Equivalence of St John’s Wort Extract and Fluoxetine: A Randomized, Controlled Study in Mild-Moderate Depression
Stephanie Shanti ©
In European countries, St John’s Wort tablets, also known as Hypericum, are often prescribed for the treatment of mild depression. According to the authors of the present study, Hypericum prescription accounts for 25% of all antidepressant drug sales in Germany, and can be purchased over the counter in various countries.
One of the main issues therapists are faced with when prescribing synthetic Selective Serotonin Reuptake Inhibitors (SSRIS) antidepressants such as Fluoxetine (Prozac) is the poor patient compliance. When suffering from mild to moderate depression, patients often choose to endure the symptoms of the depression rather than deal with the numerous side effects of the SSRIs.
To this day, the antidepressant effect of Hypericum extract is not well understood. There seems to be some indication of serotonin reuptake inhibition during transport, thus increasing extracellular serotonin concentrations. Furthermore, the extract also seems to influence night-time plasma levels of melatonin, thereby contributing to the antidepressant effects.
The purpose of Schrader’s study was to evaluate the efficacy of Hypericum tablets compared to the efficacy of Fluoxetine for the treatment of mild to moderate depression. Both drugs were given for a period of 6 weeks, in a randomized, double-blind, and parallel group comparison. Patients were evaluated with the Hamilton Depression Scale (HAM-D) by trained physicians and diagnosed with mild to moderate depression according to ICD-10 standards.
Participants were 240 outpatients (65% females; 35% males) with a mean age of 46.5 years. Participants in the two groups were either given Fluoxetine (114) or Hypericum (126). Both groups yielded equivalent scores on the HAM-D scale. Hypericum active and placebo tablets were distributed along with capsules containing Fluoxetine or placebo, thus insuring treatment blindness.
The researchers assessed participants with the 21-item Hamilton Depression Score, the Clinical Global Impression, anxiety/somatization subscores, depression subscores, and patient self-assessment with the Visual Analogue Scale (VAS).
To assess for efficacy of treatments, the researchers defined the protocol according to change from baseline (week 0) to endpoint (week 6). Thus, the efficacy of Hypericum would be considered equivalent to that of Fluoxetine if scores from the Hypericum group were less than 3.0 points of final mean HAM-D of the Fluoxetine group.
All participants were 18 years or older with a baseline depression score of 16-24 on the HAM-D scale, thus fulfilling the diagnostic criteria for mild-moderate depression. Researchers excluded from participation into the study all people with a history of alcohol or substance abuse or dependence, those suffering from dementia, severe intellectual impairment, history of seizures, glaucoma, pituitary deficiency, suicidal ideation, thyroid or parathyroid pathology, Parkinson’s disease, as well as pregnant or breast feeding women. Patients previously treated with Monoamine Oxidase (MAO) inhibitors or SSRIs underwent a “washout” period before participating in this study. Furthermore, concomitant treatments such as quinidine, anticholinergic drugs, cimetidine, cardiac glycosides, neuroleptics, sympathomimetic drugs, MAO inhibitors, Tryptophan, and any other antidepressants, were not allowed during the study.
Results indicated no statistically significant differences between the two treatment groups. Thus, confirming the hypothesis that Hypericum is equivalent to Fluoxetine in the treatment of mild-moderate depression. After analyzing secondary variables, it was noted that patients in the Hypericum group demonstrated more improvement on the overall HAM-D scores than patients in the Fluoxetine group. Also, responder rate for Hypericum was greater than for Fluoxetine (60% versus 40%, respectively).
The analysis of safety favored the herbal remedy over Fluoxetine. Side-effect events were mostly reported in the Fluoxetine group (72%), while only 28% patients in the Hypericum group reported mild reactions. Reported events in the Fluoxetine group were agitation (7.9%), gastrointestinal disturbances (6.1%), retching, dizziness, tiredness, anxiety, and erectile dysfunction. Only 4.8% of patients in the Hypericum group reported gastrointestinal disturbances.
Critique
Responding to an increasing demand for natural remedies such as Hypericum and the need to substantiate the claims of its efficacy and safety, this study was conducted following methodological and strict protocol. Physicians involved in the evaluation of patients were rigorously trained in the use of all assessment scales, and only one scorer was allowed per centre. Furthermore, this study was conducted on a double-blind basis and all medication was encapsulated. Finally, medical attention was provided to ensure a washout period of all previous antidepressant treatment to avoid any interactions.
Statistical results not only corroborated the initial hypothesis that Hypericum was equipotent to Fluoxetine, but also indicated that Hypericum might be more appropriate to relieve symptoms of mild depression compared to Fluoxetine. This finding is extremely useful for clinicians who favor the use of safer alternatives to synthetic antidepressants.
This study confirms previous findings of tolerability of Hypericum under strict adherence to a double-blind format in an objective setting. As a result, clinicians treating patients with mild-moderate depression should favor the use of Hypericum, based on both its efficacy and safety.
This study was well designed and the sample size was large enough to yield significant results. The implications of the findings should be regarded as highly significant considering all the side effects and dangers associated to synthetic drugs.
Reference
Schrader, E. (1999). Equivalence of St John’s Wort extract (Ze 117) and Fluoxetine: A randomized, controlled study in mild-moderate depression. International Clinical Psychopharmacology, 15, 61-68.
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What is the Relation Between Meat Consumption and Cancer?
Stephanie Shanti ©
This article is a review of scientific research on the link between meat consumption and the development of various forms of cancer.
According to Genkinger and Koushik (2007) significant variations in incidence rates of cancer around the world, are suggestive of a link between diet and cancer. About 35% of all cancers can be attributed to diet, which is similar in magnitude to the contribution of smoking to cancer. Furthermore, meat consumption has been directly linked to cancer incidences in over a hundred epidemiological studies. To this day, the interaction between meat consumption and colorectal cancer has been a major focus in research. Also, Genkinger and Koushik (2007) report that high intake of red meat is associated to 20% to 60% increased risk of cancer of the colon and rectum, esophagus, liver, pancreas, and lung. What is more, processed meats alone increase chances of lung cancer by 16%.
In the United States, colon cancer is the third leading cause of cancer incidence and mortality. High consumption of red meat is a known risk factor for colorectal cancer, whereas high consumption of vegetables has a protective effect against most forms of cancer.
According to Kuriki et al. (2005), a study in Japan demonstrated a significant increased risk of cancer in men consuming meat daily, with few or no vegetables. Therefore, certain researchers have proposed that colorectal cancer in industrial countries could be prevented by modifying dietary habits.
In their study, Kuriki et al. (2005) demonstrated a major interaction between moderate to high meat consumption and the CD36 gene A52C polymorphism, and the risk of colorectal cancer. The CD36 gene plays an important role in metabolism of long-chain fatty acids; meat and animal products are extremely high in fat content.
Food-derived heterocyclic amines (HCAs) are mutagenic and carcinogenic compounds resulting from cooking meat at high temperatures. These HCAs have been linked to higher cancer incidences in Western populations. Therefore, barbecues and other meat cooking methods increase chances of later developing some form of cancer (Koh, Yang, Yang, Low, & Seow, 2005).
