The psychology of health - (mass) fear, plauges and disasters (nocebo)

Mass psychogenic illness

Mass psychogenic illness (MPI), also called mass sociogenic illness or just sociogenic illness,[1] is "the rapid spread of illness signs and symptoms affecting members of a cohesive group, originating from a nervous system disturbance involving excitation, loss or alteration of function, whereby physical complaints that are exhibited unconsciously have no corresponding organic aetiology."[2] MPI is distinct from other collective delusions, also included under the blanket terms of mass hysteria, in that MPI causes symptoms of disease, though there is no organic cause.

There is a clear preponderance of female victims.[1] The DSM-IV-TR does not have specific diagnosis for this condition but the text describing conversion disorder states that "In 'epidemic hysteria', shared symptoms develop in a circumscribed group of people following 'exposure' to a common precipitant."

Contents [hide]
1 Current state of research
2 Commonalities in outbreaks
3 Common symptoms
4 Predisposition for psychogenic illness
5 History and examples 5.1 Middle Ages
5.2 18th to 21st centuries 5.2.1 In factories
5.2.2 In schools
5.2.3 Terrorism and biological warfare

6 Response to outbreaks
7 See also
8 Notes
9 References


Current state of research[edit]

According to Balaratnasingam and Janca, “mass hysteria is to date a poorly understood condition. Little certainty exists regarding its etiology.”[3]

Besides the difficulties common to all research involving the social sciences, including a lack of opportunity for controlled experiments, Mass Sociogenic Illness presents special difficulties to researchers in this field. Balaratnasingam and Janca report that the methods for “diagnosis of mass hysteria remains contentious.[3] According to Timothy Jones of the Tennessee Department of Public Health, MPI “can be difficult to differentiate from bioterrorism, rapidly spreading infection or acute toxic exposure.”[4]

These troubles result from the residual diagnosis of MPI. Singer, of the Uniformed Schools of Medicine, puts the problems with such a diagnosis thus:[5] “[y]ou find a group of people getting sick, you investigate, you measure everything you can measure . . . and when you still can't find any physical reason, you say 'well, there's nothing else here, so let's call it a case of MPI.'” There is a lack of logic in an argument that proceeds: “There isn't anything, so it must be MPI.” It precludes the notion that an organic factor could have been overlooked. Nevertheless, running an extensive number of tests extends the probability of false positives.[5]

British psychologist Wesseley distinguishes between two forms of MPI:[6]
1.mass anxiety hysteria “consists of episodes of acute anxiety, occurring mainly in schoolchildren. Prior tension is absent and the rapid spread is by visual contact.”
2.mass motor hysteria “consists of abnormalities in motor behaviour. It occurs in any age group and prior tension is present. Initial cases can be identified and the spread is gradual. . . . [T]he outbreak may be prolonged.”

While his definition is sometimes adhered to,[2][7] others such as Ali-Gombe et al. of the University of Maiduguri, Nigeria contest Wesseley's definition and describe outbreaks with qualities of both mass motor hysteria and mass anxiety hysteria.[8]

An evolutionary psychology explanation for this disorder, as well as for conversion disorder more generally, is that the symptom may have been evolutionary advantageous during warfare. A non-combatant with these symptoms signals non-verbally, possibly to someone speaking a different language, that she or he is not dangerous as a combatant and also may be carrying some form of dangerous infectious disease. This can explain that conversion disorder may develop following a threatening situation, that there may be a group effect with many people simultaneously developing similar symptoms, and the gender difference in prevalence.[9]

Commonalities in outbreaks[edit]

Qualities of MPI outbreaks often include:[1]

• symptoms that have no plausible organic basis;
• symptoms that are transient and benign;
• symptoms with rapid onset and recovery;
• occurrence in a segregated group;
• the presence of extraordinary anxiety;
• symptoms that are spread via sight, sound or oral communication;
• a spread that moves down the age scale, beginning with older or higher-status people;
• a preponderance of female participants

Also, the illness may recur after the initial outbreak.[4]

Common symptoms[edit]

Jones compiles the following symptoms based on their commonality in outbreaks occurring in 1980–1990:[4]

Symptom

Percent reporting

Headache 67
Dizziness or light-headedness 46
Nausea 41
Abdominal cramps or pain 39
Cough 31
Fatigue, drowsiness or weakness 31
Sore or burning throat 30
Hyperventilation or difficulty breathing 19
Watery or irritated eyes 13
Chest tightness/chest pain 12
Inability to concentrate/trouble thinking 11
Vomiting 10
Tingling, numbness or paralysis 10
Anxiety or nervousness 8
Diarrhea 7
Trouble with vision 7
Rash 4
Loss of consciousness/syncope 4
Itching 3

Predisposition for psychogenic illness[edit]

The hypothesis that those prone to extroversion or neuroticism, or those with low IQ scores, are more likely to be affected in an outbreak of hysterical epidemic has not been consistently supported by research. Bartholomew and Wesseley state that it “seems clear that there is no particular predisposition to mass sociogenic illness and it is a behavioural reaction that anyone can show in the right circumstances.”[2]

Females are affected with mass psychogenic illness at greater rate than males.[1] Adolescents and children are frequently affected in cases of MPI.[4]

History and examples[edit]

See also: Mass hysteria

Middle Ages[edit]

The earliest studied cases linked with epidemic hysteria are the dancing manias of the Middle Ages, including St. John's Dance and tarantism. These were supposed to be associated with spirit possession or the bite of the tarantula. Those afflicted with dancing mania would dance in large groups, sometimes for weeks at a time. The dancing was sometimes accompanied by stripping, howling, the making of obscene gestures, or even (purportedly) laughing or crying to the point of death. Dancing mania was widespread over Europe.[10]

Between the 15th and 19th centuries, instances of motor hysteria were common in nunneries. The young ladies that made up these convents were typically forced there by family. Once accepted, they took vows of chastity and poverty. Their lives were highly regimented and often marked by strict disciplinary action. The nuns would exhibit a variety of behaviors, usually attributed to demonic possession. They would often use crude language and exhibit suggestive behaviors. One convent's nuns would regularly mew like cats. Priests were often called in to exorcise demons.[2]

18th to 21st centuries[edit]

In factories[edit]

MPI outbreaks occurred in factories following the industrial revolution England, France, Germany, Italy and Russia[2] as well as the United States and Singapore.

W. H. Phoon, Ministry of Labor in Singapore gives a case study of six outbreaks of MPI in Singapore factories between 1973 and 1978.[11] They were characterized by (1) hysterical seizures of screaming and general violence, wherein tranquilizers were ineffective (2) trance states, where a worker would claim to be speaking under the influence of a spirit or jinn (or genie) and (3) frightened spells: some workers complained of unprecedented fear, or of being cold, numb, or dizzy. Outbreaks would subside in about a week. Often a bomoh (medicine man) would be called in to do a ritual exorcism. This technique was not effective and sometimes seemed to exacerbate the MPI outbreak. Females and Malays were affected disproportionately.

Especially notable is the "June Bug" outbreak:[12] In June 1962, a peak month in factory production, sixty two workers at the Montana Mills dressmaking factory experienced symptoms including severe nausea and breaking out on the skin. Most outbreaks occurred during the first shift, where four fifths of the workers were female. Of 62 total outbreaks, 59 were women. Entomologists and others were called in to discover the pathogen, but none was found. Kerchoff coordinated the interview of affected and unaffected workers at the factory and summarizes his findings:
1.Strain – those affected were more likely to work overtime frequently and provide the majority of the family income. Many were married with children.
2.Affected persons tended to deny their difficulties. Kerchoff postulates that such were “less likely to cope successfully under conditions of strain.”
3.Results seemed consistent with a model of social contagion. Groups of affected persons tended to have strong social ties.

Kerchoff also links the rapid rate of contagion with the apparent reasonableness of the bug and the credence given to it in accompanying news stories.

Stahl and Lebedun [13] describe an outbreak of mass sociogenic illness in the data center of a mid-western university town. Ten of thirty-nine workers smelling an unconfirmed “mystery gas” were rushed to a hospital with symptoms of dizziness, fainting, nausea and vomiting. They report that most workers were young women either putting their husbands through school or supplementing the family income. Those affected were found to have high levels of job dissatisfaction. Those with strong social ties tended to have similar reactions to the supposed gas, which only one unaffected woman reported smelling. No gas was detected in subsequent tests of the data center.

In schools[edit]

Thousands were affected by the spread of a supposed illness in a Serbian province of Kosovo, exclusively affecting ethnic Albanians, most of which were young adolescents.[14] A wide variety of symptoms were manifested, including: headache, dizziness, impeded respiration, weakness/adynamia, burning sensations, cramps, retrosternal/chest pain, dry mouth and nausea. After the illness had subsided, a bipartisan Federal Commission released a document, offering the explanation of psychogenic illness. Radovanovic of the Department of Community Medicine and Behavioural Sciences Faculty of Medicine in Safat, Kuwait reports:


This document did not satisfy either of the two ethnic groups. Many Albanian doctors believed that what they had witnessed was an unusual epidemic of poisoning. The majority of their Serbian colleagues also ignored any explanation in terms of psychopathology. They suggested that the incident was faked with the intention of showing Serbs in a bad light but that it failed due to poor organization.

Rodovanovic expects that this reported instance of Mass Sociogenic Illness was precipitated by the demonstrated volatile and culturally tense situation in the province.[14]

The Tanganyika laughter epidemic of 1962 was an outbreak of laughing attacks rumored to have occurred in or near the village of Kanshasa on the western coast of Lake Victoria in the modern nation of Tanzania, eventually affecting 14 different schools and over 1000 people.

On the morning of Thursday 7 October 1965, at a girls' school in Blackburn in England, several girls complained of dizziness.[15] Some fainted. Within a couple of hours, 85 girls from the school were rushed by ambulance to a nearby hospital after fainting. Symptoms included swooning, moaning,chattering of teeth, hyperpnea, and tetany. Moss and McEvedy, published their analysis of the event about one year later. Their conclusions follow.[15] Note that their conclusion about the above-average extroversion and neuroticism of those affected is not necessarily typical of MPI.:[2]

• Clinical and laboratory findings were essentially negative.
• Investigations by the public health authorities did not uncover any evidence of pollution of food or air.
• The epidemiology of the outbreak was investigated by means of questionnaires administered to the whole school population. It was established that the outbreaks began among the 14-year-olds, but that the heaviest incidence moved to the youngest age groups.
• By using the Eysenck Personality Inventory it was established that in all age groups the mean E [extroversion] and N [neuroticism] scores of the affected were higher than those of the unaffected.
• The younger girls proved more susceptible, but disturbance was more severe and lasted longer in the older girls.
• It was considered that the epidemic was hysterical, that a previous polio epidemic had rendered the population emotionally vulnerable, and that a three-hour parade, producing 20 faints on the day before the first outbreak, had been the specific trigger.
• The data collected were thought to be incompatible with organic theories and with the compromise theory of an organic nucleus.

