We all have our own particular styles – cautious, sedate, zippy, or kamikazi. There are some drivers that drive like a tortoise on tranquillisers. I always seem to get stuck behind them at traffic lights. I would describe my driving style as ‘confident’, though when I quickly nip around them at the lights, I’m sure they would think I’m in too much of a hurry.
Whether we’re on a perpetual Sunday drive or we go like a bat out of hell, there are some commonalities to how we all drive. No one drives the whole journey looking in the rearview mirror and no one crawls along in first gear all the way just in case there might be a red light or a stop sign up ahead. When we’re in control of our car, we drive according to the conditions around us at the time.
In the first two posts of this series, we looked at acceptance and values, or as the Serenity Prayer says, “give me grace to accept with serenity the things that cannot be changed, Courage to change the things which should be changed, and the Wisdom to distinguish the one from the other.” Acceptance and values intersect in the present moment, the ‘now’.
We can’t change what has happened in the past, and we can’t control what is going to happen in our future. We can advance in the direction set by our values and embrace the freedom of living in the now.
Living in the now is just like driving. There’s no point looking in the rearview mirror the whole way. We can’t change the past. Getting lost in the if-only’s of the past means we don’t get to experience what is going on around us, and it effectively stops us moving forward because we’re looking the wrong way. We become stagnant and the lack of lack of forward progress makes it hard for joy to flourish. Neither can we control the future. Sometimes we allow the what-if’s of the inherently uncertain future to slow our progress and hold us back. We don’t know what’s around the bend, and after a while we prefer the familiarity of our rut.
When we move beyond the past and leave the future to our destiny, we can focus on the richness of the present moment. Living in the present moment is both liberating and invigorating – we are no longer being held captive by what has been or what might be, and we can allow our attention to absorb all of the plentiful and pleasing details that are going on all around us, every moment of our lives.
Living in the now is part of the practice of mindfulness. Mindfulness is a skill, and like every other skill, it takes some practice to get good at it. But the practice is worth it, as mindfulness is associated with higher levels of life satisfaction, agreeableness, conscientiousness, vitality, self esteem, empathy, sense of autonomy, competence, optimism, and pleasant affect.
There are many ways to practice mindfulness, but if you’re a novice, then a good place to start is through some apps like Smiling Mind or Headspace. As you get better at living in the present moment, you will start to enjoy the richness and freedom that comes with it. If you start now, you won’t have to live haunted by the ghosts of Christmas-Past or Christmas-Future, but can have a marry and a mindful Christmas, living in the freedom of now.
Robin Williams is my favourite all time comedian. At his best, his jokes would come flying out faster than what my brain could process them, but I still found myself laughing pre—cognitively and only understanding why I was laughing once my brain had a chance to catch up. He was famous for his talent for improvisational comedy, something he demonstrated one night for a group of budding actors, using nothing but a pink scarf.
And yet, despite being one of the funniest people in history, he was plagued by depression and drug abuse and died by suicide in 2014.
“In the end, Robin is Pagliacci. He is Pagliacci, the cliche of the clown who cries – that was there every single minute, every single minute of his life, and what he did was he spared us the hard part, and he gave us the joy. What an extraordinary gift that was.”
It’s hard to understand how someone can be so seemingly full of joy, or at the very least, give so much joy to others, and still be so plagued with melancholy and psychological pain. The life and death of Robin Williams certainly challenges our understanding of the true meaning of joy.
So it’s pertinent to ask: What is joy?
Is joy laughter? Is it pleasure? Is joy the same as happiness? Is joy the absence of sadness? Is it the absence of suffering? Is joy within us, or outside our control? The answer is probably a combination of all of these things.
My dictionary explains that joy is “a feeling of great pleasure and happiness”. The ancient Greeks considered that joy had two different parts – physical pleasures associated with biological needs, and feelings of higher pleasure. Physical pleasures, such as eating and sex, are known as ‘hedonia’ while the higher feelings of pleasure, associated with the appreciation of art, music, et cetera, as ‘eudaimonia’ (‘a life well lived’) after the distinction that Aristotle made in his writings on the subject.
Is joy the same as happiness or pleasure? C. S. Lewis didn’t think so, “I call it Joy, which is here a technical term and must be sharply distinguished both from Happiness and Pleasure. Joy (in my sense) has indeed one characteristic, and one only, in common with them; the fact that anyone who has experienced it will want it again … I doubt whether anyone who has tasted it would ever, if both were in his power, exchange it for all the pleasures in the world. But then Joy is never in our power and Pleasure often is.”
George Bernard Shaw considered joy to be something greater than oneself, “This is the true joy in life, the being used for a purpose recognized by yourself as a mighty one; the being thoroughly worn out before you are thrown on the scrap heap; the being a force of Nature instead of a feverish selfish little clod of ailments and grievances complaining that the world will not devote itself to making you happy.”
It’s certainly true that depressed people can still laugh, and like Robin Williams, can make others laugh, so joy can certainly be both superficial and deep, and neither are mutually exclusive.
To add something else into the mix, the Christmas message of joy comes from the birth of the Saviour (Luke 2:10-12), so one of the Biblical meanings of joy stems from hope.
So the single definitive concept of true joy is elusive. Perhaps trying to define joy is like trying to define the ocean. We have all experienced the ocean and its beauty, and many of us have felt the coolness on our bodies as we have swam in it, or felt the awesome power of its currents and waves. Yet the ocean is so deep, so powerful and so mysterious that no one can ever truely comprehend it for itself.