According to Nowell, Ahn, and Ambrosone (2004) consumption of meat is also reported to be associated with an increased risk of breast cancer and prostate cancer. On the other hand, high consumption of fruits and vegetables provides protection against many types of cancers. Thus, fruits and vegetables contain elevated amounts of antioxidants, such as carotenoids, the tocopherols, and ascorbic acid, and may be important in preventing the onset or progression of cancer.
References
Genkinger, J., & Koushik, A. (2007). Meat consumption and cancer risk. PLoS Medicine, 4, 1883-1886.
Koh, W-P., Yang, H-N., Yang, H-Q., Low, S-H., & Seow, A. (2005). Potential sources of carcinogenic heterocyclic amines in the Chinese diet: results from a 24h dietary recall study in Singapore. European Journal of Clinical Nutrition, 59, 16-23.
Kiyonori, K., Nobuyyuki, H., Hitoshi, C., Yukihide, K., Takashi, H., Tomoyuki, K., Toshiko, S., Keitaro, M., Koichi, K., Shinkan, T., & Kazuo, T. (2005). Increased risk of colorectal cancer due to interactions between meat consumption and the CD36 gene A52C polymorphism among Japanese. Nutrition and Cancer, 51, 170-177.
Nowell, S., Ahn, J., & Ambresone, C. (2004). Gene nutrient interactions in cancer etiology. Nutrition Reviews, 62, 427-435.
The Hidden Persuaders: Persuasion Techniques and Propaganda in the Midst of our Society
By Stephanie Shanti © 
Abstract
Beginning with the Catholic Church and the dissemination of Catholicism throughout the world, propaganda has established itself as a strong weapon in the area of psychological influence. From Nazi Germany to modern marketing and warfare, the principles of persuasion remain unchanged. With the use of specific methods such as repetition, emotional arousal, humor, worry, and subliminal messaging, individuals fall prey to various types of unconscious control. In a modern era of technology where individuals are bombarded by the media on a constant basis and are thus subject to influence of various types, it is crucial to remain informed. This research paper offers an overview of the diverse effective techniques in the domain of persuasion and behavior change.
The Hidden Persuaders: Persuasion Techniques and Propaganda in the Midst of our Society
If you examine propaganda’s most secret causes, you will come to different conclusions: then there will be no more doubting that the propagandist must be the man with the greatest knowledge of souls. I cannot convince a single person of the necessity of something unless I get to know the soul of that person, unless I understand how to pluck the string in the harp of his soul that must be made to sound. (p. 24)
In March 1933, immediately after his appointment as Minister for Popular Enlightenment and Propaganda in Hitler’s first government, Josef Goebbels expressed the above view concerning propaganda (Welch, 1999). In his short statement, Goebbels described the mechanisms needed to ensure the efficiency of the propaganda methods. Hence, as he put it “the propagandist must be the man with the greatest knowledge of souls”.
The purpose of this research paper is to demonstrate how the knowledge of persuasion methods has been applied throughout history to manipulate the masses and control behaviors. Social psychologists have devised numerous experiments in order to understand the hidden mechanisms of behavior and the ways to affect change. The search for persuasion methods has become a hallmark in the annals of social influence. Not only has psychological knowledge of collective behavior been useful in understanding the motivations behind human actions, this knowledge has been exploited in the domains of politics and marketing as well. Governments have consulted with social psychologists to help them plan warfare techniques, thus applying principles of persuasion and propaganda to influence the enemy, politicians have resorted to such techniques to influence popular beliefs and gain support, sales people have relied on persuasion and deception techniques to sale their goods, and marketers have influenced the masses through the media in order to improve profits made by big corporations.
Beginning with the dissemination of religious dogmas by the Catholic Church, cardinals under the orders of Pope Gregory XIII (r.1572-85) were charged with spreading Catholicism in non-Catholic lands. A generation later, in 1622, Gregory XV coined the term “propaganda” in order to manage foreign missions. The term later evolved to encompass all techniques employed in the dissemination of ideas. In modern times, propaganda has become synonymous with lies, deceit, and brainwashing (Welch, 1999).
Throughout history, those in power have always attempted to influence the way commoners see the world. The Nazis had their Ministry of Propaganda, the Soviets had their Propaganda Committee of the Communist Party, while the British had a Ministry of Information, and the USA an Office of War Information (Welch, 1999). As a result, the employment of propaganda techniques has increased steadily, building on previous findings and adjusting to new trends.
According to Hitler, propaganda had to be simple, concise, and repeated frequently, with emphasis on such emotional elements as love and hatred. Through the continuity and sustained uniformity of its applications, propaganda would lead to results that are “almost beyond our understanding” (Welch, 1999, p.25).
With the acquired knowledge on propaganda accumulated during WWII, political scientists and sociologists theorized on the nature of man and modern society. In post-war consumer society, individuals were viewed as malleable and prone to manipulation. Thus, culture had been reduced to the lowest common denominator for the purposes of mass consumption. As a result, the use of propaganda could now be extended to “enter the thoughts of the masses and control their opinions and behaviors” (Welch, 1999, p.25).
As part of a societal framework, social behavior is predictable. Thus, propaganda and persuasion can be used through various media to shape collective behavior. In modern society, individuals are bombarded with shows and advertisements through radio, television, and the internet. Furthermore, newspapers, magazines, books, movies, and pamphlets also depict “societal norms”. As part of a mass communication network, individuals are collectively exposed to the same information, ideas, and emotional messages (Tesar & Doppen, 2006).
In their article, Tesar and Doppen (2006) provide a relevant example of the insidious power of advertising on the young generations. Considering that by the end of high school, the average American child will have spent 15,000 hours in front of the television (Gollnick & Chinn, 2002), and that most advertisement aimed at children is sponsored by the food industry, it follows that American society accounts for the largest number of overweight children worldwide. Because the media influences collective behavior and helps shape culture and how people define themselves, the constant stream emanating from the television sets into people’s minds tells them how to act, dress, eat, talk, and think in ways that reflect collective behavior ( Tesar & Doppen, 2006).
With the use of the media, another way of manipulating behavior and influencing thoughts is subliminal messaging. Subliminal messaging goes undetected by the conscious mind and therefore, cannot be purposely avoided. Without laws preventing such advertising, individuals playing video games, or watching hours of television every day, become perfect targets.
Bergmeitiger, Goelz, Hohr, Neumann, Ecker, and Doerr (2008) discuss the effects of subliminal priming while playing a video game. With the assumption that tired persons need to put more effort into a task, the authors hypothesized that they would be more motivated to enhance their concentration and thus, be influenced by the subliminal messages. Two subliminal logos were embedded into a computer game and tested on 64 participants. The results revealed a significant positive relationship between tiredness and the consumption of the target product.
In light of such results, it should be mentioned that subliminal advertising is illegal in some countries, including the United Kingdom and Australia, but not others. Thus, subliminal advertising is legal in the U.S. Furthermore, according to studies showing that an individual’s level of passiveness favors effects of subliminal stimuli, it follows that tired individuals become perfect targets for marketers.
