Depression:

• According to the World Health Organization, unipolar depression was the third most important cause of disease burden worldwide in 2004. Unipolar depression was in “eighth place in low-income countries, but at first place in middle- and high-income countries.”¹
• In a nationally representative face-to-face household survey, 6.7% of U.S. adults experienced a major depressive episode in the past 12 months.²
• Significantly greater percentages of lifetime major depression have been reported among women (11.7%) than men (5.6%).³
• Examining ethnic differences reveals lifetime percentages of depression of 6.52% among whites and 4.57% among blacks and 5.17% among Hispanics.⁴

Anxiety:

• Anxiety disorders, which include panic disorder, generalized anxiety disorder, post-traumatic stress disorder, phobias, and separation anxiety disorder, are the most common class of mental disorders present in the general population.⁵
• The estimated lifetime prevalence of any anxiety disorder is over 15%, while the 12-month prevalence is more than 10%.⁵
• Prevalence estimates of anxiety disorders are generally higher in developed countries than in developing countries.⁵
• Most anxiety disorders are more prevalent in women than in men.⁶
• One study estimated the annual cost of anxiety disorders in the United States to be approximately $42.3 billion in the 1990s, a majority of which was due to non-psychiatric medical treatment costs. This estimate focused on short-term effects and did not include the effect of outcomes such as the increased risk of other disorders.⁷

Bipolar Disorder:

• The National Comorbidity Study reported a lifetime prevalence of nearly 4% for bipolar disorder. Bipolar disorder is more common in women than men, with a ratio of approximately 3:2. The median age of onset for bipolar disorder is 25 years,⁸ with men having an earlier age of onset than women.⁸
• In an insured population, 7.5% of all claimants with behavioral health care coverage filed a claim, of which 3.0% had bipolar disorder.⁹ Persons with bipolar disorder incurred $568 in annual out-of-pocket expenses—more than double the expenses incurred by all claimants. Annual insurance payments were greater for medical services for persons with bipolar disorder than for patients with other behavioral healthcare diagnoses.⁹
• The inpatient hospitalization rate of bipolar patients (39.1%) was greater than the 4.5% characterizing all other patients with behavioral health care diagnoses.
• Bipolar disorder has been deemed the most expensive behavioral health care diagnosis,⁹ costing more than twice as much as depression per affected individual.¹⁰ Total costs largely arise from indirect costs and are attributable to lost productivity, in turn arising from absenteeism and presenteeism.¹⁰
• For every dollar allocated to outpatient care for persons with bipolar disorder, $1.80 is spent on inpatient care, suggesting early intervention and improved prevention management could decrease the financial impact of this illness.⁹

Schizophrenia:

• Worldwide prevalence estimates range between 0.5% and 1%. Age of first episode is typically younger among men (about 21 years of age) than women (27 years). Of persons with schizophrenia, by age 30, 9 out of 10 men, but only 2 out of 10 women, will manifest the illness.¹¹
• Persons with schizophrenia pose a high risk for suicide. Approximately one-third will attempt suicide and, eventually, about 1 out of 10 will take their own lives.¹¹
• A Canadian study found that the direct health care and non-health care costs of schizophrenia were estimated to be 2.02 billion Canadian dollars in 2004. This, combined with a high unemployment rate due to schizophrenia and an added productivity and morbidity and mortality loss of 4.83 billion Canadian dollars, yielded a total cost estimate of 6.85 billion in U.S. and Canadian dollars.¹²
• The economic burden of schizophrenia is particularly great during the first year following the index episode, relative to the third year onwards. This finding suggests the need for improved monitoring of persons with schizophrenia upon initial diagnosis.¹³

Frequent Mental Distress:

Frequent mental distress is defined based on the response to the following quality of life question, ‘‘Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?’’ Frequent mental distress is identified as a report of 14 or more days of poor mental health in the past 30 days.

• 9.4% of U.S. adults experienced Frequent Mental Distress (FMD) for the combined periods 1993-2001 and 2003-2006.¹⁴
• The Appalachian and the Mississippi Valley regions had high and increasing FMD prevalence, and the upper Midwest had low and decreasing FMD prevalence during this same time period.¹⁴

Alzheimer’s Disease:

• Alzheimer’s disease is the sixth leading cause of death in the United States and is the fifth leading cause among persons age 65 years and older.¹⁵
• Up to 5.3 million Americans currently have Alzheimer’s disease.¹⁶
• By 2050, the number is expected to more than double due to the aging of the population.¹⁶

The psychology behind happiness – how positive affect is quantified and what influences happiness.

Just how happy are you? Do you ever wish for a life that brought more moments to be joyful?

Happiness is often an elusive experience – people will go to great lengths for a fleeting moment of happiness. Even the U.S. Declaration of Independence, written in 1776, asserts the right to “Life, Liberty and the pursuit of Happiness”.

But what precisely is happiness – how can it be quantified, and is there any measurable benefit to possessing a happy mindset over that of a more stoic realist?

“Happiness is a mystery like religion, and should never be rationalized.”
G.K. Chesterton, English author (1874-1936)

Happiness is a subjective experience – what brings elation to one person will not necessarily satisfy another – but from a psychological viewpoint, we must be able to quantify this state of mind in order to understand it.

When we discuss happiness, we are referring to a person’s enjoyment or satisfaction, which may last just a few moments or extend over the period of a lifetime. Happiness does not have to be expressed in order to be enjoyed – it is an internalized experience, varying in degrees, from mild satisfaction to wild euphoria.

Psychologists often refer to happiness as positive affect – a mood or emotional state which is brought about by generally positive thoughts and feelings. Positive affect contrasts with low moods and negativity, a state of mind described as negative affect in which people take a pessimistic view of their achievements, life situation and future prospects.

Quantifying Happiness

With positive affect being subjective and relative to the individual, can happiness be measured? The United Nations seems to believe that it can, and releases the World Happiness Report, which ranks countries by the self-reported happiness of its citizens.

In 2016, the report listed Denmark as the happiest nation, followed by Switzerland and Iceland. The US was the 13th happiest country with the UK ranking 23rd. Nordic countries feature prominently as being amongst the happiest societies in the world (Helliwell, Layard and Sachs, 2016).¹

The World Happiness Report measured happiness levels using the Cantril Ladder, a scale devised by U.S. psychologist Hadley Cantril (1906-1969). Participants are asked to imagine a ladder with 10 rungs, with rung number 1 representing the worst life imaginable, working upto the optimal life represented by the ladder’s highest rung. They are then asked to identify the step number that they feel reflects their life situation, either at present, in the past or how they envisage it to be in the future (Cantril, 1965).²

The four happiest countries identified by the World Happiness Report placed themselves at 7.5 or higher on the Cantril Ladder (Helliwell, Layard and Sachs, 2016).¹

Given that these countries are highly developed and prosperous, it is easy to assume that positive affect is linked to wealth. A common wish in our modern age is to possess more money: wealth can signify success and increases a person’s purchasing power, giving them choices that they might not have been able to make before. But can money buy happiness?

It’s a question that troubles not only psychologists, but economists, too. Richard Easterlin, a professor of economics at the University of Southern California, noticed a strange paradox involving money and happiness. Should a positive correlation exist between the two, we might expect citizens of developed countries to be happier than those of less prosperous nations.

Easterlin discovered that this is not the case – rich people within countries tend to be happier than the poorest in the same country, but overall, more prosperous countries are no happier than their poorer counterparts. These findings, known as the Easterlin paradox, contradict popular assumptions that wealthy people enjoy happier lives.

A study of lottery winners and victims of serious accidents delved further into the link between money and happiness. The happiness of 22 winners of large lottery prizes was compared to that of both controls and 29 people who had been paralysed as a result of an accident. The level of happiness experienced by winning the lottery had numbed people to the smaller joys of everyday live – a resistance the researchers described as “habitation”, as only more significant events could bring the winners joy (Brickman, Coates, Janoff-Bulman, 1978).³

The results of these two studies suggest that money alone cannot bring people lasting happiness.