We have all experienced the wonder and beauty of joy, although it is so deep, so powerful and so mysterious that no one can ever truely comprehend joy.
Not that it will every stop us from trying.
~~~ If you are struggling with mental illness and you need urgent assistance, please talk to someone straight away:
There’s a deep part of our consciousness that acts as our inner emergency brake. You know, when you’re about to call your boss a jerk, or drunk text someone, or post something narky on social media, there’s that little voice inside your head that says, “Uh, do you really think that’s a good idea?”
Thankful most of us don’t end up drunk-texting our boss and would never let ourselves get in a position to do so. Still, it’s a good idea every now and then to reevaluate our general day-to-day decisions, our routines and patterns, to say to ourselves, “Wait … what are you doing?”
Yesterday we talked about the Serenity Prayer – “grace to accept with serenity the things that cannot be changed, Courage to change the things which should be changed, and the Wisdom to distinguish the one from the other”. We talked about acceptance – accepting the things we can not change because fighting with things we can’t change wastes our energy and gets us nowhere. We can also waste a lot of energy and not get to where we want to go by using all our energy going to the wrong place – either we drift on autopilot, doing what we’ve always done because, you know, it’s what we’ve always done, or we can deliberately set sail in the wrong direction, thinking that we’re doing the right thing.
One way that we can build our joy is to live rich and meaningful lives in service of our values. In knowing our values, we can know ourselves, and engage in life in its fullness. ’Values’ can mean different things to different people, but in the Acceptance and Commitment framework, values refer to “Leading principles that can guide us and motivate us as we move through life”, “Our heart’s deepest desires: how we want to be, what we want to stand for and how we want to relate to the world around us.”
Values help define us, and living by our values is an ongoing process that never really reaches an end. Living according to your values is like sailing due west. No matter how far you travel, there is always further west you can go. While travelling west, there will be stops along the way, stopovers along our direction of travel like islands or reefs. These are like our goals in life.
The difference between goals and values is important. You could set yourself a whole list of different goals, and achieve every one of them, but not necessarily find meaning or fulfilment if they all go against the underlying values that you have. So goals are empty and unfulfilling if they aren’t undergirded by your deeper values.
How can you understand your values? There are a couple of ways. Ask yourself: “What do I find myself really passionate about? What things irk me? If I could do anything I wanted, and money was no object, what would I do?” Is there a recurrent theme running through your answers?
There are other ways to discover what your values are. Some people have suggested writing your own eulogy (the speech someone gives about you at your funeral). It sounds a bit morbid, and it’s only a figurative exercise, but it tends to sharply clarify what you want your life to be like. What do you want your legacy to be? Think about the things that you want to be known for at the end of your life, and see if there’s a word that best describes those desires.
Understanding our values can help us to navigate the seasonal madness without becoming overwhelmed. When you understand what’s truly important to you, it’s much easier to focus on what’s really important and say no to the things that aren’t. For example, Your boss invites you to exclusive Christmas drinks are her house, with some of the regional executives. It’s on at the same time as the Christmas Carols concert your sister is performing in. If your core values are career success, then the choice is easy. If you know your values are family first, then the choice is easy. You can make the choice that will bring you the most joy, and enrich your life.
So before the malaise of merriment takes hold, say to yourself, “Wait … what are you doing?” Ensure that what you’re doing is aligned with your deepest values to maximise your joy this Christmas season, and beyond.
The auditory froth of tinny Christmas melody bubbled away in the background as I was trying to enjoy my sushi. I usually filter the incessant stream of Christmas carols from my consciousness as these days, they have become ever-increasingly cliche.
But once upon a time, Christmas carols were more than just shopping centre noise pollution. Once upon a time, Christmas carols had meaning. Even if you’re not inclined to celebrate the birth of the Saviour, there are still some Christmas themes we can all agree on, like peace on Earth, goodwill to all (women and) men, and joy to the world.
Joy. Christmas’s modern irony. In amongst the glitter and tinsel lies a season of despair for many people as the over-commercialised happiness hype and expectations of cheer amplify the sense of loneliness and pain that slowly abrades them. Then there’s the Yuletide exhaustion, the inevitable outcome of the frenetic push to shop, wrap, clean, decorate, travel to or host party after party after party – celebraters gonna celebrate! Joy is supposed to fit in your schedule or to-do list somewhere.
’Tis the season to be jolly? Yes, it is, but sometimes we work so hard to be joyful that joy itself has been lost along the way.
This year, with one thing or another, my writing has taken a bit of a backseat. I’m going to try and change that. I’m going to set myself a challenge to write one post a day for December celebrating the lost art of joy. What it’s going to look like is still anyone’s guess, with form and inspiration to be free and flowing. I’m not promising an exhaustive exposition … more a free-form exploration. Neither am I suggesting that I am an expert in such matters. I’m preaching to myself as much as anything. As someone who still battles depression, joy is often elusive to me.
Still, please come along for the ride. Together, let’s explore the many facets of one of the deepest of all emotions and how it’s an integral part of the Christmas season, and also our collective soul.
Many moons ago, I was a cub scout (which for those who don’t know, is Scouts for 8-10 year old boys). Once a week, we would get together and do outdoorsy type activities and games as part of learning about the seemingly antithetical values of teamwork and self-reliance, earning merit badges, dibbing and dobbing and all things scout.
One time I remember they divided the group into two and had us battle it out in a tug-o-war dual. Our parade area-come-battle zone was not particularly well lit, with the area just behind the scout hall in complete shadow, save for the occasional moonlight.
