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By Siegfried Weyerer

Depression in old age occurs frequently, places a severe burden on patients and relatives, and increases the utilization of medical services and health care costs. Although the association between age and depression has received considerable attention, very little is known about the incidence of depression among those 75 years of age and older. Studies that treat the group 65+ as one entity are often heavily weighted towards the age group 65-75. Therefore, the prediction of depression in the very old is uncertain, since many community-based studies lack adequate samples over the age of 75.

With the demographic change in the forthcoming decades, more emphasis should be put on epidemiological studies of the older old, since in many countries the increase in this age group will be particularly high. To study the older old is also important, since some crucial risk factors such as bereavement, social isolation, somatic diseases, and functional impairment become more common with increasing age. These factors may exert different effects in the younger old compared to the older old. Knowledge of risk factors is a prerequisite to designing tailored interventions, either to tackle the factors themselves or to define high-risk groups, since depression is treatable in most cases.

In our recent study, over 3,000 patients recruited by GPs in Germany were assessed by means of structured clinical interviews conducted by trained physicians and psychologists during visits to the participants’ homes. Inclusion criteria for GP patients were an age of 75 years and over, the absence of dementia in the GP’s view, and at least one contact with the GP within the last 12 months. The two follow-up examinations were done, on average, one and a half and then three years after the initial interview.

Depressive symptoms were ascertained using the 15-item version of the Geriatric Depression Scale (GDS). We found that the risk for incident depression was significantly higher for subjects

• 85 years and older
• with mobility impairment and vision impairment
• with mild cognitive impairment and subjective memory impairment
• who were current smokers.

It revealed that the incidence of late-life depression in Germany and other industrialized countries is substantial, and neither educational level, marital status, living situation nor presence of chronic diseases contributed to the incidence of depression. Impairments of mobility and vision are much more likely to cause incidents of depression than individual somatic illnesses such as diabetes mellitus and coronary heart disease. As such, it is vital that more attention is paid to the oldest old, functional impairment, cognitive impairment, and smoking, when designing depression prevention programs.

GP practices offers ample opportunity to treat mental health problems such as depression occurring in relation to physical disability. If functional impairment causes greater likelihood of depression, GPs should focus on encouraging older patients to maintain physical health, whether by changing in personal health habits, advocating exercise, correcting or compensating functional deficits by means of medical and surgical treatments, or encouraging use of walking aids. Additionally, cognitive and memory training could prevent the onset of depressive symptoms, as could smoking cessation. If these steps are taken, the burden of old age depression could be significantly reduced.

Siegfried Weyerer is professor of epidemiology at the Central Institute of Mental Health in Mannheim, Germany. He has conducted several national and international studies on the epidemiology of dementia, depression and substance use disorders at different care levels. He is also an expert in health/nursing services research. He is one of the authors of the paper ‘Incidence and predictors of depression in non-demented primary care attenders aged 75 years and older: results from a 3-year follow-up study’, which appears in the journal Age and Ageing. You can read the paper in full here.

Age and Ageing is an international journal publishing refereed original articles and commissioned reviews on geriatric medicine and gerontology. Its range includes research on ageing and clinical, epidemiological, and psychological aspects of later life.

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Image credit: Grief. Photo by Anne de Haas, iStockPhoto.

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By E. Tory Higgins

“Our country is divided.” “Congress is broken.” “Our politics are polarized.” Most Americans believe there is less political co-operation and compromise than there used to be. And we know who is to blame for this situation—it’s our political opponents. Democrats know that Republicans are to blame, and Republicans know that Democrats are to blame. Not only do we know that our political opponents are to blame, but we are suspicious of their motives, of why they take the positions they take. Bottom line: we can’t trust them.

This is a serious problem for our country. One source of the problem is a misperception of what really motivates people’s political opinions, judgments, and actions. People often assume such opinions are all about self-interest or all about “carrots and sticks.” As Romney recently put it, “What the president’s campaign did was focus on certain members of his base coalition, give them extraordinary financial gifts from the government, and then work very aggressively to turn them out to vote, and that strategy worked.” Plenty of commentators criticized the reference to minorities, the poor, and students as essentially being paid off for their votes, but few if any disputed the overall assumption that the “carrots” candidates offer voters determine the vote. Indeed, the field of ‘public choice’ in economics assumes just this, that voters are guided by their own self-interest and “vote their pocketbooks.”

What does it mean for our political conversation to assume that the opinions, judgments, and actions of our political opponents are motivated by self-interest? It means that their stands on political issues are selfish rather than being in the best interest of our country. We can’t trust them to be concerned about what is best for the rest of us because our interests are different than their interests. We assume that they do not have good will. But what if people are not primarily motivated by self-interest (by “carrots”) in the political domain or in any other domain of life? In fact, there is substantial evidence from research on human motivation that what people want goes well beyond attaining “carrots” (or “gifts”). What they want is to be effective.

Brian Deese, right, Special Assistant to the President for Economic Policy, and Economic Advisor Gene Sperling confer as President Barack Obama calls regional politicians to inform them of the next day’s announcement about General Motors filing for bankruptcy, Sunday night, May 31, 2009. (Official White House Photo by Pete Souza)

Yes, one way of being effective is to have desired outcomes, which can include attaining “carrots” (and avoiding “sticks”). But there is much more to being effective. People also want to be effective at establishing what’s real or right or correct (being effective in finding the truth), as when people want to hear the truth about themselves or what is happening in their lives even if “the truth hurts.” Indeed, people want to observe, discover, and learn about all kinds of things in the world that have nothing to do with their attaining “carrots” (or avoiding “sticks”). And people also want to manage what happens, to have an effect on the world (being effective in having control), as when children jump up and down in a puddle just to make a splash. Indeed, people will take on pain and even risk injury to feel in control of a difficult and challenging activity, as illustrated most vividly in extreme sports.

It is establishing what’s real (truth) and managing what happens (control) that often are our primary motivations — rather than self-interest — and this is both good news and bad news if we are to change the political conversation. The bad news is that humans, uniquely among animals, establish truth by sharing reality with others who agree with their beliefs (or with whom they can establish agreed-upon assumptions). And when they do create a shared reality with others, they experience their beliefs as objective — the whole truth and nothing but the truth. This means that when others disagree with these beliefs, as when Democrats and Republicans disagree with each other, each side is so certain that what they believe is reality, that they infer that those on the other side must either be lying about what they truly believe or they are too stupid to recognize the truth or they are simply crazy. These derogations of our political opponents don’t derive from our self-interests being in conflict with them. It is more serious than that. It derives from the establishment of a different shared reality to them, a shared reality that we are highly motivated to maintain because it gives us the truth about the how the world works.

This is bad news indeed. But if we understand that out political opponents just want to be effective in truth, there is a ‘good news’ silver lining. The good news is that we need not characterize our political opponents as being selfish, or liars, or stupid, or crazy. We need not question their good will. Instead, we can recognize that they, like us, want truth and control, and they want truth and control to work together effectively. They want to “go in the right direction.” They, like us, want our country to be strong. They want Americans to live in peace and prosperity. Yes, they have different ideas about what direction is the right one to make this happen, but this is something we can discuss. In order to establish what’s real, manage what happens, and go in the right direction — which are ways of being effective that we all want — we need to listen to one another and and learn from one another. This is a political conversation worth having. Let us have that respectful, serious conversation in the New Year and search for common ground. Good will to all.

E. Tory Higgins is the author of Beyond Pleasure and Pain: How Motivation Works. He is a Fellow of the American Academy of Arts & Sciences. He has received the Distinguished Scientist Award from the Society of Experimental Social Psychology, the William James Fellow Award for Distinguished Achievements in Psychological Science (from the Association for Psychological Science), and the American Psychological Association Award for Distinguished Scientific Contributions. He is also a recipient of Columbia’s Presidential Award for Outstanding Teaching.

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By Arthur P. Shimamura

Is it the sense of experiencing reality that makes movies so compelling? Technological advances in film, such as sound, color, widescreen, 3-D, and now high frame rate (HFR), have offered ever increasing semblances of realism on the screen. In The Hobbit: An Unexpected Journey, we are introduced to the world of 48 frames per second (fps), which presents much sharper moving images than what we’ve seen in movies produced at the standard 24 fps. Yet many viewers, including myself, have come away with a less-than-satisfying experience as the sharp rendering of the characters portrayed is reminiscent of either old videotaped TV programs (soap operas, BBC productions) or recent CGI video games. What features of HFR create this new sensory experience and why does it appear so unsettlingly similar to the experience of watching a low budget TV program?

One factor that can be ruled out is the potential difference in flicker rate. Moving images are of course created by the rapid succession of still frames, and thus the flicker or on-and-off rate must be fast enough so that we do not perceive any change in illumination between frames. With early silent films, the flicker rate was less than 16 fps, and a noticeable flashing or flickering was apparent (hence the term “flicks” to refer to these early movies). Since the advent of sound, the standard has been 24 fps, though the flicker rate is increased with the use of a propeller-like shutter that spins rapidly in a movie projector so that a movie running at 24 fps actually presents each frame two or three times, thereby increasing the flicker rate to 48 or 72 fps. Thus, with respect to flicker rate we have always watched movies at HFR.

A still from The Hobbit film. (c) Warner Bros.

Two factors have motivated the current interest in HFR. The obvious one is that actions recorded at more rapid frame rates, such as a car chase shot at 48 fps vs 24 fps, would reduce by half the distance objects move across successive frames. With HFR we are presented shorter increments of movement, and our brains need not work as hard to extrapolate apparent motion across frames, which may result in a smoother sense of motion. I, however, do not think that it is this between-frame difference that is driving our sensory experience as we watch The Hobbit. A second, less known factor, is that the movie was shot at a faster shutter speed than movies shot at 24 fps. Filmmakers have a rule that states that the shutter speed at which each frame is shot should be half as long as the frame duration. Thus, most movies we’ve seen have been shot at 24 fps with a shutter speed of 1/48 sec for each frame. Those of you who have played with photography know that this shutter speed would produce rather blurry images when the camera is hand held. On a tripod, a movie filmed with this shutter speed would show fast moving objects (e.g., cars) with a noticeable blur. When movies filmed at 24 fps are shot with a faster shutter speed and less motion blur, actions appear jerky and unnatural.

The Hobbit was filmed with a shutter speed of 1/64 sec, which produced less motion blur and thus sharper images compared to movies shot at 24 fps. At the faster frame rate, the jerkiness associated with presenting sharp images at 24 fps is largely reduced, though I did notice that on some occasions large camera movements and fast movements of actors appeared stilted and unnatural. A psychological study by Kuroki and colleagues showed that in order to perceive naturalistic movements with sharp moving images (i.e., no motion blur) it is necessary to use frame rates of 250 fps or faster. Interestingly, the shutter speed used for The Hobbit closely matches that used for old videotaped TV programs, which were filmed at 30 fps with a shutter speed of 1/60 sec. I suspect that it is this close match in shutter speed (and thus similarity in image sharpness) that creates the impression of viewing a soap opera when we watch Bilbo Baggins and company.

