ANXIETY-
Dealing with Extreme Uncertainty.
How irrational thinking can serve you.
Reviewed by Abigail Fagan

KEY POINTS-
Under extreme uncertainty, rational decisions or shortcuts in thinking do not work since information is scarce and people get stuck.
When rational thinking fails, people can turn to eristic (self-serving, wishful or superstitious) reasoning.
Eristic reasoning is self-serving, and it motivates people to keep going.

When uncertain, we typically react initially by seeking the information we need to reduce that uncertainty. We try to find mental shortcuts that help problem-solving and increase the probability of success. This is called heuristic reasoning, and it makes sense when there is enough information to draw conclusions. However, heuristics fail when there is extreme uncertainty because the information is so scarce that any heuristic would be inaccurate.

So, what can you do under these circumstances? In February 2023, a group of researchers suggested that the solution is a type of reasoning called eristic reasoning1.

What is eristic reasoning?
Whereas in heuristic decision-making, decisions are made to satisfy desires by intelligently processing the cues in the external environment (e.g., when stuck in traffic, you may decide to take an exit to find a shorter cut even if you don’t know the way), in eristic decision-making, decisions are made by blindly following desires through self-serving illusory beliefs. Eristic reasoning gives you pleasure and may involve superstitious or wishful thinking.

How can illusory beliefs help?
As a temporizing measure under conditions of extreme uncertainty, eristic reasoning can help. It gives you a sense of purpose. For example, you develop a winning mindset regardless of the circumstances under which you are competing. In some cases, this may work since such beliefs can artificially decrease the anxiety caused by uncertainty, which can boost your performance. The pleasure offsets the discomfort of the uncertainty.

What are the types of pleasure derived from eristic reasoning?
Different types of people will concoct different scenarios for themselves based on their basic needs. For example, a neurotic person may derive pleasure from relieving their anxiety. In contrast, a pleasure-seeking person might seek to bond with others or be sensation-seeking just to keep going. That’s why, when facts are questionable, people turn to their own personalities to satisfy their needs.

How does eristic reasoning show up in our daily lives?
Eristic reasoning is initiated by myths, passions, prejudices and vested interests2. You’ll often see this in political debates, where rather than a weighed argument, the goal is to win the debate at all costs. Sometimes, you see this in legal arguments, where lawyers represent their clients to win a case. One also sees this in the multitude of health-related recommendations that come from experts, where, due to the ample contradictions in the medical literature, people will take one side or another on eating meat, drinking alcohol, exercising a certain way, or following a certain diet. These recommendations are rarely heuristic, even when they are framed that way. They are often self-serving, and the person offering the advice is vested in your following it. You may even follow them to get the pleasure of that bonding and relieve yourself from the anxiety that comes with this.

What are the biases of eristic reasoning?
The biases of eristic reasoning include the overconfidence bias, the endowment effect, status quo bias, loss aversion, and wishful thinking. With overconfidence, the person’s passion is so great that they lose sight of arguments that contradict their own views. With the endowment effect, people often value what they have more highly than if they did not have them. You might, for example, value having a pet after you get one more than prior. Status quo bias keeps people stuck in their own points of view without any propensity to change. Loss aversion makes people attached to their own possessions (even if they don’t particularly want or need them.) And wishful thinking is simply about hoping that something unlikely will happen. One key shift underlying these biases is switching attention away from outside cues to only what will please us.

Why not just rely on reason?
If information sources are not available or reliable, there is no way to reason. This could paralyze you under conditions of extreme uncertainty. Turning to what pleases you is a way to escape that rut. It helps you keep an open mind, though looking for environmental cues is important. The stock market, capital raising, socio-economic shifts, and market dynamics are all situations that can create this kind of extreme uncertainty. Entrepreneurs deal with this all the time. To deal with this stress, eristic reasoning can be very helpful, but it will be dangerous if it consumes you.

Conclusion
Under conditions of extreme uncertainty, you may feel empty, lost, or paralyzed. But eristic reasoning is a way of temporarily escaping these mental states, helping you get to a place where facts will reveal themselves if you are open to them. Satisfying a basic need safely is a good way to get started.

EATING DISORDERS-
Could Exercise Be a Tool in Eating Disorder Recovery?
Exercise is often prohibited during ED treatment, but research suggests it helps.
Reviewed by Abigail Fagan

KEY POINTS-
People with ED are often scared of reintroducing exercise into their lives and triggering relapses.
Research finds that incorporating mindful exercise into ED treatments boosts weight restoration and reduces compulsive thoughts.
Exercise during recovery increases patients autonomy, motivation and active participation, which science shows improves treatment outcomes.
Traditionally, eating disorder (ED) treatment stipulates that people refrain from exercising based on the assumption that patients will misuse workout practices to compensate for enhanced food intake. Over-exercising and purging through exercise are common features across all EDs, and they're extremely unhealthy practices that are often some of the last symptoms to subside during recovery1. The degree of over-exercise, as well as body image dissatisfaction, also predicts whether a person will relapse, an occurrence that happens in up to 52% of people who have initially recovered from an ED2,3. From that perspective, it makes sense that ED treatment involves no access to exercise.

