The Bystander Effect: Why We Don't Help

If you were being attacked in public, would you rather have 20 people around or just one? You would think the chances that someone would intervene or call for help would increase with more people around, but countless incidents and psychological studies have actually shown the opposite; the more bystanders there are, the less likely any of them will help. Psychologists refer to this as the bystander effect. The bystander effect is counterintuitive and can be hard to believe, but there is a lot of real-world and research data to support it. Let's look at a few reasons that contribute to the bystander effect.

Ambiguity
One reason people do not intervene is that they are unsure if the situation warrants their help or intervention. The ambiguity of the situation makes people less likely to help. After the fact, it is very clear that a situation was an emergency or tragedy, but it is not always so clear when the situation is happening. As we go about our daily lives, we do not anticipate encountering these types of situations, and so our tendency is to assume that things are okay and go about our lives. Additionally, people do not want to look like a "fool" and think something is wrong when, in fact, everything is fine. As a result, when people are not sure if something is wrong, they tend to remain silent. This pressure appears to be even stronger in men, as they don't want to appear weak or scared in a situation. Our general preference is to look like we think everything is okay on the outside, even if we are unsure on the inside.

The ambiguity factor is further reinforced when other people are around, as when things are unclear to us we assume that other people know more about the situation than we do. The result is that everyone is waiting to respond while looking at those around them to determine what to do. Unfortunately, since they are doing the same thing, everyone assumes that no one is responding because nothing is wrong and the result is that no one intervenes. This is a form of what psychologists call pluralistic ignorance, as individuals assume that others are not intervening because they know more than they do, when in fact they are equally as ignorant. Everyone thinks that something might be wrong in their head, but when they look to others and see they are not reacting, they assume everyone believes nothing is wrong. This is why more bystanders can actually be a bad thing.

Diffusion of Responsibility
Another contributing factor is the diffusion of responsibility. When other people are around, individuals feel less responsible to help or intervene because they assume someone else will. Unfortunately, what tends to happen is that everyone has this thought and no one responds. This is why in CPR training, they tell you to point to someone specific and ask them to call 911, rather than saying "somebody call 911." They know that the "somebody" can easily turn into "nobody." By pointing to someone and asking them specifically to make the call, the diffusion of responsibility will no longer be at play and they will take ownership of that responsibility. Unfortunately, when we are not singled out in this way, we tend to assume someone else will take action.

Although this may all seem a little disheartening, here is the good news. Like many social psychology phenomena, knowledge and awareness of the bystander effect can actually help us overcome it. By understanding that we tend to think everything is okay in an ambiguous situation, we can risk looking like a "fool" and ask someone if they need our help. By knowing that the other people around us may know just as little as we do, we can be the first to ask if something is wrong. And by understanding our tendency to assume that someone else will take responsibility, we can jump to action and remember that we can only be sure something is done if we do it ourselves. The actual effect of the bystander effect will decrease as more bystanders (citizens) are aware of it.

Dealing with Death

People often become very uncomfortable when the time comes to comfort a friend who is dealing with the recent death of a loved one. And unfortunately, most of the time this discomfort causes us to say or do things that are not comforting for our friend. To begin with, most of us can not tolerate the intense emotions that are evoked by death. Tolerance for these feelings is not something that can be changed over night, but it is something we can work on. While that is something that takes some time to develop, here are some simple tips that can be applied now.

First of all, the general principle of "less is more" is definitely at play when it comes to talking to a grieving friend. Most people who have experienced the death of a loved one say that what bothered them most during the time after the death was that friends and loved ones said too much rather than too little. A simple "I'm sorry for your loss" goes a long way. Most of us feel the need to say too much in order to make our friend feel better or because it feels like we are doing more. But the truth of the matter is that they are sad and grieving and need to be sad and grieving for some time. Our desire to bring them back to "normal" is not what they need and not what they want. Being sad while they are grieving is actually normal and healthy.

In the process of saying too much, many times people begin to give justifications and explanations for the death, such as "he is in a better place" or "this must have been God's plan for him." Those who are grieving rarely find these comments comforting and they can actually make them angry or upset. The reason people are sad at the death of a loved one is generally not because they're not sure where the person has gone, it is because they miss that person. Attempts at explaining what has happened or trying to convince them that they should not feel sad usually are not helpful. Unfortunately, due to religious beliefs that the person is "in a better place," people can sometimes feel guilty for feeling sad about the death. However, it is important to keep in mind that we can feel more than one thing at a time, and this is perfectly natural. For example, based on your religious beliefs you might feel happy that your loved one is in a better place spiritually, while at the same time feeling very sad because you miss that person so much. This is a perfectly natural, healthy and okay way of feeling after the death of a loved one.

This brings me to my last point: allow the grieving person to experience his or her unique grieving process. Over the years, both professionally and personally, I have learned that there is no one way to grieve the loss of a loved one. People go through the process in many different ways. When it comes to grief, many different roads and paths lead to the destination of healing. Additionally, different cultures have different practices and traditions that may seem very strange and odd to different people. For example, in many cultures it is healthy and acceptable to talk out loud to the deceased, while in certain Western cultures this may appear bizarre or almost pathological. It is important to remember that people grieve in many different ways, and to judge their way of healing or try to change their process can be very hurtful. This is also why it is important to allow people to go through their own process and not attempt to "push" them forward in their healing. Telling someone that they have "cried enough" or "should have moved on by now" is not helpful and will only interfere with their healing process. In grief, as in all human interactions, it is important for the person to be allowed to have their unique experience, to not feel judged about it, and for you to show your support throughout the process in whatever way they may ask of it from you. It is not your role to push them to be happy again or bring things back to how they "used to be." And when it comes to what you say to your loved ones during these times, don't give in to the pressure to say too much and remember that less is more.

