Bullying is a truly horrific phenomenon that has a wide array of terrible consequences. One of these terrible consequences is an increased risk of mental health issues and even suicide, for both the person bullied and the person perpetrating the bullying.
But does this mean that bullying actually causes suicide? This is an incredibly complex question. There seems to be a lot of confusion about the relationship between bullying and suicide. News stories focusing on the tragic suicide of young children and teenagers often point to instances of bullying. The focus on these individual stories can easily lead us to believe that there must be a causal relationship between bullying and suicide. After all, we keep reading stories in which bullying occurs and a suicide follows.article continues after advertisement
These deaths are all horrible tragedies, and the bullying these children experienced is unacceptable. But we do have to be careful about how we report on the relationship between these phenomena. When news stories report on a suicide preceded by instances of bullying, the two concepts become inextricably linked in readers’ minds and the conclusion that follows—that bullying leads to suicide—may not be entirely scientifically accurate.
A proper understanding of the relationship between bullying and suicide is essential. If we believe that bullying is a sole cause of suicide, then we might spend a lot of time and effort on bullying prevention strategies as suicide prevention, only to find that bullying is only one of many factors that increase suicide risk and a focus on bullying alone is not enough to avert more suicides. In other words, our focus may become misplaced and we may ignore other important causes that must be addressed in order to truly lower the risk of suicide.
Focusing only on bullying as the cause of suicide also implies that a young person’s suicide is entirely the fault of his or her schoolmates. Instilling guilt in children following the death by suicide of one of their classmates is not an acceptable approach to dealing with the aftermath of a suicide or of preventing future suicides. Stopping bullying is essential, but blaming children for an acquaintance’s death is not the proper approach.
So what do we know about the relationship between the two? As stated earlier, we do know that involvement in bullying, either as a victim or a perpetrator, raises the risk of suicide. In addition, even witnessing bullying can lead to feelings of helplessness and poor school connectedness, which can be a risk factor for mental health issues (although it is not a sole cause). On the other hand, most youth involved in bullying do not display suicidal behavior, even though bullying may be one of many risk factors of suicidal behavior.article continues after advertisement
It’s always important to keep multiple risk factors in mind when talking about suicide. Saying that bullying is a sole cause of suicide is not only incorrect but can even be harmful. This is because such a “single-cause” mentality perpetuates the notion that suicide might be an understandable and acceptable response to bullying. In addition, this kind of thought process can lead to sensational reporting, which we’ve already seen in several instances noted above. It also takes attention away from other important risk factors that are less “sensational” and less easily reported on, such as mental illness, substance abuse, poor coping skills, and family dysfunction. Yet these risk factors deserve just as much attention as bullying and must be central components in any adequate response to suicide risk. For all these reasons, it’s absolutely essential that we not overstate the relationship between bullying and suicide. There is of course a relationship, but it is not what we may be led to believe by much of the media coverage on the topic.
Despite all of this, it is still of course the case that bullying does happen and is a risk factor for mental health issues and even suicide. Given all this, it is essential that schools do everything they can to reduce the incidence of this damaging behavior. What should schools be doing to prevent and respond to bullying? There are several strategies schools can employ that help with both stopping bullying and improving students’ mental health. For example, universal programs that increase school connectedness are effective for both bullying prevention and enhancing mental health in schools. Teaching coping and life skills, including resilience and tolerance of others, can also be effective for both bullying prevention and mental health promotion. Schools should put comprehensive policies and anti-discrimination rules in place, form a committee to review and update them regularly, and ensure that these rules are being enforced in a way that’s obvious to students and their families. Since students with different genderor sexual orientations and from different cultural backgrounds are more likely to be bullied—and to have higher risk of attempting suicide—school staff should be taught about vulnerable populations and how to protect them.article continues after advertisement
Perhaps most importantly, schools must show that they are taking every incidence (including cyberbullying outside of school) extremely seriously and remaining consistent in their response. If the response is not clear and consistent, students lose trust in the school and their sense of connectedness can erode. Working on the whole school climate is essential: A positive school climate can create broad protective factors for students that help with both bullying and suicide prevention.
The mantra that “association is not causality” cannot be repeated often enough because in instances like the connection between bullying and suicide it is persistently ignored. Journalists must be taught to take greater care in how they report on correlations between two phenomena so that their readers do not infer that one is the direct and unique cause of the other.
With the relationship between bullying and suicide remaining complex and in some ways unknown, it is essential that schools not focus narrowly on bullying prevention as a sole means to prevent suicide. Rather schools should be focusing more broadly on helping students build and cultivate protective factors. These kinds of interventions hold the greatest promise for building a foundation of resilience among young adults everywhere.Psychology Today
It first happened in the fall of 1978, during a meeting of the psychology department. The professors were engaged in a full-fledged fight—yet again—and all I wanted was for them to stop.
Suddenly, I felt I was going to pass out. My heart was racing so fast I couldn’t count the beats. Something in that awful fighting had triggered an anxiety attack the likes of which I’d never felt before. As I tried to come up with a plan for escape, the room suddenly quieted and looked at me.
I opened my mouth but no sound came out. My eyes darted helplessly around the room, taking in the horrifying sight of so many others looking at me. I struggled to breathe.article continues after advertisement
After what seemed like ages (but was probably only 10 or 15 seconds), the perplexed group went back to their fighting as I was left still clutching my chair, opening and closing my mouth like a fish out of water, having never uttered a sound.
Unfortunately, my experience with anxiety is not unusual. Anxiety disorders are among the most common forms of mental struggles, with nearly 40 million adults being affected each year in the U.S. (that’s roughly 20%).
If you are reading this and suffer from anxiety, let this be a reminder that you are not alone. In fact, every third person you ever meet is going to suffer from anxiety at some point in their lives.
Acceptance and Commitment Therapy (or ACT in short) and other evidence-based treatments offer valuable tools and techniques to effectively deal with all forms of anxiety. But while anxiety disorders are highly treatable, only 37% of those affected receive treatment.article continues after advertisement
That is just not good enough.
There seems to be a widespread false notion about what anxiety is and what can be done about it. And apparently, the answer for most people is “nothing”.
“Nothing can be done about anxiety. You either have it, or you don’t. And if you have it, there’s not much you can do about it. This is how it has always been, and this is how it will always be.”
This notion is not only wrong, but it’s also dangerous because it leads millions of people to needlessly suffer without hope for betterment. As a psychotherapist who has treated countless of people with anxiety over the past decades, and as someone who has personally struggled with panic disorder for many years, I knowthe role of anxiety in our lives can lessen. The burden can be lightened and anxiety can assume its more proper role of warning us against real danger.
To change the unhealthy role that anxiety sometimes plays we need to learn how to address anxiety in day-to-day situations, so instead of running from our fear, we can face panic situations head-on. And in order to learn how to do just that, we first need to talk about baseball.article continues after advertisement
How To Deal With An Anxiety Attack
Step 1: Let Go of Rules
Suppose you want to learn how to play baseball. It’s useful to learn the basic rules before you get on the field, like how the game is played, and how points are scored.
However, once you are on the field, relying on the rules no longer helps you. It doesn’t help you to think about “how to hold a bat”, or “at which specific angle you need to take a swing” while you are facing the pitcher. The more you engage these analyses, the more likely you are going to miss the ball because you are too caught up in your own head.
You can try this out at home right now. Stand up and walk across the room, but with every single step think hard about the exact rules of walking. How do you lift your feet? In what order? And which part of your sole touches the ground first?
The more you focus on the “right” rules of walking, the more unstable your walk is going to be. And this is exactly what it’s like dealing with anxiety.