Manipulation through insidious means can take many forms. With the assumption that the average American, apart from spending a large segment of time in front of the television and being overworked, also consumes high amounts of caffeine in various forms, researchers decided to investigate the effects of this drug on persuasion.
In their study, Hamilton, McKimmie, Terry, and Martin. (2007) examined the effects of caffeine on persuasion and attitude change. After considering the effects of caffeine on information processing such as attention, semantic memory and logical reasoning, which are processes involved in persuasion, the researchers expected the effect of caffeine consumption to increase the extent of communication processing, thus facilitating attitude change.
After testing a total of 148 participants under various conditions, results supported the hypothesis that a moderate dose of caffeine could affect attitude in favor of a persuasive message. The implications of this study are extremely important in our modern society. High caffeine consumption coupled with constant exposure to television, public media, politics, and widespread marketing advertisements, would therefore imply that the common caffeine consuming individual is highly susceptible to being persuaded and manipulated on a constant basis.
Under Nazi Germany, Hitler stated that propaganda had to be simple, concise, and be repeated frequently (Welch, 1999). Indeed, according to researchers, repeated statements are perceived as more valid than novel ones, and this is known as “the illusion of truth effect” (Moons & Mackie, 2009). To demonstrate this effect, Moons and Mackie (2009) decided to investigate the conditions under which repetition induced a nonconscious sense of familiarity. Their hypothesis was that “argument familiarity (induced by repetition) would automatically increase agreement, regardless of the argument content and regardless of information-processing conditions” (p.33). After testing a total of 174 participants and conducting three consecutive experiments, results demonstrated that when people have little motivation to process novel information, they can easily be influenced. Because of their diminished sensitivity to argument quality and their lack of motivation to counter-argue what is being presented, such individuals are willing to easily accept repeated arguments as being true. Thus, the extent to which people are willing to process repeated information will determine how this repetition-induced familiarity and the quality of persuasive arguments are influential on agreement.
As stated by the above researchers “persuasion is a pervasive and crucial component of social life. Knowing how and when repeating persuasive appeals induces desired attitude change has practical implications” (Moons & Mackie, 2009, p.44). Thus, as previous studies have already demonstrated, persuading individuals under certain circumstances becomes crucial in order to affect a change in attitude or behavior.
According to Cialdini (2001), because of the accelerating pace of modern life, careful analysis of issues is often prevented by lack of time. As a result, individuals resort to short-cut approaches in which decision to comply is made on the basis of a single piece of information or trigger. The most popular triggers include feelings of liking, authority directives, commitment, and scarcity. Thus, compliance professionals who resort to such triggers in their persuasive attempts are more likely to be successful (p.240).
According to Strick, Van Baaren, Holland, and Knippenberg (2009), the use of humor in advertisement evokes positive emotional responses, thus increasing the likelihood of attitude change and persuasion. According to the principle of “liking”, it follows that the use of humor in conjunction with advertisement increases product liking. Not only does humor enhance the attention paid to an ad, it can also affect persuasion by increasing the motivation of perceivers to process the information.
After testing a total of 181 participants and pairing a product with humorous cartoons, Strick et al., (2009) demonstrated that product evaluations and choice could be positively influenced by mere association with humor. Furthermore, the researchers noted the possible influence of affective media contexts and product placements in movies and television series on advertising effectiveness.
The art of “Influence” resorts to various manipulative techniques in order to affect attitude or behavioral change in people. As it has been well known since the WWII era, eliciting emotional feelings of love, fear, or hatred has a strong influence on human behavior. As Goebbels remarked: “Propaganda becomes ineffective the moment we are aware of it. If propaganda is too rational, it runs the risk of becoming boring; if too emotional or strident it can look absurd. As in other forms of human interaction, to work properly propaganda must strike a balance between reason and emotion” (Welch, 1999, p.26). In line with Goebbel’s comments, behavior change is also subject to emotional arousal and risk perceptions, but in order to be effective, it should strike a perfect balance between challenging messages and threatening messages.
In their research on the biobehavioral model of persuasion, Schneider and Rivers (2009) proposed that challenging health appeals may be more effective than threatening messages. In their study, their goal was to alter personal concern and efficacy beliefs, by using worry as the proxy for personal concern. After presenting various health messages eliciting worry and fear to 60 participants, the researchers concluded that challenging messages could foster behavioral change, whereas threatening messages would foster behavioral avoidance. Thus, challenging messages elicit “openness to the message, greater message elaboration, stronger intentions to act, physiological mobilization, as well as behavior change” (p.1947).
Another major application of persuasion or influence principles is within the government. The military’s modern Psychological Operations division (PSYOP) involves the use of psychological knowledge in warfare. PSYOPs are defined as “planned operations to convey selected information and indicators to foreign audiences to influence their emotions, motives, objective reasoning, and, ultimately, the behavior of foreign governments, organizations, groups, and individuals” (King, 2004, p.27). Such tactics are extensively used by various governments in times of conflict. In recent years, such operations have been used by the United States in Haiti, Somalia, the Gulf War, Bosnia, Kosovo, Afghanistan, and Iraq. Propaganda tactics have included dropping leaflets, broadcasting news and music, distributing newsletters, and providing information via truck-mounted loudspeakers (King, 2004). Considering the wide use of such covert techniques and, due to the classified nature of such research, it would be nonetheless naïve to believe that citizens in the U.S. are immune to this kind of manipulation. As King (2004) stated: “being forewarned is a major component of being forearmed. Being able to identify influence tactics is an important citizenship skill” (p.29).
The implications of the research on propaganda and persuasion are far reaching. From warfare to marketing, experts in human behavior and psychology are being employed behind the scenes to help those in power secure better control of the masses. From Hitler’s Nazi Germany to modern marketing, persuasive methods are being used in politics, sales, health campaigns, and warfare. Such tactics usually serve big corporations, pharmaceutical companies, politicians, and marketers. At times, this knowledge is also used to help people in choosing healthier lifestyles, protecting the environment, and following medical and psychological advice. Thus, as informed citizens, it is important to always “question what lies behind the media productions –the motives, the money, the values, and the ownership –and to be aware of how these factors influence people’s lives” (Tesar & Doppen, 2007, p.261).
References
Bergmeitiger, C., Goelz, R., Johr, N., Neuman, M., Ecker, U., & Doerr, R. (2008). The hidden persuaders break into the tired brain. Journal of Experimental Social Psychology, 45, 320-326.
Cialdini, R. (2001). Influence: Science and practice. Needham Heights, MA: Allyn & Bacon.
Gollnick, D., & Chinn, P. (2002). Multicultural education in a pluralistic society. Upper Saddle River, NJ: Merrill.
King, S. (2004). PSYOP and persuasion: Applying social psychology and becoming an informed citizen. Teaching of Psychology, 31, 27-30.
Martin, P., Hamilton, V., McKimmie, B., Terry, D., & Martin, R. (2007). Effects of caffeine on persuasion and attitude change: The role of secondary tasks in manipulating systematic message processing. European Journal of Social Psychology, 37, 320-338.