There are, however, two major problems with prohibiting or significantly restricting exercise during ED treatment. First, by not exercising during recovery, weight restored ED patients are often uncertain and even scared of how to reintroduce physical movement into their daily lives. This can lead to prolonged abstinence from exercising which aggravates their body image dissatisfaction and fuels future relapses into disordered eating.

“It was really scary to be allowed to exercise again. I wasn’t sure where to start or how to even exercise again without it being an eating disorder trigger.” —DB, age 34, lives in Colorado, USA

Second, scientific research is demonstrating that exercising during ED recovery improves treatment outcomes physically and mentally.

In this post, I dive into the science of how exercise benefits ED recovery, and recount how two leading ED treatment centers stand out by incorporating exercise as a standard part of therapy.

The results from research are in: Exercise benefits eating disorder recovery
Surprising to many, there are several scientific studies reporting how exercise supports ED recovery. One research group tested whether an exercise program consisting of four weekly classes improved the recovery of 127 women who received residential treatment for an ED1. Compared to the control group (which also consisted of women receiving residential treatment but without the exercise classes), the women in the exercise program had a significant reduction in compulsive thoughts around working out, and, more impressively, the women who had anorexia gained 40% more weight than the anorexic women in the control group. In other words, exercising during ED recovery boosted both their psychological and physical recovery.

We know that exercising is great for our brains and bodies. Both during and after exercise our brains produce more endorphins and increase the signaling of the neurotransmitter dopamine, both of which are well-known to increase well-being. Exercise also improves cognitive performance and even changes structures of our brain that shape the way we think4. Changing the way we think is likely one of the major ways in which exercise benefits ED recovery. In fact, the exercise program implemented as a part of the study had dedicated time periods of reflection, which compelled the participants to notice their bodies in a new and different way1.

Let’s dig into some of the components that may underlie this process of cognitive change and how it can contribute to more successful ED recovery.

Physical movement attunes our minds to our bodies
A major challenge for people with EDs is their reduced sense of interoception. Interoception is the ability to sense your internal cues, such as hunger, thirst and heartbeat, which shape how we feel and behave. People with EDs are less capable of sensing their body accurately, and this makes it more difficult for them to notice when their body is, for example, hungry. Exercising has the potential to enhance their interoceptive awareness5, thereby improving their ability to notice when they feel hunger and fatigue, which supports behavioral change (such as eating and resting).

But exercise can only increase interoceptive awareness if it is done mindfully. Mindful exercise involves paying attention to how your body moves and observing how you feel before, during and after the movement6. A critical component of the above-mentioned study was the continuous effort to facilitate reflections during and after the exercise. In this process, people become not just better at noticing internal cues but also reflecting on the meaning and purpose of these cues. This is a critical step in reconnecting with your body and stepping away from and questioning the ED behavior.

Exercising can help us say goodbye to maladaptive coping mechanisms
“We hold the belief… that the incorporation of movement in the recovery process (once someone is medically stable) works to dismantle the potential eating disordered belief that movement's sole purpose is for burning calories or body manipulation” —Dr. Jennifer Gaudiani, founder and medical director of the Gaudiani Clinic.

Exercise is abused by many people with EDs because it serves as a coping mechanism. In the face of emotional distress and uncertainty, people with EDs often turn to exercise to control the only thing that seems available to them: their body. A major component of recovery is therefore to dissociate exercise from their ED behavior, and find new coping mechanisms that are healthier and more effective (for example, mindfulness and journaling). This process is a part of therapy sessions, but could, according to scientists, be further improved by incorporating movement into the treatment program1,6.

Dr. Nicole Garber, the CMO of Alsana, an eating disorder treatment program and recovery community, told me that “what sets [Alsana] apart is that we incorporate movement into treatment. Many facilities exclude movement which is a disservice to patients. The patients have to learn how to move and at the same time find new coping mechanisms”. Notably, Alsana has a higher recovery rate than standard ED treatment centers (see the report here). One of the reasons for their success may be that their patients have learned to not abuse their bodies by over-exercising when a new stressor inevitably occurs during and after recovery.

Incorporating exercise gives people autonomy
You only need to watch the documentary Thin by Lauren Greenfield, to understand how ED treatment often equals complete loss of autonomy, which ultimately can push people farther into denial of their disease or simply make them refuse treatment. However, research demonstrates that when patients have a sense of autonomy in their recovery plan it increases their motivation to adhere to their treatment7 — this state of mind is also referred to as “active participation”. By giving access to exercise — in a structured and guided manner — patients are invited to see the treatment as something that works for them and not against them. Active participation in setting treatment goals and building a more trusting relationship between the healthcare professional and patient are known to improve treatment outcomes8,9, and one study found that letting ED patients actively participate in their treatment plan reduced drop-out rates10.

“...if movement is an enjoyable or helpful self-care tool and is connected to a personal value of a patient, we want to find ways to honor its incorporation into life in a non-disordered manner.” —Dr. Jennifer Gaudiani, founder and medical director of the Gaudiani Clinic.

