9 Myths and Misconceptions about Mental Illness

Are mentally ill people violent? Can mental illness be overcome through willpower? Is addiction a choice? This post addresses some of the myths and misconceptions about mental illness.

By Cassie Jewell, LPC, LSATP

In this post, I’ll address some of the myths and misconceptions about mental disorders. There continues to be stigma attached to mental illness; and the media is partly to blame. Every time (yet another) mass shooting occurs, the media attributes the act of violence to mental illness. This message is repeated by various news sources and then spread through social media.

Acts of senseless violence are for sure a “sickness,” but they’re not criteria for a diagnosable mental disorder. It’s not fair to compare violent criminals to individuals who struggle with depression, anxiety, schizophrenia, etc.

Mental illness misconceptions run rampant, even within the healthcare professional field. For example, I know a surgeon who believes mental illness isn’t real and a neurologist who uses words like “crazy” and “retarded.” I came across a substance abuse counselor (on Facebook) who believes addiction is a moral failing. I know a social worker who believes that severely mentally ill individuals are more likely to be violent.


Ignorance is at the root of stigma. The more you know, the less you fear, and the less you’ll stigmatize. Read on to learn what’s myth versus fact.

1. Bad parenting causes mental illness.

Even today, there is no single identified cause when it comes to mental illness. Instead, there are multiple risk factors that contribute to mental disorders. The biggest risk factor is genetics. Genes frequently determine whether or not a person develops schizophrenia, depression, substance use disorder, etc. Physiological factors (such as abnormalities in the brain) are a second risk factor.

Environmental factors, such as fetal exposure to a toxin or childhood abuse, are a third risk factor. Childhood abuse undoubtedly falls into the “bad parenting” category, but as a standalone, it can’t cause mental illness.

It’s more likely that a combination of risk factors will lead to the development of a mental disorder.

2. Mental illness is not a medical disease.

Heart disease affects the heart. Colon cancer affects the colon. Autoimmune disorders affect the immune system. Brain disorders (i.e. mental illness, addiction) affect the brain.

You can’t “see” mental health symptoms the way you can see physical health symptoms, but mental illness is without a doubt physiological in nature.

Like other organs, the brain can become diseased, and it manifests as symptoms of mental illness. You can’t “see” mental health symptoms the way you can see physical health symptoms, but mental illness is without a doubt physiological in nature.

3. All sociopaths are dangerous.

The term “sociopath” (or psychopath) is frequently associated with serial killers. The reality is that you probably know a sociopath and he/she isn’t a murderer.

In fact, “sociopathy” and “psychopathy” are no longer recognized diagnoses in the mental health world due to negative connotations. The correct term is “antisocial personality disorder” (ASPD), a mental illness characterized by an ongoing disregard for and violation of the rights of others. An individual with ASPD may also be exceptionally charismatic. (Some of the most charming and engaging clients I’ve ever worked with had ASPD.)

However, research indicates that an individual with ASPD is more likely to become involved in criminal activity,to have a substance use disorder, and to be aggressive; about 50% of individuals with ASPD have some sort of criminal record. While it’s a misconception to say all individuals with ASPD are dangerous, the link between ASPD and crime is not unfounded.

4. Mental illness can be overcome with willpower.

This is 100% myth and a huge pet peeve of mine. It goes hand-in-hand with the belief that mental illness is not a “real” medical condition. A mental disorder typically requires treatment, such as medication and therapy, and ongoing illness management. 

All the willpower in the world won’t help someone “overcome” heart disease. And it doesn’t work that way with mental illness either.

5. Addiction is a choice.

Substance use disorder is no more of a choice than diabetes or cancer. Like most diseases, addiction develops when a combination of genetic, physiological, and environmental factors are present. Lifestyle choices also play a role. Unfortunately, the myth that addiction is a moral failing persists.

An individual who struggles with addiction receives more blame than someone with a heart condition, even though lifestyle choices heavily impact both disorders. I’ve even heard it said that addicts who overdose shouldn’t be revived because it was their “choice” to use. If that’s the logic, then should we stop providing life saving care to someone who’s having a heart attack or to a smoker with lung cancer? Of course not. At times, we all make poor decisions. For someone with a predisposition for addiction, the choice to drink may lead to alcohol use disorder. For the person with a predisposition for diabetes, eating an unhealthy diet or living a sedentary lifestyle will result in consequences.

Furthermore, once a person develops a substance use disorder, physiological and structural changes in the brain dissolve the element of choice. The brain misinterprets a craving for drugs or alcohol. (Remember the last time you experienced extreme thirst? That’s what it’s like to be addicted to something.)

Having a substance use disorder is miserable, lonely, and shameful. No one would choose that.

