Posts tagged Mental health
Neurodiversity:an interview with Dr. Thomas Armstrong
Jul 31st
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I recently read ‘Neurodiversity: discovering the extraordinary gifts of Autism, ADHD, Dyslexia and other brain differences‘ (you can read a mini review here) by Dr. Thomas Armstrong and came away impressed. In the book Dr Armstrong makes a strong case for viewing the traditional disabilities from a differences perspective and to focus on the different strengths and abilities of the neurodiverse people. A recurring theme of this blog has been that autism and schizophrenia/psychosis are opposites on a continuum model as proposed amongst others by Christopher Badcock and Beranard Crespi. Dr Armstrong touches on this model in his chapter on autism, though that not central to his theis .
Dr Armstrong, was kind enough to answer a few questions for the benefit of our readers and these are reproduced below:
[SG] You have written a wonderful book on neurodiversity. Could you explain in brief, for the benefit of our readers, why neurodiversity has become so important in today’s context and why the focus on neurodiversity now when the differences that underlie the neurodiverse spectrum themselves are age-old?
[TA] I think neurodiversity is, as I’ve suggested in my book, “a concept whose time has come” because of the disability culture we live in. Almost half of us will have mental disorders sometime during our lifetime according to the National Institute of Mental Health, and even more will have “shadow syndromes” or minor versions of those disorders. When we get to the point where virtually everyone is seen as having a mental disorder to one degree or another, I think it’s time that we shift paradigms and use a diversity model instead of a disability model to account for those differences.
[SG] How much does neurodiversity owe to the Autistic advocacy movement and whether those beginnings are productive or counterproductive when one wants to bring other differences like mood or anxiety differences in the fold and talk about them as well?
[TA] I believe that the autistic advocacy movement deserves a great deal of credit for coining and developing the idea of neurodiversity. It’s rather amazing that a group of people who are known for their non-social attributes have made this contribution to our social understanding of brain differences. My hope is that my book Neurodiversity will help to broaden the concept of neurodiversity to include a wider range of abilities/disabilities. As far as I can see from looking at many sites online, there is an openness in the autism community to expanding the definition of neurodiversity beyond simply autism and Asperger’s syndrome.
[SG] Positive Psychology shares some of the same concerns as that of the Neurodiverse movement- the focus on strengths and what works and skepticism about the disease and pathology model- yet why hasn’t, in your opinion neurodiversity become center stage like the positive psychology movement has? Is it because in neurodiversity we are swinging the pendulum too much to the other side and perhaps blinding ourselves to underlying pathologies by claiming everything as differences?
[TA] No, I think it has to do with the credibility of the leadership of the Positive Psychology movement – spearheaded by a former president of the American Psychological Association and other famous professors of psychology. It’s essentially a top-down movement, whereas neurodiversity seems to me to be a bottom-up or “grass roots” movement that is coming from the people who are actually themselves neurodiverse. I don’t think of the neurodiversity movement as saying “we’re all different so leave us alone” I believe that attention needs to be given to ameliorating the disability part of neurodiversity, even as we focus the spotlight on the abilities.
[SG] For the benefit of our readers, if you could highlight the differences between the dimensional and categorical model of pathologies/differences. I believe neurodviversity leans towards the dimensional (continuum ) model. What can DSM V learn form the findings you have discussed in the Neurodiversity book? is a dimensional model of pathology a better one as compared to the categorical one? a necessary evil? or can the DSM mentality be done away with altogether?
[TA] One of the eight principles that I discuss in my book Neurodiversity is that everyone exists along “continuums of competence” with respect to a range of human processes including sociability, literacy, intelligence(s), attention, mood, and so forth. This is very similar to the DSM-V’s embracing of a dimensional perspective, and to that extent, I think the DSM-V is moving in the right direction. The problem is that the DSM-V will be a high stakes publication, and if people are put on a continuum from normal to pathological, the fuzzy line where normal becomes pathological (and vice versa) becomes very important, and may determine whether a person will be labeled with a disorder, given a drug treatment, and perhaps even stigmatized as a result. There’s a danger that many so-called normal people will be added to the ranks of the mentally disordered. Also, what’s missing from the DSM (in all its versions) is any kind of discussion of the positive dimensions of each of the disability categories.
