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HAPPINESS. Lessons from a New Science – Richard Layard.

Human beings have largely conquered nature, but they have still to conquer themselves. We have grown no happier in the last fifty years. What’s going on?

We have more food, more clothes, more cars, bigger houses, more central heating, more foreign holidays, a shorter working week, nicer work and, above all, better health. Yet we are not happier.

The best society is one where the citizens are happiest. So the best public policy is that which produces the greatest happiness.

That is what this book is about, the causes of happiness and the means we have to affect it. I hope this book will hasten the shift to a new perspective, where people’s feelings are treated as paramount. That shift is overdue.

In this new edition of his landmark book, Richard Layard shows that there is a paradox at the heart of our lives. Most people want more income. Yet as societies become richer, they do not become happier. This is not just anecdotally true, it is the story told by countless pieces of scientific research. We now have sophisticated ways of measuring how happy people are, and all the evidence shows that on average people have grown no happier in the last fifty years, even as average incomes have more than doubled, in fact, the First World has more depression, more alcoholism and more crime than fifty years ago. This paradox is true of Britain, the United States, continental Europe, and Japan. What is going on?

Now fully revised and updated to include developments since first publication, Layard answers his critics in what is still the key book in ‘happiness studies’.

Richard Layard is a leading economist who believes that the happiness of society does not necessarily equate to its income. He is best known for his work on unemployment and inequality, which provided the intellectual basis for Britain’s improved unemployment policies. He founded the Centre for Economic Performance at the London School of Economics, and since 2000 he has been a member of the House of Lords. His research into the subject of happiness brings together findings from such diverse areas as psychology, neuroscience, economics, sociology and philosophy.

I am an economist, I love the subject and it has served me well. But economics equates changes in the happiness of a society with changes in its purchasing power, or roughly so. I have never accepted that view, and the history of the last fifty years has disproved it. Instead, the new psychology of happiness makes it possible to construct an alternative view, based on evidence rather than assertion. From this we can develop a new vision of what lifestyles and what policies are sensible, drawing on the new psychology, as well as on economics, brain science, sociology and philosophy.

The time has come to have a go, to rush in where angels fear to tread. So here is my effort at a new evidence-based vision of how we can live better. It will need massive refinement as our knowledge accumulates. But I hope it will hasten the shift to a new perspective, where people’s feelings are treated as paramount. That shift is overdue.

So many people have helped in this book and helped so generously that I describe their role in a separate note at the end. I have been helped by psychologists, neuroscientists, sociologists, philosophers and of course economists, all sharing a desire for human betterment. If the book does anything, I hope it creates a bit more happiness.

Preface to the second edition

This book was first published six years ago. The wellbeing movement was already well under way and is now in full flood. Policy-makers worldwide are questioning whether wealth is a proper measure of welfare. And it has become quite respectable to say that what matters is how people experience life, inside themselves. Not everyone agrees with that, but talking about the happiness and misery which people feel no longer provokes an amused smile. The debate is on, at all levels in our society.

So this is a good moment for a second edition. In it I set out my own views in the debate, review some key new evidence, and record some major successes of the weil-being movement. I have not rewritten the main text of the book; instead I have added an extra final Part.

There is a second reason for a new edition. When the book came out, I received thousands of letters, some of them touching and mostly appreciative. Many asked, “Are you founding a movement?” For some time I thought “No.” But many things have made me change my mind. Public opinion is changing but far too slowly. There is still so much unnecessary misery that goes unaddressed while less important issues attractenormous attention. And technology now makes it much easier than before to mobilise people in a good cause.

So a group of us, including two multi-talented friends, Geoff Mulgan and Anthony Seldon, are launching a movement called Action for Happiness, which I discuss briefly in the final chapter. Our hope is that it may become a worldwide force for good. I have no doubt that we can have a happier world, and with your help we will.

Richard Layard, January 2011

What’s the problem?

“Nought’s had, all’s spent, Where our desire is got without content.” LADY MACBETH

There is a paradox at the heart of our lives. Most people want more income and strive for it. Yet as Western societies have got richer, their people have become no happier.

This is no old wives’ tale. It is a fact proven by many pieces of scientific research. As I’ll show, we have good ways to measure how happy people are, and all the evidence says that on average people are no happier today than people were fifty years ago. Yet at the same time average incomes have more than doubled. This paradox is equally true for the United States and Britain and Japan.

But aren’t our lives infinitely more comfortable? Indeed: we have more food, more clothes, more cars, bigger houses, more central heating, more foreign holidays, a shorter working week, nicer work and, above all, better health. Yet we are not happier. Despite all the efforts of governments, teachers, doctors and businessmen, human happiness has not improved.

This devastating fact should be the starting point for all discussion of how to improve our lot. It should cause each government to reappraise its objectives, and every one of us to rethink our goals.

One thing is clear: once subsistence income is guaranteed, making people happier is not easy. If we want people to be happier, we really have to know what conditions generate happiness and how to cultivate them. That is what this book is about, the causes of happiness and the means we have to affect it.

If we really wanted to be happier, what would we do differently? We do not yet know all the answers, or even half of them. But we have a lot of evidence, enough to rethink government policy and to reappraise our personal choices and philosophy of life.

The main evidence comes from the new psychology of happiness, but neuroscience, sociology, economics and philosophy all play their part. By bringing them together, we can produce a new vision of how we can live better, both as social beings and in terms of our inner spirit.

What Philosophy?

The philosophy is that of the eighteenth century Enlightenment, as articulated by Jeremy Bentham. If you pass below the fine classical portico of University College London, you will find him there near the entrance hall, an elderly man dressed in eighteenth century clothes, sitting in a glass case. The clothes are his and so is the body, except for the head, which is a wax replica. He is there because he inspired the founding of the college, and as he requested, he still attends the meetings of the College Council, being carried in for the purpose. A shy and kindly man, he never married, and he gave his money to good causes. He was also one of the first intellectuals to go jogging or trotting as he called itwhich he did until near his death. But despite his quirks, Bentham was one of the greatest thinkers of the Enlightenment.

The best society, he said, is one where the citizens are happiest. So the best public policy is that which produces the greatest happiness. And when it comes to private behaviour, the right moral action is that which produces the most happiness for the people it affects. This is the Greatest Happiness principle. It is fundamentally egalitarian, because everybody’s happiness is to count equally. It is also fundamentally humane, because it says that what matters ultimately is what people feel. It is close in spirit to the opening passages of the American Declaration of Independence.

This noble ideal has driven much of the social progress that has occurred in the last two hundred years. But it was never easy to apply, because so little was known about the nature and causes of happiness. This left it vulnerable to philosophies that questioned the ideal itself.

In the nineteenth century these alternative philosophies were often linked to religious conceptions of morality. But in the twentieth century religious belief diminished, and so eventually did belief in the secular religion of socialism. In consequence there remained no widely accepted system of ethical belief. Into the void stepped the non-philosophy of rampant individualism.

At its best this individualism offered an ideal of “selfrealisation.” But that gospel failed. It did not increase happiness, because it made each individual too anxious about what he could get for himself. If we really want to be happy, we need some concept of a common good, towards which we all contribute.

So now the tide is turning. People are calling out for a concept of the common good, and that is exactly what the Enlightenment ideal provides. It defines the common good as the greatest happiness of all, requiring us to care for others as well as for ourselves. And it advocates a kind of fellow-feeling for others that in itself increases our happiness and reduces our isolation.

What Psychology?

At the same time, the new psychology now gives us real insight into the nature of happiness and what brings it about. So the Enlightenment philosophy can now at last be applied using evidence instead of speculation.

Happiness is feeling good, and misery is feeling bad. At every moment we feel somewhere between wonderful and half-dead, and that feeling can now be measured by asking people or by monitoring their brains. Once that is done, we can go on to explain a person’s underlying level of happiness, the quality of his life as he experiences it. Every life is complicated, but it is vital to separate out the factors that really count.

Some factors come from outside us, from our society: some societies really are happier. Other factors work from inside us, from our inner life. In part 1 of the book I sort out how these key factors affect us. Then, in part 2, I focus on what kind of society and what personal practices would help us lead happier lives. The last chapter summarises my conclusions.

What Social Message?

So how, as a society, can we influence whether people are happy? One approach is to proceed by theoretical reasoning, using elementary economics. This concludes that selfish behaviour is all right, provided markets are allowed to function: through the invisible hand, perfect markets will lead us to the greatest happiness that is possible, given our wants and our resources. Since people’s wants are taken as given, national income becomes a proxy for national happiness. Government’s role is to correct market imperfections and to remove all barriers to labour mobility and flexible employment. This view of national happiness is the one that dominates the thinking and pronouncements of leaders of Western governments.

The alternative is to look at what actually makes people happy. People certainly hate absolute poverty, and they hated Communism. But there is more to life than prosperity and freedom.

In this book we shall look at other key facts about human nature, and how we should respond to them:

Our wants are not given, in the way that elementary economics assumes. In fact they depend heavily on what other people have, and on what we ourselves have got accustomed to. They are also affected by education, advertising and television. We are heavily driven by the desire to keep up with other people. This leads to a status race, which is self-defeating since if I do better, someone else must do worse. What can we do about this?

People desperately want security, at work, in the family and in their neighbourhoods. They hate unemployment, family break-up and crime in the streets. But the individual cannot, entirely on his own, determine whether he loses his job, his spouse or his wallet. It depends in part on external forces beyond his control. So how can the community promote a way of life that is more secure?

People want to trust other people. But in the United States and in Britain (though not in continental Europe), levels of trust have plummeted in recent decades. How is it possible to maintain trust when society is increasingly mobile and anonymous?

In the seventeenth century the individualist philosopher Thomas Hobbes proposed that we should think about human problems by considering men “as if but even now sprung out of the earth, and suddenly (like mushrooms) come to full maturity, without any kind of engagement with each other.”

But people are not like mushrooms. We are inherently social, and our happiness depends above all on the quality of our relationships with other people. We have to develop public policies that take this “relationship factor” into account.

What Personal Message?

There is also an inner, personal factor. Happiness depends not only on our external situation and relationships; it depends on our attitudes as well. From his experiences in Auschwitz, Viktor Frankl concluded that in the last resort “everything can be taken from a man but one thing, the last of human freedoms, to choose one’s attitude in any given set of circumstances.”

Our thoughts do affect our feelings. As we shall see, people are happier if they are compassionate; and they are happier if they are thankful for what they have. When life gets rough, these qualities become ever more important.

Throughout the centuries parents, teachers and priests have striven to instil these traits of compassion and acceptance. Today we know more than ever about how to develop them. Modern cognitive therapy was developed in the last thirty years as a forward-looking substitute for backward-looking psychoanalysis. Through systematic experimentation, it has found ways to promote positive thinking and to systematically dispel the negative thoughts that afflict us all. In recent years these insights have been generalised by “positive psychology,” to offer a means by which all of us, depressed or otherwise, can find meaning and increase our enjoyment of life. What are these insights?

Many of the ideas are as old as Buddhism and have recurred throughout the ages in all the religious traditions that focus on the inner life. In every case techniques are offered for liberating the positive force in each of us, which religious people call divine. These techniques could well become the psychological basis of twenty-first-century culture.

Even so, our nature is recalcitrant, and for some people it seems impossible to be positive without some physical help. Until fifty years ago there was no effective treatment for mental illness. But in the 1950s drugs were found that, despite side effects, could provide relief to many who suffer from schizophrenia, depression or anxiety. This, followed by the development of cognitive and behavioural therapy, has given new life to millions of people who would otherwise have been half-dead. But how much further can this process go in the relief of misery?

Human beings have largely conquered nature, but they have still to conquer themselves. In the last fifty years we have eliminated absolute material scarcity in the West. With good policies and Western help, the same could happen throughout the world within a hundred years. But in the meantime we in the West are no happier. Changing this is the new challenge and the new frontier, and much more difficult than traditional wealth-creation. Fortunately, enough tools are already available to fill this small book.

What is happiness?

“If not actually disgruntled, he was far from being gruntled” P. G. Wodehouse

In the late nineteenth century doctors noticed something strange about people with brain injuries. If the damage was on the left side of the brain, they were more likely to become depressed than if it was on the right. As time passed, the evidence built up, and it was even found that damage on the right side of the brain could sometimes produce elation. From these dim beginnings, a new science has emerged that measures what happens in the brain when people experience positive and negative feelings.

The broad picture is this. Good feelings are experienced through activity in the brain’s left-hand side behind the forehead; people feel depressed if that part of their brain goes dead. Bad feelings are connected with brain activity behind the right-hand side of the forehead; when that part of the brain is out of action, people can feel elated.

Such scientific breakthroughs have transformed the way we think about happiness. Until recently, if people said they were happy, sceptics would hold that this was just a subjective statement. There was no good way to show that it had any objective content at all. But now we know that what people say about how they feel corresponds closely to the actual levels of activity in different parts of the brain, which can be measured in standard scientific ways.

The Feeling of Happiness

So what is the feeling of happiness? Is there a state of “feeling good” or “feeling bad” that is a dimension of all our waking life? Can people say at any moment how they feel? Indeed, is your happiness something, a bit like your temperature, that is always there, fluctuating away whether you think about it or not? If so, can I compare my happiness with yours?

The answer to all these questions is essentially yes. This may surprise those of a sceptical disposition. But it would not surprise most people, past or present. They have always been aware of how they felt and have used their introspection to infer how others feel. Since they themselves smile when they are happy, they infer that when others smile, they are happy too. Likewise when they see others frown, or see them weep. It is through their feelings of imaginative sympathy that people have been able to respond to one another’s joys and sorrows throughout history.

So by happiness I mean feeling good enjoying life and wanting the feeling to be maintained. By unhappiness I mean feeling bad and wishing things were different.

There are countless sources of happiness, and countless sources of pain and misery. But all our experience has in it a dimension that corresponds to how good or bad we feel. In fact most people find it easy to say how good they are feeling, and in social surveys such questions get very high response rates, much higher than the average survey question. The scarcity of “Don’t knows” shows that people do know how they feel, and recognise the validity of the question.

When it comes to how we feel, most of us take a longish view. We accept the ups and downs and care mainly about our average happiness over a longish period of time. But that average is made up from a whole series of moments. At each moment of waking life we feel more or less happy, just as we experience more or less noise. There are many different sources of noise, from a trombone to a pneumatic drill, but we can feel how loud each noise is. In the same way there are many different sources of enjoyment, but we can compare the intensity of each. There are also many types of suffering, from toothache to a stomach ulcer to depression, but we can compare the pain of each. Moreover, as we shall see, happiness begins where unhappiness ends.

So how can we find out how happy or unhappy people are, both in general and from moment to moment? Both psychology and brain science are beginning to give us the tools to arrive at precise answers.

Asking People

The most obvious way to find out whether people are happy in general is to survey individuals in a random sample of households and to ask them. A typical question is, “Taking all things together, would you say you are very happy, quite happy, or not very happy?” Here is how people reply in the United States and in Britain: very similarly, as the table below shows. Interestingly, men and women reply very much the same.

But is everyone who answers the question using the words in the same way? Fortunately, their replies can be independently verified. In many cases friends or colleagues of the individual have been asked separately to rate the person’s happiness. These independent ratings turn out to be well related to the way the people rated themselves. The same is true of ratings made by an interviewer who has never met the person before.

Feelings Fluctuate

Of course our feelings fluctuate from hour to hour, and from day to day. Psychologists have recently begun to study how people’s mood varies from activity to activity. I will give only one example, from a study of around nine hundred working women in Texas. They were asked to divide the previous working day into episodes, like a film: typically they identified about fourteen episodes. They then reported what they were doing in each episode and who they were doing it with. Finally, they were asked how they felt in each episode, along twelve dimensions that can be combined into a single index of good or bad feeling.

The table shows what they liked most (sex) and what they liked least (commuting).

The table below shows what company they most enjoyed. They are highly gregarious, preferring almost any company to being alone. Only the boss’s company is worse than being alone.

We can also use these reports to measure how feelings change as the day goes on. As the next chart shows, these people feel better as time passes, except for a blip up at lunchtime.

I have showed these findings to stress the point that happiness is a feeling and that feelings occur continuously over time throughout our waking life. Feelings at any particular moment are of course influenced by memories of past experiences and anticipations of future ones. Memories and anticipations are very important parts of our mental life, but they pose no conceptual problems in measuring our happiness, be it instantaneous or averaged over a longer period of time.

It is the long-term average happiness of each individual that this book is about, rather than the fluctuations from moment to moment. Though our average happiness may be influenced by the pattern of our activities, it is mainly affected by our basic temperament and attitudes and by key features of our life situation, our relationships, our health, our worries about money.


Sceptics may still question whether happiness is really an objective feeling that can be properly compared between people. To reassure doubters, we can turn to modern brain physiology with its sensational new insights into what is happening when a person feels happy or unhappy. This work is currently being led by Richard Davidson of the University of Wisconsin.

In most of his studies Davidson measures activity in different parts of the brain by putting electrodes all over the scalp and reading the electrical activity. These EEG measurements are then related to the feelings people report. When people experience positive feelings, there is more electrical activity in the left front of the brain; when they experience negative feelings, there is more activity in the right front of the brain. For example, when someone is shown funny film clips, his left side becomes more active and his right side less so; he also smiles and gives positive reports on his mood. When frightening or distasteful film clips are shown, the opposite happens.

Similar findings come from direct scans of what is going on inside the brain. For instance, people can be put inside an MRI or PET scanner and then shown nice or unpleasant pictures. The chart gives an example.

People are shown pictures, first of a happy baby and then of a baby that is deformed. The PET scanner picks up the corresponding changes in glucose usage in the brain and records it as light patches in the photographs. The nice picture activates the left side of the brain, and the horrendous picture activates the right side.

So there is a direct connection between brain activity and mood. Both can be altered by an external experience like looking at pictures. Both can also be altered directly by physical means. By using very powerful magnets it is possible to stimulate activity in the left side of the forebrain, and this automatically produces a better mood. Indeed, this method has even been used to alleviate depression. Even more remarkable, it has been found to improve the immune system, which is heavily influenced by a person’s mood.

So we have clear physical measures of how feelings vary over time. We can also use physical measures to compare the happiness of different people. People differ in the pattern of their EEGs, even when they are at rest. People whose left side is especially active (“leftsiders”) report more positive feelings and memories than “riqht-siders” do. Left-siders smile more, and their friends assess them as happier. By contrast, people who are especially active on the right side report more negative thoughts and memories, smile less and are assessed as less happy by their friends.

So a natural measure of happiness is the difference in activity between the left and right sides of the forebrain. This varies closely with many measures of self-reported mood. And one further finding is interesting. When different people are exposed to good experiences (like pleasant film clips), those who are naturally happy when at rest experience the greatest gain in happiness. And when they are exposed to nasty experiences, they experience the least increase in discomfort.

The EEG approach works even on newly born babies. When they are given something nice to suck, their left forebrain starts humming, while a sour taste sets off activity in the right brain. At ten months old, a baby’s brain activity at rest predicts how well it will respond if its mother disappears for a minute. Babies who are more active on the right side tend to howl, while the left-siders remain upbeat. At two and a half years old, left-sided youngsters are much more exploratory, while right-siders cling more to their mothers. However, up to their teens there are many changes in the differences between children, both by character traits and by brainwaves. Among adults the differences are more stable.

The frontal lobes are not the only part of the brain involved in emotion. For example, one seat of raw emotions is the amygdala, which is deeper in the brain. It triggers the command centre that mobilises the body to respond to a frightening stimulus, the fight-or-flight syndrome. But the amygdala in humans is not that different from the amygdala of the lowest mammals, and works unconsciously. Our conscious experience, however, is specially linked to the frontal lobes, which are highly developed in man.

So brain science confirms the objective character of happiness. It also confirms the objective character of pain. Here is a fascinating experiment, performed on a number of people. A very hot pad is applied to each person’s leg, the same temperature for all of them. The people then report the pain. They give widely varying reports, but these different reports are highly correlated with the different levels of brain activity in the relevant part of the cortex. This confirms the link between what people report and objective brain activity. There is no difference between what people think they feel and what they “really” feel, as some social philosophers would have us believe.

A Single Dimension

But isn’t this all a bit simplistic? Surely there are many types of happiness, and of pain? And in what sense is happiness the opposite of pain?

There are indeed many types of good and bad feeling. On the positive side there is loving and being loved, achievement, discovery, comfort, tranquillity, joy and many others. On the negative side there is fear, anger, sadness, guilt, boredom and many others again. But, as I have said, this is no different from the situation with pains and pleasures that are purely “physical”: one pain can be compared with another, and one pleasure can be compared with another. Similarly, mental pain and physical pain can be compared, and so can mental and physical enjoyment.

But is happiness really a single dimension of experience running from extreme misery to extreme joy? Or is it possible to be both happy and unhappy at the same time? The broad answer to this is no; it is not possible to be happy and unhappy at the same time. Positive feelings damp down negative feelings and vice versa. So we have just one dimension, running from the extreme negative to the extreme positive.

Lest this seem very mechanical, we should immediately note that happiness can be excited or tranquil, and misery can be agitated or leaden. These are important distinctions, which correspond to different levels of “arousal.” The range of possibilities is illustrated in the diagram, which dispels any impression that happiness can only be exciting or hedonistic.

One of the most enjoyable forms of aroused experience is when you are so engrossed in something that you lose yourself in it. These experiences of “flow” can be wonderful, both at the time and in retrospect”.

Qualities of Happiness

The concept of happiness I have described is essentially the one developed by the eighteenth century Enlightenment. It relates to how we feel as we live our lives. It famously inspired the authors of the American Declaration of Independence, and it has become central to our Western heritage.

It differs, for example, from the approach taken by Aristotle and his many followers. Aristotle believed that the object of life was eudaimonia, or a type of happiness associated with virtuous conduct and philosophic reflection. This idea of types of happiness, of higher and lower pleasures, was revived in the nineteenth century by John Stuart Mill and it survives to this day. Mill believed that the happiness of different experiences could vary both in quantity and quality. (He could not accept that a given amount of satisfaction derived from the game of “pushpin” was as valuable as the same amount of satisfaction derived from poetry.)

Mill’s intuition was right but his formulation was wrong. People who achieve a sense of meaning in their lives are happier than those who live from one pleasure to another. Carol Ryff of the University of Wisconsin has provided ample evidence of this. She has compiled refined measures of such things as purpose in life, autonomy, positive relationships, personal growth and self-acceptance and used them to construct an index of psychological well-being. In a sample of US. adults this index is very highly correlated with standard selfreported measures of happiness and life satisfaction.

Thus Mill was right in his intuition about the true sources of lasting happiness, but he was wrong to argue that some types of happiness are intrinsically better than others. In fact to do so is essentially paternalistic. It is of course obvious that some enjoyments, like those provided by cocaine, cannot in their nature last long: they work against a person’s long-term happiness, which means that we should avoid them. Similarly, some unhealthy enjoyments, like those of a sadist, should be avoided because they decrease the happiness of others. But no good feeling is bad in itself, it can only be bad because of its consequences.

Happiness Improves Your Health

In September 1932 the mother superior of the American School Sisters of Notre Dame decided that all new nuns should be asked to write an autobiographical sketch. These sketches were kept, and they have recently been independently rated by psychologists to show the amount of positive feeling which they revealed. These ratings have then been compared with how long each nun lived. Remarkably, the amount of positive feeling that a nun revealed in her twenties was an excellent predictor of how long she would live.

Of the nuns who were still alive in 1991, only 21% of the most cheerful quarter died in the following nine years, compared with 55% of the least cheerful quarter of the nuns? This shows how happiness can increase a person’s length of life.

In fact most sustained forms of good feeling are good for you. However we measure happiness, it appears to be conducive to physical health (other things being equal). Happy people tend to have more robust immune systems and lower levels of stress-causing cortisol. If artificially exposed to the flu virus, they are less likely to contract the disease. They are also more likely to recover from major surgery.

Equally, when a person has a happy experience, the body chemistry improves, and blood pressure and heart rate tend to fall. Especially good experiences can have long-lasting effects on our health. If we take the 750 actors and actresses who were ever nominated for Oscars, we can assume that before the award panel’s decision the winners and losers were equally healthy on average. Yet those who got the Oscars went on to live four years longer, on average, than the losers. Such was the gain in morale from winning.

The Function of Happiness

I hope I have now persuaded you that happiness exists and is generally good for your physical health. But that does not make it supremely important. It is supremely important because it is our overall motivational device. We seek to feel good and to avoid pain (not moment by moment but overall).

Without this drive we humans would have perished long ago. For what makes us feel good (sex, food, love, friendship and so on) is also generally good for our survival. And what causes us pain is bad for our survival (fire, dehydration, poison, ostracism).

So by seeking to feel good and to avoid pain, we seek what is good for us and avoid what is bad for us, and thus we have survived as a species. The search for good feeling is the mechanism that has preserved and multiplied the human race.

Some people question whether we have any overall system of motivation. They say we have separate drives for sex, feeding and so on, and that we respond to these drives independently of their effect on our general sense of well-being. The evidence is otherwise. For we often have to choose between satisfying different drives, and our choices vary according to how easy it is to satisfy one drive compared with another. So there must be some overall evaluation going on that compares how different drives contribute to our overall satisfaction.

When one source of satisfaction becomes more costly relative to another, we choose less of it. This is the so-called law of demand, which has been confirmed throughout human life and among many species of animals. It is not uniquely human and probably applies to most living things, all of which have a tendency to pursue their own good as best they can. In lower animals the process is unconscious, and even in humans it is mostly so, since consciousness could not possibly handle the whole of this huge task. However, we do have massive frontal lobes that other mammals lack, and that is probably where the conscious part of the balancing operation is performed.

Experiments show that at every moment we are evaluating our situation, often unconsciously. We are attracted to those elements of our situation that we like and repelled by the elements we dislike. It is this pattern of “approach” and “avoidance” that is central to our behaviour.

Here are two ingenious experiments by the psychologist John Bargh that illustrate the workings of this approach-avoidance mechanism. His technique is to flash good or bad words on a screen and observe how people respond. In the first experiment he flashed the words subliminally and recorded the impact on the person’s mood. The good words (like “music” improved mood, and the bad ones (like “worm”) worsened mood. He next examined approach and avoidance behaviour by making the words on the screen legible, and asking the person to remove them with a lever. The human instinct is to pull towards you that which you like, and to push away that which you wish to avoid. So Bargh split his subjects into two groups. Group A was told to behave in the natural way, to pull the lever for the good words, and to push it for the bad ones. Group B was told to behave “unnaturally”, to pull for the bad words and to push for the good. Group A did the job much more quickly, confirming how basic are our mechanisms of approach and avoidance.

So there is an evaluative faculty in each of us that tells us how happy we are with our situation, and then directs us to approach what makes us happy and avoid what does not. From the various possibilities open to us, we choose whichever combination of activities will make us feel best. In doing this we are more than purely reactive: we plan for the future, which sometimes involves denying ourselves today for the sake of future gratification.

This overall psychological model is similar to what economists have used from Adam Smith onwards. We want to be happy, and we act to promote our present and future happiness, given the opportunities open to us.

Of course we can make mistakes. Some things that people do are bad for survival, like cigarette smoking and the self-starvation of anorexia nervosa. Also, people are often short-sighted and bad at forecasting their future feelings. Natural selection has not produced perfect bodies, and neither has it produced perfect psyches. Yet we are clearly selected to be healthy, though we sometimes get sick. Similarly, we are selected to feel good, even if we sometimes make mistakes: it is impossible to explain human action and human survival except by the desire to achieve good feelings.

This raises the obvious issue of why, in that case, we are not happier than we are. Why is there so much anxiety and depression? Have anxiety and depression played any role in explaining our survival? Almost certainly, yes. Even today, it is a good idea to be anxious while driving a car-or while writing a book. A heavy dose of self-criticism will save you from some nasty mistakes. And it is often best to be sceptical about much of what you hear from other people, until it is independently confirmed.

It was even more important to be on guard when man first evolved on the African savannah. When you are in danger of being eaten by a lion, it is a good idea to be extremely cautious. (Better to have a smoke detector that goes off when you burn the toast than one that stays silent while the house burns down.) Even depression may have had some function. When confronted with an unbeatable opponent, dogs show signs of depression that turn off the opponent’s will to attack. The same may have been true of humans?

. . .


Happiness. Lessons from a New Science

by Richard Layard

get it at Amazon.com

BASIC INCOME AND DEPRESSION. Restoring the Future – Johann Hari.

Giving people back time, and a sense of confidence in the future.

The point of a welfare state is to establish a safety net below which nobody should ever be allowed to fall. The poorer you are, the more likely you are to become depressed or anxious, and the more likely you are to become sick in almost every way.

There is a direct relationship between poverty and the number of mood-altering drugs that people take, the antidepressants they take just to get through the day. If we want to really treat these problems, we need to deal with poverty.

Instead of using a net to catch people when they fall, Basic Income raises the floor on which everyone stands.

The world has changed fundamentally. We won’t regain security by going backward, especially as robots and technology render more and more jobs obsolete, but we can go forward, to a basic income for everyone.

There was one more obstacle hanging over my attempts to overcome depression and anxiety, and it seemed larger than anything I had addressed up to now. If you’re going to try to reconnect in the ways I’ve been describing, if you’re going to (say) develop a community, democratize your workplace, or set up groups to explore your intrinsic values, you will need time, and you need confidence.

But we are being constantly drained of both. Most people are working all the time, and they are insecure about the future. They are exhausted, and they feel as if the pressure is being ratcheted up every year. It’s hard to join a big struggle when it feels like a struggle to make it to the end of the day. Asking people to take on more -when they’re already run down, seems almost like a taunt.

But as I researched this book, I learned about an experiment that is designed to give people back time, and a sense of confidence in the future.

In the middle of the 1970s, a group of Canadian government officials chose, apparently at random, a small town called Dauphin in the rural province of Manitoba. It was, they knew, nothing special to look at. The nearest city, Winnipeg, was a four-hour drive away. It lay in the middle of the prairies, and most of the people living there were farmers growing a crop called canola. Its seventeen thousand people worked as hard as they could, but they were still struggling. When the canola crop was good, everyone did well, the local car dealership sold cars, and the bar sold booze. When the canola crop was bad, everyone suffered.

And then one day the people of Dauphin were told they had been chosen to be part of an experiment, due to a bold decision by the country’s Liberal government. For a long time, Canadians had been wondering if the welfare state they had been developing, in fits and starts over the years, was too clunky and inefficient and didn’t cover enough people. The point of a welfare state is to establish a safety net below which nobody should ever be allowed to fall: a baseline of security that would prevent people from becoming poor and prevent anxiety. But it turned out there was still a lot of poverty, and a lot of insecurity, in Canada. Something wasn’t working.

So somebody had what seemed like an almost stupidly simple idea. Up to now, the welfare state had worked by trying to plug gaps, by catching the people who fell below a certain level and nudging them back up. But if insecurity is about not having enough money to live on, they wondered, what would happen if we just gave everyone enough, with no strings attached? What if we simply mailed every single Canadian citizen, young, old, all of them, a check every year that was enough for them to live on? It would be set at a carefully chosen rate. You’d get enough to survive, but not enough to have luxuries. They called it a universal basic income. Instead of using a net to catch people when they fall, they proposed to raise the floor on which everyone stands.

This idea had even been mooted by right-wing politicians like Richard Nixon, but it had never been tried before. So the Canadians decided to do it, in one place. That’s how for several years, the people of Dauphin were given a guarantee: Each of you will be unconditionally given the equivalent of $19,000 US. (in today’s money) by the government. You don’t have to worry. There’s nothing you can do that will take away this basic income. It’s yours by right. And then they stood back to see what would happen.

At that time, over in Toronto, there was a young economics student named Evelyn Forget, and one day, one of her professors told the class about this experiment. She was fascinated. But then, three years into the experiment, power in Canada was transferred to a Conservative government, and the program was abruptly shut down. The guaranteed income vanished. To everyone except the people who got the checks, and one other person, it was quickly forgotten.

Thirty years later, that young economics student, Evelyn, had become a professor at the medical school of the University of Manitoba, and she kept bumping up against some disturbing evidence. It is a well-established fact that the poorer you are, the more likely you are to become depressed or anxious, and the more likely you are to become sick in almost every way. In the United States, if you have an income below $20,000, you are more than twice as likely to become depressed as somebody who makes $70,000 or more. And if you receive a regular income from property you own, you are ten times less likely to develop an anxiety disorder than if you don’t get any income from property. “One of the things I find just astonishing,” she told me, “is the direct relationship between poverty and the number of mood-altering drugs that people take, the antidepressants they take just to get through the day.” If you want to really treat these problems, Evelyn believed, you need to deal with these questions.

And so Evelyn found herself wondering about that old experiment that had taken place decades earlier. What were the results? Did the people who were given that guaranteed income get healthier? What else might have changed in their lives? She began to search for academic studies written back then. She found nothing. So she began to write letters and make calls. She knew that the experiment was being studied carefully at the time, that mountains of data were gathered. That was the whole point: it was a study. Where did it go?

After a lot of detective work, stretching over five years, she finally got an answer. She was told that the data gathered during the experiment was hidden away in the National Archives, on the verge of being thrown in the trash. “I got there, and found most of it in paper. It was actually sitting in boxes,” she told me. “There were eighteen hundred cubic feet. That’s eighteen hundred bankers’ boxes, full of paper.” Nobody had ever added up the results. When the Conservatives came to power, they didn’t want anyone to look further, they believed the experiment was a waste of time and contrary to their moral values.

So Evelyn and a team of researchers began the long task of figuring out what the basic income experiment had actually achieved, all those years before. At the same time, they started to track down the people who had lived through it, to discover the Iong-term effects.

The first thing that struck Evelyn, as she spoke to the people who’d been through the program, was how vividly they remembered it. Everyone had a story about how it had affected their lives. They told her that, primarily, “the money acted as an insurance policy. It just sort of removed the stress of worrying about whether or not you can afford to keep your kids in school for another year, whether or not you could afford to pay for the things that you had to pay for.”

This had been a conservative farming community, and one of the biggest changes was how women saw themselves. Evelyn met with one woman who had taken her check and used it to become the first female in her family to get a postsecondary education. She trained to be a librarian and rose to be one of the most respected people in the community. She showed Evelyn pictures of her two daughters graduating, and she talked about how proud she was she had been able to become a role model for them.

Other people talked about how it lifted their heads above constant insecurity for the first time in their lives. One woman had a disabled husband and six kids, and she made a living by cutting people’s hair in her front room. She explained that the universal income meant for the first time the family had “some cream in the coffee” small things that made life a little better.

These were moving stories, but the hard facts lay in the number crunching. After years of compiling the data, here are some of the key effects Evelyn discovered:

  • Students stayed at school longer, and performed better there.
  • The number of low-birth-weight babies declined, as more women delayed having children until they were ready.
  • Parents with newborn babies stayed at home longer to care for them, and didn’t hurry back to work.
  • Overall work hours fell modestly, as people spent more time with their kids, or learning.

But there was one result that struck me as particularly important.

Evelyn went through the medical records of the people taking part, and she found that, as she explained to me, there were “fewer people showing up at their doctor’s office complaining about mood disorders.” Depression and anxiety in the community fell significantly. When it came to severe depression and other mental health disorders that were so bad the patient had to be hospitalized, there was a drop of 9 percent in just three years.

Why was that? “It just removed the stress, or reduced the stress, that people dealt with in their everyday lives,” Evelyn concludes. You knew you’d have a secure income next month, and next year, so you could create a picture of yourself in the future that was stable.

It had another unanticipated effect, she told me. If you know you have enough money to live on securely, no matter what happens, you can turn down a job that treats you badly, or that you find humiliating. “It makes you less of a hostage to the job you have, and some of the jobs that people work just in order to survive are terrible, demeaning jobs,” she says. It gave you “that little bit of power to say, I don’t need to stay here.” That meant that employers had to make work more appealing. And over time, it was poised to reduce inequality in the town, which we would expect to reduce the depression caused by extreme status differences.

For Evelyn, all this tells us something fundamental about the nature of depression. “If it were just a brain disorder,” she told me, “if it was just a physical ailment, you wouldn’t expect to see such a strong correlation with poverty,” and you wouldn’t see such a significant reduction from granting a guaranteed basic income. “Certainly,” she said, “it makes the lives of individuals who receive it more comfortable, which works as an antidepressant.”

As Evelyn looks out over the world today, and how it has changed from the Dauphin of the mid-1970s, she thinks the need for a program like this, across all societies, has only grown. Back then, “people still expected to graduate from high school and to go get a job and work at the same company [or] at least in the same industry until they’d be sixty-five, and then they’d be retired with a nice gold watch and a nice pension.” But “people are struggling to find that kind of stability in labor today, I don’t think those days are ever coming back. We live in a globalized world. The world has changed, fundamentally.” We won’t regain security by going backward, especially as robots and technology render more and more jobs obsolete, but we can go forward, to a basic income for everyone. As Barack Obama suggested in an interview late in his presidency, a universal income may be the best tool we have for recreating security, not with bogus promises to rebuild a lost world, but by doing something distinctively new.

Buried in those dusty boxes of data in the Canadian national archives, Evelyn might have found one of the most important antidepressants for the twenty-first century.

I wanted to understand the implications of this more, and to explore my own concerns and questions about it, so I went to see a brilliant Dutch economic historian named Rutger Bregman. He is the leading European champion of the idea of a universal basic income. We ate burgers and inhaled caffeinated drinks and ended up talking late into the night, discussing the implications of all this. “Time and again,” he said, “we blame a collective problem on the individual. So you’re depressed? You should get a pill. You don’t have a job? Go to a job coach, we’ll teach you how to write a résumé or [to join] LinkedIn. But obviously, that doesn’t go to the root of the problem. Not many people are thinking about what’s actually happened to our labor market, and our society, that these [forms of despair] are popping up everywhere.”

Even middle-class people are living with a chronic “lack of certainty” about what their lives will be like in even a few months’ time, he says. The alternative approach, a guaranteed income, is partly about removing this humiliation and replacing it with security. It has now been tried in many places on a small scale, as he documents in his book Utopia for Realists. There’s always a pattern, he shows. When it’s first proposed, people say, what, just give out money? That will destroy the work ethic. People will just spend it on alcohol and drugs and watching TV. And then the results come in.

For example, in the Great Smoky Mountains, there’s a Native American tribal group of eight thousand people who decided to open a casino. But they did it a little differently. They decided they were going to split the profits equally among everyone in the group, they’d all get a check for (as it turned out) $6,000 a year, rising to $9,000 later. It was, in effect, a universal basic income for everyone. Outsiders told them they were crazy. But when the program was studied in detail by social scientists, it turned out that this guaranteed income triggered one big change. Parents chose to spend a lot more time with their children, and because they were less stressed, they were more able to be present with their kids. The result? Behavioral problems like ADHD and childhood depression fell by 40 percent. I couldn’t find any other instance of a reduction in psychiatric problems in children by that amount in a comparable period of time. They did it by freeing up the space for parents to connect with their kids.

All over the world, from Brazil to India, these experiments keep finding the same result. Rutger told me: “When I ask people, ‘What would you personally do with a basic income?’ about 99 percent of people say, ‘I have dreams, I have ambitions, I’m going to do something ambitious and useful.’” But when he asks them what they think other people would do with a basic income, they say, oh, they’ll become lifeless zombies, they’ll binge-watch Netflix all day.

This program does trigger a big change, he says, but not the one most people imagine. The biggest change, Rutger believes, will be in how people think about work. When Rutger asks people what they actually do at work, and whether they think it is worthwhile, he is amazed by how many people readily volunteer that the work they do is pointless and adds nothing to the world. The key to a guaranteed income, Rutger says, is that it empowers people to say no. For the first time, they will be able to leave jobs that are degrading, or humiliating, or excruciating. Obviously, some boring things will still have to be done. That means those employers will have to offer either better wages, or better working conditions. In one swoop, the worst jobs, the ones that cause the most depression and anxiety, will have to radically improve, to attract workers.

People will be free to create businesses based on things they believe in, to run projects to improve their community, to look after their kids and their elderly relatives. Those are all real work, but much of the time, the market doesn’t reward this kind of work. When people are free to say no, Rutger says, “I think the definition of work would become; to add something of value to make the world a little more interesting, or a bit more beautiful.”

This is, we have to be candid, an expensive proposal, a real guaranteed income would take a big slice of the national wealth of any developed country. At the moment, it’s a distant goal. But every civilizing proposal started off as a utopian dream, from the welfare state, to women’s rights, to gay equality. President Obama said it could happen in the next twenty years. If we start to argue and campaign for it now, as an antidepressant; as a way of dealing with the pervasive stress that is dragging so many of us down, it will, over time, also help us to see one of the factors that are causing all this despair in the first place. It’s a way, Rutger explained to me, of restoring a secure future to people who are losing the ability to see one for themselves; a way of restoring to all of us the breathing space to change our lives, and our culture.

I was conscious, as I thought back over these seven provisional hints at solutions to our depression and anxiety, that they require huge changes, in ourselves, and in our societies. When I felt that way, a niggling voice would come into my head. It said, nothing will ever change. The forms of social change you’re arguing for are just a fantasy. We’re stuck here. Have you watched the news? You think positive changes are a-coming?

When these thoughts came to me, I always thought of one of my closest friends.

In 1993, the journalist Andrew Sullivan was diagnosed as HIV-positive. It was the height of the AIDS crisis. Gay men were dying all over the world. There was no treatment in sight. Andrew’s first thought was: I deserve this. I brought it on myself. He had been raised in a Catholic family in a homophobic culture in which, as a child, he thought he was the only gay person in the whole world, because he never saw anyone like him on TV, or on the streets, or in books. He lived in a world where if you were lucky, being gay was a punchline, and if you were unlucky, it got you a punch in the face.

So now he thought, ‘I had it coming. This fatal disease is the punishment I deserve.’

For Andrew, being told he was going to die of AIDS made him think of an image. He had once gone to see a movie and something went wrong with the projector, and the picture went all wrong, it displayed at a weird, unwatchable angle. It stayed like that for a few minutes. His life now, he realized, was like sitting in that cinema, except this picture would never be right again.

Not long after, he left his job as editor of one of the leading magazines in the United States, the New Republic. His closest friend, Patrick, was dying of AlDS, the fate Andrew was now sure awaited him.

So Andrew went to Provincetown, the gay enclave at the tip of Cape Cod in Massachussetts, to die. That summer, in a small house near the beach, he began to write a book. He knew it would be the last thing he ever did, so he decided to write something advocating a crazy, preposterous idea, one so outlandish that nobody had ever written a book about it before. He was going to propose that gay people should be allowed to get married, just like straight people. He thought this would be the only way to free gay people from the self-hatred and shame that had trapped Andrew himself. It’s too late for me, he thought, but maybe it will help the people who come after me.