It was a gripping contest and during the battle, the other team managed to swing themselves around and pull their end of the rope into the inky darkness beside the scout hall. Our side doubled our effort, but despite what felt like an eternity of vigorous straining, we weren’t moving anywhere. We understood why when the other team started peeling away one by one and laughing at us – in the cover of darkness, they had managed to tie the tug-o-war rope to one of the poles supporting the balcony of the scout hall. We were struggling when we were fighting against human opposition, but we were clearly no chance at ever beating the scout hall in tug-o-war.
What do my #cubscoutfails have to do with joy? The scout hall tug-o-war episode is a good analogy for acceptance.
The self-help industry has, at one point or another, made us all want to better ourselves … which is fine, but only if what we wanted to change was actually changeable. By trying to change some part of us that is difficult to the point of being insurmountable, we expend huge amounts of energy to get nowhere. And it changes nothing, except for diminished motivation, volition and resistance to the thing we wanted to change in the first place. How many diets have ended in a flurry of ice-cream or Mars bars? We figuratively try to beat the scout hall in tug-o-war. The futile fighting with things that can not be changed makes it hard for joy to flourish.
The Serenity Prayer, made famous by Alcoholics Anonymous and other 12-step programs, is simple but profound. It starts by saying, “God, give me grace to accept with serenity the things that cannot be changed, Courage to change the things which should be changed, and the Wisdom to distinguish the one from the other.”
Accepting those things that can not be changed is life-changing! The frustration of constant failure destroys the soul and steals away any joy. It we want to protect our joy, we can start by accepting that there are things in life we can’t change. In the immortal words of that other modern ear worm – “let it go”. Don’t sweat and strain, heaving and pulling on something that can’t be moved.
Of course, acceptance isn’t the whole story, but the other aspects of the serenity prayer (wisdom and courage) might be topics for another day.
Suffice to say, picking our battles can make a profound difference to our life, and acceptance is the key to that.
Thanks for reading, and I hope we can talk more tomorrow.
“If you want to go fast, go alone. If you want to go far, go in a team.” ~ African Proverb
Melbourne … rain. It’s so cliché, but here I am in Melbourne, staring out at the dismal misty greyness enveloping the city, displacing all warmth and joy.
Perhaps it was the dreariness combined with the light stupor that comes from being in a meeting all day, but as I was watching the incessant drizzling, I drifted into a contemplative trance, pondering the power of water.
By itself, one drop of water can do very little. No one notices the effect of one drop of rain. Though with more and more drops comes more and more change. Wet ground grows puddles, then tiny rivulets, then streams of water which, when they combine, can form a raging torrent strong enough to change entire landscapes in a day.
And then I wondered, what allows something so individually weak to be so forceful en masse? I don’t want to sound like a B-grade motivational speaker, but I think this is so important for any single person or organisation that wants to achieve anything of significance.
There are two properties that give a stream of water its power.
* A common direction
* A strong bond
As the sheer might of a violent surge so aptly demonstrates, there is immense power when small drops all combine to move together in one direction. Yet the former property is only possible because of the latter. Without the strong molecular bonds between them, water molecules would simply dissipate, along with all of their power.
So how can we apply this analogy to an organisation? Well, if an organisation wants to be successful in achieving whatever plans it has, each part of that organisation needs to be moving together in the same direction.
Ok, that’s rather trite, but bear with me, because my cathartic discourse isn’t about the power of common direction, but about the bonds that confer the power to the forward momentum.
The molecular bond of any powerful organisation is trust.
Stephen Covey wrote that, “Trust is the glue of life. It’s the most essential ingredient in effective communication. It’s the foundational principle that holds all relationships.”
Peg Streep, writing in Psychology Today, wrote, “Trust is the foundation of all human connections, from chance encounters to friendships and intimate relationships. It governs all the interactions we have with each other. No one would drive a car or walk down a sidewalk, or board a train or an airplane, if we didn’t ‘trust’ that other people took their responsibilities seriously, and would obey whatever rules applied to the endeavour at hand. We trust that other drivers will stay in their lanes, that conductors and pilots will be sober and alert. And that people will generally do their best to discharge their obligations toward us. Culture, civilization, and community all depend on such trust.”
Trust means that we have confidence in the intentions and motives of others. For example, patients trust doctors because they have confidence that the doctor knows what they’re doing and has the patient’s best interest at heart. A recent meta-analysis showed that patients were more likely to have more beneficial health behaviours, less symptoms, higher satisfaction with treatment and a higher quality of life when they had higher trust in their doctor. Trust enables positive progress.
Trust brings cohesiveness organizationally as well as socially. If employees don’t trust each other or their managers then all sorts of problems start to arise: collaboration and communication stagnates, innovation ceases, employee engagement declines, productivity falls, and in general the workplace becomes unsuitable to be around.
Paul J. Zak is a neuroscientist that has studied the neuroscience and value of trust in the employees of Fortune 500 companies and in mountain tribesman. His data shows that employees who feel trusted perform better at work, stay with employers longer, and are significantly more innovative.
In order to foster trust, organisations have to build confidence in the intentions and motives of others – between workers and managers and between the workers themselves. When you have the confidence that your co-workers are going to pull their weight and do their jobs, it makes it easier to get on with yours. When you know management aren’t going to make arbitrary, selfish or irrational decisions, it’s much easier to follow their lead.
So how do you build trust within a relationship or an organisation? There are many ways to inspire confidence, but conflict resolution expert, Dr Aldo Civico suggests five different strategies:
Trust generously – or in other words, trust first.
Be patient and flexible. Trust is built over time.