[SG] Just like DSM, positive psychologists have come up with a list of character strengths and virtues as for ex can be seen on VIA signature strength website. Do you think those lists are sufficiently inclusive and give equal weighting to the special abilities found in neurodiverse individuals?
[TA] I think the VIA-IS (or Values in Action Inventory of Strengths) is a positive contribution to our understanding of human personality. It would be good to see someone take this inventory and map it onto the various pathologies taken up in the DSM-V. Wedding the two manuals would be a definite step in the right direction.
[SG] How much yours and your fathers experience of depression has been a driving force in your passion for psychology and especially instrumental in your focusing energies on the neurodiverse people.
[TA] I think it’s been very much a contributory factor. Seeing how my father’s depression affected our family’s functioning while growing up, and how my own depression has shaped my adult life, has been extremely influential in leading me to the field of psychology, and in trying to find the silver lining beyond the dark cloud.
[SG] People who are on extremes of the neurodiverse spectrum face immense stigma in our society. Your chapter on neurodiverstity in classroom talks about inclusive classrooms as you believe special classrooms for special ed programs end up labeling children. How practical you think is the concept of a neurodiverse classroom, esp in developing countries like India. Is a special ed class, even if it ends up labeling a child, better than no intervention at all and traditional classroom education only?
[TA] In a system based on traditional classroom learning, I believe that special education programs outside of the traditional classroom have a place, especially if they are using cutting-edge techniques for helping kids with special needs. But as an educational reformer, I am always pressing educators to expand beyond traditional learning environments for all kids, and when we utilize teaching methods that are good for all kids, we end up helping kids with special needs in the process.
[SG] Niche construction appears to be one of the special focus of your book. would you support or recommended special reservations in jobs/academics for neurodiverse people who may do especially well in those particular niches? For ex. would you favor a legislation that mandated for reservation for autistic people in computer testing industry. I’m thinking of cultural diversity guidelines in colleges, should we have similar neurodiversity guidelines too?
[TA] Are you talking about affirmative action for neurodiverse people? If so, then I believe there might be some merit in exploring how this might work. ([SG] note: yes, I was indeed talking about affirmative action; in India we typically refer to the issue as that of reservations!)
[SG] How did the writing of Neurodiversity enrich you as an individual. wWat can readers hope to take away from the book?
[TA] I wrote Neurodiversity while in the midst of a major depressive episode. At times I could hear myself saying “why are you looking at the strengths of these disorders, for God’s sake, when you know that they’re hell to deal with?” But there was another part of me, an intuitive part I believe, that instinctively believed it was important for me to bring strengths into the discourse about mental disabilities. I hope that readers will see this book as a supplementary guide to all the other books on disabilities that focus on the negatives. It’s important that we see both sides of the issue. We are, after all, whole human beings, with a great deal of complexity and richness. I hope that readers will take away a sense of this richness in the diversity of minds that make up humanity.
I would like to thank Dr Armstrong for taking some time off for the interview and would recommended the readers to read up some of his books, many of which focus on the special abilities and aptitudes of the neurodiverse people.
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Am happy, will broaden-and-build; am angry, will narrow-and-save
Apr 28th
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Regular readers of this blog will be aware of my conception of positive emotions in terms of promotion focus and negative emotions in terms of prevention focus. Today I will try to relate this to the specific action-tendency theory of negative emotions and broaden-and-build theory of positive emotions (as proposed by Barbara Fredrickson).
First its instructive to distinguish between negative and positive emotions. Negative emotions, like Fear, Anger, Disgust, traditionally have been conceptualized as specific action tendencies that get triggered or activated by particular type of threatening situations/stimuli. I view them as sensory driven. A stimuli impinges and is either presumed to be attacking/trespassing (thus arousing anger) or dangerous and threatening survival (thus arousing fear) or intimidating and overbearing (thus arousing sadness and disengagement) or sickening and to be avoided (thus arousing disgust) ; in all cases a stimuli or situation acts as an immediate trigger for a specific action tendency – that of defending, fighting or fleeing, disengaging and surrendering or vomiting and keeping away.
