Is that a revelation to any of you? I think at one point in time in my life it was a revelation to me. How much daily energy do we spend trying to overtly or covertly change those around us? A friend, a boyfriend, a family member, a wife? Why? Why do we exert so much of our precious energy trying to change everyone else around us... except for ourselves? How can we take self-responsibility in our own lives and leave the change and growth of others up to those individuals? So many questions. Maybe this article will have some answers.
By John M. Grohol, Psy.D. (on PsychCentral)
One of life’s hardest lessons to learn is that you can only change yourself.
Some people spend inordinate amounts of time and energy upset, angry, or frustrated by other people’s thoughts and behaviors.
But to what end? You can rail against the rain or feel sanguine about the snow, but there’s not a whole lot you can do about it. Why should we, by default, believe we can change another person’s — an independent, thinking self just like us — behaviors and thoughts with just a few choice words? If you think about it for a minute, it sounds kind of ridiculous.
Yet we don’t think about it when we have an emotional reaction to someone else’s behavior or words. We say things like, “How could they say such a thing!” or “How can anyone be so rude!?” or “Don’t they know how much they hurt me? Why do they do that?!”
We often react in this way because our emotions are a part of most people’s innate decision-making skills. We react and respond emotionally to emotional needs of our own, rather than in a logical, rational manner. So when someone touches one of these emotional needs, we can respond in a way that may not make a whole lot of sense to an outside observer.
What you can do, just once, is to make a polite request for another to stop the behavior that you find frustrating, annoying or disturbing. But that’s it, just once (or maybe twice, if you feel the person really didn’t hear or understand the initial request). After that, you just become a nag and will be ignored. Repeating something over and over again doesn’t suddenly make people more aware of themselves, it just makes them aware of how annoying you can be.
There’s no magic to stopping trying to change other people’s behavior. Catch your thoughts (by writing them down in a journal or blog, for instance) when you find yourself saying something like, “I wish she wouldn’t do..” or “I can’t believe he thinks that…” — things like that. Making a note of it, mental or otherwise, allows you to pause your automatic thinking before you jump to the next step in your response (which is usually to say something to the person).
If you’ve already said something, now’s the time to stop and go no further. Unless you’re the other person’s parent, they’ve probably already heard it and may have even tried stopping the behavior. Hearing it again isn’t going to suddenly change their behavior.
People can spend weeks, months and in some cases years in psychotherapy working on changing their thoughts or behaviors. That’s because such change often takes that long to understand, practice, and then implement. Behaviors most important to others are also likely behaviors that are important to ourselves and not readily changed, even if we wanted to. They sometimes are integrated part of another’s personality or way of thinking about and looking at the entire world.
So save yourself some frustration today and try to learn to stop trying to change others. Focus instead on changing your own faults and you may find yourself living a happier and more peaceful life.
How many times have you heard this? How many times have you said this? Be honest now... it could have been some variation on that theme to sugar coat it... but we have all said it! Why do people play the blame game? Here is an excellent article byKeith Ferrazzion this topic.
Whom do we blame when we fail? The short answer is "everyone but ourselves." Extensive research in psychology (Jones & Harris 1967, Ross 1977) has shown that when we fail, we tend to attribute the cause of our failure to reasons outside of ourselves: The market was weak. The inputs were poor. The weather was bad.
Think about it. When was the last time you failed to complete something on time at work - and why? Most people will list reasons that seem to be completely beyond their control. But now consider the last time a colleague or a subordinate (or family member or friend) failed to deliver on a project. Whom did you blame then? Well, if you're like most people, you blamed the colleague or subordinate.
This phenomenon, dubbed the Fundamental Attribution Error, is a pervasive bias that affects all of us to some degree, but why? Psychologists would argue that in our attempt to preserve our self-respect and self-esteem that we internalize our successes and externalize our failures. In other words, we like to like ourselves! Seems innocent enough, maybe even healthy, right? The problem is when "liking ourselves" turns into complacency, and we stop seeing room for improvement. Clearly there are times when we are to blame for our failures.