Another possible case occurred in Belgium in June 1999 when people, mainly schoolchildren, became ill after drinking Coca-Cola.[16] In the end, scientists were divided over the scale of the outbreak, whether it fully explains the many different symptoms and the scale to which sociogenic illness affected those involved.[17][18]

A possible outbreak of mass psychogenic illness occurred at Le Roy Junior-Senior High School in upstate New York, United States, in which multiple students began suffering symptoms similar to Tourette Syndrome. Various health professionals like Dr. Jennifer McVige, Dr. Laszlo Mechtler and personnel from the New York Department of Health had ruled out such factors as Gardasil, drinking water contamination, illegal drugs, carbon monoxide poisoning and various other potential environmental or infectious causes, before diagnosing the students with a conversion disorder and mass psychogenic illness.[19]

Terrorism and biological warfare[edit]

Bartholomew and Wessely anticipate the “concern that after a chemical, biological or nuclear attack, public health facilities may be rapidly overwhelmed by the anxious and not just the medical and psychological casualties.”[2] Additionally, early symptoms of those affected by MPI are difficult to differentiate from those actually exposed to the dangerous agent.[4]

The first Iraqi missile hitting Israel during the Persian Gulf War was believed to contain chemical or biological weapons. Though this was not the case, 40% of those in the vicinity of the blast reported breathing problems.[2]

Right after the 2001 anthrax attacks in the first two weeks of October 2001, there were over 2300 false anthrax alarms in the United States. Some reported physical symptoms of what they believed to be anthrax.[2]

Also in 2001, a man sprayed what was later found to be a window cleaner into a subway station in Maryland. 35 people were treated for nausea, headaches and sore throats.[2]

Response to outbreaks[edit]

Timothy F. Jones, of the Tennessee Department of Health recommends the following action be taken in the case of an outbreak:[4]

• Attempt to separate persons with illness associated with the outbreak.
• Promptly perform physical examination and basic laboratory testing sufficient to exclude serious acute illness.
• Monitor and provide oxygen as necessary for hyperventilation.
• Minimize unnecessary exposure to medical procedures, emergency personnel, media or other potential anxiety-stimulating situations.
• Notify public health authorities of apparent outbreak.
• Openly communicate with physicians caring for other patients.
• Promptly communicate results of laboratory and environmental testing to patients.
• While maintaining confidentiality, explain that other people are experiencing similar symptoms and improving without complications.
• Remind patients that rumors and reports of "suspected causes" are not equivalent to confirmed results.
• Acknowledge that symptoms experienced by the patient are real.
• Explain potential contribution of anxiety to the patient's symptoms.
• Reassure patient that long-term sequelae from current illness are not expected.
• As appropriate, reassure patient that thorough clinical, epidemiologic and environmental investigations have identified no toxic cause for the outbreak or reason for further concern.

Some responses by authorities to MPI are not appropriate. Intense media coverage seems to exacerbate outbreaks.[3][4][7] Once it is determined that the illness is psychogenic, it should not be given credence by authorities.[7] For example, in the Singapore factory case study, calling in a medicine man to perform an exorcism seemed to perpetuate the outbreak.[11]

Click to expand...

Nocebo

In medicine, a nocebo (Latin for "I shall harm") is a harmless substance that creates harmful effects in a patient who takes it. The nocebo effect is the negative reaction experienced by a patient who receives a nocebo. Conversely, a placebo is an inert substance that creates either a positive response or a negative response in a patient who takes it. The phenomenon in which a placebo creates a positive response in the patient to which it is administered is called the placebo effect. The nocebo effect is less well-studied and well-known, by both scientists and the public, than the placebo effect.[1][2]

Both nocebo and placebo effects are entirely psychogenic. Rather than being caused by a biologically active compound in the placebo itself, these reactions result from a patient's expectations about how the substance will affect him or her. Though they originate exclusively from psychological sources, nocebo effects can be either psychological or physiological.

Contents [hide]
1 Etymology
2 Description
3 Response
4 Causes
5 Ambiguity of medical usage
6 Ambiguity of anthropological usage
7 See also
8 Notes
9 References
10 External links


Etymology[edit]

The term nocebo (Latin nocēbō, "I shall harm", from noceō, "I harm")[3] was chosen by Walter Kennedy, in 1961, to denote the counterpart of one of the more recent applications of the term placebo (Latin placēbō, "I shall please", from placeō, "I please");[4] namely, that of a placebo being a drug that produced a beneficial, healthy, pleasant, or desirable consequence in a subject, as a direct result of that subject's beliefs and expectations.

Description[edit]

W.R. Houston may have been the first to have spoken of a doctor's deliberate application of harmful "placebo" procedures, as distinct from the other, harmless sort of "placebo" procedures a doctor might apply and whose "usefulness was in direct proportion to the faith that the doctor had and the faith that he was able to inspire in his patients." Houston (1938, p. 1418) wrote:


... [and while the efficacy of the placebo procedure] is believed in by the doctor, [the placebo procedure itself] is no longer harmless but harmful, sometimes very dangerous. It would seem peculiarly contradictory to speak of the painful and dangerous placebo, yet men are so constituted that they feel the need in dire extremity of resorting to dread measures. Nervous patients in particular, feel that a certain standing and sanction is bestowed upon their maladies when violent therapeutic measures are used.

Houston spoke of three significantly different categories of placebo (pp.1417-1418):

• the drug that the physician knows to be inert, but which the subject believes to be potent;
• the drug which is believed to be potent by both subject and physician, but which later investigation proves to have been totally inert;
• the drug which is believed to be impotent by both subject and physician, but is actually harmful and dangerous, rather than being inert and harmless.

The term "nocebo response" originally meant only an unpredictable and unintentional belief-generated injurious response to an inert procedure, but there is an emerging practice of labelling drugs that produce unpleasant consequences as "nocebo drugs" meaning that the term "nocebo response" may be used to label an intentional, entirely pharmacologically-generated and quite predictably injurious outcome that has ensued from the administration of an active (nocebo) drug.[citation needed]

Anthropologists use the term "nocebo ritual" to describe a procedure, treatment, or ritual that has been performed (or a herbal remedy or medication that has been administered) with malicious intent, by contrast with a placebo procedure or treatment or ritual that is performed with a benevolent intent.

An example of nocebo effect would be someone who dies of fright[dubious – discuss] after being bitten by a non-venomous snake.[citation needed]

Response[edit]

In the strictest sense, a nocebo response occurs when a drug trial's subject's symptoms are worsened by the administration of an inert, sham,[5] or dummy (simulator) treatment, called a placebo.

According to current pharmacological knowledge and the current understanding of cause and effect, a placebo contains no chemical (or any other agent) that could possibly cause any of the observed worsening in the subject's symptoms. Thus, any change for the worse must be due to some subject-internal factor.

Negative expectations can also cause analgesic effects of anesthetic medications to be abolished.[6]

The worsening of the subject's symptoms or elimination of positive effects is a direct consequence of their exposure to the placebo, but those symptoms have not been chemically generated by the placebo. Because this generation of symptoms entails a complex of "subject-internal" activities, in the strictest sense, we can never speak in terms of simulator-centred "nocebo effects," but only in terms of subject-centred "nocebo responses."

Although some attribute nocebo responses (or placebo responses) to a subject's gullibility, there is no evidence that an individual who manifests a nocebo/placebo response to one treatment will manifest a nocebo/placebo response to any other treatment; i.e., there is no fixed nocebo/placebo-responding trait or propensity.

McGlashan, Evans & Orne (1969, p. 319) found no evidence of what they termed a "placebo personality." Also, in a carefully designed study, Lasagna, Mosteller, von Felsinger and Beecher (1954), found that there was no way that any observer could determine, by testing or by interview, which subject would manifest a placebo reaction and which would not.

Experiments have shown that no relationship exists between an individual's measured hypnotic susceptibility and his/her manifestation of nocebo or placebo responses.[7]

Causes[edit]

The term "nocebo response" was coined in 1961 by Walter Kennedy (he actually spoke of a "nocebo reaction").

He had observed that another, entirely different and unrelated, and far more recent meaning of the term "placebo" was emerging into far more common usage in the technical literature (see homonym); namely that a "placebo response" (or "placebo reaction") was a "pleasant" response to a real or sham/dummy treatment (this new and entirely different usage was based on the Latin meaning of the word placebo, "I shall please").

Kennedy chose the Latin word nocebo ("I shall harm") because it was the opposite of the Latin word "placebo", and used it to denote the counterpart of the placebo response: namely, an "unpleasant" response to the application of real or sham treatment.

Kennedy very strongly emphasized that his specific usage of the term "nocebo" did not refer to "the iatrogenic action of drugs":[8] in other words, according to Kennedy, there was no such thing as a "nocebo effect", there was only a "nocebo response".

He insisted that a nocebo reaction was subject-centred, and he was emphatic that the term nocebo reaction specifically referred to "a quality inherent in the patient rather than in the remedy."[8]

Even more significantly, Kennedy also stated that whilst "nocebo reactions do occur [they should never be confused] with true pharmaceutical effects, such as the ringing in the ears caused by quinine".[8]

This is strong, clear and very persuasive evidence that Kennedy was precisely speaking of an outcome that had been totally generated by a subject's negative expectation of a drug or ritual's administration; which was the exact counterpart of a placebo response that would have been generated by a subject's positive expectation.

And, finally, and most definitely, Kennedy was not speaking of an active drug's unwanted, but pharmacologically predictable negative side-effects (something for which the term nocebo is being increasingly used in current literature).

Ambiguity of medical usage[edit]

In a paper,[9] Stewart-Williams and Podd argue that using the contrasting terms "placebo" and "nocebo" to label inert agents that produce pleasant, health-improving or desirable outcomes, or unpleasant, health-diminishing, or undesirable outcomes (respectively), is extremely counterproductive.

For example, precisely the same inert agents can produce analgesia and hyperalgesia, the first of which, from this definition, would be a placebo, and the second a nocebo.[citation needed]

A second problem is that precisely the same effect, such as immunosuppression, may be quite desirable for a subject with an autoimmune disorder, but be quite undesirable for most other subjects. Thus, in the first case, the effect would be a placebo, and in the second, a nocebo.[citation needed]

A third problem is that the prescriber does not know whether the relevant subjects consider the effects that they experience to be subjectively desirable or undesirable until some time after the drugs have actually been administered.[citation needed]

A fourth problem is that, in cases such as this, precisely the same phenomena are being generated in all of the subjects, and these are being generated by precisely the same drug, which is acting in all of the subjects through precisely the same mechanism. Yet, just because the phenomena in question have been subjectively considered to be desirable to one group, but not the other, the phenomena are now being labelled in two mutually exclusive ways (i.e., placebo and nocebo); and this is giving the false impression that the drug in question has produced two entirely different phenomena.[citation needed]

These sorts of argument produce a strong case that – despite the fact that, in some of its applications, the term "placebo" is used to denote something that pleases (compared with it denoting an inert simulator) – the desirability (placeboic nature) or undesirability (noceboic nature) of the phenomena that have been manifested by a subject, after a drug has been administered, should never be part of the definition of what constitutes either "a placebo" or "a placebo response".[citation needed]

Ambiguity of anthropological usage[edit]

Some people maintain that belief kills (e.g., "voodoo death": Cannon (1942) describes a number of "voodoo deaths" from a variety of different cultures) and belief heals (e.g., faith healing).

