"Spent" by Geoffrey Miller -- a discussion of evolutionary psychology

 "Spent" is a good book by evolutionary psychologist Geoffrey Miller, looking particularly at consumer behaviour, including purchasing and marketing, through the lens of evolutionary psychology, concluding with some recommendations for a healthier, happier life based on his insights.  

There are parts of this book where he gets carried away, or makes what I thought were absurd suggestions, but overall I find him an important author and scientist to be aware of.  

Some of the content here reminded me a little bit of a book I previously reviewed called "The Case Against Education" by Bryan Caplan.  In this book, Caplan, an economist, argues that much post-secondary education provides only "signaling value" rather than tangible skills, expertise, or even enjoyment.  In this way, education can become akin to a peacock's tail -- offering a sign to employers or peers that you are intelligent or capable or "fit."  This may indeed be an accurate sign of fitness, but Caplan argues that it is a needlessly expensive one, in terms of time, money, effort, and emotional investment.  The time spent labouring to get your degree could have been spent doing something you found more enjoyable, productive, meaningful, or lucrative.  The intelligence it required to finish your degree could theoretically have been measured before you did your degree, allowing you entry to your career destination without wasting several years of your life in a program you didn't find useful or enjoyable.   Finally I disagreed with Caplan, since he goes too far in his condemnation of post-secondary education, but I have to acknowledge that he is at least partially right, that many of us pursue post-secondary courses that are more "hoops to jump through" to get a degree rather than providing any sort of benefit that we would use for any esthetic or job-related purpose later on.  

Miller looks more broadly at signaling, particularly with respect to consumer behaviour.   Many of the products we buy are chosen not because of their objective utility, but because they have a signaling value of some sort.   That is, they demonstrate either personality traits, or some intrinsic attractive characteristic such as health, stability, capacity to be caring, or humour, that would be desirable or compatible in a relationship partner.  For example, owning a luxury car would be a signal of financial well-being, which would often be found attractive in a a mate.  Different brands of car are more likely favoured by people with different personality traits, hence brand choice could advertise your personality style.  A degree from a prestigious university would advertise intelligence, and perhaps also stability and financial wealth, which are attractive features in a partner.  A diamond ring demonstrates financial stability and the willingness to sacrifice for your partner.  But the business of diamond rings for weddings is a relatively novel human cultural invention, leading to people sacrificing months of their income, further magnified by group norms about this, just to demonstrate a character trait that both partners should have known about each other just through the time they spent together.  

Miller's overarching thesis is not necessarily that these signaling phenomena are intrinsically bad, but that they are often needlessly or absurdly "expensive" which then causes harm to individuals or even to the world.  If everyone is chasing after expensive objects just to show that they are stable or a good catch, it is depleting to the world, and it is depleting to people's time and energy and money, often with small special interest groups (such as those in the sordid world of diamond mining) making huge profits.  

He argues that simple, wholesome signaling is the best and healthiest way to go.  If you would like to signal your personality traits, it is best to simply have sincere conversations with people so they can get to know you.  In conversation, you don't have to boast about yourself, you just have to "be yourself."    You don't have to demonstrate your character through the purchase of a car, or organic produce, or an Apple computer, or designer shoes.  A better signal about character integrity might come from activities, such as the manner in which you conduct relationships with your friends or family, or volunteering, or taking care of a pet.   

Some types of signaling that are meant to be "deceptive" could backfire.  Spending vast sums of money on cosmetic procedures to make yourself look younger and healthier, could in some extreme cases show others that you are overly preoccupied or insecure or "lying" about your appearance.  But wholesome and enjoyable and sincere self-care that is consistent with your interests and personality would always attract the people who are best for you, since it is honest, uncomplicated, non-deceptive signaling.  

In a concluding section, he makes the point that much of human evolution occurred over hundreds of thousands of years during which we lived in small groups surrounded by wilderness.  Effective signaling would have mostly required conversation, simple daily social or individual actions in the community, acts of work or service that would be seen and appreciated by others, demonstrations of particular interests or talents true to our character, and negative social or community consequences for people who behaved badly.  

Instead of buying expensive objects as gifts, Miller argues that it is more meaningful and authentic, healthier for society, and also more effective signaling, to do personalized activities as gifts, such as making someone something using your own efforts and creativity, or taking them on a special outing.  

Activities we would see as daily features of early human communities, such as playing with children, spending time with the elderly, preparing food, doing simple home maintenance for self and others, going for walks in the forest and identifying the bird calls and the plants by name, and managing the duties of daily life with warmth and humour rather than complaint, is a good foundation for a happy and healthy life and a good source of esteem from others.   Demonstrating skill and prowess and enjoyment in these areas would be a universally attractive thing, and hence is much more effective "signaling" than buying an expensive car or obtaining fancy credentials.  I'm a big fan of recommending such simple activities as a foundation of maintaining good mental health.  

Education for gifted teens

I'm uncomfortable with the term "gifted" since it implies that some people have "gifts" while others do not.  Really, everyone is gifted, and it should be a project in life to help all people cultivate their gifts and be acknowledged and appreciated for them.  

But admittedly, there are some students who whose talents and abilities allow them to be doing university-level academic work, or advanced work in performing arts,  by mid-childhood.  Leaving these children in the regular educational system could be boring or stifling for them, both intellectually and socially.  

There are various sources of data about the value of various educational programs, including those catering to students with unusual talents.  Testimonial accounts from the students and teachers are obviously an important source of data.  There could be very glowing accounts of particular programs, or perhaps also scathing critiques, from different individuals, during or after their exposure to the programs.    These are bound to influence subsequent policy.  Or there could be "before" and "after" data, showing that most students in these programs do extremely well by some measure (unfortunately the measures often do not look at long-term psychological health).  