When the book, Virtually Normal, came out a year later, Patrick died when it had only been in the bookstores for a few days, and Andrew was widely ridiculed for suggesting something so absurd as gay marriage. Andrew was attacked not just by right-wingers, but by many gay left-wingers, who said he was a sellout, a wannabe heterosexual, a freak, for believing in marriage. A group called the Lesbian Avengers turned up to protest at his events with his face in the crosshairs of a gun. Andrew looked out at the crowd and despaired. This mad idea, his last gesture before dying, was clearly going to come to nothing.

When I hear people saying that the changes we need to make in order to deal with depression and anxiety can’t happen, I imagine going back in time, to the summer of 1993, to that beach house in Provincetown, and telling Andrew something:

Okay, Andrew, you’re not going to believe me, but this is what’s going to happen next. Twenty-five years from now, you’ll be alive. I know; it’s amazing; but wait, that’s not the best part. This book you’ve written, it’s going to spark a movement. And this book, it’s going to be quoted in a key Supreme Court ruling declaring marriage equality for gay people. And I’m going to be with you and your future husband the day after you receive a letter from the president of the United States telling you that this fight for gay marriage that you started has succeeded in part because of you. He’s going to light up the White House like the rainbow flag that day. He’s going to invite you to have dinner there, to thank you for what you’ve done. Oh, and by the way, that president? He’s going to be black.

It would have seemed like science fiction. But it happened. It’s not a small thing to overturn two thousand years of gay people being jailed and scorned and beaten and burned. It happened for one reason only. Because enough brave people banded together and demanded it.

Every single person reading this is the beneficiary of big civilizing social changes that seemed impossible when somebody first proposed them. Are you a woman? My grandmothers weren’t even allowed to have their own bank accounts until they were in their forties, by law. Are you a worker? The weekend was mocked as a utopian idea when labor unions first began to fight for it. Are you black, or Asian, or disabled? You don’t need me to fill in this list.

So I told myself: if you hear a thought in your head telling you that we can’t deal with the social causes of depression and anxiety, you should stop and realize that’s a symptom of the depression and anxiety itself.

Yes, the changes we need now are huge. They’re about the size of the revolution in how gay people were treated. But that revolution happened.

There’s a huge fight ahead of us to really deal with these problems. But that’s because it’s a huge crisis. We can deny that, but then we’ll stay trapped in the problem. Andrew taught me: The response to a huge crisis isn’t to go home and weep. It’s to go big. It’s to demand something that seems impossible, and not rest until you’ve achieved it.

Every now and then, Rutger, the leading European campaigner for a universal basic income, will read a news story about somebody who has made a radical career choice. A fifty-year-old man realizes he’s unfulfilled as a manager so he quits, and becomes an opera singer. A forty-five-year-old woman quits Goldman Sachs and goes to work for a charity. “It is always framed as something heroic,” Rutger told me, as we drank our tenth Diet Coke between us. People ask them, in awe: “Are you really going to do what you want to do?” Are you really going to change your life, so you are doing something that fulfills you?

It’s a sign, Rutger says, of how badly off track we’ve gone, that having fulfilling work is seen as a freakish exception, like winning the lottery, instead of how we should all be living. Giving everyone a guaranteed basic income, he says “is actually all about making it so we tell everyone, ‘Of course you’re going to do what you want to do. You’re a human being. You only live once. What would you want to do instead, something you don’t want to do?’”

. . .


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

by Johann Hari

get it at Amazon.com

CHILDHOOD TRAUMA AND MENTAL ILLNESS. Overcoming Childhood Trauma, Beyond the smoke – Johann Hari.

Depression isn’t a disease; depression is a normal response to abnormal life experiences.

For every category of traumatic experience you go through as a kid, you are radically more likely to become depressed as an adult. The greater the trauma, the greater your risk of depression, anxiety, or suicide.

Chronic adversities change the architecture of a child’s brain, altering the expression of genes that control stress hormone output, triggering an overactive inflammatory stress response for life, and predisposing the child to adult disease.

Emotional abuse especially, is more likely to cause depression than any other kind of trauma, even sexual molestation. Being treated cruelly by your parents is the biggest driver of depression, out of all categories.

Vincent Felitti didn’t want to discover just a sad fact, he wanted to discover a solution. He was the doctor who uncovered the startling evidence about the role childhood trauma plays in causing depression and anxiety later in life. He proved that childhood trauma makes you far more likely to be depressed or severely anxious as an adult. He traveled across the United States explaining the science, and there is now a broad scientific consensus that he was right. But for Vincent, that wasn’t the point. He didn’t want to tell people who’d survived trauma that they were broken and doomed to a diminished life because they were not properly protected as kids. He wanted to help them out of this pain. But how?

He had established these facts partly by sending a questionnaire to every single person who received health care from the insurance company Kaiser Permanente. It asked about ten traumatic things that can happen to you as a kid, and then matched them against your current health. It was only after he had been doing this for more than a year, and the data was clear, that Vincent had an idea.

What if, when a patient checked that they had suffered a trauma in childhood, the doctor waited until they next came in for health care of any kind, and asked the patient about it? Would that make any difference?

So they began an experiment. Every doctor providing help to a Kaiser Permanente patient, for anything from hemorrhoids to eczema to schizophrenia, was told to look at the patient’s trauma questionnaire, and if the patient had suffered a childhood trauma, the doctors were given a simple instruction. They were told to say something like: “I see you had to survive X or Y in your childhood. I’m sorry that happened to you, it shouldn’t have. Would you like to talk about those experiences?” If the patient said she did, the doctor was told to express sympathy, and to ask: Do you feel it had negative long-term effects on you? Is it relevant to your health today?

The goal was to offer the patient two things at the same time. The first was an opportunity to describe the traumatic experience, to craft a story about it, so the patient could make sense of it. As this experiment began, one of the things they discovered almost immediately is that many of the patients had literally never before acknowledged what happened to them to another human being.

The second, just as crucial, was to show them that they wouldn’t be judged. On the contrary, as Vincent explained to me, the purpose was for them to see that an authority figure, who they trusted, would offer them real compassion for what they’d gone through.

So the doctors started to ask the questions. While some patients didn’t want to talk about it, many of them did. Some started to explain about being neglected, or sexually assaulted, or beaten by their parents. Most, it turned out, had never asked themselves if these experiences were relevant to their health today. Prompted in this way, they began to think about it.

What Vincent wanted to know was, would this help? Or would it be harmful, stirring up old traumas? He waited anxiously for the results to be compiled from tens of thousands of these consultations.

Finally, the figures came in. In the months and years that followed, the patients who had their trauma compassionately acknowledged by an authority figure seemed to show a significant reduction in their illnesses, they were 35 percent less likely to return for medical help for any condition.

At first, the doctors feared that this might be because they had upset the patients and they had felt shamed. But literally nobody complained; and in follow-ups, a large number of patients said they were glad to have been asked. For example, one elderly woman, who had described being raped as a child for the first time, wrote them a letter: “Thank you for asking,” it said simply. “I feared I would die, and no one would ever know what had happened.”

In a smaller pilot study, after being asked these questions, the patients were given the option of discussing what had happened in a session with a psychoanalyst. Those patients were 50 percent less likely to come back to the doctor saying they felt physically ill, or seeking drugs, in the following year.

So it appeared that they were visiting the doctor less because they were actually getting less anxious, and less unwell. These were startling results. How could that be? The answer, Vincent suspects, has to do with shame. “In that very brief process,” he told me, “one person tells somebody else who’s important to them something [they regard as] deeply shameful about themselves, typically for the first time in their life. And she comes out of that with the realization, ‘I still seem to be accepted by this person.’ It’s potentially transformative.”

What this suggests is it’s not just the childhood trauma in itself that causes these problems, including depression and anxiety, it’s hiding away the childhood trauma. It’s not telling anyone because you’re ashamed. When you lock it away in your mind, it festers, and the sense of shame grows. As a doctor, Vincent can’t (alas) invent time machines to go back and prevent the abuse. But he can help his patients to stop hiding, and to stop feeling ashamed.

There is a great deal of evidence that a sense of humiliation plays a big role in depression. I wondered whether this was relevant here, and Vincent told me: “I believe that what we’re doing is very efficiently providing a massive reduction in humiliation and poor self-concept.” He started to see it as a secular version of confession in the Catholic Church. “I’m not saying this as a religious person because I’m not [religious, but confession has been in use for eighteen hundred years. Maybe it meets some basic human need if it’s lasted that long.”

You need to tell somebody what has happened to you, and you need to know they don’t regard you as being worth less than them. This evidence suggests that by reconnecting a person with his childhood trauma, and showing him that an outside observer doesn’t see it as shameful, you go a significant way toward helping to set him free from some of its negative effects.

“Now, is that all that needs to be done?” Vincent asked me. “No. But it’s a hell of a big step forward.”

Can this be right? There is evidence, from other scientific studies, that shame makes people sick. For example, closeted gay men, during the AIDS crisis, died on average two to three years earlier than openly gay men, even when they got health care at the same point in their illness. Sealing off a part of yourself and thinking it’s disgusting poisons your life. Could the same dynamic be at work here?

The scientists involved are the first to stress that more research needs to be done to find out how to build on this encouraging first step. This should only be the start. “Right now, I think that is waiting to happen, in terms of the science of it,” Vincent’s scientific partner, Robert Anda, told me. “What you’ve asked about is going to require a whole new thinking, and a generation of studies that has to put all this together. It hasn’t been done yet.”

I didn’t talk at all about the violence and abuse I survived as a child until I was in my mid-twenties, when I had a brilliant therapist. I was describing the course of my childhood to him, and I told him the story I had told myself my whole life: that I had experienced these things because I had done something wrong, and therefore I deserved it.

“Listen to what you’re saying,” he said to me. At first I didn’t understand what he meant. But then he repeated it back to me. “Do you think any child should be treated like that? What would you say if you saw an adult saying that to a ten-year-old now?”

Because I had kept these memories locked away, I had never questioned the narrative I had developed back then. It seemed natural to me. So I found his question startling.

At first I defended the adults who had behaved this way. I attacked the memory of my childhood self. It was only slowly, over time, that I came to see what he was saying.

And I felt a real release of shame.



Johann Hari

Depression isn’t a disease; depression is a normal response to abnormal life experiences.

The medical team, and all their friends, expected these people, who had been restored to health to react with joy. Except they didn’t react that way. The people who did best, and lost the most weight were often thrown into a brutal depression, or panic, or rage. Some of them became suicidal.

Was there anything else that happened in your life when you were eleven? Well, Susan replied that was when my grandfather began to rape me.

“Overweight is overlooked, and that’s the way I need to be.”

What we had perceived as the problem, major obesity, was in fact, very frequently, the solution to problems that the rest of us knew nothing about. Obesity, he realized, isn’t the fire. It’s the smoke.

For every category of traumatic experience you go through as a kid, you are radically more likely to become depressed as an adult. The greater the trauma, the greater your risk of depression, anxiety, or suicide.

Emotional abuse especially, is more likely to cause depression than any other kind of trauma, even sexual molestation. Being treated cruelly by your parents is the biggest driver of depression, out of all these categories.

We have failed to see depression as a symptom of something deeper that needs to be dealt with. There’s a house fire inside many of us, and we’ve been concentrating on the smoke.

CHILDHOOD TRAUMA AND MENTAL ‘ILLNESS’. Beyond the smoke – Johann Hari


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

by Johann Hari

get it at Amazon.com

ADVERTISING SHITS IN YOUR HEAD. Reconnecting to Meaningful Values * JUNK VALUES. Consumerism literally is depressing – Johann Hari.

Advertising is the PR team for an economic system, Neoliberal Globalisation, that operates by making us feel inadequate and telling us the solution is to constantly spend.

We are constantly bombarded with messages that we will feel better only if we buy some specific product; and then buy something more; and buy again, and on and on, until finally your family buys your coffin.

Can we turn off the autopilot, and take back control for ourselves?

Spending often isn’t about the object itself. It is about getting to a psychological state that makes you feel better.

When there is pollution in the air that makes us feel worse, we ban the source of the pollution.

Advertising is a form of mental pollution.

When I was trying to apply everything I had learned to change, in order to be less depressed, I felt a dull, insistent tug on me. I kept getting signals that the way to be happy is simple. Buy stuff. Show it off. Display your status. Acquire things. These impulses called to me, from every advertisement, and from so many social interactions. I had learned from Tim Kasser that these are junk values, a trap that leads only to greater anxiety and depression. But what is the way beyond them? I could understand the arguments against them very well. I was persuaded. But there they were, in my head, and all around me, trying to pull me back down.

But Tim, I learned, has been proposing two ways, as starters, to wriggle free. The first is defensive. And the second is proactive, a way to stir our different values.

When there is pollution in the air that makes us feel worse, we ban the source of the pollution: we don’t allow factories to pump lead into our air. Advertising, he says, is a form of mental pollution. So there’s an obvious solution. Restrict or ban mental pollution, just like we restrict or ban physical pollution.

This isn’t an abstract idea. It has already been tried in many places. For example, the city of Sao Paulo, in Brazil, was being slowly smothered by billboards. They covered every possible space, gaudy logos and brands dominated the skyline wherever you looked. It had made the city look ugly, and made people feel ugly, by telling them everywhere they looked that they had to consume.

So in 2007 the city’s government took a bold step, they banned all outdoor advertising: everything. They called it the Clean City Law. As the signs were removed one by one, people began to see beautiful old buildings that had long been hidden. The constant ego-irritation of being told to spend was taken away, and was replaced with works of public art. Some 70 percent of the city’s residents say the change has made it a better place. I went there to see it, and almost everyone says the city seems somehow psychologically cleaner and clearer than it did before.

We could take this insight and go further. Several countries, including Sweden and Greece, have banned advertising directed at children. While I was writing this book, there was a controversy after a company marketing diet products put advertisements in the London Underground asking, ARE YOU BEACH BODY READY? next to a picture of an impossibly lithe woman. The implication was that if you are one of the 99.99 percent of humans who look less buff than this, you are not “ready” to show your flesh on the beach. There was a big backlash, and the posters were eventually banned. It prompted a wave of protests across London, where people defaced ads with the words “Advertising shits in your head.”

It made me think: Imagine if we had a tough advertising regulator who wouldn’t permit ads designed to make us feel bad in any way. How many ads would survive? That’s an achievable goal, and it would clear a lot of mental pollution from our minds.

This has some value in itself, but I think the fight for it could spur a deeper conversation. Advertising is only the PR team for an economic system that operates by making us feel inadequate and telling us the solution is to constantly spend. My hunch is that, if we start to really talk about how this affects our emotional health, we will begin to see the need for more radical changes.

There was a hint of how this might start in an experiment that tried to go deeper, not just to block bad messages that divert our desires onto junk, but to see if we can draw out our positive values. This led to the second, and most exciting, path back that Tim has explored.

The kids were telling Nathan Dungan one thing, over and over again. They needed stuff. They needed consumer objects. And they were frustrated, outright angry, that they weren’t getting them. Their parents were refusing to buy the sneakers or designer clothes or latest gadgets that they needed to have, and it was throwing them into an existential panic. Didn’t their parents know how important it is to have all this?

Nathan didn’t expect to be having these conversations. He was a middle-aged man who had worked in financial services in Pennsylvania for years, advising people on investments. One day, he was talking to an educator at a middle school and she explained that the kids she was working with, middle-class, not rich, had a problem. They thought satisfaction and meaning came from buying objects. When their parents couldn’t afford them, they seemed genuinely distressed. She asked, could Nathan come in and talk to the kids about financial realities?

He agreed cautiously. But that decision was going to set him on a steep learning curve, and lead him to challenge a lot of what he took for granted.

Nathan went in believing his task was obvious. He was there to educate the kids, and their parents, about how to budget, and how to live within their financial means. But then he hit this wall of need, this ravenous hunger for stuff. To him, it was baffling. Why do they want it so badly? What’s the difference between the sneakers with the Nike swoosh and the sneakers without? Why would that gap be so significant that it would send kids into a panic?

He began to wonder if he should be talking not about how to budget, but why the teenagers wanted these things in the first place. And it went deeper than that. There was something about seeing teenagers craving apparently meaningless material objects that got Nathan to think, as adults, are we so different?

Nathan had no idea how to start that conversation, so he began to wing it. And it led to a striking scientific experiment, where he teamed up with Tim Kasser.

A short time later, in a conference room in Minneapolis, Nathan met with the families who were going to be the focus of his experiment. They were a group of sixty parents and their teenage kids, sitting in front of him on chairs. He was going to have a series of long sessions with them over three months to explore these issues and the alternatives. (At the same time, the experiment followed a separate group of the same size who didn’t meet with Nathan or get any other help. They were the experiment’s control group.)

Nathan started the conversation by handing everyone worksheets with a list of open-ended questions. He explained there was no right answer: he just wanted them to start to think about these questions. One of them said: “For me, money is …” and you had to fill in the blank.

At first, people were confused. They’d never been asked a question like this before. Lots of the participants wrote that money is scarce. Or a source of stress. Or something they try not to think about. They then broke into groups of eight, and began to contemplate their answers, haltingly. Many of the kids had never heard their parents talk about money worries before.

Then the groups began to discuss the question, why do I spend? They began to list the reasons why they buy necessities (which are obvious: you’ve got to eat), and then the reasons why they buy the things that aren’t necessities. Sometimes, people would say, they bought nonessential stuff when they felt down. Often, the teenagers would say, they craved this stuff so badly because they wanted to belong, the branded clothes meant you were accepted by the group, or got a sense of status.

As they explored this in the conversation, it became clear quite quickly, without any prompting from Nathan, that spending often isn’t about the object itself. It is about getting to a psychological state that makes you feel better. These insights weren’t deeply buried. People offered them quite quickly, although when they said them out loud, they seemed a little surprised. They knew it just below the surface, but they’d never been asked to articulate that latent feeling before.

Then Nathan asked people to list what they really value, the things they think are most important in life. Many people said it was looking after your family, or telling the truth, or helping other people. One fourteen-year-old boy wrote simply “love,” and when he read it out, the room stopped for a moment, and “you could hear a pin drop,” Nathan told me. “What he was speaking to was, how important is it for me to be connected?”

Just asking these two questions, “What do you spend your money on?” and “What do you really value?”, made most people see a gap between the answers that they began to discuss. They were accumulating and spending money on things that were not, in the end, the things that they believed in their heart mattered. Why would that be?

Nathan had been reading up on the evidence about how we come to crave all this stuff. He learned that the average American is exposed to up to five thousand advertising impressions a day, from billboards to logos on T-shirts to TV advertisements. It is the sea in which we swim. And “the narrative is that if you [buy] this thing, it’ll yield more happiness, and so thousands of times a day you’re just surrounded with that message,” he told me. He began to ask: “Who’s shaping that narrative?” It’s not people who have actually figured out what will make us happy and who are charitably spreading the good news. It’s people who have one motive only, to make us buy their product.

In our culture, Nathan was starting to believe, we end up on a materialistic autopilot. We are constantly bombarded with messages that we will feel better (and less stinky, and less disgustingly shaped, and less all-around worthless) only if we buy some specific product; and then buy something more; and buy again, and on and on, until finally your family buys your coffin. What he wondered is, if people stopped to think about this and discussed alternatives, as his group was doing, could we turn off the autopilot, and take back control for ourselves?

At the next session, he asked the people in the experiment to do a short exercise in which everyone had to list a consumer item they felt they had to have right away. They had to describe what it was, how they first heard about it, why they craved it, how they felt when they got it, and how they felt after they’d had it for a while. For many people, as they talked this through, something became obvious. The pleasure was often in the craving and anticipation. We’ve all had the experience of finally getting the thing we want, getting it home, and feeling oddly deflated, only to find that before long, the craving cycle starts again.

People began to talk about how they had been spending, and they were slowly seeing what it was really all about. Often, not always, it was about “filling a hole. It fills some sort of loneliness gap.” But by pushing them toward that quick, rapidly evaporating high, it was also nudging them away from the things they really valued and that would make them feel satisfied in the long run. They felt they were becoming hollow.

There were some people, both teens and adults, who rejected this fiercely. They said that the stuff made them happy, and they wanted to stick with it. But most people in the group were eager to think differently.

They began to talk about advertising. At first, almost everyone declared that ads might affect other people but didn’t hold much sway over them. “Everyone wants to be smarter than the ad,” Nathan said to me later. But he guided them back to the consumer objects they had longed for. Before long, members of the group were explaining to each other: “There’s no way they’re spending billions of dollars if it’s not having an impact. They’re just not doing that. No company is going to do that.”

So far, it had been about getting people to question the junk values we have been fed for so long.

But then came the most important part of this experiment.

Nathan explained the difference that I talked about before between extrinsic and intrinsic values. He asked people to draw up a list of their intrinsic values, the things they thought were important, as an end in themselves and not because of what you get out of it. Then he asked: How would you live differently if you acted on these other values? Members of the groups discussed it.

They were surprised. We are constantly encouraged to talk about extrinsic values, but the moments when we are asked to speak our intrinsic values out loud are rare. Some said, for example, they would work less and spend more time with the people they loved. Nathan wasn’t making the case for any of this. Just asking a few open questions took most of the group there spontaneously.

Our intrinsic motivations are always there, Nathan realized, lying “dormant. It was brought out into the light,” he said. Conversations like this, Nathan was realizing, don’t just happen “in our culture today. We don’t allow space or create space for these really critical conversations to take place, so it just creates more and more isolation.”

Now that they had identified how they had been duped by junk values, and identified their intrinsic values, Nathan wanted to know: could the group choose, together, to start to follow their intrinsic goals? Instead of being accountable to advertising, could they make themselves accountable to their own most important values, and to a group that was trying to do the same thing? Could they consciously nurture meaningful values?

Now that each person had figured out his or her own intrinsic goals, they would report back at the next series of meetings about what they’d done to start moving toward them. They held each other accountable. They now had a space in which they could think about what they really wanted in life, and how to achieve it. They would talk about how they had found a way to work less and see their kids more, for example, or how they had taken up a musical instrument, or how they had started to write.

Nobody knew whether all this would have any real effect, though. Could these conversations really reduce people’s materialism and increase their intrinsic values?

Independent social scientists measured the levels of materialism of the participants at the start of the experiment, and they measured them again at the end. As he waited for the results, Nathan was nervous. This was a small intervention, in the middle of a lifetime of constant consumerist bombardment. Would it make any difference at all?

When the results came through, both Nathan and Tim were thrilled. Tim had shown before that materialism correlates strongly with increased depression and anxiety. This experiment showed, for the first time, that it was possible to intervene in people’s lives in a way that would significantly reduce their levels of materialism. The people who had gone through this experiment had significantly lower materialism and significantly higher selfesteem. It was a big and measurable effect.

It was an early shot of proof that a determined effort to reverse the values that are making us so unhappy works.

The people who took part in the study could never have made these changes alone, Nathan believes. “There was a lot of power in that connection and that community for people, removing the isolation and the fear. There’s a lot of fear around this topic.” It was only together, as a group, that they there were able to “peel those layers away, so you could actually get to the meaning, to the heart: their sense of purpose.”

I asked Nathan if we could integrate this into our ordinary lives, if we all need to form and take part in a kind of Alcoholics Anonymous for junk values, a space where we can all meet to challenge the depression-generating ideas we’ve been taught and learn to listen instead to our intrinsic values. “I would say, without question,” he said. Most of us sense we have been valuing the wrong things for too long. We need to create, he told me, a “counter-rhythm” to the junk values that have been making us mentally sick.

From his bare conference room in Minneapolis, Nathan has proven something, that we are not imprisoned in the values that have been making us feel so lousy for so long. By coming together with other people, and thinking deeply, and reconnecting with what really matters, we can begin to dig a tunnel back to meaningful values.



Johann Hari

Just as we have shifted en masse from eating food to eating junk food, we have also shifted from having meaningful values to having junk values.

All this mass-produced fried chicken looks like food, and it appeals to the part of us that evolved to need food; yet it doesn’t give us what we need from food, nutrition. Instead, it fills us with toxins.

In the same way, all these materialistic values, telling us to spend our way to happiness, look like real values; they appeal to the part of us that has evolved to need some basic principles to guide us through life; yet they don’t give us what we need from values, a path to a satisfying life.

Studies show that materialistic people are having a worse time, day by day, on all sorts of fronts. They feel sicker, and they are angrier. Something about a strong desire for materialistic pursuits actually affects their day-to-day lives, and decreases the quality of their daily experience. They experienced less joy, and more despair.

For thousands of years, philosophers have been suggesting that if you overvalue money and possessions, or if you think about life mainly in terms of how you look to other people, you will be unhappy.

Modern research indicates that materialistic people, who think happiness comes from accumulating stuff and a superior status, have much higher levels of depression and anxiety. The more our kids value getting things and being seen to have things, the more likely they are to be suffering from depression and anxiety.

The pressure, in our culture, runs overwhelmingly one way, spend more; work more. We live under a system that constantly distracts us from what’s really good about life. We are being propagandized to live in a way that doesn’t meet our basic psychological needs, so we are left with a permanent, puzzling sense of dissatisfaction.

The more materialistic and extrinsically motivated you become, the more depressed you will be.


. . .


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

by Johann Hari

get it at Amazon.com

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.


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.


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.

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).

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.


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.


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.

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.

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


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?

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.


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.

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.

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.

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.

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.

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.


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.

. . .


The Spirit Level. Why equality is better for everyone

by Richard Wilkinson and Kate Pickett

get it at Amazon.com

SINS OF OMISSION, EMOTIONAL NEGLECT. What Did Your Family Cook Up For Christmas? * Running on Empty: Overcome Your Childhood Emotional Neglect – Jonice Webb PhD.

Good enough parents, or chronic empathic failure?

When a parent effectively recognizes and meets her child’s emotional needs in infancy, a “secure attachment” is formed and maintained. This first attachment forms the basis of a positive self-image and a sense of general well-being throughout childhood and into adulthood.

Your parents’ failure to validate or respond enough to your emotional needs as a child has massive consequences, coming from the totality of important moments in which emotionally neglectful parents are deaf and blind to the emotional needs of their growing child.

There is a minimal amount of parental emotional connection, empathy and ongoing attention which is necessary to fuel a child’s growth and development so that he or she will grow into an emotionally healthy and emotionally connected adult. Less than that minimal amount and the child becomes an adult who struggles emotionally, outwardly successful, perhaps, but empty, missing something within, which the world can’t see.

Childhood Emotional Neglect has a tremendous impact on your ability to achieve happiness and fulfillment in adulthood. You’re feeling empty, disconnected, and different; as if you don’t actually belong anywhere.

It also wreaks havoc with your relationships with your parents and family in adulthood. The CEN adult feels so uncomfortable and empty with family not because of what’s there, but because of what’s missing.

This book is written to help you become aware of what didn’t happen in your childhood, what you don’t remember.

Childhood Emotional Neglect is the result of your parent’s inability to validate and respond adequately to your emotional needs. Childhood emotional neglect can be hard to identify because it’s what didn’t happen in your childhood. It doesn’t leave any visible bruises or scars, but it’s hurtful and confusing for children.

Symptoms of Childhood Emotional Neglect include:



Feeling something’s fundamentally wrong with you

Feeling unfulfilled even when you’re successful

Difficulty connecting with most of your feelings, not feeling anything

Burying, avoiding, or numbing your feelings

Feeling out of place or like you don’t fit in

Difficulty asking for help and not wanting to depend on others

Depression and anxiety

High levels of guilt, shame, and/or anger

Lack of deep, intimate connection with your friends and spouse

Feeling different, unimportant or inadequate

Difficulty with self-control (this could be overeating or drinking)

People-pleasing and focusing on other people’s needs

Not having a good sense of who you are, your likes and dislikes, your strengths and weaknesses

Sharon Martin, LCSW

What’s Your Family Cooking Up For Christmas?

Jonice Webb PhD

Do you look forward to family holiday gatherings, but then often end up feeling disappointed?

Do you dread family holiday dinners, but feel confused about the reasons why?

Do you feel guilty for avoiding or snapping at your parents at holiday gatherings, but just can’t stop yourself?

Do you feel strangely uncomfortable when you’re with your family as if you don’t belong there?

In my experience as a psychologist, I have come to realize that for every irritable, out-of-place, or disappointed person at a family gathering, there is a valid explanation for how that person feels.

I have also found that the explanation is often something rooted in childhood. Something that as an adult you can’t see or remember but is likely still happening to this day: Childhood Emotional Neglect.

Childhood Emotional Neglect (CEN) happens when your parents fail to validate or respond enough to your emotional needs as they raise you. Adults whose parents failed them in this way in childhood typically have no awareness that this failure happened. A failure to validate or respond is not an action or an event. It’s a failure to act and a non-event. Therefore, your eyes don’t see it and your brain can’t record it. As an adult, you will likely have no memory of it.

Yet CEN has a tremendous impact on your ability to achieve happiness and fulfillment in adulthood. Growing up with your feelings unaddressed in your family plays out in your own adult life in some very important ways. But it also wreaks havoc with your relationships with your parents and family in adulthood.

Once you’re grown up, Emotional Neglect from childhood can make you resent your parents and feel uncomfortable with your family without you even realizing it. On top of all that, CEN can leave you feeling empty, disconnected, and different; as if you don’t actually belong anywhere.

There is no situation that immerses you in all of your CEN symptoms more than being at a family gathering. And this is especially true when it happens under the pressure-cooker of the holidays.


Chelsea fastened her necklace while simultaneously calling up the stairs for her 3 children to find their shoes and put them on. “We don’t want to be late to Grandma and Grandpa’s house for holiday brunch!” she yelled. As she gathered up the pie she’d made and the bottle of wine she was taking, she was confused by her own mood. She was definitely excited about the holiday and looking forward to the day, but there was also a feeling of darkness lurking in the pit of her stomach. “What is wrong with me? I’m 43 years old and I’m all over the place. This makes no sense,” she thought, angry at herself. She closed her eyes and commanded herself to just be happy and enjoy the day.


28-year-old Jack sat in his parents’ family room surrounded by his niece and nephew, siblings and dad. It’s their annual New Years Day family dinner. As everyone watches the children play, Jack is sitting very uncomfortably in his comfortable chair. Knowing he should be feeling happy and warm and loved, he’s never felt less so. He feels deeply uneasy and out of place as if he is among strangers. He feels unknown, invisible, and deeply bored. “What is my problem?” he agonizes.

Chelsea and Jack don’t know it, but they are both struggling to identify something in themselves that’s very hard to see. Their confusion and contradictory feelings do all make sense, and they have them for a reason. But in looking for answers they are both doing what people with emotional neglect usually do: they are getting angry at themselves for having the feelings they have because they can’t see what’s wrong. They are blaming the pain and deprivation from their childhoods on themselves.

The CEN adult feels so uncomfortable and empty with family not because of what’s there, but because of what’s missing.

What’s missing could be best described as three things:

The feeling that people are genuinely interested in you.

Questions about yourself and your life.

Meaningful conversations about interpersonal issues and the feelings involved.

So when Chelsea and Jack see their families now, it’s a sad continuation of their childhoods. Their parents do not ask them genuine questions about themselves or their lives, no one shows interest in their problems or genuine life experience or feelings. And no one talks about anything that really matters, like problems or conflicts or feelings.

What’s missing is what’s failing to happen, which is something Chelsea and Jack may never see because it’s been their reality from childhood. They can feel it but they cannot see it unless they stop blaming themselves for having negative feelings and acknowledge how their parents failed them.

What To Do Differently

Learn as much as you can about Childhood Emotional Neglect (CEN) before your holiday event. This will help you see that this problem is real as well as understand how it’s affected you. Instead of trying to ban your negative feelings (like Chelsea did), do the opposite. Pay attention to them as important messages from your body trying to alert you to a real problem in your experience of your family. Think about how to protect yourself this year. For example, you may limit your time present at the event or bring a support person who understands CEN and your situation. You might lower your expectations or stick close to someone you’re most comfortable with.

Now here’s the thing. The power of Childhood Emotional Neglect comes from your lack of awareness of it. Once you see it, you can beat it. You can treat yourself differently than your family ever treated you. By caring about your own feelings and validating your own experience you can start protecting yourself.

And when you do you will experience your holidays in a very different way. And then you will see that it makes all the difference in the world.

Jonice Webb has a PhD in clinical psychology, and is author of the bestselling books Running on Empty: Overcome Your Childhood Emotional Neglect and Running On Empty No More: Transform Your Relationship. She currently has a private psychotherapy practice in the Boston area, where she specializes in the treatment of couples and families. To read more about Dr. Webb, her books and Childhood Emotional Neglect, you can visit her website, Emotionalneglect.com.


Running on Empty: Overcome Your Childhood Emotional Neglect

Jonice Webb PhD

Writing this book has been one of the most fascinating experiences of my life. As the concept of Emotional Neglect gradually became clearer and more defined in my head, it changed not only the way I practiced psychology, but also the way I looked at the world. I started to see Emotional Neglect everywhere: in the way I sometimes parented my own children or treated my husband, at the mall, and even on reality TV shows. I found myself often thinking that it would help people enormously if they could become aware of this invisible force that affects us all: Emotional Neglect.

After watching the concept become a vital aspect of my work over several years, and becoming fully convinced of its value, I finally shared it with my colleague, Dr. Christine Musello. Christine responded with immediate understanding, and quickly began seeing Emotional Neglect in her own clinical practice, and all around her, as I had. Together we started to work on outlining and defining the phenomenon. Dr. Musello was helpful in the process of putting the initial words to the concept of Emotional Neglect. The fact that she was so readily able to embrace the concept, and found it so useful, encouraged me to take it forward.

Although Dr. Musello was not able to continue in the writing of this book with me, she was a helpful support at the beginning of the writing process. She composed some of the first sections of the book and several of the clinical vignettes. I am therefore pleased to recognize her contribution.


What do you remember from your childhood? Almost everyone remembers some bits and pieces, if not more. Perhaps you have some positive memories, like family vacations, teachers, friends, summer camps or academic awards; and some negative memories, like family conflicts, sibling rivalries, problems at school, or even some sad or troubling events.

Running on Empty is not about any of those kinds of memories. In fact, it’s not about anything that you can remember or anything that happened in your childhood. This book is written to help you become aware of what didn’t happen in your childhood, what you don’t remember. Because what didn’t happen has as much or more power over who you have become as an adult than any of those events you do remember. Running on Empty will introduce you to the consequences of what didn’t happen: an invisible force that may be at work in your life. I will help you determine whether you’ve been affected by this invisible force and, if so, how to overcome it.

Many fine, high-functioning, capable people secretly feel unfulfilled or disconnected. “Shouldn’t I be happier?” “Why haven’t I accomplished more?” “Why doesn’t my life feel more meaningful?” These are questions which are often prompted by the invisible force at work. They are often asked by people who believe that they had loving, wellmeaning parents, and who remember their childhood as mostly happy and healthy. So they blame themselves for whatever doesn’t feel right as an adult. They don’t realize that they are under the influence of what they don’t remember, the invisible force.

By now, you’re probably wondering, what is this Invisible Force? Rest assured it’s nothing scary. It’s not supernatural, psychic or eerie. It’s actually a very common, human thing that doesn’t happen in homes and families all over the world every day. Yet we don’t realize it exists, matters or has any impact upon us at all. We don’t have a word for it. We don’t think about it and we don’t talk about it. We can’t see it; we can only feel it. And when we do feel it, we don’t know what we’re feeling.

In this book, I’m finally giving this force a name. I’m calling it Emotional Neglect. This is not to be confused with physical neglect. Let’s talk about what Emotional Neglect really is.

Everyone is familiar with the word “neglect.” It’s a common word. The definition of “neglect,” according to the Merriam-Webster Dictionary, is “to give little attention or respect or to disregard; to leave unattended to, especially through carelessness.”

“Neglect” is a word used especially frequently by mental health professionals in the Social Services. It’s commonly used to refer to a dependent person, such as a child or elder, whose physical needs are not being met. For example a child who comes to school with no coat in the winter, or an elder shut-in whose adult daughter frequently “forgets” to bring her groceries.

Pure emotional neglect is invisible. It can be extremely subtle, and it rarely has any physical or visible signs. In fact, many emotionally neglected children have received excellent physical care. Many come from families that seem ideal. The people for whom I write this book are unlikely to have been identified as neglected by any outward signs, and are in fact unlikely to have been identified as neglected at all.

So why write a book? After all, if the topic of Emotional Neglect has gone unnoticed by researchers and professionals all this time, how debilitating can it really be? The truth is, people suffering from Emotional Neglect are in pain. But they can’t figure out why, and too often, neither can the therapists treating them. In writing this book, I identify, define and suggest solutions to a hidden struggle that often stymies its sufferers and even the professionals to whom they sometimes go for help. My goal is to help these people who are suffering in silence, wondering what is wrong with them.

There is a good explanation for why Emotional Neglect has been so overlooked. It hides. It dwells in the sins of omission, rather than commission; it’s the white space in the family picture rather than the picture itself. It’s often what was NOT said or observed or remembered from childhood, rather than what WAS said.

For example, parents may provide a lovely home and plenty of food and clothing, and never abuse or mistreat their child. But these same parents may fail to notice their teen child’s drug use or simply give him too much freedom rather than set the limits that would lead to conflict. When that teen is an adult, he may look back at an “ideal” childhood, never realizing that his parents failed him in the way that he needed them most. He may blame himself for whatever difficulties have ensued from his poor choices as a teen. “I was a real handful”; “I had such a great childhood, I have no excuse for not having achieved more in life.” As a therapist, I have heard these words uttered many times by high-functioning, wonderful people who are unaware that Emotional Neglect was an invisible, powerful force in their childhood. This example offers only one of the infinite numbers of ways that a parent can emotionally neglect a child, leaving him running on empty.

Here I would like to insert a very important caveat: We all have examples of how our parents have failed us here and there. No parent is perfect, and no childhood is perfect. We know that the huge majority of parents struggle to do what’s best for their child. Those of us who are parents know that when we make parenting mistakes, we can almost always correct them. This book is not meant to shame parents or make parents feel like failures. In fact, throughout the book you’ll read about many parents who are loving and well-meaning, but still emotionally neglected their child in some fundamental way. Many emotionally neglectful parents are fine people and good parents, but were emotionally neglected themselves as children. All parents commit occasional acts of Emotional Neglect in raising their children without causing any real harm. It only becomes a problem when it is of a great enough breadth or quantity to gradually emotionally “starve” the child.

Whatever the level of parental failure, emotionally neglected people see themselves as the problem, rather than seeing their parents as having failed them.

Throughout the book I include many examples, or vignettes, taken from the lives of my clients and others, those who have grappled with sadness or anxiety or emptiness in their lives, for which there were no words and for which they could find little explanation. These emotionally neglected people most often know how to give others what they want or need. They know what is expected from them in most of life’s social environments. Yet these sufferers are unable to label and describe what is wrong in their internal experience of life and how it harms them.

This is not to say that adults who were emotionally neglected as children are without observable symptoms. But these symptoms, the ones that may have brought them to a psychotherapist’s door, always masquerade as something else: depression, marital problems, anxiety, anger. Adults who have been emotionally neglected mislabel their unhappiness in such ways, and tend to feel embarrassed by asking for help. Since they have not learned to identify or to be in touch with their true emotional needs, it’s difficult for therapists to keep them in treatment long enough to help them understand themselves better.

So this book is written not only for the emotionally neglected, but also for mental health professionals, who need tools to combat the chronic lack of compassion-for-self which can sabotage the best of treatments.

Whether you picked up Running on Empty because you are looking for answers to your own feelings of emptiness and lack of fulfillment, or because you are a mental health professional trying to help “stuck” patients, this book will provide concrete solutions for invisible wounds.

In Running on Empty, I have used many vignettes to illustrate various aspects of Emotional Neglect in childhood and adulthood. All of the vignettes are based upon real stories from clinical practice, either my own or Dr. Musello’s. However, to protect the privacy of the clients, names, identifying facts, and details were altered, so that no vignette depicts any real person, living or dead. The exceptions are the vignettes involving Zeke which appear throughout Chapters 1 and 2. These vignettes were created to illustrate how different parenting styles might affect the same boy, and are purely fictitious.

Are you wondering if this book applies to you? Take this questionnaire to find out. Circle the questions to which your answer is YES.

Emotional Neglect Questionnaire

Do You:

  • Sometimes feel like you don’t belong when with your family or friends
  • Pride yourself on not relying upon others
  • Have difficulty asking for help
  • Have friends or family who complain that you are aloof or distant
  • Feel you have not met your potential in life
  • Often just want to be left alone
  • Secretly feel that you may be a fraud
  • Tend to feel uncomfortable in social situations
  • Often feel disappointed with, or angry at yourself
  • Judge yourself more harshly than you judge others
  • Compare yourself to others and often find yourself sadly lacking
  • Find it easier to love animals than people
  • Often feel irritable or unhappy for no apparent reason
  • Have trouble knowing what you’re feeling
  • Have trouble identifying your strengths and weaknesses
  • Sometimes feel like you’re on the outside looking in
  • Believe you’re one of those people who could easily live as a hermit
  • Have trouble calming yourself
  • Feel there’s something holding you back from being present in the moment
  • At times feel empty inside
  • Secretly feel there’s something wrong with you
  • Struggle with self-discipline

Look back over your circled (YES) answers. These answers give you a window into the areas in which you may have experienced Emotional Neglect as a child.

Part 1 Running on Empty

Chapter 1


“…I am trying to draw attention to the immense contribution to the individual and to society which the ordinary good mother with her husband in support makes at the beginning, and which she does simply through being devoted to her infant. ”

D.W. Winnicott, (1964) The Child, the Family, and the Outside World

It doesn’t take a parenting guru, a saint, or, thank goodness, a Ph.D. in psychology to raise a child to be a healthy, happy adult. The child psychiatrist, researcher, writer and psychoanalyst Donald Winnicott emphasized this point often throughout writings that spanned 40 years.

While today we recognize that fathers are of equal importance in the development of a child, the meaning of Winnicott’s observations on mothering is still essentially the same:

There is a minimal amount of parental emotional connection, empathy and ongoing attention which is necessary to fuel a child’s growth and development so that he or she will grow into an emotionally healthy and emotionally connected adult. Less than that minimal amount and the child becomes an adult who struggles emotionally, outwardly successful, perhaps, but empty, missing something within, which the world can’t see.

