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Do antidepressants create more mental illness than they cure?
Robert Whitaker discusses the long-term impact of prescription medication.
- Many antidepressants show no better efficacy than placebo or talk therapy in long-term usage.
- Proselytizing pharmaceutical interventions has been part of a concerted effort since the 1970s.
- Journalist Robert Whitaker discusses the impact of pathologizing children, moral therapy, and more.
Doctors wrote a record number of prescriptions for Zoloft in March, causing the FDA to add this SSRI to its drug shortage list. Zoloft prescriptions then dropped in April—4.5 million, down from 4.9 million—yet these numbers represent a startling upward trend in antidepressant usage. Nearly 13 percent of the US population over age 12 now regularly swallow these pills.
Why would a 12-year-old need an antidepressant? Robert Whitaker, author of "Mad in America" and Anatomy of An Epidemic," discusses the pathologizing of children during our recent conversation. Whitaker has won a number of awards for his reporting on the psychiatry industry; he was a Pulitzer finalist for a series on psychiatric research he co-wrote for the Boston Globe. While his investigative reporting covers a range of topics, an important thread weaves together his work: Why do Americans take so many prescription drugs?
In"Anatomy of an Epidemic," Whitaker points out that as prescriptions for SSRIs, SNRIs, and antipsychotics rise, so do anxiety and depression diagnoses. If these drugs worked, fewer people should be diagnosed. In a for-profit health care system, however, new customers are always needed. Minor complaints are now pathologized. Creating an illness is the best way to sell a drug.
The 20th century represented a remarkable turning point in medicine. It also marked the beginning of a tragic misunderstanding of mental health. After millions of years of successful evolution, humans were suddenly victims to brain chemistry gone awry. We were sold on the idea that chemical imbalances are the cause of anxiety and depression, not a biological effect created by environmental conditions. Antidepressants predominantly treat a symptom, not the cause, of our malaise.
As Whitaker mentions, short-term use of antidepressants can be helpful. Even with an increasing number of studies detailing the negative long-term effects of these drugs, we're swallowing more pills than ever. I chatted with Robert about why that is and how we can course correct. Our talk was edited for clarity, but you can watch the full conversation or read the transcript below.
EarthRise 91: Do antidepressants create more mental illness than they cure? (with Robert Whitaker)
Derek: Why did you begin investigating the medicalization of psychiatry?
Bob: I co-wrote a series for The Boston Globe on abuses of psychiatric patients in research settings. While I was doing that research, I came upon two World Health Organization studies on outcomes for schizophrenia patients. They were cross-cultural studies in nine different nations, and both times they found outcomes were much better in poor countries than "developing" countries. India, Colombia, and Nigeria fared better than the US and other rich countries. The World Health Organization actually concluded that living in a developed country is a strong predictor you'll have a bad outcome if you're diagnosed with schizophrenia. I wondered why living in a developed country, with all of our advances in medicine, would be a predictor of a bad outcome.
The common narrative was how we were making progress in treating mental disorders. We were finding that they were due to chemical imbalances; we had drugs to fix those chemical imbalances. Yet here were cross-cultural studies finding something much different.
I also found that they use antipsychotics very differently: for short-term but not long-term. That also went against what I knew to be true.
The final thing that launched me into this was looking at a Harvard study that found outcomes for schizophrenia patients in the US had declined in the last 30 years; they're no better than they'd been in the first third of the 20th century. That also belied the narrative of progress.
D: I was prescribed Xanax for a short period of time when I suffered from severe panic disorder. When I explained to my doctor what was happening, she immediately said, "What you're going through is no different than any physical disease." When I read "Anatomy of an Epidemic," it struck me how this exact message had been marketed as the proper approach for treating mental health in the early fifties. Writing of that era, you discuss the American Medical Association, pharmaceutical industry, and government working together to drive that narrative.
B: I love science. It's one of the most beautiful manifestations of the human mind. What I gradually came to understand is that we weren't seeing the presence of a scientific mind in this creation of the narrative of a chemical imbalance.
Guild interests were at play. You said you were told that "this is like any other physical disease." The reason that works so well for a commercial narrative is because I can't get a drug approved for "anxiety of life" or "general unhappiness." But I can get a drug for panic disorder. I can get approved for something seen as a biological condition.