6. People with mental illness are violent.

A person with mental illness is no more likely to be violent than someone in the general population. In fact, acts of violence are not diagnostic criteria for any of the known mental disorders.

If I had to choose someone to hold a loaded gun, I’d pick the person with schizophrenia over someone who’s prone to anger or has poor self-control.

I work with clients who hear “command” voices (auditory hallucinations that tell them to harm or kill); yet I’ve never felt unsafe. In my experience, it’s uncommon for an individual to obey the voices. If I had to choose someone to hold a loaded gun, I’d pick the person with schizophrenia over someone who’s prone to anger or has poor self-control.

While the media would have us believe that mental illness is at the root of every mass shooting, that isn’t the case. (Not to say that mental illness can’t play a role, but it’s not always the trigger.) The biggest risk factor for violence is a history of violence, especially domestic violence, or crime.

Regarding violence, what’s true is that individuals with mental illness are more likely to die by suicide. Persons with schizophrenia have higher rates of suicide than the general population. Depression, bipolar disorder, and borderline personality disorder are also linked to suicide.

Don’t confuse mental illness with a lack of morals.

A mental disorder is a medical condition; having weak morals is a personality trait, and while it seems mentally sick, it’s not fair to compare a lack of morals to a condition like depression or anxiety.

7. Mental illness is the same thing as mental retardation.

I’m friends with a nurse who didn’t even know the difference (until I pointed it out). A person with a mental illness may seem less intelligent due to various factors, but mental illness is not comparable to mental retardation. Today, we refer to mental retardation as intellectual disability (due to the negative connotations attached to the word “retarded”).

A person with an intellectual disability (ID) struggles to understand, comprehend, and/or form memories. A person with mental illness, on the other hand, may have superior intelligence, but could seem “slow” due to distractions brought on by their illness. (For example, it’s difficult to focus on a conversation when you’re having racing thoughts or hearing voices.)

8. A person with schizophrenia has multiple personalities.

Nope; total myth. In fact, multiple personality disorder (MPD) doesn’t exist (technically). What was formally known as MPD in the DSM-IV TR (the previous version of the Diagnostic and Statistical Manual) is now termed disassociative identity disorder [DID]. A person with DID has at least two distinct personality “states” and suffers from gaps in memory. DID is incredibly rare.

A person with schizophrenia, on the other hand, has one personality state. However, he/she may hear voices that take on distinct identities.

In addition to auditory hallucinations, someone with schizophrenia may experience visual hallucinations, delusions, disorganized thoughts, cognitive deficits, and/or what’s referred to as “negative” symptoms. (A negative symptom is a lack of something that’s typically present in someone without schizophrenia. For example, a person with schizophrenia may be socially withdrawn or he/she may seem very “flat” [without emotion]).

9. Alcohol makes you depressed because it’s a depressant.

Yes, alcohol is a depressant; but as a “depressant,” it depresses your central nervous system, leading to slurred speech, trouble with coordination, etc. The “depressant” effects of alcohol are unrelated to clinical depression.

However, heavy alcohol use is associated with depression and other mental disorders. Someone who is struggling with depression or anxiety may drink as a way to self-medicate. Alternatively, someone with an alcohol use disorder may develop depression, as alcohol upsets the chemical balance in the brain. The lifestyle of someone with alcohol use disorder may also lead to intense guilt, shame, and/or hopelessness, which can in turn lead to depression.


Please help end the stigma attached to mental and substance use disorders by sharing this post!


What Counseling Has Taught Me (Part Two)

Learn to be more effective in your personal and professional life! This is the second installment of how counseling has led to a better understanding of people. Working with addiction and mental illness has gifted me with the capacity to better recognize why people do what they do, which in turn enhances how I relate to others.

By Cassie Jewell, LPC, LSATP

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This is the second installment of how counseling has led me to a better understanding of people. (In Part One, I discussed calmness, silence, active listening, partial truths, and hidden agendas.)

Working with addiction and mental illness has gifted me with the capacity to better recognize why people do what they do, which in turn enhances how I relate to others. As a result, I’m more effective in my personal and professional life. I have a sense of peace and “okayness” in the world.

One thing I hadn’t previously considered was brought up by Quora user and mental health professional, G. Bernard (MA Counseling); he shared that counseling revealed the truth about change. “It has really reinforced that idea that people who want change will work harder to achieve it; those who are forced (legally, by parents, spouse etc.) probably won’t.” I agree with this 100%. People can’t be forced into change; and when they are, their efforts lack fortitude and it doesn’t last. Those who are internally motivated will fight for change, making it worthwhile and enduring.

Here are some additional truths and realizations that I gained through my counseling career.

