A psychiatric diagnosis can be more than an unkind ‘label’
A popular and longstanding wave of thought in psychology and psychotherapy is that diagnosis is not relevant for practitioners in those fields.
19 January, 2021
Chris J Ratcliffe/Getty Images for Sotheby's
When I was training as a clinical psychologist, I had a rotation in a low-cost psychotherapy clinic.
<p> Among the first people I met was a young man who believed that he might be responsible for harm coming to his family if he didn't engage in time-consuming rituals, including arranging his shoes very particularly for up to half an hour. The logic motivating this man's behaviour was notably rather magical and unrealistic, appealing to notions of spirit possession and evil, which were culturally alien to his family. My supervisor, a sensitive and empathic clinician, who believed that most issues could be addressed by attentive listening and interpretation, tended to have a single diagnostic concern. The central question for him was whether the person was experiencing anxiety or manifesting the early symptoms of a psychosis. The latter ought to receive a more thorough assessment and more support than our clinic could offer.</p><p>Because of the magical quality to this person's reasoning, my supervisor decided that this might be an early sign of psychosis. He instructed me to refer the man to a new research clinic near my training site, which specialised in treating and researching the 'at risk' state for psychosis.</p><p>Of course, sensible and cautious though this seemed to me, it entailed telling this young man that he could not be seen by us for talking therapy. Instead, he should go to a clinic that specialised in something serious and frightening-sounding. When I broke the news, he was devastated. He left our clinic, and I later learned that he never followed up with the referral.</p>
<p>What I failed to appreciate at the time – and what some remedial reading later painfully revealed to me – was that, rather than being an early manifestation of psychosis, this man's presentation was more likely a case of obsessive compulsive disorder (OCD), a common condition in which people develop obsessive thoughts and feel compelled to engage in actions to prevent feared harms. If I'd had the diagnostic knowledge and confidence to assert this to my supervisor during the initial consultation, the man I met would likely have received help, rather than being referred to an inappropriate clinic that led to him falling through the cracks.</p><p>Yet, a popular and longstanding wave of thought in psychology and psychotherapy is that diagnosis is not relevant for practitioners in those fields, and should be left to psychiatrists, if at all. This is not a fringe view, it has been perennially present in clinical psychology since at least the 1960s, when the iconoclastic psychiatrists Thomas Szasz and R D Laing presented a dual challenge to their profession.</p><p>Szasz, a Hungarian émigré to the United States, <a href="https://psycnet.apa.org/record/1961-01456-001" target="_blank">argued</a> that mental illness is a 'myth', rooted in a misuse of language. Neurological diseases are real, Szasz suggested, because they can be confirmed by a postmortem examination of the brain. In contrast, he argued that psychiatric 'illness' has no such neurological basis, and is just a medicalised way of talking about problems in life that could be solved by taking responsibility for yourself and your actions.</p><p>Meanwhile, Laing, a Scot who trained at the Tavistock Institute in London, <a href="https://www.penguinrandomhouse.com/books/274343/the-divided-self-by-r-d-laing/" rel="noopener noreferrer" target="_blank">argued</a> in <em>The Divided Self</em> (1960) that psychosis is a psychic response to an increasingly alienated 'false self' obscuring the true emotional core of an individual. He held that so-called 'symptoms' (hearing voices, believing unusual things) were actually attempts at recovery in the face of this alienation.</p>
<p>These ideas resonated and had significant influence over psychiatric thinking throughout the 1960s. They contributed to diagnostic approaches to mental health – the idea that there are illnesses called schizophrenia, bipolar disorder and depression – becoming decidedly <a href="https://aeon.co/essays/the-psychiatrist-who-didn-t-believe-in-mental-illness" target="_blank">unfashionable</a>. Indeed Szasz's and Laing's critiques became so popular that already by the early 1970s, the influential US clinical psychologist Paul Meehl grumbled in his 1973 paper 'Why I Do Not Attend Case Conferences' about an 'antinosological' (ie, antidiagnostic) bias taking hold in his profession.</p><p>Recently, the animus against psychiatric diagnosis has become more formal and scientifically argued. The British Psychological Society's Division of Clinical Psychology (DCP) – one of the official bodies representing the profession – published <a href="https://dxrevisionwatch.files.wordpress.com/2013/05/position-statement-on-diagnosis-master-doc.pdf" target="_blank">two</a> <a href="http://www.newvisionformentalhealth.com/2018/01/26/guidelines-on-language-in-relation-to-functional-psychiatric-diagnosis/" rel="noopener noreferrer" target="_blank">documents</a> in 2013 and 2015 articulating the difficulties with diagnosis, and promoting instead the value of individualised 'formulations'. While it is clear that the DCP's position on diagnosis is not universally held by practitioners in the UK, British psychologists are around half as likely to report regular use of a diagnostic classificatory system as their colleagues in some other countries (for <a href="https://onlinelibrary.wiley.com/doi/abs/10.1080/00207594.2013.804189" rel="noopener noreferrer" target="_blank">example</a>, fewer than 35 per cent of psychologists in the UK say that they use diagnosis regularly, compared with more than 70 per cent of psychologists in the US, Germany and South Africa). This likely reflects a UK professional culture steeped in suspicion of diagnostic thinking.