A "self-willed" death (due to voodoo hex, evil eye, pointing the bone procedure,[10] etc.) is an extreme form of a culture-specific syndrome or mass psychogenic illness that produces a particular form of psychosomatic or psychophysiological disorder which results in a psychogenic death.
Rubel (1964) spoke of "culture bound" syndromes, which were those "from which members of a particular group claim to suffer and for which their culture provides an etiology, diagnosis, preventive measures, and regimens of healing” (p.268).
It is important to distinguish these "self-willed deaths" from other "self-imposed" sorts of death, such as:

• the "self-inflicted deaths" of suicide, voluntary euthanasia, or the refusal of life-extending treatment;
• the "heroic" "self-inflicted death" of a soldier who throws himself on a hand grenade to save his mates, or that of the Antarctic explorer Captain Lawrence Oates ("I am just going outside and may be some time"); or
• the "religious self-inflicted death"' of the self-immolating suttee, or the mors voluntaria religiosa (= "voluntary religious death") of the aged person, whom religious elders have permitted to voluntarily, peacefully, and slowly die by fasting.

Certain anthropologists, such as Robert Hahn and Arthur Kleinman, have extended the placebo/nocebo distinction into this realm in order to allow a distinction to be made between rituals, like faith healing, that are performed in order to heal, cure, or bring benefit (placebo rituals) and others, like "pointing the bone", that are performed in order to kill, injure or bring harm (nocebo rituals).

As the meaning of the two inter-related and opposing terms has extended, we now find anthropologists speaking, in various contexts, of nocebo or placebo (harmful or helpful) rituals:

• that might entail nocebo or placebo (unpleasant or pleasant) procedures;
• about which subjects might have nocebo or placebo (harmful or beneficial) beliefs;
• that are delivered by operators that might have nocebo or placebo (pathogenic, disease-generating or salutogenic, health-promoting) expectations;
• that are delivered to subjects that might have nocebo or placebo (negative, fearful, despairing or positive, hopeful, confident) expectations about the ritual;
• which are delivered by operators who might have nocebo or placebo (malevolent or benevolent) intentions, in the hope that the rituals will generate nocebo or placebo (lethal, injurious, harmful or restorative, curative, healthy) outcomes;

and, that all of this depends upon the operator's overall beliefs in the harmful nature of the nocebo ritual or the beneficial nature of the placebo ritual.

Yet, it may become even more terminologically complex; for, as Hahn and Kleinman indicate, there can also be cases where there are paradoxical nocebo outcomes from placebo rituals (e.g. the TGN1412 drug trial[11][12]), as well as paradoxical placebo outcomes from nocebo rituals (see also unintended consequences).

Writing from his extensive experience of treating cancer (including more than 1,000 melanoma cases) at Sydney Hospital, Milton (1973) warned of the impact of the delivery of a prognosis, and how many of his patients, upon receiving their prognosis, simply turned their face to the wall and died an extremely premature death: "... there is a small group of patients in whom the realisation of impending death is a blow so terrible that they are quite unable to adjust to it, and they die rapidly before the malignancy seems to have developed enough to cause death. This problem of self-willed death is in some ways analogous to the death produced in primitive peoples by witchcraft ("Pointing the bone")." (p.1435)

Click to expand...

The Dark Side of the Placebo Effect: When Intense Belief Kills

They died in their sleep one by one, thousands of miles from home. Their median age was 33. All but one -- 116 of the 117 -- were healthy men. Immigrants from southeast Asia, you could count the time most had spent on American soil in just months. At the peak of the deaths in the early 1980s, the death rate from this mysterious problem among the Hmong ethnic group was equivalent to the top five natural causes of death for other American men in their age group.

Something was killing Hmong men in their sleep, and no one could figure out what it was. There was no obvious cause of death. None of them had been sick, physically. The men weren't clustered all that tightly, geographically speaking. They were united by dislocation from Laos and a shared culture, but little else. Even House would have been stumped.

Doctors gave the problem a name, the kind that reeks of defeat, a dragon label on the edge of the known medical world: Sudden Unexpected Nocturnal Death Syndrome. SUNDS. It didn't do much in terms of diagnosis or treatment, but it was easier to track the periodic conferences dedicated to understanding the problem.

Twenty-five years later, Shelley Adler's new book pieces together what happened, drawing on interviews with the Hmong population and analyzing the extant scientific literature. Sleep Paralysis: Night-mares, Nocebos, and the Mind Body Connection is a mind-bending exploration of how what you believe interacts with how your body works. Adler, a professor at the University of California, San Francisco, comes to a stunning conclusion: In a sense, the Hmong were killed by their beliefs in the spirit world, even if the mechanism of their deaths was likely an obscure genetic cardiac arrhythmia that is prevalent in southeast Asia.

* * *

By 1986, the Hmong deaths had slowed, but remained a striking epidemiological fact. Adler was a graduate student at UCLA studying traditional belief narratives at the time. She'd been researching what she called "nocturnal pressing spirit attacks," or what scientific literature called sleep paralysis. Fascinatingly, sleep paralysis is known to just about all cultures, and it is almost always associated with nocturnal evil. In Indonesia, it's called digeunton ("pressed on"). In China, it's bei gui ya ("held by a ghost"). The Hungarians know it as boszorkany-nyomas, "witches' pressure." In Newfoundland, the spirit that comes is called the Old Hag, and the experience of sleep paralysis, ag rog, "hag ridden." The Dutch name comes closest to what English speakers know. They call the presence nachtmerrie, the night-mare. The "mare" in question comes from the German mahr or Old Norse mara, which denoted a generally female supernatural being who in Adler's words, "lay on people's chests, suffocating them." The etymology of mare isn't clear, but the term is a fruit of the Indo-European language tree, likely from moros (death), mer (drive out), or mar (to pound, bruise, crush).

Results like these seem improbable, or anti-reason, or something. But Adler's book is an attack on the "Oh, come on!" form of argument.

Across cultures, night-mare visits play out in very similar ways. Victims experience the strange feeling of being "awake." While they have a realistic perception of their environment, they can't move. Worse, they feel an "overwhelming fear and dread" accompanied by chest pressure and difficulty breathing. Scientists have a pretty good grasp of how all of this happens. The paralysis, the feeling of pressure on the chest, all that is explained quite nicely within the scientific models of sleep. During sleep paralysis, a person experiences an "out of sequence" REM state. In REM sleep, we dream and our minds shut off the physical control of the body; we're supposed to be temporarily paralyzed. But we are not supposed to be conscious in REM sleep. Yet that is precisely what happens during sleep paralysis: it is a mix of brain states that are normally held separate.

And then there is the weird stuff, the Old Hag part, the night-mare. People who have an experience of sleep paralysis tend to feel some horrible, evil being is near them. "I just knew this presence was there. An ominous presence ... not only could I not see it, but I couldn't defend myself, I couldn't do anything," one victim told Adler. This feeling is consistent across cultures, even if it goes by different names and presents through the culture one knows.

I experienced sleep paralysis twice in college. I can vouch for the sheer terror that attends the experience. I saw -- no, felt -- an evil presence to my left. I can't tell you what was evil about it or how I knew it was so nasty. But I did. As the experience progressed, it came closer. It didn't feel like my life was at risk. That was, in fact, too small. It felt like the presence was after something else, probably what you'd call my soul or my being, even though intellectually I'm a straight materialist. I woke up more scared than I've ever been in my life. Overwhelming fear. Overwhelming dread. Overwhelming fear and dread. When I read about sleep paralysis, I immediately identified that presence (which remained just to the left of my visual field) as the Old Hag.

But there is a one big difference between sleep paralysis, which impacts a substantial percentage of the global population at least once, and what the Hmong immigrants experienced in the 1980s. The Old Hag was terrifying but harmless; whatever happened in the night to the Hmong killed them.

* * *

Adler studied the Hmong and their relationship to what they call tsog tsuam for years and years. That research forms the core of her book. Adler went out into the field. She collected dozens of experiences of sleep paralysis among the Hmong both from her own interviews and other researchers. One 49-year old Adler interviewed provided this typical experience:

I remember a few months after I first came here -- I was asleep. I turned out the light and everything, but I kind of think ... and then -- all of a sudden, I felt that -- I cannot move. I just feel it, but I don't see anything, but I -- then I tried to move my hand, but I cannot move my hand. I keep trying, but I cannot move myself. I know it is tsog tsuam. I am so scared. I can hardly breathe. I think, "Who will help? What if I die?"

Click to expand...

She brought her background in exploring traditional belief systems to bear on attacks like the one above. She found that the nighttime attacks were part of a matrix of beliefs held by both animist and Christian Hmong. A powerful folklore had built up around tsog tsuam that included both causes and cures for the attacks.

"When the Hmong don't worship properly, do not perform the religious ritual properly or forget to sacrifice or whatever, then the ancestor spirits or the village spirits do not want to guard them," one man explained to Adler. "That's why the evil spirit is able to come and get them." And for a lot of reasons, the Hmong in the late 1970s and early 1980s were not able to worship properly.

The ethnic group fought a guerrilla war against the government of Laos with U.S. backing during the Vietnam War. When the Laotian communists won, many Hmong struck out for America to avoid reprisals. The U.S. government decided to scatter the Hmong randomly across the U.S. to 53 different cities, breaking up the immigration patterns we generally see. In short order, the Hmong organized and made a "secondary migration" to California, Wisconsin, and Minnesota. The immigrants ran into all kinds of problems making their way in the States. Highland Laos, where farming and hunting were the norm, was not Minneapolis-St. Paul or Fresno. Unemployment was obscenely high and the sense of community that many had enjoyed in the old country was gone.

Some Hmong felt that they had not properly honored the memories of their ancestors, which was a known risk factor among the Hmong for being visited by the tsog tsuam. Once the night-mare visitations began, a shaman was often needed to set things right. And in the scattered communities of Hmong across the country, they might not have access to the right person. Without access to traditional rituals, shamans, and geographies, the Hmong were unable to provide themselves psychic protection from the spirits of their sleep.

Adler makes the provocative claim that the Laotian immigrants were in some sense killed by their powerful cultural beliefs.

Drawing on all this evidence, Adler makes the provocative claim that the Laotian immigrants of the 1980s were in some sense killed by their powerful cultural belief in night spirits. It was not a simple process.

"It is my contention that in the context of severe and ongoing stress related to cultural disruption and national resettlement (exacerbated by intense feelings of powerlessness about existence in the United States), and from the perspective of a belief system in which evil spirits have the power to kill men who do not fulfill their religious obligations," Adler writes, "the solitary Hmong man confronted by the numinous terror of the night-mare (and aware of its murderous intent) can die of SUNDS."