From a pharmaceutical point of view, if you can create a narrative that the discomfort of life is a biological condition, you're going to expand your market dramatically. Before 1980—which is when panic disorder was first identified as a specific disorder—the group of things that were seen as biological was pretty small. It was going to be hard for the pharmaceutical market to expand beyond that.
Why did psychiatry want to tell this tale? Psychiatry in the fifties and sixties had a lot of Freudian impulses and psychodynamic thinking. Then in the seventies, you see a guild whose survival as a medical discipline was under attack. As the benzodiazepines were popping up—those were the first real popular psychiatric drugs—there were problems with addiction, withdrawal, and lack of efficacy over time.
In the seventies, the American Psychiatric Association as a guild felt threatened. Diagnoses were being challenged. It was in competition with talk therapy counseling and other ways of approaching wellness. You can see them saying, "How can we rise above this competitive fray?"
Well, what image has power in American society? The white coat. They said, "We need to put on the white coat. If we call these diseases of the brain, we're now in that field of (almost) infectious disease medicine." You start telling yourself a story and you're going to want to believe that story. You can see psychiatry trying to convince itself that these diseases are chemical imbalances.
A worker at Galenika, a major Serbian pharmaceutical company, stacks on October 23, 2009 packages of Bensedin anti-depressant pills. "A Benjo a day takes your troubles away," said a tongue-in-cheek Belgrade graffiti featuring the slang name of the popular antidepressant in the 1990s.
Photo: AFP via Getty Image
D: A recent analysis showed that trials for esketamine were rushed and did not show true efficacy, but the FDA approved the drug anyway. This is the first psychedelic approved for medical use, yet we seem to be making the same mistakes as with other drugs. How do we break this loop?
B: When a pharmaceutical company wants to get a drug approved, they're going to design the study in ways that make their drug look good. There are all sorts of tricks. If you know of certain side effects, don't put them on the checklist of problems that you look for and you won't get nearly as many spontaneously reported actions. People who are funding the studies of these drugs by and large have a vested interest in seeing them approved.
Our mechanism of approval is also misunderstood. People generally think that if a drug is approved by the FDA, that means it's safe and good for you. The FDA isn't actually saying that the benefits outweigh the harms. It's saying we have this standard for approving a drug: if you can show two trials where it has statistically significant benefit over placebo, that's a sign of efficacy.
Let's say you have a drug that provides a relief of symptoms in 20 percent of people. In placebo it's 10 percent. How many people in that study do not benefit from the drug? Nine out of 10. How many people are exposed to the adverse effects of the drug? 100 percent.
They'll pass that drug because it meets this small standard of benefit over placebo. And they're not subtracting the risk; they're just warning of the risk. It's not up to doctors to decide whether it's helpful. This process is just saying, "it's met our societal standard for getting it on the market."
We also don't measure long-term exposure. If you look at Xanax, it doesn't show any efficacy after about four weeks. If you're taking it on a daily basis, you really should get off it. But all sorts of people have been on it for two years, three years, five years, 10 years. We don't have a mechanism for assessing what happens to people on these drugs for that amount of time.
D: Why does the medical industry not discuss the power of placebo more often?
B: This goes to a larger question about how we think about wellness as a society. There have been a lot of changes in medicine, but the benefits of antibiotics created a mindset about how effective drugs could be for whatever ails you. It set in motion this idea that medicine could come forth with pills that could help whatever you might be presenting with. You see this rapid rise in the use of prescriptions as well.
Increasingly, doctors found themselves in a position where patients were hoping to leave with a prescription. You can't write a prescription for placebo. It would probably be very helpful if you could. The interaction between doctor and patient is actually a sort of placebo interaction. The patient comes for help, they think the doctor has magical potions, and they want to leave with that magical potion. That's in our mindset.
Original building of The Retreat, York. Instituted 1792.
Photo: Wikimedia Commons
D: One of the most powerful stories in "Anatomy of an Epidemic" is the 19th century Quaker practice of moral therapy. Can you foresee a return to this sort of model?
B: I love the humility in it. They admitted they didn't really know what causes madness, but here's the key: they said, "we know they're brethren. They're humans, like all of us." Then they asked, "What do we like? We all like a comforting environment; we need shelter; we need food; it's good to have interests; it's good to have socialization and respect toward each other."
One of the beautiful aspects of moral therapy is they wanted to create these residences out in the country. They thought nature could be very healing, diet could be very healing, a little glass of port at four in the afternoon could be healing.
