Rates of depression and anxiety were significantly higher in people with chronic pain than in those without pain, results of a new meta-analysis and systematic review showed. Prevalence was also higher based on pain type, with higher rates of depression and anxiety among those with fibromyalgia than those with osteoarthritis, investigators found. “The surprising finding is the significant distribution of prevalence in different pain conditions — people with certain types of pain are more vulnerable to depression and anxiety, which is important from a clinical perspective,” lead investigator Rachel Aaron, PhD, assistant professor at Johns Hopkins Medicine, Department of Physical Medicine and Rehabilitation, Baltimore, told Medscape Medical News. The findings were published online on March 7 in the JAMA Network Open . Addressing the Gap In previous population studies, prevalence rates of co-occurring chronic pain and anxiety and depression symptoms varied widely. There was the need for a systematic review to synthesize the findings and clearly define the overall impact of chronic pain and co-occurring depression and anxiety. To address the gap, researchers reviewed 376 studies published between 2013 and 2023 with 347,468 adults with chronic pain (excluding chronic headaches) and 160,564 control participants across 50 countries. The mean age of the pain group was 51 years, and 70% were women. Overall, adults with chronic pain were at higher risk for clinical symptoms of depression and anxiety than clinical and nonclinical control individuals. Investigators recorded a pooled prevalence of 39.3% for clinical symptoms of depression (95% CI, 37.3%-41.1%) and 40.2% for clinical symptoms of anxiety (95% CI, 38%-42.4%). This was considerably higher than rates of depression (13.9%) and anxiety (16.4%) reported in the control groups. Based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnosis criteria, 37% of adults with chronic pain met diagnostic criteria for major depressive disorder compared with 10.1% in the control group. Generalized anxiety disorder was also more common in the chronic pain group vs the control group (16.7% vs 3.5%, respectively). Importance of Pain Type? Investigators also found that certain types of pain conditions were more strongly associated with depression and anxiety than others. For example, depression and anxiety were higher in people with fibromyalgia than in those with osteoarthritis (54% vs 29.1% and 55.5% vs 17.5%, respectively). “Although we were unable to test directionality of the relationship between chronic pain, depression, and anxiety in the study, one thought is people with fibromyalgia and other nociplastic-related pain conditions are more vulnerable to developing depression and anxiety in the first place, and that could be a factor driving chronic pain,” Aaron said. Prevalence of depression and anxiety was also higher in younger individuals and in women (P < .001 for both), which Aaron said, “replicates what we see in the general population that rates of depression and anxiety are higher in women.” Clinical symptoms of depression were higher among those recruited from clinical settings, while longer pain duration was associated with greater risk for anxiety symptoms . The authors reported high heterogeneity, particularly across subgroup analyses. “What that means is that we cannot say with a great deal of certainty who is more vulnerable to depression and anxiety in chronic pain and why, although we can make some broader generalizations,” Aaron explained. The findings point to the importance of routine screening of depression and anxiety in clinical settings where people with chronic pain are seen, Aaron said. Moreover, “while we highlight that depression and anxiety is high, we don’t want to forget that it is not the case for everybody,” Aaron added, noting that 60% of people with chronic pain did not meet criteria for significant levels of depression and anxiety. Directionality Problems Commenting on the study for Medscape Medical News, Gary Small, MD, chair of Psychiatry at Hackensack University Medical Center, Hackensack, New Jersey, noted that the finding that rates of depression and anxiety varied based on pain type was particularly interesting. “With arthritis, there are recognized underlying pathological processes; anxiety and depression rates were lower. But, in people with diffused pain from fibromyalgia, where you cannot locate source of pathology, depression, and anxiety rates were higher,” Small said. “This suggests a feedback mechanism between the mental experience and physical source of pain. You get anxious about your pain, and when you don’t understand where it is coming from, it makes feelings of depression and anxiety worse,” said Small, who was not involved in the study. Christina Lee, MD, psychiatrist and medical director of Mental Health Services at Kaiser Permanente in Baltimore, felt the large dataset of nearly 350,000 patients across 376 studies was both a strength and limitation. “While it provides robust evidence for the link between chronic pain and mental health, the high variability across studies makes it difficult to draw precise conclusions. Some studies used self-reported symptoms, while others relied on clinical diagnoses, leading to inconsistencies in measurement,” she said. She also noted that the actual rate of diagnosed psychiatric disorders was lower. “Are we underdiagnosing these conditions, or are symptoms fluctuating rather than meeting full clinical criteria?” she asked. “This study does not establish causation. Does chronic pain trigger depression, or do mood disorders exacerbate pain perception?” Lee said. Note: This article originally appeared on Medscape .

Girls are twice as likely as boys to be diagnosed with depression, and researchers in London have now uncovered clues as to why. Girls' brains are more likely to use a common dietary amino acid called tryptophan in a way that is neurotoxic, or harmful to nerves, even though most people's brains use it to make a compound that is neuroprotective, or helpful to nerves. Girls whose brains tended toward this neurotoxic process also were more likely to have blood test results that showed their bodies were in an inflammatory state. The girls most likely to have these processes also scored highly on a depression risk assessment or had already been diagnosed with major depression . "Depression during adolescence can significantly impact social and emotional development and increases the risk of suicide," said first author Naghmeh Nikkheslat, PhD, a senior research associate at King's College London. "Our findings offer a hopeful step toward personalized, proactive approaches that address the underlying biological factors of depression, particularly in girls." The findings build on previous evidence showing that girls are more at risk of getting depression, highlighting the need for targeted prevention and treatment. An estimated 53% of teen girls reported persistent feelings of sadness or hopelessness, compared to 28% of boys, according to a 2024 CDC report. Girls were also more likely to have suicidal thoughts and behaviors. The new study, which included 75 girls and 75 boys all around the age of 15 who lived in Brazil, showed that girls with depression, or at high risk of it, were more likely to have lower neuroprotective compound levels, compared to girls at low risk of depression . The differences were not seen among boys. The route these compounds take in the brain – either neuroprotective or neurotoxic – is called the kynurenine pathway. "Our study suggests that targeting the kynurenine pathway may offer a personalized treatment avenue for female adolescents with depression," said Nikkheslat. "By reducing inflammation or encouraging the pathway to produce more neuroprotective rather than neurotoxic metabolites, we may prevent depression from developing or becoming chronic." The researchers also found that high neurotoxic compound levels three years later were linked to an increased likelihood of persistent depression, while those whose levels had fallen were more likely to have recovered. This suggests that the neurotoxic activity makes depression harder to overcome, said Nikkheslat, who is an expert in the field of psychoneuroimmunology (the study of how the mind affects health and risk of disease). Researchers are still working to understand why these chemical differences exist between boys and girls. But "we know that increased inflammation can potentially affect the levels of these chemicals," Nikkheslat said. Childhood trauma or sexual hormones can impact inflammation, so it's possible one or the other (or both) "could contribute to these chemical abnormalities in girls." Potential treatments to be evaluated may include anti-inflammatory medications to see if their use helps push the brain away from using the neurotoxic pathway, Nikkheslat said. Stress management, exercise, and dietary interventions known to reduce inflammation should also be considered. Tryptophan – the amino acid at the center of this research – is in many common foods like poultry, dairy, seeds, and nuts, and the body uses it for many essential processes like supporting infant growth, and in making melatonin and serotonin, the latter of which is important in regulating appetite and mood. Dietary approaches and the use of or development of medications that can impact how the brain ultimately uses the byproducts of tryptophan warrant exploration as possible treatments, Nikkheslat said, noting that it also could be lifesaving to identify girls at highest risk before they develop depression. Note: This article originally appeared on Medscape .