Her argument amounts to a stirring and chilling case for the power of the nocebo, the flipside to the placebo effect. While placebo studies have grown in importance, the nocebo effect has not been studied well in scientific literature, in part because of the ethical issues involved in deliberately doing something that might harm people. Limited studies suggest that it is real and it is powerful. For example, doctors have found that patients made to feel anxious need larger amounts of opiates after surgery than other people. They've found that pretending to expose people who say they are sensitive to electromagnetic radiation to cell phone signals can give them debilitating headaches. Even patients' level of side effects from arthritis medication seem determined by those patients' beliefs about those medicines. Logically speaking, if the evidence shows the upside of belief, why wouldn't we believe in the downside, too? And why wouldn't we believe that the intensity of the downside would vary with the intensity of the belief, even if those beliefs were about something unscientific, like spirits or astrology?

If you're still unsure that the nocebo effect could actually lead to premature death, Adler cites one stunning example of the effect from China. A team of researchers found that Chinese Americans die younger than expected "if they have a combination of disease and birth year which Chinese astrology and medicine considers ill-fated." That is to say, if they were born in a year that was astrologically linked to poor lung health, they would die an average of five years earlier from lung-related disease than someone born in some other year with the same disease. Similar effects were not found in the white populations around them. And how much sooner you died depended on the people's "strength of commitment to traditional Chinese culture."

Think about that for a minute. If you were born under a bad sign, you died five years younger from the same diseases as people born under good signs. But only if you believed in Chinese astrology.

Results like these seem improbable, or anti-reason, or something. But Adler's book is an attack on the "Oh, come on!" form of argument. She uses her understanding of both science and traditional belief structures to argue for what she calls "local biology."

"Since meaning has biological consequences, and meanings vary across cultures, biology can operate differently in different contexts," she writes. "In other words, biology is 'local' -- the 'same' biological processes in different places have different 'effects' on people."

The truth is that we don't understand the relationship between belief and biology quite as well as we'd like to think. That's one reason sleep paralysis is so useful as a probe for the boundary of mind and body. The night-mare is "a link between our biological and cultural selves." While people of all cultures experience sleep paralysis in similar ways, the specific form and intensity it takes varies by culture, soaking up whatever local spirits or monsters happen to be lurking nearby.

Click to expand...

4. Psychoimmunology

4.1. Moods and Disease

A mental 'fighting spirit' has been shown to be an effective aid to combating (physical) cancer14. How can this be? A leading psychologist, Richard Gross, explains that psychoimmunology involves studying how emotion, mood and optimism/pessimism affect our immune systems and susceptibility to disease, and elaborates on how:

An important way in which stress may result in disease is through its influence on the body's immune system [...]. The study of the effect of psychological factors on the immune system is called psychoimmunology. People often catch a cold soon after a period of stress (e.g. final exams) because stress seems to reduce the immune system's ability to fight off cold viruses. Goetsch and Fuller (1995) refer to studies that show decreases in the activity of lymphocytes, 'natural killer cells' (a particular type of white blood cell which normally fights off viruses and cancer cells), among medical students during their final exams.

A study of Greer et al. (1979) in England of women who had been diagnosed as having breast cancer (and actually had a mastectomy) found that those who reacted either by denying what had happened or by showing a 'fighting spirit' were significantly more likely to be free of cancer five years later than women who stoically accepted it or felt helpless. [...]

The study by Stone et al. (1987) [...] found that changes in mood (that are influenced by daily events) are linked to changes in the level of antibodies contained with immunoglobulin A (IgA), a substance found in tears, saliva, bronchial and other bodily secretions. [The] higher the level of positive mood, the higher the level of antibodies.

Click to expand...

"Psychology: The Science of Mind and Behaviour" by Richard Gross (1996)15

The link is not just one-way. Diseases can cause depression because of the reactions of our immune system.

The immune response to illness can cause depression. Recently scientists have pinpointed an enzyme that could be the culprit. [...] In the new study, immunophysiologist Keith Kelley and his colleagues at the University of Illinois [implicated] an enzyme called IDO, which breaks down tryptophan [...]. "If you block IDO, genetically or pharmaceutically, depression goes away" without interfering with the immune response, Kelly explains. The research makes a solid case that the immune system communicates directly with the nervous system and affects important health-related behaviours such as depression.

Click to expand...

Scientific American Mind (2009)16

Psychology and biology have become blurred: Our minds effect the biological functioning of our body. This does not surprise materialistic biologists, who know that the mind itself is a part of the body, and that it is controlled by our nervous system which is commanded by the brain. Emotions that arise from the brain can be used as part of the feedback system to change the way the body works, because the brain is not only effect by, but is also in charge of, the body.

4.2. The Long-term Health Benefits of Dealing Well with Stress

If uncontrollable stress affects health [...] then will people who exhibit [...] pessimism be more vulnerable to illness? Several studies have confirmed that a pessimistic style of explaining bad events (saying, "It's my responsibility, it's going to last, and it's going to undermine everything") makes illness more likely. [...] Even cancer patients appear more likely to survive if their attitude is hopeful and determined (Levy & others, 1988; Pettingale & other, 1985). One study of [cancer patients, showed that] those who participated in morale-boosting weekly support group sessions survived an average of 37 months, double the 19-month average survival time among the nonparticipants (Spiegel & others, 1989). [...] Beliefs, it seems, can boost biology.

Click to expand...

"Social Psychology" by David Myers (1999)17

We see in the above examples that stress is the emotional factor relevant in most of psychoimmunology. It has already been found that those with bad stress responses are more likely over the long term to suffer from ill health.

In their 1981 book Present and Past in Middle Life, Dorothy Eichorn and her colleagues report a significant relationship between mental health early in life and physical health during maturity. Those subjects who showed emotional stability and controlled responses to stress as adolescents had far better health at age 50 than did those subjects who had poor stress reactions when young.

Click to expand...

"Understanding Human Behavior" by James V. McConnel (1986)18

A group of researchers in 2006 studied the effects of various forms of god-belief on stress and anxiety. They looked at low- and high-income brackets by race, and found that individuals in most groups who believe in a powerful God who was actively involved in life, had lesser anxiety. Except for one group; low-income whites, amongst whom belief in such a God correlated with increased stress. For many, it seems that belief in a provident God leads to reduced stress. It should be expected therefore that religiosity has a measurable effect on the long-term prevalence of disease that are easily effect by psychoimmunological factors.19

Click to expand...

Social isolation rearing induces mitochondrial, immunological, neurochemical and behavioural deficits in rats, and is reversed by clozapine or N-acetyl cysteine.

Möller M1, Du Preez JL, Viljoen FP, Berk M, Emsley R, Harvey BH.

Author information

Abstract

Apart from altered dopamine (DA) function, schizophrenia displays mitochondrial and immune-inflammatory abnormalities, evidenced by oxidative stress, altered kynurenine metabolism and cytokine release. N-acetyl cysteine (NAC), an antioxidant and glutamate modulator, is effective in the adjunctive treatment of schizophrenia. Social isolation rearing (SIR) in rats is a valid neurodevelopmental animal model of schizophrenia. This study evaluated whether SIR-induced behavioural deficits may be explained by altered plasma pro- and anti-inflammatory cytokines, kynurenine metabolism, and cortico-striatal DA and mitochondrial function (via adenosine triphosphate (ATP) release), and if clozapine or NAC (alone and in combination) reverses these changes. SIR induced pronounced deficits in social interactive behaviours, object recognition memory, and prepulse inhibition (PPI), while simultaneously increasing striatal but reducing frontal cortical accumulation of ATP as well as DA. SIR increased pro- vs. anti-inflammatory cytokine balance and altered kynurenine metabolism with a decrease in neuroprotective ratio. Clozapine (5mg/kg/day×14days) as well as clozapine+NAC (5mg/kg/day and 150mg/kg/day×14days) reversed these changes, with NAC (150mg/kg/day) alone significantly but partially effective in some parameters. Clozapine+NAC was more effective than clozapine alone in reversing SIR-induced PPI, mitochondrial, immune and DA changes. In conclusion, SIR induces mitochondrial and immune-inflammatory changes that underlie cortico-striatal DA perturbations and subsequent behavioural deficits, and responds to treatment with clozapine or NAC, with an additive effect following combination treatment. The data provides insight into the mechanisms that might underlie the utility of NAC as an adjunctive treatment in schizophrenia.

Click to expand...

Immunology: The pursuit of happiness

When Steve Cole was a postdoc, he had an unusual hobby: matching art buyers with artists that they might like. The task made looking at art, something he had always loved, even more enjoyable. “There was an extra layer of purpose. I loved the ability to help artists I thought were great to find an appreciative audience,” he says.

At the time, it was nothing more than a quirky sideline. But his latest findings have caused Cole — now a professor at the Cousins Center for Psychoneuroimmunology at the University of California, Los Angeles — to wonder whether the exhilaration and sense of purpose that he felt during that period might have done more than help him to find homes for unloved pieces of art. It might have benefited his immune system too.

At one time, most self-respecting molecular biologists would have scoffed at the idea. Today, evidence from many studies suggests that mental states such as stress can influence health. Still, it has proved difficult to explain how this happens at the molecular level — how subjective moods connect with the vastly complex physiology of the nervous and immune systems. The field that searches for these explanations, known as psychoneuroimmunology (PNI), is often criticized as lacking rigour. Cole's stated aim is to fix that, and his tool of choice is genome-wide transcriptional analysis: looking at broad patterns of gene expression in cells. “My job is to be a hard-core tracker,” he says. “How do these mental states get out into the rest of the body?”

With his colleagues, Cole has published a string of studies suggesting that negative mental states such as stress and loneliness guide immune responses by driving broad programs of gene expression, shaping our ability to fight disease. If he is right, the way people see the world could affect everything from their risk of chronic illnesses such as diabetes and heart disease to the progression of conditions such as HIV and cancer. Now Cole has switched tack, moving from negative moods into the even more murky territory of happiness. It is a risky strategy; his work has already been criticized as wishful thinking and moralizing. But the pay-off is nothing less than finding a healthier way to live.

“If you talk to any high-quality neurobiologist or immunologist about PNI, it will invariably generate a little snicker,” says Stephen Smale, an immunologist at the University of California, Los Angeles, who is not affiliated with the Cousins Center. “But this doesn't mean the topic should be ignored forever. Someday we need to confront it and try to understand how the immune system and nervous system interact.”

The best medicine?

In 1964, magazine editor Norman Cousins was diagnosed with ankylosing spondylitis, a life-threatening autoimmune disease, and given a 1 in 500 chance of recovery. Cousins rejected his doctors' prognosis and embarked on his own programme of happiness therapy, including regular doses of Marx Brothers films, and credited it with triggering a dramatic recovery. He later established the Cousins Center, which is dedicated to investigating whether psychological factors really can keep people healthy.

At the time, mainstream science rejected the idea that any psychological state, positive or negative, could affect physical well-being. But studies during the 1980s and early 1990s revealed that the brain is directly wired to the immune system — portions of the nervous system connect with immune-related organs such as the thymus and bone marrow, and immune cells have receptors for neurotransmitters, suggesting that there is crosstalk.

