Stress, Illness, Growth, and Strength
Building a Better You
In This Chapter
Living under pressure
Keeping it together
Flexing your mental muscle
When I was a college I could stay up all night studying, take exams the next day, and then go to work as a busboy in the evening — without even thinking about breaking plans with my friends at night. I could just keep going and going. When I hit the work world, I could work as a jail psychologist during the day, teach community college at night, and do mental disability testing on the weekends. I must have worked more than 100 hours every week. But something changed as I got older. I slowed down. I couldn’t pull all-nighters. Working 100 hours a week and holding down five jobs was just no longer possible. With age came additional responsibilities and preferences for how I spent my time.
“Life” was happening around me and to me, and I came to know stress illness, and the challenges of everyday life in new and sometimes-upsetting ways. I found myself looking for sources of energy, strength, replenishment, and inner reserve.
Then it dawned on me that I’m a psychologist, and psychological science probably has something to say about these issues. This field of research studies stress, illness, coping, and resilience. I wish I could report that reading up on these issues in the psychological literature gave me everything I needed to fix myself, but that’s not the case. However, psychological science does offer a great deal of information about these matters.
In this chapter, I introduce the concepts of stress and coping and the growing field of health psychology to describe psychology’s approach to stress, illness, coping, and human psychological strength and resilience.
Every year around the same time I get sick. It never fails. Come October, I’ve got a cold. Is it the weather? Is it a cosmic curse? At some point I made a connection between my getting sick and stress. In school, it was the stress of midterms. Now, it’s the stress of the holidays. Everyone gets stressed about different stuff, and sometimes the stress makes people become physically ill.
Psychologists have worked hard over the years, trying to figure out what triggers stress. Within the last 20 years or so, they’ve started to use their knowledge of human behavior and mental processes to learn more about what makes people sick and how people cope with illness.
What is stress? When most people talk about stress, they refer to the things or events that cause worry, anxiety, and strain — work, money, bills, kids, bosses, and so on. The strains and pace of modern life seem to get the best of most people at one time or another. Often, even the gadgets that people get to make their lives easier end up complicating things. Stress can be defined as a person’s subjective experience of being overwhelmed, burdened, or run down.
Considering ways to think about stress
Formal definitions of stress range from descriptions of bodily reactions to different ways of thinking about stress. In his 1997 book Stress and Health: Biological and Psychological Interactions, William Lavallo defined stress as a bodily or mental tension to something that knocks people off balance, either physically or mentally. Conversely, when a person has equilibrium, he’s maintaining a balance between the external world and his internal world. Walter Cannon, an American physiologist at Harvard Medical School, in 1939, called this concept homeostasis. So basically, people feel stressed when they’re out of homeostatic balance.
Hans Selye, an endocrinologist at the Université de Montréal and Nobel Prize nominee, gave one of the most famous theories of stress. His theory was based on something he called the general adaptation syndrome (GAS). The idea is that when someone is confronted with something that threatens either her physical or mental equilibrium, she goes through a series of changes:
Alarm: The initial reaction to the stressor. The brain and hormones are activated in order to provide the body with the necessary energy to respond to the element causing stress.
Resistance: The activation of the body system best suited to deal with the stressor. If the stressor requires that you run — if you’re being chased by a pack of wild dogs — then your nervous system and hormones make sure that you’ve got enough blood pumping to your legs to get the job done. Plus, extra energy is provided to your heart so it can pump blood faster. It’s a beautifully designed system.
Exhaustion: The final stage. If the bodily system activated in the resistance stage gets the job done, your trip down GAS lane ends. If the stressor continues, you enter this final stage. When you’re exhausted, your body is no longer able to resist the stress, and it becomes vulnerable to disease and breakdown.
