Tagged Mind

To Boost Memory: Study, Wait, Then Exercise

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Credit Illustration by Renaud Vigourt

Learning requires more than the acquisition of unfamiliar knowledge; that new information or know-how, if it’s to be more than ephemeral, must be consolidated and securely stored in long-term memory.

Mental repetition is one way to do that, of course. But mounting scientific evidence suggests that what we do physically also plays an important role in this process. Sleep, for instance, reinforces memory. And recent experiments show that when mice and rats jog on running wheels after acquiring a new skill, they learn much better than sedentary rodents do. Exercise seems to increase the production of biochemicals in the body and brain related to mental function.

Researchers at the Donders Institute for Brain, Cognition and Behavior at Radboud University in the Netherlands and the University of Edinburgh have begun to explore this connection. For a study published this month in Current Biology, 72 healthy adult men and women spent about 40 minutes undergoing a standard test of visual and spatial learning. They observed pictures on a computer screen and then were asked to remember their locations.

Afterward, the subjects all watched nature documentaries. Two-thirds of them also exercised: Half were first put through interval training on exercise bicycles for 35 minutes immediately after completing the test; the others did the same workout four hours after the test.

Two days later, everyone returned to the lab and repeated the original computerized test while an M.R.I. machine scanned their brain activity.

Those who exercised four hours after the test recognized and recreated the picture locations most accurately. Their brain activity was subtly different, too, showing a more consistent pattern of neural activity. The study’s authors suggest that their brains might have been functioning more efficiently because they had learned the patterns so fully. But why delaying exercise for four hours was more effective than an immediate workout remains mysterious. By contrast, rodents do better in many experiments if they work out right after learning.

Eelco van Dongen, the study’s lead author and a former researcher at Radboud University (he is now a policy officer at the Netherlands Organization for Scientific Research), hopes that future studies will help determine both the optimal time to exercise and the ideal activity to reinforce learning. Workouts that are too strenuous “could be less positive or even detrimental” to acquiring knowledge, Dr. van Dongen says, while gentle exertions — “a short, slow walk,” he adds — might not prompt enough of an increase in the biochemicals needed to influence how the brain learns.

For now, he says, if you are trying to memorize a PowerPoint narrative or teach yourself macroeconomics, it could be beneficial to exercise a few hours after a study session. “Long-term memory is not only influenced by what happens when you learn new things,” he says, “but also by the processes that take place in the hours and days afterward, when new information is stabilized and integrated in your brain.”

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The Narcissist Next Door

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Credit Paul Rogers

Does this sound like anyone you know?

*Highly competitive in virtually all aspects of his life, believing he (or she) possesses special qualities and abilities that others lack; portrays himself as a winner and all others as losers.

*Displays a grandiose sense of self, violating social norms, throwing tantrums, even breaking laws with minimal consequences; generally behaves as if entitled to do whatever he wants regardless of how it affects others.

*Shames or humiliates those who disagree with him, and goes on the attack when hurt or frustrated, often exploding with rage.

*Arrogant, vain and haughty and exaggerates his accomplishments; bullies others to get his own way.

*Lies or distorts the truth for personal gain, blames others or makes excuses for his mistakes, ignores or rewrites facts that challenge his self-image, and won’t listen to arguments based on truth.

These are common characteristics of extreme narcissists as described by Joseph Burgo, a clinical psychologist, in his book “The Narcissist You Know.” While we now live in a culture that some would call narcissistic, with millions of people constantly taking selfies, spewing out tweets and posting everything they do on YouTube and Facebook, the extreme narcissists Dr. Burgo describes are a breed unto themselves. They may be highly successful in their chosen fields but extremely difficult to live with and work with.

Of course, nearly all of us possess one or more narcissistic trait without crossing the line of a diagnosable disorder. And it is certainly not narcissistic to have a strong sense of self-confidence based on one’s abilities.

“Narcissism exists in many shades and degrees of severity along a continuum,” Dr. Burgo said, and for well-known people he cites as extreme narcissists, he resists making an ad hoc diagnosis of narcissistic personality disorder, as defined by the American Psychiatric Association.

The association’s diagnostic manual lists a number of characteristics that describe narcissistic personality disorder, among them an impaired ability to recognize or identify with the feelings and needs of others, grandiosity and feelings of entitlement, and excessive attempts to attract attention.

Dr. Giancarlo Dimaggio of the Center for Metacognitive Interpersonal Therapy in Rome, wrote in Psychiatric Times that “persons with narcissistic personality disorder are aggressive and boastful, overrate their performance, and blame others for their setbacks.”

According to the Mayo Clinic, people with a narcissistic personality disorder think so highly of themselves that they put themselves on a pedestal and value themselves more than they value others. They may come across as conceited or pretentious. They tend to monopolize conversations, belittle those they consider inferior, insist on having the best of everything and become angry or impatient if they don’t get special treatment.

Underlying their overt behavior, however, may be “secret feelings of insecurity, shame, vulnerability and humiliation,” Mayo experts wrote. To ward off these feelings when criticized, they “may react with rage or contempt and try to belittle the other person.”

Dr. Burgo, who sees clients by Skype from his home in Grand Lake, Colo., noted that many “grandiose narcissists are drawn to politics, professional sports, and the entertainment industry because success in these fields allows them ample opportunity to demonstrate their winner status and to elicit admiration from others, confirming their defensive self-image as a superior being.”

The causes of extreme narcissism are not precisely known. Theories include parenting styles that overemphasize a child’s special abilities and criticize his fears and failures, prompting a need to appear perfect and command constant attention.

Although narcissism has not been traced to one kind of family background, Dr. Burgo wrote that “a surprising number of extreme narcissists have experienced some kind of early trauma or loss,” like parental abandonment. The family lives of several famous narcissists he describes, Lance Armstrong among them, are earmarked by “multiple failed marriages, extreme poverty and an atmosphere of physical and emotional violence.”

As a diagnosable personality disorder, narcissism occurs more often in males than females, often developing in the teenage years or early adulthood and becoming more extreme with age. It occurs in an estimated 0.5 percent of the general population, and 6 percent of people who have encounters with the law who have mental or emotional disorders. One study from Italy found that narcissistic personality traits were present in as many as 17 percent of first-year medical students.

As bosses and romantic partners, narcissists can be insufferable, demanding perfection, highly critical and quick to rip apart the strongest of egos. Employee turnover in companies run by narcissists and divorce rates in people married to them are high.

“The best defense for employees who choose to stay is to protect the bosses’ egos and avoid challenging them,” Dr. Burgo said in an interview. His general advice to those running up against extreme narcissists is to “remain sane and reasonable” rather than engaging them in “battles they’ll always win.”

Despite their braggadocio, extreme narcissists are prone to depression, substance abuse and suicide when unable to fulfill their expectations and proclamations of being the best or the brightest.

The disorder can be treated, though therapy is neither quick nor easy. It can take an insurmountable life crisis for those with the disorder to seek treatment. “They have to hit rock bottom, having ruined all their important relationships with their destructive behavior,” Dr. Burgo said. “However, this doesn’t happen very often.”

No drug can reverse a personality disorder. Rather, talk therapy can, over a period of years, help people better understand what underlies their feelings and behavior, accept their true competence and potential, learn to relate more effectively with other people and, as a result, experience more rewarding relationships.

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An Early Bedtime for Kids May Fight Weight Gain

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Preschool children who are in bed by 8 p.m. are far less likely to be obese during adolescence than children who stay up late, a study has found. Their risk of teenage obesity is half the risk faced by preschoolers who stay up past 9 p.m.

The research analyzed data gathered on nearly 1,000 children born in 1991 whose bedtimes were recorded when they were 4½ years old, and whose height and weight were recorded at age 15. The children were part of the Study of Early Child Care and Youth Development, done under the auspices of the National Institute of Health’s Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Among the children who were in bed by 8 p.m., 10 percent were obese as teens, compared to 16 percent of those who went to bed between 8 and 9 and 23 percent of those who went to bed after 9, according to the study, published in The Journal of Pediatrics.

The researchers adjusted for such factors as socioeconomic status, maternal obesity and parenting style and still found that the children who went to bed by 8 p.m. were at less than half the risk of teenage obesity as those who were up past 9, said Sarah E. Anderson, the paper’s lead author and an associate professor of epidemiology at the Ohio State University College of Public Health in Columbus.

Although the study does not prove that early bedtimes protect against obesity, Dr. Anderson said, “there is a great deal of evidence linking poor sleep, and particularly short sleep duration, to obesity, and it’s possible the timing of sleep may be important, above and beyond the duration of sleep.”

“This provides more evidence that having an early regular bedtime and bedtime routine for young children is helpful,” she said.

With Coercive Control, the Abuse Is Psychological

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Credit Maggie Chiang

Lisa Fontes’s ex-boyfriend never punched her, or pulled her hair. But he hacked into her computer, and installed a spy cam in her bedroom, and subtly distanced her from her friends and family.

Still, she didn’t think she was a victim of domestic abuse. “I had no way to understand this relationship except it was a bad relationship,” said Dr. Fontes, 54, who teaches adult education at the University of Massachusetts, Amherst.

It was only after doing research on emotional abuse that she discovered a name for what she experienced: Coercive control, a pattern of behavior that some people — usually but not always men — employ to dominate their partners. Coercive control describes an ongoing and multipronged strategy, with tactics that include manipulation, humiliation, isolation, financial abuse, stalking, gaslighting and sometimes physical or sexual abuse.

“The number of abusive behaviors don’t matter so much as the degree,” said Dr. Fontes, the author of “Invisible Chains: Overcoming Coercive Control in Your Intimate Relationship.” “One woman told me her husband didn’t want her to sleep on her back. She had to pack the shopping cart a certain way, wear her clothes a certain way, wash herself in the shower in a certain order.”

While the term “coercive control” isn’t widely known in the United States, the concept of nonphysical forms of mistreatment as a kind of domestic abuse is gaining recognition. In May, the hashtag #MaybeHeDoesntHitYou took off on Twitter, with users sharing their own stories.

Last December, England and Wales expanded the definition of domestic abuse to include “coercive and controlling behavior in an intimate or family relationship,” making it a criminal offense carrying a maximum sentence of five years. To date, at least four men have been sentenced under the new law.

“In this approach, many acts that had been treated as low-level misdemeanors or not treated as offenses at all are considered as part of a single course of serious criminal conduct,” said Evan Stark, a forensic social worker and professor emeritus at Rutgers University, whose work helped shaped the new law in England and Wales.

Dr. Stark, the author of “Coercive Control,” noted that the English law pertains to a course of conduct over time. American law still does not address coercive control; it deals only with episodes of assault, and mainly protects women who have been subjected to physical attacks. But in about 20 percent of domestic violence cases there is no bodily harm, he said.

Coercive control often escalates to spousal physical violence, as a 2010 study in The Journal of Interpersonal Violence found. “Control is really the issue,” said Connie Beck, a co-author of the study and an associate professor of psychology at the University of Arizona. “If you can control a person’s basic liberties verbally — where they go, who they see, what they do — you do not necessarily have to hit them regularly, but if a person is not complying, then often physical abuse escalates.”