In contrast consider positive emotions like Joy, Interest, Contentment and Love. They all happen when the environment is safe and bodily needs are met- they are not need driven, but growth oriented. They are not based around survival, but around growth. they are non -specific thought action repertoire that is a broadened set and is not narrowly focused- rather one of the prime effects of positive emotions is to broaden attention, thought/cognition, actions and interactions. I consider them as motor driven. they are not a response to a stimulus. Rather they are specific patterns of spontaneous action tendencies and opportunities to practice giving outlet to ones spontaneous action tendencies in a safe environmental. That is why every sort of play- be it physical rough-and-tumble or intellectual play of creativity or social play of flirting – is associated with the positive emotions.
To make my analogy more clear consider the fact that actions can be classically conditioned (and thus response to US/CS stimulus) or operant conditioned (and thus not reactive or reflexive but intrinsically driven and proactive) and while former may be more or less determined by the external stimulus and internal associations and is deterministic in nature, the latter has spontaneous behavioral variability and initiation as its premise and has room for free will. What I claim today is that negative emotions are reactive and thus keep you stuck in deterministic rut, while positive emotions are expansive and provide opportunities for exercise of free will in safe and playful environments by encouraging spontaneous behavioral fluctuations and felkxibility.
It has been found time and again that positive emotions are associated with a broadening and resource-building effect. Consider Joy. It encourages one to engage in acts for acts sake or encourages rough and tumble play- it builds physical resources. Consider Interest . It encourages one to engage in exploration of a domain- be it actual physical domain or conceptual domain – it builds cognitive maps and cognitive or intellectual resources. Consider contentment. It encourages one to engage in reflection and self assessment and self integration – it builds psychological resources. consider Love (care-giving variety not romantic which is pathological and more of a negative emotion). It encourages one to engage in reciprocal interactions and to explore, act on and reflect on the other- it builds social resources.
Thus it is evident that positive emotions do help to broaden and build. That much has been proved by Barbara’s research program . My additional claim is that negative emotions are sensory oriented and reactive while positive emotions are motor oriented, spontaneous and proactive. By signalling safe environments in which behavioral flexibility can be played around with they push us to relate to life more intrinsically.
Perhaps another analogy will be relevant. there is a sympathetic nervous system and there is parasympathetic system. the sympathetic system helps us respond to stressful situations and readies the body. the parasympathetic restores the body and helps in regeneration of the body. So do negative emotions help us react to outside threats and make the mental-illness dimension while positive emotions help match intrinsic activity to opportunities in the environment and makes the mental health dimension.
The former (mental illness continuum) is a zero sum game- if I win someone looses. For eg if a dominance hierarchy is there and I am on top I may feel manic while the person at bottom may feel depressed..but as long as dominance and survival and predation and germs are there the negative emotions would be there …the latter (mental health continuum) is a win-win game. There are more opportunities for everyone to fare better if everyone is positioned high on mental health spectrum as then doors to creativity and productivity open right then and there for all concerned. thus, I have become an advocate of the positive psychology movement and would like more efforts devoted to study of positive emotions.
Fredrickson, B. (1998). What good are positive emotions? Review of General Psychology, 2 (3), 300-319 DOI: 10.1037//1089-2680.2.3.300
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Happiness opposed to despair/ennui; sadness to anger/irritability
Mar 7th
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We normally view happiness and sadness to be opposites on a single continuum, but I propose that it is time to change the textbooks and view happiness as opposed to ennui/despair and sadness as opposed to anger/irritability when it comes to basic opponent affects.
But before we go down that path first a detour.
I recently read Flourishing: edited by Keyes & Haidt , and the last article by Keyes caught my attention. I looked up a few more articles by Keyes and found this one that again elaborates on the theory put forward in the book chapter.