Moons, W., & Mackie, D. (2009). The impact of repetition-induced familiarity on agreement with weak and strong arguments. Journal of Personality and Social Psychology, 96, 32-44.
Schneider, T., & Rivers, S. (2009). The biobehavioral model of persuasion: Generating challenge appraisals to promote health. Journal of Applied Social Psychology, 39, 1928-1952.
Strick, M., Van Baaren, R., Holland, R., & Van Knippenberg, A. (2009). Humor in advertisements enhances product liking by mere association. Journal of Experimental Psychology, 15, 35-45.
Tesar, J. & Doppen, F. (2006). Propaganda and collective behavior: Who is doing it, how does it affect us, and what can we do about it? The Social Studies, 257-261.
Welch, D. (1999). Powers of persuasion. History Today, 24-26.
Schizophrenia and Hallucinations
Stephanie A. Shanti ©
Abstract
Schizophrenia often results in chronic disability and poor outcome. The present paper focuses on positive symptoms, and more precisely on hallucinations. With the current scientific and technological advances, mapping of the brain becomes possible, and symptoms such as hallucinations can be better understood. In fact, neurological studies seem to corroborate the fact that numerous brain abnormalities such as enlarged cranial ventricles, especially the third ventricle, and decreased cerebral size tend to correlate with the positive and negative symptoms found in schizophrenia. In fact, imaging studies utilizing blood flow and glucose metabolism indicate that positive symptoms are highly correlated to temporal lobe dysfunction. Thus, current evidence suggests that auditory hallucinations are connected to anatomical structures and pathways related to the language system. In light of the biological substrates of this illness, various promising treatments are reviewed.
Schizophrenia and Hallucinations
Throughout history, there have been beings who claim to hear voices or witness apparitions. In certain cultures, individuals who hear voices or communicate with the “other” world are highly respected. For example, shamans of various indigenous groups enter states of trance in order to receive valuable information from the “spirits” in the form of voices or visual images, and thereby help their people heal from different ailments. Furthermore, in modern societies, individuals often seek guidance from so-called psychics, who claim to communicate with the deceased, or channel teachings from certain entities. In fact, whole cults evolve around such circumstances. Also, some humans seem to be endowed with capacities that challenge all scientific concepts and cultural understanding. Therefore, as a therapist, diagnosing a case of schizophrenia might result in cultural conflict. Thus, new scientific evidence strives at differentiating states of psychosis from religious trances and compiling a cluster of symptoms that are specific to the psychological disorder known as schizophrenia.
Etiology
According the Surgeon General, the cause of schizophrenia has not been determined. Research indicates that genetic predisposition coupled with major environmental disruption during the developmental stage of the brain is implicated in the development of this disorder. Furthermore, environmental factors can later either exacerbate or ameliorate the expression of a genetic predisposition to developing schizophrenia (http://www.surgeongeneral.gov).
Assessment
According to the DSM-IV-TR, the essential features of schizophrenia include both positive and negative symptoms. In order to diagnose this disorder, the symptoms must have been experienced for at least one month, with some signs of the disorder persisting for at least six months. Signs and symptoms are associated with serious social or occupational dysfunction and include a range of cognitive and emotional dysfunctions such as perception, inferential thinking, communication, behavioral monitoring, affect, fluency and productivity of thought and speech, volition and drive, and attention. On the one hand, the positive symptoms can manifest as distortions in thought content (delusions), perception (hallucinations), disorganized speech, and disorganized behavior. For example, “patients may believe that other people can hear their thoughts or that the government is monitoring their every action” (Fletcher & Frith, 2009). On the other hand, negative symptoms include flat affect, diminished productivity of speech (alogia), and inability in initiating goal-directed behavior (avolition). This paper focuses on the positive symptoms, especially the auditory hallucinations.
Neuropsychological aspects
According to a report of the Surgeon General (http://www.surgeongeneral.gov) patients suffering from schizophrenia exhibit numerous brain abnormalities such as enlarged cranial ventricles, especially the third ventricle, and decreased cerebral size. Furthermore, these brain abnormalities tend to correlate with the positive and negative symptoms found in schizophrenia. In fact, imaging studies utilizing blood flow and glucose metabolism indicate that positive symptoms are highly correlated to temporal lobe dysfunction. Also, excessive levels of dopamine seem to be implicated in schizophrenia.
“Hallucinations as they typically occur in schizophrenia commonly contain spoken language in the form of words or entire sentences. Their relationship to the language system of human brain is therefore evident” (Strik & Dierks, 2008). In their fMRI study of hallucinating patients with schizophrenia, Strik and Dierks (2008) demonstrated that during auditory hallucinations, the motor speech area, also known as Broca’s area, and the primary auditory cortex (Heschl’s gyrus) in the language dominant hemisphere were activated. As a result of this co-activation, this abnormal excitatory event is related to the subjective experience of a real acoustic stimulus. Thus, current evidence suggests that auditory hallucinations are connected to anatomical structures and pathways related to the language system. Corroborating these findings, Spencer, Niznikiewicz, Nestor, Shenton, and McCarley (2009) state that there is sufficient evidence implicating the language related areas of the left cerebral hemisphere in auditory hallucinations in schizophrenia. In addition, they also indicate that the left primary auditory cortex (Heschl’s gyrus) is related to auditory hallucinations as well.
According to Boska (2009), auditory hallucinations are a diagnostic feature of schizophrenia occurring in 60%-70% of people with this disorder. As a result, many studies have focused on the visible changes within the nervous system structure, function and connectivity. Findings demonstrate reduced areas of grey matter in the superior temporal gyrus, including the primary auditory cortex. Furthermore, volume reduction in the dorsolateral prefrontal cortex has also been reported, thus implying that faulty frontotemporal interactions may contribute to involuntary hallucinations. Also, current results in neuroimaging tend to indicate overactivity in the primary and/or secondary auditory cortices in the superior temporal gyrus and altered connectivity with language processing areas in the inferior frontal cortex. Thus, current data seems to corroborate the expectation that hallucinations involve altered activity in the neural circuitry known to be involved in normal audition and language. To this date, the cause of this altered activity remains unknown.
In their study Zhang, Hao, Shi, Mou, Yao, and Chen (2008) confirmed that schizophrenic patients with auditory hallucinations (AVHs) exhibited less cerebral activation in the right superior temporal gyrus as compared with healthy controls. Furthermore, hallucinating patients also demonstrated decreased activation in the areas implicated in voice perception, thus creating difficulty in recognizing external voices. The authors cite the example of a woman with schizophrenia whose auditory hallucinations stopped while she was exposed to loud external speech, thus implying that patients suffering from auditory hallucinations have impairment in the ability to discriminate between their own voice and another person’s voice.
In their study, Fletcher and Frith (2009) speculate that abnormal perceptions are due to a failure to ignore irrelevant stimuli, such as one’s own thoughts. Thus, patients suffering from such hallucinations are unable to tag these stimuli as self-generated. Physiologically, the ability to distinguish personal thoughts and actions requires a form of self-monitoring dependent on processes such as corollary discharge and efference copy. These processes help other brain structures attenuate responses to the sensory consequences of self-generated actions or speech. Therefore, when such processes are disrupted for unknown reasons, one’s experiences might not be attenuated and experienced as caused by external forces.
