Roller Coaster Ride

Sometimes life can feel like a bit of a roller coaster ride. There is a wealth of ways to describe the same situation which in turn feedback to the brain about how the body has interpreted a particular situation. For example, if two people sit next to each other on a roller coaster ride, one may return saying “that was exhilarating”, yet the other may report “that was petrifying”. These phrases give insight into how the body has interpreted its own physiological response. The two people on the roller coaster ride both went around the same track and both experienced the same acceleration down the big dipper; yet one interpreted their physiological response as exhilarating and the other as petrifying. These words are their conscious mind describing their inner emotional state. Words can be important in determining future action and may impact upon the action of others. For instance, it is unlikely that the petrified passenger would wish to go on the ride again, nor that friends would suggest that they come back another day to go on the same fairground ride. This example illustrates the impact of words and how verbal descriptions can transform actions.

Should the state intervene with child eating disorders?

This clip is from 18 Doughty Street last night where I was one of the guests on their sofa discussing obesity in children. I am a complete novice at TV appearances, so don't feel you have to watch it.

Young or Old?

This is Boring's 'Old/Young Woman'. It is a figure which is reversible. The figure can be perceived as the profile of a young woman's face with the tip of her nose just visable, or a much older woman, where the young woman's chin can be seen as the nose of the older woman.

The Sunday - test your brain.

1) Ask yourself about the picture on the left:
What do you see?

This is an example of how your sensory information is interpreted. The brain tends to create a coherent image or structures from incoming information into a meaningful form, distinct from surrounding. Hence most people usually see a vase or faces in this somewhat ambiguous drawing.


2) Then try: How do you spell SILK?
Then say SILK five times
SILK
SILK
SILK
SILK
SILK
What do cows drink?

Most people answer milk to the second question. It seems so obvious, the words just come out immediately, but of course cows produce milk, yet more often drink water. Part of the explanation is that milk rhymes with silk, but it is also that the word milk is associated with the word cow. Therefore what tends to happen is that the word milk comes to consciousness so quickly it arrives before, or overrides, an approapriate answer.

To continue with the theme yesterday, stress can make this kind of error more frequent even in spontaneous speech. So watch out when you start putting silk in your tea at work, it could be time for some time out.

Are Modern Careers Good for Health?

Today it has been reported that people affected by work burn-out are more likely to suffer from diabetes (type 2). There is accumulating psychological evidence that much work stress arises from interacting with people rather than things. In fact, ‘emotional labour’ is more mentally taxing than the old fashion labour jobs that were more physically taxing. It has been shown that the more your job requires you to 'fake emotions', the more emotionally detached you become from those around you. Hiding or faking emotions, can lead to ‘clinical burnout’. Burnout can result in symptoms of emotional exhaustion, fatigue, detached attitude towards others, low sense of effectiveness, helplessness, low mood and now the increased risk of developing diabetes.

The Israeli study looked at 677 mostly male, middle-aged workers and found that those affected by burn-out were nearly twice as likely to develop the condition and after the possible effect of blood pressure levels was eliminated, the risk was more than four-fold higher. This is certainly something the medical profession should consider, not only for their patients, but also for themselves as it is thought that 25%-60% of practising physicians experience burnout.

What is in a word?

Yesterday the post was about listening, today it's about spoken words. Words are the bridge between peoples’ minds and bring people together. Words are so important as a means of communicating thoughts, which otherwise may remain trapped inside the imagination. Below 7 helpful communication tools are considered:

1) Communication is very often over-formalised, yet the views are often easier to remember if the human element to the story is added.
2) When putting a point it’s often helpful to tell a story; people are more likely to remember a story as opposed to a collection of random points.

3) It is important that whatever view point is suggested it is accurate.
4) Simplicity and clarity are essential to reflect the strength of the arguments. Issues, however complicated should not appear so, if at all possible.
5) The general rule is that if in any doubt veer on the side of being concise rather than lengthy. Consider the power of the short phrase which was offered by President Kennedy in his Inaugural Address: "And so, my fellow Americans, ask not what your country can do for you; ask what you can do for your country."

6) Metaphors are powerful language tools. Consider Winston Churchill's "The nation had the lion's heart. I had the luck to give the roar"
7) Just as the use of the imagined image in the metaphor is useful, so is the physical image of a visual aid which can sometimes be used to facilitate .

Listening - A True Art Form.