To a victim of coercive control, a threat might be misinterpreted as love, especially in the early stages of a relationship, or when one is feeling especially vulnerable.

Dr. Fontes, for example, was in her 40s and newly divorced when she met her ex-boyfriend. He was charming and adoring, and though he was a little obsessive, she overlooked it. Never mind that she has a Ph.D. in counseling psychology, and specializes in child abuse and violence against women.

“For a person looking for love and romance, it can feel wonderful that someone wants to monopolize your time,” she admitted.

For Rachel G., 46, a mother of three who lives outside Boston (she didn’t want her full name used to protect her privacy), the manipulation was all-consuming. Her ex-husband made them share a toothbrush, and wouldn’t let her shut the bathroom door — ever. He set up cameras around the house, and fastened a GPS in her car to track her movements. Sometimes he would show up at her work unannounced, “always framed as him needing to know where I was in case the kids needed me, or because he missed me and wanted to see me, but it was just his way of regulating my behavior.”

She was miserable, but stuck it out for 18 years. It never occurred to her to leave: She had three children, and “he had convinced me that I would be unhappy anywhere,” said Ms. G., who does fund-raising for a nonprofit. “I wasn’t only a bad wife — in every respect — but I was a negligent mother, or an overbearing mother, I was unsupportive of him, I was a bad cook, I prioritized work over family, my family liked him better than me, our friends liked him better than me. The worse I felt about myself and doubted myself and internalized his view of me and the way the world should work, the more submissive and accommodating I became.”

In the end, it was he, not she, who filed for divorce, after catching her in an extramarital affair. She is not proud of her actions, but she is grateful it got her out of the relationship. “I would never have left if he hadn’t filed,” she said. “I was afraid.” Since then, she has been trying to re-establish connections with family members and friends.

Dr. Fontes ultimately left her partner after four years. The decision came after she spent two weeks away from him, and realized how diminished she had become. “There were repeated telephone calls and emails every day, but it was such a relief to wake up and go to sleep without having to check in with this other person,” she said. “I recovered a sense of who I was as a separated person, my own opinions, my own perspective.”

The Connections Between Spanking and Aggression

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Credit iStock

In the 1990s, in my first month in practice as a pediatrician, I asked the mother of a 4-year-old about discipline and she told me that her son was often out of line and wild, and spanking was the only thing that worked, though she was sure I was going to tell her not to, just as her previous pediatrician had done. Around the same time, my colleague in the same clinic walked into an exam room to find a cranky toddler who was acting out, and a frustrated father who was taking off his belt and threatening punishment. In each case, and in many others, we had to decide how to talk to the parents, and whether to bring up the issue of child abuse — which is definitely an issue when a child is being struck, or threatened, with a belt.

Corporal punishment, also known as “physical discipline,” has become illegal in recent decades in many countries, starting with Sweden in 1979. The United States is not one of those countries, and pediatricians regularly find ourselves talking with parents about why hitting children is a bad idea. The American Academy of Pediatrics officially recommends against physical discipline, saying that evidence shows it is ineffective and puts children at risk for abuse; pediatricians are mandated reporters, responsible for notifying the authorities if we think there is a possibility of abuse, though the boundaries are not clearly defined by law.

But many parents continue to spank, even when they don’t think it does much good. In a recent report by the nonprofit organization Zero to Three of a national sample of 2,200 parents of children birth to age 5, parents were asked which discipline strategies they used a few times a week or more. Twenty-six percent said they “pop or swat” their child, 21 percent spank, and 17 percent reported hitting with an object like a belt or a wooden spoon. (Parents could respond that they used more than one strategy.) Zero to Three reported that even those who used these strategies frequently did not rate them as effective, and 30 percent agreed with the statement, “I spank even though I don’t feel O.K. about it.”

One reason the A.A.P. opposes spanking is because of evidence that it is associated with aggressive behavior in children. But does that mean that hitting children produces aggressive behavior, or that aggressive behavior in children elicits more and sterner parental measures?

Michael MacKenzie, an associate professor of social work and pediatrics at Rutgers, called the association “bidirectional and transactional.” How you discipline your child shapes your child, but also shapes you as a parent. But if you control for the child’s behavior, comparing more aggressive young children with other children who behave in the same ways, those who are frequently hit or spanked are more likely to show aggressive behavior and rule-breaking later on.

In a study published last year, he and his colleagues looked at these bidirectional effects. Children who were spanked were more likely to show disruptive, aggressive behaviors later on. Those behaviors, in turn, made it more likely that those children would be spanked more in the future.

“It mattered for everybody, but it mattered more for these kids in riskier contexts, the families facing more stress,” Dr. MacKenzie said. Other research showed that spanking was associated with poorer cognitive outcomes for children, even when the researchers controlled for factors such as maternal intelligence, maternal depression and cognitive stimulation in the home.

Dr. MacKenzie suggested that some families get caught in a “feedback loop,” in which children who are spanked respond more aggressively, and become even more challenging, reinforcing parents’ sense that only harsh discipline will work, so parents find themselves escalating the discipline, which in turn evokes more intense behavior.

“We want to think about these cycles and how they amplify,” he said, and to think as well about how to support families early on so that they set up different patterns. “We’ve sort of suggested the removal of a tool that many parents use, most parents use, without discussion of what the alternatives might be.”

Michael Lorber, a research scientist in the Family Translational Research Group at New York University, has found that parents who interpret their children’s behavior more negatively than an objective observer tend to use more harsh discipline. These patterns begin younger than we think, he told me, with parents in their studies clearly identifying children as young as 8 months old as difficult and aggressive.

“We think the infancy period is probably the time when parents begin to develop their disciplinary practices,” Dr. Lorber said. “Call it difficult temperament or incipient externalizing behaviors or contentiousness, it’s definitely the case that infants’ behaviors influence their parents, including physical discipline.”

One complicated question that researchers raise about physically aggressive children and their physically aggressive parents is whether there may be a genetic component to this behavior, which would be shared across the generations.

Leslie Leve, a professor of counseling psychology and human services at the University of Oregon College of Education, said that it was possible there were genetic predispositions toward aggressive behavior, which might affect both parents and children. “There is a common misperception that when people think of a behavior as ‘genetic’ that it’s not changeable, and that is not true,” Dr. Leve said. “With A.D.H.D. or aggression we know there is a genetic component, but there is a lot we can do in a family or educational environment. Genetics does not mean immutable.”

Dr. Leve has participated in studies of adopted infants, which can help tease out these effects, but which also show how complex the interactions are, with harsh parental responses affected by the child’s characteristics but also by factors in their own temperaments and their marriage.

Zero to Three reported that 69 percent of the parents said that “if they knew more positive parenting strategies they would use them.” Pediatricians try to help parents develop such strategies, discussing what behavior is developmentally realistic for young children; helping them interpret behavior without regarding it as defiant; counseling them about setting limits; and helping them find positive behaviors to praise and enjoy.

Disciplinary choices reflect parental stress, family circumstances and the whole complex cocktail of emotion and personal history and daily life at home. What parents do affects their children — their brains and their behavior — and the ways that children behave affects their parents. And the cycle of spanking and aggressive behavior seems to leave everyone worse off.

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The Challenges of Male Friendships

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Credit Paul Rogers

Christopher Beemer, a 75-year-old Brooklynite, is impressed with how well his wife, Carol, maintains friendships with other women and wonders why this valuable benefit to health and longevity “doesn’t come so easily to men.”

Among various studies linking friendships to well-being in one’s later years, the 2005 Australian Longitudinal Study of Aging found that family relationships had little if any impact on longevity, but friendships boosted life expectancy by as much as 22 percent.

Mr. Beemer urged me to explore ways to promote male friendships, especially for retired men who often lose regular contact with colleagues who may have similar interests and experiences.

After Marla Paul, a Chicago-area writer, wrote a book, “The Friendship Crisis: Finding, Making, and Keeping Friends When You’re Not a Kid Anymore,” about establishing meaningful friendships with other women, she was inundated with requests from men to give equal treatment to male friendships.

“A lot of men were upset because I didn’t include them,” Ms. Paul told me. “They felt that making and keeping friends was a lot harder for men, that close friendships were not part of their culture. They pointed out that women have all kinds of clubs, that there’s more cultural support for friendships among women than there is for men.”

In a study in the 1980s about the effect on marriage of child care arrangements, two Boston-area psychiatrists, Dr. Jacqueline Olds and Dr. Richard Stanton Schwartz, found that, “almost to a man, the men were so caught up in working, building their careers and being more involved with their children than their own fathers had been, something had to give,” Dr. Schwartz said. “And what gave was connection with male friends. Their lives just didn’t allow time for friendships.”

In their book, “The Lonely American: Drifting Apart in the Twenty-First Century,” the doctors, who are a husband-and-wife team, noted a current tendency for men to foster stronger, more intimate marriages at the expense of nearly all other social connections.

When these men are older and work no longer defines their social contacts, “there’s a lot of rebuilding that has to be done” if they are to have meaningful friendships with other men, Dr. Schwartz said in an interview.

From childhood on, Dr. Olds said, “men’s friendships are more often based on mutual activities like sports and work rather than what’s happening to them psychologically. Women are taught to draw one another out; men are not.”

Consciously or otherwise, many men believe that talking about personal matters with other men is not manly. The result is often less intimate, more casual friendships between men, making the connections more tenuous and harder to sustain.

Dr. Olds said, “I have a number of men in my practice who feel bad about having lost touch with old friends. Yet it turns out men are delighted when an old friend reaches out to revive the relationship. Men might need a stronger signal than women do to reconnect. It may not be enough to send an email to an old friend. It may be better to invite him to visit.”

Some married men consider their wives to be their best friend, and many depend on their wives to establish and maintain the couple’s social connections, which can all but disappear when a couple divorces or the wife dies.

Differences between male and female friendships start at an early age. Observing how his four young granddaughters interact socially, Mr. Beemer said, “They have way more of that kind of activity than boys have. It may explain why as adults they continue to do a much better job of it.”

In defense of his gender, he observed, “Men have a harder time reaching their emotions and are less likely than women to reveal their emotional side. But when you have a real friendship, it’s because you’ve done just that.”

He has found that “it’s important to expose yourself and be honest about what’s going on. If you reveal yourself in the right way to the right person, it will be just fine. There are risks, you can’t force it. Sometimes it doesn’t work — you get a don’t-burden-me-with-that kind of response and you know to back off. But more often men will respond in kind.”

Mr. Beemer has worked hard to establish and maintain valuable relationships with other men of a similar vintage. He joined a men’s book group that meets monthly, and after about two years, he said, “it became a group where the members really mean something to one another.”

He’s also in a men’s walking group that meets three times a week and gathers after each walk to share more conversation and a snack at a local cafe. When one member of the group had a heart attack, they visited him, cheering him up with the latest gossip and a favorite cafe snack.

“What sustains relationships over time is a regular rhythm of seeing each other,” Dr. Schwartz said. “It’s best to build a regular pattern of activities rather than having to make a special effort to see one another.”

He recalls “curing” a 70-year-old patient of his loneliness by encouraging him to join a bunch of guys who regularly dined and joked around at a neighborhood Panera Bread. “There are a lot of cafes in the Boston area where small groups of older men get together for breakfast everyday,” Dr. Schwartz said.