But using data from testimonial accounts or "before/after" studies is fraught with problems.  Students gifted in mathematics or other sciences should understand this very well -- it is a foundation of understanding treatment effects in medical statistics.  If there are many students who give glowing accounts of a particular academic program, or entire cohorts who do well compared to their previous state, what does this really mean?  It could mean that the program itself is excellent and should be continued.  But another possibility is that gifted students are likely to thrive because of their giftedness or intelligence, and they would have thrived regardless of what type of program they were in.  It is possible that the particular program was actually harmful to them compared to some conventional alternative, but they still gave a positive review because of their innate tendency to thrive adaptively.  Similarly, negative reviews of a particular program could be caused by a bad program, or it could be caused by character traits in the reviewers, such as perfectionism, narcissism, or depressive symptoms. 

Some positive reviews could be inaccurate judgments, skewed by other factors such as pride or narcissism.  For example, graduates from an ivy league university may give inflated reviews of their educational experience because of the pride of being associated with such an elite institution.  They may have had a similarly good undergraduate experience at a small local college.  Of course, it is not an "either-or" issue.  Ivy league education is indeed probably better in many ways, but not as much better as people believe it is.  

In order to really determine the effectiveness and healthiness of a gifted program, one would have to do sufficiently powered randomized controlled studies, with both subjective and objective short and long-term assessments looking broadly at social and psychological well-being as well as academic achievement or career success.     Testimonial data is useful but not sufficient.  Jargon-laden theorizing by educational scholars is particularly meaningless and tiresome unless grounded by controlled data.   

Aside from the need to have policy grounded in RCT data, there are a few features that need to be present to have a healthy, effective educational program for gifted children: 

1) there should be specialized teaching to fully develop the students' capacities, otherwise they would be bored and understimulated.  For some students, "teaching" per se is not required -- the students can teach themselves, and an external didactic teacher, especially one trained to be a high school teacher, could often just get in the way.  But there should be adult mentors who are at least supporting and guiding the students' progress, and forming a warm personal connection with the students.  For technical subjects, there should be access to advanced laboratory materials.  And probably there should be access to experts such as university professors who can interact with and challenge the students at their level.  

Some teachers who specialize in teaching gifted children may simply load the students with an enormous quantity of material.  This leads to a risk of harming the children.  In some cases I have to wonder if this behaviour is a product of some teachers having ego issues themselves, feeling a need to drive the students beyond a healthy limit, due to feeling insecure that their students are brighter than they are.  

2) it is most likely of benefit for gifted children to be in a group of peers who have comparable abilities.  This is one of the stronger arguments for a "gifted program."   However, this could be achieved in other ways, such as through clubs, in a regular high school or community.   For some, though not all, gifted students, the regular high school social environment would be an oppressive chore to deal with

It should be noted that such peer affiliation may not always be positive.  It could foster elitism in some cases, or interfere with social skills.  Or ironically, for some gifted kids, a special program would take them away from peers rather than bring them closer.  Peership is not necessarily about mutual expertise in mathematics or some other academic subject--it could have to do with character, shared interests, or There could be a lot of variation between individuals with respect to this.  

3) educators should be aware of the phenomenon of eager parents pushing their children, driven by the parents' pride or ego or perhaps well-meaning but misguided notions as to what is best or healthiest.   

4) Regardless of whether children are in a gifted program or not, and regardless of these kids' talents, their academic program during childhood should allow for a balanced, healthy lifestyle.  There should never be so much homework that kids would not have time for sleep.  Lengthy commutes to and from some special school program, taking 1-2 hours of time daily, should be understood to have a negative impact on a teenager's mental and physical health -- these are hours that could have been spent playing or exercising or socializing or sleeping or studying.  

5) Rushing children through 5 years of high school in just 2 years, even when the kids are very capable intellectually to do this, necessarily will narrow the academic breadth of learning, even for the brightest of children.    Consideration should be given of broadening what is offered, over a longer period of time, rather than narrowing over a short period. 

6) For particular subjects such as literature, it will not be possible to introduce as much breadth of content in a confined period, whether the students are gifted or not.  Furthermore, many gifted programs are so oriented towards students who are destined to study engineering or other hard sciences, that English is glossed over.  In some cases the program may be engaging in some degree of grade inflation regarding literature courses, so that the students end up spuriously receiving good enough English grades to get university admission, even though their actual performance is mediocre or poor.    Mind you, this touches on the subject of university admission criteria--a genius-level student in mathematics perhaps should not be expected to have high grades in English or history in order to gain admission to an advanced university math program.  Demanding high grades across the board for university entrance discriminates against those who have focal areas of excellence but also focal areas of academic weakness.  However, giving high grades in English to students who lack literary skills is unfair to those who have true excellence in literature, and demeans the subject.  

The converse problem is often present in university-level literature courses.  There is a tradition of professors giving very low grades in university English courses, often with the highest grade being in the mid 80's, very few students earning an A, and very few students actually able to change their grade through a term by following any type of constructive feedback from the instructors.   I suspect that if student essays in these courses were objectively and blindly graded by a panel of professional writers and journalists, we would not see good correlations with the professors' grading.  I suspect that adherence to what Steven Pinker called "academese" is unfortunately rewarded, rather than good writing.  This issue may also be amplified by insecurity within this academic community, giving a false sense of importance of the subject by giving low grades to most students.  

7) For scientific subjects, cramming students through high school level courses quickly may well facilitate successful early university entrance, into engineering or physics programs etc.  But often the curriculum offered is narrow.  A gifted program could instead offer greater breadth rather than only greater speed of traversing curricula.  For example, adjunctive courses in statistics would be tremendously useful for any science prodigy, but this material is usually neglected, in favour of advanced calculus or computer science etc.  An enjoyably broad survey of scientific subjects would also be possible for gifted students, to gain a basic understanding of astronomy, geology, meteorology, climate science, ecology, botany, evolutionary biology, etc.   