As a psychiatrist I would say that possibly the most important, yet also the most under-rated of all skills is that of listening. Important details are gathered not necessarily from great oratory, but by picking up on what the person you are talking to is saying, which give crucial indications that often go unnoticed. When you are listening to someone face to face, it’s worth taking an active part to show the speaker that you are taking in what they are saying. Nodding, responding and maintaining appropriate eye contact can all help. The danger in not listening carefully to what is being said is illustrated by the following somewhat apocryphal transcript of which there are a number of different versions, this one being between a US navy ship and a Canadian authority:

U.S. Navy: Please divert your course 15 degrees to the north to avoid a collision.
Canadians: Recommend you divert your course 15 degrees to the north to avoid a collision.

U.S. Navy: This is the captain of a U.S. Navy ship. I say again, divert your course.

Canadians: No. I say again, you divert your course.

U.S. Navy: This is the aircraft carrier USS Lincoln, the second largest ship in the United States’ Atlantic fleet. We are accompanied by three destroyers, three cruisers and numerous support vessels. I demand that you change your course 15 degrees north, or counter-measures will be undertaken to ensure the safety of this ship.

Canadians: This is a lighthouse. Your call.

Prevention Better than Cure?

With drugs hitting the UK headlines, it seems only fitting to write a short note about alcohol, drugs and mental illness. In clinical practice people commonly tell me that they are unaware about the mental health risks of illicit drug taking, and I am always keen to highlight mental health promotion.

It is known that drugs such as cannabis, cocaine, amphetamines, ecstasy, LSD and heroin in some people can precipitate an acute mental illness, as well as dependency. Of course, some people who develop a psychotic illness following drug abuse had precursor symptoms of a psychotic illness, and were trying to self-medicate with drugs, which led to an exacerbation of the illness, and sometimes schizophrenia.

Whilst talking of mental health preservation it is also worth briefly discussing alcohol. With alcohol consumption increasing in some age groups and pubs being open longer hours it is important to be constantly vigilant to vulnerablities of alcohol dependence. One way of preventing this is to try and ansure at least two or three days a week are completely alcohol free. Another useful alcohol indicator is to ask the CAGE questionnaire:

Have you ever tried to Cut down on your drinking?
Have you ever got Annoyed because someone mentioned your drinking?
Have you ever felt Guilty about the amount you are drinking?
Have you ever started to drink Early in the morning?

Mental Health Promotion is not about waiting until the sickness has set in, but trying to increase education to help people make informed choices.

Who Are You?

Does the importance of identity and self-identity make any difference? In 1973 the ‘Prison Simulation Experiment’ gave a real insight into how the brain manages an identity. Male participants were recruited through newspaper advertisements, asking for student volunteers for a two-week study. Twenty-four suitable and healthy participants were selected. They were then randomly assigned to their role in this prison experiment as either ‘prisoner’ or ‘guard’ and a mock prison was set up. On the first morning, those allocated to be prisoners were unexpectedly arrested by local police and charged with felony, read their rights, searched, handcuffed, fingerprinted and taken to the basement prison. Upon arrival, prisoners were stripped naked, searched, deloused and issued with prisoner uniforms and bedding. Prisoners were referred to by number only. The guards wore uniforms, reflective sunglasses (making eye contact with them impossible) and carried whistles, clubs, handcuffs and the keys to the cells and main gate. Guards were on duty twenty-four hours per day, working eight hour shifts. They had complete control over the prisoners, who were kept in their cells, except for meals, toilet privileges, head counts and work.

After an initial rebellion had been quashed, the prisoners began to act passively and the guards stepped up their aggression each day. For example, guards had a head count in the middle of the night simply to disrupt the prisoners’ sleep. After less than 36 hours one of the prisoners had to be released because of uncontrollable crying, fits of rage, disorganised thinking and psychological depression. Three others developed similar symptoms and another developed an all over body rash after his ‘parole’ request was rejected. The whole experiment, which was planned to run for two weeks, was abandoned after just six days due to the prisoner reactions. One of the guards later said "I was surprised at myself – I made them call each other names and clean the toilets out with their bare hands". Zimbardo et al concluded that the study showed the power of identity, and the power of social and institutional forces can even make good men engage in evil deeds. In other words, identity is flexible and can be changed by societal and other external factors.

You may wish to try this identity exercise.
Bearing in mind the importance of identity, it is worth spending a bit of time exploring your own identity. Howard Martin said:
"Don’t ask the what the world needs – ask what makes you come alive and then go and do that. Because what the world needs is people who have come alive."

The exercise:
List all the elements you identify yourself with.
Then think about who you would like to be.
Then list the words you’d like to identify yourself with.
Then commit to moving towards this identity in your actions.