So how do we sort through our bias to narrow in on that slippery but useful thing we call "reality?" That's where peers come in. Since they're biased in the opposite way that we are, they're a neat check to our own perspective. That is, if we consistently internalize our successes, others will consistently externalize them, and the reverse with failure. Presto!: We compare notes, and start to get a more nuanced picture of what's contributing to our downfalls - and as importantly, of what'll deliver the most and the richest success.
This is an important article on a vital topic. I have worked both with Veterans, and with Domestic Violence offenders. Both populations are both challenging and rewarding to work with. I heard many stories of returning Vets struggling to reintegrate themselves into their worlds while also struggling to manage their increased inner rage and irritability--possibly brought to the surface by PTSD. In the article below (from Psych Central) new research suggests the risk of domestic violence will rise as increasing number of veterans are diagnosed with posttraumatic stress disorder (PTSD).
"The consequences (of PTSD and domestic violence) on families and children in communities across the United States are an emerging concern says Monica Matthieu, Ph.D., an expert on veteran mental health and an assistant professor of social work at Washington University in St. Louis.
'Treatments for domestic violence are very different than those for PTSD. The Department of Veterans Affairs (VA) has mental health services and treatments for PTSD, yet these services need to be combined with the specialized domestic violence intervention programs offered by community agencies for those veterans engaging in battering behavior against intimate partners and families.'
Matthieu and Peter Hovmand, Ph.D., domestic violence expert and assistant professor of social work at Washington University, are merging their research interests and are working to design community prevention strategies to address this emerging public health problem.
'The increasing prevalence of traumatic brain injury and substance use disorders along with PTSD among veterans poses some unique challenges to existing community responses to domestic violence' says Hovmand.
'Community responses to domestic violence must be adapted to respond to the increasing number of veterans with PTSD. This includes veterans with young families and older veterans with chronic mental health issues.'
Even as the demographic of the veteran population changes as World War II veterans reach their 80s and 90s and young veterans completing tours of duty in Iraq and Afghanistan, the numbers of living veterans who have served in the United States military is staggering. Current estimates indicate that there are 23,816,000 veterans.
Matthieu says there are evidence-based psychological treatment programs that can be a great resource for clinicians to learn how to identify and treat PTSD symptoms. However, identifying battering behaviors among veterans with active PTSD symptoms may be difficult and may require consultation and referral to domestic violence experts.
Research in the VA shows that male veterans with PTSD are two to three times more likely than veterans without PTSD to engage in intimate partner violence and more likely to be involved in the legal system.
'Community violence prevention agencies and services need to be included in a veteran’s treatment plan to address the battering behaviors,' says Hovmand.
.Veterans need to have multiple providers coordinating the care that is available to them, with each provider working on one treatment goal. Coordinated community response efforts such as this bring together law enforcement, the courts, social service agencies, community activists and advocates for women to address the problem of domestic violence. These efforts increase victim safety and offender accountability by encouraging interorganizational exchanges and communication'."
Anyone else out there feel the joys and the pains of being in a relationship? It can be the best thing that ever happened to us, and yet it can also provide some of the biggest challenges in our lives. However, I would like to see those challenges become bridges to greater health, understanding and connecting--rather than become road blocks leading to breakdown of harmony and functioning. There is a lot of good stuff inthe below article. Not all of it will apply to every relationship, as we are all so very different in the ways we relate. But there may just be some helpful pieces that can be taken from the information and used to enhance your relational world. So, take what is useful and leave the rest.
Improving Communication Skills in Relationships
Create a context in which your partner can feel free to share feelings, thoughts, fantasies, hurts, and complaints, without the fear that you will condemn, attack, lecture, or simply withdraw. We tend to be as critical of others as we are of ourselves.
Know that you have a right to your feelings as others have a right to theirs.
Working on a relationship always begins with working on ourselves.
Try not to blame all of the relational problems on your partner.
Remember, you only have control over changing yourself, not others, and the temptation is to blame others for our problems.
Don't rush yourself into sharing emotionally painful information.
Sometimes it's best to write out your concerns in private then share them with your partner at a later time.
The Sentence-Completion method can help. Set aside a block of time when you and your partner can talk and after obtaining agreement, do the following exercise. Practice now with your partner...
Both of you should take turns completing the following statements on communication:
Communication to me means ...
The hard thing about intimate communication is ...
Sometimes I withdraw from communication when ...