Be dependable and be reliable. Take your own words very seriously. Don’t make up excuses, take responsibility for mistakes. Don’t be afraid to apologise.
Be consistent.
Be open and transparent in your communication. Don’t undermine or backstab.
The rain has stopped here, now it’s just cold! I hope that you can grow trust in within your organisation so that you and your team can move forward with strength and purpose.
Birkhäuer J, Gaab J, Kossowsky J, Hasler S, Krummenacher P, et al. (2017) “Trust in the health care professional and health outcome: A meta-analysis”, PLOS ONE 12(2): e0170988. https://doi.org/10.1371/journal.pone.0170988
When I was a kid growing up, there wasn’t much that my father couldn’t repair.
Dad was extremely gifted with his hands, a talent that I certainly didn’t inherit. He was able to take a problem, come up with a practical solution in his mind’s eye, then build it out of whatever scraps of wood, metal or plastic he could lay his hands on. It was the ultimate expression of frugality and recycling that comes from a limited income and four growing children.
Dad was also able to resurrect nearly everything that broke in our house. Plates, cups, teapots, toys, tools … it seemed there wasn’t anything that couldn’t be fixed by the careful application of Araldite.
Araldite, for those unfamiliar with it, is some sort of epoxy resin that, in the right hands, possesses mystical properties of adhesion. It would stick anything to anything.
Dad’s gift for repairing things with Araldite meant that a lot of our things were patched up. Some of our most loved possessions were the most cracked. Despite being glued together several times, each item was still functional. Maybe not as pretty as it may have once been, but still useful, and more importantly, still treasured. Each time the Araldite came out, it taught me that whilst all things have the capacity to be broken, they also have the capacity for redemption.
There’s an ancient Japanese tradition that shares the same principles. For more than 400 years, the Japanese people have practiced kintsukuroi. Kintsukuroi (pronounced ‘kint soo koo ree’) is the art of repairing broken pottery with gold or silver lacquer, and the deep understanding that the piece is more beautiful for having been broken.
The edges of the broken fragments are coated with the glue made from Japanese lacquer resin and are bonded back into place. The joints are rubbed with an adhesive until the surface is perfectly smooth again. After drying, more lacquer is applied. This process is repeated many times, and gold dust is also applied. In kintsukuroi, the gold lacquer accentuates the fracture lines, and the breakage is honoured as part of that piece’s history.
Mental illness is a mystery to most people, shrouded by mythology, stigma, gossip or Hollywood hype. It’s all around us, affecting a quarter of the population every year, but so often those with mental illness hide in plain sight. Mental illness doesn’t give you a limp, a lump, or a lag. It affects feelings and thoughts, our most latent personal inner world, the iceberg underneath the waters.
On the front line of medicine, I see people with mental health problems every day, but mental health problems don’t limit themselves to the doctor’s office. They’re spread throughout our everyday lives. If one in four people have a mental health problem of one form or another, then one in four Christians have a mental health problem of one form or another. If your church experience is anything like mine, you would shake hands with at least ten people from the front door to your seat. Statistically speaking, two or three of them will have a mental illness. Could you tell?
It’s a fair bet that most people wouldn’t know if someone in their church had a mental illness. Christians battling with mental illness learn to present a happy façade, or face the judgment if they don’t), so they either hide their inner pain, or just avoid church altogether.
Experiencing a mental illness also makes people feel permanently broken. They feel like they’re never going to be whole again, or good enough, or useful, or loved. They’re often treated that way by well-meaning but ill-informed church members whose idea’s and opinions on mental illness is out-of-date.
The truth is that Christians who have experienced mental ill-health are like a kintsukuroi pot.
Mental illness may break them, sure. But they don’t stay broken. The dark and difficult times, and their recovery from their illness is simply God putting lacquer on their broken pieces, putting them back together, and rubbing gold dust into their cracks.
We are all kintsukuroi Christians – we’re more beautiful and more honoured than we were before, because of our brokenness, and our recovery.
I’m pleased to announce that my book, Kintsukuroi Christians, is now available. I’ve written this book to try and bring together the best of the medical and spiritual.
Unfortunately, good scientific information often bypasses the church. The church is typically misled by Christian ‘experts’ that preach a view of mental health based on a skewed or outdated understanding of mental illness and cognitive neuroscience. I want to present a guide to mental illness and recovery that’s easy for Christians to digest, adopting the best spiritual AND scientific perspective.
In the book, I look at some scientific basics. Our mental world is based on the physical world. Our mind is a function of the brain, just like breathing is a function of our lungs. Just as we can’t properly understand our breathing without understanding our lungs, so it is that if we’re going to understand our thinking and our minds, we are going to have to understand the way our brain works. So the first part of this book will be an unpacking of the neurobiology of thought.
We’ll also look at what promotes good mental health. Then we’ll look at what causes mental illness, specifically looking at the most common mental health disorders. I will only look at some of the most common disorders to demonstrate some general principles of psychiatric illnesses and treatments. This book won’t be an encyclopaedia, and it doesn’t need to be. I hope to provide a framework so that common and uncommon mental health disorders can be better understood. I also discuss suicide, which is sadly more common than most people realise, and is rarely discussed.
I know mental illness is difficult, and we often look at ourselves or others as though the brokenness is abhorrent, ugly and deforming.
My hope is that through Kintsukuroi Christians, you’ll see the broken pieces are mended with gold, and realise that having or recovering from a mental illness doesn’t render someone useless or broken, but that God turns our mental brokenness into beauty.
