Mental Health and Well-Being

Getting Over It
by Malcolm Gladwell

This article begins by comparing two novels, The Man in the Gray Flannel Suit, by Sloan Wilson (1955) and In the Lake of the Woods, by Tim O’Brien (1994).  The novels are similar in that they both concern young veterans of war, attempting to resume normal civilian life.  Both of the protagonists have had horrible war time experiences.  The difference between them is that in Wilson’s novel the main character does so successfully- or at least the problems he experiences are not explained as the result of the war.  O’Brien’s main character, Wade, on the other hand, is never able to forget and the memory of the war destroys him.

But John Wade cannot forget. That's the point of O'Brien's book. "The Man in the Gray Flannel Suit" ends with Tom Rath stronger, and his marriage renewed. Wade falls apart, and when he returns home to the woman he left behind he wakes up screaming in his sleep. By the end of the novel, the past has come back and destroyed Wade, and one reason for the book's power is the inevitability of that disaster. This is the difference between a novel written in the middle of the last century and a novel written at the end of the century. Somehow in the intervening decades our understanding of what it means to experience a traumatic event has changed. We believe in John Wade now, not Tom Rath, and half a century after the publication of "The Man in the Gray Flannel Suit" it's worth wondering whether we've got it right.
Gladwell sees the difference between these two books, not as the difference between two psychological types, but as a difference in the assumptions we have learned to make about trauma.  Today we do not regard O’Brien’s book as plausible, or we search for a way to interpret it as really being all about the war.  We have been trained to believe that people never really get over traumatic events; that they are there with us forever no matter what.  But this, it turns out, is actually false.
Gladwell focuses on the work of Rind, Basuerman and Tromovitch, who performed a meta-analysis of 59 studies of the long term effects of childhood sexual abuse.  Essentially, they found that adults who had been sexually abused as children (CSA) were only very slightly more likely to manifest psychological problems in adult life than children who were not.  Moreover, they found that the psychological problems manifested by people who had experienced CSA were more plausibly attributed to physical abuse, which often  persisted throughout their young lives. Gladwell noted that their work was widely denounced by the popular media as insensitive and irresponsible, and formally denounced in both the House and the Senate, but it has largely stood up to peer scrutiny.
(Note that this is a very nice example of what we mean by neutrality in science.  There is a strong cultural predisposition to explain, and therefore excuse, the behavior of people who have been traumatized in the past, and when scientific evidence does not support this predisposition it is very upsetting to people.)
Gladwell writes: 
All Rind and his colleagues were saying is that sexual abuse is often something that people eventually can get over, and one of the reasons that the Rind study was so unacceptable is that we no longer think that traumatic experiences are things we can get over. We believe that the child who is molested by an uncle or a priest, on two or three furtive occasions, has to be permanently scarred by the experience—just as the soldier who accidentally kills his best friend must do more than sit down on the beach and decide that sometimes things just "happen."
This attachment we have to John Wade over Tom Rath is not merely a preference for one kind of war narrative over another. It is a shift in perception so profound that the United States Congress could be presented with evidence of the unexpected strength and resilience of the human spirit and reject it without a single dissenting vote.

Gladwell then generalizes the discussion for other kinds of trauma.   People who lose spouses, for example, are taught by bereavement specialists that there is a process they need to go through in order to fully accept the death of a loved one.   Columbia psychologists George Bonanno has subjected this paradigm to empirical scrutiny and found that, while the full range of reactions exists, the most common one is a relatively brief period of grief symptoms, and then a return to normal functioning. 
Daniel Gilbert (one of our other authors) has shown that a we are generally very bad at forecasting our emotional states.   We almost always have an exaggerated expectation of just how bad (or good) we are going to feel after a particular event is imagined. We have what Gilbert likes to call a “psychological immune system” that is designed to protect us from getting too distracted by grief.