The body is not the only thing at work when you’re stressed. Numerous cognitive (thinking) and emotional responses are also going on. Arnold Lazarus, a South African psychologist known for his work on behavior therapy, stated that during times of stress, an individual goes through a process of emotional analysis. It’s kind of like having a little psychologist inside your head. You ask yourself to determine the current significance of the problem and its importance for the future. How does this stress work? You make two important appraisals, or evaluations — known as primary and secondary appraisals.
In most stressful situations, something important is at stake, or at least you think it is; otherwise, you wouldn’t be stressed about it. The evaluation of what is at stake is the primary appraisal of the situation. At this stage, situations are classified into one of three categories:
Threat: An example of a threatening situation is a situation that requires a response. If I’m standing in line at the grocery store and someone cuts in front of me, I’m not forced to respond. But if a guy grabs me by the shirt and threatens to kick my butt if I don’t let him in front of me, I have to respond in one way or another. Like run!
Harm-loss: A harm-loss situation may involve getting hurt in some way — physically, mentally, or emotionally. A blow to my pride may be seen as a harm-loss situation. It’s relative.
Challenge: I can also look a threatening person straight in the eye and see the perceived threat as a challenge. Instead of seeing the situation in dangerous terms, I may see it as an opportunity to try out those judo lessons I’ve been taking.
After figuring out what’s at stake, I take stock of the resources I have available to deal with the situation. This is secondary appraisal. I may take a look at my previous experience with this type of situation. What did I do when this happened before, and how did that turn out? Most people also take a look at how they feel about themselves. If you see yourself as a capable person, then you’re likely to become less stressed out than someone who thinks less of their capabilities.
Stress can be viewed as something more than the actual situation; a person’s reaction depends on how he looks at the stressor. Stress is not a situation; it’s a consequence of how a situation and a person’s response to that situation interact. I can react differently to the same situation. For example, If I’m called on to pitch for the final out in the bottom of the ninth inning in the World Series I could get all stressed out because I dread failing, giving up the game losing home run. Or, I could look at the situation with excitement because I have the opportunity to pitch for the last out and the win. The situation didn’t change, but my reaction to it did. One leads to the experience of stress, one does not.
Stress can also be a product of how much control a person thinks she has over events and situations. Stress arises when people lack an adequate response to a situation, and the consequences of failure are important. Seeing yourself as having little or no control can have negative psychological and physical consequences.
On the other hand, feeling like the “master of your domain” may help keep stress at bay. I remember a cartoon from my childhood called He-Man; He-Man had this phrase that he yelled out when he was getting ready to kick butt: “I have the power!” It would be nice if I could just yell that out and be ready to take on the world. In 1982, George Mandler, professor emeritus at the University of California, San Diego, defined mastery as the thought or perception that things in an individual’s environment can be brought under her control. Sounds like He-Man to me.
Stressing to the types
So, stress isn’t just a situation. It’s the coping process and a result of how you think and feel about a situation. That explains why some stimuli are stressors and some are not, and why some people get stressed out by certain things that don’t affect other people. However, some situations are pretty stressful for nearly everyone. Here are some things that most people find stressful:
Extreme stressors: Events that occur rarely and that have a severe and dramatic impact on routines and access to normalcy, such as natural disasters, human-made disasters (such as an oil spill), war, terrorism, migration, and watching others get hurt
Developmental and psychosocial stressors: Events that occur as you grow and change, including marriage, childbirth, raising children, caring for a sick person, and being a teenager
Common stressors: Things you deal with in daily life — urban living, daily hassles (like driving to work), job pressure, and household chores
Psychologists Holmes and Rahe in 1967 created a list of stressful events called the social readjustment rating scale. They took different stressful events and assigned a point value to each of them — the higher the point value, the more stressful the event is. Here are the top five:
Death of a spouse
Death of a close family member
If you’re wondering what the bottom-five stressful events are, they are (in descending order of stressfulness): change in number of family get-togethers, change in eating habits, vacation, Christmas, and minor violations of the law.