</p><p>The suspicion is not unwarranted. One of the most interesting recent critiques of diagnosis has come from the Belgian psychoanalyst and clinical psychologist Stijn Vanheule. He <a href="https://www.ncbi.nlm.nih.gov/pubmed/22903905" rel="noopener noreferrer" target="_blank">invoked</a> the philosophy of language to argue that diagnosis necessarily draws our attention to the shared meanings conjured by diagnostic language, rather than to the individual meanings inherent to people's experiences. Thus, for example, when I say 'schizophrenia', I focus attention on a generalised, clinical definition that exists in a book, rather than on the individual, personal significance of hearing voices or believing unusual things. For psychotherapists, Vanheule argued, the former is irrelevant, the latter vital.</p>
<p>These arguments are valuable, and they are correct in important ways. Their conclusions are a significant part of what inspired me to get into clinical psychology in the first place. Reading Laing as a teenager, I thrilled to the challenge he presented: to understand people as they endure the most extreme and bewildering psychic states; to try to find coherence even where it seems to be absent. This impulse is essential. Patience and careful listening can reveal that people are capable of engaging in communication more often than we tend to give them credit for. But my clinical training has shown me that, despite the importance of understanding people in an individualised way, having a knowledge of diagnostic categories is also essential.</p><p>To return to the example above, my supervisor and I were ignorant of valuable diagnostic information; we were ignorant of the ways that clinicians can distinguish magical obsessions from the early hints of delusion. We were ignorant of the fact that even quite magical ideas are well within the range of the former without shading into the latter. We were ignorant of how easy it would have been to provide effective help without raising the prospect of a terrifying psychosis down the pipeline. Our ignorance cost someone dearly.</p><p>Diagnosis is often vital for ensuring good care. Apart from the importance of ruling out organic causes for apparently straightforward instances of depression and anxiety (which can be symptomatic of a surprising range of endocrine, infectious and neurological diseases), linking psychological distress into a broader framework also helps clinicians make sense of the people they are trying to help. Certain forms of substance misuse could represent attempts at self-medication for highly treatable disorders of mood or attention, for instance. Correct identification of trauma symptoms can avert diagnosis of a psychotic illness. Proper diagnosis of depression in later life can frequently account for changes in memory and attention that might otherwise be mistaken for dementia, as unfortunately often happens. Diagnosis of bipolar mood disorder can prevent people being inappropriately treated for personality disorders.</p><p>Psychology's antinosological tendency encourages a belief that diagnostic thinking is somehow inherently unkind; that in thinking about categories you are always only 'labelling' people, and that this is an inhumane thing to do.</p>
<p>Conversely, it also encourages a belief that all you really need in mental healthcare is sympathy, rapport and interpretative heroics. This appeals to some of the questionable impulses of professionals: to our desire to see ourselves as people uniquely able to understand others, and to our ordinary human laziness. Who would want to engage in learning about taxonomy if to do so is both unkind and unnecessary?</p><p>Understanding people is a multifaceted enterprise. We all manifest a splendid idiosyncrasy, living out lives that could never be copied or repeated, so it makes sense to consider one another in the light of this uniqueness. But we also bear resemblances to one another. Important though it is to be seen in all your individuality, it is also helpful to know when your problems have precedent.</p><p>Psychiatric diagnoses are imperfect, sketchy theories about how people's minds can give them trouble. We know that they are largely less precise and valid than is popularly understood, but this does not render them totally uninformative. We have learned snippets of useful information by considering psychological problems in terms of categories: the effectiveness, or not, of treatments for particular groups of people; the elevated risk of suicide among others. Many symptoms can seem to 'make sense' in the context of a person's life, but we know that humans are sense-making machines, so we need to be vigilant against 'making sense' where it is only illusory. The great intellectual challenge of clinical psychology is to integrate knowledge about reasons and people with knowledge about causes and mechanisms. We should avoid relying solely on diagnostic information, but we shouldn't discard it altogether.<img src="https://metrics.aeon.co/count/3533ace3-823d-4522-8d68-702c1e19f406.gif" alt="Aeon counter – do not remove"></p><p>Huw Green</p><p>This article was originally published at <a href="https://aeon.co/?utm_campaign=republished-article" target="_blank">Aeon</a> and has been republished under Creative Commons. Read the <a href="https://aeon.co/ideas/a-psychiatric-diagnosis-can-be-more-than-an-unkind-label" target="_blank">original article</a>.</p>
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10 things you may not know about anxiety
Cold hands and feet? Maybe it's your anxiety.