It’s useful to learn the basic processes first about what anxiety is, and how to effectively address it. However, once the anxiety sets in, focusing on the “right” thoughts and actions will not help you. In fact, entertaining these thoughts will keep you stuck in your own head and further pull you into your anxiety.
Dealing with anxiety is not a matter of following a specific set of rules. The rules can at best bring you to the edge. Instead, effectively dealing with anxiety requires you to let go of these rules and allow yourself to have “imperfect” thoughts and actions, so you can put your attention where it matters.
Step 2: Embrace Opportunities to Practice
When we are struggling there is often an “oh no” quality to the flow of events. “Not now”, “not again”, “this is too much”, “why me”, or “when will this end”. It’s as if some moments belong and others don’t, and we are winning when we get the “good” ones, and we are losing when we get the “bad” ones.
In actuality, however, all moments belong. All moments are opportunities for growth, especially hard ones. When else can we work on dealing with difficult thoughts and feelings?
We can practice the skill of dealing with anxiety through meditation, therapy, or workbooks. But ultimately, the best place to practice these skills is in the context of anxiety itself.
We can practice in the context of a small anxiety storm, such as when we’re stuck in traffic. We might then notice judgments of others, a childish pull to throw a tantrum, rising emotions, and physiological reactions. And while we notice this inner struggle, we also notice that there’s more going on in the present moment.
We hear the sound of the song on the radio, and we notice the children in the car next to us. And we recall that we are going somewhere and that being stuck in traffic is part of this bigger journey.
As those smaller moments are mastered, we can even practice in the context of a large anxiety storm – perhaps when experiencing waves of anxiety right before standing to speak in front of a group. This, again, is an opportunity to notice what comes up.
We notice the familiar cacophony in our head, the pull to run away as if we could run from our own bodies. We feel the beats of our heart and the sensations of our physiological reactions.
And we notice something more than just ourselves. We see the faces of the human beings in front of us, and we recall that we stood up on the stage to say something in the service of others. We direct our attention to what we came to do and let go of all the rest even as it thunders on.
Gradually, gradually, we can learn what to do inside the storms, small, medium, and large. Bring on “not now” or “not again” or “this is too much”. They are just thoughts to notice. Bring on sensations. They are but your body reacting. And bring on life. Successfully dealing with anxiety comes down to practice, and whenever difficult thoughts and feelings come along, you find yourself in an ideal opportunity to practice.
Step 3: Meet Your Anxiety With Curiosity
Would it be possible to be genuinely interested in your experience of anxiety? I mean really genuinely interested?
You can learn to explore your anxiety, without having to run from it. You can even set limits on the time and situation, by making a commitment like this:
“I am going to go to place _____ where I will likely have an anxiety attack, and I will stay there for _____ amount of time.”
And then go there with no secret outcome in mind. None. Your goal is NOT to have any less anxiety. Your goal is NOT to feel it so often that something different will happen.
Instead, go there out of genuine interest in what this anxiety even IS. Stay present with yourself and look carefully, with an attitude of genuine interest, curiosity, and openness at your own experience. Like a scientist discovering a new planet … or when you were a small child looking at the clouds.
Exactly what thoughts show up? Note them. Name them. Watch them. What bodily sensations? Where do they begin and end? How do they ebb and flow? What emotions to feel (watch closely and name each — there are far more than “anxiety”!) What are you pulled to do?
If you are not sure you can do this, set the timer so short that you are 100% sure. One minute. Or even just ten seconds.
You can evaluate how you did by this standard: Were you psychologically present, and were you open to what came up? Not passively open like “I can tolerate this”, but really curious and open. Like a little boy playing with a weird bug. A sure measure is this: Are you now more or less willing to do it again?
If you can do it for ten seconds, can you do it for one minute? If you can do it for one minute, can you do it for ten minutes? If you can do it at the drugstore, can you do it in the mall?
Painful emotions, difficult thoughts, odd sensations, unwelcome urges — none of these are 100% under your control. Sufficient force can take away your behavioral control. You can lose your freedom; you can lose your comfort. Only a few things are under your absolute control. What do you care about and will you choose to be present or not to your own experience? Those are things no one can take away, so long as you are conscious.
Don’t give it away. Don’t let your anxiety fool you into thinking that you have to give away your presence and caring. Only you get to choose those parts.
The anxiety may go away or it may not. What matters is whether you will show up to your own experience and restart doing the things you care about but stopped doing because of anxiety. Walking that walk is how you regain your ability to say “yes” to life. When you learn how to do that, your anxiety is no longer in charge. You are.
In the United States, there are record amounts of single people. According to the 2017 Census data, there are more than 110 million adult single Americans. All over the world, people are opting for the single life as the cultural and societal norms of society have shifted, the economic incentive to get married has declined, and individualistic values rose.
But the rise of singlehood has tackled criticism: society teaches us that married people have someone to help them and support them in time of need, while single people are lonely.article continues after advertisement
However, a mounting amount of research shows that this is a myth. Being happy is not about being married but rather about having strong social relationships. William Chopik, a Michigan State University professor, conducted a study with more than 270,000 people in about 100 countries. He found that among people aged 65 or older, meaningful friendships were stronger indicators of health and happiness than familial relationships. As people age, friendships become increasingly more important for people’s health. Chopik found that single seniors (either divorced or never married) who have good friends are just as happy and healthy as married people. This is while familial relationships can be beneficial, but they sometimes come with difficulties and hectic interactions.
Maybe it will surprise some, but friendships are something that singles excel in. Recent studies show that singles have more friends and are better at maintaining their friendships than married people. In contrast, married couples tend to spend a majority of their time with their partner, and often leave friendships behind.
A 2015 study conducted by Natalia Sarkisian and Naomi Gerstel discovered that “being single increases the social connections of both women and men.” Not only do single people have more friends, but they are also better at maintaining their friendships. In contrast, when people get married, they tend to leave their friends behind. Sarkisian and Gerstel concluded that single people are more likely to keep in contact with and receive assistance from friends, family, and neighbors than those who are married.article continues after advertisement
Another research shows that on average, people in a committed relationship tend to lose two close friends. Both married and exclusive couples tend to spend the majority of their time with their partner at the expanse of spending time with friends. Oftentimes, marriages have a negative impact on people’s relationships with other people.
In turn, friendships have a strong and positive impact on singles. A 75 year Harvard human happiness study found that the best indicator of happiness is good social relationships. Another study conducted in the UK found that 45-year-olds with 10 or more friendships had higher levels of psychological well-being and happiness at age 50 than individuals with fewer friendships. Happy Singlehood shows that it all sums up to an advantage that singles hold.
No doubt, multiple studies show the benefits of having friends. Humans need friendships, but they no longer necessarily need marriages and relationships to be happy. Once people begin to stop questioning “why they are single” and embrace and take advantage of their singlehood, they will reap the benefits of being single. Perhaps it is time to fully eradicate the idea that single people are miserable and lonely. Single people can and do live their happily ever after.
The concept of the psychopath in the boardroom gained support from research suggesting that leaders become leaders through their ruthlessness, fearlessness, and ability to dominate. People high in psychopathy are known for their tendency to push anyone aside in their need to become all-powerful. What separates CEOs or politicians from the criminal, according to this view, is their ability to avoid engaging in overt antisocial behavior so that they don’t actually get arrested. They lack empathy, are willing to exert brute force to get their way, and have no regrets over actions they’ve taken that have hurt others. Perhaps you or your partner has a boss who has a strong mean streak and who has no qualms about trying to make others appear weak and inferior. It seems that all this person cares about is stepping over everyone else and doesn’t mind leaving a trail of hurt and angry supervisees in his or her wake.article continues after advertisement
According to University of Alabama’s Karen Landay and colleagues (2018), in an article fittingly titled “Shall We Serve the Dark Lords?” the claims that corporate leaders lack a moral compass, as reflected in psychopathic traits, is overblown. The story that has developed around this notion is an appealing one, giving it traction in the popular and professional literature regarding the “successful psychopath.” However, as Landay et al. believe, the story leaves out important details.