Rouhani and Obama: A Call of Hope

Yesterday's historic phone call between Presidents Obama and Rouhani marked the first time in 34 years that the leaders of the U.S. and Iran communicated with each other directly. There is great hope that this conversation is a sign of improved relations between the countries, and I am hopeful, too. As an Iranian-American, I am hopeful both for Iran and America. For Iran, I am hopeful that this marks a shift in their foreign relations, a change in the country's perception by the rest of the world, the end of Iran's international isolation, and that the result will be economic and social prosperity for Iran and the Iranian people.

For the U.S. I am also hopeful that this will mark a shift in their foreign relations policy and strategy. U.S. foreign policy tends to be a mixture of diplomacy and violence, with violence too often taking precedence. The common U.S. response to an international situation they do not like is to attack or threaten attack. Take a look at the situation with Syria for a recent example. The initial U.S. response to the chemical weapons attacks was something like "We do not like the way you are killing your own citizens, so in order to show you that this is not okay, we will kill more of your citizens." I know that the plan called for "targeted attacks," but the killing of innocent civilians in the process was inevitable. This strategy is similar to the father who beats his son to teach him that it was not okay for him to hit his sister. It is in essence hypocritical and ineffective. History has shown us time and time again that violence does not lead to resolutions, but only temporary solutions that result in ruptured relations and future violence

And unfortunately, the violence solution strategy trickles down to the culture and citizens of America, as well. People look to violence as a possible solution to a situation they do not like. When faced with a conflict with another person or group, violence and aggression are considered viable first-line options. The basic philosophy is that when you don't like something, use force to change it into what you want it to be. This contributes to the violence and killing we see in our own country. If the U.S. begins to use diplomacy and peaceful resolution as their first-line approach to foreign affairs, it is likely that the American people will be influenced by these strategies, as well.

I am hopeful that this phone call will be a harbinger of things to come for Iran, the United States and the rest of the world. Hopefully the international community will move away from war and violence to resolve our conflicts and instead usher in an era of communication, connection, compassion and collaboration.

Special Needs

We all have "special needs," it is just that some are more evident than others. As a society, we are to meet the needs of all citizens in a reasonable manner. This issue is particularly important with children in our schools. In recent years, there has been a shift towards tailoring education to meet the specific needs of individual children, with advancements such as IEPs (Individualized Education Programs). This is definitely a step in the right direction.

Some people do not like such changes in how things are done, using the argument that to treat people differently is unfair and everyone should get the same treatment. To begin with, equal treatment does not necessarily mean the same treatment. You would not make the same meal for an infant and a grown adult, and I'm sure you wouldn't consider this unfair.  It would actually be unfair to make them the same meal (same treatment would not be equal, or fair treatment). Taking this example to a school setting, if one student is having vision problems requiring eyeglasses, does that mean every student should get eyeglasses regardless of their vision? Or should none of the students, including the one with vision problems, get glasses to make sure everyone is treated the "same"? Taken a step further, if one student begins choking on his snack, should the teacher not perform the Heimlich maneuver on that child because they can't perform it on every child? Of course this is an extreme example, but I believe it illustrates the importance of recognizing the unique needs of each child and meeting those specific needs.

Meeting the needs of our children is not a matter of life or death, but it is a matter of happiness or sadness, success or failure, self-confidence or self-doubt. At the end of the day, the goal of individualized treatment is to treat everyone the same; everyone is treated in a way that meets their needs and causes them the least pain and suffering. And that's as fair as it gets.

Being a Sports Fans: More Than Just a Game

To the non-sports fan, the emotional investment and intense reactions of sports fans can seem bizarre, over-the-top, and just plain ridiculous. To the die-hard sports fan, not reacting with intense emotion to sporting events seems odd and inconceivable. So why do people get so into sports? Part of it has to do with what our favorite teams represent. When we have a favorite team, part of our identity merges with that team, and so their performance and stature is our performance and stature, too. As renowned author Isaac Asimov put it, "Whomever you root for represents you; when he wins, you win." The result is that our sense of self is tied into the performance of our team. This helps explain why people make an effort to associate themselves with their favorite team when they win and distance themselves with the team after they lose. For example, in a study conducted on several college campuses it was found that more students wore school shirts on Monday mornings after a football win as compared to when the school lost their previous game. Another study found that people used the word "we" more often when describing a team win (as in "we won 24-14") and used distancing words like "they" or the team name when describing a loss (as in "they lost 35-10"). We try to connect ourselves to the team when "we" win, but try to distance ourselves from the team when "they" lose. This is primarily to preserve our sense of self and to display our superiority to ourselves, and, of course, to others as well. There are even implications on an internal, biological level. Research has shown that after winning a match, male athletes show an increase in testosterone levels, while the loser experiences a dip in testosterone. Interestingly enough, the same results were also found in fans watching their favorite team: male fans showed an increase in testosterone levels after watching their team win and a decrease in testosterone levels following a team loss (I have not come across any study of this kind using female participants). Not only can our favorite team's performance affect our sense of self, but it can affect our hormonal balance, as well. So the next time you see some sports fans (or maybe yourself) getting a little too into the game, you now know that there is even more at stake than you might have realized.