Getting sick of being worried
I’ve heard people say that they thrive on stress or that they do their best work when they’re under pressure. Yet research shows that this is not true for most people. Stress can have very serious effects on people; and usually, if you do work well under stress, you’ll do even better when you’re not under stress.
As researchers learn more about stress, a psychological and biological phenomenon, the connection between stress and illness — both psychological and physical — has become impossible to deny.
One of the most well-known psychological results of exposure to extreme stress is posttraumatic stress disorder (PTSD). PTSD can occur when a person is exposed to a life-threatening situation or a situation that may involve serious injury. War, car accidents, plane crashes, rape, and physical assault are all examples of situations that may cause PTSD. The symptoms include emotional numbing, guilt, insomnia, impaired concentration, avoidance of trauma-related events and memories, and excessive physiological arousal (hyperactivity due to fear). Many Vietnam War and Iraq War veterans returned home with PTSD. During World War I, PTSD was called shell shock.
Have you ever wondered what it must be like to be a firefighter, police officer, or emergency physician? I mean, all the death and destruction they see every day has to be stressful. And, according to research, it is. People in very stressful occupations have been found to be at increased risk for secondary traumatic stress disorder (STSD). The symptoms of STSD are exactly like those of PTSD, but instead of the sufferers themselves facing a life-threatening or harmful stressor, people with STSD receive “vicarious exposure” to stressors. In other words, they’re around people who are exposed to life-threatening and harmful situations all the time, and it takes a toll. People who witness an event and feel fear, horror, or helplessness may be at risk for developing STSD.
Hans Selye looked at the connections between stress, mental problems, difficulties adjusting, physical health problems, and disease. He found that the same things that help people cope with stress sometimes lead to disease. When the body and mind react to stress, the reactions don’t diminish right away. In fact, when Selye performed experiments with stressed-out pigeons, he found that a lot of the pigeons died after his stress experiments, even if they coped well when the stressor was active. Selye identified several conditions that he called “diseases of adaptation,” including peptic ulcers, high blood pressure, heart incidents, and “nervous disturbances.”
Based on the work of Selye and others, it’s been discovered that stress can lead to physical health problems or illness in several ways. An indirect link between stress and physical health problems may involve people who engage in potentially physically harmful behaviors as a means to cope with stress. A lot of people drink alcohol when they’re stressed. Drinking alcohol can be harmful to your health, especially if you drink and drive. Another dangerous behavior often associated with stress is increased cigarette smoking. I’ve heard plenty of patients talk about smoking as a way to relax. But it’s so unhealthy!
Another link between stress and physical illness comes from the new and exciting field of psychoneuroimmunology, the study of the connection between psychology and the immune system. Researchers have long suspected that there’s a connection between the two systems, and there actually is. High levels of stress and intense emotions can suppress nervous system functioning. There isn’t a clear-cut diagnosis of all the ins and outs, but the suspicion is that the cost of the body’s coping reactions to stress is paid in part by the immunity department.
Ever heard of the flight-or-fight response? Walter Cannon showed that exposure to extreme stress causes people to decide whether they’re going to take off running or stand their ground and fight. It sounds animalistic, but you can also look at it as a choice between walking away or yelling at someone. Either way, these protective actions require energy. Arguing and running from someone can be tiring! So, the brain sends signals to the heart and the hormone system that causes blood pressure to increase. The heart races, respiration quickens, and sugar levels in the blood rise. When these changes occur, all of the body’s vital resources are devoted to the moment. Resources from other areas are used for the immediate purpose of fighting or fleeing.
The hormones that kick in when you’re in fight-or-flight mode are epinephrine and cortisol — both have immunosuppressive effects. If higher-than-normal levels of epinephrine and cortisol are present in the blood stream, then the immune system doesn’t work as well. It kind of makes sense, if you think about it. If a bear is chasing you, probably the last thing on your mind is getting the flu. Forget the flu; you can’t get the flu if that bear rips your head off! Save the head, and you can deal with the flu later.