AFFIRMING PSYCHIATRY In the early morning hours of December 4, 2024, United Healthcare CEO Brian Thompson was gunned down on the streets of New York. Although the motives of the murderer are not certain, there are indications that he carried out a vigilante-style execution as an act of terror against the insurance company itself. Unsurprisingly, his death sparked a national outpouring of opinions on the subject of health insurance and health care generally. Much of that opinion was unsparing. Rather than sympathy toward Thompson or United, most immediate social media responses ranged from ironic jokes about denied coverage to outright celebration. The schadenfreude and public rage both continued as United Group’s CEO (Andrew Witty) took to the editorial pages of The New York Times to defend his own. “Healthcare,” he opined, “is both intensely personal and very complicated, and the reasons behind coverage decisions are not well understood. We share some of the responsibility for that.” Readers do not appear to have been convinced. They called the essay “sanctimonious” and “self-serving.” “More gaslighting from an industry that has zero need to exist except to siphon profits from a non-discretionary sector,” said commentator “J M” to the tune of 4488 recommends. While I personally do not agree with Witty’s opinion, I do have to admire his courage in speaking out just days after the assassination. And I can respect the courage of other commentators who went on record to speak up for insurance companies, paddling against the riptide of public emotion that was churning forth. For instance, the editorial board of the Wall Street Journal was sympathetic to insurance companies’ efforts to “control costs,” blaming government for “policies that distort the markets and force rationed care.” Matthew Yglesias, a nationally prominent blogger, has long maintained that the major problem with America’s health care system is that providers charge too much. Economist and blogger Noah Smith has been even more forthright: I think the outpouring of schadenfreude at Thompson’s killing reflects some deep-seated popular misconceptions about the US health care industry. A whole lot of people—maybe most people—seem to regard health insurance companies as the main villains in the system, when in fact they’re only a very minor source of the problems. The insurance companies are simply hired to play the bad guy—and they’re paid a relatively modest fee for that service. Who is the real “bad guy” in our health care system? Well doctors and nurses, of course! Sure, doctors and nurses take good care of patients during the treatment process, but yet they charge “excessive prices.” According to Smith, doctors and nurses know that insurance is not going to pay a lot of those costs. The “smiling doctor” and the “gentle nurse” know full well that insurance is going to fight expensive procedures and drugs, and yet they never mention it. They offer all sorts of treatments knowing and apparently not caring that patients will get stuck with the bill. It is the providers that are the problem, you see. Insurance companies are just the poorly paid fall guy who cut costs so that doctors, nurses, and hospitals can play the ‘good guy.’ Rage Against the Insurance Companies Not surprisingly, I as a physician have a different idea about all this. My idea is that the costs of treatment are only a secondary factor in the titanic rage against the insurance companies. I truly believe that while the expense of medical care is a serious problem for our system, the rage has to do with something else: The experience of being repeatedly and systematically hoodwinked. Hoodwinked? Exactly, at least according to 1 definition of the word: “To conceal one’s true motives from, especially by elaborately feigning good intentions so as to gain an end.” That is a precise description of what many of us experience with insurance companies. We feel repeatedly deceived by protestations of the best intentions followed by cold, calculating, and duplicitous treatment. And that is why so many New York Times readers responded so negatively to Witty’s bland pronouncements of goodwill on behalf of the insurance industry. Although I have no hard evidence for this idea, I do have 20 years of experience with it in private practice. Whenever I treated individuals who paid for treatment directly out of pocket, I noticed the same pattern: They did not like the high price of treatment, but handled it calmly and kindly as long as they knew the costs in advance and could plan for them. On the other hand, individuals became absolutely livid if they had any sense of being deceived about the nature of our arrangement. For instance, people who felt deceived about being charged for no-shows, or ill-informed about whether I was an in-network provider, would turn against me instantly and literally curse me to my face. Whenever individuals did not clearly understand the deal in advance, whenever they felt ambushed by hidden costs after committing themselves to treatment, learning of some new loophole or obligatory expense felt like a stab in the back. I have never seen anyone take kindly to a stab in the back. And so, I submit that the rage against the insurance companies comes from a sense of being duped, not simply from high costs or limits of coverage. It is not the fact that insurance does not cover everything that makes people so angry. It is the impression that they pretend to cover so much, take your money for years in the form of high monthly premiums, and then in your hour of desperation and need, they refuse to pay up. Instead, they seem to find loopholes, make excuses, refuse to help, hide behind rules that no one can understand, and make it excessively difficult even to get a person on the telephone who can address the situation. It is not that insurance seems costly. It is that insurance seems duplicitous. What We Want From Insurance What do we want from insurance companies? We simply want a fair deal, a deal that we can understand in advance, a deal that they will faithfully honor. What we want is an end to the befuddling obfuscation of a secret system that resembles Kafka’s The Trial more than something designed to facilitate health care. What we want is an end to insurance feeling like a lotto card as you scratch off the next panel desperately hoping to win some actual coverage when you get sick. What we want is an end to the infuriating game of ‘heads I win, tails you lose’ routinely played in the insurance business. What we want is a straightforward transaction, not bland promises of ‘your health is in good hands with us,’ followed by callous disregard of our well-being. What we want is an end to the systematic use of delays, knee-jerk denials, inefficiencies, time-wasting, and double-talk to numb us into passive acceptance of such ethical criminality. Dearest Insurance Companies: Just offer us a deal that is straightforward and transparent, and live up to that deal. Then we can all decide if it is worth the cost, rather than going into apoplectic rage the next time that you manipulate the system against us—the very system that you design, administrate, and change at will. And then, perhaps, all the rest of us might really feel that we are on the same side, all trying our best to balance cost vs care, all trying to make the best of a very difficult situation. And then no one will have to be the “bad guy” in health care anymore. Note: This article originally appeared on Psychiatric Times .