In his writings, Winnicott coined the now wellknown term, “Good Enough Mother” to describe a mother who meets her child’s needs in this way. Parenting that is “good enough” takes many forms, but all of these recognize the child’s emotional or physical need in any given moment, in any given culture, and do a “good enough” job of meeting it. Most parents are good enough. Like all animals, we humans are biologically wired to raise our children to thrive. But what happens when life circumstances interfere with parenting? Or when parents themselves are unhealthy, or have significant character flaws?

Were you raised by “good enough” parents? By the end of this chapter, you will know what “good enough” means, and you will be able to answer this question for yourself.

But first…

If you are a parent as well as a reader, you may find yourself identifying with the parental failures presented in this book, as well as with the emotional experience of the child in the vignettes (because you are, no doubt, hard on yourself.) Therefore, I ask that you pay close attention to the following warnings:

First – All good parents are guilty of emotionally failing their children at times. Nobody is perfect. We all get tired, cranky, stressed, distracted, bored, confused, disconnected, overwhelmed or otherwise compromised here and there. This does not qualify us as emotionally neglectful parents.

Emotionally neglectful parents distinguish themselves in one of two ways, and often both:

Either they emotionally fail their child in some critical way in a moment of crisis, causing the child a wound which may never be repaired (acute empathic failure)

OR they are chronically tone-deaf to some aspect of a child’s need throughout his or her childhood development (chronic empathic failure).

Every single parent on earth can recall a parenting failure that makes him cringe, where he knows that he has failed his child. But the harm comes from the totality of important moments in which emotionally neglectful parents are deaf and blind to the emotional needs of their growing child.

Second – If you were indeed emotionally neglected, and are a parent yourself as well, there is a good chance that as you read this book you will start to see some ways in which you have passed the torch of Emotional Neglect to your child. If so, it’s extremely vital for you to realize that it is not your fault. Because it’s invisible, insidious, and easily passes from generation to generation, it’s extremely unlikely and difficult to stop unless you become explicitly aware of it.

Since you’re reading this book, you are light-years ahead of your parents. You have the opportunity to change the pattern, and you are taking it. The effects of Emotional Neglect can be reversed. And you’re about to learn how to reverse those parental patterns for yourself, and for your children.

Keep reading. No self-blame allowed.

The Ordinary Healthy Parent in Action

The importance of emotion in healthy parenting is best understood through attachment theory. Attachment theory describes how our emotional needs for safety and connection are met by our parents from infancy.

Many ways of looking at human behavior have grown out of attachment theory, but most owe their thinking to the original attachment theorist, psychiatrist John Bowlby. His understanding of parent-child bonding comes from thousands of hours of observation of parents and children, beginning with mothers and infants.

It suggests, quite simply, that when a parent effectively recognizes and meets her child’s emotional needs in infancy, a “secure attachment” is formed and maintained. This first attachment forms the basis of a positive self-image and a sense of general well-being throughout childhood and into adulthood.

Looking at emotional health through the lens of attachment theory, we can identify three essential emotional skills in parents:

1) The parent feels an emotional connection to the child.

2) The parent pays attention to the child and sees him as a unique and separate person, rather than, say, an extension of him or herself, a possession or a burden.

3) Using that emotional connection and paying attention, the parent responds competently to the child’s emotional need.

Although these skills sound simple, in combination they are a powerful tool for helping a child learn about and manage his or her own nature, for creating a secure emotional bond that carries the child into adulthood, so that he may face the world with the emotional health to achieve a happy adulthood.

In short, when parents are mindful of their children’s unique emotional nature, they raise emotionally strong adults. Some parents are able to do this intuitively, but others can learn the skills. Either way, the child will not be neglected.

. . .


Running on Empty: Overcome Your Childhood Emotional Neglect

by Jonice Webb PhD.

get it at Amazon.com



DEPRESSION. It’s what’s Inside Your Head? – Johann Hari.

“Ask not what’s inside your head, ask what your head’s inside of” W. M. Mace.

“It is no measure of health to be well-adjusted to a sick society.” Jiddu Krishnamurti.

How does your brain change when you are deeply distressed? Do those changes make it harder to recover? The real role of genes and brain changes.

The distress caused by the outside world, and the changes inside your brain come together. If the world keeps causing you deep pain, of course you’ll stay trapped there for a long time, with the snowball growing, your genes are activated by the environment. They can be switched on, or off, by what happens to you.

Genes increase your sensitivity, sometimes significantly. But they aren’t, in themselves, the cause of depression. Your genes can certainly make you more vulnerable, but they don’t write your destiny.

Marc Lewis’s friends thought he was dead.

It was the summer of 1969, and this young student in California was desperate to block out his despair any way he could. He had swallowed, snorted, or injected any stimulant he could find for a week now.

After he had been awake for thirty-six hours straight, he got a friend to inject him with heroin, so he could finally crash.

When Marc regained consciousness, he realized his friends were trying to figure out where they could find a bag big enough to dump his body in.

When Marc suddenly began to talk, they were freaked out. His heart, they explained to him, had stopped beating for several minutes.

About ten years after that night, Marc left drugs behind, and started to study neuroscience. He became a leading figure in the field, and a professor in the Netherlands.

He wanted to know: How does your brain change when you are deeply distressed? Do those changes make it harder to recover?

If you look at a brain scan of a depressed or highly anxious person it will look different from the brain scan of somebody without these problems. The areas that relate to feeling unhappy, or to being aware of risk, will be lit up like Christmas tree lights. They will be bigger, and more active.

Fifteen years ago, if you had shown me a diagram of my brain and described what it was like, I and most people, would have thought: that’s me, then. If the parts of the brain that relate to being unhappy, or being frightened, are more active, then I’m fixed as a person who is always going to be more unhappy, or more frightened. You might have short legs, or long arms; I have a brain with more active parts related to fear and anxiety; that’s how it is.

Wrong. To understand why we have to grasp a crucial concept called neuroplasticity.

Your brain changes according to how you use it. Neuroplasticity is the tendency for the brain to continue to restructure itself based on experience. Your brain is constantly changing to meet your needs. It does this mainly in two ways: by pruning the synapses you don’t use, and by growing the synapses you do use.

For as long as you live, this neuroplasticity never stops, and the brain is always changing.

A brain scan is a snapshot of a moving picture. You can take a snapshot of any moment in a football game, it doesn’t tell you what’s going to happen next, or where the brain is going. The brain changes as you become depressed and anxious, and it changes again when you stop being depressed and anxious. It’s always changing in response to signals from the world.

Social and psychological factors have the capacity to physically change your brain. Being lonely, or isolated, or grossly materialistic, these things change your brain, and, crucially, reconnection can change it back.

We have been thinking too simplistically. You couldn’t figure out the plot of Breaking Bad by dismantling your TV set. In the same way, you can’t figure out the root of your pain by dismantling your brain. You have to look at the signals the TV, or your brain, is receiving to do that.

They, the distress caused by the outside world, and the changes inside the brain come together.

Once this process begins, it, like everything else that happens to us, causes real changes in the brain, and they can then acquire a momentum of their own that deepens the effects from the outside world.

Imagine that your marriage just broke up, and you lost your job, and you know what? Your mother just had a stroke. It’s pretty overwhelming. Because you are feeling intense pain for a long period, your brain will assume this is the state in which you are going to have to survive from now on, so it might start to shed the synapses that relate to the things that give you joy and pleasure, and strengthen the synapses that relate to fear and despair. That’s one reason why you can often start to feel you have become somehow fixed in a state of depression or anxiety even if the original causes of the pain seems to have passed.

While it’s wrong to say the origin of these problems is solely within the brain, it would be equally wrong to say that the responses within the brain can’t make it worse. They can. The pain caused by life going wrong can trigger a response that is so powerful that the brain tends to stay there, in a pained response, for a while, until something pushes it out of that corner, into a more flexible place.

And if the world keeps causing you deep pain, of course you’ll stay trapped there for a long time, with the snowball growing.

How much of depression is carried in your genes?

I had assumed I inherited it in my genes. I sometimes thought of depression as a lost twin, born in the womb alongside me.

Scientists haven’t identified a specific gene or set of genes that can, on their own, cause depression and anxiety, but we do know there is a big genetic factor.

Scientists studying the genetic basis for depression and anxiety have concluded that it’s real, but it doesn’t account for most of what is going on. There is, however, a twist here.

A group of scientists led by a geneticist named Avshalom Caspi did one of the most detailed studies of the genetics of depression ever conducted. For twenty-five years, his team followed a thousand kids in New Zealand from being babies to adulthood. One of the things they were trying to figure out was which genes make you more vulnerable to depression.

Years into their work, they found something striking. They discovered that having a variant of a gene called 5-HTT does relate to becoming depressed.

Yet there was a catch. We are all born with a genetic inheritance, but your genes are activated by the environment. They can be switched on, or off, by what happens to you.

If you have a particular flavor of 5-HTT, you have a greatly increased risk of depression, but only in a certain environment. If you carried this gene, the study showed, you were more likely to become depressed, but only if you had experienced a terribly stressful event, or a great deal of childhood trauma.

If those bad things hadn’t happened to you, even if you had the gene that related to depression, you were no more likely to become depressed than anyone else.

So genes increase your sensitivity, sometimes significantly. But they aren’t, in themselves, the cause of depression.

This means that if other genes work like 5-HTT, and it looks as if they do, then nobody is condemned to be depressed or anxious by their genes.

Your genes can certainly make you more vulnerable, but they don’t write your destiny.

For example, we know that even if you are genetically more prone to put on weight, you still have to have lots of food in your environment for your genetic propensity to put on weight to kick in. Stranded in the rain forest or the desert with nothing to eat, you’ll lose weight whatever your genetic inheritance is.

Depression and anxiety, the current evidence suggests, are a little like that. The genetic factors that contribute to depression and anxiety are very real, but they also need a trigger in your environment or your psychology. Your genes can then supercharge those factors, but they can’t create them alone.

Endogenous Depression?

Is there some group of depressed people whose pain really is caused in just the way my doctor explained to me, by their brain wiring going wrong, or some other innate flaw? If it exists, how common is it?

It used to be thought that some depressions are caused by what happened to us in our lives, and then there is another, purer kind of depression that is caused by something going badly wrong in your brain. The first kind of depression was called “reactive,” and the second, purely internal kind was called “endogenous.”

Scientists have studied people who had been hospitalized for reactive depressions and compared them to people who had been classed as having endogenous depressions. It turned out that their circumstances were exactly the same: they had had an equal amount of things happen to them to trigger their despair. The distinction seemed, to them at that time, based on their evidence, to be meaningless.

There’s no agreement and scant evidence that endogenous depression actually exists, but researchers generally agree that if it exists at all, it’s a tiny minority of depressed people. This means that telling all depressed people a story that focuses only on these physical causes is a bad idea.

There are however situations, in addition to manic depression and bipolar disorder where we know that a biological change can make you more vulnerable. People with glandular fever, or underactive thyroids, are significantly more likely to become depressed.

It is foolish to deny there is a real biological component to depression and anxiety, and there may be other biological contributions we haven’t identified yet, but it is equally foolish to say they are the only causes.

Why then do we cling to the idea these problems are caused only by our brains.

Junk Values. You can have everything a person could possibly need by the standards of our culture, but those standards can badly misjudge what a human actually needs in order to have a good or even a tolerable life. Our culture creates a picture of what you “need” to be happy, through all the junk values we have been taught, that doesn’t fit with what we actually need.

Get a Grip. For a long time, depressed and anxious people have been told their distress is not real, that it is just laziness, or weakness, or self-indulgence.

The right-wing British pundit Katie Hopkins said depression is “the ultimate passport to self-obsession. Get a grip, people,” and added that they should just go out for a run and get over their moaning.

The way we have resisted this form of nastiness is to say that depression is a disease. You wouldn’t hector a person with cancer to pull themselves together, so it’s equally cruel to do it to somebody with the disease of depression or severe anxiety. The path away from stigma has been to explain patiently that this is a physical illness like diabetes or cancer.

We have come to believe that the only route out of stigma is to explain to people that this is a biological disease with purely biological causes. So, based on this positive motive, we have scrambled to find the biological effects, and held them up as evidence to rebut the sneerers.
“See! Even you admit it’s not a disease like cancer. So pull yourself together!”

But does saying something is a disease really reduce stigma?
Everybody knew, right from the start, that AIDS was a disease. It didn’t stop people with AIDS from being horribly stigmatized. People with AIDS are still stigmatized, greatly stigmatized. Nobody ever doubted leprosy was a disease, and lepers were persecuted for millennia.

Professor Sheila Mehta set up an experiment to figure out whether saying that something is a disease makes people kinder to the sufferer, or crueller.

Believing depression was a disease didn’t reduce hostility. In fact, it increased it.

“This way is better”, Marc said, “because if it’s an innate biological disease, the most you can hope for from other people is sympathy, a sense that you, with your difference, deserve their big-hearted kindness.
But if it’s a response to how we live, you can get something richer: empathy, because it could happen to any of us. It’s not some alien thing. It’s a universal human source of vulnerability.

The evidence suggests Marc is right, looking at it this way makes people less cruel, to themselves and to other people.

Pills Pay Big

For decades, psychiatrists have, in their training, been taught something called the bio-psycho-social model. They are shown that depression and anxiety have three kinds of causes: biological, psychological, and social. And yet almost nobody I know who has become depressed or severely anxious was told this story by their doctor, and most were not offered help for anything except their brain chemistry.

Why? CASH!

It is much more politically challenging to say that so many people are feeling terrible because of how our societies now work. It fits much more with our system of neoliberal capitalism to say, “Okay, we’ll get you functioning more efficiently, but please don’t start questioning … because that’s going to destabilize all sorts of things.”

The pharmaceutical companies are major forces shaping a lot of psychiatry, because it’s this big, big business, billions of dollars.

They pay the bills, so they largely set the agenda, and they obviously want our pain to be seen as a chemical problem with a chemical solution. The result is that we have ended up, as a culture, with a distorted sense of our own distress.

Just defective tissue!?

Telling people their distress is due mostly or entirely to a biological malfunction has several dangerous effects on them.

You leave the person disempowered, feeling they’re not good enough, because their brain’s not good enough.

Secondly: it pitches us against parts of ourselves. It says there is a war taking place in your head. On one side there are your feelings of distress, caused by the malfunctions in your brain or genes. On the other side there’s the sane part of you. You can only hope to drug the enemy within into submission, forever.

But it does something even more profound than that. It tells you that your distress has no meaning, it’s just defective tissue.

This is the biggest division between the old story about depression and anxiety and the new story. The old story says our distress is fundamentally irrational, caused by faulty apparatus in our head. The new story says our distress is, however painful, in fact rational, and Sane.

You’re not crazy to feel so distressed. You’re not broken.

“It is no measure of health to be well-adjusted to a sick society.” Jiddu Krishnamurti.


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

by Johann Hari

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).

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).

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.

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.

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


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.


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.

. . .


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

DEPRESSION, IT’S OUR HABITAT! Biophilia – Edward O. Wilson.

“I imagined that this place and all its treasures were mine alone and might be so forever in memory, if the bulldozer came.”

To explore and affiliate with life is a deep and complicated process in our mental development. Our existence depends on this propensity, our spirit is woven from it, hope rises on its currents.

To the degree that we come to understand other organisms, we will place a greater value on them, and on ourselves.

Everywhere I have gone, South America, Australia, New Guinea, Asia, I have thought that jungles and grasslands are the logical destinations, and towns and farmland the labyrinths that people have imposed between them sometime in the past. I cherish the green enclaves accidentally left behind.

What if humans, like animals in a zoo, become depressed when we are deprived of access to the kind of landscape we evolved in?

It’s been known for a long time that all sorts of mental health problems, including ones as severe as psychosis and schizophrenia, are considerably worse in cities than in the countryside.

Studies have clearly shown that people who move to green areas experience a big reduction in depression, and people who move away from green areas see a big increase in depression.

One of the most striking studies is perhaps the most simple. They got people who lived in cities to take a walk in nature, and then tested their mood and concentration. Everyone, predictably, felt better and was able to concentrate more, but the effect was dramatically bigger for people who had been depressed. Their improvement was five times greater than the improvement for other people.

Why would this be? What was going on?

We have been animals that move for a lot longer than we have been animals that talk and convey concepts, but we still think that depression can be cured by this conceptual layer. I think the first answer is more simple. Let’s fix the physiology first. Get out. Move!

The scientific evidence is clear that exercise significantly reduces depression and anxiety, because it returns us to our more natural state, one where we are embodied, we are animal, we are moving, our endorphins are rushing. Kids or adults who are not moving, and are not in nature for a certain amount of time, cannot be considered fully healthy animals.

When scientists have compared people who run on treadmills in the gym with people who run in nature, they found that both see a reduction in depression, but it’s higher for the people who run in nature. So what are the other factors?

Biologist Edward O. Wilson, one of the most important people in his field in the twentieth century, argued that all humans have a natural sense of something called Biophilia, an innate love for the landscapes in which humans have lived for most of our existence, and for the natural web of life that surrounds us and makes our existence possible. Almost all animals get distressed if they are deprived of the kinds of landscape that they evolved to live in. A frog can live on land, it’ll just be miserable as hell and give up.

Why would humans be the one exception to this rule? Looking around us: it’s our habitat that’s making us depressed.

This is a hard concept to test scientifically, but there has been one attempt to do it. The social scientists Gordon Orians and Judith Heerwagen worked with teams all over the world, in radically different cultures, and showed them a range of pictures of very different landscapes, from the desert to the city to the savanna. What they found is that everywhere, no matter how different their culture, people had a preference for landscapes that look like the savannas of Africa. There’s something about it, they conclude, that seems to be innate.

Johann Hari

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


by Edward O. Wilson

ON MARCH 12, 1961, I stood in the Arawak village of Bernhardsdorp and looked south across the white-sand coastal forest of Surinam. For reasons that were to take me twenty years to understand, that moment was fixed with uncommon urgency in my memory. The emotions I felt were to grow more poignant at each remembrance, and in the end they changed into rational conjectures about matters that had only a distant bearing on the original event.

The object of the reflection can be summarized by a single word, biophilia, which I will be so bold as to define as the innate tendency to focus on life and lifelike processes. Let me explain it very briefly here and then develop the larger theme as I go along.

From infancy we concentrate happily on ourselves and other organisms. We learn to distinguish life from the inanimate and move toward it like moths to a porch light. Novelty and diversity are particularly esteemed; the mere mention of the word extraterrestrial evokes reveries about still unexplored life, displacing the old and once potent exotic that drew earlier generations to remote islands and jungled interiors. That much is immediately clear, but a great deal more needs to be added. I will make the case that to explore and affiliate with life is a deep and complicated process in mental development. To an extent still undervalued in philosophy and religion, our existence depends on this propensity, our spirit is woven from it, hope rises on its currents.

There is more. Modern biology has produced a genuinely new way of looking at the world that is incidentally congenial to the inner direction of biophilia. In other words, instinct is in this rare instance aligned with reason. The conclusion I draw is optimistic: to the degree that we come to understand other organisms, we will place a greater value on them, and on ourselves.


AT BERNHARDSDORP on an otherwise ordinary tropical morning, the sunlight bore down harshly, the air was still and humid, and life appeared withdrawn and waiting. A single thunder-head lay on the horizon, its immense anvil shape diminished by distance, an intimation of the rainy season still two or three weeks away. A footpath tunneled through the trees and lianas, pointing toward the Saramacca River and far beyond, to the Orinoco and Amazon basins. The woodland around the village struggled up from the crystalline sands of the Zanderij formation. It was a miniature archipelago of glades and creekside forest enclosed by savannagrassland with scattered trees and high bushes. To the south it expanded to become a continuous lacework fragmenting the savanna and transforming it in turn into an archipelago. Then, as if conjured upward by some unseen force, the woodland rose by stages into the triple-canopied rain forest, the principal habitat of South America’s awesome ecological heartland.

In the village a woman walked slowly around an iron cooking pot, stirring the fire beneath with a soot-blackened machete. Plump and barefoot, about thirty years old, she wore two long pigtails and a new cotton dress in a rose floral print. From politeness, or perhaps just shyness, she gave no outward sign of recognition. I was an apparition, out of place and irrelevant, about to pass on down the footpath and out of her circle of required attention. At her feet a small child traced meanders in the dirt with a stick. The village around them was a cluster of no more than ten one-room dwellings. The walls were made of palm leaves woven into a herringbone pattern in which dark bolts zigzagged upward and to the onlooker’s right across flesh-colored squares. The design was the sole indigenous artifact on display. Bernhardsdorp was too close to Paramaribo, Surinam’s capital, with its flood of cheap manufactured products to keep the look of a real Arawak village. In culture as in name, it had yielded to the colonial Dutch.

A tame peccary watched me with beady concentration from beneath the shadowed eaves of a house. With my own, taxonomist’s eye I registered the defining traits of the collared species, Dicotytes tajacu: head too large for the piglike body, fur coarse and brindled, neck circled by a pale thin stripe, snout tapered, ears erect, tail reduced to a nub. Poised on stiff little dancer’s legs, the young male seemed perpetually fierce and ready to charge yet frozen in place, like the metal boar on an ancient Gallic standard.

A note: Pigs, and presumably their close relatives the peccaries, are among the most intelligent of animals. Some biologists believe them to be brighter than dogs, roughly the rivals of elephants and porpoises. They form herds of ten to twenty members, restlessly patrolling territories of about a square mile. In certain ways they behave more like wolves and dogs than social ungulates. They recognize one another as individuals, sleep with their fur touching, and bark back and forth when on the move. The adults are organized into dominance orders in which the females are ascendant over males, the reverse of the usual mammalian arrangement. They attack in groups if cornered, their scapular fur bristling outward like porcupine quills, and can slash to the bone with sharp canine teeth. Yet individuals are easily tamed if captured as infants and their repertory stunted by the impoverishing constraints of human care.

So I felt uneasy, perhaps the word is embarrassed, in the presence of a captive individual. This young adult was a perfect anatomical specimen with only the rudiments of social behavior. But he was much more: a powerful presence, programed at birth to respond through learning steps in exactly the collared-peccary way and no other to the immemorial environment from which he had been stolen, now a mute speaker trapped inside the unnatural clearing, like a messenger to me from an unexplored world.

I stayed in the village only a few minutes. I had come to study ants and other social insects living in Surinam. No trivial task: over a hundred species of ants and termites are found within a square mile of average South American tropical forest. When all the animals in a randomly selected patch of woodland are collected together and weighed, from tapirs and parrots down to the smallest insects and roundworms, one third of the weight is found to consist of ants and termites. If you close your eyes and lay your hand on a tree trunk almost anywhere in the tropics until you feel something touch it, more times than not the crawler will be an ant. Kick open a rotting log and termites pour out. Drop a crumb of bread on the ground and within minutes ants of one kind or another drag it down a nest hole. Foraging ants are the chief predators of insects and other small animals in the tropical forest, and termites are the key animal decomposers of wood. Between them they form the conduit for a large part of the energy flowing through the forest. Sunlight to leaf to caterpillar to ant to anteater to jaguar to maggot to humus to termite to dissipated heat: such are the links that compose the great energy network around Surinam’s villages.

I carried the standard equipment of a field biologist: camera; canvas satchel containing forceps, trowel, ax, mosquito repellent, jars, vials of alcohol, and notebook; a twenty-power hand lens swinging with a reassuring tug around the neck; partly fogged eyeglasses sliding down the nose and khaki shirt plastered to the back with sweat. My attention was on the forest; it has been there all my life. I can work up some appreciation for the travel stories of Paul Theroux and other urbanophile authors who treat human settlements as virtually the whole world and the intervening natural habitats as troublesome barriers. But everywhere I have gone, South America, Australia, New Guinea, Asia-I have thought exactly the opposite. Jungles and grasslands are the logical destinations, and towns and farmland the labyrinths that people have imposed between them sometime in the past. I cherish the green enclaves accidentally left behind.

Once on a tour of Old Jerusalem, standing near the elevated site of Solomon’s Throne, I looked down across the Jericho Road to the dark olive trees of Gethsemane and wondered which native Palestinian plants and animals might still be found in the shade underneath. Thinking of “Go to the ant, thou sluggard; consider her ways,” I knelt on the cobblestones to watch harvester ants carry seeds down holes to their subterranean granaries, the same food-gathering activity that had impressed the Old Testament writer, and possibly the same species at the very same place. As I walked with my host back past the Temple Mount toward the Muslim Quarter, I made inner calculations of the number of ant species found within the city walls. There was a perfect logic to such eccentricity: the million-year history of Jerusalem is at least as compelling as its past three thousand years.

AT BERNHARDSDORP I imagined richness and order as an intensity of light. The woman, child, and peccary turned into incandescent points. Around them the village became a black disk, relatively devoid of life, its artifacts adding next to nothing. The woodland beyond was a luminous bank, sparked here and there by the moving lights of birds, mammals, and larger insects.

I walked into the forest, struck as always by the coolness of the shade beneath tropical vegetation, and continued until I came to a small glade that opened onto the sandy path. I narrowed the world down to the span of a few meters. Again I tried to compose the mental set, call it the naturalist’s trance, the hunter’s trance, by which biologists locate more elusive organisms. I imagined that this place and all its treasures were mine alone and might be so forever in memory, if the bulldozer came.

In a twist my mind came free and I was aware of the hard workings of the natural world beyond the periphery of ordinary attention, where passions lose their meaning and history is in another dimension, without people, and great events pass without record or judgment. I was a transient of no consequence in this familiar yet deeply alien world that I had come to love. The uncounted products of evolution were gathered there for purposes having nothing to do with me; their long Cenozoic history was enciphered into a genetic code I could not understand. The effect was strangely calming. Breathing and heartbeat diminished, concentration intensified. It seemed to me that something extraordinary in the forest was very close to where I stood, moving to the surface and discovery.

I focused on a few centimeters of ground and vegetation. I willed animals to materialize, and they came erratically into view. Metallic-blue mosquitoes floated down from the canopy in search of a bare patch of skin, cockroaches with variegated wings perched butterfly-like on sunlit leaves, black carpenter ants sheathed in recumbent golden hairs filed in haste through moss on a rotting log. I turned my head slightly and all of them vanished. Together they composed only an infinitesimal fraction of the life actually present. The woods were a biological maelstrom of which only the surface could be scanned by the naked eye. Within my circle of vision, millions of unseen organisms died each second. Their destruction was swift and silent; no bodies thrashed about, no blood leaked into the ground. The microscopic bodies were broken apart in clean biochemical chops by predators and scavengers, then assimilated to create millions of new organisms, each second.

Ecologists speak of “chaotic regimes” that rise from orderly processes and give rise to others in turn during the passage of life from lower to higher levels of organization. The forest was a tangled bank tumbling down to the grassland’s border. Inside it was a living sea through which I moved like a diver groping across a littered floor. But I knew that all around me bits and pieces, the individual organisms and their populations, were working with extreme precision. A few of the species were locked together in forms of symbiosis so intricate that to pull out one would bring others spiraling to extinction. Such is the consequence of adaptation by coevolution, the reciprocal genetic change of species that interact with each other through many life cycles.

Eliminate just one kind of tree out of hundreds in such a forest, and some of its pollinators, leafeaters, and woodborers will disappear with it, then various of their parasites and key predators, and perhaps a species of bat or bird that depends on its fruit, and when will the reverberations end? Perhaps not until a large part of the diversity of the forest collapses like an arch crumbling as the keystone is pulled away. More likely the effects will remain local, ending with a minor shift in the overall pattern of abundance among the numerous surviving species. In either case the effects are beyond the power of present-day ecologists to predict. It is enough to work on the assumption that all of the details matter in the end, in some unknown but vital way.

After the sun’s energy is captured by the green plants, it flows through chains of organisms dendritically, like blood spreading from the arteries into networks of microscopic capillaries. It is in such capillaries, in the life cycles of thousands of individual species, that life’s important work is done. Thus nothing in the whole system makes sense until the natural history of the constituent species becomes known. The study of every kind of organism matters, everywhere in the world. That conviction leads the field biologist to places like Surinam and the outer limits of evolution, of which this case is exemplary:

The three-toed sloth feeds on leaves high in the canopy of the lowland forests through large portions of South and Central America. Within its fur live tiny moths, the species Cryptoses choloepi, found nowhere else on Earth. When a sloth descends to the forest floor to defecate (once a week), female moths leave the fur briefly to deposit their eggs on the fresh dung. The emerging caterpillars build nests of silk and start to feed. Three weeks later they complete their development by turning into adult moths, and then fly up into the canopy in search of sloths. By living directly on the bodies of the sloths, the adult Cryptoses assure their offspring first crack at the nutrient-rich excrement and a competitive advantage over the myriad of other coprophages.

At Bernhardsdorp the sun passed behind a small cloud and the woodland darkened. For a moment all that marvelous environment was leveled and subdued. The sun came out again and shattered the vegetative surfaces into light-based niches. They included intensely lighted leaf tops and the tops of miniature canyons cutting vertically through tree bark to create shadowed depths two or three centimeters below. The light filtered down from above as it does in the sea, giving out permanently in the lowermost recesses of buttressed tree trunks and penetralia of the soil and rotting leaves. As the light’s intensity rose and fell with the transit of the sun, Silverfish, beetles, spiders, bark lice, and other creatures were summoned from their sanctuaries and retreated back in alternation. They responded according to receptor thresholds built into their eyes and brains, filtering devices that differ from one kind of animal to another. By such inborn controls the species imposed a kind of prudent self-discipline. They unconsciously halted their population growth before squeezing out competitors, and others did the same. No altruism was needed to achieve this balance, only specialization. Coexistence was an incidental by-product of the Darwinian advantage that accrued from the avoidance of competition. During the long span of evolution the species divided the environment among themselves, so that now each tenuously preempted certain of the capillaries of energy flow. Through repeated genetic changes they sidestepped competitors and built elaborate defenses against the host of predator species that relentlessly tracked them through matching genetic countermoves. The result was a splendid array of specialists, including moths that live in the fur of three-toed sloths.

Now to the very heart of wonder.

Because species diversity was created prior to humanity, and because we evolved within it, we have never fathomed its limits. As a consequence, the living world is the natural domain of the most restless and paradoxical part of the human spirit. Our sense of wonder grows exponentially: the greater the knowledge, the deeper the mystery and the more we seek knowledge to create new mystery. This catalytic reaction, seemingly an inborn human trait, draws us perpetually forward in a search for new places and new life. Nature is to be mastered, but (we hope) never completely. A quiet passion burns, not for total control but for the sensation of constant advance.

At Bernhardsdorp I tried to convert this notion into a form that would satisfy a private need. My mind maneuvered through an unending world suited to the naturalist. I looked in reverie down the path through the savanna woodland and imagined walking to the Saramacca River and beyond, over the horizon, into a timeless reconnaissance through virgin forests to the land of magical names, Yékwana, Jivaro, Sirioné, Tapirapé, Siona-Secoya, Yumana, back and forth, never to run out of fresh jungle paths and glades.

The same archetypal image has been shared in variations by others, and most vividly during the colonization of the New World. It comes through clearly as the receding valleys and frontier trails of nineteenth-century landscape art in the paintings of Albert Bierstadt, Frederick Edwin Church, Thomas Cole, and their contemporaries during the crossing of the American West and the innermost reaches of South America.

In Bierstadt’s Sunset in Yosemite Valley (1868), you look down a slope that eases onto the level valley floor, where a river flows quietly away through waist-high grass, thickets, and scattered trees. The sun is near the horizon. Its dying light, washing the surface in reddish gold, has begun to yield to blackish green shadows along the near side of the valley. A cloud bank has lowered to just beneath the tops of the sheer rock walls. More protective than threatening, it has transformed the valley into a tunnel opening out through the far end into a sweep of land.

. . .


Biophilia. The human bond with other species

by Edward O. Wilson

get it at Amazon.com

CHILDHOOD TRAUMA AND MENTAL ‘ILLNESS’. Beyond the smoke – Johann Hari.

Depression isn’t a disease; depression is a normal response to abnormal life experiences.

The medical team, and all their friends, expected these people, who had been restored to health to react with joy. Except they didn’t react that way. The people who did best, and lost the most weight were often thrown into a brutal depression, or panic, or rage. Some of them became suicidal.

Was there anything else that happened in your life when you were eleven? Well, Susan replied that was when my grandfather began to rape me.

“Overweight is overlooked, and that’s the way I need to be.”

What we had perceived as the problem, major obesity, was in fact, very frequently, the solution to problems that the rest of us knew nothing about. Obesity, he realized, isn’t the fire. It’s the smoke.

For every category of traumatic experience you go through as a kid, you are radically more likely to become depressed as an adult. The greater the trauma, the greater your risk of depression, anxiety, or suicide.

Emotional abuse especially, is more likely to cause depression than any other kind of trauma, even sexual molestation. Being treated cruelly by your parents is the biggest driver of depression, out of all these categories.

We have failed to see depression as a symptom of something deeper that needs to be dealt with. There’s a house fire inside many of us, and we’ve been concentrating on the smoke.

When the women first came into Dr. Vincent Felitti’s office some of them found it hard to fit through the door. These patients weren’t just a bit overweight: they were eating so much that they were rendering themselves diabetic and destroying their own internal organs. They didn’t seem to be able to stop themselves. They were assigned here, to his clinic, as their last chance.

It was the mid-1980s, and in the California city of San Diego, Vincent had been commissioned by the not-for-profit medical provider Kaiser Permanente to look into the fastest-growing driver of their costs, obesity. Nothing they were trying was working, so he was given a blank sheet of paper. Start from scratch, they said. Total blue-sky thinking. Figure out what we can do to deal with this. And so the patients began to come. But what he was going to learn from them led, in fact, to a major breakthrough in a very different area: how we think about depression and anxiety.

As he tried to scrape away all the assumptions that surround obesity, Vincent learned about a new diet plan based on a maddeningly simple thought. It asked: What if these severely overweight people simply stopped eating, and lived off the fat stores they’d built up in their bodies until they were down to a normal weight? What would happen?

In the news, curiously, there had recently been an experiment in which this was tried, eight thousand miles away, for somewhat strange reasons. For years in Northern Ireland if you were put in jail for being part of the Irish Republican Army’s violent campaign to drive the British out of Northern Ireland, you were classed as a political prisoner. That meant you were treated differently from people who committed (say) bank robberies. You were allowed to wear your own clothes, and you didn’t have to perform the same work as other inmates.

The British government decided to shut down that distinction, and they argued that the prisoners were simply common criminals and shouldn’t get this different treatment anymore. So the prisoners decided to protest by going on a hunger strike. They began, slowly, to waste away.

So the designers of this new diet proposal looked into the medical evidence about these Northern Ireland hunger strikers to find out what killed them. It turns out that the first problem they faced was a lack of potassium and magnesium. Without them, your heart stops beating properly. Okay, the radical dieters thought, what if you give people supplements of potassium and magnesium? Then that doesn’t happen. If you have enough fat on you, you get a few months more to live, until a protein deficiency kills you.

Okay, what if you also give people the supplements that will prevent that? Then, it turns out, you get a year to live, provided there’s enough fat. Then you’ll die from a lack of vitamin C, scurvy, or other deficiencies.

Okay, what if you give people supplements for that, too? Then it looks as though you’ll stay alive, Vincent discovered in the medical literature, and healthy, and you’ll lose three hundred pounds a year. Then you can start eating again, at a healthy level.

All this suggested that in theory, even the most obese person would be down to a normal weight within a manageable time. The patients coming to him had been through everything, every fad diet, every shaming, every prodding and pulling. Nothing had worked. They were ready to try anything. So, under careful monitoring, and with lots of supervision, they began this program. And as the months passed, Vincent noticed something. It worked. The patients were shedding weight. They were not getting sick, in fact, they were returning to health. People who had been rendered disabled by constant eating started to see their bodies transform in front of them.

Their friends and relatives applauded. People who knew them were amazed. Vincent believed he might have found the solution to extreme overweight. “I thought my god, we’ve got this problem licked,” he said.

And then something happened that Vincent never expected.

In the program, there were some stars, people who shed remarkable amounts of weight, remarkably quickly. The medical team, and all their friends, expected these people who had been restored to health to react with joy. Except they didn’t react that way.

The people who did best, and lost the most weight were often thrown into a brutal depression, or panic, or rage. Some of them became suicidal. Without their bulk, they felt they couldn’t cope. They felt unbelievably vulnerable. They often fled the program, gorged on fast food, and put their weight back on very fast.

Vincent was baffled. They were fleeing from a healthy body they now knew they could achieve, toward an unhealthy body they knew would kill them. Why? He didn’t want to be an arrogant, moralistic doctor, standing over his patients, wagging his finger and telling them they were ruining their lives, that’s not his character. He genuinely wanted to help them save themselves. So he felt desperate. That’s why he did something no scientist in this field had done with really obese people before. He stopped telling them what to do, and started listening to them instead. He called in the people who had panicked when they started to shed the pounds, and asked them: What happened when you lost weight? How did you feel?

There was one twenty-eight-year-old woman, who I’ll call Susan to protect her medical confidentiality. In fifty-one weeks, Vincent had taken Susan down from 408 pounds to 132 pounds. It looked like he had saved her life. Then, quite suddenly, for no reason anyone could see, she put on 37 pounds in the space of three weeks. Before long, she was back above 400 pounds. So Vincent asked her gently what had changed when she started to lose weight. It seemed mysterious to both of them. They talked for a long time. There was, she said eventually, one thing. When she was very obese, men never hit on her, but when she got down to a healthy weight, one day she was propositioned by a man, a colleague who she happened to know was married. She fled, and right away began to eat compulsively, and she couldn’t stop.

This was when Vincent thought to ask a question he hadn’t asked his patients before. When did you start to put on weight? If it was (say) when you were thirteen, or when you went to college, why then, and not a year before, or a year after?

Susan thought about the question. She had started to put on weight when she was eleven years old, she said. So he asked: Was there anything else that happened in your life when you were eleven? Well, Susan replied that was when my grandfather began to rape me.

Vincent began to ask all his patients these three simple questions. How did you feel when you lost weight? When in your life did you start to put on weight? What else happened around that time? As he spoke to the 183 people on the program, he started to notice some patterns. One woman started to rapidly put on weight when she was twenty-three. What happened then? She was raped. She looked at the ground after she confessed this, and said softly: “Overweight is overlooked, and that’s the way I need to be.”

“I was incredulous,” he told me when I sat with him in San Diego. “It seemed every other person I was asking was acknowledging such a history. I kept thinking, it can’t be. People would know if this was true. Somebody would’ve told me. Isn’t that what medical school is for?” When five of his colleagues came in to conduct further interviews, it turned out some 55 percent of the patients in the program had been sexually abused, far more than people in the wider population. And even more, including most of the men, had had severely traumatic childhoods.

Many of these women had been making themselves obese for an unconscious reason: to protect themselves from the attention of men, who they believed would hurt them. Being very fat stops most men from looking at you that way. It works. It was when he was listening to another grueling account of sexual abuse that it hit Vincent. He told me later:

“What we had perceived as the problem, major obesity, was in fact, very frequently, the solution to problems that the rest of us knew nothing about.”

Vincent began to wonder if the anti-obesity programs, including his own, had been doing it all wrong, by (for example) giving out nutritional advice. Obese people didn’t need to be told what to eat; they knew the nutritional advice better than he did. They needed someone to understand why they ate. After meeting a person who had been raped, he told me, “I thought with a tremendously clear insight that sending this woman to see a dietitian to learn how to eat right would be grotesque.”

Far from teaching the obese people, he realized they were the people who could teach him what was really going on. So he gathered the patients in groups of around fifteen, and asked them: “Why do you think people get fat? Not how. How is obvious. I’m asking why. What are the benefits?” Encouraged to think about it for the first time, they told him. The answers came in three different categories. The first was that it is sexually protective: men are less interested in you, so you are safer. The second was that it is physically protective: for example, in the program there were two prison guards, who lost between 100 and 150 pounds each. Suddenly, as they shed their bulk, they felt much more vulnerable among the prisoners, they could be more easily beaten up. To walk through those cell blocks with confidence, they explained, they needed to be the size of a refrigerator.

And the third category was that it reduced people’s expectations of them. “You apply for a job weighing four hundred pounds, people assume you’re stupid, lazy,” Vincent said. If you’ve been badly hurt by the world, and sexual abuse is not the only way this can happen, you often want to retreat. Putting on a lot of weight is, paradoxically, a way of becoming invisible to a lot of humanity.

“When you look at a house burning down, the most obvious manifestation is the huge smoke billowing out,” he told me. It would be easy, then, to think that the smoke is the problem, and if you deal with the smoke, you’ve solved it. But “thank God that fire departments understand that the piece that you treat is the piece you don’t see, the flames inside, not the smoke billowing out. Otherwise, house fires would be treated by bringing big fans to blow the smoke away. [And that would] make the house burn down faster.”

Obesity, he realized, isn’t the fire. It’s the smoke.

One day, Vincent went to a medical conference dedicated to obesity to present his findings. After he had spoken, a doctor stood up in the audience and explained: “People who are more familiar with these matters recognize that these statements by patients describing their sexual abuse, are basically fabrications, to provide a cover for their failed lives. It turned out people treating obesity had noticed before that a disproportionate number of obese people described being abused. They just assumed that they were making excuses.

Vincent was horrified. He had in fact verified the abuse claims of many of his patients, by talking to their relatives, or to law enforcement officials who had investigated them. But he knew he didn’t have hard scientific proof yet to rebut people like this. His impressions from talking to individual patients, even gathering the figures from within his group, didn’t prove much. He wanted to gather proper scientific data. So he teamed up with a scientist named Dr. Robert Anda, who had specialized for years in the study of why people do self-destructive things like smoking. Together, funded by the Center for Disease Control, a major US. agency funding medical research, they drew up a way of testing all this, to see if it was true beyond the small sample of people in Vincent’s program.

They called it the Adverse Childhood Experiences (ACE) Study, and it’s quite simple. It’s a questionnaire. You are asked about ten different categories of terrible things that can happen to you when you’re a kid, from being sexually abused, to being emotionally abused, to being neglected. And then there’s a detailed medical questionnaire, to test for all sorts of things that could be going wrong with you, like obesity, or addiction. One of the things they added to the list, almost as an afterthought, was the question: Are you suffering from depression?

This survey was then given to seventeen thousand people who were seeking health care, for a whole range of reasons, from Kaiser Permanente in San Diego. The people who filled in the form were somewhat wealthier and a little older than the general population, but otherwise fairly representative of the city’s population.

When the results came in, they added them up, at first, to see if there were any correlations.

