Tag Archives: acceptance

The lost art of joy – Change

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“The only thing that is constant is change” ~ Heraclitus

2017 is drawing to a close and 2018 is rapidly approaching. It always seems like such a big transition, moving from one year to the next, but when you think about it, December 31st, 2017 and January 1st, 2018 aren’t going to be that much different. Let’s face it, 11:59pm on the 31st of December is really not much different to 12:01am on January the 1st. Rationally, the transition into 2018 holds no more meaning than the transition from November 30 to December 1, or as 3:36am quietly clicks over to 3:37am. Why does the passage of time matter so much more at the stroke of midnight? 11:57pm is probably feeling a bit irked.

Change in all other parts if our lives is a bit like the movement of the clock. Every now and then, we look to see that change has happened but it’s been happening imperceptibly all around us, the state of perpetual flux.

There are always constants – the immutable sunrise and sunset, the lunar rhythm of the full moon, the soft cycle of the seasons. It’s easy to be distracted by their comforting predictability. And yet, ironically, it is these power of these cycles that creates the constant change all around us that we fail to perceive – the winds, the rain, the tides which ever change our natural world, sculpting our land and changing our oceans over eons.

Change is constant, whether it be in our natural world, in our community, or in our body. How we approach this change is a key to living a life of joy and meaning.

It’s natural to dislike change. Our brains are essentially predictive pattern recognition engines. Our brain understands our environment by using the pattern of the world it’s already learnt to make a prediction of what it thinks will happen, and then it compares that prediction to the current inflow of information. If the brain’s prediction and the inflow of information match, the brain doesn’t need to do any more work. When the brain encounters something it didn’t predict, it has to work a lot harder to process the new information and use that information to update its internal model of the world.

I don’t like to shave, because shaving takes time, energy and resources. By not shaving, I’m being much more efficient (though some would say ‘lazy’).

Our brains are like my shaving habits. The brain would much rather not have to process any extra information because that takes time, energy and resources. By not having to process any more new information, our brains are efficient. Unlike my shaving habits, which probably are born of laziness, the brain likes to conserve energy since there’s only so much fuel the body can spare for it, and the more efficient the brains processing is, the less fuel it needs.

So by keeping things fairly constant and avoiding change, the brain can just plod along rather efficiently without all the extra resources needed if it had to process constant change.

But this puts us in a bit of a bind, since change is happening anyway whether our brains want it to or not.

It becomes the immovable force versus the irresistible object. We can dig in and resist the inevitable, or we can adapt to the change.

If we dig in, if we stay static, if we fail to adapt, then it eventually costs us more in terms of energy. It creates a greater cognitive load – maybe not in the short term, but resisting change is like padding against the current … it takes a lot of work, and it’s cognitively taxing. All that energy for no actual gain, well, we’ve talked about that before in other posts.

We can’t change ‘change’, and by trying to change ‘change’, we expend huge amounts of energy to get nowhere. And it changes nothing, except for diminished motivation, volition and resistance. The futile fighting with ‘change’ makes it hard for joy to flourish, not that it stops us trying sometimes.

John C. Maxwell wrote, “Change is inevitable, growth is optional”. You can certainly keep swimming upstream if you want to, or you can accept that change can not be changed and adapt in productive ways You can channel the energy that would have otherwise gone into resisting change and put it into something that aligns with your values and helps to enhance your life of meaning, in turn helping you to grow your joy, not unwittingly sabotage it.

If you don’t want to get stuck at 11:57pm and you want to move forward into the new year, accept the inevitability of change, and take that first step of committed action in the direction of your values.

The lost art of joy – Adaptability

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A few years ago, I performed in a Christmas musical.

Thankfully, I got the part of the narrator – lots of lines to learn but no singing, because I sing like a cat with laryngitis. I was also hoping to get away without any dancing, because I dance like a dyspraxic hippo, but the director was adamant – all the cast had to participate in the closing number.