Key Takeaways Immersive VR meditation offers personalized experiences, enhancing symptom relief for MDD and GAD compared to traditional meditation. The study utilized Meta Oculus Quest 2 headsets, with participants engaging in 30-minute sessions over 10 weeks. Emotional regulation improvements were measured using HeartMath biofeedback, affirming VR meditation's efficacy. Limitations include a single-arm design and small sample size, yet findings support VR integration in mental health care. A new study shows that meditation using immersive virtual reality devices provides greater relief from major depressive disorder (MDD) and generalized anxiety disorder (GAD) symptoms than meditation alone. “Treatments that use medications are the most effective in addressing mental health disorders, but they also can bring unwanted side effects,” said Junhyoung Kim, PhD, a researcher in the Department of Health Behavior involved with the study. “That led to the current effort to develop treatments that rely less on drugs or are entirely drug-free, such as the practice of mindfulness through meditation.” In this longitudinally designed, single-arm clinical trial, participants used Meta brand Oculus Quest 2 digital headsets for 30-minute meditation sessions 3 times a week for 10 weeks. Investigators recruited participants based on referrals from clinician progress notes and initial entrance exams. Of the initial group of 36 participants, each participant engaged in an average of 5.1 sessions, but 11 participants left the study without undergoing the exit assessment when they were discharged from the hospital. This left the 25 participants—11 males and 14 females, with a mean age of 42.1 years—who took part in an average of 2.7 intervention sessions, equaling a total of 68 observations. The most important part of immersive virtual reality meditation that distinguishes it from traditional meditation is the personalized meditation experience. The headsets provided an immersive virtual reality experience in which users selected their desired outcome, such as stress reduction or improved sleep3,4; scenery, like a meadow, savannah, or beach; and natural sounds, like birds chirping. The 30-minute sessions were provided according to the preference and requirements of each participant. Before and after each session, participants completed a General Anxiety Disorder-7 questionnaire. They also completed the Patient Health Questionnaire-9 before and after 2 sessions. Investigators also used HeartMath (electrocardiogram) to measure the changes in emotional regulation related to immersive virtual reality meditation participation. HeartMath, a biofeedback monitoring system that measures heart rhythm changes and coherence levels between sympathetic and parasympathetic activities in the autonomic nervous system,5 allowed investigators to objectively measure coherence level and related achievement scores that are associated with levels of depression and anxiety (Drageset et al., 2012; Edwards, 2016; Minen et al., 2021). The study affirmed previous findings that virtual reality meditation sessions significantly alleviated participants’ MDD and GAD symptoms and improved their emotional regulation. “This is important knowledge for mental health professionals, clinicians and caregivers,” Kim said. “Meditation using immersive virtual reality has the potential to greatly benefit those in the United States who will experience depression at some point.” Limitations included the single arm clinical trial and small sample size. “While the outcomes of the study cannot be generalized and there are reliability issues, our study can serve as an initial test of the application of a technology to mindfulness therapy for MDD and GAD patients,” wrote the study authors. “The results of our study provide a rationale for implementing immersive virtual reality meditation with patients with MDD and GAD and shed light on how mental health professionals , clinical practitioners, and caregivers can integrate VR technology into existing mental health care programs.” Note: This article originally appeared on Psychiatric Times .

TOPLINE: Walking 7000 or more steps per day is associated with fewer depressive symptoms and a 31% lower risk for depression than taking fewer steps, a new meta-analysis shows. METHODOLOGY: Researchers conducted a systematic review and meta-analysis of 33 observational studies that included more than 96,000 adults aged 18-91 years. Data were obtained from 27 cross-sectional and 6 longitudinal studies and from 5 major databases through May 2024. Objectively measured daily step counts and depression data were collected via various assessment tools. TAKEAWAY: The number of daily steps had a significant inverse correlation with depressive symptoms in both cross-sectional (correlation coefficient [r], −0.12; 95% CI, −0.20 to −0.04) and panel studies (r, −0.17; 95% CI, −0.28 to −0.04). Participants achieving 7000 steps per day or more showed a lower risk for depression than those achieving less than 7000 steps per day (risk ratio [RR], 0.69; 95% CI, 0.62-0.77). An additional increase of 1000 steps per day was associated with a 9% lower risk for depression (RR, 0.91; 95% CI, 0.87-0.94). Cross-sectional analysis showed that, compared with walking less than 5000 steps per day, walking 5000-7499 steps per day, 7500-9999 steps per day, and at least 10,000 steps per day were all significantly associated with fewer depressive symptoms (standardized mean difference, −0.17, −0.27, and −0.26, respectively). IN PRACTICE: "The objective measurement of daily steps may represent an inclusive and comprehensive approach to public health that has the potential to prevent depression. Small amounts of PA [physical activity] may be particularly relevant for specific populations, such as older adults and individuals with limited activities of daily living, for whom daily steps emerge as an accessible PA strategy," the investigators wrote. SOURCE: The study was led by Bruno Bizzozero-Peroni, PhD, Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain. It was published online December 16 in JAMA Network Open . LIMITATIONS: Reverse associations were possible, and causal inferences could not be made from the findings. In addition, the analysis showed substantial between-study heterogeneity in some pooled estimates, partially explained by differences in participant characteristics and step-counting devices. Most studies also lacked robust methods, potentially affecting result reliability, and the meta-analysis comparing high vs low daily step counts may have been susceptible to publication bias. DISCLOSURES: The study was funded by the University of Castilla-La Mancha, National Agency for Research and Innovation, Ministry of Economy and Competitiveness of Spain, Carlos III Health Institute, European Regional Development Fund, and European Union's Next Generation EU initiative. No conflicts of interest were reported. Note: This article originally appeared on Medscape .

A new study provides more evidence that glucagon-like peptide 1 receptor agonists (GLP-1 RAs) used to treat diabetes and obesity could be repurposed for opioid use disorder (OUD) and alcohol use disorder (AUD). Researchers found that patients with OUD or AUD who were taking semaglutide (Ozempic, Novo Nordisk) or similar medications for diabetes or weight-related conditions had a 40% lower rate of opioid overdose and a 50% lower rate of alcohol intoxication than their peers with OUD or AUD who were not taking these medications. Their real-world study of more than 1 million adults with a history of OUD or AUD provide “foundational” estimates of the association between glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 RA prescriptions and opioid overdose/alcohol intoxication “and introduce the idea that GLP-1 RA and other related drugs should be investigated as a novel pharmacotherapy treatment option for individuals with OUD or AUD,” the investigators led by Fares Qeadan, PhD, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois, wrote. The study was published online on October 17 in the journal Addiction . Protective Effect? As previously reported by Medscape Medical News, earlier studies have pointed to a link between weight loss drugs and reduced overdose risk in people with OUD and decreased alcohol intake in people with AUD. Until now, most studies on GLP-1 RAs and GIP agonists like tirzepatide (Mounjaro) to treat substance use disorders consisted of animal studies and small-scale clinical trials, investigators noted. This new retrospective cohort study analyzed de-identified electronic health record data from the Oracle Health Real-World Data. Participants, all aged 18 years or older, included 503,747 patients with a history of OUD, of whom 8103 had a GLP-1 RA or GIP prescription, and 817,309 patients with a history of AUD, of whom 5621 had a GLP-1 RA or GIP prescription. Patients with OUD who were prescribed GLP-1 RAs had a 40% lower rate of opioid overdose than those without such prescriptions (adjusted incidence rate ratio [aIRR], 0.60; 95% CI, 0.43-0.83), the study team found. In addition, patients with AUD and a GLP-1 RA prescription exhibited a 50% lower rate of alcohol intoxication (aIRR, 0.50; 95% CI, 0.40-0.63). The protective effect of GLP-1 RA on opioid overdose and alcohol intoxication was maintained across patients with comorbid conditions, such as type 2 diabetes and obesity. “Future research should focus on prospective clinical trials to validate these findings, explore the underlying mechanisms, and determine the long-term efficacy and safety of GIP/GLP-1 RA medications in diverse populations,” Qeadan and colleagues concluded. “Additionally, the study highlights the importance of interdisciplinary research in understanding the neurobiological links between metabolic disorders and problematic substance use, potentially leading to more effective treatment strategies within healthcare systems,” they added. Questions Remain In a statement from the UK nonprofit Science Media Centre, Matt Field, DPhil, professor of psychology, The University of Sheffield, Sheffield, England, noted that the findings “add to those from other studies, particularly animal research, which suggest that this and similar drugs might one day be prescribed to help people with addiction.” However, “a note of caution is that the outcomes are very extreme instances of substance intoxication,” added Field, who wasn’t involved in the study. “Those outcomes are very different from the outcomes used when researchers test new treatments for addiction, in which case we might look at whether the treatment helps people to stop taking the substance altogether (complete abstinence), or if it helps people to reduce the amount of substance they consume, or how often they consume it. Those things could not be measured in this study,” he continued. “This leaves open the possibility that while Ozempic may — for reasons currently unknown — prevent people from taking so much alcohol or heroin that they overdose and end up in hospital, it may not actually help them to reduce their substance use, or to abstain altogether,” Field said. The study had no specific funding. The study authors and Field declared no relevant conflicts of interest. Note: This article originally appeared on Medscape .

