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Antidepressants and Suicide: WHO Scientists Weigh In

February 4, 2009 in Blogs, Psychology Today by Psychology Today

On the question of new antidepressants and suicide, the evidence we have has been synthesized, and the results are in : the medications prevent suicides in adults, and especially in the elderly. For children and adolescents, we simply don’t know – and the gap in our knowledge has had dangerous effects. World Health Organization scientists based in Italy and Canada have re-analyzed data on over 200,000 patients with depression treated with serotonergic antidepressants, or SSRIs. With a pool this large, the researchers were able to look past ideation to actual attempts or completed suicides. The study found a strong protective effect for adults, including young adults, aged 18 to 25, and the elderly, over age 65. The medications decreased the risk of suicide by over 40 per cent in adults aged 18 to 64, and by over 50 per cent in older patients. These results are striking, especially in the light of earlier FDA summaries that found a neutral effect for non-elderly adults and a negative effect for young adults. But the FDA reports were based on research not designed to investigate suicidality, and the data were skewed conservatively, that is, in ways that might over-identify suicidal behavior. The new analysis is more clear-cut; it moves the line of high risk down from age 25 to age 18. What happens below age 18 is uncertain. Both the FDA summary and yesterday’s analysis found a marked increase in suicidality in depressed adolescents treated with SSRIs. (Unless I’m reading the data wrong, the risk for youth looks to be almost double on medication.) But as an accompanying editorial indicates, a large body of research points in the opposite direction. For instance, examining all youth suicides (42 deaths) over a five-year period, Danish pathologists found that none of the adolescents had been on SSRIs. In many countries, studies have found that low SSRI prescribing levels correlate with high youth suicide rates. Decreased SSRI prescribing since the FDA issued its "black box" warning has been associated with increased rates of suicide in adolescents. And some of the studies (including ones in the current WHO analysis) that have demonstrated an increase in suicidality are poorly controlled, so that the young people on SSRIs may be more seriously ill than those in the comparison group. We need to settle this issue: As regards risk of suicide, do SSRIs help or harm depressed adolescents? The editorial assessing the WHO study contains these disturbing sentences: "Alarmingly, concerns about the risk of suicide in youth have led not only to fewer SSRI prescriptions without substitution of alternative medications or psychotherapies, but also to a decrease in predicted rates of diagnosis of mood disorders. Since a decrease in the rate of true depression is improbable, clinicians may be avoiding making this diagnosis to avoid the dilemma of whether to prescribe antidepressants to children or adolescents." This worry was one that experts raised when the FDA was considering its action – that a warning, however carefully worded, might cost lives. (I should note that on balance I favored the black box warning.) As the editorial indicates, "in youth, suicide appears to occur most commonly among those with untreated mood disorders." My own impression – I discuss it in Against Depression – is that antidepressants simply work less well in children, and for reasons that accord well with the prevailing neurobiological theories of mood disorder. But when the medications do appear to help, are they dangerous? The new study again raises special worries about Paxil and also Effexor in young patients. Incidentally, two of the WHO researchers on the new study, Andrea Cipriani and Corrado Barbui, were also authors of the widely publicized recent summary analysis that rated the relative merits of antidepressants. As in the prior report, in the new one Zoloft looks especially safe, at least in adults. © 2009 Psychology Today. This RSS Feed is for personal non-commercial use only. If you are not reading this material in your news aggregator, the site you are looking at is guilty of copyright infringement. Please contact blogs@psychologytoday.com so we can take legal action immediately.

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Masturbation Paranoia May Cause Cancer