You’re probably saying, “Yeah, but I haven’t been chased by a bear in at least five years, so why does it seem like I still get sick from stress?” You get sick for the same reason that I used to get sick during every midterm-exam week in college. These are stressful times! But it’s not the same kind of stress that running from bears every day would produce. Modern stress is typically chronic and low grade. It’s always there, constantly gnawing away at the immune system because the fight-or-flight system stays on medium alert most of the time. So instead of going from no alert (relaxed) to high alert (bear attack), most people are on medium alert (daily hassles, work, bills, kids, and so on) all the time. It slowly takes its toll on the immune-system functions.
Relationships between stress and specific diseases seem to exist. Strong negative emotions such as anger, chronic hostility, and anxiety are associated with hypertension, ulcers, rheumatoid arthritis, headaches, and asthma.
A risk to the heart
People with the Type A personality — a personality pattern characterized by an aggressive and persistent struggle to achieve more and more in less and less time — are the real go-getters of the world. They’re the corporate executives who build a Fortune 500 company from the bottom up in a matter of years, the millionaire workaholics, and the hyper-competitive college students driven by perfection. Type A people tend to be very impatient and view almost everything as urgent.
You may be thinking, “So what? These people can be very successful, right?” Yes, but they also generally have a higher risk of suffering from coronary heart disease — hardening of the arteries, angina, and heart attacks. But before you quit school and make relaxing walks on the beach your full-time job, remember that the relationship between Type A personalities and developing coronary heart disease is not one-to-one. The research shows an increase in risk; developing these health problems is not inevitable.
Risk means that these folks need to take precautions and be aware of contributing factors and warning signs. Read up on coronary heart disease if you’re worried; check out Heart Disease For Dummies by James M. Rippe, MD (Wiley, 2004). And if you’re really worried, go see your family physician.
Coping Is No Gamble
Stress, stress, stress — everyone’s got it. So what can you and I do about it? This question brings me to the concept of coping, the response to stressful and upsetting situations. Sometimes a person’s coping strategies can make things better (as in getting healthy from exercising) and sometimes they can make things worse (if your way of coping is to blow your paycheck at a casino). There are many different ways of coping with stress; some are good and some are bad.
Even though bad coping skills can lead to problems, having no coping skills can lead to vulnerability and, sometimes, more problems. That’s why on occasion, using bad coping techniques is better than not coping at all.
Discovering how to cope
Most psychologists classify coping behaviors into two big categories, approach processes and avoidance processes. Approach coping is more active than its avoidance cousin; approach processes resemble a take-charge kind of response to stress.
Common approach coping responses include:
Logical analysis: Looking at a situation in as realistic terms as possible
Reappraising or reframing: Looking at a situation from a different perspective and trying to see the positive side of things
Accepting responsibility: Taking charge of your part in a situation
Seeking guidance and support: Asking for help (see the next section Finding resources)
Problem solving: Coming up with alternatives, making a choice, and evaluating outcomes
Information gathering: Collecting additional information about the stressor so you can more easily cope
Avoidance coping strategies are less active and involve coping in less direct ways. Here are some common avoidance coping strategies:
Denial: Refusing to admit that a problem exists
Avoidance: Evading possible sources of stress
Distraction or seeking alternative rewards: Trying to get satisfaction elsewhere like watching a funny movie when feeling sad or enjoying recreational activities on the weekend to cope with having a bad job
Venting or emotional discharge: Yelling, getting depressed, worrying
Sedation: Numbing oneself to the stress through drugs, alcohol, sex, eating binges, and so on
Coping is more than just the actions that a person takes in response to stress. The way an individual copes also depends on the resources available to him. After all, a billionaire who loses her job may experience a lot less stress than a suddenly unemployed day laborer who makes $30 a day and has a family of five.
A person’s response to stress is a complex reaction that depends on her coping skills, environmental resources, and personal resources. Any life event that a person encounters is influenced by the interaction of the person’s ongoing life stressors, social coping resources, demographic characteristics, and personal coping resources. Further, the person’s cognitive appraisals of the stressor influence her health and well-being in both positive and negative ways.