These connections seem to have clinical relevance, at least in the case of stress. One of the first researchers to show this was virologist Ronald Glaser, now director of the Institute for Behavioral Medicine Research at the Ohio State University in Columbus. “When I started working on this in the 1980s, nobody believed what stress could do, including me,” he recalls. He and his colleagues sampled blood from medical students, and found that during a stressful exam period, they had lower activity from virus-fighting immune cells1, and higher levels of antibodies for the common virus Epstein–Barr2, suggesting that stress had compromised their immune systems and allowed the normally latent virus to become reactivated.

The field of PNI has grown hugely since then, with medical schools worldwide boasting their own departments of mind–body medicine, of which PNI is just one component. It is now accepted that the body's response to stress can suppress parts of the immune system and, over the long term, lead to damaging levels of inflammation. Large epidemiological studies — including the Whitehall studies, which have been following thousands of British civil servants since 1967 — suggest3 that chronic work stress increases the risk of coronary heart disease and type 2 diabetes, for example. Low socio-economic status increases susceptibility to a wide range of infectious diseases, and there is considerable evidence that stress increases the rate of progression of HIV/AIDS. But researchers have a long way to go before they will understand exactly how signals from the brain feed into physical health.

Worried sick

PNI studies have mostly tended to look at levels of individual immune-cell types or molecular messengers — such as the stress hormone cortisol and the immune messenger proteins called cytokines — or the expression of individual genes. But Cole wanted to get a sense of how the whole system was working.

His first foray, published in 2007, looked at loneliness4. Social isolation is one of the most powerful known psychological risk factors for poor health, but it is never certain whether it causes the health problems, or whether a third factor is involved: lonely people might be less likely than others to eat well, for example, or to visit their doctor regularly.

Cole and his colleagues looked at gene expression in the white blood cells of six chronically lonely people — people who had said consistently over several years that they felt lonely or isolated, and were fearful of other people — and eight people who said that they had great friends and social support. Out of the roughly 22,000 genes in the human genome, the researchers identified 209 that distinguished the lonely people from the sociable ones: they were either regulated up to produce more of an individual protein or regulated down to produce less. Any individual gene could easily look different by chance, but Cole was struck by the overall pattern. A particularly large proportion of the upregulated genes in the lonely group turned out to be involved in the inflammatory response, whereas many of the downregulated genes had antiviral roles. In sociable people, the reverse was true. It was a small study, but one of the first to link a psychological risk factor with a broad underlying change in gene expression.

The researchers have since replicated that result in a group of 93 people5. Cole says that he has also seen a similar shift in gene expression in individuals exposed to various types of social adversity, from imminent bereavement to low socio-economic status.

The results make evolutionary sense, he says. Early humans in close-knit social groups would have faced increased risk of viral infections, so they would have benefited from revved-up antiviral genes. By contrast, people who were isolated and under stress faced greater risk of injuries that could cause bacterial infection — and thus would need to respond by ramping up genes associated with inflammation, to help heal wounds and fight off those infections. But modern stresses lead to chronic and unhelpful inflammation, which over time damages the body's tissues, increasing the risk of chronic diseases such as atherosclerosis, cancer and diabetes.

To a classical immunologist such as Smale, Cole's results are “intriguing, wonderful observations”, but not yet completely convincing. In future work, he wants to see the rest of the physiological pathway nailed down. “Until you put together a full understanding of that mechanism, you have this level of uncertainty and scepticism,” he says. That sentiment is echoed by Alexander Tarakhovsky, an immunologist at the Rockefeller University in New York City. Pinning down precise mechanisms — for example, which neurotransmitters cause which specific effects — is extremely difficult, he says, because the brain and the immune system are both so complex. Cole's research “makes you think about what the consequences of social hardship could be, but it doesn't really tell you how it works”.

Greg Gibson, director of the Center for Integrative Genomics at the Georgia Institute of Technology in Atlanta, wants to see larger studies but argues that the big-picture “genetic architecture” that Cole is uncovering is worth studying, even if not every detail of the mechanism is yet understood. “A lot of people are taking a whole-genome approach, but they focus only on a handful of 'top hits'. They are missing the wood for the trees.”

Don't worry, be happy

In 2010, Cole received an e-mail from Barbara Fredrickson, a friend from graduate school who was now studying emotional well-being at the University of North Carolina in Chapel Hill. “Remember me?” she said. She was interested in the biological correlates of happiness and other positive emotional states, and suggested that the pair collaborate. After years of looking at stress and adversity, Cole loved the idea. “I was bored as hell with misery,” he says.

If PNI as a whole has credibility issues, studying well-being is even trickier. It is more slippery to measure than stress — there is no biological marker such as cortisol to fall back on and no simple way to induce it in the lab, and mainstream biologists tend to look down on fuzzy methods of data collection such as questionnaires.

One approach is to test whether it is possible to reverse the adverse effects on gene expression caused by stress. Cole has collaborated in three small, randomized, controlled trials that attempt to do this. Studies involving 45 stressed caregivers6 and 40 lonely adults7 respectively found that courses in meditation shifted gene-expression profiles in the participants' white blood cells away from inflammatory genes and towards antiviral genes. A third trial8, led by psycho-oncologist Michael Antoni at the University of Miami, Florida, involved 200 women with early-stage breast cancer. In those who completed a ten-week stress-management programme, genes associated with inflammation and metastasis were downregulated compared with those of women in the control group, who attended a one-day educational seminar. Meanwhile, genes involved in the type I interferon response (which fights tumours as well as viruses) were upregulated in the women who took the stress-management course. “Our conclusion was that mood matters,” says Antoni. “If we change the psychology, physiological changes do parallel that.”

Cole and Fredrickson aspired to go further. Instead of looking at the benefits of blocking stress, they wanted to investigate what happens in the body when people are happy. To that end, they asked 80 participants 14 questions, such as how often in the past week they had felt happy or satisfied, and how often they felt that their life had a sense of meaning9. The questions were designed to distinguish between the two forms of happiness recognized by psychologists: hedonic well-being (characterized by material or bodily pleasures such as eating well or having sex) and eudaimonic well-being (deeper satisfaction from activities with a greater meaning or purpose, such as intellectual pursuits, social relationships or charity work).

The researchers were surprised to find that the two types of happiness influenced gene expression in different ways. People with a meaning-based or purpose-based outlook had favourable gene-expression profiles, whereas hedonic well-being, when it occurred on its own, was associated with profiles similar to those seen in individuals facing adversity. {feelgood/wishful thinking will get you every time!}

One interpretation is that eudaimonic well-being benefits immune function directly. But Cole prefers to explain it in terms of response to stress. If someone is driven purely by hollow consumption, he argues, all of their happiness depends on their personal circumstances. If they run into adversity, they may become very stressed. But if they care about things beyond themselves — community, politics, art — then everyday stresses will perhaps be of less concern. Eudaimonia, in other words, may help to buffer our sense of threat or uncertainty, potentially improving our health. “It's fine to invest in yourself,” says Cole, “as long as you invest in lots of other things as well.”

Perils of positive thinking

This is just the kind of advice that attracts some of the most vociferous criticisms of Cole's work. James Coyne, a health psychologist and emeritus professor at the University of Pennsylvania in Philadelphia, says that Cole and Frederickson's well-being study is simply too small to show anything useful. He also argues that the measures of eudaimonic and hedonic happiness are so highly correlated in the study as to be essentially the same thing. Coyne says that early results are being vastly over-sold. “They claim that if you make the right choices, you'll be healthy. And if you don't, you'll die.”

Coyne wants researchers across the field of PNI to stop publicizing claims about health benefits until the science is more solid. “They're turning it into books and workshops, telling people how to live their lives.”

Fredrickson, for example, is the author of two popular books, including Positivity (Crown Archetype, 2009), which posits that a specific ratio of positive to negative emotions (2.9013, to be precise) is linked to good health. The book has been praised by eminent psychologists such as Daniel Goleman and Martin Seligman, but the set of equations behind the ratio was criticized this year10 by Alan Sokal, a physicist at New York University (who famously published a deliberately nonsensical paper in the journal Social Text in 1996, intended to expose the lack of rigour in the field of cultural studies). He pointed out that the equations are based on parameters from a 1962 paper on air flow, with no connection to psychological data at all. Fredrickson acknowledges problems with the maths, which she based on a peer-reviewed paper on the complex dynamics of teams11, but says that she stands by the fundamental principles described in the book. “There seems good enough evidence to suggest that emotions contribute to health.”

Cole and Fredrickson agree that their study is small and needs to be repeated. But they say that extensive previous research has validated the questionnaire they used and confirmed that it measures two distinct, albeit highly correlated, emotional states. They also note that correlation does not necessarily mean that two states are the same: height and weight are also highly correlated, for example, yet describe different things. Each type of happiness tends to encourage the other, says Fredrickson, “but we can try to understand which is leading the way towards health”.

The researchers are not the first from the PNI community to face accusations of wishful thinking. Indeed, the story of the field's founder — hailed in the press as proof of the power of positive emotions — has been questioned. Immunologists have suggested that Cousins was not suffering from ankylosing spondylitis at all, but from polymyalgia rheumatica, which often clears up on its own. His “health probably coincidentally remitted”, says Cole.

Despite the criticisms, and the fact that his work is in its early days, Cole says that he is struck by the evidence that positive emotions can override the biological effects of adversity — enough to make changes in his own life. Although he no longer has time to engage in the art trade, he has embraced the ways that his hobby helped him. “I have spent most of my career and personal life trying to avoid or overcome bad things,” he says. “I spend a lot more time now thinking about what I really want to do with my life, and where I'd like to go with whatever years remain.”

Click to expand...

Q: (Atriedes) If you could give 3 pieces of advice to the world, what would they be?

A: I was wrong to think I could change the masses by example. Humans are fickle and self-centered for the most part. Thus, if you wish to really effect changes, it can only be done by early education, and even then it is fragile and will not last. In the end you must be true to your own nature and fear nothing. If you do that you may make a difference after you are gone. That is not exactly what you are looking for, but there are no 3 pieces of advice that serve all events.

Click to expand...

Philip Strong
Epidemic psychology: a model
Abstract When the conditions are right ,epidemics can potentially create
a medical version of the Hobbesian nightmare - the war of all
against all. A major outbreak of novel, fatal epidemic disease
can quickly be followed both by plagues of fear, panic, suspicion
and stigma; and by mass outbreaks of moral controversy, of
potential solutions and of personal conversion to the many
different causes which spring up. This distinctive collective
social psychology has its own epidemic form, can be activated
by other crises besides those of disease and is rooted in the
fundamental properties of language and human interaction. It is
thus a permanent part of the human condition - and widely
known to be such.

Click to expand...

Social isolation refers to a complete or near-complete lack of contact with people and society for members of a social species. It is not the same as loneliness rooted in temporary lack of contact with other humans. Social isolation can be an issue for anyone despite their age, each age group may show more symptoms than the other as children are different from adults.

