When is behavior an illness?

This sounds like a simple question, yet it is a fundamentally important one. It is a question that I for one have tried to answer to some degree of rational certainty over the many years of my work in the mental health field. It is a question that a recent news article I happened to read once again raised in my mind.

Briefly, the article: “Cheaters do prosper, but are they psychologically ill?” from the Globe and Mail: http://www.theglobeandmail.com/life/health-and-fitness/health/conditions/cheaters-do-prosper---but-are-they-psychologically-ill/article4258538/. The study reported there found that university students who admitted to cheating scored high on personality traits of psychopathy. This suggests that psychopathy which in its most extreme forms can translate to Psychopath may be associated with self-reported cheating. The one obvious question that I would ask is why do we think that cheaters are honest about reporting if they cheat or not – but that is a question for the researchers.

Cheating clearly has adaptive value and in evolutionary terms probably has an evolutionary advantage. It happens in every society that I know of and I would not be surprised if it is common behavior in animals, particularly primates. So what does this say about how we think about “normal” behavior and “illness”?

Obviously this is very complex and one blog can not address this issue. But we can start. So here is one thought to help us think more. Most if not all behaviors that we exhibit, occur on a continuum or spectrum. The point at which a particular behavior “crosses” from “normal” to pathological depends on many things. Think of it as “carving nature at the joints”. How we decide where to carve is very complicated and lots of different perspectives come into play, including; statistics; probability theory; social and cultural frameworks; emotion; history; personal bias; etc.  One of the cutting points commonly considered, is: does it create harm to self or others, does it lead to impairment in functioning? Does stopping or diminishing the behavior lead to better outcomes for all concerned?

What do you think about this as a “cutting point”. What other “cutting points” do you think are useful?

Back to School

Recent newspaper articles and electronic media stories have drawn attention to the relationship between going to university or college and mental health problems and mental disorders. In both the USA and Canada this has been headline news.

It is really difficult to tell if the rates of mental health problems are going up or not but it is true that between the early 1990’s and early 2000’s, suicide rates have fallen. This has been closely associated with better identification and treatment of young people with mental disorders.

Certainly there is a clear need for universities, colleges and other institutions of higher learning to actively promote mental health literacy and provide contextualized information known to enhance knowledge and help seeking behavior for their students. Across Canada, over 30 institutions of higher learning have done so – using the “Transitions” program developed by our group. 

What is confusing to me is why so many have chosen not to do so, or have tried to reinvent the wheel by developing one-offs of undemonstrated value but with local small “p” political appeal. In my opinion this once again illustrates why it would be a good idea to have a single point national clearing house for mental health programs. But not just any kind of clearing house – one that only includes programs for which there is substantive evidence of effectiveness and cost effectiveness. Both are needed. And, this is not a “best practice” list of programs. I for one would like to see the whole idea of “best practice” scrapped and replaced by the framework of “best evidence”. I have seen to many “best practices” unable to demonstrate substantive value while at the same time costing us dearly in both implementation and opportunity lost.

This could surely be a role of the Public Health Agency of Canada. But it will take a bit of reforming to ensure it is responsibly carried out.

--Stan

Human rights, gender issues and suicide

The tragic story of Tyler Clementi’s suicide is well known to many by now . It was an event, not improved by the media circus that has erupted after it. And it raises a number of fundamental issues. Here are three that come to mind, I am sure that there are more.

First: human rights. The secret video and its subsequent broadcast of Mr. Clementi’s intimate activities violated his human rights – period. That is clear, regardless of whom his intimate partner (or partners) was. The electronic age has made it easier to both address and infringe on human rights. The digital world is a global world. We as a global society will have to deal with this, and quickly. 

Second: gender issues. My family, my community, my country and my world are places in which diversity is celebrated, where gender inequalities are not tolerated and where gender differences are embraced. It seems that we still have a lot of work to do on these issues. We cannot stop until they have been long relegated to the dustbin of history.

Third: suicide. Mr. Clementi’s suicide was certainly a tragic event. Yet we do not know all the details of his story and it is too easy to jump to certainty about what emotional turmoil and what other factors lead him to choose the tack that he did. We do not need to argue that we must respect and support human rights and gender differences by raising the specter of suicide. We need to address suicide on its own terms, in all its complexities and in all its layers. We need to do the right thing not just something.

 I for one, look forward to a time when I do not ever read a media story such as the one about Mr. Clementi. Not because the media has not made a circus about it, but because there are no more similar stories to tell. But in order to do that, we must work hard to make sure our friends and our neighbors are on a similar page. And who is my neighbor? Everyone is my neighbor, and everyone is your neighbor.

--Stan

The Healing Touch

The idea of the healing touch has a very long history. The New Testament recounts stories of miracles of healing resulting from touch. Pop psychology trumpets the necessity for “group hugs”. Mother infant bonding is enhanced by skin to skin “touch”. Different cultures have different approaches to “touch”, some celebrate it and some fear it. Metaphorically we are told to “reach out and touch somebody” and about a decade ago, a pseudo-science initiative called “therapeutic touch” caused all sorts of enthusiasm until controlled research studies showed that not touching someone was not the same as actually touching someone. And who has not felt the complex meaning of touch from a loved one? Few types of human interaction have been so well understood or so much misunderstood as “touch”.

As a recent news article has noted:http://www.npr.org/templates/story/story.php?storyId=128795325&ps=cprs, human touch is an essential component of the human condition. This is because we touch with our brains. Every touch is a perception that has meaning – and that meaning is created and applied in our brain. We no more touch with our fingers or skin than we see with our eyes or hear with our ears. And the meaning of touch results in the activation of specific brain areas, areas that can lead to a host of positive or negative emotions and cognitions. Basically put, touch is a key component of human connection. And, as I have often said: human connection is the key to improving the human condition.

As human beings we live in complex family and community settings. How we navigate those settings depends on many things. Hope and connection are fundamental to health. Touch is fundamental to healing. So why are we so afraid to give someone a hug?