In the future, after years of experiencing HFR movies, will we be able to appreciate the more realistic renderings garnered by this new technology? Will a younger generation without prior associations to videotaped TV programs be enamored by the sharper images? Time will tell, though I’m skeptical. HFR does offer a more realistic rendering than what we’ve previously encountered at the movies, and further advances may help to refine its use. Yet do we really want to have an entirely realistic portrayal? In most cases that would mean having the experience of sitting next to the director watching actors on a sound stage with artificial lighting, which is exactly the impression I had while watching Bilbo backlit by what was supposed to be moonlight. Instead, we may end up preferring a softer image which maintains the illusion of being engaged in an adventure with our favorite fictional characters and partaking in a wonderfully unexpected journey.

Arthur P. Shimamura is Professor of Psychology at the University of California, Berkeley and faculty member of the Helen Wills Neuroscience Institute. He studies the psychological and biological underpinnings of memory and movies. He was awarded a John Simon Guggenheim Fellowship in 2008 to study links between art, mind, and brain. He is co-editor of Aesthetic Science: Connecting Minds, Brains, and Experience (Shimamura & Palmer, ed., OUP, 2012), editor of the forthcoming Psychocinematics: Exploring Cognition at the Movies (ed., OUP, March 2013), and author of the forthcoming book, Experiencing Art: In the Brain of the Beholder (May 2013). Further musings can be found on his blog, http://psychocinematics.blogspot.com.

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By Mark S. Gold, MD

Public health officials and academics identified cigarette smoking and related disease as the nation’s number one killer and foremost driver of health costs in the 1980s. At that time overeating and obesity were not major problems, yet they may soon cause more disease, deaths, and health care costs than cigarettes. Food addiction, which may explain part of the epidemic, is slowly and finally  “catching on”. It’s been controversial, with some scientists dismissing it out of hand, so like any hypothesis, it needs additional tests.

If overeating is due to food acquiring drug-like or tobacco-like brain reinforcement properties, then the current globesity and overeating-related health crisis might have lessons to learn from tobacco. For example, taxes on tobacco products have been the single most important prevention tool in reducing smoking. Based on food addiction hypothesis, higher prices might also reduce soda consumption. A review suggested that for every 10% increase in price, consumption decreases by 7.8%. An industry trade publication reported even larger reductions; as prices of carbonated soft drinks increased by 6.8%, sales dropped by 7.8%, and as Coca-Cola prices increased by 12%, sales dropped by 14.6%. It follows that a tax on sweetened beverages might help consumers switch to water or more healthful beverages. Such a switch would lead to reduced caloric intake, and less weight gain.

Changing the attitudes and behaviors of the public combined to reduce smoking and smoking-related health care costs and suffering. Changing access to cigarettes by elimination of cigarette vending machines, raising the price per pack to decrease numbers of cigarettes or packs/day smoked, crafting PSAs to reduce smoking initiation, and training medical professionals to intervene and not look the other way, all helped reduce smoking.

Age of onset and exposure can change genes, and make use and addiction more likely. We know that early exposure to tobacco via second-hand-smoke, either in utero or in early life greatly increases the risk of life-long tobacco use and addiction. In the 1990s, children’s intake of sweetened beverages surpassed that of milk. In the past decade, per capita intake of calories from sugar/HFCS-sweetened beverages has increased by nearly 30%. Beverages now account for 10–15% of the calories consumed by children and adolescents. It is likely that food addiction models can be used to explain early exposure and changes in preference becoming fixed and persistent for life.  An extra can or glass of sugar or HFCS sweetened beverage consumed per day increases the likelihood of a child’s becoming obese increases by 60%.

Our efforts to manage and treat overeating and obesity might benefit from addiction methods and experience. We could develop realistic food addiction models and test new treatments. Would animals self-administer food or food constituents, avidly, with bingeing and loss of control? Yes. Our work (and Bart Hoebel’ s before) clearly demonstrates that sucrose and fructose corn syrup are self-administered as if they were drugs and that an opiate-like abstinence syndrome could be produced by detoxification or antagonist administration. Sugar stimulates its own taking  causes craving, wanting, withdrawal, and can motivate and change our behavior.. If the food addiction hypothesis were relevant to the human condition, these animal models could be used to test new medications. New treatments developed for overeating and obesity were previously shown to be effective in addiction medicine.

These new treatments approved by the FDA include phentermine plus topiramate and bupropion plus naltrexone. Topiramate has been used with success in alcohol dependence, bupropion in nicotine dependence, and naltrexone in opiate and also alcohol dependence. While early, these treatments are important tests of the addiction hypothesis and harbingers of more progress in the future. With addiction medicine and food addiction model systems, we may develop treatments which change food preference and not just appetite.

Food addiction may explain some, but certainly not all obesity. The Yale Food Addiction Scale may be used to screen patients for addiction-like pharmacological and psychological interventions. Medically-assisted smoking cessation efforts were enhanced once treatment advanced from simple nicotine replacement or detoxification, to the brain and the neurobehavioral attachment to cigarettes. With an addiction hypothesis that included dopamine, we discovered the efficacy of bupropion and then Chantix. Thus, rather than a successful short term treatment rate of less than 20%, we routinely helped 30% of smokers. Still, addiction-inspired public health measures rather than medically-assisted treatment were responsible for most of the successful cessation efforts, early intervention, and prevention.

Smoking-related disease caused 400,000 deaths per year in the USA plus an additional 40,000 deaths due to second-hand smoke. Until recently little effort was directed at preventing smoking or treating smokers, although we treated the lung cancers, stroke, erectile dysfunction and other diseases caused by smoking. With all this progress, all of the health savings related to smoking cessation will soon be replaced by obesity-related costs. Are these two events related? As smoking and addiction is associated with decreases in eating and weight, a nation detoxifying from smoking addiction should be expected to become overweight. Until recently, with the scientific support provided by food and addiction models, we have not applied the same lessons learned from tobacco to overeating and obesity.

Proposals for food taxes have been made and calculations formulated of revenue-benefits based on our experiences with tobacco taxation. Even when these fail, the public and health experts have to think through the idea that fruits and vegetables are more costly than fatty, sweet, fast foods. Using taxes on ingredients such as added sugar and fructose corn syrup would decrease exposure according to addiction models. This might make Coca-Cola and other sodas return to sucrose as in Mexican or Kosher Coke. Reducing portion size, while supported by cigarette experience with numbers of cigarettes per pack and purchase limits, is a weaker intervention than other approaches. Now we see food labels and calorie postings. This educates everyone as they consider is it worth the calories and do they have the time and energy to exercise away the calories ingested. Exercise is important, and promotes health, but is not a stand-alone obesity treatment or management strategy. Stigmatizing the overweight with added health premiums and workplace incentives has not worked well in the past. Blaming the patient, creating shame and guilt, doesn’t do much to inspire treatment efficacy.

Obesity has changed the width of the seats in airplanes, dress, and trouser sizes. It has also made high cholesterol, high blood pressure, high blood sugars, knee and joint pain, and other obesity-related problems routine in medical practice and treatment. Over the past three decades, rates of obesity have increased in the United States and elsewhere, so that now more people are obese and in need of treatment than ever. New approaches, evidence-based approaches, like those that have been used successfully to develop novel public health and treatment approaches for tobacco, alcohol, and other addictions are needed.

Mark S. Gold, MD is the co-editor of Food and Addiction: A Comprehensive Handbook with Kelly D. Brownell. He is the Donald Dizney Eminent Scholar, Distinguished Professor and Chair of Psychiatry at the University of Florida. Dr Gold is a teacher of the year, researcher and inventor who has focused for much of his career on the development of models for understanding the effects of tobacco, cocaine, opiates, other drugs, and also food, on the brain and behavior. He began his work on the relationship between food and drug addictions while at Yale working with addicts in withdrawal. He has worked for 30+ years trying to understand how to change food preferences, make eating and drugs of abuse less interesting or reinforcing at the brain’s dopamine and other reinforcement sites. Kelly D. Brownell, PhD is professor of psychology, epidemiology, and public health at Yale University and is director of Yale’s Rudd Center for Food Policy & Obesity. Dr. Brownell does work at the intersection of science and public policy. The Rudd Center assesses, critiques and strives to improve practices and policies related to nutrition and obesity so as to inform the public and to maximize the impact on public health.

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Image credits: (1) Young mother and her baby, sleeping in bed. Photo by SvetlanaFedoseeva, iStockphoto. (2) Shrimp cocktail elegantly served in a martini glass accompanied by a glass of white wine. Photo by sbossert, iStockphoto.

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By Sergio Della Sala & Mike Anderson

In the past ten years, there has been growing interest in applying our knowledge of the human brain to the field of education, including reading, learning, language, and mathematics. Teachers themselves have embraced the neuro revolution enthusiastically. A recent investigation in the US-based journal Mind, Brain, and Education showed that almost 90% of teachers consider knowledge about brain functioning relevant for the planning of education programmes.

This has resulted in the development of a number of new practices in education: some good, some bad, and some just crazy. Too often, people with the clout to make decisions about which practice is potentially profitable in the classroom setting, ignore evidence in favour of gut feelings, the authority of ‘gurus’, or unwarranted convictions. In short, opinions rather than data too often inform implementations in schools. Hence we have had theories suggesting that listening to Mozart can boost intelligence, foot massages can help unruly pupils, fish oil can boost brain power, and even the idea that breathing through your left nostril can enhance creativity! Sadly, it is often scientists themselves who promulgate unsubstantiated procedures.

We shouldn’t ignore the good practices and innovations in education thanks to the developing neuro revolution. A popular example might be the neuroscience data suggesting a strong neural link between fingers and numbers. This is testified by the observation that 6 year old children who are good in recognizing their fingers when touched will later also be better at arithmetical performances. However, more often than not “the good” classroom developments are actually centered around more mainstream cognitive findings. One such finding, named spaced practice, has been replicated many times; it shows that distributing learning over time is more efficient than massing it all together. For example, if students stockpile learning just before an exam, they may do well enough, but if they want to retain the material in the long term, then retrieving it via multiple tests is much better.

Inevitably, we are drawn to discussing “the bad” developments: one of our favourite examples is the use of ineffective coloured lenses to aid reading. This and several other unproven “aids” are potentially damaging the whole idea that knowledge of the mind-brain may contribute to efficacious educational practice. And of course much of current enthusiasm for neuroeducation involves ugly mistranslations of excellent research into an educational arena. Take for instance the misapplication of the well developed theory of reading  (the so called dual-route theory) which has been caricatured and wrongly applied in education to justify an ideological stance from teachers preferring a whole-reading (or holistic) approach at the expense of phonics-based teaching. Briefly, the dual-route theory says that single-word reading can be accomplished through a route of letter to sound conversion (phonics) or through a route of direct visual recognition (whole word reading). It does not say that both are equally effective in teaching children to read. Indeed, several studies have demonstrated that phonics is a more effective method; yet the holistic approach to learning to read rages in the classrooms.

The neuro- prefix is very fashionable nowadays, and neuroeducation is just one of the myriad offsprings. Neuroscience offers an invaluable contribution to assess, diagnose, and perhaps manage pathologies, including pathologies of learning in children and adolescents. However, neuroscience as such has so far proved to have little to offer to everyday, normal education. The discipline which has most to offer is instead cognitive psychology, and from this comes some of the “good” that scientists could endow education with. Some of the findings from cognition are solid and counter-intuitive; for example, retrieval practice that, though receiving little support by pedagogists, has proved effective in improving pupils’ learning. This practice is based on the finding that retrieving material through several testing enhances learning of that material more than studying it over and over again.