Why it Matters: Benefits of Happiness

Happiness signifies an increased enjoyment of life, which is of course beneficial in itself. But beyond this obvious advantage, are there any further gains to be had from increased happiness?

One study looked at wide-ranging research into happiness to better understand the link between happiness in successful people.

Researchers suggested that there may be a causal link between positive affect and success – that success not only brings happiness, but that a person who is happy has an higher chance of achieving success than somebody experiencing negative affect (Lyubomirsky et al, 2005).⁴

The findings of this research support another, earlier, study by Daubman and Nowicki (1987) which artificially induced positive affect in participants in a series of experiments by subjecting them to watching comic films and providing them with sweets.

Subjects were then timed whilst they completed an exercise in creative problem-solving. The researchers found that those in a state of positive affect were able to solve the problems quicker than those in a neutral state or those experiencing negative affect (Daubman and Nowicki, 1987).⁵ Positive affect prior to success, it appears, boosts our intuitive abilities and enables us to achieve more.

Do Happier People Live Longer?

Can happiness lead to a healthier, longer life? Koopmans et al (2010) conducted a 15-year longitudinal study into the happiness of elderly people, known as the Arnhem Elderly Study. They found higher levels of happiness in those who lived longer.⁶

But does happiness lead to a longer life or does good health and longevity give people reason to be happier? The researchers also accounted for the participants’ levels of physical activity and found that, once exercise was accounted for, the link between happiness and life span was insignificant. This indicates that happiness may lead to increased physical activity, which in turn can be beneficial.

Indeed, a 2011 study suggested that exercise in sedentary males could be increased by first boosting their positive affect levels (Baruth, 2011).⁷

Encouraging Happiness

Book store shelves are awash with self-help books claiming to nurture happiness – but is positive affect something that we can nurture, or as the World Happiness Report emphasises, is influenced by our environment and life circumstances, often beyond our control?

Let’s look at some factors which can influence and encourage positive affect:

Acts of Kindness

Contradicting the idea that possessions can bring happiness, giving to others may in fact be more beneficial in terms of positive affect. Stephen Post (2005) noted that, whilst citizens in the US and Europe are more wealthy than previous generations, we are no happier as a result. Post emphasizes the personal benefit that acts of altruism – selfless giving or assistance – can provide (Post, 2005).⁸

The effect of selflessness on happiness was further supported by a 2008 experiment in which participants were given a gift of $5 or $20 and instructed to either spend it on themselves or on other people. Whilst the amount of money received had no notable effect on happiness, participants who gave away the money experienced elevated positive affect following the experiment (Dunn et al, 2008).⁹

Relationships

Familial relationships and friendships affect happiness and can also be impacted by a person’s levels of positive affect. Our ability to make friends often affects our self-esteem – unsurprisingly, people with extrovert personalities have been to found to enjoy higher levels of happiness than introverts (Argyle and Lu, 1990).¹⁰

The contagiousness of happiness is not limited to direct relationships: it can influence the happiness of people by up to 3 degrees of separation from the original individual¹¹

A 20-year study of interpersonal relationships demonstrated just how important the happiness of a person’s friends and family is to their own wellbeing.

Between 1983 and 2003, James Fowler and Nicholas Christakis looked relationships between close relatives and found that the happiness of a friend or close family member who lives up to a mile away from a person can boost their prospects of happiness by around 25%.

The study also suggests that the contagiousness of happiness is not limited to direct relationships: it can influence the happiness of people by up to 3 degrees of separation from the original individual (Fowler and Christakis, 2008).¹¹

Spousal relationships can be of particular influence on happiness levels. A study across 17 countries found that marriage does tend to lead to increased levels of happiness. Cohabiting also boosts happiness but by a lesser degree than marriage. The research emphasises the secondary effects of matrimony, such as the emotional and financial support provided by a partner, may explain this change rather than the act of marriage itself (Stack and Eshleman, 1998).¹²

Self-Determined Happiness

Positive affect might be influenced by external factors in our everyday life, but if people yearn for more happiness, can they bring it about themselves? Schütz et al (2013) studied the habits and happiness of people whose affect levels varied. The study observed a number of ways in which some people were able to proactively nurture their own happiness:¹³

The self-fulfilling participants showed significantly higher results than all other profiles on the direct attempts strategy, suggesting that in order to increase their happiness the self-fulfilling individuals are more prone to directly attempt to smile, get themselves in a happy mood, improve their social skills, and work on their self-control.

What someone’s eyes can tell you about what they’re thinking.

They’ve existed for 540 million years and most of us have a pair, but aside from giving us sight, what can we tell from looking at someone’s eyes?

People say that the eyes are a “window to the soul” – that they can tell us much about a person just by gazing into them. Given that we cannot, for example, control the size of our pupils, body language experts can deduce much of a person’s state by factors relating to the eyes.

The Pupils

The pupils are a part of our body language that we practically have no control over.

As well as adjusting the amount of light taken in the process of sight (Dilation: pupil size increasing; Contracting: pupil size decreasing), Eckhard Hess (1975) found that the pupil dilates when we are interested in the person we’re talking to or the object we’re looking at.

As an indicator, check a friend’s pupil size when you’re talking to them about something interesting, then change the subject to something less interesting and watch their pupils contract!

Eye Contact

For making contact and communicating with a person, effective eye contact is essential to our every day interaction with people, and also to those who want to be effective communicators in the public arena:

Persistent eye contact

Generally in Western societies and many other cultures, eye contact with a person is expected to be regular but not overly persistent. Constant eye contact is often considered to be an attempt at intimidation, causing the person who’s the object of a person’s gaze to feel overly studied and uncomfortable.

Even between humans and non-humans, persistent eye contact is sometimes unadvisable: the New Zealand Medical Journal reported that one reason so many young children fall victim to attacks by pet dogs is their over-poweringly regular eye contact with pets, which causes them to feel threatened and defensive.

Overly persistent eye contact is also a sign of a person’s over-awareness of the messages they are emmiting. In the case of a person who is try to deceive someone, they may distort their eye contact so that they’re not avoiding it – a widely recognised indicator of lying.

Avoiding Eye Contact

Why do we avoid looking at a person? It may be because we feel ashamed to be looking at them if we’re being dishonest of trying to deceive them. However, Scotland’s University of Stirling found that, in a question-and-answer study among children, those who maintained eye contact were less likely to come up with the correct answer to a question than those who looked away to consider their response.

Eye contact, as a socialising device, can take a surprising amount of effort to maintain when this energy could be spend on calculating, as opposed to perceptive, tasks.

Crying

In most cultures around the world, crying is considered to be caused by an extreme experience of emotion; usually, it’s associated with sadness or grief, though often extreme experiences of happiness, and through humor, can cause us to cry. Often, forced crying in order to gain sympathy or deceive others is known as “crocodile tears” – an expression from myths of crocodiles ‘crying’ when catching prey.

Blinking

Aside from our instinctive need to blink, our emotions and feelings towards the person we’re talking to can cause us to subconciously alter our blink rate.

Blinking more than the average 6-10 times per minute (see right) can be a good indicator that a person is attracted to the person they’re talking to, and is for this reason used as a sign of flirting.

Winking

In the West, we consider winking to be a cheeky form of flirting – something we do with people that we know or are on good terms with. However, there are cross-cultural variations on the issue of winking: some Asian cultures frown up on the use of this form of facial expression.²

Eye Direction

What does the direction that someone looking in tell us about what they’re thinking or feeling? Well, probably just what they’re looking at.

The thing to look out for is the direction someone’s eyes are looking in when they’re thinking. Looking to their left indicates that they’re reminiscing or trying to remember something. On the other hand, looking to their right indicates more creative thoughts, and this is often interpreted as a potential sign that someone may be being deceitful in some situations, i.e. creating a version of events.

Note: if a person is left handed, the direction indicators may be reversed.

Eye Reading Summary

From the findings above, what’s the best way to convey a “positive you” using eye contact? If you want to show you’re interested in what someone has to say, make eye contact often, but remember that unblinking stares are disconcerting.