Providing patients with choice and autonomy requires that the treatment team sees the patient as a capable person who can recover under the right conditions. Unfortunately, this is often not the prevailing mindset among healthcare professionals, and ED patients are frequently told that they will never recover, nor are they allowed to provide any meaningful input to their treatment plan. Again and again, this dismissive approach stalls patients’ intrinsic motivation for receiving and adhering to recovery.

“I’m not sure I have ever met a professional who believed in full recovery from ED. It has been incredibly discouraging.” —DB, age 34, lives in Colorado, USA.

Exercise could make a difference for many ED patients, but we need to be cautious
Based on the scientific evidence and low cost, exercise programs have enormous potential in supporting a healthy recovery from ED, and that’s important to consider these days. During the pandemic, the number of people with EDs exploded, but despite research efforts, it is still less than 50% of people that recover, many of whom will relapse. Currently, two evidence-based treatments for EDs exist: cognitive behavioral therapy for adults and family based therapy for children and adolescents. Yet, many patients do not receive these evidence-based treatment methods, either because they cannot access treatment at all or because the treatment they receive comes from professionals without a specialty in EDs. From this perspective, it is tempting to think of exercise as a new accessible panacea for ED treatments. However, it is critical that we take caution to ensure that the implementation is done right. This necessitates proper education of healthcare professionals, which, according to Dr. James Lock, a researcher and psychiatrist at Stanford University, is currently lacking: “When it comes to eating disorders, most therapists are not trained in using evidence-based therapy methods. They end up relying on their own [professional] beliefs, which is not proven to help”. This challenge further underscores the importance of incorporating mindful exercise programs that are led by specialized professionals who can ascertain when movement can benefit an ED patient.

For recovery to start, people with EDs have to rethink why they exercise. During the disease, exercise is a way to exert control. During the recovery, it can start being a part of a healthy and fun lifestyle. This mental transition is much easier said than done, and requires enormous support from healthcare professionals, family members and friends.

Think religion is useless? Think again.
What if Religion Can Prolong Life?
Should doctors be prescribing attendance at religious services?
Reviewed by Michelle Quirk

KEY POINTS-
Religious affiliation appears to prolong life.
Even when correcting for social integration and volunteer activity, religious affiliation appears to confer a longevity benefit.
Religious affiliation may offer a relatively inexpensive means of promoting health, yet no genuinely religious person could use it this way.
It would be noteworthy if religious faith or regular attendance at worship services prevented disease, improved health, and prolonged life. For one thing, the United States now spends an average of more than $13,000 per person per year on health care, so if religious observance could enhance health, it might provide a comparatively inexpensive means of tackling many contemporary health challenges, such as declining life expectancy. Moreover, many religious people are probably unaware of an important benefit they may be deriving from their faith. And, yet, no matter how useful religion turned out to be as a means of promoting health, no sincere person could turn to religion with this goal in mind.

First, the case that religion might promote health: Consider evidence from a 2018 study by University of Chicago researcher Laura Wallace and colleagues. They looked at more than 500 obituaries published in Des Moines, Iowa, comparing the age at death of individuals whose obituaries mentioned a religious affiliation with those that did not, and correlating these results with other factors known to influence longevity, such as gender (on average, U.S. women live almost 6 years longer than men), marital status (the married live about two years longer than singles), and social and volunteer activities (which lower mortality rates by 4 years).

The researchers found that religious affiliation was significantly associated with longevity. Alone, it was associated with an almost 10-year increase in longevity. Even after controlling for gender and marital status, the effect was still 6.5 years.

To test these findings, the researchers then examined obituaries from online newspapers in 42 metropolitan areas around the United States. This approach would help to compensate for the fact that there are large regional variations in religious affiliation. Analysis of nearly 1,100 obituaries showed that religious affiliation was associated with a 5-year increase in longevity. And even when the researchers corrected for the effects of known benefits of religious affiliation, such as social integration and volunteer activity, the relationship between religious affiliation and longevity persisted. To be sure, those who are involved in social groups and who volunteer experience advantages, but religious affiliation alone appears to increase the number of years persons live.

Could people achieve similar results without going to church? The answer might be yes. For example, they could become deeply involved in one or more social networks, devote considerable time to volunteer activities, and engage in some form of nonreligious stress reduction, such as meditation. Perhaps when it comes to the aspects of religion that enhance health and prolong life, belief in God by itself does not constitute a “special sauce” that adds extra value beyond other health-related practices.

But if we take the findings of Wallace and colleagues at face value—that religious affiliation seems to offer a significant length-of-life benefit, independent of other factors that might be invoked to account for it—what practical conclusion might someone wishing to lead a longer, healthier life draw from such research? One might be that religious affiliation is an attractive and relatively inexpensive way to prolong life. Such a person might decide to join a faith community, to begin attending worship services regularly, and to become involved in the congregation’s volunteer activities.