It is also beneficial to complete the following statements on self-disclosure:
I am a person who ...
One of the things I'd like people to know about me is ...
When I try to talk about things that are important to me...
When I try to express intimate feelings ...
If I were more open about expressing my feelings and opinions ...
When people try to talk with me, sometimes I ...
Further it is useful to explore obstacles to communication by completing these statements:
If I weren't concerned about the listener's response ...
Sometimes I become blocked when ...
One of the ways I sometimes make it difficult for people to talk to me is ...
Miscommunication - Root Cause of Problems?
People with opposing ideas can soon stir up arguments and fights. It's that situation when one thinks he has the right concept while the other one also believes he has the proper notion. Both of them may try to outsmart each other until one claims victory.
There's a conflict with their beliefs. No two people are exactly alike. We are totally unique; not only physically, but mentally and emotionally as well.
There will be many times when your opinion will not correspond with that of another. So how can we prevent this kind of conflict from occurring? Communication is the key to overcoming doubts and misunderstandings. You should let other people know what's in your mind. Don't keep them guessing.
Why would people prefer to keep their complaints and criticisms to themselves? What's holding them back? It's because they do not want to be rejected. Most, people, if not all, would like to be accepted and to be perceived as likeable in the eyes of others.
So can you get your message across without hurting the other person's feelings? One thing you can do is to substitute negative statements with more positive ones.
Instead of saying, "You don't understand," say "Let me explain."
Instead of remarking, "You're wrong," say "Permit me to clarify."
Instead of stating, "You failed to say..." just mention, "Perhaps this was not stated..."
There are certain words that affect a person more negatively in comparison with other words that have the same meaning. Nothing is more pleasing than hearing someone else say that you are right. In this case, be prepared to let other people know that you respect their opinions.
You may add your comments at the end, but acknowledge them first. Say something like:
"You're right, although..."
"Great suggestion, however..."
"I agree with your opinion, but have you also considered..."
"I would feel the same way if I were you, although..."
"I understand your situation. From my point of view..."
Communication is a gift. Use it wisely for everyone's advantage.
Think first before you speak. Many relationships have been ruined by the wrong choice of words. Some people voice out anything that comes to their mind, without first filtering the good words from the bad ones. This might result in misunderstandings and arguments, which could have easily been prevented if we had spoken in a way that was neutral and non-offensive, even empathic.
Words are very powerful indeed. Use them responsibly for the benefit of all.
Personal relationships deteriorate when what is needed and wanted is not expressed; the resulting frustrations build up and result in increasing anxiety and upset. This is particularly likely to occur with sexual relationships, when problems or disagreements about sexual issues are not discussed openly and honestly. If this is the case in your personal life, then here's how to go about improving matters.
Note: this is an exercise to do with your sexual partner. Of course, many of the principles apply equally to any sensitive issue.
Break The Ice
Talk with your partner about why it's hard to talk about sex.
Share earlier experiences with talking about sex.
Gradually move toward discussing more personal feelings and concerns.
Read and discuss material if it seems easier than spontaneously talking about personal matters.
Share your sexual histories including such areas as sex education, first experience with sexuality, etc.
Listen and Provide Feedback
Active listening helps to show you are interested in what your partner is saying. Ask questions and make brief comments to help increase your understanding of what is being said.
Maintaining eye contact displays caring and validation.
Reflect back to your partner what you have understood them to say. This conveys active listening and an interest in understanding.
Be supportive of your partner's efforts to communicate.
A statement of appreciation or thanks can go a long way to strengthening a relationship.
Express "unconditional positive regard." Convey the sense that you will value your partner regardless of what they communicate to you.
Discover Your Partner's Needs
Ask open-ended, clarifying and extending questions to gain the most information about your companion's desires. Your partner will probably appreciate your concern.
If the subject you are interested in is particularly sensitive, try self- disclosing first. Self-disclosure will model trust and a willingness to take risks.
Compare notes on sexual preferences. This can be an effective way of learning about what does and doesn't stimulate your partner, and is certainly more efficient than trial and error.
Give your partner permission to talk about his/her feelings.
Learn To Make Requests
Take responsibility for your own pleasure. Realize that people are not mind readers and genuinely communicate your needs and desires.
Make requests specific. This will increase the chance that your wishes will be understood and granted.