National Psychotherapy Day

Today marks the first National Psychotherapy Day; a day to promote the utilization of therapy in general, to help fight the stigma that comes with going to therapy, and to bring awareness to the improvements needed for community mental health programs. Although there seems to be a National Something Day virtually everyday, this is one that has a good mission and one I'm hoping makes an impact. Due to the stigma attached to mental illness, there is also a stigma attached to going to therapy. This is in part a byproduct of the bias that views medical illness as more acceptable than psychiatric illness. In fact, they are both types of ailments that humans can have and they both need and require treatment. Once we equate medical and psychiatric illness, society will devote more resources to mental health services, the stigma of mental illness will be eliminated, and people will not be reluctant to seek therapy. I'm hopeful that some day in the near future, therapy will become so common and acceptable that people will talk about their "general therapist" the way they talk about their "general practitioner." Another myth that leads to the stigma of therapy is that going to therapy means you are "crazy" or have "serious issues." This is definitely not the case. People go to therapy for all kinds of reasons and issues, from very minor to serious, and many people enter therapy just to learn more about themselves, without any significant "problem" bringing them in. As a therapist, I know that for every person in therapy, there are many more people not going to therapy who need it even more. Going to therapy should be recognized as a sign of strength and responsibility, rather than a sign of being "weak" or "crazy." The truth is that the process of therapy can be healthy and helpful for everyone. And there is a lot of research showing that psychotherapy works. Many studies have demonstrated the effectiveness of therapy, and even shown it to be as effective or even more effective than medications in the treatment of common mental disorders like depression and anxiety. Additionally, even in disorders where medication is necessitated, adding psychotherapy will almost always facilitate healing and recovery and help prevent the relapse of symptoms. So it's very clear that psychotherapy works. Hopefully more and more people will let it work for them.

Waiting For Love

When it comes to finding a life partner, a lot of people are waiting: waiting for the right person to come along, waiting for the timing to be right. The assumption is that when the right person comes along and the timing is right, all we have to do is enjoy being in love. And that we know we have found the right person when being together is "easy" and doesn't ask much of us. The truth of the matter is that love is serious work and we must take it very seriously. Psychologist Erich Fromm, a luminary on the topic of love, said that love "requires knowledge and effort." In his masterpiece The Art of Loving, he says that love "requires discipline, concentration, patience, faith, and the overcoming of narcissism. It isn't a feeling, it is a practice." He likens love to an art or skill. Like any art or skill, we must put work in preparing ourselves before the time comes to perform. This means we must prepare ourselves for love before we find our partner. This preparation includes putting time and effort into truly understanding ourselves, learning what it really means to love, studying what makes for effective and ineffective communication in a relationship, and understanding what real love looks like and feels like (I would also add reading The Art of Loving to this list). This also means that we need to continue to work on love after we have found our partner. We cannot just sit back thinking the rest will work itself out and we will live happily ever after. We must continue our loving work, which includes working with our partner on strengthening the relationship, putting effort into working through any problems or challenges in the relationship, and continuing to practice and develop our capacity to love. It is only through hard work, dedication and effort that we can have that fairy tale ending.

A Case of the Mondays

We all know the feeling of waking up after the weekend with the Monday morning blues. It can include feelings of anxiety, sadness, stress, and the dread that the weekend is so far away. While it is quite normal to prefer our leisure time over our work time, if you regularly dread Monday mornings, it might be a good time to look at what you are doing for work and what is going on at your workplace. Do you feel fulfilled in what you do? Are you in a career that utilizes your strengths and makes use of your full potential? Do you enjoy the company of your colleagues? Do you have a bad relationship with a boss or superior at work? If you dread Monday mornings, there's a good chance you don't like your answers to some of these questions. And it might be time for a change: either in what you do, where you do it, or maybe how you are functioning at your current job. If you can make your work more fulfilling and enjoyable, you will not dread your job and will even look forward to going to work. As the saying goes, find a job you love and you won't have to work a day in your life. Although it sounds cliché, I'm a firm believer that such a career and job exists for everyone. So find a job that has you waking up excited every morning. Once we find that job, we can achieve the ultimate balance of looking forward to both our work and leisure, and Monday mornings won't feel so different from Saturday mornings. And in the meantime, cheer up! The weekend is only a workweek away!