8) Arts subjects are often neglected in gifted programs.   Breadth in arts and literature could involve studying a wider range of contemporary and historic literature, including a survey of world literature outside the usual western focus.   Many gifted programs tragically do not have robust opportunities for students to participate in performing arts or fine arts activities such as dance, theatre productions, or visual arts.  

9) It is absolutely unacceptable for children not to have regular physical education.  This doesn't necessarily require sports teams, etc. (although this should probably be an option), but a culture of regular, daily fitness is a foundation of a mentally and physically healthy lifestyle.   It is one of the things that teachers would definitely be in a leadership position to offer.  

10) Subjects relating to basic well-being, self-care, etc. are often neglected.  This could include courses in nutrition, food preparation, practical life skills, social and conversational skills, psychology (including an introduction to CBT), and personal finance.  

In assessing programs of this type, it is perilous to gather data only through something like an external review.  Such reviews are often "corporate" style as though one were assessing a factory.  The data gathered would be cross-sectional or testimonial in nature.  This could highlight very serious issues with leadership, safety,  incompetence etc.  Once again, in order to guide sound policy on this matter, RCT data would need to be gathered systematically, such as by doing a prospective randomized study of two or three different approaches to help gifted children, compared with a control group, with a sufficient number of participants, repeated over many years of time.   Such data would likely be "noisy" just as it is in psychotherapy research, because often the strengths or weaknesses of a program are strongly impacted by the particular individual teachers, rather than the style or format. 

In the meantime, simple alternatives for students who are much more academically advanced than their peers could include allowing the freedom to take individual university-level courses before having graduated from high school at all.  Each student could possibly have an individualized plan to help them, perhaps with exposure to advanced material in one area of their life, while having an "ordinary" childhood experience in other areas, depending on that student's wishes or needs.  

Another issue with policy that is usually neglected is consideration of the well-being of the teachers and other staff.  If teachers are bogged down by administrative duties such as long, pedantic meetings, are restricted in their actions through micromanagement or rigid policy, or are simply overworked without time for their own self-care, this is harmful not only to the individual teachers but obviously to the students as well.  One of the roles of a teacher, for any student, gifted or not, is as a stable, healthy, happy, mentor, who can engage in work in a sustainable, enjoyable way.  A teacher who is stressed out, overworked, unhappy, trapped in an unhealthy bureaucracy, etc. is less available and effective for the students.  Gifted students could be particularly harmed by this, since many of them would have a tendency to push themselves too hard, to the detriment of their mental health.  They would need to have adult role models who have balanced lifestyles, and time for personal connection.    A negative environment of this type cannot be hidden, since children are often much more insightful about the problems 

As a psychiatrist, with decades of experience working with a university student population, I have seen many gifted young people.  While many young people in this population are outstandingly happy and mentally healthy, often going on to amazing achievements in their personal and professional lives,  there are many mental health phenomena that are more common in this group, such as autism-spectrum symptoms, perfectionism, obsessive-compulsive phenomena, eating disorders, and sometimes narcissistic traits.  There have been cases of major mental illnesses and suicides.   In general, I have not found that people in this group have been helped dramatically by their high school gifted program, though many of them would have positive things to say about it.    Usually in their accelerated program, they did not have time nor were they offered any compelling help for mental health issues or to simply have the healthy, well-balanced lifestyle that would have benefited them.  Often they had inordinate pressure from parents.   In many cases, it probably led to them being in a university too young.  In many other cases, I think these students would have thrived regardless of what type of program they were in during high school.  

This subject speaks to a broader issue of "giftedness."  Everyone is gifted, in the sense that we have beautiful qualities which need to be cared for or developed.  But development of gifts must occur in a way that is compatible with physical, mental, social, and community health.  Gift development may require special resources, but we should resist the urge to drive this development at the fastest possible pace.  Sometimes such an intensive but well-meaning drive can damage people, and damage their gifts, rather than help them.   

Physical Warmth promotes Interpersonal Warmth

In an amusing study by LE Williams and JA Bargh, published in Science in 2008, subjects exposed to warm objects behaved in a manner which was more interpersonally warm. Here is the reference:
http://www.ncbi.nlm.nih.gov/pubmed/18948544

In the first experiment described by the authors, subjects in the elevator on the way to the study lab were asked to hold an experimenter's drink cup for a moment, while the experimenter wrote some identifying information down on a clipboard. The experimenter in the elevator did not have knowledge of the study's hypotheses. In the study lab afterward, the subjects were given a brief written description of a person (the same description given to all subjects), and were asked to rate that person in terms of a variety of personality dimensions. The subjects who briefly had held a cup of hot coffee gave personality ratings that were significantly "warmer," compared to the subjects who had held a cup of iced coffee. The ratings for warmth were 4.71 out of 7 for the "hot coffee" group, compared to 4.25 out of 7 for the "iced coffee" group; these differed with a p value of 0.05. "Warmth" in this sense refers to traits such as friendliness, helpfulness, and trustworthiness.

The second experiment was more blinded, in that the experimenters did not know whether the subjects were handling a warm or cold object. This time, subjects were offered a choice of two types of gifts after the experiment: the first type would be for personal use, the second would be a gift for a friend. Those who had handled a warm object were substantially more likely to choose a gift for a friend, rather than for themselves.
Those who had handled a cold object chose a "selfish" gift 75% of the time.
Those who had handled a warm object chose the "selfish" gift 46% of the time.

The authors discuss attachment theory, and suggest that one explanation for these findings, on a neurobiological level, is that the insular cortex in the brain is responsible for processing information about both physical and psychological warmth, therefore the two types of warmth perception may influence each other.

I find this type of cross-sectional social-psychological research fun and a bit lighthearted, but often containing kernels of wisdom.

It would be interesting to do similar studies of this sort, but with different groups of subjects who are stratified according to interpersonal style, depressive symptoms, etc. Perhaps there are subjects who are most sensitive to these environmental effects.