January 30, 2009 in Blogs, Psychology Today by Psychology Today

They say masturbation can cause insanity and blindness. It can, but only in science reporters and others who get too worked up to think straight. The headline reads: "Masturbation May Increase Risk of Prostate Cancer." But the headline misrepresents the study being reported — and doesn’t even accurately summarize the content of the story. In fact, all the researchers found was a preliminary suggestion of a correlation between frequency of masturbation among some men in their 20s and higher occurrence of prostate cancer later in life. Correlation, not causation (a more thorough discussion of the study’s methodology can be found here ). Logic would lead one to think that some men might masturbate more than others because they have a higher sex drive, which would likely be related to higher levels of testosterone and related hormones. The science around the relation between androgens (male sex-related hormones) and prostate cancer is unclear. A number of studies have found no relation at all, while others (like the study cited above) have found that higher levels of these hormones appear to indicate increased risk of developing prostate cancer later in life. A few examples of reports on these contradictory studies can be found here , here , and here . A team of Australian researchers, for example, found that men who had ejaculated more than five times per week between the ages of 20 and 50 were a third less likely to develop prostate cancer later in life.  Graham Giles, of the Cancer Council Victoria in Melbourne, who led the research team, describes his as “a prostatic stagnation hypothesis.” Along with the fructose, potassium, zinc, and other benign components of semen, trace amounts of carcinogens are often present, such as 3-methylchloranthrene, found in tobacco smoke. Giles believes the reduction in cancer rates may be due to the fact that, “The more you flush the ducts out, the less there is to hang around and damage the cells that line them.” So the message being sent by the headline, that masturbation could cause cancer, may well be not only wrong, but destructive. If Giles and his team are correct that frequently flushing away these accumulated carcinogens has a protective effect, irresponsible headlines like that could be causing higher rates of cancer by scaring young men away from masturbation. But anti-masturbation paranoia is nothing new. While the anti-masturbation frenzy has roots deep in Western history, these forces found apparent medical support in the work of Simon André Tissot, who published A Treatise on the Disease Produced by Onanism in 1758.  Sexologist John Money tells the sad story: "With the knowledge of hindsight, it is possible to infer that Tissot recognized the symptoms of social vice, namely syphilis and gonorrhea, which in the era before germ theory were considered a single disease. He attributed these symptoms not only to excessive semen depletion secondary to promiscuity and prostitution but, in one of the great biomedical errors of all time, to the secret vice of masturbation, also." Although certainly not the source of the original opposition to masturbation, this supposed medical confirmation could not have helped matters. A century later, in 1858, a highly respected British gynecologist named Isaac Baker Brown (president of the Medical Society of London at the time), proposed that most women’s diseases were attributable to over-excitement of the nervous system, with the pudic nerve, which runs to the clitoris, being particularly culpable.  He listed the eight stages of progressive disease triggered by masturbation: first comes hysteria, then spinal irritation, hysterical epilepsy, cataleptic fits, epileptic fits, idiocy, mania and finally, death. Baker Brown performed an unknown number of clitorectomies in his clinic (The London Surgical Home) before finally being disgraced and expelled from the London Obstetrical Society for irregularities in obtaining consent from his victims/patients. Baker Brown subsequently went insane (or, one might argue, his insanity was subsequently recognized) and clitorectomy was promptly discredited in British medical circles.  Unfortunately, Baker Brown’s writing had already had a significant impact on American medical practice – an impact unmitigated by his fall from grace in Britain.  The procedure continued to be practiced in the United States well into the 20th century as a cure for hysteria, nymphomania, and the scourge of female masturbation. As late as 1936, Holt’s Diseases of Infancy and Childhood , a respected medical-school text, recommended surgical removal or cauterization of the clitoris as a cure for masturbation in girls. The craziness around masturbation would be amusing if it hadn’t led to so much suffering (did you know, for example, that Graham crackers were invented as a way to discourage boys from polishing their rockets? Bland foods were thought to dampen the flames of libido, so Graham and Kellog invented their nearly tasteless foods to help boys control their urges). Check out the book or film: The Road to Wellville for more on this. © 2009 Psychology Today. This RSS Feed is for personal non-commercial use only. If you are not reading this material in your news aggregator, the site you are looking at is guilty of copyright infringement. Please contact blogs@psychologytoday.com so we can take legal action immediately.

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Now You See Him, Now You Don’t

