October 21st, 2007 by Dr. Val Jones in Expert Interviews
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As Halloween approaches, I was asked a really interesting psychological question from Lauren (of Love, Lauren fame) at Revolution Health. She asked, “Why do people like to be frightened? I don’t like horror movies or haunted houses, but some people love that stuff. Why, Dr. Val?”
I scratched my head and looked at her for a moment as images of Saw, Freddie Kruger, and Jason Voorhees (the only Dutch Halloween “slasher” protagonist I know) went through my mind. I offered an unsatisfactory reply, and promised to take this up with someone more learned in the ways of fear. Luckily for me, Dr. Andrew Gerber– a thoughtful psychiatrist whose research focuses on brain response to emotion (how perfect) was up to the task. Here’s what he had to say:
Our enjoyment of being afraid is a wonderful example of how the human mind works in mysterious ways that are often not immediately transparent to our own introspection. Psychiatrists, psychologists, and cognitive scientists are coming up with new ways to study exactly these sorts of things (located in a psychological structure called the “dynamic,” “adaptive,” or “cognitive” unconscious) and have a variety of possible explanations.
1. We like to feel things strongly.
Even if something has a negative part to it, it can be overridden by our preference to feel something as opposed to nothing. This may be the same phenomenon that drives our curiosity (even when it gets us into trouble, like a cat), our restlessness, or the discomfort of boredom. Increasing evidence from brain imaging studies tells us that a large part of our brain is devoted to processing intense emotion. It’s pretty likely that these regions were very important in our evolution and survival as a species.
2. We love the experience of a building up of tension and relief.
The best part of all about being scared on Halloween or in a scary movie is the huge relief at the end when we or our hero emerges safe and sound. A part of us remembers the whole time that relief is coming, so the tension part is worthwhile. There are lots of experience in our life that have the same kind of tension and relief pleasure to them – for example, missing a loved one and then seeing them, being hungry and eating a delicious meal, or being really tired and then getting to relax. You might say that the more the tension builds, the more the relief feels good. Brain imaging studies show that motivational systems located in the deep and archaic part of the brain operate on a tension and relief principle. When this works well, we feel motivated to go about the business of our lives. This very system can go awry in disorders such as depression and drug addiction.
3. We like to work through old situations and make them come out better.
For better or for worse, humans are consummate problem solvers and when things didn’t go well in the past, we like to replay the situation and have it come out differently. We all recall the experience of being scared as a child when it didn’t feel so good. This makes it all the more fun as older children or adults to replay that experience but this time to have the experience come out in a more positive way.
And there you have it – our brains crave “tension and release” to feed parts of our large emotion-processing centers, we like to problem solve in controlled environments where the outcomes are not truly dangerous, and we derive pleasure from strong emotions. That being said, I prefer action flicks to the horror movies myself. Though I’m a sucker for a good Sci-Fi thriller. What about you? What’s your favorite “tension release” movie?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
October 6th, 2007 by Dr. Val Jones in News
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Have you ever been singled out in a lecture and picked on? Or maybe at a comedy club? It’s somehow awkward when everyone is looking at you, and you can’t really defend yourself. That happened to me yesterday in a lecture about how email can transform medical practices. My friend Joe Scherger was talking about the beauty of asynchronous communication, and how much time it saves – when out of the blue, he said that Blackberries defeated the whole purpose of emailing, and that people who used them lead unbalanced lives. He then pointed at me and said, “See my friend Val Jones, there? She uses a Blackberry all the time!”
All eyes fixed on me with a sort of half pity, half “tisk, tisk” expression.
“She answers all her emails within minutes… She never unplugs.”
I shrugged and smiled sheepishly. Soon the conversation turned to other subjects, and I resisted the urge to pull my Blackberry out of my bag to check my emails.
Today I heard that Intel instituted email-free Fridays as a means to force their engineers to talk to others face-to-face. Apparently, the company was worried that interpersonal skills were being lost, and that people were not developing normal working relationships because of the artificial distance created by email-only communication.
“Well, at least I’m not alone,” I thought as I read the news story. “This is a serious problem across the country.”
There has been recent debate in the psychiatric community about whether or not video games could be considered an addiction (just as drugs and alcohol can be). Some have proposed that it be added to the DSM-V due out in 2012, others have said that compulsive video game playing is a sign of other underlying pathology (such as depression or social anxiety) but not a true addiction.
But the bottom line is that overuse of the Internet can disrupt a person’s time available for meaningful interpersonal relationships, be they with a spouse, a parent, a relative, or a friend. When your husband is sitting in the same room with you and has to get your attention by IM-ing or emailing you, you know there’s a problem.