The point Keyes wants to make is that mental illness and mental health are two different things and are relatively independent of each other. Traditionally mental health has been conceptualized as the absence of mental illness, but Keyes says that our intuitions are incorrect here and mental health is another, parallel continuum on which people can differ.
Throughout human history, there have been three conceptions of health.The pathogenic approach is the first, most historically dominant vision, derived from the Greek word pathos, meaning suffering or an emotion evoking sympathy. The pathogenic approach views health as the absence of disability, disease, and premature death. The second approach is the salutogenic approach, which can be found in early Greek writings and was popularized by Antonovsky (1979) and humanistic scholarship (e.g., Carl Rogers and Abraham Maslow). Derived from the word salus, meaning health, the salutogenic approach views health as the presence of positive states of human capacities and functioning in thinking, feeling, and behavior (Stru¨mpfer, 1995). The third approach is the complete state model, which derives from the ancient word for health as being hale, meaning whole and strong. This approach is exemplified in the World Health Organization’s (1948) definition of overall health as a complete state, consisting of the presence of a positive state of human capacities and functioning as well as the absence of disease or infirmity. By subsuming the pathogenic and salutogenic paradigms, the whole states approach is, in my opinion, the only paradigm that can achieve true population health.
Thus when we talk of whole states mental health we are basically talking about two related things- a mental illness or disability dimension and a flourishing or mental health dimension. Keyes et al have performed confirmatory factor analysis on measure used to measure mental health and illness and found that the data is best explained by two latent factors-one related to flourishing and the other to illness.
This is how they define mental health or flourishing dimension.
Until recently, mental health remained undefined, unmeasured, and therefore unrecognized at the level of governments and nongovernmental organizations. In 1999, the Surgeon General, then David Satcher, conceived of mental health as “a state of successful performance of mental function, resulting in productive activities, fulfilling relationships with people, and the ability to adapt to change and to cope with adversity” (U.S. Public Health Service, 1999, p. 4). In 2004, the World Health Organization published a historic first report on mental health promotion, conceptualizing mental health as not merely the absence of mental illness but the presence of “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community” (World Health Organization, 2004, p. 12).
Keyes comes up with 13 symptoms of mental health and these include Positive emotions (i.e., emotional well-being) including positive affect and avowed quality of life; Positive psychological functioning (i.e., psychological well-being) consisting of self-acceptance, positive relations with others, personal growth, purpose in life, environmental mastery, and autonomy (see Keyes & Ryff, 1999); and Positive social functioning (i.e., social well-being) consisting of social coherence, social actualization, social integration, social acceptance, and social contribution. In DSM style they propose that individuals exhibit some minimum symptoms to classify as flourishing and those with very low scores be classified as languishing.
To be diagnosed as flourishing in life, individuals must exhibit high levels on at least one measure of hedonic well-being and high levels on at least six measures of positive functioning. Individuals who exhibit low levels on at least one measure of hedonic well-being and low levels on at least six measures of positive functioning are diagnosed as languishing in life. Adults who are moderately mentally healthy do not fit the criteria for either flourishing or languishing in life.
Keyes then goes on to show the costs of languishing and not focusing on mental health and why a narrow focus on cure/prevention of mental illness is detrimental, but that is beside the point as to today’s topic. what is most important take way for today is that there are two separate factors of mental health and mental illness.
This brings us back to the affects- happiness, sadness, ennui/despair and anger/irritability. Consider for a moment depression. It is an illness characterized by sad mood and anhedonia etc. Consider its counterpart on the illness spectrum. while a normal person not having depression may seem the counterpart, the real counterpart is mania which often has a angry/irritable mood (alongside euphoria) associated with it. Also depression is characterized as a reaction to losses/continuous exposure to stresses that makes goals out of reach/unachievable. Here the focus is preventive in nature- the state does not deteriorate further and goals do not remain unmet. However, depression or sad mood is also an avoidance reaction. One becomes withdrawn from the situation and does not fight the stress, but flights from the stress by withdrawing in a cocoon. The loss of appetite and more sleep can be seen as behavioral counterparts of withdrawing or exhibiting a flight response to stress.