Rehearsals for the dance were somewhat embarrassing. There was me – middle-aged, sedentary, overweight and unfit – surrounded by a bunch of skinny, limber teenagers and twenty-somethings. The dance instructor would take us through the warm up and while I would be struggling to get my feet more than shoulders width apart or my fingers much past my knees, the teenage whippets would be doing the splits all the way to the ground, or bending forward with their palms on the floor. Even those who weren’t very good dancers made up for it by the fact that their body had to strength and flexibility to adapt to the moves they had to learn. My body was tight and unforgiving, and I had to work really hard to do what the flexible people did very simply.

The world is in constant motion. Every day brings new challenges as the swirling currents of our social and physical environments push and pull us in different directions. Our inner world swirls just as much, as our feelings and emotions ebb and flow, churn and whirl. The collision of the swirling oceans of our outer world and the turbulent air of our inner worlds can create rain, storms or even hurricanes of psychosocial distress. Even without the bad weather, the constantly changing social and emotional forces creates never-ending demands on our ability to cope, and the exigencies can be exhausting.

Just like those people who were physically more flexible were able to better cope with the demands of the dance number, those people who are emotionally more flexible are able to better cope with the demands of our inner and outer worlds.

Psychological flexibility is being able to adjust our short term feelings in service of our long term values. In the research, psychological flexibility actually refers to a number of dynamic processes that unfold over time, such as how a person adapts to fluctuating situational demands, reconfigures mental resources, shifts perspective, and balances competing desires, needs, and life domains.

In other words, psychologically flexibility involves travelling in the direction of your deepest values, but being in touch with the present moment so that adjustments can be made to keep you on track.

Being psychologically flexible is like turning south for a little while to compensate for the northerly breeze so you can keep sailing in the direction of your long term values.

In day to day life, being psychologically flexible means not holding too tightly to our feelings, emotions or thoughts which can change rapidly and which aren’t always reliably in service of our deeper values.

So how can we become more psychologically flexible so that we can enhance the joy that psychological flexibility encourages?

It starts with knowing what your values are, and moving towards them.

We also need to work on acceptance, allowing our feelings and emotions, as strong and as distressing as they are at times, to ebb and flow as they do without rigidly fighting against them or trying to suppress them.

In order to build our capacity to cope with changing situational demands, we also need to “stretch” our mental “muscles” like I needed to stretch my physical muscles to be able to dance better. To become more mentally limber,
1. Learn something new every day, even if it’s something small
2. Do something differently, even if it’s a small change, but don’t always stick to the same routine
3. Do different things, things that you may not have done before. Again, doesn’t have to be much, but try a different coffee order, or a new meal at a restaurant. Listen to some new music.
4. Challenge yourself. Just a little bit every day. It’s ok to be a little bit mentally uncomfortable. Stretching is good for you!

As you continue to grow more psychological flexible, you will open yourself to new and greater experiences of joy.

The lost art of joy – Forgiveness

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Even suits like this can be forgiven …

Fun movie fact – The phrase “Revenge is a dish best served cold” was first said, in those exact words, in the Star Trek movie, Star Trek II, The Wrath of Kahn in 1982.

Revenge is one of the most classic of all movie plot lines. According to the Oxford Research Encyclopaedia of Criminology, there are over 1000 catalogued films that are specifically “revenge” films. It sort of makes sense … imagine if the protagonist was decisively wronged, and instead of embarking on a convoluted scheme of vengeance, they just got on with their lives. Cue theme music, roll credits, yawn … not a particularly exciting movie.

And lets face it, we like movies with a theme of vengeance because no one likes being maligned or abused. It’s human nature to repay wrong with another wrong. Eye for an eye, tooth for a tooth. If you hurt me, natural justice is fulfilled if I make you feel the same pain in return.

Revenge might make for a good movie plot, but does it make for a good life? As the old proverb goes, “Two wrongs don’t make a right.” If you hurt me, hurting you back doesn’t make my pain go away. It just adds more pain to the world, because I’m still in pain and now you’re in pain. Then you’ll want to hurt me back, and the cycle escalates.