I'm amused and delighted, in any case, that figurative or "metaphorical" warmth seems to match up with literal or physical warmth. A nice meeting of the metaphorical with the literal. Perhaps this is typical of what the brain does.

In any case, this little piece of evidence further supports the recommendation to do sensually pleasing, "warmth-oriented" activities, as part of a regimen for maintaining psychosocial health. There may be something in particular about heat which could be therapeutic. Hot baths are anecdotally helpful for relaxation, pain relief, and to promote deeper sleep. I've encountered a few examples in which people found saunas quite helpful for seasonal depressive symptoms. Maybe a very warm, cozy sweater can be helpful for your mental health, and even have positive effects on others!

Here are references to a few studies showing improvement in insomnia following hot baths:
http://www.ncbi.nlm.nih.gov/pubmed/10566907 {a 1999 study from the journal Sleep, showing improvements in sleep continuity and more slow-wave sleep earlier in the night, in older females with insomnia who had 40-40.5 °C baths 1.5-2 hours before bedtime}
http://www.ncbi.nlm.nih.gov/pubmed/15879585 {a 2005 study in the American Journal of Geriatric Psychiatry showing improved sleep in elderly people with vascular dementia, following 30 minute baths in 40°C water, 2 hours before bedtime}

A precipitant of some seasonal depression, at least in Canada, may be not only the darkness but the cold. The cold may lead not only to a disinclination to go outside, but also to a less generous or a "colder" interpersonal stance, which would further perpetuate a depressive cycle. This is another reason to heed that advice mothers often give young children, to dress warmly in the winter.

Here is a link to the abstract of a study from Japan, published in Psychosomatic Medicine in 2005: http://www.ncbi.nlm.nih.gov/pubmed/16046381

In this study, mildly depressed subjects were randomized to receive one of two treatments, 5 days per week, for 4 weeks, in addition to daily physical and occupational therapy:
1) "thermal therapy" in a 60 °C sauna for 15 minutes, followed by 30 minutes wrapped in a blanket, in a 28 °C room.
2) "non-thermal therapy" of 45 minutes in a 24°C room

The thermal therapy group had a 33% reduction in psychological symptoms, compared to a 14% reduction in the non-thermal therapy group.
The thermal group had a 42% reduction in somatic complaints, compared to an 8% reduction in the non-thermal group.

The research literature on this subject is quite limited, but there is some evidence that warmth--physical and psychological--is therapeutic!

Healthy Eating

-lots of fresh vegetables & fruits (except for root vegetables), in amount and variety
-lots of high-fiber foods
-less meat, if any
-fish is healthy, especially fatty red fish such as salmon (an omega-3 source)
-but this has to be moderated due to the unfortunate risk of heavy metal contamination from eating a lot of fish, and due to the environmental problem of worldwide overfishing
-tea is good, in moderation (green & black), unless the caffeine is interfering with sleep
-dark chocolate is good for you; but it has to be in moderation, since it contains a lot of saturated fat
-carbohydrates (carbs) are probably important and necessary for mental health; low-carb ketotic diets are probably hard on the brain. But it is important to choose complex carbs that are released more gradually into your body. Sprouted whole grain breads are better. White bread or rice is almost like pure sugar, in terms of its rate of digestion into simple carbohydrates. Sugar itself should be cut down substantially (it has addictive properties; once you have gradually weaned sugar from cooking and baking, perhaps to 1/3 or 1/4 of what most recipes recommend, you will enjoy the intrinsic flavour of the baking more, and find the higher-sugar recipes unpleasantly sweet).
-components of the "Mediterranean" diet in which there is abundant use of olive oil, is probably healthy
-eliminate trans-fatty-acids from the diet (e.g. hydrogenated oils, often present in many packaged foods to prolong shelf life -- remember this may prolong the oil's "shelf life" on the inside of your arteries as well).
-there is some evidence that there is an excess of omega-6 fatty acids in the typical North American diet; this can be addressed by reducing use of omega-6 rich oils such as sunflower and corn oils, and instead using oils such as canola. Walnuts and flax are other natural sources of healthier omega-3 oils.
-1 to 2 glasses of wine (125-250 mL) per day may improve health compared to abstainers, and compared to those who drink more. But some individuals may have health problems as a result of drinking even small amounts of alcohol. In this case it is best to abstain.
-drinking water is great, but you really don't have to drink huge amounts. Keep yourself well-hydrated, but you only need to drink if you're thirsty.
-I do encourage people to leave all soft drinks behind -- the sugary ones are obviously bad for you. The ones with artificial sweeteners are probably not great for you either, and are also training you to expect sweetness while you hydrate yourself--this conditioning may exacerbate an unhealthy dependence upon simple carbohydrates and sweets, and cause you to be perceive the simple joy of drinking pure water to be unpleasantly mundane. Also do you really want to financially support the big soft-drink companies, with their expanding presence in children's schools, developing countries (many of whose people are dying from starvation), etc.?
-minimize the use of salt
-high-temperature cooking such as barbecuing adds flavour to food, but may result in higher levels of unhealthy chemicals, so it is probably best to reduce the intake of charred food.
-if you are a vegetarian or have other dietary restrictions, make sure you get an adequate intake of vitamins and minerals. A simple daily vitamin supplement should usually be sufficient. I do not see compelling evidence that "megadose" vitamins are beneficial.
-but there is some evidence that the RDA for vitamin D ought to be higher, perhaps up to 1000 IU per day or more.
-extra calcium supplementation may also be needed for many people on a long-term basis, to maintain bone health

While much of this advice is part of basic general health, I think that basic general health is also beneficial to mental health. And there may possibly be specific direct benefits to mental health from a very healthy diet.

I do qualify the above remarks, by saying that extremely clear, direct evidence linking healthy nutritional habits to improved mental health, is lacking. Much of the evidence is indirect or anecdotal. Many exaggerated claims are made in the advertising found in health-food stores. There are a few small studies looking at specific supplements, such as omega-3 supplements, which show some modest evidence that this can improve mood.