Use "I" language. Although it is sometimes difficult to personalize requests, it is often the best means of getting a positive response.
Delivering Criticism
Be aware of your motivation. Is it based on a constructive desire to make your relationship better?
Choose the right time and place. Try not to be critical when anger is at it's peak. Give your partner a choice about when he/she would like to talk. Be aware of your partner's needs when choosing a location.
Temper criticism with praise. This will reduce the likelihood of your partner responding in a defensive or angry fashion, and increase the chances of him/her accepting what you have to say.
Nurture small steps toward change. Be generous with your support and encouragement of change. Realize that it is normal to revert back to comfortable patterns which have developed over time, so don't be too discouraged if there is some backsliding.
Avoid "why" questions. They tend to be perceived as attacking and hurtful. Better to say 'I don't understand...'
Express your anger appropriately. Direct your anger toward your partner's behaviors, not his/her character. Don't forget to remind your partner that you appreciate them as a person. Take responsibility for your anger.
Your partner cannot make you feel angry; you choose to respond that way.
But not before checking to see if anyone out there once attended LaSalle University in Mandeville, LA. If you did, please come check in with an Alumni page on Facebook.
I work with a domestic abuse intervention program, co-facilitating a group designed to rehabilitate the domestic abuse offenders. This post is not about that as much as it is about the age old question that is asked of any victim of domestic abuse: "why do they stay?" I read an excellent article recently that eloquently and pretty thoroughly covers this quandary. Here is a part of the article. The link will take you to the website and the entire article.
1. Ethical objections to leaving. Some people feel that it is their duty to stay in a relationship where they suffer violence. This is easy to reject out of hand but I’m not sure we should. Most of us don’t leave a relationship as soon as it doesn’t suit us. ... I want to pay tribute to the honor and truth in this position. Suffering can be positive.
I grew up in a tradition that values martyrdom - mainstream christianity. This is quite a different evaluation of suffering to the “If I’m not enjoying it I’m out of here” school.
So I understand and honor some elements of this ethical stance. And I think it is usually best for people to leave a situation where they are suffering violence.
Firstly about martyrdom. The martyrs went to their deaths rejoicing. If you can’t do this then it seems most likely that the suffering is demonic rather than a summons from the divine. Secondly, about children. The value of suffering for our children is in the context of the growth of a healthy person and a healthy relationship. Usually staying in a situation of domestic violence perpetuates a very unhealthy relationship - this is a decisive difference.
2. Psychological difficulties with leaving.
This can be what is called ‘learned helplessness’. People who are violated often are left devoid of initiative. (The complement to this is an all-consuming and unreasoning rage, which they suppress because they feel to let it out will have devastating consequences.)
It can also be that they feel they ‘deserve’ to be treated badly. This is often the case with abused children. They feel that they are in some way to blame, or if they weren’t bad then the other person wouldn’t have done this to them.
This can be extreme and extraordinarily difficult to be with. A woman therapist I knew was working with a woman in an awfully abusive relationship - she had been hospitalized many times and still wouldn’t leave. The woman therapist said, “Look, he nearly killed you - it probably was just an accident that you weren’t killed. What could be worse about leaving?” Dealing with this kind of stuff is quite awful.
It is important to say that rage can be worked with in a way that is safe to all people and that doesn’t damage the furniture. It can take time and patience and lots of support but it can be done. It is sometimes part of self defense for women classes.
3. Nowhere to go. Sometimes external circumstances are very difficult. In small communities - whether geographically like a town with a small population, or in other ways (eg religious or other groups) - there can be no external supports. Leaving means leaving the whole social network.
This is really a problem with the rest of us. I’ll give an example from my own tradition - mainstream christianity. The denominations could get together and announce that every congregation would now have people in it who would offer sanctuary to anyone suffering domestic violence (the names would be kept secret). There could be a phone number for people to ring so that anonymity could be guarded. They would also institute programs that worked with perpetrators. This would involve some training and other costs. My guess is that it could easily be funded in each country by the selling of a cathedral or large piece of land.