January 27, 2009 in Blogs, Psychology Today by Psychology Today

When you’re mute and paralyzed and hooked up to machines and you didn’t used to be this way, people treat you differently. They don’t want to, and they might tell themselves they aren’t, but they do. They see only the helpless flesh, those hands and feet that someone else put into position for you — and you know and they know that anyoneat all could put your limbs into any position at all, could put them into a silly pose or a humiliating pose, and you couldn’t fight back. Most who see you in this state, even your loved ones, see only the flesh. First, they cry. Then as the days and weeks pass they start talking around you, and/or about you, as if you weren’t there. Some address you directly, but they appear nervous and even embarrassed as they do, enunciating as if you were a child. A relative of mine, whom onlookers see as a motionless 250-pound hillock under a floral-patterned sheet, is learning this right now, to his horror, day by day. A year ago, when he was only thirty, Jake had a brainstem stroke. He collapsed at work; colleagues who found him on the floor called 911. Jake was not expected to survive. According to the National Stroke Association, only 10 percent of strokes occur in the brainstem, which connects to the spinal cord and controls automatic functions such as breathing, heart rate, blood pressure, swallowing, and sleep patterns. Most such strokes are fatal. Jake’s wife, Ashley, rushed to the hospital and found him comatose. Doctors told her to expect the worst. And did the worst occur? That depends on what you consider "the worst." To Ashley, "the worst" meant death. But to some of those close to Jake and Ashley, "the worst" meant life: that is, life spent in a coma, or — if Jake ever awoke — as the quadriplegic that his doctors declared he would be: a sweet, smart, funny young man who could swallow only via machine, immobilized forever with what neurologists call "locked-in syndrome," a fully aware mind inhabiting a fully inert body. (Locked-in syndrome, for which there is no cure, gained notice in recent years after French journalist Jean-Dominique Bauby suffered a brainstem stroke that left him utterly paralyzed but for one eyelid. Using that eyelid, Bauby dictated his memoir, The Diving Bell and the Butterfly ; it became a bestseller and was made into a film last year.) Some folks seemed to feel that, for his own good, Jake was better off dead. Ashley was overjoyed when Jake regained consciousness a week or so after the stroke. The couple made eye contact and she squeezed his hand. He couldn’t squeeze back, but she knew he longed to. Ashley spent every possible hour at the hospital. She talked to Jake. She brought him an iPod filled with his favorite music — Coldplay, Gigi D’Agostino, Maroon 5. She placed one earbud into Jake’s ear, the other in her ear, clasped his hand and danced by his bedside. The first time she did this it was, she wrote in her blog that day, "the best dance of my life." After five months in the hospital, during which he experienced several emergencies that required brain surgery — part of his forehead was removed, then replaced with a plastic prosthetic — Jake was transported to a rehab center. Soon he’ll move into a cottage on his parents’ property, specially outfitted for his needs. Three people are required to turn Jake in bed. He makes rough sounds which only Ashley can interpret, and even then only a fraction of the time. He cannot register emotions, cannot frown or smile. A former executive, once the life of every party, he has been rendered largely invisible — a sensation that other disabled people have told me they share. And from this realm, stuck in such a literal way, from the mind that sees while some fail to see it, comes a message posted on Ashley’s blog, dictated to her via sounds and hand signals: "I am doing OK. Therapy has really helped me. I never thought I would eat again but it is going to happen. Last week I had ice cream twice and I loved it. I have some movement back in my right hand which was totally unfeeling and I am filled with hope recently at my many small improvements. Thank you for keeping me in your thoughts. My family is building me a place to live and my dad works very hard every day to get it done. And my mom makes food and drink for all the workers. I love my wife and my family and my friends. "Love, Jake." © 2009 Psychology Today. This RSS Feed is for personal non-commercial use only. If you are not reading this material in your news aggregator, the site you are looking at is guilty of copyright infringement. Please contact blogs@psychologytoday.com so we can take legal action immediately.

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When friends are just acquaintances

January 25, 2009 in Blogs, Psychology Today by Psychology Today

The February, 2009 issue of Men’s Health Magazine quotes my four categories of friendships (see p. 24 of that issue) from Buddy System: Understanding male friendships.  The categories are just, rust, must, and trust friends.  In today’s blog, I will briefly describe the lowest level of friendship – the just friends (the highest level are must friends – people you must call if there is a crisis or if you hit the lottery). Your just friends are people who live with you in the dorm, work with you on the job, or men you know from the community. They are your acquaintances.  You might hang out with them if you are free but you most likely will not make plans to see them in advance.  You won’t invite them over to your house.  This is usually a large body of people as they can encompass most people who you know but do not feel very close with.  You may wish to establish a closer level of friendship with them (a trust or must level) but have not done so at this point.  OR they may be people you are happy to keep at arm’s length.  You may not share their world views, politics, or like how they treat other people.  You know them but they are just friends.  In the next few blogs I will talk about the other levels of friendship. © 2009 Psychology Today. This RSS Feed is for personal non-commercial use only. If you are not reading this material in your news aggregator, the site you are looking at is guilty of copyright infringement. Please contact blogs@psychologytoday.com so we can take legal action immediately.