Finding Comfort in Discomfort

One of the main reasons people go to therapy is to make changes in their life: to change their pattern of relationships, to change a pattern of behavior, or to change the way they cope with stress. For example, a young female comes in to therapy complaining of loneliness and social isolation. She hates the fact that she only has a few friends and that she spends most of her weekends alone. After a closer examination, it becomes clear that although she hates the loneliness, she has also become very comfortable in her loneliness. When offered opportunities to hang out with friends or go to a party, she tends to make excuses and stay home. At home, in her comfort zone, she does not have to face the anxiety provoked by her fear of rejection, which gives her a feeling of relief. In a sense, she also loves her loneliness. This is a complicated love/hate relationship. We regularly use our feeling of comfort as a barometer as to whether or not we should do something. Many times this can be a good index to inform our behavior. For example, a colleague asks us to make a minor ethical violation in order to help the company. We feel a sense of discomfort within us which helps inform us that we don't want to follow through with the behavior. Here the comfort barometer works in our benefit. However, when it comes to areas of personal growth, the comfort barometer is essentially reversed; feeling discomfort is a sign of progress and growth while feeling comfort indicates we are reverting to our old ways and reinforcing the problem. In order to make changes in the right direction we need to get comfortable with feeling uncomfortable, and this means acknowledging but then ignoring our instincts telling us to stay in the comfort zone. If we don't, we might just spend the rest of our lives feeling comfortable but miserable.

Veteran Suicides (Almost One Every Hour)

Recent figures from the Department of Veterans Affairs indicate that roughly 22 veterans commit suicide every day. That's close to one every single hour. Worse yet, these numbers are most likely underestimates of the actual figures. What's leading to this high suicide rate? For starters many veterans return from their service with psychological issues related to being exposed to the atrocities of war, including PTSD, severe depression, and crippling anxiety. Unfortunately, the majority of these individuals receive little or no treatment for their mental health needs. Additionally, veterans often struggle to integrate themselves back into society after returning from war. Unemployment rates are consistently higher for veterans compared to non-veterans. They are often provided a hero's welcome, but not a hero's stay. Taken together, these circumstances put veterans at a much higher risk of committing suicide. The issue of veterans' mental health and suicide should not be ignored. These consequences must be calculated into the cost of war. The casualties of war are not just the lives lost on the battlefield, but also the lives that are compromised and lost due to being on the battlefield. What is desperately needed for our veterans are better resources in terms of psychological services and also resources to facilitate their successful integration back into society. And, hopefully, soon those in power will come to realize the actual consequences of sending our youth into the battlefield.

You Can't Take Back a Bullet

You can't take back a bullet once its been fired. Our words and actions can be like bullets to our loved ones. When we become angry during an argument, we can have moments where an impulse comes to say or do something hurtful. In that moment, it might even feel like the right thing to do, but the negative consequences of our actions can last a lifetime. Many times in my office I have heard a client share a painful memory of when a parent said something that they can never forget: maybe the parent said they were a failure or told them they wish they never had been born. The pain from those bullets remain and the person's self-esteem and self-concept are still negatively affected by those remarks even years later. This is also very common with couples. I have seen couples who's relationship has been compromised due to a bullet or bullets fired by one or both partners. In the heat of an argument, a woman tells her boyfriend he is "a pathetic loser," or a man throws a vase across the room, or worse, strikes his wife for the first time. These bullets, although lasting a brief moment, can negatively affect the relationship from that point forward. The person may never forget or forgive the partner. Especially in instances of physical threat or assault, the trust and emotional intimacy will never fully recover. All arguments may result in some pain, but bullets leave scars, and scars never go away. Keep that in mind the next time you feel yourself becoming angry in an argument with a loved one, especially with a child or romantic partner. When the impulse comes to do or say that hurtful thing, that's your cue to take a few minutes to cool off before continuing. After a few minutes, that impulse will have likely gone and you can go back to working out the disagreement in a calm manner. And even more importantly, you will have stopped yourself from hurting your loved one and causing permanent damage to the relationship. Because once a bullet has been fired out of the gun, there's no taking it back.

Navy Yard Shooting

The tragic events that took place on Monday in Washington, D.C. are becoming all too familiar in our country. The shooting has sparked debates on several issues related to the event: gun rights, violent video games, security clearance, and mental health, amongst others. I will not comment on most of these issues, but will focus on the one that is most relevant to what I do; mental health. As in all tragedies like this, we immediately want to know the motive to understand why someone would have committed such a horrific act. And once again we hear phrases like "unstable" and "mentally ill" to describe the perpetrator and explain what has happened. Two thoughts come to mind regarding this. One, stories like this and the way they are portrayed in the media further reinforce the misconception that the mentally ill are violent and dangerous. The truth of the matter is that the vast majority of individuals who are severely mentally ill are not dangerous at all. In fact, they are more likely to be the victims of violence rather than the perpetrators. Unfortunately, this misconception that the mentally ill are violent and dangerous affects the amount of help and support they receive both from individuals and society as a whole. It is part of the stigma that is attached to the mentally ill which makes it easier for their needs to be ignored by our people and institutions. The second thought that comes to mind is related and very straightforward: we need improvements in mental health services and mental health awareness, in general. Nearly half of all Americans will have a mental health issue at some point in their life, and approximately 1/4 of all American adults suffer from a mental illness at any given time. Clearly, it is not a rare few that are in need of mental health services. However, only about 20-25% of those struggling with mental health issues actually receive services. This is due both to a lack of available resources and a reluctance to seek out mental health services. Due to the stigma of mental illness, many of those who are suffering do not get the help they need and instead try to cope with it on their own. This only leads to further deterioration of their mental health and more problems down the line. If we remove the stigma of being mentally ill and receiving mental health services, while also improving and increasing the availability of services, the result will be improved mental health outcomes for all Americans. Again, the numbers show that mental illness is not an affliction that affects only a select few, but rather it is an almost certainty that either we ourselves or a loved one will struggle with a mental illness at some point. Removing the stigma and improving mental health services is something that will benefit us all.