It turned out that for every category of traumatic experience you went through as a kid, you were radically more likely to become depressed as an adult. If you had six categories of traumatic events in your childhood, you were five times more likely to become depressed as an adult than somebody who didn’t have any. If you had seven categories of traumatic events as a child, you were 3,100 percent more likely to attempt to commit suicide as an adult.

“When the results came out, I was in a state of disbelief,” Dr. Anda told me. “I looked at it and I said, really? This can’t be true.” You just don’t get figures like this in medicine very often. Crucially, they hadn’t just stumbled on proof that there is a correlation, that these two things happen at the same time. They seemed to have found evidence that these traumas help cause these problems. How do we know? The greater the trauma, the greater your risk of depression, anxiety, or suicide. The technical term for this is “dose-response effect.” The more cigarettes you smoke, the more your risk of lung cancer goes up, that’s one reason we know smoking causes cancer. In the same way, the more you were traumatized as a child, the more your risk of depression rises.

Curiously, it turned out emotional abuse was more likely to cause depression than any other kind of trauma, even sexual molestation. Being treated cruelly by your parents was the biggest driver of depression, out of all these categories.

When they showed the results to other scientists, including the Centers for Disease Control (CDC), who cofunded the research, they too were incredulous. “The study shocked people,” Dr. Anda told me. “People didn’t want to believe it. People at the CDC didn’t want to believe it. There was resistance within the CDC when I brought the data around, and the medical journals, initially, didn’t want to believe it, because it was so astonishing that they had to doubt it. Because it made them challenge the way they thought about childhood. It challenged so many things, all at one time.” In the years that followed, the study has been replicated many times, and it always finds similar results. But we have barely begun, Vincent told me, to think through its implications.

So Vincent, as he absorbed all this, came to believe that we have been making the same mistake with depression that he had been making before with obesity. We have failed to see it as a symptom of something deeper that needs to be dealt with. There’s a house fire inside many of us, Vincent had come to believe, and we’ve been concentrating on the smoke.

Many scientists and psychologists had been presenting depression as an irrational malfunction in your brain or in your genes, but he learned that Allen Barbour, an internist at Stanford University, had said that depression isn’t a disease; depression is a normal response to abnormal life experiences. “I think that’s a very important idea,” Vincent told me. “It takes you beyond the comforting, limited idea that the reason I’m depressed is I have a serotonin imbalance, or a dopamine imbalance, or what have you.” It is true that something is happening in your brain when you become depressed, he says, but that “is not a causal explanation”; it is “a necessary intermediary mechanism.”

Some people don’t want to see this because, at least at first, “it’s more comforting,” Vincent said, to think it’s all happening simply because of changes in the brain. “It takes away an experiential process and substitutes a mechanistic process.” It turns your pain into a trick of the light that can be banished with drugs. But they don’t ultimately solve the problem, he says, any more than just getting the obese patients to stop eating solved their problems. “Medications have a role,” he told me. “Are they the ultimate be and end-all? No. Do they sometimes short-change people? Absolutely.”

To solve the problem for his obese patients, Vincent said, they had all realized, together, that they had to solve the problems that were leading them to eat obsessively in the first place. So he set up support groups where they could discuss the real reasons why they ate and talk about what they had been through. Once that was in place, far more people became able to keep going through the fasting program and stay at a safe weight. He was going to start exploring a way to do this with depression, with startling results.

More than anyone else I spoke to about the hidden causes of depression, Vincent made me angry. After I met with him, I went to the beach in San Diego and raged against what he had said. I was looking hard for reasons to dismiss it. Then I asked myself. Why are you so angry about this? It seemed peculiar, and I didn’t really understand it. Then, as I discussed it with some people I trust, I began to understand.

If you believe that your depression is due solely to a broken brain, you don’t have to think about your life, or about what anyone might have done to you. The belief that it all comes down to biology protects you, in a way, for a while. If you absorb this different story, though, you have to think about those things. And that hurts.

I asked Vincent why he thinks traumatic childhoods so often produce depressed and anxious adults, and he said that he honestly doesn’t know. He’s a good scientist. He didn’t want to speculate. But I think I might know, although it goes beyond anything I can prove scientifically.

When you are a child and you experience something really traumatic, you almost always think it is your fault. There’s a reason for this, and it’s not irrational; like obesity, it is, in fact, a solution to a problem most people can’t see. When I was young, my mother was ill a lot, and my father was mostly gone, usually in a different country. In the chaos of that, I experienced some extreme acts of violence from an adult in my life. For example, I was strangled with an electrical cord on one occasion. By the time I was sixteen, I left to go and live in another city, away from any adults I knew, and when I was there, I found myself, like many people who have been treated this way at a formative age, seeking out dangerous situations where I was again treated in ways I should not have been treated.

Even now, as a thirty-seven-year-old adult, I feel like writing this down, and saying it to you, is an act of betrayal of the adult who carried out these acts of violence, and the other adults who behaved in ways they shouldn’t have.

I know you can’t figure out who these people are from what I’ve written. I know that if I saw an adult strangling a child with an electrical cord, it would not even occur to me to blame the child, and that if I heard somebody try to suggest such a thing, I would assume they were insane. I know rationally where the real betrayal lies in this situation. But still, I feel it. It’s there, and that feeling almost stopped me from saying this.

Why do so many people who experience violence in childhood feel the same way? Why does it lead many of them to self-destructive behavior, like obesity, or hard core addiction, or suicide? I have spent a lot of time thinking about this. When you’re a child, you have very little power to change your environment. You can’t move away, or force somebody to stop hurting you. So you have two choices. You can admit to yourself that you are powerless, that at any moment, you could be badly hurt, and there’s simply nothing you can do about it. Or you can tell yourself it’s your fault. If you do that, you actually gain some power, at least in your own mind. If it’s your fault, then there’s something you can do that might make it different. You aren’t a pinball being smacked around a pinball machine. You’re the person controlling the machine. You have your hands on the dangerous levers.

In this way, just like obesity protected those women from the men they feared would rape them, blaming yourself for your childhood traumas protects you from seeing how vulnerable you were and are. You can become the powerful one. If it’s your fault, it’s under your control.

But that comes at a cost. If you were responsible for being hurt, then at some level, you have to think you deserved it. A person who thinks they deserved to be injured as a child isn’t going to think they deserve much as an adult, either.

This is no way to live. But it’s a misfiring of the thing that made it possible for you to survive at an earlier point in your life.

You might have noticed that this cause of depression and anxiety is a little different from the ones I have discussed up to now, and it’s different from the ones I’m going to discuss next.

As I mentioned before, most people who have studied the scientific evidence accept that there are three different kinds of causes of depression and anxiety, biological, psychological, and social. The causes I’ve discussed up to now, and will come back to in a moment, are environmental. I’ll come to biological factors soon.

But childhood trauma belongs in a different category. It’s a psychological cause. By discussing it here, I’m hoping childhood trauma can indicate toward the many other psychological causes of depression that are too specific to be discussed in a big, broad way. The ways our psyches can be damaged are almost infinite. I know somebody whose wife cheated on him for years with his best friend and who became deeply depressed when he found out. I know somebody who survived a terror attack and was almost constantly anxious for a decade after. I know someone whose mother was perfectly competent and never cruel to her but was relentlessly negative and taught her always to see the worst in people and to keep them at a distance. You can’t squeeze these experiences into neat categories, it wouldn’t make sense to list “adultery,” “terror attacks,” or “cold parents” as causes of depression and anxiety.

But here’s what we know.

Psychological damage doesn’t have to be as extreme as childhood violence to affect you profoundly. Your wife cheating on you with your best friend isn’t a malfunction in your brain. But it is a cause of deep psychological distress, and it can cause depression and anxiety. If you are ever told a story about these problems that doesn’t talk about your personal psychology, don’t take it seriously.

Dr. Anda, one of the pioneers of this research, told me it had forced him to turn his thinking about depression and other problems inside out.

“When people have these kind of problems, it’s time to stop asking what’s wrong with them,” he said, “and time to start asking what happened to them.”


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

by Johann Hari

get it at Amazon.com


Just as we have shifted en masse from eating food to eating junk food, we have also shifted from having meaningful values to having junk values.

All this mass-produced fried chicken looks like food, and it appeals to the part of us that evolved to need food; yet it doesn’t give us what we need from food, nutrition. Instead, it fills us with toxins.

In the same way, all these materialistic values, telling us to spend our way to happiness, look like real values; they appeal to the part of us that has evolved to need some basic principles to guide us through life; yet they don’t give us what we need from values, a path to a satisfying life.

Studies show that materialistic people are having a worse time, day by day, on all sorts of fronts. They feel sicker, and they are angrier. Something about a strong desire for materialistic pursuits actually affects their day-to-day lives, and decreases the quality of their daily experience. They experienced less joy, and more despair.

For thousands of years, philosophers have been suggesting that if you overvalue money and possessions, or if you think about life mainly in terms of how you look to other people, you will be unhappy.

Modern research indicates that materialistic people, who think happiness comes from accumulating stuff and a superior status, have much higher levels of depression and anxiety. The more our kids value getting things and being seen to have things, the more likely they are to be suffering from depression and anxiety.

The pressure, in our culture, runs overwhelmingly one way, spend more; work more. We live under a system that constantly distracts us from what’s really good about life. We are being propagandized to live in a way that doesn’t meet our basic psychological needs, so we are left with a permanent, puzzling sense of dissatisfaction.

The more materialistic and extrinsically motivated you become, the more depressed you will be.

When I was in my late twenties, I got really fat. It was partly a side effect of antidepressants, and partly a side effect of fried chicken. I could still, from memory, talk you through the relative merits of all the fried chicken shops in East London that were the staples of my diet, from Chicken Cottage to Tennessee Fried Chicken (with its logo of a smiling cartoon chicken holding a bucket of fried chicken legs: who knew cannibalism could be an effective marketing tool?). My own favorite was the brilliantly named Chicken Chicken Chicken. Their hot wings were, to me, the Mona Lisa of grease.

One Christmas Eve, I went to my local branch of Kentucky Fried Chicken, and one of the staff behind the counter saw me approaching and beamed. “Johann!” he said. “We have something for you!” The other staff turned and looked at me expectantly. From somewhere behind the grill and the grizzle, he took out a Christmas card. I was forced, by their expectant smiles, to open it in front of them. “To our best customer,” it said, next to personal messages from every member of the staff.

I never ate at KFC again.

Most of us know there is something wrong with our physical diets. We aren’t all gold medalists in the consumption of lard like I was, but more and more of us are eating the wrong things, and it is making us physically sick. As I investigated depression and anxiety, I began to learn something similar is happening to our values, and it is making many of us emotionally sick.

This was discovered by an American psychologist named Tim Kasser, so I went to see him, to learn his story.

As a little boy, Tim arrived in the middle of a long stretch of swampland and open beaches. His dad worked as a manager at an insurance company, and in the early 1970s, he was posted to a place called Pinellas County, on the west coast of Florida. The area was mostly undeveloped and had plenty of big, broad outdoor spaces for a kid to play, but this county soon became the fastest growing in the entire United States, and it was about to be transformed in front of Tim’s eyes. “By the time I left Florida,” he told me, “it was a completely different physical environment. You couldn’t drive along the beach roads anymore and see the water, because it was all condos and high-rises. Areas that had been open land with alligators and rattlesnakes became subdivision after subdivision after shopping mall.”

Tim was drawn to the shopping malls that replaced the beaches and marshes, like all the other kids he knew. There, he would play Asteroids and Space Invaders for hours. He soon found himself longing for stuff, the toys he saw in ads.

It sounds like Edgware, where I am from. I was eight or nine when its shopping mall, the Broadwalk Centre, opened, and I remember wandering around its bright storefronts and gazing at the things I wanted to buy in a thrilled trance. I obsessively coveted the green plastic toy of Castle Grayskull, the fortress where the cartoon character He-Man lived, and Care-a-Lot, the home in the clouds of some animated creatures called the Care Bears. One Christmas, my mother missed my hints and failed to buy me Care-a-Lot, and I was crestfallen for months. I ached and pined for that lump of plastic.

Like most kids at the time, I spent at least three hours a day watching TV, usually more, and whole days would pass in the summer when my only break from television would be to go to the Broadwalk Centre and back again. I don’t remember anyone ever telling me this explicitly, but it seemed to me then that happiness meant being able to buy lots of the things on display there. I think my nine-year-old self, if you had asked him what it meant to be happy, would have said: somebody who could walk through the Broadwalk Centre and buy whatever he wanted. I would ask my dad how much each famous person I saw on television earned, and he would guess, and we would both marvel at what we would do with the money. It was a little bonding ritual, over a fantasy of spending.

I asked Tim if, in Pinellas County where he grew up, he ever heard anyone talking about a different way of valuing things, beyond the idea that happiness came from getting and possessing stuff. “Well, I think, not growing up. No,” he said. In Edgware, there must have been people who acted on different values, but I don’t think I ever saw them.

When Tim was a teenager, his swim coach moved away one summer and gave him a small record collection, and it included albums by John Lennon and Bob Dylan. As he listened to them, he realized they seemed to be expressing something he didn’t really hear anywhere else. He began to wonder if there were hints of a different way to live lying in their lyrics, but he couldn’t find anyone to discuss it with.

It was only when Tim went to study at Vanderbilt University, a very conservative college in the South, at the height of the Reagan years, that it occurred to him, slowly, to think more deeply about this. In 1984, he voted for Ronald Reagan, but he was starting to think a lot about the question of authenticity. “I was stumbling around,” he told me. “I think I was questioning just about everything. I wasn’t just questioning these values. I was questioning lots about myself, I was questioning lots about the nature of reality and the values of society.” He feels like there were pinatas all around him and he was hitting chaotically at them all. He added: “I think I went through that phase for a long time, to be honest.”

When he went to graduate school, he started to read a lot about psychology. It was around this time that Tim realized something odd.

For thousands of years, philosophers had been suggesting that if you overvalue money and possessions, or if you think about life mainly in terms of how you look to other people, you will be unhappy, that the values of Pinellas County and Edgware were, in some deep sense, mistaken. It had been talked about a lot, by some of the finest minds who ever lived, and Tim thought it might be true. But nobody had ever conducted a scientific investigation to see whether all these philosophers were right.

This realization is what launched him on a project that he was going to pursue for the next twenty-five years. It led him to discover subtle evidence about why we feel the way we do, and why it is getting worse.

It all started in grad school, with a simple survey.

Tim came up with a way of measuring how much a person really values getting things and having money compared to other values, like spending time with their family or trying to make the world a better place. He called it the Aspiration Index, and it is pretty straightforward. You ask people how much they agree with statements such as “It is important to have expensive possessions” and how much they agree with very different statements such as “It is important to make the world a better place for others.” You can then calculate their values.

At the same time, you can ask people lots of other questions, and one of them is whether they are unhappy or if they are suffering (or have suffered) from depression or anxiety. Then, as a first step, you see if they match.

Tim’s first tentative piece of research was to give this survey to 316 students. When the results came back and were all calculated out, Tim was struck by the results: materialistic people, who think happiness comes from accumulating stuff and a superior status, had much higher levels of depression and anxiety.

This was, he knew, just a primitive first shot in the dark. So Tim’s next step was, as part of a larger study, to get a clinical psychologist to assess 140 eighteen-year-olds in depth, calculating where they were on the Aspiration Index and if they were depressed or anxious. When the results were added up, they were the same: the more the kids valued getting things and being seen to have things, the more likely they were to be suffering from depression and anxiety.

Was this something that happened only with young people? To find out, Tim measured one hundred citizens of Rochester in upstate New York, who came from a range of age groups and economic backgrounds. The result was the same.

But how could he figure out what was really happening, and why?

Tim’s next step was to conduct a more detailed study, to track how these values affect you over time. He got 192 students to keep a detailed mood diary in which, twice a day, they had to record how much they were feeling nine different emotions, such as happiness or anger, and how much they were experiencing any of nine physical symptoms, such as backache. When he calculated out the results, he found, again, higher depression among the materialistic students; but there was a result more important than that. It really did seem that materialistic people were having a worse time, day by day, on all sorts of fronts. They felt sicker, and they were angrier. “Something about a strong desire for materialistic pursuits,” he was starting to believe, “actually affected the participants’ day-to-day lives, and decreased the quality of their daily experience.” They experienced less joy, and more despair.

Why would this be? What could be happening here? Ever since the 1960s, psychologists have known that there are two different ways you can motivate yourself to get out of bed in the morning. The first are called intrinsic motives, they are the things you do purely because you value them in and of themselves, not because of anything you get out of them. When a kid plays, she’s acting totally on intrinsic motives, she’s doing it because it gives her joy. The other day, I asked my friend’s five-year-old son why he was playing. “Because I love it,” he said. Then he scrunched up his face and said “You’re silly!” and ran off, pretending to be Batman. These intrinsic motivations persist all through our lives, long after childhood.

At the same time, there’s a rival set of values, which are called extrinsic motives. They’re the things you do not because you actually want to do them, but because you’ll get something in return, whether it’s money, or admiration, or sex, or superior status. Joe, who you met two chapters ago, went to work every day in the paint shop for purely extrinsic reasons, he hated the job, but he needed to be able to pay the rent, buy the Oxy that would numb his way through the day, and have the car and clothes that he thought made people respect him. We all have some motives like that.

Imagine you play the piano. If you play it for yourself because you love it, then you are being driven to do it by intrinsic values. If you play in a dive bar you hate, just to make enough cash to ensure you don’t get thrown out of your apartment, then you are being driven to do it by extrinsic values.

These rival sets of values exist in all of us. Nobody is driven totally by one or the other.

Tim began to wonder if looking into this conflict more deeply could reveal something important. So he started to study a group of two hundred people in detail over time. He got them to lay out their goals for the future. He then figured out with them if these were extrinsic goals, like getting a promotion, or a bigger apartment, or intrinsic goals, like being a better friend or a more loving son or a better piano player. And then he got them to keep a detailed mood diary.

What he wanted to know was, Does achieving extrinsic goals make you happy? And how does that compare to achieving intrinsic goals?

The results, when he calculated them out were quite startling. People who achieved their extrinsic goals didn’t experience any increase in day-to-day happiness, none. They spent a huge amount of energy chasing these goals, but when they fulfilled them, they felt the same as they had at the start, Your promotion? Your fancy car? The new iPhone? The expensive necklace? They won’t improve your happiness even one inch.

But people who achieved their intrinsic goals did become significantly happier, and less depressed and anxious. You could track the movement. As they worked at it and felt they became (for example) a better friend, not because they wanted anything out of it but because they felt it was a good thing to do, they became more satisfied with life. Being a better dad? Dancing for the sheer joy of it? Helping another person, just because it’s the right thing to do? They do significantly boost your happiness.

Yet most of us, most of the time, spend our time chasing extrinsic goals, the very thing that will give us nothing. Our whole culture is set up to get us to think this way. Get the right grades. Get the best-paying job. Rise through the ranks. Display your earnings through clothes and cars. That’s how to make yourself feel good.

What Tim had discovered is that the message our culture is telling us about how to have a decent and satisfying life, virtually all the time, is not true. The more this was studied, the clearer it became! Twenty-two different studies have in the years since, found that the more materialistic and extrinsically motivated you become, the more depressed you will be. Twelve different studies found that the more materialistic and extrinsically motivated you become, the more anxious you will be. Similar studies, inspired by Tim’s work and using similar techniques, have now been carried out in Britain, Denmark, Germany, India, South Korea, Russia, Romania, Australia, and Canada-and the results, all over the world, keep coming back the same.

Just as we have shifted en masse from eating food to eating junk food, Tim has discovered, in effect, that we have shifted from having meaningful values to having junk values. All this mass-produced fried chicken looks like food, and it appeals to the part of us that evolved to need food; yet it doesn’t give us what we need from food, nutrition. Instead, it fills us with toxins.

In the same way, all these materialistic values, telling us to spend our way to happiness, look like real values; they appeal to the part of us that has evolved to need some basic principles to guide us through life; yet they don’t give us what we need from values, a path to a satisfying life. Instead, they fill us with psychological toxins. Junk food is distorting our bodies. Junk values are distorting our minds.

Materialism is KFC for the soul.

When Tim studied this in greater depth, he was able to identify at least four key reasons why junk values are making us feel so bad.

The first is that thinking extrinsically poisons your relationships with other people. He teamed up again with another professor, Richard Ryan, who had been an ally from the start, to study two hundred people in depth, and they found that the more materialistic you become, the shorter your relationships will be, and the worse their quality will be. If you value people for how they look, or how they impress other people, it’s easy to see that you’ll be happy to dump them if someone hotter or more impressive comes along. And at the same time, if all you’re interested in is the surface of another person, it’s easy to see why you’ll be less rewarding to be around, and they’ll be more likely to dump you, too. You will have fewer friends and connections, and they won’t last as long.

Their second finding relates to another change that happens as you become more driven by junk values. Let’s go back to the example of playing the piano. Every day, Tim spends at least half an hour playing the piano and singing, often with his kids. He does it for no reason except that he loves it, it makes him, on a good day, feel satisfied, and joyful. He feels his ego dissolve, and he is purely present in the moment. There’s strong scientific evidence that we all get most pleasure from what are called “flow states” like this, moments when we simply lose ourselves doing something we love and are carried along in the moment. They’re proof we can maintain the pure intrinsic motivation that a child feels when she is playing.

But when Tim studied highly materialistic people, he discovered they experience significantly fewer flow states than the rest of us. Why would that be?

He seems to have found an explanation. Imagine if, when Tim was playing the piano every day, he kept thinking: Am I the best piano player in Illinois? Are people going to applaud this performance? Am l going to get paid for this? How much? Suddenly his joy would shrivel up like a salted snail. Instead of his ego dissolving, his ego would be aggravated and jabbed and poked.

That is what your head starts to look like when you become more materialistic. If you are doing something not for itself but to achieve an effect, you can’t relax into the pleasure of a moment. You are constantly monitoring yourself. Your ego will shriek like an alarm you can’t shut off.

This leads to a third reason why junk values make you feel so bad. When you are extremely materialistic, Tim said to me, “you’ve always kind of got to be wondering about yourself, how are people judging you?” It forces you to “focus on other people’s opinions of you, and their praise of you, and then you’re kind of locked into having to worry what other people think about you, and if other people are going to give you those rewards that you want. That’s a heavy load to bear, instead of walking around doing what it is you’re interested in doing, or being around people who love you just for who you are.”

If “your self-esteem, your sense of self-worth, is contingent upon how much money you’ve got, or what your clothes are like, or how big your house is,” you are forced into constant external comparisons, Tim says. “There’s always somebody who’s got a nicer house or better clothes or more money.” Even if you’re the richest person in the world, how long will that last? Materialism leaves you constantly vulnerable to a world beyond your control.

And then, he says, there is a crucial fourth reason. It’s worth pausing on this one, because I think it’s the most important.

All of us have certain innate needs, to feel connected, to feel valued, to feel secure, to feel we make a difference in the world, to have autonomy, to feel we’re good at something. Materialistic people, he believes, are less happy, because they are chasing a way of life that does a bad job of meeting these needs.

What you really need are connections. But what you are told you need, in our culture, is stuff and a superior status, and in the gap between those two signals, from yourself and from society, depression and anxiety will grow as your real needs go unmet.

You have to picture all the values that guide why you do things in your life, Tim said, as being like a pie. “Each value” you have, he explained, “is like a slice of that pie. So you’ve got your spirituality slice, and your family slice, and your money slice, and your hedonism slice. We’ve all got all the slices.” When you become obsessed with materialism and status, that slice gets bigger. And “the bigger one slice gets, the smaller other slices have to get.” So if you become fixated on getting stuff and a superior status, the parts of the pie that care about tending to your relationships, or finding meaning, or making the world better have to shrink, to make way.

“On Friday at four, I can stay [in my office] and work more, or I can go home and play with my kids,” he told me. “I can’t do both. It’s one or the other. If my materialistic values are bigger, I’m going to stay and work. If my family values are bigger, I’m going to go home and play with my kids.” It’s not that materialistic people don’t care about their kids, but “as the materialistic values get bigger, other values are necessarily going to be crowded out,” he says, even if you tell yourself they won’t.

And the pressure, in our culture, runs overwhelmingly one way, spend more; work more. We live under a system, Tim says, that constantly “distracts us from what’s really good about life.” We are being propagandized to live in a way that doesn’t meet our basic psychological needs, so we are left with a permanent, puzzling sense of dissatisfaction.

For millennia, humans have talked about something called the Golden Rule. It’s the idea that you should do unto others as you would have them do unto you. Tim, I think, has discovered something we should call the I-Want-Golden-Things Rule. The more you think life is about having stuff and superiority and showing it off, the more unhappy, and the more depressed and anxious, you will be.

But why would human beings turn, so dramatically, to something that made us less happy and more depressed? Isn’t it implausible that we would do something so irrational? In the later phase of his research, Tim began to dig into the question.

Nobody’s values are totally fixed. Your level of junk values, Tim discovered by following people in his studies, can change over your lifetime. You can become more materialistic, and more unhappy; or you can become less materialistic, and less unhappy. So we shouldn’t be asking, Tim believes, “Who is materialistic?” We should be asking: “When are people materialistic?” Tim wanted to know: What causes the variation?

There’s an experiment, by a different group of social scientists, that gives us one early clue. In 1978, two Canadian social scientists got a bunch of four and five year old kids and divided them into two groups. The first group was shown no commercials. The second group was shown two commercials for a particular toy. Then they offered these four or five year old kids a choice. They told them: You have to choose, now, to play with one of these two boys here. You can play with this little boy who has the toy from the commercials, but we have to warn you, he’s not a nice boy. He’s mean. Or you can play with a boy who doesn’t have the toy, but who is really nice.

If they had seen the commercial for the toy, the kids mostly chose to play with the mean boy with the toy. If they hadn’t seen the commercial, they mostly chose to play with the nice boy who had no toys.

In other words, the advertisements led them to choose an inferior human connection over a superior human connection, because they’d been primed to think that a lump of plastic is what really matters.

Two commercials, just two, did that. Today, every person sees way more advertising messages than that in an average morning. More eighteen-month-olds can recognize the McDonald’s M than know their own surname. By the time an average child is thirty-six months old she aIready knows a hundred brand logos.

Tim suspected that advertising plays a key role in why we are, every day, choosing a value system that makes us feel worse. So with another social scientist named Jean Twenge he tracked the percentage of total US. national wealth that’s spent on advertising, from 1976 to 2003, and he discovered that the more money is spent on ads, the more materialistic teenagers become.

A few years ago, an advertising agency head named Nancy Shalek explained approvingly: “Advertising at its best is making peopie feel that without their product, you’re a loser. Kids are very sensitive to that. You open up emotionaI vulnerabilities, and it’s very easy to do with kids because they’re the most emotionally vulnerable.”

This sounds harsh, until you think through the logic. Imagine if I watched an ad and it told me, Johann, you’re fine how you are. You look good. You smell good. You’re likable. People want to be around you. You’ve got enough stuff now. You don’t need any more. Enjoy life.

That would, from the perspective of the advertising industry, be the worst ad in human history, because I wouldn’t want to go out shopping, or lunge at my laptop to spend, or do any of the other things that feed my junk values. It would make me want to pursue my intrinsic values, which involve a whole lot less spending, and a whole lot more happiness.

When they talk among themselves, advertising people have been admitting since the 1920s that their job is to make people feel inadequate, and then offer their product as the solution to the sense of inadequacy they have created. Ads are the ultimate frenemy, they’re always saying: Oh babe, I want you to look/smell/feel great; it makes me so sad that at the moment you’re ugly/ stinking/miserable; here’s this thing that will make you into the person you and I really want you to be. Oh, did I mention you have to pay a few bucks? I just want you to be the person you deserve to be. Isn’t that worth a few dollars? You’re worth it.

This logic radiates out through the culture, and we start to impose it on each other, even when ads aren’t there. Why did I, as a child, crave Nike air-pumps, even though I was as likely to play basketball as I was to go to the moon? It was partly because of the ads, but mostly because the ads created a group dynamic among everyone I knew. It created a marker of status, that we then policed. As adults, we do the same, only in slightly more subtle ways.

This system trains us, Tim says, to feel “there’s never enough. When you’re focused on money and status and possessions, consumer society is always telling you more, more, more, more. Capitalism is always telling you more, more, more. Your boss is telling you work more, work more, work more. You internalize that and you think: Oh, I’ve got to work more, because my self depends on my status and my achievement. You internalize that. It’s a kind of form of internalized oppression.”

He believes it also explains why junk values lead to such an increase in anxiety. “You’re always thinking: Are they going to reward me? Does the person love me for who I am, or for my handbag? Am I going to be able to climb the ladder of success?” he said. You are hollow, and exist only in other people’s reflections. “That’s going to be anxiety-provoking.”

We are all vulnerable to this, he believes. “The way I understand the intrinsic values,” Tim told me, is that they “are a fundamental part of what we are as humans, but they’re fragile. It’s easy to distract us from them. You give people social models of consumerism and they move in an extrinsic way.” The desire to find meaningful intrinsic values is “there, it’s a powerful part of who we are, but it’s not hard to distract us.” And we have an economic system built around doing precisely that.

As I sat with Tim, discussing all this for hours, I kept thinking of a middle-class married couple who live in a nice semidetached house in the suburbs in Edgware, where we grew up. They are close to me; I have known them all my life; I love them.

If you peeked through their window, you’d think they have everything you need for happiness, each other, two kids, a good home, all the consumer goods we’re told to buy. Both of them work really hard at jobs they have little interest in, so that they can earn money, and with the money they earn, they buy the things that we have learned from television will make us happy, clothes and cars, gadgets and status symbols. They display these things to people they know on social media, and they get lots of likes and comments like “OMG, so jealous!” After the brief buzz that comes from displaying their goods, they usually find they become dissatisfied and down again. They are puzzled by this, and they often assume it’s because they didn’t buy the right thing. So they work harder, and they buy more goods, display them through their devices, feel the buzz, and then slump back to where they started.

They both seem to me to be depressed. They alternate between being blank, or angry, or engaging in compulsive behaviors. She had a drug problem for a long time, although not anymore; he gambles online at least two hours a day. They are furious a lot of the time, at each other, at their children, at their colleagues, and, diffusely, at the world, at anyone else on the road when they are driving, for example, who they scream and swear at. They have a sense of anxiety they can’t shake off, and they often attach it to things outside them, she obsessively monitors where her teenage son is at any moment, and is afraid all the time that he will be a victim of crime or terrorism.

This couple has no vocabulary to understand why they feel so bad. They are doing what the culture has been priming them to do since we were infants, they are working hard and buying the right things, the expensive things. They are every advertising slogan made flesh.

Like the kids in the sandbox, they have been primed to lunge for objects and ignore the prospect of interaction with the people around them.

I see now they aren’t just suffering from the absence of something, such as meaningful work, or community. They are also suffering from the presence of something, an incorrect set of values telling them to seek happiness in all the wrong places, and to ignore the potential human connections that are right in front of them.

When Tim discovered all these facts, it didn’t just guide his scientific work. He began to move toward a life that made it possible for him to live consistent with his own findings, to go back, in a sense, to something more like the beach he had discovered joyfully in Florida as a kid. “You’ve got to pull yourself out of the materialistic environments, the environments that are reinforcing the materialistic values,” he says, because they cripple your internal satisfactions. And then, he says, to make that sustainable, you have to “replace them with actions that are going to provide those intrinsic satisfactions, and encourage those intrinsic goals.”

So, with his wife and his two sons, he moved to a farmhouse on ten acres of land in Illinois, where they live with a donkey and a herd of goats. They have a small TV in the basement, but it isn’t connected to any stations or to cable, it’s just to watch old movies on sometimes. They only recently got the Internet (against his protestations), and they don’t use it much. He works part time, and so does his wife, “so we could spend more time with our kids, and be in the garden more and do volunteer work and do activism work and I could write more”, all the things that give them intrinsic satisfaction. “We play a lot of games. We play a lot of music. We have a lot of family conversations.” They sing together.

Where they live in western Illinois is “not the most exciting place in the world,” Tim says, “but I have ten acres of land, I have a twelve-minute commute with one flashing light and three stop signs on my way to my office, and we afford that on one [combined full-time] salary.”

I ask him if he had withdrawal symptoms from the materialistic world we were both immersed in for so long. “Never,” he says right away. “People ask me that: “Don’t you miss this? Don’t you wish you had that?” No, I don’t, because I am never exposed to the messages telling me that I should want it. I don’t expose myself to those things, so no, I don’t have that.”

One of his proudest moments was when one of his sons came home one day and said: “Dad, some kids at school are making fun of my sneakers.” They were not a brand name, or shiny-new. “Oh, what’d you say to them?” Tim asked. His son explained he looked at them and said: “Why do you care?” He was nonplussed, he could see that what they valued was empty, and absurd.

By living without these polluting values, Tim has, he says, discovered a secret. This way of life is more pleasurable than materialism. “It’s more fun to play these games with your kids,” he told me. “It’s more fun to do the intrinsically motivated stuff than to go to work and do stuff you don’t necessarily want to do. It’s more fun to feel like people love you for who you are, instead of loving you because you gave them a big diamond ring.”

Most people know all this in their hearts, he believes. “At some level I really believe that most people know that intrinsic values are what’s going to give them a good life,” he told me. When you do surveys and ask people what’s most important in life, they almost always name personal growth and relationships as the top two. “But I think part of why people are depressed is that our society is not set up in order to help people live lifestyles, have jobs, participate in the economy, or participate in their neighborhoods” in ways that support their intrinsic values. The change Tim saw happening in Florida as a kid, when the beachfronts were transformed into shopping malls and people shifted their attention there, has happened to the whole culture.

Tim told me people can apply these insights to their own life, on their own, to some extent. “The first thing is for people to ask themselves, Am I setting up my life so I can have a chance of succeeding at my intrinsic values? Am I hanging out with the right people, who are going to make me feel loved, as opposed to making me feel like I made it? Those are hard choices sometimes.” But often, he says, you will hit up against a limit in our culture. You can make improvements, but often “the solutions to the problems that I’m interested in can’t be easily solved at the individual person level, or in the therapeutic consulting room, or by a pill.” They require something more, as I was going to explore later.

When I interviewed Tim, I felt he solved a mystery for me. I had been puzzled back in Philadelphia about why Joe didn’t leave the job he hated at the paint company and go become a fisherman in Florida, when he knew life in the Sunshine State would make him so much happier. It seemed like a metaphor for why so many of us stay in situations we know make us miserable.

I think I see why now. Joe is constantly bombarded with messages that he shouldn’t do the thing that his heart is telling him would make him feel calm and satisfied. The whole logic of our culture tells him to stay on the consumerist treadmill, to go shopping when he feels lousy, to chase junk values. He has been immersed in those messages since the day he was born. So he has been trained to distrust his own wisest instincts.

When I yelled after him “Go to Florida!” I was yelling into a hurricane of messages, and a whole value system, that is saying the exact opposite.


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

by Johann Hari

get it at Amazon.com


There is a problem with what everyone knows about antidepressant drugs. It isn’t true. The whole idea of mental distress being caused simply by a chemical imbalance is “a myth,”, sold to us by the drug companies.

In the United States, 40 percent of the regulators’ wages are paid by the drug companies, and in Britain, it’s 100 percent. The rules they have written are designed to make it extraordinarily easy to get a drug approved.

“There was never any basis for it, ever. It was just marketing copy. At the time the drugs came out in the early 1990s, you couldn’t have got any decent expert to go on a platform and say, ‘Look, there’s a lowering of serotonin in the brains of people who are depressed’ There wasn’t ever any evidence for it.” It hasn’t been discredited, because “it didn’t ever get ‘credited.” We don’t know what a “chemically balanced” brain would look like. The effects of these drugs on depression itself are in reality tiny. No matter what chemical you tinker with, you get the same outcome. Antidepressants are little more than active placebos, drugs with very little specific therapeutic benefit, but with serious side effects.

What do the people taking these different drugs actually have in common? Only one thing: the belief that the drugs work, because you believe you are being looked after and offered a solution. Clever marketing over solid empirical evidence.

The serotonin theory “is a lie. I don’t think we should dress it up and say, ‘Oh, well, maybe there’s evidence to support that.’ There isn’t.” Most people on these drugs, after an initial kick, remain depressed or anxious. The belief that antidepressants can cure depression chemically is simply wrong.

The year after I swallowed my first antidepressant, Tipper Gore, the wife of Vice President Al Gore, explained to the newspaper USA Today why she had recently become depressed. “It was definitely a clinical depression, one that I was going to have to have help to overcome,” she said. “What I learned about is your brain needs a certain amount of serotonin and when you run out of that, it’s like running out of gas.” Tens of millions of people, including me, were being told the same thing.

When Irving Kirsch discovered that these serotonin boosting drugs were not having the effects that everyone was being sold, complete/nonfiltered FDA drug company study/research records show that the effects of these drugs on depression itself are in reality tiny, he began, to his surprise, to ask an even more basic question.

What’s the evidence, he began to wonder, that depression is caused primarily by an imbalance of serotonin, or any other chemical, in the brain? Where did it come from?

The serotonin story began, Irving learned, quite by accident in a tuberculosis ward in New York City in the clammy summer of 1952, when some patients began to dance uncontrollably down a hospital corridor. A new drug named Marsilid had come along that doctors thought might help TB patients. It turned out it didn’t have much effect on TB, but the doctors noticed it did something else entirely. They could hardly miss it. It made the patients gleefully, joyfully euphoric, some began to dance frenetically.

So it wasn’t long before somebody decided, perfectly logically, to try to give it to depressed people, and it seemed to have a similar effect on them, for a short time. Not long after that, other drugs came along that seemed to have similar effects (also for short periods), ones named Ipronid and Imipramine. So what, people started to ask, could these new drugs have in common? And whatever it was, could it hold the key to unlocking depression?

Nobody really knew where to look, and so for a decade the question hung in the air, tantalizing researchers. And then in 1965, a British doctor called Alec Coppen came up with a theory. What if, he asked, all these drugs were increasing levels of serotonin in the brain? If that were true, it would suggest that depression might be caused by low levels of serotonin.

“It’s hard to overstate just how far out on a limb these scientists were climbing,” Dr. Gary Greenberg, who has written the history of this period, explains. “They really had no idea what serotonin was doing in the brain.” To be fair to the scientists who first put forward the idea, he says, they put it forward tentatively, as a suggestion. One of them said it was “at best a reductionist simplification,” and said it couldn’t be shown to be true “on the basis of data currently available.”

But a few years later, in the 1970s, it was finally possible to start testing these theories. It was discovered that you can give people a chemical brew that lowers their serotonin levels. So if this theory was right, if low serotonin caused depression, what should happen? After taking this brew, people should become depressed. So they tried it. They gave people a drug to lower their serotonin levels and watched to see what would happen. And, unless they had already been taking powerful drugs they didn’t become depressed. In fact, in the vast majority of patients, it didn’t affect their mood at all.

I went to see one of the first scientists to study these new antidepressants in Britain, Professor David Healy, in his clinic in Bangor, a town in the north of Wales. He has written the most detailed history of antidepressants we have. When it comes to the idea that depression is caused by low serotonin, he told me: “There was never any basis for it, ever. It was just marketing copy. At the time the drugs came out in the early 1990s, you couldn’t have got any decent expert to go on a platform and say, ‘Look, there’s a lowering of serotonin in the brains of people who are depressed’ There wasn’t ever any evidence for it.” It hasn’t been discredited, he said, because “it didn’t ever get ‘credited,’ in a sense. There wasn’t ever a point in time when 50 percent of the field actually believed it.” In the biggest study of serotonin’s effects on humans, it found no direct relationships with depression. Professor Andrew Skull of Princeton has said attributing depression to low serotonin is “deeply misleading and unscientific.“

It had been useful in only one sense. When the drug companies wanted to sell antidepressants to people like me and Tipper Gore, it was a great metaphor. It’s easy to grasp, and it gives you the impression that what antidepressants do is restore you to a natural state, the kind of balance that everyone else enjoys.

Irving learned that once serotonin was abandoned by scientists (but certainly not by drug company PR teams) as an explanation for depression and anxiety, there was a shift in scientific research. Okay, they said: if it’s not low serotonin that’s causing depression and anxiety, then it must be the lack of some other chemical. It was still taken for granted that these problems are caused by a chemical imbalance in the brain, and antidepressants work by correcting that chemical imbalance. If one chemical turns out not to be the psychological killer, they must start searching for another one.

But Irving began to ask an awkward question. If depression and anxiety are caused by a chemical imbalance, and antidepressants work by fixing that imbalance, then you have to account for something odd that he kept finding. Antidepressant drugs that increase serotonin in the brain have the same modest effect, in clinical trials, as drugs that reduce serotonin in the brain. And they have the same effect as drugs that increase another chemical, norepinephrine. And they have the same effect as drugs that increase another chemical, dopamine. In other words, no matter what chemical you tinker with, you get the same outcome.

So Irving asked: What do the people taking these different drugs actually have in common? Only, he found, one thing: the belief that the drugs work. It works, Irving believes, largely for the same reason that John Haygarth’s wand worked: because you believe you are being looked after and offered a solution.

After twenty years researching this at the highest level, Irving has come to believe that the notion depression is caused by a chemical imbalance is just “an accident of history,” produced by scientists initially misreading what they were seeing, and then drug companies selling that misperception to the world to cash in.

And so, Irving says, the primary explanation for depression offered in our culture starts to fall apart. The idea you feel terrible because of a “chemical imbalance” was built on a series of mistakes and errors. It has come as close to being proved wrong, he told me, as you ever get in science. It’s lying broken on the floor, like a neurochemical Humpty Dumpty with a very sad smile.

I had traveled a long way with Irving on his journey but I stopped there, startled. Could this really be true? I am trained in the social sciences, which is the kind of evidence that I’ll be discussing in the rest of this book. I’m not trained in the kind of science he is a specialist in. I wondered if I was misunderstanding him, or if he was a scientific outlier. So I read all that I could, and I got as many other scientists to explain it to me as possible. “There’s no evidence that there’s a chemical imbalance” in depressed or anxious people’s brains, Professor Joanna Moncrieff, one of the leading experts on this question-explained to me bluntly in her office at the University College of London. The term doesn’t really make any sense, she said: we don’t know what a “chemically balanced” brain would look like. People are told that drugs like antidepressants restore a natural balance to your brain, she said, but it’s not true-they create an artificial state. The whole idea of mental distress being caused simply by a chemical imbalance is “a myth,” she has come to believe, sold to us by the drug companies.