Usually perpetrators do not stop their violence until someone outside the relationship becomes involved. Usually someone with social sanction, such as the police or other officials. Perpetrators usually don’t change until they ‘have to’ - having to because otherwise they’ll lose the relationship or end up in gaol. This is unfortunate but it is true in most areas: we usually feel stressed and over-burdened and don’t want the hassle of changing. It is just as true in the situation of domestic violence. If you are in a violent relationship or know of one, it is well worth considering getting officialdom involved.
Finally, it is important to say that domestic violence can and does end. There are relationships where the perpetrators have changed: their violence has stopped never to return. In my experience this has always been after the person suffering the violence has left. I have personally known relationships where this has happened.
I’ve written this with much nervousness. Writing about this in cold type means it can feel cold and like the suffering is being trivialized. I hope this doesn’t read this way. I decided to take the risk because it is a topic that needs dealing with.
From "Family Corner.com"--here are some really important keys to making sure you really hear what your loved ones (or anyone you interact with really) are telling you.
"One of the most important skills that you need in any and all of these relationships is listening. Better listening skills will allow you to create a more harmonious relationship where respect and cooperation are more likely to occur. How well do I really listen to others? How well do I listen to myself? Can I be still and quiet enough to really listen? Or do I feel restless when there is silence and so I start talking right away?
Listen with concern and a desire to understand. Do not pretend to be listening or give only part of your attention if you are distracted. If you need and it is possible, ask the person to wait until you can be more attentive.
Let the other person talk without interrupting. Avoid quickly giving advice interrupting or making assumptions as to what you think they are going to say. Pause and breathe staying present and silent until he/she is finished.
Do not prepare your answer while they are talking. Try to stay only in the listening mode. Once you have all the information you will be more prepared to respond.
Do not engage in selective listening. Listen to the words, facts and overall content of the person's story. Do not just pay attention to what you find interesting.
While you are listening observe their facial expressions, gestures, eye movement and body posture.This will give you information as to what they might be feeling about their conversation, more information to help you understand.
The second part of the skill is learning to reflect back what you heard the person saying. Paraphrasing and repeating back what you heard allows the person to know you have been listening. It keeps clarity in conversation and allows for overall better communication. This is also a skill that requires some practice. Here are a few tips.
Try to briefly summarize what you heard them say and repeat it back to them.
Ask them if this is what they were trying to tell you. If not, try again to summarize or ask them to repeat part of what you did not understand.
Do not immediately respond with your belief, opinion or advice before you have clarified their position. Only give advice if they are asking for it.
Use empathy in your response instead of being judgmental. Be neutral and clarify what you heard their feelings, thoughts or opinions to be. Do not yell, argue or criticize. Ask more questions. Try asking why, when, where or who questions. This gives you more information.
Determine what they need from you. Would they like you just to listen and say nothing, give feedback, provide advice, help them problem solve a situation? Of course, if you are talking to young children, you may have to interrupt this yourself and offer what your intuition feels they need.
Make a note of the new interaction and compare it with your old way of listening or not listening. Observe their manner- are they calmer, more appreciative? What do you notice?
We all have a need to be listened to and understood."
Researchers are exploring the scientific basis of this vital emotion that has the ability to alter the course of illness. By Ted Kreiter
The ability of the mind to foster healing has long been an intriguing concept. Ailing patients who believe that they can get better often do. In his practice, Dr. Jerome Groopman, an expert in blood diseases, cancer, and AIDS at Beth Israel Deaconess Medical Center in Boston, recognized that giving patients hope for recovery could be helpful in their treatment. But he never realized the full importance of hope for healing until he experienced it firsthand in his recovery from a chronic ailment. In his new book, The Anatomy of Hope: How People Prevail in the Face of Illness, Dr. Groopman tells the dramatic story of his delivery from pain and explains what researchers are discovering about how emotions can control the outcome of illness.
For 19 years, Dr. Groopman suffered from severe back pain. A spinal surgery had paralyzed his legs for a time, and ever since he had lived by restricting his movements for fear of debilitating muscle spasms that would erupt at the slightest provocation. To avoid hurting his back, Groopman had to get out of bed in a special way and sit in a particular manner. He could not play catch with his children and could walk only a few blocks at a time. For the scar tissue that was irritating his spinal nerves, he knew there was no surgical solution.