Course
According to the DSM-IV-TR, the first psychotic episode of schizophrenia is usually experienced in the early to mid-20s for men and in the late 20s for women. Incremental and insidious signs and symptoms, such as social withdrawal, loss of interest in school or work, lack of hygiene, strange behavior, and outbursts of anger, are the first indications of a disturbance. At first, family members might assign such behaviors to a “difficult” phase, and it is not until the “active” phase begins, that schizophrenia is diagnosed. Additionally, the onset of schizophrenia may be characterized by negative symptoms, but with the progression of the illness, more positive symptoms appear. Furthermore, males demonstrate poorer premorbid adjustment, lower educational achievement, evidence of structural brain abnormalities, and a worse outcome. On the other hand, females tend to experience a better outcome and demonstrate less structural brain abnormalities.
Complete remission is unlikely, and the course of the illness can either be stable in some individuals, or worsen in others. In general, positive symptoms are better responsive to treatment and can diminish, but for the majority of patients, negative symptoms persist.
Treatment
According to research, auditory hallucinations that are not threatening to the individual, but instead are positive and supportive seem to act as barriers to treatment seeking (Jenner, Rutten, Beuckens, Boonstra, & Systema, 2008). When dealing with schizophrenia, it appears that auditory hallucinations are mostly negative. Thus, according to the researchers, the hearing of positive voices is usually experienced among non-psychotic patients, “but the specific characteristics and diagnosis are not significantly associated” (Jenner et al., 2008). Furthermore, patients who exhibit both types of voices seem to find consolation in the positive and gentle voices and therefore, express a desire to preserve these voices. Jenner et al. (2008) describe the case of a 42-year old woman seeking treatment to help her deal with the imperative and controlling negative voice she was hearing, but reporting also hearing a soft and gentle female voice, which she qualified as supportive. In addition, this gentle female voice reminded her of her appointments and aided in treatment compliance.
To this day, no diagnostic physiological markers have been found in the case of schizophrenia. Therefore, clinicians must apply judgment when compiling the various symptoms reported by the patients. Thus, diagnosis is made on the basis of signs observed and previous history (Fletcher & Frith, 2009). Although drug treatment and cognitive behavioral therapy might help in certain instances, there is no cure for this disorder.
Because of the cognitive impairments associated with schizophrenia, interventions that improve cognitive functions also have the capacity to improve the quality of life. In her review of the various drugs used to treat cognitive impairment in schizophrenia, Galletly (2009) warns of the biases inherent in industry-sponsored research. Thus, after reviewing the effects and side-effects of antipsychotic drugs, dopaminergic agents, cholinergic agents, acetylcholinesterase inhibitors, nicotinic receptor agonists, muscarinic agonists, glutamate, and other possible cognitive enhancers, she concludes that none of the drugs available today stand out as effective cognition enhancers in schizophrenia.
In another study, Naeem, Kingdon, and Turkington (2008) recommend using cognitive therapy (CBT) for the treatment of schizophrenia. According to them, there is ample evidence that cognitive therapy is effective in the treatment of psychotic symptoms. Furthermore, they add that insight about one’s illness is a predictor of good outcome. Thus, good insight increases compliance and motivation. Unfortunately, the authors fail to mention what pharmacological treatments participants were receiving at the time of the intervention. Therefore, results concerning the effectiveness of CBT cannot fully be considered without the knowledge of accompanying treatments. Furthermore, results of this study are also questionable considering the fact that cognitive therapy was administered by nurses instead of clinicians.
A promising new approach to the treatment of schizophrenia, and especially auditory hallucinations, is transcranial magnetic stimulation. As is mentioned above, many patients fail to respond to standard antipsychotic medications, thus, repetitive transcranial magnetic stimulation (rTMS) was developed. TMS is a non-invasive means of stimulating nerve cells in superficial areas of the brain with an electrical current passing through a wire coil placed over the scalp. As a result of this procedure, a magnetic field produces a depolarization of nerve cells resulting in the stimulation or disruption of brain activity (Fitzgerald & Daskalakis, 2008). In accordance with the previous researchers, Tranulis, Sepehri, Galinowski, and Stip (2008) also conclude that transcranial magnetic stimulation is highly efficient in reducing hallucinations, but they add that to this day, data is insufficient to conclude that this technique also improves global psychopathology, overall functioning, or quality of life.
Finally, another promising and non-invasive technique to help patients suffering from schizophrenia is electro-acupuncture. According to the oldest text on traditional Chinese medicine, acupuncture has been successful in treating schizophrenia-like diseases and auditory hallucinations (Jing, Gaohua, Ling, Huiling, & Xiaopong, 2009). In their study, Jing et al. (2009) compared two groups of patients experiencing auditory hallucinations. One group received electro-acupuncture while the control group received sham electro-acupuncture. Results indicated a significant improvement in positive symptoms of participants receiving electro-acupuncture. Thus, their findings are consistent with previous trials in demonstrating the beneficial effects of electro-acupuncture in the treatment of auditory hallucinations in patients with schizophrenia.
In light of the above results, there seems to be hope in the use of non-invasive therapies. Techniques such as acupuncture have successfully been used for thousands of years. Considering all the negative side-effects associated with the use of various pharmacological drugs, more research should perhaps be conducted with natural techniques.
References
American Psychiatric Association. (2005). Diagnostic and statistical manual of mental disorders. Arlington, VA: American Psychiatric Association.
Boska, P. (2009). On the neurobiology of hallucinations. Journal of Psychiatry & Neuroscience, 34, 260-262.
Fitzgerald, P., & Daskalakis, J. (2008). A review of repetitive transcranial magnetic stimulation use in the treatment of schizophrenia. The Canadian Journal of Psychiatry, 53, 567-576.
Fletcher, P., & Frith, C. (2009). Perceiving is believing: A Bayesian approach to explaining the positive symptoms of schizophrenia. Macmillan Publishers Limited, 10, 48-58.
Galletly, C. (2009). Recent advances in treating cognitive impairment in schizophrenia. Psychopharmacology, 202, 259-273.
Jenner, J., Rutten, S., Beuckens, J., Boonstra N., & Sytema, S. (2008). Positive and useful auditory vocal hallucinations: prevalence, characteristics, attributions, and implications for treatment. Acta Psychiatrica Scandinavia, 118, 238-245.
Jing, C., Gaohua, W., Ling, X., Huiling, W., & Xiaoping, W. (2009). Electro-acupuncture versus sham electro-acupuncture for auditory hallucinations in patients with schizophrenia: A randomized controlled trial. Clinical Rehabilitation, 23, 579-588.
Naeem, F., Kingdon, D., & Turkington, D. (2008). Predictors of response to cognitive behavior therapy in the treatment of schizophrenia: A comparison of brief and standard interventions. Cognitive Therapy & Research, 32, 651-656.
