Perception and Automatic Thoughts

Understanding the limits of human perception is an essential ingredient to good mental health and good communication skills.  Take any decent Psych 101 course and you will see just how limited our perceptual skills can be.  Long ago, during a lecture, I held up a plain sheet of yellow paper.  The yellow color could be described, in objective fashion, by its emitted wavelength and that would probably be well beyond dispute.  But that did not interest me.  I asked the audience to write down what they saw and any thoughts or feelings which arose from the "stimulus", the yellow paper.  There were, quite literally, as many perceptions as there were people in the room, though of course everyone "saw" the exact same thing.

How much more complex, then, are the other things we all experience in the course of our lives?  Yet all of us, often beyond our awareness, form impressions and interpretations of very complex information, and this in turn often leads to choices and actions which impact our lives and the lives of others.  Some of these make us happy, and some definitely do not.  By the time we reach early adolescence this dynamic has become like a reflex; it is lightning quick and automatic.  It is also dangerous.  You know what "they" say about assumptions.  "They" are correct.

The scale of this pattern of human behavior is enormous.  In a recent article, psychologist Jonathan Haidt discussed the science behind political and religious polarization in America, which has led to and may well lead to a great many more social conflicts and problems.  This polarization is partly borne of reflexive assumptions and automatic thoughts.  We would all do well to slow down, understand that we may be making attribution errors, and actively seek disconfirming evidence for our interpretations.  This is admittedly a difficult thing to do, given our well-researched human nature in this area.

But try we must, if we hope to have sound emotional health and positive relationships.  The recipe is actually quite simple.  Question what you think you see and understand.  Take your time, as very few things in life require instantaneous responding.  If you experience strong emotion, wait until the immediate feelings subside a little before you do the cognitive work of analyzing information.  This gives our higher cortex a chance to do its magic instead of our being controlled by the more primitive, reptilian portions of the brain.  Check out your understanding by getting feedback from others.  The payoff is tremendous: often we learn that what we thought we understood was WAY off.  Have you ever fired off an email or text and immediately wished you could suck it back through the electronic ether?  Then you know what I am talking about.

So really, it comes down to humility.  Knowing that we have a limited range of perception means knowing that we are often capable of being wrong.  It helps us exercise caution in forming conclusions about ourselves and others and the world around us.  Benefits of this practice are improved mood and self-esteem, and improved relating with individuals, groups, and cultures.  That makes it very worthwhile.

Loss of Chewing Ability May Be Linked to Dementia

Researchers from the Department of Dental Medicine and the Aging Research Center (ARC) at Karolinska Institutet and from Karlstad University in Sweden suggest that the loss of chewing ability may be linked to cognitive decline and a higher risk of dementia.

Dementia is a serious loss of global cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging. It is not considered a single disease, but rather a set of signs and symptoms, in which affected areas of cognition may be memory, attention, language, and problem solving.

The study randomly selected a nationwide sample of 577 participants aged 77 or older to investigate tooth loss, chewing ability and cognitive function. Results showed that individuals that experienced more difficulty chewing hard foods were more at risk of developing cognitive impairments, even when controlling other variables such as sex, age, education and mental health. In addition, chewing with dentures or real teeth had no impact on their results.

It could be that “few or no teeth makes chewing difficult, which leads to a reduction in the blood flow to the brain. However, to date there has been no direct investigation into the significance of chewing ability in a national representative sample of elderly people.”

Unfortunately, this study does not specify whether all participants consumed similarly nutritious meals. Those with a reduced ability to chew certain foods may have been malnourished, which could have played a major role in their cognitive decline.

Nevertheless, the preliminary results of such research certainly provide further support for the fact that oral health impacts overall health. Good oral health brings significant benefits to self-esteem, dignity, social integration and general nutrition.

According the World Health Organization, the proportion of people aged 60 years and older is growing faster than any other age group, as a result of both longer life expectancy and declining fertility rates. Therefore, as our society ages, this type of research becomes more and more relevant…

• As of 2010, more than 35.6 million people worldwide are living with dementia, or more than the total population of Canada.


• The global prevalence of dementia stands to double every 20 years, to 65.7 million in 2030, and 115.4 million in 2050.


• Total health-care costs for people with dementia amount to more than 1 per cent of the global gross domestic product (GDP), or US$604 billion in 2010.

Chewing Ability Linked to Reduced Dementia Risk
Dementia
Ageing
Facts about dementia

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Early Emotional Neglect May Predict Strokes

New research conducted by the Rush Alzheimer's Disease Center at Rush University Medical Center suggests that emotionally neglected children are at risk of stroke as adults. 

"Studies have shown that children who were neglected emotionally in childhood are at an increased risk of a slew of psychiatric disorders. However, our study is one of few that looked at an association between emotional neglect and stroke," said study author Robert S. Wilson, PhD, a neuropsychologist at Rush.