The Grief Industry
by Jerome Groopman

Groopman’s article is concerned with the same phenomenon as Gladwell’s, but he approaches it through post-traumatic stress disorder, and the methods that have been developed to prevent it.  Jeffrey Mitchell is credited with developing the standard 7-step method for preventing PTS – critical incident debriefing- which essentially involves confronting and exploring the factual and emotional details of the event in question.  Part of the theory is that debriefing has to occur very soon- within 72 hours – of the event to be effective.  Groopman focuses on the colossal and systematic debriefing effort that followed the WTC bombing, and interviews a travel agent who experienced both the WTC bombing and a debriefing.  
I asked the agent whether he had chosen to attend the debriefing. “Well, they felt everyone should participate,” he said. When he was asked if it had been helpful, he shrugged and said that, like most of his Liberty Street colleagues, he was relatively numb during the debriefing. “Some people burst into tears,” he said. “But the people who were really crying hadn’t even been downtown.” 
At the end of the session, the two counsellors gave telephone numbers to the workers and encouraged them to call if they felt distressed. The travel agent had nightmares for weeks after the debriefing, and often felt as if he were choking. Images similar to the ones he had described during the session would flash through his mind. He didn’t pursue further therapy, though. “I had to take care of my family; they rely on me,” he explained. After several months, he said, the flashbacks and the sense of choking subsided. “You just block it out,” he said. “You have to get on with life.” 
Groopman’s question is whether any of these debriefing systems do any real good. He notes that participants tend to report that the sessions are helpful, but that is highly subjective.  We can not determine by purely introspective methods whether we would have done just as well without it. (It is very difficult to overstate the importance of this point.)  Beyond the subjective reports, there is little evidence that routine debriefing does any good.
Clinical trials of individual psychological debriefings versus no intervention after a major trauma, such as a fire or a motor-vehicle accident, have had discouraging results. Some researchers have claimed that debriefing can actually impede recovery. One study of burn victims, for example, found that patients who received debriefing were much more likely to report P.T.S.D. symptoms than patients in a control group. It may be that debriefing, by encouraging patients to open their wounds at a vulnerable moment, augments distress rather than lessens it.
Noting that the widespread PTSD that was expected after the WTC bombings never materialized, Groopman suggests that the debriefing industry is “predicated on a false notion: that we are all at high risk for PTSD after exposure to a traumatic event.”  Essentially, Groopman and others have concluded that predictions of PTSD tend to be self-fulfilling.  Quoting the Malachy Corrigan, the director of the New York city Counseling Service Unit on the effects of debriefing:
 “Sometimes when we put people in a group and debriefed them, we gave them memories that they didn’t have,” he told me. “We didn’t push them to psychosis or anything, but, because these guys were so close and they were all at the fire, they eventually convinced themselves that they did see something or did smell something when in fact they didn’t.” For the workers in the pit at Ground Zero, Corrigan enlisted other firefighters to be “peer counsellors” and to provide moral support and educational information about the possible mental-health impact of sustained trauma. 
Returning to Gladwell’s war theme, Groopman notes that susceptibility to PTSD has a great deal to do with baseline mental health.  People who do not have a history of mental illness have relatively low rates of PTSD.   A 1996 study of pilots who were prisoners of war in Vietnam, for example and endured years of torture did not have high rates of PTSD.
Groopman notes that an alternative cognitive-behavioral approach to dealing with and preventing PTSD has shown a great deal of promise.  Rather than focusing on exploring the feelings associated with a traumatic event, it slowly helps patients to reprogram their fear and revulsion responses by introducing them back into environments they have become afraid of.  This approach is more effective than debriefing, but also less popular with therapists because it is dry and technical.

Affective Forecasting
by Daniel Gilbert

Edge Video

This short article elaborates the point made above, that humans aren’t particularly good at imagining how they will feel in future situations.  

Actually human beings are the only animals that can think about the future at all, so when we say they aren’t particularly good at forecasting, that just means that we often make bad predictions.  Gilbert points out that the ability to think about the future is one of our most remarkable evolutionary adaptations.  We take it for granted, but the ability to imagine what would happen if we did X, rather than simply do X and find out is what put the most evolutionary distance between us and our closest non human relations.

Gilbert claims that people have a systematic tendency to overestimate the impact of future events, something that he calls the impact bias.  Examples of these are:
•	Voters invariably predict that if their candidate wins they're going to be happy for months, and if their candidate loses they'll be unhappy for months. In fact, their happiness is barely influenced by electoral outcomes. 
•	People predict that they will be very unhappy for a very long time after a romantic relationship dissolves, but the fact is that they are usually back to their baseline in a relatively short time—a much shorter time than they predicted.
•	Professors expect to be happier for years after getting tenure than after being denied tenure, but the two groups are equally happy in a brief time. 

