EATING DISORDERS-
“The Whale”: A Theme of Redemption.
Personal Perspective: My take on the Oscar-winning film.
Reviewed by Gary Drevitch

I hadn’t planned on seeing The Whale for reasons that had to do with the disrespectful depiction of obesity and fatphobia in movies, but when Brendan Fraser won an Oscar for his performance, I changed my mind because I love a good redemption story. I had no idea that the movie was also about redemption.

The Whale brought up strong emotions for me – but not the same feelings that many critics of the movie felt. Roger Ebert wrote that it’s “an abhorrent film, but it also features excellent performances. It gawks at the grotesqueness of its central figure beneath the guise of sentimentality, but it also offers sharp exchanges between its characters that ring with bracing honesty.” Many said it was hard to watch. People get uncomfortable around really fat bodies. In the film, the food delivery boy fell to the ground, running away, and the online students gasped when getting a glimpse of the central figure, Charlie, who was 600 pounds. I was sad and angry because the movie brings to light a common story of an uncommon life that few understand.

Activists protested that producers cast a normal-weight individual who wore prosthetics rather than hiring an obese actor. I felt the portrayal, although fabricated, was authentic and true to the human experience of living with severe obesity. Fraser was able to bring humanity to the role. We saw Charlie – the man, the father, the lover, the teacher, the good and decent person – without making this movie about his body. People don’t decide to end up in these body-bound and home-ridden situations; they all have real and sometimes tragic stories like the main character in this film. Religious trauma leading to suicide, love, loss, secrets, regret, redemption, and binge eating disorder are themes in Darren Aronofsky’s The Whale.

Throughout the movie, Charlie inflicted more pain and trauma on his body with every episode of binge eating. He eats to numb his pain but also sadly to harm himself. One binge episode, brought on by rage, was truly depicted: a frenzied, dissociative process of stuffing anything edible he could find. It wasn’t about the food. He understood that he was dying, his health compromised due to too much strain on his heart, and yet, he continues. He loses hope.

I have seen this play out in the lives of the clients that I treat. Those that want help have few options. We simply aren’t equipped to care for them. Many can’t get medical procedures that they need due to their girth, as the equipment will not accommodate their size. Even eating disorder treatment centers don’t have the proper furniture and special equipment for showering, transferring, and mobilizing. We once we spent six weeks preparing for a client’s admission to a reputable treatment center only for them to be discharged a day later because their “bariatric bed” was too small to accommodate the 450-pound client. It was a traumatic experience for her. Every treatment center that I have worked with that has tried to accommodate large-bodied clients has gone out of business because insurance wouldn’t pay to treat these individuals.

Loved ones are torn as to how to care for them. Charlie’s caretaker brings in supersized meatball subs, while his daughter offers only to make a turkey sandwich with no mayo – and yet, who is being crueler? It’s complicated. Within the medical and eating disorder treatment communities, we also can’t agree. There’s outrage over obesity medication and surgery recommendations, but binge eating disorder is a real mental health issue with no treatment options for those who need more than virtual cognitive behavioral therapy. We need to do better. Meanwhile, real people with real stories are suffering, feeling trapped in their own bodies and unable to leave their homes.

The movie, The Whale, was named for an essay by Ellie, Charlie’s daughter, about the book, Moby-****. He considered it the most honest piece of work he had ever read. Charlie implored his students to write something honest. The Whale may have had a metaphoric meaning, referring to Charlie's size, but this movie was not about his size; it was about honesty and being redeemed for mistakes. I hope we find redemption and figure this very real problem out.

STRESS-
Design With All Your Senses.
Being is more than seeing.
Reviewed by Ekua Hagan

KEY POINTS-
A person's dominant sense affects how they experience a particular space.
Designing a space solely based on looks is not enough to create a fully supportive experience.
Certain design materials may have unexpected downsides that aren't revealed until the designer tries them out.
Each of us has a dominant sense. That dominant sense significantly affects how the world around us influences our thoughts and behavior.

For a lot of us, our dominant sense is vision.
That means, as start to put the design for a space together, many of us get caught up in what it will look like—which is not surprising since we often seek design inspiration by reviewing options online and in design magazines.

However, vision is not the only sensory route from outside our heads to inside them. Many people experience the world through other sensory channels—they hear things and feel textures, for instance.

Regardless of the specific set of operational sensory apparatus we have, we combine the inputs we gather about our physical environment into one holistic impression. Then, we consciously come up with a plan for how to think and behave wherever we are.

