The Body Keeps the Score p.151

Technology always produces new directions for research, and when it became possible to do genetic testing, psychiatry became committed to finding the genetic causes of mental illness. Finding a genetic link seemed particularly relevant for schizophrenia, a fairly common (affecting about 1 percent of the population), severe, and perplexing form of mental illness and one that clearly runs in families. And yet after thirty years and millions upon millions of dollars’ worth of research, we have failed to find consistent genetic patterns for schizophrenia – or for any other psychiatric illness, for that matter. Some of my colleagues have also worked hard to discover genetic factors that predispose people to develop traumatic stress. That quest continues, but so far it has failed to yield any solid answers.

Recent research has swept away the simple idea that “having” a particular gene produces a particular result. It turns out that many genes work together to influence a single outcome. Even more important, genes are not fixed; life events can trigger biochemical messages that turn them on or off by attaching methyl groups, a cluster of carbon and hydrogen atoms, to the outside of the gene (a process called methylation), making it more or less sensitive to messages from the body. While life events can change the behavior of the gene, they do not alter its fundamental structure. Methylation patterns, however, can be passed on to offspring – a phenomenon know as epigenetics. Once again, the body keeps the score, at the deepest levels of the organism.

 

Bessel van der Kolk – The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma p.151

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The Body Keeps the Score p.137

Psychiatry, as as subspecialty of medicine, aspires to define mental illness as precisely as, let’s say, cancer of the pancreas, or streptococcal infection of the lungs. However, given the complexity of mind, brain, and human attachment systems, we have not come even close to achieving that sort of precision. Understanding what is “wrong” with people currently is more a question of the mind-set of the practitioner (and of what insurance companies will pay for) than of verifiable, objective facts.

 

Bessel van der Kolk – The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma p.137

Against Empathy p.144

The risks of empathy are perhaps most obvious with therapists, who have to continually deal with people who are depressed, anxious, deluded, and often in severe emotional pain. There is a rich theoretical discussion amongst therapists, particularly those of a psychoanalytic orientation, about the complex interpersonal relationships between therapists and their clients. But anyone who thinks that it’s important for a therapist to feel depressed or anxious while dealing with depressed or anxious people is missing the point of therapy.

Actually, therapy would be an impossible job for many of us because of our inability to shut down our empathic responses. But good therapists are unusual in this regard. A friend of mine is a clinical psychologist with a busy schedule, working for several hours at a stretch, with one client leaving and the next coming in. This would kill me. I find it exhausting to spend even a short time with someone who is depressed or anxious. But my friend finds it exhilarating. She is engaged by her clients’ problems, interested in the challenges that arise, and excited by the possibility of improving their lives.

Her description reminded me of a discussion by the writer and surgeon Atul Gawande about the attitudes of “tenderness and aestheticism” that good surgeons feel toward their patients, treating them with respect but seeing them also as problems that need to be solved. Freud himself made a similar analogy: “I cannot advise my colleagues too urgently to model themselves during psycho-analytic treatment on the surgeon, who puts aside all his feelings, even his human sympathy, and concentrates his mental forces on the single aim of performing the operations as skillfully as possible.”

My friend does get into her client’s heads, of course – she would be useless if she couldn’t – but she doesn’t feel what they feel. She employs understanding and caring, not empathy.

 

Paul Bloom – Against Empathy: The Case for Rational Compassion p.144

Unconditional Parenting p.119

I want to propose a baker’s dozen guiding principles. Each of these has practical implications that may be more surprising and challenging than its capsule description would imply.

Here they are all together:

  1. Be reflective.
  2. Reconsider your requests.
  3. Keep your eye on you long-term goals.
  4. Put the relationship first.
  5. Change how you see, not just how you act.
  6. R-E-S-P-E-C-T
  7. Be authentic.
  8. Talk less, ask more.
  9. Keep their ages in mind.
  10. Attribute to children the best possible motive consistent with the facts.
  11. Don’t stick your no’s in unnecessarily.
  12. Don’t be rigid.
  13. Don’t be in a hurry.

 

Alfie Kohn – Unconditional Parenting: Moving from Rewards and Punishments to Love and Reason p.119

Unconditional Parenting p.55

When we make children feel powerless, forcing them to submit to our will, this often generates intense anger, and just because that anger can’t be expressed at the moment doesn’t mean it disappears. What happens to it depends on the child’s personality and the specifics of the situation. Sometimes the result is more battles with the parent. As author Nancy Samalin comments, even “when we ‘win,’ we lose. When we make children obey by force, threats, or punishment, we make them feel helpless. They can’t stand feeling helpless, so they provoke another confrontation to prove they still have some power.” And where do they learn how to use that power? From us. Not only does authoritarian parenting make them mad; it also teaches them how to direct that anger against another person.

Such children may grow up with a constant need to thumb their noses at authority figures. Sometimes they bring all that hostility with them to school or the playground…

And sometimes, if a child is afraid of defying you to your face, he’ll figure out a way to do it behind your back. Lay-down-the-law parenting may produce kids who seem to be so well behaved as to be the envy of the neighbors. Often, however, they’ve just learned to be sneakier about their misbehavior, which sometimes turns out to be appallingly mean-spirited.