My favorite part of the moral therapy approach was they would hold a mirror to reflect the image back not of a bad person, but the image of someone who could be in society, who could be with others without fear. They were creating environments where people felt safe and found meaning. They felt respected as well.
If you look at the medical notes, these people were psychotic. They were having trouble assessing reality. Historians found that with this sort of comforting environment many people, about two-thirds, their psychosis would abate naturally over time. Most would never come back to the hospital; they would have a time of psychosis rather than a chronic illness.
Our drug basis is very different: We're going to fix something wrong with the inside of your head. Moral therapy is about fixing the environment you move through and creating a new environment. Our mental health arises within environments, not just the inside of your head.
D: I walked a half-mile to school at age six, so I come from quite a different time, even though I'm only 44. If I was growing up now, I would be put on a drug for ADHD, as I was pretty hyper. Yet our prefrontal cortex doesn't fully develop until our twenties. The idea of putting six-year-olds on these drugs is insane.
B: This is one of the biggest moral questions of our time: How do we raise our children? The biggest moral question of our time is climate change. If we don't respond to that, we're really screwing future generations. But it is a big question.
We've created a pathologizing environment for them. Why did we do that?
If you go back to the early nineties, the drug companies recognized the adult market for SSRIs was being saturated. Where's the untapped market? Kids.
You had already started to see that with stimulants for ADHD, but what you see post-1980 is market forces: pharmaceutical companies worked with academic psychiatry to start talking about all of these childhood disorders and the need to medicate them.
What I find particularly distressing is that all the data you can find on medicating kids is ultimately negative, even on symptoms, cognitive function, social functioning, and academic achievement. Most frightening of all—since you opened this with ideas of frontal lobe development—all of our animal studies show that these drugs affect brain development.
If you look at the harm done from pathologizing childhood, it's so broad-based. Kids are taught to monitor their own self. If they find themselves sad, that's wrong, that's abnormal. Whereas in the past, you might think, "I'm sad today." You're expected to be happy, and if you're not happy, that's a problem. We've created a situation where kids are primed to think, "something's wrong with me," and parents are primed to think, "something's wrong with my kid."
Going back to moral therapy: Do we ask about the spaces kids inhabit today? You got to walk a half-mile to school. How many kids get to walk to school today? How many kids feel pressure by second grade to start getting good grades because they have to worry about getting into college?
You create a narrative that helps drive people into this "abnormal" category, so they start using these drugs. And we have all this evidence that it isn't benefiting kids.
We've seen rising suicide rates in kids. Then there's the rise in antidepressants, too. Go to college campuses today, the percentage of kids that arrive with a diagnosis and a prescription is 25 to 30 percent. Do you really think 30 percent of our kids are mentally ill?
You've given kids messages that they're abnormal, ill, and compromised, instead of giving them messages of resilience, of how to grow into life. You can't chase happiness. You can chase meaning in life. You can chase doing things that have some meaning to the social good. I can't just try to be happy. Happy visits you when you're engaged in social relationships, meaning, community, that sort of thing.
The pathologizing of kids is taking away the right of every child to become the author of their own life: to make choices, to try things out, to decide what they want to be, and to grapple with their own minds.
Northwell Health is using insights from website traffic to forecast COVID-19 hospitalizations two weeks in the future.
- The machine-learning algorithm works by analyzing the online behavior of visitors to the Northwell Health website and comparing that data to future COVID-19 hospitalizations.
- The tool, which uses anonymized data, has so far predicted hospitalizations with an accuracy rate of 80 percent.
- Machine-learning tools are helping health-care professionals worldwide better constrain and treat COVID-19.
The value of forecasting<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNTA0Njk2OC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYyMzM2NDQzOH0.rid9regiDaKczCCKBsu7wrHkNQ64Vz_XcOEZIzAhzgM/img.jpg?width=980" id="2bb93" class="rm-shortcode" data-rm-shortcode-id="31345afbdf2bd408fd3e9f31520c445a" data-rm-shortcode-name="rebelmouse-image" data-width="1546" data-height="1056" />
Northwell emergency departments use the dashboard to monitor in real time.