Social isolation takes fairly common forms across the spectrum regardless of whether that isolation is self-imposed or is a result of a historical lifelong isolation cycle that has simply never been broken, which also does exist. All types of social isolation can lead to staying home for days or weeks at a time; having no communication with anyone including family or even the most peripheral of acquaintances or friends; and willfully avoiding any contact with other humans when those opportunities do arise. Even when socially isolated people do go out into public and attempt social interactions, the social interactions that succeed — if any — are brief and at least somewhat superficial.

The feelings of loneliness, fear of others, or negative self-esteem can produce potentially very severe psychological injuries.[1]

Effects[edit]

True social isolation over years and decades tends to be a chronic condition affecting all aspects of a person's existence. These people have no one to turn to in personal emergencies, no one to confide in during a crisis, and no one to measure their own behavior against or learn etiquette from — referred to sometimes as social control, but possibly best described as simply being able to see how other people behave and adapt oneself to that behavior.

Lack of consistent human contact can also cause conflict with the (peripheral) friends the socially-isolated person might occasionally talk to, or might cause interaction problems with family members. It may also give rise to uncomfortable thoughts and behaviors within the person.

The day to day effects of this type of deep-rooted social isolation can mean:

• staying home for days or even weeks at a time due to lack of access to social situations rather than a desire to be alone;
• both not contacting, and not being contacted by, any acquaintances, even peripherally; for example, never being called by anybody on the telephone and never having anyone visit one's residence;
• a lack of meaningful, extended relationships, and especially close intimacy (both emotional and physical).[citation needed]

Social isolation also affects the community, especially when it involves the elderly; in the United States, Canada, and United Kingdom, for example, a significant sector of the elderly who are in their 80s and 90s are brought to nursing homes if they show severe signs of social isolation. Other societies such as many in East Asia, and also the Caribbean (like Jamaica) and South America, do not normally share the tendency towards admission to nursing homes, preferring instead to have children and extended-family of elderly parents take care of those elderly parents until their deaths.[2]

Background[edit]

Social isolation is potentially both a cause and a symptom of emotional or psychological challenges. As a cause, the perceived inability to interact with the world and others can create an escalating pattern of these challenges. As a symptom, the periods of isolation can be chronic or episodic, depending upon any cyclical changes in mood, especially in the case of clinical depression, and possibly bipolar disorders. If social isolation in a particular person is lifelong, historical, patterned, unbroken, and chronic (i.e. from extremely young childhood all the way through full adulthood), it tends to perpetuate itself even if the person actually does not fundamentally desire to be alone, and sometimes even if the person also makes good-faith individual efforts to socialize. In the case of mood related isolation, the individual may isolate during a depressive episode only to 'surface' when their mood improves. The individual may attempt to justify their reclusive or isolating behavior as enjoyable or comfortable for them rather than displaying to others disordered thinking and response. There can be an inner realization on the part of the individual that there is something wrong with their isolating responses which can lead to heightened anxiety. Relationships can be a struggle, the individual 'reconnects' with others during a healthier mood episode only to have it dashed during a subsequent low or depressed mood where they will isolate.

Isolation increases the feelings of loneliness and depression, fear of other people, or even create a more negative self-image. There is a realization in the individual that their isolating is not 'normal behavior' and can create the feeling that there is a whole world going on that they are not or unable to be a part of. A feeling of being detached can create at times an inner panic.

Substance abuse can also be an element in isolation, whether a cause or a result. This can and many times does coincide with mood related disorders, but also with loneliness. According to a study that was conducted by Kimmo Herttua, Pekka Martikainen, Jussi Vahtera, and Mika Kivimäki, living alone can increase rates of being socially isolated and leading individuals to turn to the use of alcohol and other substances. This comorbid combination of isolation and substance abuse can compound the isolating dynamic to serious proportions.

Social isolation can begin early in life. An example would be a sensitive child who find him or herself bullied or ridiculed. This is a time when the ego is not fully developed. Sigmund Freud proposed the idea of a person's self, physically and mentally.[citation needed] During this time of development, a person may become more preoccupied with feelings and thoughts of their individuality that are not easy to share with other individuals. This can be a result from feelings of shame, guilt, or alienation during childhood experiences.[3]

Whether new technologies such as the Internet and mobile phones exacerbate social isolation (of any origin) is a debated topic among sociologists. With the advent of online social networking communities, there are increasing options to become involved with social activities that do not require real-world physical interaction. Chat rooms, message boards, and other types of communities are now meeting the need for those who would rather stay home alone, yet still develop communities of online friends. But those who oppose leading one's life primarily or exclusively online claim that virtual friends are not adequate substitutes for real-world friends, and research[who?] does suggest that individuals who substitute virtual friends for physical friends become even lonelier and more depressive than before.[citation needed]

Technology dependence is a problem in today's society. Not only can internet, phones, video game systems, etc. be an issue for interaction between beings but so can technology that is used for critical health issues. In a study conducted by Andrea Cockett, she focuses on children that are ventilator dependent and consequences that have been led by dependence upon technology. These technologies are keeping the children alive but also isolating them from what is beyond the hospital and home. Many parents agreed that home was the most appropriate place for their child to be cared for. However, children are being isolated from the outside world. This can lead to emotional burdens that hinder a child's ability to form relationships with other individuals.[4]

Social isolation can also coincide with developmental disabilities. Individuals with learning impairments may have trouble with social interaction. The difficulties experienced academically can greatly impact the individuals esteem and sense of self-worth. An example would be a the need to repeat a year of school. During the early childhood developmental years, the need to fit in and be accepted is paramount. Having a learning deficit can in turn lead to feelings of isolation, that they are somehow 'different' from others.

The elderly have their own set of isolating dynamics. Increasing frailty, possible declines in overall health, absent or uninvolved relatives or children, economic struggles can all add to the feeling of isolation. Among the elderly, childlessness can be a cause for social isolation. Whether their child is deceased or they didn't have children at all, the loneliness that comes from not having a child can cause social isolation.[5] Retirement, the abrupt end of daily work relationships, the death of close friends or spouses can also contribute to social isolation. .[6]

The loss of a loved one also contributes to social isolation. For example, if an individual loses a spouse, they lose their social support. They now must find some other kind of support to help them through this fragile time. Studies have showed that widows that keep in contact with friends or relatives have better psychological health. A study conducted by Jung-Hwal Ha and Berit Ingersoll-Dayton concluded that widows that had a lot of social contact and interactions lead to fewer depressive symptoms. During a time of loss social isolation is not beneficial to an individual's mental health.[7]

Although objective social isolation can affect perceived social isolation (loneliness), it is perceived isolation that is more closely related to the quality than quantity of social interactions.[8] This is in part because loneliness is influenced by factors unrelated to objective isolation, including genetics, childhood environment, cultural norms, social needs, physical disabilities, and discrepancies between actual and desired relationships. Accordingly, perceived social isolation predicts various outcomes above and beyond what is predicted by objective isolation.[citation needed] Research by Cole and colleagues showed that perceived social isolation is associated with gene expression — specifically, the under-expression of genes bearing anti-inflammatory glucocorticoid response elements and over-expression of genes bearing response elements for pro-inflammatory NF-κB/Rel transcription factors.[9] This finding is paralleled by decreased lymphocyte sensitivity to physiological regulation by the hypothalamic pituitary adrenocortical (HPA) axis in lonely individuals, which together with evidence of increased activity of the HPA axis, suggests the development of glucocorticoid resistance in chronically lonely individuals.[citation needed]

Throughout the past two decades social isolation has increased causing family interaction and communication to decrease. Individuals lack the feeling of being able to approach others in order to find comfort, seek advice or physically and emotionally network with.[10]

Risk factors[edit]

The following risk factors contribute to reasons why individuals distance themselves from society.[2][11]

• Health and disabilities - People may be embarrassed by their disabilities or health issues so they have a tendency to isolate themselves to avoid social interaction out of fear that they would be judged or stigmatized.
• Loss of a spouse - Once a spouse has died, the other person may feel lonely and depressed.
• Living alone.
• Unemployment.
• Aging - Once a person reaches an age where issues such as cognitive impairments and disabilities arise, they are unable to go out and be social.
• Transportation issues - If the person doesn't have transportation to attend gatherings or to simply get out of the house, they have no choice but to stay home all day which can lead to those feelings of depression.
• Societal adversity - Desire to avoid the discomfort, dangers, and responsibilities arising from being among people. This can happen if other people are sometimes or often rude, hostile, critical or judgmental, crude or otherwise unpleasant. The person would just prefer to be alone to avoid the hassles and hardships of dealing with people.

Perspectives[edit]

According to James House, when it comes to physical illness, "The magnitude of risk associated with social isolation is comparable with that of cigarette smoking and other major biomedical and psychosocial risk factors. However, our understanding of how and why social isolation is risky for health — or conversely — how and why social ties and relationships are protective of health, still remains quite limited."[12]

The research of Brummett[13] shows that social isolation is unrelated to a wide range of measures of demographic factors, disease severity, physical functioning, and psychological distress. Hence, such factors cannot account for or explain the substantial deleterious effects of social isolation.

However, they also show that isolated individuals report fewer interactions with others, fewer sources of psychological/emotional and instrumental support, and lower levels of religious activity. The obvious question is whether adjusting for one or more of these factors reduces the association of social relationships/isolation with health, and which factors constitute the active ingredient in social isolation producing its deleterious effects on health.

There are things people can do to help those who are socially isolated. According to Boufford, "many cities, with encouragement from the World Health Organization, are developing age-friendly initiatives for all seniors, regardless of their location. Specifically, they seek to improve transportation, housing, social inclusion, community support and health services."[14] In addition, paying attention to the person who is socially isolated can make a difference. Taking a day to spend time with someone can change their perspective on life.[citation needed]

A common sense notion frequently expressed is that social relationships beneficially affect health, not only because of their supportiveness, but also because of the social control that others exercise over a person, especially by encouraging health-promoting behaviors such as adequate sleep, diet, exercise, and compliance with medical regimens or by discouraging health-damaging behaviors such as smoking, excessive eating, alcohol abuse, or drug abuse.[citation needed] Another hypothesis is that social ties link people with diffuse social networks that facilitate access to a wide range of resources supportive of health, such as medical referral networks, access to others dealing with similar problems, or opportunities to acquire needed resources via jobs, shopping, or financial institutions. These effects are different from support in that they are less a function of the nature of immediate social ties but rather of the ties these immediate ties provide to other people. Also, social isolation can sometimes go hand in hand with mental illness because of behaviors mentioned beforehand.[citation needed]

In social animal species in general[edit]

Yet another hypothesis proposed by Cacioppo and colleagues is that the isolation of a member of social species has deleterious biological effects. In a 2009 review, Cacioppo and Hawkley noted that the health, life, and genetic legacy of members of social species are threatened when they find themselves on the social perimeter.[8] For instance, social isolation decreases lifespan in the fruit fly; promotes obesity and Type 2 diabetes in mice;[15] exacerbates infarct size and edema and decreases post-stroke survival rate following experimentally induced stroke in mice; promotes activation of the sympatho-adrenomedullary response to an acute immobilization or cold stressor in rats; delays the effects of exercise on adult neurogenesis in rats; decreases open field activity, increases basal cortisol concentrations, and decreases lymphocyte proliferation to mitogens in pigs; increases the 24 hr urinary catecholamines levels and evidence of oxidative stress in the aortic arch of rabbits; and decreases the expression of genes regulating glucocorticoid response in the frontal cortex of piglets.