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The Cultural Context of Depression

January 23, 2009 in Blogs, Psychology Today by Psychology Today

One cannot fully assess the nature of depression without addressing the context (cultural, communal, familial) within which it occurs, any more than one could fully understand the growth of a bacterium without understanding the medium within which it grows. To focus the analogy even further, we might say that we cannot fully understand the growth of the phenomenon of depression, the rising incidence and prevalence, without understanding the medium within which this phenomenon is growing. That medium is the western culture, the community one lives in, the schools and groups one belongs to, and the family. Much has been written about the influence of marital status, marital satisfaction, early parental loss, and early developmental trauma on the vulnerability to depression. However, much less information has found its way into the mainstream psychosocial literature in regards to the influences of both the community and the larger western culture on the growing incidence of depression. What is this culture of depression? Families, communities, and farms have been broken apart as a result of the industrial revolution, economic swings, technology, and the pursuit of work. Two income families have become much more prevalent as personal income in the US became flat in 1973, and then has been declining since 1980. With both parents working, and grandparents in another city, most children are spending their critical attachment years in pre-school or a series of day care centers. Western culture, according to Richard Tarnas, author of: The Passion of the Western Mind & Cosmos and Psyche , has evolved over the last few millennia in such a manner that modern humankind is now alienated, disoriented, and unconscious. Despite the very significant advances afforded by the current world view, we are seeing the darker aspects of that world view come to the fore in the form of world wars, holocausts, the threat of nuclear annihilation, and now global warming and ecologic disequilibrium. Furthermore, the western world-view is that we live in an inanimate universe, with other life forms, which are essentially unconscious. We consider ourselves to be unique in the universe, and as a corollary to that, we are superior, and we are, by definition, alone. Additionally, we believe that science is the only valid way of knowing. In a neuroanatomical sense, we have over-privileged the functions of the prefrontal cortex and left hemisphere, over the rest of our brain. Logic rules, and instinct and tradition have become stepchildren. More and more, if we think about it, we grapple with what seems to be an inescapable conclusion: we live in an essentially meaningless, purely physical, random world, in which we are essentially alone, separate from others, separate from nature, and separate from (if we even believe in) a creator. We wonder if we may be nothing more than meaning-seeking specks of dust in an infinite, uncaring, and unconscious universe. We are here. The creator, if there is one, is out/up there. This then, is the world-view and the culture, within which depression (not to mention greed and corruption) has grown in incidence and prevalence. If world-views create worlds, as the leading psychotherapy of depression, cognitive therapy, asserts, then we must wonder what it is about the assumptions of the western world view that have created a new reality in which depression is rapidly becoming the second leading cause of disability in the world. Could the assumptions (outlined above) be mistaken, or harmful? Adapted from Depression: Advancing the Treatment Paradigm. © 2009 Psychology Today. This RSS Feed is for personal non-commercial use only. If you are not reading this material in your news aggregator, the site you are looking at is guilty of copyright infringement. Please contact blogs@psychologytoday.com so we can take legal action immediately.