Kintsukuroi Christians is available to purchase from good Christian bookstores around the world including:
Mental illness can be challenging. Sometimes learning about mental illness can bring up difficult feelings or emotions, either things that you’ve been through yourself, or because you develop a better understanding of what a loved one is going through or has been through. Sometimes old issues that have been suppressed or not properly dealt with can bubble up to the surface. If at any point you feel distressed, I strongly encourage you to talk to your local doctor, psychologist, or pastor. If the feelings are so overwhelming that you need to talk to someone quickly, then please don’t delay, but reach out to a crisis service in your country
In Australia Lifeline 13 11 14, or BeyondBlue Call 1300 22 4636 Daily web chat (between 3pm–12am) and email (with a response provided within 24 hours) https://www.beyondblue.org.au/about-us/contact-us.
USA = National Suicide Prevention Lifeline 1-800-273-TALK (8255)
New Zealand = Lifeline Aotearoa 24/7 Helpline 0800 543 354
It’s not often I see something positive in Dr Leaf’s work, but today was one such occasion.
I’m often (legitimately) critical of Dr Leaf’s paucity of references and citations for her Facebook posts and social media memes. Today was different – Dr Leaf made a statement and backed it up with an easily obtainable peer-reviewed journal article. It’s a shame it wasn’t backed up by an accurate interpretation, but it’s a positive step none-the-less.
Dr Leaf claimed that “People who served others experienced a 68% increase in healing compared to those who only got treatment for themselves.”
Since the article was so easy to find, I decided to look it up. The article was by Poulin et al, “Giving to others and the association between stress and mortality”, in the American Journal of Public Health [1]. Actually, the article was familiar, because Dr Leaf has written about the same article before, but her social media post that time was more nebulous.
So does the study by Poulin and his colleagues show that people who served others experienced a 68% increase in healing compared to those who only got treatment for themselves? In a word … no.
First of all, the study wasn’t looking at healing, it was looking at mortality. They may seem similar, but getting better from something (“healing”) is not the same as not dying from something (“mortality”).
Second, no one in the study was being “treated”. I’m not sure where Dr Leaf got the idea that the control group was getting “treatment”. The study compared those who self-reported “helping behavior directed toward close others … in any of 4 unpaid helping activities directed toward friends, neighbors, or relatives who did not live with them” versus those that did not.
Thirdly, there’s no mention of a 68% improvement anywhere in the article. The article gives its results as hazard ratios. For the non-statisticians, the hazard ratio is “the ratio of the particular event taking place in treatment group compared to control group.” The simplest (probably over-simplified way) way of thinking about hazard ratios is to do a simple sum – the hazard ratio minus 1 is the percentage increase or decrease in risk, where a positive number is an increased risk and a negative number is a decreased risk. So a hazard ratio of 1.13 means that a person in the exposure group has a 13% increased risk compared to the control group (=1.13 – 1). And a hazard ratio of 0.7 means a 30% decreased risk (0.7 – 1 = -0.3). So for the helping group to have a 68% decreased risk of dying, the hazard ratio would be 0.32 (0.32 – 1 = -0.68).
If you’re lost in the numbers, don’t stress. The point is that Dr Leaf was very specific about the helping group increasing in healing by 68%, but there’s nothing in the results to suggest this. The study authors wrote, “When we adjusted for age, baseline health and functioning, and key psychosocial variables, Cox proportional hazard models for mortality revealed a significant interaction between helping behavior and stressful events (hazard ratio [HR] = 0.58; P < .05; 95% confidence interval [CI] = 0.35, 0.98). Specifically, stress did not predict mortality risk among individuals who provided help to others in the past year (HR = 0.96; 95% CI = 0.79, 1.18), but stress did predict mortality among those who did not provide help to others (HR = 1.30; P < .05; 95% CI = 1.05, 1.62).” Unless I’m missing something, there’s nothing in the results that remotely suggests a 68% improvement in anything.
And for what it’s worth, the study shows very weak associations anyway (in statistical terms, the confidence intervals are broad, and almost cross 1), so even if the study really did say something about a “68% increase in healing”, it’s something that is only slightly more likely to occur than by chance alone. Then there’s other evidence that contradicts this particular study’s findings, so in all fairness, this study shouldn’t be used to base social media memes on in the first place.
Overall, it’s good that Dr Leaf cited an article in her social media meme, but her interpretation of the study was poor, something more at the level of a university freshman than a supposed expert in her field. And it reflects badly on the Christian church that this is the level of ‘expertise’ that the church accepts and then promotes.
I would encourage Dr Leaf to continue to cite references for her memes, but she really needs to learn how to interpret clinical studies if she and the church are going to continue to promote her as some sort of expert.
References
[1] Poulin MJ, Brown SL, Dillard AJ, Smith DM. Giving to others and the association between stress and mortality. Am J Public Health 2013 Sep;103(9):1649-55.
“He’s not the messiah, he’s a very naughty boy, now go away!”
Ah, Monty Python – six university students with a penchant for satire who changed the face of comedy. They say that “Imitation is the sincerest form of flattery”, and if that’s the case, Monty Python should be very flattered! Nearly five decades later, you still hear people throwing around lines from their sketches and getting a laugh.
Their movie, “The Life of Brian” remains one of the most critically acclaimed and most controversial of all movies. It was the story of Brian, born in the stable next door to Jesus, and who later in life unintentionally becomes the focus of a bunch of people who mistakenly believe he’s the messiah. One morning he opens his window to find a large crowd of people waiting for him outside his house, leaving his mother to try and dismiss the crowd with that now famous rebuke.