Spencer, K., Niznikiewicz, M., Nestor, P., Shenton, M., & McCarley, R. (2009). Left auditory cortex gamma synchronization and auditory hallucination symptoms in schizophrenia. BMC Neuroscience, 10:85, 1-13.
Strik, W., & Dierks, T. (2008). Neurophysiological mechanisms of psychotic symptoms. European Archives of Psychiatry & Clinical Neuroscience, 258, 66-70.
Tranulis, C., Sepehry, A., Galinowski, A., & Stip, E. (2008). Should we treat auditory hallucinations with repetitive transcranial magnetic stimulation? A metaanalysis. The Canadian Journal of psychiatry, 53, 577-586.
Zhang, Z-J., Hao, G-F., Shi, J-B., Mou, X-D., & Chen, N. (2008). Investigation of the neural substrates of voice recognition in Chinese schizophrenic patients with auditory verbal hallucinations: An event-related functional MRI study. Acta Psychiatrica Scandinavia, 118, 272-280.
A Review of Dr. A. McDougall M.D.’s “Five Major Poisons Inherently Found in Animal Foods”
By Stephanie A. Shanti ©
For those of you consuming a Standard American Diet (SAD), this article describes the overall and detrimental health effects to be expected from high animal fat consumption.
Research is showing that it takes four or more decades of consumption of animal protein, fat, cholesterol, and dietary acids, which are all overly abundant in animal foods, to notice disabilities, disfigurement, or death. Unfortunately, this “long latent period fools the public into thinking there is no harm done by choosing an animal-food-based diet”.
History has taught us many lessons. Two of the biggest failures of the medical establishment have been the ability to more rapidly appreciate the slow poisoning effects inherent to the consumption of tobacco and alcohol.
The scientific community has been aware of the detrimental effects of such substances, but has had to face a bigger challenge; corporate agendas. Indeed, the tobacco, as well as the meat and dairy industries are extremely powerful. Marketing and advertising strategists have accomplished substantial success in convincing the general population that milk and cheese are rich in calcium, and that eggs and beef are sources of high quality protein. Nothing could be further from the truth.
To understand how animal foods slowly poison our systems, it is important to understand that such foods burden our bodies with three times more protein, 15 times more fat, greater than 100 times more cholesterol, and at least 10 times more dietary acid. Furthermore, the resulting toxic effects are interactive. Thus, excess of protein and dietary acids destroy the bones, and excess of dietary fat and cholesterol damage the arteries and promote cancer.
The problem is that when the body is burdened with too high amounts of animal proteins, the excess must be eliminated, primarily by the liver and kidneys. A strong smell of urine and sweat is an indication of protein overload. What is more, excess protein also damages the bones. According to McDougall “doubling the dietary intake of protein increases the loss of calcium into the urine by 50%, fostering the development of osteoporosis and kidney stones”.
This excess protein intake results in a surplus of fats stored in your liver, heart, and muscles, thus causing insulin resistance, vascular diseases of the heart and brain, and cancer development.
In view of the above health impact caused by the consumption of animal proteins, a progressive change in diet is needed. By making the right food choices and detoxing the body from the accumulated waste, it becomes possible to regain health, slow the aging process, and increase energy. Furthermore, by eliminating certain deadly foods from your diet, you will be “reducing your intake of pesticides, antibiotics and other toxic chemicals found in high concentrations in animal foods”.
Why Raw Foods Help You Lose Weight Naturally
Stephanie A. Shanti ©
In order to lose weight, exercise and cutting back on carbs is not enough. You need to eat foods rich in enzymes, in order for your body to break down and metabolize fats.
When you cook foods above 105 F, most of the enzymes are destroyed. Unfortunately, our bodies only contain a limited supply of enzymes. Therefore, we must obtain our enzymes from the foods we eat; otherwise, the body utilizes enzymes found in glands, muscles, nerves, and blood to help in the digestive process.
According to medical research, enzyme deficiencies are commonly found in numerous chronic illnesses, such as allergies, skin conditions, obesity, heart disease, aging, and cancer.
Enzymes are proteins that activate chemical reactions in our bodies. They are known as catalysts, meaning that they accelerate chemical reactions. The two main groups of enzymes are known as metabolic and digestive enzymes. Childhood diseases such as PKU and Tay Sachs, which both result in mental retardation, are caused by metabolic enzyme deficiencies.
Digestive enzymes accelerate the breakdown of proteins, fats, and carbohydrates. With age and poor diet resulting in enzyme deficiency, many health issues begin developing. For example, heartburn, fatigue, and obesity increase. Unfortunately, be eating a cooked food diet, those enzymes cannot be replaced, thus depleting the limited amounts in our bodies.
A living foods diet consisting of uncooked and unprocessed vegetables, fruits, seeds, nuts, and sprouts, is rich in active digestive enzymes. Therefore, such foods are easily digested and people consuming such diets avoid the fatigue, bloating, and weight gain.
Ecopsychology and Nature-Based Therapies
Stephanie A. Shanti ©
Introduction
Theodore Roszak was one of the first to develop the term “ecopsychology” and write about it. His work emphasizes the implications of our disconnection from nature for mental health. In his writings he emphasizes the integration of psychology and ecology; the bringing together of psychological principles and practices to environmental education and action. Psychotherapy and personal growth can be shown to benefit from the contributions of ecological thinking and the values of the natural world. Lifestyles can be followed that are both ecologically and psychologically healthy.
The emerging field of ecopsychology brings psychological principles to environmental education. It is based on three ideas: “genuine sanity, which is grounded in the reality of the natural world; ecological crisis, which signifies a break from this reality; and the route out of the crisis, which involves a psychological reconciliation with the living earth” (Fisher, 2002, p. 8). Thus, we can say that there is a deeply bonded and reciprocal relationship between humans and nature. The separation of humans and nature leads to suffering for both the environment and for humans. Realizing this connection results in a healing for both; a reconnection. Hence, ecopsychology integrates ecology and psychology. Its function is to bring psychological principles and practices to environmental education and action, bring the contributions of ecological thinking and the values of the natural world to psychotherapy and personal growth, and promote lifestyles that are both ecologically and psychologically healthy.
The core belief within ecopsychology is that sanity cannot be attained in an unhealthy environment. In order to lead a healthy and balanced life, one needs to reconnect to the natural world. For too many years, mainstream psychology has only been concerned with the individualistic aspects of sanity, without paying attention to the surroundings. Ecopsychology proposes to bridge the gap between the ethnocentric view that human beings are at the center of the universe and the native belief that we are all part of the same world. Within this view, the notion of self is redefined and the boundaries are moved, connecting the outside world to the internal world.
Ecopsychology encompasses various dimensions: it is a philosophical, social, environmental and psychological movement, with applied therapeutic methods. Some of those methods have blurred boundaries and can be classified as nature-based therapies. Ecotherapy, wilderness therapy, nature therapy, and outdoor therapy, all possess some of the fundamental aspects that are defined within ecopsychology; they all use nature as a tool to promote health. Thus, in this paper, I propose an overview of such techniques and their benefits on health by first discussing two empirical articles on wilderness therapy and then, two theoretical articles on ecotherapies.