What counseling has taught me (the second installment):

1. A new perspective

The DSM – Diagnostic and Statistical Manual (the “Bible” for mental health professionals) – uncovered a whole new world for me. Sure, I was familiar with mental illnesses like depression, PTSD, and anxiety before grad school. I took Abnormal Psych in college and even before that, I’d read books on schizophrenia, eating disorders, and other mental disorders. (Guess who did their middle school science project on schizophrenia? Me!) But my fleeting knowledge was laughable compared to what I found in the DSM; it provided me with information on every single diagnosable mental disorder. When I started working with clients, I was able to see how mental illness manifests in real life.

The more I learned (and saw), the more I was able to make sense of behaviors. Consequently, this led to me looking back on people I’ve encountered throughout the years. I realized how many of them had been struggling with a mental illness. (At the time, I probably just thought they were just a jerk, or acting inconsiderately.)

I also became more aware of the prevalence of severe mental illness and the way it presents in society. This led to increased tolerance and patience regarding behaviors I’d previous found annoying; I learned to recognize them for what they were.

Mental illness can easily be interpreted as something it’s not. By having an awareness, I’m more compassionate. Instead of judging, I observe. Someone who seems snobby may have social anxiety. That coworker who calls out sick every Monday may be struggling with addiction. A friend who never wants to go out anymore could be depressed.

Mental illness is everywhere if you know what to look for. I strive to give everyone the benefit of the doubt, which is better for my mental health.

2. Don’t give money to the homeless

I knew a client at a residential program with a talent for making clever signs. He’d use markers to write his message (“Will dance for food!”) on a piece of cardboard before grabbing his pail to hit the streets. He didn’t need the money; he received government benefits (funded by taxpayers). The money he earned panhandling funded his K2 habit or the occasional beer.

Many of the “homeless” people you meet are not homeless; they’re con men (or women) who make a profit on your sympathy. Most are either addicted to drugs/alcohol and/or severely mentally ill; they need treatment, not the crinkled dollar bill in your pocket. Giving your spare change isn’t helping that person. Instead, offer to buy a meal, give them a pair of socks, or hand them a bottle of water.

3. Telling someone what to do is not helpful

Giving advice rarely leads to lasting change.

There are a few different reasons why advice, no matter how well-meaning, isn’t helpful. Firstly, it doesn’t account for the person’s full experience or struggle; it could seem ignorant or insensitive. (For example, “Why don’t you just get a divorce?” is not helpful to a woman struggling with her husband’s infidelity; the problem is more complex than just getting a divorce. Children could be involved. Maybe she’s financially dependent on her husband. Maybe she’s still in love with him. Or maybe it’s against her religious beliefs.)

Advice also robs a person of the ability to solve their own problem. We need to learn to find solutions in life in order to grow and to be effective. If someone is always told what to do, they’re not going to learn to function independently.

Lastly, if advice is taken, and it works, the credit goes to the advice giver, not the taker. The results are less meaningful. Alternatively, if advice is taken and it doesn’t work, it becomes the advice giver’s fault. Advice deprives a person of being able to take full ownership of their actions.

If you own your decision and fail, the blame falls on you (helping you to grow as a person) or if you succeed, the triumph is yours alone. Either way, you’re better off finding your own solutions; this allows you to feel capable and you’ll become better at solving problems in the future.

4. The value of transparency and honesty

People like to know what’s happening and what to expect. I get better reactions from clients when I explain why I’m doing or saying what I am. I’m honest, and when I can’t be (or believe it would be inappropriate to do so), I tell clients exactly that. For example, if a client asks about my religion, I’d let them know I don’t feel comfortable sharing personal aspects of my life.

Personally, I prefer the company of others who are straightforward. I don’t like having to guess if someone is upset with me. I don’t like it when someone is nice to my face, but gossips when I’m not around. Those types of games are played by people who are insecure or who are attempting to manipulate you. Life is complicated enough. With me, you’ll know if your fly is down, and if you ask for my opinion, you’ll get it. (There’s much to be said for tact though!) Gentle truths are worth more than flattery. 

5. You can’t demand respect

It’s something that’s earned through words and actions, not freely given. Forced respect is not true respect; it’s fear or deception. And while I believe in treating everyone with respect, I don’t truly respect someone until I know what kind of person they are.

Furthermore, I’ve learned that if someone chooses to disrespect me, it’s not a threat. Respect is powerful, but disrespect? Feeble and pathetic. If someone is disrespectful, it won’t harm you or make you less of a person (unless you give it that control).

Throughout my career, I’ve been disrespected on many, many occasions by clients who don’t want to be in treatment (and even by colleagues with differing opinions). But my sense of self-worth is not dependent on how others treat me. As a result, disrespect from angry clients (or rude salespersons or drivers who cut me off, etc.) doesn’t faze me.