The important distinction that Landay and her collaborators believe is ignored is between leadership emergence and leadership effectiveness. People high in psychopathy may wish to become great leaders due to their desire to dominate others, but they may not be all that good should they actually make it to the top. Think about that mean boss. Do you really want to work for such a person? Wouldn’t you try to the best of your ability to sabotage his or her goals? Aren’t you always spending every available coffee and lunch break hatching plots with your coworkers as you fantasize various whistleblower scenarios? How, then, could such an individual be an effective leader? The only way such individuals could get to the top would be if they can either fool their own bosses into promoting them or perhaps, more diabolically, use tactics such as blackmail involving threats of ugly lawsuits should they be let go.article continues after advertisement
Landay et al. note that there are several distinctions necessary to make that previous studies have not sufficiently taken into account. First is that idea the psychopathy is not a unitary construct. Although some measures of psychopathy use a single factor score, other researchers advocate looking at psychopathy as a multifaceted quality consisting of interpersonal dominance (boldness), impulsivity (disinhibition), and meanness (lack of empathy). Another related part of the psychopathic equation is manipulativeness, allowing such individuals to appear charming and friendly as they step all over everyone else to make their way up the ladder. Furthermore, leadership emergence is not all that easy to define. Individuals may be promoted to positions of increasing prominence, but only be around for two or three years in those jobs. Perhaps their employers became fed up with them and they left before they could be fired. Leadership effectiveness is not all that clearly defined either. Are you an effective leader because other people like you and want to work for you, or because you have a firm view of the organization’s bottom line? You may behave horribly to everyone in, for example, your volunteer group, but somehow your group manages to secure the most donations for the cause.
Apart from methodological and definitional issues, Landay and her colleagues suggest that gender might play a role in the psychopathy-leadership relationship. After all, it is well known not only that women are less represented in top echelon positions, but that they are rated as less effective in the qualities of dominance needed to make it to those higher levels of prominence. Women cannot show the same “dark” behaviors as men and expect others to see them as good leaders.article continues after advertisement
After scouring the potential literature for published and unpublished studies that met their inclusion criteria, Landay and her fellow researchers were able to obtain 92 independent samples with data on leader emergence, informal leadership, effectiveness, and finally “transformational” leadership, or the type of leadership that inspires followers based on high ethical standards. The research team was interested in testing not only the psychopathy-leadership relationship for men and women but also to test the possibility that a moderate amount of psychopathy would be the most predictive of leadership qualities.
Based on this large repository of empirical data, the research team discerned only a weak positive relationship between psychopathic traits and leadership emergence, and a weak negative link between psychopathy and effectiveness. As you might expect, individuals high in psychopathy also had low scores on measures of transformational leadership. Interestingly, when subordinates rated their bosses, the psychopathy-transformational leadership relationship was lower than when people rated their own psychopathy. However, when gender was added to the mix, the picture shifted considerably. Psychopathic women did not emerge as leaders, but psychopathic men did. Similarly, in ratings of effectiveness, women high in psychopathy were negatively rated but men were positively related. Thus, the overall psychopathy-leadership relationship seemed to depend heavily on the gender of the leader. Finally, some degree of psychopathy seemed to benefit leaders in all aspects of leadership, including transformational.
The authors concluded that, when put under the scrutiny of an empirical test made across multiple investigations, there is substance to the fear that people with psychopathic tendencies are indeed more likely to emerge as leaders. The effect, though small, is “potentially important in practice” (p. 8). However, more is not necessarily better, as it was only when individuals had moderate levels of psychopathic traits that they were more likely to become leaders, more effective, and even transformational. The story is different for women, however, for whom psychopathy seems to backfire as a personality trait to bring into the workplace. At home, women may express their psychopathic traits not as antisocial behavior but as emotional outbursts, perhaps due to feeling thwarted at work.
To sum up, there’s no direct one-to-one relationship between psychopathy and the attainment of leadership in an individual’s organization. Women have a tougher time than men if they show these qualities, and even highly psychopathic men are likely to experience pushback when they try to claw their way to the top. Being a little bit nice may actually go a long way in progressing to the positions in life you most desire.
Landay, K., Harms, P. D., & Credé, M. (2018). Shall we serve the dark lords? A meta-analytic review of psychopathy and leadership. Journal of Applied Psychology. doi:10.1037/apl0000357.
Wouldn’t it be great if you could automatically read the emotions of the important people in your life? How nice to know, without their telling you, whether they’re sad or happy, scared or calm, angry or pleased. You could adjust your own reactions to their feeling state without having to exchange a word, and you would almost never have to deal with the misunderstandings that occur when people get confused about each other’s feelings. It is true that the better you know someone, the better able you are to decipher their facial cues, but this is not always a guarantee, even if you’ve lived with your partner for years.article continues after advertisement
The ability to detect emotions remains one of the most fascinating areas of research on interpersonal relations. Because there is no completely direct pathway from emotions to facial cues and then to the interpretation of those cues, researchers must devise clever ways to trace these complex connections. New technologies in the lab are making it possible to present endless variations on the basic human expressions with stimuli designed to overcome the traditional limitations in which a flesh-and-blood face’s attractiveness is confounded with that person’s facial expressions. People can be created via computer graphics as abstract images so that the experimenter manipulates only the most relevant features that contribute to the way that participants interpret that face’s emotions.
Anderson University’s Robert Franklin, Jr., and colleagues (2019) noted that “the face gives people their best glimpse into the otherwise invisible mental and emotional processes that occur in others’ minds” (p. 209). Moreover, getting this glimpse is important, because “emotions convey functional information about others’ probable behavior toward a perceiver,” or “behavioral forecasts.” In other words, if you want to know what the person you’re dealing with is going to do, you’ll get the most information possible from that person’s facial expressions. The two cues that seem most germane to predicting people’s behavior, Franklin et al. argue, are what they call angularity and roundness. Angularity is a predictor of anger, they maintain, and roundness suggests joy.article continues after advertisement
Think now about what your face does when you are angry. You feel your eyebrows point downward into a frown, and you may even turn the edges of your mouth downward too. Conversely, when you’re feeling happy or pleased, the lines in your face soften as you allow everything to relax. Your eyes may crinkle when you smile, but your eyebrows look less like arrows and more like commas. Moving beyond just what your face does, however, Franklin and his colleagues cite previous research supporting the idea that negative emotions, in general, are associated with lines and jagged edges, but that positive emotions are associated with curves and circles. Angularity is associated with the threat, they point out, and roundness with safety.
Moving on from the association between threat with angularity and safety with roundness, the downward-facing V of the eyebrows of the angry person plus the X-shaped angry mouth would signal that you’re under threat. You’d regard the softer curves of the happy person as suggesting that nothing bad will happen to you.