COMMENTARY For those of us who grew up in Chicago, as I did, it was virtually impossible to ignore University of Chicago’s Orthogenic School. The school ostensibly treated youths with autism spectrum disorder (ASD) . At the time, autism was blamed on “refrigerator mothers,” a term coined by Bruno Bettelheim, PhD, a psychology professor and an administrator at the school. Related psychoanalytically inspired theories also loomed large in the 1950s and 1960s, which were the heydays of psychoanalysis. A European emigree who escaped the Reich, Bettelheim was a larger-than-life figure, even though his credentials later came under fire. In contrast, his book about the psychological underpinnings of fairy tales, The Uses of Enchantment (1973), retains its cache to this day. Much like the “disappeared” from Argentina’s “Dirty War,” or like fictional serial killers’ victims on Netflix, it sometimes seemed as if everyone had a friend of a friend or knew of a neighbor’s family member who had been carted off to this once prestigious but subsequently disgraced school. The school’s staff—and Bettelheim himself—would later stand accused of physically mistreating those youthful charges, not to mention psychologically damaging their maligned mothers. Even the diagnoses of ASD that supposedly “qualified” students for admission to the school would be called into question. Bettelheim eventually died by suicide. Bettelheim did indeed have a PhD in aesthetics, which probably contributed to the quality of his well-received book about fairy tales. But he represented himself as a psychologist, even though his European diploma could not be found. He claimed that it was misplaced during the war years. In contrast, it was confirmed that he trained as a psychoanalyst in Europe, where prior training in psychiatry, neurology, or psychology was not required, as it once was in the US. There is much to be said about Bettelheim that is beyond our scope here but suffice it to say that what he lacked in credentials, he compensated for with chutzpah. He was lauded for his 3 weeks’ worth of “research” (conducted without experimental design) on children reared by Israeli collectives or kibbutzim.2 That study became Children of the Dream (1967). Previously, Bettelheim chronicled his own concentration camp experiences in a widely cited 1943 paper on “Individual and Mass Behavior in Extreme Situations.” That study made him a de facto spokesperson about the stresses of concentration camps—yet it was later learned that he himself had never been incarcerated in a camp, as he had claimed. Most importantly, Bettelheim promoted since-debunked and much-maligned—yet highly persuasive—theories about “refrigerator mothers” who allegedly caused their children’s autism. His best-selling book, The Empty Fortress: Infantile Autism and the Birth of the Self (1967), established him as an expert in the field and attracted the not-always-favorable attention of well—respected reviewers, such as Stella Chess, MD, in JAMA, and elsewhere. Many medical journals subsequently denounced his studies on autism. Scientific research has since linked up to 80% of ASD cases to genetic factors (with some inherited from parents, but probably more from accidental chromosomal breakage or spontaneous mutations). Some 200 to 1000 genes contribute to ASD risks . Moving forward to the present day: knowing about this background—and remembering my “disappeared” neighbor—I would come to feel especially saddened whenever I encountered parents of children on the spectrum who could not shake the lingering shadows left by these unfounded accusations made decades earlier. As recompense, I could console them with current scientific data that contradicts Bettelheim’s theory, or I could direct them to high quality informational programs on ASD, like the ones hosted by Mount Sinai’s Seaver Center, which is affiliated the same medical school where I serve as voluntary faculty. . . or I could take an entirely different approach and alert them to the success of IDF’s Unit 9900. This unique unit is comprised of young adults who are on the spectrum and who are recruited because they can hyperfocus for hours on end and can attend to details that escape the attention of neurotypical soldiers. These volunteer recruits are noncombatants who work on computer screens and take part in an aptly named program, Spectrum of Talent. My goal was not to goad anyone to enlist their children in Israel’s IDF, not by a longshot, given that we in psychiatry are mandated to maintain strict boundaries about separating our own political or philosophical or religious persuasions from our patients’ belief systems. Rather, my intent was to reassure distressed families that their children with ASD could possess untapped abilities that are deemed valuable enough to merit a special program. More about Unit 9900, which is referred to as “Roim Rachok” (translated as “we see far”) and which was the progenitor of related and expanded programs in IDF, and which has been written about extensively in Times of Israel articles,5-8 as well as by American business publications. Articles on the topic appear in men’s magazines such as Esquire or in The Atlantic, a more generic literary monthly. Hadassah Magazine, published by a Jewish women’s organization, also weighs in on “An IDF Program for Teens on the Autism Spectrum.” The mere fact that this unique unit was the brainchild of unrelated parents of adolescents with ASD is especially compelling, for it confirms that families can advocate for their children, to help them achieve more than had previously been expected of them and to help these young adults integrate into society at large and shed their outsider status. Even though persons with ASD can be exempted from Israel’s military obligations, the participants in this pilot program volunteer on their own accord. Many elect to remain after completing their terms of service. Qualified volunteers are routed to professional training programs that tap into their innate skills, skills which confer a comparative advantage over neurotypical individuals. By their own admission, these young adults with autism focus on details for extended periods of time and relish repetitive tasks rather than resenting them. Many like lists of tasks. The first graduates learned to analyze aerial and satellite photographs. The expanded program trains participants for software quality assurance, information sorting, electro-optics, and electronics. A key 9900 task is to screen vast numbers of photos of the same subject matter in order to detect small variations between them. Sometimes they scour social media for emerging trends. Apart from their technological know-how, many participants possess specialized knowledge on topics ranging from archaeology, languages, or music. When enlisted, these special soldiers are accompanied by therapists and psychologists who help them navigate potentially stress-inducing social barriers that they face. About 90% finish their program, prepared for future careers in technological fields should they decide to leave the IDF. As testimony to the success of this pilot program, military divisions in the UK, US, and Singapore expressed interest in developing the model on their own shores. How uplifting this information can be, especially for families of children who might have been marginalized and undermined. Note: This article originally appeared on Psychiatric Times .