In sum, being a counselor is life-changing. I imagine many professions are to a degree, but I can’t picture any other job leading to such a deep understanding of humanity. Entering the mental health field is like having horrible vision and then finally getting glasses (except it happens over the course of years). I have an enhanced awareness of who I am along with an unforeseen sense of serenity. 

Every single client who’s shared a piece of their story has contributed to my awareness (and to my own personal growth), and I owe them each a gratitude. I’m more cautious in life, yes, but I’m also more compassionate. Instead of having high expectations, I have high hopes. I don’t attempt to control things I have no control over; and I don’t get angry over the decisions, views, or actions of others. Instead, I channel my energy into something more productive; I’m passionate and I’m an advocate. My beauty pageant answer to the stereotypical question is not “world peace”; it’s for everyone to have a deeper understanding of each other.

What insights have you gained from your chosen career? Please share in a comment!

 

What Counseling Has Taught Me (Part One)

Counseling is generous in that it’s supplied me with the tools needed for not only professional growth, but personal success, emotional well-being, personal development, and effective communication. It’s also taught me about various aspects of human nature, from the brightest to the murkiest.

By Cassie Jewell, LPC, LSATP

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In grad school, I learned theories and techniques of counseling. I learned basic and advanced counseling skills; I practiced various interventions and methods. My professors taught developmental theories and multicultural competence. I took classes in career counseling, family counseling, and couples counseling; I studied research and ethics.

And when I accepted a substance abuse counselor position at a drug and alcohol treatment center… I had no clue what I was doing… or how to be a counselor. I went into my first year as a clinician with self-doubt and uncertainty.

Negative thoughts consumed me. I questioned myself and wondered if I was in the right field.

“Do I have what it takes to be an effective counselor?” 

“Should I have pursued a career in research instead?” 

“Should I have pursued anything instead?” 

“Am I capable of helping others?” 

Furthermore, social anxiety crippled my ability to relate to clients; being genuine was difficult. I couldn’t stop comparing myself to other “seasoned” clinicians, which only made things worse.

Gradually, my doubts and fears subsided; I felt more comfortable in my role. I accepted and settled into my new identity as a professional counselor; it was a good fit. I stopped trying to “fix” or control clients.

Anxiety no longer dictated my actions; I found a way to take ownership of my mistakes and accomplishments. Moreover, I learned to be okay with making mistakes. I accepted that I would never have all the answers. I let go of irrational beliefs that had previously plagued me. I thrived.

Today, I can reflect on my journey and on the positive changes I’ve made throughout the years. My chosen career is generous in that it’s supplied me with the tools needed for not only professional growth, but personal growth — success, emotional well-being, personal development, and effective communication.

I’ve learned a lot the past ten years. This post explores the discoveries I’ve made and how I apply that knowledge to my life. But before delving into what I’ve learned, here’s what a few other clinicians have said on the topic:

Nancy Lee, MA, LPCC, Psychotherapist in Aurora, CO

“Being a counselor has shown me that it’s possible to live on the edge of what I know and don’t know. In a single moment, I can feel strong and confident, yet small and humble. Counseling isn’t about fixing problems. It’s about believing in my client’s capacity to connect with their own solutions, insight, and growth.”

 

Robert Martin, M.Ed Early Childhood Education & Counseling, Francis Marion University

“There is no learning … if there is not a relationship… The foundation of counseling and teaching is [the] relationship. There must be a connection. The student must know that you care about them personally and it is ok to make a mistake … Consequences and corrections can be given, but always directed at the behavior [and] never the person … That you are only talking about their behavior when you correct them … and not them. They must feel that you respect them … and if you make a mistake say, “I’m so sorry. I made a mistake.” … [Always respect] their differences, their hopes and weakness, their failures, their dreams, their divinity. There is nothing more important than this…”

 

Bridget Cameron, Artist, Depth Psychologist, Stress Counselor (1992-present)

“To accept people as they are, to be non-judgmental, to be directed by compassion, and to know how to be impartial so that I am fair-minded with all people and do not project any of myself into my client’s history and am non-attached to the outcome.”

 

In comparison, while I’ve learned much about compassion, connecting, and being okay with being wrong, I’ve also learned how to use counseling to be effective, both personally and professionally… and I’ve learned to be more guarded due to the darker aspects of human nature.

Here’s my list of small wisdoms, or, what counseling has taught me (the first installment):

1. How to remain calm

Emotion regulation was difficult for me as an adolescent and young adult. My emotions ruled me – lorded over me, even! Then, as a counselor, I observed emotion disregulation in clients. I realized how truly counterproductive (and ridiculous-looking) it can be.