Dr. Olds said of her husband, “Richard has a regular group phone call with friends who live in different parts of the country. We program it into our schedule or it would disappear.”

Among other ways men can make new friends in their later years are participating in classes, activities, trips and meals at senior centers; taking continuing education courses at a local college; joining a gym or Y and taking classes with people you then see every week; volunteering at a local museum, hospital, school or animal shelter; attending worship services at a religious center; forming a group that plays cards or board games together; perhaps even getting a dog to walk in the neighborhood.

After my dentist’s wife died, he made several new friends and enjoyed lovely dinners with other men when he joined a group called Romeo, an acronym for retired old men eating out.

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Reading Novels at Medical School

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Credit Getty Images

Sitting in a classroom at Georgetown Medical School usually reserved for committee meetings, we begin by reading an Emily Dickinson poem about the isolating power of sadness:

I measure every Grief I meet
With narrow, probing, eyes –
I wonder if It weighs like Mine –
Or has an Easier size.

It’s a strange sight: me, a surgical resident, reading poetry to 30 medical students late on a Tuesday night. Some of us are in scrubs, others in jeans; there are no white coats. Over the past four years, as the leader of the group, this has become my routine.

The students are here after long days in class and on the wards because they have discovered that medical education is changing them in ways that are unsettling. I remember that uneasiness well. My own medical education began with anatomy lab. The first day with the cadaver was unnerving, but after the first week the radio was blaring as we methodically dissected the anonymous body before us.

Two years later, on my first clinical rotation, I discovered that it does not take long to acclimate to the cries of patients as I hurried past their rooms, eager not to fall behind in a setting where work must be done quickly and efficiently. This practiced detachment feels necessary, a form of emotional and physical self-preservation. But with little time to slow down, ignoring our own thoughts and feelings quickly hardens into a habit.

During my first year in medical school, I found myself gravitating toward my old comfort zone — literature. As an English major, I had grown accustomed to the company of books and was feeling their absence now that “Don Quixote” had been displaced by Netter’s “Atlas of Human Anatomy.” I could look to Netter for concrete answers, but I needed Cervantes to help me formulate questions I had trouble pinning down, like why it was so easy to ignore the dead (and later, living) bodies around me? Illustrated cross-sections of the brain did little to illuminate the workings of my own mind. I needed time and space for introspection. The solution came in the form of a book club that later became an official course.

At Georgetown, the goal of our new literature and medicine track is to foster habits of reflection over four years of medical school. On the surface, the assigned books have nothing to do with medicine. We read no patient narratives, doctors’ memoirs or stories about disease.

Today’s topic is Haruki Murakami’s novel “Colorless Tsukuru Tazaki and His Years of Pilgrimage,” which tells the story of a depressed middle-aged Tokyoite’s attempt to retrace his past in order to understand how his life became so empty. We talk about the main character’s colorless perception of the world, and why his mind feels so inaccessible to us.

I receive an email from a student later that evening. He, an aspiring psychiatrist, tells me the story of a much-admired college mentor. “I heard last week that he committed suicide. I am still crushed,” he writes. “He was diagnosed with depression but seemed to be doing great.” If he so misjudged his teacher’s state of mind, he worries, how will he make it as a psychiatrist?

Earlier this year, we placed the ethics of animal testing under the magnifying glass of Karen Joy Fowler’s “We Are All Completely Beside Ourselves.” The novel is narrated by a woman whose “sibling,” we later discover, is a chimpanzee who was raised with her as part of a human-chimp experiment. We used the book to think through real-life examples like the Silver Spring Monkeys — a series of gruesome primate experiments that both galvanized American animal-rights groups and led to breakthrough scientific discoveries.

A third-year student talked about the three years he spent working with rhesus macaques. Research from his lab led to breakthrough discoveries about memory and behavior and contributed to therapies such as deep brain stimulation. “Doesn’t that answer the ethical questions?” he asked.

Another student talked about studies that she worked on for several years before starting medical school. “Have you heard of professional testers?” she asked the room. “People whose only source of income is volunteering for different studies, mostly college kids and immigrants? Shouldn’t we be talking about human research also?” For me, the discussion proved transformative. I walked into that class firmly supporting animal research and walked away still supporting research but no longer eating meat.

Our busy jobs on the hospital wards require precision and efficiency, but in literature class we can slow down and explore human lives and thoughts in a different, more complex way. The class is an anatomy lab of the mind. We examine cultural conventions and conflicting perspectives, and reflect on our own preconceived notions about life and work. Reading attentively and well, we hope, will become a sustaining part of our daily lives and practice.

As I’m walking out of the classroom at the end of the evening, a third-year student approaches me to tell me he’s been thinking more deeply about his experience of being an unrelated organ donor to his step-uncle, a man he barely knew. “It’s been on my mind since we read Ishiguro’s ‘Never Let Me Go’ last month,” he says. “I want to write about it. I don’t even know how I feel about it, and I need to figure it out.”

Daniel Marchalik, M.D., is a urologist in Washington and heads the literature and medicine track at the Georgetown University School of Medicine.

Alzheimer’s Disease as an Adventure in Wonderland

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A page from “Aliceheimer’s: Alzheimer’s Through the Looking Glass,” by Dana Walrath.

A page from “Aliceheimer’s: Alzheimer’s Through the Looking Glass,” by Dana Walrath.Credit

In her memoir “Aliceheimer’s: Alzheimer’s Through the Looking Glass,” Dana Walrath uses drawings and stories to chronicle three years of caregiving for her mother, Alice, who was in the middle stages of Alzheimer’s disease. The experience turned out to be a magical trip down the rabbit hole of memory loss, an outcome that inspired Dr. Walrath, a medical anthropologist who taught at the University of Vermont College of Medicine and who also studied art and writing, to share their tale.

Refusing to accept the dominant narrative of Alzheimer’s disease as a horror story, Dr. Walrath used the techniques of graphic medicine to create “Aliceheimer’s,” an 80-page, 35-picture tribute to her mother’s animated mind. Graphic medicine uses text and graphics to, as she writes in the book’s introduction, “let us better understand those who are hurting, feel their stories, and redraw and renegotiate those social boundaries.”

We spoke with Dr. Walrath to learn more about graphic medicine, how the book came into being, and what it can teach others about caring for someone with Alzheimer’s disease. Here’s an edited excerpt of our conversation.

Q.

You say that “Aliceheimer’s” found you, not the other way around. What’s the backstory of your story?

A.

After a lifetime of mutually abrasive interaction, my mother moved into my home when a lock-down memory-care unit was her only other option. The years of living together not only brought us closure, but it also integrated my disparate career threads. Medical anthropology, creative writing, visual art — who knew they were connected? I sure didn’t. But Alice must have. During dementia, she said to me, “You should quit your job and make art full time.”

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A page from “Aliceheimer’s: Alzheimer’s Through the Looking Glass,” by Dana Walrath.

A page from “Aliceheimer’s: Alzheimer’s Through the Looking Glass,” by Dana Walrath.Credit

Q.

What is “graphic medicine” and how did you discover the genre?

A.

I started making “Aliceheimer’s” comics before I knew that graphic medicine existed. Watching Alice — a lifelong reader who was finding straight prose too hard to track — eat up books like “Maus,” “Persepolis,” “American Born Chinese” and “Fun Home” when she lived with me, made me certain that to tell our story I wanted to use a form that a person with dementia could access. When a fellow medical anthropologist introduced me to graphic medicine, I knew I had found my tribe. The “Graphic Medicine Manifesto” defines graphic medicine as “the intersection of the medium of comics and the discourse of health care.”

Q.

Which came first: your drawings or your stories? When and how did they merge?

A.

The drawings came first. If you page through “Aliceheimer’s” looking only at the left-hand pages, you can read the original comic, a love story in pictures. I started writing short vignettes, each one in response to one of the original drawings. I began posting them on a blog until the content felt right for the intimate interior of a book.

Q.

How did the “Alice in Wonderland” theme come into play?

A.

My father had read it out loud to us as kids, and during dementia Alice and I often recited parts of it together. But the day I cut up a cheap paperback copy of “Alice in Wonderland” to depict Alice’s bathrobe, her favorite garment, I knew I had found the voice for the story. Life with dementia is filled with alternate realities and magic, both scary and uplifting. Accepting wonderland as our baseline made day to day life an adventure.

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<strong> </strong>A page from “Aliceheimer’s: Alzheimer’s Through the Looking Glass,” by Dana Walrath.

A page from “Aliceheimer’s: Alzheimer’s Through the Looking Glass,” by Dana Walrath.Credit

Q.

How might “Aliceheimer’s” influence the medical, artistic and caregiving communities?

A.

I would love to see “Aliceheimer’s” contribute to reframing dementia as a diversity issue. Of course there is loss involved, but the more we can see people living in this state as useful true humans who might teach us all something about living in the present, about knowing sides of our loved ones that social processes kept inaccessible, the better it will be.

I would love for the medical community to start to touch on the opportunities for closure and forgiveness that this condition might bring instead of the ongoing fight for the cure. For artistic and caregiving communities, I hope the book empowers people to tell their stories, particularly in comics form.

Q.

In “Aliceheimer’s,” you suggest new ways of thinking about Alzheimer’s. How did your mother’s memory-stealing disease open your mind?

A.

The dominant zombie story of bodies without minds strips people with dementia of their humanity and interferes with creating new kinds of familial connections. How many of us have the privilege of knowing our parents as children? Through connection we heal. Comics lead us to light because, subconsciously, we associate comics with laughter, and we need permission to laugh at sickness and not just describe it in medical terms. Laughter is respite. It opens new possibilities for how to cope.

Photo

A page from “Aliceheimer’s: Alzheimer’s Through the Looking Glass,” by Dana Walrath.

A page from “Aliceheimer’s: Alzheimer’s Through the Looking Glass,” by Dana Walrath.Credit

Q.

What suggestions do you have for people caring for a loved one with Alzheimer’s?

A.

Learn to read the signs and messages embedded in your loved one’s actions. Often what looks delusional is an attempt to express a deeply felt need or desire. Dementia has them communicating through a code that we can track. Use the “Yes, and” principle from improv — in which you accept what the other person has said (“yes”) and then expand on that line of thinking (“and”) — to build on what your loved one is experiencing instead of contradicting them, and it will be easier to decipher his or her intentions.

Dementia lets all of us connect back to our deepest memories, to a time when we could communicate — give and receive stories — through the looks in each other’s eyes, through touch, facial expressions, actions and gestures. In this way, even in the midst of loss, dementia lets us heal.

For U.S. Parents, a Troubling Happiness Gap

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Credit Getty Images

For years, social scientists have known that nonparents are happier than parents. Study after study has confirmed the troubling finding that having kids makes you less happy than your child-free peers.

Now new research helps explain the parental happiness gap, suggesting it’s less about the children and more about family support in the country where you live.

Based on data from 22 countries and two international surveys of well-being, researchers found that American parents face the largest happiness shortfall compared to people who don’t have children. The happiness gap between parents and nonparents in the United States is significantly larger than the gap found in other industrialized nations, including Great Britain and Australia. And in other Western countries, the happiness gap is nonexistent or even reversed. Parents in Norway, Sweden and Finland — and Russia and Hungary — report even greater levels of happiness than their childless peers.