Embracing Your Shadow

(Painting by Remedios Varo)

In yesterday's post, I talked about the shadow and how awareness and recognition of this "dark" part of our psyche can be beneficial to us. Today I will elaborate on the shadow to provide a more complete description of this complex psychic phenomenon. The implication in my last post was that the shadow is the "bad" part of ourselves and something we should learn to cope with or tolerate. This is true for the most part, but it is also important to mention that the shadow includes elements that are actually good or positive aspects of who we are. As I mentioned yesterday, our shadow consists of thoughts, feelings and impulses that we deem unacceptable. However, we might deem something as unacceptable that is actually a healthy part of being human. For example, for many people their shadow includes their anger, as they somehow came to the conclusion that it was not okay to feel or express their angry feelings. Maybe they had a rageful father and were so hurt by his anger that they desired to never be like him and cast their own anger away forever. Or conversely they were scolded anytime they showed even the slightest sign of being angry or upset and learned that anger is unacceptable. In both situations, the individual has learned to ignore their anger and eventually represses it, causing it to gradually become part of their hidden shadow. However, anger is a natural human emotion and denying that part of ourselves means we are denying part of what makes us whole, complete individuals. As long as we express our anger in a way that is not destructive to ourself or others, it is healthy for us to be in touch with our anger. The healthiest individuals are those who can integrate and incorporate all parts of themselves into a unified whole. Until we achieve awareness and acceptance of all parts of ourselves, including our shadow, we cannot achieve this integration. Integration allows us to get in touch with our true self, as we allow all aspects of our true self to emerge unencumbered by potential judgments from within. When we accept and embrace the full gauntlet of human emotions, we can respond genuinely in all situations and in all of our relationships. Additionally, when we learn to accept the various aspects of our own psyche, we also become more tolerant and accepting of the various aspects of others' psyches as well. We become more accepting of people, allowing them the space to be who they truly are. Intolerance within breeds intolerance without, and likewise acceptance within breeds acceptance without.

You Can't Outrun Your Own Shadow

 



(Painting by Remedios Varo)

 

We all like to hear compliments about our strengths and to think about the good parts of ourselves. There is, of course, nothing wrong with this. However, what is equally important, if not even more important, is to know and recognize our weaknesses and the "bad" parts of ourselves. When I talk about strengths and weaknesses here, I am not talking about whether or not we are good at drawing or bad at cooking (both of which I am pretty bad at), even though knowing these strengths and weaknesses can be helpful. Instead, I am focusing on the strengths and weakness of our character and psyche. Am I a generally kind person, a jealous person, am I conscientious, do I enjoy closeness or fear intimacy? Having awareness of these aspects of ourselves is extremely beneficial for our relationships with others, and also, for the most important relationship, the one we have with ourselves. When it comes to our psyche and emotional world, recognition and awareness of the negative aspects is even more important than the positive ones. This negative, or dark portion of our psyche is sometimes referred to as our shadow. Our shadows can consist of feelings of inadequacy, the desire for power, lust, greed, envy, rage, or any other thought, feeling or impulse we deem unacceptable. Most people, most of the time are trying their best to avoid seeing and being aware of their emotional shadow. The reason why our shadows tend to remain hidden to us is that we don't like to look at them. We put a lot of energy to find ways to ignore them or pretend they do not exist. Like virtually anything we try to avoid , the avoidance itself causes new problems, and the original issue is not addressed and continues to exist. And so, as much as we try to avoid our shadows, pretend they do not exist, or look the other way, certain as the sun, our shadows remain behind us. Knowing our shadows and understanding where they come from can allow us to reduce the harm they cause to ourselves and our relationships. Genuine introspection and psychotherapy are two ways to better understand your complete psyche, including your shadow. The better we know ourselves, (the good, the bad, and the ugly), the better our chances of happiness and success in all domains of our lives. You can't outrun your own shadow, you can only learn how best to live it.

Homelessness and Mental Health (Part 4)

The relationship between homelessness and mental illness is a complicated one. To begin with, we know that the rate of mental illness is much higher in the homeless population, as about 1/4 t o1/3 of homeless individuals have a serious mental illness, such as Schizophrenia, Bipolar Disorder, or Major Depressive Disorder. In comparison only 6% of the American population has a serious mental illness. Next there is the chicken or the egg question: does homelessness lead to mental illness or does mental illness lead to homelessness? And the answer, as you might guess, is yes. It is definitely not a one-way relationship in either direction, and is instead a very complex interaction. While interning at a psychiatric hospital, I worked with many individuals who became homeless due to a debilitating mental illness, which would seem to suggest that mental illness causes homelessness. However, as I learned more about their stories, I saw how being homeless created increased emotional distress and exacerbated their symptoms and mental illness. Also, being homeless left them with little or no consistent mental health services, including barriers to receiving the medications they desperately needed. For example, I regularly heard from patients in the hospital suffering from Schizophrenia that when they ran out their medication they began using drugs or alcohol to help "quiet the voices" in their head. The pain and agony of hearing voices can become almost unbearable, and left without necessary treatment they sought any solution they could. This, or course, would often lead to an additional issue of substance abuse, adding to the list of their hardships and difficulties. My experience at the psychiatric hospital and interactions with the homeless have made it clear to me that the relationship between mental illness and homelessness is dynamic and complex one. Being that homelessness and mental illness have this interwoven relationship, it follows that many of the solutions that address either issue will help the other, as well. The most significant and straightforward of these solutions is to increase the mental health services available to all individuals, in particular those who are or are at risk for being homeless. The current system is not sufficient: the services available are not adequate and additionally there are barriers to accessing mental health services and medications, especially for those struggling with homelessness. It is imperative that we increase and improve the mental health services available in our country to help advance the lives of all who have mental illnesses and in the process reduce the number of individuals suffering from homelessness.