Researchers have found that when people are engaged in an interesting conversation, their eyes remain focused on their partner’s face about 80% of the time – but not exclusively on the eyes. Instead, they focus on the eyes for two to three minutes, then move down to the nose or lips, then back up to the eyes. Occasionally, they look down to the table momentarily, then back up to the eyes.

Avoid looking up and to the right – it’s a universal symbol of boredom and dismissal.

Also remember the following key points with regards to eye contact:

• Demonstrate that you’re interested and active in interacting with someone by maintaining regular intervals of eye contact, but remember that contant eye contact can be intimidating.
• Pupil dilation can indicate someone is interested; it could, alternatively, be that the room has become brighter.
• Wink sparingly, even in cultures you know accept such a gesture in jest.
• Avoid “crocodile tears” if you want to be considered trustworthy by your peers.

Introduction to the cognitive approach in psychology. Explanation and evaluation of this approach.

The Cognitive Approach in psychology is a relatively modern approach to human behaviour that focuses on how we think, with the belief that such thought processes affect the way in which we behave (other approaches take other factors into account, such as the biological approach, which acknowledges the influences of genetics and chemical imbalances on our behaviour).

What it is and where the cognitive approach came from

1. Stimulus (External Factor)
2. affects:
3. Response (Human Behavior)

There is some dispute as to who created the cognitive approach, but some sources attribute the term to the 1950s and 1960s, with Ulric Neisser’s book Cognitive Psychology, which made allusions of the human mind working in a similar fashion to computers. The approach came about in part due to the dissatisfaction with the behavioural approach, which focused on our visible behaviour without understanding the internal processes that create it. The approach is based on the principle that our behaviour is generated by a series of stimuli and responses to these by thought processes.

Comparison to other approaches

Cognitive (meaning “knowing”) psychologists attempt to create rules and explanations of human behavior and eventually generalise them to everyone’s behaviour. The Humanistic Approach opposes this, taking into account individual differences that make us each behave differently. The cognitive approach attempts to apply a scientific approach to human behaviour, which is reductionist in that it doesn’t necessarily take into account such differences. However, popular case studies of individual behaviour such as HM have lead cognitive psychology to take into account ideosynchracies of our behaviour. On the other hand, cognitive psychology acknowledges the thought process that goes into our behaviour, and the different moods that we experience that can impact on the way we respond to circumstances.

Key Assumptions

• Human behaviour can be explained as a set of scientific processes.
• Our behaviour can be explained as a series of responses to external stimuli.
• Behaviour is controlled by our own thought processes, as opposed to genetic factors.

Evaluation of the Cognitive Approach

Are mental illnesses becoming more prevalent, or is psychiatry overdiagnosing?

By Dulce Zamora
WebMD Feature

Reviewed By Brunilda Nazario

In the span of a few months, Jacqueline Castine went from making $2,000 as a motivational speaker to getting fired from a minimum-wage post office job. She had successfully promoted a book on career enhancement, but then years later, was cleaning houses because she couldn’t hold jobs elsewhere.

The Michigan resident’s highs and lows came to a head when, as a sales manager for a Detroit broadcasting outlet, she had a grand delusion that God was telling her to bankroll one of the station’s charitable events.

The result: Castine ended up with a $43,000 credit card debt and thoughts of suicide.

“It was as if the bubble of unreality and distorted thinking had (burst),” says Castine, noting periods of despair coexisting with moments of great creativity. She sought psychiatric help and was diagnosed with bipolar disorder, also known as manic depression.

Mental Disorders Are Common

Castine’s story may seem unique, but millions of Americans share her plight. According to the Depression and Bipolar Support Alliance, 3.7% of American adults have bipolar disorder, and 4 out of 5 of those who have it may not know it.

In the bigger picture of psychological illness, the statistics may be even more alarming. The National Institute of Mental Health (NIMH) reports that roughly 22% of U.S. adults — about one in five — suffer from a diagnosable mental disorder in a given year. According to the NIMH, about 1% of the population age 18 and older in any given year has bipolar disorder.

The numbers, however, may vary depending on the diagnostic criteria used by researchers, says William Narrow, MD, associate director of the division of research at the American Psychiatric Association (APA). He was part of the study that came up with the 22% figure cited by the NIMH.

That number, he says, may include people who may have a mild disorder — those who may benefit from preventative treatment to keep symptoms from impairing their lives.

After reanalyzing the data, Narrow says the number of Americans with a mental disorder is closer to 15% in all ages. “I think it’s more realistic in terms of who needs treatment acutely,” he says.

Nonetheless, Narrow’s study and several others indicate that psychological illnesses are common, and there is evidence that the problem may be growing.

Mental disorders account for a significant burden of disease in all societies. The World Health Organization (WHO) projects that mental disorders will increase from nearly 12% of the all diseases worldwide to almost 15% by the year 2020.

The statistics have experts emphasizing the need for more awareness and treatment, and skeptics blaming psychiatry for going overboard with overdiagnosing ordinary problems.

The debate unearths the contentious issue of where to draw the line between what is normal behavior and what is considered part of a mental illness.

A Different World

There is dispute over whether a greater number of people have psychological illnesses now compared with past generations, or whether there is just more awareness of the subject and more folks are diagnosed.

Some experts say depression and anxiety boost the number of people with mental disorders.

“Depression and anxiety are the common colds of the psychiatric field in that they come and go without getting treatment,” says C. David Jenkins, PhD, adjunct professor of epidemiology and psychiatry for the University of North Carolina at Chapel Hill.

By analogy, he says the number of respiratory illness would rise if the number of people with the common cold were included.

In his study of air traffic controllers, Jenkins found many of them met the criteria for depression or anxiety for a month or two, and then they would “straighten up, and feel a lot better, until maybe six to eight months later when they would have another month that was a little low.”

Yet these mood disorders — depression and anxiety — do not always “come and go” so easily. Without treatment, the disorders can prevent people from living productive lives, says Kathy HoganBruen, PhD, senior director of prevention for the National Mental Health Association.

HoganBruen says she is not sure why the mental disorder numbers are so high, but she’s not surprised that they are. “In our society, there are lots of potential stressors,” she says, pointing to the uncertain economy, terrorism , worries about parenting, and health care as part of the gamut of concerns.

Indeed, the stress-related version of mental illness is what’s on the rise, says Ron Kessler, PhD, professor of health care policy at Harvard Medical School, distinguishing between conditions such as depression and anxiety (which are mostly caused by biological and environmental factors), and what he says are largely genetic conditions such as schizophrenia and bipolar disorder.

The global rates of schizophrenia and bipolar disorder have, for the most part, not changed, says Kessler, while depression and anxiety disorders are more common.

He says urbanization probably had a role in the rise of stress-related mental disorders. “People are moving to cities, moving far away from where their parents lived, and having jobs that their fathers didn’t have before,” says Kessler.

Urbanization, according to the WHO, is accompanied by increased homelessness, poverty, overcrowding, disruption of family structure, and loss of social support, all of which are risks for mental disorders.

With the uncertainty of the future and fewer family and community ties to help deal with problems, Kessler says more people become anxious, breeding secondary depression, and the two are associated with drinking and using drugs.

“That triumvirate of anxiety, depression, and substance abuse — those are the ones that are changing,” he says. “There’s a lot of thinking that anxiety is right at the core of it. That’s sort of the foundation.”

Anxiety may also be heightened by other factors related to modern society, such as globalization and more advanced technology.

“Right now the whole world is at our fingertips, no further away than the television screen, and I believe we get churned up, and our view of everything going to the dogs is heightened by our easy access to all this information,” says Jenkins.

At the same time, he says expectations now are higher than they were many years ago. People now expect to have jobs, enough money to go to a dinner and movie, and many kids expect to have a cell phone in high school and a car at graduation.

Shades of Gray

What type of behavior is considered normal and what classifies as a mental disorder? When is it appropriate to treat a problem with drugs? These questions often spark controversy in and out of the psychiatric field.

The 1999 U.S. Surgeon General’s report on mental health defines mental disorders as “health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning.”

Critics, however, have questioned the extent to which psychiatry has labeled thinking, mood, and behavior. There are charges of overdiagnosing people and “medicalizing” troublesome characteristics, thoughts, and actions.