Credit: Northwell Health<p>One unique benefit of forecasting COVID-19 hospitalizations is that it allows health systems to better prepare, manage and allocate resources. For example, if the tool forecasted a surge in COVID-19 hospitalizations in two weeks, Northwell Health could begin:</p><ul><li>Making space for an influx of patients</li><li>Moving personal protective equipment to where it's most needed</li><li>Strategically allocating staff during the predicted surge</li><li>Increasing the number of tests offered to asymptomatic patients</li></ul><p>The health-care field is increasingly using machine learning. It's already helping doctors develop <a href="https://care.diabetesjournals.org/content/early/2020/06/09/dc19-1870" target="_blank">personalized care plans for diabetes patients</a>, improving cancer screening techniques, and enabling mental health professionals to better predict which patients are at <a href="https://healthitanalytics.com/news/ehr-data-fuels-accurate-predictive-analytics-for-suicide-risk" target="_blank" rel="noopener noreferrer">elevated risk of suicide</a>, to name a few applications.</p><p>Health systems around the world have already begun exploring how <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7315944/" target="_blank" rel="noopener noreferrer">machine learning can help battle the pandemic</a>, including better COVID-19 screening, diagnosis, contact tracing, and drug and vaccine development.</p><p>Cruzen said these kinds of tools represent a shift in how health systems can tackle a wide variety of problems.</p><p>"Health care has always used the past to predict the future, but not in this mathematical way," Cruzen said. "I think [Northwell Health's new predictive tool] really is a great first example of how we should be attacking a lot of things as we go forward."</p>
Making machine-learning tools openly accessible<p>Northwell Health has made its predictive tool <a href="https://github.com/northwell-health/covid-web-data-predictor" target="_blank">available for free</a> to any health system that wishes to utilize it.</p><p>"COVID is everybody's problem, and I think developing tools that can be used to help others is sort of why people go into health care," Dr. Cruzen said. "It was really consistent with our mission."</p><p>Open collaboration is something the world's governments and health systems should be striving for during the pandemic, said Michael Dowling, Northwell Health's president and CEO.</p><p>"Whenever you develop anything and somebody else gets it, they improve it and they continue to make it better," Dowling said. "As a country, we lack data. I believe very, very strongly that we should have been and should be now working with other countries, including China, including the European Union, including England and others to figure out how to develop a health surveillance system so you can anticipate way in advance when these things are going to occur."</p><p>In all, Northwell Health has treated more than 112,000 COVID patients. During the pandemic, Dowling said he's seen an outpouring of goodwill, collaboration, and sacrifice from the community and the tens of thousands of staff who work across Northwell.</p><p>"COVID has changed our perspective on everything—and not just those of us in health care, because it has disrupted everybody's life," Dowling said. "It has demonstrated the value of community, how we help one another."</p>
"You dream about these kinds of moments when you're a kid," said lead paleontologist David Schmidt.
- The triceratops skull was first discovered in 2019, but was excavated over the summer of 2020.
- It was discovered in the South Dakota Badlands, an area where the Triceratops roamed some 66 million years ago.
- Studying dinosaurs helps scientists better understand the evolution of all life on Earth.
Credit: David Schmidt / Westminster College<p style="margin-left: 20px;">"We had to be really careful," Schmidt told St. Louis Public Radio. "We couldn't disturb anything at all, because at that point, it was under law enforcement investigation. They were telling us, 'Don't even make footprints,' and I was thinking, 'How are we supposed to do that?'"</p><p>Another difficulty was the mammoth size of the skull: about 7 feet long and more than 3,000 pounds. (For context, the largest triceratops skull ever unearthed was about <a href="https://www.tandfonline.com/doi/abs/10.1080/02724634.2010.483632" target="_blank">8.2 feet long</a>.) The skull of Schmidt's dinosaur was likely a <em>Triceratops prorsus, </em>one of two species of triceratops that roamed what's now North America about 66 million years ago.</p>
Credit: David Schmidt / Westminster College<p>The triceratops was an herbivore, but it was also a favorite meal of the T<em>yrannosaurus rex</em>. That probably explains why the Dakotas contain many scattered triceratops bone fragments, and, less commonly, complete bones and skulls. In summer 2019, for example, a separate team on a dig in North Dakota made <a href="https://www.nytimes.com/2019/07/26/science/triceratops-skull-65-million-years-old.html" target="_blank">headlines</a> after unearthing a complete triceratops skull that measured five feet in length.</p><p>Michael Kjelland, a biology professor who participated in that excavation, said digging up the dinosaur was like completing a "multi-piece, 3-D jigsaw puzzle" that required "engineering that rivaled SpaceX," he jokingly told the <a href="https://www.nytimes.com/2019/07/26/science/triceratops-skull-65-million-years-old.html" target="_blank">New York Times</a>.</p>
Morrison Formation in Colorado
James St. John via Flickr
|Credit: Nobu Tamura/Wikimedia Commons|
New research suggests you can't fake your emotional state to improve your work life — you have to feel it.