To test the idea that facial angularity signals anger and roundness signals joy, Franklin and his fellow researchers designed computer-generated stimuli of faces that blurred everything except the abstract angularity or roundness cues. An “X” shaped face, then, has downward-facing eyebrows and downward-turning edges of the mouth. A diamond-shaped face has as eyebrows the inverted “V” and as a mouth a smile that roughly fits the “V” pattern. The preliminary pilot findings showed that by superimposing these angles onto actual human faces depicting differing emotions, the faces intended to show anger fit indeed matched the “X” pattern, and those intended to show joy fit the diamond shape.article continues after advertisement
With this connection between angularity/roundness and anger/joy established, the research team then presented a sample of 33 undergraduates with a set of eight faces (four male and four female) showing either angry or joyful expressions. In one set of faces, the outward lines were filtered out, and in the other, the inward lines were filtered. The test of the hypothesis involved asking participants to rate the expressions shown in these faces, with the expectation being that participants would perform emotion judgments more quickly when the lines that were filtered matched the emotion depicted in the face. People took longer to judge the emotion of anger when some lines showing roundness were left in the filtered picture, and longer to judge joy when they could still see the X-shaped lines in the faces they were judging.
The final investigation tested how angularity and roundness would affect the judgments made of neutral faces. Using, once again, an undergraduate sample, the researchers were able to establish that even when the face in the picture had no overt expression, filtering the images to accentuate angularity or roundness led participants to interpret the emotions like anger or joy, respectively.
From a theoretical perspective, the authors note that there could be adaptive reasons that people associate angularity with anger and roundness with joy. Returning to the idea that angularity poses a threat, Franklin and his collaborators suggest that these cues may be learned early in development. Angular — i.e., sharp — things hurt, but round things (for the most part) do not. You could drop a stone on your toe, and that would hurt, but you’re less likely to tear your skin with a stone than with a twig. Another possibility is that because round faces look younger and more babyish than angular faces, which reflect greater age and maturity, people feel less threatened by them. You are also more likely to regard as “cute” the soft, round features of a baby or young child. That image of “Hello Kitty” is one that people are drawn to for similar reasons.
To sum up, the findings have two implications. First, when you’re looking at other people’s faces, those V’s and X’s signal whether you’ve made them angry or happy. Second, look at your own facial expressions. Are you inadvertently looking angry when you really feel pleasure? Finding fulfillment in relationships with others relies heavily on the expression and reading of emotions. The Franklin et al. study shows how those emotions play out on your chief signaling device — your face.
Franklin, R. G., Jr., Adams, R. B., Jr., Steiner, T. G., & Zebrowitz, L. A. (2019). Reading the lines in the face: The contribution of angularity and roundness to perceptions of facial anger and joy. Emotion, 19(2), 209–218. doi: 10.1037/emo0000423
I was a young doctor in 1990 when I met a patient with rheumatoid arthritis. Mrs. P told me quietly but in no uncertain terms that she ticked all the boxes for a diagnosis of co-occurring depression. When I reported this to the senior physician in charge of her case, he said: “Well, you would too, wouldn’t you?” and changed the subject. He meant that her mood was obviously a reasonable reflection on her current state of disability and a future of inexorably deteriorating health and mobility. Mrs. P was “understandably” depressed because she was thinking about, and ruminating on, what it meant to have an inflammatory disorder. And so there was nothing we physicians could do about it. It was a matter of the mind, not of the body—the province of psychiatry.
Mrs. P’s symptoms, which were intimately interconnected in her lived experience of arthritis, were split apart by doctors into mental and physical symptoms. Having diagnostically divided Mrs. P in two, we proceeded to treat her physical disease—her swollen joints—in completely different and disconnected way from her mental illness—her depression and fatigue. We used the medical language of immune cells to treat her inflammation, and a different team of doctors, in a different hospital, used the language of serotonin and psychotherapy to treat her depression.
Depression is a widely used word of many meanings. The mainstream clinical sense today is similar to what the ancient Greek physicians called melancholia—a syndrome of sadness or low mood, low energy, reduced capacity for pleasure (or anhedonia), reduced appetite for sex and food, pessimistic anticipation of the future, guilty rumination on the past, and a strongly self-critical bias in thinking that can lead to self-harming or suicidal behavior.article continues after advertisement
No question, it’s depressing to be sick. But what if depression were not strictly a disorder of the mind? The notion that Mrs. P might be depressed because she was inflamed—not because she was thinking about being inflamed—did not cross my mind in 1990, and such an idea would have been medical bonkers even if I had been clever enough to conceive of it back then.
But the notion is very much a matter of investigation today, a centerpiece of the burgeoning science of neuroimmunology. And it not only reflects a new way of looking at the disorder but also promises new ways to treat it, to track it—even new measures to prevent it among those whose life experience puts them at risk for developing it.
A New Path to Pathology
Epidemiological data put the prevalence of depression at approximately 10 percent among the general population and significantly higher among patients with rheumatoid arthritis (25 percent), inflammatory bowel disease, psoriasis, chronic lung disease, or any number of other inflammatory or autoimmune disorders. Advocacy groups, like the National Rheumatoid Arthritis Society in the U.K., highlight psychological symptoms such as depression, fatigue, and “brain fog,” as key areas of unmet need for many patients who have a physical disease.article continues after advertisement
Establishing that depression can be caused by inflammation somewhere —anywhere—in the body demands much evidence. But it also requires more: a radical shift in mindset, because it overrides one of the distinguishing features of Western thinking—the deep fault line that separates ideas about the workings of the body from those about the workings of the mind.
Photo by Peter Hapakarticle continues after advertisement
Even now, in 2019, Mrs. P’s experience is not uncommon. Many patients with inflammatory disorders consult well-meaning specialist physicians, like rheumatologists, who may recognize the symptoms of depression but don’t feel that they know how to treat them—or understand how they are linked to the swollen joints that they do feel qualified to treat. Physicianly disengagement from psychological symptoms is not surprising in view of the mind-body split of Western medicine, but it is surprising given that most physicians have some first-hand clinical experience of the mood-boosting effects of anti-inflammatory drugs.
Steroids are among the most powerful anti-inflammatory drugs available. They mimic the effects of cortisol, the body’s own anti-inflammatory hormone, in counteracting the influence of immune activators called cytokines. Steroid treatment is well known to cause rapid and dramatic improvements in mood and energy (although such effects are generally not long-lasting, and chronic steroid use can be associated with depression and psychosis).
Antibodies against cytokines—one type is marketed as Remicade—have been a dramatic advance in the treatment of inflammatory disorders in the last 15 years. They very selectively target and disable inflammatory hormones and often have an antidepressant effect—called “the Remicade high”—within a few days of treatment.
An antidepressant effect of anti-inflammatory drugs in patients with comorbid depression—that’s exactly what you’d expect if their depression was directly caused by their inflammation. But it is not usually explained that way. Instead, the Remicade high is seen as a placebo response: The patients would have been equally uplifted if they thought they were getting Remicade but got an innocuous substitute.
Placebo-controlled, randomized trials of anticytokine antibodies in patients with arthritis, psoriasis, and inflammatory bowel disease have often demonstrated mood improvements. But it has still been argued that the mental health effects of anticytokine antibodies are a psychological reaction to their physical health benefits: Patients are less depressed because they have less joint pain and swelling and easier mobility. One way or another, the antidepressant effects of anti-inflammatory drugs in comorbid depression have been explained away as a function of the disembodied mind.
The Berlin Wall in the Brain Is Crumbling
Until relatively recently, the brain was considered to be “immune-privileged”: The immune system couldn’t get at it. The brain was protected behind the blood-brain barrier, formed by tight packing of the endothelial cells lining the blood vessels in the brain—and understood to be about as permeable as the Berlin Wall.
The wall in Berlin has since been broken through, and so too has the blood-brain barrier. It is increasingly clear that there are many channels of communication between the immune system and the nervous system. It is no longer absurd to think that they talk to each other; in fact, it is obvious that they do so all the time, and with significant implications for our health and survival in a hostile and competitive world.
The new science of neuroimmunology posits that the inflammatory response of the immune system includes changes in the way the brain works, leading to a behavioral response. Just as inflammation often causes an increase in body temperature, so it can often cause a decrease in energy levels and in pleasure-seeking behaviors.