Give Yourself a Break: The Power of Self-Compassion Self Compassion When people experience a setback at work whether it's a bad sales quarter, being overlooked for a promotion, or an interpersonal conflict with a colleague it's common to respond in one of two ways. Either we become defensive and blame others, or we berate ourselves. Unfortunately, neither response is especially helpful. Dodging responsibility by getting defensive may alleviate the sting of failure, but it comes at the expense of learning. Self-flagellation, on the other hand, may feel warranted in the moment, but it can lead to an inaccurately gloomy assessment of one's potential, which undermines personal development. What if instead we were to treat ourselves as we would a friend in a similar situation? More likely than not, we'd be kind, understanding, and encouraging. Directing that type of response internally, toward ourselves, is known as self-compassion, and it's been the focus of a good deal of research in recent years. Psychologists are discovering that selfcompassion is a useful tool for enhancing performance in a variety of settings, from healthy aging to athletics. For most, (self-compassion is a less familiar concept than self-esteem or self-confidence. Although it's true that people who engage in self-compassion tend to have higher self-esteem, the two concepts are distinct. Self-esteem tends to involve evaluating oneself in comparison with others. Self-compassion, on the other hand, doesn't involve judging the self or others. Instead, it creates a sense of self-worth because it leads people to genuinely care about their own well-being and recovery after a setback. People with high levels of self-compassion demonstrate three behaviors: First, they are kind) rather than judgmental about their own failures and mistakes; second, they recognize that failures are a shared human experience; and third, they take a balanced approach to negative emotions when they stumble or fall short -they allow themselves to feel bad, but they don't let negative emotions take over. A Growth Mindset Most organizations and people want to improve--and self-compassion is crucial for that. We tend to associate personal growth with determination, persistence, and hard work, but the process often starts with reflection.) One of the key requirements for self-improvement is having a realistic assessment of where we stand -of our strengths and our limitations. Convincing ourselves that we are better than we are leads to complacency, and thinking we're worse than we are leads to defeatism. When people treat themselves with compassion, they are better able to arrive at realistic self-appraisals, which is the foundation for improvement. They are also more motivated to work on their weaknesses rather than think "What's the point?" and to summon the grit required to enhance skills and change bad habits. Being True to the Self Self-compassion has benefits for the workplace beyond boosting employees' drive to improve. Over time, it can help people gravitate to roles that better fit their personality and values. Living in accord with one's true self -what psychologists term ("authenticity" results in increased motivation and drive (along with a host of other mental health benefits). Unfortunately, authenticity remains elusive for many in the workplace. People may feel stuck in jobs where they have to suppress their true self because of incongruent workplace norms around behavior, doubts about what they have to contribute, or fears about being judged negatively by colleagues and superiors. But self-compassion can help people assess their professional and personal trajectories and make course corrections when and where necessary. A self-compassionate sales executive who misses a quarterly target, for example, not only will focus on how she can make her numbers next quarter but also will be more likely to take stock of whether she is in the right sort of job for her temperament and disposition. Self-compassion can help people gravitate to roles/that better fit their personality. What's happening here? Treating oneself with kindness, understanding, and without judgment alleviates fears about social disapproval, paving the way for authenticity. Optimism also seems to play a role. Having a positive outlook on life makes people more willing to take chances -such as revealing their true selves. In fact, research shows that optimistic people are more likely to reveal negative things about themselves -such as distressing experiences they've endured or difficult medical challenges they face. In effect, optimism increases people's inclination to be authentic, despite the potential risks involved. I believe that the relative emotional calm and the balanced perspective that come with being self-compassionate can help people approach difficult experiences with a positive attitude. Turbocharged Leadership A self-compassionate mindset produces benefits that spread to others, too. This is especially the case for people in leadership roles. That's because self-compassion and compassion for others are linked: Practicing one boosts the other. Being kind and nonjudgmental toward the self is good practice for treating others compassionately, just as compassion for others can increase how compassionate people are toward themselves, creating an upward cycle of compassion -and an antidote to "incivility spirals" that too often plague work environments. The fact that self-compassion encourages a growth mindset is also relevant there. Research shows that when leaders adopt a growth mindset (that is, believe that change is possible), they're more likely to pay attention to changes in subordinates' performance and to give useful feedback on how to improve. Subordinates, in turn, can discern when their leaders have growth mindsets, which makes them more motivated and satisfied, not to mention more likely to adopt growth mindsets themselves. The old adage "lead by example" applies to self-compassion and the growth mindset it encourages. A similar link between leader and subordinates exists for authenticity, too. People can sense authenticity in others, and when leaders are seen as being true to themselves, it creates an atmosphere of authenticity throughout the workplace. There's also substantial evidence that stronger relationships are forged when people feel authentic in their interactions with others. When leaders respond to failures and setbacks with a self-compassionate attitude, they themselves benefit, being more likely to exhibit psychological and behavioral tendencies that bode well for their own professional development and success. And the benefits can trickle down to subordinates, making the practice of self-compassion a win-win for leaders and those they lead. Fostering Self-Compassion Fostering self-compassion is not complicated or difficult. It's a skill that can be learned and enhanced. For the analytically minded, I suggest using psychologists' definition of self compassion as a three-point checklist: Am I being kind and understanding to myself? Do l acknowledge shortcomings and failure as experiences shared by everyone? Am I keeping my negative feelings in perspective? If this doesn't work, a simple "trick" can also help: Sit down and write yourself a letter in the third person, as if you were a friend or loved one. Many of us are better at being a good friend to other people than to ourselves, so this can help avoid spirals of defensiveness or self-flagellation. The business community at large has done a good job of removing the stigma around failure in recent years at the organizational level -it's a natural byproduct of experimentation and, ultimately, innovation. But too many of us are not harnessing the redemptive power of failure in our own work lives. As more and more industries are disrupted and people's work lives are thrown into upheaval, this skill will become more important.