My intention in writing this paper was to collect relevant data concerning the effects of nature on patients and demonstrate the benefits of the natural environment on well-being. Unfortunately, due to the lack of research in the field of ecopsychology, my primary Boolean search using the key words Ecopsychology AND Ecotherapy did not return any empirical data, only theoretical articles and book reviews. As a consequence, I entered the words Wilderness AND Therapy and found the relevant empirical data I was searching for.
Clark, J., Marmol, L., Cooley, R., & Gathercoal, K. (2004). The effects of wilderness therapy on the clinical concerns (on axes I, II, and IV) of troubled adolescents. Journal of Experiential Education, 27, 213-232.
In this experimental article, the authors hypothesize that strenuous physical outdoor group experiences, such as those found in Wilderness Therapies (WT), can be very effective therapy forms. In fact, they believe that WT has the potential for effecting “characterological” change, especially with adolescents suffering from maladaptive behaviors. In order to effect a change, the authors believe that it is important to intervene in the early stages of personality disorders, before personality traits become more entrenched. Because of the physically and emotionally demanding nature of such experiences, one’s safety depends upon adaptive behavior within the group. As a result, participants gain in self-esteem and ego-strengths, and learn healthier coping mechanisms in a very short period.
The purpose of this study was to empirically evaluate the effects of WT on various dysfunctional personality patterns and identify the types of clinical concerns on Axes I, II, and IV for which WT is most effective. Participants were 109 (68 male, 41 female) with a mean age of 15.39, selected from a convenience sample. The program evaluated for this study was the 21-day Catherine Freer Wilderness Therapy Expeditions program (CFWTE). The statistically significant results supported the author’s hypothesis that WT would have a positive effect on the post-test immature defense, expressed concerns, dysfunctional personality patterns, and maladaptive behavior scores of participants. Furthermore, statistically significant results were also found for clinical syndromes such as: eating disorders, anxiety, depressive affect, and suicidal tendencies. Moderate effects were found for substance abuse proneness and delinquent predisposition.
The principal strength of this study is the scope of its findings and their implications for future research. Furthermore, not only did the authors base their hypothesis on previous empirical data and were able to replicate some of the results, but they also looked at the effects of WT from a holistic perspective. Such findings open the door to a brand new vision of the implication of the environment on mental health, and especially on its effects on personality disorders.
One of the weaknesses of this study is the fact that there was no comparison group and that only one WT program was surveyed. Thus, the results cannot be generalized to other programs. Furthermore, for readers who are not familiar with this type of WT program, there is no mention of what happened during the 21 days. Only statistical results are presented, but no descriptions of the types of activities are provided. Also, with such a study, it is difficult to differentiate between the effects of tenuous and challenging physical exercise on the participants and the mere effects of just being in nature.
Despite the fact that this article was not really reader friendly and was mainly based on statistical evidence with little theoretical background and descriptive information, it holds a great potential for future research. By demonstrating that WT can be so effective on personality disorders and behavioral problems in a very short period, it is an encouragement for the implementation of more such programs in the health care system.
Russel, K., & Phillips-Miller, D. (2002). Perspectives on the wilderness therapy process and its relation to outcome. Child and Youth Care Forum, 31, 415-437.
The purpose of this multi-site case study was to investigate the effect the wilderness therapy process would have on adolescents with problematic behavior such as school problems, substance abuse, repressed anger, and resistance to other forms of counseling. Participants were nine adolescent males and three adolescent females with an average age of 17, who suffered from behavioral problems and participated in one of four different wilderness programs. The average length of each program was 38 days in wilderness. In order to collect data, one of the researchers served as an observer who spent seven to-ten days in the field, observing three client cases at each program and taking notes. At the end of the program, all participants were interviewed and were asked to comment on their reasons for attending the program, what they thought of it, and what they had learned from this wilderness therapy experience. Also, a clinical debriefing was conducted with staff members including licensed psychologists, Master’s level counselors, and social workers. The results indicated a deeper relationship with the therapist, good peer dynamic and facilitated reflection on life: especially during the solo journey into wilderness. Finally, by the end of the program, participants noted a deep desire for change.
The basic strength of this article was the fact that the author surveyed not just one wilderness program, but four. All of the programs were selected based on their inclusion in the Outdoor Behavioral Healthcare Industry Council (OBHIC), a national organization providing clinical supervision of therapeutic wilderness programs. Furthermore, the authors began by defining wilderness therapy and giving some historical perspectives. They also included in their article many of the written statements given by the participants, thus, providing the reader with a deeper and more personal understanding. Finally, the authors also discussed the therapeutic effects of the solo journey, which is comparable to the rite of passage in native cultures. In doing so, they acknowledged the fact that such transition rites are now absent in Western cultures, thus, potentially creating a void resulting in conflicting messages for adolescents, and indicated that more research in this field is needed.
The main limitation of this study is the small number of participants and the fact that all data was collected using interviews and open questions only. Furthermore, the observer interacted with the participants on a daily basis, which could have influenced the objectivity of the assessments.
Despite the limited number of participants, this article was very informative, well written, and because of its numerous case examples, was easy to read for professionals and non-professionals. The authors based their hypothesis on previous findings and produced detailed information on wilderness therapy. Furthermore, they proposed several new research ideas that seem very promising for the future of the counseling profession. Also, the authors’ suggestion that by incorporating some of the wilderness aspects such as: outdoor exercise, healthy food, journal keeping, and solo time into clinical settings, provides other clinicians with a valuable insight that could greatly benefit clients.
Berger, R., & McLeod, J. (2005). Doing therapy in nature: developing a framework for practice. Counseling and Psychotherapy Research Journal, 1, 1-5.
In this theoretical article, the authors present an overview of different techniques used as part of nature therapy. In their opinion, nature is a powerful “healing resource” that can be used in order to restore well-being. Since the time of industrialization, humans have lost their connection to their natural surroundings. As a result, a duality has emerged and the sense of connectedness to the environment and its living creatures has disappeared, thus generating new types of symptoms. In this article, the authors suggest we learn from our ancestors who lived in communion with the cycles of nature and carried out regular religious rituals marking changes. The purpose of such rituals was a social commitment to one’s community and a sense of order and security. Furthermore, the authors note that in our modern individualistic societies, people experience similar distress as their predecessors, such as fear of uncertainty and the unknown, but instead of rituals, seek therapy.
One of the strengths of this article is the fact that the authors acknowledge the importance of nature therapy as a vehicle for raising ecological awareness and moving from an individualistic perspective to a more collective view. Also, they discuss the value of incorporating nature into the therapeutic setting and provide the reader with concrete cases. For example, confrontation with the elements seems to trigger fears that are imbedded in one’s personality and reveal avoidance patterns. In nature, clients are faced with their own anxieties and need to learn new coping mechanisms to overcome the obstacles they encounter. Furthermore, the authors provide examples of working with the natural environment such as holding therapeutic sessions outdoors and working with the arising emotions, or bringing nature indoors, by introducing elements such as plants, stones, wood, and water into the counseling office. Thus, by providing the reader with a multitude of examples, the authors are able to demonstrate the potential value of such techniques and give a brief overview of the possibilities.