Of course, to promote religious practices for any reason other than sincere piety is to use religion as a means to some other end, and, by extension, to use God as a tool. We would be attending worship, praying, or engaging in a faith community’s activities not because we believe it is bringing us closer to God or enabling us to participate in God’s work but because we believe godly modes of conduct might bring us what we really desire—namely, a longer, healthier, more stable, richer, or even happier life. God could be likened to vitamin G—just one among many factors that, if properly exploited in the appropriate dose and on the appropriate schedule, can make our lives better.

Suppose, however, that there is something about religion and God that resists such attempts to repurpose them as means to some other end. Perhaps God does not exist for our convenience, welfare, or even happiness. Perhaps God has other purposes in creation that exceed not only our own benefit but even our own comprehension. Perhaps those who attempt to put God in such a box, or in such a pill, are engaged in a fundamentally irreligious endeavor. Perhaps God, as the Book of Job so eloquently indicates, refuses to be placed in any humanly erected boundaries or serve any strictly human purposes. Perhaps the human problem is not how to make God do our bidding but to discern and align ourselves with God’s purposes.

Josef Pieper had much the same thing in mind when he wrote in Leisure: the Basis of Culture, “The man who says his nightly prayers may sleep the better for it, but no one could say his nightly prayers with that in mind.” We may derive all sorts of benefits from going through the motions of religious observance, but doing so is in no way a true expression of faith. Perhaps God cannot be put to any human purpose, for in so doing, we would be placing something higher below something lower, supposing that the overarching end of all things can somehow become a mere means for something lesser.

STRESS-
The Power of the Breath to Ease Pain.
Breathing exercises can decrease stress and chronic pain.
Reviewed by Abigail Fagan

KEY POINTS-
Breathing exercises help to manage stress and chronic pain by relaxing muscles and the nervous system.
Breathing slowly and rhythmically, breathing through the nose, lengthening the exhale, and breathing from the belly can lessen tension and pain.
Don't wait for pain to increase to practice; breathing exercises are most effective if you initially practice them when pain is not severe.

Just breathe. Sound familiar? These two words are ubiquitous. Whether trying to decrease stress, anxiety, and muscle tension or increase our focus and centeredness, we are frequently encouraged to breathe.

There is a good reason for this, particularly when it comes to muscle tension and pain. Physical pain and emotional stress often go hand in hand. When we are stressed, our muscles tense, and this tension can increase the physical sensation of pain. Pain can also cause stress, increasing muscle tension and creating more pain. Also, it is common to hold our breath when we are stressed or in pain. I catch myself holding my breath all the time. Unfortunately, doing so increases pain and stress.

So, one helpful way to manage stress and chronic pain is to practice relaxing our muscles and nervous system via breathing exercises. These exercises may sound simple yet consistently practicing them can be easier said than done.

Many helpful breathing exercises exist, and I am going to outline some of my favorites. While it is true that there are times when it is beneficial to engage in longer relaxation exercises — If your muscles are particularly tense, it may take 15 to 20 minutes to feel a sense of relaxation — I am a fan of practicing brief exercises that you can quickly, and realistically, implement regularly.

1. Breathe Slowly and Rhythmically
Practice breathing in and out slowly. Imagine your breath is a wave in the ocean that is slowly coming into shore and then slowly receding back into the ocean. See if you can practice breathing slowly and steadily for about two to five minutes (or longer as helpful).

2. Breathe Through Your Nose
It can be helpful to practice breathing from your nose only. This helps us breathe more slowly, aiding stress relief and muscle relaxation. So, practice keeping your mouth closed and breathing in and out from your nose. Again, breathe slowly.

3. Lengthen the Exhale Portion of Your Breath
The exhale part of the breath is the most relaxing. The exhale is like a brake for our nervous system helping it slow down. Practice making the exhale portion of the breath longer than the inhale. For example, if you naturally inhale to a count of three, practice slowly exhaling to a count of five.

4. Breathe From Your Belly
Diaphragmatic or belly breathing tends to be the most relaxing type of breath. This is because when you breathe using your belly, you stimulate the vagus nerve which activates the relaxation response, reducing your heart rate and blood pressure and lowering stress. With belly breathing, you want to breathe deeply into your belly.

To practice, sit or lie down, and place one hand on your chest and the other hand on your belly. Slowly inhale through your nose, practicing keeping the hand on your chest still, and allowing the movement to come from your belly. When you inhale, your belly should rise as if you have a balloon in your belly that is filling with air, and when you slowly exhale, your belly should gently collapse as if the balloon is deflating.

If you are not familiar with belly breathing it can take practice. To start, you can sit in a chair and lean forward placing your elbows on your knees while breathing naturally and slowly. This position forces you to breathe from your belly so you can get to know what the sensation feels like.

Brief (Can Be) Best
Sometimes longer practice is most helpful. Yet, I am a fan of consistent, brief practice throughout the day. This may mean taking a few intentional breaths throughout your day or sitting and breathing for several minutes. One quick way to practice is to pause multiple times per day and take about three to five intentional breaths using one of the breathing styles from the exercises above.

Don’t Wait to Practice
It is important to not wait until tension and pain increase to practice these exercises. They will be most effective if you initially practice them when you are not in a lot of pain. This will help you to remember to use them and will make them more effective when your pain increases.