Animal experiments show that if a rat or a mouse is infected with a germ, its behavior changes. It becomes less active, as if less energetic and less sociable, and demonstrates less of a positive preference for sweetened water, as if it found sweet taste sensations less pleasurable than usual. This syndrome, resembling the behavioral features of depression, is called illness or sickness behavior. It is seen in a wide range of species, including Homosapiens. Sickness behavior is not directly triggered by the infectious germ, but by the immune response to it. A rat injected with cytokines will typically show the same sickness behavior as a rat infected with germs.
Photo by Peter Hapak
Cytokines can pass through the blood-brain barrier quite easily, it turns out. There are big enough gaps between the endothelial “bricks” lining the walls of the blood vessels to allow proteins like cytokines to diffuse from the blood into the brain. Even white blood cells, the circulating immune cells, can be actively assisted to squeeze past the endothelial cells and enter the brain. And there are other channels of communication, like the vagus nerve, which is sensitive to changing cytokine levels in the body and can send electrical signals directly into the brain.
It’s Depressing Being Inflamed
Depression is a common complaint of those with inflammatory disease, but among patients with major depressive disorder (MDD), it’s not so clinically obvious that there’s a link to inflammation. Confusingly, by DSM-5 definition, MDD can’t be diagnosed in patients with a major inflammatory disorder. But studies starting in the 1990s have consistently found that levels of inflammatory proteins—including one known as C-reactive protein (CRP), as well as cytokines—are significantly increased in patients with MDD compared to healthy controls.
The difference in blood levels of inflammatory proteins between MDD patients and controls is not large, compared to the much higher levels of such proteins in patients with arthritis. And not every patient with MDD has cytokine or CRP levels outside the normal range. About a third of patients with MDD also have low-grade inflammation. There are many possible interpretations of this persistent fact: It could mean that depression causes inflammation, that inflammation causes depression, or that both are caused by some third, confounding factor.
If inflammation causes depression, we would expect to find evidence that it occurs first. Several studies have assessed patients repeatedly over time and confirmed that inflammation can indeed predict depression.
In southwest England, 14,000 people born in 1991 were repeatedly assessed from birth to study normal development. Nine-year-olds with blood cytokine levels in the upper third of the distribution had significantly increased rates of depression at age 18. Another study, of British civil servants older than 50, found that those who had higher levels of CRP but were not depressed when first assessed in 2004 and 2008 had significantly higher rates of depression when reassessed in 2012. In both cohorts, inflammation preceded depression by several years.
Other studies have investigated the sequence of events over shorter periods of time. For example, patients with hepatitis who were not depressed before receiving antiviral treatment with a cytokine called interferon had significantly increased risk of being depressed about six weeks after treatment. And healthy young people who were studied after a placebo injection and again after a typhoid vaccination experienced relatively mild and fleeting depressive symptoms 48 hours after vaccination. A clinically administered inflammatory shock like interferon treatment or a typhoid vaccination can predict subsequent depression over time periods ranging from days to decades.
Inflammatory precedence in time is compatible with inflammation’s causing depression but not conclusive. It’s still not understood how an inflammatory signal in the blood triggers changes in the brain that could, in turn, cause the mood and behavioral changes of depression. Animal experiments indicate that such a chain of events is conceivable in humans, but it is much trickier to measure the status of immune cells or nerve cells in the living human brain than in the rat brain.
Brain-scanning methods, like functional magnetic resonance imaging (fMRI), show that MDD patients with higher levels of CRP in their blood have reduced strength of connectivity between components of the brain circuits or networks known to be important for emotional processing and mood disorders. Peripheral inflammation, occurring in far-flung parts of the body, disrupts the coherent function of the emotional brain in depression. Marvelous though fMRI is, it cannot provide information about individual nerve cells or tell us anything specific about the inflammatory status of the brain’s immune cells. In fact, there is no good way of measuring human brain inflammation at the moment; it is one of the current roadblocks to working out exactly how inflammation of the body begets inflammation in the human brain, which in turn begets changes in mood and behavior.
Sparked by Stress
There are many possible sources of inflammation that could cause MDD in a patient. The immune system is responsive to many internal and external factors that can influence its state of inflammation. For example, cytokine levels increase in winter months and decrease in the summer. Aging and postmenopausal hormone changes are associated with increased inflammation. Obesity is strongly correlated with inflammation—fatty tissue is rich in macrophages. All these factors and others known to increase inflammation are also known to increase the risk of depression.
But the most significant source of inflammation causing MDD is likely stress. Social stress is the single biggest risk factor for depression. Major life events like bereavement, divorce, and loss of employment, as well as burdensome adult social roles, like caring for a dependent loved one, increase the risk of depression weeks, months, or years later. Childhood stresses, like early separation from parents, are also predictive of depression decades later.
Intriguingly, there is growing evidence that the relationship between stress and depression could be mediated by inflammation—that stress causes inflammation, which in turn causes depression. In a large long-term study of a birth cohort in New Zealand, children who had experienced abuse or adversity by age 8 had increased levels of inflammatory proteins in their blood at age 21. A study of stressed and resilient teachers found that the burnt-out teachers produced more cytokines than the resilient ones—and all the teachers pumped out more cytokines within an hour of the acutely stressful task of public speaking. There is much more evidence of stress causing inflammation in animals.
Photo by Peter Hapak
Why Does the Immune System Make Us Depressed?
Like all “Why?” questions in biology, the answer goes back to Darwin. There must be some way depressive behavior as part of the inflammatory response boosts our fitness for survival.
It is not glaringly obvious that depression is good for survival or reproduction. Patients with MDD are typically poorer, have fewer stable partnerships and children, and have lower life expectancy than the nondepressed. In the British National Health Service in 2016, serious mental illness—MDD, bipolar disorder, schizophrenia—cut life expectancy by 12 years. Clearly MDD has not been selected because it makes us fitter to survive in the 21st century. But depression-like behaviors in response to inflammation could have helped our ancestors survive in the distant past, when they were much more vulnerable to infectious disease.
Reduced energy and activity might have conserved energy to fight infection. Social withdrawal might have protected the “patient” from competitive stress and protected the rest of the tribe from the possibly contagious infection. Anxiety and interrupted sleep might have made a patient more vigilant, less vulnerable to opportunistic predation.
It could even be that our ancestors evolved to become inflamed not just in response to infection but in anticipation of the threat of infection. Social situations like conflict or competition for resources, which would likely lead to violence and trauma—with a high risk of infection—could have triggered a preemptive inflammatory response, including sickness behavior.
If so, the genes that increase the risk for MDD today should include genes that produce cytokines or other proteins of the immune system. Ideally, the genes would control the behavioral response to inflammation and infection in animals and humans. Unfortunately, our understanding of the genetics of depression is not this advanced—yet.
We do know that depression runs in families and is genetically heritable. Not until 2018 were the first really solid data published identifying 44 “genes for depression,” although collectively they account for less than 10 percent of the total risk for MDD. The work of gene discovery for MDD has been slow because, it turns out, there are likely thousands of genes involved, each having a tiny effect. And scientists must look at DNA from very large numbers of patients and controls to spot the significant MDD genes from among all the other genes on the genome.
Now that we have DNA from hundreds of thousands of patients, we can identify with certainty some of the genes linked to MDD. Many are genes that code proteins in the brain; some are genes related to the immune system. The single gene most strongly associated with MDD—called olfactomedin 4—is known to control the inflammatory response of the stomach to infection. This is the kind of thing you might expect if the evolutionary explanation is to be believed. But it will require much more rigorous analysis of the data to be sure.