The criticism seems to intensify when kids are involved and when prescribing them drugs is at issue.

In 1996, the United Nations’ International Narcotics Control Board raised concern about the increasing use of the stimulant Ritalin for the treatment of ADHD in children, particularly in the U.S. Authorities reporting to the board said the disorder may be diagnosed too often and the stimulant prescribed without considering other types of treatment.

Many mental health professionals have little doubt that there are people who are either misdiagnosed, overdiagnosed, or given drugs too easily.

Yet the much bigger problem, says HoganBruen, is that people who need help are not being assessed or treated for mental health disorders.

The exact point when normal problems become a disorder needing treatment is apparently tough to figure out, even with the APA’s Diagnostic and Statistical Manual of Mental Disorders (DSM) — the reference guide used by professionals to classify psychiatric symptoms.

“There is a continuum between normal behavior and abnormal behavior for a lot of different symptoms,” says Narrow. Nonetheless, psychiatrists make diagnoses the best they can by considering how severe symptoms are and how much they impair daily life.

Sometimes medicine draws the illness line at the point where doctors know how to treat, suggests Kessler. “If it turned out that some pill was developed tomorrow … and it would make (problems) go away … we would declare it in an illness, and we would start treating it,” he says.

While psychiatry continues to search for more effective treatments and a better understanding of mental disorders, there are some remedies – including drugs — that are scientifically proven to work.

Kids with ADHD who receive treatment are less likely later in life to get divorced, be on welfare, get into trouble with the law, or be dead, says Kessler.

Mental illness is and always has been a burden on society, even though the problem was not discussed as openly in the past, says Narrow.

According to the WHO, estimates from the year 2000 have placed mental disorders as six of the top 20 leading causes of disabilities worldwide.

Among children, the APA reports that ADHD is the most commonly diagnosed mental health condition in the U.S. According to the Surgeon General’s Report on Mental Health, ADHD afflicts between 3% and 5% of school-age children in any six month period.

As bleak as the reports may seem, HoganBruen says there is effective treatment and it’s possible, with treatment, to lead productive lives.

A Brighter Outlook

Castine says she didn’t think there was anything to live for when she lost all her money while suffering with bipolar disorder. But after taking medication and working with a therapist, she was able to find a job as a community education specialist, publicly speaking about her personal experiences with mental illness.

The 63-year-old now has plenty of savings in the bank and hopes to earn enough for retirement from the publication of her next book, due out this summer.

If you suspect that you or a loved one might have a mental disorder, experts suggest a visit to a primary care doctor or a mental health professional.

• Drug abuse and addiction, now both grouped as drug use disorder, is a condition that is characterized by a self-destructive pattern of using a substance that leads to significant problems and distress, which may include tolerance to or withdrawal from the substance.
• Drug use disorder is unfortunately quite common, affecting more than 8% of people in the United States at some point in their lives.
• Dual diagnosis refers to the presence of both a drug-use issue in addition to a serious mental-health condition in an individual.
• Virtually any substance whose ingestion can result in a euphoric (“high”) feeling can be abused.
• Inhalants like household cleaners are some of the most commonly abused substances.
• While the specific physical and psychological effects of drug use disorder tend to vary based on the particular substance involved, the general effects of a substance use disorder involving any drug can be devastating.
• Although drug use disorders have no single cause, there are a number of biological, psychological, and social risk factors that can predispose a person to developing a chemical use disorder.
• Symptoms of a drug use disorder include recurrent drug use that results in legal problems, occurs in potentially dangerous situations, interfere with important obligations, results in social or relationship problems, tolerance, withdrawal, using a lot of the drug or for a long period of time, persistent desire to use the drug, unsuccessful efforts to stop using the drug, neglecting other aspects of life because of their drug use, and spending inordinate amounts of time or energy getting, using, or recovering from the effects of the drug.
• While the specific effects of drugs on the brain can somewhat vary depending on the drug that is being used, virtually every substance that is abused has an effect on the executive-functioning areas of the brain. Drugs particularly affect the brain’s ability to inhibit actions that the person would otherwise delay or prevent.
• Since there is no single test that can definitively diagnose someone with a chemical use disorder, health-care professionals assess these disorders by gathering comprehensive medical, family, and mental-health
  • information, as well as securing a physical examination and lab tests to assess the sufferer’s medical state.
  • Treatment services for drug use disorders remain largely underutilized by most people who suffer from these conditions.
  • The primary goals of recovery are abstinence, relapse prevention, and rehabilitation.
  • During the initial stage of abstinence, a person who suffers from chemical dependency may need detoxification treatment to help avoid or lessen the effects of withdrawal.
  • Often, much more challenging and time-consuming than recovery from the physical aspects of addiction is psychological addiction.
  • The treatment of dual diagnosis seems to be more effective when treatment of the sufferer’s mental illness is integrated with the treatment of the individual’s chemical dependency.
  • Drug addiction increases the risk of a number of negative life stressors and conditions, particularly if left untreated.
  • Recovery from a substance use disorder is usually characterized by episodes of remission and relapse.
• Quick GuideAddicted to Pills: The Health Risks of Drug Abuse

  

  What is drug use disorder?

  Formerly separately called drug abuse and drug addiction, drug use disorder, also called substance use or chemical use disorder, is an illness that is characterized by a destructive pattern of using a substance that leads to significant problems or distress, including tolerance to or withdrawal from the substance, as well as other problems that use of the substance can cause for the sufferer, either socially or in terms of their work or school performance. The effects of drug use disorders on society are substantial. The economic cost, including everything from lost wages to medical, legal, and mental-health implications is estimated to be about $215 billion. The cultivation of marijuana and production of synthetic drugs like methamphetamine has negative impact on soil and water supplies. Drug law infractions make up the most common reason for arrest in the United States, more than 14 million in 2008.

  Teens are increasingly engaging in prescription drug abuse, particularly narcotics (which are prescribed to relieve severe pain), and stimulant medications, which treat conditions like attention-deficit disorder and narcolepsy.

  The term dual diagnosis refers to the presence of both a drug use disorder and a serious mental-health problem in a person. Substance use disorders, unfortunately, occur quite commonly in people who also have severe mental illness. Individuals with dual diagnosis are also at higher risk of being noncompliant with treatment.

  What types of drugs are commonly abused?

  Virtually any substance whose ingestion can result in a euphoric (“high”) feeling can be abused. While many are aware of the abuse of legal substances like alcohol or illegal drugs like marijuana (in most states) and cocaine, less well-known is the fact that inhalants like household cleaners and over-the-counter medications like cold medicines are some of the most commonly abused substances. The following are many of the drugs and types of drugs that are commonly abused and/or result in dependence:

  • Alcohol: Although legal, alcohol is a toxic substance, especially for a developing fetus when a mother consumes this drug during pregnancy. One of the most common addictions, alcoholism can have devastating effects on the alcoholic individual’s physical well-being, as well as his or her ability to function interpersonally and at work.
  • Amphetamines: This group of drugs comes in many forms, from prescription medications like methylphenidate (for example, Ritalin, Concerta, Focalin) and dextroamphetamine and amphetamine (Adderall) to illegally manufactured drugs like methamphetamine (“crystal meth”). Overdose of any of these substances can result in seizure and death.
  • Anabolic steroids: A group of substances that is most often abused by bodybuilders and other athletes, this group of drugs can lead to devastating emotional symptoms like aggression and paranoia, as well as severe long-term physical effects like infertility and organ failure.
  • Caffeine: While it is consumed by many coffee, tea, and soda drinkers, when consumed in excess, this substance can be habit-forming and produce palpitations, insomnia, tremors, irritability, and significant anxiety.
  • Cannabis: More usually called marijuana, the scientific name for cannabis is tetrahydrocannabinol (THC). Marijuana is the most commonly used illicit drug, with nearly 29 million people 12 years or older reporting having used this drug in the past year. In addition to the negative effects the drug itself can produce (for example, infertility, difficulties with sexual performance, paranoia, lack of motivation), the fact that it is commonly mixed (“cut”) with other substances so drug dealers can make more money selling the diluted substance or expose the user to more addictive drugs exposes the marijuana user to the dangers associated with those added substances. Examples of ingredients that marijuana is commonly cut with include baby powder, oregano, embalming fluid, phencyclidine (PCP), opiates, and cocaine.
  • Cocaine: A drug that tends to stimulate the nervous system, cocaine can be snorted in powder form, smoked when in the form of rocks (“crack” cocaine), or injected when made into a liquid.
  • Ecstasy: Also called MDMA to denote its chemical composition (methylenedioxymethamphetamine), this drug tends to create a sense of euphoria and an expansive love or desire to nurture others. In overdose, it can increase body temperature to the point of causing death.
  • Hallucinogens: Examples include LSD and mescaline, as well as so-called naturally occurring hallucinogens like certain mushrooms. These drugs can be dangerous in their ability to alter the perceptions of the user. For example, a person who is intoxicated (“high” on) with a hallucinogen may perceive danger where there is none and to think that situations that are truly dangerous are not. Those misperceptions can result in dangerous behaviors (like jumping out of a window because the person thinks they have wings and can fly).
  • Inhalants: One of the most commonly abused group of substances due to its easy accessibility, inhalants are usually in household cleaners, like ammonia, bleach, and other substances that emit fumes. Brain damage, to the point of death, can result from using an inhalant even just once or over the course of time, depending on the individual.
  • Nicotine: The addictive substance found in cigarettes, nicotine is actually one of the most addictive substances that exists. In fact, nicotine addiction is often compared to the intense addictiveness associated with opiates like heroin.
  • Opiates: This group is also called narcotics and includes drugs like heroin, codeine, hydrocodone, morphine, methadone, Vicodin, OxyContin, Percocet, and Percodan. This group of substances sharply decrease the functioning of the nervous system. The lethality of opiates is often the result of the abuser having to use increasingly higher amounts to achieve the same level of intoxication, ultimately to the point that the dose needed to get high is the same as the dose that is lethal by overdose for that individual by halting the person’s breathing (respiratory arrest).
  • Phencyclidine: Commonly called PCP, this drug can cause the user to feel highly suspicious, become very aggressive, and to have an exceptional amount of physical strength. This can make the person quite dangerous to others.
  • Sedative, hypnotic, or antianxiety drugs: The second most commonly used group of illicit drugs, these substances quiet or depress the nervous system. They can therefore cause death by stopping the breathing (respiratory arrest) of the individual who either uses these drugs in overdose or who mixes one or more of these drugs with another nervous system depressant (like alcohol, another sedative drug, or an opiate).

The link between the unconscious and emotion.

No feeling is permanent. There is a constant oscillation between the positive and negative feelings. Emotions are constantly changing, in part because feelings change, and in part due to the constant stream of ideas that flow in the unconscious mind. At the conscious and subconscious levels of mind we can focus on an unconscious idea and use it to pursue a trend or theme about something that interests us at that moment. Hence we can make an emotion last whilst we follow that trend.

The difference between the flow of ideas at the conscious and subconscious levels is mainly related to the issue of change. The conscious flow is easy to change, especially when we are in social company, but the subconscious flow seems to have a life of its own and is highly resistant to conscious attempts to change it. In social company or if we are idealistic we can give preference to our conscious ideas, and hence control our conscious emotional response. But on our own, without the influence of idealism, the subconscious mind usually exerts priority in emotional response. If the conscious mind is not dominant, that is, if we do not value what we are doing at any particular moment, then the subconscious mind is dominant (and so we may become subject to uncontrollable moods).

As I show below, emotions can be grouped into complementary pairs. I call these pairs �binaries’. A few lines above I used two examples of binary emotions. I paired anger and fear together, and then love and hate together. Another binary is vanity and self-pity. What determines the choice of either emotion in a pair ? For example, what governs a person, at a particular moment, in their selection of either anger or fear as their response to something? The choice is not a random one. The choice revolves around the dominating influence of value.

We put a value on emotional experience. By either liking or disliking things, relationships, situations, etc we put a value on them. At any particular moment we may either like or dislike something ; but this liking and disliking can take many forms. For example, the way that we like that something may lead us to choose between anger, love or vanity as our response. Anger allows us to dominate the situation ; love enables us to harmonise with other people ; vanity lets us feel important. The way that we dislike it may focus on fear, hate or self-pity.

So at any particular moment we are focusing on a trend of thought, with a relevant emotion being experienced. Then there is some change in the situation that needs an emotional response from us. Sometimes we can consciously choose our response, particularly if the situation is a pleasant one. But more often than not we act subconsciously. The value that we place on the situation at that moment determines which emotion will be felt. For example, if we are feeling discontented, we will place little positive value on our present experience ; then when we have to respond to something we are more likely to choose some form of hostile or fearful response.

As well as putting value on our situations, we also put value on our thoughts and ideas. Now an unconscious idea has two values : it is good or it is bad. The good value is supported by the pleasant feeling, the bad value by the unpleasant feeling. This division leads to two choices. One choice gives rise to one emotion, the other choice to its complement. Hence emotions can be grouped into complementary pairs, or binaries.

In general then, if we are free-wheeling in our thoughts, we can let our emotions be positive or negative according to whether the feeling is positive or negative. Otherwise, by placing value on our experience, we can generate positive or negative emotions as we choose. However, the generation of a positive emotion is often difficult if the feeling that is current is the negative one, and vice versa.

The unconscious idea enables all emotions to be arranged in pairs of complementary opposites. The one exception is that the neutral feeling is unique, it is not part of a binary. It is the basis of equanimity, the ability to be unaffected by any kind of stress. Equanimity should not be confused with indifference or even peace ; indifference is a protective mechanism of withdrawal from responsibility and is underpinned by fear, whilst peace is achieved by repressing internal conflict (that is, conflict that is within the mind of a person).

In psychological language, equanimity is the state of mind which denotes the absence of projection and introjection. When a person uses the mechanisms of projection and introjection, they are making value judgements about the characteristics of other people that they admire or dislike. When they cease making such value judgements, they thereby cease to desire anything of a personal nature. [³]

I list some emotions which are binary to each other :

fear – anger
love – hate
jealousy – narcissism
pride – guilt
vanity – self-pity
resentment – bitterness

Some emotions have an additional complexity: they are compound and consist of two simpler emotions. I call such an emotion either a compound emotion or a �doublet’, and each of the separate emotions within a doublet I call a �mode ‘ of that doublet. For example, guilt comprises the two simpler emotions of self-pity and self-hate. So guilt is experienced as guilt (in the mode of self-pity) or as guilt (in the mode of self-hate).

I list some compound emotions and then I give a table of unconscious ideas that determine emotions.

Table 1: Compound Emotions

Guilt = self-pity + self-hate.
Pride = vanity + hatred of other people.

Narcissism = love + vanity.
Jealousy = love + self-pity.

Resentment = guilt + idealism.
Bitterness = pride + idealism

Repentance = regret + guilt (mode of self-pity).
Sadness = regret + jealousy (mode of self-pity).

Paranoia = fear + pride (mode of vanity).
Anxiety = fear + vanity.

In the compound emotions of guilt, pride, narcissism, and jealousy, only one mode is felt at any one time � they are never experienced simultaneously. For example, guilt is felt as either self-pity or as self-hate.

How do I know that some emotions are compound ones ? Guilt was the first one that I identified. Once I learned to detect guilt by empirical awareness I became puzzled by the fact that it seemed to exhibit contrary impressions. Then I realised that this difficulty could be explained by postulating that guilt consisted of two factors. It then became an empirical task to see if I could detect these two separate factors � and I did.

Now guilt equals self-pity plus self-hate. This arrangement of the two emotions within guilt has three other possible combinations, by taking the binaries of self-pity and self-hate. So if my factorisation of guilt was correct then three other compound emotions should also exist, with their factors being:

self-pity + love

vanity + love

vanity + hate

Eventually I realised through intuition that these compound emotions represented jealousy, narcissism, and pride. Then again I empirically verified that my theorising was correct. The hallmark of a compound emotion is that it produces ambiguous responses ; the ambiguity always falls into two categories, thus indicating that two factors are present and need to be separated.