Social isolation in the common starling, a highly social, flocking species of bird, has also been shown to stress the isolated birds.[16]

Indicators[edit]

A person showing the following signs may be socially isolated: depression, mental disorder, mood disorder, inability to connect with others, refusal to leave the house, and avoiding people[17] in addition to being anxious, nervous and keeping the door closed to lessen the ability of others to reach them.[1]

Click to expand...

Alone and Without Purpose: Life Loses Meaning Following Social Exclusion

Tyler F. Stillman, Roy F. Baumeister, Nathaniel M. Lambert, A. Will Crescioni, C. Nathan DeWall, and Frank D. Fincham

Where do people find meaning in life? In principle, people could find meaning in communing with nature or with divinity, engaging in philosophical or religious contemplation, pursuing scientific or artistic or technological innovation, or other potentially solitary pursuits. Life’s meaning does not obviously or inherently depend on social relations. Yet in practice, it seems likely that people find meaning in their social relations. Unlike most other animals, humans obtain much of what they need from their social group, rather than directly from the natural environment. Consequently, the human capacity for sociality and for participation in culture likely evolved to facilitate survival (Baumeister, 2005; Dunbar, 1993, 1997). Hence social exclusion could threaten people at such a basic level that it would impair their sense of meaningful existence, as suggested by Williams (1997; 2002). A related prediction is made by Twenge, Catanese, and Baumeister (2003), who proposed that one effect of social exclusion is a retreat from meaningful thought. In the present investigation, we tested the hypothesis that social exclusion causes a global decrease in the perception of life as meaningful.

Meaning.

Literally, meaning refers to a nonphysical reality inherent in the relationship between a symbol or representation and that to which it refers. By meaning of life, however, people typically intend not a dictionary definition of life but rather a way to make sense of their existence. This subjective evaluation of the meaningfulness of one’s life is how meaning is traditionally assessed (e.g., Crumbaugh & Maholick, 1964; Mascaro & Rosen, 2006). For instance, the Meaning in Life Questionnaire asks participants to rate their agreement with statements such as “My life has a clear sense of purpose” (Steger, Frazier, Oishi, & Kaler, 2006).

The belief that one is living a meaningful life is associated with positive functioning. This includes satisfaction with life (Chamberlain & Zika, 1988), enjoyment of work (Bonebright, Clay, & Ankenmann, 2000), happiness (Debats, van der Lubbe, & Wezeman, 1993), positive affect (Hicks & King, 2007; King, Hicks, Krull, & Del Gaiso, 2006), and hope (Mascaro & Rosen, 2005). Perceiving life as meaningful is even associated with physical health and general well-being (Reker, Peacock, & Wong, 1987; Ryff, 1989; Ryff & Singer; 1998; Wong & Fry, 1998; Zika & Chamberlain, 1987; 1992). Higher levels of perceived meaning are also associated with lower levels of negative functioning, including psychopathology (Crumbaugh & Maholick, 1964), stress (Mascaro & Rosen, 2006), need for therapy (Battista & Almond, 1973), suicidal ideation (Harlow, Newcomb, & Bentler, 1986), and depression (Debats et al, 1993; Mascaro & Rosen, 2005). Steger (in press) provides a comprehensive treatment of the benefits of perceiving meaning in life.

Based on a review of empirical findings on a broad array of topics including love, work, religion, culture, suicide, and parenthood, Baumeister (1991) concluded that the human experience is shaped by four needs for meaning, which can be understood as four ingredients or criteria of a meaningful life. First, a sense of purpose is reached when people perceive their current activities as relating to future outcomes, so that current events draw meaning from possible future conditions. Second, people desire feelings of efficacy. People feel efficacious when they perceive that they have control over their outcomes and that they can make a difference in some important way. Third, people want to view their actions as having positive value or as being morally justified. That is, people are motivated to act in a way that reflects some positive moral value, or at least to interpret their behavior as conforming to ideals and standards of what is approved and acceptable. Fourth, people want a sense of positive self-worth. They seek ways of establishing that they are individuals with desirable traits. Finding some way of believing oneself to be better than other people seems to be a common form of this need for meaning.

All four of these needs for meaning must be based on one’s daily experiences (Baumeister, 1991; Sommer, Baumeister, & Stillman, in press). In other words, satisfying these needs must be achieved through one’s actual experience in life. Thus, the events that directly affect meaning in life—perhaps including social exclusion—will likewise affect one’s senses of purpose, efficacy, value, and/or positive self-worth.

Social Exclusion.

The formation and maintenance of positive close relationships can aptly be characterized as one of the primary motivations for human beings (Buss, 1990; Maslow, 1968). This pervasive drive has been described as the need to belong (Baumeister & Leary, 1995). We define social exclusion as a perceived deficit in belongingness.

Past research has used two main approaches to studying social exclusion, and the present investigation used both. One research approach has centered on experimentally administered social rejection, in which participants are led to believe that others have rejected them (or will reject them) as social interaction partners (e.g., Bushman, Bonacci, Van Dijk, & Baumeister, 2003; DeWall, Twenge, Gitter, & Baumeister, in press; Maner, DeWall, Baumeister, & Schaller, 2007; Williams, 2002; Williams & Sommer, 1997). The other approach has used individual differences in chronic loneliness. Most such work relies on self-ratings and self-reports (e.g., Cacioppo et al., 2006). Both approaches have merits. The experimental approach can use controlled manipulations to test causal hypotheses, while the loneliness approach uses feelings of exclusion as experienced out of the laboratory and thus has greater external validity than the laboratory manipulations. In the present work, we tested the effect of exclusion on meaning using both loneliness and social rejection as operationalizations of exclusion.

To be sure, the difference between loneliness and rejection is not simply methodological; people who are generally lonely can experience moments of inclusion and people who experience rejection are not necessarily lonely. Yet there are important similarities between rejection and loneliness, the most salient of which is that they are both deficits in belongingness; loneliness is a protracted and negatively valenced feeling of social exclusion (Peplau & Perlman, 1982), whereas rejection is a pointed, specific instance of social exclusion. The overlap between rejection and loneliness has been demonstrated empirically by research showing that social rejection often results in feelings of loneliness (Boivin, Hymel, & Burkowski, 1995; Cacioppo, Hawkley & Berntson, 2003; de Jong-Gierveld, 1987). We consider both loneliness and rejection important forms of social exclusion, such that the assessment of both provides a more complete understanding of the effects of belongingness deficits than assessing either one alone. Convergence across different methods and measures provides valuable confidence that conclusions are not artifacts of one method but rather reflect general patterns. If both laboratory-administered rejection and chronic feelings of loneliness converge in predicting a low sense of meaningfulness in life, then one may have confidence that the hypothesis linking meaning to belongingness has broad validity.

Social Exclusion and Meaning.

Why should social exclusion reduce the sense of life as meaningful? The pervasive reliance on social connection as humankind’s biological strategy entails that people are deeply motivated to connect with other people as a fundamental aspect of nearly all human striving. Meaning itself is acquired socially. Hence to be cut off from others is potentially to raise the threat of losing access to all socially mediated meanings, purposes, and values.

Prior work suggests that social exclusion reduces some meaningful thought, though this has generally not extended to the broad sense of whether life itself is meaningful. Twenge et al. (2003) found that social exclusion caused people to seek refuge in a state of cognitive deconstruction, characterized by decreased meaningful thought, as well as lethargy, altered time flow, the avoidance of emotion, and decreased self-awareness. In one study, participants who were told they were exceptionally well-liked and popular responded more favorably to a single item about life being meaningful than participants who were socially rejected, though the design of that study lacked a neutral control and so there was no way of knowing whether the difference was due to acceptance or rejection.

Williams (1997, 2002) theorized that being ostracized (a repeated form of social exclusion) impairs multiple psychological needs, including the need for a meaningful existence (as well as belongingness, self-esteem, and control). He and his colleagues have provided evidence that being ostracized reduces the ratings of meaningfulness of specific events (Sommer, Williams, Ciarocco, & Baumeister, 2001; Van Beest & Williams, 2006; Williams, Cheung, & Choi, 2000; Zadro, Williams, & Richardson, 2004). In particular, when confederates gradually cease to throw the ball to the participant as part of a ball-tossing game, participants tend to rate their participation in the game as relatively less meaningful, as compared to participants who continue to be included in the game (e.g., Zadro et al., 2004). Although such findings suggest some loss of meaning, they may reflect participants’ accurate perception that they were not involved in the game.

Recent work using the computerized ball-tossing procedure (dubbed Cyberball) took a step toward assessing whether exclusion affects global perceptions of meaning in life by assessing meaning both immediately following social exclusion and again after a delay (Zadro, Boland, Richardson, 2006). Immediately following exclusion, there was a reduction in a composite measure of well-being that included a meaning dimension (e.g., feeling non-existent while playing the game) as well as the three other proposed needs. Forty-five minutes later, participants responded to similar questions, except that they were asked to provide their current feelings—those not tied directly to the exclusion experience (e.g., feeling non-existent right now). Although exclusion did not have a significant effect on the composite measure, there was an interaction between social anxiety and experimental condition, such that those high in social anxiety reported significantly lower composite scores than those low in social anxiety following social exclusion. These findings suggest that exclusion may affect meaning in a global way rather than in reference to the exclusion event, and that the effects of exclusion on meaning are most likely to be observed immediately following the exclusion event. The present research sought to build on these findings and to extend them.

Click to expand...

“There are a lot of people walking around who feel that they don’t fit in, they don’t belong. That sense of disconnection is really common. But when you realize that you’re like everyone else, not only in your dreams and passions but also in your pain and sadness, there’s incredible comfort in that.”

Click to expand...

How the Stress of Disaster Brings People Together

New evidence that men are more likely to cooperate in difficult circumstances
Nov 6, 2012 |By Emma Seppala

Ever feel that stress makes you more cranky, hot-headed or irritable? For men in particular, we think of stress as generating testosterone-fueled aggression – thus instances of road rage, or the need to “blow off steam” after work with a trip to the gym or a bar. On the other hand, in circumstances of extreme stress such as during natural disasters like Hurricane Sandy, we hear moving accounts of people going out of their way to help others. Hurricane Sandy has led to a flourish of supportive tweets and Facebook messages directed to people on the East Coast. The tsunami in Asia a couple of years ago led to a huge influx of financial support to help afflicted areas. Many who lived in New York City during 9/11 remember that, for a few days afterward, the boundaries and class divisions between people dissolved: people greeted each other on the street and were more considerate, sensitive to each other, and gentle than normal.