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Maktub: It is Written

January 17, 2009 in Blogs, Psychology Today by Psychology Today

Aside from being a psychologist in nursing homes, I also had the pleasure of being a caregiver to my own aging parents–as a consumer of the same services I provide, the personal meets the professional. I work both sides of the streets. My father spent the last years of his life in a nursing home descending into deeper and deeper dementia. It’s time for the quarterly care plan meeting at Dad’s nursing home. My father, who has a right to be there, is not there. He wouldn’t have a clue. I’m sitting at a table squeezed into an office not meant for conferences, fiddling with my cell phone. My brother, Robert, attends via speakerphone. I chat up a nurse about her golf game. This is the functional equivalent of a parent-teacher conference. We’re going over the functional equivalent of a report card. The golfing nurse–the care plan coordinator–chairs the meeting. Every three months, each of the departments files a report for Dad’s chart. Usually the staff moves along the agenda along minus the impediment of family, like my brother and me. First up, the dietitian. But before she begins, we hear an impediment from Robert on the speaker. "I was in town from Boston last weekend, and there was a banana on my dad’s lunch tray." Dad’s kidney has been slowly failing for most of his adult life–slowly enough so something else will likely kill him first. But bananas and other high potassium foods are poison. He loves bananas. "Sorry, I’ll look into it," says the dietitian. I’m personally not at the top of the charts when it comes to caregiving time; I’m not spending hours a day or even every week with Dad, but I worry about the bad kidneys of residents whose families never show up. The doctor never attends care planning. Unlike the nurse, he might be actually golfing. A nurse drones on about Dad’s vital signs and the ups and downs of his meds. There’s no physical therapist, either. My dad has "plateaued." There is no hope of additional progress for his fractured hips. Medicare won’t pay for plateaus. Exercise would still be good for his hips, but he’ll have to get someone other than Medicare to pay for him to walk across a plateau. Pushing ninety, he’s a Medicare orphan. My brother and I pester the recreational therapist and the social worker about exercise, having the aides walk him. This is when we get the lines about staffing shortages, and how he doesn’t want to go on walks, anyway. Neither does he want to go to recreation. "Forget about his rights and just wheel him down to the damn sing-along!" I implore. They write that down. Reminds me of the patient who asked, "Do you write down everything I say?" "What do you think?" I ask, as I write that down. For those who remember Lawrence of Arabia, "Everything is written." Maktub in Arabic. You may think you’re in something like a home, but you’re a 24/7 patient for the rest of your life. It is written. Maktub . To mix metaphors. Sysiphus has nothing on me. *                                           *                                            * This post was adapted from my forthcoming book, Nasty, Brutish, and Long:Adventures in Old Age and the World of Eldercare (Avery/Penguine, March 2009). © 2009 Psychology Today. This RSS Feed is for personal non-commercial use only. If you are not reading this material in your news aggregator, the site you are looking at is guilty of copyright infringement. Please contact blogs@psychologytoday.com so we can take legal action immediately.

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Retirement Communities Selling Out to Young Buyers

December 30, 2008 in Blogs, Psychology Today by Psychology Today

Prehistoric folks had a life expectancy of eighteen. But this brief span was world enough and time for reproduction and survival of the human species. They died too young to have a legal drink, but they had quite enough life span to discover fire and invent the wheel. A handful of twenty-year-old elders was sufficient to pass along a modicum of culture-how to organize the hunting and gathering, how to extract not only food, clothing, and shelter from dead game, how to bury the bodies. Over the next several millennia, as life expectancy crept up to thirty, there was plenty of time to be Alexander the Great, Jesus, or Mozart. Fast-forward to 1946, the year I was born, and life expectancy was sixty-seven-approaching the Biblical three score and ten-quite enough time to invent the computer, triumph over Fascism, and replace swing with bebop. People considerately exited before becoming demographic undesirables to TV advertisers. You could briefly savor your life achievements in full command of your senses and then leave the scene. So what’s the meaning of the extra twenty or thirty years we have attained since my birth? This question came to mind reading a piece in the Wall Street Journal, "Retiree Havens Turn Younger to Combat the Housing Bust" (December 28, 2008). The article focuses on the