This article’s main weakness is the fact that it is not based on any empirical research. Even though the authors note that, at the present time, there is very little research evidence concerning the use of nature-based therapies, none of the existing evidence is mentioned. Unfortunately, the entire article consists of examples without concrete outcomes and no scientific data to back up their claims. Furthermore, although the authors briefly discuss rituals, there is no mention of rites of passage and vision quests. Unlike the examples provided above, such rituals can be very powerful because clients are left alone in wilderness for a few days, before returning to their base-camp and being debriefed by therapists.
Despite the lack of empirical support for this article, therapists might benefit from the information presented and incorporate some of the techniques into their own practice. Also, this article presents an array of different nature-based approaches and can serve as an introduction to the fields of ecotherapy and wilderness therapies. Considering the current state of our environment and the rising concerns linked to our own well-being, such therapies seem to be very promising.
Surridge, J., McKie, J., Housden, J., & Whitt, D. (2004). Wild at heart: tapping into the restorative power of the great outdoors. Mental Health Practice, 7, 20-23.
In this article, the authors describe and discuss the benefits of a newly added program at Darwin Ward, a 20-bed mental hospital unit in England. Until recently, patients in this psychiatric ward were not given much hope and were usually never reintegrated into society. Because of the lack of activity, many patients had abandoned the hope of ever getting better and became totally dependant on the staff for daily activities. With the changes in the health care system and the new expectation of moving toward less intense rehabilitative environments, the staff at Darwin Ward was faced with a new challenge: They needed to re-orient their therapeutic approach and begin teaching their patients more independent ways of living. As a result, one the authors, while trekking in the Himalayan region, reflected on the beauty of the natural environment and on its potential therapeutic benefits. On return to the UK, he became acquainted with the emerging field of ecopsychology, which provided a reference point for the creation of the new program: Reflection. The foundation of ecopsychology is that the state of the natural environment is close to our internal, psychological state. The current destruction of our environment is understood as a projection of our anxieties. In order to bring sanity back, we need to reconnect to our surroundings and realize the beauty and oneness of nature, thereby realizing our own beauty and oneness with the elements. Therefore, the aim of the program “Reflection” was to take a few patients outdoors into wilderness and teach them new skills. By reconnecting to nature and experiencing its beauty, the few who participated in the pilot study developed a sense of belongingness and discovered new meaning in their lives. Some were reminded of their youth and felt immense freedom and joy. The program was a success and patients are now looking forward to new wilderness journeys.
The strength of this article is its innovative nature. Most wilderness programs cater to young adolescents with behavioral problems. None of the research has yet addressed the impact of wilderness on the mentally ill adults. Therefore, this non-empirical article describes the potential benefits of nature and the outdoors on a different population. Furthermore, this article introduces the emerging field of ecopsychology and its new tenet that mental health is closely linked to environmental health, and that sanity cannot be achieved in an unhealthy environment. Thus, this new program can serve as an inspiration to other mental health settings and clinics.
The fact that this article describes a tentative program which has not yet been evaluated through empirical research is its main weakness. Unfortunately, to this day, not much research has been done in the field of ecopsychology and ecotherapy, therefore, the authors of this article had to inspire themselves from previous studies on wilderness therapies.
With this last article, the focus has moved from wilderness therapies, which give little acknowledgment to the therapeutic effects of nature itself, to ecotherapies, which stem from ecopsychology and the belief that sanity is dependant on our connection to the natural world. Thus, this new vision of sanity encompasses population as a whole and shows us a new direction toward greater fulfillment and well-being.
Summary
There is general agreement that there has been, and continues to be, a violation of non human life on the planet and a gradual wasting of the earth. There is an irony in the idea that the health system provides for the treatment of people with mental disorders to undergo psychotherapy while everyday social forces continue to violate nature by destroying the biosphere unabated, which in itself guarantees a steady supply of patients.
Ecopsychology is an effort at recovery, at recalling just how, in psychological terms, we humans are part of the life process. Human healing needs to be done in concert with the healing of the larger natural world. The emphasis is on the human-nature relationship, the link connecting psychology and ecology.
In reviewing the literature on nature-based therapies, it becomes quite clear that humans greatly benefit from the natural environment. Most of the empirical data covers the effects of wilderness therapy on adolescents with behavior problems. Apparently, being in the outdoors for prolonged periods of time and undergoing strenuous physical activity holds the potential for effecting changes of character. The statistically significant results attest to the fact that such therapy helps change maladaptive behaviors, thus enhancing the sense of responsibility, reducing substance dependence and abuse, and improves team spirit and cohesiveness. Furthermore, participants create deeper bonding with therapists when challenged by nature and respond more positively to therapy. One of the most interesting effects of such therapy is its capacity to foster a more reflective environment in which participants enjoy solo time and discover deeper meaning in their lives. In native cultures, solo time and rites of passage are inherent to the process of maturing of young adults. Such rituals allow young people to formally step into adulthood and be acknowledged and respected for it.
The powerful healing effects of nature stem from the fact that when confronted with the elements, avoidance patterns are revealed and new and healthier coping mechanisms are learned. Furthermore, by enabling patients to reconnect to nature and experience its beauty, a sense of belongingness emerges and life becomes more meaningful. In certain cases, mental health patients who had been institutionalized for many years and lost all hope were able to recollect positive memories of their childhoods and feel immense joy once more. The beauty of experimental programs such as the one conducted in the psychiatric ward in England, is that they not only hold a positive outcome for health agencies by cutting down the costs of long-term institutionalization, but also bring back meaning into people’s lives, thereby giving them something positive to look forward to once they are released.
With ecopsychology and nature-based therapies, there is an emergence of greater respect toward the environment and the awareness of its therapeutic values. The positive and encouraging results of the current research pave the way for therapists to incorporate the healing resources of the natural world and the use of the outdoors into their practice. Hence, this new eco-awareness promotes a paradigm shift in the health professions, allowing the future generation of therapists, myself included, to redefine sanity and place the notion of mental health in a broader context.
References
Berger, R., & McLeod, J. (2005). Doing therapy in nature: developing a framework for practice. Counseling and Psychotherapy Research Journal, 1, 1-5.
Clark, J., Marmol, L., Cooley, R., & Gathercoal, K. (2004). The effects of wilderness therapy on the clinical concerns (on axes I, II, and IV) of troubled adolescents. Journal of Experiential Education, 27, 213-232.
Fisher, A. (2002). Radical Ecopsychology. New York, NY: State University Press.
Roszak, T. (1995). Ecopsychology. San Francisco, CA: Sierra Club Books.
Russel, K., & Phillips-Miller, D. (2002). Perspectives on the wilderness therapy process and its relation to outcome. Child and Youth Care Forum, 31, 415-437.
Surridge, J. (2004). Wild at heart: tapping into the restorative power of the great outdoors. Mental Health Practice, 7, 20-23.