I made a choice to stop engaging in negativity, with both self and with others. Feeding into an argument solves nothing, but the effort leaves you emotionally and physically drained. Luckily, my personal transition from chaos to calm was painless. By the time I learned how to remain calm, I was in my mid-20s; the intensity of my emotions had already naturally subsided. Today, calmness is my natural state.

2. Comfortable silence

In grad school, I learned to use silence as a counseling technique. Instead of filling up every minute of a session with reflections, open-ended questions, and paraphrases, we were encouraged to use “comfortable silence.”

Silence allows the client time to process and/or collect their thoughts. To me, it always felt horribly awkward (remember, social anxiety!) and wrong. I wanted to rush on to the next topic or to ask a question or… anything.

I’m not sure when it finally stopped feeling awkward. I just knew that one day I was sitting in silence with a client and it felt natural. Today, I use silence in my professional and personal life all the time. It feels nice to sit quietly and not feel pressured to talk.

3. Active listening

Counseling taught me to really listen. I learned to quiet my internal dialogue to hear and comprehend what’s being said. Instead of thinking about how I’m going to respond, I give my full attention to the speaker. I’m aware of body language and other nonverbals. Counseling has strengthened my communication skills.

4. Partial truths

Counseling taught me that people don’t always say what they mean. They often tell partial truths. There are many reasons for this: Fear of being judged, not fully trusting the therapist, feeling embarrassed, etc.

For example, a client who isn’t ready to change their drinking probably wouldn’t tell me they drink three bottles of wine every night. Instead, they’d offer a partial truth. “I usually drink a glass of wine with dinner, but that’s it.”

Partial truths are not lies; they allow for a certain measure of comfort. (A lot of people feel uncomfortable with lying because they were taught it was wrong, or possibly because they view themselves as honest – and honest people don’t lie.) Partial truths, on the other hand, don’t feel wrong (or less wrong, at least). Plus, they’re safe. A person can be partially truthful and still protect their secrets.

When I realized how common partial truths are, I changed the way I listened to clients… and to everyone. Instead of taking things at face value, I listen to what is being said while recognizing that much more is not being said.

5. Hidden agendas

I also discovered that there are plenty of people out there who seek counseling with hidden agendas. For example, a man sees a therapist, stating he wants to learn anger management techniques. What he doesn’t reveal is that he’s abusive to his wife. He recently lost control in an argument and pushed her down the stairs. She gave him an ultimatum: Therapy or divorce. He doesn’t believe he needs counseling, but he’ll do it to save his marriage. And he doesn’t tell his therapist this (of course). Why would he? It’s none of her business.

Both partial truths and hidden agendas happen outside of therapy (and for similar reasons). Words paint a very limited piece of the entire picture. People often show only what they want others to see while keeping their true motives hidden.

Because of counseling, I have a better awareness and understanding of why hidden agendas (and partial truths) exist. It’s not cynicism, but a form of acceptance. I recognize that half truths and hidden agendas serve a purpose. While I may never understand their purpose, I’m okay with it.

This awareness fosters caution; I’ll never be caught off guard.

There’s more to tell, but for the sake of keeping this post to a reasonable length, I’ll save my remaining insights for the second installment of this post (in which I’ll discuss giving money to the homeless and demanding respect, among other “lessons” from counseling).

 

Free Online Academic Journals for Mental Health Professionals

Peer-reviewed scholarly journals you can access for free online. Access the latest research findings related to mental health, addiction, and wellness.

Compiled by Cassie Jewell, LPC, LSATP

Updated November 12, 2018

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This list is comprised of 70+ academic journals that you can access online. Most of the journals are open-access; others offer limited access (with some free articles). All of the publications are related to mental health, addiction, or wellness. I use many of them for research for this blog. The research is relevant to all health professionals and to anyone who is interested in learning more about mental illness. 