Dr. Groopman had long since given up seeing specialists for his condition. But in the summer of 1999, an extreme and persistent pain attack led him to Dr. James Rainville at the New England Baptist Hospital Spine Center.
After thoroughly examining Groopman, Dr. Rainville surprised him by saying that he could be freed of his pain. Rainville used a colorful metaphor to describe Groopman's condition. "You are worshiping the volcano god of pain," he said. "The volcano god of pain is your master."
He would have to stop sacrificing to the volcano god who would never be satisfied, Dr. Rainville said. To do this he would have to "reeducate" his muscles, tendons, and ligaments to "erase the memory of trauma" they carried. A program of therapy challenging him with increasing weights would rebuild his muscles, and the pain would eventually subside.
Although skeptical and fearful of the trauma the therapy would cause, Dr. Groopman decided reluctantly to try it. Dr. Rainville had given him something no one else had, a tantalizing vision of hope.
As expected, the therapy caused considerable pain. But while lying on soothing ice packs, Groopman visualized activities he would like to be able to do, such as walking with his daughter or dancing at a wedding. With these thoughts, a warm feeling seemed to envelop him.
After a little over a year of therapy, the pain subsided. Dr. Rainville had been right. The recovery "seemed almost magical," Dr. Groopman writes. Somehow he had taught his body to forget the pain, and was convinced that the emotion of hope had played a decisive role.
"I was most intrigued by the sense that I may have felt physical changes caused by hope," he writes. "But I distrusted my impression. So I asked, as a scientist, is there a biological mechanism whereby the feeling of hope can contribute to clinical recovery?"
Dr. Groopman delved into the various lines of research that are shedding light on the way the mind can affect the body and promote healing. One of them involves the placebo effect. A leader in this area is Dr. Fabrizio Benedetti of the University of Turin in Italy. The word "placebo," Dr. Groopman notes, is Latin for "I shall please" and comes from the Catholic vesper service for the dead, in which mourners were paid to participate to help calm grieving loved ones. Most people think of placebos as fake medications, the sugar pills once given to problem patients to assuage their demands for relief. The thing is, placebos really do work, and sometimes dramatically. Dr. Benedetti has shown experimentally that a neutral agent, such as saline, can actually be as effective as morphine in relieving pain when administered to a patient who is preconditioned to believe. He theorizes that in responding to the placebo, the patient's body produces its own pain-relieving chemicals called endorphins and enkephalins that mimic morphine. He also has shown that subjects experience more pain relief when they are aware they are receiving a painkiller than when the painkiller is delivered unannounced, because in expectation of relief, the body's own pain relievers bolster the morphine's effects.
Just as important as this mind-body connection demonstrated in the placebo studies, Dr. Groopman suggests, is the opposite: a body-mind connection that occurs when an injured or ill part of the body suddenly improves and the brain detects it. This sparks hope in a patient, which sets off a chain reaction of pain-relieving chemicals. The possibility exists that if doctors can make a small improvement in just one symptom (a slight diminution in pain, for example) in an ill patient, the brain may kick in and help provide an even bigger boost toward recovery.
Studies of the circuitry and functioning of the brain have shown no single "hope center" or "hope neurotransmitter," Groopman writes. However, brain researchers such as Joseph LeDoux, professor of science at New York University, have learned that negative emotions such as fear arise in a deep brain structure called the amygdala.
What we have found out about the biological mechanisms of hope is only the beginning, Dr. Groopman writes. He had been taught in a traditional medical curriculum in which each organ was approached "in an isolated, reductionist way." The mind was linked to the body "only in rare instances" such as anxiety and despair. Now Groopman has come full circle in his beliefs. "We are just beginning to appreciate hope's reach and have not defined its limits," he writes. "I see hope as the very heart of healing."
Laughter isn't just fun and enjoyable, it's good for our health. Each month modern medicine is discovering more about the therapeutic dimension of humor and laughter and is encouraging us to add them to our wellness program.
the health benefits of laughter
When we laugh we ...
- Alleviate depression;
- Lower our blood pressure;
- Promote relaxation;
- Reduce stress;
- Increase the oxygen level in our blood, giving us more energy;
- Increase the endorphin activity in our body resulting in a sense of well being;
- Are able to keep things in perspective;
- Banish boredom;
- Are more socially attractive - people enjoy being with those who laugh easily and often; and
- Immeasurably increase our enjoyment of life.