And there doesn’t seem to be much of a break in sight – with Facebook, MySpace, Linked-In, YouTube, Pownce, Twitter, GTalk, blogs, podcasts, discussion boards, chat rooms, forums, etc. available as 24-7 forms of entertainment and communication, and companies like Intel trying to forbid this kind of stuff at least 1 day per week, Blackberries are the least of our worries. I wonder if these programs are like junk food for the brain? Will we soon suffer from cerebral obesity?
I’m afraid that I recognize that there is a problem, but I’m not sure what the solution is. “Just say no” to email doesn’t work for me… I like the fast-paced interactivity and connection I get from these activities. Maybe there’s a positive feedback loop at work, though – we spend a lot of time involved in online activities and become more isolated and lonely in our personal lives. In the end we become more and more engaged with the Internet to fill the emotional gap that we’re actually creating by overusing it.
I’ll ask my husband what he thinks… perhaps I’ll send him an email about it tonight.
What do you think?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 7th, 2007 by Dr. Val Jones in Expert Interviews
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Two new studies reported increasing suicide rates in teenagers. The first noted a trend between decreased use of anti-depressant medications (SSRIs) in teens and an increase in suicide, the second reported an increase in female teen suicide in particular.
What could be causing these tragic increases? I interviewed Revolution Health psychologist, Dr. Mark Smaller and child psychiatrist, Dr. Andrew Gerber, to get their take on this disturbing trend.
1. In previous research,
increased suicidality was associated with SSRI use in teens. Now this study
suggests that lower SSRI use is associated with increased suicidality. How do
you explain this?
Dr. Smaller: Following the previous research, parents and some physicians cut back on SSRI use for depressed teens. However, in doing so they may have neglected those teenagers who could have benefitted from an antidepressant. The problem with these medications is that they effect so many parts of the brain that it’s difficult to predict how different patients will respond to them. Also, these medications are often prescribed in too high a dosage. What needs to happen is that the patient, teen, child, or adult must have a full psychosocial evaluation that takes into account the whole person, and the environment in which he or she is living. A clear treatment plan combining talking therapy (individual or family) and perhaps medication must be implemented. This is not being done in enough instances. With a proper evaluation and a carefully designed treatment plan (as well as close monitoring of the teen) therapy may be further customized to the individual.
Dr. Gerber: The possibility of an association between suicidality and SSRI use in children
and adolescents is of clear concern to many people, including all psychiatrists
and parents of children on medication. Despite all the accumulated research to
date, it is still very unclear how this association works. However, we do know a
few important things.
First, in all the studies of SSRI use in children, there
is no report of a completed suicide attempt in a child who was taking an SSRI.
This goes to show that completed suicides in children, while tragedies whenever
they do happen, are rare events and therefore very hard to study methodically.
Second, in those studies that have shown a possible association of suicidal
thoughts (though not actual suicides) with SSRIs, there is a lot of disagreement
and controversy over how to best measure these thoughts in an accurate way. How
one does this influences the results considerably.
Third, it is important to
keep in mind all the ways in which an association between SSRIs and suicidal
thoughts may appear to exist because of how the data are collected, even if SSRIs
really don’t bring about suicidality at all. For example, it’s certainly true
that doctors are most likely to give medications to the kids who are the most
depressed and the kids who are the most depressed are most likely to be
suicidal. So it might look like SSRIs are related to suicidality, when they are
really being used to treat those kids who are most likely to develop it.
The
best way to really tease these apart is to randomly assign enough children
either to SSRIs or non-SSRI treatment and then observe what the differences are.
The problem, is that (1) the data are so good that SSRIs help many kids with
depression that it would be unethical to withhold treatment from half the
children in order to complete such a study, and (2) suicidality is rare enough
that this study would have to be enormous, and thus is impossible to
do.
With all this said, it is not surprising at all that an overall
decrease in the use of SSRIs, most likely due to the greater caution that
clinicians now have in using these medications in children, would lead to more
suicidality on a broader scale. We know that SSRIs help most children who take
them and this is undoubtedly a more powerful effect than any extent to which
SSRIs cause suicidality (if this is true at all).
2. Is there a role for
SSRIs in teens?
Dr. Smaller: I think so but only after a full diagnostic evaluation is made by a skilled mental health professional who works with teens, family and is familiar with the developmental phase of adolescence.
Dr. Gerber: There is unquestionably still a role for SSRIs in teens as long as they are
monitored carefully by a well trained clinician who, following agreed upon
guidelines, has decided that an SSRI is the right treatment for this teen. Of
course, as always, other treatments and their advantages and disadvantages
should be considered too. But for the best interests of kids and teens, SSRIs
need to remain a possibility.
3. What would you counsel
parents about these drugs?
Dr. Smaller: Get a full physchological evaluation and treatment plan so that you can make an informed decision about what might help. The mental health professional and the parent must have a working alliance to insure that the treatment is successful.