Francis Bacon said, “A man that studieth revenge keeps his own wounds green, which otherwise would heal and do well.” In other words, you may be able to bring about retribution, but during the process, you’ll end up keeping your own wounds open and festering, instead of letting them close and heal. It’s like someone cut you with a knife, and in order to show them what damage they did to you, you keep reopening the wound every few days. The wound may look open and fresh should they ever care to notice, but you’re the one who had to put up with an open wound for an extended time, and re-live the pain every time you reopened it.

Douglass Horton wrote, “While seeking revenge, dig two graves – one for yourself.” Vengeance rarely ends well.

Interestingly, research has shown how the desire for revenge can affect you mentally and physically. One study showed that when subjects were asked to think of reacting aggressively to a given scenario, parts of the limbic system in their brains increased in activity. This isn’t unsurprising, given that our brain subconsciously prepares us all the time for fight or flight responses when it starts to sense danger, in preparation for possible action.

What was more interesting is that angry rumination also reduced the activity of the subject’s frontal lobes as well, which is really important for reasoning. So it might be that reasoning is disrupted by anger, and that rehearsing angry and aggressive mental scenarios shuts down the brains problem solving approach and calm emotions.
The other alternative to nursing the grudge is forgiveness. Forgiveness is a particular form of acceptance. It’s the act of moving on from insult or injustice. It isn’t saying that what was done to you was ok, but rather, that you aren’t going to be held captive by it.
There have been lots of studies looking at different aspects of forgiveness, but without getting bogged down in details, forgiveness helps to rebalance things. People who forgive habitually tend to also have lower blood pressure, while individual acts of forgiveness and lower hostility predict lower stress levels, which in turn predicts lower self-reported illness. The reduction of negative affect (a “bad mood”) was the strongest mediator between forgiveness and physical health symptoms, although the study authors noted other variables such as spirituality, social skills, and lower stress also had a role in the forgiveness-health relationship.

Forgiveness is a complex psychological process, but it is primarily built on acceptance, another practical example of the serenity prayer. Forgiveness involves letting go of those things that can not be changed. You can’t change the past. Old wrongs will still be old wrongs, no matter what happens to the perpetrator in the future.

Like so many examples of acceptance, by letting go of the old hurts, you free up room for new joy. You’re no longer bound by the painful past, which means you can move forward into a joyous future. In this sense, think of revenge and forgiveness in terms of gifts. Specifically, those awful gifts that you accept under obligation from distant relatives. You know, stuff you might get from your great aunt, like a pair of festive Christmas crocs three sizes too small, or a Meowy Christmas suit and tie. Imagine your great aunt accidentally got the decimal place on the order form wrong and she sent you 1000 of them, making your house look like Santa’s workshop on acid.

Revenge would be keeping all 1000 pairs of Christmas crocs and Meowy Christmas suits in your house, waiting for the chance to show your great aunt what a terrible thing she did and how she’s filled your house with ugly Christmas-themed draff. Forgiveness is to send it all back to the manufacturer, every single last croc and tie, so that once again you have room for what’s important to you.

I don’t know if there is any one particular method to forgive. Apologies help, but they aren’t necessary to be able to forgive someone. Sometimes people find actually saying the words “I forgive you” to be a powerful release. That can be to a person directly, although that may not always go down so well. Saying it internally is valid. Sometimes writing it in a letter, and then tearing it up as an act of finality, can be useful.

This Christmas, if you’re hanging on to the festive crocs and Meowy suits of past hurts, let them go and fill your life with joy instead.

Post-script:

I understand that talking about forgiveness can bring up some deep and difficult feelings in some people. Just like physical wounds, some traumas are shallow and heal quickly, but others are inflicted so deep that they are hard to heal, like rape, childhood abuse, domestic violence and other deep psychological insults. It’s important to clarify here that memories of such traumatic events often intrude into your conscious awareness, where it takes over and replays in your memory. That’s different to unforgiveness and rumination, which are memories that we foster and encourage by actively rehearsing them. Forgiveness is still a part of the healing process of severe psychological trauma, but the healing process may take longer, and the process of finding that forgiveness may require a professional to help walk through the process. If you’ve been the victim of a severe trauma, you don’t need to go it alone. Find a psychologist or talk to your doctor if you’re not sure.