Burnout Prevention and Treatment If constant stress has you feeling helpless, disillusioned, and completely exhausted, you may be on the road to bumout. Learn what you can do to regain your balance and feel positive and hopeful again. Stress VS Burnout What is burnout? Burnout is a state of emotional, physical, and mental exhaustion caused by excessive and prolonged stress. It occurs when you feel overwhelmed, emotionally drained, and unable to meet constant demands. As the stress continues, you begin to lose the interest and motivation that led you to take on a certain role in the first place. Burnout reduces productivity and saps your energy, leaving you feeling increasingly helpless, hopeless, cynical, and resentful. Eventually, you may feel like you have nothing more to give. The negative effects of burnout spill over into every area of life -including your home, work, and social life. Burnout can also cause long-term changes to your body that make you vulnerable to illnesses like colds and flu. Because of its many consequences, it's important to deal with burnout right away. Are you on the road to burnout? You may be on the road to burnout if: Every day a is a bad day. Caring about your work or home life seems like a total waste of energy. You're exhausted all the time. The majority of your day is spent on tasks you find either mind-numbingly dull or overwhelming. You feel like nothing you do makes a difference or is appreciated. Signs and symptoms of burnout Most of us have days when we feel helpless, overloaded, or unappreciated-when dragging ourselves out of bed requires the determination of Hercules. If you feel like this most of the time, however, you may be burned out. Stress vs Burnout Burnout is a gradual process. It doesn't happen ovenight, but it can creep up on you. The signs and symptoms are subtle at first, but become worse as time goes on. Think of the early symptoms as red flags that is something is wrong that needs to be addressed. If you pay attention and actively reduce your stress, you can prevent a major breakdown. If you ignore them, you'll eventually bum out. Physical signs and symptoms of burnout Feeling tired and drained most of the time. Lowered immunity, frequent illnesses. Frequent headaches or muscle pain. Change in appetite or sleep habits. Emotional signs and symptoms of burnout Sense of failure and self-doubt. Feeling helpless, trapped, and defeated. Detachment, feeling alone in the world. Loss of motivation. Increasingly cynical and negative outlook. Decreased satisfaction and sense of accomplishment. Behavioral signs and symptoms of burnout Withdrawing from responsibilities. Isolating yourself from others. Procrastinating, taking longer to get things done. Using food, drugs, or alcohol to cope. Taking out your frustrations on others. Skipping work or coming in late and leaving early. The difference between stress and burnout Burnout may be of the result of unrelenting stress, but it isn't the same as too much stress. Stress, by and large, involves too much: too many pressures that demand too much of you physically and mentally. However, stressed people can still imagine that if they can just get everything under control, they'll feel better. Burnout, on the other hand, is about not enough. Being burned out means feeling empty and mentally exhausted, devoid of motivation, and beyond caring. People experiencing burnout often don't see any hope of positive change in their situations. If excessive stress feels like you're drowning in responsibilities, burnout is a sense of being all dried up. And while you're usually aware a of being under a lot of stress, you don't always notice burnout when it happens. Causes of burnout Burnout often stems from your job. But anyone who feels overworked and undervalued is at risk for burnout, from the hardworking office worker who hasn't had a vacation in years, to the frazzled stay -at-home mom tending to kids, housework, and an aging parent. But burnout is not caused solely by stressful work or too many responsibilities. Other factors contribute to burnout, including your lifestyle and personality traits. In fact, what you do in your downtime and how you look at the world can play just as big of a role in causing overwhelming stress as work or home demands. Work-related causes of burnout Feeling like you have little or no control over your work. Lack of recognition or reward for good work. Unclear or overly demanding job expectations. Doing work that's monotonous or un-challenging. Working in a chaotic or high-pressure environment. Lifestyle causes of burnout Working too much, without enough time for socializing or relaxing. Lack of close, supportive relationships. Taking on too many responsibilities, without enough help from others. Not getting enough sleep. Personality traits can contribute to burnout Perfectionist tendencies; nothing is ever good enough. Pessimistic view of yourself and the world. The need to be in control; reluctance to delegate to others. • High-achieving, Type A personality. Dealing with burnout Whether you recognize the warning signs of impending burnout or you're already past the breaking point, trying to push through the exhaustion and continuing as you have been will only cause further emotional and physical damage. Now is the time to pause and change direction by learning how you can help yourself overcome bumout and feel healthy and positive again. Dealing with burnout requires the "Three R" approach: Recognize. Watch for the warning signs of burnout. Reverse. Undo the damage by seeking support and managing stress. Resilience. Build your resilience to stress by taking care of your physical and emotional health. The following tips for preventing or dealing with bumout can help you cope with symptoms and regain your energy, focus, and sense of well-being. Dealing with burnout tip 1: Turn to other people When you're burned out, problems seem insurmountable, everything looks bleak, and it's difficult to muster up the energy to care, let alone take action to help yourself. But you have a lot more control over stress than you may think. There are positive steps you can take to deal with overwhelming stress and get your life back into balance. One of the most effective is to reach out to others. Social contact is nature's antidote to stress and talking face to face with a good listener is one of the fastest ways to calm your nervous system and relieve stress. The person you talk to doesn't have to be able to fix" your stressors; they just have to be good listener, someone who'll listen attentively without becoming distracted or expressing judgment. Reach out to those closest to you, such as your partner, family, and friends. Opening up won't make you a burden to others. In fact, most friends and loved ones will be flattered that you trust them enough to confide in them, and it will only strengthen your friendship. Try not to think about what's burning you out and make the time you spend with loved ones positive and enjoyable. Be more sociable with your coworkers. Developing friendships with people you work with can help buffer you from job burnout. When you take a break, for example, instead of directing your attention to your smartphone, try engaging your colleagues. Or schedule social events together after work. Limit your contact with negative people. Hanging out with negative-minded people who do nothing but complain will only drag down your mood and outlook. If you have to work with a negative person, try to limit the amount of time you spend together. Connect with a cause or a community group that is personally meaningful to you. Joining a religious, social, or support group can give you a place to talk to like-minded people about how to deal with daily stress--and to make new friends. If your line of work has a professional association, you can attend meetings and interact with others coping with the same workplace demands. Find new friends. If you don't feel that you have anyone to turn to, it's never too late to build new friendships and expand your social network. The power of giving Being helpful to others delivers immense pleasure and can help to significantly reduce stress as well as broaden your social circle. While it's important not to take on too much when you're facing overwhelming stress, helping others doesn't have to involve a lot oftime or effort. Even small things like a kind word or friendly smile can make you feel better and help lower stress both for you and the other person. Tip 2: Reframe the way you look at work Whether you have job that leaves you rushed off your feet or one that is monotonous and unfulfilling, the most effective way to combat job burnout is to quit and find a job you love instead. Of course, for many of us changing job or career is far from being a practical solution, we're grateful just to have work that pays the bills. Whatever your situation, though, there are still steps you can take to improve your state of mind. Try to find some value in your work. Even in some mundane jobs, you can often focus on how your role helps others, for example, or provides a much-needed product or service. Focus on aspects of the job that you do enjoy, even if it's just chatting with your coworkers at lunch. Changing your attitude towards your job can a help you regain a sense of purpose and control. Find balance in your life. If you hate your job, look for meaning and satisfaction