An integrative approach considers three factors when attempting to predict the health outcome of a particular stressor:
The resources an individual possesses prior to encountering a stressor or stressful event
The event itself
The appraisal of the event
An individual’s ability to resist stress is called resilience — the outcome of the interaction between an individual’s personal and social resources and his coping efforts. Personal coping resources include stable personality traits, beliefs, and approaches to life that help us cope:
Self-efficacy: Your belief in yourself and that you can handle a situation based on your experience
Optimism: Having a positive outlook on the future and expecting positive outcomes
Internal locus of control: Your belief that certain things are within, not out of, your control
One type of environmental resource that is helpful in coping is social resources, which aid in coping by providing support, information, and problem-solving suggestions. Good social resources include family, friends, significant others, religious and spiritual organizations, and sometimes even co-workers and supervisors. Other environmental resources include money, shelter, health services, and transportation. These things can make all the difference in the world when someone’s attempting to cope with stress.
Going Beyond Stress: The Psychology of Health
Psychologists don’t stop at the intersection of stress, disease, and coping. They’re also attempting to apply what they know about human behavior and mental processes to the problems of health in general. They’re looking for ways to keep people physically well and trying to find out how people’s behavior contributes to illness. Psychology researchers work in the field of health psychology, the psychological study of health and illness.
Health psychologists work in many types of settings, ranging from universities (conducting research) to clinics and hospitals, which involve the direct care of patients. Their main activities include preventing illness, helping people and families cope with illness, and developing programs for health-related behavior change and maintaining a healthy lifestyle.
Health psychologists engage in three types of illness prevention:
Primary: Preventing an illness from occurring in otherwise healthy people. Examples of primary prevention programs are childhood immunization, condom use, and HIV-awareness campaigns.
Secondary: Focusing on the early identification and treatment of a developing illness or disease. Secondary prevention programs include breast cancer awareness campaigns and the promotion of self-examinations for testicular cancer.
Tertiary: Helping people cope with already developed diseases and preventing them from getting worse. Tertiary prevention programs include helping people reduce high blood pressure, quit smoking, and treat obesity.
Have you ever kept a New Year’s resolution to start doing something healthy — exercise more often, take a yoga class, eat better, get more rest, wear your seat belt? Why not? If you’re being honest, I bet you’re thinking it was harder than you thought it would be. Take a minute to think about what keeps you from doing what’s most healthy?
A common problem with health-related behavior is people not sticking to the course they know is right. Part of this problem falls under the heading of compliance — whether or not someone follows through with a physician’s recommendations and treatment or his own health-related plans. But what determines whether or not someone engages in health-promoting behavior to begin with? Some people make it look so easy. They go to the gym regularly. They eat right consistently. They don’t smoke — ever.
Some people do unhealthy things than others for numerous reasons. For starters, a lot of people won’t start or stick with a health-related behavior if substantial barriers are in the way. It’s too easy to give up if something or someone makes it hard. Perhaps you don’t go to the gym because it’s too expensive, or you don’t sleep enough because you don’t have a nice set of pajamas. Money is a commonly cited barrier to engaging in healthy behavior. Another reason people don’t just do it is that the health-related behavior may cut into something more fun or necessary. If I go to the gym, I’ll miss my television programs. If I eat right, I’ll have to go to the grocery store, and then I’ll have to cook, and then I’ll never finish any of my other household duties.
Commitment to change is most often brought about when a person believes that he can make a difference. A lot of people have a fatalistic attitude toward their physical health — the “you go when you go” philosophy. They don’t see their behavior as contributing to their health and, therefore, don’t bother to change.
This mind-set is also known as having an external locus of control — thinking that control over something rests outside of oneself. Having the belief that the power to change a situation or event resides inside yourself, that it’s under your control, is called an internal locus of control. When someone feels that he can control something, he’s more likely to try and do something about it.