19 January, 2021
Credit: Antonioguillem / Adobe Stock
- When we feel anxious, the brain's fight or flight instinct kicks in, and the blood flow is redirected from your extremities towards the torso and vital organs.
- According to the CDC, 7.1% of children between the ages of 3-17 (approximately 4.4 million) have an anxiety diagnosis.
- Anxiety disorders will impact 31% of Americans at some point in their lives.
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Here's what you may not know about anxiety...
<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="0ed8bd7fb8626babd10933f7ce630f96"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/w4jiLIzTAa0?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p><strong>There's a fine line between stress and anxiety - and many people don't know what the difference is.</strong></p><p>Both stress and anxiety are <a href="https://www.apa.org/topics/stress-anxiety-difference" target="_blank">emotional responses</a>, but stress is typically caused by an external trigger and can be short-term (a looming deadline at work, for example). People under stress experience mental and physical symptoms such as irritability, anger, fatigue, muscle pain, digestive troubles, insomnia, and headache. </p><p>Anxiety, on the other hand, is defined as a persistent, excessive worry. Even in the absence of the thing that triggered it, anxiety lingers. It can lead to a nearly identical set of symptoms, which is why they are often confused. Feelings of anxiety then differ from an anxiety disorder - an anxiety disorder means your anxiety typically persists for months and negatively impacts your daily functioning. </p><p><strong>There are five major types of anxiety disorders:</strong></p><ol><li>Generalized anxiety (GAD) is characterized by chronic anxiety, exaggerated worry, and tension, even when there is little or nothing to provoke it. </li><li>Obsessive-Compulsive Disorder (OCD) is characterized by recurrent, unwanted thoughts (or obsessions) and/or repetitive behaviors (compulsions). </li><li>Panic disorder is characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms such as chest pain, heart palpitations, shortness of breath, dizziness, and/or abdominal distress. </li><li>Post-Traumatic Stress Disorder (PTSD) is also an anxiety disorder, and it can develop after exposure to a terrifying event in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD include things like personal assaults, natural and/or human-caused disasters, accidents, or military combat. </li><li>Social Anxiety Disorder (also known as 'social phobia') is characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations. </li></ol><p><strong>Anxiety disorders can impact 31 percent of Americans at some point in their life. </strong></p><p>According to the <a href="https://www.apa.org/topics/stress-anxiety-difference" target="_blank" rel="noopener noreferrer">American Psychological Association</a>, 19 percent of Americans over the age of 18 have had an anxiety disorder in the past year and 31 percent of Americans will experience an anxiety disorder at some point in their lives. </p><p><strong>Anxiety may be genetic. </strong></p><p><a href="https://www.healthline.com/health/mental-health/is-anxiety-genetic#:~:text=Most%20researchers%20conclude%20that%20anxiety,and%20more%20research%20is%20needed." target="_blank" rel="noopener noreferrer">According to HealthLine</a>, anxiety may be genetic but can also be influenced by environmental factors. It's possible to have anxiety without it running in your family, however, there is speculated to be some genetic component that makes anxiety more prevalent in some individuals. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573560/" target="_blank" rel="noopener noreferrer">Research</a> has indicated some link between genetics and anxiety, though much more research is required in this area. </p><p><strong>Anxiety often begins in childhood. </strong></p><p><a href="https://www.cdc.gov/childrensmentalhealth/data.html#:~:text=For%20children%20aged%203%2D17,also%20have%20depression%20(32.3%25).