Some useful links:
1) the USDA nutrient database (detailed nutritional data about different foods):
http://www.nal.usda.gov/fnic/foodcomp/search/

2) the Cornell University food psychology page:
http://www.foodpsychology.cornell.edu/

The American Journal of Clinical Nutrition is a good academic journal to browse through, to get a good sense of what is going on in food & nutrition research. You can head to an academic library, and leaf through the past year's issues.

Addendum:

After reading the excellent comment on this entry, I feel compelled to add a few things to what I now recognize has been a very dry and pedantic set of comments:
I forgot to mention that I think food is one of the great joys and pleasures of life!
As with other joys, it is wonderful and healthy to develop and nurture a rich culinary experience.
Not only are food, cooking, and eating sources of sensual pleasure, they are also part of a rich and healthy culture (and a way to introduce oneself to new cultures), a part of a social and community life, and a part of an active intellectual life. It is a delight of human nature that we can start with something basic (e.g. an onion, or a grape), and keep refining it, transforming it, and using it in new ways, until we derive more and more art and pleasure from it. There is something very basic about the meaning of life itself in this kind of dynamic.

So I wholeheartedly endorse the idea of embracing and developing a rich culinary culture as part of healthy living. I do still maintain, however, that every culture ought to be informed by science and evidence, and perhaps adaptations can be made to certain cultural practices if we learn that they are harmful (to ourselves, to others, or to the environment). Sometimes the symbolic or esthetic value of a cultural practice can be preserved while the unhealthy aspects can be minimized.

Dietary Extremism

This is a sensitive topic, as many people feel badly about their weight, body image, and dietary habits. And many people have eating disorders, in which difficult relationships with food and with body image lead to a variety of behaviours that can do severe physical and emotional harm.
In this post, I wanted to address the specific phenomenon of what I call "dietary extremism". I consider the phenomenon to be similar to dogmatic religious belief.

Dietary extremism occurs as a result of people struggling to find some change in their lives that truly makes a difference for the better. They may have tried a wide variety of "standard routes" but continue to struggle with the same problems.

Extremism can often yield results for people, because it involves a radical change in lifestyle. It is something like joining a monastery. The lifestyle becomes more sustainable because of the community of fellow extremists (the other "monks in the monastery"), and because the community sets itself apart from the mainstream. The extremist beliefs are entrenched within the community, especially when members of the community are seeing significant changes within themselves for the first time.

Yet, the beliefs themselves are often extremely dogmatic and inaccurate. While I am a fan of permanent, positive life change, I believe that we must always stay attuned with the truth, always be open-minded to hear the facts, always be willing to question and challenge, always be wary of being told what to do by a guru-like figure (who, incidentally, may be making a lot of money and enjoying a lot of attention from fans, by selling books or running retreats).

A specific example that has come to my attention is the "raw food diet". Adherents have made substantial changes to their lifestyle. And, in my opinion, they are usually healthier for it. There is quite a bit of evidence that eating more fruits & vegetables, eating less meat, eating fewer animal products, etc. is part of good self-care. Furthermore, it is better for the environment, better to address world hunger (since raising animals instead of plants on agricultural land produces less nutritional energy per acre), and more humane (fewer sentient creatures need to be killed).

But most informational tracts about "raw food" are filled with claims that sound "scientific". The use of false or misleading pseudo-scientific claims is a typical tool used in charlatanism. This is one of the pathways that makes this potentially healthy dietary idea stultified by dogma. If you encounter statements about various types of nutritional degradation caused by heating, or about the miraculous virtues of some kind of oil (e.g. coconut oil), or about the advantages of choosing foods that are "less acidic", etc. I encourage you to be aware that there may be some dogmatic, charismatic salesmanship going on. The fact that these statements sound "scientific" may simply be fooling you. If you really want to know the truth, or what the evidence shows, then I think it is important to look closely yourself, at primary sources in reputable research journals.

The concern I have about the dogma doesn't necessarily mean that I think "raw food" (or some other diet) is a bad thing. I think it is a cultural practice, which has healthy aspects to it. Like other cultural practices, there may be a well-developed estheticism within it, leading, for example, to some really good recipes with raw food ingredients. The cultural practice crosses the line, though, into dogmatism, when it pronounces itself better than all other practices, and starts to support this claim using spurious or misleading information. All the while, many people are probably making quite a profit by marketing these ideas.

One of the phenomena often described in extremist groups is a collection of testimonial accounts from people whose lives have been radically changed for the better (e.g. cured of cancer, reached their ideal weight, felt healthy for the first time in their lives, etc.). While it may well be true that these individuals are genuinely thriving as a result of their new cultural practice, the mechanism of this change may be the result of very different factors than what they believe. Most any radical life change that leads to a sense of purpose, community, consistency, and meaning can have a transformative positive effect on an individual's health. I encourage such quests for purpose, community, and meaning -- but I encourage people to keep an open mind and to avoid dogma.

There are some good journals of scientific nutrition, such as the American Journal of Clinical Nutrition, and others. Abstracts are available on-line for free, and you can search on medical databases for information. Once again I encourage you to explore the evidence first-hand. When you read a claim about the nutritional virtues about this or that food, or this or that diet, be aware that you may be reading an ad, or an "info-mercial", and be prepared to search further yourself to clarify this kind of information before you make a needless change in your health behaviours.