Researchers’ selected 1,040 participants aged 55+ without dementia from the Memory and Aging Project were surveyed on physical and emotional abuse before the age of 18. Participants were questioned on such areas as how much love they felt from their parents or caregivers as children, whether they felt afraid or intimidated by their caregivers, the method of physical punishment suffered and other questions relating to divorce and family finances.

The participants were followed over a period of 3.5 years. In that time, 257 participants had died. Of the deceased participants, only 192 had brain autopsies, which revealed that 89 of them had experienced strokes. Furthermore, forty of the participants were said to have had strokes based on medical history or an examination.

Furthermore, participants that expressed moderately high levels of emotional neglect in childhood were nearly 3 times more likely to experience a stroke than those reporting moderately low levels of emotional childhood neglect, even when other factors such as diabetes, physical activity, smoking, anxiety and heart problems were controlled.

"The results add to a growing body of evidence suggesting that early life factors such as traumatic childhood experiences influence the development of physical illness and common chronic conditions of old age" says Dr. David A. Bennett, director of the Rush Alzheimer's Disease Center and co-author of the study

Of course results may not be completely reliable since this study relies on a self-report of recalled events many years later, which may be even further clouded given the nature of the potentially traumatic memories.

Emotional Neglect in Children Linked to Increased Stroke Risk Later in Life

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The Silver Lining in Today's College Student

From the beginning of time, I suppose, each generation has been identified as headed to hell in a hand basket.  Or so the pundits would have us believe.  Teens and young adults are favorites for social critiquing and waxing philosophical on the demise of civilization as we know it.  Little awareness of the irony involved is apparent; what about the older adults who have a more direct role in today's events?  While the "adults" work feverishly to destroy each other in various parts of the world, for example, one group of Christian, Jewish and Muslim teenagers are hoping to better understand and communicate with each other.

This is not to say that troubling trends or themes don't exist.  In their book Generation on a Tightrope: A Portrait of Today’s College Student, Arthur Levine and Diane Dean write about such themes in young adults.  They tell us that they are at once low in resilience and high in self-confidence.  They think their grades don't actually reflect their performance.  They embrace social media extensively, yet lack actual in-person communication skills.  They see themselves as worldly, but can't identify world leaders.  And so on.  There are data to support these observations.  But do these data mean they are a hopeless, "broken generation", or just different from us older, wiser folk?  I vote for the latter.

Jonny Wakefield, himself a college student from Canada, would vote similarly, I think.  He warns of the dangers of such trendspotting in the lives of young adults.  He posits, rightly, that sweeping generational narratives are both imprecise and subject to self-fulfilling prophesies.  Which, in the case of young adult mental health, is precisely what we don't want to invoke.  Do we really want college students to see themselves as feckless and entitled losers?  I think not.

It might just be that we do not understand what we are seeing.  It may be that youth are doing what each generation did before them: doing their best, with what we gave them, to adjust to a challenging and rapidly changing world.  Sure, some of what they will do will fail.  Just as my generation did, and as my parents' generation did before me.  They will undoubtedly learn some hard lessons along the way.  But the seeds of seeing and doing things differently are already in them, and those will bear surely some fruit later on.  When I encounter young people in my work, I detect a level of energy and boundary-busting creativity that I don't see as much in my peers.  That is cause for hope, my friends.  Perhaps they will be able to make things better in the world, if we celebrate and cultivate their strengths rather than focus on their shortcomings.

The Failure and Growth Cycle

Some view western culture, and American culture in particular, as a society which places a premium on the success and advancement of the individual.  Critics of this view argue that this premium diminishes some individuals and groups, but others say this does not necessarily have to occur; that one can promote the interests of the individual and society at the same time.  See the works of Ruth Benedict and John Kenneth Galbraith for references on that subject.  In my experience it takes an educated and enlightened individual to pursue "success" and also orient that success to higher purposes, such as benefiting larger and larger circles of human beings.

Enter typical college students and their families.  As noted elsewhere in my blog they tend to arrive being very focused on pragmatic issues such as living arrangements and choice of major.  There is a tremendous amount of energy focused on moving the late adolescent and young adult along a continuum of advancement, however that may be conceived in family ethics and values.  Getting good grades, joining the "right" organizations, and networking for future employment are, in the minds of those involved, locked in rather tightly.  Variance from this template is often frowned upon, if not met with punitive consequences.

But college life is a crucible for the formation of both individuality and responsibility or conscience.  Mistakes and failures are inevitable, and the stuff which catalyzes the higher calling of the young adult.  In his book, How Children Succeed, Paul Tough theorizes that non-cognitive skills such as persistence, resilience and fortitude are actually the bases of future success, though it is cognitive skills that often get the attention.  In this view mistakes and failures are desirable, the launching pad for growth.  In short, one gets intimately acquainted with one's self, with both talents and foibles, through a cycle of failure and growth.