After you’ve changed, either because of external rewards or because of your belief that you can make a difference, how do you maintain those changes? It’s easy to quit smoking, for example, but staying smoke-free is another story. You can maintain a commitment to healthy behavior by first examining the pros and cons of changing and not changing. Your ability to develop an accurate tally depends on having access to reliable information. Confusing or conflicting health messages don’t quite do the job.
Getting the message in the information age
People like to call this period of time the “Information Age.” No question, there’s a lot of information out there. At times, the world seems to suffer from an information overload. With all of these facts, figures, and opinions floating about, who and what information do you tend to believe? Do those stop-smoking ad campaigns really work?
Media campaigns usually are only effective when they inform people about something they didn’t already know. By now, though, almost everyone knows that smoking is harmful to health. People didn’t always know about the health risks associated with smoking, and when that information finally became public knowledge, smoking rates dropped. But a lot of people kept smoking anyway, and many people actually picked up the habit after the warnings were put out there. Then again, many people feel that the mainstream media is not trustworthy. I’ve even heard people say that the idea that smoking causes cancer is bogus.
A number of factors influence people’s tendencies to listen to and believe a particular source of information. Research on persuasion — getting somebody to do something he may not do on his own accord — has supplied psychologists with much of their knowledge in the area of source believability. Who do people believe?
For a message to be persuasive, it must grab your attention, be easy to understand, and be acceptable and worthwhile. You also have to be able to remember it. If you don’t remember the message, who cares what it said? Persuasive arguments tend to present both sides of an issue, making the arguments look fair and unbiased. Fear-inducing messages work best when attainable steps are mentioned along with the scary stuff.
Decisions to engage or not to engage in healthy behavior are based on many factors, including your beliefs about the behavior and your locus of control. Researchers Hochbaum, Rosenstock, and Kegels, working in the US Public Health Services in the 1950s, came up with the health belief model to demonstrate the psychological processes someone goes through when making health-related decisions. The model is based on beliefs about the following:
Severity: How bad can the illness or disease get if I don’t do something about it?
Susceptibility: How likely am I to get sick if I don’t engage in healthy behavior?
Benefits outweighing costs: What’s in it for me, and is it worth it?
Efficacy: How effective will my attempts at change be? I don’t want to work for nothing.
The answers to these questions play a role in determining the likelihood that a person will do the healthy thing. If I arrive at a high severity, high susceptibility, high benefits-over-costs, and high-efficacy conclusion, then the likelihood that I’ll choose the healthy option goes up. Otherwise, the healthy path may not seem to be worth the sacrifice and effort.
What’s the next step after you decide to do something about your unhealthy lifestyle? What can you actually do to get the ball rolling? A health psychologist or other health professional can design interventions that help you change and then maintain that change.
Behavior modification is a powerful method of behavior change. The most basic, yet very powerful, form of behavior modification is to use punishments and rewards for either not engaging or engaging in the target behavior. For example, if I schedule myself to run three times a week at 5:30 p.m. and I don’t do it, then I have to clean the kitchen and bathroom, and do the laundry that night. If I comply, I get to treat myself to a nice dip in the spa. The trick with this technique is to enlist a partner to keep you from cheating on your rewards and punishments. I may decide to skip the laundry and go in the spa even if I don’t run. A partner helps keep you honest.
Cognitive change is a process by which I examine the mental messages I give myself that may prevent me from changing a behavior or maintaining a change. Everyone has automatic thoughts — thoughts that they don’t realize automatically go through their minds in certain situations. I may tell myself that I really want to run three times a week, but I also may be having the automatic thought, “You’ll never do it; you never follow through with anything.” Well, thanks for the positive reinforcement, me!
The good news is that automatic thoughts can be replaced with positive self-statements. This process takes a lot of practice and encouragement from other people, but the conversion is usually worth the hard work.