Thought for Sunday

Fourteen fundamentals of people who score high on measures of happiness include:
1) spend more time socializing
2) be productive at meaningful work
3) get better organized and plan things
4) lower or at least make more realistic your expectations
5) become present orientated
6) work on a healthy personality
7) develop an outgoing, social personality
8) be yourself
9) eliminate negative feelings and problems
10) develop close relationships as these are the number one source of happiness
11) put happiness as your most important priority
12) stop worrying
13) develop optimistic thinking
14) keep busy and be more active
(these were designed by psychologist Michael Fordyce.)

Happy Sunday!

The Extremes of Body Mass Index

Scientists for years been asking the question about why modern Western society has high amounts of people suffering from the extremes of eating disorders; both anorexia and obesity. Much has been made of the effect of overly thin models on young women and the so-called ‘thinspiration’, possibly linking to anorexia. Whatever the answer, the neurological connection between the images and the illness is discussed below:

I Can Not See the Clothes for the Illness

When I saw the television news last night, concern was raised about the fact that the print press were more interested in the ‘size zero model debate’ than the designer clothes on display in London Fashion week. Perhaps this time, the print press have got it right. Anorexia nervosa and bulimia are both on the increase and are currently one of the biggest killers amongst young British women. Although the causes of eating disorders are multi-factorial, few would dispute the social pressures to be thin, especially for women. However, London Fashion week decided against following the medical advice given during the Madrid fashion parade, where models had to have a Body Mass Index (BMI) of 18 or over before going down the catwalk.

Last year, I made up a short exercise to celebrate London Fashion Week: Count the number of times your brain registers an image of a size 0 model between getting up and going to work. Check your cereal box, your newspaper, your morning TV, bill boards at the bus stop. When I carried out this exercise, I was staggered to count 63 models that appeared underweight in less than an hour. This means almost every minute my brain had been subjected to an unhealthy image. Modern society seems used to the phrase ‘you are what you eat’ and accepts that what you put into your body has an affect on body physiology. Yet, people rarely seem to take the next step and conclude that what you put into your head can affect your brain physiology hence, ‘you are what you think’.

Neuroplasticy is the posh sounding name for how brain inputs affect and can change the wiring in the brain. For example, if the brain is analogous to a computer, then it can be modified by creating new connections, deleting files, uploading or upgrading pieces of computer software. This is a somewhat over simplistic view of how the brain works, but considering just how vigilantly programmes are uploaded onto computers, it seems somewhat strange that such a care free attitude is taken to the inputs into our own brain.

It is said that trends within a society can shape the collective culture, in other words, influence internal beliefs and expectations of what is normal. Hence, it’s possible to postulate that if the brain is bombarded with images of unhealthily thin models and given the unsaid impression that this is to be desired, then this will have an affect, perhaps even resetting what was previously considered normal. Currently this debate is rife with the radical change in model size down from the Marilyn Munroe curvy figure of the fifties, to the pre-pubescent shape of the modern size zero vogue, in the aptly named noughties.

Although much research still needs to be done into neuroplasticity, it does highlight the power of brain inputs. Could inputs of size zero models into the conscious and unconscious mind really encourage unhealthy food restriction? Also, could the opposite occur? Despite the fact that I am unaware of any debate or research about this, I ponder the possibility that inputs of underweight models may lead the unconscious brain into the false belief that famine is approaching, hence increasing the appetite so the body can gain weight as an energy store. No matter on the theory, the West is currently in a public health quandary of what causes the modern day epidemic of extremes in BMI; with unhealthy thin and unhealthy overweight. Can it all be down to food, or do brain inputs and neuroplasticity play a part?

What is life?

There will never be a single answer to this question, but this is a touching quotation from Mother Theresa:

“Life is an opportunity, benefit from it.
Life is a beauty, admire it.
Life is a dream, realize it.
Life is a challenge, meet it.
Life is a duty, complete it.
Life is a game, play it.
Life is a promise, fulfill it.
Life is sorrow, overcome it.
Life is a song, sing it.
Life is a struggle, accept it.
Life is a tragedy, confront it.
Life is an adventure, dare it.
Life is luck, make it.
Life is life, fight for it!”

Love sick?

A while back I read this bit of medical history and decided to make it the blog entry for Valentines Day - so I hope it makes you smile.

During the middle ages in some Arabic countries 'love' was known as a disease. The symptoms were noted as - loss of appetite, lack of sleep, loss of interest in life and difficulty concentrating on anything. The physicians back then established the final diagnosis by listing the names of all the eligible members of the opposite sex who lived in the same village, whilst simultaneously taking the patient's pulse. At the sound of the name where the patient's pulse quickened, the illness was confirmed, and the treatment was marriage.