elsewhere in your life: in your family, friends, hobbies, or voluntary work. Focus on the parts of your life that bring you joy. Make friends at work. Having strong ties in the workplace can help reduce monotony and counter the effects of burnout. Having friends to chat and joke with during the day can help relieve stress from an unfulfilling or demanding job, improve your job performance, or simply get you through a rough day. Take time off. If burnout seems inevitable, try to take a complete break from work. Go on vacation, use up your sick days, ask for a temporary leave-of-absence, anything to remove yourself from the situation. Use the time away to recharge your batteries and pursue other methods of recovery. Tip 3: Reevaluate your priorities Burnout is an undeniable sign that something important in your life is not working. Take time to think about your hopes, goals, and dreams. Are you neglecting something that is truly important to you? This can be an opportunity to rediscover what really makes you happy and to slow down and give yourself time to rest, reflect, and heal. Set boundaries. Don't overextend yourself. Learn how to say "no" to requests on your time. If you find this difficult, remind yourself that saying "no" allows you to say "yes" to the commitments you want to make. Take a daily break from technology. Set a time each day when you completely disconnect. Put away your laptop, turn off your phone, and stop checking email or social media. Nourish your creative side. Creativity is powerful antidote to burnout. Try something new, start a fun project, or resume a favorite hobby. Choose activities that have nothing to do with breathing work or whatever is causing your stress. Set aside relaxation time. Relaxation techniques such as yoga, meditation, and deep activate the body's relaxation response, a state of restfulness that is the opposite of the stress response. Get plenty of sleep. Feeling tired can exacerbate burnout by causing you to think irrationally. Keep your cool in stressful situations by getting a good night's sleep. Boost your ability to stay on task If you're having trouble following through with these self-help tips to prevent or overcome burnout, Rediscover joy and meaning that make work and life worthwhile. Increase your overall health and happiness. Tip 4: Make exercise a priority Even though it may be the last thing you feel like doing when you're burned out, exercise is a powerful antidote to stress and burnout. It's also something you can do right now to boost your mood. Aim to exercise for 30 minutes or more per day or break that up into short, 10-minute bursts of activity. A 10-minute walk can improve your mood for two hours. Rhythmic exercise, where you move both your arms and legs, is a hugely effective way to lift your mood, increase energy, sharpen focus, and relax both the mind and body. Try walking, running, weight training, swimming, martial arts, or even dancing. To maximize stress relief, instead of continuing to focus on your thoughts, focus on your body and how it feels as you move: the sensation of your feet hitting the ground, for example, or the wind on your skin. Tip 5: Support your mood and energy levels with a healthy diet What you put in your body can have huge impact on yourmood and energy levels throughout the day. Minimize sugar and refined carbs. You may crave sugary snacks or comfort foods such as pasta or French fries, but these high -carbohydrate foodsquickly lead to a crash in mood and energy. Reduce your high intake of foods that can adversely affect your mood, such as caffeine, unhealthy fats, and foods with chemical preservatives or hormones. Eat more Omega-3 fatty acids to give your mood a boost. The best sources are fatty fish (salmon, herring, mackerel, anchovies, sardines), seaweed, flaxseed, and walnuts. Avoid nicotine. Smoking when you're feeling stressed may seem calming, but nicotine is a powerful stimulant, leading to higher, not lower, levels of anxiety. Drink alcohol in moderation. Alcohol temporarily reduces worry, but too much can cause anxiety as it wears off. Authors: Melinda Smith, M.A., Jeanne Segal, Ph.D., and Lawrence Robinson

Too Much Closeness: Learning to Say "No" in Relationships Why is it important to say "no"? It means setting a limit to protect yourself in relationships. For example, "If you show up with coke, I'm leaving," or "Unless you stop yelling at me, I'm walking out." Saying "no" is an important skill for setting boundaries. At a deeper level, setting boundaries is a way of conveying that both people in relationship deserve care and attention. It is a healthy a way of respecting your separate identity. a man and women holding a large yellow marker SITUATIONS WHERE YOU CAN LEARN TO SAY "NO" Refusing drugs and alcohol. Pressure to say more than you want to. Going along with things that you do not want to do. When you're taking care of everyone but you. When you do all the giving in a relationship. When you make promises to yourself that you do not keep. When you're doing things that take your focus away from recovery. EXAMPLES: SAYING "NO" IN SUBSTANCE ABUSE AND PTSD With Others; With Yourself Substance "No thanks; I don't want any now." Abuse "Drinking is not allowed on my diet." "I need you to stop talking to me like that." PTSD "Please don't call me again." "Self-respect means no substances today." "If anybody offers me drugs at the party, I need to leave." "Working as a prostitute is making my PTSD worse; I need to stop." "Seeing war movies is triggering my PTSD; need to stop." Learning to Say No - Setting Boundaries HOW TO SAY "NO" * Try different ways to set a boundary: Polite refusal: "No thanks, I'd rather not." Insistence : 'No, I really mean it, and I'd like to drop the subject." Partial honesty : "I cannot drink because I have to drive." Full honesty: "I cannot drink because I'm an alcoholic." Stating consequences: "If you keep bringing drugs home, will have to move out." * Remember that it is a sign of respect to say "no." Protecting yourself is part of developing self-respect. Rather than driving people away, it helps them value you more. You can be vulnerable without being exploited. You can enjoy relationships without fearing them. In healthy relationships, saying "no" appropriately promotes closeness. How Do Approach the Situation * How much or how little you say is up to you. if however, if you can comfortably provide an explanation, this can make it easier on the other person. * You will find the words if you are motivated to say "no." Once you commit to protecting your needs, the how will present itself. * Take care of yourself; let others take care of themselves. You can only live your life, not theirs. * If you are afraid of hurting the other person, it remember that it may take repeated work, both with the other person and within yourself. Over time, you will realize that healthy people can tolerate hearing what you think and feel. * You can set a boundary before, during, or after an interaction with someone. Try discussing a difficult topic beforehand (e.g., discuss safe sex before a sexual encounter), during an interaction (e.g., try saying "no" to alcohol when it is offered), or afterward (e.g., go back and tell someone you did not like being talked to abusively). *Be careful about how much you reveal. PTSD and substance abuse are sensitive topics, and discrimination against these disorders is very real and harmful. You can never take back a statement once it has been said. You do not need to be open with people you do not know well, people in work settings, or people who are abusive to you. **Be extremely careful if there is a possibility of physical harm. Seek professional guidance. ROLE PLAYS FOR SAYING "NO" * Try rehearsing the following situations out loud. What could you say? With Others You are at a holiday party and your boss says, "Let's celebrate! Have a drink!" - Your partner says you should "just get over your trauma already." A friend tells you not to take psychiatric medications because "that's substance abuse too." -* Your sister wants to know all about your trauma, but you don't feel ready to tell her. Your partner keeps drinking around you, saying "You need to learn to deal with it." - Your date says, "Let's go to my place," and you don't want to. -› Your boss gives you more and more work, and it's too much. You suspect that your uncle is abusing your daughter. With Yourself - You want to have "just one drink." - You keep taking care of others but not yourself. -You promised to stop bingeing on food but keep doing it. - You are working too many hours, with no time left for recovery activities. Source: Therapist Aid (2023)

One of my most favorite philosophers Sir Alan Watts. Alan Wilson Watts (6 January 1915 – 16 November 1973) was an English writer, speaker and self-styled "philosophical entertainer",[2] known for interpreting and popularising Japanese, Chinese and Indian traditions of Buddhist, Taoist, and Hindu philosophy for a Western audience. Born in Chislehurst, England, he moved to the United States in 1938 and began Zen training in New York. He received a master's degree in theology from Seabury-Western Theological Seminary and became an Episcopalpriest in 1945. He left the ministry in 1950 and moved to California, where he joined the faculty of the American Academy of Asian Studies.[3] He has such an amazing perspective on life and how to deal with adversity.

