Power drills vs. dental drills

At the beginning of this year I went to the dentist for the first time in… a while, and learned I had five cavities. Five! I brush my teeth – I even floss! – but somehow three of my old fillings had failed me and two new ones were needed. This wouldn’t have been that big of a deal except… and now you’re really going to judge me… I am afraid of Novocaine.

Now, let me say as clearly as I can: this is a 95% irrational fear. Novocaine is extremely safe and I trust my dentist to use it properly, and I am even fairly certain if I used it nothing bad would happen. But because I have an anxiety brain, this was my thought process upon learning I needed five fillings:

Shit, that’s going to be expensive and take a while. Also, crap, they’ll give me Novocaine, and that has the potential to cause heart palpitations, and I’ll probably already be having them because I’ll be nervous, and that could create a dangerous situation, oh shit shit how do I get around this?

Again, Novocaine is extremely safe. Irregular heart beat is a very rare potential side effect associated with many medications – it’s part of the generic list of allergic reactions a step above itchiness and swelling. But since I’ve dealt (rather poorly, I’ll admit) with heart palpitations caused by stress and anxiety for years, I am hyper-vigilant about avoiding situations that might cause them. So, how did I get around it? I opted out. I said no to the Novocaine and sucked it up. And yeah, it hurt. I spaced the procedure out into three visits to spread out both the cost and the pain. In the end, each procedure took less time than it would have with numbing, and I was able to eat and drink right afterward. Most of all, I survived (which of course I would have regardless). The dentists and hygienists kept calling me a badass and saying how well I handled the pain, but I wasn’t proud; I was honestly a little embarrassed, and exhausted, and sore.

As I waited in the chair for each procedure to start, I stared at a flat screen monitor. The first time it scrolled through pictures of cute kids and puppies (including a truly awesome slideshow of dogs that look like other things); on my second visit it was a silent presentation about my dentist’s trip to Haiti, complete with facts about the country; and on the third and final visit I was treated to calming videos of waves crashing on sand.

During each procedure, there was a moment or two when I thought I couldn’t handle any more – when the drill would hit a specific spot on the tooth that was just too close to a nerve. During those times, I had the old calming television standby to distract me from another monitor on the ceiling: HGTV. (I have seen this in at least one other dental office and several specialists’ offices – there’s just something about Chip and Joanna…) And I have to tell you, these things worked. In the moments I would have gritted my teeth at the pain (which was obviously impossible) I instead focused all of my energy and attention on the wall demo or sconce selection happening on the ceiling screen. And it worked, in the sense that avoiding a full-on panic attack or biting off my dentist’s fingers = “working.” Which… I’ll take it!

It’s not shiplap that helps with pain and anxiety in the dental chair – it’s that shift in energy and attention. And it still works on me even though I know this. And I actually found myself thinking, as I left the dental office for the last time (for a while, at least…I hope…) that I really wish more medical offices had this kind of programming. Not just HGTV, but slideshows and silent videos made with the explicit goal of helping patients calm down. Not just cheesy quotes about serenity, but soothing images that are scientifically correlated with lower blood pressure and cortisol. Imagine if more clinicians acknowledged that we might be anxious, and rather than ignoring that or explaining it away, just empathized with it and tried to set a calmer tone. This sort of thing is relatively common in dentistry and in pediatrics; imagine if our anxiety and potential medical trauma was taken more seriously even in cardiology, physical therapy, dermatology, and other offices! I think it’s something to work toward.

 

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Empathy is both given & made

When the subject of empathy comes up, there’s often a debate about whether we’re born with it, or whether it’s something we learn. As with most things, the answer is probably not at either end of the spectrum  – it’s most likely in the middle.

In the past few months, I’ve been researching and writing about both ends.

For Woolly, I wrote about the empathy movement in podcasting, where a growing collection of shows aims to get people to listen to (and have) tough conversations. I wrote about my personal retreat into podcasts (and away from cable news and social media) after the 2016 presidential election, and how some of them – especially With Friends Like These – helped me find empathy where I didn’t expect it.