The crowd at Brian’s window aptly demonstrates a quirk in our collective psyche. We humans have a bipolar tendency to latch on to something that seems like a good idea at the time and blow it’s benefits out of all proportion, only to later discover it wasn’t as good as our overblown expectations and unfairly despise it on the rebound.
Anti-depressant medications are a bit like Monty Python’s Brian. Back in the late 1980’s when Prozac first came on the market, doctors saw it as the mental health messiah. Prozac improved cases of long-standing severe depression and was much safer in overdose compared to older classes of psychiatric medications. The idea that depression and other mental illnesses were related to chemical imbalances fit nicely with the cultural shift away from the Freudian psychotherapy model that was prevalent at the time. People were describing life changing experiences on Prozac: “One morning I woke up and really did want to live … It was as if the miasma of depression had lifted off me, in the same way that the fog in San Francisco rises as the day wears on.” [1] Prescribing for Prozac and other SSRI anti-depressants took off.
Fast forward to the present day, where the pendulum has swung back violently. Anti-depressants are considered by some to be nothing more than over-prescribed placebo medications used by a pill-happy, time-poor culture demanding simple cures for complex problems. Some commentators have gone so far as to label anti-depressants as an evil tool of the corrupt capitalist psychiatric establishment.
“Anti-depressants are not the messiah, they’re very naughty boys, now go away!” they exclaim.
But are anti-depressants really the enemy, or could they still be friendly, even if they’re not the messiah?
In the Medical Journal of Australia this month, two Australian psychiatrists, Christopher Davey and Andrew Chanen, carefully review the place of anti-depressants in modern medicine [2]. It’s a very balanced and pragmatic view.
They bring together all the evidence to show that while anti-depressants aren’t the elixir of happiness that we once assumed, they also don’t deserve the accusation that they’re nothing but fakes.
When drugs are scientifically tested, they’re usually studied in placebo-controlled trials. The medications are given to one target group of people and a fake medicine is given to a similar group. In the best trials, the patients aren’t aware of which they’re actually getting, and the physicians aren’t aware either. That way personal bias and expectations can be reduced. To reduce these biases even further, other scientists can pool all of the quality research on a topic in what’s called a meta-analysis.
Trials on anti-depressants initially showed very strong positive results, or in other words, the patients on the drug did much better than those on the placebo. Anti-depressants lost a lot of their shine in the last decade or so as researchers began pointing out that the placebo effect, the number of patients improving on the fake medicine, was also very high.
There was also the serious, and largely legitimate accusation that drug companies ignored trials with less favourable results to make their drugs look better. The reputation of anti-depressants was forever tarnished.
One of the most out-spoken critics of anti-depressants, Harvard psychologist Irving Kirsch, tried to show that when all of the trials on anti-depressants were taken together, the placebo effect wasn’t just close to the effectiveness of the real medicine, but was actually the same.
The problem with Kirsch’s analysis is that not all trials are created equal. Some have negative results because they were poor trials in the first place. When experts reapplied Kirsch’s methods to the best quality trials, the results suggested that anti-depressants are still effective, but for moderate and severe depression [1]. Anti-depressants for mild depression weren’t of great benefit.
This is take home point number one:Don’t believe the hype. Anti-depressants are useful, but not for all cases of depression. #happypillshelp
So if anti-depressants aren’t useful for all cases of depression, are other therapies better? This is where psychological therapies come in to the equation. Those who are the most vocal opponents of modern psychiatry and psychiatric medications are also the most vocal promoters of the benefits of talking therapies. They won’t admit it, but there’s usually an ideological bias or financial incentive driving the feverish worship of talking therapies and their overzealous defence.
Though in the cold hard light of evidence-based science, talking therapies aren’t much of a panacea either. Pim Cuijpers, a professor of Clinical Psychology in Amsterdam lead a team who reviewed the effectiveness of trials of psychotherapy, and found that their effectiveness has also been overstated over the last few decades. Quality studies show that talking therapies are equivalent in effectiveness compared to anti-depressants for depression [3].
What’s important to understand about talking therapies in general is that any benefit they have is related to changing behaviour, but that’s not dependent on changing your thoughts first [4-6]. Talking and thinking differently is fine, but unless that results in a change to your actions, there will probably be little benefit.
This is take home message number two:Talking therapies help, but you don’t need to change your thinking, you need to change your actions. #walkthetalk
The million-dollar question is how to apply all of this. If talking therapies have the same benefit as anti-depressants, then do we go for tablets before talking or the other way around? Are both together more powerful than each one alone?
In their paper, Davey and Chanen outline what has become the generally accepted pecking order for anti-depressant therapy. They recommend that all patients should be offered talking treatments where it’s available. Medication should only be considered if:
a person’s depression is moderate or severe;
a person doesn’t want to engage with talking therapies; or
talking therapies haven’t worked.
Some overseas guidelines recommend this order based on projected bang for your buck. While talking therapies are initially more expensive, they seem to have a more durable effect than medications, which are initially cheaper and easier, but have a greater cost with prolonged use [7]. In other words, if you learn better resilience and coping skills, you’re less likely to fall back into depression, compared to the use of the medications.
This is take home message number three:Use talking therapies first, with medications as a back up. #skillsthenpills
At this point in history, we seem to finally be finding some balance. Just as anti-depressants aren’t the messiah, they’re not the devil either, despite the vocal minority doing their best to demonise them.
With a few decades of research and clinical experience since Prozac was first released on to the market, we’re finally getting an accurate picture of the place of talking therapies and medications in the treatment of depression. Both are equally effective, and each have their place in the management of mental illness in our modern world.