The clinical psychologist Dr. Lucy Johnstone was more blunt still. “Almost everything you were told was bullshit,” she said to me over coffee. The serotonin theory “is a lie. I don’t think we should dress it up and say, ‘Oh, well, maybe there’s evidence to support that.’ There isn’t.”

Yet it seemed wildly implausible to me that something so huge, one of the most popular drugs in the world, taken by so many people all around me, could be so wrong. Obviously, there are protections against this happening: huge hurdles of scientific testing that have to take place before a drug gets to our bathroom cabinets. I felt as if I had just landed in a flight from JFK to LAX, only to be told that the plane had been flown by a monkey the whole way. Surely there are procedures in place to stop something like this from happening? How could these drugs have gotten through the procedures in place, if they were really as limited as this deeper research suggested?

I discussed this with one of the leading scientists in this field, Professor John Ioannidis, who the Atlantic Monthly has said “may be one of the most influential scientists alive.” He says it is not surprising that the drug companies could simply override the evidence and get the drugs to market anyway, because in fact it happens all the time. He talked me through how these antidepressants got from the development stage to my mouth.

It works like this: “The companies are often running their own trials on their own products,” he said. That means they set up the clinical trial, and they get to decide who gets to see any results. So “they are judging their own products. They’re involving all these poor researchers who have no other source of funding, and who have little control over how the results will be written up and presented.” Once the scientific evidence is gathered, it’s not even the scientists who write it up much of the time. “Typically, it’s the company people who write up the published scientific reports.”

This evidence then goes to the regulators, whose job is to decide whether to allow the drug onto the market. But in the United States, 40 percent of the regulators’ wages are paid by the drug companies, and in Britain, it’s 100 percent. When a society is trying to figure out which drug is safe to put on the market, there are meant to be two teams: the drug company making the case for it, and a referee working for us, the public, figuring out if it properly works. But Professor Ioannidis was telling me that in this match, the referee is paid by the drug company team, and that team almost always wins.

The rules they have written are designed to make it extraordinarily easy to get a drug approved. All you have to do is produce two trials, any time, anywhere in the world, that suggest some positive effect of the drug. If there are two, and there is some effect, that’s enough. So you could have a situation in which there are one thousand scientific trials, and 998 find the drug doesn’t work at all, and two find there is a tiny effect, and that means the drug will be making its way to your local pharmacy.

“I think that this is a field that is seriously sick,” Professor Ioannidis told me. “The field is just sick and bought and corrupted, and I can’t describe it otherwise.” I asked him how it made him feel to have learned all of this. “It’s depressing,” he said. That’s ironic, I replied. “But it’s not depressing,” he responded, “to the severe extent that I would take SSRIs [antidepressants].”

I tried to laugh, but it caught in my throat.

Some people said to Irving, so what? Okay, so say it’s a placebo effect. Whatever the reason, people still feel better. Why break the spell? He explained: the evidence from the clinical trials suggests that the antidepressant effects are largely a placebo, but the side effects are mostly the result of the chemicals themselves, and they can be very severe.

“Of course,” Irving says, there’s “weight gain.” I massively ballooned, and saw the weight fall off almost as soon as I stopped. “We know that SSRIs [the new type of antidepressants] in particular contribute to sexual dysfunction, and the rates for most SSRIs are around 75 percent of treatment-engendered sexual dysfunction,” he continued. Though it’s painful to talk about, this rang true for me, too. In the years I was taking Paxil, I found my genitals were a lot less sensitive, and it took a really long time to ejaculate. This made sex painful and it reduced the pleasure I took from it. It was only when I stopped taking the drug and I started having more pleasurable sex again that I remembered regular sex is one of the best natural antidepressants in the world.

“In young people, these chemical antidepressants increase the risk of suicide. There’s a new Swedish study showing that it increases the risk of violent criminal behavior,” Irving continued. “In older people it increases the risk of death from all causes, increases the risk of stroke. In everybody, it increases the risk of type 2 diabetes. In pregnant women, it increases the risk of miscarriage and of having children born with autism or physical deformities. So all of these things are known.” And if you start experiencing these effects, it can be hard to stop, about 20 percent of people experience serious withdrawal symptoms.

So, he says, “if you want to use something to get its placebo effect, at least use something that’s safe.” We could be giving people the herb St. John’s Wort, Irving says, and we’d have all the positive placebo effects and none of these drawbacks. Although, of course, St. John’s Wort isn’t patented by the drug companies, so nobody would be making much profit off it.

By this time, Irving was starting, he told me softly, to feel “guilty” for having pushed those pills for all those years.

In 1802, John Haygarth revealed the true story of the wands to the public. Some people are really recovering from their pain for a time, he explained, but it’s not because of the power in the wands. It’s because of the power in their minds. It was a placebo effect, and it likely wouldn’t last, because it wasn’t solving the underlying problem.

This message angered almost everyone? Some felt duped by the people who had sold the expensive wands in the first place, but many more felt furious with Haygarth himself, and said he was clearly talking rubbish. “The intelligence excited great commotions, accompanied by threats and abuse,” he wrote. “A counterdeclaration was to be signed by a great number of very respectable persons”, including some leading scientists of the day, explaining that the wand worked, and its powers were physical, and real.

Since Irving published his early results, and as he has built on them over the years, the reaction has been similar. Nobody denies that the drug companies’ own data, submitted to the FDA, shows that antidepressants have only a really small effect over and above placebo. Nobody denies that my own drug company admitted privately that the drug I was given, Paxil, was not going to work for people like me, and they had to make a payout in court for their deception.

But some scientists, a considerable number, do dispute many of Kirsch’s wider arguments. I wanted to study carefully what they say. I hoped the old story could still, somehow, be saved. I turned to a man who, more than anyone else alive, successfully sold antidepressants to the wider public, and he did it because he believed it: he never took a cent from the drug companies.

In the 1990s, Dr. Peter Kramer was watching as patient after patient walked into his therapy office in Rhode Island, transformed before his eyes after they were given the new antidepressant drugs. It’s not just that they seemed to have improved; they became, he argued, “better than well”, they had more resilience and energy than the average person. The book he wrote about this, Listening to Prozac, became the bestselling book ever about antidepressants. I read it soon after I started taking the drugs. I was sure the process Peter described so compellingly was happening to me. I wrote about it, and I made his case to the public in articles and interviews.

So when Irving started to present his evidence, Peter, by then a professor at Brown Medical School, was horrified. He started taking apart Irving’s critique of antidepressants at length, in public, both in books and in a series of charged public debates.

His first argument is that Irving is not giving antidepressants enough time. The clinical trials he has analyzed, almost all the ones submitted to the regulator, typically last for four to eight weeks. But that isn’t enough. It takes longer for these drugs to have a real effect.

This seemed to me to be an important objection. Irving thought so, too. So he looked to see if there were any drug trials that had lasted longer, to find their results. It turns out there were two, and in the first, the placebo did the same as the drug, and in the second, the placebo did better.

Peter then pointed to another mistake he believed Irving had made. The antidepressant trials that Irving is looking at lump together two groups: moderately depressed people and severely depressed people. Maybe these drugs don’t work much for moderately depressed people, Peter concedes, but they do work for severely depressed people. He’s seen it. So when Irving adds up an average for everyone, lumping together the mildly depressed and the severely depressed, the effect of the drugs looks small, but that’s only because he’s diluting the real effect, as surely as Coke will lose its flavor if you mix it with pints and pints of water.

Again, Irving thought this was a potentially important point, and one he was keen to understand, so he went back over the studies he had drawn his data from. He discovered that, with a single exception, he had looked only at studies of people classed as having very severe depression.

This then led Peter to turn to his most powerful argument. It’s the heart of his case against Irving and for antidepressants.

In 2012, Peter went to watch some clinical trials being conducted, in a medical center that looked like a beautiful glass cube, and gazed out over expensive houses.

When the company there wants to conduct trials into antidepressants, they have two headaches. They have to recruit volunteers who will swallow potentially dangerous pills over a sustained period of time, but they are restricted by law to paying only small amounts: between $40 and $75. At the same time, they have to find people who have very specific mental health disorders, for example, if you are doing a trial for depression, they have to have only depression and no other complicating factors. Given all that, it’s pretty difficult for them to find anyone who will take part, so they often turn to quite desperate people, and they have to offer other things to tempt them. Peter watched as poor people were bused in from across the city to be offered a gorgeous buffet of care they’d never normally receive at home, therapy, a whole community of people who’d listen to them, a warm place to be during the day, medication, and money that could double their poverty-level income.

As he watched this, he was struck by something. The people who turn up at this center have a strong incentive to pretend to have any condition they happen to be studying there, and the for-profit companies conducting the clinical trials have a strong incentive to pretend to believe them. Peter looked on as both sides seemed to be effectively bullshitting each other. When he saw people being asked to rate how well the drugs had worked, he thought they were often clearly just giving the interviewer whatever answer they wanted.

So Peter concluded that the results from clinical trials of antidepressants, all the data we have, are meaningless. That means Irving is building his conclusion that their effect is very small (at best) on a heap of garbage, Peter declared. The trials themselves are fraudulent.

It’s a devastating point, and Peter has proved it quite powerfully. But it puzzled Irving when he heard it, and it puzzled me. The leading scientific defender of antidepressants, Peter Kramer, is making the case for them by saying that the scientific evidence for them is junk.

When I spoke to Peter, I told him that if he is right (and I think he is), then that’s not a case for the drugs. It’s a case against them. It means that, by law, they should never have been brought to market.

When I started to ask about this, in a friendly tone Peter became quite irritable, and said even bad trials can yield usable results. He soon changed the subject. Given that he puts so much weight on what he’s seen with his own eyes, I asked Peter what he would say to the people who claimed that John Haygarth’s wand worked, because they, too, were just believing what they saw with their own eyes. He said that in cases like that, “the collection of experts isn’t as expert or as numerous as what we’re talking about here. I mean, this would be [an] orders-of-magnitude bigger scandal if these were [like] just bones wrapped in cloth.”

Shortly after, he said: “I think I want to cut off this conversation.”

Even Peter Kramer had one note of caution to offer about these drugs. He stressed to me that the evidence he has seen only makes the case for prescribing antidepressants for six to twenty weeks. Beyond that, he said, “I think that the evidence is thinner, and my dedication to the arguments is less as you get to long-term use. I mean, does anyone really know about what fourteen years of use does in terms of harm and benefit? I think the answer is we don’t really know.” I felt anxious as he said that, I had already told him that I used the drugs for almost that long. Perhaps because he sensed my anxiety, he added: “Although I do think we’ve been reasonably lucky. People like you come off and function.”

Very few scientists now defend the idea that depression is simply caused by low levels of serotonin, but the debate about whether chemical antidepressants work for some other reason we don’t fully understand, is still ongoing. There is no scientific consensus. Many distinguished scientists agree with Irving Kirsch; many agree with Peter Kramer. I wasn’t sure what to take away from all of this, until Irving led me to one last piece of evidence. I think it tells us the most important fact we need to know about chemical antidepressants.

In the late 1990s, a group of scientists wanted to test the effects of the new SSRI antidepressants in a situation that wasn’t just a lab, or a clinical trial. They wanted to look at what happens in a more everyday situation, so they set up something called the Star-D Trial. It was pretty simple. A normal patient goes to the doctor and explains he’s depressed. The doctor talks through the options with him, and if they both agree, he starts taking an antidepressant. At this point, the scientists conducting the trial start to monitor the patient. If the antidepressant doesn’t work for him, he’s given another one. If that one doesn’t work, he’s given another one, and on and on until he gets one that feels as though it works. This is how it works for most of us out there in the real world: a majority of people who get prescribed antidepressants try more than one, or try more than one dosage, until they find the effect they’re looking for.

And what the trial found is that the drugs worked. Some 67 percent of patients did feel better, just like I did in those first months.

But then they found something else. Within a year, half of the patients were fully depressed again. Only one in three of the people who stayed on the pills had a lasting, proper recovery from their depression. (And even that exaggerates the effect, since we know many of those people would have recovered naturally without the pills.)

It seemed like my story, played out line by line. I felt better at first; the effect wore off; I tried increasing the dose, and then that wore off, too. When I realized that antidepressants weren’t working for me any more, that no matter how much I jacked up the dose, the sadness would still seep back through, I assumed there was something wrong with me.

Now I was reading the Star-D Trial’s results, and I realized I was normal. My experience was straight from the textbook: far from being an outlier, I had the typical antidepressant experience.

This evidence has been followed up several times since, and the proportion of people on antidepressants who continue to be depressed is found to be between 65 and 80 percent.

To me, this seems like the most crucial piece of evidence about antidepressants of all: most people on these drugs, after an initial kick, remain depressed or anxious.

I want to stress, some reputable scientists still believe that these drugs genuinely work for a minority of people who take them, due to a real chemical effect. It’s possible. Chemical antidepressants may well be a partial solution for a minority of depressed and anxious people, I certainly don’t want to take away anything that’s giving relief to anyone. If you feel helped by them, and the positives outweigh the side effects, you should carry on. (And if you are going to stop taking them, then it’s essential that you don’t do it overnight, because you can experience severe physical withdrawal symptoms and a great deal of panic as a result. I gradually reduced my dose very slowly, over six months, in consultation with my doctor, to prevent this from happening.)

But it is impossible, in the face of this evidence, to say they are enough, for a big majority of depressed and anxious people.

I couldn’t deny it any longer: for the vast majority we clearly needed to find a different story about what is making us feel this way, and a different set of solutions. But what, asked myself, bewildered, could they be?

The Emperor’s New Drugs

Irving Kirsch

Everyone knows that antidepressant drugs are miracles of modern medicine. Professor Irving Kirsch knew this as well as anyone. But, as he discovered during his research, there is a problem with what everyone knows about antidepressant drugs. It isn’t true.

How did antidepressant drugs gain their reputation as a magic bullet for depression? And why has it taken so long for the story to become public? Answering these questions takes us to the point where the lines between clinical research and marketing disappear altogether.

Using the Freedom of Information Act, Kirsch accessed clinical trials that were withheld, by drug companies, from the public and from the doctors who prescribe antidepressants. What he found, and what he documents here, promises to bring revolutionary change to the way our society perceives, and consumes, antidepressants.

The Emperor’s New Drugs exposes what we have failed to see before: depression is not caused by a chemical imbalance in the brain; antidepressants are significantly more dangerous than other forms of treatment and are only marginally more effective than placebos; and, there are other ways to combat depression, treatments that don’t only include the empty promise of the antidepressant prescription.

This is not a book about alternative medicine and its outlandish claims. This is a book about fantasy and wishful thinking in the heart of clinical medicine, about the seductions of myth, and the final stubbornness of facts.

Irving Kirsch is a lecturer in medicine at the Harvard Medical School and a professor of psychology at Plymouth University, as well as professor emeritus of psychology at the University of Hull, and the University of Connecticut. He has published eight books and numerous scientific articles on placebo effects, antidepressant medication, hypnosis, and suggestion. His work has appeared in Science, Science News, New Scientist, New York Times, Newsweek, and BBC Focus and many other leading magazines, newspapers, and television documentaries.

Like most people, I used to think that antidepressants worked. As a clinical psychologist, I referred depressed psychotherapy clients to psychiatric colleagues for the prescription of medication, believing that it might help. Sometimes the antidepressant seemed to work; sometimes it did not. When it did work, I assumed it was the active ingredient in the antidepressant that was helping my clients cope with their psychological condition.

According to drug companies, more than 80 per cent of depressed patients can be treated successfully by antidepressants. Claims like this made these medications one of the most widely prescribed class of prescription drugs in the world, with global sales that make it a $19-billion-a-year industry. Newspaper and magazine articles heralded antidepressants as miracle drugs that had changed the lives of millions of people. Depression, we were told, is an illness a disease of the brain that can be cured by medication. I was not so sure that depression was really an illness, but I did believe that the drugs worked and that they could be a helpful adjunct to psychotherapy for very severely depressed clients. That is why I referred these clients to psychiatrists who could prescribe antidepressants that the clients could take while continuing in psychotherapy to work on the psychological issues that had made them depressed.

But was it really the drug they were taking that made my clients feel better? Perhaps I should have suspected that the improvement they reported might not have been a drug effect. People obtain considerable benefits from many medications, but they also can experience symptom improvement just by knowing they are being treated. This is called the placebo effect. As a researcher at the University of Connecticut, I had been studying placebo effects for many years. I was well aware of the power of belief to alleviate depression, and I understood that this was an important part of any treatment, be it psychological or pharmacological. But I also believed that antidepressant drugs added something substantial over and beyond the placebo effect.

As I wrote in my first book, ‘comparisons of antidepressive medication with placebo pills indicate that the former has a greater effect, the existing data suggest a pharmacologically specific effect of imipramine on depression’. As a researcher, I trusted the data as it had been presented in the published literature. I believed that antidepressants like imipramine were highly effective drugs, and I referred to this as ‘the established superiority of imipramine over placebo treatment’.

When I began the research that I describe in this book, I was not particularly interested in investigating the effects of antidepressants. But I was definitely interested in investigating placebo effects wherever I could find them, and it seemed to me that depression was a perfect place to look. Why did I expect to find a large placebo effect in the treatment of depression? If you ask depressed people to tell you what the most depressing thing in their lives is, many answer that it is their depression. Clinical depression is a debilitating condition. People with severe depression feel unbearably sad and anxious, at times to the point of considering suicide as a way to relieve the burden. They may be racked with feelings of worthlessness and guilt. Many suffer from insomnia, whereas others sleep too much and find it difficult to get out of bed in the morning. Some have difficulty concentrating and have lost interest in all of the activities that previously brought pleasure and meaning into their lives. Worst of all, they feel hopeless about ever recovering from this terrible state, and this sense of hopelessness may lead them to feel that life is not worth living. In short, depression is depressing. John Teasdale, a leading researcher on depression at Oxford and Cambridge universities, labelled this phenomenon ‘depression about depression’ and claimed that effective treatments for depression work at least in part by altering the sense of hopelessness that comes from being depressed about one’s own depression?!

Whereas hopelessness is a central feature of depression, hope lies at the core of the placebo effect. Placebos instil hope in patients by promising them relief from their distress. Genuine medical treatments also instil hope, and this is the placebo component of their effectiveness.

When the promise of relief instils hope, it counters a fundamental attribute of depression. Indeed, it is difficult to imagine any treatment successfully treating depression without reducing the sense of hopelessness that depressed people feel. Conversely, any treatment that reduces hopelessness must also assuage depression. So a convincing placebo ought to relieve depression.

It was with that in mind that one of my postgraduate students, Guy Sapirstein, and I set out to investigate the placebo effect in depression, an investigation that I describe in the first chapter of this book, and that produced the first of a series of surprises that transformed my views about antidepressants and their role in the treatment of depression. In this book I invite you to share this journey in which I moved from acceptance to dissent, and finally to a thorough rejection of the conventional view of antidepressants.

The drug companies claimed and still maintain that the effectiveness of antidepressants has been proven in published clinical trials showing that the drugs are substantially better than placebos (dummy pills with no active ingredients at all). But the data that Sapirstein and I examined told a very different story. Although many depressed patients improve when given medication, so do many who are given a placebo, and the difference between the drug response and the placebo response is not all that great.

What the published studies really indicate is that most of the improvement shown by depressed people when they take antidepressants is due to the placebo effect.

Our finding that most of the effects of antidepressants could be explained as a placebo effect was only the first of a number of surprises that changed my views about antidepressants. Following up on this research, I learned that the published clinical trials we had analysed were not the only studies assessing the effectiveness of antidepressants. I discovered that approximately 40 per cent of the clinical trials conducted had been withheld from publication by the drug companies that had sponsored them. By and large, these were studies that had failed to show a significant benefit from taking the actual drug. When we analysed all of the data, those that had been published and those that had been suppressed my colleagues and I were led to the inescapable conclusion that antidepressants are little more than active placebos, drugs with very little specific therapeutic benefit, but with serious side effects. I describe these analyses and the reaction to them in Chapters 3 and 4.

How can this be? Before a new drug is put on the market, it is subjected to rigorous testing. The drug companies sponsor expensive clinical trials, in which some patients are given medication and others are given placebos. The drug is considered effective only if patients given the real drug improve significantly more than patients given the placebos. Reports of these trials are then sent out to medical journals, where they are subjected to rigorous peer review before they are published. They are also sent to regulatory agencies, like the Food and Drug Administration (FDA) in the US, the Medicines and Healthcare products Regulatory Agency (MHRA) in the UK and the European Medicine Agency (EMEA) in the EU. These regulatory agencies carefully review the data on safety and effectiveness, before deciding whether to approve the drugs for marketing. So there must be substantial evidence backing the effectiveness of any medication that has reached the market.

And yet I remain convinced that antidepressant drugs are not effective treatments and that the idea of depression as a chemical imbalance in the brain is a myth. When I began to write this book, my claim was more modest. I believed that the clinical effectiveness of antidepressants had not been proven for most of the millions of patients to whom they are prescribed, but I also acknowledged that they might be beneficial to at least a subset of depressed patients. During the process of putting all of the data together, those that I had analysed over the years and newer data that have just recently seen the light of day, I realized that the situation was even worse than I thought.

The belief that antidepressants can cure depression chemically is simply wrong.

In this book I will share with you the process by which I came to this conclusion and the scientific evidence on which it is based. This includes evidence that was known to the pharmaceutical companies and to regulatory agencies, but that was intentionally withheld from prescribing physicians, their patients and even from the National Institute for Health and Clinical Excellence (NICE) when it was drawing up treatment guidelines for the National Health Service (NHS).

My colleagues and I obtained some of these hidden data by using the Freedom of Information Act in the US. We analysed the data and submitted the results for peer review to medical and psychological journals, where they were then published. Our analyses have become the focus of a national and international debate, in which many doctors have changed their prescribing habits and others have reacted with anger and incredulity.

My intention in this book is to present the data in a plain and straightforward way, so that you will be able to decide for yourself whether my conclusions about antidepressants are justified.

The conventional view of depression is that it is caused by a chemical imbalance in the brain. The basis for this idea was the belief that antidepressant drugs were effective treatments. Our analysis showing that most if not all of the effects of these medications are really placebo effects challenges this widespread view of depression. In Chapter 4 I examine the chemical-imbalance theory. You may be surprised to learn that it is actually a rather controversial theory and that there is not much scientific evidence to support it. While writing this chapter I came to an even stronger conclusion. It is not just that there is not much supportive evidence; rather, there is a ton of data indicating that the chemical-imbalance theory is simply wrong.

The chemical effect of antidepressant drugs may be small or even non-existent, but these medications do produce a powerful placebo effect. In Chapters 5 and 6 I examine the placebo effect itself. I look at the myriad of effects that placebos have been shown to have and explore the theories of how these effects are produced. I explain how placebos are able to produce substantial relief from depression, almost as much as that produced by medication, and the implications that this has for the treatment of depression.

Finally, in Chapter 7, I describe some of the alternatives to medication for the treatment of depression and assess the evidence for their effectiveness. One of my aims is to provide essential scientifically grounded information for making informed choices between the various treatment options that are available.

Much of what I write in this book will seem controversial, but it is all thoroughly grounded on scientific evidence, evidence that I describe in detail in this book. Furthermore, as controversial as my conclusions seem, there has been a growing acceptance of them. NICE has acknowledged the failure of antidepressant treatment to provide clinically meaningful benefits to most depressed patients; the UK government has instituted plans for providing alternative treatments; and neuroscientists have noted the inability of the chemical-imbalance theory to explain depression. We seem to be on the cusp of a revolution in the way we understand and treat depression.

Learning the facts behind the myths about antidepressants has been, for me, a journey of discovery. It was a journey filled with shocks and surprises, surprises about how drugs are tested and how they are approved, what doctors are told and what is kept hidden from them, what regulatory agencies know and what they don’t want you to know, and the myth of depression as a brain disease. I would like to share that journey with you. Perhaps you will find it as surprising and shocking as I did. It is my hope that making this information public will foster changes in the way new drugs are tested and approved in the future, in the public availability of the data and in the treatment of depression.


Listening to Prozac, but Hearing Placebo

In 1995 Guy Sapirstein and I set out to assess the placebo effect in the treatment of depression. Instead of doing a brand-new study, we decided to pool the results of previous studies in which placebos had been used to treat depression and analyse them together. What we did is called a meta-analysis, and it is a common technique for making sense of the data when a large number of studies have been done to answer a particular question. It was once considered somewhat controversial, but meta-analyses are now common features in all of the leading medical journals. Indeed, it is hard to see how one could interpret the results of large numbers of studies without the aid of a meta-anaiysis.

In doing our meta-analysis, it was not enough to find studies in which depressed patients had been given placebos. We also needed to find studies in which depression had been tracked in patients who were not given any treatment at all. This was to make sure that any effect we found was really due to the administration of the placebo. To better understand the reason for this, imagine that you are investigating a new remedy for colds. If the patients are given the new medicine, they get better, if they are given placebos, they also get better. Seeing these data, you might be tempted to think that the improvement was a placebo effect. But people recover from colds even if you give them nothing at all. So when the patients in our imaginary study took a dummy pill and their colds got better, the improvement may have had nothing to do with the placebo effect. It might simply have been due to the passage of time and the fact that colds are short-lasting illnesses.

Spontaneous improvement is not limited to colds. It can also happen when people are depressed. Because people sometimes recover from bouts of depression with no treatment at all, seeing that a person has become less depressed after taking a placebo does not mean that the person has experienced a placebo effect. The improvement could have been due to any of a number of other factors. For example, people can get better because of positive changes in life circumstances, such as finding a job after a period of unemployment or meeting a new romantic partner. Improvement can also be facilitated by the loving support of friends and family. Sometimes a good friend can function as a surrogate therapist. In fact, a very influential book on psychotherapy bore the title Psychotherapy: The Purchase of Friendship. The author did not claim that psychotherapy was merely friendship, but the title does make the point that it can be very therapeutic to have a friend who is empathic and knows how to listen.

The point is that without comparing the effect of placebos against rates of spontaneous recovery, it is impossible to assess the placebo effect. Just as we have to control for the placebo effect to evaluate the effect of a drug, so too we have to control for the passage of time when assessing the placebo effect. The drug effect is the difference between what happens when people are given the active drug and what happens when they are given the placebo. Analogously, the placebo effect is the difference between what happens when people are given placebos and what happens when they are not treated at all.

It is rare for a study to focus on the placebo effect or on the effect of the simple passage of time, for that matter. So where were we to find our placebo data and no-treatment data? We found our placebo data in clinical studies of antidepressants, and our no-treatment data in clinical studies of psychotherapy. It is common to have no-treatment or wait-list control groups in studies of the effects of psychotherapy. These groups consist of patients who are not given any treatment at all during the course of the study, although they may be placed on a wait list and given treatment after the research is concluded.

For the purpose of our research, Sapirstein and I were not particularly interested in the effects of the antidepressants or psychotherapy. What we were interested in was the placebo effect. But since we had the treatment data to hand, we looked at them as well. And, as it turned out, it was the comparison of drug and placebo that proved to be the most interesting part of our study.

All told, we analysed 38 clinical trials involving more than 3,000 depressed patients. We looked at the average improvement during the course of the study in each of the four types of groups: drug, placebo, psychotherapy and no-treatment. I am going to use a graph here (Figure 1.1) to show what the data tell us. Although the text will have a couple more such charts, I am going to keep them to a minimum. But this is one that I think we need, to make the point clearly. What the graph shows is that there was substantial improvement in both the drug and psychotherapy groups. People got better when given either form of treatment, and the difference between the two was not significant. People also got better when given placebos, and here too the improvement was remarkably large, although not as great as the improvement following drugs or psychotherapy. In contrast, the patients who had not been given any treatment at all showed relatively little improvement.

The first thing to notice in this graph is the difference in improvement between patients given placebos and patients not given any treatment at all. This difference shows that most of the improvement in the placebo groups was produced by the fact that they had been given placebos. The reduction in depression that people experienced was not just caused by the passage of time, the natural course of depression or any of the other factors that might produce an improvement in untreated patients. It was a placebo effect. and it was powerful.

Figure 1.1. Average improvement on drug, psychotherapy, placebo and no treatment. ‘lmprovement’ refers to the reduction of symptoms on scales used to measure depression. The numbers are called ‘effect sizes’. They are commonly used when the results of different studies are pooled together. Typically, effect sizes of 0.5 are considered moderate, whereas effect sizes of 0.8 are considered large. So the graph shows that antidepressants, psychotherapy and placebos produce large changes in the symptoms of depression, but there was only a relatively small average improvement in people who were not given any treatment at all.

One thing to learn from these data is that doing nothing is not the best way to respond to depression. People should not just wait to recover spontaneously from clinical depression, nor should they be expected just to snap out of it. There may be some improvement that is associated with the simple passage of time, but compared to doing nothing at all, treatment even if it is just placebo treatment provides substantial benefit.

Sapirstein and I were not surprised to find that there was a powerful placebo effect in the treatment of depression. Actually, we were quite pleased. That was our hypothesis and our reason for doing the study. What did surprise us, however, was how small the difference was between the response to the drug and the response to the placebo. That difference is the drug effect. Although the drug effect in the published clinical trials that we had analysed was statistically significant, it was much smaller than we had anticipated. Much of the therapeutic response to the drug was due to the placebo effect.

The relatively small size of the drug effect was the first of a series of surprises that the antidepressant data had in store for us.

One way to understand the size of the drug effect is to think about it as only a part of the improvement that patients experience when taking medication. Part of the improvement might be spontaneous that is, it might have occurred without any treatment at all and part may be a placebo effect. What is left over after you subtract spontaneous improvement and the placebo effect is the drug effect. You can see in Figure 1.1 that improvement in patients who had been given a placebo was about 75 per cent of the response to the real medication. That means that only 25 per cent of the benefit of antidepressant treatment was really due to the chemical effect of the drug. It also means that 50 per cent of the improvement was a placebo effect. In other words, the placebo effect was twice as large as the drug effect.

The drug effect seemed rather small to us, considering that these medications had been heralded as a revolution in the treatment of depression, blockbuster drugs that have been prescribed to hundreds of millions of patients, with annual sales totalling billions of pounds: Sapirstein and I must have done something wrong in either collecting or analysing the data. But what? We spent months trying to figure it out.


One thing that occurred to us, when considering how surprisingly small the drug effect was in the clinical trials we had analysed, was that a number of different medications had been assessed in those studies. Perhaps some of them were effective, whereas others were not. If this were the case, we had underestimated the benefits of effective drugs by lumping them together with ineffective medications. So before we sent our paper out for review, we went back to the data and examined the type of drugs that had been administered in each of the clinical trials in our meta-analysis.

We found that some of these trials had assessed tricyclic antidepressants, an older type of medication that was the most commonly used antidepressant in the 1960s and 1970s. In other trials, the focus was on selective serotonin reuptake inhibitors (SSRIs) like Prozac (fluoxetine), the first of the ‘new-generation’ drugs that replaced tricyclics as the top-selling type of antidepressant. And there were other types of antidepressants investigated in these trials as well. When we reanalysed the data, examining the drug effect and the placebo effect for each type of medication separately, we found that the diversity of drugs had not affected the outcome of our analysis. In fact, the data were remarkably consistent much more so than is usually the case when one analyses different groups of data. Not only did all of these medications produce the same degree of improvement in depression, but also, in each case, only 25 per cent of the improvement was due to the effect of the drug. The rest could be explained by the passage of time and the placebo effect.

The lack of difference we found between one class of antidepressants and another is now a rather frequent finding in antidepressant research. The newer antidepressants (SSRIs, for example) are no more effective than the older medications. Their advantage is that their side effects are less troubling, so that patients are more likely to stay on them rather than discontinue treatment. Still, the consistency of the size of the drug effect was surprising. It was not just that the percentages were close; they were virtually identical. They ranged from 24 to 26 per cent. At the time I thought, ‘What a nice coincidence! It will look great in a PowerPoint slide when I am invited to speak on this topic.’ But since then I have been struck by similar instances in which the consistency of the data is remarkable, and it is part of what has transformed me from a doubter to a disbeliever. I will note similar consistencies as we encounter them in this book.

The consistency of the effects of different types of antidepressants meant that we had not underestimated the antidepressant drug effect by lumping together the effects of more effective and less effective drugs. But our re-examination of the data in our meta-analysis held another surprise for us. Some of the medications we had analysed were not antidepressants at all, even though they had been evaluated for their effects on depression. One was a barbiturate, a depressant that had been used as a sleeping aid, before being replaced by less dangerous medications. Another was a benzodiazepine a sedative that has largely replaced the more dangerous barbiturates. Yet another was a synthetic thyroid hormone that had been given to depressed patients who did not have a thyroid disorder. Although none of these drugs are considered antidepressants, their effects on depression were every bit as great as those of antidepressants and significantly better than placebos. Joanna Moncrieff, a psychiatrist at University College London, has since listed other drugs that have been shown to be as effective as medications for depression. These include antipsychotic drugs, stimulants and herbal remedies. Opiates are also better than placebos, but I have not seen them compared to antidepressants.

If sedatives, barbiturates, antipsychotic drugs, stimulants, opiates and thyroid medications all outperform inert placebos in the treatment of depression, does this mean that any active drug can function as an antidepressant? Apparently not. In September 1998 the pharmaceutical company Merck announced the discovery of a novel antidepressant with a completely different mode of action than other medications for depression. This new drug, which they later marketed under the trade name Emend for the prevention of nausea and vomiting due to chemotherapy, seemed to show considerable promise as an antidepressant in early clinical trials. Four months later the company announced its decision to pull the plug on the drug as a treatment for depression. The reason? It could not find a significant benefit for the active drug over placebos in subsequent clinical trials.

This was unfortunate for a number of reasons. One is that the announcement caused a 5 per cent drop in the value of the company’s stock. Another is that the drug had an important advantage over current antidepressants, it produced substantially fewer side effects. The relative lack of side effects had been one reason for the enthusiasm about Merck’s new antidepressant. However, it may also have been the reason for its subsequent failure in controlled clinical trials. It seems that easily noticeable side effects are needed to show antidepressant benefit for an active drug compared to a placebo.

. . .



by Irving Kirsch

get it at Amazon.com

ANGER CORRODES THE VESSEL THAT CONTAINS IT. Self Compassion and Anger in Relationships – Kristin Neff and Christopher Germer.

Our deepest need as human beings is the need to be loved. Our brains communicate emotions to one another, regardless of how carefully we chose our words.

Much of our relationship suffering is unnecessary and can be prevented by cultivating a loving relationship with ourselves. Cultivating self-compassion is one of the best things we can do for our relationship interactions.

Anger has a way of popping up around disconnection and can sometimes linger for years, long after the relationship has ended.

Sometimes we turn the anger against ourselves in the form of harsh self-criticism, which is a surefire way to become depressed. And if we get stuck in angry rumination, who did what to whom and what they deserve for it, we live with an agitated state of mind and may end up getting angry at others for no apparent reason.

“Anger corrodes the vessel that contains it.”

To have the type of close, connected relationships we really want with others, we first need to feel close and connected to ourselves. Cultivating self-compassion is far from selfish.

Much of our suffering arises in relationship with others. As Sartre famously wrote, “Hell is other people.” The good news is that much of our relationship suffering is unnecessary and can be prevented by cultivating a loving relationship with ourselves.

There are at least two types of relational pain. One is the pain of connection, when those we care about are suffering.

The other type is the pain of disconnection, when we experience loss or rejection and feel hurt, angry, or alone.

Our capacity for emotional resonance means that emotions are contagious. This is especially true in intimate relationships. If you are irritated with your partner but try to hide it, for instance, your partner will often pick up on your irritation. He might say, “Are you angry at me?” Even if you deny it, your partner will feel the irritation; it will affect his mood, leading to an irritated tone of voice. You will feel this, in turn, and become even more irritated, and your responses will have a harsher tone, and on it goes. This is because our brains would have been communicating emotions to one another regardless of how carefully we chose our words.

In social interactions, there can be a downward spiral of negative emotions, when one person has a negative attitude, the other person becomes even more negative, and so on. This means that other people are partly responsible for our state of mind, but we are also partly responsible for their state of mind. The good news is that emotional contagion gives us more power than we realize to change the emotional tenor of our relationships. Self-compassion can interrupt a downward spiral and start an upward spiral instead.

Compassion is actually a positive emotion and activates the reward centers of our brain, even though it arises in the presence of suffering. A very useful way to change the direction of a negative relationship interaction, therefore, is to have compassion for the pain we’re feeling in the moment. The positive feelings of compassion we have for ourselves will also be felt by others, manifested in our tone and subtle facial expressions, and help to interrupt the negative cycle, in this way cultivating self-compassion is one of the best things we can do for our relationship interactions as well as for ourselves.

Not surprisingly, research shows that self-compassionate people have happier and more satisfying romantic relationships. In one study, for instance, individuals with higher levels of self-compassion were described by their partners as being more accepting and nonjudgmental than those who lacked self-compassion. Rather than trying to change their partners, self-compassionate people tended to respect their opinions and consider their point of view. They were also described as being more caring, connected, affectionate, intimate, and willing to talk over relationship problems than those who lacked self-compassion. At the same time, self-compassionate people were described as giving their partners more freedom and autonomy in their relationships. They tended to encourage partners to make their own decisions and to follow their own interests. In contrast, people who lacked self-compassion were described as being more critical and controlling of their partners. They were also described as being more self-centered, inflexibly wanting everything their own way.

Steve met Sheila in college, and after 15 years of marriage he still loved her dearly. He hated to admit this to himself, but she was also starting to drive him crazy. Sheila was terribly insecure and constantly needed Steve to reassure her of his love and affection. Wasn’t sticking around for 15 years enough? If he didn’t tell her “I love you ” every day, she would start to worry, and if a few days went by she got into a proper sulk. He felt controlled by her need for reassurance and resented the fact that she didn’t honor his own need to express himself authentically. Thair relationship was starting to suffer.

To have the type of close, connected relationships we really want with others, we first need to feel close and connected to ourselves. By being supportive toward ourselves in times of struggle, we gain the emotional resources needed to care for our significant others. When we meet our own needs for love and acceptance, we can place fewer demands on our partners, allowing them to be more fully themselves. Cultivating self-compassion is far from selfish.

It gives us the resilience we need to build and sustain happy and healthy relationships in our lives.

Over time Sheila was able to see how her constant need for reassurance from Steve was driving him away. She realized that she had become a black hole and that Steve would never be able to fully satisfy her insecurity by giving her “enough” love. It would never be enough. So Sheila started a practice of journaling at night to give herself the love and affection she craved. She would write the type of tender words to herself that she was hoping to hear from Steve, like “I love you sweetheart. I won’t ever leave you.” Then, first thing in the morning, she would read what she had written and let it soak in. She began giving herself the reassurance she was desperately seeking from Steve and let him off the hook. It wasn’t quite as nice, she had to admit, but she liked the fact that she wasn’t so dependent. As the pressure eased, Steve started to be more naturally expressive in their relationship, and they became closer. The more secure she felt in her own self-acceptanee, the more she was able to accept his love as it was, not just how she wanted it to be. Ironically, by meeting her own needs she became less self-focused and started to feel an independence that was new and delicious.

Self-Compassion and Anger in Relationships

Another type of relational pain is disconnection, which occurs whenever there is a loss or rupture in a relationship. Anger is a common reaction to disconnection. We might get angry when we feel rejected or dismissed, but also when disconnection is unavoidable, such as when someone dies. The reaction may not be rational, but it still happens. Anger has a way of popping up around disconnection and can sometimes linger for years, long after the relationship has ended.

Although anger gets a bad rap, it isn’t necessarily bad. Like all emotions, anger has positive functions. For instance, anger can give us information that someone has overstepped our boundaries or hurt us in some way, and it may be a powerful signal that something needs to change. Anger can also provide us with the energy and determination to protect ourselves in the face of threat, take action to stop harmful behavior, or end a toxic relationship.

While anger in and of itself is not a problem, we often have an unhealthy relationship with anger. For instance, we may not allow ourselves to feel our anger and suppress it instead. This can be especially true for women, who are taught to be “nice,” i.e., not angry. When we try to stuff down our anger, it can lead to anxiety, emotional constriction, or numbness. Sometimes we turn the anger against ourselves in the form of harsh self-criticism, which is a surefire way to become depressed. And if we get stuck in angry rumination, who did what to whom and what they deserve for it, we live with an agitated state of mind and may end up getting angry at others for no apparent reason.

Nate was an electrician who lived in Chicago. He had split from his wife, Lila, over five years ago, but he still got enraged every time he thought about her. It turns out that Lila had an affair with a close friend of theirs, someone they often socialized with, and that this went on behind his back for almost a year. As soon as Nate found out about it, he was seething with anger. He somehow managed to refrain from calling her every name in the book, but he was sick to his stomach whenever he thought about what had happened. He filed for divorce almost immediately, thank goodness they didn’t have children, so the process was relatively quick and easy. Although he hadn’t had any contact with Lila for several years, his anger never really subsided. And the trauma of the affair kept Nate from forming new relationships because he had such a hard time trusting anyone.

If we continually harden our emotions in an attempt to protect ourselves against those we’re angry at, over time we may develop bitterness and resentment. Anger, bitterness, and resentment are “hard feelings.” Hard feelings are resistant to change and often stick with us long past the time when they are useful. (How many of us are still angry at someone we are unlikely to ever see again?) Furthermore, chronic anger causes chronic stress, which is bad for all the systems of the body, cardiovascular, endocrine, nervous, even the reproductive system. As the saying goes, “Anger corrodes the vessel that contains it.” Or “Anger is the poison we drink to kill another person.” When anger is no longer helpful to us, the most compassionate thing we can do is change our relationship to it, especially by applying the resources of mindfulness and self compassion.

How? The first step is to identify the soft feelings behind the hard feelings of anger. Often anger is protecting more tender, sensitive emotions, such as feeling hurt, scared, unloved, alone, or vulnerable. When we peel back the outer layer of anger to see what is underneath, we are often surprised by the fullness and complexity of our feelings. Hard feelings are difficult to work with directly because they are typically defensive and outward focused. When we identify our soft feelings, however, we turn inward and can begin the transformation process.

To truly heal, however, we need to peel back the layers even further and discover the unmet needs that are giving rise to our soft feelings. Unmet needs are universal human needs, those experiences that are core to any human being. The Center for Nonviolent Communication offers a comprehensive list of needs at http://www.cm/cnrg/ training/needs inventory. Some examples are the need to be safe, connected, validated, heard, included, autonomous, and respected. And our deepest need as human beings is the need to be loved.