The lost art of joy – Acceptance

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“’Tis the season to be jolly”

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.

Running of the Elephants – Why thought suppression doesn’t work

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Have you ever found yourself about to give a speech or sit an exam, and one of your friends tries to calm you down by saying, “Stop worrying … just don’t think about it!”  Does that ever work?  Not usually!  The more you try to intentionally block it from your mind, the more it wants to pop up again.

Why is that?  It seems intuitive that if you don’t want to think about something, all you need to do is to take control and block it out of your mind, right?

One of Hollywood’s better movies in recent times was “Inception”.  In one of the key early scenes, Arthur is explaining to Saito why inception is impossible,

“Saito: If you can steal an idea, why can’t you plant one there instead?
Arthur: Okay, this is me, planting an idea in your mind. I say: don’t think about elephants. What are you thinking about?
Saito: Elephants?”

This is a great little dialogue about thought suppression.  Thought suppression is the process of consciously trying to avoid certain thoughts, either by trying to replace the unwanted thought with another thought, or simply trying to repress the unwanted thought.

Our minds tend to focus on the content of a subject.  If the subject is elephants, no matter what words I put in front of it, your mind will think about elephants.  Like if I say, “I love elephants, or I say “Don’t think about elephants”, your brain hears, “blah blah blah elephants.”  And having been sensitized to the idea of not thinking about elephants, when your mind inevitably brings it up again, you’re primed to pay even more attention to it, “D’oh, I’ve just thought about elephants again … stop thinking about elephants …”.

This phenomenon is even more pronounced if your mind has already been focusing on the subject.  If you’re mind is going over and over a speech you have to give and I say, “Oh, don’t worry about that speech”, all your mind registers is, “blah blah blah SPEECH”.

Although it’s been discussed in the psychological sciences for decades, it’s only been since the late 1980’s that considerable attention has been given to the concept of thought suppression.  Despite our natural tendencies to try it or recommend it to people, the conclusion of nearly all the research is the same: thought suppression doesn’t work.

Wenzlaff and Wegner, two American psychology researchers, looked at all of the different research on thought suppression and came to the following conclusion,

“What has compelled the interest of the scientific and clinical communities is that suppression is not simply an ineffective tactic of mental control; it is counterproductive, helping assure the very state of mind one had hoped to avoid. The problem of thought suppression is aggravated by its intuitive appeal and apparent simplicity, which help mask its false promises.” [1]

I’m not really sure why we naturally gravitate to thought suppression.  Perhaps it’s part of our natural delusion of control.  Perhaps it’s a throwback from the pop-psychology assumptions that we can control our destiny, or the common myth that our mind is in control of our brain.

Whatever the reason, as time has passed, researchers are coming to understand why thought suppression is so unhelpful.  This quote from Magee and his colleagues helps to explain why:

“This shift in focus parallels advances in cognitive theories of intrusive thoughts, which suggest that having intrusive thoughts is a normative phenomenon; instead, the way an individual interprets those thoughts is expected to lead to benign versus serious outcomes … Similarly, having difficulties with thought suppression is a common experience … it is the way an individual interprets that experience that may be key. Previous discussions of thought suppression have frequently implied that people having difficulties with thought suppression often ascribe negative meaning to their difficulties.” [2]

We naturally struggle to suppress intrusive thoughts because intrusive thoughts are normal.  Trying to suppress them is like trying to suppress any other normal biological process.  Try to stop breathing for any length of time and you’ll see what I mean – it’s impossible, and trying is simply counterproductive.

The key is how we react to or feel about our thoughts.  If we feel like our thoughts might be somehow causing us harm, then our failure to stop them from bubbling up to the surface of our consciousness is going to cause us distress.  It’s a double whammy – we’re stressed because we’re expecting the negative consequences of our thoughts, and we’re distressed by our ‘failure’ to stop them.

Since it first started more than a century ago, the death toll from the famous Pamplona event, “Running of the Bulls” currently stands at 13.  Countless others have been gored and trampled.  Who are the people who get injured during the event?  Certainly not the smart ones standing behind the barriers on the edge of the streets, or the ones watching it broadcast on TV?  Only the morons who try to outrun the pack of foot-long bony skewers attached to the half-ton lumps of very cranky steak.