The researchers, led by the University of Texas sociology professor Jennifer Glass, looked for factors that might explain the international differences in parental happiness, and specifically why parents in the United States suffer a greater happiness penalty than their peers around the world.

They discovered the gap could be explained by differences in family-friendly social policies such as subsidized child care and paid vacation and sick leave. In countries that gave parents what researchers called “the tools to combine work and family,” the negative impact of parenting on happiness disappeared.

“We comprehensively tested every other alternative,” said Dr. Glass, the lead author of the study, which will be published in the American Journal of Sociology in September. “The two things that came out most strongly in explaining the variation were the cost of care for the average 2-year-old as a percent of wages and the total extent of paid sick and vacation days.”

Notably, the researchers found that economic differences, whether a parent was married or partnered and whether the pregnancy was planned or unintended had no impact on the happiness gap. They also considered the impact of other family-friendly social policies, such as extended maternity and paternity leaves, flexible schedules and even policies that gave money to parents in the form of a child allowance or monthly payments.

Paid parenting leave has “nowhere near as big an effect as these other two policies, “said Dr. Glass, while the other policies didn’t have a significant impact on the happiness gap. Policies that made it less stressful and less costly to combine child rearing with paid work “seem to be the ones that really matter.”

Those same two policies, she said, were also correlated with increased happiness among nonparents. That more paid sick leave and vacation time would make nonparents happier was no surprise, but “we were a little puzzled that lower child care costs would show an effect on nonparents,” Dr. Glass said. She and her colleagues speculate that the result is what economists call an indirect benefit: Everyone is better off when countries invest in the future of their labor force, and everyone suffers when they don’t.

But while there are certainly distinctions in family policy to be made between the United States and other developed countries, there are also substantial cultural differences in the ways children are raised here and in other countries. Those distinctions are hard to measure, but might also account for some of the relative difference between parental and nonparental happiness.

“There’s an incredible anxiety around parenting here that I just don’t feel in other countries,” said Christine Gross-Loh, the author of “Parenting Without Borders,” a comprehensive look at modern parent culture across the developed world, who is raising her children between the United States and Japan. She points to Americans’ anxiety around children’s college and future prospects, and also to our emphasis on keeping children physically safe, and the harsh judgment of parents who are perceived to be doing a poor job of it.

“In Japan, my 6-year-old and my 9-year-old can go out and take the 4-year-old neighbor, and that’s just normal,” she said, while in the United States that kind of freedom can draw criticism and even lead to interventions by Child Protective Services.

In countries where there is a strong agreement about the norms around parenting, parents may worry less about their own choices. Without a single overarching parenting tradition, American parents may feel like they have “too many choices” as compared to parents in more homogeneous cultures, says W. Bradford Wilcox, an associate professor of sociology and the director of the National Marriage Project at the University of Virginia. “A clear and well-defined script can be psychologically comforting,” he said, and its lack can leave parents feeling “unmoored.”

Dr. Glass agrees that cultural differences add to the greater relative parent and nonparent happiness gap — but she notes that those cultural differences are also reflected in our family policies. Much of our anxiety around our children in the United States, she said, is very clearly a reflection of our policy choices.

“We have to compete for good child care. We compete to live where there’s a good elementary school,” she said. “We compete for activities because a child’s entire fate seems to depend on where he goes to college, because there’s no guarantee — if we don’t, our child might be left behind.”

Those fears, Dr. Glass said, come in part from our country’s high tolerance for unequal access to the resources families need. In countries that offer policies supporting a parent’s ability to balance work and family, she sees a commitment to egalitarianism. “A crucial part of what’s going on is the idea that every child deserves an equal chance in life,” she said.

The good news is that the findings show that the happiness gap of parenting is not inevitable. Stephanie Coontz, who teaches history and family studies at The Evergreen State College in Olympia, Wash., and is co-chairwoman of the Council on Contemporary Families, said it was a pleasant surprise to see the researchers document the need for better family policies.

“Don’t just swoop in and give a longer maternity leave,” Dr. Coontz said. “It’s a lifetime investment in helping people combine work and family for the long haul.”


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How Exercise May Help the Brain Grow Stronger

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Credit Getty Images

Physical activity is good for our brains. A wealth of science supports that idea. But precisely how exercise alters and improves the brain remains somewhat mysterious.

A new study with mice fills in one piece of that puzzle. It shows that, in rodents at least, strenuous exercise seems to beneficially change how certain genes work inside the brain. Though the study was in mice, and not people, there are encouraging hints that similar things may be going on inside our own skulls.

For years, scientists have known that the brains of animals and people who regularly exercise are different than the brains of those who are sedentary. Experiments in animals show that, for instance, exercise induces the creation of many new cells in the hippocampus, which is a part of the brain essential for memory and learning, and also improves the survival of those fragile, newborn neurons.

Researchers believe that exercise performs these feats at least in part by goosing the body’s production of a substance called brain-derived neurotropic factor, or B.D.N.F., which is a protein that scientists sometimes refer to as “Miracle-Gro” for the brain. B.D.N.F. helps neurons to grow and remain vigorous and also strengthens the synapses that connect neurons, allowing the brain to function better. Low levels of B.D.N.F. have been associated with cognitive decline in both people and animals. Exercise increases levels of B.D.N.F. in brain tissue.

But scientists have not understood just what it is about exercise that prompts the brain to start pumping out additional B.D.N.F.

So for the new study, which was published this month in the journal eLIFE, researchers with New York University’s Langone Medical Center and other institutions decided to microscopically examine and reverse engineer the steps that lead to a surge in B.D.N.F. after exercise.

They began by gathering healthy mice. Half of the animals were put into cages that contained running wheels. The others were housed without wheels. For a month, all of the animals were allowed to get on with their lives. Those living with wheels ran often, generally covering several miles a day, since mice like to run. The others remained sedentary.

After four weeks, the scientists looked at brain tissue from the hippocampus of both groups of animals, checking for B.D.N.F. levels. As expected, the levels were much higher in the brains of the runners.

But then, to better understand why the runners had more B.D.N.F., the researchers turned to the particular gene in the animals’ DNA that is known to create B.D.N.F. For some reason, the scientists realized, this gene was more active among the animals that exercised than those that did not.

Using sophisticated testing methods, the scientists soon learned why. In both groups of animals, the B.D.N.F. gene was partially covered with clusters of a particular type of molecule that binds to the gene, though in different amounts.

In the sedentary mice, these molecules swarmed so densely over the gene that they blocked signals that tell the gene to turn on. As a result, the B.D.N.F. genes of the sedentary animals were relatively muted, pumping out little B.D.N.F.

But among the runners, the molecular blockade was much less effective. The molecules couldn’t seem to cover and bind to the entire B.D.N.F. gene. So messages from the body continued to reach the gene and tell it to turn on and produce more B.D.N.F.

Perhaps most remarkably, the researchers also found a particular substance in the runners’ brains that fended off the action of these obstructionist molecules. The runners’ brains contained high levels of ketones, which are a byproduct of the breakdown of fat. During strenuous exercise, the body relies in part on fat for fuel and winds up creating ketones, some of which migrate to the brain. (They are tiny enough to cross the blood-brain barrier.) The brain uses these ketones for fuel when blood sugar levels grow low.

But it appears that ketones also cause the molecules that hinder the B.D.N.F. gene to loosen their grip, as the scientists realized when they experimentally added ketones to brain tissue from some of the mice. Afterward, their B.D.N.F. genes were not blocked by nearly as many of the bothersome molecules, and those genes could get on with the job of making B.D.N.F.

None of this occurred in the brains of the sedentary mice.

“It’s incredible just how pervasive and complex the effects of exercise are on the brain,” said Moses Chao, a professor at the Skirball Institute of Biomolecular Medicine at N.Y.U. who oversaw the study.

Whether the same mechanisms that occur in mice occur in our own brains when we exercise is still unknown. But, Dr. Chao pointed out, like the mice, we have more B.D.N.F. in our bodies after exercise. We also create ketones when we exercise, and those ketones are known to migrate to our brains..

Generally, however, this process requires exerting yourself vigorously for an hour or more, after which time your body, having exhausted its stores of sugar, starts burning stored fat and making ketones.

If an hour or more of intense exercise seems daunting — and it does to me — don’t despair. “We are only starting to understand” the many ways in which exercise of any kind and amount is likely to alter our brains, Dr. Chao said. For now, he says, “it’s a very good idea to just keep moving.”

For Teenagers, the Pleasure of ‘Likes’

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Credit Jim Wilson/The New York Times

Move over sex, drugs and rock ‘n’ roll. For today’s teenager, it’s all about the “likes.”

A “like,” for the uninitiated, refers to the positive feedback given to a post on social media. And new research shows that likes appear to be somewhat intoxicating to teenagers. The same reward center in the brain that is involved in the sensation of pleasure and activated by thoughts of sex, money or ice cream also is turned on when teenagers see their photos getting a lot of likes on social media.

To learn more about what drives social media use among teenagers, researchers at the University of California, Los Angeles, conducted a novel experiment in which they recreated a photo-sharing social network similar to Instagram. The paper was published in the journal Psychological Science.

To do the study, the researchers recruited 32 people ages 13 to 18 and told them they were participating in a small social network modeled after Instagram, where friends or followers can endorse an image or video by clicking on a heart-shape icon.

In the experiment, researchers asked the teenagers to contribute some of their own photos, and then had them come in to the lab to look at nearly 150 images – including fairly bland photos, images of risky behavior and some of the teens’ own photos – while scientists analyzed their brain activity with functional magnetic resonance imaging.

As part of the experiment, the teens could also see how many likes had been given to each photo. Although the researchers had assigned the likes as part of the experiment, the teenagers were given the impression that the endorsements came from their peers.

When the youngsters viewed images that had a lot of likes, there was greater activity in neural regions of the brain involved with reward processing, social cognition, imitation and attention, researchers said, compared with neural reactions when the teens looked at photos with fewer likes.

The effect was magnified when they saw an image they themselves had contributed which had received a large number of likes, researchers said.

Teenagers were more likely to give a like to an image that had already gotten dozens of likes, even if it was a fairly banal picture of a plate of food or a pair of sunglasses. They were less apt to like the same kind of image if it had gotten few likes.

While the experiment focused on only a small group, it seemed to capture peer pressure in real time. But peer pressure is not always a bad thing, said the paper’s lead author, Lauren Sherman, and may play a critical role in teens’ accrual of social and cultural knowledge that’s essential to their development.

“Conformity is part of adolescence, and some of it is normal,” said Ms. Sherman, who prefers the term “peer influence” to “peer pressure.” “It’s how teenagers learn the rules of how to communicate and how to develop relationships.”

When the adolescents viewed images suggesting risky behavior (such as a bag of marijuana or pack of cigarettes), they were still influenced by their peers’ likes, but to a lesser extent, Ms. Sherman said. The researchers also did not see the same activation of the brain reward center, although they don’t know why. Teenagers viewing risky photos also exhibited decreased activity in brain regions involved in cognitive control and response inhibition, the regions that Ms. Sherman described as those that “put the brakes on, that tell us to be careful.”