For example, in sadness there is sorrow (from the regret) plus a sweetness (from the jealousy). When the jealousy factor is highlighted, then I always find that sadness is a lovely emotion in which I often like to linger, whereas the sorrow element makes sadness unpleasant.

Unconscious Ideas

Now I turn to unconscious ideas. Deriving them was not easy. Some emotions occur three times ; for example, self-pity occurs on its own, as a mode of jealousy, and as a mode of guilt, and each one produces a different response. To work out the underlying idea, the overall theme or motif of the emotion needs to be considered, that is, what the emotion is trying to express. Also, in a doublet, one unconscious idea needs to be harmonious with the other one. Below are the results that I derived.

I use the word �implies’ to indicate the central idea that determines a particular emotion. These ideas are focused on relationships. When a relationship is not the issue, then different responses may occur. For example, the vanity mode of pride, when applied to crafts, produces the satisfaction of doing good work.

Table 2 :Unconscious Ideas

• The motif of guilt and pride is punishment / humiliation
  Guilt is self-punishment
  self-pity mode implies life is punishment.
  self-hate mode implies I deserve punishment.

  Pride is punishment / humiliation of other people.
  vanity mode implies you are inferior to me.
  hate mode implies I despise you / I will punish you.

• The motif of jealousy and narcissism is responsibility
  Jealousy is social responsibility.
  self-pity mode implies I need a reward (from other people).
  love mode implies I reward other people.
• Narcissism is self-responsibility.
  vanity mode implies I will do it my way.
  love mode implies I do not depend on anyone.
• The motif of self-pity and vanity is help
  Self-pity implies I need help.
  Vanity implies I do not need any help.
• The motif of anger and fear is domination
  Anger implies I need to dominate other people
  Fear implies the world is dominating me.
• The motif of love and hate is identity
  Love implies I am the same as everyone else.
  Hate implies I am different from everyone else.
• The motif of envy and greed is the need to acquire importance
  Envy implies I become important if I can get what you have.
  Greed implies I become important if I possess things.
• The motif of resentment and bitterness is disgust
  Resentment implies people are repulsive.
  Bitterness implies life is repulsive.
• The motif of paranoia is the betrayal of trust
  Paranoia implies I trust no one.
• The motif of anxiety is a sense of oppression by one’s conscience or by other people
  fear mode implies do as you are told / control yourself.
  vanity mode implies I am uneasy in the presence of other people.

Depression arises from self-pity; there are three forms of the latter, so there are three forms of the former.

The most common type arises from jealousy (mode of self-pity) and is the depressive stage of manic depression. Guilt-based depression (or �endogenous’ depression) has its source in the infant’s traumatic experience of parental relationships and represents a response to the feeling of being rejected. Depression that arises from self-pity may be seen in political refugees denied asylum, and in anyone who is a victim of injustice. [4]

• The motif of manic depression is victimisationdepression mode implies I am a victim.
  mania mode implies I help victims.
• The motif of guilt-based depression is self-denigration
  Depression implies I am a sinner.
• The motif of depression based on self-pity is the absence of equity or fairness
  Depression implies there is no equity, no fairness in life.

These ideas enable me to state how motivation is usually handled by the subconscious mind.

Subconscious motivation usually means the influence of the current subconscious mood and its associated ideas.

By dwelling on an associated idea, an emotion becomes prolonged into a mood. Since moods change frequently, this form of motivation is short-term. Long-term subconscious motivation requires a subconscious desire, but unless this desire is powered by idealism it is likely to be much weaker as an influence on the ego than any mood.

Copyright © 2002 Ian Health. All Rights Reserved

Why do people and animals experience emotions, and what makes us experience different types of emotions. Ian Heath looks at emotional states, the link between the sub-conscious and our feelings.

The analysis of emotions has been ineffectual up till now since they are very difficult to identify, except for a few such as fear and anger. Many years ago I began an intense psycho-analysis (which I did on my own). It took me five years of constant awareness to finally identify the range of emotions that I usually experience.

The peculiarity of any particular emotion is that, whilst it is just an emotion, it is nevertheless intimately associated with specific mental attitudes and ideas that have become characteristic of that emotion. In general, I found that each emotion acts as a nucleus for pre-set ideas about the world. This fact gives rise to a notable phenomenon. As one emotion fades away and the next one is generated, so the ideas in a person’s mind automatically change : the fresh emotion brings with it its associated ideas.

A person is always experiencing some emotion at any time, since when the present emotion fades away so another emotion will take its place and be felt by him / her. No single emotional response can be permanent. When any emotion, such as anger, is experienced the person can stay angry only for some time ; eventually the anger will fade away and a fresh emotion will arise.

Many people orientate on feeling responses to the world: an abundance of good feelings, and emotional satisfaction, become the criteria for a successful life. However, emotions present problems for the ego. When emotions become intense they neutralise intellectual concerns. In fact, common negatively-valued emotions such as self-pity, fear, anxiety, as well as moods like depression, actually tend to inhibit rationality � in particular, intense anxiety seems to produce a mental fog in one’s mind, making it impossible to study.

Understanding the nature of emotions has profound implications for psycho- therapy. In this set of three articles I present my ideas on emotion. In the subsequent set of five articles on abreaction I focus on their relevance to psycho-therapy and the development of self-awareness.

PART 2

One area of confusion is that feelings are often loosely equated with emotions. This is all right for colloquial use. I can ask a friend how he is feeling today ; it would be awkward to ask him how emotional he is being today. Some people might take offence if they were thought to be emotional, whereas it is acceptable for them to show feelings. However, there are fundamental differences between feelings and emotions.

There are just three feelings : the pleasant one, the unpleasant one, and the neutral one. This is the Buddhist understanding and I verified this fact directly during the time when I used to practise meditation. In the past, some moral theorists believed that the neutral feeling is only an equal mixture of both pleasant and unpleasant feelings, so that the net effect is zero. But meditational awareness disproves this assumption.

PART 3

Model of Emotions

Emotions are partly derived from feelings. To explain how this derivation occurs I use a model of consciousness that is a traditional one: consciousness has three modes, those of will, mind, and feeling. Past variations on this model substituted action for will, and emotion or sensibility for feelings. In this model I distinguish between consciousness and mind. Consciousness is the totality of the person, whilst mind is only one feature of it. However, my model has an innovative feature: the three modes are separate, but they interlock by the production of desires and emotions.

In this model, mind has two aspects, intelligence and intellect. Intelligence links to will and to feeling, and intellect is the source of abstraction. The former expresses the activity of the mind, whilst the latter is an indication of the degree of maturity of the mind. [¹]

Mind is the key to consciousness. Mind, in fact, is the �cement’ that keeps all aspects of consciousness together.

Now the mind helps to produce desires and emotions. In this aspect of mind we use ideas or concepts.

I give definitions of desire and emotion that brings out their reliance on concepts.

Will is a pure striving, an undirected effort. When will is united with mind, it generates desire. Desire is the activity of will directed into a mental concept. The concept governs the use of will. The concept directs the will.

For example, will plus the concept �social status’ gives rise to the desire to achieve social status. Will plus the concept �fame’ gives rise to the desire for fame. Without the presence of desire it is very difficult to sustain the use of will ; if a person tries to renounce desire then he / she is quite likely to become lethargic.

When feeling is united with mind, it generates emotion. Emotion is the activity of feeling directed into a mental concept. The feeling energises a conceptual response to a stimulus. Feelings are primarily either pleasant or unpleasant; rarely are they neutral. Hence there are two possible conceptual responses to any stimulus, which in turn leads to two possible emotional responses.

For example, feeling plus the concept �domination’ gives rise to the emotions of anger and fear : anger arises because the pleasant feeling makes domination of others acceptable to me, whereas the unpleasant feeling makes fear arise when I become subject to domination by others.