Similarly, the best way to manage our thoughts is to learn not to fight with them in the first place.  By non-judgmentally observing them, we can simply observe our thoughts for what they are … just thoughts.  By stepping back from our thoughts and giving them room, we find that they don’t have any real power over us.  Stepping back away from our thoughts and letting them be is the skill of defusion, one part of the process of psychological acceptance.  It’s the first step in living a life abundant in meaning and significance.

So just remember: don’t try to suppress an unwelcome thought.  Having intrusive thoughts is actually a normal process, not a sign of disease or mental weakness.  They’re not toxic or harmful, they’re just thoughts.  Give them space, like you would a charging angry bull (or elephant!)

References

[1]        Wenzlaff RM, Wegner DM. Thought suppression. Annual review of psychology 2000;51(1):59-91.
[2]        Magee JC, Harden KP, Teachman BA. Psychopathology and thought suppression: a quantitative review. Clinical psychology review 2012 Apr;32(3):189-201.

Dr Caroline Leaf and the case of the killer reactions

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Stress! Believe the media and seemingly every disease known to man is in some way linked to it. Heart disease = stress. Cancer = stress. Flatulence = stress.

Dr Caroline Leaf, Communication Pathologist and self-titled cognitive neuroscientist, has been of a similar opinion for the last couple of decades. Dr Leaf must have been kind enough to read my book, because after teaching for the last fifteen years that stress is toxic, a subtle shifting under the weight of evidence has appeared.

In her 2009 book [1], Dr Leaf wrote,
“The result of toxic thinking translates into stress in your body.” (p15)
“Stress is a global term for the extreme strain on your body’s systems as a result of toxic thinking.” (p15)
“Stress is a direct result of toxic thinking.” (p29)
“These stages of stress are scientifically significant because they illustrate how a single toxic thought causes extreme reactions in so many of our systems.” (p39)

In 2013, her position on stress hadn’t really changed that much: “Even a little bit of these negative levels of stress from a little bit of toxic thinking has far-reaching consequences for mental and physical health”, and “The association between stress and disease is a colossal 85 percent.” [2: p36-37]

Again in her 2009 book [1], Dr Leaf devotes an entire chapter to the alleged effects of the toxic stress pathway on our body (chapter 4, p39-43).

Now in her latest social media update, tucked in amongst the gratuitous selfies and holiday snaps, comes something that’s actually about mental health: “Stress does not kill… is good for us! Its our negative reactions to stressful events that pushes into negative stress…and this is what kills! Sistas 2014 NZ”

The problem for Dr Leaf is that any stress, whether it’s caused by our “negative” reactions or not, doesn’t actually kill us.

There is a phrase used in science, “Correlation does not equal causation”. This simply means that just because two things occur together, one doesn’t necessarily cause the other. For example, do my red watery eyes cause my hives? They always appear together, but they don’t cause each other. The common element that causes both of them is actually the cat that I’ve just patted.

Just because stress is correlated with certain illnesses does not mean that stress causes or contributes to those illnesses. In fact, one of Dr Leafs own pivotal references, an article by Cohen and colleagues in the Journal of the American Medical Association in 2007, discussed the weakness of assuming that stress causes most diseases. As they say, “Although stressors are often associated with illness, the majority of individuals confronted with traumatic events and chronic serious problems remain disease-free.” [3]

Even if it were true that it how we react to stress contributes to the outcome of that stress, Dr Leaf’s statement about our killer reactions incorrectly presumes that both how we cope with stress, and the physical outcome of stress are the result of our choices.

Our levels of stress, and the way we cope with our stress, is mostly caused by our genetics. Some people will be naturally less stressed, and some people will be naturally better at coping with stress (see chapter 5 of my book [4] for a full discussion on the science of resilience). Just because you’re more prone to stress doesn’t mean that it’s all down to your bad choices. Assumptions like these only add to your already high levels of stress.