Freud may justly be called the most influential intellectual legislator of his age. His creation of psychoanalysis was at once a theory of the human psyche, a therapy for the relief of its ills, and an optic for the interpretation of culture and society. Despite repeated criticisms, attempted refutations, and qualifications of Freud’s work, its spell remained powerful well after his death and in fields far removed from psychology as it is narrowly defined. If, as the American sociologist Philip Rieff once contended, “psychological man” replaced such earlier notions as political, religious, or economic man as the 20th century’s dominant self-image, it is in no small measure due to the power of Freud’s vision and the seeming inexhaustibly of the intellectual legacy he left behind. Here are shocking facts about Sigmund! Here is facts about the "father of psychoanalysis" that will confuse. Cocaine addiction?? Top 10 Insane Facts About Sigmund Freud Who is Dr. Sigmund Freud? Sigmund Freud , (born May 6, 1856, Freiberg, Moravia, Austrian Empire [now Příbor, Czech Republic]—died September 23, 1939, London, England), Austrian neurologist and the founder of psychoanalysis. Freud may justly be called the most influential intellectual legislator of his age. His creation of psychoanalysis was at once a theory of the human psyche, a therapy for the relief of its ills, and an optic for the interpretation of culture and society. Despite repeated criticisms, attempted refutations, and qualifications of Freud’s work, its spell remained powerful well after his death and in fields far removed from psychology as it is narrowly defined. If, as the American sociologist Philip Rieff once contended, “psychological man” replaced such earlier notions as political, religious, or economic man as the 20th century’s dominant self-image, it is in no small measure due to the power of Freud’s vision and the seeming inexhaustibility of the intellectual legacy he left behind. Early life and training Freud’s father, Jakob, was a Jewish wool merchant who had been married once before he wed the boy’s mother, Amalie Nathansohn. The father, 40 years old at Freud’s birth, seems to have been a relatively remote and authoritarian figure, while his mother appears to have been more nurturant and emotionally available. Although Freud had two older half-brothers, his strongest if also most ambivalent attachment seems to have been to a nephew, John, one year his senior, who provided the model of intimate friend and hated rival that Freud reproduced often at later stages of his life. n 1859 the Freud family was compelled for economic reasons to move to Leipzig and then a year after to Vienna, where Freud remained until the Nazi annexation of Austria 78 years later. Despite Freud’s dislike of the imperial city, in part because of its citizens’ frequent anti-Semitism, psychoanalysis reflected in significant ways the cultural and political context out of which it emerged. For example, Freud’s sensitivity to the vulnerability of paternal authority within the psyche may well have been stimulated by the decline in power suffered by his father’s generation, often liberal rationalists, in the Habsburg empire. So too his interest in the theme of the seduction of daughters was rooted in complicated ways in the context of Viennese attitudes toward female sexuality. In 1873 Freud was graduated from the Sperl Gymnasium and, apparently inspired by a public reading of an essay by Goethe on nature, turned to medicine as a career. At the University of Vienna he worked with one of the leading physiologists of his day, Ernst von Brücke, an exp onent of the materialist, antivitalist science of Hermann von Helmholtz. In 1882 he entered the General Hospital in Vienna as a clinical assistant to train with the psychiatrist Theodor Meynert and the professor of internal medicine Hermann Nothnagel. In 1885 Freud was appointed lecturer in neuropathology, having concluded important research on the brain’s medulla. At this time he also developed an interest in the pharmaceutical benefits of cocaine, which he pursued for several years. Although some beneficial results were found in eye surgery, which have been credited to Freud’s friend Carl Koller, the general outcome was disastrous. Not only did Freud’s advocacy lead to a mortal addiction in another close friend, Ernst Fleischl von Marxow, but it also tarnished his medical reputation for a time. Whether or not one interprets this episode in terms that call into question Freud’s prudence as a scientist, it was of a piece with his lifelong willingness to attempt bold solutions to relieve human suffering. Freud’s scientific training remained of cardinal importance in his work, or at least in his own conception of it. In such writings as his “Entwurf einer Psychologie” (written 1895, published 1950; “Project for a Scientific Psychology”) he affirmed his intention to find a physiological and materialist basis for his theories of the psyche. Here a mechanistic neurophysiological model vied with a more organismic, phylogenetic one in ways that demonstrate Freud’s complicated debt to the science of his day. In late 1885 Freud left Vienna to continue his studies of neuropathology at the Salpêtrière clinic in Paris, where he worked under the guidance of Jean-Martin Charcot. His 19 weeks in the French capital proved a turning point in his career, for Charcot’s work with patients classified as “hysterics” introduced Freud to the possibility that psychological disorders might have their source in the mind rather than the brain. Charcot’s demonstration of a link between hysterical symptoms, such as paralysis of a limb, and hypnotic suggestion implied the power of mental states rather than nerves in the etiology of disease. Although Freud was soon to abandon his faith in hypnosis, he returned to Vienna in February 1886 with the seed of his revolutionary psychological method implanted. Psychoanalytic theory of Sigmund Freud Sigmund Freud Freud, still beholden to Charcot’s hypnotic method, did not grasp the full implications of Breuer’s experience until a decade later, when he developed the technique of free association. In part an extrapolation of the automatic writing promoted by the German Jewish writer Ludwig Börne a century before, in part a result of his own clinical experience with other hysterics, this revolutionary method was announced in the work Freud published jointly with Breuer in 1895, Studien über Hysterie ( Studies in Hysteria ). By encouraging the patient to express any random thoughts that came associatively to mind, the technique aimed at uncovering hitherto unarticulated material from the realm of the psyche that Freud, following a long tradition, called the unconscious. Because of its incompatibility with conscious thoughts or conflicts with other unconscious ones, this material was normally hidden, forgotten, or unavailable to conscious reflection. Top 10 Insane Facts About Sigmund Freud Difficulty in freely associating—sudden silences, stuttering, or the like—suggested to Freud the importance of the material struggling to be expressed, as well as the power of what he called the patient’s defenses against that expression. Such blockages Freud dubbed resistance, which had to be broken down in order to reveal hidden conflicts. Unlike Charcot and Breuer, Freud came to the conclusion, based on his clinical experience with female hysterics, that the most insistent source of resisted material was sexual in nature. And even more momentously, he linked the etiology of neurotic symptoms to the same struggle between a sexual feeling or urge and the psychic defenses against it. Being able to bring that conflict to consciousness through free association and then probing its implications was thus a crucial step, he reasoned, on the road to relieving the symptom, which was best understood as an unwitting compromise formation between the wish and the defense. Source: Britannica (2023)