References
[1] Mukherjee S. Post Prozac Nation – The Science and History of Treating Depression. The New York Times. 2012 Apr 19
[2] Davey CG, Chanen AM. The unfulfilled promise of the antidepressant medications. Med J Aust 2016 May 16;204(9):348-50.
[3] Cuijpers P, van Straten A, Bohlmeijer E, Hollon SD, Andersson G. The effects of psychotherapy for adult depression are overestimated: a meta-analysis of study quality and effect size. Psychological medicine 2010 Feb;40(2):211-23.
[4] Herbert JD, Forman EM. The Evolution of Cognitive Behavior Therapy: The Rise of Psychological Acceptance and Mindfulness. Acceptance and Mindfulness in Cognitive Behavior Therapy: John Wiley & Sons, Inc., 2011;1-25.
[5] Longmore RJ, Worrell M. Do we need to challenge thoughts in cognitive behavior therapy? Clinical psychology review 2007 Mar;27(2):173-87.
[6] Dobson KS, Hollon SD, Dimidjian S, et al. Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression. Journal of consulting and clinical psychology 2008 Jun;76(3):468-77.
[7] Anderson I. Depression. The Treatment and Management of Depression in Adults (Update). NICE clinical guideline 90.2009. London: The British Psychological Society and The Royal College of Psychiatrists, 2010.
IMPORTANT
If you have questions about what treatment type might be better for you in your situation, please talk to your local GP, psychologist or psychiatrist, or if you need urgent crisis support, then:
In Australia
you can call either Lifeline on 13 11 14,
BeyondBlue provides a number of different support options
the BeyondBlue Support Service provides advice and support via telephone 24/7 (call 1300 22 4636)
It’s ok, we’re all friends here. You can admit it – lying is a regular part of everyday social cohesion. We don’t call it lying, we call it tact, but it’s still lying.
Like when we automatically say to the mother of a newborn baby, “Oh, your baby’s adorable”. Sure, most of them are, but there are some newborns that, shall we say, need to grow into their features.
Or when a patient walks in and asks, “Hey, have you lost some weight?!” No, I’ve actually gained five kilos, but thanks for your flattery.
Even some of the most brutally honest people still figure out they have to lie at some point. My children, for example. They have absolutely no diplomacy filter between their brains and their mouths, “Aw, Dad … you stink”, or “Dad, you’re really fat. You need to exercise.” But when their butt’s on the line, things change, “I only ate one biscuit …”, or, “He started it …”.
Adults are no better. Sometimes when things are important enough to us, we bend the truth to fit our world-view. It’s often subconscious, though confirmation bias of our opinions can also be overt.
Sometimes we’re right, sometimes we’re wrong, and sometimes there is no right or wrong, but our beliefs shape our interpretation of the world, and the language and actions that stem from them. And most of the time, it doesn’t really matter.
“Chocolate is the nicest flavour of ice-cream”.
“Beer is better than cider.”
“The Broncos shouldn’t have lost the NRL Grand Final.”
“Holden’s are better than Ford’s at Bathurst.”
“Donald Trump is a great guy.” **
Hey, if you think Donald Trump is a great guy, then you’re welcome to your opinion. It ultimately makes no difference, if you like Trump, or I like vanilla ice-cream, or if you’re a ‘Ford guy’.
Though what about when someone in the public sphere lies, or allows their opinion to shape their version of truth? Is ‘a little white lie’ ever truly acceptable?
For example, is it justifiable if news reporters lie about themselves or their motives to get to the truth of a story? For example, in an article written as an ethical primer for journalism students at Indiana University, Henry McNulty recalled an expose he was part of in which reporters posed as couples trying to get into the local real estate market. The investigation exposed some inherent racial prejudice amongst the realtors, and eventually lead to the state governor ordering a formal investigation into real estate discrimination.
While he noted that the investigation had noble goals and positive outcomes for the community, he also concluded that the end should never justify the means.
“Credibility is our most important asset. And if we deceive people in order to do our job, we’ve compromised that credibility before a word is written”, he said.
In recent times, the Safe School’s program has come under intense scrutiny. For those not familiar with it, the Safe Schools program was touted by its supporters as an evidence-based anti-bullying program for mid-late primary school students, although its primary agenda appears to be in promoting the Lesbian-Gay-Bisexual-Transgender (LGBT) lifestyle and ideology. Or as one commentator put it, “In reality, the debate is between those who support the right to childhood and children’s bodily dignity, the right to an education that educates, not indoctrinates, versus those who believe Marxist activism constitutes sound school curriculum.”
A post came up on my Facebook feed in the last couple of days, titled, “Gender Ideology Harms Children”. It was published by the American College of Pediatricians, which sounds like an official body, except that the American Academy of Pediatrics is the peak body of paediatricians in America. Then the style of language of the statement was inconsistent with that used by most peak bodies – this statement by the American College of Pediatricians was very strongly partisan. I couldn’t help but wonder who the American College of Pediatricians actually were.
As it turns out, the American College of Pediatricians are a group that promote a very conservative agenda under the guise of official medical and scientific opinion.
In their core values, they state that their college:
“A: Recognizes that there are absolutes and scientific truths that transcend relative social considerations of the day.
B: Recognizes that good medical science cannot exist in a moral vacuum and pledges to promote such science.”
I’m all for good science, but one has to wonder if they’re going about it the right way, because while they declare their pledge to scientific truth, their next core value is essentially an opinion:
“C: Recognizes the fundamental mother-father family unit, within the context of marriage, to be the optimal setting for the development and nurturing of children and pledges to promote this unit.”