For another example: feeling plus the concept �identity’ gives rise to the emotions of love and hate. Here the pleasant feeling makes a social identity acceptable to me, since I am the same as everyone else: identity produces love. The unpleasant feeling makes me reject a social identity � I prefer to be different and have an individual identity: difference produces hate.

PART 4

Emotion: Unconscious Ideas

The mental concept that is associated with an emotion actually creates the boundaries of that emotion. If the mental concept changes, the emotion does not change ; instead, it fades away and a different emotion arises, one that fits the current mental concept. The mental concepts of emotions are not normally a part of our awareness. Emotions are not unique to any particular individual, so the mental concepts that underlie them come from the unconscious mind. Since the mental concepts are unconscious they are extremely difficult to identify. The mental concept is normally unconscious, so I call it an unconscious concept or an unconscious idea.

At this point I need to clarify my usage of two important terms.

I use the term �subconscious mind’ for what is personal to the individual, and the term �unconscious mind’ for what is general to humanity. [²]

An emotion is not unique to any particular individual, so the mental concept that underlies it comes from the unconscious mind.

Now an unconscious idea has two values : it is good or it is bad. The good value generates the pleasant feeling, the bad value the unpleasant feeling. This division leads to two choices. One choice gives rise to one emotion, the other choice to its complement.

In general, the definition of an emotion is that it is an unconscious idea powered by either a pleasant or an unpleasant feeling.

A look at common defense mechanisms we employ to protect the ego.

Whilst defense mechanisms such as repression, sublimation and identification with an aggressor can often be identified, there are also numerous other mechanisms that have been identified since Sigmund Freud first noted them more than a century ago.

Sigmund Freud

Let’s take a look at some common and less well known defense mechanisms that a person might deploy, along with some examples of how the mind might use them:

Acceptance

Acceptance of a situation that has been causing anxiety is one technique that we might use to live with an undesirable circumstances or feelings. For instance, someone may acknowledge that they have behaved unreasonably towards their father owing to an Oedipus Complex, or accept their new circumstances after separating from a partner.

Acting Out

When the id component of the human psyche signals the desire to act on an impulse, the ego and super ego will often counteract it if they feel that that behavior would be counterproductive or immoral. A person may want to curse after falling over in a busy street, but the ego, perceiving this as contradicting social etiquette, will often lead to them holding back on the expletives. On some occasions, however, we may not be able to balance the impulses of the id and will defend the ego by simply acting out the irrational desires.

For example a person might “act out” by theatrically storming out of a stressful meeting when they would otherwise stay calm and hide their unease.

Anticipation

The anticipation of a potentially stressful event is one way a person might mentally prepare for it. Anticipation might involve rehearsing possible outcomes in one’s mind or telling oneself that will not be as bad as they imagine. A person with a phobia of dentists might anticipate an appointment to have a tooth filling by telling themselves that the procedure will be over in just a few minutes, and reminding themselves that they have had one previously without any problems.

Altruism

An act of goodwill towards another person, known as altruistic behavior, can be used as a way of diffusing a potentially anxious situation. Altruism may be used as a defence mechanism, for example, by being particularly helpful to a person who we feel might dislike us or neutralising an argument with kind words and positivity.

Avoidance

When a perceived situation creates anxiety, one convenient option is sometimes to avoid it. Although avoidance can provide an escape from a particular event, it neglects to deal with the cause of the anxiety. For example, a person might know that they are are due to give a stressful presentations to colleagues at work, and take a sick day in order to avoid giving it. Avoidance in this situation might be only a short term option, however, if the presentation is rescheduled to another day. Someone may also avoid thinking about something which causes anxiety, preferring to leave it unresolved instead of confronting it.

Conversion

Conversion is a defence mechanism whereby the anxiety caused by repressed impulses and feelings are ‘converted’ into a physical complaint such as a cough or feelings of paralysis. Freud observed this physical manifestation of anxieties in clients such as Dora, who complained of a cough, losing her voice and feelings resembling appendicitis. Upon investigation, Freud attributed her cough to fixation during the oral stage of psychosexual development, and linked her appendicitis to a “childbirth fantasy”.

Denial

The self denial of one’s feelings or previous actions is one defence mechanism to avoid damage to the ego caused by the anxiety or guilt of accepting them. A married woman might deny to herself that she hold affections for her husband’s friend, rather than accepting her true feelings. A person might also deny to their physical behavior, such as theft, preferring to think that someone forced them into committing the crime, in order to avoid dealing with the guilt should they accept their actions. Denial is an undesirable defense mechanism as it contravenes the reality principle that the id adheres to, delving into an imaginary world that is separate from our actual environment.

Displacement

Displacement occurs when a person represses affection, fear or impulses that they feel towards another person. Accepting that it is irrational or socially unacceptable to demonstrate such feelings, the psyche prevents them from being converted into actions. However, the feelings are instead displaced towards a person or animal whom it is acceptable to express such sentiments for.

A person who dislikes their teacher after being given low grades may feel that they would be punished if they express their hostility towards them. Therefore, they may unconsciously displace their antipathy onto their best friend, making excuses for treating them badly without justification.

In the case of Little Hans, Freud believed that the boy had displaced a fear of his father onto horses, whose blinkers and facial features reminded him of his parent. Instead of misbehaving towards his father, he felt anxious at being in the presence of horses and would avoid leaving the house when possible.

Dissociation

People who use dissociation as a defense mechanism tend to momentarily lose their connection to the world around them. They may feel separated from the outside world, as though they exist in another realm. Dissociation often helps people to cope with uncomfortable situations by ‘removing’ themselves from them. The may enter a state of daydreaming, staring into space and letting their mind wander until someone nudges them, prompting them to acknowledge reality once more.

A case which Freud analysed after reading an autobiographical account of an illness was that of Daniel Schreber, a German judge who described the dissociative feeling that he and the rest of the world were separated by a veil. Schreber felt as though he was not entirely a part of his environment and that he was in some way separate from it.

Fantasy

When life seems mundane or distressing, people often use fantasy as a way of escaping reality. They may fantasise about winning the lottery or idealised outcomes of their lives changing for the better in some way. Fantasies help us to explore alternatives to situations that we are unhappy with but unrealistic expectations of them being fulfilled can lead to us losing touch with reality and taking more viable actions to improve our lives.

Humor

George Vaillant described the use of humor as a “mature” defense mechanism – a primarily adaptive technique to help us to cope with tense or stressful situations. Looking for a funny aspect in an environment in which we lack control can help us to endure it, and can even be an altruistic act in helping others to better cope as well.

Humility

Showing humility involves lowering our expectations and view of our self importance, sacrificing our pride and often focussing on others. Humility can enable us to pacify those around us in tense conflicts and encourage cooperation with other people to take place. For example, someone who is known to boast about their abilities may show humility whilst trying to complete a difficult task. This might encourage others to empathise with, and help, them.

Idealisation

Idealisation involves creating an ideal impression of a person, place or object by emphasising their positive qualities and neglecting the those that are negative. Idealisation adjusts the way in which we perceive the world around us and can lead us to make judgement that support our idealised concepts. People often idealise their recollections of being on holiday or memories from childhood, seeing them as ‘happier times’, but fail to recollect arguments or stresses during those periods. We often idealise the image we hold of people we admire – relatives, partners or celebrities, making excuses for their failures and emphasising their more admirable qualities.

Identification

According to Freud’s concept of the Oedipus Complex, a child may experience feelings of resentment towards their father as they compete for the affection of their mother and the resulting castration anxiety – an irrational fear directed towards the father – may lead them to feel the need to appease the father. In order to pacify a person whom we perceive to be a threat, we may emulate aspects of their behavior. By adopting their mannerisms, repeating phrases or language patterns that they tend to use and mirroring their character traits, a person may attempt to appease a person. This defense mechanism was described by Anna Freud as identification with an aggressor.

A person moving schools or countries, starting a new job or entering a new social circle might adopt the social norms or attitudes of classmates, neighbors, colleagues or other people whom they seek acceptance from, for example, in order to avoid being rejected by their new peers.