&text=For%20children%20aged%203%2D17%20years%20with%20behavior%20problems%2C%20more,also%20have%20depression%20(20.3%25)." target="_blank" rel="noopener noreferrer">According to the CDC</a>, 7.1 percent of children between the ages of 3-17 (approximately 4.4 million) have an anxiety diagnosis. Six in ten children (59.3 percent) between the ages of 3-17 have received anxiety therapy or treatment. </p><p><strong>Having an anxiety disorder can increase your risk of other physical health complications. </strong></p><p>According to research from <a href="https://www.health.harvard.edu/topics/anxiety" target="_blank" rel="noopener noreferrer">Harvard Medical School</a>, anxiety has been indicated in several chronic physical illnesses, including heart disease, chronic respiratory disorders, gastrointestinal conditions such as IBS, and more. </p><p><strong>Cold hands and feet? Anxiety may be the reason. </strong></p><p>If you're someone who constantly struggles with having cold hands or feet, it could be a result of your anxiety. When we feel anxious, the brain's <a href="https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response#:~:text=The%20autonomic%20nervous%20system%20has,can%20respond%20to%20perceived%20dangers." target="_blank" rel="noopener noreferrer">fight or flight instinct</a> kicks in, and the blood flow is redirected from your extremities towards the torso and vital organs. </p><p><strong>Anxiety can be related to anger issues and memory loss. </strong></p><p>A lesser-known side effect of anxiety is <a href="https://discoverymood.com/blog/anxiety-and-anger/#:~:text=Anxiety%20is%20often%20connected%20with,which%20can%20lead%20to%20anger." target="_blank" rel="noopener noreferrer">anger</a>. When you feel powerless over a situation, expressing anger is a natural way to feel as though you have some kind of control. With chronic sufferers of anxiety, depression is the most common issue to develop, but anger is close behind. As <a href="https://discoverymood.com/blog/anxiety-and-anger/#:~:text=Anxiety%20is%20often%20connected%20with,which%20can%20lead%20to%20anger." target="_blank" rel="noopener noreferrer">Discovery Mood</a> explains, "anxiety is often connected with overstimulation from a stressful environment or threat, combined with the perceived inability to deal with that threat. In contrast, anger is often tied to frustration. When anxiety is left unacknowledged or unexpressed, it can turn into frustration which then easily leads to anger." </p><p><strong>Anxiety can also cause memory problems. </strong></p><p>According to <a href="https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/memory-loss/art-20046326#:~:text=Stress%2C%20anxiety%20or%20depression%20can,loss%20by%20interacting%20with%20medications." target="_blank" rel="noopener noreferrer">Mayo Clinic</a>, stress, anxiety, or depression can often cause forgetfulness, confusion, and difficulty concentrating. <a href="https://www.verywellmind.com/anxiety-and-memory-1393133" target="_blank" rel="noopener noreferrer">VeryWellMind</a> explains further, "memories can be affected when you are under periods of stress or experience some sort of disturbance in mood. Having a significant anxiety disorder like GAD can create some of these problems routinely, leaving you operating below your normal level of memory functioning." </p><p><strong>Anxiety can even impact your sense of smell. </strong></p><p>People who struggle with anxiety may be more likely to label natural smells as bad smells, according to research published in the <a href="https://www.jneurosci.org/content/33/39/15324" target="_blank" rel="noopener noreferrer">Journal of Neuroscience</a>. When processing smells, typically it's only the olfactory system that is activated. However, in people with high anxiety levels, the emotional system can become intertwined with the olfactory system, which can slightly alter our perception of smells.</p>
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What can Avicenna teach us about the mind-body problem?
The Persian polymath and philosopher of the Islamic Golden Age teaches us about self-awareness.
15 January, 2021
Photo by Andrew Spencer on Unsplash
Philosophers of the Islamic world enjoyed thought experiments.