Then I wrote for Vitals, Lifehacker’s health vertical, about the newest development in the search for an empathy gene. Researchers have figured out that at least some of individuals’ differences in empathy can be explained by DNA, so we might inherit our empathy levels, and disorders characterized by low empathy, like schizophrenia, might have a genetic cause. But they’re still trying to find out how. This latest study didn’t come up with any major revelations, but it’s a step forward, and it also validated a lot of previous findings.

That’s all for now. Apologies for being so absent these past few months. I moved from New York back to North Carolina and have been settling in. Now that things are starting to feel normal, I’ll be back to blogging more regularly!

When the robots do it better…

Ellie
US soldiers and veterans revealed significantly more post-traumatic stress symptoms to a virtual interviewer than through a standard or anonymous Post-Deployment Health Assessment survey. CREDIT: USC Institute for Creative Technologies

It’s clear that PTSD is a major problem among American war veterans. According to the U.S. Department of Veterans Affairs, symptoms of PTSD affect almost 31 percent of Vietnam veterans, up to 10 percent of Gulf War veterans, and 11 percent of veterans who served in Afghanistan. But, as with many mental health issues, those numbers might be off because there is still a stigma attached. Veterans Affairs can’t count — or help — the soldiers who don’t feel comfortable coming forward. But what if instead of talking to people who might affect their careers, they could talk to robots?

Not, like, Bender robots, but artificial intelligence presented as kind strangers on a computer screen. In a recent study that used this technology, the AI made a big difference. Researchers at the University of Southern California found that service members who volunteered to try this out were more open about their symptoms with the “virtual human” they spoke to than they were when filling out a military required survey. Gale Lucas, who led the research, thinks this is likely because when PTSD symptoms are conveyed via the military survey (or directly to a military psychiatrist) they must be reported, which can affect service members’ career prospects. Speaking to the AI, known as “Ellie,” felt more anonymous.

“These kinds of technologies could provide soldiers a safe way to get feedback about their risks for post-traumatic stress disorder,” Lucas said in a statement. “By receiving anonymous feedback from a virtual human interviewer that they are at risk for PTSD, they could be encouraged to seek help without having their symptoms flagged on their military record.”

So, can AI provide potential life-saving empathy that real humans can’t?

Well, there’s (at least one) catch. Ellie makes soldiers feel comfortable, safe, and understood, but she is currently operated by researchers. If and when she becomes integrated into the military health system, she might lose her real magic: anonymity.

Joseph Hayes, a psychiatrist at University College London, told Newsweek

“For an intervention to be possible ultimately, the disclosure would have to be shared with the same commanding officers who have traditionally received the results of the service members PDHA, and entered into their military health record. Once this is made explicit, would disclosure reduce to levels seen previously? If so, it is a culture change (reducing public stigma–within the military and more broadly) which is truly going to impact on disclosure and provision of appropriate treatment.”

Lucas thinks her team can get around this by only requiring Ellie to alert humans if a service member threatens to hurt him- or herself or someone else, and leaving it up to the individual whether they want to follow up their session with the AI with a session with a real doctor.

The jury’s out on the ethics and implementation, but this is one more step toward empathetic AI, which is… well, both exciting and terrifying!

To learn more about this technology, check out the USC Institute for Creative Technologies website.

 

On empathy and stress

Last week, I reached a stress peak.

I’ve always experienced a slightly higher-than-average level of anxiety, and after several weeks of disturbed sleep and steadily increasing work stress, I sort of lost it. Instead of spending the (finally) warm Brooklyn weekend outside, I spent most of it in bed, binge-watching Netflix and trying to recover from burnout. I even canceled my Easter plans to visit family. This week, I feel a lot better, and I’m beginning to analyze what went wrong in order to avoid repeating the same cycle in the future. So when this study about the connection between stress and empathy popped into my inbox, I was intrigued.