Intellectualisation

When a person is attached emotionally to an issue, they may be tempted to consider it in intellectual terms. This often involves standing back from the situation and attempting to take a cold, neutral view of it. For instance, a person who has been made redundant after twenty years of service to a company may intellectualise it, acknowledging the management’s view that redundancies needed to be made for the company to survive. However, this defense mechanism of intellectualisation would not necessarily prevent the person’s passionate feeling that they have been betrayed after committing to work for the company for so long.

Introjection

Introjection occurs when a person takes stimuli in their environment and adopts them as their own ideas. This may involve internalising criticism from another person and believing the other person’s points to be valid. A person may introject religious ideas that they have heard at church, or political opinions that friends espouse. Behavior can also be introjected – the mannerisms of a father may be observed by his son and then replicated.

Isolation

The defense mechanism of isolation can lead a person to separate ideas or feelings from the rest of their thoughts. In distinguishing an emotion or impulse from others in this way, a person attempts to protect the ego from anxieties caused by a specific situation. For example, a person with a particularly stressful job may use isolation to separate their work life from their family life, avoiding the stress affecting their relationships.

Passive Aggression

Displays of aggression are considered unsociable and undesirable in many societies, so when aggressive or violent impulses are experienced, people tend to avoid them as much as possible. However, the remaining energy driving such aggression may prove to be more difficult contain, and may manifest in other forms, known as passive aggression. A passive aggressive person may be uncooperative in carrying out their duties or other tasks, may deliberately ignore someone when spoken to and might adopt a negative view of their situation, such as their job, and of those around them (e.g. colleagues).

Projection

When we experience feelings or desires that cause anxiety, or that we are unable to act on owing to the negative impact that they would have on us or those around us, we may defend the ego from resulting anxieties by projecting those ideas onto another person. A person who is afraid of crossing a bridge with a friend might accuse them of having a fear of heights, for example, and in doing so, avoids accepting their own weaknesses. In the case of Daniel Schreber, who accused his therapist of attempting to harm him, projection may have occurred when he attributed his own feelings and desires onto his therapist, Professor Flechsig.

Rationalisation

Rationalisation occurs when a person attempts to explain or create excuses for an event or action in rational terms. In doing so, they are able to avoid accepting the true cause or reason resulting in the present situation.

Examples of rationalisation include a shoplifter blaming the high price of sweets to justify their theft of a chocolate bar, when in reality they simply enjoyed the act of shoplifting. If a person fails an exam, they may excuse themselves from blame by rationalising that they were too busy to revise during the revision period.

Reaction Formation

When the insatiable desires of the id conflict with the ego and super ego, a person may formulate a reaction to those impulses. Often, this action is the direct opposite to the demans of the original desire, and helps to counteract impulses which may be unacceptable to act out or fulfill.

For example, a man may experience feelings of love towards a married woman. The super ego recognises that the fulfillment of his desires would contradict social norms regarding acceptable behavior, and so a reaction formation would occur – the man may experience feelings of dislike towards her – the opposite of the original feelings.

Repression

Repression is perhaps the most significant of defense mechanisms in that repressed feelings and impulses can lead to the use of many other mechanisms. According to Sigmund Freud’s psychodynamic theory, the impulsive desires of the psyche’s id are prevented by being fulfilled by the ego, which observes the Reality Principle – that our actions are restricted by our environment, including social etiquette. Moreover, the superego acts as our moral compass, inducing feelings of guilt at having experienced the irrational desires that the id creates.

Tensions inevitably arise between the id, ego and super ego and the guilt induced by the latter can lead to feelings of anxiety and shame. In order to live with such feelings, Freud believed that our minds repress the thoughts at the source of our anxieties: instead of contemplating them consciously, they are ‘bottled up’ in the unconscious mind, emerging in symbolic dreams and unexplained patterns of behavior.

Freud and his colleague, Josef Breuer, used techniques such as hypnosis, regression and free association to encourage clients to recall and accept repressed memories and impulses.

Regression

Regression occurs when a person reverts to the types of behavior that they exhibited at an earlier age. Stress of adult life and the associated anxiety may lead to a person seeking comfort in things which they associate with more secure, happier times. They might regress by eating meals that they were given as a child, watching old films or cartoons, acting without thought for the consequences of their actions.

Self Serving Bias

The self serving bias arises from our need to protect the ego from self criticism and to defend ourselves from the complaints of others. We show a self serving bias when we exaggerate the importance of our own achievements – after passing a test, we might over-estimate the significance of that particular exam, and take credit for completing it without acknowledging the role that tutors played in our success. Similarly, when faced with potential criticism we might deflect blame, apportioning responsibility for failure to anybody but ourselves. Whilst many of us show signs of this self serving bias, it can be an ineffective method of defence as it distort our view of reality and our ability to rationalise and interpret events effectively.

Social Comparison

When people feel that they have been victims of unjust actions, they may defend the ego by comparing themselves to those worse off. Similarly, we may see similarities between ourselves and others in a better position to improve our self image. These defense mechanisms are known as download or upward social comparisons. For example, a man who has broken a leg and confined to a wheelchair may make a downwards social comparison with a person who has been diagnosed with a more serious condition to make their own situation seem less troublesome. Alternatively, a person might seek to identify with a person of a perceived higher social position, such as when they learn that a celebrity is eating at the same restaurant as they are.

Splitting

Splitting occurs when the ego attempts to reconcile multiple aspects or rationales, but resorts to understanding the world in “black and white” terms. A person who experiences splitting may take an “either-or” approach when making evaluations of the world around them, including objects, situations, and people. They tend to view ideas as either right or wrong, with no middle ground or compromise. Similarly, they may take a “good versus bad” approach in relationships, admiring one group of people whilst completely rejecting those who do not live upto their expectations.

Sublimation

Sublimation is considered to be a more adaptive defence mechanism in that it can transform negative anxiety into a more positive energy. Psychiatrist George Vaillant identified it as a mature defense mechanism, which we can use to adapt to arising anxieties.

When the energy of the libido surfaces in the form of impulses in the psyche’s id, these desires are disabled by the ego, and the super ego may produce guilt at having experienced unacceptable feelings. Whilst these impulses may be repressed, the energy behind them remains. Instead of converting this energy into socially unacceptable behavior, a person may use sublimation to redirect this motivation into more acceptable, even productive, endeavours.

Freud believed that artists’ creative energies were often a refocusing of carnal impulses or other anxieties, through sublimation, onto their work. Athletes may also use sublimation to concentrate their energy on productive activities such as training.

Somatization

The somatization defence mechanism occurs when the internal conflicts between the drives of the id, ego and super ego take on physical characteristics.

Josef Breuer, a colleague of Sigmund Freud, observed this in the case of Anna O, who sought help from Breuer for hysteria. Breuer discovered that Anna’s anxieties had resulted from traumatic events that had been repressed, but later manifested themselves physically. For example, she experienced paralysis on one side, which Breuer linked to a dream in which she felt paralysed whilst trying to fend off a snake from her bed-bound father.

Anna O: Sigmund Freud’s Case History

Suppression

Unlike many other defense mechanisms, the suppression of thoughts and emotions is something which occurs consciously and we may be entirely aware that we are attempting to suppress anxieties. Suppression involves attempting not to think about a memory or feelings – a person may try to think of another subject when an uneasy thought enters their mind or they might preoccupy their minds by undertaking an unrelated task to distract themselves. A person may also suppress feelings of love or dislike towards a person, behaving normally towards them as though they felt dispassionate towards them.

Undoing

When we act on an idea or impulse that we later regret, we may adopt a defense mechanism of attempting to “undo” that action in order to protect the ego from feelings of guilt or shame. A person may intentionally push past someone in a shop, but realising that the person was frail, feel guilty with regards to their behavior. They may try to undo their action by apologising or offering to help the person.

Wishful Thinking

We all engage in wishful thinking to some extent in an attempt to avoid facing undesirable realities. A football fan might deceive themselves that the ailing team that they support will miraculously turn themselves around and win all of the future matches of the season. Such wishful thinking enables the person to avoid disappointment and sadness for as long as possible.

Defense Mechanisms Quiz