Homelessness and Mental Health (Part 3)

Within the issue of homelessness, a troubling trend is emerging related to sexual orientation and lifestyle. Research suggests that 20-40 percent of all homeless youth identify as lesbian, gay, bisexual, or transgender (LGBT). Given that only 3-5 percent of the U.S. population identifies as lesbian, gay, or bisexual, it is clear that LGBT youth experience homelessness at a disproportionate rate. The number of LGBT youth that are becoming homeless is reaching epidemic levels. What is leading to this phenomenon? To begin with, family conflict is the primary cause of homelessness for all youth, LGBT or heterosexual. It probably comes as no surprise that familial conflict over a youth's sexual orientation or gender identity is a significant factor that leads to homelessness. According to one study, 50 percent of LGBT teens experienced a negative reaction from their parents when they came out and 26 percent were kicked out of their homes. That means that the parents of 1 out of every 4 youth that comes out kicks their child out of the home to fend for him or herself on the streets. Unfortunately, this is reflective of the heterosexism in our society and the discrimination members of the LGBT community face in general. Although progress has been made in regards to the treatment of the LGBT community in recent years, we are still leaps and bounds away from true equality. Sadly, it is still acceptable at times to discriminate, bully, and direct hate toward members of the LGBT community. As this inequality persists, we will continue to observe a disproportionate number of homeless LGBT youth. With increased tolerance and acceptance of the LGBT community as a whole, we will also achieve a reduction in the number of LGBT youth who are driven to homelessness. And that's a win-win if you ask me.

Homelessness and Mental Health (Part 2)

There are many myths, misconceptions, and negative attitudes about the homeless that contribute to homelessness and prevent society from making progress in helping this population. Many of them are defenses we use to not feel emotional distress about homelessness or the fact that we do very little to help the problem. Here are a few of them.

-They don’t want help. People often tell stories of a time they took leftovers to a homeless individual only to be rejected and told angrily that he or she didn't want the food. Or you might hear someone say that most homeless people want to be homeless and do not want to be part of society. These statements are used to justify not getting involved and "letting them be." However, the truth is that the majority of homeless individuals desperately want the help and assistance they need, especially access to medications and mental health services.

-They somehow brought it upon themselves or They are to blame for being homeless. The reality is that many Americans are living paycheck to paycheck and are thus one paycheck away from being homeless. Sure, many people who become homeless have made bad choices and mistakes, but that is usually not why they are homeless. They are homeless because they didn't have the resources and support that prevent most of us from becoming homeless after we make mistakes or bad choices. Additionally, many homeless individuals are victims or byproducts of our society: children born and raised in a homeless family, mentally ill individuals not receiving adequate care, victims of abuse/domestic violence, and children who have outgrown the foster care system (up to 30% of the homeless population in the U.S. were former foster children). When you hear more and more of the stories of individuals who are homeless, you come to realize that no one is homeless just because they are "lazy" or don't have a "good work ethic."

-Having poor/homeless people is unavoidable. It is a natural part of every society and cannot be eliminated. There have always been poor people in every society and there always will be. This is not true. Yes, it might make sense that not everyone will have exactly the same amount of material wealth. However, this does not mean that the extremes of wealth and poverty are to be tolerated and must exist. Furthermore, some people having less than others does not mean that some people should suffer and die due to lack of means. Extreme poverty is not a necessity of any society and can, and hopefully will, be eliminated.

-Dehumanization. This is probably the most negative and costly of this list. Unfortunately, society tends to view the homeless as somehow less than human. This almost justifies their suffering and makes their struggles appear as less painful, and more acceptable to society. It also allows us as a society to be okay with continuing to do nothing to help change the problem. We justify our inaction and continue on with our lives. Until we recognize the homeless as equal members of society, we will not take the necessary steps to reduce the suffering of this population in need.