The psychology of learning could prove efficacious in an educational context.  However, science should never be prescriptive; it offers possible windows of knowledge which may or may not be applicable or relevant in specific contexts such as the classroom. There are no ready-made recipes when it comes to mastering the relevance of brain functioning to teaching today. The last thing teachers need is to be superficially trained in neuroscience, but they should certainly watch this space.

Sergio Della Sala is a Clinical Neurologist, Professor of Human Cognitive Neuroscience at the University of Edinburgh, UK. He is co-editor with Mike Anderson of Neuroscience in Education: the good, the bad, and the ugly, and editor of Cortex. His research focuses on the cognitive deficits associated with brain damage.

Mike Anderson is a Professor of Psychology and Director of the Neurocognitive Development Unit at the University of Western Australia. His research focuses on the influence of the developing brain on intellectual functions in children.

Image credit: Photograph of boy studying by Lewis Wickes Hine, ca. 1924, via Library of Congress, Prints & Photographs Division, National Child Labor Committee Collection, [image number nclc.05276].

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It’s that time again: time to set resolutions and goals for ourselves as we enter the New Year. In this excerpt from Pursuing the Good Life, the late Christopher Peterson puts the spotlight on Benjamin Franklin, encouraging us to take the statesman a little more seriously… not for his political or scientific achievements, but for the way he set and cultivated his personal goals. Peterson shows that whether our resolutions are set in the beginning of January or halfway through the year, Franklin’s approach is one that we can all take some notes from.

Net worth to the world is usually determined by what remains after your bad habits are subtracted from your good ones. —Benjamin Franklin

I am writing this reflection on the last day of the year. Have you made any New Year’s resolutions? I just read an article on the most typical resolutions made by adults in the United States, and I was struck by how many of them embody the strengths of character that have been the subject of my research: spending more time with friends and family (love), saying no to cigarettes and alcohol (self-regulation), getting organized (prudence), learning something new (love of learning), helping others (kindness), getting fi t and losing weight (perseverance), and so on. Another common resolution is climbing out of debt, which in today’s world probably requires creativity coupled with good judgment.

If you want to make your resolutions happen, I suggest one more: taking Benjamin Franklin seriously.

Benjamin Franklin (1706–1790) is of course widely acclaimed as a statesman and scientist, but he may also deserve credit as America’s fi rst positive psychologist. Not only did he enumerate 13 praiseworthy character strengths (virtues), but he also took on the challenge of cultivating each of them, using himself as a research subject (Franklin, 1791/1962).

Franklin characterized each of the virtues of interest to him in terms of what he called their precepts . In modern psychological language, these precepts were behavioral markers of the virtue in question. For example, the precepts for industry were “lose no time; be always employ’d in something useful; cut off all unnecessary actions” and for temperance were “eat not to dullness; drink not to elevation” (p. 67).

From my perspective, too many of Franklin’s precepts are phrased in terms of what a person should not do, refl ecting his concern with what contemporary virtue ethicists call corrective virtues , those that protect against human inclinations to act in bad ways. But good character is not simply the absence of bad character. Just because people refrain from mean-spirited actions does not make them kind, any more than being free from anxiety or depression necessarily makes people happy.

Nonetheless, the value of his precepts is that they are behavioral, observable, and countable. The goals they represent are hard and specifi c, which modern psychologists know are more effective in motivating change than the vague “do your best” (DYB) goals that many of us have.

Franklin’s own program of character cultivation was prescient. He recognized that exhortation would not suffi ce to change anyone, including himself, which is a point still not fully grasped by some proponents of today’s character education. Merely hanging a character-relevant poster on a classroom wall (or for that matter, the Ten Commandments) will not lead to change.

I spent my elementary school years staring daily at the periodic table of elements, and that did not make me into a chemist or even into a passable student of chemistry. What is needed is a concrete strategy of changing behavior. Franklin believed, as do I, that most people want to be good and decent. The problem is that we may not know how to do it. One does not tell a depressed patient simply to cheer up or a person prone to procrastination to just do it. If they knew how to be cheerful or how to get things done, then they would do so. What is more helpful is to tell them how to do these things. The same point applies to the cultivation of strengths of character.

Franklin also recognized that it would be too daunting to attempt to strengthen all virtues at the same time, so he prioritized them and tackled them in order. He further observed that the strengthening of one virtue might help with the subsequent cultivation of other virtues. For example, Franklin reasoned that the virtue of moderation should facilitate the virtue of silence, given that the latter requires the skills involved in the former.

Anticipating the modern behavior change strategy of “objectively” monitoring progress, Franklin made a book, with one page for each of the virtues he wished to strengthen. He organized each page by the day of the week. At the end of each day, he would think back over his actions and make “a black mark” if he had failed in following the precept. Again, I gently criticize Franklin for emphasizing his transgressions rather than his positive accomplishments, but that followed from the way he defined the precepts for each virtue.

He resolved to address one virtue per week, in the order he had prioritized, so that in 13 weeks he would have addressed all of them in succession. Then he would do it again, and in a year he would have completed four courses. Again, this is very modern, because Franklin anticipated the need for the maintenance of change.

His goal was to have a clean book, and to help him along the way, he included in his log relevant maxims and prayers, much as people today use Post-Its on their refrigerator to keep their goals front and center. For example, my own refrigerator door has a Post-It asking “Are you really that hungry?”

Franklin judged his program a success, in that he accorded himself fewer black marks as time passed. Still, some virtues were harder for him to strengthen than others. In particular, the strength of order gave him great trouble, as he was wont to scatter about his things and could typically rely on his good memory to know where things were amidst chaos. (Does this sound familiar to any of you readers?) In any event, he decided he was incorrigible with respect to this virtue and decided to accept the fault as part of who he was. From a positive psychology perspective, this is okay. No one can have it all, although to Franklin’s credit, he tried to change before he accepted the less than desirable conclusion.

Franklin did fret that his “success” with respect to some of the virtues refl ected changes in the appearance of the character strength rather than in its reality, but from my vantage point, this is a diffi cult distinction to maintain if we regard character strengths as habits. “Fake it until you can make it” is one of the slogans of Alcoholics Anonymous, and it means that if we behave in a sober way, no matter how deliberate or stilted our initial attempts, then eventually we will be sober. We are what we do.

Appreciate that Franklin did all of this when he was 79 years of age!

In Pursuing the Good Life, one of the founders of positive psychology, Christopher Peterson, offers one hundred bite-sized reflections exploring the many sides of this exciting new field. With the humor, warmth, and wisdom that has made him an award-winning teacher, Peterson takes readers on a lively tour of the sunny side of the psychological street. Christopher Peterson was Professor of Psychology at the University of Michigan. One of the world’s most highly cited research psychologists and a founder of the field of positive psychology, Peterson was best-known for his studies of optimism and character strengths and their relationship to psychological and physical well-being. He was a frequent blogger for Psychology Today, where many of these short essays, including this one, first appeared.

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By Adam Ockelford

I spend around 12 hours a week – every week – sharing thoughts, feelings, new ideas, reminiscences and even jokes with some very special children who have extraordinary musical talents, and many of whom are severely autistic. I’m Professor of Music at the University of Roehampton, and the children come to see me in a large practice room in Southlands College where there are two pianos, so we don’t have to scrap over personal space. My pupils usually indicate what piece they would like us to play together, and they tell me when they’ve had enough. Sometimes, they tease me by seeming to suggest one thing when they mean another. We share many jokes and the occasional sad moment too.

But the children rarely say a word. They communicate everything through their playing. For them, music is a proxy language.

On Sunday mornings, at 10.00 a.m., I steel myself for Romy’s arrival. I know that the next two hours will be an exacting test of my musical mettle. Yet Romy, aged 11, has severe learning difficulties, and she doesn’t speak at all. She is musical to the core, though: she lives and breathes music – it is the very essence of her being. With her passion comes a high degree of particularity: Romy knows precisely which piece she wants me to play, at what tempo and in which key. And woe betide me if I get it wrong.

When we started working together, four years ago, mistakes and misunderstandings occurred all too frequently, since (as it turned out), there were very few pieces that Romy would tolerate: the theme from Für Elise (never the middle section), for example, the Habanera from Carmen, and some snippets from ‘Buckaroo Holiday’ (the first movement of Aaron Copland’s Rodeo). Romy’s acute neophobia meant that even one note of a different piece would evoke shrieks of fear-cum-anger, and the session could easily grow into an emotional conflagration.

So gradually, gradually, over weeks, then months, and then years, I introduced new pieces – sometimes, quite literally, at the rate of one note per session. On occasion, if things were difficult, I would even take a step back before trying to move on again the next time. And, imperceptibly at first, Romy’s fears started to melt away. The theme from Brahms’s Haydn Variations became something of an obsession, followed by the slow movement of Beethoven’s Pathetique sonata. Then it was Joplin’s The Entertainer, and Rocking All Over the World by Status Quo.

Over the four years, Romy’s jigsaw box of musical pieces – fragments ranging from just a few seconds to a minute or so in length – has filled up at an ever-increasing rate. Now it’s overflowing, and it’s difficult to keep up with Romy’s mercurial musical mind: mixing and matching ideas in our improvised sessions, and even changing melodies and harmonies so they mesh together, or to ensure that my contributions don’t!

As we play, new pictures in sound emerge and then retreat as a kaleidoscope of ideas whirls between us. Sometimes a single melody persists for 15 minutes, even half an hour. For Romy, no matter how often it is repeated, a fragment of music seems to stay fresh and vibrant. At other times, it sounds as though she is trying to play several pieces at the same time – she just can’t get them out quickly enough, and a veritable nest of earworms wriggle their way onto the piano keyboard. Vainly I attempt to herd them into a common direction of musical travel.

So here I am, sitting at the piano in Roehampton, on a Sunday morning in mid-November, waiting for Romy to join me (not to be there when she arrives is asking for trouble). I’m limbering up with a rather sedate rendition of the opening of Chopin’s Etude in C major, Op. 10, No. 1, when I hear her coming down the corridor, vocalising with increasing fervour. I feel the tension rising, and as her father pushes open the door, she breaks away from him, rushes over to the piano and, with a shriek and an extraordinarily agile sweep of her arm, elbows my right hand out of the way at the precise moment that I was going to hit the D an octave above middle C. She usurps this note to her own ends, ushering in her favourite Brahms-Haydn theme. Instantly, Romy smiles, relaxes and gives me the choice of moving out of the way or having my lap appropriated as an unwilling cushion on the piano stool. I choose the former, sliding to my left onto a chair that I’d placed earlier in readiness for the move that I knew I would have to make.