Abnormal and Behavioural Psychology  
Addiction Science and Clinical Practice  
Addiction Professional
Addictive Behavior Reports
Addictive Behaviors  
Aggression and Violent Behavior  
Alcohol and Alcoholism
Alcohol Research: Current Reviews
The American Journal of Drug and Alcohol Abuse
Annals of Behavioural Science  
Behavior and Brain Functions
Bipolar Disorder 
BMC Neuroscience 
BMC Psychiatry
BMC Psychology 
Borderline Personality Disorder and Emotion Regulation
Brain: A Journal of Neurology
Brain and Cognition
Brain Disorders and Therapy 
The British Journal of Psychiatry
Child and Adolescent Psychiatry and Mental Health
Clinical Depression 
Clinical Psychology Review 
Cognition
Cognitive Psychology
Consciousness and Cognition
Culture and Psychology
Current Addiction Reports
Current Opinion in Psychology
Current Psychology Letters: Behaviour, Brain, & Cognition
Drug and Alcohol Dependence
Dual Diagnosis 
Emotion Review
Electronic Journal of Research in Educational Psychology
European Journal of Trauma and Disassociation
Frontiers in Psychology
Harm Reduction Journal 
Health Psychology and Behavioral Medicine
Health Psychology Open 
International Journal of High Risk Behaviors and Addiction
International Journal of Mental Health and Psychiatry 
International Journal of Mental Health Systems
JAMA Internal Medicine
Journal of Abnormal Psychology
Journal of Addictive Behaviors, Therapy, & Rehabilitation 
Journal of Alcoholism and Drug Abuse 
Journal of Anxiety Disorders
Journal of Applied Behavior Analysis
Journal of Behavior Therapy and Experimental Psychiatry
Journal of Obsessive Compulsive and Related Disorders
Journal of Depression and Anxiety 
Journal of Drug Abuse 
Journal of Eating Disorders 
Journal of Experimental Social Psychology 
Journal of Human Values 
Journal of Interpersonal Violence 
Journal of Mental Disorders and Treatment 
The Journal of Neuroscience
Journal of Psychological Abnormalities
Journal of Psychology and Psychotherapy  
Journal of Sleep Disorders and Therapy 
Journal of Substance Abuse Treatment 
Journal of Traumatic Stress Disorders & Treatment 
Learning & Memory
Mental Health and Physical Activity
New Ideas in Psychology
Nicotine & Tobacco Research 
Nutrition Journal 
Personality and Individual Differences
PsyArt Journal
Punishment and Society
Schizophrenia Bulletin
Sexual Offender Treatment
Sleep
Sleep Science and Practice 
Social Media + Society 
Social Psychological and Personality Science 
Substance Abuse: Research and Treatment 
Substance Abuse Treatment, Prevention, and Policy 
Theory & Psychology 
Thinking Skills and Creativity
Tobacco Use Insights

Please contact me if you have a suggestion or if a link is not working!

Why “Playing Hardball” Doesn’t Work

How can you consistently get great results when dealing with customer service? Hint: “Playing hardball” doesn’t work. Instead, use seven basic counseling skills to get the best deal.

By Cassie Jewell, LPC

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Years ago, I was visiting new friends at their home to watch a college football game on TV. (It should be noted that I’m not a big sports fan, but my at-the-time boyfriend was.) The game couldn’t be viewed unless it was pre-ordered through the cable company, so the couple had had purchased the game ahead of time. We were all relaxing in the living room, eating snacks and chatting, waiting to watch some football. When the game didn’t come on as scheduled, they called the cable company… and much to my dismay, my male friend starting yelling and cursing at the customer service representative. I felt embarrassed, and couldn’t help thinking how awful it would feel to be on the receiving end of that call. (It’s not like it was the representative’s fault; they were trying to fix the problem!) At one point, my angry friend got too worked up and ended up handing the phone over to his female counterpart. I thought, Thank god! She’ll smooth this over. And then she proceeded to shout and cuss!

What is it that makes people think they can treat another human being like scum? Why do some believe that yelling, cursing, intimidating, or “playing hardball” is the way to go?

More recently, my husband and I went to a store to pick up an item he’d ordered online. He had previously called the store to ensure he’d be able to use a gift card for part of the balance, and was assured he could. However, upon arrival, we were informed that since his credit card had already been charged, there was no way to apply the gift card to his purchase. My husband was soooo mad! His typically easy-going, relaxed demeanor changed. He started arguing with the clerk; he was rude and sarcastic. Naturally, the clerk became defensive (and somewhat defiant). I wanted to disappear. My husband ended up paying full price for the item. The clerk’s day was probably ruined. I wondered if things would have turned out differently had my husband been his usual friendly self.

Why it is widely believed that “playing hardball” is the best approach for getting what you want?

Think about what motivates you to go out of your way to help; maybe you’re inspired to help someone because they’re friendly (and likeable). Or maybe you feel sorry for them. Maybe you want to help them because they’ve helped you in some way or shown you a kindness; you’re happy to return the favor. It’s less likely you’re motivated to help the angry guy who insults you. So why would it be different with customer service? Customer service reps are human, and therefore deserve to be treated with dignity and respect.

In my experience, consideration and good manners (thanks, Mom!) go a long way. And I (almost) always get excellent results with customer service. Not once have I played “hardball” or yelled, cursed, or threatened. People typically want to help me. By utilizing one or more of the following therapeutic techniques, you can be more effective when returning an item without a receipt, requesting a lower interest rate, or asking your cable company for a better deal.

1. Unconditional positive regard

Instead of bracing yourself for the worst, anticipate that they’ll be able to help.