Homelessness and Mental Health (Part 1)

I will be dedicating the next few posts to the topic of homelessness. Unfortunately, the homeless represent a forgotten and neglected segment of our population. Society tends to ignore their suffering or pretend they do not exist. Or worse, they are often viewed as somehow less than human, almost justifying what they are going through and making it okay. We ignore the issue or make it seem more okay to minimize our own emotional distress about it. If it is not there or is not that big of a deal, then I don't need to feel so bad about it. The truth of the matter is that every homeless individual is equal to every non-homeless individual on the planet, and his or her pain and suffering is the same as the pain of suffering of anyone else. We must accept the reality of the situation and face the problem head-on, as this is the only way we will ever reduce and eliminate the suffering of our fellow brothers and sisters. And the reality of the situation is that many individuals in our very own country do not have their basic human rights met, as outlined by the United Nations' Declaration of Human Rights, which include food, shelter, and adequate medical and mental health care. Although gathering accurate statistics on homelessness is difficult, estimates are that between 600,000 to 750,000 people are homeless on a given night in America. Over a five-year period, 2%-3% of the population, as many as 8 million people, will be homeless for at least one night. So it is clear that homelessness is a significant issue and not one that only affects a small segment of the population. This also means that there isn't an "us" and "them" when it comes to homelessness, as it is more common than most of us would like to think. Homelessness is not their problem, it is our problem. The next few posts will delve deeper into the issue of homelessness and its relationship to mental health.
“Poverty is not an accident. Like slavery and apartheid, it is man-made and can be removed by the actions of human beings. Overcoming poverty is not a gesture of charity. It is an act of justice. It is the protection of a fundamental human right, the right to dignity and a decent life. While poverty persists, there is no true freedom.” –Nelson Mandela

 

In Memory

Today marks the  12th anniversary of a very dark day in American history, September 11th 2001. It was a very sad day because of the horrors we witnessed, the lives cut short, and the sense of security we lost. What we also witnessed was the human reaction to being attacked; after the sadness set in, we quickly observed anger and the desire for immediate revenge. It is a natural tendency to become angry and to want to strike back after being hurt or attacked by another person or group. And we saw many instances of this, as hate crimes against Muslims (or anyone who might be confused as looking Middle Eastern or Muslim) occurred in our very country, and wars began in reaction to the attacks. However, as some time has passed since 9/11, we can see that giving in to our natural reaction of hate and violence does not solve anything, leaving us in the same place we were, maybe even worse. We must overcome our natural tendency toward revenge after being hurt, and instead recognize the need for increased love and compassion to prevent hurtful acts in the future. As Martin Luther King, Jr. said, "Hate cannot drive out hate: only love can do that." More violence will not lead to end of violence, only peaceful thoughts and actions can. To honor the memory of the victims of 9/11, let's move away from violence and war as a solution to disagreements and towards the path of compassion. Promoting and developing compassion in ourselves and future generations is our only shot at achieving world peace.

Help You Help Me

 

One of the most effective ways to help get out of a depression, whether it be from the death of a loved one, a breakup, or we're just feeling the blues, is to do something for someone else. This seems almost counterintuitive but appears to be true: when we are depressed and might feel like we need help and support more than ever, what can actually be most beneficial for us is to help someone else. And here are a few reasons why. 1. When we are depressed, we get lost in a sea of self; our thoughts and emotions are focused inward and not in a good way. We lack confidence, tend to feel regret and ruminate over past mistakes, and we can engage in very negative and hurtful self-talk (self-talk is the ongoing internal conversation we have with ourselves). Doing something helpful for someone else takes us out of the negative sea of self and turns our focus outward. The negative energy inward is inverted and becomes positive energy outward, and the result is that we begin to feel more positive energy going inward again. 2. Doing someone a favor or getting involved in community service makes us feel productive and useful. When we are depressed, we feel down about ourselves and become less active in all positive aspects of our lives. The result is a diminished feeling of self-efficacy and a feeling of uselessness. By doing something tangible for others we once again feel useful and remind ourselves of our ability to be helpful and productive. 3. The social isolation and loneliness it produces can be one of the most painful aspects of being depressed. Doing community service or helping a friend rekindles our feeling of connection to other people, our community, and humanity as a whole. Not only do we feel connected to those we interact with in the process, but we once again feel like we are part of something bigger, which is in and of itself comforting and calming. We are taken out of our negative self-state and our focus turns to others and the world at large, which is a relief for our psyche. And of course, doing community service is not just helpful to get us out of a depression, but rather doing community service regularly can help serve as a buffer to feeling down and getting depressed in the first place. There are tons of ways to get involved in community service: feeding the homeless, reading to children at a local hospital, picking up trash at a neighborhood park, and the list goes on and on. Find a way to serve that resonates with you and make it a part of your weekly routine. And the next time you're feeling down, do yourself a favor and do someone else a favor.

Rich From Within

No amount of riches and goods on the outside can ever fill a feeling of poverty on the inside. When we have low self-esteem and lack a strong sense of self and self-worth, we struggle to fill this emptiness inside with the goods of the outside world: attention, compliments, money, clothes, power, etc. But like a round peg and a square hole, these goods on the outside cannot fill the void on the inside. So we strive for more and more of these goods, hoping that maybe enough of them will eventually fill that hole and bring about contentment. Yet still, with one million round pegs, the square hole remains empty and unfulfilled. The solution to this puzzle and the way to bring about a generation of children who possess this all important square peg on the inside comes from parenting and how we raise our children. When our children have their physical and emotional needs met, feel validated and appreciated as individuals, and experience consistent, unconditional love, they internalize a feeling of contentment and self-worth that can withstand the ups and downs of the outside world. With the possession of the square peg of self-esteem and self-worth within them, they will not desire an excess of the pegs the outside world has to offer; they will be content with a round peg or two, a rectangle peg, and maybe a couple interestingly shaped pegs here and there. And more importantly, the square peg from within will even give them the strength to withstand not having all the other pegs all of the time. They will still feel okay on the inside even when they are lacking things on the outside. Because when we feel rich from within, even extreme poverty on the outside cannot make us feel poor. Money can't buy you happiness, only square pegs can.