Stress is often described as part of our biological “fight or flight” response. When we get too stressed too often, our bodies can start to mistake relatively benign situations for potentially dangerous ones, and we can get stuck in “fight or flight” mode at inappropriate times and for long periods. There are a lot of other things at play as well – I don’t want to simplify stress! But for the purposes of understanding this research, let’s think about it that way. And then let’s shake up that thinking, because, according to Science Daily,

“NEWER FINDINGS REVEALED THAT HUMANS SHOW AN INCREASE IN PROSOCIAL BEHAVIOR UNDER STRESS.”

That’s prosocial, as opposed to antisocial, the latter of which is generally how one would describe fighting or fleeing. Claus Lamm and his team from the University of Vienna asked study participants to solve difficult tasks under a time limit while providing regular negative feedback (hello, stress) and measured their cortisol levels and brain activity. Then, they showed the participants photos of painful medical procedures and asked them to “vividly imagine” the pain of the patients in the photos. In some cases, they told the participants that the patients had received anesthesia. The researchers then also played the experimental economics “dictator game,” in which participants have to distribute a certain amount of money in whatever ratio they see fit (it’s used to test self-interest).

According to the fMRI results, the participants’ neural empathy networks reacted more strongly to the painful-looking images when they were under stress. The surprising thing was that this was true regardless of whether or not they believed the patient in the photos had received anesthesia. The same neural activation also reportedly correlated with the amount of money shared during the “dictator game.” The stronger the apparent empathy reaction in the game, the more money the participant shared.

“OUR RESULTS THUS SUPPORT THE HYPOTHESIS THAT HUMANS SHOW MORE EMPATHY AND ARE MORE PRONE TO HELPING OTHERS WHEN THEY ARE UNDER STRESS, BUT THAT THEIR PERSPECTIVE TAKING SKILLS MIGHT DETERIORATE,” SAID CLAUS LAMM.

Which is perhaps why, even though I felt myself getting more and more stressed out over the past few weeks, I kept saying yes to bids for my attention, work, and physical presence. It wasn’t until I had to leave a meeting to catch my breath and then cancel everything for a long weekend that I snapped out of this empathy-stress-empathy cycle.

Now that I’m on the other side of my stress crisis, I can see how I misread several situations during that time, and how internalizing those misread emotions so deeply could have caused further unnecessary damage to my already frayed nerves. Think about it – do you feel especially affected by others’ emotions and experiences when you are stressed yourself? When you’re at your wit’s end, do you feel like you empathize more with each person who asks you for something, or the main character in the show you’re binge-watching? Or are you more likely to shut down?

Of course, this is just one piece of research. But if Lamm had put me in an fMRI machine this time last week and asked me to look at photos of patients undergoing painful medical procedures, anesthesia or not, I certainly would have felt something!

Empathy = hygge?

I have been thinking a lot about Denmark, recently. For one thing, Pinterest learned that I’m interested in Scandinavia and started really pushing Copenhagen on me. So I started researching the city a bit more, and learning about things like hygge, and the place is really growing on me. Not only is it gorgeous and apparently a hipster haven (apparently Brooklynites fit in quite well over there), the country is really serious about empathy.

If you’ve been following along here lately, you know empathy is a topic of particular interest for me. So when I saw this story start to circulate earlier this month, my ears perked up. I’ve been doing a bunch of research lately into psychological and sociological beliefs about empathy, particularly the question of whether or not it can be taught. Many seem to have come to the conclusion that it can, but the question of how is a bit trickier, especially because different cultures seem to approach and define empathy differently.

According to some recent research linked in the Quartz story above, an empathy deficit may be leading to higher levels of anxiety and depression in teenagers in the U.S. Over in Denmark, they’ve been taking this issue to heart for a while longer, and as Quartz explains, empathy building is a required part of the school curriculum for students between the ages of six and 16. During these workshops, which sound like mini group therapy sessions, students talk about interpersonal issues. The goal is to create a nice sense of coziness – hygge! – and ultimately more empathy.