Some alternative ideas that can be worth a try

1) Learn to meditate. Mindfulness-based meditation has a growing evidence-base, showing benefits for psychiatric problems as well as other physical problems such as chronic pain. You may need to attend a course, or several courses, to find the best setting for you to learn (there might be variations in the quality of teaching offered, so you may need to try several different times). Some of my patients did not benefit immediately from meditation techniques, but after many months of practice are now finding the skills very useful in managing ongoing symptoms.
2) Have a pet. It can help to care for, and bond with, another living creature. But, of course, you do need to be well enough to handle the responsibility. If you can't have a pet, consider finding a place to be around animals -- e.g. volunteer to do some dog-walking; or take some horseback riding lessons. Or visit your friend's pet once in a while.
3) Exercise. Try different types. Weightlifting can be great for some, endurance training (running or cycling) could be best for another. Swimming is often uniquely therapeutic. It can help to try a different exercise activity than what you're used to. Consider hiring a personal trainer to get you going, if you can afford one.
4) Activity clubs. There are groups out there dedicated to various activities, such as hiking, cycling, chess, reading books, gourmet cooking, etc. This could be a good way to make new friends and get going with a healthy activity. Local community centres often have classes, groups, or programs of all sorts to attend. Some groups of this type now advertise on internet community discussion boards, etc. Remember that you may have to try several times to find a group that "clicks" with you; it can be disappointing if you work up the nerve to join a group, only to find that it doesn't feel right.
5) Toastmaster's. A place to practice public speaking. This is excellent "behavioural therapy" for the great many of us who have some social anxiety. Attending can build confidence, speaking skill, and other social skills.
6) Consider taking an acting or theatre class. The theory of theatre & acting technique reminds me of psychotherapeutic theory. And the practice is excellent behavioural therapy, in that you are communicating clearly in a group, conveying emotion deliberately, and opening yourself to a bit of vulnerability. Sometimes it can also be quite liberating for a shy person to discover that they can perform theatre with relative ease. You can find these at community centres, continuing education groups, as well as acting schools & colleges.

7) Art therapy: another wonderful resource, if you have the chance to try it out. I think art therapy is underutilized in the therapeutic community these days. At the very least it can be a helpful and enjoyable adjunct to other therapy.
8) Music therapy: music can be powerfully soothing and therapeutic. Consider music therapy, or take a music lesson, or join a choir (you don't have to have strong musical skills to benefit). Also there is a phenomenon called "drum circles" in which a percussionist/therapist leads a group in pounding African drums, creating rhythms. A wonderful experience, and there are good therapeutic results in a variety of different populations. Once again, no prior musical experience is necessary.

Here's a link to Vancouver community centres; you can find the various courses they offer:
http://vancouver.ca/parks/rec/programs/refunds.htm

Here's a link to other classes & programs through the Vancouver school board:
http://www.continuinged.ca/nr/vsb/cie/session.asp

Religion

Well, of course, here's another subject that most of us have strong feelings about, one way or another. I realize it's a dicey issue for me to wade into this one as a psychiatrist.

Here are my frank opinions:

There are many varieties of religious belief and practice. Many religions hold views that are quite opposite or contradictory to what other religions hold. Even subgroups of the same religious group can have vigorous differences in belief.

As far as the literal beliefs themselves go, I as a scientist would be closest in my view to Richard Dawkins, who boldly pronounces a belief in God to be a "delusion."

Yet I think there is a lot of wisdom, beauty, and truth that Dawkins misses with his pronouncement (accurate though it may be on one level) of delusiveness. Here, I think someone like Joseph Campbell is a wiser figure, in that his analysis of religious belief is anthropological, where religious stories are understood as metaphors, often with pearls of wisdom or insights about the human condition. His view is that most every religion or mythological system shares similar stories and insights.

This is my own view -- religious stories contain metaphorical insights and truths, which can teach, guide, warn, or comfort us. In a sense these insights and truths could be understood as part of what "God" is (literally). Interesting phrases such as "the Word made flesh" found in the Bible (John 1:14) exemplify the concept that the application or vivification of ideas or metaphors can be understood as the core of what "God" is.

Mind you, many religious stories may be very much coloured by the impressions or cultural values of the human authors of the stories--and perhaps of the subsequent editors over the years or centuries. Some of these values may in some cases be quite idiosyncratic or highly influenced by the conservatism or liberalism of the individuals in their time, and not very reflective of deep truths about humanity or life.

In any case, I do think that many religious stories contain valuable insights, also their familiarity to people over many centuries or even millenia, have caused the stories to become more richly ingrained in the culture. Perhaps the passage of time, of many generations, acts as a sort of "cultural filter" through which religious texts pass, allowing the texts to acquire more universal relevance. I encourage the interested reader to look at some of Northrop Frye's work: he was an important scholar who looked at the deep impact of religious texts on literature, with the keen eye of a literary critic.

Some of the richer psychiatric theory of the past century looks deeply at the human condition, at unconscious drives & motivations; art, literature, and religious mythology are important illuminations in this psychological exploration. The creative act of participating in the arts, literature, and in religious metaphor, can be a healing act--from a psychiatric point of view, or in a broader way-- provided the experience is not simply part of a neurotic defense (e.g. projection, suppression, distraction, rationalization, denial, etc.).

There are several advantages to "organized religion":
1) there is a community of people who care about each other, who care about the community itself, and hopefully who care about other external communities. This is healthy, and there are not enough such communities outside of religion in our culture today. So organized religion can be a source of friendship, social warmth, an antidote to loneliness.
2) Also, most religious groups are devoted to altruistic service in some way; there is absolutely no doubt that altruistic service is psychologically healthy. It can be hard to find satisfying altruistic opportunities outside of such an organized setting
3) Many religious groups celebrate a long cultural heritage of its members; this can add to a sense of meaningfulness and a connection to the past, and to family. Unfortunately, many individuals may feel excluded by, or that they do not fit in with, the group's cultural heritage. I think it is important to find a group that suits your own personal culture, and I think there are more choices in this regard nowadays. Many religious groups are trying harder to address this need.
4) Many religious groups have particular expressions of faith using media such as music and the other creative arts. This element alone can be comforting, enjoyable, and inspiring. (an example for me would be listening to the music of Bach, or to simple a cappella choral songs in an acoustically-perfect church building).
5) Religious buildings can be soothing, comforting, calming, safe, beautiful, and meditative. A physical place which helps calm the mind.
6) Certain religious practices and symbolism can become calming, meditative habits that teach one to relax the mind, be gently and quietly, reverently present. It is a form of relaxation therapy, yet imbued with a stronger sense of meaning in most cases, and therefore can be more appealing and effective.
7) Religious involvements can help frame major life events, such as births, marriages, and deaths. The community can come together in celebration or in grief. These events then can become accepted with greater meaning, and less loneliness.