<p>If the heavens vanished, they wondered, would time continue to pass? If existence were distinct from essence, would that mean that existence itself must exist? Can God turn your household servant into a horse, so that you come back home to find it has urinated all over your books?</p><p>But the most famous is the so-called 'flying man' thought experiment, devised by the most influential philosopher of the Islamic world, Avicenna (in Arabic, <em>Ibn Sīnā</em>, who lived from 980 to 1037 CE). Imagine, he says, that a person is created by God in mid-air, in good condition but with his sight veiled and his limbs outstretched so that he is touching nothing, not even his own body. This person has no memories, having only just been created. Will his mind be a blank, devoid as it is of past or present sensory experience? No, says Avicenna. He will be aware of his own existence.</p><p>Three questions immediately arise. First, when Douglas Adams, the author of <em>The Hitchhiker's Guide to the Galaxy</em> (1978), imagined a whale popping into existence in mid-air above an alien planet, had he been reading Avicenna? I have no idea, but I like to think so.</p><p>Second, is Avicenna right that the 'flying man' would be self-aware? Well, it's important to realise that Avicenna does not attempt to <em>argue</em> that the flying man would know that he exists. Rather, he takes it as obvious. In one version, he even tells readers that we should imagine ourselves being so created. If we put ourselves in the flying man's dangling shoes, we should just see that we would be self-aware. Indeed, this turns out to be a fundamental idea in Avicenna's philosophy. He thinks that we are all always self-aware, even when we're asleep or focusing hard on something other than ourselves. Paradoxically, we're often not <em>aware</em> of being self-aware: it is the non-interruptive background music of human psychology, something we notice only when our attention is called to it, a pre-reflective awareness of self. The flying man thought experiment is itself one way to call attention to this self-awareness: Avicenna calls it a <em>tanbīh</em>, meaning a 'pointer' to something.</p>
<p>Our self-awareness is a foundation for our first-person perspective on things. It's a sign of this that when I see, imagine or think something, I can immediately apprehend that I am seeing, imagining or thinking about that thing. Any other form of cognition – any awareness of other things – presupposes awareness of oneself.</p><p>Incidentally, you might object that the flying man would have certain forms of bodily awareness despite his lack of vision, hearing and so on. Wouldn't he at least sense the location of his limbs by another form of sensation, namely proprioception? Imagine you are in total darkness and your arm is not resting on anything: proprioception is the sense that tells you where it is. This is indeed a problem for the thought experiment as Avicenna sets it up, but it isn't really philosophically decisive. One can just modify the scenario by adding that God blocks the man's ability to use proprioception, or that the flying man's proprioceptive faculty happens to be defective. Avicenna's claim will then be that, even under these circumstances, the flying man would be aware of himself.</p><p>Now for the third, and hardest, question: what does the flying man thought experiment prove? Avicenna draws a surprising conclusion: it shows that we are not identical with our bodies. Just consider. The flying man is aware of himself; he knows that he exists. But he is not aware of his body; he doesn't know that his body exists, nor indeed that any body exists. And if I am aware of one thing but not another, how can those two things be identical?</p>
<p>This sounds pretty persuasive, until you reflect that one can be conscious of a thing without being conscious of everything about it. You, for example, have been aware of reading this article for the past few minutes, but you haven't been aware of reading something written while Dixieland jazz was playing. It would be a mistake to conclude from this that the article is not something written with Dixieland jazz playing. In fact, that is exactly what it is. To put it another way, the flying man could be aware of his self without realising that his self is a body. Contemporary philosophers would say that Avicenna is mistakenly moving from a 'transparent' to an 'opaque' context, which is basically a fancy way of saying what I just said.</p><p><a href="http://philpapers.org/rec/MARAFM" target="_blank">Efforts</a> have been made to spare Avicenna from this mistake. One possible way to rescue the argument would go like this. Avicenna is trying to criticise another way of thinking about the soul, one that goes back to Aristotle. According to the theory he rejects, the soul is so closely associated with the body that it can only be understood as an aspect or organising principle of the body, which Aristotle called the body's 'form'. The thought experiment is designed to show that this is wrong. It does so by calling to our attention that we have a means of access to our souls apart from bodily sensation, namely self-awareness.</p><p>How would this refute Aristotle? Well, consider again just why it is that the flying man is not aware of his body. It is because he is not currently using his senses and has never done so (he only just started existing, remember), and sense perception is, Avicenna assumes, the <em>only</em> way to become aware of any body. If this is right, then anything that the flying man grasps without using sense perception is not a body, not material. Since he does grasp his soul without using sense perception, his soul is therefore not a body.</p><p>On this reading, Avicenna would be helping himself to a pretty big assumption, which is that bodies can be discovered only by the senses. You can see, hear, touch, taste or smell them, but otherwise you can never so much as know that they exist. Since for Aristotle the soul was a form of the body, if you couldn't experience the body, you would not, on his account, have access to the soul; and yet, Avicenna claims, the falling man <em>would</em> have access to his soul.</p><p>I suspect this is (at least in part) what he had in mind in creating this thought experiment. But that's not to say that I'm convinced. All Avicenna has really done is to throw down a challenge to his materialist opponents: show me how a body could be aware of itself without using sensation to do so.</p><p><a href="https://global.oup.com/academic/product/philosophy-in-the-islamic-world-9780199577491?cc=au&lang=en&" rel="noopener noreferrer" target="_blank"><em>Philosophy in the Islamic World</em></a><em> by Peter Adamson is out now through Oxford University Press.</em><img src="https://metrics.aeon.co/count/99e82cab-61e0-4404-a510-3e190ab2802e.gif" alt="Aeon counter – do not remove"></p><p>Peter Adamson</p><p>This article was originally published at <a href="https://aeon.co/?utm_campaign=republished-article" target="_blank">Aeon</a> and has been republished under Creative Commons. Read the <a href="https://aeon.co/ideas/what-can-avicenna-teach-us-about-the-mind-body-problem" target="_blank">original article</a>.</p>
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You’re simply not that big a deal: now isn’t that a relief?