Dr. Gerber: I would advise parents that it is always good for them to be well informed and
vigilant about the risks and benefits of all treatment that they consider for
their children. There is much that we do not know about child psychiatric
illness and we are working furiously to learn more. In the meantime, though we
have to be careful to keep an open mind to both sides and to not make premature
judgments either in favor or against any one treatment. SSRIs have shown
themselves to be useful with many children and, in the hands of a well trained
professional, can continue to be very helpful to the right children and their
families.
4. What do you make of
the suicide rate increase in girls? What could be behind
this?
Dr. Smaller: This is alarming. The onset of adolescence for girls and boys is a hugely disruptive developmental phase, and maybe more so for girls with the onset of puberty. The teen years can be fraught with family issues that exacerbate moods and create symptoms. Our culture puts huge demands on all of our adolescents and this research might be showing that it is taking a high toll on girls. Social roles, peer pressure and issues, academic demands and family strife all contribute. The high incidence of eating disorders among teenage girls is a clear example of a symptom to which many teenage girls are vulnerable.
Dr. Gerber: The greater increase in suicide rates among teenage girls is surprising and
experts are unsure of how to interpret this. Since the overall number of
suicides is small – 94 in 2003 and 56 in 2004 – it is hard to interpret what was
different in this group of teenage girls. There are so many increasing pressures
on teenage girls today – from issues around body image and weight to balancing
complicated societal expectations, what some experts term pressure to live up to
a “superwoman ideal” – that one might speculate it is leading more and more
teenage girls to feel overwhelmed and hopeless. However, what we really need, as
with the SSRI controversy, is more carefully collected data and thoughtful
discussions between families, patients, and clinicians, to understand what is
happening and how we can prevent it.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 15th, 2007 by Dr. Val Jones in Expert Interviews
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The Washington Post featured an article about how social networking tools like Facebook are influencing student socialization at college. Some say that the frenetic texting, online communications, and iPhone chatter are causing students to lose the ability to socialize normally in-person. Others say that technology levels the social “playing field” for introverts. I interviewed Revolution Health’s psychologist, Dr. Mark Smaller, to get his thoughts on the matter. Feel free to add your perspective in the comments section of this blog.
Dr. Val: The article
suggests that technology can become a social crutch, keeping people from making
new friends. Do you think that the
Internet can isolate students from one another?
Dr. Smaller: I think the long term impact of the Internet in
social interactions is unclear. For now
such technology does allow students to remain in touch with one another
instantly, but that’s not too different from what the telephone did for
previous generations. If anything, I’d
say that technology can interfere with isolation, especially for the new
college student away from home for the first time. If there is a propensity for isolation, any
activity in excess – reading, school work, drinking, etc. will become the means
to continue that isolation.
Dr. Val: Do you think
that social networking and Internet based methods of communication are
particularly healthy for introverts?
Dr. Smaller: Being able to communicate sincerely or
genuinely but indirectly and not in person may help the otherwise shy person. Some of our most brilliant artists and
writers have used their craft as a means to communicate to others in ways they
could not in social situations.
Dr. Val: Overall do
you think that socializing via the Internet is a good thing or a bad thing for
college students?
Dr. Smaller: One things is certain on and off the Internet:
relationships for children, adolescents, and adults can become quite intense
with this way of communicating because of fantasy and anonymity. Previous generations used the art of letter
writing to express intense feelings, followed by the telephone, and now online
communication. What they all have in
common is the essential human need to connect – including the satisfaction of
doing so and the frustration when it chronically does not occur.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 14th, 2007 by Dr. Val Jones in News
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A recent analysis (via KevinMD) of average IQs of individuals in certain professions revealed that doctors have a mean IQ of almost 10 points higher than lawyers. Go ahead and snicker, docs – we may be smarter, but are we more successful?
Social and economic success does not have a 1:1 correlation with IQ. The study authors list several other determinants of success:
Ambition, perseverance, responsibility, personal attractiveness, physical or artistic skills, access to social support and to favorable social and economic networks and resources.
So basically, you can be quite a dim wit – but with perseverance, artistic skills and personal attractiveness, the world is your oyster. Or better yet, you can have no redeeming qualities whatsoever, but be born into a favorable social and economic network and do just fine.
However, in medicine you’re not really going to get by on charm alone. The grueling nature of the educational process (and the vast amount of information that one must master) requires substantial cognitive reserves. So I’m not surprised that doctors do well on IQ tests. However, the sign of a great doctor is not his/her IQ, but a complex interplay of character, compassion, and emotional intelligence. That being said – if I’m wheeled into an ER after being run over by a truck, I’d be pretty glad to know that the man or woman taking care of me is smart. And you can be pretty sure that he/she will be.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