Kate Mills, a postdoctoral fellow in developmental cognitive neuroscience at the University of Oregon, agreed. “Peer pressure gets bad press when peers are influential in a negative direction, but peers can also be influential in a good way,” Dr. Mills said. “The wonderful thing about our reward circuitry is that it’s not just involved with things we think of as hedonistically pleasurable. This is a circuitry that’s involved in learning about the environment.”

The likes are “potentially serving as a social cue, orienting them to what is cool or socially appropriate,” Ms. Sherman said. “Learning about the social world is a really important task of adolescence.”

Churchgoers May Live Longer

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St. Patrick’s Cathedral in Manhattan.

St. Patrick’s Cathedral in Manhattan.Credit Chang W. Lee/The New York Times

Going to church may lower the risk for premature death, a new study suggests.

Researchers used data from a long-term study of 75,534 women that tracked their health and lifestyle, including their attendance at religious services, over 16 years through 2012. The report is in JAMA Internal Medicine.

After controlling for more than two dozen factors, they found that compared with those who never went to church, going more than once a week was associated with a 33 percent lower risk for death from any cause, attending once a week with a 26 percent lower risk, and going less than once a week a 13 percent lowered risk. Risks for mortality from cardiovascular disease and cancer followed a similar pattern.

The researchers statistically eliminated the possibility of reverse causation — that is, that healthy people go to church more than unhealthy ones. And they found that some variables, such as social support and a tendency not to smoke, contributed to the effect. But no matter how they analyzed the data, the effect of church attendance alone seemed to have benefits.

“This suggests that there is something powerful about the communal religious experience,” said the senior author, Tyler J. VanderWeele, a professor of epidemiology at Harvard. “These are systems of thought and practice shaped over millennia, and they are powerful.”

How to Tiptoe Around a Depressed Mother

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Credit Giselle Potter

A depressed mother hates noise. She hates a lot of things — sometimes it seems as if she hates everything. But noise is her particular enemy. This is because she needs her sleep. She doesn’t always seem tired. But sleep is sacred to her, and you must never interfere with it. Particularly in the mornings. This makes life complicated if your bedroom — the nursery — is directly above hers and the floors are covered in linoleum, as they are in London in the 1960s. When you wake up and need to go to the bathroom you must avoid certain creaky spots. So you navigate like a cat burglar, tiptoeing on the more solid sections until you get to the stairs down to the bathroom. You hold your breath as you pee as if not breathing will somehow mitigate the sound. Do you flush? Not at this ungodly hour.

Silence is what your mother craves, but it is also her weapon. When she is in one of her moods, she settles into a powerful silence. She actively ignores you. She doesn’t respond to your attempts at conversation, your questions, your pathetic efforts to amuse her, to cheer her up. It’s as if you don’t exist, even when you’re in the same room. Over the years you learn what can trigger these silences and you do everything you can to avoid them. But when they inevitably settle in, it’s as if the world as you know it comes to an end.

Your mother’s depression, previously intermittent yet intense, has settled in with a permanence since your father left the house and your parents announced they would be getting divorced. You’ve always known she suffered from the blackest of moods. Your father has told you the story of your younger brother’s birth, and how he wanted the new baby christened Sebastian. But because your mother “wasn’t speaking” to your father throughout the period between birth and baptism, your brother is now called Paul.

Paul is the person you go to after you’ve been to the bathroom. He’s a little boy, just 4, and at three and a half years his senior it’s your responsibility to put him in his uniform, tie his tie and get him down to the kitchen where you make his breakfast. Your mother can’t tie a tie. And she doesn’t get up for breakfast. She doesn’t get up to see you off to school. The two of you eat quietly, grab your anoraks and having quietly shut the front door behind you, walk together. Recently, Paul has begun to stutter. Eventually he will be taken to a specialist who will try to find out the cause. Your father says he used to stutter a bit as a boy, too, and often imitates Paul. This drives you mad.

It’s hard to remember when you decided that you don’t love your mother. But there is a definite line in the sand when you become her fiercest critic. You hate her arbitrary moods. You hate her selfishness. You hate her neglect. Being depressed and being maternal don’t exactly go hand in hand. A depressed mother rarely puts her children first. For example, if on a Saturday morning you’ve been told to stay upstairs until your mother says you can come down, don’t (dying of boredom) find a rubber ball and start to play catch with it by yourself. Because every so often you’ll drop it. Eventually there will be a roar of rage from below. “GIVE ME THAT BALL,” she’ll yell. As you silently hand it to her, she will shout in your face, “GET DRESSED! AND GET DOWNSTAIRS!”

You’ll put on your clothes and creep down to the hallway with Paul. The two of you will half run, struggling to keep up with her as she marches rapidly and in silence out of the house and into Hyde Park about 10 minutes away. As you cross the street into the park she’ll hurl the ball into the trees.

“Go find your ball,” she will say. “And get lost.”

Having a depressed mother is an excellent way to turn a child into a liar. It’s completely against your nature, but some instinct in you makes you aware that there are some things your mother just can’t handle. So you lie by omission — you don’t tell her a lot of the fun things you do with your father. You’re hardly aware that you do this, until a few years later when Paul tells you he finds it easier to lie than to tell the truth. He’s more used to it.

Is it the lying that causes you anxiety? Or is it the general atmosphere in the house? Anxiety is the air you breathe, and it constantly affects how your body works. You’re supposed to put your light out at 7:30 at night, but sleep doesn’t come easily now, so you put your lamp under the covers and read for another two hours or so. Sometimes when you have to go to the bathroom you are too scared to, so you have accidents. You throw up from nerves. You watch yourself as if from a distance, interested in the experience, making a mental note of it.

You make mental notes of everything. (Having a depressed mother is great training for a journalist.) You note when the fridge is empty to get your mother to call the grocers. Your first experience of actual note-taking is when you decide to make shopping lists for her. You see when the laundry hamper is three-quarters full so you can start encouraging her to get the washing done. When she ignores you and you run out of clean underwear, you turn your dirty underwear inside out.

Routine is extremely important to children of depressed mothers. The clock becomes the nanny. Any deviation from a schedule is not to be allowed. The moment tea is over you take Paul upstairs for bathtime. You lay out your grubby clothes for tomorrow, and you brush your teeth. You go downstairs to say goodnight to your mother, now in her best mood of the day. There is a drink in her hand. She laughs as she allows the two of you to jump on her bed.

Then she says goodnight, and up you go to bed where you read about jolly red-cheeked children with fathers who smoke pipes and mothers who bake pies, wearing aprons over their tweed skirts, until you fall asleep.

Emma Gilbey Keller is a journalist and author who is working on a memoir about her experience of motherhood, from which this essay is adapted.

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War Wounds That Time Alone Can’t Heal

Video

“Almost Sunrise”

A clip from “Almost Sunrise.”

By THOUGHTFUL ROBOT PRODUCTIONS on Publish Date June 5, 2016.

No doubt in the course of your life, you did something, or failed to do something, that left you feeling guilty or ashamed. What if that something was in such violation of your moral compass that you felt unable to forgive yourself, undeserving of happiness, perhaps even unfit to live?

That is the fate of an untold number of servicemen and women who served in Iraq, Afghanistan, Vietnam and other wars. Many participated in, witnessed or were unable to help in the face of atrocities, from failing to aid an injured person to killing a child, by accident or in self-defense.

For some veterans, this leaves emotional wounds that time refuses to heal. It radically changes them and how they deal with the world. It has a name: moral injury. Unlike a better known casualty of war, post-traumatic stress disorder, or PTSD, moral injury is not yet a recognized psychiatric diagnosis, although the harm it inflicts is as bad if not worse.

The problem is highlighted in a new documentary called “Almost Sunrise,” which will be shown next weekend at the Human Rights Watch Film Festival in New York and on June 23 and 24 at AFI Docs in Washington, D.C. The film depicts the emotional agony and self-destructive aftermath of moral injury and follows two sufferers along a path that alleviates their psychic distress and offers hope for eventual recovery.

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The new documentary “Almost Sunrise” follows Tom Voss and Anthony Anderson, two troubled Iraq war veterans, walking from Milwaukee to Los Angeles.

The new documentary “Almost Sunrise” follows Tom Voss and Anthony Anderson, two troubled Iraq war veterans, walking from Milwaukee to Los Angeles.Credit Courtesy of Thoughtful Robot Productions

Therapists both within and outside the Department of Veterans Affairs increasingly recognize moral injury as the reason so many returning vets are self-destructive and are not helped, or only partly helped, by established treatments for PTSD.

Moral injury has some of the symptoms of PTSD, especially anger, depression, anxiety, nightmares, insomnia and self-medication with drugs or alcohol. And it may benefit from some of the same treatments. But moral injury has an added burden of guilt, grief, shame, regret, sorrow and alienation that requires a very different approach to reach the core of a sufferer’s psyche.

Unlike the soldiers who were drafted to serve in Vietnam, the members of the armed forces today chose to enlist. Those deployed to Iraq thought at first they were fighting to bring democracy to the country, then were told later it was to win hearts and minds. But to many of those in battle, the real effect was “to terrorize people,” as one veteran says in the film. Another said, “That’s not what we signed up for.”

That war can be morally compromising is not a new idea and has been true in every war. But the therapeutic community is only now becoming aware of the dimensions of moral injury and how it can be treated.

Father Thomas Keating, a founding member of Contemplative Outreach, says in the film, “Antidepressants don’t reach the depth of what these men are feeling,” that they did something terribly wrong and don’t know if they can be forgiven.

The first challenge, though, is to get emotionally damaged veterans to acknowledge their hidden agony and seek professional help instead of trying to suppress it, often by engaging in self-destructive behaviors.

“A lot of vets won’t seek help because what’s haunting them are not heroic acts, or they were betrayed, or they can’t live with themselves because they made a mistake,” said Brett Litz, a mental health specialist with the V.A. Boston Healthcare System and a leading expert on moral injury.

The second challenge is to win their trust, to reassure them that they will not be judged and are deserving of forgiveness.

Therapists who study and treat moral injury have found that no amount of medication can relieve the pain of trying to live with an unbearable moral burden. They say those suffering from moral injury contribute significantly to the horrific toll of suicide among returning vets — estimated as high as 18 to 22 a day in the United States, more than the number lost in combat.

The film features two very troubled veterans of the war in Iraq, Tom Voss and Anthony Anderson, who decide to walk from Milwaukee to Los Angeles — 2,700 miles taking 155 days — to help them heal from the combat experiences that haunt them and threaten to destroy their most valued relationships. Six years after returning from his second deployment in Iraq, Mr. Voss said of his mental state before taking the cross-country trek, “If anything, it’s worse now.”

Along the way, the two men raise awareness of the unrelenting pain of moral injury many vets face and encourage them to seek treatment. Mr. Voss and Mr. Anderson were helped by a number of counselors and treatments, including a Native American spiritual healer and a meditative technique called power breathing. They also found communing with nature to be restorative, enabling them to again recognize beauty in the world.