Such is the process of learning who we are, what we can do, and the limitations presented by our perceptions and biases.  The process of "advancement" is much more earthy and sobering than western mythologies would have us believe.  It is very much two steps forward, one backward, a thousand blind alleys to ten workable paths.  And this is to be embraced, not belittled.  Great achievers like Newton, Edison, Einstein, and Carver all said so.

Families can be wonderful allies in the young adult's search for self by understanding this cycle, by welcoming it, and by patiently waiting for their children to learn life's lessons.  Students will succeed in their journey to self-hood by minimizing anxieties about social perfection, or, better yet, rooting them out altogether.  It takes courage to advance.  Fear won't get us there.

How to improve dental care in psychiatry

Dental care is poor and a disregarded health issue among people with serious mental illness. They are on a higher risk than average for tooth decay,inflamed gums and denture problems. Medication combined with reduced self care is an important cause. 

Poor dental health can increase the risk for social stigmatization / isolation and serious physical health problems. 
There is a causal link between poor oral health and cardiovascular disease and even stroke.Considering that people with serious mental illness like schizophrenia die 15-20 years earlier on average than the general population we have have enough reasons to take dental health seriously.

According to Danish research only 31% of schizophrenia patients complied with a regular annual dental check-up visit , compared to 68% in the general adult Danish population.  http://www.ncbi.nlm.nih.gov/pubmed/20584518 

Huge risks for poor dental care are: substance abuse diagnosis ,living in an institution or admission to a psychiatric facility for a minimum of 30 days  and male sex.

However Clozapine treatment, at least monthly outpatient visits , and age 50+ were associated with a lower risk for inappropriate dental care.

 

 Psychotropic meds can cause shortage or too much saliva or a change in acidity. Combined with poor oral health  this can make tooth decay occur faster. 

Many patients smoke. This increases the risk for gum disease : one of the leading causes of tooth loss in adults.

Smoking also slows down healing after oral surgery. It can damage gum tissue and receding gums leaving the roots of the teeth exposed. This can increase the risk of tooth decay and cause hot/cold sensitivity.

To improve the level of dental health we can help patients to

- Use less sugar and acidic products like carbonated drinks

- brush 2x a day preferably with an electrical toothbrush , they are much more efficient than ordinary brushes

- use fluoride toothpaste

- use floss or interdental cleaning brushes twice a day

- visit a dentist and support the visit if needed. We may ask the dentist about screening for the rate of salivation to see if the amount and acidity of the saliva is within limits.

- decrease smoking 
- Use 4 - 7 xylitol chewing gums or lozenges devided over the day. It needs to be 100% xylitol, no other sugar substitutes.This reduces dental    plaque. It stimulates the production of anti-bacterial saliva and remineralization of the teeth. And it partially replaces sugars in the diet (satisfies the ‘sweet tooth’) Using Xylitol chewing gum or rinse can decrease tooth decay with 60 %. For those who cant use gum or lozenges xylitol mouth water may be an option.

 In high amounts xylitol can have a laxative effect and cause flatulence.
- Inform patients that they should avoid to consume acidic products one hour before brushing  teeth. The surface of teeth is softened by the acid and can be damaged.

Let's make dental care a priority in psychiatry. After all it is basic care, not luxury .

Ethics and Meaning in College Life

Recently USA Today College ran a nice little piece concerning ethics in college.  The author, Miriam Schulman, assistant director of the Markkula Center for Applied Ethics at Santa Clara University, posed five simple questions for students to consider:

1. What is college worth to me?
2. How can I live with someone I don’t like?
3. How far will I go to be accepted?
4. Should I tell on someone who is doing something I think is wrong?
5. Is casual sex going to be part of my life?

Wonderful questions.  College life offers so many rich academic and personal experiences.  So many, in fact, that it is very easy to lose sight of fundamental questions which we all must face in our lives: Why am I here, and what am I going to do with my life?  From where I sit, working closely with students, a great many issues and problems could be averted, and a great many lives enhanced, through an active search for answers to these questions.  I believe Socrates said so way back in the misty past.

Students and their families are today focused on the practicalities of college life.  They rightfully ponder over where their students will live, what they will study, how will they spend their time, how will they make friends, and of course how they are going to pay for it all.  These are questions that do in fact need responses.  But the inquiry should not stop there, and all too often it does.  Without the bigger responses to bigger questions, students often live incongruently to their genuine identities and values.  They associate with people they don't truly respect.  They engage in activities which are meaningless or even harmful to them, which may result in a resume' packed with awesomeness but reveals experiences with little or poor quality.  A competent employer will see this instantly.

Spend time, ideally well before college starts, mulling over the big questions.  Set a target, well ahead in time and space, about where you would like to land and explore your existence.  One doesn't travel to another part of the world without having some sense of how one will live after arrival.  Why in the world would we cheat our future selves by not doing the same thing before our college and career journey begins?