The impact bias has been established beyond reasonable doubt.  But why does it exist?
The answer Gilbert proposes is that we are basically unaware of our ability to adapt to bad circumstances.  When we disparage this ability, we call it “rationalization”.  However, it is extremely useful.  If, for example, your mate dumps you for someone else, you initially think it is the end of the world, but then in a very short time you begin to “see” that this person was never right for you anyway.  Gilbert says:
Soon after a bad event occurs, unconscious processes are activated and these processes begin to generate different ways of construing the event. Thoughts such as "Maybe I was never really in love" seem to come to mind all by themselves, and we feel like the passive recipients of a reasonable suggestion. Because we don't consciously experience the cognitive processes that are creating these new ways of thinking about the event, we don't realize they will occur in the future. 
The specific cause of our bad predictions about our future happiness is the mechanism by which we make such predictions.  Gilbert gives us the example of asking people how they will feel a year after their child dies.  They invariably predict that they will feel horrible, and the reason is that they make this prediction by using mental imagery that conveys that horrible feeling.  For example, they imagine being at their child’s funeral, rather than being at work or on vacation a year later.  Or, as Gilbert puts it:
When we're trying to predict how happy we will be in a future that contains Event X, we tend to focus on Event X and forget about all the other events that also populate that future—events that tend to dilute the hedonic impact of Event X. In a sense, we are slaves to the focus of our own attention. For example, in one study we asked college students to predict how happy or unhappy they would be a few days after their home team won or lost a football game, and they expected the game to have a large impact on their hedonic state. But when we simply asked them to name a dozen other things that would happen in those days before they made their predictions, the game had far less impact on their predictions. In other words, once they thought about how well-populated the future was, they realized that the game was just one of many sources of happiness and that its impact would be diluted by others.
Would it be a good idea to eliminate forecasting errors?
That’s a hard question to answer, because some kinds of systematic errors do have adaptive value.  In general, it seems obvious that our survival depends on more or less accurately representing our environment, but in certain circumstances it can be safer to overestimate danger.  If, for example, 9 out of 10 similar looking kinds of snakes in your environment are benign, while one is deadly, generalized fear of snakes may be an excellent survival strategy.  
Similarly, our systematic tendency to overestimate the emotional impact of future events may be an essential motivator for most of us.  For example, would it be a good thing to have a more realistic view of how the loss of a loved one will affect us?  Would this cause us to treat them less lovingly?
Still, Gilbert shows that it is not really all that difficult to avoid forecasting errors. The best way is to stop relying on mental imagery, and simply ask someone who has already had the experience.  People are actually surprisingly reluctant to do this.  We like to get more information relevant to our decision making, but we tend to think that we are special with respect to the kinds of things we will enjoy:
Try this thought experiment: You're going to go on a vacation to a tropical island. It's offered at a very good price, and you have to decide whether you're willing to pay. You are offered one of two pieces of information to help you make your decision. Either you can have a brochure about the hotel and the recreational activities on the island, or you can find out how much a randomly selected traveler who recently spent time there liked his or her experience. Which would you prefer? In studies we've done that are modeled on this thought experiment, roughly 100% of the people prefer the kind of information contained in the brochure. After all, who the hell wants to hear from some random guy when they can look at the brochure and judge for themselves? 
What’s fascinating is that people make much better forecasts of the future when they use the information from the random guy rather than the fancy brochures.  
(This, btw, is the basis of collaborative filtration.)

Where does happiness come from?
The old adage that money doesn’t buy happiness is only partly correct.  Actually, money does buy happiness up to a point.  Basically, what happiness researchers have found is that money has decreasing marginal utility, with the result that people in our society who make a million dollars a year do not report significantly higher (or lower) levels of happiness than people who make 50,000.  However, people who make 50,000 report much higher levels of happiness than people who make 20,000.
The most powerful predictor of (un)happiness is social networks.  People who live in rich social networks and enjoy good relations with people in those networks reliably report the highest levels of happiness.  This is interesting because most of us spend more time trying to increase our wealth than to enrich our social lives.  This is at least partly due to the fact that our economy depends on production and consumption, activities that are enhanced by unrealistic beliefs about the happiness that results thereby.

Buddhist and Psychological Perspectives on Emotions and Well-Being
by Paul Eckman, et al.

This paper concerns the nature of emotion, and the extent to which emotions contribute to or interfere with out attempts to be happy.  As background, it is useful to know that even though various subjective feelings of pleasure are emotional in nature, much philosophy emphasizes the importance of rationality over emotion in achieving happiness.  In recent years, cognitive psychologists have begun to believe that our emotional and rational faculties are not essentially at odds with each other, and that in fact all rational decision making requires the participation of our emotions to some extent.  In simple terms, while we need our ability to reason to deliberate and plan, we need our emotions to actually do anything.
Traditional Buddhism identifies desire as the source of all suffering, and prescribes a path toward enlightened living which helps people to both grasp this fact and to learn to extinguish desire and gain release from suffering.  Buddhism is not so much different than Christianity in that it denies the importance of the fleeting pleasures associated with worldly desires (dukha) and identifies a more permanent and spiritualized form of happiness that comes as a result of transcending our material nature (sukha).  Sukha is something that is believed to be achievable through rigorous meditative practices aimed at mindfulness and emotional balance. 
The Dalai Lama, who is the spiritual leader of Tibet, is intensely interested in cognitive neuroscience, and his interest has led to a reciprocal interest on the part of psychologists in Buddhist philosophy and practice.
Afflictive Mental States
The basic Buddhist analysis of afflictive or destructive mental states is that it results from trying to hard to achieve positive affective mental states.  
There are also three inherently destructive mental states. 
•	Craving
•	Hatred
•	Desire for permanence and stability
 All of these end up being roughly about the same thing, namely the valuing of the self over all other things. (In Buddhism the idea that there is a permanent self is an illusion.  Christianity captures this idea in its view that pride is the worst of all sins.)