What is deep acting?<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNTQ1NDk2OS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxNTY5MzA0Nn0._s7aP25Es1CInq51pbzGrUj3GtOIRWBHZxCBFnbyXY8/img.jpg?width=1245&coordinates=333%2C-1%2C333%2C-1&height=700" id="ddf09" class="rm-shortcode" data-rm-shortcode-id="9dc42c4d6a8e372ad7b72907b46ecd3f" data-rm-shortcode-name="rebelmouse-image" data-width="1245" data-height="700" />
Arlie Russell Hochschild (pictured) laid out the concept of emotional labor in her 1983 book, "The Managed Heart."
Credit: Wikimedia Commons<p>Deep and surface acting are the principal components of emotional labor, a buzz phrase you have likely seen flitting about the Twittersphere. Today, "<a href="https://www.bbc.co.uk/bbcthree/article/5ea9f140-f722-4214-bb57-8b84f9418a7e" target="_blank">emotional labor</a>" has been adopted by groups as diverse as family counselors, academic feminists, and corporate CEOs, and each has redefined it with a patented spin. But while the phrase has splintered into a smorgasbord of pop-psychological arguments, its initial usage was more specific.</p><p>First coined by sociologist Arlie Russell Hochschild in her 1983 book, "<a href="https://www.ucpress.edu/book/9780520272941/the-managed-heart" target="_blank">The Managed Heart</a>," emotional labor describes the work we do to regulate our emotions on the job. Hochschild's go-to example is the flight attendant, who is tasked with being "nicer than natural" to enhance the customer experience. While at work, flight attendants are expected to smile and be exceedingly helpful even if they are wrestling with personal issues, the passengers are rude, and that one kid just upchucked down the center aisle. Hochschild's counterpart to the flight attendant is the bill collector, who must instead be "nastier than natural."</p><p>Such personas may serve an organization's mission or commercial interests, but if they cause emotional dissonance, they can potentially lead to high emotional costs for the employee—bringing us back to deep and surface acting.</p><p>Deep acting is the process by which people modify their emotions to match their expected role. Deep actors still encounter the negative emotions, but they devise ways to <a href="http://www.selfinjury.bctr.cornell.edu/perch/resources/what-is-emotion-regulationsinfo-brief.pdf" target="_blank">regulate those emotions</a> and return to the desired state. Flight attendants may modify their internal state by talking through harsh emotions (say, with a coworker), focusing on life's benefits (next stop Paris!), physically expressing their desired emotion (smiling and deep breaths), or recontextualizing an inauspicious situation (not the kid's fault he got sick).</p><p>Conversely, surface acting occurs when employees display ersatz emotions to match those expected by their role. These actors are the waiters who smile despite being crushed by the stress of a dinner rush. They are the CEOs who wear a confident swagger despite feelings of inauthenticity. And they are the bouncers who must maintain a steely edge despite humming show tunes in their heart of hearts.</p><p>As we'll see in the research, surface acting can degrade our mental well-being. This deterioration can be especially true of people who must contend with negative emotions or situations inside while displaying an elated mood outside. Hochschild argues such emotional labor can lead to exhaustion and self-estrangement—that is, surface actors erect a bulwark against anger, fear, and stress, but that disconnect estranges them from the emotions that allow them to connect with others and live fulfilling lives.</p>
Don't fake it till you make it<p>Most studies on emotional labor have focused on customer service for the obvious reason that such jobs prescribe emotional states—service with a smile or, if you're in the bouncing business, a scowl. But <a href="https://eller.arizona.edu/people/allison-s-gabriel" target="_blank">Allison Gabriel</a>, associate professor of management and organizations at the University of Arizona's Eller College of Management, wanted to explore how employees used emotional labor strategies in their intra-office interactions and which strategies proved most beneficial.</p><p>"What we wanted to know is whether people choose to engage in emotion regulation when interacting with their co-workers, why they choose to regulate their emotions if there is no formal rule requiring them to do so, and what benefits, if any, they get out of this effort," Gabriel said in <a href="https://www.sciencedaily.com/releases/2020/01/200117162703.htm" target="_blank">a press release</a>.</p><p>Across three studies, she and her colleagues surveyed more than 2,500 full-time employees on their emotional regulation with coworkers. The survey asked participants to agree or disagree with statements such as "I try to experience the emotions that I show to my coworkers" or "I fake a good mood when interacting with my coworkers." Other statements gauged the outcomes of such strategies—for example, "I feel emotionally drained at work." Participants were drawn from industries as varied as education, engineering, and financial services.