Learn how to practice "self-indifference."
11 January, 2021
Photo by Kazuo ota on Unsplash
There is a meme that speaks directly to the hearts and minds of the overly self-conscious.
<p> Perhaps you've seen it; it goes something like this: 'Brain: “I see you are trying to sleep. May I offer you a selection of your most embarrassing memories from the past 10 years?"'</p><p>At first, it seems odd to think that this meme is so popular among those of us whom you would call 'millennials', who grew up steeped in the self-esteem movement of the 1990s. We were raised, after all, to <em>love ourselves</em>, not to quietly torture ourselves with decade-old memories. We were taught in classroom exercises how <em>special</em> we were, the prevailing pop-psych theory of the day being that high self-esteem would carry us to success.</p><p>And yet this turns out to be poor preparation for dealing with the everyday embarrassments of being human. Instead of single-mindedly trying to love yourself, may I suggest a self-directed attitude that has been famously called the opposite of love: indifference.</p><p>In the 2000s, as the self-esteem movement was ageing, psychology researchers began publishing a series of papers on something called self-compassion, which Kristin Neff at the University of Texas at Austin in 2003 <a href="https://www.researchgate.net/publication/277517590_The_Development_and_Validation_of_a_Scale_to_Measure_Self-Compassion" rel="nofollow noreferrer noopener">defined</a> this way:</p><blockquote>[B]eing open to and moved by one's own suffering, experiencing feelings of caring and kindness toward oneself, taking an understanding, nonjudgmental attitude toward one's inadequacies and failures, and recognising that one's own experience is part of the common human experience.</blockquote><p>Back then, much of this work sought to contrast self-compassion with self-esteem. Consider one <a href="https://www.ncbi.nlm.nih.gov/pubmed/17484611" rel="nofollow noreferrer noopener">study</a> that relates to the aforementioned meme, in which researchers asked college students to recall an embarrassing high-school memory. Some of the students were then given writing prompts meant to bring out their self-compassionate side; they were told to 'list ways in which other people also experience similar events', and to express 'understanding, kindness, and concern to themselves in the same way that they might express concern to a friend'. In contrast, other students were given writing prompts intended to stoke their self-esteem: they were told to 'write down [their] positive characteristics' and to describe why an incident wasn't really their fault – and that, anyhow, the event 'does not really indicate anything about the kind of person [they] are'.</p>
<p>The point, the researchers go on to argue in that paper, subtitled 'The Implications of Treating Oneself Kindly', is that the tenets of self-esteem will tell you to try to convince yourself that the stupid thing you did wasn't really all that stupid – or if it was, that it was someone else's fault. Self-esteem tells you to focus on all your wonderful, positive qualities. In contrast, self-compassion says it's best to acknowledge your own role in an unflattering moment; when the memories come back at night, a self-compassionate person will say to herself: 'Huh, yeah – that really <em>was</em> pretty embarrassing.'</p><p>But she'll also say: 'So what?' Plenty of other people have embarrassed themselves in similar ways. In the end, this study showed that those who'd been prodded toward the direction of self-esteem felt worse about themselves after remembering the high-school embarrassment than those who'd been led toward self-compassion.</p><p>Self-esteem has fallen out of favour, and it is starting to seem these days as if self-compassion is taking its place. The headlines that keep popping up are: 'Why Self-love Is Important And How To Cultivate It' (Medical News Today, 23 March 2018); '8 Powerful Steps To Self-Love' (Psychology Today, 29 June 2017); 'The Not-So-Secret Secret To Happiness: Be Kinder To Yourself, Okay?' (The Cut, 22 April 2016). (Fine: I wrote the last one.) The focus in these pop-psych stories tends to stay squarely on the first part of Neff's 15-year-old definition: 'experiencing feelings of caring and kindness toward oneself, taking an understanding, nonjudgmental attitude toward one's inadequacies and failures'. From reading many of these pieces, self-compassion seems like self-kindness, and nothing more.</p>