growing number of vacancies in the so-called active adult communities such as Century Village or Sun City. Typically, these enclaves require buyers to be at least 55 years old, and ban children under 19 as permanent residents. Lowering the age requirement is a way of expanding the market and reducing financial stress on the communities. The fewer the residents, the less money there is for mowing the lawn, cleaning the pools, and paying for the staff at the clubhouse. For people younger than 55, the attraction-along with the swimming pools, and the weight rooms unused by 80 somethings-is the comparatively reasonable prices of the adult communities. For example, in Century Village, Deerfield Beach, Florida, a two-bedroom condo goes for $40,000, quite a bargain even in the reduced state of today’s housing market. As a psychologist who works with the elderly in nursing homes and assisted living facilities, I was less interested in the economics of the situation than this comment from a retired physicist in an adult community in Massachusetts, "we want to live with people our own age and interests." Younger people "would change the general complexion of our community." Retirement communities are a very recent development on the time-line of human history. In traditional societies, elders are leaders and teachers. If they wanted to live by themselves, they would be unproductive mouths to feed. In nomadic societies when you become too frail and elderly, they move on and leave you behind. This perhaps is an ironic analog of modern elders segregating themselves in retirement communities; rather than being left behind, they leave the rest of us behind. The idea of retirement itself and living out your days among elderly peers is a recent invention and artifact of the rise of a large middle class amid the widespread post World War II prosperity. It is no accident that retirement communities like Sun City followed soon after suburban developments like Levittown. But it would be a mistake to think that most elders either desire to or can afford to live in a gilded cage. According to the last U.S. census in 2001, only 10 percent of people under the age of 79 live in housing specifically built for the older people. For those between 80 and 84, the number rises only to 13 percent. And for those aged 85 or older only, it’s only 19 percent. These findings closely mirror a 2004 survey of pre-retirees-500 responses from 50-65 year olds-conducted by The MetLife Mature Market Institute and AARP Health Care Options. Almost all wanted to live in their own homes. Even if they were to require some kind of ongoing assistance, almost half would prefer to receive it in their own homes. A large chunk of those surveyed were by age my fellow baby boomers-a generation that has stereotypically wanted and expected it all. I wonder if my parents’ generation-my parents did move to Century Village-would have shared these more recent attitudes. The children of the Depression first wanted to move to the suburbs and then to the senior version of the suburbs-"active adult communities." But my contemporaries are reversing this trend. People who raised their families in suburbs are foregoing golf and swimming pools to move into cities to be near art galleries and concert halls. There are even new high-rise adult communities being built to meet this demand. Although most in the MetLive/AARP survey wanted to live at home, and not move, adult communities were the second choice. A luxurious high-rise community such as Chicago’s Gold Coast Clare at Water Tower has hotel-style amenities along with and medical services characteristic of an assisted living center-combining the lure of the big city with the helping hand of a home health aide. But this is not an option for everyone. Entry fees range from $500,000 to more than $1 million, with monthly maintenance ranging from two to four thousand, not something you can do on your Social Security check. More likely for most is a place like the Bella Vista in New Haven-monthly fees of less than a thousand, the public bus to downtown, but with beautiful views of the harbor. Being over 55, I joke to my wife that I’m headed there after-let’s call it-an animated discussion. So, in the end, the financial bust and the opening of sales to those under 55 at Century Village is a case of back to the future. As some old folk are moving out of their retirement communities to rejoin the world at large, young folk are moving out of the city to fill up those vacancies. Count me among those who would like to stay where I am. "Age in place," as we geriatric types like to say. Or as one woman in her seventies exclaimed to me after she moved into her gilded cage at a posh active adult community: "I didn’t realize these people would be so old!" © 2008 Psychology Today. This RSS Feed is for personal non-commercial use only. If you are not reading this material in your news aggregator, the site you are looking at is guilty of copyright infringement. Please contact blogs@psychologytoday.com so we can take legal action immediately.