So, slow down and breathe on!

EMOTION REGULATION-
What Is Emotional Lability?
A guide to the causes, symptoms, and treatment of emotional lability.
Reviewed by Abigail Fagan

KEY POINTS-
Emotional lability is a rapid and intense change in a person’s emotions or mood, typically inappropriate to the setting.
Emotional lability is a symptom of various disorders including borderline personality disorder and bipolar disorder.
Ways to deal with emotional lability include being aware of symptoms, taking care of yourself, and asking for help.

Do you feel like your emotions swing all over the place? Once you start experiencing emotions, does it feel hard to stop? Or, do your emotions feel especially intense? Then you may be experiencing some form of emotional lability.

Emotional lability is a rapid and intense change in a person’s emotions or mood, typically inappropriate to the setting (Posner et al., 2014). For example, a person can suddenly start crying uncontrollably because of any strong emotion, even though they do not feel sad, frustrated, or happy. The term originally comes from the Latin word labilis, meaning “transient, fleeting, slippery” (World of Dictionary, n.d.), which highlights the dramatic and frequent shift between emotional experiences. Emotional lability can also be an over-expression of positive emotions, such as enthusiasm or energy, either disproportionate to the event or improper to the circumstance (Posner et al., 2014). One example is when a person suddenly laughs uncontrollably at a funeral.

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5; American Psychiatric Association, 2013) states that emotional lability appears as a symptom in various disorders, including:

Borderline personality disorder (BPD), which is a mental illness characterized by unstable moods, impulsive behavior, and problems in relationships.
Bipolar disorder (BP), which is characterized by episodes of intense mood swings, with depressive lows and manic highs. In bipolar disorder, emotional lability often lasts longer (e.g., days-weeks; Posner et al., 2014)
Substance use, which can include alcohol or any illicit drugs.
Attention-deficit/hyperactivity disorder (ADHD), a common disorder defined by inattention, hyperactivity, and impulsivity.

Post-traumatic stress disorder (PTSD), a disorder in which a person struggles to recover after witnessing or experiencing a traumatic event.
What Are Emotional Lability Symptoms?
Extreme emotions and sudden mood shifts. For example, those suffering from emotional lability experience intense feelings that change rapidly and often fluctuate throughout the day.
Improper reactions. If a person laughs uncontrollably at a funeral, it is a sign of emotional lability, as it refers to inappropriate reactions.
Difficulty controlling emotions. People who experience emotional lability may have little control over their feelings, which can make it more difficult to stop them.

​Emotional lability can negatively impact a person’s daily life and these behaviors can be confusing or embarrassing.

How to Deal With Emotional Lability
If you, or someone close to you, are experiencing emotional lability, here are a few things to do to better cope with it (Acquired Brain Injury Outreach Service, 2021).

Be aware. It is important to be aware of what triggers emotional lability and to try to avoid them whenever possible. Some of these triggers include extreme fatigue, stress, or certain social situations or environments.
Take care of yourself. By taking care of yourself, both physically and mentally, you may reduce tension and stress. Make sure that you get enough sleep every night, have a balanced diet, and exercise regularly. By doing something that makes you feel better, such as going on a stroll or spending quality time alone, you may increase your overall well-being.
Take a break. If you experience lability, it’s OK to take a step back for a few minutes to cope with the emotions.

Find a distraction. Sometimes it can be helpful to change the topic or to engage in a different activity to reduce stimulation and regain control of the emotions.
Acknowledge the feelings. It’s important to realize that sometimes you can’t control your emotions, and that’s OK. You just have to take care of yourself and practice self-compassion.
Educate. Other people can be confused or frightened about what they can’t understand. If you feel comfortable, you can let people know what happened.
Ask for help. It is important to remember that you are not alone in this. You can talk to your friends or family members, or ask for help from a professional, such as a therapist or psychiatrist. ​
In summary, emotional lability can be a challenge. By understanding its roots, it may become easier to manage.

TRAUMA-
9 Signs We Are Healing From Trauma.
A look at the most common ways survivors recognize healing and growth.
Reviewed by Michelle Quirk

KEY POINTS-
Many ask, “How will I know when I have healed?” When the pain of healing feels too intense, we want to know when it will end.
Each of us has our own journey, and we are the best judge in our own healing.
Decreased self-doubt and increased self-compassion are reliable markers of healing.
Often when the pain of healing feels unbearable, many survivors ask me, “How will I know when I have healed?” This is a normal question, as we want to know when the pain will end, and when we will see the figurative light at the end of the trauma tunnel. But the answer is not so simple. Conquering a trauma history is nothing like climbing a mountain or completing an obstacle course. There is no identified, objective peak. No hanging a flag or taking a victorious selfie.

Instead, everyone’s peak will look different. The goalpost will likely move throughout your life. You may think you are your best self at 45 years old only to look back on your 60th birthday at how much you still had yet to learn.