One Size Does Not Fit All
What difference could it make to treatment and prevention if further research continued to validate and refine the idea that depression can sometimes be caused by inflammation?
One obvious innovation could be the use of anti-inflammatory drugs as antidepressants for patients with MDD and comorbid depression. Many clinical trials of anti-inflammatory drugs have served up circumstantial evidence of antidepressant efficacy. But far fewer effectiveness. There have been a handful of small studies of nonster-oidal anti-inflammatory drugs for the treatment of MDD, but when all the data are analysed, there’s no clear evidence that they work as antidepressants.
Still, the studies suggest something potentially important—not to get overexcited about the prospect of a panacea. The history of antidepressant drug development has been dominated by the search for a magic bullet that will work for everyone with depression. The antidepressant drugs already available, like Prozac and related serotonin-tweaking SSRIs, are licensed for use in everyone with depression, and they work moderately well on average. But MDD would not be on track to become the single biggest cause of disability in the world if SSRIs worked well for everyone with depression. Evidently, one size does not fit all.
Anti-inflammatory interventions will never be the answer for all patients with depression. Currently under development are new alternative antidepressant treatments: dietary regimens to alter the microbiome, electromagnetic stimulating devices designed to change the function of emotional brain circuits, and drugs, like ketamine, that work primarily on glutamate rather than on serotonin receptors. The future promises a spectrum of treatment choices. But how to know which treatment is likely to work best for each patient?
Photo by Peter Hapak
A Therapeutic Revolution?
When the scientists running one of the antidepression trials of an anti-inflammatory drug—the nonsteroidal agent Remicade—dissected their data, they found that some patients responded better than others. The beneficial effects of treatment were greater in those MDD patients who had the highest levels of the inflammatory protein CRP in their blood before they started treatment. That is, the anti-inflammatory treatment for depression worked best for the depressed patients who were most inflamed—not surprising. What is surprising is the improved way of approaching depression that the results point to for the future.
They suggest that blood tests will become much more important in psychiatry than they have been in the past. The next wave of clinical trials of anti-inflammatory drugs for depression are more likely to measure biological markers of inflammation to predict which patients are most likely to respond.
Numerous interventions of varying efficacy and invasiveness are now in use to reduce depression. They range from the purely psychological, like mindfulnesstraining, to the surgical, such as vagal nerve stimulation, in which a device is implanted under the skin to deliver electrical impulses to the vagus nerve, which mediates an anti-inflammatory reflex. The procedure is risky and reserved for patients who have not responded to other therapies. Biomarkers of immune system status could not only indicate which people are most likely to respond to a given approach but also guide treatment progress.
This is standard practice in other areas of medicine. It would be a major advance if psychiatry could do likewise.
I predict that in the future, we will be using biomarkers of the immune system—CRP, cytokines, and more—to identify those patients whose depression is caused by inflammation. That will allow us to offer them a more customized treatment plan with targeted anti-inflammatory interventions. It may even be possible to leverage the immune system not just to treat depression but to prevent it as well.
Childhood abuse or adversity is a strong predictive risk factor for depression, sometimes decades later. It’s long been known that the immune system has a remarkable memory of exposure to biological threats, like infection, in childhood. For example, survivors of a potentially fatal childhood infection like measles retain an immune memory that enables them to respond aggressively if they are exposed again to the virus later in life. Could it be similar for social threats to survival in childhood?
There is growing evidence that a history of childhood adversity is associated with increased inflammatory proteins in adults. In animal experiments, there is detailed evidence that early life stress—like separation from a parent—can leave a mark on the genome that biases the animal’s inflammatory response to later stresses. In other words, a rat’s immune system can hold a long-term memory of being exposed to stress in childhood that could make it more likely to become inflamed (and depressed) as an adult.
If this turns out to also be true for humans, then perhaps biomarkers of the immune memory of childhood abuse or adversity could be used to identify children likely at risk of mental health disorders in later life—and therefore most likely to benefit from preventative programs. Eventually, perhaps scientists will find ways of reprogramming the immune memory of abuse so that survivors don’t carry the risk of depression for the rest of their lives.
Immune Warriors: Macrophages and Microglia
The high-level mission of the immune system is to defend the self against the nonself. The classic example is the immune response to infection. We live in a world teeming with germs—microscopic particles of nonself—that can damage or kill us. If we are infected by a dangerous germ—a bacterium or virus—the immune system is on call to deal with the situation. Bacteria are detected and destroyed by immune cells called macrophages, a made-up word meaning “big eater.”
The first immune response to infection is typically inflammation. When macrophages detect the presence of an infectious germ, they get “angry,” or activated. They move towards the germ, trying to make contact with it, and then ingest and digest it. Effective as macrophages are, germs can proliferate very rapidly and outnumber them. To aid in the battle against potentially overwhelming numbers of nonself agents, activated macrophages summon support: They release into nearby blood vessels signaling proteins called cytokines, which circulate throughout the body, attracting other macrophages to reinforce the immediate immune response to attack.
In the days and weeks following infection, other specialized immune cells and systems get involved. For example, lymphocytes, a type of white blood cell, may ramp up production of antibodies, the proteins that can help macrophages recognize and kill the same type of germ more quickly if it reappears in future.
Once inflammatory signals from the body reach the brain, they are often picked up and amplified by the brain’s resident macrophages, called microglia. Microglial cells are activated by cytokines to produce more cytokines—a positive feedback loop that can have adverse effects on the function of neighboring nerve cells. Cytokines make the nervous system less plastic; the synaptic connections between nerve cells don’t adapt so rapidly to changing patterns of stimulation. They also make nerve cells less likely to reproduce and more likely to die. What’s more, inflammation makes some nerve cells cut back production or release of serotonin, the neurotransmitter that is thought to play a key role in depression. Combined, the changes wrought by inflammation lead to behavioral inflexibility, a hallmark of depression.
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There are a lot of ways that life can get worse when you and your significant other are in conflict. The problem may not be the conflict itself, a natural part of living and loving, but the way you handle your differences.
One couple I worked with had an amazing ability to go from mild irritation to threats of divorce in mere seconds. I’ve seen other couples fight with screaming threats, name-calling and blame heaped on each other. None of this, of course, is productive in resolving differences.article continues after advertisement
But there is one habit or inclination that may well be the most destructive of all: silent withdrawal.
Sometimes this is an aggressive silence: a refusal to speak to the other, angrily shutting him or her out, sometimes for days at a time. This has become increasingly identified as a form of psychological abuse.
Sometimes the silence is more passive but nonetheless destructive: withdrawal and refusal to engage in conflict because one is conflict or confrontation adverse.
The problem is, this can be misread as not caring or as manipulative, abusive, aggressive silence. Withdrawing and hoping that the conflict will simply blow over is wishful thinking. The conflict is likely to go underground, simmering into ongoing resentment. It may prompt the other partner to use more divisive language or to offer up outrageous or explosive expressions of anger and frustration in an effort to be heard. The distance between you can grow into a chasm. And nothing gets resolved.
What can you do if you see this pattern in your own – or your spouse’s – reaction to conflict?
1. Venture out of your comfort zone: This is, of course, easier said than done. A client I’ll call Cynthia grew up in a seething, but conflict adverse home. There were multiple emotional elephants in the room and little discussion to resolve these lingering conflicts. “We just stepped around them and soldiered on,” she told me. “We prided ourselves on never fighting. We kept the peace. Well, sort of. We just never got close. We never talked about anything emotional. That’s just the way I was raised. It’s hard to be any different now.”article continues after advertisement
The thing is, when you were a child, you had no power over how you were raised in your family dynamic. You have the power now to choose to live a different sort of life. Don’t limit yourself to “That’s the way I was raised!”. Try something different. It may be uncomfortable initially. Realize that giving in to your desire to avoid conflict may have short term gains and long term pain. Speak up. Let your partner know that you hear what he or she is saying and that you know you are inclined shut down in conflict, but that you want to change that, to do what is difficult for you and begin to make a positive difference. Ask for his or her help.