I join in the Brahms, and encourage her to use her left hand to add a bass line. She tolerates this up to the end of the first section of the theme, but in her mind she’s already moved on, and without a break in the sound, Romy steps onto the set of A Little Night Music, gently noodling around the introduction to Send in the Clowns. But it’s in the wrong key – G instead of E flat – which I know from experience means that she doesn’t really want us to go into the Sondheim classic, but instead wants me to play the first four bars (and only the first four bars) of Schumann’s Kleine Studie Op. 68, No. 14. Trying to perform the fifth bar would in any case be futile since Romy’s already started to play … now, is it I am Sailing or O Freedom. The opening ascent from D through E to G could signal either of those possibilities. Almost tentatively, Romy presses those three notes down and then looks at me and smiles, waiting, and knowing that whichever option I choose will be the wrong one. I just shake my head at her and plump for O Freedom, but sure enough Rod Stewart shoves the Spiritual out of the way before it has time to draw a second breath.

From there, Romy shifts up a gear to the Canon in D ­– or is it really Pachelbel’s masterpiece? With a deft flick of her little finger up to a high A, she seems to suggest that she wants Streets of London instead (which uses the same harmonies). I opt for Ralph McTell, but another flick, this time aimed partly at me as well as the keys, shows that Romy actually wants Beethoven’s Pathetique theme – but again, in the wrong key (D). Obediently I start to play, but Romy takes us almost immediately to A flat (the tonality that Beethoven originally intended). As soon as I’m there, though, Romy races back up the keyboard again, returning to Pachelbel’s domain. Before I’ve had time to catch up, though, she’s transformed the music once more; now we’re hearing the famous theme from Dvorak’s New World Symphony.

I pause to recover my thoughts, but Romy is impatiently waiting for me to begin the accompaniment. Two or three minutes into the session, and we’ve already touched on 12 pieces spanning 300 years of Western music and an emotional range to match.

Yet here is a girl who in everyday life is supposed to have no ‘theory of mind’ ­– the capacity to put yourself in other people’s shoes and think what they are thinking. Here is someone who is supposed to lack the ability to communicate. Here is someone who functions, apparently, at an 18-month level.

But I say here is a joyous musician who amazes all who hear her. Here is a girl in whom extreme ability and disability coexist in the most extraordinary way. Here is someone who can reach out through music and touch one’s emotions in a profound way.

Click here to view the embedded video.

I explore the science of how Romy and her peers are able to do what they do in my new book Applied Musicology, which uses a theory of how music makes sense to all of us to explore intentionality and influence in children who use little or no language. If music is important to us all, it is truly the lifeblood of many children with autism. Essential brain food.

Adam Ockelford is Professor of Music and Director of the Applied Music Research Centre at the University of Roehampton in London. He is the author of Applied Musicology: Using Zygonic Theory to Inform Music Education, Therapy, and Psychology Research (OUP, 2012).

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By Susan David

We humans are funny. Often we create beliefs or engage in behaviors that seem to help us in the short term, only to discover they get in the way of the lives we really want to live, or the people we want to become.

Allow me to share the story of my friend, Erin. Over lunch one day, she told both her mentor and me about a division director job she had truly wanted. The role offered good challenges, the chance to develop her skills, fabulous travel, and unparalleled flexibility. It would have been “a dream come true”.

But then Erin began to recite a litany of reasons why she hadn’t gone after the job. She wasn’t good in interviews, having never received the coaching that so many candidates are privy to these days. She was overweight, which would surely make a poor impression. On top of all this, due to the economic downturn, many people more qualified than she would apply. She thought she’d be great at the job if she could have made it beyond the interview, but all things considered, she “knew” she hadn’t stood a chance.

“So I never applied,” she told us. “Instead, I sent the advertisement to a peer and encouraged him to interview.” She paused. “He got the job.”

How was it that this bright, hardworking, lovely young woman also had such an aptitude for self-sabotage?

There are plenty of smart, even gifted, people like Erin. They are bonded by a common behavior psychologists call “self-handicapping,” which involves anticipating a real or imagined obstacle that might get in the way of success, and using that obstacle as an excuse.

Self-handicapping allows us to protect ourselves from the pain of assuming responsibility for our failures, and people do it all the time. In a groundbreaking 1978 study, psychologists Berglas and Jones found that participants who “succeeded” at a test (that was really just luck-based) were more likely to choose to take a performance-inhibiting drug before taking a second test. In other words, they actively set themselves up for failure on the second try. By doing this, they could blame their subsequent poor performance on the drug, and also protect their earlier feeling of success.

In a more recent set of experiments conducted by psychologist Sean McCrea at the University of Konstanz in Germany, participants were asked to take several intelligence tests under a variety of conditions. The research showed that people who were encouraged to make excuses for their poor performance — blaming poor performance on loud noises, for example — maintained high self-esteem, but were also less motivated to improve.

This kind of behavior is often so subtle and habitual that we don’t notice we’re doing it. Think about the manager who has to give a big presentation and fails to practice ahead of the event, or people who procrastinate on work projects and wind up “not having enough time” to do a good job. In a 2010 HBR article, Jeffrey Pfeffer identified self-handicapping as one of three major barriers to building professional power: people avoid the pain of failure by never trying to build power in the first place.

What can you do to overcome self-handicapping? Here are four steps:

1. Watch for the warning signs. Drawing down your efforts, generating lists of excuses, or distracting yourself (music, alcohol, etc.) are signs that you’re engaging in self-handicapping. Everyone needs to take breaks and manage energy during the work day, but these activities can be clues that you are veering onto the trail of self-sabotage. A mentor or colleague can often help steer you back on course.
2. Use “what-ifs” and “if-onlys” to help you generate goals instead of excuses. Research shows that the thinking people engage in during self-handicapping can just as easily be flipped to be motivational. When you ponder what could have gone better, or recognize obstacles in your way, you generate valuable information. Identify factors within your control, and see what you can do about them. Erin, for example, could have responded to the thought “I’m not great in interviews” by researching the right skills, practicing them, and requesting support from her mentor.
3. Recognize and manage your negative emotions. Research shows that when we use our “if-onlys” to motivate rather than excuse ourselves, we will also likely experience negative emotions, such as disappointment and self-directed anger . If you can notice these emotions and be kind to yourself in working through them, you’re more likely to be able to move into positive, empowering behavior.
4. Go for mastery. Self-handicapping is most likely to kick in when we are trying to perform well in order to avoid negative feedback from external sources, such as criticism from colleagues. When we focus instead on developing mastery in a domain we care about, we tap into our inherent motivation to learn and grow. Recognize what matters to you, and brainstorm ideas to get yourself moving in that direction.

Going for what you really want takes considerable courage. Let’s face it, even when you put forth your best effort, things don’t always turn out as you would like. But by taking a risk you open yourself not only to the possibility of failure, but also the possibility of learning, growth, and real attainment. It’s up to you to decide which is more perilous: the risk of disappointment, or the risk of never reaching your potential.

Reprinted with permission from Harvard Business Reveiw.  This blog was originally published here.

Susan David is co-editor of the Oxford Handbook of Happiness (due out in January 2013) with Ilona Boniwell and Amanda Conley Ayers. Susan is is a founder and co-director of the Harvard/McLean Institute of Coaching and a member of the Harvard faculty. She is also the director of Evidence Based Psychology, a leadership development organization and management consultancy.

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By Robert Hull

As parents, children, and communities struggle to come to terms with the events in Newtown last week, it is important for educators and parents to be aware of just how deeply children can be affected by violence.

Community violence is very different from other sources of trauma that children witness or experience. Most trauma impacts individual students or small groups, whereas the violence that was experienced in Newtown affected the local community and the entire nation. The lack of warning and the unexpected nature of these kinds of events, combined with the seemingly random nature of the attack, contribute to a change in individuals’ personal views of the world, and their ideas about how safe they and their loved ones actually are. The world comes to seem more dangerous, people less trustworthy.

Exposure to trauma can impact several areas of children’s functioning. Teachers may notice that students who have experienced trauma appear to be shut down, bored, and/or hyperactive and impulsive. Interpersonal skills might be impacted, which can lead to social withdrawal, isolation, or overly aggressive behavior. Students might appear confused or easily frustrated. In addition they might have difficulty understanding and following directions, making decisions, and generating ideas or solving problems.

Family members and educators are often at a loss in how to support students following an event such as what happened in Newtown. The following are guidelines on helping students exposed to community violence:

• Teachers and family members should attempt to maintain the routines and high expectations of students. This directly communicates to children that they can succeed in the face of traumatic events.
• Reinforcing safety is essential following unpredictable violence. Remind children that the school is a safe place and that adults are available to provide assistance.
• Do not force children to talk. This can lead to withdrawal and downplaying the impact. A neutral conversation opening can be stated in this way: “You haven’t seemed yourself today. Would you like to share how you are feeling?”
• Teachers can model coping mechanisms such as deep breathing, relaxation and demonstrating empathy.
• Being flexible is a must following traumatic events. Teachers should allow students to turn in work late or to postpone testing.
• Educators should increase communication with parents in order to provide support that recognizes a specific child’s vulnerabilities.

There are several websites that can provide additional information on supporting students who have been exposed to violence. These include:

• The National Child Traumatic Stress Network
• The National Association of School Psychologists
• The National Center for Children Exposed to Violence

Robert Hull is an award-winning school psychologist with over 25 years of experience working in some of the most challenging of educational settings, and was for many years the facilitator of school psychology for the Maryland State Department of Education. Currently he teaches at the University of Missouri. He is the co-editor, with Eric Rossen, of Supporting and Educating Traumatized Students: A Guide for School-Based Professionals.

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By Donald W. Black

For many years I have pondered the mental state and motivations of mass shooters. The tragic events in Newtown, CT this past week have brought this to the fore. Mass shootings have become everyday occurrences in the United States, and for that reason tend not to attract much attention unless the circumstances are especially heinous, such as this instance in which the victims were young children. We are all left wondering what can be done. While the attention span of the general public and the media is usually a matter of nanoseconds, this mass shooting seems different, and I hope will lead to positive policy changes. This tragedy presents an opportunity for our leaders to step up to the plate and lead and, one hopes, implement rational gun control legislation most of us agree is necessary.

But back to the shooters. As a psychiatrist with an intense interest in bad behavior, I expect that discussions will center on mental health issues which many believe motivate the shooters. I am intensely interested in these “issues” because, to me, the main issue that keeps coming up is that of psychiatric diagnosis. Everyone seems interested in the possibility of a psychiatric diagnosis, because it suggests that we might “understand” the shooter, and this may lead to better identification of future shooters, and both improved treatment and prevention.

But will the presence of a psychiatric diagnosis improve our understanding? Probably not, because — at least in the cases we know about — the apparent psychiatric diagnosis runs the gamut. Some shooters appear to have schizophrenia, others a depressive disorder, and still others a personality disorder, as has been alleged in the case of Adam Lanza. While we seem able to understand that a “crazy” person out of touch with reality might carry out an otherwise senseless act, the thought that someone who is not psychotic carrying out such an act is very unsettling. How could a person who is not psychotic behave this way? For example, depressed persons are by and large not psychotic, yet some will — in the context of being hopeless and suicidal — want to take others with them: spouses, children, etc. More typically, while planning to harm themselves, most depressed persons have no desire to hurt anyone else.

What about the non-psychotic people with a personality disorder? The Diagnostic and Statistical Manual of Mental Disorders — a compendium of psychiatry’s officially recognized disorders (about to come out in its 5th edition) — lists ten personality disorders; the most relevant to our discussion is antisocial personality disorder. This disorder is quite common (up to 4.5% of the population) and causes all manner of problems because the antisocial person always seems to be in trouble with the law, their spouses and families, or their employers.