<p>But it's the second part of that definition that has proven the most helpful for me: 'recognising that one's own experience is part of the common human experience'. It's the idea of taking a zoomed-out look at yourself, and realising that you are more similar to others than you are different, even (maybe especially) considering how ridiculous you often are. As Neff herself said in an interview with The Atlantic in 2016: '[W]hen we fail, it's not "poor me," it's "well, everyone fails." Everyone struggles. This is what it means to be human.'</p><p>In fact, it's this part of the definition of self-compassion that makes me question whether it should be called self-compassion at all. Neff's concept isn't really about adoring yourself, or not entirely, anyway; this piece of it isn't actually about you. Rather, it's about the importance of recalling that you are but one small part of an interconnected whole.</p><p>For me, the term 'self-indifference' communicates this part of Neff's message better than her own term does: when it comes to embarrassing moments, it means considering your own highlight reel of flaws, acknowledging that, yes, maybe the moment really <em>was</em> that bad – but then responding with a shrug. It is, to come back to my earlier point, something you could call self-indifference, by which I mean the comfort of realising that you are not all that unique.</p>
<p>Really, though, self-indifference and self-compassion are just new-fangled terms for an ancient concept: humility. We tend to think of humility as if it means putting yourself down, a mischaracterisation that a recent <a href="http://psycnet.apa.org/record/2017-49118-001" target="_blank">study</a> in the <em>Journal of Applied Psychology</em> seems to buy into in its examination of 'humble leaders'. Humility in a manager, according to these researchers, is defined as 'being open to admitting one's limitations, shortcomings and mistakes'. To be humble, in these researchers' view, is to focus on your flaws.</p><p>But modern scholars who study humility see it differently. Humble people don't focus on their flaws – not exactly, anyway. It's more that humble people don't focus on themselves very much at all. 'This is not to say that a humble person fails to care about her own welfare or pursue her own interests – it is simply that she sees these as being deeply intertwined with the welfare and interests of others,' <a href="https://www.tandfonline.com/doi/abs/10.1080/17439760.2016.1167940" target="_blank">write</a> the authors of a 2017 paper in <em>The Journal of Positive Psychology.</em> You <em>are</em> important, and you <em>are</em> worthy of love, just like we millennials were taught in school – but that's true only because <em>everyone</em> is important, and <em>everyone</em> is worthy of love. You matter because everyone else matters. It reminds me again of the way in which Neff defines what she would call self-compassion, and I would call self-indifference: 'recognising that one's own experience is part of the common human experience'. Maybe the most compassionate attitude you can take toward yourself is to stop obsessing over yourself.</p><p>This is the great relief of self-indifference, especially for those of us raised in the self-esteem movement. The truth is that you <em>aren't</em> that big of a deal. And isn't that great?<img src="https://metrics.aeon.co/count/038d8f29-4205-4c04-b2ff-a161882d45c1.gif" alt="Aeon counter – do not remove"></p><p>Melissa Dahl</p><p>This article was originally published at <a href="https://aeon.co/?utm_campaign=republished-article" target="_blank">Aeon</a> and has been republished under Creative Commons.</p>
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Study shatters the myth that BDSM is linked to early-life trauma
No, being interested in BDSM does not mean you had a traumatic childhood.
05 January, 2021
Credit: LIGHTFIELD STUDIOS / Adobe Stock
- BDSM is a kind of sexual expression and/or practice that refers to three main subcategories: Bondage/Discipline, Dominance/submission, and Sadism/Masochism.
- It has been widely speculated that many BDSM practitioners or people who enjoy the BDSM lifestyle are drawn to it because of sexual trauma they experienced in the past.
- This 2020 study claims that BDSM practitioners deserve perception as normal sexual practice free from stigmatization rather than deviant behavior.