There are some interesting comparisons to be made here.
•	Note that the Buddhist view on pleasure seeking is roughly consistent with what Gilbert has told us about affective forecasting.  People think they are going to be happy by getting a better job, more money, etc., but in fact we only produce momentary fluctuations by doing these things, nothing permanent.
•	On the other hand, cognitive psychology has provided no real support for the view that a more permanent rise in our level of happiness or well-being can be achieved by Buddhist meditative practices.  If this is truly an empirical claim, we should be able to produce evidence for it.
•	Interestingly, however, psychology has never been much interested in inquiring into purely cognitive means for basically functional individuals to become happier.  It has always focused on bringing mentally ill people back to a level of normal functioning.
•	This paper notes that Buddhist meditative practices are specifically designed to counteract craving.  Buddhists see intensely addictive practices (like gambling and shopping) as a manifestation of the desire to acquire things for oneself.  If this is correct then we might expect cognitive practices to be effective at dealing with addictive pathologies.  (Recall that Groopman cites evidence that cognitive therapies have been better than emotional ones at dealing with PTSD, but that they are decidedly unpopular with professionals.)

Emotional Disorders in Evolutionary Perspective
by Randolph Nesse
This paper provides a decidedly different perspective.  Buddhist philosophy is in not inherently inimical to the evolutionary perspective, but it is also not particularly inspired by it.  Hence, Buddhism identifies destructive emotions in relation to their apparent effects on human beings without giving any real thought to why they are there in the first place.  This paper cautions us to realize that most of our emotions arose because they conferred some evolutionary advantage on individuals that experienced them.  It is, of course, quite possible that emotions that conferred a fitness advantage in the past no longer do so now.  However, this is not the sort of thing we can simply assume without knowing exactly what advantage they once conferred.
The most important thing to understand about the evolutionary perspective is that emotions aren’t categorized in subjective terms, by how they feel.  Rather, they are categorized by what they make the organism do.  Fear, for example, might be considered a negative emotion in subjective terms, but objectively speaking it may have quite positive effects.
The Utility of Negative Emotions
Anxiety
Nesse believes that we have a tendency to underestimate the utility of negative emotions.  For example, it is typical to treat anxiety as if it is always destructive.  He notes that people don’t go to psychiatrists because they are experiencing too little anxiety.  However, people clearly can experience too little anxiety, since anxiety is the means by which we are alerted to the need to take care of various kinds of business.  People who are insufficiently motivated to achieve may in fact suffer from experiencing too little of this negative emotion. 
Grief
As Groopman has pointed out, the “grieving industry” is highly invested in the idea that grieving is an essential step in psychological recovery.  This is not based on an evolutionary perspective, however.  The evolutionary value of grieving is not at all clear, and most possibilities are highly speculative.  It may be, for example, that grieving and sadness are special states that help the brain to re-evaluate ones circumstances.  Another interesting suggestion is that grieving is a form of social communication that brings friends and relatives to ones aid in a time of need. 
Depression
It is very difficult to see what good comes of depression, which is characterized by incapacitating lethargy and the desire to do practically nothing.  Nesse and others have noted that depression is typical of people who are involved in failing enterprises.  In evolutionary terms depression may be a crude way of discouraging habitual behaviors that are not producing any tangible advantages.

Parent-Child Conflict
A variety of negative emotions arise in the context of parent-child relations.  Freud’s idea of the Oedipus complex is not clearly inspired by evolutionary considerations, but it can be partially reconstructed in evolutionary terms where limited family resources require that the youth begin pulling their own weight.  Fathers are often the disciplinarians in this regard, and male resentment toward the father together with a longing for the nurturing environment of the mother makes evolutionary sense. 
In this contest Nesse notes that weaning conflicts are well-studied across species and basically arise from the same conditions.  At some point it is in the interest of the mother to have another child rather than to continue to nurse an existing one.  But it is in the existing child’s interest to continue receiving nourishment from the mother.  Hence, the competitive relationship that drives evolution may require negative emotions between even family relations.