There is one main disadvantage to "organized religion", in my opinion:
Dogma. When an inspired piece of wisdom or a metaphorical truth is understood as a literal fact, it becomes dogmatic. It would be like reading a fascinating, insightful, and enjoyable novel, but then starting to believe that the events in the novel are literally true, and acting accordingly. Many religious groups are quite dogmatic. The problem here is that dogmatism is an innate psychological tendency, which leads to different groups opposing and fighting with one another. It is understandable that most religions become dogmatic, because the founding of the religion and its texts is usually based on characters who really lived and stories which really happened -- it's just that the characters become idealized and the stories become more legendary and fictionalized over time.

The focus on dogma tends to distract attention away from whatever metaphorical truths may underlie the dogma. It would be like reading a fairy tale in a concrete or literal way, without considering whether there is a "moral to the story". Religious ideas can then also become judgmental and paternalistic, phenomena which can add to the already robust burden of self-judgment and self-criticism experienced by those going through a mental illness.

One can see in the world today a lot of religious dogma, leading to a lot of fighting about religion, all the while some of the core wisdom, such as "love one another", etc. falls by the wayside. Through history, a substantial portion of large-scale and small-scale human cruelty, catastrophe, political manipulation, and war, have been driven at least in part by religious dogmatism (even if seemingly well-meaning). We don't have to look far in today's news to find ongoing examples.

Dogmatism, from a psychiatric perspective, is fed by a variety of innate human personality traits, such as "obsessive-compulsiveness" (the tendency to require very clear, strict, or rigid pronouncements about what is right and what is wrong); also many dogmas are fed by narcissism (those who proclaim dogmatic statements are often doing so arrogantly, egotistically, forcefully, unempathically, in a grandiose way, or with an intent to control). Even without these two traits at play, it can be psychologically comforting to pronounce something as an absolute truth, because it may soothe the uncertainty and fear we may have about a variety of deep issues (such as dealing with death or mortality, finding meaning in life, explaining senseless tragedy, etc.). The difficulty is that the soothing effect may occur even if the "absolute truth" is an arbitrary--and fictional-- dogmatic pronouncement.

Ironically, some of the poignant themes in major religions such as Christianity, or Buddhism (others too, I suspect--though I do not feel well-enough informed to list them), encourage humility, gentleness, openness, acceptance, and encourage us to move away from obsessive-compulsiveness, narcissism, and absolutism in our thinking. Unfortunately, many self-proclaimed adherents of these belief systems may not actually embrace, perceive, or live out these themes. I suppose, within any set of beliefs, individuals may "pick out" selective elements which happen to suit them, while perhaps missing a broader perception of the whole. (I recognize I'm being a bit judgmental here, and I need to continue examining my thinking on this matter, to prevent my own dogmas from entrenching themselves)

So I think religion can be quite positive, with certain provisos. Nowadays, I do find that there are opportunities to participate in something religious without having to be dogmatic.

Here is a link to a recent Canadian Journal of Psychiatry article on religion, spirituality, and mental health:
http://www.ncbi.nlm.nih.gov/pubmed/19497160

While these articles are quite enthusiastic about the role of religion in mental health, I should point out several confounding variables:
1) Those who are more religious may also have more conservative beliefs, and a more conservative lifestyle. These traits are likely to be partially heritable, partially learned or chosen. This conservatism may protect individuals from various forms of life adversity. The problem is, many individuals do not fit into a conservative lifestyle paradigm, and may feel strongly excluded. Furthermore, the health of society as a whole would be strongly compromised by having such uniformity or constraint in lifestyle variables. We can look to nations with very strict moral or religious codes to observe the decrement in cultural and intellectual life that results.
2) Other lifestyle factors among the more religious may include a stronger focus on community, stable relationships, healthy diet, less substance abuse, etc. -- all these factors could mediate better mental health, rather than the religious faith per se. (From my own personal point of view about "God", though, I consider factors such as community, relationship, care for self & others, healthy lifestyle, etc. to be equivalent to "relationship with [or love for] God")
3) Those who already have better mental health may be more likely to form a stable, long-term relationship with religious (or other community or group) involvement. Thus, the relationship between mental health and religiosity may be associative, not causative.

Stepping out of this critique, though, I do genuinely believe that religious involvement is likely to benefit mental health directly in many cases, for the other reasons I've summarized above (e.g regarding community, meditation, friendship, support, having a setting to contemplate moral issues, etc.).

For some people, religion will not be "their thing", and in that case, I do think it will be important for them to find other sources of community, altruism, meditative calm, etc. Hopefully there will be more cultural development in this area in the coming generations.