The most interesting part of this story to me, though, was the end, when the author notes that while Denmark is often held up as one of the happiest countries in the world, some studies have suggested that’s because Danes have lower expectations for happiness, and there isn’t evidence that they actually have an easier time with mental health than us. So, it’s hard to tell whether this empathy training in schools is really working. But maybe taking empathy seriously as a nation is good enough, for now? What do you think?

What we can say, and whether we should

I love the First Amendment. I really do. It’s why I have my job. It’s why you get to watch bro movies and cooking shows on Netflix. It’s a big part of the reason that this country even exists. Obviously, with the good comes the bad. The First Amendment – the inability for the U.S. government to make laws that abridge freedom of speech, religion and assembly – is also the reason we have things like Donald Trump and naturalnews.com. It’s give and take, but ultimately it’s worth it.

In college, I took a media law class that included a moot court experience. It was SCOTUS role play, and I was nicknamed “Ruth.” If you know me, that’s probably not surprising. I don’t remember what case we discussed, but I remember it was about the First Amendment, and I remember grappling with this idea that yes, even horrible things people say are, for the most part, legal, and cannot be censored by the government. At the time, I was still learning what it really meant to be a journalist, and what kind of power a writer can have. I was learning my own voice, and the responsibility that I would have once I published something – anything, journalism or not. I remember sitting in the small auditorium, channeling RBG but fielding so many emotions. Some things are just wrong, I thought, and we should discuss why. But in that class, and in my brief encounter with studying for the LSAT and my 3+ years writing about the law, I learned that there’s a big difference between what’s legal and what’s “right.” There is overlap, sure. But while Little Kait once believed that laws were made only to help people and ensure everyone got along while living the American Dream, Grown Up Kait understands there is nuance. Thankfully, there is also ethics.

Today, an essay on xoJane in which one woman shared her opinions and feelings about another woman’s mental illness and death, went viral. The author of the piece concluded that this person – who she didn’t know very well and hadn’t spoken to for a while, and didn’t particularly like – was better off dead, because she was so mentally ill she must have been miserable, and also quite a burden to her family. I’m paraphrasing, but if you Google “xoJane” today, you will see several response pieces and probably also a cached copy (xoJane took the piece down and replaced it with an apology after the obvious blowback). Apart from the obvious question – why is this an “essay” worth publishing? – this brought out a lot of concern in the online writing community. One reason: it essentially encouraged the idea that if one is extremely mentally ill, one may be better off dead, something that people who are already more likely to consider suicide really don’t need to hear. The second reason: it’s yet another symptom of the clickbait outrage manipulation machine. Media critic Jenn Pozner calls these #clickbaitcrimes. Sites like xoJane and YourTango mine for the juiciest, most scandalous stories and opinions (or stories and opinions that they can make juicy and scandalous with wild headlines) and throw their authors to the wolves. And sometimes those wolves are rightfully hungry.

This piece was obviously horrible, and it started a lot of good conversations about mental health and media ethics, hopefully before it did any damage. But it also brought out the trusty First Amendment argument, and its little sister “censorship!” I was really disappointed to see several writers – including journalists – argue that unpublishing an essay like this is censorship that puts publications on a “slippery slope” toward silencing any “unpopular opinion.”