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Singlism: Should We Just Shrug It Off?

December 13, 2008 in Blogs, Psychology Today by Psychology Today

Thanks to Governor Ed Rendell’s proclamation that single woman Janet Napolitano will be "perfect" for the job of Secretary of Homeland Security because she has "no life ," and Gail Collins’s glorious send-up of the matter in her op-ed in the New York Times , singlism is having its day. This matter of stereotyping and stigmatizing people who are single has now been addressed in the Wall Street Journal , on CNN’s American Morning , on the ABC news website , and on the Ron Reagan Show on Air America , to name just a few national venues. It also made the cover of The Week magazine, and it is all over the blogs. (A few examples are here and here and here .) I love all this attention that singlism is garnering, and not because the commentary has been uniformly approving or affirming. It hasn’t. Consider, for example, the 205 comments that were posted in response to Gail Collins’ column before the comments option was closed. Many were positive, and I was heartened by them. The readers thanked Collins for her insight and her wit, and recounted their own experiences of singlism in the workplace and beyond. I was most intrigued, though, by the nasty stuff. One said that if the choice for the position of Homeland Security chief was between someone "with a spouse and kids" and another "with no responsibilities other than filling the cat’s food bowl at night," then he would "pick the loner every time." (Singlism, anyone?) More than a few commenters chastised Collins for writing about the topic at all. They said it was "much ado about nothing," it was "silly" and "ridiculous," and that she should have instead discussed "an issue, ANY issue, that actually matters." Several said that we single people are just crying victim, that we are hypersensitive and resentful, and that we should just "let it go." One person even made the clever (if obnoxious) suggestion that anyone who thought Rendell’s "no life" comment was offensive should "get a life." What made all these dismissive and derogatory comments especially interesting to me was that I’ve heard similar versions from fellow scholars. In an academic publication , they have suggested that singles are not really perceived negatively, that any stereotyping or discrimination they experience is small potatoes and is doled out only very selectively (for instance, to people who remain single after the age when most others are married). Some have advised me and my colleagues to put aside the study of singlism and focus on something else. I thought long and hard about how such otherwise intelligent people could be so apparently resistant to the idea that singlism really does exist and that it matters. Even more importantly, I thought about how I could make my case more persuasively. I went through all the predictable options. I pointed to data documenting the practice of singlism, and showing that even young singles are perceived negatively, relative to young people who are coupled. I repeated an important qualification that I had already articulated – that in the degree of viciousness and violence it can engender, singlism is not akin to some of the other isms such as racism and heterosexism. I tried making my case with logic, asking how extreme or hurtful an unfair behavior would have to be before it would be considered appropriate to try to address it. And: who should decide this? Then I came up with this thought experiment. If you think that singlism really is "much ado about nothing," that we singles are just being hypersensitive and should "let it go," then it should also be perfectly fine to turn the tables. I liked this approach so much that I made it the opening page of my book, Singled Out . Here it is: EXCERPT FROM PAGE 1 OF SINGLED OUT : How Singles are Stereotyped, Stigmatized, and Ignored, and Still Live Happily Ever After : I think married people should be treated fairly. They should not be stereotyped, stigmatized, discriminated against, or ignored. They deserve every bit as much respect as single people do. I can imagine a world in which married people were not treated appropriately, and if that world ever materialized, I would protest. Here are a few examples of what I would find offensive: • When you tell people you are married, they tilt their heads and say things like "aaaawww" or "don’t worry honey, your turn to divorce will come." • When you browse the bookstores, you see shelves bursting with titles such as If I’m So Wonderful, Why Am I Still Married and How to Ditch Your Husband After Age 35 Using What I Learned at Harvard Business School . • Every time you get married, you feel obligated to give expensive presents to single people. • When you travel with your spouse, you each have to pay more than when you travel alone. • At work, the single people just assume that you can cover the holidays and all of the other inconvenient assignments; they figure that as a married person, you don’t have anything better to do. • Single employees can add another adult to their health care plan; you can’t. • When your single co-workers die, they can leave their Social Security benefits to the person who is most important to them; you are not allowed to leave yours to anyone – they just go back into the system. • Candidates for public office boast about how much they value single people. Some even propose spending more than a billion dollars in federal funding to convince people to stay single, or to get divorced if they already made the mistake of marrying. • Moreover, no one thinks there is anything wrong with any of this. Married people do not have any of these experiences, of course, but single people do. People who do not have a serious coupled relationship (my definition – for now – of single people) are stereotyped, discriminated against, and treated dismissively. This stigmatizing of people who are single – whether divorced, widowed, or ever-single — is the 21st century problem that has no name. I’ll call it singlism. END OF EXCERPT If these kinds of things really did happen to married people, how long do you think it would take before we would all start hearing about the unfairness of it all? Like I said, I wouldn’t want that. I want fairness for all, and I’m searching for ways to make my case. —————- [Note to readers of this Living Single blog: If you are interested in a special offer on copies of Singled Out , effective through December 21, 2008, Click here . Then click on the HOLIDAY SPECIAL OFFER which is just above the word WELCOME at the top of the page. ]     © 2008 Psychology Today. This RSS Feed is for personal non-commercial use only. If you are not reading this material in your news aggregator, the site you are looking at is guilty of copyright infringement. Please contact blogs@psychologytoday.com so we can take legal action immediately.

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Singlism: Should We Just Shrug It Off?