While each of us has our own journey, and you are the best judge in your own healing, here are some common details survivors report noticing as they near the healing or maintenance stages in their recovery:

Decreased self-doubt: Survivors report feeling fewer episodes of self-doubt. They will learn to trust their own decisions, their recognition of red flags, and their remembrance of the past and the trauma they experienced. They will start to hear fewer self-told messages of, “Was it just me?” and decrease the number of dismissive statements such as, "Many had it worse."
Changes in health or body: When we start to heal one aspect of our being, mentally or physically, it causes a chain reaction that spurs improvement in all other areas of life. Maybe one day you realize you haven’t had any nightmares in the past couple of months or that you can now look at family pictures without crying.

Being less offended or bothered by others' boundaries: If your household was chaotic and your caregivers were disrespectful of personal boundaries, it can be hard to learn that other people deserve their own boundaries as much as we do. Survivors entering the healing stage start to recognize themselves being more understanding of others' boundaries and being better about setting their own.

No longer having conversations with "them" in your head: You know those moments when you think of what you would say when you confront the people who have wronged you? Many people want to have their moment in the sun, sharing their feelings and experiences with a neglectful caregiver or another who hurt us, even if they were forced to listen. Many survivors report that they notice fewer of these conversations in their head as they heal.
Increased comfort acknowledging—and feeling—your feelings: Instead of dismissing your feelings, feeling shame or embarrassment over them, or doubting their legitimacy, you start to learn that the only way to process feelings is to acknowledge and allow them to be felt. Survivors approaching healing find themselves more equipped to let themselves respect their feelings and start taking steps to process uncomfortable ones in healthier ways.

Increased comfort with asking for help from others: Instead of believing yourself and your struggles to be a burden on others, you learn to trust in the kindness of the people who support you and learn that they want you to be happy and well. Not only do survivors who arrive at healing report finding it easier to ask for help, but they also recognize how the external perspectives of others benefit them in their journey.

Increased self-compassion: Self-compassion is when we have compassion for ourselves. Many survivors struggle with this, as it was not shown to us in childhood. But as we heal, we learn how to show ourselves kindness and grace for the mistakes we make as we grow.
Ability to recognize when something has triggered you: In many ways, developing self-understanding is a lifelong process. But, as we heal, we are able to recognize when something triggers us—that feeling of being brought back to that feeling of the little child standing helpless while being yelled at, for example. This does not mean that the triggers won't happen, only that we will be able to recognize them as being drawn from something deeper, instead of coming from the present situation.

A decline in self-soothing or self-medicating: Survivors will notice a decline in self-soothing behaviors. Perhaps you notice that you are not reaching for the comfort foods—or substances—you once depended on every evening. Please understand that many times self-soothing behaviors can merge into compulsive behavior or addiction. Many are unable to decrease their use of food or substances without treatment, and this is OK; it does not mean you are not “healing” the correct way. There is no shame in seeking support.

As with any trauma, recovery from abuse is not something that someone can expect to wake up one day and notice they are healed. It is much more gradual, and you are likely to notice small changes. The truth is that we never really get over it: You have to keep working at it. Healing doesn’t mean you stop feeling negative feelings—only that you feel them when it's appropriate to do so, and you are able to recover from them without staying activated.

Balancing the Potential for Harm With Our Capacity for Good.
Thinking about proportionality in public health.
Reviewed by Ekua Hagan

KEY POINTS-
Public health leaders must have a clear-eyed view of the potential harms of any step they are considering so the harm doesn't outweigh the good.
Public health recommendations must account for the disproportionate burden of poor health experienced by marginalized groups.
Different populations have different definitions of harm, which is important for public health to take into account.
In public health, we can find ourselves in positions where proportionality is of core importance. Public health often makes recommendations to policymakers that involve “asks” of the public. We propose actions that entail some restraint or sacrifice in exchange for less risk of harm. We saw this during the pandemic when public health played a role in the adoption of lockdowns, mask mandates, and vaccination requirements.

This recent history reflects a dynamic that has long characterized what we do. As long as public health has existed, it has at times placed checks on individual autonomy in the name of the greater good of supporting a healthier society. From quarantines during times of plague to mandatory treatment for diseases like tuberculosis to taxes on harmful products like sugar-sweetened beverages, public health has supported measures that place impositions on the public.

In some cases, such as the extended restrictions on movement of the COVID-19 moment, these impositions created their own challenges for health. This places public health, a field which exists to shape healthier populations, in the difficult position of sometimes proposing measures which create tradeoffs for health. In order to be effective in our core mission, we, at times, impose restrictions on populations which, if too tight, could cause undue harm, but, if too loose, could mean opening the door to greater harm. Proportionality helps us to strike this balance; to advocate for policies that suit the moment, imposing on the public no more than is necessary to support health.

It strikes me that proportionality in public health is fundamentally about the question: What is the potential for harm and what is the potential for good in a public health action? As we navigate this philosophical space, the following three principles can, I think, serve as useful guides, helping us to better engage with proportionality in this post-war moment.