Brain Questions...Keeping Alert!

Today why not try these 4 basic brain questions and see how good your brain wiring is.


Below are 4 questions which you should answer immediately. The answers are given on scrolling down.

1) You're participating in a race. You overtake the second person.What position are you in now?

2) If you overtake the last person in the same race, then you are ........?

3) Now for arithmetic! Note: This must be done in your head only, no calculator or pencil and paper. Try it. Take 1000 and add 40 to it. Now add another 1000. Now add 30. Add another 1000. Now add 20. Now add another 1000. And finally, add 10. What's the total?

4) Mary's father has five daughters: Nana, Nene, Nini, and Nono. What is the name of the 5th daughter?

Now for the answers - how many did you get right?

1) Many people answer that they are in first place, but this is not correct. By overtaking the the second person, it means you take up the second position.

2) If you answered that you are second to last, then you are wrong. As it's not possible to overtake the last person.

3) Did you get 5000? The correct answer is actually 4100. If you don't believe me, check it with a calculator.

4) Many people answer Nunu? Yet this is not correct - her name is Mary. Read the question again!

I hope you liked the brain questions and that they kept your brain alert.

A lesser known Oscar finding

Dame Helen Mirren has added the best actress Bafta to her long list of awards for The Queen, and she is now tipped for an Oscar. An interesting but lesser known fact about Oscars, is the research showing that winning can dramatically increase a performer´s life-span. Plus, winning the award more than once is even better for the health than just winning once. Multiple Oscar winners live almost three years longer than those with just one Oscar.

It is thought that the crucial factor is that those in higher status positions have more control over their work, compared to lower status colleagues. Oscar winners are more likely to be able to choose the roles they play, and this in turn gives them a sense of control over their work life, which has stress and health implications. Another theory is that an increase in self-esteem coincides with winning an award, which may counteract the link between low self-esteem, heart disease, cancer and depression.

Overall, we could perhaps all learn something from this research; to understand the importance of self esteem and keeping a sense of control over our own work life balance.

A week of British Beauty

Are you grateful for your life? Or do you whinge about everything? Gratitude is all about appreciating the things you have in your life. It is a way of reaching back to your inner happiness and allows you to notice what is right instead of just what is wrong.

Exercise an Attitude of Gratitude

Try listing 10 things you are grateful for in your life, including things you usually take for granted. This could include your health, family, home, friends, work colleagues. After that add to the list all things you could not survive without, such as air, water and food. Take time to focus on the awesome wonders of the world. See things as if you are seeing them for the first time ever. Go outside, slow down and appreciate the natural beauty around you and begin to enjoy the simple things in life, such as walks and sharing meals with people. Become aware, every second, of just how much joy there is in your life. Say ‘thank you’ as often as possible to all the people who make your life what it is. Adopt gratitude.

In the modern consumer society it can sometime feel that no matter how fast you run, you will never catch up with expectations. This feeling extends beyond being a perfectionist, into living for the future, where you hurriedly already want to be on the next rung of a ladder, but forget to give thanks for all the things you already have. In a week when most of the country has experienced the natural beauty of snow - it has certainly reminded me how picturesque Britain is.

Are Words Important?

The effect of changing a single word in questions has been tested by psychologists Loftus and Palmer in the context of eye witness statements. In one example participants were shown a 30 second videotape of 2 cars colliding, then they were asked questions about the collision. Some participants were asked "About how fast were the cars going when they hit?’ For other people the word ‘hit’ was replaced by ‘smashed’, ‘collided’, ‘bumped’ or ‘contacted’. These words have very different connotations regarding both the speed and force of impact, and this was reflected in the estimated speeds given.

People who heard ‘smashed’ gave a speed estimate of 40.8 miles per hour (mph), people who heard ‘collided’ gave an estimate of 39.3 mph, people who heard ‘bumped’ gave an estimate of 38.1 mph, people who heard ‘hit’ gave an estimate of 34.0 mph and people who heard ‘contacted’ gave an estimate of 31.8 mph. The significance between ‘smashed’ and ‘contacted’ gave a change in the estimated speed of 9mph. In other words, witnesses are potentially highly suggestible and words are important.This article is being published in this weeks Medico Legal Brief Update Newsletter

However, one person who understandably may not wish to think about this study is David Milliband, following his words on Question Time yesterday: "I predict that when I come back on this programme... people will be saying ‘wouldn’t it be great to have that Blair back because we can’t stand that Gordon Brown’ ".