Consider the full range of experiences in your space
When developing a space, keeping in mind the full range of experiences people will have in it will determine if you generate an alternative that simply excels on one parameter (for example, it “photographs well”) or an area that supports the life you planned.

A marble floor that’s lovely to look at can lead to annoying sounds as people walk across it. (For example, consider the clip of high-heeled shoes or the screech of sneakers.) A natural fiber that seems like the perfect fabric for the sofa, because it blends so well with the wallpaper, may be incredibly itchy under the elbows resting on the arms of that sofa. Or, perhaps even worse, it may not have a “positive” smell—for example, it may inherently smell like a wet dog or capture and retain the smell of any wet dog that happens to travel by it.

Spend time with your design materials first
It's best not to mentally commit to designing with something until you’ve spent at least a little bit of time in its presence—that’ll likely be enough to alert you to squeaky, itchy, and stinky stuff, for instance. Spending time with something before “working it in” can be difficult now that online shopping is such a big part of our lives, so be alert to return policies. Having to keep using something that’s unpleasant to spend time around can destroy your well-being.

Not all sensory consequences will be obvious
Bear in mind that not all of the bad sensations that tag along with the good ones will necessarily broadcast their undesirable presence.

An example: A chair that looks wonderful, positioned in the middle of a space with people walking in front of and behind it, won’t be an A+ place to be when the person sitting in it can hear movement behind them as they sit. Sensing movement behind us is stressful; when we were a young species, things behind us might have been getting ready to eat us, and our brains have not forgotten that. The visuals of that chair position and the sounds of someone actually sitting in it don’t align. (The more subtle lesson here: Layouts/floorplans have sensory consequences.)

Design for all of your senses so you can spend time in places where you and others live the lives that you’ve planned.

INSOMNIA-
AI Identifies Depression as Highest Risk Factor for Insomnia.
CDC study uses AI machine learning and health records to predict insomnia risk.
Reviewed by Ekua Hagan

KEY POINTS-
AI machine learning can identify individual risk factors for insomnia based on health record data.
A machine learning model using fully anonymized data from over 7,900 patient records found depression to be the strongest predictor of insomnia.
Scientists say the greatest strength of this algorithmic method of research is the ability of AI to review a massive amount of data without bias.

The use of artificial intelligence (AI) machine learning for healthcare screening, medical diagnostics, and life sciences is an exciting growth area. A new peer-reviewed study published in the journal PLOS ONE demonstrates how AI machine learning can identify individual risk factors for insomnia based on health record data and found depression to be the strongest predictor.

“Machine learning models can effectively predict risk for a sleep disorder using demographic, laboratory, physical exam, and lifestyle covariates and identify key risk factors,” wrote Alexander A. Huang and Samuel Y. Huang, who co-authored the research by the National Health and Nutrition Examination Survey (NHANES). “Depression, age, weight, and waist circumference were the strongest predictors of sleep disorder."

The retrospective study used fully anonymized data from over 7,900 patient records from adult Americans, aged 18 years or older, from the National Health and Nutrition Examination Survey (NHANES), a major program of the National Center for Health Statistics (NCHS) which is part of the U.S. Centers for Disease Control and Prevention (CDC).

“The greatest strength of this algorithmic method for identification of the covariates is the ability to search through hundreds of covariates systematically without relying upon judgment from the researcher, which may be muddled by potential personal biases,” the scientists wrote.

Each NHANES database patient record had over 680 variables with information from physical exams, lab data, and self-reported questionnaires, including the Patient Health Questionnaire (PHQ-9) for depression, as well as diet, exercise, and demographic information.

The nine-question Patient Health Questionnaire (PHQ-9) incorporates DSM-IV diagnostic criteria (American Psychiatric Association, 1994) for major depressive disorder (MDD) symptoms into a self-reporting survey that is used for diagnosing, screening, and monitoring the severity of depression in adults. The PHQ-9 is from the longer Patient Health Questionnaire (PHQ) assessment. Both the PHQ and PHQ-9 were created in 1999 via an educational grant from Pfizer Inc. by Robert L. Spitzer, MD, Janet Williams, DSW, and Kurt Kroenke, MD, and their colleagues at Columbia University.

“We observed that increased PHQ-9 scores were strongly linked to the odds of a sleep disorder,” the researchers observed.