It is my hope that most people can see this situation for what it really is – not just an unpopular opinion or poorly-written essay, but a missive that could cause real harm to vulnerable people, and not a government-sanctioned silencing of protected speech, but private companies and groups choosing not to associate with such content. Not all writers are journalists, or go to journalism school. And I understand how attached we are to the ability to share our thoughts and opinions through the written word. But I think deep down, most of us understand that doing so is a privilege, not a right. If a publication or group decides that they think we are dangerous, or unfair, or simply not good at writing, they are within their rights to say so, and take action. And the great news is that we are within our rights to spread our views elsewhere. As much as it pains me to say it, there are dozens of other websites that would publish this woman’s words and not think twice, no matter the response. And no law should prevent them from doing so. But, ethics…

Ethics aren’t something that can be forced on anyone. In the writing community, we don’t have any kind of code that we have to sign in order to publish. We do have the Society of Professional Journalists, which does a great job of setting standards and best practices, but not all writers are journalists, and not all journalists agree with what the SPJ has to say. Ethics, in general, are often very personal. They come from experience, education, empathy. They take work to cultivate and truly put into practice.

My worry is that with the current clickbait outrage manipulation machine, in which publications like xoJane and its parent company Time Inc. want you to be upset, want you to comment, want you to share indignantly, people aren’t taking time to develop these ethics, or implement them. And I don’t just mean writers – an editor had to say “OK, sure!” to the piece celebrating an ex-friend’s death. I think the solution to this is better media literacy, which is a huge issue that I am working on getting more involved in. But in the meantime, I hope writers – who I know are tired, and broke, and struggling – will be more careful with the way they treat the First Amendment. Bringing it up as a reason why someone like the author mentioned above should not be criticized, or asked to leave a publication or group, is inaccurate, and it’s frankly a cop out. The First Amendment is vital, it’s important, and yes, it protects even words we do not like. But it’s not a substitute for ethics.

Memory, anxiety and the “full brain”

I often wonder if my brain can get “too full.” Not permanently — no, even I am not narcissistic enough to believe I could ever know that much — but temporarily. I worry that all of the little bits of information coming at me (and all of us) all the time might have some larger affect on my ability to remember more valuable things. Are Facebook statuses and Tweets and pop-up ads cluttering up precious space that I need for financial articles and interviews?

Wired had a great piece this afternoon answering this very question, and leading me to ask some more of my own.

It turns out that yes, you can clutter yourself up too much sometimes, but it’s unlikely for your brain to ever reach its max. Some people even have issues forgetting, which can be really problematic for various reasons. Take a look at the piece – there are some links to research and some really interesting points about how memory works and about the true difference between short- and long-term memory.

This piece also left me wondering about some things about my own brain. I personally have a lot of trouble with long-term memory. I don’t remember much from more than a few years ago. I remember bits and pieces — scenes, smells, places, people — but I can almost never recall full events. Maybe there’s a particular name for this, I’m not sure. And maybe no one can truly remember much more than me — there’s a lot of evidence that many of our memories are basically filler (see links in above-linked piece). But it’s always bothered me that while I know intellectually that they happened, I can’t actually remember a lot of my “firsts” or happenings that other people in my life deem important. Sometimes this is OK, like when my fiancé remembers a fight from five years ago that I thankfully do not, but sometimes it’s a little sad. No, I don’t remember going on that trip with my family, or what it felt like the first time I rode a bike, or what I got for my 17th birthday.

I know that people can sometimes “block things out” after a traumatic experience, but nothing in four years of therapy has suggested that I had such an experience. I did, however, grow up with a lot of anxiety. (Outing myself here – and not for the first time on this blog – that’s why I’m in therapy!) The more I read about how memory works, the more I wonder if that has something to do with my limited recall ability. Maybe something to do with “working” memory?

From the Wired piece:

Juggling more than just a few pieces of information in your head at once is really hard. Throw one item too many into the mix and you’ve forgotten the name of the person you were just introduced to, or lost the idea you had before you got that phone call.

If that’s true, and if working memory is the foundation of long-term memory (my reading suggests that this may be true?) it seems like it wouldn’t be a far stretch to suggest that a child or teenager who is constantly thinking or worrying about something else in the back of her mind might have a tough time building long-term memories. I’m looking forward to reading more about it; let me know if you have suggestions!