The term antisocial is almost always misunderstood and is often construed to mean ”shy” or “inhibited,” yet in a psychiatric sense the term suggests rebellion against society. My profession has done a poor job in educating the general public about the disorder and for that reason it remains under the radar screen. (An older term that seems more entrenched is sociopathy.) In the DSM, the diagnosis rests on the person having three or more of seven symptoms (such as deceitfulness, impulsivity, irritability and aggressiveness, etc). Perhaps the most important is “lack of remorse,” which occurs in about half of those diagnosed antisocial. This is what allows the antisocial person to hurt, to mistreat, or even to kill others. These are the “psychopaths” we read about and fear. (Psychopathy is at the extreme end of the antisocial spectrum of behavior.) Few antisocials are killers, but many of today’s mass shooters would fit the description of antisocial personality disorder. I don’t know if Adam Lanza would, but as we peel back the layers of his personal history, we might find that he does.

We don’t know what causes antisocial personality disorder, but like many disorders it probably results from a combination of genetic and environmental factors. I have argued for many years that the federal government needs to direct more funds to investigating its causes and developing effective treatments. Despite its high prevalence and the fact that it contributes to so much of society’s ills, the government has shown little interest in funding research on the disorder. The National Institutes of Health RePORTER website lists only two projects in which the term “antisocial” appears in the title and only five in which the terms “psychopathy” or “psychopathy” are used. Considering that NIH funds literally thousands of projects, this can only be considered hopelessly inadequate. Overcoming this resistance to research on antisocial personality disorder and related conditions must be a priority.

We need wide-ranging projects to explore the origins of antisocial behavior and search for methods to change its course. Geneticists should investigate the mechanisms underlying antisocial behavior, locating genes that might predispose individuals to antisocial behavior and determining how these genes function. Neuroscientists should pinpoint brain regions or networks linked to antisocial behavior and identify biochemical and physiological pathways that influence its expression. A range of treatments — both drugs and therapy — need to be developed, tested, and refined.

Will these steps help us understand the conundrum of the mass shooter? Will they allow us to treat antisocial persons and prevent youth with antisocial tendencies from developing a full-blown disorder? We can certainly hope.

Donald W. Black, MD is a professor of psychiatry at the University of Iowa Roy J. and Lucille A. Carver College of Medicine in Iowa City. He is the author of Bad Boys, Bad Men: Confronting Antisocial Personality Disorder (Sociopathy), Revised and Updated (Oxford University Press, 2013).

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By Eric Rossen

In the wake of another national tragedy, it is more apparent than ever that our schools must embrace a stronger role in supporting the mental health of our youth by developing trauma-sensitive schools. The mass shooting in Newtown, Connecticut that killed several staff and 20 elementary school students came less than two months after Hurricane Sandy, a storm that brought devastation and displacement to tens of thousands of people in the Northeast. Both events offer stark reminders of the acute stress our students may face when experiencing cataclysmic events. However, even in the absence of such tragedies, many of our nation’s children are in chronic distress.

Despite our collective efforts, youth continue to have adverse and traumatic experiences, such as chronic child maltreatment, domestic and community violence, homelessness, natural disasters, parental substance abuse, death of a loved one, and the list goes on. These experiences can significantly undermine the ability to learn, form relationships, and manage emotions and behavior; all critical components of succeeding in school and in life. To improve our country’s education system, we must first address these barriers to progress; and schools remain the most logical place to do it.

As a school psychologist, I have had the privilege of working with students, parents, and fellow educators to help students learn, develop, and grow in a healthy environment. I have also had the challenge of identifying the mental health problems that impede learning where all too often, the initial question is, “What’s wrong with you?” rather than “What happened to you?” or “How can we help?” Some believe that schools are in the business of educating, not mental health. On the contrary, supporting student mental health is a pre-requisite to learning, not an afterthought.

Interestingly, while only a fraction of kids who need mental health care actually receive it, 70-80% of those that do receive it get it at school. Schools often have a cadre of health and mental health supports available. For example, in the aftermath of Hurricane Sandy, the NYC Department of Education mobilized their staff with an all hands on deck approach. However, even with the most talented and ambitious group of mental health professionals in a school system, it’s unlikely that they can provide the full range of mental health supports to every student in need. A main challenge is first identifying students in need when a stressor is not as obvious as a hurricane or a school shooting. Moreover, some symptoms of childhood trauma may not fully manifest until adolescence, at a time where some may view that behavior as an unrelated outcome of that early experience.

Trauma-sensitive classrooms and schools provide an environment where all adults in the building have an awareness and sensitivity to the potential impact of trauma and adverse experiences on students’ lives. The initial thinking behind low academic performance or bad behavior is not automatically that the student is willfully disobedient, unmotivated, and unintelligent. Trauma-sensitive schools are places where all youth feel safe, connected, and supported — not just the youth who don’t need mental health care or those that need it most. Trauma-sensitive schools augment and supplement the herculean efforts of the school-based mental health professionals and in a sense, provide a continuous and universal mental health intervention system.

Creating trauma-sensitive schools requires a great deal of commitment. First, we know that most, if not all, teacher preparation programs don’t include training to prepare teachers to identify, teach, and support traumatized students. This is a problem, particularly given the demands on teacher preparation programs, and teachers themselves. The duties of a teacher are added on with regularity, and rarely removed. Therefore, we must infuse some content on the impacts of trauma and mental health on learning throughout teacher preparation and professional development programs.

Second, we must leverage the existing mental health professionals that exist in schools, including school psychologists, school counselors, school social workers, school nurses, and other school-based mental health providers. Utilizing them more effectively could include more regular consultation with teachers and administrators on developing trauma-sensitive strategies and perspectives. These individuals can also provide in-services to staff at no additional cost. Meeting this demand also means properly funding enough positions to provide these services along with the intensive direct services to students in need.

Finally, this requires a culture change — often more easily said than done. Luckily, some groups have emerged as leaders in creating trauma-sensitive schools, including the Massachusetts Department of Elementary and Secondary Education and the State of Washington Office of the Superintendant of Public Education. Much can be learned from the efforts of these pioneer systems.

Many of our kids are in distress, and our schools remain our frontline opportunity to support them.

Eric Rossen is the co-editor of Supporting and Educating Traumatized Students: A Guide for School-Based Professionals with Robert Hull. Eric Rossen, Ph.D., is a nationally certified school psychologist and licensed psychologist in Maryland. He currently serves as Director of Professional Development and Standards at the National Association of School Psychologists. Robert Hull, Ed.S., MHS, is a school psychologist in Prince George’s County Public Schools, Maryland, serves on the faculty at the University of Missouri, and holds a position as adjunct faculty at Goucher College.

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By Kenneth Barish

At this holiday season, I would like to offer a few thoughts on how we can help nurture in our children a spirit of generosity and concern for others. I cannot write this post, however, without first expressing my deepest condolences to the families of Newtown, Connecticut, for their unimaginable and unbearable loss.

Much of the year, parents are understandably concerned with their children’s achievement. We focus our daily attention on helping children develop the skills they will need to succeed in a competitive world.

Most parents, however, want more for their children than individual achievement. We also want them to be “good kids” — children who act with kindness and generosity toward their families, their friends, and their communities. These are universal values, shared by parents who are secular and religious, liberal and conservative.

How can we best accomplish these goals? How can we nurture a child’s feelings of empathy and concern for others, of appreciation and gratitude, and a desire for giving, not just getting.

Caring and Responsibility

Several years ago, psychologists Nancy Eisenberg and Paul Mussen presented a comprehensive review of research on the development of pro-social behavior (caring, sharing, and helping) in children. They concluded that pro-social behavior begins with a child’s empathy (her awareness of the feelings of others) and is then strengthened when children observe the caring behavior of admired adults and older children.

For young boys, a warm relationship with their father may be especially important. In one study, preschool boys who were generous toward other children portrayed their fathers as “nurturant and warm, as well as generous, sympathetic, and compassionate, whereas boys low in generosity seldom perceived their fathers in these ways.”

Eisenberg and Mussen also found that, across cultures, children who are given family responsibilities, including household chores and teaching younger children, show more helpful and supportive behavior toward their families and their peers.

In a more recent series of studies, psychologist Ross Thompson and his colleagues found that children’s moral understanding and pro-social behavior were also strengthened by a mother’s use of emotion language in conversation with her child. Mothers of children who were high in conscience used what Thompson labelled an “elaborative” conversational style and made frequent references to other people’s feelings.

Ideals and Idealism

In thinking about children’s moral development, we also need to remember the intangibles. Our children look up to us. They look up to us even when they are angry and defiant, or when they are defensive or withdrawn, and even when, as adolescents (or before), they challenge our ideas and rebel against our rules.

Because they look up to us, they want to be, and to become, like us. We can observe this, every day, in the admiring statements of young children, when first grade boys and girls tell their teacher, “I want to be fireman, like my daddy” or “I want to be a doctor and help people, like my mom.” Recall the looks on the faces of Scout and Jem when Atticus talks with them, or when he delivers his summation to the jury in To Kill a Mockingbird.

A child’s admiration of her parents is an important moral influence throughout childhood — a source of conscience, ideals, and long-term goals. When a child looks up to us — and in return, feels our genuine interest, warmth, and pride — we have strengthened an important pathway of healthy development, a pathway that leads toward commitment to ideals and a sense of purpose in life.

We also support our children’s idealism when we talk with them about people we admire, people who have inspired us and who we hope will inspire them. We need to let them know that there is so much good work to be done in the world, work that they will be able to do and can do, even now. And we should help them appreciate what others do for us. We should talk with them about heroes who may not be famous, heroes of everyday life: the people who build our cities, protect our safety, and save our lives.

Doing for Others

A growing body of scientific research now supports an important conclusion: Doing good for others is also good for us. Most of this research has been conducted with late adolescents and adults. My personal experience suggests that doing for others is also good for children.

In a recent review, psychologist Jane Piliavin concluded that community service (helping others as part of an institutional framework) leads to improved self-esteem, less frequent depression, better immune system functioning, even a longer life.

Piliavin found significant benefits when older elementary school students read to kindergartners or first graders. Good effects, including lower dropout rates, were also reported when middle school students were randomly assigned to tutor younger children, as little as 1 hour a week. An evaluation of student volunteering that involved 237 different locations and almost 4,000 students concluded that volunteering “led to increased intrinsic work values, the perceived importance of a career, and the importance of community involvement.”

I therefore now recommend that parents find some way, especially as a family, to make doing for others a regular, not just occasional, part of their children’s lives. Children learn from this work that they have something to offer and they experience the appreciation of others. They learn how good it feels, to themselves and to others, to do good work.

Kenneth Barish is the author of Pride and Joy: A Guide to Understanding Your Child’s Emotions and Solving Family Problems and Clinical Associate Professor of Psychology at Weill Medical College, Cornell University. He is also on the faculty of the Westchester Center for the Study of Psychoanalysis and Psychotherapy and the William Alanson White Institute Child and Adolescent Psychotherapy Training Program. Read his previous blog posts on parenting.