Laughter has been called social glue because it bonds us to the people we laugh with. The message is clear: To live better ... laugh more.
If it feels good to laugh then laugh to feel good.
I read this article in Newsweek today, and I think I was a little taken aback. I believe that in some situations the "placebo effect" can play a role in "improvement," but I have also seen various medications make a difference in the lives of those who really need them ("need" being determined hopefully by a skilled and insightful primary care provider who does a full examination and psycho-social evaluation).
"Placebo Nation: Just Believe"
It's not that medicines are 'crummy,' but that placebos are so powerful. It's time scientists learned why.
When you write about science, there is no shortage of topics that incite the wrath of readers. Climate change. Evolution. Racial differences in IQ. But say that dummy pills with no pharmacologically active ingredients—placebos—are about as effective as antidepressants in treating depression, and watch out. People are incensed at the very thought that the (often expensive) meds they rely on might be 21st-century versions of the magic feather that Dumbo, the flying elephant, was told would make him airborne. It was only when Dumbo dropped the feather he was clutching in his trunk while in free fall, and started flapping his ears, that he grasped that his powers actually came from within, allowing him to fly.
No one is saying "positive thinking" can cure cancer, or that patients should throw out their pills, let alone that illnesses that respond to the placebo effect are "all in your head"—imagined. But there is no denying the drumbeat of studies on the therapeutic power of placebos. Over the years they have been shown to relieve asthma, lower blood pressure, reduce angina and stop gastric reflux. An inert solution injected into the brains of patients with Parkinson's disease reduced muscle rigidity about as well as standard drugs. In a bizarre finding, sham surgery of the knee, in which patients got sedation and an incision but no actual procedure, relieved the pain of osteoarthritis better than actual arthroscopy—and produced an equal improvement in joint function, scientists reported in 2002. And last month an analysis of clinical trials of a range of antidepressants found that, except in the most severe cases, placebos lifted the black cloud as well as meds did.
To be sure, no study is perfect. In the antidepressant one, the placebo might not have looked as effective if it had been compared with the drug that worked best for each patient, rather than with the one that happened to be chosen for the clinical trial. (Some patients respond better to Paxil, some to Effexor or others, for reasons that remain murky.) But the fact remains that placebos are at least somewhat effective and sometimes very effective for some patients. Rather than railing against that finding or pretending it doesn't exist, what we should be doing is learning how brain activity that corresponds to the expectation of cure translates into clinical improvement. As Dan Ariely of Duke University says, "It's not that medicines are crummy, but that the placebo effect is so powerful."
There have been clues about the source of that power. In Parkinson's disease, studies find, the expectation of getting better raises brain levels of the neurochemical dopamine, whose shortage underlies Parkinson's, and normalizes the pattern of firing in a region of the brain where aberrant firing causes the loss of motor control. When the placebo effect relieves pain, it releases natural opioid-like molecules in the brain that have analgesic effects like morphine.
Ariely, a behavioral economist, saw the power of placebos during the three years he spent in a hospital recovering from a horrific accident that left him with third-degree burns over 70 percent of his body. Night after excruciating night, patients would beg for painkillers. One day, he recalls, "I overheard the doctors telling the nurses not to give a certain patient any more morphine. A few hours later, when the same patient started begging for painkillers I saw the nurse going to her room with an injection," and soon the patient fell asleep. When Ariely asked the nurse about it, she said the injection was plain saline—a placebo.
Ariely's curiosity about the power of expectation—which he explores in his new book, "Predictably Irrational"—inspired a study of what affects those expectations. He and colleagues gave 82 volunteers a brochure explaining that they would be testing a new pain drug called Validone that worked like codeine, but faster. (It was actually a placebo.) Each then received a series of electrical shocks on their wrists, rating them from "no pain at all" to "the worst pain imaginable." Each then took a "Validone." Half were told it cost $2.50, the other half that it cost a dime. They then received shocks again. Of those who got the $2.50 pill, 85 percent felt less pain from the same voltage than before taking it; 61 percent of those taking the cheap pill felt less pain, the scientists reported last week in The Journal of the American Medical Association. The pricier the drug, the higher the expectation of efficacy, and the stronger the placebo effect.