By having the courage to turn toward and experience our authentic feelings and needs, we can begin to have insight into what is really going on for us. Once we contact the pain and respond with self-compassion, things can start to transform on a deep level. We can use self-compassion to meet our needs directly.

Self-compassion in response to unmet needs means that we can begin to give ourselves what we have yearned to receive from others, perhaps for many years. We can be our own source of support, respect, love, validation, or safety. Of course, we need relationships and connection with others. We aren’t automatons. But when others are unable to meet our needs, for whatever reason, and have harmed us in the process, we can recover by holding the hurt, the soft feelings, in a compassionate embrace and fill the hole in our hearts with loving, connected presence.

Nate worked hard at transforming his anger because he realized it was holding him back. He had tried catharsis to get it out, punching pillows, yelling at the top of his lungs but it didn’t work. Eventually Nate signed up for an MSC course because a friend was very enthusiastic about it and said it would reduce his stress.

When Nate came to the part of the MSC course that focused on transforming anger by meeting his unmet needs, he felt nervous but did it anyway. It was easy to get in touch with his anger, and even the hurt behind it, and feel it in his body. The toughest part was identifying his unmet need. Certainly Nate felt betrayed and unloved, but that wasn’t what seemed to be holding him back. Nate stuck with the exercise, and finally the unmet need revealed itself, and his whole body relaxed. Respect!

Nate came from a hardworking hlue-collar family, and his parents were still happily married after 30 years. He tried to do everything right in his own marriage, to the best of his ability, and he took his vows very seriously. Honesty and respect were core values for Nate. Knowing that Lila would never give him the respect he needed, it was too late for that, he took the plunge and tried to give it to himself. “I respect you,” he told himself. At first it felt silly and empty and hollow. So he paused and tried to say the words as if they were true. He thought about how much he had sacrificed to get his master electrician’s certification and open a business, the long hours he had put in to pay the mortgage and build a savings account. “I respect you,” he repeated, over and over, though it still just sounded like words. Then he thought of how honest and hardworking he had tried to be in his marriage, even though that wasn’t enough for Lila.

Very, very slowly, Nate started to take it in. Finally he put his hand on his heart and said it like he really meant it: “I respect you.” He started to tear up, because he actually felt it. Once he did, the anger at his wife started to melt away. He began to see her unmet needs, different from his, for more closeness and affection. Not that what Lila did was okay, but Nate realized that her behavior had nothing to do with his worth or value as a person. He couldn’t rely on any outside person, even one who was reliable and faithful, to give him the respect he needed. It had to come from within.

Self-Compassion and Forgiveness

When someone has harmed us and we still feel anger and bitterness, sometimes the most compassionate thing to do is to forgive. Forgiveness involves letting go of anger at someone who has caused us harm. But forgiveness must involve grieving before letting go. The central point of forgiveness practice is that we cannot forgive others without first opening to the hurt that we have experienced. Similarly, to forgive ourselves, we must first open to the pain, remorse, and guilt of hurting others.

Forgiveness doesn’t mean condoning bad behavior or resuming a relationship that causes harm. If we are being harmed in a relationship, we need to protect ourselves before we can forgive. If we are harming another in a relationship, we cannot forgive ourselves if we are using this as an excuse for acting badly. We must first stop the behavior, then acknowledge and take responsibility for the harm we have caused.

At the same time, it’s helpful to remember that the harm done is usually the product of a universe of interacting causes and conditions stretching back through time. We have partly inherited our temperament from our parents and grandparents, and our actions are shaped by our early childhood history, culture, health status, current events, and so forth. Therefore, we don’t have complete control over precisely what we say and do from one moment to the next.

Sometimes we cause pain in life without intending it, and we may still feel sorry about causing such pain. An example is when we move across the country to start a new life, leaving friends and family behind, or when we can’t give our elderly parents the attention they need because of our work situation. This kind of pain is not the fault of anyone, but it can still be acknowledged and healed with self compassion.

The capacity to forgive requires keen awareness of our common humanity. We are all imperfect human beings whose actions stem from a web of interdependent conditions that are much larger than ourselves. In other words, we don’t have to take our mistakes so personally.

Paradoxically, this understanding helps us take more responsibility for our actions because we feel more emotionally secure. One research study asked participants to recall a recent action they felt guilty about, such as cheating on an exam, lying to a romantic partner, saying something harmful, that still made them feel bad about themselves when they thought about it. The researchers found that participants who were helped to be self-compassionate about their transgression reported being more motivated to apologize for the harm done, and more committed to not repeating the behavior, than those who were not helped to be selfcompassionate.

Anneka really struggled to forgive herself after getting super angry at her friend and coworker Hilde, whom she told to f-off. Anneka had been under a tremendous amount of pressure at work to secure a contract with new clients and was all set to close the deal at a dinner that they were hosting. The clients were pretty conservative, and Anneka knew she had to be on time and look appropriate for them to trust her. Hilde was supposed to pick her up for the dinner, but she wasn’t there at the appointed time. Frantic, Anneka called her. “Where are you?” Hilde had completely forgotten about the event. “Oh, I ’m so sorry,” she offered lamely. Anneka dropped the f bomb, said a few more unpleasant things, then hung up and called a taxi. Immediately after ward, Anneka felt terrible. This was her friend! Hilde hadn’t done anything purposefully harmful, she simply forgot, and Anneka has been too busy to remind her. The truth was that Anneka was so anxious about closing the deal that she lost perspective and ouerreacted.

There are five steps to forgiveness:

1. Opening to pain, being present with the distress of what happened.

2. Self Compassion, allowing our hearts to melt with sympathy for the pain, no matter what caused it.

3. Wisdom, beginning to recognize that the situation wasn’t entirely personal, but was the consequence of many interdependent causes and conditions.

4. Intention to forgive. “May I begin to forgive myself [another] for what I [he/she] did, wittingly or unwittingly, to have caused them [me] pain.”

5. Responsibility to protect, committing ourselves to not repeat the same mistake; to stay out of harm’s way, to the best of our ability.

At first Anneka harshly berated herself for her behavior, but she knew that heating up on herself wouldn’t help anyone. Instead, Anneka needed to forgive herself for having made a mistake, just as everyone makes mistakes.

Anneka had learned the five steps to forgiveness from her MSC course, so she knew what to do. First, she had to accept the pain she had caused Hilde. This was really tough for Anneka, especially since she didn’t get the contract she was hoping for. Her mind wanted to pin all the blame on Hilde. It was Hilde’s fault! But Anneka knew the truth. There was no excuse for talking to Hilde that way. It was wrong.

Anneka allowed herself to feel in her bones what it must have been like for Hilde to hear those words, from someone she considered a friend. That took some courage because Anneka felt so bad about it. Then Anneka gave herself compassion for the pain of hurting someone she loved. “Everyone makes mistakes. I’m so sorry you wounded your friend in this manner. I know you deeply regret it.” Giving herself compassion provided a bit of perspective, and Anneka was able to acknowledge the incredible stress she was under. The circumstances brought out the worst in her. Then Anneka tried to forgive herself, at least in a preliminary way, for her behavior. “May I begin to forgive myself for the pain I unwittingly inflicted on my dear friend Hilde.” Anneka also made a commitment to take at least one deep breath before speaking when she felt angry. Anneka knew this might take some time because she didn’t always know when she felt angry, but she was determined to try to be less reactive when under stress.

The central point of forgiveness is first opening to the hurt that we experienced or caused to others. Timing is very important because we are naturally ambivalent about feeling the guilt of hurting others or making ourselves vulnerable to being hurt again. As the saying goes, first we need to “give up all hope of a better past.”

Embracing the Good

One of the biggest benefits of self compassion is that it doesn’t just help you cope with negative emotions, it actively generates positive emotions. When we embrace ourselves and our experience with loving, connected presence, it feels good. It doesn’t feel good in a saccharine way, nor does it resist or avoid what feels bad. Rather, self compassion allows us to have the full range of experience, the bitter and the sweet.

Typically, however, we tend to focus much more on what’s wrong than on what’s right in our lives. For example, when you get an annual review at work, what do you remember the most, the points of praise or criticism? Or if you go shopping at the mall and interact with five polite salespeople and one rude one, which is most likely to stick in your mind?

The psychological term for this is negativity bias. Rick Hanson says the brain is like “Velcro for bad experiences and Teflon for good ones.” Evolutionarily speaking, the reason we have a negativity bias is that our ancestors who fretted and worried at the end of the day, wondering where that pack of hyenas was yesterday and where it might be hanging out tomorrow, were more likely to survive than our ancestors who kicked back and relaxed. This is evolutionarily adaptive when we face physical danger. However, since most of the dangers we face nowadays are threats to our sense of self, it is self-compassionate to correct the negativity bias because it distorts reality.

We need to intentionally recognize and absorb positive experiences to develop more realistic, balanced awareness that is not skewed toward the negative. This requires some training, just like mindfulness and self-compassion require training. Furthermore, since compassion training includes opening to pain, we may need the energy boost of focusing on positive experience to support our compassion practice.

Focusing on the positive also has important benefits. Barbara Fredrickson, who developed the “broaden and build” theory, posits that the evolutionary purpose of positive emotions is to broaden attention. In other words, when people feel safe and content, they become curious and start exploring their environment, noticing opportunities for food, shelter, or rest. This allows us to take advantage of opportunities that would otherwise go unnoticed.

“When one door of happiness closes, another opens, but often we look so long at the closed door that we do not see the one that has been opened for us.” Helen Keller

Recently there has been a movement in psychology that focuses on finding the most effective ways to help people cultivate positive emotions, and two powerful practices that have been identified are savoring and gratitude.


Savoring involves noticing and appreciating the positive aspects of life, taking them in, letting them linger, and then letting them go. It is more than pleasure, savoring involves mindful awareness of the experience of pleasure. In other words, being aware that something good is happening while it’s happening.

Given our natural tendency to skip over what’s right and focus on what’s wrong, we need to plut a little extra effort into paying attention to what gives us pleasure. Luckily, savoring is simple practice, noticing the tart and juicy taste of a fresh apple, a gentle cool breeze on your cheek, the warm smile of your coworker, the hand of your partner gently holding your own. Research suggests that simply taking the time to notice and linger with these sorts of positive experiences can greatly increase our happiness.


Gratitude involves recognizing, acknowledging, and being grateful for the good things in our lives. If we just focus on what we want but don’t have, we’ll remain in a negative state of mind. But when we focus on what we do have, and give thanks for it, we radically reframe our experience.

Whereas savoring is primarily an experiential practice, gratitude is a wisdom practice. Wisdom refers to understanding how everything arises interdependently, The confluence of factors required for even a simple event to occur is mind boggling and can inspire an attitude of awe and reverence. Gratitude involves recognizing the myriad people and events that contribute to the good in our lives. As an MSC participant once remarked, “The texture of wisdom is gratitude.”

Gratitude can be aimed at the big things in life, like our health and family, but the effect of gratitude may be even more powerful when it is aimed at small things, such as when the bus arrives on time or the air conditioning is working on a hot summer day. Research shows that gratitude is also strongly linked to happiness. As the philosopher Mark Nepo wrote: “One key to knowing joy is to be easily pleased.”

The meditation teacher James Baraz tells this wonderful story about the power of gratitude in his book Awakening Joy, which we’ve adapted here by permission.

One year I was visiting my then eighty-nine-year-old mother and brought along a magazine with an article on the beneficial effects of gratitude. As we ate dinner I told her about some of the findings. She said she was impressed by the reports but admitted she had a lifetime habit of looking at the glass half empty. “I know I ’m very fortunate and have so many things to be thankful for, but little things just set me off” She said she wished she could change the habit but had doubts whether that was possible. “I’m just more used to seeing what’s going wrong,” she concluded.

“You know, Mom, the key to gratitude is really in the way we frame a situation,” I began. “For instance, suppose all of a sudden your television isn’t getting good reception.”

“That’s a scenario I can relate to, ” she agreed with a knowing smile.

“One way to describe your experience would be to say, ‘This is so annoying I could scream.” Or you could say, ‘This is so annoying. . . and my life is really very blessed. She agreed that could make a big difference.

“But I don’t think I can remember to do that,” she sighed.

So together we made up a gratitude game to remind her. Each time she complained about something, I would simply say “and . . . ,” to which she would respond “and my life is very blessed.” I was elated to see that she was willing to try it out. Although it had started as just a fun game, after a while it began to have some real impact. Her mood grew brighter as our weeks became filled with gratitude. To my delight and amazement, my mother has continued doing the practice, and the change has been revolutionary.


Most people recognize the importance of expressing gratitude and appreciation toward others. But what about ourselves? That one doesn’t come so easily.

The negativity bias is especially strong toward ourselves. Self appreciation not only feels unnatural it can feel downright wrong. Because our tendency is to focus on our inadequacies rather than appreciate our strengths, we often have a skewed perspective of who we are. Think about it, When you receive a compliment, do you take it in, or does it bounce off you almost immediately? We usually feel uncomfortable just thinking about our good qualities. The counterargument immediately arises: “I’m not always that way” or “I have a lot of bad qualities too.” Again, this reaction demonstrates the negativity bias because when we receive unpleasant feedback, our first thoughts are not typically “Yes, but I’m not aiways that way” or “Are you aware of all my good qualities?”

Many of us are actually afraid to acknowledge our own goodness. Some common reasons given for this are:

– I don’t want to alienate my friends by being arrogant.

– My good qualities are not a problem that needs to be fixed, so I don’t need to focus on them.

– I’m afraid I would be putting myself on a pedestal, only to fall off.

– It will make me feel superior and separate from others.

Of course, there is a big difference between simply acknowledging what’s true, that we have good as well as not so good qualities, and saying that we’re perfect or better than others. It’s important to appreciate our strengths as well as have compassion for our weaknesses so that we embrace the whole of ourselves, exactly as we are.

We can apply the three components of selfcompassion, self kindness, common humanity, and mindfulness, to our positive qualities as well as our negative ones. These three factors together allow us to appreciate ourselves in a healthy and balanced way.

Self Appreciation

Self Kindness: Part of being kind to ourselves involves expressing appreciation for our good qualities, just as we would do with a good friend.

Common Humanity: When we remember that having good qualities is part of being human, we can acknowledge our strengths without feeling isolated or better than others.

Mindfulness: To appreciate ourselves, we need to pay attention to our good qualities rather than taking them for granted.

It’s important to recognize that the practice of self appreciation is not selfish or self centered. Rather, it simply recognizes that good qualities are part of being human, Although some children may have been raised with the belief that humility means not recognizing their accomplishments, that approach can harm children‘s self-concept and get in the way of knowing themselves properly. Self-appreciation is a way to correct our negativity bias toward ourselves and see ourselves more clearly as a whole person. Self-appreciation also provides the emotional resilience and selfconfidence needed to give to others.

The best selling author and spiritual teacher Marianne Williamson writes, “We are all meant to shine, as children do. . . . And as we let our own light shine, we unconsciously give other people permission to do the same. As we are liberated from our own fear, our presence automatically liberates others.”

Wisdom and gratitude are central to selfappreciation as well. These qualities help us to see our good qualities in a broader context. When we appreciate ourselves, we’re also appreciating the causes, conditions, and people, including friends, parents, and teachers, who helped us develop those good qualities in the first place. This means we don’t need to take our own good qualities so personally!

Alice grew up in a stern Protestant family where humility and self effacement were the expected norm. When she was eight years old and came home with a trophy for winning her third-grade spelling bee, she remembers, her mother just raised her eyebrows and said, “Now don’t you be getting too big for your britches.” Every time Alice accomplished anything she felt she had to downplay it or else receive the disapproval of her family.

Later on in life, Alice started dating a man named Theo who thought she was beautiful and kind and smart and wonderful and liked to tell her so. Alice would not only cringe with embarrassment; Theo’s comments made her anxious. What if Theo finds out I’m not perfect? What happens if I let him down? She would continually push aside his comments when he said something nice, leaving Theo feeling perplexed and on the other side of an invisible wall.

Alice was becoming adept at self-compassion, especially the capacity to see her personal inadequacies as part of common humanity. Self-appreciation made sense to Alice, primarily conceptually, but she knew she had a way to go. First Alice made a mental note of everything good that she did during the day, a moment of kindness, a success, a small accomplishment. Then she tried to say something appreciative about it, such as “That was well done, Alice.” When Alice spoke to herself like this, she felt like she was violating an invisible contract from childhood and it made her uneasy, but she persisted. “I’m not saying I’m better than anyone else or that I’m perfect I’m simply acknowledging that this too is true.”

Eventually Alice made a commitment to take in and savor the heartfelt compliments Theo gave her. Theo was so delighted by this turn of events that he bought her a bracelet that said on the inside, I may not be perfect, but parts of me are excellent!


The Mindful Self-Compassion Workbook. A proven way to accept yourself, build inner strength, and thrive

by Kristin Neff, PhD and Christopher Germer, PhD

get it at Amazon.com







HOW TO ACCEPT YOURSELF, BUILD INNER STRENGTH, AND THRIVE. The Mindful Self-Compassion Workbook – Kristin Neff and Christopher Germer.

“Be kind to yourself in the midst of suffering.”

Western culture places great emphasis on being kind to our friends, family, and neighbors who are struggling. Not so when it comes to ourselves.

Are you kinder to others than you are to yourself? More than a thousand research studies show the benefits of being a supportive friend to yourself, especially in times of need.

In the blink of an eye we can go from “I don’t like this feeling” to “I don’t want this feeling” to “I shouldn’t have this feeling” to “Something is wrong with me for having this feeling” to “I’m bad!”

The seeds of self-compassion already lie within you, learn how you can uncover this powerful inner resource and transform your life.

Self-compassion is the perfect alternative to self-esteem because it offers a sense of self-worth that doesn’t require being perfect or better than others.

This science-based workbook offers a step-by-step approach to breaking free of harsh self-judgments and impossible standards in order to cultivate emotional well-being. The book is based on the authors’ groundbreaking eight-week Mindful Self-Compassion (MSC) program, which has helped tens of thousands of people worldwide. It is packed with guided meditations (with audio downloads); informal practices to do anytime, anywhere; exercises; and vivid stories of people using the techniques to address relationship stress, weight and body image issues, health concerns, anxiety, and other common problems.

Kristin Neff, PhD, is Associate Professor of Human Development and Culture at the University of Texas at Austin and a pioneer in the field of self-compassion research.

Christopher Germer, PhD, has a private practice in mindfulnessand compassionbased psychotherapy in Arlington, Massachusetts, and is a part-time Lecturer on Psychiatry at Harvard Medical School/Cambridge Health Alliance. He is a founding faculty member of the Institute for Meditation and Psychotherapy and of the Center for Mindfulness and Compassion.


How To Approach This Workbook

“Our task is not to seek for love, but merely to seek and find all the barriers within yourself that you have built against it.” Rumi

We have all built barriers to love. We’ve had to in order to protect ourselves from the harsh realities of living a human life. But there is another way to feel safe and protected. When we are mindful of our struggles, and respond to ourselves with compassion, kindness, and support in times of difficulty, things start to change. We can learn to embrace ourselves and our lives, despite inner and outer imperfections, and provide ourselves with the strength needed to thrive.

An explosion of research into self-compassion over the last decade has shown its benefits for well-being. Individuals who are more self-compassionate tend to have greater happiness, life satisfaction, and motivation, better relationships and physical health, and less anxiety and depression. They also have the resilience needed to cope with stressful life events such as divorce, health crises, academic failure, even combat trauma.

When we struggle, however, when we suffer, fail, or feel inadequate, it’s hard to be mindful toward what’s occurring; we’d rather scream and beat our fists on the table. Not only do we not like what’s happening, we think there is something wrong with us because it’s happening. In the blink of an eye we can go from “I don’t like this feeling” to “I don’t want this feeling” to “I shouldn’t have this feeling” to “Something is wrong with me for having this feeling” to “I’m bad!”

That’s where self-compassion comes in. Sometimes we need to comfort and soothe ourselves for how hard it is to be a human being before we can relate to our lives in a more mindful way.

Self-compassion emerges from the heart of mindfulness when we meet suffering in our lives. Mindfulness invites us to open to suffering with loving, spacious awareness. Self-compassion adds, “be kind to yourself in the midst of suffering.” Together, mindfulness and self-compassion form a state of warmhearted, connected presence during difficult moments in our lives.


Mindful Self-Compassion (MSC) was the first training program specifically designed to enhance a person’s self-compassion. Mindfulness-based training programs such as mindfulness-based stress reduction and mindfulness-based cognitive therapy also increase self-compassion, but they do so more implicitly, as a welcome byproduct of mindfulness. MSC was created as a way to explicitly teach the general public the skills needed to be self-compassionate in daily life. MSC is an eight-week course where trained teachers lead a group of 8 to 25 participants through the program for 234 hours each week, plus a half-day meditation retreat. Research indicates that the program produces long-lasting increases in self-compassion and mindfulness, reduces anxiety and depression, enhances overall well-being, and even stabilizes glucose levels among people with diabetes.

The idea for MSC started back in 2008 when the authors met at a meditation retreat for scientists. One of us (Kristin) is a developmental psychologist and pioneering researcher into self-compassion. The other (Chris) is a clinical psychologist who has been at the forefront of integrating mindfulness into psychotherapy since the mid-1990s. We were sharing a ride to the airport after the retreat and realized we could combine our skills to create a program to teach self-compassion.

I (Kristin) first came across the idea of self-compassion in 1997 during my last year of graduate school, when, basically, my life was a mess. I had just gotten through a messy divorce and was under incredible stress at school. I thought I would learn to practice Buddhist meditation to help me deal with my stress. To my great surprise the woman leading the meditation class talked about how important it was to develop self-compassion. Although I knew that Buddhists talked a lot about the importance of compassion for others, I never considered that having compassion for myself might be just as important. My initial reaction was “What? You mean I’m allowed to be kind to myself? Isn’t that selfish?” But I was so desperate for some peace of mind I gave it a try. Soon I realized how helpful self-compassion could be. I learned to be a good, supportive friend to myself when I struggled. When I started to be kinder to and less judgmental of myself, my life transformed.

After receiving my PhD, I did two years of postdoctoral training with a leading self-esteem researcher and began to learn about some of the downsides of the self-esteem movement.

Though it’s beneficial to feel good about ourselves, the need to be “special and above average” was being shown to lead to narcissism, constant comparisons with others, ego-defensive anger, prejudice, and so on.

The other limitation of self-esteem is that it tends to be contingent, it’s there for us in times of success but often deserts us in times of failure, precisely when we need it most!

I realized that self-compassion was the perfect alternative to self-esteem because it offered a sense of self-worth that didn’t require being perfect or better than others.

After getting a job as an assistant professor at the University of Texas at Austin, I decided to conduct research on self-compassion. At that point, no one had studied selfcompassion from an academic perspective, so I tried to define what self-compassion is and created a scale to measure it, which started what is now an avalanche of selfcompassion research.

The reason I really know self-compassion works, however, is because I’ve seen the benefits of it in my personal life. My son, Rowan, was diagnosed with autism in 2007, and it was the most challenging experience I had ever faced. I don’t know how I would have gotten through it if it weren’t for my self-compassion practice. I remember the day I got the diagnosis, I was actually on my way to a meditation retreat. I had told my husband that I would cancel the retreat so we could process, and he said, “No, go to your retreat and do that self-compassion thing, then come back and help me.”

So while I was on retreat, I flooded myself with compassion. I allowed myself to feel whatever I was feeling without judgment, even feelings I thought I “shouldn’t” be having. Feelings of disappointment, even of irrational shame. How could I possibly feel this about the person I love most in the world? But I knew I had to open my heart and let it all in. I let in the sadness, the grief, the fear. And fairly soon I realized I had the stability to hold it, that the resource of self-compassion would not only get me through, but would help me be the best, most unconditionally loving parent to Rowan I could be. And what a difference it made!

Because of the intense sensory issues experienced by children with autism, they are prone to violent tantrums. The only thing you can do as a parent is to try to keep your child safe and wait until the storm passes. When my son screamed and flailed away in the grocery store for no discernible reason, and strangers gave me nasty looks because they thought I wasn’t disciplining my child properly, I would practice self-compassion. I would comfort myself for feeling confused, ashamed, stressed, and helpless, providing myself the emotional support I desperately needed in the moment. Self-compassion helped me steer clear of anger and self-pity, allowing me to remain patient and loving toward Rowan despite the feelings of stress and despair that would inevitably arise. I’m not saying that I didn’t have times when I lost it. I had many. But I could rebound from my missteps much more quickly with self-compassion and refocus on supporting and loving Rowan.

I (Chris) also learned self-compassion primarily for personal reasons. I had been practicing meditation since the late ’70s, became a clinical psychologist in the early ’80s, and joined a study group on mindfulness and psychotherapy. This dual passion for mindfulness and therapy eventually led to the publication of Mindfulness and Psychotherapy.

As mindfulness became more popular, I was being asked to do more public speaking. The problem, however, was that I suffered from terrible public speaking anxiety. Despite maintaining a regular practice of meditation my whole adult life and trying every clinical trick in the book to manage anxiety, before any public talk my heart would pound, my hands began to sweat, and I found it impossible to think clearly. The breaking point came when I was scheduled to speak at an upcoming Harvard Medical School conference that I helped to organize. (I still tried to expose myself to every possible speaking opportunity.) I’d been safely tucked in the shadows of the medical school as a clinical instructor but now I’d have to give a speech and expose my shameful secret to all my esteemed colleagues.

Around that time, a very experienced meditation teacher advised me to shift the focus of my meditation to loving-kindness, and to simply repeat phrases such as “May I be safe,” “May I be happy,” “May I be healthy,” “May I live with ease.” So I gave it a try. In spite of all the years I’d been meditating and reflecting on my inner life as a psychologist, I’d never spoken to myself in a tender, comforting way. Right off the bat, I started to feel better and my mind also became clearer. I adopted loving-kindness as my primary meditation practice.

Whenever anxiety arose as I anticipated the upcoming conference, I just said the loving-kindness phrases to myself, day after day, week after week. I didn’t do this particularly to calm down, but simply because there was nothing else I could do. Eventually, however, the day of the conference arrived. When I was called to the podium to speak, the typical dread rose up in the usual way. But this time there was something new, a faint background whisper saying, “May you be safe. May you be happy . . .” In that moment, for the first time, something rose up and took the place of fear, self-compassion.

Upon later reflection, I realized that I was unable to mindfully accept my anxiety because public speaking anxiety isn’t an anxiety disorder after all, it’s a shame disorder, and the shame was just too overwhelming to bear. Imagine being unable to speak about the topic of mindfulness due to anxiety! I felt like a fraud, incompetent, and a bit stupid. What I discovered on that fateful day was that sometimes, especially when we’re engulfed in intense emotions like shame, we need to hold ourselves before we can hold our moment-to-moment experience. I had begun to learn self-compassion, and saw its power firsthand.

In 2009, I published The Mindful Path to Self-Compassion in an effort to share what I had learned, especially in terms of how self-compassion helped the clients I saw in clinical practice. The following year, Kristin published Self-Compassion, which told her personal story, reviewed the theory and research on self-compassion, and provided many techniques for enhancing self-compassion.

Together we held the first public MSC program in 2010. Since then we, along with a worldwide community of fellow teachers and practitioners, have devoted a tremendous amount of time and energy to developing MSC and making it safe, enjoyable, and effective for just about everyone. The benefits of the program have been supported in multiple research studies, and to date tens of thousands of people have taken MSC around the globe.


Most of the MSC curriculum is contained in this workbook, in an easy-to-use format that will help you start to be more self-compassionate right away. Some people who use this workbook will be currently taking an MSC course, some may want to refresh what they previously learned, but for many people this will be their first experience with MSC.

This workbook is designed to also be a stand-alone pathway for you to learn the skills you need to be more self-compassionate in daily life. It follows the general structure of the MSC course, with the chapters organized in a carefully sequenced manner so the skills build upon one another. Each chapter provides basic information about a topic followed by practices and exercises that allow you to experience the concepts firsthand.

Most of the chapters also contain illustrations of the personal experiences of participants in the MSC course, to help you know how the practices may play out in your life. These are composite illustrations that don’t compromise the privacy of any particular participant, and the names are not real. In this book, we also alternate between masculine and feminine pronouns when referring to a single individual. We have made this choice to promote ease of reading as our language continues to evolve and not out of disrespect toward readers who identify with other personal pronouns. We sincerely hope that all will feel included.

We recommend that you go through the chapters in order, giving the time needed in between to do the practices a few times. A rough guideline would be to practice about 30 minutes a day and to do about one or two chapters per week. Go at your own pace, however. If you feel you need to go more slowly or spend extra time on a particular topic, please do so. Make the program your own. If you are interested in taking the MSC course in person from a trained MSC teacher, you can find a program near you at http://www.centerformsc.org. Online training is also available. For professionals who want to learn more about the theory, research, and practice of MSC, including how to teach self-compassion to clients, we recommend reading the MSC professional training manual, to be published by The Guilford Press in 2019.

The ideas and practices in this workbook are largely based on scientific research (notes at the back of the book point to the relevant research). However, they are also based on our experience teaching thousands of people how to be more selfcompassionate. The MSC program is itself an organic entity, continuing to evolve as we and our participants learn and grow together.

Also, while MSC isn’t therapy, it’s very therapeutic, it will help you access the resource of self-compassion to meet and transform difficulties that inevitably emerge as we live our lives. However, the practice of self-compassion can sometimes activate old wounds, so if you have a history of trauma or are currently having mental health challenges, we recommend that you complete this workbook under the supervision of a therapist.

Tips for Practice

As you go through this workbook, it’s important to keep some points in mind to get the most out of it.

– MSC is an adventure that will take you into uncharted territory, and unexpected experiences will arise. See if you can approach this workbook as an experiment in self-discovery and self-transformation. You will be working in the laboratory of your own experience, see what happens.

– While you will be learning numerous techniques and principles of mindfulness and self-compassion, feel free to tailor and adapt them in a way that works for you. The goal is for you to become your own best teacher.

– Know that tough spots will show up as you learn to turn toward your struggles in a new way. You are likely to get in touch with difficult emotions or painful self-judgments. Fortunately, this book is about building the emotional resources, skills, strengths, and capacities to deal with these difficulties.

– While self-compassion work can be challenging, the goal is to find a way to practice that’s pleasant and easy. Ideally, every moment of self-compassion involves less stress, less striving, and less work, not more.

– It is good to be a “slow learner.” Some people defeat the purpose of self compassion training by pushing themselves too hard to become self compassionate. Allow yourself to go at your own pace.

– The workbook itself is a training ground for self-compassion. The way you approach this course should be self-compassionate. In other words, the means and ends are the same.

– It is important to allow yourself to go through a process of opening and closing as you work through this book. just as our lungs expand and contract, our hearts and minds also naturally open and close. It is self-compassionate to allow ourselves to close when needed and to open up again when that naturally happens. Signs of opening might be laughter, tears, or more vivid thoughts and sensations. Signs of closing might be distraction, sleepiness, annoyance, numbness, or self-criticism.

– See if you can find the right balance between opening and closing. Just like a faucet in the shower has a range of water flow between off and full force that you can control, you can also regulate the degree of openness you experience. Your needs will vary: sometimes you may not be in the right space to do a particular practice, and other times it will be exactly what you need. Please take responsibitty for your own emotional safety, and don’t push yourself through something if it doesn’t feel right in the moment. You can always come back to it later, or do the practice with the help and guidance of a trusted friend or therapist.

1. What is Self-Compassion?

Selt-compassion involves treating yourself the way you would treat a friend who is having a hard time, even if your friend blew it or is feeling inadequate, or is just facing a tough life challenge. Western culture places great emphasis on being kind to our friends, family, and neighbors who are struggling. Not so when it comes to ourselves. Self-compassion is a practice in which we learn to be a good friend to ourselves when we need it most, to become an inner ally rather than an inner enemy. But typically we don’t treat ourselves as well as we treat our friends.

The golden rule says “Do unto others as you would have them do unto you.” However, you probably don’t want to do unto others as you do unto yourself! Imagine that your best friend calls you after she just got dumped by her partner, and this is how the conversation goes.

“Hey,” you say, picking up the phone. “How are you?”

“Terrible,” she says, choking back tears. “You know that guy Michael I’ve been dating? Well, he’s the first man I’ve been really excited about since my divorce. Last night he told me that I was putting too much pressure on him and that he just wants to be friends. I’m devastated.”

You sigh and say, “Well, to be perfectly honest, it’s probably because you’re old, ugly, and boring, not to mention needy and dependent. And you’re at least 20 pounds overweight. I’d just give up now, because there’s really no hope of finding anyone who will ever love you. I mean, frankly you don’t deserve it!”

Would you ever talk this way to someone you cared about? Of course not. But strangely, this is precisely the type of thing we say to ourselves in such situations, or worse. With self-compassion, we learn to speak to ourselves like a good friend. “I’m so sorry. Are you okay? You must be so upset. Remember I’m here for you and I deeply appreciate you. Is there anything I can do to help?”

Although a simple way to think about self-compassion is treating yourself as you would treat a good friend, the more complete definition involves three core elements that we bring to bear when we are in pain: self-kindness, common humanity, and mindfulness.

Self-Kindness. When we make a mistake or fail in some way, we are more likely to beat ourselves up than put a supportive arm around our own shoulder. Think of all the generous, caring people you know who constantly tear themselves down (this may even be you). Self-kindness counters this tendency so that we are as caring toward ourselves as we are toward others. Rather than being harshly critical when noticing personal shortcomings, we are supportive and encouraging and aim to protect ourselves from harm. Instead of attacking and berating ourselves for being inadequate, we offer ourselves warmth and unconditional acceptance. Similarly, when external life circumstances are challenging and feel too difficult to bear, we actively soothe and comfort ourselves.

Theresa was excited. “I did it! I can’t believe I did it! I was at an office party last week and blurted out something inappropriate to a coworker. Instead of doing my usual thing of calling myself terrible names, I tried to be kind and understanding. I told myself, ‘Oh well, it’s not the end of the world. I meant well even if it didn’t come out in the best way.”

Common Humanity. A sense of interconnectedness is central to self-compassion. It’s recognizing that all humans are flawed works-in-progress, that everyone fails, makes mistakes, and experiences hardship in life. Self-compassion honors the unavoidable fact that life entails suffering, for everyone, without exception. While this may seem obvious, it’s so easy to forget. We fall into the trap of believing that . . .


The Mindful Self-Compassion Workbook. A proven way to accept yourself, build inner strength, and thrive

by Kristin Neff, PhD and Christopher Germer, PhD

get it at Amazon.com






MIGRAINE AND DEPRESSION: It’s All The Same Brain – Gale Scott * Migraine May Permanently Change Brain Structure – American Academy of Neurology * Migraine: Multiple Processes, Complex Pathophysiology – Rami Burstein, Rodrigo Noseda, and David Borsook.

The symptoms that accompany migraine suggest that multiple neuronal systems function abnormally. Neuroimaging studies show that brain networks, brain morphology, and brain chemistry are altered in episodic and chronic migraineurs. As a consequence of the disease itself or its genetic underpinnings, the migraine brain is altered structurally and functionally.

Migraine tends to run in families and as such is considered a genetic disorder. Genetic predisposition to migraine resides in multiple susceptible gene variants, many of which encode proteins that participate in the regulation of glutamate neurotransmission and proper formation of synaptic plasticity.

Migraine is a leading cause of suicide, an indisputable proof of the severity of the distress that the disease may inflict on the individual. 40% of migraine patients are also depressed.

Migraine and Depression: It’s All The Same Brain

Gale Scott

When a patient suffers from both migraines and depression or other psychiatric comorbidities, physicians have to treat both. It’s a common situation, since 40% of migraine patients are also depressed. Anxiety is even more prevalent in these patients. An estimated 50% of migraine patients are anxious whether with generalized anxiety, phobias, panic attacks. or other forms of anxiety, said Mia Minen, MD Director of Headache Services at NYU Langoni Medical Center.

Health care costs in treating these co-morbid patients are 1.5 times higher than for migraine patients without accompanying psychiatric disorders.

But sorting out whether one problem is causing the other is not always easy, she said in a recent interview at NYU Langone. “it’s really interesting, which came first,” she said, “We really don’t know.”

There may be a bidirectional relationship with depression. Anxiety may precede migraines, then depression may follow.

Fortunately, she said, the question of which problem came first doesn’t really matter that much.

“It’s all one brain, one organ, and some of the same neurotransmitters are implicated in both disorders.” Serotonin is affected in migraine just as it is in depression and anxiety, she said. Dopamine and norepinephrine are also related both to migraines and psychiatric comorbidities.

“So it’s really one organ that’s controlling all these things,” Minen said.

The first step in treatment is having patients keep a headache diary to track the intensity and frequency and what they take when they feel it coming on.

For a mild migraine that might be ibuprofen or another over-the-counter pain killer.

If the migraine is moderately severe there are 7 migraine-specifuc medications that are effective, she said. There are oral, nasal, and injectable forms of triptans a family of tryptamine-based drugs. “We sometimes tell patients to combine the triptan with Naprosyn,” she said.

If triptans are contraindicated because the patient has other health problems, there are still more pharmaceutical options.

Those include some classes of beta blockers, antiseizure medications, and tricyclic antidepressants at low doses.

The drug regimen may vary with the particular comorbidity. For instance, for migraines with anxiety, venlafaxine might work. If patients have sleep disturbances, amitriptyline might be effective. “Lack of sleep is also a trigger for migraine,” she noted.

The toughest co-morbidity to treat in patients with migraine is finding a regimen that works for patients who are taking a lot of psychiatric medications, like SSRIs and antipsychotics.

For older patients with migraines plus cardiovascular disease, drug choices are also limited.

Botox injections seem promising, but Minen is cautious. “It’s a great treatment for patients with chronic migraines but they have to have failed 2 or 3 medications before they qualify for Botox.” Treatment involves 31 injections over the forehead, the back of the head and the neck. Relief lasts about 3 months, she said.

In addition to pharmaceutical treatment, there are cognitive behavior approaches that can work, like biofeedback and progressive muscle relaxation therapy.

Opioids are not the treatment of choice, she said. They have not been shown to be effective, Minen said and reduce the body’s ability to respond to triptans.

“For chronic migraine, studies don’t show opioids enable patients to return to work; there is no objective study showing they work,” and their uses raises other problems. Patients used to taking opioids who go to an emergency room and request them may find themselves suspected of drugseeking behavior. “It’s hard for doctors and patients,” she said, when patients ask for opioids “It puts doctors in a predicament.”

New drugs are on the horizon, she said. “Calcitonin gene related peptide antagonists look good,” and unlike triptans are not contraindicated for people at risk of strokes or heart attacks.

For now, said Minen, treating migraine and comorbidities “is more an art than a science,” she said, “But a large majority of patients do get better.”

Migraine May Permanently Change Brain Structure

American Academy of Neurology

Migraine may have longlasting effects on the brain’s structure, according to a study published in the August 28, 2013, online issue of Neurology®, the medical journal of the American Academy of Neurology.

“Traditionally, migraine has been considered a benign disorder without long-term consequences for the brain,” said study author Messoud Ashina, MD, PhD, with the University of Copenhagen in Denmark. “Our review and meta-analysis study suggests that the disorder may permanently alter brain structure in multiple ways.”

The study found that migraine raised the risk of brain lesions, white matter abnormalities and altered brain volume compared to people without the disorder. The association was even stronger in those with migraine with aura.

Migraine with aura
A common type of migraine featuring additional neurological symptoms. Aura is a term used to describe a neurological symptom of migraine, most commonly visual disturbances.
People who experience ‘migraine with aura’ will have many or all the symptoms of a ‘migraine without aura‘ and additional neurological symptoms which develop over a 5 to 20 minute period and last less than an hour.
Visual disturbances can include: blind spots in the field of eyesight, coloured spots, sparkles or stars, flashing lights before the eyes, tunnel vision, zig zag lines, temporary blindness.
Other symptoms include: numbness or tingling, pins and needles in the arms and legs, weakness on one side of the body, dizziness, a feeling of spinning (vertigo).
Speech and hearing can be affected and some people have reported memory changes, feelings of fear and confusion and, more rarely, partial paralysis or fainting.
These neurological symptoms usually happen before a headache, which could be mild, or no headache may follow.

For the meta-analysis, researchers reviewed six population-based studies and 13 clinic-based studies to see whether people who experienced migraine or migraine with aura had an increased risk of brain lesions, silent abnormalities or brain volume changes on MRI brain scans compared to those without the conditions.

The results showed that migraine with aura increased the risk of white matter brain lesions by 68 percent and migraine with no aura increased the risk by 34 percent, compared to those without migraine. The risk for infarct-like abnormalities increased by 44 percent for those without aura. Brain volume changes were more common in people with migraine and migraine with aura than those with no migraines.

“Migraine affects about 10 to 15 percent of the general population and can cause a substantial personal, occupational and social burden,” said Ashina. “We hope that through more study, we can clarify the association of brain structure changes to attack frequency and length of the disease. We also want to find out how these lesions may influence brain function.”

The study was supported by the Lundbeck Foundation and the Novo Nordisk Foundation.

To learn more about migraine, please visit American Academy of Neurology.

Migraine: Multiple Processes, Complex Pathophysiology

Rami Burstein (1,3), Rodrigo Noseda (1,3) and David Borsook (2,3)
1 – Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston
2 – Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital
3 – Harvard Medical School

Migraine is a common, multifactorial, disabling, recurrent, hereditary neurovascular headache disorder. It usually strikes sufferers a few times per year in childhood and then progresses to a few times per week in adulthood, particularly in females. Attacks often begin with warning signs (prodromes) and aura (transient focal neurological symptoms) whose origin is thought to involve the hypothalamus, brainstem, and cortex.

Once the headache develops, it typically throbs, intensifies with an increase in intracranial pressure, and presents itself in association with nausea, vomiting, and abnormal sensitivity to light, noise, and smell. It can also be accompanied by abnormal skin sensitivity (anodynia) and muscle tenderness.

Collectively, the symptoms that accompany migraine from the prodromal stage through the headache phase suggest that multiple neuronal systems function abnormally.

As a consequence of the disease itself or its genetic underpinnings, the migraine brain is altered structurally and functionally. These molecular, anatomical, and functional abnormalities provide a neuronal substrate for an extreme sensitivity to fluctuations in homeostasis, a decreased ability to adapt, and the recurrence of headache.

Homeostasis is the state of steady internal conditions maintained by living things.