This section only begins to scratch the surface of health psychology and stress-related issues, but I hope this overview of the subject whets your appetite for more knowledge about living a less stressful and healthier life. Remember to relax, believe in yourself, and don’t avoid things. And reward yourself when you follow through with this advice!
Harnessing the Power of Positivity
Some people criticize psychology as “negatively focused” with all its focus on therapy and pathology and learning disabilities; they say it’s always trying to fix people and groups. Well, a group of psychologists in the late 1990s and early 2000s, headed by the well-known psychologists Martin Seligman and Mihaly Csikszentmihalyi, introduced an essentially new branch of psychology known as positive psychology. Positive psychology is defined as a science of positive subjective experience, positive individual traits, and positive institutions that improve quality of life and prevents pathologies.
Positive psychology as a science of human strength covers a range of topics:
Since its inception, research programs have taken positive psychology into the realms of business, sports, the military, and stress and illness. The military has sought the help of positive psychologists to alleviate stress and bolster the hardiness of its troops. Patients with terminal illnesses seek help in finding hope and courage in the face of death. Creative professionals want to be more innovative.
A central organizing concept in positive psychology is the idea of optimal living, characterized by two opposing poles of success: flourishing and floundering.
Flourishing (and its opposite, floundering) is synonymous with positive mental health as opposed to mental illness or disorder. Imagine going to a psychologist for a mental health check-up or wellness visit instead of the traditional “what’s wrong with me?” focus. This can happen on a yearly basis the same way some people visit a medical doctor for an annual physical — not because they’re sick but because they want to get a checkup. Call it a mentacal (ment-uh-cull). Okay, so I need to work on the name, but you get the point.
Psychologist C. L. M. Keyes, professor of sociology at Emory University in Atlanta, Georgia, identifies the following dimensions of flourishing/mental health:
Positive affect: Emotional well-being
Avowed quality of life: Satisfied with life
Self-acceptance: Positive attitude toward oneself
Personal growth: Seeking challenges
Purpose in life: Meaning
Environmental mastery: The ability to select, manage, and mold one’s environment
Autonomy: Guided by one’s own standards
Positive relations with others: Calm, trusting relationships
Social acceptance: Positive attitude toward others and human differences
Social actualization: Belief in people’s potential for growth
Social contribution: Seeing one’s daily activities as useful to others
Social coherence: Interest in society and social life
Social integration: Belonging
Flourishing as a concept is used by some psychologists in therapy as a guide in determining broad, more lifestyle-oriented goals for therapy clients or patients as they set goals for themselves in life. It can be used as an informal metric of client well-being, pointing therapist and client toward areas in need of improvement. However, it is not a formal component of therapy and is not considered part of formal diagnosis. That is, therapy focusing on flourishing, as opposed to treating a mental disorder, is not typically reimbursed by third-party payers such as insurance companies. Professional therapy provided by a psychologist would not necessarily focus on flourishing as a primary goal in therapy but could include, interweave, and use the concept within therapy in providing direction for personal growth to a client in a general manner. This crosses over a bit into the realm of life coaching or advice giving, roles that therapists typically do not engage in. However, if a client asks for this service and consents to it, understanding the psychologist’s training and expertise in this regard, then what happens between two consenting adults can be considered generally acceptable.
Acquiring the Bionic Brain
Something happens to me nearly every day at around two in the afternoon. After a busy morning of report writing, therapy sessions, e-mails, phone calls, testing, and other doings of a psychologist, I “hit a wall.” That is, I slow way down, have trouble concentrating, and become much less productive. After doing some reading, I realized that maybe my brain glucose levels are lower at this time and my brain isn’t firing on all cylinders. I started eating a little protein snack and hydrating a little better, which seems to perk me up. My brain needed a boost, I guess.
Athletes train to get stronger, faster, and more agile. Musicians practice to get more fluid and precise. But what if you want to get mentally quicker, more agile, stronger, more precise, or just plain smarter? This is an area of psychology known as cognitive enhancement, defined in 2008 by psychologists Nick Bostrom and Anders Sandberg as the amplification or extension of core capacities of the mind through improvement of external information-processing systems.