A smile can go a long way.

Poor Tony doesn't seem to have much to smile about lately, and this may be making him feel even more blue than usual. Did you know that a smile can have a positive effect on one'e mood? Try, for example, pulling the sides of your mouth up in the shape of a smile and holding it for twenty seconds. To the average person this may seem very silly yet often it can tangibly improve one’s mood. Making the shape of a smile uses the muscle groups in your face that connect with a particular pattern of brain activity. Because the brain links these areas, a chain reaction is set up in between the movement of your face muscles and the pattern of activity within your brain. This chain reaction induced is associated with positive happy feelings in your emotional centres. Because cells that ‘wire together fire together’ and by activating the wires that cause a smile, they fire links to positive emotions. So, just by moving your mouth into a smile causes a small increase in positive emotion related brain activity...poor Tony!

Stress and Self-Esteem

A large quantity of people who suffer with stress also suffer with low self-esteem. Low self-esteem can be caused by a bias in two complementary ways of thinking. First, a bias in perception and second, a bias in interpretation. Hans Christian Anderson wrote a story ‘The Snow Queen’. At the beginning of the story, the devil makes a mirror. No one who looks in the mirror sees a reflection of his or her true self, but instead, sees a distorted image, twisted and ugly. Low self-esteem can distort self-perception in a similar way to the devil’s mirror. It can distort interpretation, so rather than seeing a true reflection, what jumps out are specific self dislikes or perceived weaknesses and faults, yet inevitably differences make us all human.

Positive self-esteem empowers you to meet life’s challenges and to consider yourself worthy of happiness. Focusing on your positive traits will immediately improve your chances of creating the life you desire and deserve and stop you from putting yourself down if this is what you are prone to. So, today try to remember to praise yourself and work on increasing your self-esteem, which may also reduce your stress levels.

Britain - the most stressed nation in Europe

This week The Times newspaper ran an article about a survery commissioned by the Samaritans, which confirmed that Britain was one of the most stressed nations in Europe. It showed that 20% of Britons felt 'their life was out of control'. Today's blog talks briefly about some of the basics when dealing with stress.

The following offers a set of general tools:
• Take time out from stress, this will prevent unhealthy obsessing.
• Get a good nights sleep.
• Never be afraid to ask for help or advice, the chances are someone else will have faced a similar task.
• Think what you would advise someone else in the situation; we are often good at solving other peoples problems, so why not use your own advice?
• Confide in someone and remember the old saying ‘a problem shared is a problem halved’.
• Stop beating your self up. Everyone makes mistakes.
• Avoid imagining that the problem is worse than it actually is.
• Divide tasks into chunks – take each source of stress in turn and think of three ways of increasing your control, even if this is to a very tiny extent.

The final point about gaining control of the stressful situation is perhaps highlighted by a famous psychology stress study, when participants were asked to work on a task that demanded a lot of concentration. The task was made even more difficult by adding a level of background distraction noise whilst trying to complete the task. This induced a stressed feeling in the volunteers. Then they were told that they could switch off the background noise if they wanted to, by pressing a button. Their stress levels immediately dropped simply knowing that they could push the button if they wanted to, even though they hardly ever did. This shows that stress may partly be due to the work demands made on you, but it's also due to the stress you put on yourself. When you gain a sense of control or even potential control over this, it can be a great stress antidote. Hence, taking even small steps to increase your control over a stressful task, can really help reduce the overall stress level.

STRESSED?

It was reported today that people in Yorkshire are most likely to suffer from stress. Stress can be used to drive you in the direction you desire and can be channelled to generate energy, utilized as a useful tool rather than a treated as a foe. However, the feeling of stress develops when there is mismatch between what you think you can do and what’s expected of you (including expected by yourself). The message is that you need to take stock and evaluate this mismatch.

Society can often exacerbate this situation with extra pressure. Consider the example of the ‘superwoman syndrome’ where women of today sometimes seem to be expected to do everything. They may be expected to be the main carers for the husband, children, parents and friends, to be successful in business and to keep the house. All whilst recycling the waste, being fashionable, fitting energy saving light bulbs and every other societal expectation. Do you think this is expecting too much? Even Cherie Booth, mother of four children, top barrister and wife to a world leader was forced to tackle this expectation syndrome and knocked it on the head by saying “I am not superwoman.” Men, too, can feel the pressure of expectations. Perhaps expecting to be strong, sensitive, successful, wealthy, good cooks and emotionally supportive.

So, perhaps we should all remember that it's alright to be human and not super human.