That will not surprise doctors whose arthritis patients screamed bloody murder after Vioxx was withdrawn from the market after studies showed it raised the risk of heart attacks. People insisted that switching to cheap aspirin just did not relieve their pain and suffering. Maybe. But in light of Ariely's research, you've got to wonder. And patients who protest when their insurer makes them switch from a name-brand drug to a cheaper, biologically identical generic? "Many claim the generic is less effective," says Ariely, "but you have to consider whether that's an effect of the price. The placebo effect is about expectations, and we expect more-expensive medicines to work better." Maybe researchers would be interested in figuring out how to harness that effect if only it were patentable.
The mental illness your partner suffers with is something that is happening to your entire family. All are affected and it is nobody's fault. It is not your fault, your partner's or your children's fault. It is an unfortunate illness.
You cannot fix your partner. There is nothing you can do to make him or her well, so don't feel compelled to try. What you can do is be supportive, loving and handling the everyday details and practical issues of life that he or she cannot cope with.
All members of the family have a responsibility to cope with the illness. Escape is not a helpful way of dealing with crisis. You all need each other.
The ill partner must recognize and accept the illness, be willing to receive treatment, and if possible, learn to manage the illness. If the ill partner is not willing to do these things, it may become impossible for the family to continue to support him or her. The family is not required to throw away their own lives for someone who refuses to cooperate. There are limits and they must be enforced without feelings of guilt.
Educate yourself concerning every aspect of the illness. Education brings compassion. Ignorance just encourages anger and fear.
Grieve your loss. It is a great loss. You need to allow yourself the time and energy to experience the entire process of grieving.
Get help for yourself to cope with this incredible challenge, either from your own counselor or a support group. You can't do it alone. Don't refuse to recognize your own need for help, just because the ill partner is getting most of the attention.
Help your children understand the illness as much as their age allows. NO FAMILY SECRETS. Don't deny them the opportunity to learn about the illness, the unfair stigma attached to it, and developing their own skills in coping. It can be an incredible learning opportunity for them. If they need proof and help to understand it and their own feelings, get it for them.
Try to create a safe environment for the partner to express himself/herself without feeling threatened, constrained or condemned. He or she desperately needs a nurturing, safe place to express the incredible frustration he or she is feeling about coping with mental illness.
You and your children need to share your feelings, honestly and openly. It's okay to feel angry and cheated. At times you may feel embarrassed by the ill partner's behavior, avoid trying to protect your partner by not discussing the problem with family or friends. Don't require your children to conspire with you in a code of "family secrecy." Family secrets will only isolate you from others. Remember that small children, by their very nature, assume that they are responsible for anything in their environment that goes wrong.
Never put yourself or your children in physical danger. If you sense your partner is becoming dangerous, you should leave and call for professional help. You should never tolerate abuse of you or your children. Trust your instincts and intuitions on this one. Say, "no way" and mean it.
Become your partner's advocate with the medical professionals, assertively involved in his treatment and medications. If the medical professional or psychiatrist won't cooperate with you, demand a different one! Treatment should involve the entire family, so find a professional who will work with the whole family. You know more about your partner's illness than anyone else. Trust your instincts.
Frankly assess what your partner can and cannot handle, the compensate assertively. Some people with mental illness cannot handle money, some household chores, time commitments and too much stress. You must not do things for your partner that he or she can do for themselves. Don't rob him or her of their dignity.
Maintain your own identity; resist becoming consumed with your partner's illness. Life goes on. You have an obligation to yourself and your children to take care of yourself and meet your own needs. You all must continue to develop your own interests and talents. You are a valuable human being, so don't play the martyr role and sacrifice yourself. That's just self pity. "Get a life."
Always hope for healing. The medications do work and new ones are being developed. You may get your partner back whole some day. If nothing else, the experience will broaden and deepen you in ways you never imagined. Or, you can choose to let it destroy you, your family and your relationship. It is your choice.
Keep in mind that bad things happen to good people and you're no exception. You have not been singled out for a special persecution. Trying to make good choices in life won't protect you from misfortune. You haven't been "dumb" to "get yourself in this situation." It is not your fault. Life is not easy, we have to take what we get and make the best of it.
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