The Road of Love

In life, we are constantly making choices as to how to act and respond to others, from complete strangers to significant others. I like to view our choices as being on a continuum from least loving (or most hurtful) to most loving. As you might expect, I recommend choosing the most loving option as often as possible. Of course, I could argue that this would be best for the world as a whole, but there is a more selfish argument I will make; do it for yourself. When we act in a hurtful way, usually at best you might feel good or feel a release for a brief moment, but shortly after you will feel guilty and not very good. On the other hand, acting in a loving way gives us a feeling of peace and calm, puts us in a better mood and leaves us feeling better about ourselves afterwards. More importantly, you are much likelier to regret doing something on the hurtful/less loving side of the continuum. And regret is one of the worst feelings we can experience as human beings. On the other hand, you will almost never regret doing something loving to someone else. The road of love is paved with few regrets. Similar to an accomplishment in your life, when you reflect on a loving act, you will feel happy and proud with what you have done. Of course, when you act in a loving way, your relationships will improve and be more enjoyable as well; just another benefit. So think of yourself, and when choosing what path to take in your relationships, always choose the road of love. 

Cry on...

What's the most common thing people say to a friend when they begin to cry? My guess would be something like "oh no it's ok, don't cry." The friend usually feels like they're doing something nice for the friend who is crying, and unfortunately it has become accepted that this is the appropriate response to a friend who is in tears. Interestingly enough, making the "don't cry" comment is more about the friend who is consoling and his or her discomfort with sad feelings, rather than the friend who is crying. Most of us have a hard time tolerating our own sad feelings and similarly get very uncomfortable when someone is expressing sad feelings to us, especially with tears. Also, we likely think that since we have a hard time tolerating our own sad feelings, our friend does not want to feel his or her sad feelings either. Unfortunately, telling someone not to cry does not take away his or her sad feelings, and instead leaves them feeling like they should not feel what they are feeling and like they are a burden for you when they cry. People learn more and more that they should only cry by themselves, to not burden anyone, and that being sad and crying is evidence of something that is "wrong" with them. Instead, we should let our loved ones know that it's ok to cry, that they can cry as long as they feel like crying, and that we will be there to talk about whatever is making them sad whenever they are ready. By allowing our loved one the space to cry and express the sad feelings, we are actually facilitating the process of healing and the likelihood that our loved one will get through whatever was creating the sadness in the first place. And at the same time, we will be allowing for an opportunity to connect with our loved ones and create more emotional intimacy in our relationships. So the next time a friend or loved one comes to you in tears, instead of saying "don't cry" with your words, tell them to "cry on" with your open arms and open heart. 

Seeing the Glass as Half Empty and Half Full

People often ask the philosophical question "do you see the glass as half empty or half full?" with the answer determining if someone is an optimist or a pessimist. If you see the glass as half full, then you are considered an optimist, as you see the good in the situation. If you see the glass as half empty, you are deemed a pessimist who sees the bad, or what's missing. However, when it comes to life, I think the healthier viewpoint is to see the glass as half full and half empty at the same time. By seeing the glass of life as half full, you have contentment; appreciation for all that you have and satisfaction in all that you have accomplished. You recognize and are grateful for the good things in your life and can easily see how your glass could be less full than it is. Now at the same time it is important to not let this contentment and satisfaction turn into complacency. This is where seeing the glass as half empty comes in to play. Recognizing that your cup is still half empty creates the awareness that the full potential for your life has not yet been met, that there is plenty of room for you to grow, plenty for you to learn, and plenty of goals left for you to achieve. Envisioning the half empty part of our cup elicits a desire to strive towards filling our cup of life to its brim. And this, after all, is our calling in life: to fill the cup, which is our full potential, to its utmost. Each individual's cup may differ in shape and size, but everyone's goal, to fill their cup to the top, is the same. By seeing the cup as half full and half empty at the same time we can maintain a sense of satisfaction and contentment, while cultivating the desire and motivation to strive for more. So the next time someone asks you if you see the cup as half empty or half full, simply answer "yes."

The Stigma of Being Human

The stigma attached to mental illness and seeking out mental health services places a significant burden on society and its individuals. The stigma creates shame in having a mental illness and also delays/prevents people from seeking out either help from a professional or support from a friend. It could be argued that the suffering created by the stigma nearly matches the suffering produced by mental illnesses themselves. That's why it is important for us to shift our perception of mental illnesses and mental health services. Mental illness shoul be viewed, like physical illness, as just another ailment of the human condition. When we have a physical illness or pain, we do not feel ashamed for having it or that we might be judged negatively if others learn of it. Additionally, seeking out the care of a medical doctor for our ailment is commended by our loved ones, and certainly would not be frowned upon or considered taboo. Similarly, mental illness and pain should be viewed in such a manner. We should commend those who seek out a practitioner to help ameliorate their pain and suffering, recognizing that what they are going through is just another part of being human, which we likely have or will experience ourselves. Shaming and judging someone for feeling depressed is like shaming and judging someone for having a cold. This shift in perspective can undo and prevent a great deal of unnecessary suffering.