 

Alfie Kohn – Unconditional Parenting: Moving from Rewards and Punishments to Love and Reason p.55

Why Gender Matters p.270

A popular notion about transgender individuals is that sex-reassignment surgery reliably relieves the mental distress associated with being transgender. But researchers who have actually studied transgender individuals postsurgery have arrived at a different conclusion. As one investigator found, “even once the transsexual has achieved sex reassignment, the figure of being trapped in the wrong body, or being wrongly encased, continues to be evoked.”

Transgender adults who begin receiving hormonal therapy do benefit, on average, from that therapy: one year after starting hormonal therapy to transition to the desired gender, the rates of anxiety, depression, and impairment among transgender individuals are significantly reduced. Nevertheless, even after sex-reassignment surgery and hormone treatment, the rate of mental illness such as anxiety, depression, and bipolar disorder among transgender individual remains much higher than among the general population. “Sex reassignment is associated with more serious psychological sequelae and more prevalent regret than had previously been supposed,” conclude other reviewers. In the largest and longest follow-up available, researchers studied everybody who underwent sex-reassignment surgery in Sweden between 1973 and 2003: 191 MtF individual and 131 FtM individuals. These investigators found that 19 percent of MtF clients and 17 percent of FtM clients had been hospitalized for psychiatric problems prior to undergoing sex reassignment, compare with less than 4 percent of matched controls. After sex-reassignment surgery, transsexual clients were still nearly three times more likely than controls to be hospitalized for psychiatric problems other than gender dysphoria, even after adjustment for prior psychiatric problems. There was some benefit from sex-reassignment surgery, to be sure. Transsexuals who had undergone sex-reassignment surgery reported feeling less gender dysphoria – less of a sense of being trapped in the wrong body – and were somewhat less likely to be hospitalized for psychiatric problems than they were before the surgery.

But only somewhat. Even after sex-reassignment surgery, transsexual clients were still nearly five times more likely to have made a suicide attempt and nineteen times more likely to have died from suicide than were matched controls, again after adjusting for prior psychiatric problems. The researchers did not find any significant differences between MtF individual and FtM individuals on any of these outcomes. Being transgender, even in Sweden and even after having sex-reassignment surgery, puts you at much greater risk of having major psychiatric problems, including death by suicide. This finding is consistent with multiple other studies.

 

Leonard Sax – Why Gender Matters p.270

Why Gender Matters p.327

Professor Kim Wallen and his colleagues at the Yerkes National Primate Research Center in Atlanta decided to do this familiar study again, with a little twist: instead of offering human children a choice between dolls and trucks, they gave that choice to monkeys. They gave monkey the opportunity to play with a “boy toy” such as a truck or with a “girl toy” such as a doll.

The basic pattern of results was similar to the pattern seen with human children. The female monkeys slightly prefer to play with dolls rather than trucks. The males substantially prefer to play with trucks rather than dolls.

It is difficult to invoke the social construction of gender to accommodate this finding. You would have to assert that a monkey in authority, maybe a parent, is saying to a young male monkey, Don’t let me catch you playing with a doll! But in fact nothing of the sort happens. Monkeys don’t appear to care whether other monkeys, female or male, are playing with trucks or with dolls. And yet the main effect – the preference of the male to play with a truck rather than with a doll – is clearly present in monkeys, as it is in human children. But the social construction of gender cannot reasonably be invoked to explain this effect in humans, in view of the fact that a similar effect is present in monkeys…

Developmental psychologist Gerianne Alexander found sex differences among monkeys similar to the sex difference we see among human children. In 2003, one year after she published her monkey study. Professor Alexander published her theory explaining why female and male monkeys – as well as female and male humans – might prefer to play with different toys.

Scientists have known for more than thirty years that our visual system is actually two separate systems operating in parallel, beginning at the level of the ganglion cells in the retina and extending back to the visual cortex and visual  association cortex. One system is devoted to answering the question What is it? What’s its color? What’s its texture? The other system is devoted to answering the question Where is it going? And how fast is it moving? These two systems in the brain are often referred to as the “what” and the “where” system.

Professor Alexander was the first to suggest that hardwired sex differences in the visual system may explain finding such as the observed sex difference is the toy preferences of children (as well as monkeys). She conjectured that maybe girls have more resources in the “what” system, while boys have more resources in the “where” system. Girls are more likely to play with a doll rather than with a dull gray truck because the doll has a more interesting color and texture. Boys are more likely to play with the dull gray truck because it has wheels. It moves.

Professor Alexander’s hypothesis helps to make sense of many finding that otherwise are hard to explain. For example, baby girls (three to eight months of age), but not baby boys of the same age, prefer to look at dolls rather than at toy trucks. When researchers show women and men different colors and ask them to name the colors, “women respond faster and more accurately than men.” When researchers test men and women to see how accurately they can target a moving object, men are significantly more accurate than women… Finally researchers in Germany have reported dramatic sex differences in the anatomy of the human visual cortex in adults, with significantly more resources devoted to the “where” system in men that in women, even after adjusting for any overall size difference in the brain.

 

Leonard Sax – Why Gender Matters p.327