The researchers conducted the study using four types of AI machine learning algorithms: Artificial Neural Network (ANN), Random Forest (RF), Adaptive Boost (ADABoost), and XGBoost. Out of these four, XGBoost performed the best with the highest mean AUROC (Area under the receiver operator characteristic curve).

“Machine learning models can effectively predict risk for a sleep disorder using demographic, laboratory, physical exam, and lifestyle covariates and identify key risk factors,” the scientists concluded.

INFIDELITY-
New Research on 5 Types of Infidelity and the Dark Triad.
A recent investigation examines the views of Dark Triad individuals on cheating.
Reviewed by Ekua Hagan

KEY POINTS-
New research examines the views of people with Dark Triad personality traits regarding infidelity.
Research shows Machiavellians rarely consider fantasizing about someone or forming intimate emotional bonds with strangers as being unfaithful.
Psychopaths, in contrast, tend to view emotional bonds and fantasizing, but not sexual acts, as infidelity.

A recent study by Brewer et al., published in Personality and Individual Differences, suggests there are five types of infidelity, and that personality traits (the Dark Triad traits) predict which of these acts are perceived as cheating.

The Dark Triad
The Dark Triad consists of three personality traits associated with manipulative and exploitative tendencies:

Machiavellians—People high on Machiavellianism are cold, cynical, and calculating.
Psychopaths—Individuals high on psychopathy are callous and ruthless but superficially charming.
Narcissists—Those high on narcissism tend to feel superior, entitled, self-important, and often jealous.
Note: Sometimes sadism is added to the list of the Dark Triad, forming the Dark Tetrad.

Sadists, simply put, enjoy causing others suffering. For instance, individuals who meddle and interfere in the relationships of friends and family may have sadistic tendencies.

What people with Dark Triad traits have in common is being manipulative, overvaluing themselves, devaluing others, and creating “justifications” for their views.

To illustrate, a narcissist may reason, “I deserve special treatment because I am more attractive, intelligent, and popular than others. People who disagree are either too stupid to see my superiority or too jealous to admit it.”

The study by Brewer and coauthors examined what unfaithfulness means to individuals with Dark Triad personality traits.

Investigating how Dark Triad personalities view infidelity
Sample: 676 (436 women); age range of 18 to 73 years (average of 30 years old), 72% heterosexual and 22% bisexual.

Measures
Mach IV: Twenty items measuring Machiavellianism (e.g., “Anyone who completely trusts anyone else is asking for trouble”).
NPI-16: Sixteen statement pairs measuring narcissism. For example, “I like to be the center of attention.”
Levenson Self-Report Psychopathy Scale: Twenty-six statements assessing psychopathy, such as, “For me, what’s right is whatever I can get away with.”
Perceived Infidelity Questionnaire: Twenty-one items. Participants were asked whether specific acts—such as having intimate phone conversations with strangers—should be considered cheating.

The Dark Triad and 5 types of unfaithfulness
The research identified five types of infidelity:
Emotional infidelity, fantasized infidelity, sexual infidelity, online infidelity, and hidden attachment (i.e. secret feelings of attraction).

Analysis of data showed the Dark Triad personality traits of Machiavellianism and psychopathy “predicted the extent to which specific acts were perceived to constitute infidelity.”

Namely, Machiavellians did not consider fantasizing an act of infidelity. Why?

Remember that Machiavellians are long-term strategists; their romantic relationships tend to be characterized by manipulation and exploitation. Hence, unless a partner’s fantasy interferes with their strategic goals of status or control in the relationship, Machiavellians might not worry about, say, erotic daydreams.

Neither were they, according to the data, inclined to see expressed emotion as infidelity.

This makes intuitive sense because Machiavellians dislike intimacy; therefore, learning that their mate has formed an emotional bond with another person does not worry them either.

The results showed psychopaths, in contrast, viewed emotional expression and sexual fantasies as infidelity.

This may be due to their keen sensitivity to infidelity and strong tendency to experience jealousy.

A second potential explanation is that due to a lack of empathy and deficiencies in perspective-taking, a psychopath may find it difficult to understand why his or her husband/wife engages in sexual fantasizing or has formed emotional attachments to others.

In other words, psychopaths cannot distinguish these behaviors from more blatant acts of infidelity.

Surprisingly, psychopaths were less inclined to “consider sexual acts or hidden attachment as indicators of infidelity.” Why? Psychopaths are more likely than others to commit sexual infidelity themselves; so, by saying sex outside the relationship is not cheating, they may be attempting to justify their own unfaithfulness and extramarital affairs.