<p>BDSM is a kind of sexual expression or practice that refers to three main subcategories: </p><ul class="ee-ul"><li>Bondage and Discipline (BD)</li><li>Dominance and submission (DS)</li><li>Sadism and Masochism (SM) </li></ul><p>It has been widely speculated that many BDSM practitioners or people who enjoy the BDSM lifestyle are more drawn to the kinky lifestyle because of sexual trauma they have experienced in the past. </p><p>A <a href="https://link.springer.com/article/10.1007/s13178-020-00438-w" rel="noopener noreferrer" target="_blank">2020 study</a> smashed this myth by surveying 771 BDSM practitioners and 518 non-practitioners from the general population. These participants all completed a survey assessing BDSM interests as well as the Brief Trauma Questionnaire that is used to gauge traumatic events, and the Relationships Questionnaire that is used to assess a person's attachment style. </p><p><strong>What is the Brief Trauma Questionnaire? </strong></p><p>The BTQ, as it's referred to by the <a href="https://www.ptsd.va.gov/professional/assessment/documents/BTQ.pdf" rel="noopener noreferrer" target="_blank">National Center for PTSD</a>, is a self-report questionnaire derived from the <a href="https://health.oregonstate.edu/sites/health.oregonstate.edu/files/char/military-life-course/publications/schnurr_spiro_vielhauer_findler_hamblen_2002_trauma_in_the_lives_of_older_men-_findings_from_the_normaitve_aging_study.pdf" target="_blank">Brief Trauma Interview</a>. This questionnaire is used to assess whether an individual has had an event that meets the criteria for traumatic events.</p><p><strong>What is the Relationships Questionnaire? </strong></p><p>The RQ, as it's referred to by <a href="http://fetzer.org/sites/default/files/images/stories/pdf/selfmeasures/Attachment-RelationshipsQuestionnaire.pdf" target="_blank">the Fetzer Institute</a>, is a four-item survey designed to measure adult attachment styles. There are four main attachment styles: secure, dismissive-avoidant, anxious-preoccupied, and fearful-avoidant. <a href="https://www.quickanddirtytips.com/relationships/dating/your-attachment-style?utm_source=sciam&utm_campaign=sciam" target="_blank">This article</a> does a wonderful job summarizing the various attachment styles by comparing them to relationships on the television show "How I Met Your Mother."</p>
No, being interested in BDSM doesn’t mean you had a traumatic childhood
<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="20118e9474ed94bd8e4d50bc166b1bee"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/ZfSyq8gRsyM?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>While many may assume being interested in BDSM may mean you've experienced unhealthy or violent relationships/situations in your formative years, this study explains why that myth should be put to rest.</p><p>BDSM practitioners across the study scored higher levels of physical abuse in adulthood. However, no significant differences emerged for other traumatic experiences (including childhood physical abuse or unwanted sexual trauma).<br></p><p>There have been many accounts (<a href="https://www.youtube.com/watch?v=tYG0pajxLuY" target="_blank">such as this</a>) from BDSM practitioners that have claimed there is a certain "healing process" involved in finding a trustworthy BDSM relationship after escaping from a toxic relationship. This could account for why people who have experienced physically abusive relationships as adults then turn to the BDSM community and BDSM-related sexual interests. </p><p>When it came to the Relationship Questionnaire, people who engaged in the BDSM lifestyle more often scored in the "secure" attachment style than people who were not BDSM practitioners. While many BDSM practitioners had secure attachment styles, there was also a significant spike in anxious-preoccupied attachment styles when it came to people who practiced BDSM. In particular, the "secure" attachment style was associated with BDSM practitioners who identified as "Dominant" and the "anxious-preoccupied" attachment style was associated with people who identified as "submissive."</p><p><strong>There are no findings to support the hypothesis of BDSM being a coping mechanism for early life dynamics or trauma.</strong> </p><p>This authors of the study claim that BDSM practitioners deserve perception as normal sexual practice free from stigmatization rather than deviant behavior—and the final results of the study support this idea. </p>Are people involved in BDSM practices more aware of their attachment styles?
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNTIwMDc2OS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY2OTYwMjA1OX0.2cQbq1Nka_9dWd6GvzyoWjc68JU3Oor-1d6PKnUWBmY/img.jpg?width=1245&coordinates=0%2C292%2C0%2C292&height=700" id="c0877" class="rm-shortcode" data-rm-shortcode-id="6eb72a2ee78fb73264254d33e4411364" data-rm-shortcode-name="rebelmouse-image" alt="man and woman holding paper heart" data-width="1245" data-height="700" />Could people who engage in BDSM be more mindful in their relationships?
Photo by Tiko on Adobe Stock
<p>While many people insist engaging in BDSM practices means you've had significant traumatic experienced that led you to do so, there are some experts that argue BDSM practitioners are actually more in tune with their own psychopathology than people who do not engage in BDSM activities.</p><p>BDSM involves a diverse range of practices which can involve role-playing games in which one person assumes a dominant role and the other assumes a submissive role. These activities are often intense and can involve activities such as physical restraint, power plays, humiliation, and sometimes (but not always) pain. </p><p><a href="https://www.nhs.uk/news/mental-health/fans-of-bondage-and-sm-report-better-mental-health/" target="_blank" rel="noopener noreferrer">According to a study</a> published in the Journal of Sexual Medicine, people involved in BDSM may actually be more mentally healthy. The study suggests people who engage in BDSM activities often show more extroverted qualities and tend to be more open to experiences and more conscientious. They also tend to be less neurotic and less sensitive to rejection. The study also showed BDSM practitioners had a more secure attachment style, which is supported in the more recent study listed above. </p><p>Additionally, <a href="https://www.bustle.com/articles/186777-bdsm-may-be-the-most-mindful-type-of-sex-study-finds" target="_blank" rel="noopener noreferrer">it's been hypothesized</a> that people involved in BDSM are more mindful during sex than those who do not engage in BDSM practices. </p>
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