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Image credit: Big sister sharing her books and showing little brother pictures. Photo by JLBarranco, iStockphoto.

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One-third of the world's population are introverts, and we are quietly going to take over the world while you extroverts are busy yapping it up and not paying attention. Don't say you haven't been warned. Books mentioned in this post

By Kathleen M. Heide, Ph.D.

The mass shooting in Newtown, Connecticut is a tragic event that is particularly painful as it comes at a time when people across the world are trying to focus on the upcoming holidays as the season of peace bringing good tidings of great joy.

Three factors about the Newtown school shooting are noteworthy. First, it was a mass murder. Second, it appears to have been precipitated by the killing of a parent (parricide). Third, it was committed by a 20-year old man. All of these factors are relevant in making sense of what appears to be inexplicable violence.

What drives a person to take an assault rifle into an elementary school and open fire on very young children and the teachers, some of whom died protecting them? Individuals in these cases are typically suicidally depressed, alienated, and isolated. They have often suffered a series of losses and are filled with a sense of rage. All too frequently they see themselves as having been wronged and want to play out their pain on a stage. The fact that mass shootings are routinely covered in depth by the media is not lost on them. They are typically aware that their name will go down in history for their destructive acts. Their murderous rampage is an act of power by an individual who feels powerless. Unable to make an impact on society in a positive way, the killer knows that he can impact the world through an act of death and destruction.

The fact that the first victim was reportedly the victim’s mother is significant. The first victims in other adolescent school shootings have also involved parents in some cases. My research and clinical practice has indicated that there are four types of parricide offenders.

• The first type is the severely abused parricide offender who kills out of desperation or terror; his or her motive is to stop the abuse. These individuals are often diagnosed as suffering from post-traumatic stress disorder or depression.
• The second type is the severely mentally ill parricide offender who kills because of an underlying serious mental illness. These individuals typically have a longstanding history of severe mental illness, often along the schizophrenia spectrum disorder or might be diagnosed as having depression or bi-polar disorder with psychotic features.
• The third type is the dangerously antisocial parricide offender who kills his or her parent to serve a selfish, instrumental reason. Reasons include killing to get their parents’ money, to date the boy or girl of their choice, and freedom to do what they want. These individuals are often diagnosed as having conduct disorder if under age 18 and antisocial personality disorder if over age 18. Some meet the diagnostic criteria of psychopathy. Psychopaths have interpersonal and affective deficits in additional to antisocial and other behavioral problems. They lack a connection to others and do not feel empathy. They do not feel guilty for their wrongdoing because they do not have a conscience.
• The fourth type is a parricide offender who appears to have a great deal of suppressed anger. If the anger erupts to a boiling point, the offspring may kill in an explosive rage often fueled by alcohol and/or drugs.

Interestingly, most parents are slain by their offspring in single victim-single offender incidents. Multiple victims incidents are rare. In an analysis of FBI data on thousands of parricide cases reported over a 32 year period, I found that on the average there were only 12 cases per year when a mother was killed along with other victims by a biological child. In more than 85% of these cases, the matricide offender was a son.

The actual number of victims involved in multiple victim parricide situations was small, usually two or three. Murders of the magnitude as seen in Newtown, CT that involved a parent as a first victim are exceedingly rare.

Assessment of the dynamics involved in the killing of parents is also important in terms of prognosis and risk assessment. The first victims of some serial murderers were family members, including parents. Serial murderers are defined as individuals who kill three or more victims in separate incidents with a cooling off period between them. If the parricide offender intended to kill his parent and derived satisfaction from doing so, he represents a great risk to society. (This type of killer is known as the Nihilistic Killer.)

The gunman’s age (in Newtown’s case, he was 20 years old) is also an important factor in understanding how an individual could engage in such horrific violence. Research has established that the brain is not fully developed until an individual reaches the age of 23 to 25 years old. The last area of the brain to develop is the pre-frontal cortex. This area of the brain is associated with thinking, judgment, and decision making. A 20-year-old man filled with rage would have great difficulty stopping, thinking, deliberating, and altering his course of action during his violent rampage. He is likely to be operating from the limbic system, the part of the brain associated with feelings. Adam Lanza was likely driven by raw feeling and out of control when he sprayed little children with rounds of gunfire. Simply put, it would be very difficult for him to put the brakes on and desist from his violent behavior.

Events like the shooting in Newtown leave society once again asking what can be done to stop the tide of senseless violence. Clearly Adam Lanza and other mass killers have been able to kill dozens of people in a matter of a few moments because of high powered weaponry. It is time to ask whether our nation can continue to allow assault weapons appropriate for our military to be easily available to citizens in our society. It is time for us to ask what can be done to increase access to mental health services to those who desperately need them. My prediction is, when the facts are more clearly known, risk factors will be identified in the case of Adam Lanza and missed opportunities to intervene to help Adam will be uncovered, contributing to the profound sadness that we are experiencing in the United States and across the world.

Kathleen M. Heide, Ph.D., is Professor of Criminology at the University of South Florida. Her lastest book, Understanding Parricide: When Sons and Daughters Kill Parents, was published in December 2012 by Oxford University Press.

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By J. Reid Meloy, Ph.D.

As the debate concerning public and social policy surrounding gun control intensifies, I would like to offer some comments on the identification of individuals who concern us as potential perpetrators of planned killing(s). These thoughts are from the trenches of threat assessment, and don’t address or offer opinions concerning the larger policy issues we face as a country regarding firearms and public mental health care — one of which is emotionally charged and the other sorely neglected.

The usual demographic characteristics such as a young male, loner, psychiatrically impaired, bullied, and angry don’t work as markers of risk, simply because there are hundreds of thousands of individuals in the USA, and the world, who match these demographics and pose no risk at all. The disturbing fact is that targeted violent events, such as the mass murder in Newtown, cannot be predicted because they are too rare. If we attempt to do this, we err on the side of labeling thousands of individuals as potential perpetrators when they are not a risk at all. So where do we turn?

For the past several years we have been working on identifying warning behaviors (acute and dynamic patterns of risk), which may signal an impending act of targeted violence, including mass murder. These patterns create concern in observers, and warrant a reasonable response to mitigate such risk, whether that involves increased community and educational attention, mental health intervention, or law enforcement interdiction. Anyone can evidence these warning behaviors:

1. Pathway warning behavior: any behavior that is part of research, planning, preparation, or implementation of an attack.
2. Fixation warning behavior: any behavior that indicates an increasingly pathological preoccupation with a person or a cause. There is a noticeable increase in perseveration; strident opinion; negative statements about the target(s); increasing anxiety and/or fear in the target; and an angry emotional undertone. It is accompanied by social or occupational deterioration.
3. Identification warning behavior: any behavior that indicates a psychological desire to be a “pseudocommando” or have a “warrior mentality”, closely associate with weapons or other military paraphernalia, identify with previous attackers or assassins, or identify oneself as an agent to advance a particular cause or belief system.
4. Novel aggression warning behavior: an act of violence which appears unrelated to any pathway warning behavior which is committed for the first time, often to test the ability of the individual to actually do a violent act.
5. Energy burst warning behavior: an increase in the frequency or variety of any noted activities related to the target, even if the activities themselves are relatively innocuous, often in the hours or days before the attack.
6. Leakage warning behavior: the communication to a third party of an intent to do harm to a target through an attack.
7. Last resort warning behavior: increasing desperation or distress through declaration in word of deed; there is no other choice but violence, and the consequences are justified.
8. Directly communicated threat warning behavior: the communication of a direct threat to the target or law enforcement beforehand.

If we observe these warning behaviors in others, we should be concerned. If we see something, we should say something. We don’t know if these warning behaviors predict targeted violence, yet these accelerating patterns have been found in a number of small samples of subjects in Germany and the US that have committed school shootings, mass murders, attacks and assassinations of public figures, and acts of terrorism. We are getting some tantalizing results: in comparing a small sample of school shooters and school threateners in Germany, our research group (with Dr. Jens Hoffmann) found that the school shooters were much more likely to exhibit pathway, fixation, identification, novel aggression, and last resort warning behaviors when compared to the school threateners who had no intention to attack. Although the samples were small, the effect sizes were large in a statistical sense.

The paradox in all this work — targeted violence threat assessment — is that we will never know which of the individuals of concern would have carried out an act of violence if there had been no intervention.

J. Reid Meloy, Ph.D. is Clinical Professor of Psychiatry at the University of California, San Diego, and President of Forensis, Inc., a nonprofit dedicated to forensic psychiatric and psychological research. He co-edited Stalking, Threatening, and Attacking Public Figures (OUP, 2008) with Lorraine Sheridan and Jens Hoffmann, and is currently co-editing another volume entitled International Handbook of Threat Assessment, which is scheduled to publish in 2013. Learn about his latest news by following Forensis on Twitter at @ForensisInc. The scientific basis of this blog article is available in Behavioral Sciences and the Law, 30:256-279, 2012.

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By Brenda Bursch

Children look to their parents to help them understand the inexplicable. They look to their parents to assuage worries and fears. They depend on their parents to protect them. What can parents do to help their children cope with mass tragedy, such as occurred this week with the shooting at Sandy Hook Elementary School in Newtown, Connecticut?

The first thing that parents can do is to calm themselves. Remember that your children will react to your fear and distress. It will be reassuring to them to see that you are calm and not afraid to discuss the event with them.

Next, parents can consider limiting their children’s exposure to media coverage and to adult discussions of the shooting. Young children may have particular difficulty understanding what they see on news stories and what they overhear from adult discussions. They may also have difficulty assessing their own level of safety.

It can be helpful for parents to check in with their children in order to learn about their thoughts and emotional reactions to the shooting. After carefully listening to their children, parents can then determine if it is necessary to correct distressing misunderstandings, answer questions, validate feelings of anger or sadness, and remind their children about how their family members and others, including police officers, help to keep them safe.

Most children will not be traumatized by their media exposure to the shooting, but they may have questions or concerns. Some children will be fearful about returning to school or have other signs of distress, but will adjust with the support and reassurances provided by parents and others. Children who are especially sensitive, those who have a tendency to worry, those with little emotional support, and those who have been previously traumatized, may be more vulnerable.

Trauma symptoms among children vary, but include talking about the event, distress when reminded of the trauma, nightmares, new separation anxiety or clinginess, new fears, sleep disturbance, physical symptoms (such as stomachaches), and more irritability or tantrums. Children may regress, that is, soothe or express themselves in ways they did when they were younger. For example, they might want to sleep with parents or they may wet the bed. Parents might notice an increase in behavioral problems or a decrease in school functioning. If these symptoms don’t improve in the coming weeks, such children may benefit from professional assistance.

Children are reassured by calm and supportive adults, by their normal routines, and by age-appropriate information when they have questions or misconceptions. For those children with ongoing signs of trauma, effective treatments are available. For additional information, parents can access information from the National Child Traumatic Stress Network website.

Brenda Bursch, PhD is a pediatric psychologist and Professor of Psychiatry & Biobehavioral Science, and Pediatrics at the David Geffen School of Medicine at UCLA. She is co-author of “How Many More Questions?” : Techniques for Clinical Interviews of Young Medically Ill Children.