As a recent addendum (today in April 2015), I have become a great fan of Richard Dawkins as a scientist and writer.  I had been hesitant to read or discuss some of his work which specifically addresses religion (such as The God Delusion) but having read this recently, I have to say that I don't find his work very controversial at all.   He summarizes a lot of reasoned discourse and insightful historical summary of quite convoluted, biased thinking that has influenced religious belief and practice for millenia.  Richard Dawkins' greatest gift, though, in my opinion, is that he is a wonderful storyteller.  In some ways I think he shares this talent in common with some thinkers about religion or mythology, such as C.S. Lewis or Joseph Campbell:  in Dawkins' case, his best stories are about the joy and wonder of the way life works, in terms of genetics, biology, and natural selection.  Dawkins is very passionate about science, and has become very passionate about challenging dogmatic belief systems which obscure the pursuit and joy of scientific understanding.   In fact, he as well as others such as Stephen Pinker, show that obscuration of knowledge through dogmatic or mystical belief systems is a major hindrance to the health and peacefulness of society, and a major unnecessary cause of strife and conflict in the world.    One element about religion, though, which Dawkins may not have attended to enough, is of the tendency for the brain to project idealizations or personifications of issues and desires, as a core element of religiosity, which then could be experienced in a psychologically healthy way, particularly if combined with a supportive community, tradition, and adornment from the creative arts.   It is a human psychological capacity to personify metaphors or ideas, and treat them as external characters.   I think it is easier to adapt existing religious cultures, to maintain positive elements of these traditions and possibly beneficial meditative practices and opportunities for ethical reflection in religious services, while moving away from a focus on dogmatic or fictional mystical beliefs.  In this way, religious practice could move away any sort of conflict with science.  Otherwise, there is very little at this point in atheistic culture which offers as much focused, organized opportunity for supportive community, meditative reflection, altruistic involvement, ethical discussions, infused by great art, music, and architecture.

A Rambling List of Helpful Ideas

This is just brainstorming now. Thinking of things that help with mental illness:
-find a good family physician
-have your overall health checked carefully
-have blood tests done to check thyroid, fasting glucose, ferritin (a measure of iron stores), B12 levels (a vitamin), and other basic bloodwork
-allow time in your daily life for rest, relaxation, hobbies, or other simple pleasures. It's particularly good to actually build this time right into your schedule
-have some structure in your day -- get up at roughly the same time, try to go to bed around the same time, eat meals consistently
-try to appreciate the simple pleasures of life -- the taste of your toast in the morning, the colour of the flowers, the texture of the sidewalk -- see, feel, experience, enjoy what you can
-do meditative things. For some this is a meditation class, for others it might be listening to music, a quiet evening walk, for others it could be a workout, for others it could be prayer or another religious activity
-examine your lifestyle...be willing to make changes, to let go of things (small and large) that are unhealthy for you, inconsistent with your personality or lifestyle; be willing to add things (small and large) that are healthy for you, consistent with your personality, values, and lifestyle. Be careful about these decisions though, because a depressive state can cause you to feel unhappy about every external thing, and your depressive symptoms may therefore prompt you to make changes that are not really helpful to you. Imagine that your mind is like the "senate", make sure all the different opinions are heard, from a depressed perspective, to an intellectual perspective, to a happy perspective, etc. Then decide & make changes if necessary. Some changes are hard to make -- e.g. letting go of the need to keep up with the mortgage by maintaining an extremely unpleasant job -- maybe you need to consider letting go of the house, simplifying your life, and doing something with your time that is more enjoyable or meaningful.
-do altruistic activities, in some way. Volunteer. Help others out. Do what you can.
Here's a link to search for volunteer opportunities in Vancouver:
http://www.volunteervancouver.ca/volunteering/search.asp
-exercise. every day. in moderation.
-eat healthy food. learn about nutrition. insist on the best quality your budget will allow. If you indulge once in a while in decadent foods, make it something REALLY GOOD. Not McDonalds.
-no more than 1 or 2 drinks of alcohol per day, ever. (it is possible that very light regular drinking is healthier than not drinking at all. But if you ever drink more than 2 per day, it is very bad for your emotional and physical health; also some people may not be able to healthily drink at all.
-don't smoke.
-don't use street drugs. There's a big marijuana lobby out there that makes claims about the health virtues of cannabis. Go examine the evidence for yourself. It's not good for you!
-reserve a little bit of energy, every day, or every week, for friendships. For many of us, this is an energy-consuming activity, and we neglect this. The energy could be spent in conversation, in doing an activity, or in expressing something positive about your friendship.
-be willing to move away from, or let go of, friendships that are not healthy for you.
-be willing to make new friends. This can be hard to do. You may need to try many different ways to meet new friends, such as joining recreational groups, clubs, churches (in my opinion, one need not have to espouse the literal belief system of a church to benefit from its social community, altruistic focus, and positive values), formal or informal educational classes (e.g. an acting class, or an art class, etc.), or internet sites (be careful of course!)
-be willing to try new things. a new activity. a new hobby. a new skill. a new language. a new place to travel. a new group.
Here's a link to Vancouver community centres; you can find the various programs & services they offer:
http://vancouver.ca/parks/rec/programs/refunds.htm
Here's a link to other classes & programs through the Vancouver school board:
http://www.continuinged.ca/nr/vsb/cie/session.asp

-some people change their lives for the better through months or years of slow, steady work...be open to this. Others can make a "radical life change", where improvements in life, meaning, and joy can happen almost immediately. Be open to this too.
-consider finding a therapist. you may need to give this time, just like any new experience. But be willing to change therapists, if the one you find doesn't feel right, or if you feel that you aren't getting anywhere after giving it a good chance.
-consider other types of therapy: if you have had only open-ended, "classical" psychotherapy, consider trying cognitive-behavioural therapy. And vice-versa.
-consider seeing a psychiatrist. You may need to give this time too, and may need to see a different one if the experience doesn't feel right to you.
-consider medications. Some patients I've seen have had life stories that sound like their problems would be solved by talking things through, by working things out in talking therapy. Sometimes they have given this years of effort, but have not improved. Then they try an antidepressant, or find a combination of medications, and feel truly well for the first time in their lives. For others, they have the opposite story: they may have tried one medication after another to treat their symptoms. Nothing works. Then they engage in a good psychotherapy experience, and this becomes the first treatment that helps; sometimes these patients may discontinue their medications. For the majority of patients I see with chronic or recurrent depression, though, what seems to help best is a mixture of psychotherapy, a medication combination, and healthy lifestyle changes.