Many forms of cognitive enhancement are being researched, and some have been around for a very long time. In essence, education is a form of cognitive enhancement. Other forms include mental training, medications, transcranial magnetic stimulation (TMS), relaxation techniques, neurofeedback, and biofeedback.
Some techniques that are being investigated in animals (not on humans) include genetic and prenatal and perinatal processes such as gene replacement and fetal supplementation in mice.
Before you go out and buy that Baby Einstein DVD collection for your unborn genius, know that there has been absolutely no data to support that any “make your baby smarter” program has ever actually made a baby smarter.
Doing smart drugs
I once had a gig doing learning disability and psychological assessments for a local university, and I witnessed something interesting. A whole bunch of students were actually looking for me to diagnose them with ADHD! It didn’t take me long to figure out why. The doctors over at the university health center would not prescribe a psychostimulant to a student without an official diagnosis of ADHD. Now, these students weren’t looking to get “high” off Ritalin or Strattera, and they weren’t necessarily looking to sell the pills. But they were looking to boost their attention and concentration skills so they could excel academically.
In these modern times, medications and pharmacology are an integral and widely accepted part of life. Medications that are designed and used for cognitive and neuropsychological improvement and/or enhancement are called nootropics.
Many ethical and moral objections exist to using drugs to enhance mental performance, and some people see them in the same way they think of using steroids or performance-enhancing drugs in sports; it’s cheating. That’s a huge discussion. But, for a moment, consider that a person with a learning disability, brain injury, or other cognitive deficit could take a medication to improve his mental functioning. Is this any different than taking medicine for other types of ailments?
The fact is, this is already happening — sometimes in overt ways and often in indirect ways. An indirect way of using medication to improve thinking comes from the use of antidepressant medication. Anyone who’s ever been severely depressed can attest that the condition comes with a mental fog of sorts (something professionals call pseudodementia) that accompanies the depressed mood and feelings of guilt and lack of pleasure and motivation. Antidepressants help ease this cognitive dullness.
Medications that enhance or otherwise assist in cognitive processes include the following:
Stimulants: Used for increased attention and short-term memory and includes such drugs as Adderall, Vyvanse, Atomoxetine (Strattera), and good old-fashioned caffeine
Cholinergics: Used as memory enhancing-drugs; examples are Aricept and medical cannabis
Dopaminergics: Used to increase attention and alertness and includes such drugs as methylphenidate (Ritalin, Concerta) and modafinil (Provigil)
The list of known or suspected nootropic drugs is much larger and expanding. However, I must point out that the number of prescriptions written for these drugs for actual nootropic purposes is still fairly limited. It would seem that physicians may be somewhat hesitant to go down the rabbit hole of drug-induced or assisted cognitive enhancement.
Hitting the limits of the skull
Just as mental training, neurofeedback, and drugs can enhance cognitive processes, so to can devices such as cochlear implants, computers, smart phones, and even Post-it Notes. The field of technological devices that enhance cognitive processes is known in some circles as cognitive prosthetics or neuroprosthetics.
Many scientists show incredible interest in the promise and possibility of the field of cognitive prosthetics. Some fairly well-established devices are already available, including speech production devices, mobile phone or mobile technology software programs that “talk” for individuals who cannot or do not speak, memory aide software programs, and even voice-activated and -prompted GPS route and guidance systems.
Perhaps one of the most interesting approaches to cognitive prosthetics comes from work being done with brain-computer-interfacing in which external computer and/or other digital devices are directly wired into the brain and controlled directly by brain activity. Studies reveal that when electrodes are inserted into the brain of a primate or human, even those with fairly profound neurological damage, control of a computer cursor is possible. Doesn’t sound like much at first, but think about it; controlling a computer interface by just thinking about it is downright telepathic almost — and pretty cool!