That’s not to say that we don’t have a way to improve our responses. For those of us at the stressed end of the spectrum, successful psychological therapies such as Acceptance and Commitment Therapy will help to improve our coping, and certainly have been shown to improve (not cure) mental illnesses like anxiety and depression, and other chronic conditions like chronic pain (see [5] for a review).

ACT and other modern psychological therapies recognise that trying to change our thoughts doesn’t make any difference to how we cope. So like I said before, it’s partly true that how we react to normal life experience will help us live full and productive lives, but it’s not about fighting or changing our thoughts. It’s about being mentally flexible enough to make room for our thoughts and fears and move forward towards meaningful action. I’m sure that the ladies at ‘Sistas 2014’ wouldn’t be hearing that from Dr Leaf.

Anyways, I’m glad that Dr Leaf is changing her tune on stress, but there’s still more room for change before she meets up with current scientific understanding.

For an in-depth review of the teachings of Dr Leaf, visit http://www.smashwords.com/books/view/466848 where you can download a free copy of “Hold That Thought: Reappraising the work of Dr Caroline Leaf.“

References

  1. Leaf, C., Who Switched Off My Brain? Controlling toxic thoughts and emotions. 2nd ed. 2009, Inprov, Ltd, Southlake, TX, USA:
  2. Leaf, C.M., Switch On Your Brain : The Key to Peak Happiness, Thinking, and Health. 2013, Baker Books, Grand Rapids, Michigan:
  3. Cohen, S., et al., Psychological stress and disease. JAMA: the journal of the American Medical Association, 2007. 298(14): 1685-7
  4. Pitt, C.E., Hold That Thought: Reappraising the work of Dr Caroline Leaf, 2014 Pitt Medical Trust, Brisbane, Australia, URL http://www.smashwords.com/books/view/466848
  5. Harris, R., Embracing Your Demons: an Overview of Acceptance and Commitment Therapy. Psychotherapy In Australia, 2006. 12(6): 1-8 http://www.actmindfully.com.au/upimages/Dr_Russ_Harris_-_A_Non-technical_Overview_of_ACT.pdf

Autism Series 2013 – Part 3: The Autism “Epidemic”

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Weintraub, K., Autism counts. Nature, 2011. 479(7371): 22-4.

Weintraub, K., Autism counts. Nature, 2011. 479(7371): 22-4.

It seems that autism is on the rise.  Once hidden away in institutions or just dismissed as odd, society is now faced with a condition that it is yet to come to grips with.  Some out in the community believe that it must be a toxin, or vaccines or mercury.  Others accuse doctors of simply giving in to the unreasonable demands of pushy parents to defraud the system of money – “Things have reached the point these days where any kid that’s not a charming little extrovert will be accused of being, ‘on the spectrum.’”[1]

So is there an epidemic of kids who are “not charming little extroverts”?  It depends on who you ask.

Take, for example, two articles written in the year 2000.  In the first, titled “The autism epidemic, vaccinations, and mercury”, Rimland said,

“While there are a few Flat-Earthers who insist that there is no real epidemic of autism, only an increased awareness, it is obvious to everyone else that the number of young children with autism spectrum disorders (ASD) has risen, and continues to rise, dramatically.”[2]

The other, written by Professor Tony Attwood, a world authority on Aspergers Syndrome, said,

“… is there an epidemic of people being diagnosed as having Asperger’s Syndrome? At present we cannot answer the question, as we are unsure of the diagnostic criteria, the upper and lower levels of expression and the borders with other conditions. Nevertheless, we are experiencing a huge increase in diagnosis but this may be the backlog of cases that have been waiting so long for an explanation.”[3]

I don’t think it’s very often Prof Attwood is lumped with ‘flat-earthers’.  But you can see the change in perspective from one side looking objectively to the other who need for there to be an “epidemic” of autism in order to strengthen their case.

So who’s right?  To see if this autism “epidemic” hypothesis has any real merit, we need to delve into some numbers.

First, some basic epidemiology – because part of the confusion in looking at the autism numbers is defining exactly what those numbers represent.  Here are some important epidemiology terms from the “Physicians Assistant Exam for Dummies”[4]:

Incidence: For any health-related condition or illness, incidence refers to the number of people who’ve newly acquired this condition.