Shira Maguen, a research psychologist and clinician at the San Francisco V.A. Medical Center, who studies and treats vets suffering from moral injury, said, “We have a big focus on self-forgiveness. We have them write a letter to the person they killed or to a younger version of themselves. We focus on making amends, planning for their future and moving forward,” especially important since many think they have no future.

Dr. Maguen, who studied how killing during combat affects suicidal ideation in returning vets, found that “those who had killed were at much higher risk of suicide,” even when controlling for factors like PTSD, depression and alcohol and drug abuse. She said in an interview that decades after the Vietnam War “there was still an impact on veterans who killed enemy combatants, and an even stronger effect on those who killed women and children.”

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Tom Voss’ journey took 155 days, spanning 2,700 miles.

Tom Voss’ journey took 155 days, spanning 2,700 miles.Credit Courtesy of Thoughtful Robot Productions

To overcome veterans’ reluctance to seek help for moral injury, Dr. Maguen incorporates mental health care into routine clinical visits.

In Boston, Dr. Litz and colleagues are testing a related therapeutic approach called adaptive disclosure, a technique akin to confession. With eyes closed, the vets are asked to verbally share vivid details of their trauma with an imagined compassionate person who loves them, then imagine how that person would respond. The therapist guides the conversation along a path toward healing.

“Disclosing, sharing, confessing is fundamental to repair,” Dr. Litz said. “In doing so, the vets learn that what happened to them can be tolerated, they’re not rejected.” They are also encouraged to “engage in the world in a way that is repairing — for example, by helping children or writing letters.” The goal is to find forgiveness within themselves or from others.

One fact that all agree on: The process is a lengthy one. As Mr. Voss said, “I knew after the walk I still had a long road of healing ahead of me.” Now, however, he has some useful tools and he shares them freely.

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Using Meditation to Help Close the Achievement Gap

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Students meditating at Phillip and Sala Burton Academic High School in San Francisco.

Students meditating at Phillip and Sala Burton Academic High School in San Francisco.Credit

Closing the so-called achievement gap between poor inner-city children and their more affluent suburban counterparts is among the biggest challenges for education reformers. The success of some schools’ efforts suggests that meditation might significantly improve children’s school performance – and help close that gap.

In 2007, James Dierke, then the principal of the Visitacion Valley Middle School in a troubled neighborhood in San Francisco, was determined to improve both the quality of education and student behavior in his school. He adopted a system called the Quiet Time Program, developed by the David Lynch Foundation for Consciousness-Based Education and World Peace. The program, implemented in partnership with the nonprofit Center for Wellness and Achievement in Education, involved introducing two 15-minute periods of quiet into the school day. During those times students could either practice Transcendental Meditation, which is taught as part of the program, or engage in other quiet activities like silent reading.

A major factor preventing underserved children from learning is the stress they encounter on a daily basis – from factors like poverty, deprivation, lack of steady parental input, physical danger and constant fear. Research shows that chronic stress can impair healthy brain development and the ability to learn, and that Transcendental Meditation, a stress-reducing technique that involves thinking of a mantra, can reduce stress and its manifestations – for example, anxiety, high blood pressure and cardiovascular disease. Mr. Dierke wondered whether meditation might reduce students’ stress levels and help them learn.

Over the next three years, Visitacion Valley’s suspensions dropped by 79 percent, attendance rose to 98 percent, and students’ grade point averages rose each year. Of even greater interest, the increase in G.P.A. for the lowest performing demographic was double that for the overall student group.

Anecdotally, favorable feedback poured in from both students and staff members. One seventh grader at Visitacion Valley said, “I used to be really fidgety, couldn’t stay in my seat for very long. Now, after meditating, I can sit down for a whole class without standing up.” Barry O’Driscoll, the school’s director of physical education for the past 14 years, said, “In the first seven years of my tenure, the school was dominated by stress and fighting.” But in the last few years, he said, “we have had very few fights.”

One other middle school and two high schools in the Bay Area adopted the program. And a 2015 review of the program, issued by the Center for Wellness and Achievement in Education in collaboration with the San Francisco Unified School District research department, had more good news.

The results of 17 studies conducted to date in the Bay Area, varying in duration from three months to one year, showed benefits across parameters including reduced stress, increased emotional intelligence, reduced suspensions, increased attendance and increased academic performance.

Although controlled studies are difficult to perform in an academic setting, collectively the results of the Bay Area studies are encouraging. Two controlled studies have been published so far; others are in submission for publication. In one, the effects of the Quiet Time Program, conducted over half the academic year, were evaluated in public middle school students performing below proficiency level. Annual math and English scores improved in the students who meditated, while they declined in those who didn’t meditate. Given that the students in the study were performing below par at baseline, these results are promising.

The second controlled study, authored by WestEd, an independent evaluator, found that after seven months of the Quiet Time Program, ninth grade students who meditated showed a significant decrease in anxiety and a significant increase in resilience compared to nonmeditating students. In addition, meditating students reported sleeping better as well as higher levels of self-confidence and happiness.

It would be naïve to think that meditation alone could erase the effects of the many factors, like poverty, that are barriers to educational achievement. But Quiet Time is a relatively inexpensive intervention that teachers and students enjoy and which preliminary data suggest is effective.

And although this program has focused on schools in low-income areas, adolescents from middle-class and affluent families could benefit from stress reduction as well. Why shouldn’t all our students have access to meditation?

Norman E. Rosenthal is a psychiatrist and the author of “Super Mind: How to Boost Performance and Live a Richer and Happier Life Through Transcendental Meditation.”

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Talking About Male Rape

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Raymond M. Douglas

Raymond M. DouglasCredit

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Credit

In his new book, “On Being Raped,” Raymond M. Douglas, a professor of history at Colgate University, writes publicly for the first time about being brutally beaten and raped at the age of 18 by a familiar parish priest. The assault transformed and shaped his life. More than 30 years later, the trauma of the four-hour-long assault continues to have repercussions, and Dr. Douglas argues persuasively that rape is an experience that one can never really relegate to one’s past. Rape, he says, “is always now.”

I recently spoke with Dr. Douglas about his decision to break his decades-long silence about the assault, why he prefers the word “victim” to “survivor” when talking about sexual violence, and his hope of initiating a broader public conversation about sexual assaults on men and boys. Here’s an edited excerpt of our conversation.

Q.

You’ve avoided discussing the assault for more than three decades. Why are you breaking your silence now?

A.

There wasn’t a specific trigger, but advancing age may have had something to do with it. I have been aware for many years that little has changed for men since the time of my attack. I am familiar with the women’s anti-rape movement in the late 1960s and early ’70s, and it was clear to me that what moved the needle of public perception about rape at that time was the willingness of victims to speak publicly under their own names about their experiences. In my mother’s time, rape was very much the “Great Unspeakable” for women. What changed that was people coming out and challenging the depictions of their experience. I didn’t see things changing for men unless they started doing the same thing.

Q.

Talking about the assault was so traumatic for you that you confided in very few people, and did not even tell your wife, whom you met many years after the assault. How did you prepare her for the book?

A.

We did have a conversation, and I did disclose to her. It didn’t come as a massive surprise to her, oddly enough. She said that she had suspected something of the kind for quite a few years, though she always assumed that it had been something that had happened to me in childhood, rather than early adulthood. That took her aback to a degree.

Q.

After the assault, you found out that there had been rumors about this priest for years and that there had been jokes about him having sexually assaulted other young men. Was his behavior an open secret?

A.

It certainly wasn’t [an open secret] to me. My friends knew him as a certain kind of, shall we say, boundary pusher. I don’t think they had the faintest idea just how dangerous he was. But I found out — and I was neither the first nor the last of his victims — that it went further than that. You need to remember the time and the place this occurred, and especially the time. It was a period where priests were quite literally gods anointed. They were the moral exemplars, the arbiters of good and evil, of what is acceptable conduct and what is not. They were not used to being contradicted and those who did challenge them were not supported – especially if you were an 18-year-old kid just out of school.

Q.

One of the most powerful messages of the book is that the trauma of being raped never goes away. Why do you think this is the case?

A.

In my opinion the real damage, the lasting damage, isn’t done by the episode as much as by the aftermath. Humans encounter trauma not infrequently. What’s different about sexual trauma is the type of social response one encounters from both sexes. I’ve spoken to people who have managed quite successfully to get over what were objectively pretty ghastly episodes of sexual victimization — much, much worse than anything I experienced. The common factor I’ve seen in those circumstances is that you find appropriate reactions on the part of others in the victim’s circle.

When you experience something as a big deal, and everybody else around you asserts with great certainty that no, it isn’t, or worse, that it isn’t even a thing, then trying to bridge that conceptual gap is likely to exacerbate difficulties with adjustment.

When you’re encountering denial, impatience, dismissal, contempt – which of course is something common to victims of both sexes – or when there is not even a vocabulary with which to describe the events to oneself, much less to others, the difficulties are increased exponentially.

Q.

In the book you tell us that you still have an aversion to being touched without permission and would prefer to sleep with the lights on. You say there is occasionally a “third person” in the room with you and your wife. Is your response typical?

A.

People respond to things like this in different ways. Some engage in a great deal of sexual activity, often risky sexual activity which can frequently lead to re-victimization. Another common way out is to withdraw into oneself. This was, as you know, my first sexual experience. It wasn’t of the nature to make me look forward to the next one with keen anticipation.

Q.

You talk about language a lot in this book, and say you prefer the word “victim” to “survivor.” Can you explain that?

A.

I strongly believe people should be able to call themselves whatever they like. But just as there are problematic overtones bound up with the word “victim,” it seems to me that there are problematic elements with the term “survivor.” It takes for granted something that requires demonstration. For both men and women, the suicide rate is increased very dramatically when people have undergone experiences of this kind. One can never be entirely sure that one has survived. I think most people who have had experiences like this would agree that years and decades afterward it still has the capacity to surprise them.

Our notion of trauma is a linear sort of notion: a bad experience, followed by a crisis, followed by re-normalization when you put it behind you, as the saying goes. I think most specialists would tell you that’s not really how it works in real life. Sometimes people are fine in the immediate aftermath and only have difficulties afterward. A lot of people have problems when they have children of their own, or when those children reach the age that they were when they were assaulted. Sometimes they get over some aspects of the experience and not others. I don’t think it’s ever safe to say one is ever completely past this kind of thing.

Q.

You say that you have maintained your Catholic faith, but have lost your trust in the leadership of the church, which never took action against your assailant. Is it difficult to walk this fine line?

A.

It’s very difficult, and that is reinforced every time I go to Mass on Sunday. The record of the church on this question is atrociously bad. It’s not on the radar screens of any of the major Christian denominations. This is something that we have a duty to do for our brothers and sisters, against whom we are sinning by omission as well as by commission.

Q.

Has any progress been made since your assault?

A.

At the time the very existence of male rape outside correctional institutions was largely and explicitly denied. This was a huge stumbling block for me at the time. I was assured that what I had experienced did not in fact happen.

Q.

You say your book is a first step to drawing attention to male-on-male rape. What must come next?

A.