As a professional counselor, I value my clients while appreciating their unique perspectives and views. This principle can be applied to a conversation with a customer service representative. Approach them with respect. Be appreciative of their hard work. Treat them with kindness. Instead of, “I need this issue resolved,” try, “Hi [their name], how is your day going?” Instead of bracing yourself for the worst, anticipate that they’ll be able to help. Say, “I’m hoping you’re the person who can help me with…” It’s likely the person you’re speaking with will strive to live up to your expectations; they will be the person who can help you.

2. Empathy

Empathy, the ability to understand another’s perspective and sense their emotions, is crucial to all helping relationships. Empathy is not sympathy or feeling sorry for someone. Sympathy pities; empathy empowers.

Empathy has the potential to open the door for exploration and healing.

To illustrate, I’ll discuss empathy’s role in counseling. Imagine a client who’s afraid she’ll be deemed selfish or weak for contemplating suicide. She recently lost her job and is going through a horrific divorce. She feels worthless; she thinks the world would be better off without her. Empathy drops you into in her shoes and allows you to experience her anguish. To convey empathy, I’d say, “I can see you’re in a tremendous amount of pain. It’s gotten so bad, suicide seems like the only solution.” Empathy validates her suffering and recognizes that her pain is unbearable. Empathy has the potential to open the door for exploration and healing. (In contrast, the opposite approach would be to scold her, to tell her “it’s not that bad,” or to say she’s only looking for attention. All of those things are harmful and would invalidate her struggle.)

When applied to customer service, empathy acknowledges the experience of being a service representative. If you’re empathetic, you understand what they feel. You recognize the challenges of dealing with angry customers who yell or threaten (like my football-loving friends). Furthermore, it’s known that empathy promotes helping behaviors. Convey empathy by saying, “I can’t imagine what you must deal with.” Or “I imagine this job requires a lot of patience.” Empathy has also been linked to persuasiveness. On the flip side, if the customer service rep empathizes with you, you may have a better chance of convincing them to grant your request, at least according to one study.

3. Genuineness

With clients, I say what I mean. I share what I’m thinking or feeling. I’m myself, flaws and all. Genuineness promotes trust and strengthens the therapeutic relationship. When talking to a customer service rep, don’t put on an act. Don’t play tough and/or make threats. That’s not how you’d treat a co-worker or an acquaintance (at least, I would hope not?) And don’t play dumb. Instead of, “I had no idea my payment was late,” try, “My payment was two days late, but since this is the first time, would you consider waiving the fee?” You could also explain your situation: “Honestly, I’ve always been happy with your services, but since the rates went up, I’ve been thinking about canceling. I’ve researched [competing company] and they have better rates. I’m not sure if I can afford your services anymore.” The rep would probably be able to relate (and even empathize), which translates to a better outcome for you.

4. Using names

Dale Carnegie said, “A person’s name is to him or her the sweetest and most important sound in any language.” Using a name isn’t a basic counseling skill, but what it conveys is. Using a name conveys respect. It makes that person feel important and valued. Speaking a person’s name also commands their attention. In a counseling session, to make the greatest impact with my words, I’ll say the client’s name before sharing a thought. A name is powerful.

When navigating customer service, repeat the rep’s name after they introduce themselves to help you remember. (Write it down if you’re on the phone.) Use their name throughout the conversation. Someone who feels respected, important, and valued is more likely to help than someone who feels disrespected, unimportant, and unappreciated.

5. Patience

Patience is invaluable in counseling. I’m patient with clients who are guarded and with clients who aren’t ready to change. I’m patient in my sessions; I sometimes sit in silence, allowing for the time to process, contemplate, or sort through thoughts. I’m patient when a client isn’t progressing. (Change takes time.) Lastly, I’m patient with myself when I say the wrong thing or when it seems my efforts aren’t helping. (I remind myself that I’m human; I make mistakes. I can’t help everyone.)

Customer service requires patience. Hold times can be ridiculously long. It also takes time to connect with an actual human. And when you do connect, they could say you’ve reached the wrong department. They’d transfer the call to someone in a different department (who may then have to transfer you again). You’ll probably be placed on hold a few times (and have to explain yourself multiple times). The call could be dropped and then you’d have to start all over again. You may have trouble understanding a rep’s accent. They may be unable to help you if you don’t know your account number (or the first concert you attended, the name of the street you grew up on, etc.) They could ask for a PIN or password you don’t remember creating.

Alternatively, if you’re dealing with customer service in-person, the line could be long. There could be a crying baby nearby or a man with strong body odor standing in front of you. Or maybe the person behind you is in your “bubble”; they keep bumping into you. It could be too hot or too cold in the store. Once you get to the front of the line, the clerk could be new; they don’t know how to resolve your issue. You’d be asked to step aside and wait for the manager, which would take even more time.