Prevalence: Prevalence concerns the number of people who have this condition over a defined time interval.

Most autism figures are for prevalence, or often more specifically, point prevalence – “the number of people who have this condition at any given point in time.”

The other thing to remember from my last blog is that initially autism was only diagnosed on the strict rules of Kanner, and was considered to be a single disease caused mainly by bad parenting [5].  So through the 1960’s and 1970’s, only the most severe children were diagnosed as having autism because the high-functioning autism would not have met Kanners criteria, and even if they did, most parents didn’t want the label for fear of the social stigma.

So then, what are the numbers?  The early prevalence was estimated to be less than 5/10,000 or 1 in 2000[6], although in surveys done after 1987, the numbers began to rise past 7/10,000[7].  In the 1990’s, Autism prevalence climbed into the teens and the latest prevalence has been documented for autism is 20.6/10,000[7].

But that’s only about 1 in 485.  The CDC estimated a prevalence of 1 in 88 (113/10,000)[8].  Where did the other 400 people go?

This is where the importance of definitions is highlighted.  Autism is considered part of a spectrum, and at the time of the surveys reviewed by Fombonne, DSM III then DSM IV considered conditions like Pervasive Developmental Disorder and then Aspergers Disorder to be part of that spectrum.  Adding in the rate of PDD and you have a figure of 57.7/10,000 and adding in Aspergers gives you a combined rate of 63.7/10,000, or 1 in 157 people surveyed[7].

And yet even then, who you measure and how you measure makes much more of a difference, because a recent, rigorous study targeting all 7 to 12 year old children in a large South Korean populous found a prevalence of 2.64%, which is 264/10,000 or 1 child in every 38.  The authors noted that, “Two-thirds of ASD cases in the overall sample were in the mainstream school population, undiagnosed and untreated. These findings suggest that rigorous screening and comprehensive population coverage are necessary to produce more accurate ASD prevalence estimates and underscore the need for better detection, assessment, and services.”[9]

So if there has been a fifty-fold change in prevalence (from 5 to 264 cases per 10,000 people) in just thirty years, isn’t that an epidemic?

Well, no.  As much as some might ignorantly deny it, there is no real evidence for it.  Remember the definitions from the “Physicians Assistant Exam for Dummies”[4]:

Incidence: For any health-related condition or illness, incidence refers to the number of people who’ve newly acquired this condition.

Prevalence: Prevalence concerns the number of people who have this condition over a defined time interval.

It’s the rapid rise in the number of new cases diagnosed that defines an epidemic, which is the incidence and not the prevalence[10].  While the prevalence has changed a lot, the incidence has been fairly stable.  From Nature, “Christopher Gillberg, who studies child and adolescent psychiatry at the University of Gothenburg in Sweden, has been finding much the same thing since he first started counting cases of autism in the 1970s. He found a prevalence of autism of 0.7% among seven-year-old Swedish children in 1983 and 1% in 1999. ‘I’ve always felt that this hype about it being an epidemic is better explanation’, he said.”[11]

Fombonne agrees. “As it stands now, the recent upward trend in estimates of prevalence cannot be directly attributed to an increase in the incidence of the disorder.”[7]  He said later in the article that a true increase in the incidence could not be ruled out, but that the current epidemiological data which specifically studied the incidence of autism over time was not strong enough to draw conclusions.

While there’s no epidemic, there is the real issue of the genuinely increasing prevalence.  Why the rise in those numbers?  Fombonne went on to explain, “There is good evidence that changes in diagnostic criteria, diagnostic substitution, changes in the policies for special education, and the increasing availability of services are responsible for the higher prevalence figures.”[7]  Nature published a graph from the work of Professor Peter Bearman, showing that 54% of the rise in the prevalence of autism could be explained by the refining of the diagnosis, greater awareness, an increase in the parental age, and clustering of cases in certain geographic areas.