As much as I agree with and share most of their values, their pledge to opinion-based science is somewhat duplicitous, because opinion-based science isn’t absolute truth, it’s still a version of truth relative to their values and presumptions.
The irony hasn’t escaped some of the colleges critics, who have highlighted some of the factual errors and bad science that inevitably occurs when one tries to fit scientific findings into a set of values rather than drawing conclusions from the science.
In fairness, I’m not saying that the LGBT community is faultless either. I’m sure that an in-depth study of their sources would find some over-zealous misinterpretations of scientific data as well.
My point is that we tend to look for information that suits our own pre-conceived notions, and the Christian community can get itself into trouble by doing this. Christian lobby groups and church leaders need to be wary selectively accepting ‘scientific’ information that conforms to their world-view. They need to, in all diligence, ensure that the data they cite really does support their position, not cherry-pick or over-extrapolate. Otherwise they’re no better than the moral relativists on the other side of the political spectrum, or journalists who would justify mistruth to achieve a higher goal, or my eleven-year-old denying his biscuit binge.
One critic of the American College of Pediatricians wrote something very incisive in the title of his blog, “Lies in the name of God are still lies.”
It’s a fair call. Misleading with the best of intentions is still misleading. We may have the best of intentions, and feel justified in picking the science that conforms to our world-view.
Even so, God called us to speak the truth, because Jesus was the way, truth and life, and it’s the truth that sets us free. And our credibility is our witness. If we deceive people in order to do our job, we’ve compromised that witness before a word is written.
That’s the honest truth.
** The opinions expressed here do not necessarily represent those of the authors, and are for illustrative purposes only … except the bit about the Broncos … but the rest is just illustrative.
Many a stirring yarn has been started with those exact words, as aging men relive their childhood adventures with sentimental grandiosity increasingly taking over from detail as each passing year blends in with the blur of distant memories.
Ps Greg Gibson wrote an article that caught my attention as it floated across my Facebook feed last night. Gibson is a pastor in Knoxville, Tennessee. His “when I was a boy” story recalled his happy times as an energetic child, a serene innocence punctuated by two years of Ritalin-induced misery.
His point: “I think we should let boys be boys, and non-medicated ones at that. Therefore, parents, if at all possible, don’t medicate your boys.”
I think I understand what he’s trying to say, that it’s ok to be an energetic child and to see the extra energy as a strength to harness, not a weakness to control.
That would be fine, except that in trying to normalise energetic behaviour, he also winds up demonising Ritalin. It may not have been his intention, but whenever someone respected in the community says something negative about stimulant medication or ADHD, it reinforces the oppressive stigma attached to those who suffer from it.
Ps Gibson’s fundamental assumption, that normal but energetic children are being misdiagnosed as ADHD and therefore unnecessarily medicated, happens far less often than the opposite – children with ADHD are misdiagnosed as energetic children that just need to be taught how to control themselves.
Personally, I don’t know of any parent who ever wanted to medicate their child with Ritalin. If anything, it’s the opposite, because if your child’s on Ritalin, then you must be a lazy parent, or given them too much sugar, or too much screen time, or not hugged them enough as babies, or didn’t practice vaginal seeding, or whatever other form of parent-guilt is being perpetrated by the media at the time. Parents will do everything they can in their power to avoid using Ritalin, because of a culture that blames and shames.
Unfortunately, this means that children who could be helped by Ritalin or other stimulant medication are left behind, because ADHD isn’t the mislabeling of normal energetic children who just need better structure, or better posture, or who learn differently. ADHD is a real disability, a dysfunctional lack of planning and control that’s abnormal compared to other children, affecting their entire lives.
For example, these children find it hard to play with other kids because they can’t follow basic social rules like the rules of games, or waiting their turn. These children find school difficult, because they can’t concentrate for long enough to focus on completing a multi-step task, or have a long enough attention span to make new memories for words or facts.
One of my patients, a little boy about seven years old, was brought in by his mother because a chiropractor wanted me to arrange a blood test on his behalf. When I asked why, the mother said the little boy had dyslexia which the chiropractor was ‘treating’ (actually, this chiropractor was blaming a disease that didn’t exist, and wanted me to arrange a test that was resigned to the pages of history, but that’s another story). When I talked to the mother about the child’s symptoms, it was pretty obvious that he had ADHD, amongst other things. After seeing a developmental paediatrician to confirm the diagnosis, and taking Ritalin for just one week, his reading improved three whole reading levels, and after a month, he had not only caught up, but had passed a number of his class-mates.
This is a real life example of how ADHD can hold children back, and how stimulant medication can help. While there are always exceptions to the rule, stimulant medications help more often than they hinder. They’re sometimes the difference between a child meeting his full learning potential, or being unnecessarily held back, languishing at the bottom of his class as his peers go further ahead in leaps and bounds.
Our culture needs to move on. We need to stop our social prejudices making life more difficult than it already is for children and their families who battle with ADHD. We need to see that medications for ADHD can be the difference between a life of learning and a life unfairly held back.
Let’s change the tune. Rather than saying, “Let boys be non-medicated boys”, how about we say, “Let boys be non-stigmatised boys.” It’s only through the break-down of the stigma surrounding ADHD and stimulant medications, that all boys (and girls) can truly meet their full potential, whether they have ADHD or are just a bit more energetic.
If you want more information on ADHD and its treatments, this is a good place to start: http://www.rch.org.au/kidsinfo/fact_sheets/ADHD_an_overview/
If you are concerned that you or your child might have ADHD, talk to your local GP or paediatrician.
Dr C. Edward Pitt 