I think we’re doing an abominable job of listening to men and boys who have been raped. When we notice their existence at all — which is a rare thing — we’re extremely prone to talk over them and to redefine their experience for them. We need more research that’s victim-centered. Our current understanding of what that experience involves is obtained from the crudest possible stereotypes, principally Hollywood films like “Deliverance” or “The Shawshank Redemption.” It’s not merely because men and boys are not speaking about it. The question worth asking is: What needs to be done that would make them feel safe in disclosing their experience?

Second, we need somewhere for men and boys to go when this has happened to them. We don’t have that. If one of my female students came to me on a Monday morning and said that something terrible happened last Saturday night, I have a good idea where to send her for support. If one of my male students came to me, I haven’t a bloody clue where to send him.

Third, we need an integrated approach to the whole problem of sexual violence. Right now there are numerous bodies and agencies and victims’ groups, each with its own particular mission, but in my view this situation is not advantageous to anybody.

We can talk about the gendered aspects certainly, but in my view, the fight against sexual violence in all its aspects is a single fight that ought to unite people of all genders and sexual orientations. The basic elements are fundamentally the same.

The Breakup Marathon

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Brian Eastwood during the Boston Marathon in 2016.

Brian Eastwood during the Boston Marathon in 2016.Credit Zeth Weissman

Brian Eastwood was a pretty good runner, but he’d always come up a bit short in trying to reach his goal of qualifying for the Boston Marathon.

When he set out to train for the 2015 Vermont City Marathon, though, his 12th try at qualifying, he had something new in his life: a divorce.

“The day my wife and I went to court was the first day of 16 weeks of training,” said Mr. Eastwood, 35, of Somerville, Mass. His life was, to put it mildly, in flux. Not only was he on the verge of divorce, but he was in the middle of trying to make a career shift, too.

But his training paid off: Mr. Eastwood ran the race of his life in Vermont, finishing in 3 hours, 1 minute, 17 seconds, more than seven minutes under his best time, and more than eight minutes under the Boston Marathon qualifying standard for men his age.

His divorce, he says, most likely made the difference. During that difficult time, “running was my only real constant,” he said.

For some people, a life trauma like a breakup or divorce might mean curling up in bed and shutting down. But others find more active ways to cope.

Those people “are better at compartmentalizing or utilizing some of the energy that surrounds the emotions they’re experiencing — maybe it’s anger, maybe it’s sadness — and channeling that into another venue or arena,” said Trent Petrie, director of the University of North Texas Center for Sport Psychology. For runners, that could mean challenging themselves to run better and faster, or to shoot for a longer distance.

“Chronic or traumatic stress leads to structural and functional alterations in the traumatized brain,” said Ken Yeager, director of the stress, trauma and resilience program at the Ohio State University Wexner Medical Center. And while a breakup or divorce may feel like a single traumatic event, it is often the culmination of months or even years of “mini-traumas” and ongoing stress.

“You had those tensions building up in your body,” Dr. Yeager said. “Most people don’t realize the way you release those tensions is movement.” He compares the situation to the nervous tension that builds up at the start of a race. “Before any major race, you have this release of tension, and that movement is what releases the trauma and tension,” he said.

Maya Harmon, 32, ran seven half-marathons in 2015 — the year that she and her husband of seven years divorced. She’d picked up running in 2009 when she moved to Phoenix, but started doing it more when the marriage started to unravel in 2011.

“When things really started to go bad, I started to focus on trying to do something to stay active because I knew that as long as I stayed active, it would keep me slightly happy,” she said. Even though her time was limited between work, graduate school and becoming a single mother, she still got out there, trained and ran races.

Her mother asked if she was trying to run away from her problems. Maybe, she said, though the escape that running provided was at least a healthy one, and kept her from feeling overwhelmed.

“If I had time to sit and think about it, I probably wouldn’t have made it through that time,” Ms. Harmon said. “Running gave me something to focus on that was positive.”

Dr. Petrie says that while there’s a risk that running might be used as an escape that prevents people from confronting the issues that are causing their stress, it can also be a useful tool for processing painful events. “Sometimes in the moment, these escapes into running or exercising or finding a slightly different focus is a way for us to garner the psychological resources we need to circle back and face the other stuff in a more productive way,” he said.

For Ms. Harmon, who had been casually involved with the Black Girls RUN! group via Facebook before her divorce, running gave her a chance to expand her social horizons. She dove in to the local activities of that national group’s Phoenix chapter and is now their running ambassador, a journey that may have helped to strengthen her psychological resilience.

When people are “depressed or stressed out, they tend to isolate themselves, and that facilitates negative moods,” said Jasper Smits, a professor of psychology at the University of Texas at Austin and a co-author of “Exercise for Mood and Anxiety: Proven Strategies for Overcoming Depression and Enhancing Well-Being.” Studies he and his colleagues have conducted suggest that exercise may help to lessen anxiety and panic attacks and provide other benefits for mental health.

This past April, Mr. Eastwood ran that Boston Marathon for which he had worked so hard to qualify. Now his life is very different: He has a new girlfriend, a new job. He was recovering from a calf injury when he started training this time, so he set a more moderate goal. He finished in 3 hours, 24 minutes, 37 seconds, more than 20 minutes slower than his post-divorce performance, but he has no complaints.

“Everyone who saw me along the course said I looked happy and strong, which is exactly what I wanted,” he said.

Jen A. Miller is the author of “Running: A Love Story.”

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Out With the Old

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Credit Illustration by Sam Island

Experiments involving health and well­-being typically require their subjects to change just one aspect of their lives. Focusing on a single variable like diet or exercise makes it simpler to collect data and draw conclusions. But some researchers at the University of California, Santa Barbara, recently wondered if this minimalist approach might be shortchanging people’s potential to improve their health. Maybe it’s better to address all of our bad habits at once rather than try to make incremental changes to our lives.

For their study, published in March in the journal Frontiers in Human Neuroscience, the researchers put 31 college students, who tend to have flexible daily schedules, through a series of physical, cognitive and emotional tests and gave them brain scans. Roughly half the students served as a control group and continued their daily routines; the other half overhauled their lives completely. Every morning, they visited the school for an hour of supervised stretching, resistance training and balance exercises, followed by an hour of training in mindfulness and stress reduction, which included quiet walks and meditation. In the afternoon, they exercised for an additional 90 minutes. Twice a week they completed two interval-style endurance workouts on their own. They attended lectures about nutrition and sleep and kept daily logs detailing their exercise, diets, sleep patterns and moods.

After six weeks, the students retook the original tests. Those in the control group showed no changes. But the others were substantially stronger, fitter and more flexible. They performed much better on tests of thinking, focus and working memory. They also reported feeling happier and calmer; their self-esteem was much higher. Their brain scans showed a pattern of activity believed to indicate a greatly enhanced ability to stay focused.

These improvements, especially on measures of mood and stress reduction, generally exceeded by a great deal what had been seen in many past experiments whose subjects altered only one behavior. The study’s authors suggest that one kind of change, like starting an exercise regimen, may amplify the effects of another, like taking up meditation. What’s more, the improvements persisted: According to Michael Mrazek, the director of research at the Center for Mindfulness and Human Potential at U.C.S.B. and the study’s lead author, another set of tests six weeks after the experiment’s end showed that the change-everything students still scored much higher than they originally had on measures of fitness, mood, thinking skills and well-being, even though none of them were still exercising or meditating as much as they did during the experiment.

Of course, this study couldn’t isolate which elements of the lifestyle makeover were essential, or how the various changes influenced one another. There were too many moving parts. Dr. Mrazek says that he and his colleagues plan to tackle these issues in future experiments. For now, he says, the results suggest that “the limits of the human capacity for change may be much greater than we, as scientists, have given people credit for.”

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The Mindful Child

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Credit Sam Kalda

It’s long been known that meditation helps children feel calmer, but new research is helping quantify its benefits for elementary school-age children. A 2015 study found that fourth- and fifth-grade students who participated in a four-month meditation program showed improvements in executive functions like cognitive control, working memory, cognitive flexibility — and better math grades. A study published recently in the journal Mindfulness found similar improvements in mathematics in fifth graders with attention deficit hyperactivity disorder. And a study of elementary school children in Korea showed that eight weeks of meditation lowered aggression, social anxiety and stress levels.

These investigations, along with a review published in March that combed the developmental psychology and cognitive neuroscience literature, illustrate how meditative practices have the potential to actually change the structure and function of the brain in ways that foster academic success.

Fundamental principles of neuroscience suggest that meditation can have its greatest impact on cognition when the brain is in its earliest stages of development.

This is because the brain develops connections in prefrontal circuits at its fastest rate in childhood. It is this extra plasticity that creates the potential for meditation to have greater impact on executive functioning in children. Although meditation may benefit adults more in terms of stress reduction or physical rejuvenation, its lasting effects on things like sustained attention and cognitive control are significant but ultimately less robust.

clinical study published in 2011 in The Journal of Child and Family Studies demonstrates this concept superbly. The research design allowed adults and children to be compared directly since they were enrolled in the same mindfulness meditation program and assessed identically. Children between 8 and 12 who had A.D.H.D. diagnoses, along with parents, were enrolled in an eight-week mindfulness-training program. The results showed that mindfulness meditation significantly improved attention and impulse control in both groups, but the improvements were considerably more robust in the children.

Outside of the lab, many parents report on the benefits of early meditation. Heather Maura of Vienna, Va., who was trained in transcendental meditation, leads her 9-year-old daughter Daisy through various visualization techniques and focused breathing exercises three nights a week, and says her daughter has become noticeably better at self-regulating her emotions, a sign of improved cognitive control. “When Daisy is upset, she will sit herself down and concentrate on her breathing until she is refocused,” Ms. Maura said.

Amanda Simmons, a mother who runs her own meditation studio in Los Angeles, has seen similar improvements in her 11-year-old son, Jacob, who is on the autism spectrum. Jacob also has A.D.H.D. and bipolar disorder, but Ms. Simmons said many of his symptoms have diminished since he began daily meditation and mantra chants six months ago. “The meditation seems to act like a ‘hard reboot’ for his brain, almost instantly resolving mood swings or lessening anger,” Ms. Simmons said. She believes it has enabled him to take a lower dose of Risperdal, an antipsychotic drug used to treat bipolar disorder.

Whether children are on medication or not, meditation can help instill self-control and an ability to focus. Perhaps encouraging meditation and mind-body practices will come to be recognized as being as essential to smart parenting as teaching your child to work hard, eat healthfully and exercise regularly.

Learn some meditation techniques you can teach your child, read Three Ways for Children to Try Meditation at Home

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Three Ways for Children to Try Meditation at Home

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There are many apps, classes and books to guide children in meditation, but it is easy (and free) to start at home. You don’t need props like chimes or incense. The more meditation becomes integrated into daily living, the more successful it will be. Here are some exercises to try.

1. Elevator down. Imagine an elevator going down three floors. (Older children may prefer to imagine more floors.) Imagine now that the elevator is in your body. When you are sitting, imagine the top floor is from your head to your chest. The next floor is from your chest to your belly, and the third from your belly to your seat.

Begin at the crown of your head. On your next exhale mentally chant “three” as you imagine the elevator lowering from your crown to your chest. Pause for an inhale. When the doors open, imagine your breath coming in and freshening up the elevator, the way opening a window brings a fresh breeze into the room. On the next exhale, mentally chant “two.” Imagine going down another flight to your belly. Continue to the ground floor, chanting “one.” Pause and feel your seat on the ground floor and enjoy landing fully.