Advances in understanding the genetic predisposition to migraine, and the discovery of multiple susceptible gene variants (many of which encode proteins that participate in the regulation of glutamate neurotransmission and proper formation of synaptic plasticity) define the most compelling hypothesis for the generalized neuronal hyperexcitability and the anatomical alterations seen in the migraine brain.

Regarding the headache pain itself, attempts to understand its unique qualities point to activation of the trigeminovascular pathway as a prerequisite for explaining why the pain is restricted to the head, often affecting the periorhital area and the eye, and intensities when intracranial pressure increases.


Migraine is a recurrent headache disorder affecting 15% of the population during the formative and most productive periods of their lives, between the ages of 22 and 55 years. It frequently starts in childhood, particularly around puberty, and affects women more than men.

It tends to run in families and as such is considered a genetic disorder.

In some cases, the headache begins with no warning signs and ends with sleep. In other cases, the headache may be preceded by a prodromal phase that includes fatigue; euphoria; depression; irritability; food cravings; constipation; neck stiffness; increased yawning; and/or abnormal sensitivity to light, sound, and smell and an aura phase that includes a variety of focal cortically mediated neurological symptoms that appear just before and/or during the headache phase. Symptoms of migraine aura develop gradually, feature exeitatory and inhibitory phases, and resolve completely. Positive (gain of function) and negative (loss of function) symptoms may present as scintillating lights and scotomas when affecting the visual cortex; paresthesia, and numbness of the face and hands when affecting the somatosensory cortex; tremor and unilateral muscle weakness when affecting the motor cortex or basal ganglia; and difficulty saying words (aphasia) when affecting the speech area.

The pursuant headache is commonly unilateral, pulsating, aggravated by routine physical activity, and can last a few hours to a few days (Headache Classification Committee of the International Headache Society, 2013). As the headache progresses, it may be accompanied by a variety of autonomic symptoms (nausea, vomiting, nasallsinus congestion, rhinorrhea, lacrimation, ptosis, yawning, frequent urination, and diarrhea), affective symptoms (depression and irritability), cognitive symptoms (attention deficit, difficulty finding words, transient amnesia, and reduced ability to navigate in familiar environments), and sensory symptoms (photophobia, phonophobia, osmophobia, muscle tenderness, and cutaneous allodynia).

The extent of these diverse symptoms suggests that migraine is more than a headache. It is now viewed as a complex neurological disorder that affects multiple cortical, subcortical, and brainstem areas that regulate autonomic, affective, cognitive, and sensory functions. As such, it is evident that the migraine brain differs from the non-migraine brain and that an effort to unravel the pathophysiology of migraine must expand beyond the simplistic view that there are “migraine generator” areas.

In studying migraine pathophysiology, we must consider how different neural networks interact with each other to allow migraine to commence with stressors such as insufficient sleep, skipping meals, stressful or post stressful periods, hormonal fluctuations, alcohol, certain foods, flickering lights, noise, or certain scents, and why migraine attacks are sometimes initiated by these triggers and sometimes not.

We must tackle the enigma of how attacks are resolved on their own or just weaken and become bearable by sleep, relaxation, food, and/or darkness. We must explore the mechanisms by which the frequency of episodic migraine increases over time (from monthly to weekly to daily), and why progression from episodic to chronic migraine is uncommon.

Disease mechanisms

In many cases, migraine attacks are likely to begin centrally, in brain areas capable of generating the classical neurological symptoms of prodromes and aura, whereas the headache phase begins with consequential activation of meningeal nociceptors at the origin of the trigeminovascular system.

A nociceptor is a sensory neuron that responds to damaging or potentially damaging stimuli by sending “possible threat” signals to the spinal cord and the brain. If the brain perceives the threat as credible, it creates the sensation of pain to direct attention to the body part, so the threat can hopefully be mitigated; this process is called nociception.

The meninges are the three membranes that envelop the brain and spinal cord. In mammals, the meninges are the dura mater, the arachnoid mater, and the pia mater. Cerebrospinal fluid is located in the subarachnoid space between the arachnoid mater and the pia mater. The primary function of the meninges is to protect the central nervous system.

While some clues about how the occurrence of aura can activate nociceptors in the meninges exist, nothing is known about the mechanisms by which common prodromes initiate the headache phase or what sequence of events they trigger that results in activation of the meningeal nociceptors. A mechanistic search for a common denominator in migraine symptomatology and characteristics points heavily toward a genetic predisposition to generalized neuronal hyperexcitability. Mounting evidence for alterations in brain structure and function that are secondary to the repetitive state of headache can explain the progression of disease.


In the context of migraine, prodromes are symptoms that precede the headache by several hours. Examination of symptoms that are most commonly described by patients point to the potential involvement of the hypothalamus (fatigue, depression, irritability, food cravings, and yawning), brainstem (muscle tenderness and neck stiffness), cortex (abnormal sensitivity to light, sound, and smell), and limbic system (depression and anhedonia) in the prodromal phase of a migraine attack. Given that symptoms such as fatigue, yawning, food craving, and transient mood changes occur naturally in all humans, it is critical that we understand how their occurrence triggers a headache; whether the routine occurrence of these symptoms in migraineurs (i.e., when no headache develops) differs mechanistically from their occurrence before the onset of migraine; and why yawning, food craving, and fatigue do not trigger a migraine in healthy subjects.

Recently, much attention has been given to the hypothalamus because it plays a key role in many aspects of human circadian rhythms (wake sleep cycle, body temperature, food intake, and hormonal fluctuations) and in the continuous effort to maintain homeostasis. Because the migraine brain is extremely sensitive to deviations from homeostasis, it seems reasonable that hypothalamie neurons that regulate homeostasis and circadian cycles are at the origin of some of the migraine prodromes.

Unraveling the mechanisms by which hypothalamic and brainstem neurons can trigger a headache is central to our ability to develop therapies that can intercept the headache during the prodromal phase (i.e., before the headache begins. The ongoing effort to answer this question focuses on two very different possibilities (Fig. 1). The first suggests that hypothalamic neurons that respond to changes in physiological and emotional homeostasis can activate meningeal nociceptors by altering the balance between parasympathetic and sympathetic tone in the meninges toward the predominance of parasympathetic tone. Support for such a proposal is based on the following: (1) hypothalamic neurons are in a position to regulate the firing of preganglionic parasympathetic neurons in the superior salivatory nucleus (SSN) and sympathetic preganglionic neurons in the spinal intermediolateral nucleus. (2) the SSN can stimulate the release of acetylcholine, vasoactive intestinal peptide, and nitric oxide from meningeal terminals of postganglionic parasympathetic neurons in the Spheno palatine ganglion (SPG), leading to dilation of intracranial blood vessels, plasma protein extravasation, and local release of inflammatory molecules capable of activating pial and dural branches of meningeal nociceptors; (3) meningeal blood vessels are densely innervated by para sympathetic fibers. (4) activation of SSN neurons can modulate the activity of central trigeminovascular neurons in the spinal trigeminal nucleus. (5) activation of meningeal nociceptors appears to depend partially on enhanced activity in the SPG. (6) enhanced cranial parasympathetic tone during migraine is evident by lacrimation and nasal congestion, and, finally, (7) blockade of the sphenopalatine ganglion provides partial or complete relief of migraine pain.

The second proposal suggests that hypothalamic and brainstem neurons that regulate responses to deviation from physiological and emotional homeostasis can lower the threshold for the transmission of nociceptive trigeminovascular signals from the thalamus to the cortex, a critical step in establishing the headache experience. This proposal is based on understanding how the thalamus selects, amplifies, and prioritizes information it eventually transfers to the cortex, and how hypothalamic and brainstem nuclei regulate relay thalamocortical neurons. It is constructed from recent evidence that relay trigeminothalamic neurons in sensory thalamie nuclei receive direct input from hypothalamic neurons that contain dopamine, histamine, orexin, and melanin concentrating hormone (MCH), and brainstem neurons that contain noradrenaline and serotonin. In principle, each of these neuropeptides/neurotransmitters can shift the activity of thalamic neurons from burst to tonic mode if it is excitatory (dopamine, and high concentration of serotonin, noradrenaline, histamine, orexin, and from tonic to burst mode if it is inhibitory (MCH and low concentration of serotonin). The opposing factors that regulate the firing of relay trigeminovascular thalamic neurons provide an anatomical foundation for explaining why prodromes give rise to some migraine attacks but not to others, and why external (e.g., exposure to strong perfume) and internal conditions (e.g., skipping a meal and feeling hungry, sleeping too little and being tired, or simple stress) trigger migraine attacks so inconsistently.

In the context of migraine, the convergence of these hypothalamic and brainstem neurons on thalamic trigeminovascular neuruns can establish high and low set points for the allostatic load of the migraine brain. The allostatic load, defined as the amount of brain activity required to appropriately manage the level of emotional or physiological stress at any given time, can explain why external and internal conditions only trigger headache some of the times, when they coincide with the right circadian phase of cyclic rhythmicity of brainstem, and hypothalamic and thalamic neurons that preserve homeostasis.

Cortical spreading depression

Clinical and preclinical studies suggest that migraine aura is caused by cortical spreading depression (CSD), a slowly propagating wave of depolarization/excitation followed by hyperpolarization/inhibition in cortical neurons and glia. While specific processes that initiate CSD in humans are not known, mechanisms that invoke inflammatory molecules as a result of emotional or physiological stress, such as lack of sleep, may play a role. In the cortex, the initial membrane depolarization is associated with a large efflux of potassium; influx of sodium and calcium; release of glutamate, ATP, and hydrogen ions; neuronal swelling ; upregulation of genes involved in inflammatory processing; and a host of changes in cortical perfusion and enzymatic activity that include opening of the megachannel Panxl, activation of caspase-1, and a breakdown of the blood brain barrier.

Outside the brain, caspase-1 activation can initiate inflammation by releasing high mobility group protein B1 and interleukin-1 into the CSF, which then activates nuclear factor KB in astrocytes, with the consequential release of cyclooxygenase-2 and inducible nitric oxide swithase (iNOS) into the subarach noid space. The introduction into the meninges of these proinflammatory molecules, as well as calcitonin gene related peptide (CGRP) and nitric oxide, may be the link between aura and headache because the meninges are densely innervated by pain fibers whose activation distinguishes headaches of intracranial origin (e.g., migraine, meningitis, and subaraeh noid bleeds) from headaches of extracranial origin (e.g., tension type headache, cervicogenic headache, or headaches caused by mild trauma to the cranium).

Anatomy and physiology of the trigeminovascular pathway: from activation to sensitization

Anatomical description

The trigeminovascular pathway conveys nociceptive information from the meninges to the brain. The pathway originates in trigeminal ganglion neurons whose peripheral axons reach the pia, dura, and large cerebral arteries, and whose central axons reach the nociceptive dorsal horn laminae of the SpV. In the SpV, the nociceptors converge on neurons that receive additional input from the periorbital skin and pericranial muscles. The ascending axonal projections of trigeminovascular SpV neurons transmit monosynaptic nocieeptive signals to (1) brainstem nuclei, such as the ventro lateral periaqueductal gray, reticular for mation, superior salivatory, parabrachial, cuneiform, and the nucleus of the solitary tract; (2) hypothalamic nuclei, such as the anterior, lateral, perifornical, dorsome dial, suprachiasmatic, and supraoptic; and (3) basal ganglia nuclei, such as the caudate putamen, globus pallidus, and sub stantia innominata. These projections maybe critical for the initiation of nausea, vomiting, yawning, lacrimation, urination, loss of appetite, fatigue, anxiety, irritability, and depression by the headache itself.

Additional projections of trigeminovascular SpV neurons are found in the thalamic ventral posteromedial (VPM), posterior (PO), and parafascicular nuclei. Relay trigeminovascular thalamic neurons that project to the somatosensory, insular, motor, parietal association, retrosplenial, auditory, visual, and olfactory cortices are in a position to construct the specific nature of migraine pain (i.e., location, intensity, and quality) and many of the cortically mediated symptoms that distinguish between migraine headache and other pains. These include transient symptoms of motor clumsiness, difficulty focusing, amnesia, allodynia, phonophobia, photophobia, and osmophobia. Figure 2A illustrates the complexity of the trigeminovascular pathway.


Studies in animals show that CSD initiates delayed activation (Fig. 2D, 2B,C) and immediate activation (Fig. 2D) of peripheral and central trigeminovascular neurons in a fashion that resembles the classic delay and occasional immediate onset of headache after aura, and that systemic administration of the M type potassium channel opener KCNQ2/3 can prevent the CSD induced activation of the nociceptors.

These findings support the notion that the onset of the headache phase of migraine with aura coincides with the activation of meningeal nociceptors at the peripheral origin of the trigeminovascular pathway. Whereas the vascular, cellular, and molecular events involved in the activation of meningeal nocieeptors by CSD are not well under stood, a large body of data suggests that transient constriction and dilatation of pial arteries and the development of dural plasma protein extravasation, neurogenic inflammation, platelet aggregation, and mast cell degranulation, many of which may be driven by CSD dependent peripheral CGRP release, can introduce to the meninges proinflammatory molecules, such as histamine, bradykinin, serotonin, and prostaglandins (prostaglandin E2), and a high level of hydrogen ions thus altering the molecular environment in which meningeal nociceptors exist.


When activated in the altered molecular environment described above, peripheral trigeminovascular neurons become sensitized (their response threshold decreases and their response magnitude increases) and begin to respond to dura stimuli to which they showed minimal or no response at base line. When central trigeminovascular neurons in laminae I and V of SpV (Fig. 2F) and in the thalamic PO/VPM nuclei (Fig. 2G) become sensitized, their spontaneous activity increases, their receptive fields expand, and they begin to respond to innocuous mechanical and thermal stimulation of cephalic and extracephalic skin areas as if it were noxious. The human correlates of the electrophysiological measures of neuronal sensitization in animal studies are evident in contrast analysis of BOLD signals registered in MRI scans of the human trigeminal ganglion (Fig. 2H), spinal trigeminal nucleus (Fig. 2I), and the thalamus (Fig. 2J), all measured during migraine attacks.

The clinical manifestation of peripheral sensitization during migraine, which takes roughly 10 mins to develop, includes the perception of throbbing headache and the transient intensiflcation of headache while bending over or coughing, activities that momentarily increase intracranial pressure.

The clinical manifestation of sensitization of central trigeminovascular neurons in the SpV, which takes 30-60 min to develop and 120 min to reach full extent, include the development of cephalic allodynia signs such as scalp and muscle tenderness and hypersensitivity to touch. These signs are often recognized in patients reporting that they avoid wearing glasses, earrings, hats, or any other object that come in contact with the facial skin during migraine.

The clinical manifestation of thalamic sensitization during migraine, which takes 2-4 h to develop, also includes extracephalic allodynia signs that cause patients to remove tight clothing and jewelry, and avoid being touched, massaged, or hugged.

Evidence that triptans, 5HT agonists that disrupt communications between peripheral and central trigeminovascular neurons in the dorsal horn, are more effective in aborting migraine when administered early (i.e., before the development of central sensitization and allodynia) rather than late (i.e., after the development of allodynia) provides further support for the notion that meningeal nociceptors drive the initial phase of the headache. Further support for this concept was provided recently by studies showing that humanized monoclonal antihodies against CGRP, molecules that are too big to penetrate the bloodbrain barrier and act centrally (according to the companies that developed them), are effective in preventing migraine. Along this line, it was also reported that drugs that act on central trigeminovascular neurons, e.g., dihydroergotamine (DHE), are equally effective in reversing an already developed central sensitization a possible explanation for DHE effectiveness in aborting migraine after the failure of therapy with triptans.

Genetics and the hyperexcitable brain

Family history points to a genetic predisposition to migraine. A genetic association with migraine was first observed and defined in patients with familial hemiplegic migraine (FHM).

The three genes identified with FHM encode proteins that regulate glutamate availability in the synapse. FHM1 (CACNAIA) encodes the pore-forming a1 subunit of the P/Q type calcium channel; FHM2 (ATP1A2) encodes the 112 subunit of the Na+/K+ ATPase pump; and the FHM3 (SCNIA) encodes the a1 sub unit of the neuronal voltage gated Nav1.1 channel.

Collectively, these genes regulate transmitter release, glial ability to clear (reuptake) glutamate from the synapse, and the generation of action potentials.

Since these early findings, large genome wide association studies have identified 13 susceptibility gene variants for migraine with and without aura, three of which regulate glutaminergic neurotransmission (MTDH/AEG-1 downregulates glutamate transporter, LPRI modulates synaptic transmission through the NMDA receptor, and MEF-2D regulates the glutamatergic excitatory synapse), and two of which regulate synaptic development and plasticity (ASTN2 is involved in the structural development of cortical layers, and FHI5 regulates cAMP sensitive CREB proteins involved msynaptic plasticity).

These findings provide the most plausible explanation for the “generalized” neuronal hyperexcitability of the migraine brain.

In the context of migraine, increased activity in glutamalergic systems can lead to excessive occupation of the NMDA receptor, which in turn may amplify and reinforce pain transmission, and the development of allodynia and central sensitization. Network wise, wide spread neuronal hyperexcitability may also be driven by thalamocortical dysrhythmia, defective modulatory brainstem circuits that regulate excitability at multiple levels along the neuraxis; and inherently improper regulation/habituation of cortical, thalamic, and brainstem functions by limbic structures, such as the hypothalamus, amygdala, nucleus accumbens, caudate, putamen, and globus pallidus. Given that 2 of the 13 susceptibility genes regulate synaptic development and plasticity, it is reasonable to speculate that some of the networks mentioned above may not be properly wired to set a normal level of habituation throughout the brain, thus explaining the multi factorial nature of migraine. Along this line, it is also tempting to propose that at least some of the structural alterations seen in the migraine brain may be inherited and, as such, may be the “cause” of migraine, rather than being secondary to (i.e., being caused by) the repeated headache attacks. But this concept awaits evidence.

Structural and functional brain alterations

Brain alterations can be categorized into the following two processes: (1) alteration in brain function and (2) alterations in brain structure (Fig. 3). Functionally, a variety of imaging techniques used to measure relative activation in different brain areas in migraineurs (vs control subjects) revealed enhanced activation in the periaqueductal gray; red nucleus and substantia nigra; hypothalamus; posterior thalamus; cerebellum, insula, cingulate and prefrontal cortices, anterior temporal pole, and the hippocampus; and decreased activation in the somatosensory cortex, nucleus cuneiformis, caudate, putamen, and pallidum. All of these activity changes occurred in response to nonrepetitive stimuli, and in the cingulate and prefrontal cortex they occurred in response to repetitive stimuli.

Collectively, these studies support the concept that the migraine brain lacks the ability to habituate itself and consequently becomes hyperexcitable. It is a matter of debate, however, if such changes are unique to migraine headache. Evidence for nearly identical activation patterns in other pain conditions, such as lower back pain, neuropathic pain, Hbromyalgia, irritable bowel syndrome, and cardiac pain, raises the possibility that differences between somatic pain and migraine pain are not due to differences in central pain processing.

Anatomically, voxel based morphometry and diffusion sensor imaging studies in migraine patients (vs control subjects) have revealed thickening of the somatosensory cortex; increased gray matter density in the caudate; and gray matter volume loss in the superior temporal gyms, inferior frontal gyms, precentral gyms, anterior cingulate cortex, amygdala, parietal operculum, middle and inferior frontal gyrus, inferior frontal gyrus, and bilateral insula.

Changes in cortical and subcortical structures may also depend on the frequency of migraine attacks for a number of cortical and subcortical regions. As discussed above, it is unclear whether such changes are genetically predetermined or simply a result of the repetitive exposure to pain/stress. Favoring the latter are studies showing that similar gray matter changes occurring in patients experiencing other chronic pain conditions are reversible and that the magnitude of these changes can be correlated with the duration of disease.

Further complicating our ability to determine how the migraine brain differs from the brain of a patient experiencing other chronic pain conditions are anatomical findings showing decreased gray matter density in the prefrontal cortex, thalamus, posterior insula, secondary somatosensory cortex, precentral and posteentral gyms, hippocampus, and temporal pole of chronic back pain patients; anterior insula and orbitofrontal cortex of complex regional pain syndrome patients; and the insula, midanterior cingulate cortex, hippocampus and inferior temporal coxtex in osteoarthritis pa tients with chronic back pain.

Whereas some of the brain alterations seen in migraineurs depend on the sex of the patient, little can he said about the role played by the sex of patients who experience other pain conditions.

Treatments in development

Migraine therapy has two goals: to terminate acute attacks; and to prevent the next attack from happening. The latter can potentially prevent the progression from episodic to chronic state. Regarding the effort to terminate acute attacks, migraine represents one of the few pain conditions for which a specific drug (i.e., triptan) has been developed based on understanding the mechanisms of the disease. In contrast, the effort to prevent migraine from happening is likely to face a much larger challenge given that migraine can originate in an unknown number of brain areas (see above), and is associated with generalized functional and structural brain abnormalities.

A number of treatments that attract attention are briefly reviewed below.

Medications The most exciting drug currently under development is humanized monoclonal antibodies against CGRP. The development of these monoclonal antibodies are directed at both CGRP and its receptors. The concept is based on CGRP localization in the trigeminal ganglion and its relevance to migaine patho-physiology. In recent phase II randomized placebo-controlled trials, the neutralizing humanized monoclonal antibodies against CGRP administered by injection for the prevention of episodic migraine, showed promising results. Remarkably, a single injection may prevent or significantly reduce migraine attacks for 3 months.

Given our growing understanding of the importance of prodromes (likely representing abnormal sensitivity to the fluctuation in hypothalamically regulated homeostasis) and aura (likely representing the inherited conical hyperexcitability) in the pathophysiology of migraine, drugs that target ghrelin, leptin, and orexin receptors may be considered for therapeutic development which is based on their ability to restore proper hypothalamic control of stress, hyperphagia, adiposity, and sleep. All may be critical in reducing allostatic load and, consequently, in initiating the next migraine attack.

Brain modification

Neuroimaging studies showing that brain networks, brain morphology, and brain chemistry are altered in episodic and chronic migraineurs justify attempts to develop therapies that widely modify brain networks and their functions. Transcranial magnetic stimulation, which is thought to modify cortical hyperexcitability, is one such approach. Another approach for generalized brain modification is cognitive behavioral therapy.


Migraine is a common and undertreated disease. For those who suffer, it is a major cause of disability, including missing work or school, and it frequently has associated comorbidities such as anxiety and depression. To put this in context, it is a leading cause of suicide, an indisputable proof of the severity of the distress that the disease may inflict on the individual.

There is currently no objective diagnosis or treatment that is universally effective in aborting or preventing attacks. As an intermittent disorder, migraine represents a neurological condition wherein systems that continuously evaluate errors (error detection) frequently fail, thus adding to the allostatic load of the disease.

Given the enormous burden to society, there is an urgent imperative to focus on better understanding the neurobiology of the disease to enable the discovery of novel treatment approaches.

AN ANXIOUS PARADISE. Crisis in New Zealand mental health services as depression and anxiety soar – Eleanor Ainge Roy * World in mental health crisis of monumental suffering – Sarah Broseley.

System neglects ‘missing middle’ of the population who face common problems.
50-80% of New Zealanders experience mental distress or addiction challenges at some point in their lives, while each year one in five people experience mental illness or significant mental distress.

A landmark inquiry has found New Zealand’s mental health services are overwhelmed and geared towards crisis care rather than the wider population who are experiencing increasing rates of depression, trauma and substance abuse.

It has urged the government to widen provision of mental health care from 3% of the population in critical need to “the missing middle” – the 20% of the population who struggle with “common, disabling problems” such as anxiety.

New Zealand has one of the highest rates of suicide in the OECD, especially among young people. In 2017, 20,000 people tried to take their own life.

. . . The Guardian


World in mental health crisis of ‘monumental suffering’, say experts – Sarah Broseley.

“Mental health problems kill more young people than any other cause around the world.” Prof. Vikram Patel, Harvard Medical School
Lancet report says 13.5 million lives could be saved every year if mental illness addressed.

OFC, Brain Stimulation for Depression – Janice Wood * Direct Electrical Stimulation of Lateral OFC Acutely Improves Mood.

“You could see the improvements in patients’ body language. They smiled, they sat up straighter, they started to speak more quickly and naturally. They said things like ‘Wow, I feel better,’ ‘I feel less anxious,’ ‘I feel calm, cool and collected.”

An important step toward developing a therapy for people with treatment-resistant depression.

Converging lines of evidence from lesion studies, functional neuroimaging, and intracranial physiology point to a role of OFC in emotion processing. Clinically depressed individuals have abnormally high levels of activity in OFC as ascertained by functional neuroimaging, and recovery from depression is associated with decreased OFC activity.

We found that lateral OFC stimulation acutely improved mood in subjects with baseline depression and that these therapeutic effects correlated with modulation of large-scale brain networks implicated in emotion processing.

Our results suggest that lateral OFC stimulation improves mood state at least partly through mechanisms that underlie natural mood variation, and they are consistent with the notion that OFC integrates multiple streams of information relevant to affective cognition.

Unilateral stimulation of lateral OFC consistently produced acute, dose-dependent mood-state improvement across subjects with baseline depression traits.

In a new study, patients with moderate to severe depression reported significant improvements in mood when researchers stimulated the orbitofrontal cortex (OFC).

The orbitofrontal cortex (OFC) is a prefrontal cortex region in the frontal lobes in the brain, which is involved in the cognitive processing of decision-making.


Researchers at the University of California San Francisco say the study’s findings are “an important step toward developing a therapy for people with treatment-resistant depression, which affects as many as 30 percent of depression patients.”

Using electrical current to directly stimulate affected regions of the brain has proven to be an effective therapy for treating certain forms of epilepsy and Parkinson’s disease, but efforts to develop therapeutic brain stimulation for depression have so far been inconclusive, according to the researchers.

“The OFC has been called one of the least understood regions in the brain, but it is richly connected to various brain structures linked to mood, depression, and decision making, making it very well positioned to coordinate activity between emotion and cognition.”

Two additional observations suggested that OFC stimulation could have therapeutic potential.

First, the researchers found that applying current to the lateral OFC triggered wide-spread patterns of brain activity that resembled what had naturally occurred in volunteers’ brains during positive moods in the days before brain stimulation. Equally promising was the fact that stimulation only improved mood in patients with moderate to severe depression symptoms but had no effect on those with milder symptoms.

“These two observations suggest that stimulation was helping patients with serious depression experience something like a naturally positive mood state, rather than artificially boosting mood in everyone.

This is in line with previous observations that OFC activity is elevated in patients with severe depression and suggests electrical stimulation may affect the brain in a way that removes an impediment to positive mood that occurs in people with depression.”

Psych Central

Direct Electrical Stimulation of Lateral Orbitofrontal Cortex Acutely Improves Mood in Individuals with Symptoms of Depression

Vikram R. Rao, Kristin K. Sellers, Deanna L. Wallace, Maryam M. Shanechi, Heather E. Dawes, Edward F. Chang.

Mood disorders cause significant morbidity and mortality, and existing therapies fail 20%–30% of patients. Deep brain stimulation (DBS) is an emerging treatment for refractory mood disorders, but its success depends critically on target selection. DBS focused on known targets within mood-related frontostriatal and limbic circuits has been variably efficacious.

Here, we examine the effects of stimulation in orbitofrontal cortex (OFC), a key hub for mood-related circuitry that has not been well characterized as a stimulation target. We studied 25 subjects with epilepsy who were implanted with intracranial electrodes for seizure localization. Baseline depression traits ranged from mild to severe. We serially assayed mood state over several days using a validated questionnaire. Continuous electrocorticography enabled investigation of neurophysiological correlates of mood-state changes.

We used implanted electrodes to stimulate OFC and other brain regions while collecting verbal mood reports and questionnaire scores. We found that unilateral stimulation of the lateral OFC produced acute, dose-dependent mood-state improvement in subjects with moderate-to-severe baseline depression. Stimulation suppressed low-frequency power in OFC, mirroring neurophysiological features that were associated with positive mood states during natural mood fluctuation. Stimulation potentiated single-pulse-evoked responses in OFC and modulated activity within distributed structures implicated in mood regulation.

Behavioral responses to stimulation did not include hypomania and indicated an acute restoration to non-depressed mood state.

Together, these findings indicate that lateral OFC stimulation broadly modulates mood-related circuitry to improve mood state in depressed patients, revealing lateral OFC as a promising new target for therapeutic brain stimulation in mood disorders.

Experimental Design and Locations of Stimulated Sites



A modern conception of mood disorders holds that the signs and symptoms of emotional dysregulation are manifestations of abnormal activity within large-scale brain networks. This view, evolved from earlier hypotheses based on chemical imbalances in the brain, has fueled interest in selective neural network modulation with deep brain stimulation (DBS). Although the potential for precise therapeutic intervention with DBS is promising, its efficacy is sensitive to target selection. In treatment-resistant depression (TRD), for example, well-studied targets for DBS include the subgenual cingulate cortex (SCC) and subcortical structures, but the benefits of DBS in these areas are not clearly established.

A major challenge in this regard relates to the fact that clinical manifestations of mood disorders like TRD are heterogeneous and involve dysfunction in cognitive, affective, and reward systems. Therefore, brain regions that represent a functional confluence of these systems are attractive targets for therapeutic brain stimulation.

Residing within prefrontal cortex, the orbitofrontal cortex (OFC) shares reciprocal connections with amygdala, ventral striatum, insula, and cingulate cortex, areas implicated in emotion regulation. As such, OFC is anatomically well positioned to regulate mood. Functionally, OFC serves as a nexus for sensory integration and has myriad roles related to emotional experience, including predicting and evaluating outcomes, representing reward-driven learning and behavior, and mediating subjective hedonic experience.

Converging lines of evidence from lesion studies, functional neuroimaging, and intracranial physiology point to a role of OFC in emotion processing. Clinically depressed individuals have abnormally high levels of activity in OFC as ascertained by functional neuroimaging, and recovery from depression is associated with decreased OFC activity.

Repetitive transcranial magnetic stimulation (rTMS) of OFC was shown to improve mood in a single-subject case study and in a series of patients who otherwise did not respond to rTMS delivered to conventional (non-OFC) targets, but whether intracranial OFC stimulation can reliably alleviate mood symptoms is not known.

Furthermore, OFC is relatively large, and functional distinctions between medial and lateral subregions are known, raising the possibility that subregions of OFC may play distinct roles in mood regulation.

More generally, it remains poorly understood how direct brain stimulation affects local and network-level neural activity to produce complex emotional responses.

We hypothesized that brain networks involved in emotion processing include regions, like OFC, that represent previously unrecognized stimulation targets for alleviation of neuropsychiatric symptoms. To test this hypothesis, we developed a system for studying mood-related neural activity in subjects with epilepsy who were undergoing intracranial electroencephalography (iEEG) for seizure localization. In addition to direct recording of neural activity, iEEG allows delivery of defined electrical stimulation pulses with high spatiotemporal precision and concurrent measurement of behavioral correlates.

Using serial quantitative mood assessments and continuous iEEG recordings, we investigated the acute effects of OFC stimulation on mood state and characterized corresponding changes in neural activity locally and in distributed brain regions. We found that lateral OFC stimulation acutely improved mood in subjects with baseline depression and that these therapeutic effects correlated with modulation of large-scale brain networks implicated in emotion processing.

Our results suggest that lateral OFC stimulation improves mood state at least partly through mechanisms that underlie natural mood variation, and they are consistent with the notion that OFC integrates multiple streams of information relevant to affective cognition.


Here, we show that human lateral OFC is a promising target for brain stimulation to alleviate mood symptoms. Unilateral stimulation of lateral OFC consistently produced acute, dose-dependent mood-state improvement across subjects with baseline depression traits. Locally, lateral OFC stimulation increased cortical excitability and suppressed low-frequency power, a feature we found to be negatively correlated with mood state. At the network level, lateral OFC stimulation modulated activity within a network of limbic and paralimbic structures implicated in mood regulation.

Relief of mood symptoms afforded by lateral OFC stimulation may arise from OFC acting as a hub within brain networks that mediate affective cognition.

Previous studies identify OFC as a key node within an emotional salience network activated by anticipation of aversive events. Within this network, OFC is thought to integrate multimodal sensory information and guide emotion-related decisions by evaluating expected outcomes.

Stimulation of other brain regions that encode value information, such as SCC and ventral striatum, has also been found to improve mood, highlighting the relevance of reward circuits to mood state.

Here, using iEEG, we extend previous studies that employed indirect imaging biomarkers, such as glucose metabolism or blood oxygen level, to show that direct OFC stimulation modulates neural activity within a distributed network of brain regions. Our finding that lateral OFC stimulation was more effective than medial OFC stimulation for mood symptom relief advances the idea that these regions have differential contributions to depression, likely due to differences in network connectivity.

We did not observe consistent differences based on laterality of stimulation, but future studies powered to discern such differences may reveal additional layers of specificity.

Although few behavioral variables have been identified to predict which individuals will respond to stimulation of a given target for depression, we found that only patients with significant trait depression experienced mood-state improvement with lateral OFC stimulation. Based on speech-rate analysis, lateral OFC stimulation did not produce supraphysiological mood states, as can be seen with stimulation of other targets, but did specifically elevate speech rate in trait-depressed subjects, resulting in a level similar to that of the non-depressed subjects. Local neurophysiological changes induced by stimulation were opposite of those observed during spontaneous negative mood states. Taken together, these findings suggest that the effect of lateral OFC stimulation is to normalize or suppress pathological activity in circuits that mediate natural mood variation.

Our observations provide potential clues about how lateral OFC stimulation may impact mood. Although functional imaging biomarkers of depression are not firmly established, increased activity in lateral OFC is seen in patients with depression and normalizes with effective antidepressant treatment, and lateral OFC hyperactivity has been proposed as a mood-state marker of depression.

Thus, a speculative possibility is that our stimulation paradigm works by decreasing OFC theta power in a way that may impact baseline hyperactivity. We cannot exclude the possibility that the mechanisms underlying mood improvement with lateral OFC stimulation involve multiple regions and may at least partially overlap with mechanisms responsible for mood improvement with stimulation of SCC. In fact, based on anatomic and functional connectivity between these regions, and the constellation of white matter tracts likely affected by stimulation of these sites, some mechanistic overlap seems probable.

Our results have potential implications for interventional treatments for psychiatric disorders like TRD and anxiety. DBS efficacy for TRD is inconsistent, and a major thrust of the field has been to understand and circumvent inter-subject variability. For example, the heterogeneous responses seen with SCC stimulation may relate to laterality and precise anatomic electrode position. In our study, positive mood responses were induced by unilateral stimulation of the OFC in either hemisphere, and although stimulation of lateral OFC improved mood more than stimulation of medial OFC, we observed mood improvement with stimulation across lateral OFC and did not see evidence of fine subregion specificity. These findings suggest that lateral OFC may be a more forgiving site for therapeutic stimulation than previously reported targets.

Another practical advantage of OFC relative to other targets is that the cortical surface is generally more surgically accessible than deep brain targets and that the ability to forego parenchymal penetration may impart lower risk during electrode implantation. Although seizures are a theoretical risk with any cortical stimulation, this risk is thought to be acceptably low, and we did not observe seizures during OFC stimulation.

Despite the widespread use of DBS in clinical and research applications, the mechanisms by which focal brain stimulation modulates network activity to produce complex behavioral changes remain largely unknown. The effects of stimulation are not limited to the targeted region, and stimulation-induced activity can propagate through anatomical connections to influence distributed networks in the brain. Previous studies have shown that target connectivity may determine likelihood of response to DBS.

Deciphering the precise mechanism of mood improvement with OFC stimulation requires future study, but our observation that stimulation suppresses low-frequency activity broadly across multiple sites suggests a possible local inhibitory effect that reverberates through connected brain regions. Consistent with this, inhibitory transcranial magnetic stimulation of OFC was recently reported to improve mood in one depressed patient. Since the OFC is relatively large and bilateral, it is possible that the mood effects we observed could be improved by more widespread stimulation.

Our study has limitations. The sample size was relatively small, reflecting the rare opportunity to directly and precisely target brain stimulation in human subjects. Although electrode coverage was generally extensive in our subjects, basal ganglia structures known to be important for mood are not typically implanted with electrodes for the purposes of seizure localization. Subjective self-report of mood has intrinsic limitations but remains the best instrument available to measure internal experience.

Our subjects, who had medically refractory epilepsy, may not be representative of all patients with mood disorders. While we cannot rule out the possibility that mood symptoms in our subjects had a seizure-specific etiology, the observed effects of lateral OFC stimulation were robust in a patient group with diverse underlying seizure pathology. To establish generalizability, our findings will need to be replicated in other cohorts.

Finally, it is possible that the acute effects of stimulation we observed may not translate into chronic efficacy for mood disorders in clinical settings. Indeed, rapid mood changes have been previously reported in TRD patients treated with bilateral DBS of SCC and subcortical targets. Whether chronic OFC stimulation can produce durable mood improvement is an important question for future study, ideally under controlled clinical trial conditions with appropriate monitoring of relevant outcomes and adverse events.

The clinical heterogeneity of mood disorders suggests that brain stimulation paradigms may need to be tailored for individual patients. Importantly, this study is one of few to assess the functional consequences of brain stimulation with direct neural recordings. The approach we used for serial quantitative mood state assessment may be useful for sensitively tracking symptoms of mood disorders during clinical interventions, including DBS trials. Our identification of a novel, robust stimulation target and our observation of stimulation-induced changes in endogenous mood-related neural features together set the stage for the next generation of stimulation therapies. OFC theta power may be useful for optimization of stimulation parameters for non-invasive stimulation modalities targeting the OFC in depression, and further characterization of mood biomarkers might enable personalized closed-loop stimulation devices that ameliorate debilitating mood symptoms.

Although the OFC is currently among the least understood brain regions, it may ultimately prove important for the treatment of refractory mood disorders.

Study: Current Biology

University of California, San Francisco (UCSF)

MIND IN THE MIRROR * Neuroplasticity in a Nutshell * Mindsight, Change Your Brain and Your Life – Daniel J. Siegel MD.

We come to know our own minds through our interactions with others.

As we welcome the neural reality of our interconnected lives, we can gain new clarity about who we are, what shapes us, and how we in turn can shape our lives.

Riding the Resonance Circuits

It’s folk wisdom that couples in long and happy relationships look more and more alike as the years go by. Peer closely at those old photographs, and you’ll see that the couples haven’t actually grown similar noses or chins. Instead, they have reflected each other’s expressions so frequently and so accurately that the hundreds of tiny muscle attachments to their skin have reshaped their faces to mirror their union. How this happens gives us a window on one of the most fascinating recent discoveries about the brain, and about how we come to “feel felt” by one another.

Some of what I’ll describe here is still speculative, but it can shed light on the most intimate ways we experience mindsight in our daily lives.

Neurons That Mirror Our Minds

In the mid-1990s, a group of Italian neuroscientists were studying the premotor area of a monkey’s cortex. They were using implanted electrodes to monitor individual neurons, and when the monkey ate a peanut, a certain electrode fired. No surprise there, that’s what they expected. But what happened next has changed the course of our insight into the mind. When the monkey simply watched one of the researchers eat a peanut, that same motor neuron fired. Even more startling: The researchers discovered that this happened only when the motion being observed was goal-directed. Somehow, the circuits they had discovered were activated only by an intentional act.

This mirror neuron system has since been identified in human beings and is now considered the root of empathy. Beginning from the perception of a basic behavioral intention, our more elaborated human prefrontal cortex enables us to map out the minds of others. Our brains use sensory information to create representations of others’ minds, just as they use sensory input to create images of the physical world. The key is that mirror neurons respond only to an act with intention, with a predictable sequence or sense of purpose. If I simply lift up my hand and wave it randomly, your mirror neurons will not respond. But if I carry out any act you can predict from experience, your mirror neurons will “figure out” what I intend to do before I do it. So when I lift up my hand with a cup in it, you can predict at a synaptic level that I intend to drink from the cup. Not only that, the mirror neurons in the premotor area of your frontal cortex will get you ready to drink as well.

We see an act and we ready ourselves to imitate it. At the simplest level, that’s why we get thirsty when others drink, and why we yawn when others yawn. At the most complex level, mirror neurons help us understand the nature of culture and how our shared behaviors bind us together, mind to mind. The internal maps created by mirror neurons are automatic, they do not require consciousness or effort. We are hardwired from birth to detect sequences and make maps in our brains of the internal state, the intentional stance, of other people. And this mirroring is “cross-modal”, it operates in all sensory channels, not just vision, so that a sound, a touch, a smell, can cue us to the internal state and intentions of another.

By embedding the mind of another into our own firing patterns, our mirror neurons may provide the foundation for our mindsight maps.

Now let’s take another step. Based on these sensory inputs, we can mirror not only the behavioral intentions of others, but also their emotional states. In other words, this is the way we not only imitate others’ behaviors but actually come to resonate with their feelings, the internal mental flow of their minds. We sense not only what action is coming next, but also the emotional energy that underlies the behavior. In developmental terms, if the behavioral patterns we see in our caregivers are straightforward, we can then map sequences with security, knowing what might happen next, embedding intentions of kindness and care, and so create in ourselves a mindsight lens that is focused and clear. If, on the other hand, we’ve had parents who are confusing and hard to “read,” our own sequencing circuits may create distorted maps.

So from our earliest days, the basic circuitry of mindsight can be laid down with a solid foundation, or created on shaky ground.

Knowing Me, Knowing You

I once organized an interdisciplinary think tank of researchers to explore how the mind might use the brain to perceive itself. One idea we discussed is that we make maps of intention using our cortically based mirror neurons and then transfer this information downward to our subcortical regions. A neural circuit called the insula seems to be the information superhighway between the mirror neurons and the limbic areas, which in turn send messages to the brainstem and the body proper. This is how we can come to resonate physiologically with others, how even our respiration, blood pressure, and heart rate can rise and fall in sync with another’s internal state.

These signals from our body, brainstem, and limbic areas then travel back up the insula to the middle prefrontal areas. I’ve come to call this set of circuits, from mirror neurons to subcortical regions, back up to the middle prefrontal areas, the “resonance circuits.” This is the pathway that connects us to one another. Notice what happens when you’re at a party with friends. If you approach a group that is laughing, you’ll probably find yourself smiling or chuckling even before you’ve heard the joke. Or perhaps you’ve gone to dinner with people who’ve suffered a recent loss. Without their saying anything, you may begin to sense a feeling of heaviness in your chest, a welling up in your throat, tears in your eyes. Scientists call this emotional contagion. The internal states of others, from joy and play to sadness and fear, directly affect our own state of mind. This contagion can even make us interpret unrelated events with a particular bias, so that, for example, after we’ve been around someone who is depressed we interpret someone else’s seriousness as sadness.