Takeaway
New research identified five categories of infidelity:
Online infidelity: These included behaviors with clear sexual intentions but also ones with unspecified intentions (e.g., receiving pictures from a stranger).
Fantasized infidelity: Solitary sexual behavior, such as erotic fantasizing about a friend.
Emotional infidelity: Having an emotional bond with a stranger.
Sexual infidelity: Engaging in sexual behaviors with a person other than the partner.
Hidden attachment: Unexpressed/unfulfilled feelings of attraction to another individual.
Dark Triad personality traits correlated with the extent to which particular acts were seen as infidelity.

Machiavellians were less likely to consider emotional bonding or sexual fantasizing as cheating.
Psychopaths showed a greater inclination toward categorizing emotional attachment and fantasizing as cheating but less inclination toward doing so for hidden attachments and actual sexual behaviors.
(Note, there was no clear relationship between narcissistic tendencies and perceptions of infidelity.)

Individuals with Dark Triad personality traits are, by definition, manipulative, so it is not surprising that they seek particular types of sexual and romantic relationships (e.g., psychopaths’ preference for one-night stands) or have unique views of infidelity.

By learning more about how Dark Triad individuals use their partners to pursue hidden agendas (e.g., obtain money, status, control, admiration), we can become better at preventing being taken advantage of and manipulated by them. Knowing their views on what it means to be unfaithful is a first step in that direction.

DEPRESSION-
Why You Should Avoid Heartbreak Music After a Breakup.
Here's why you might want to save the sad songs for a different day.
Reviewed by Kaja Perina

People who come to therapy after experiencing a difficult breakup often mention that they have been turning to music as a source of emotional release. They sometimes ponder questions such as:

“Why am I drawn to sad music after a breakup?”
“Is it healthy to seek solace in the same breakup song over and over again?”
“Is listening to sad songs making me cynical about my love life?”
It is clear that music holds immense power to move us. A 2015 study found that one key reason behind the phenomenon has to do with the "default mode network," which is a set of interconnecting brain networks involved in conscious awareness, self-reflection, and autobiographical memories and emotions. When we experience emotional pain, our default mode network can be thrown out of whack. Listening to our preferred music can flip it back into gear – engendering a sense of familiarity and safety in the midst of a tumultuous period.

The jury is still out, however, on whether matching sad music to a sad emotional state is actually therapeutic. Here are two findings that may help clarify your questions about how listening to sad songs affects you after a breakup.

1. Some people are more prone to negative emotions from sad songs.
A 2021 paper published in the journal Psychology of Music found that people listen to sad music for aesthetic pleasure, to cope with negative emotions, and to find comfort. Individuals high in personality traits such as absorption, empathy, and openness to experience were found to be more likely to appreciate sad music and rely on it to work through their difficult emotions.

Additionally, the study showed that a significant number of adolescents (17%), particularly girls, were negatively affected by listening to sad music. These findings suggest that while sad music may not have a universal effect on mood, certain individuals, especially those with a specific set of personality traits, may be more susceptible to experiencing negative emotions due to sad songs.

As a listener, you need to understand that not everything you hear in a song is based on reality. So, while sad pop songs can be appreciated for their artistic sensibilities (and can sometimes even help improve your mood), relying on them for mental health support is not advised as they can sometimes, intentionally or unintentionally, glamorize mental health issues.

If you are experiencing distress or suspect that a breakup is affecting your life in self-destructive ways, reach out to a mental health professional who is trained to effectively deal with such a situation.

2. Breakup songs can make moving on from an old relationship harder.
An over-reliance on heartbreak anthems to get you through a difficult breakup can make you feel like you are trapped in a constant state of separation from your former partner.

A study published in PLOS ONE found that nostalgia, not necessarily sadness, is the most likely emotion one experiences when listening to a sad song. While it may be comforting to reminisce about happier times with an ex, constantly dwelling on the past can prevent someone from moving on and forming new romantic connections in the future.

Sad songs have their place in dealing with a breakup initially, as they can help you look at your old relationship, cherish the good memories, and examine the unhappy ones. However, research cautions against ruminating on the things you or your ex could have done differently, as it can quickly go from an innocent trip down memory lane to an exercise in pointing fingers.

Conclusion
Open discussions about mental health are now commonplace in pop culture and vernacular, a welcome change to the status quo. However, this can sometimes lead to a glamorized depiction of sadness. It is crucial to seek professional help for any serious distress you may experience due to heartbreak.

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