2. Finger-counting breaths. This is a useful do-anywhere exercise for the middle of the day to calm a child who is having a meltdown at a birthday party or just to re-center. Create gentle fists with your hands, and with each breath, unfurl a finger from your palm. For example, on your first exhale open your left thumb from your fist. Pause and enjoy an inhale. On your next exhale, unfurl your left index finger. Pause and enjoy an inhale. Continue until you have two open palms on your lap.

Sometimes we “om” for each finger unfurled, or use a personal mantra that evokes the feeling we are looking for, like peace, love, quiet, calm or relax. When children make up the mantra, it helps them have self-awareness of what they may need, as well as how they can take charge of how they want to feel.

3. Deep breaths before bed. Take a deep breath in through the nose, and on the exhale chant out loud: “three” (thrreee). Enjoy another deep in-breath, and on the next exhale, chant “two” (twwooo). Take a last deep breath in and exhale, chanting: “one” (onnee). Relax for a few breaths, and enjoy feeling your body sitting or lying on the floor or your bed. Repeat if desired.

Learn why meditation can be so important for children, read The Mindful Child

Jillian Pransky is the director of therapeutic yoga teacher training for YogaWorks and the mother of a 12-year-old. Her debut wellness book is scheduled to be published in fall 2017.

Worried? You’re Not Alone

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Credit Oliver Munday

I’m a worrier. Deadlines, my children, all the time they spend online — you name it, it’s on my list of worries. I even worry when I’m not worried. What am I forgetting to worry about?

Turns out I’m not alone. Two out of five Americans say they worry every day, according to a new white paper released by Liberty Mutual Insurance. Among the findings in the “Worry Less Report”: Millennials worry about money. Single people worry about housing (and money). Women generally worry more than men do and often about interpersonal relationships. The good news: Everyone worries less as they get older.

“People have a love-hate relationship with worry,” said Michelle Newman, a professor of psychology and psychiatry at Pennsylvania State University, who was not involved in the writing of the report. “They think at some level that it helps them.”

The belief that worrying somehow helps to prevent bad things from happening is more common than you might think. Researchers say the notion is reinforced by the fact that we tend to worry about rare events, like plane crashes, and are reassured when they don’t happen, but we worry less about common events, like car accidents.

But that doesn’t mean all worrying is futile. “Some worry is actually good for you,” said Simon A. Rego, the author of the new report and a cognitive behavioral psychologist who specializes in anxiety disorders and analyzed decades of research on worrying for the paper. “It’s what we call productive or instructive worry, that can help us take steps to solve a problem.”

One study published in 2002 recruited 57 young adults and asked them to list their worries in a diary for seven days and rate each worrying episode.

When the researchers analyzed the results, they determined that about 20 percent of the worries were about anticipating a negative outcome in the future. But nearly half of all the documented worries reflected a process of problem solving. While that can be constructive, people who worried a lot and couldn’t control their worrying were less likely to find a solution to their problem. The researchers, Marianna Szabo, now at the University of Sydney, and Peter F. Lovibond of University of New South Wales in Australia, concluded that failing to come up with solutions may actually lead to more pathological worrying.

In 2007, the same researchers tried to correlate aspects of worrying with specific components of problem-solving, like defining the problem, gathering information, generating solutions, evaluating and choosing a solution. Once again, they concluded about half the cognitive content of the worry episodes included attempts to solve a problem. Once people devise a solution, they quit worrying one-third of the time. But people found it hard to stop worrying if they weren’t satisfied with the solution they came up with.

People “get caught up in the worry itself,” Dr. Newman said. “It becomes so habitual, I call it ‘a process looking for content.’”

That kind of worrying can get out of hand. “Excessive worriers have multiple domains that they worry about, and if something triggers a worry in one domain, it can seep into other areas,” Dr. Rego said, “and things can move back and forth like wildfires — once one gets going, it can start other fires as well.”

Worrying, a cognitive process, should not be confused with anxiety, which generally refers to an emotional state of unease that also includes worry. While 38 percent of people worry every day, most of them do not have anxiety. Generalized anxiety disorder, the primary feature of which is excessive and uncontrollable worrying, affects only 2 to 5 percent of the population.

Liberty Mutual Insurance officials commissioned the report to better understand how Americans can “break the worry cycle,” since the insurance business is designed “around helping people live with less worry,” said Margaret Dillon, the company’s executive vice president and chief customer officer for the United States, adding that it could also help them develop the most appropriate products. The report noted, for example, that top worries for people ages 25 to 44 are about finances and housing, she said.

If you’re worried about your worrying, the report suggests some coping strategies, including:

Divide and conquer Try to come up with a solution to a worrisome problem by breaking it down into four parts: defining the problem, clarifying your goals, generating solutions and experimenting with solutions. Grab a pen and paper and brainstorm, the report suggests.Studies have shown this approach can help ease depression and anxiety.

Practice mindfulness Choose a routine activity or part of the day and try to experience it fully. Set aside concerns, and try to be “in the moment.”

Schedule a worry session Pick a designated time of day to mull your problems. If a worrying thought enters your mind outside of your scheduled worry session, jot it down so you can think about it during your scheduled worry time. Then get back to your day.

Practice accepting uncertainty Notice your thoughts and label them (as in “there is the thought that I can’t manage”). Let go of tension in your body; soften your forehead, drop your shoulders and relax your grip.

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Asperger’s Are Us Offers Comedy for All

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The Asperger’s Are Us comedy troupe, from left to right, Jack Hanke, Ethan Finlan, New Michael Ingemi and Noah Britton, jokingly protested their own movie at its SXSW premiere.

The Asperger’s Are Us comedy troupe, from left to right, Jack Hanke, Ethan Finlan, New Michael Ingemi and Noah Britton, jokingly protested their own movie at its SXSW premiere.Credit Andrew Cohen

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The four members of Asperger’s Are Us decided a long time ago that their main goal would be to amuse themselves.

But after nearly a decade of laughing and writing punch lines together, Asperger’s Are Us, which is probably the only comedy troupe made up of people on the autism spectrum, is on the cusp of comedic success.

A documentary about the group premiered at the SXSW conference in Austin in March and was recently sold to Netflix. The troupe is also preparing for its first national tour this summer.

Comedy might be a surprising choice for someone with Asperger’s syndrome, since stereotypically, people with autism are generally regarded as socially awkward loners. But the four men in the group bonded at summer camp 11 years ago, when one was a counselor and the other three were campers, and are clearly great friends.

An “Aspergers Are Us” performance from 2011.

Talking recently via Skype, Noah Britton, the former counselor, settles giant black rabbit ears onto his head. Jack Hanke, another member of the troupe, dons his favorite sombrero – the black one he took with him to Oxford University during his recent junior year abroad – accessorized with a red sombrero on top.

They slip into their usual banter when asked what they thought of the film, named for the group, which will be shown publicly for the first time on Friday at the Somerville Theater outside of Boston.

“I liked the four weird guys in it,” Mr. Britton said.

“It was better than ‘Jaws 2,’ but not as good as ‘Jaws 3,’” Mr. Hanke insisted.

“I found it kind of annoying myself,” added Ethan Finlan, another member of the group.

The fourth member, who changed his first name to New Michael to distinguish himself from his father, Michael Ingemi, didn’t want to join the call.

The filmmaker, Alex Lehmann, said he had planned to make a short documentary until he realized he had a powerful coming-of-age story to tell about these men and their relationships that goes well beyond their autism. The final film runs about two hours.

Like many people on the autism spectrum, which is characterized by impaired social skills, communication difficulties and repetitive behaviors, each of the troupe members can get overwhelmed by sounds, sights or smells. When one gets stressed out or acts particularly “aspie,” another – usually Mr. Britton – steps in to restore calm.

Their obsessive interests – including a passion for Elton John – are often the starting point of their sketches. Mr. Finlan’s preoccupation with trains becomes another of the group’s strengths: He always knows when they need to end rehearsals to catch their trains home.

The men have also grown up with one another. Mr. Britton, 33, a musician and adjunct professor of psychology at Bunker Hill Community College in Boston, recently moved in with his girlfriend. The others, now 23, are done or nearly done with college. “It’d better be your last semester,” Mr. Britton told Mr. Hanke.  “A year ago it was your last semester, too.”

“This is my last semester three,” Mr. Hanke responded. “Last year I tried to get three semesters in two. It did not work out well. I’m making up a couple of classes now.”

Mr. Britton couldn’t resist playing on his friend’s words: “You should only take real classes,” he admonished.

Underneath the jokes there’s clearly a real admiration for one another, and an emotional connection that’s important for all of them.

“There are like two people in the world who make me feel as myself as these guys do,” said Mr. Britton, who often acts as the group’s spokesman. “When they’re not around, I can’t be what I want to be.”

All four are putting everything else on hold this summer as they launch into comedy full time.

Although they have done 15 to 20 shows together, this will be their first chance to hone their jokes night after night before a live audience. They plan to keep some of their favorite sketches and jokes – many of which were featured in the film – but also introduce new material that they will write before the tour begins, with shows planned at the Improv Asylum in Boston on July 11, and Carolines on Broadway in New York City on July 12.

“Hopefully it’ll be a lot of good new stuff, but maybe it’ll be a lot of bad new stuff. That’ll be great, too,” Mr. Britton said.

Mr. Lehmann said he got interested in the troupe when he read an article about them that “changed everything that I had assumed about Asperger’s.”

Happy to have made a film he’s passionate about, rather than shooting horror flicks to pay the bills as he did earlier in his career, Mr. Lehmann said he’s proud to have played a role in the troupe’s success.

He’s confident other people will come to appreciate the humor of Asperger’s Are Us, particularly their “hilarious one-liners,” as much as he does.

“They wanted to be professional comedians – they’re at least getting a summer of it and hopefully a lot more,” Mr. Lehmann said. “I think they’re going to be a hit.”

Treating Pregnant Women for Depression May Benefit Baby, Too

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Treating pregnant women for depression may benefit not just themselves but their babies as well.

A study, in the May issue of Obstetrics & Gynecology, included 7,267 pregnant women, of whom 831 had symptoms of depression. After controlling for maternal age, race, income, body mass index and other health and behavioral characteristics, the researchers found that depressive symptoms were associated with a 27 percent increased relative risk of preterm birth (less than 37 weeks of gestation), an 82 percent increased risk of very preterm birth (less than 32 weeks of gestation), and a 28 percent increased risk of having a baby small for gestational age.

They also found that among those who were treated with antidepressants for depression — about a fifth of those with the diagnosis — there was no association with increased risk for any of these problems. But they acknowledge that this group was quite small, which limits the power to draw conclusions.

Still, the lead author, Dr. Kartik K. Venkatesh, a clinical fellow in obstetrics and gynecology at Harvard, said that it was important to screen mothers for depression, not only for their health but for that of their babies.

“By screening early in pregnancy, you could identify those at higher risk and counsel them about the importance of treatment,” he said. “Treating these women for depression may have real benefits.”