Prioritizing proportionality
First, proportionality has to be central to public health. Throughout the history of public health, we have, at various points, chosen to embrace certain concepts as core to our field. For example, as we became more focused on crafting policies that shape health at the population level, we began to have more conversations about advancing these policies while respecting individual autonomy. As it became clear that social exclusion and historical injustice are foundational drivers of poor health, we embraced the pursuit of equity as a foundational focus. Now, in this post-COVID moment, public health has, in many ways, more power than ever before to shape policy and engage with the public debate to advance our favored solutions.

With this newfound power comes the responsibility to place proportionality at the center of public health thought and action. We should never find ourselves in the position of recommending an action that might cause more harm than it prevents. This means having a clear-eyed view of the potential harms of any step we are considering. We need to engage dispassionately with the data to see both the costs and benefits of a given action.

The pursuit of equity
Second, it is important that our focus on proportionality is informed, always, by our pursuit of equity. Just as public health is centrally concerned with ensuring that all have access to the resources and opportunities that support health, it has a responsibility to ensure that no groups bear undue burdens.

This means that our calculus when it comes to the harm our interventions may cause must account for the disproportionate burden of poor health experienced by certain marginalized groups. This can help us avoid taking actions that may worsen inequities even as they might benefit the overall population. It is not enough for a given measure to be worth the inconvenience or harm it may cause the population at large. We must also consider how it may affect groups whose health is poorer than the average, or for whom the burden of our intervention will be particularly heavy.

Understanding various perspectives
Third, it is important to remember that our conception of harm is shaped by what we value. Proportion depends on being able to weigh the risks and benefits of a given measure, but, as I have recently written, risk is not a value-neutral concept. It is influenced by our biases, by the individual and cultural lens through which we view the world. This has implications for how we determine whether a policy or action is truly proportional.

Consider the example of alcohol consumption. It is, I think, fair to say that many in public health regard alcohol consumption as nothing more than a health hazard. For this reason, we may not regard efforts to ban or severely limit the sale of alcoholic beverages as anything less than an unalloyed good. We might therefore favor, of all possible actions to address the health harms of drinking alcohol, the strictest possible ban on the practice. But for many, consuming alcohol is a source of pleasure, and an activity tempered by moderation. This reality should change our understanding of proportion as we consider alcohol policy. Even if it does not change our position on alcohol, it should help us to think about how different populations have different definitions of harm and how it is important for public health to take these perspectives into account. And that should guide how we approach efforts to limit alcohol consumption, through changing what does give pleasure in the direction of more healthful pastimes, rather than simply imposing a ban heedless of how weighty it may feel for some.

I have been writing this set of essays in 2023 to the end of articulating a practical philosophy of health in what I have called a post-war period. This leads me to focusing on principles that allow us to maximize our capacity to support health while minimizing the harms our efforts may cause. Choosing to prioritize proportionality as central to our thinking can help us to do so. It can ensure we act, always, within the bounds of what is necessary to create better health for all, imposing on the public just as much as we need to, but never more than we must.

FORGIVENESS-
A Body Apology: Taking a Step to Befriend Your Body.
A Personal Perspective: Improve your body image with a genuine apology.
Reviewed by Abigail Fagan

Body dissatisfaction is rampant in our image-obsessed culture. In my psychotherapy practice, I’ve worked with kids as young as six years old who were already hating their precious bodies. I’ve treated people in their eighties who’ve been at war with their bodies for as long as they can recall. And I’ve seen nearly every age in between who bear the brunt of the cultural spell of body perfection.

I was lost in the brambles of a bad body image for decades. After many years and tears, I made a vow to befriend my body and as a result, I was moved to extend it a sincere apology. After all, if I spent years berating or mistreating someone else, I would surely owe them sincere amends.

If your body image has been less than kind, may my body apology inspire you to write one of your own.

Dear Body,
I am sorry for ignoring your hunger signals for so many years.
I am sorry for making you drink disgusting diet shakes and eat tasteless diet foods.
I am sorry for stuffing you with excess food and then shaming you when you were only responding to the restrictions and self-hate that I was inflicting on you.
I am sorry for comparing you to other women I knew nothing about and thinking you were supposed to look like them.
I am sorry I thought of you as an object to gain approval and attention, rather than the amazing miracle that you are.
I am sorry for hating every freckle, lump, and bump on your skin.
I am sorry for stuffing you into clothes that felt too tight and hating you when things no longer fit.

I am sorry for making you wear high-heeled shoes that felt way too cramped and uncomfortable.
I am sorry for criticizing you every time I saw your reflection in a mirror or a window.
I am sorry for thinking you could not leave the house without wearing make-up.
I am sorry for depriving you of rest when you were tired.
I am sorry for pumping you with caffeine instead of listening to your natural rhythms.
I am sorry you had to ingest unhealthy substances because I wanted to fit in and l didn’t yet know how to handle painful thoughts and emotions.
I am sorry I made you exercise in ways you didn't even like.
I am sorry I put you in situations you did not want to be in.
I am sorry I ignored your wise intuition and said “yes” to others when you clearly felt “no.”
I am sorry I stayed silent when you nudged me to speak up because I feared disapproval and rejection.
I am sorry I spent so much time criticizing you that I forgot to say thank you and acknowledge your amazing senses, systems, limbs, and organs.
I am sorry I thought my value as a human being was entirely dependent on you.
Oh, and I am sorry about those leg warmers and shoulder pads in the 80s!