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By Rochelle Caplan, MD

Surely the time has finally come to put our heads together and focus on three seldom connected variables regarding mass murders in the United States: the lack of comprehensive psychiatric care for individuals with mental illness, poor public recognition of the red flags that an individual might harm others, and easy access to firearms.

How should we address the first problem? The fiscal problems this country has faced during the past decade, combined with skewed budget priorities, have lead to a significant reduction in public health care, in particular for mental illness. Insurance companies have limited the time providers have for mental health assessments, the duration and frequency of treatment, and the types of intervention they cover. These cutbacks have forced psychiatrists to do abbreviated and superficial psychiatric evaluations and to prescribe medications as stopgap treatment in lieu of more effective evidence-based therapies. Furthermore, the number of individuals without mental health coverage who also face unemployment, homelessness, or insufficient money to feed and clothe their families — all significant mental health stressors — is steadily rising.

How then can mental health professionals conduct the comprehensive, time consuming evaluations needed to determine if an individual might be dangerous towards others? Self-report questionnaires, another quick method professionals use to conduct psychiatric evaluations, are clearly not the answer. Few people with homicidal or suicidal thoughts acknowledge these “socially unacceptable” intentions or plans on paper. Expert clinical acumen is needed to carefully and sensitively help patients talk about these “taboo” topics and their triggers. A five-to-ten minute psychiatric appointment clearly doesn’t do the job!

The lack of comprehensive mental health care is most sorely evident for such conditions as schizophrenia, as well as psychosis associated with substance abuse, depression, bipolar disorder, neurological disorders, or medical illnesses. In these conditions individuals can be plagued by and act in response to hallucinations that include voices commanding them to kill or visions that incite their aggressive response. Delusions (rigid, pervasive, and unreasonable thoughts) that people threaten them can also cause an aggressive response. Mass murderers might act out their hallucinations and delusions, as in the attempted assassination of congresswoman Gabrielle Gifford and murder of five bystanders, and in the Columbine, Batman, and Virginia Tech massacres.

Lack of time often precludes pediatric professionals from seeing children without their parents and detecting early warning signs of homicidal or suicidal plans. Similarly, physicians might have time to talk to adolescents but not to their parents. As a result, they might miss hearing about red flags of possible aggression by the youth and/or his peers.

The Affordable Care Act (Obamacare) will provide health insurance for more people, but what about quality mental health care? Few mentally ill patients are able to fight for their sorely needed unmet mental health care needs. Due to the stigma of mental illness and the related financial and heavy emotional burden, their families seldom have the power and resources needed to lobby elected officials or use the Internet and other media to publicize their plight.

How can we recognize the red flags of a potential mass murderer? In addition to well-trained mental health professionals with expertise, clinical acumen, and sufficient time with their patients, there is a need to educate the public about severe mental illness. Parents, family members, teachers, community groups, and religious leaders all need instruction to recognize possible early signs of mental illness. This knowledge will help them understand the plight and suffering of individuals with severe mental illness. And, most importantly, this awareness can lead to early referral, treatment, and prevention of violence due to mental illness.

Prompt recognition and early treatment of these symptoms are essential because firearms are so easily obtained in the United States. To get a driver’s license, individuals complete a Driver’s Ed course, pass a knowledge test, take driving lessons, drive a car with an adult for a fixed period, and then take a driving test. The underlying assumption is that irresponsible driving can physically harm others, the driver, and property. For this reason, individuals with epilepsy who experienced a seizure within the past year are barred from driving. Shouldn’t the same principles apply to guns? Yet, individuals can obtain guns without prior psychiatric evaluations, and there are no laws and regulations to safeguard these weapons in homes to prevent children and individuals with severe mental illness from gaining access to them. Reports on accidents caused by children and suicide by adolescents with their parents’ guns are common. According to a Center for Disease Control study, 1.6 million homes have loaded and unlocked firearms (Okoro et al., 2005).

As a child psychiatrist and parent, I regard the Newtown horrific mass murder of elementary age children as a final wake up call so that we will never again ask, “How many more children have to die?” Nothing can justify this preventable tragedy to the parents and families of their murdered beloved ones. The time has come to halt the unrelentless chipping away of our mental health care services and quality of care for mental illness, to educate the community about severe mental illness, and to implement strict controls on access to firearms.

Rochelle Caplan, M.D. is UCLA Professor Emeritus of Psychiatry and past Director the UCLA Pediatric Neuropsychiatry Program. She is co-author of “How many more questions?” : Techniques for Clinical interviews of Young Medically Ill Children (Oxford University Press) and author of Manual for Parents of Children with Epilepsy (Epilepsy Foundation). She studies thinking and behavior in pediatric neurobehavioral disorders (schizophrenia, epilepsy, attention-deficit hyperactivity disorder, high functioning autism) and related brain structure and function; unmet mental health need in pediatric epilepsy; and pediatric non-epileptic seizures.

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By Gregory Tate

This year marked the bicentenary of the birth of the Victorian poet Robert Browning in 1812, although this news might come as something of a surprise. The bicentenary of Browning’s contemporary Charles Dickens was celebrated with so many exhibitions, festivals, and other events that an official Dickens 2012 group was set up to co-ordinate and keep track of them all. The writings of Alfred Tennyson, Browning’s (consistently more popular) rival, also cropped up in some high-profile places throughout the year. But although academic specialists and other Browning enthusiasts organised conferences and special publications in 2012, media commentators and cultural institutions remained almost wholly silent about the Browning anniversary.

There are many possible reasons for this silence. There’s the issue of religion: Browning’s robust Christian faith, and his love of abstruse theological speculation, are perhaps less congenial to twenty-first-century tastes than the yearning doubt of Tennyson or the pious sentimentality of Dickens. Browning’s habit of writing poems about arcane subjects (such as the thirteenth-century troubadour Sordello or the sixteenth-century alchemist Paracelsus) might also alienate readers. The reason might, however, be something even more fundamental: Browning’s poetry is difficult, and discomfiting, to read. When Browning was buried in Poets’ Corner in Westminster Abbey on 31 December 1889, Henry James wrote that “a good many oddities and a good many great writers have been entombed in the Abbey; but none of the odd ones have been so great and none of the great ones so odd.” For James, Browning’s oddness was an essential part of his poetic achievement. Today, it seems, the general view (if there is a general view on him at all) is that his oddness precludes greatness.

For most of his life, Browning’s oddness was seen by his Victorian contemporaries as the key characteristic of his writing. John Ruskin, for example, wrote to the poet in 1855 to describe the poems in his new book Men and Women as “absolutely and literally a set of the most amazing Conundrums that ever were proposed to me.” Browning’s reply to Ruskin is significant, because it suggests that his difficult style is central to the goals of his poetry: “I know that I don’t make out my conception by my language; all poetry being a putting the infinite within the finite.” This definition of poetry was closely tied to Browning’s views on psychology: throughout his career he was preoccupied with the question of how to fit what he saw as the infinite capacities of the human mind into the finite media of language and poetic form. His answer was to adopt a knotty, convoluted, and tortuous syntax which articulated the difficulty, but also the necessity, of conveying the workings of the mind through the more or less inadequate tools of language.

Browning’s approach is exemplified in what is arguably his greatest poem, The Ring and the Book (1868-1869), a psychological epic which recounts the events of a seventeenth-century murder case from nine different perspectives. Browning sets out to integrate these conflicting perspectives into an authoritative and morally educational account of the murder, describing them as:

The variance now, the eventual unity,
Which make the miracle. See it for yourselves,
This man’s act, changeable because alive!
Action now shrouds, now shows the informing thought.

The poem’s concern is not with the murder itself, “this man’s act”, but with tracing “the informing thought,” the motive behind the act. This poetic analysis of thought, Browning argues, enables the synthesis of conflicting accounts into an “eventual unity,” and the dense style of his verse is a key element of this process. “Art,” he states “may tell a truth / Obliquely, do the thing shall breed the thought.” By testing and confounding his readers, Browning’s difficult (and odd) poetry invites them to think carefully about the minds of other people, breeding new thoughts and telling oblique truths.

In The Ring and the Book Browning addresses the “British Public, ye who like me not.” The publication of this poem, however, marked a sea change in Victorian opinions of the poet. In the 1870s and 1880s his writing was admired simultaneously for its evident Christianity and its intellectual richness, and he was venerated as a sage and a moral teacher by the Browning Society which was founded in 1881 to study and champion his work. He was also celebrated, by Henry James and by Modernists such as Ezra Pound, as (in James’s words) “a tremendous and incomparable modern.” In 2012, though, Browning’s modernity and relevance have not been sufficiently emphasised. This is a shame, because, in his psychological sophistication and in his awareness of the complexities and limitations of language, he still has truths to tell to the British public, who like him not. Those truths, and Browning’s poems, might be oblique and difficult, but they’re worth the effort.

Gregory Tate is Lecturer in English Literature at the University of Surrey. His book, The Poet’s Mind: The Psychology of Victorian Poetry 1830-1870,  was published by OUP in November 2012. You can follow him on Twitter @drgregorytate.

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Image credit: Robert Browning. Public domain via Wikimedia Commons.

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By Leonard A. Jason

Are art and science so different? At the deepest levels, the overlap is stunning. The artist wakes us from the slumber of ordinary existence by uncovering a childlike wonder and awe of the natural environment. The same magical processes occur when a scientist grasps the mysteries of nature, and by doing so, ultimately shows a graceful interconnectedness.

The intuition of the artist is no different from the hunches of a scientist. Both draw from unconscious realms where inner voices and soaring images provide sustenance for the imagination. Distractions and blind alleys often prevent the grasping of new visions or unraveling of complex social problems. Instincts and other primordial sources can break these intellectual and emotional barriers, and provide unparalleled insights into the vital nature of reality.

Both artist and scientist are revolutionaries, trying to change our perceptions and understanding of the world. Sometimes the fuel is no more than an outrage that “this must change”. Their paths often begin with a gnawing realization that something is askew in nature, which sets the traveler on a journey into the unknown to find what is missing, such as bringing about a more just and humane society.

Pansy (Viola x wittrockiana) at the Winterthur Country Estate. Photo by Derek Ramsey, (c) 2007. GNU Free Documentation License 1.2.

Artists and scientists use similar strategies and tactics to confront power structures that perpetuate institutional stagnation. Resources need to be identified and mobilized to buttress dreams and inspiration, to weather the assaults of critiques and forces inimical to new perspectives. Focus and commitment against seemingly insurmountable opposition can be sustained and validated by nurturing coalitions, including professional colleagues, friends, and family members. These cadres of supportive counter-change agents often provide a life-affirming antidote to the isolation and even animosity that can be engendered by radical transformative ideas and solutions to aesthetic and social issues. New professional and community coalitions can provide alternative sources of meaning by challenging existing reference groups and standards, and by validating innovative ways of approaching formerly intractable problems.

Suffice it to say, scientists and artists are often greeted with suspicion, disbelief, or even outright disdain for their offerings. Some retreat whereas others persist in sharing their new insights and knowledge in the public domain, regardless of the ego injuries and accruing disrespect. These prophets often feel as if they are lost in a dense fog or dark forest, but their enduring resolve to pursue an unconventional line of research or provide an alternative glimpse of reality represents a sustaining force. It is not fleeting happiness nor a drunken sense of wild abandon that uphold these commitments, but rather a deep sense of conviction and faith about one’s liberating vision.