The classic view is that, under stress, men respond with "fight or flight,” i.e. they become aggressive or leave the scene, whereas women are more prone to “tend and befriend,” as has been shown in research by Shelley Taylor. A new study by Markus Heinrichs and Bernadette von Dawans at the University of Freiburg, Germany, however, suggests that acute stress may actually lead to greater cooperative, social, and friendly behavior, even in men. This more positive and social response could help explain the human connection that happens during times of crises, a connection that may be responsible, at least in part, for our collective survival as a species.

In Heinrichs’ and Dawans’ study, male participants were assigned to either an experimental group, with a stress procedure (a public speaking exercise followed by a complicated mental arithmetics), or a control group with no stress. They all were then asked to play an economics game involving potential financial gain based on the choices they make. In this game, they could choose to cooperate with others and trust them or not. The researchers found that, rather than becoming more aggressive after stress, men in the stress group actually became more trusting of others, displayed more trustworthy behavior themselves, and were more likely to cooperate and share profits. The researchers also found that these results were not due to weakened judgment in the stress group: the stress group did not differ from the control groups in their ability to make decisions or their willingness to sanction another participant who behaved unfairly.

One reason why stress may lead to cooperative behavior is our profound need for social connection. Human beings are fundamentally social animals and it is the protective nature of our social relationships that has allowed our species to thrive. Decades of research shows that social connection is a fundamental human need linked to both psychological and and physical health including a stronger immune system, faster recovery from disease and even longevity.

Social connection may be particularly important under stress because stress naturally leads to a sense of vulnerability and loss of control. A study by Benjamin Converse and colleagues at the University of Virginia found that feeling out of control (through a reminder of one’s mortality) leads to greater generosity and helpfulness while research at Stanford University by Aneeta Rattan and Krishna Savani showed that the opposite is true when we are primed with feelings of self-determination and control. Think back to a time when you felt out of control, for example during a romantic break-up, when you had an empty bank account, or lost a job. Chances are your feeling of vulnerability and feelings of lack of control may have made you seek the comfort of others in some way. Brene Brown, Professor at the University of Houston Graduate College of Social Work and expert in the field of social connection, explains that vulnerability is a core ingredient of social bonding.

War is one of the greatest stresses anyone could ever encounter yet it also often leads to deep human friendships and incredible acts of heroism and sacrifice for one other. In my research with returning veterans, I have often heard them speak of the tight bond that occurs between servicemembers on the battlefield — one of the most stressful situations that exists. Countless soldiers have perished running into a line of fire to save an injured brother-in-arms. Some believe that it these experiences of profound human bonding that, despite the acute anguishes of war, makes some veterans long to return to war.

If stress leads to bonding, why then do we sometimes experience stress as making us cranky? The cause may be explained by a difference between acute and chronic stress. We know from research by Robert Sapolsky that acute stress prepares the body for resistance (physiological readiness, increased immune response, and heightened awareness) but that chronic stress slowly beats down the body. It may be that “acute” stress, i.e. a one-time stressful experience may lead to social bonding, as shown in the study, but that “chronic” stress, i.e. repeated exposure to stress over a long period, might wear us out. More research is needed to thoroughly examine the impact of chronic stress on social behavior.

Acute stress may help remind us of a fundamental truth: our common humanity. Understanding our shared vulnerability — life makes no promises — may be frightening, but it can inspire kindness, connection, and desire to stand together and support each other. Acute stress, as unpleasant as it may be, may also be an opportunity to experience the most beautiful aspects of life: social connection and love.

Click to expand...

Community connections and social capital: especially important in times of disaster

How well do you and your neighbours know each other?

In the season of fires and floods, this is an important question, as research shows that well-connected communities do better at responding to and coping with disasters, according to public health researcher Professor Penny Hawe.

In the article below, she explains why social capital is especially important in times of disaster.

This article was first published in the December 2011 edition of Insight, published by the Victorian Council of Social Service (VCOSS) with the theme, Emergency Management: Trauma and Resilience. It can be downloaded here: http://vcoss.org.au/pubs/insight_issues/issue_5.htm

***

Resilience: finding the right ingredients

Penny Hawe writes:

The day before I was due to pick up two dozen cupcakes from the bakery in Lorne, there was a message on my phone asking what kind of passionfruit icing I wanted.

The butter cream swirly type or the hard shiny fondant?

I took a note of the name of the caller and phoned back. The swirly type please.

The next day 24 little works of art were stacked up into three boxes waiting for me. As the baker’s daughter and I carried them to my car, I said:

“You’re Cleo, right?”

“Yes,” she replied.

“I’m Penny.”

“Yes, I knew you, but I didn’t know your name. Hi.”

“Hi.”

I now know 23 people in Lorne by name to say ‘hello’. I know some people well enough to stop and chat. Two and a half years ago I would not have known any of them.

Nor would I have appreciated the significance of this.

But I now know how my connections with people in my coastal town could save my life. Although that is not my reason for buying cupcakes.

In February 2011 my husband and I returned to Australia after ten years of living in Canada. Our former holiday home in Lorne is now our permanent residence.

Like an episode of SeaChange we are shaping a new life in a new community – pulling out weeds with Lorne Care, dragging our labrador to dog obedience class, taking our turn on the roster for the historical society.

Two years earlier, on Black Saturday, we were also in Lorne. At that time we were holidaymakers swapping minus 25 degree Celsius temperatures in Canada for the blistering dry, windy, 40-plus heat that swept Victoria that day.

Many of the long-term residents were probably thinking of the 1983 Ash Wednesday fires. That was when a spark from a sawmill in Deans Marsh started a fire that was burning houses in Lorne within 15 minutes. On Black Saturday 2009 a cool change breezed into Lorne by the late afternoon. Relief was coupled with sickening guilt, knowing that this time other communities had copped it instead.

Reviewing the evidence

Two days later, on my way back to Canada, I got the request from the Victorian Department of Health to put together a review of the evidence and set of recommendations that would help Victoria rebuild the fire-affected communities around Kinglake.1

So for the next two months, while the temperature in Calgary gradually rose to a balmy minus 15, I immersed myself in the international evidence on best ways to help rebuild the social fabric of communities that have been burnt to a cinder.

I learned a lot.

First up though, I believe we have to pause and admire the policy makers in the Victorian Department of Health. When politicians would have been breathing down their necks, they had the steady nerve to think, ‘Hang on, there must be right ways and wrong ways of going about community rebuilding and betterment. Let’s find out.’

Sure enough, for a start, there was evidence on what not to do. For years ‘psychological debriefing’ had been used after disaster events until some canny research showed that it actually did more harm than good.2,3

It was also evident that many traditional practices in aiding community recovery were largely unevaluated. Much money had been thrown at disaster recovery, but not enough people were figuring out what strategies worked best.

On top of that it was clear that the Victorian Heath Department’s interest in seeking the evidence to foster a strong, community-led recovery was not wacky or out of order at all. It was in keeping with what the Australasian Journal of Disaster Management had been calling for since 1997.4

But the cries were largely ignored, perhaps, since the call for involving communities in all aspects of decision-making had been repeated everywhere. Even as late as the Canberra bushfires in 2003, some government and community agencies were unaware or forgetful that playing a personal role in community reconstruction is an important part of community healing.5

Social capital is crucial

But the highlight for me – and you must forgive me for being an academic, but I do experience ‘highlights’ just from reading stuff – was the work by the Disaster Research Centre at the University of Delaware.

They showed how people’s social capital explained the well-known differential impact of disasters.6

People who live alone get left under buildings. People with friends and relatives know that they are missing and where to look. People on their own don’t seek help about symptoms experienced in the aftermath. People with family get nagged into it. People evacuate early when they feel obliged to act in ways that will reduce threat to others. People on their own wait.

Even warning messages broadcast on public radio or television are mediated through social networks. Communication processing involves hearing a message, understanding, believing, personalising and then responding. What processes all of this for us is other people. We hear and interpret through them.

This explains why the newly arrived, less connected, ‘tree change’ residents in the Tasmania bushfires in 2006 had lower preparedness and worse outcomes.7

They are like the extra nine or ten thousand people who can swell the population of Lorne in January, outnumbering the permanent residents ten to one. They are potential babes in the wood, when it comes to appreciating the gravity of a warning message.

So that’s why I am thinking about who I know in Lorne this summer. The Country Fire Authority wants people across the state to do fire plans, as residents or as possible travellers on high fire danger days.

I want to discuss my fire plan with my new neighbours, friends and acquaintances. I will be wiser for it and by knowing each other’s plans, we can back each other up.

Community connections

It follows from this that any initiatives that build connections between people in fire vulnerable areas could be thought of as mediators of disaster impact and accorded appropriate respect. Arts projects. Sports projects. Environment projects. The people you meet when you band together to fight off development of the foreshore.

Knowing names and making connections should be viewed as a success indicator for such ventures – alongside the sculptures erected, events held and community gardens planted.

Of course I am acutely aware that in an emergency, among my neighbours, there are those who can drive fire trucks, those who can make fire breaks and those who can deal with fallen power lines.

I, on the other hand, stand out somewhat lamely as a person who can do a literature review. I can’t see myself being called on too often for that.

But we enjoy living here and we are being made welcome. And that, in a place as beautiful as Lorne, is like the icing on the cake.

• Professor Penelope Hawe is the founder of the Population Health Intervention Research Centre at the University of Calgary, Canada, where she continues to work part-time, mostly by telecommuting. She is the author of Community recovery after the February 2009 bushfires: A rapid review, an evidence checkreview brokered by the Sax Institute for the Victorian Department of Health in 2009.

References

1. Hawe P, Community recovery after the February 2009 bushfires: A rapid review,

An evidence check review brokered by the Sax Institute for the Public Health Branch, Victorian Government, Department of Health, 2009, available at http://www.health.vic.gov.au/healthpromotion/downloads/bushfire_rapid_review.pdf

2. Raphael B, Wilson JP Eds, Psychological Debriefing: Theory, Practice and Evidence, New York, Cambridge University Press, 2000.

3. Forbes D, Creamer M, Phelps A, Bryant R, McFarlane A, Devilly G, et al, ‘Australian guidelines for the treatment of adults with acute stress disorder and post-traumatic stress disorder’, Australian and New Zealand Journal of Psychiatry, 2007, vol. 41, no. 8, pp. 637-48.

4. Paton D, ‘Disaster and trauma studies: developing an Australasian perspective’.Australasian Journal of Disaster and Trauma Studies, 1997, vol. 1.

5. Camilleri P, Healy C, Macdonald E, Nicholls S, Sykes J, Winkworth G, & Woodward M, Recovering from the 2003 Canberra Bushfires. A Work in Progress, Report prepared for Emergency Management Australia, Australian Catholic University, 2007.

6. Dynes RR, ‘Social capital: Dealing with community emergencies’, Homeland Security Affairs, 2006, vol. 2, no. 2, pp. 1-26.

7. Prior T & Paton D, ‘Understanding the context: The value of community engagement in bushfire risk communication and education: Observations following the East Coast Tasmania bushfires of December 2006’,
Australasian Journal of Disaster and Trauma Studies, 2008, vol. 2.

***

Click to expand...