As opposed to this, mania can be seen behaviorally as an active approach state in which one works actively towards the things required to overcome the loss of valued entity/life goal. Again, I propose that mania is a reaction to a situation similar to depression – when something is lost/ is under threat of losing- but this time , under stress, one fights and not flights- thus one becomes energized to right the wrong and may become angry/ irritable if the efforts to retain goals/ valued entities are frustrated by external world. It is important that both mania and depression are on the illness scale of functioning/ mental health and are a result of life trauma/ stress/ perceived/ real/ threat of loss of loved object/person. Thus the focus is preventive and the state is of scarcity.
Contrast this to a state of abundance when ones (life) goals have been met/ are within reach.// This apparent positive state of affairs may again give rise to different emotions/ behavioral manifestations depending on whether one has approach or avoidance dominant reaction. If one approaches the more free time available after goal accomplishment as a boon that can be used to home ones hobbies/find other meaning in life/ build relationships etc and not as a threat ( free time can be a threat) then one experiences positive emotion of happiness and behaviorally flourishes.
In contrast consider a similar person who has achieved everything in life – (a good job, wife, kids etc ) , but given the fact that one is living in abundance is frightened or flights from the free time that has been made available. that person will be listless, will exhibit ennui or boredom and may even exhibit despair as he finds life meaningless. Thus behaviorally he would languish.
Thus, I rest my case that happiness is opposed to ennui/despair while sadness is opposed to anger/irritability and while happiness is a measure of flourishing; sadness is a measure of illness. One can definitely conduct experiments , perform factor analysis to confirm, that indeed happiness and sadness is not a unitary construct, but are two separate but related dimensions. I would love to hear your comments.
Keyes, C. (2007). Promoting and protecting mental health as flourishing: A complementary strategy for improving national mental health. American Psychologist, 62 (2), 95-108 DOI: 10.1037/0003-066X.62.2.95
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Orchids wither with stress, but bloom with care
Mar 5th
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Traditionally, it has been evident that some children who show high stress reactivity or inbuilt vulnerability to stress (the diathesis of stress-diathesis model) fare badly when exposed to adverse early life circumstances/events. These adverse environmental influences can range from marital discord in family to stress of being born in a low socio economic status (SES) family or the stress of joining a new peer group.
A new theory however has been gaining ground that these children are orchid children who show high biological and behavioral sensitivity to context and thus can wither in stressful situations while at the same time have the capability to bloom far greater than a normal child given supportive and nurturing environments. One way to conceptualize this is to think of these child as showing greater phenotype variability and adaptability and being more plastic- so the underlying genotype manifest itself differently depending on environmental input. Being more plastic the orchid kids are able to use the environment to their best; or get abused by the environment for the worst.
A new study by Boyce et al looks at the interaction between stressful conditions and stress reactivity in 383 pre-primary children (aged 5-6 years) and reached a similar conclusion that there is indeed an interaction between life stress and stress reactivity such that those who are highly reactive are also more prone to developmental extremes mediated by environmental quality. they thus found that the orchid kids with high stress reactivity showed better adaptation in low life stress conditions, but worse adaptation in high life stress conditions, compared to the dandelions kids who had normal stress reactivity and were more or less immune to life stress. The adaptation measures they measured included clinical and pathological indexes like externalizing symptoms, as well as positive indexes like pro-social behavior, school engagement and academic competence.
The authors looked at two measures of human stress reactivity – Respiratory sinus arrhythmia (RSA)(related to heart rate variability and parasympathetic stress response) and salivary cortisol level changes. High resting RSA/ high RSA reactivity is good and indicates buffering against environmental stress; while low resting RSA / low RSA reactivity is bad and indicates high stress response to stressors . the picture with cortisol reactivity is much unclear and it was not clear (before this study) how cortisol reactivity would interact with life stress to affect adaptation of pre-primary children. the main goal of the study was to find how children stress reactivity and overall family adversity interact to affect adaptation of the child.