Finally, learning, experimentation, feedback, and refinement are the backbone of both the sciences and the arts. Decades of painstaking analysis and observation were critical in the development of Darwin’s grand theory of evolution. The dissection of corpses and countless sketches polished and unleashed Michelangelo’s genius in capturing the human spirit in exquisite detail. Sweat and toil nurture the fertile imagination and fine tune the ability to peer through nature’s veil and uncover eternal truths that lead to Eureka moments of exhilarating discovery.

Spectacular gifts await us as we work to unravel the DNA of equality, faith, love, and compassion, and thereby usher in a world saturated with meaning, surrounded by creative rapturous forces. True research has a soul of an artist.

Leonard A. Jason is a Professor of Clinical and Community Psychology at DePaul University, and the Director of the Center for Community Research. For 38 years, he has been studying the interplay between creative forces and the process of community change. He is the author of Principles of Social Change (2013), published by Oxford University Press.

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By Professor Jane Edwards

What does the baby have to learn in these first 12-18 months (before they can speak)? The list  includes what you do with your eyes when with another, how long to hold a mutual gaze, what turn-off head movements work, and with whom, how close you should let the other come to you… how to read body positions… how to enter into turn taking when vocalizing with another… how to joke around, negotiate escalate, back off… make friends, and so on.
Daniel Stern, Forms of Vitality (OUP, 2010) p. 110-111

As a music therapy scholar, teacher, and practitioner for more than 20 years, I have been able to learn from many sources about the crucial role our early years play in our lives. The ability to reflect on challenges experienced in our adult lives by linking back to childhood experiences is an essential aspect of the way that many music therapists practice. Rather than using descriptions of family histories to apportion blame, the therapist tries to understand the current experience of the patient and their worldview through the lens of past experience, to see if there is some way to make sense of self-destructive behaviours, or difficulties experienced in creating meaningful and satisfying relationships with others.

I began my early music therapy practice in mental health services and in nursing homes, working with people diagnosed with Alzheimer’s Disease or other types of dementia. Many people, whether in group or individual music therapy programmes, offered reflections on their early life, and described aspects of their parents’ availability or unavailability; referring to the quality of these first relationships in ways that helped me to understand something of what might have been unresolved or unsatisfying for them. Eventually I found myself very keen to work with people much earlier in life to see whether music therapy could ameliorate some of the issues my older patients were facing.

Although I worked in paediatric music therapy for seven years at a children’s hospital, it was only when I was writing the first proposal to found the (now) international parent-infant support programme Sing & Grow that I had the chance to bring all of my past experience to bear: to make a case for the importance of promoting loving, playful, and nurturing interactions between parents and infants where vulnerability was in evidence. Through my work in this field, I have become increasingly aware of an unrecognised field of practice in music therapy: parent-infant work. This involves the referral of vulnerable parents to a music therapy service. Parents usually attend with their infants and the music therapist provides a safe and accepting space in which the parent and infant pair or group can be encouraged to play and interact in supportive and mutually satisfying ways. This is not always ‘music’ as it might be generally understood; rather it is a musical way of interacting that the therapist encourages.

When adults speak to infants we use particular ways of interaction that seem to be the same across the world. But we should ask why do we use such an exaggerated, playful, and musical way of speaking to infants? The obvious answer is because the infants like it — they raise their eyebrows, fix their gaze on the speaker’s face, and sometimes smile quite quickly on hearing us say ‘ooohhh whooo is my little baaaby?’ This is especially true if the speaker is a family member but it also can occur in new encounters when the conversational partner knows and can offer this communication in a playful and experimental way.  However, there are many more powerful scientific and theoretical findings that indicate how this type of interaction builds the bonds of trust and love between parents and infants.

Work by psychobiologist Colwyn Trevarthen, the ethologist Ellen Dissanayake, and researcher Sandra Trehub and her team at the University of Toronto, has paved the way in showing how the functions of this interaction have less to do with entertaining and engaging the baby and are more aligned with the infant’s ability to evoke and interpret these signals from adults and their siblings within weeks of birth. For me, and for the researchers mentioned above, these interactions are easily identified as musical. Observations of the nature of these interactions between parents and infants led Stephen Malloch to coin the term ‘Communicative Musicality’, to capture the unique pitch and rhythmic structures that communicative partners use.

This type of interaction is, as the quote from Stern at the opening attests, playful, rich, and highly involved. It teaches the many skills we need in being able to be with people successfully in intimate relationships, in relationships involving teachers and students, and in work groups. When we do not have adequately rich and supported experiences of attachment in infancy there can be lifelong consequences. Therefore, offering support to parents and infants in difficulty can provide long term benefits. Music therapy is uniquely poised to make a useful contribution to this work as infants are receptive to musical and music-like interactions from sensitive and responsive adults.

Professor Jane Edwards is an Associate Professor at the University of Limerick where she directs the Music & Health Research Group and is co-ordinator of the MA in Music Therapy in the Irish World Academy of Music & Dance. She was formerly a guest professor at the University of the Arts in Berlin (2004-2011). She is President of the International Association for Music & Medicine. She has published extensively in the field of music therapy including Music Therapy and Parent-Infant Bonding (OUP, 2011), and is sole editor for the first Oxford Handbook of Music Therapy (forthcoming).

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Image credit: ‘Mother Kissing Baby’ By Vera Kratochvil (public domain via Wikimedia Commons).

By Edward Shorter

Ben Carey’s thought-provoking article in the New York Times about the treatment of personality disorders in the forthcoming fifth edition of the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association raises two questions:

1. Do disorders of “personality” really exist as natural phenomena, comparable to mania or dementia?

2. If they do exist, do they belong to the clinical specialty of psychiatry, or are they better considered characteristics of the human condition that have little to do with illness? Psychosis and melancholia are real illnesses, comparable to tuberculosis and mumps. Do personality disorders have that status?

Psychiatry’s involvement with personality disorders goes back to the early nineteenth century and the diagnosis of “hysteria”: the female character was considered weak and vulnerable. Women by virtue of their very personalities were deemed more vulnerable than men to feelings and emotional changability. Viennese psychiatry professor Ernst von Feuchtersleben wrote in 1845, “[The causes of] hysteria include everything that increases sensitivity, weakens spontaneity, gives predominance to the sexual sphere, and validates the feelings and drives associated with sexuality.”

In terms of the scientific assessment of personality and its breakdowns, this was not a promising beginning.

Things got worse. In 1888 German psychiatrist Julius Koch said there was such a thing as a personality that was “psychopathically inferior,” a product of genetic degeneration. Such degenerates were not exactly mentally ill, he said, merely unable to get their act together, and also showed “a pathological lack of reproductive drive.”

So psychiatry has always thought there were people who had something really wrong with their characters without being necessarily depressed or psychotic. But how to classify them?

Classification is obsessing the current debate. The struggle over what disorders to identify began with the great German classifier of disease (nosologist) Emil Kraepelin who, in the eighth edition of his Psychiatry textbook in 1915 expanded to seven types the list of “psychopathic personalities” with which he and his colleagues had been working. The list is interesting because it is very different from our own: the “excitable”; the irresolute; those driven by pleasure to seek out alochol, gambling, and who generally become wastrels; the eccentric; the liars and swindlers; and the quarrelsome, sometimes called the querulants.

Doesn’t sound very familiar, does it? That’s because each culture compiles a list of the personality traits it dislikes, or that are harmful to the further flourishing of things; and in Imperial Germany being querulous by challenging authority or being irresolute by not seeing France as the enemy were viewed as disorders.

There was lots yet to come, that I’m going to skip over. But what has most greatly influenced the current debate is the concept of personality disorders laid down by the psychoanalysts, the followers of Freud. Their list is quite different from Kraepelin’s because they were not interested in making war on France but on inner conflicts within the psyche. In 1908 Freud suggested the existence of an “anal” character, poeple who were orderly, tidy and meticulous and who in childhood had somehow come to dwell upon the anal region.

Freud’s followers came up with a whole list of character pathologies: Fritz Wittels’ “hysterical character,” Wilhelm Reich’s notion of “character armor” and its various guises, such as the “compulsive character,” the “phallic-narcissitic character,” and so forth.

We’re getting hot now. The modern concept of personality disorder comes directly to us from the psychoanalysts and from their current desperate desire to stay relevant. In 1938 Adolph Stern laid out a kind of personality disorder that was unresponsive to psychoanalysis, calling it “borderline personality disorder.”

Fourteen years later, in 1952, the American Psychiatric Association took a first cut at personality disorders, in its new DSM series, assigning them to three groups: (1) Those that were constitutional (inborn) in nature and unresponsive to change though psychotherapy, including “inadequate personality” and “paranoid personality”; (2) Those individuals with emotionally “unstable” and “passive aggressive” personalities; and (3) the sociopaths, such as the homosexuals, fetishists and other deviants.

American society in the early 1950s did not like those who deviated from the missionary position, who were inadequate to the challenges of empire-building, and who accepted authority but badmouthed it at the water-cooler.

Wilhelm Reich had laid out the concept of “narcicism” in 1933 and New York psychiatrist Heinz Kohut gave it pride of place in 1971. We are totally mired in the swamp of psychoanalysis here, a swamp that DSM-II in 1968 and DSM-III in 1980 failed to pull us out of, though DSM-III constructed an “axis II,” along which personality disorders could be arrayed, in addition to axis I for the real psychiatric disorders.

So this brings us to the current scene. The most recent edition of the DSM series, DSM-IV in 1994, had a whole slew of personality disorders, including histrionic, narcissistic, borderline, and so forth. The editor of DSM-IV, Allen Frances, was a psychoanalyst, and the list is a kind of last gasp. The problem is that patients who qualified for one, tended to qualify for almost all of them. The individual “disorders” were quite incapable of identifying individuals who had something psychiatrically wrong with them; the “disorders” had become labels for personality characteristics that are found in abundance in the population.

Moreover, who needed labels? Psychiatrists had a seat-of-the pants definition of a PD: “If your first impression of your patient is that he is an asshole, then he probably has a personality disorder.”

And what kind of disorder was this anyway, an illness in which the identified patient thinks he personally is fine but is making everyone around him unhappy? This is not like psychosis.

You can see why the drafters of DSM-V, due this May, have despaired. They wanted something clinically relevant and that also would sound vaguely like science (which psychoanalysis certainly didn’t). It will be interesting to see how the APA sorts this out. Personality disorders exist not as natural phenomena but as cultural phenomena: We as a society need some way of identifying people who can’t quite get it all together. But is this an illness that psychiatrists can treat? In the way that they treat schizophrenia with Zyprexa and depression with Prozac? What do we, as a society in 2012, do with people who can’t quite get it all together? I’m asking you.

Edward Shorter is an internationally-recognized historian of psychiatry and the author of numerous books, including A History of Psychiatry from the Era of the Asylum to the Age of Prozac (1997), Before Prozac (2009), and the forthcoming How Everyone Became Depressed: The Rise and Fall of the Nervous Breakdown. Shorter is the Jason A. Hannah Professor in the History of Medicine and a Professor of Psychiatry in the Faculty of Medicine, University of Toronto. Read his previous OUPblog posts.

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