</p><p>The results, <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2Fapl0000473" target="_blank" rel="noopener noreferrer">published in the Journal of Applied Psychology</a>, revealed four different emotional strategies. "Deep actors" engaged in high levels of deep acting; "low actors" leaned more heavily on surface acting. Meanwhile, "non-actors" engaged in negligible amounts of emotional labor, while "regulators" switched between both. The survey also revealed two drivers for such strategies: prosocial and impression management motives. The former aimed to cultivate positive relationships, the latter to present a positive front.</p><p>The researchers found deep actors were driven by prosocial motives and enjoyed advantages from their strategy of choice. These actors reported lower levels of fatigue, fewer feelings of inauthenticity, improved coworker trust, and advanced progress toward career goals. </p><p>As Gabriel told <a href="https://www.psypost.org/2021/01/new-psychology-research-suggests-deep-acting-can-reduce-fatigue-and-improve-your-work-life-59081" target="_blank" rel="noopener noreferrer">PsyPost in an interview</a>: "So, it's a win-win-win in terms of feeling good, performing well, and having positive coworker interactions."</p><p>Non-actors did not report the emotional exhaustion of their low-actor peers, but they also didn't enjoy the social gains of the deep actors. Finally, the regulators showed that the flip-flopping between surface and deep acting drained emotional reserves and strained office relationships.</p><p>"I think the 'fake it until you make it' idea suggests a survival tactic at work," Gabriel noted. "Maybe plastering on a smile to simply get out of an interaction is easier in the short run, but long term, it will undermine efforts to improve your health and the relationships you have at work. </p><p>"It all boils down to, 'Let's be nice to each other.' Not only will people feel better, but people's performance and social relationships can also improve."</p>
You'll be glad ya' decided to smile<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="88a0a6a8d1c1abfcf7b1aca8e71247c6"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/QOSgpq9EGSw?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>But as with any research that relies on self-reported data, there are confounders here to untangle. Even during anonymous studies, participants may select socially acceptable answers over honest ones. They may further interpret their goal progress and coworker interactions more favorably than is accurate. And certain work conditions may not produce the same effects, such as toxic work environments or those that require employees to project negative emotions.</p><p>There also remains the question of the causal mechanism. If surface acting—or switching between surface and deep acting—is more mentally taxing than genuinely feeling an emotion, then what physiological process causes this fatigue? <a href="https://www.frontiersin.org/articles/10.3389/fnhum.2019.00151/full" target="_blank">One study published in the <em>Frontiers in Human Neuroscience</em></a><em> </em>measured hemoglobin density in participants' brains using an fNIRS while they expressed emotions facially. The researchers found no significant difference in energy consumed in the prefrontal cortex by those asked to deep act or surface act (though, this study too is limited by a lack of real-life task).<br></p><p>With that said, Gabriel's studies reinforce much of the current research on emotional labor. <a href="https://journals.sagepub.com/doi/abs/10.1177/2041386611417746" target="_blank">A 2011 meta-analysis</a> found that "discordant emotional labor states" (read: surface acting) were associated with harmful effects on well-being and performance. The analysis found no such consequences for deep acting. <a href="https://doi.apa.org/doiLanding?doi=10.1037%2Fa0022876" target="_blank" rel="noopener noreferrer">Another meta-analysis</a> found an association between surface acting and impaired well-being, job attitudes, and performance outcomes. Conversely, deep acting was associated with improved emotional performance.</p><p>So, although there's still much to learn on the emotional labor front, it seems Van Dyke's advice to a Leigh was half correct. We should put on a happy face, but it will <a href="https://bigthink.com/design-for-good/everything-you-should-know-about-happiness-in-one-infographic" target="_self">only help if we can feel it</a>.</p>
Archaeologists discover a cave painting of a wild pig that is now the world's oldest dated work of representational art.
- Archaeologists find a cave painting of a wild pig that is at least 45,500 years old.
- The painting is the earliest known work of representational art.
- The discovery was made in a remote valley on the Indonesian island of Sulawesi.