If the cultural pressure of perfection has led you to criticize or neglect your body, perhaps you will join me in writing a body apology of your own.

BIAS-
Are You Seeing Patterns That Don't Exist?
How to protect yourself from the pitfalls of patternicity.
Reviewed by Ekua Hagan

KEY POINTS-
Humans have a natural tendency to perceive patterns even when none exist, which is known as patternicity.
Patternicity affects decision-making, as the brain seeks out patterns and connections even when they are not supported by evidence.
To protect oneself from patternicity, one should be aware of personal biases, seek out diverse perspectives, and consult relevant experts.

"A man sees what he wants to see, and disregards the rest." —Paul Simon

Humans are naturally inclined to seek out patterns in the world around them, even in situations where none exist. This tendency, known as patternicity, is a fascinating psychological phenomenon that has puzzled researchers for decades. A variety of factors contribute to our perception of patterns, including cognitive, perceptual, and social factors. One of the most compelling explanations for why we perceive patterns even when they don't exist comes from cognitive psychology.

In psychology, the cognitive process of schema formation involves the construction of mental frameworks or models that help us organize and interpret information from our environment. These schemas are built on our prior experiences and expectations, allowing us to quickly make sense of new information that matches our existing mental models. However, when we encounter information that does not fit our established schemas, our brains may attempt to reconcile the new information by "force-fitting" it into a pre-existing pattern, even if it is not a fit. This process is known as assimilation, where we try to interpret new information within our existing schemas. This can result in the perception of patterns that are not present, known as patternicity. The tendency to assimilate new information into existing schemas is a natural cognitive process but can lead to errors in perception and is a key aspect of patternicity.

How Does Patternicity Affect Us?
Patternicity affects our everyday lives by influencing how we perceive and interpret information. Our brains naturally seek out patterns and connections, even when they don't exist, and this can lead us to draw false conclusions or believe in conspiracy theories. For example, in politics, people may see patterns or connections between unrelated events, leading them to believe in conspiracy theories. Similarly, in sports, fans, and analysts may perceive a team's success or failure as part of a larger pattern, even when there is no clear evidence to support such claims.

Patternicity can also affect our personal beliefs and decision-making. We may rely on patterns we see to make decisions, even when those patterns are not supported by evidence. This can lead to biases and false beliefs, impacting our personal and professional lives.

Common Manifestations of Patternicity
Here are some common manifestations of patternicity:
Seeing faces in random patterns: People often see faces in clouds, tree bark, or other natural elements.
Superstitions: This refers to the belief that specific actions or events bring good or bad luck.
Conspiracy theories: This idea is that certain events result from secret, coordinated actions by a powerful group.
Pareidolia: The tendency to perceive meaningful patterns in random data, such as hearing hidden messages in music or seeing images in static on a TV screen.
Numerology: The belief that specific numbers have special meaning or significance.
Astrology: The belief that the positions and movements of celestial objects can influence human affairs and personalities.

Perceiving connections between unrelated events: People often perceive connections between unrelated events, such as believing their lucky charm helped them win a game.
Illusory correlation: The correlation is the perception of a relationship between two variables when no such relationship exists, such as believing that wearing a particular color shirt brings good luck.
Apophenia: The tendency to perceive meaningful connections between unrelated things, such as believing that a particular song on the radio is a message from a deceased loved one.
Seeing patterns in randomness: People often see patterns in random events, such as believing that a sequence of coin tosses is not random because there have been too many heads or tails in a row.

Protection From Patternicity
According to research in cognitive psychology, patternicity is driven by various factors, including the human brain's natural tendency to seek out order and meaning in the environment. However, there are several ways to protect ourselves from falling prey to patternicity.

Research has shown that awareness of our biases can help us avoid patternicity. A study by Stanovich and West (2007) found that people who scored higher on measures of cognitive reflection, which is the ability to recognize and overcome cognitive biases, were less likely to fall prey to illusionary patterns. Additionally, seeking out diverse perspectives has been shown to reduce the effects of confirmation bias, which is the tendency to seek out information that confirms our existing beliefs and ignore information that contradicts them.

Looking for alternative explanations and consulting experts can also help protect us from patternicity. Various debiasing strategies to help people overcome cognitive biases, such as seeking alternative answers and consulting experts, can be better equipped to recognize and counteract biases like patternicity and other cognitive errors. Research has shown that people who consult experts in the relevant field are less likely to fall prey to false beliefs and misconceptions.

Challenge Your Biases
Actively seeking out diverse perspectives and alternative explanations can help us avoid the dangers of patternicity and broaden our horizons. As the author Chimamanda Ngozi Adichie once said, "The single story creates stereotypes, and the problem with stereotypes is not that they are untrue, but that they are incomplete. They make one story become the only story." We can challenge our biases and thoroughly understand the world by seeking out multiple stories and perspectives. By being open to new information and actively seeking diverse perspectives, we can protect ourselves from falling prey to patternicity and develop a more nuanced worldview.