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Young Doctors Burn Out

December 2, 2008 in Blogs, Psychology Today by Psychology Today

I remember one on-all night as a first year medical intern at 4 AM. My first year teammate was exhausted and our senior resident looked worn out . After working a straight 20 hour shift with no breaks, we were beat. In my twenties, I looked fresh, and could continue to work in the Emergency Room like the Energizer Bunny. I knew I could go on all night without sleep but would also feel my speech would be somewhat off the next day. This was more of a subjective observation as others told me I looked just fine. My head would feel heavy and full, I felt my speech was not as clear as usual, and I’d still work the whole next day. This schedule went on for months. There is a caveat, though. My fellow intern and I had a brilliant idea which we put into effect the first few weeks: she had a hard time staying awake after midnight and, instead, I felt better if I went on through the night and then got a few hours of sleep before the next workday. She would go to bed at midnight and I would take care of all hospital needs until 4 AM. We would then switch places, she would take care of all consults and I would try to get some sleep from 4 AM to 8 AM. The deal was in place as long as the other one didn’t feel overwhelmed with all the admissions and consults. We never called the other one for back-up; we took the hectic schedule as those hours made a great difference in our performance the following day. We usually worked weekends and had a full free weekend every few months. My colleague and I were married to doctors and we both had young children. This was almost two decades ago. At the time, residents stayed awake and worked all night long for months and even years. Doctors took pride of their ability – whether because of a genetic-based capability or an ability to adapt to an environmental demand. The idea was: if you wanted to be a doctor, you first needed to live up to the challenge. While practicing physicians understand that reducing errors and improving working conditions are of essence, many of us have also observed some new attitudes. Not that there weren’t ever senior residents taking advantage of the younger ones. And yet, some of the younger physicians will now say their time is up and they may be more reluctant to seeing any more patients although there may be a need. Other doctors would present a smoother transition before their shift is up. Many experienced physicians miss the old days with a bitter-sweet taste. Many believe they chose the challenges of being available to serve in extreme circumstances. Medicine has been a profession of service although the current practicing scenario has converted into more of a commodity. If these young doctors are burning out when they haven’t even started practicing medicine, what will happen next? There is a well-anticipated shortage of physicians expected in the coming years. Add the younger generation’s expectations to live a better life with less work and many young women doctors already planning a part-time practice. Food for thought: Do you share long work hours? Do you believe both male and female physicians should have similar opportunities? Do you believe physicians who train less hours or who work less hours than their counterparts can develop a similar degree of expertise as their counterparts?   © 2008 Psychology Today. This RSS Feed is for personal non-commercial use only. If you are not reading this material in your news aggregator, the site you are looking at is guilty of copyright infringement. Please contact blogs@psychologytoday.com so we can take legal action immediately.

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Young Doctors Burn Out

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Thick Skin Pays Off in Leadership

December 1, 2008 in Blogs, Psychology Today by Psychology Today

Women still dodge low balls in the public sphere . They are ready to brush off personal attacks to focus on what matters to them in politics or in the workplace. Whether we are talking about Hillary Clinton or Sarah Palin, we all agree that thick skin pays off in leadership positions. The most humiliating moments for either one of these two candidates may have been when their personal lives were questioned: for Palin, needing to "prove" to the world that her youngest son was really hers and not her daughter’s (a lioness in defense of not one but two of her cubs) or putting up with the media’s criticisim of a woman not being able to be a good mother and an effective leader at the same time. While hers has been a recent bout with the sometimes heartless media, Clinton’s putting up with her husband’s infidelity disclosed to the world while in power has been public for years. After something as embarrassing as her marriage made public, I don’t believe there is anything that nominee for Secretary of State, Hillary Clinton, can’t face. These women have what it takes in a tough world: they have thick skin. Pros of having thick skin in the workplace: 1. Although most people like to be liked, others strive on getting things done regardless of whether they win the popularity contest or not. 2. Disregarding both hurtful and senseless criticisms will allow you to focus on the bottom line, the common goal, without being distracted by personal attacks. This does not mean that leaders don’t listen to others’ advice; it just means they should be able to filter personal attacks and dismiss them. 3. Inner strength shows itself not when the world is praising you but when others are critical. It is easy to feel powerful when everyone around you is smiling at you, but the criticisms truly show who your true friends and foes are. Some cons about having thick skin in the workplace: 1. Many see this inner feeling of self-assurance as outward arrogance, creating distance between the leader and his or her employees. 2. Because others may perceive this "arrogant" leader as cold, robotic, and manipulative, many will suggest that the leader does not care about or even understand them. 3. This strength may be perceived as unemotional in others, particularly if the leader is a woman. The gender expectation is that a woman leader is generally more dramatic or more emotion-driven. Food for thought: Do you have thick skin or are you a drama queen? What are the advantages you’ve observed in leaders with thick skin versus the prima donnas? When is it a good idea to have thick skin and when is it a good idea to speak up about unfair comments? Do you notice gender differences in the way men and women control their emotions in the workplace? © 2008 Psychology Today. This RSS Feed is for personal non-commercial use only. If you are not reading this material in your news aggregator, the site you are looking at is guilty of copyright infringement. Please contact blogs@psychologytoday.com so we can take legal action immediately.

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