For therapists, it’s crucial to keep this bias in mind. Otherwise a prior session may shape our internal state so much that we aren’t open and receptive to the new person with whom we need to be resonating.

Our awareness of another person’s state of mind depends on how well we know our own. The insula brings the resonating state within us upward into the middle prefrontal cortex, where we make a map of our internal world. So we feel others’ feelings by actually feeling our own, we notice the belly fill with laughter at the party or with sadness at the funeral home. All of our subcortical data, our heart rate, breathing, and muscle tension, our limbic coloring of emotion, travels up the insula to inform the cortex of our state of mind. This is the main reason that people who are more aware of their bodies have been found to be more empathic.

The insula is the key: When we can sense our own internal state, the fundamental pathway for resonating with others is open as well.

The mind we first see in our development is the internal state of our caregiver. We coo and she smiles, we laugh and his face lights up. So we first know ourselves as reflected in the other. One of the most interesting ideas we discussed in our study group is that our resonance with others may actually precede our awareness of ourselves. Developmentally and evolutionarily, our modern self-awareness circuitry may be built upon the more ancient resonance circuits that root us in our social world.

How, then, do we discern who is “me” and who is “you”? The scientists in our group suggested that we may adjust the location and firing pattern of the prefrontal images to perceive our own mind. Increases in the registration of our own bodily sensations combined with a decrease in our mirror neuron response may help us know that these tears are mine, not yours, or that this anger is indeed from me, not from you. This may seem like a purely philosophical and theoretical question until you are in the midst of a marital conflict and find yourself arguing about who is the angry one, you or your spouse. And certainly, as a therapist, if I do not track the distinction between me and other, I can become flooded with my patients’ feelings, lose my ability to help, and also burn out quickly.

When resonance literally becomes mirroring, when we confuse me with you, then objectivity is lost. Resonance requires that we remain differentiated, that we know who we are, while also becoming linked. We let our own internal states be influenced by, but not become identical with, those of the other person.

It will take much more research to elucidate the exact way our mindsight maps make this distinction, but the basic issues are clear. The energy and information flow that we sense both in ourselves and in others rides the resonance circuits to enable mindsight.

As I consider the resonance circuits, two mind lessons stand out for me. One is that becoming open to our body’s states, the feelings in our heart, the sensations in our belly, the rhythm of our breathing, is a powerful source of knowledge. The insula flow that brings up this information and energy colors our cortical awareness, shaping how we reason and make decisions. We cannot successfully ignore or suppress these subcortical springs. Becoming open to them is a gateway to clear mindsight.

The second lesson is that relationships are woven into the fabric of our interior world. We come to know our own minds through our interactions with others. Our mirror neuron perceptions, and the resonance they create, act quickly and often outside of awareness. Mindsight permits us to invite these fast and automatic sources of our mental life into the theater of consciousness. As we welcome the neural reality of our interconnected lives, we can gain new clarity about who we are, what shapes us, and how we in turn can shape our lives.

Neuroplasticity in a Nutshell – Daniel J. Siegel MD

Change Your Brain and Your life – Daniel J. Siegel MD


Mindsight, change your brain and your life

by Daniel J. Siegel MD

get it at Amazon.com

Does using testosterone to treat depression work? – Tim Newman.

Medical professionals have been discussing whether testosterone treatment can actually reduce depressive symptoms in men for many years. A recent meta-analysis attempts to draw a clearer picture.

Depression is a major global concern. Per year, major depressive disorder affects an estimated 16.1 million adults in the United States alone.

The World Health Organization (WHO) describe depression as “the leading cause of ill health and disability worldwide.”

There are drugs available to manage depressive symptoms, but they do not work for everyone. In fact, a significant percentage of people do not experience long-term relief, even after trying multiple drugs. Existing depression therapies only work for a subset of the population. For this reason, it is vital to understand whether testosterone might help in treatment-resistant cases.

. . . Medical News Today

MINDING THE BRAIN. Neuroplasticity in a Nutshell – Daniel J. Siegel MD * Neuroplasticity – Wikipedia.

“The brain is so complicated it staggers its own imagination.”

“Neurons that fire together, wire together”, “neurons that fire out of sync, fail to link”.

We can use the power of our mind to change the firing patterns of our brain and thereby alter our feelings, perceptions, and responses. The power to direct our attention, focus, has within it the power to shape our brain’s firing patterns, as well as the power to shape the architecture of the brain itself.

The causal arrows between brain and mind point in both directions. When we focus our attention in specific ways, we create neural firing patterns that permit previously separated areas to become linked and integrated. The synaptic linkages are strengthened, the brain becomes more interconnected, and the mind becomes more adaptive.

Daniel J. Siegel, MD, is a clinical professor of psychiatry at the UCLA School of Medicine, co-director of the UCLA Mindful Awareness Research Center, and executive director of the Mindsight Institute.


/,njuaraupla’stisiti/ noun

The ability of the brain to form and reorganize synaptic connections, especially in response to learning or experience or following injury. “neuroplasticity offers real hope to everyone from stroke victims to dyslexics”

It’s easy to get overwhelmed thinking about the brain. With more than one hundred billion interconnected neurons stuffed into a small, skull-enclosed space, the brain is both dense and intricate. And as if that weren’t complicated enough, each of your average neurons has ten thousand connections, or synapses, linking it to other neurons. In the skull portion of the nervous system alone, there are hundreds of trillions of connections linking the various neural groupings into a vast spiderweb-like network. Even if we wanted to, we couldn’t live long enough to count each of those synaptic linkages.

Given this number of synaptic connections, the brain’s possible on-off firing patterns, its potential for various states of activation, has been calculated to be ten to the millionth power, or ten times ten one million times. This number is thought to be larger than the number of atoms in the known universe. It also far exceeds our ability to experience in one lifetime even a small percentage of these firing possibilities. As a neuroscientist once said, “The brain is so complicated it staggers its own imagination.” The brain’s complexity gives us virtually infinite choices for how our mind will use those firing patterns to create itself. ‘If we get stuck in one pattern or the other, we’re limiting our potential.

Patterns of neural firing are what we are looking for when we watch a brain scanner “light up” as a certain task is being performed. What scans often measure is blood flow. Since neural activity increases oxygen use, an increased flow of blood to a given area of the brain implies that neurons are firing there. Research studies correlate this inferred neural firing with specific mental functions, such as focusing attention, recalling a past event, or feeling pain.

We can only imagine how a scan of my brain might have looked when I went down the low road in a tense encounter with my son one day: an abundance of limbic firing with increased blood flow to my irritated amygdala and a diminished flow to my prefrontal areas as they began to shut down. Sometimes the out-of-control firing of our brain drives what we feel, how we perceive what is happening, and how we respond. Once my prefrontal region was off-Iine, the firing patterns from throughout my subcortical regions could dominate my internal experience and my interactions with my kids. But it is also true that when we’re not traveling down the low road we can use the power of our mind to change the firing patterns of our brain and thereby alter our feelings, perceptions, and responses.

One of the key practical lessons of modern neuroscience is that the power to direct our attention has within it the power to shape our brain’s firing patterns, as well as the power to shape the architecture of the brain itself.

As you become more familiar with the various parts of the brain, you can more easily grasp how the mind uses the firing patterns in these various parts to create itself. It bears repeating that while the physical property of neurons firing is correlated with the subjective experience we call mental activity, no one knows exactly how this actually occurs. But keep this in the front of your mind:

Mental activity stimulates brain firing as much as brain firing creates mental activity.

When you voluntarily choose to focus your attention, say, on remembering how the Golden Gate Bridge looked one foggy day last fall, your mind has just activated the visual areas in the posterior part of your cortex. On the other hand, if you were undergoing brain surgery, the physician might place an electrical probe to stimulate neural firing in that posterior area, and you’d also experience a mental image of some sort.

The causal arrows between brain and mind point in both directions.

Keeping the brain in mind in this way is like knowing how to exercise properly. As we work out, we need to coordinate and balance the different muscle groups in order to keep ourselves fit. Similarly, we can focus our minds to build the specific “muscle groups” of the brain, reinforcing their connections, establishing new circuitry, and linking them together in new and helpful ways. There are no muscles in the brain, of course, but rather differentiated clusters of neurons that form various groupings called nuclei, parts, areas, zones, regions, circuits, or hemispheres.

And just as we can intentionally activate our muscles by flexing them, we can “flex” our circuits by focusing our attention to stimulate the firing in those neuronal groups. Using mindsight to focus our attention in ways that integrate these neural circuits can be seen as a form of “brain hygiene.”


You may have heard this before: As neurons fire together, they wire together. But let’s unpack this statement piece by piece. When we have an experience, our neurons become activated; What this means is that the long length of the neuron, the axon, has a flow of ions in and out of its encasing membrane that functions like an electrical current. At the far end of the axon, the electrical flow leads to the release of a chemical neurotransmitter into the small synaptic space that joins the firing neuron to the next, postsynaptic neuron. This chemical release activates or deactivates the downstream neuron. Under the right conditions, neural firing can lead to the strengthening of synaptic connections. These conditions include repetition, emotional arousal, novelty, and the careful focus of attention! Strengthening synaptic linkages between neurons is how we learn from experience.

One reason that we are so open to learning from experience is that, from the earliest days in the womb and continuing into our childhood and adolescence, the basic architecture of the brain is very much a work in progress.

During gestation, the brain takes shape from the bottom up, with the brainstem maturing first. By the time we are born, the limbic areas are partially developed but the neurons of the cortex lack extensive connections to one another.

This immaturity, the lack of connections within and among the different regions of the brain, is what gives us that openness to experience that is so critical to learning.

A massive proliferation of synapses occurs during the first years of life. These connections are shaped by genes and chance as well as experience, with some aspects of ourselves being less amenable to the influence of experience than others. Our temperament, for example, has a nonexperiential basis; it is determined in large part by genes and by chance. For instance, we may have a robust approach to novelty and love to explore new things, or we may tend to hang back in response to new situations, needing to “warm up” before we can overcome our initial shyness. Such neural propensities are set up before birth and then directly shape how we respond to the worId-and how others respond to us.

From our first days of life, our immature brain is also directly shaped by our interactions with the world, and especially by our relationships. Our experiences stimulate neural firing and sculpt our emerging synaptic connections. This is how experience changes the structure of the brain itself, and could even end up having an influence on our innate temperament.

As we grow, then, an intricate weaving together of the genetic, chance, and experiential input into the brain shapes what we call our “personality,” with all its habits, likes, dislikes, and patterns of response. If you’ve always had positive experiences with dogs and have enjoyed having them in your life, you may feel pleasure and excitement when a neighbor’s new dog comes bounding toward you. But if you’ve ever been severely bitten, your neural firing patterns may instead help create a sense of dread and panic, causing your entire body to shrink away from the pooch. If on top of having had a prior bad experience with a dog you also have a shy temperament, such an encounter may be even more fraught with fear. But whatever your experience and underlying temperament, transformation is possible. Learning to focus your attention in specific therapeutic ways can help you override that old coupling of fear with dogs.

The intentional focus of attention is actually a form of self-directed experience: It stimulates new patterns of neural firing to create new synaptic linkages.

You may be wondering, “How can experience, even a mental activity such as directing attention, actually shape the structure of the brain?” As we’ve seen, experience means neural firing. When neurons fire together, the genes in their nuclei, their master control centers, become activated and “express” themselves. Gene expression means that certain proteins are produced. These proteins then enable the synaptic linkages to be constructed anew or to be strengthened.

Experience also stimulates the production of myelin, the fatty sheath around axons, resulting in as much as a hundredfold increase in the speed of conduction down the neuron’s length. And as we now know, experience can also stimulate neural stem cells to differentiate into wholly new neurons in the brain.

This neurogenesis, along with synapse formation and myelin growth, can take place in response to experience throughout our lives. As discussed before, the capacity of the brain to change is called neuroplasticity. We are now discovering how the careful focus of attention amplifies neuroplasticity by stimulating the release of neurochemicals that enhance the structural growth of synaptic linkages among the activated neurons.


An additional piece of the puzzle is now emerging. Researchers have discovered that early experiences can change the long-term regulation of the genetic machinery within the nuclei of neurons through a process called epigenesis.

If early experiences are positive, for example, chemical controls over how genes are expressed in specific areas of the brain can alter the regulation of our nervous system in such a way as to reinforce the quality of emotional resilience. If early experiences are negative, however, it has been shown that alterations in the control of genes influencing the stress response may diminish resilience in children and compromise their ability to adjust to stressful events in the future.

The changes wrought through epigenesis will continue to be in the science news as part of our exploration of how experience shapes who we are.

In sum, experience creates the repeated neural firing that can lead to gene expression, protein production, and changes in both the genetic regulation of neurons and the structural connections in the brain. By harnessing the power of awareness to strategically stimulate the brain’s firing, mindsight enables us to voluntarily change a firing pattern that was laid down involuntarily. When we focus our attention in specific ways, we create neural firing patterns that permit previously separated areas to become linked and integrated. The synaptic linkages are strengthened, the brain becomes more interconnected, and the mind becomes more adaptive.


It’s important to remember that the activity of what we’re calling the “brain” is not just in our heads. For example, the heart has an extensive network of nerves that process complex information and relay data upward to the brain in the skull. So, too, do the intestines, and all the other major organ systems of the body. The dispersion of nerve cells throughout the body begins during our earliest development in the womb, when the cells that form the outer layer of the embryo fold inward to become the origin of our spinal cord. Clusters of these wandering cells then start to gather at one end of the spinal cord, ultimately to become the skull-encased brain. But other neural tissue becomes intricately woven with our musculature, our skin, our heart, our lungs, and our intestines. Some of these neural extensions form part of the autonomic nervous system, which keeps the body working in balance whether we are awake or asleep; other circuitry forms the voluntary portion of the nervous system, which allows us to intentionally move our limbs and control our respiration. The simple connection of sensory nerves from the periphery to our spinal cord and then upward through the various layers of the skull-encased brain allows signals from the outer world to reach the cortex, where we can become aware of them. This input comes to us via the five senses that permit us to perceive the outer physical world.

The neural networks throughout the interior of the body, including those surrounding the hollow organs, such as the intestines and the heart, send complex sensory input to the skull-based brain. This data forms the foundation for visceral maps that help us have a “gut feeling” or a “heartfelt” sense. Such input from the body forms a vital source of intuition and powerfully influences our reasoning and the way we create meaning in our lives.

Other bodily input comes from the impact of molecules known as hormones. The body’s hormones, together with chemicals from the foods and drugs we ingest, flow into our bloodstream and directly affect the signals sent along neurai routes. And, as we now know, even our immune system interacts with our nervous system. Many of these effects influence the neurotransmitters that operate at the synapses. These chemical messengers come in hundreds of varieties, some of which, such as dopamine and serotonin, have become household names thanks in part to drug company advertising. These substances have specific and complex effects on different regions of our nervous system. For example, dopamine is involved in the reward systems of the brain; behaviors and substances can become addictive because they stimulate dopamine release. Serotonin helps smooth out anxiety, depression, and mood fluctuations. Another chemical messenger is oxytocin, which is released when we feel close and attached to someone.

Throughout this book, I use the general term brain to encompass all of this wonderful complexity of the body proper as it intimately intertwines with its chemical environment and with the portion of neural tissue in the head. This is the brain that both shapes and is shaped by our mind. This is also the brain that forms one point of the triangle of well-being that is so central to mindsight.

By looking at the brain as an embodied system beyond its skull case, we can actually make sense of the intimate dance of the brain, the mind, and our relationships with one another. We can also recruit the power of neuroplasticity to repair damaged connections and create new, more satisfying patterns in our everyday lives.


Mindsight, change your brain and your life

by Daniel J. Siegel MD

get it at Amazon.com

See also: MINDSIGHT, OUR SEVENTH SENSE, an introduction. Change your brain and your life – Daniel J. Siegel MD.

Neuroplasticity – Wikipedia

Neuroplasticity, also known as brain plasticity and neural plasticity, is the ability of the brain to change throughout an individual’s life, e.g., brain activity associated with a given function can be transferred to a different location, the proportion of grey matter can change, and synapses may strengthen or weaken over time.

Research in the latter half of the 20th century showed that many aspects of the brain can be altered (or are “plastic”) even through adulthood.“ However, the developing brain exhibits a higher degree of plasticity than the adult brain.

Neuroplasticity can be observed at multiple scales, from microscopic changes in individual neurons to larger-scale changes such as cortical remapping in response to injury. Behavior, environmental stimuli, thought, and emotions may also cause neuroplastic change through activity-dependent plasticity, which has significant implications for healthy development, learning, memory, and recovery from brain damage.

At the single cell level, synaptic plasticity refers to changes in the connections between neurons, whereas non-synaptic plasticity refers to changes in their intrinsic excitability.


One of the fundamental principles underlying neuroplasticity is based on the idea that individual synaptic connections are constantly being removed or recreated, largely dependent upon the activity of the neurons that bear them. The activity-dependence of synaptic plasticity is captured in the aphorism which is often used to summarize Hebbian theory: “neurons that fire together, wire together”/”neurons that fire out of sync, fail to link”. If two nearby neurons often produce an impulse in close temporal proximity, their functional properties may converge. Conversely, neurons that are not regularly activated simultaneously may be less likely to functionally converge.

Cortical maps

Cortical organization, especially in sensory systems, is often described in terms of maps. For example, sensory information from the foot projects to one cortical site and the projections from the hand target another site. As a result, the cortical representation of sensory inputs from the body resembles a somatotopic map, often described as the sensory homunculus.

In the late 1970s and early 1980s, several groups began exploring the impact of interfering with sensory inputs on cortical map reorganization. Michael Merzenich, Jon Kaas and Doug Rasmusson were some of those researchers. They found that if the cortical map is deprived of its input, it activates at a later time in response to other, usually adjacent inputs. Their findings have been since corroborated and extended by many research groups. Merzenich’s (1984) study involved the mapping of owl monkey hands before and after amputation of the third digit. Before amputation, there were five distinct areas, one corresponding to each digit of the experimental hand. Sixty-two days following amputation of the third digit, the area in the cortical map formerly occupied by that digit had been invaded by the previously adjacent second and fourth digit zones. The areas representing digit one and five are not located directly beside the area representing digit three, so these regions remained, for the most part, unchanged following amputation. This study demonstrates that only those regions that border a certain area invade it to alter the cortical map. In the somatic sensory system, in which this phenomenon has been most thoroughly investigated, JT Wall and J Xu have traced the mechanisms underlying this plasticity. Reorganization is not cortically emergent, but occurs at every level in the processing hierarchy; this produces the map changes observed in the cerebral cortex.“

Merzenich and William Jenkins (1990) initiated studies relating sensory experience, without pathological perturbation, to cortically observed plasticity in the primate somatosensory system, with the finding that sensory sites activated in an attended operant behavior increase in their cortical representation. Shortly thereafter, Ford Ebner and colleagues (1994) made similar efforts in the rodent whisker barrel cortex (also part of the somatosensory system). These two groups largely diverged over the years. The rodent whisker barrel efforts became a focus for Ebner, Matthew Diamond, Michael Armstrong-James, Robert Sachdev, and Kevin Fox. Great inroads were made in identifying the locus of change as being at cortical synapses expressing NMDA receptors, and in implicating cholinergic inputs as necessary for normal expression. The work of Ron Frostig and Daniel Polley (1999, 2004) identified behavioral manipulations causing a substantial impact on the cortical plasticity in that system.

Merzenich and DT Blake (2002, 2005, 2006) went on to use cortical implants to study the evolution of plasticity in both the somatosensory and auditory systems. Both systems show similar changes with respect to behavior. When a stimulus is cognitively associated with reinforcement, its cortical representation is strengthened and enlarged. In some cases, cortical representations can increase two to threefold in 1-2 days when a new sensory motor behavior is first acquired, and changes are largely finalised within at most a few weeks. Control studies show that these changes are not caused by sensory experience alone: they require learning about the sensory experience, they are strongest for the stimuli that are associated with reward, and they occur with equal ease in operant and classical conditioning behaviors.

An interesting phenomenon involving plasticity of cortical maps is the phenomenon of phantom limb sensation. Phantom limb sensation is experienced by people who have undergone amputations in hands, arms, and legs, but it is not limited to extremities. Although the neurological basis of phantom limb sensation is still not entirely understood it is believed that cortical reorganization plays an important role.

Norman Doidge, following the lead of Michael Merzenich, separates manifestations of neuroplasticity into adaptations that have positive or negative behavioral consequences. For example, if an organism can recover after a stroke to normal levels of performance, that adaptiveness could be considered an example of “positive plasticity”. Changes such as an excessive level of neuronal growth leading to spasticity or tonic paralysis, or excessive neurotransmitter release in response to injury that could result in nerve cell death, are considered as an example of “negative” plasticity. In addition, drug addiction and obsessive-compulsive disorder are both deemed examples of “negative plasticity” by Dr. Doidge, as the synaptic rewiring resulting in these behaviors is also highly maladaptive.

A 2005 study found that the effects of neuroplasticity occur even more rapidly than previously expected. Medical students’ brains were imaged during the period of studying for their exams. In a matter of months, the students’ gray matter increased significantly in the posterior and lateral parietal cortex.

Applications and example

The adult brain is not entirely “hard-wired” with fixed neuronal circuits. There are many instances of cortical and subcortical rewiring of neuronal circuits in response to training as well as in response to injury. There is solid evidence that neurogenesis (birth of brain cells) occurs in the adult mammalian brain, and such changes can persist well into old age. The evidence for neurogenesis is mainly restricted to the hippocampus and olfactory bulb, but current research has revealed that other parts of the brain, including the cerebellum, may be involved as well. However, the degree of rewiring induced by the integration of new neurons in the established circuits is not known, and such rewiring may well be functionally redundant.

There is now ample evidence for the active, experience-dependent reorganization of the synaptic networks of the brain involving multiple inter-related structures including the cerebral cortex. The specific details of how this process occurs at the molecular and ultrastructural levels are topics of active neuroscience research. The way experience can influence the synaptic organization of the brain is also the basis for a number of theories of brain function including the general theory of mind and Neural Darwinism. The concept of neuroplasticity is also central to theories of memory and learning that are associated with experience-driven alteration of synaptic structure and function in studies of classical conditioning in invertebrate animal models such as Aplysia.

Treatment of brain damage

A surprising consequence of neuroplasticity is that the brain activity associated with a given function can be transferred to a different location; this can result from normal experience and also occurs in the process of recovery from brain injury. Neuroplasticity is the fundamental issue that supports the scientific basis for treatment of acquired brain injury with goal-directed experiential therapeutic programs in the context of rehabilitation approaches to the functional consequences of the injury.

Neuroplasticity is gaining popularity as a theory that, at least in part, explains improvements in functional outcomes with physical therapy post-stroke. Rehabilitation techniques that are supported by evidence which suggest cortical reorganization as the mechanism of change include constraint-induced movement therapy, functional electrical stimulation, treadmill training with body-weight support, and virtual reality therapy. Robot assisted therapy is an emerging technique, which is also hypothesized to work by way of neuroplasticity, though there is currently insufficient evidence to determine the exact mechanisms of change when using this method.

One group has developed a treatment that includes increased levels of progesterone injections in brain-injured patients. “Administration of progesterone after traumatic brain injury (TBI) and stroke reduces edema, inflammation, and neuronal cell death, and enhances spatial reference memory and sensory motor recovery.” In a clinical trial, a group of severely injured patients had a 60% reduction in mortality after three days of progesterone injections?” However, a study published in the New England Journal of Medicine in 2014 detailing the results of a multi-center NIH-funded phase III clinical trial of 882 patients found that treatment of acute traumatic brain injury with the hormone progesterone provides no significant benefit to patients when compared with placebo.”


For decades, researchers assumed that humans had to acquire binocular vision, in particular stereopsis, in early childhood or they would never gain it. In recent years, however, successful improvements in persons with amblyopia, convergence insufficiency or other stereo vision anomalies have become prime examples of neuroplasticity; binocular vision improvements and stereopsis recovery are now active areas of scientific and clinical research.

Brain training

Several companies have offered so-called cognitive training software programs for various purposes that claim to work via neuroplasticity; one example is Fast ForWord which is marketed to help children with learning disabilities. A systematic metaanalytic review found that “There is no evidence from the analysis carried out that Fast ForWord is effective as a treatment for children‘s oral language or reading difficulties”. A 2016 review found very little evidence supporting any of the claims of Fast ForWord and other commercial products, as their task-speciflc effects fail to generalise to other tasks.

Sensory prostheses

Neuroplasticity is involved in the development of sensory function. The brain is born immature and it adapts to sensory inputs after birth. In the auditory system, congenital hearing impairment, a rather frequent inborn condition affecting 1 of 1000 newborns, has been shown to affect auditory development, and implantation of a sensory prostheses activating the auditory system has prevented the deficits and induced functional maturation of the auditory system. Due to a sensitive period for plasticity, there is also a sensitive period for such intervention within the first 2-4 years of life. Consequently, in prelingually deaf children, early cochlear implantation, as a rule, allows the children to learn the mother language and acquire acoustic communication.

Phantom limb sensation

In the phenomenon of phantom limb sensation, a person continues to feel pain or sensation within a part of their body that has been amputated. This is strangely common, occurring in 60-80% of amputees. An explanation for this is based on the concept of neuroplasticity, as the cortical maps of the removed limbs are believed to have become engaged with the area around them in the postcentral gyrus. This results in activity within the surrounding area of the cortex being misinterpreted by the area of the cortex formerly responsible for the amputated limb.

The relationship between phantom limb sensation and neuroplasticity is a complex one. In the early 1990s V.S. Ramachandran theorized that phantom limbs were the result of cortical remapping. However, in 1995 Hertz Flor and her colleagues demonstrated that cortical remapping occurs only in patients who have phantom pain.” Her research showed that phantom limb pain (rather than referred sensations) was the perceptual correlate of cortical reorganization. This phenomenon is sometimes referred to as maladaptive plasticity.

In 2009 Lorimer Moseley and Peter Brugger carried out a remarkable experiment in which they encouraged arm amputee subjects to use visual imagery to contort their phantom limbs into impossible configurations. Four of the seven subjects succeeded in performing impossible movements of the phantom limb. This experiment suggests that the subjects had modified the neural representation of their phantom limbs and generated the motor commands needed to execute impossible movements in the absence of feedback from the body. The authors stated that: “In fact, this finding extends our understanding of the brain’s plasticity because it is evidence that profound changes in the mental representation of the body can be induced purely by internal brain mechanisms, the brain truly does change itself.”

Chronlc pain

Individuals who suffer from chronic pain experience prolonged pain at sites that may have been previously injured, yet are otherwise currently healthy. This phenomenon is related to neuroplasticity due to a maladaptive reorganization of the nervous system, both peripherally and centrally. During the period of tissue damage, noxious stimuli and inflammation cause an elevation of nociceptive input from the periphery to the central nervous system. Prolonged nociception from the periphery then elicits a neuroplastic response at the cortical level to change its somatotopic organization for the painful site, inducing central sensitization.“ For instance, individuals experiencing complex regional pain syndrome demonstrate a diminished cortical somatotopic representation of the hand contralaterally as well as a decreased spacing between the hand and the mouth.

Additionally, chronic pain has been reported to significantly reduce the volume of grey matter in the brain globally, and more specifically at the prefrontal cortex and right thalamus. However, following treatment, these abnormalities in cortical reorganization and grey matter volume are resolved, as well as their symptoms. Similar results have been reported for phantom limb pain, chronic low back pain and carpal tunnel syndrome.


A number of studies have linked meditation practice to differences in cortical thickness or density of gray matter. One of the most well-known studies to demonstrate this was led by Sara Lazar, from Harvard University, in 2000. Richard Davidson, a neuroscientist at the University of Wisconsin, has led experiments in cooperation with the Dalai Lama on effects of meditation on the brain. His results suggest that long-term or short-term practice of meditation results in different levels of activity in brain regions associated with such qualities as attention, anxiety, depression, fear, anger, and the ability of the body to heal itself. These functional changes may be caused by changes in the physical structure of the brain.

Fitness and exercise

Aerobic exercise promotes adult neurogenesis by increasing the production of neurotrophic factors (compounds that promote growth or survival of neurons), such as brain-derived neurotrophic factor (BDNF), insulin-like growth factor (IGF-1), and vascular endothelial growth factor (VEGF). Exercise-induced neurogenesis in the hippocampus is associated with measurable improvements in spatial memory. Consistent aerobic exercise over a period of several months induces marked clinically significant improvements in executive function (i.e., the “cognitive control” of behavior) and increased gray matter volume in multiple brain regions, particularly those that give rise to cognitive control. The brain structures that show the greatest improvements in gray matter volume in response to aerobic exercise are the prefrontal cortex and hippocampus; moderate improvements are seen in the anterior cingulate cortex, parietal cortex, cerebellum, caudate nucleus, and nucleus accumbens. Higher physical fitness scores (measured by V02 max) are associated with better executive function, faster processing speed, and greater volume of the hippocampus, caudate nucleus, and nucleus accumbens.

Human echolocation

Human echolocation is a learned ability for humans to sense their environment from echoes. This ability is used by some blind people to navigate their environment and sense their surroundings in detail. Studies in 2010 and 2011 using functional magnetic resonance imaging techniques have shown that parts of the brain associated with visual processing are adapted for the new skill of echolocation. Studies with blind patients, for example, suggest that the click-echoes heard by these patients were processed by brain regions devoted to vision rather than audition.

ADHD stimulants

Reviews of MRI studies on individuals with ADHD suggest that the long-term treatment of attention deficit hyperactivity disorder (ADHD) with stimulants, such as amphetamine or methylphenidate, decreases abnormalities in brain structure and function found in subjects with ADHD, and improves function in several parts of the brain, such as the right caudatenucleus of the basal ganglia.

In children

Neuroplasticity is most active in childhood as a part of normal human development, and can also be seen as an especially important mechanism for children in terms of risk and resiliency. Trauma is considered a great risk as it negatively affects many areas of the brain and puts strain on the sympathetic nervous system from constant activation. Trauma thus alters the brain’s connections such that children who have experienced trauma may be hyper vigilant or overly aroused. However a child’s brain can cope with these adverse effects through the actions of neuroplasticity.

In animals

In a single lifespan, individuals of an animal species may encounter various changes in brain morphology. Many of these differences are caused by the release of hormones in the brain; others are the product of evolutionary factors or developmental stages. Some changes occur seasonally in species to enhance or generate response behaviors.

Seasonal brain changes

Changing brain behavior and morphology to suit other seasonal behaviors is relatively common in animals. These changes can improve the chances of mating during breeding season. Examples of seasonal brain morphology change can be found within many classes and species.

Within the class Aves, black-capped chickadees experience an increase in the volume of their hippocampus and strength of neural connections to the hippocampus during fall months. These morphological changes within the hippocampus which are related to spatial memory are not limited to birds, as they can also be observed in rodents and amphibians?“ In songbirds, many song control nuclei in the brain increase in size during mating season. Among birds, changes in brain morphology to influence song patterns, frequency, and volume are common. Gonadotropin-releasing hormone (GnRH) immunoreactivity, or the reception of the hormone, is lowered in European starlings exposed to longer periods of light during the day.

The California sea hare, a gastropod, has more successful inhibition of egg-laying hormones outside of mating season due to increased effectiveness of inhibitors in the brain. Changes to the inhibitory nature of regions of the brain can also be found in humans and other mammals. In the amphibian Bufo japonicus, part of the amygdala is larger before breeding and during hibernation than it is after breeding.

Seasonal brain variation occurs within many mammals. Part of the hypothalamus of the common ewe is more receptive to GnRH during breeding season than at other times of the year.

Humans experience a change in the size of the hypothalamic suprachiasmatic nucleus and vasopressin-immunoreactive neurons within it during the fall, when these parts are larger. In the spring, both reduce in size.

Traumatic brain injury research

Randy Nudo’s group found that if a small stroke (an infarction) is induced by obstruction of blood flow to a portion of a monkey’s motor cortex, the part of the body that responds by movement moves when areas adjacent to the damaged brain area are stimulated. In one study, intracortical microstimulation (ICMS) mapping techniques were used in nine normal monkeys. Some underwent ischemic-infarction procedures and the others, ICMS procedures. The monkeys with ischemic infarctions retained more finger flexion during food retrieval and after several months this deficit returned to preoperative levels.

With respect to the distal forelimb representation, “postinfarction mapping procedures revealed that movement representations underwent reorganization throughout the adjacent, undamaged cortex.” Understanding of interaction between the damaged and undamaged areas provides a basis for better treatment plans in stroke patients. Current research includes the tracking of changes that occur in the motor areas of the cerebral cortex as a result of a stroke. Thus, events that occur in the reorganization process of the brain can be ascertained. Nudo is also involved in studying the treatment plans that may enhance recovery from strokes, such as physiotherapy, pharmacotherapy, and electrical-stimulation therapy.

Jon Kaas, a professor at Vanderbilt University, has been able to show “how somatosensory area 3b and ventroposterior (VP) nucleus of the thalamus are affected by longstanding unilateral dorsal-column lesions at cervical levels in macaque monkeys.” Adult brains have the ability to change as a result of injury but the extent of the reorganization depends on the extent of the injury. His recent research focuses on the somatosensory system, which involves a sense of the body and its movements using many senses. Usually, damage of the somatosensory cortex results in impairment of the body perception. Kaas’ research project is focused on how these systems (somatosensory, cognitive, motor systems) respond with plastic changes resulting from injury.

One recent study of neuroplasticity involves work done by a team of doctors and researchers at Emory University, specifically Dr. Donald Stein and Dr. David Wright. This is the first treatment in 40 years that has significant results in treating traumatic brain injuries while also incurring no known side effects and being cheap to administer. Dr. Stein noticed that female mice seemed to recover from brain injuries better than male mice, and that at certain points in the estrus cycle, females recovered even better. This difference may be attributed to different levels of progesterone, with higher levels of progesterone leading to the faster recovery from brain injury in mice. However, clinical trials showed progesterone offers no significant benefit for traumatic brain injury human patients.



The term “plasticity” was first applied to behavior in 1890 by William James in The Principles of Psychology. The first person to use the term neural plasticity appears to have been the Polish neuroscientist Jerzy Konorski.

See also: William James’s Revolutionary 1884 Theory of How Our Bodies Affect Our Feelings – Maria Popova * What is an Emotion? – William James (1884).

In 1793, Italian anatomist Michele Vicenzo Malacarne described experiments in which he paired animals, trained one of the pair extensively for years, and then dissected both. He discovered that the cerebellums of the trained animals were substantially larger. But these findings were eventually forgotten.

The idea that the brain and its function are not fixed throughout adulthood was proposed in 1890 by William James in The Principles of Psychology, though the idea was largely neglected. Until around the 1970s, neuroscientists believed that the brain’s structure and function was essentially fixed throughout adulthood.

The term has since been broadly applied:

“Given the central importance of neuroplasticity, an outsider would be forgiven for assuming that it was well defined and that a basic and universal framework served to direct current and future hypotheses and experimentation. Sadly, however, this is not the case. While many neuroscientists use the word neuroplasticity as an umbrella term it means different things to different researchers in different subflelds. In brief, a mutually agreed upon framework does not appear to exist.”

Research and discovery

In 1923, Karl Lashley conducted experiments on rhesus monkeys that demonstrated changes in neuronal pathways, which he concluded were evidence of plasticity. Despite this, and other research that suggested plasticity took place, neuroscientists did not widely accept the idea of neuroplasticity.

In 1945, Justo Gonzalo concluded from his research of brain dynamics, that, contrary to the activity of the projection areas, the “central” cortical mass (more or less equidistant from the visual, tactile and auditive projection areas), would be a “maneuvering mass”, rather unspecific or multisensory, with capacity to increase neural excitability and re-organize the activity by means of plasticity properties. He gives as a first example of adaptation, to see upright with reversing glasses in the Stratton experiment, and specially, several first-hand brain injuries cases in which he observed dynamic and adaptive properties in their disorders, in particular in the inverted perception disorder. He stated that a sensory signal in a projection area would be only an inverted and constricted outline that would be magnified due to the increase in recruited cerebral mass, and re-inverted due to some effect of brain plasticity, in more central areas, following a spiral growth.

Marian Diamond of the University of California, Berkeley, produced the first scientific evidence of anatomical brain plasticity, publishing her research in 1964.

Other significant evidence was produced in the 1960s and after, notably from scientists including Paul Bach-y-Rita, Michael Merzenich along with Jon Kaas, as well as several others.

In the 1960s, Paul Bach-y-Rita invented a device that was tested on a small number of people, and involved a person sitting in a chair, in which were embedded nubs that were made to vibrate in ways that translated images received in a camera, allowing a form of vision via sensory substitution.

Studies in people recovering from stroke also provided support for neuroplasticity, as regions of the brain that remained healthy could sometimes take over, at least in part, functions that had been destroyed; Shepherd Ivory Franz did work in this area.

Eleanor Maguire documented changes in hippocampal structure associated with acquiring the knowledge of London’s layout in local taxi drivers. A redistribution of grey matter was indicated in London Taxi Drivers compared to controls. This work on hippocampal plasticity not only interested scientists, but also engaged the public and media worldwide.

Michael Merzenich is a neuroscientist who has been one of the pioneers of neuroplasticity for over three decades. He has made some of “the most ambitious claims for the field that brain exercises may be as useful as drugs to treat diseases as severe as schizophrenia, that plasticity exists from cradle to the grave, and that radical improvements in cognitive functioning, how we learn, think, perceive, and remember are possible even in the elderly.

Merzenich’s work was affected by a crucial discovery made by David Hubel and Torsten Wiesel in their work with kittens. The experiment involved sewing one eye shut and recording the cortical brain maps. Hubel and Wiesel saw that the portion of the kitten’s brain associated with the shut eye was not idle, as expected. Instead, it processed visual information from the open eye. It was “…as though the brain didn’t want to waste any ‘cortical real estate’ and had found a way to rewire itself.”

This implied neuroplasticity during the critical period. However, Merzenich argued that neuroplasticity could occur beyond the critical period. His first encounter with adult plasticity came when he was engaged in a postdoctoral study with Clinton Woosley. The experiment was based on observation of what occurred in the brain when one peripheral nerve was cut and subsequently regenerated. The two scientists micromapped the hand maps of monkey brains before and after cutting a peripheral nerve and sewing the ends together. Afterwards, the hand map in the brain that they expected to be jumbled was nearly normal. This was a substantial breakthrough. Merzenich asserted that, “If the brain map could normalize its structure in response to abnormal input, the prevailing view that we are born with a hardwired system had to be wrong. The brain had to be plastic.” Merzenich received the 2016 Kavli Prize in Neuroscience “for the discovery of mechanisms that allow experience and neural activity to remodel brain function.”

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




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.


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 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.


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.


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.


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.


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.


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.



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.


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.



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.


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.


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.


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


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.


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.


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.


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.


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.


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.


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.


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.


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.


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.


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 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).


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 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.


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.


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.


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.


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.


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.

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MINDSIGHT, OUR SEVENTH SENSE, an introduction. Change your brain and your life – Daniel J. Siegel MD.

Mindsight, the brain’s capacity for both insight and empathy.

How can we be receptive to the mind’s riches and not just reactive to its reflexes? How can we direct our thoughts and feelings rather than be driven by them?

And how can we know the minds of others, so that we truly understand “where they are coming from” and can respond more effectively and compassionately?

Mindsight is a kind of focused attention that allows us to see the internal workings of our own minds, making it possible to see what is inside, to accept it, and in the accepting to let it go, and finally, to transform it.

When we develop the skill of mindsight, we actually change the physical structure of our brain. How we focus our attention shapes the structure of the brain.

Mindsight has the potential to free us from patterns of mind that are getting in the way of living our lives to the fullest.

Mindsight, our ability to look within and perceive the mind, to reflect on our experience, is every bit as essential to our wellbeing as our six senses. Mindsight is our seventh sense.

What is Mindsight?

“Mindsight” is a term coined by Dr. Dan Siegel to describe our human capacity to perceive the mind of the self and others. It is a powerful lens through which we can understand our inner lives with more clarity, integrate the brain, and enhance our relationships with others. Mindsight is a kind of focused attention that allows us to see the internal workings of our own minds. It helps us get ourselves off of the autopilot of ingrained behaviors and habitual responses. It lets us “name and tame” the emotions we are experiencing, rather than being overwhelmed by them.

“I am sad” vs. “I feel sad”

Mindsight is the difference between saying “I am sad” and ”I feel sad.” Similar as those two statements may seem, they are profoundly different. “I am sad” is a kind of limited selfdefinition. “I feel sad” suggests the ability to recognize and acknowledge a feeling, without being consumed by it. The focusing skills that are part of mindsight make it possible to see what is inside, to accept it, and in the accepting to let it go, and finally, to transform it.

Mindsight: A Skill that Can Change Your Brain

Mindsight is a learnable skill. It is the basic skill that underlies what we mean when we speak of having emotional and social intelligence. When we develop the skill of mindsight, we actually change the physical structure of the brain. This revelation is based on one of the most exciting scientific discoveries of the last twenty years: How we focus our attention shapes the structure of the brain. Neuroscience has also definitively shown that we can grow these new connections throughout our lives, not just in childhood.

What’s Interpersonal Neurobiology?

Interpersonal neurobiology, a term coined by Dr. Siegel in The Developing Mind, 1999, is an interdisciplinary field which seeks to understand the mind and mental health. This field is based on science but is not constrained by science. What this means is that we attempt to construct a picture of the ”whole elephant” of human reality. We build on the research of different disciplines to reveal the details of individual components, while also assembling these pieces to create a coherent view of the whole.

The Mindsight Institute

Through the Mindsight Institute, Dr. Siegel offers a scientificaliy-based way of understanding human development. The Mindsight Institute serves as the organization from which interpersonal neurobiology first developed and it continues to be a key source for learning in this area. The Mindsight Institute links science, clinical practice, education, the arts, and contemplation, serving as an educational hub from which these various domains of knowing and practice can enrich their individual efforts. Through the Mindsight Institute’s online program, people from six continents participate weekly in our global conversation about the ways to create more health and compassion in the world.

Mindsight Institute

Daniel J. Siegel, MD, is a clinical professor of psychiatry at the UCLA School of Medicine, co-director of the UCLA Mindful Awareness Research Center, and executive director of the Mindsight Institute. A graduate of Harvard Medical School, he is the author of the internationally acclaimed professional texts The Mindful Brain and The Developing Mind, and the co-author of Parenting from the Inside Out.