2. If you catch your spouse withdrawing in conflict, ask him or her to do one thing different this time. Perhaps you could say “I know this is hard for you. I understand. But please stay with me here. We need to discuss this and resolve this. I really want to work this out.” This is what Cynthia’s husband Ron said when his feelings began to escalate and Cynthia began to withdraw during a couples counseling session. Fighting tears, Cynthia expressed her desire to talk but asked him to help by lowering his voice and listening instead of talking over her. They both made changes in their conflict styles and this made a big difference in their ability to resolve their differences.article continues after advertisement
3. Show a willingness to engage even if you’re momentarily overwhelmed. You might tell your spouse that you want to discuss and resolve the issue between you, but need time to calm down and think this through or discuss it at a time when you can focus fully on the problem (perhaps after the children have gone to bed). What’s important is that you show a willingness to confront the problem and suggest a specific time to talk with each other — and stick to that time!
4. Express your desire to do whatever it takes to resolve your differences, as hard as this might be for you. Though it might feel easier to go for short term escape tactics, you know that isn’t best for the relationship or, ultimately, for you. Show a willingness to follow through with difficult discussions or even to get professional help in order to resolve your differences. Refusing to talk or to seek couples counseling, if necessary, out of shame or pride or fear of what might happen if you speak up is a guarantee of more serious trouble ahead.
5. Remind yourself that your relationship is worth the discomfort of facing conflict and resolving your differences. Things can get worse, much worse if you don’t face a problem at the time.
“My sister and I are so alike. We both get intimidated easily and retreat into ourselves instead of speaking up when there’s a disagreement with anyone, especially a loved one,” my friend Candace told me recently. “I watched my sister and her husband grow apart and finally divorce, never having had an honest discussion about differences that I think could have been resolved. I didn’t want that to happen to Ken and me. So now when things get tense, I take a deep breath and say ‘So I think we have a problem here. What are we going to do about it? I love you and I want to work this out together.’ What a difference — a wonderful difference — that has made in our relationship! We feel closer than ever, even when life isn’t perfect!”
Worrying is one of the most futile or purposeless things that people can do. Unless your worry can tangibly help you identify solutions that you can implement to prevent a negative outcome, worry is often something that people do to feel as though they are being productive when really they’re only creating more distress for themselves.
Since I work quite frequently with anxiety disorders, most of the time I end up having discussions with my patients about worry. People tell me such things as “I can’t control my worry,” “I worry about things that I know will not happen,” and “I have a hard time getting these ideas out of my head.”article continues after advertisement
And that is exactly what worry is. But the first step to reducing the amount of worry in your life is recognizing that it is purposeless. Again, unless your worrying is going to lead you to identify a great solution (or, heck, just any tangible solution) that you can implement in order to prevent something from happening, most of the time worry is:
1. Concern about something that does not even actually exist (possibly yet, but probably ever)
2. Concern about something that does exist, but that is entirely out of your control
3. Nothing more than an “action” that we as humans engage in to feel as though we are being productive
4. Something that gets in the way of our actually living our lives
With regard to number three, many times people actively worry because they believe they are actually doing something by giving their attention to a perceived or real situation. But again, unless you can do something that will have an influence on the outcome, what is the real purpose of worrying?
“In reality, unless you can do something and your worry is going to get you to the point where you identify what that something is, worrying only leads you to feel stress, anxiety, discomfort, and discontent.”
For those individuals who tell me that they have a hard time getting their worries out of their head, I totally understand (really, I do).
There are specific strategies, however, that therapy and professional assistance can implement to help you curb the worry that you experience. At a minimum, the strategies are helpful at reducing your anxiety. Rather than allowing your worrisome thoughts to spiral out of control, these techniques help you to reel in your thinking and recognize when your thoughts are not realistic or helpful. This, in turn, leads to your understanding that you do not need to focus on these thoughts or allow them to continue to plague your mind.
However, just as in any type of psychotherapy, this change cannot happen without your very active involvement. It requires work and active engagement in the process, but it is some of the most beneficial work you can do.
Some 40 years ago, Jonathan Freedman’s Happy People was published, marking a new era in the study of happiness in America. Freedman was a Columbia University professor who had co-led an exhaustive research project on happiness a few years back for Psychology Today. Freedman (now a professor at the University of Toronto) remained interested in who was and wasn’t happy, and why, as he pushed his findings from the landmark study further in the 1978 book. Freedman had what was unarguably a goldmine of research into the subject at his disposal, as the responses from the Psychology Today questionnaire were combined with those from a similar survey published in Good Housekeeping to generate a total of almost 100,000 responses.article continues after advertisement
Readers hoping there would be a simple formula or recipe to happiness presented in the book would be disappointed, however, as artificially producing the emotion just didn’t work, Freedman explained. One could have all the typical social and economic ingredients for happiness but still be miserable, he made clear upfront. Or, completely conversely, could be thoroughly happy without having any of them. Happiness was a function of how an individual responded to environmental conditions rather than the conditions themselves, his extensive investigation showed, making one’s approach to life the key to how happy one was likely to be.
In his book, Freedman presented a number of leading theories about happiness, and then measured their validity against his research findings. He was quick to discount the popular “comparison” theory of happiness, in which individuals determined how happy they were or weren’t in relation to other people. Rather than being absolute, in other words, happiness was relative, this theory went, not unlike how economic or social status was often believed to work. Because we lived in groups, humans measured whatever they possessed in relation to that of others, many an anthropologist argued, making it easy to transfer the theory to the arena of happiness. But that was just one piece of the story, Freedman thought, as his research showed that a good number of people had no interest in comparing common elements to happiness—sexual satisfaction, say—to what others possessed. “The absolute scale seems to me to work for internal states that contribute to happiness,” he stated, thinking that, “comparisons to others are largely irrelevant.”article continues after advertisement
Freedman also did not heavily subscribe to the “expectation” theory of happiness, in which individuals measured how happy they were based on the “spread” between what they hoped for and what they had actually realized. Individuals with a narrow spread possessed a high level of happiness, according to this theory, as they were getting most or all that they wanted in life. Conversely, those with big gaps between their expectations and reality were unhappy people, as life was just not turning out to be as good as they had believed. While there was some validity to this idea, Freedman explained, the expectations versus achievements theory was, like the comparison theory, not the basis for most people’s happiness. In his research, Freedman found individuals who had reached or surpassed all their goals in life but remained despondent, supporting his view that the population was generally sorted into happy and unhappy people. “They continue to view life as an unhappy state,” he wrote of these unfortunate folks, more reason to subscribe to his contention that “attitudes toward life determine how much we enjoy what happens to us and what we achieve.”
While not totally dismissing the comparison—or expectation-based theories of happiness— Freedman leaned more to one in which adaptation played a significant role. Like all organisms, humans adapted or got used to their environment, with this normal process providing a kind of benchmark level of happiness for each individual. We became happier people when the circumstances of life exceeded our adaptation level, according to this theory, and unhappier people when things fell below that level. An increase in happiness could thus only be realized by surpassing our adaptive state in some way, suggesting that we had to continually shake things up at least a bit in our lives if we hoped to become ever happier. “This theory explains why people who seem to have everything are not necessarily happy,” Freedman wrote, an idea that supported the fact that money was not strongly linked to happiness. The apparent luxury of having all of one’s needs and desires met was therefore not a particularly good enabler of happiness, something that might have come as a surprise to those wishing they could be in someone else’s (more pricey) shoes.
