In the past few years, the National Institutes of Health, the main body funding medical research in the United States, has stopped funding studies that present depression and anxiety as different diagnoses. “They want something more realistic that corresponds to the way people are in actual clinical practice,” he explains.

I started to see depression and anxiety as like cover versions of the same song by different bands. Depression is a cover version by a downbeat emo band, and anxiety is a cover version by a screaming heavy metal group, but the underlying sheet music is the same. They’re not identical, but they are twinned.

*

from

Lost Connections. Uncovering the Real Causes of Depression and the Unexpected Solutions

by Johann Hari

get it at Amazon.com