Here is the hypothesis in authors own words:
Based on the broad literature on risk and adversity, we hypothesized a robust negative main effect of family adversity across all indices of adaptation. We also expected to find main effects of stress reactivity on adaptation, but given the simultaneous test of interactive effects, as well as the paucity of studies examining the effects of RSA and cortisol reactivity, especially for positive developmental outcomes, and some inconsistencies within such studies, we did not hypothesize the directions of these main effects. More importantly, in accordance with the theory of biological sensitivity to context (Boyce & Ellis, 2005; Ellis et al., 2005), we expected to find evidence that ANS and HPA reactivity moderate the effects of early family adversity on various domains of functioning. We hypothesized that in high-adversity family environments, elevated levels of stress reactivity would be associated with maladaptive outcomes, whereas low stress reactivity would act as a protective factor. In the context of low family adversity, on the other hand, we expected high levels of reactivity to be associated with better adaptation. It is important to note that although biological sensitivity to context should be examined in both positive and negative settings, our assessment focuses on six types of family adversities, and a lack of overall family adversity does not necessarily imply a supportive and nurturing environment. In addition to the hypothesized Adversity × Stress Reactivity interactions, we controlled for children’s sex and tested whether main and interactive effects of adversity and reactivity vary across sex.
And this is what they found too! Here are the results:
The study’s most novel and salient findings emerged when adversity and stress reactivity were considered together, as components of interactions between environmental exposures and measures of biological sensitivity. Stress reactivity moderated the negative effect of family adversity across various domains of adaptation. Overall, the findings are consistent with the stress diathesis hypothesis that high-reactive children show worse adaptive functioning in the context of high adversity. Indeed, such children generally evinced the lowest levels of adaptive functioning of the entire study sample.
However, equally reactive children in settings of low adversity showed the highest levels of adaptation, levels even higher than those of their less reactive counterparts. Specifically, in the context of low family adversity, children who showed high RSA reactivity in response to challenges had the lowest levels of externalizing symptoms and the highest levels of prosocial behaviors and school engagement. Although adaptation showed significant stability from fall to spring, high-reactive children showed improvement in academic competence in the context of low adversity and a decline in competence in the context of high adversity, whereas the inverse was true for low reactive children. Similarly, children who showed high cortisol reactivity to the challenge protocol had the highest levels of prosocial behaviors in the context of low adversity. Further, children exhibiting low RSA reactivity in response to challenges were fully or partially buffered against the harmful effects of adversity on externalizing symptoms, prosocial behavior, and school engagement. Likewise, among children who showed low cortisol reactivity, levels of prosocial behaviors did not significantly change across different levels of adversity.
These findings support the biological sensitivity to context (BSC) theory advanced by Boyce and colleagues (Boyce 2007; Boyce & Ellis, 2005) and the concept of differential susceptibility to environmental influences proposed by Belsky and colleagues (Belsky, 2005; Belsky et al., 2007). This study illustrates that high reactivity is not merely a pathogenic, risk-amplifying response to adversity but can also promote adaptive functioning. Corroborating Boyce and colleagues’ theoretical perspective, children exhibiting high levels of biological sensitivity to context, as indexed by high autonomic and adrenocortical reactivity, were more susceptible to environmental influences in the context of both low and high family adversity. Thus, biologically sensitive children showed the highest levels of symptoms in the context of high family adversity but the highest levels of competence in the context of low family adversity. However, a lack of family adversity does not necessarily imply the presence of a nurturing family environment. Thus, future studies will need to further examine the role of heightened biological sensitivity to context across both stressful, health-undermining and supportive, health-enhancing contexts.
The conceptual figure clearly shows that for low Biological Sensitivity to Context (low BSC) children, adversity has relatively no effect on adaptation/maladaptation. However, for high BSC children, there is an inverse relation between adversity and adaptivity. To me this is further proof of the now robust orchid and dandelion theory of child development.
Obradovi?, J., Bush, N., Stamperdahl, J., Adler, N., & Boyce, W. (2010). Biological Sensitivity to Context: The Interactive Effects of Stress Reactivity and Family Adversity on Socioemotional Behavior and School Readiness Child Development, 81 (1), 270-289 DOI: 10.1111/j.1467-8624.2009.01394.x
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