Weintraub, K., Autism counts. Nature, 2011. 479(7371): 22-4. (Adapted from King, M. and Bearman, P., Diagnostic change and the increased prevalence of autism. International Journal of Epidemiology, 2009. 38(5): 1224-34 AND King, M.D. and Bearman, P.S., Socioeconomic Status and the Increased Prevalence of Autism in California. Am Sociol Rev, 2011. 76(2): 320-46.)

Weintraub, K., Autism counts. Nature, 2011. 479(7371): 22-4. (Adapted from King, M. and Bearman, P., Diagnostic change and the increased prevalence of autism. International Journal of Epidemiology, 2009. 38(5): 1224-34 AND King, M.D. and Bearman, P.S., Socioeconomic Status and the Increased Prevalence of Autism in California. Am Sociol Rev, 2011. 76(2): 320-46.)

From Nature: “The fact that he still cannot explain 46% of the increase in autism doesn’t mean that this ‘extra’ must be caused by new environmental pollutants, Bearman says. He just hasn’t come up with a solid explanation yet. ‘There are lots of things that could be driving that in addition to the things we’ve identified,’ he says.”[11]

There is no autism epidemic, just medical science and our population realising just how common autism is as the definition becomes more refined, people become more aware, and some other biosocial factors come into play.

What can we take from the numbers?  That we’re being overtaken by Sheldon clones?  That soon there will be no more “charming little extroverts”?  If the CDC figure is accurate, then one person in every hundred is on the spectrum, so the world is hardly being overtaken by autism.  But the take home message is that Autism Spectrum Disorders are more common that we ever thought, and there are more people on the spectrum “hiding in plain sight”.  If the study from South Korea is accurate then one person in every thirty-eight is on the spectrum, but two thirds of them are undiagnosed.

Should there be more funding, more resources, or more political representation for people on the spectrum?  Perhaps, although the public and research funds are not unlimited, and other health concerns should also be treated fairly.  But since autism is life long and impacts on so many areas of mental health and education, understanding autism and managing it early could save governments billions of dollars into the future.

Rather, I think that the climbing prevalence of ASD is a clarion call for understanding and tolerance.  If we learn to tolerate differences and practice discretionary inclusion, then both the autistic and the neuro-typical can benefit from the other.  That’s a world which we’d all like to live.

REFERENCES

1. Bolt, A. If the autistic don’t get full cover, where’s the money going? 2013  2013 May 11]; Available from: http://blogs.news.com.au/heraldsun/andrewbolt/index.php/heraldsun/comments/if_the_autistic_dont_get_full_cover_wheres_the_money_going/.

2. Rimland, B., The autism epidemic, vaccinations, and mercury. Journal of Nutritional and Environmental Medicine, 2000. 10(4): 261-6.

3. Attwood, T., The Autism Epidemic: Real or Imagined, in Autism Aspergers Digest2000, Future Horizons Inc: Arlington, TX.

4. Schoenborn, B. and Snyder, R., Physician Assistant Exam For Dummies. 2012: John Wiley & Sons.

5. Pitt, C.E. Autism Series 2013 – Part 2: The History Of Autism. 2013  [cited 2013 2013 Aug 15]; Available from: https://cedwardpitt.com/2013/08/15/autism-series-2013-part-2-the-history-of-autism/.

6. Rice, C.E., et al., Evaluating Changes in the Prevalence of the Autism Spectrum Disorders (ASDs). Public Health Reviews. 34(2).

7. Fombonne, E., Epidemiology of pervasive developmental disorders. Pediatric research, 2009. 65(6): 591-8.

8. Baio, J., Prevalence of Autism Spectrum Disorders: Autism and Developmental Disabilities Monitoring Network, 14 Sites, United States, 2008. Morbidity and Mortality Weekly Report. Surveillance Summaries. Volume 61, Number 3. Centers for Disease Control and Prevention, 2012.

9. Kim, Y.S., et al., Prevalence of autism spectrum disorders in a total population sample. American Journal of Psychiatry, 2011. 168(9): 904-12.

10. “Epidemic vs Pandemic”. 2013  [cited 2013 Sept 03]; Available from: http://www.diffen.com/difference/Epidemic_vs_Pandemic.

11. Weintraub, K., Autism counts. Nature, 2011. 479(7371): 22-4.