Related to the adaptive theory of happiness was the concept that each individual was fundamentally a work in process, making the common pursuit of becoming a happier person a mostly lost cause. As Maslow had proposed in his hierarchy of needs, humans strive to achieve a higher state of being once a certain level of needs are met, turning life into an endless climbing of an existential ladder. While a good thing in terms of personal evolution, this continual reaching for something “higher” was not at all an effective agent of happiness in that one was never satisfied or fulfilled in the present moment. Freedman believed that this theory helped to explain why so many people remained frustrated in their efforts to achieve happiness regardless of how hard they tried. “Once attained for a moment, it seems to slip from one’s grasp and be just around the bend,” he observed, an apt description of the elusive nature of happiness.
Finally, Freedman believed that based on his interpretation of some hundred thousand accounts of personal happiness that some people were simply better at being happy than others. There was thus a sort of talent attached to being happy, just as achieving anything in life required having a certain aptitude or set of skills to actually get it done. Why some people had this ability and why others didn’t remained a total mystery, but there did seem to be some validity to the idea that happiness was either a competence developed over time or a gift that one was lucky enough to be born with. Freedman had perhaps more insights into the subject than anyone else on the planet, but he readily admitted that he had yet to crack the code of happiness. “Happiness is an enormously complex concept and feeling,” he concluded in his Happy People, thinking there was still much work to be done in the field to try to solve one of life’s greatest puzzles.
We all have something, something that we don’t ever talk about, don’t express, don’t show, don’t reveal. It may be some painful events from our past. It may be something we are struggling with in the present — an addiction, a mental healthdisorder, a question of genderidentity. It may be certain emotions — anger, sadness. It may be our opinions, our needs and wants. It may be ourselves where what we show is only some persona that we constantly use to hide who we are.article continues after advertisement
Why do we hold back and hide these aspects of ourselves? Here are some of the common culprits:
We feel shame
The porn addiction, the binging and purging, our OCD. We’re ashamed . . . because it is so out of our control, we know in our rational brain that it doesn’t make sense. We feel embarrassment at the thought that someone would know this about us.
We are afraid of others’ reactions
Obviously, this is part of shame, but this is also part of expressing our anger or stating our needs or our opinions. We fear that the other person will become angry, or critical, or blame us, or worst of all, dismiss what we are saying.
We need to make others happy and like us
This takes the fear of others’ reactions to a larger level, where in our everyday life our default method of survival, of managing our anxiety in a fearful world is to be nice, to accommodate, to put others and their needs ahead of our own. This is learned in childhood, it is our way of coping in the world. We hold back ourselves . . . because we hold back ourselves.
We fear being seen for the phony we feel we are
We put on a persona of competence, but basically, we’re faking it, holding on by our fingernails, thinking it is only a matter of time till someone sees through us, sees us for the incompetent or despicable person we are. But our fear of being busted only intensifies our drive to keep up the veneer.article continues after advertisement
We don’t deserve to get what we need
We don’t say what we want and need not because we fear that our request will be denied, but because we feel like we don’t even deserve to get anything more than we have right now, and/or we don’t even deserve what we have already. Our self-criticism and self-disgust are at their max and constant, often a product of childhood abuse.
It’s too painful to express what we are hiding
We don’t talk about that traumatic childhood event, because we’ve compartmentalized it. Even moving towards it creates unbearable anxiety. We struggle to even find words to describe the tumble of dark thoughts and emotions that rise up.
We hold back, because the world is incredibly unsafe, and no one can be trusted
There’s me . . . and there’s me. I take care of me, and others can’t be trusted; they are objects of manipulation that I use to get through life. I never show my true self. I act and say what I need to get others to leave me alone or give me what I want.
Hiding Takes a Toll
If you’ve ever made up an elaborate white lie, you probably know how hard it can be to manage it: You worry that you won’t keep the story straight, that someone will see cracks in it; you feel anxious and on-edge.
The same thing happens with these bigger issues, but even more so. Just like it takes tremendous structural strength for a dam to hold back the river, it takes tremendous emotional and psychological energy to hold back what we hide, and the anxiety we feel can be difficult to contain. Like spilled water on a countertop, the anxiety of disclosure, of discovery, spreads. Not only do we avoid, for example, talking about some traumatic event in our childhood, we avoid talking about our childhood at all; not only do we hold back our anger, we hold back other emotions as well; not only do we avoid talking about our addiction issues, we instead keep all our conversations superficial or relegated to a few safe topics.article continues after advertisement
What often comes with this maneuvering is a loss of connection and intimacy. If others close to us only know our persona, our “safe” self, and we hide our vulnerabilities, we actually are unknown; we do become alone in the world.
How to Open Up
If you are ready to stop hiding and let others in, here are some suggestions to help you get started:
Do a writing exercise
This is a two-part exercise. The first part is to write down your thoughts and feelings about what you’re hiding. You are not going to show this to anyone; the goal is to just begin to link emotions to words, and put words on paper. The words will help you mentally process your emotions; the writing will not only help you get these thoughts and emotions out, but also help you emotionally step back from them. Go slow, take your time. If you start to get overwhelmed, stop, take a break. If you are still overwhelmed, consider seeing a therapist to support you through this.
Part two is to now imagine how you would ideally respond to what you wrote if it was written by your own young child. Write down your compassionate, accepting thoughts and advice that you would want to say to quell the child’s fears and shame and struggle.
The purpose here is to give yourself the support and comfort that you never did get, hear what you probably never heard, have some closure.
Take baby steps to expand your comfort zone
In order to stop the rippling effect of anxiety, in order to make the world and others become safer, you want to take baby steps to increase your comfort zone. This can be as simple as doing even small things that feel a bit uncomfortable. You can start with tasks — like doing something out of the routine that you normally wouldn’t do — and then expand the same small challenges to others — for example, speaking up in a staff meeting when your default is to always remain silent.
The content of what you do or say is not as important as taking the small risk and finding out that nothing bad happens. This is about building your self-confidence, about loosening the ground for taking bigger risks with your secrets.
Take baby steps towards sharing your secret with people you trust most
Here you broach the subject of your porn addiction or your gender identity struggle with a therapist or your sister, who you know will be compassionate. You want time to put your feelings into words, you want help to sort out your emotions, you want to have a success experience that will give you the traction you need to move forward.
Send a letter or email to those most difficult to approach
Did you say a letter? What do you think this is, 1853? I know, you probably don’t even know where to find an envelope. But consider it. Or if not, compose an email. For those who are most difficult to approach and whose reactions you most fear — talking to your parents, for example, about something in your childhood, or revealing something that feels shameful to your partner — writing out your thoughts and feelings gives you the space and time to craft what you want to say, rather than feeling the pressure of having to think on your feet or freezing up by seeing their facial expressions. In addition to sharing your secret, say why you feel it is important to talk about this now, why you didn’t talk about this before, what you hope will come out of this disclosure. Your letter or email gives them time to process what you’ve said, rather than reacting in the moment.
But no, you’re not done. You send it, and then you follow up — you call your parents, you circle back and talk to your partner. This is where the harder work begins of moving towards what you most wanted to gain — it may be simply ending the dance of avoidance; it may be opening a door to getting more of what you need or increasing intimacy in your relationship.
Revealing what you’ve been hiding is not an end in itself, but a means to something else: to feeling less afraid in the world, to feeling less alone, more connected, a means to beginning to control those parts of you that seem out of control.
A way of expanding your life and having the life that you ultimately envision.