Patience is an art; it can be cultivated through mindfulness and gratitude. To foster patience, anticipate that your customer service issue is going to take a considerable amount of time. Expect to run into some unforeseen snags. If you’re already rushed or in a bad mood, just skip it. Instead, make that call or trip to the store when you’re relaxed and have plenty of time to spare.

6. Humor

Okay, this one isn’t an official counseling skill, but it’s one of my counseling skills. What’s more, research suggests that when used appropriately (and never at a client’s expense), humor is a powerful tool for healing. In my experience, humor allows clients to open up and relax. It improves mood and helps clients to view their problems from an alternative perspective. Humor is an important coping skill and may reduce mental health symptoms. Humor connects us; laughing together fosters positivity. Also, never underestimate the power of laughing at yourself. If you can find humor in your flaws and life fails, you can forgive yourself and move on. (It’s refreshing to not have to take yourself so seriously.) Humor makes me a better counselor… and a better person.

Humor connects us; laughing together fosters positivity.

When talking to a customer service rep, use humor if possible. (“Does the warranty cover a four-year old’s mission to see if phones float?”) Poke fun at yourself or your inadequacies. If your issue is even the slightest bit funny, go ahead and laugh. For example, a year or so ago, I had a problem with my FitBit. According to FitBit, I was climbing hundreds of flights of stairs every day. I contacted customer service to report the issue. In my email I wrote, “Although I wish it were true, I can assure you that I have not been climbing hundreds of flights of stairs on a daily basis. Please assist.” They sent a new FitBit. Humor generates positive feelings; research suggests that a positive mood increases helpfulness. For in-person customer service, a smile may increase your chances of getting the help you need. A happy customer service rep is more likely to grant your request.

7. Remaining calm

Composure is the opposite of reactivity. An effective clinician is calm and serene; this promotes healing while reducing client anxiety. Moreover, it’s essential to remain calm in a crisis or with trauma work. Reactivity, on the other hand, is chaotic and ineffective.

When you react, you lose a small piece of your control. The more you react, the more out of control you feel. When fully escalated, you give up all your power; you’ve essentially handed it over to the person you’re reacting to. Furthermore, when emotions are heightened, the logical part of your brain becomes less active. You’re driven by your emotions.

In contrast, remaining calm enables you to respond instead of react. Maintaining composure will almost always benefit you in an argument. Similarly, it’s to your benefit to remain calm when talking to a customer service rep. If you get angry or upset, you lose effectiveness. Research indicates that when negotiating, people dealing with angry counterparts are more likely to walk away from the deal. Expressing anger has limited effectiveness when employed as a negotiation strategy. If you happen to anger the customer service rep, you won’t end up getting what you want, at least according to one study.

To increase your ability to regulate your emotions, practice mindfulness meditation or deep breathing exercises. Neurofeedback is another tool for training your brain to remain calm.

In conclusion, the best strategies for getting your needs met include respect, genuineness, and empathy. Use a customer service rep’s name throughout the conversation. Be patient. Increase your likability with humor; remain calm (no matter what). These methods aren’t infallible, but they’ll boost your odds for great customer service. (And if you still aren’t getting results, politely end the conversation, hang up, and call back to be connected to someone else.)

Do you have any tips for getting exceptional customer service? Share about it in a comment!

Interview: We Only Get One Body in Life

“We only get one body in life, so it makes sense to treat it well by fueling it with nutritious foods.” An interview with Dr. Lisal Folsom, who discusses optimal health, nutrition, and sustainable weight loss.

Interviewer: Cassie Jewell, LPC

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An Endocrinologist’s Thoughts On Health and Sustainable Weight Loss

On a typical day, what are your patients’ complaints and how do you resolve them?

As an endocrinologist, I care for patients with all types of gland and hormone disorders. The most common reasons patients come to see me include diabetes (both type 1 and type 2), concerns about growth and puberty, thyroid dysfunction, hirsutism (unwanted hair growth), polycystic ovarian syndrome, and adrenal disorders. I also provide gender-affirming hormone therapy for transgender individuals. Depending on the patient’s symptoms and diagnosis, I may order lab tests and/or radiology studies such as thyroid ultrasounds or bone age xrays as part of my evaluation. Once we have a diagnosis, I work with the patient to create a personalized plan for treatment and follow up.

What about common questions or concerns?

Regardless of the reason they’ve come to see me, many patients are concerned about fatigue and weight gain. Everyone loves to blame these symptoms on the thyroid gland, but there are many other possible contributors to both fatigue and weight gain, including lack of quality sleep, sleep apnea, suboptimal eating habits, and infrequent exercise.

How does diet impact health?

A balanced diet and good nutrition are essential for optimal health. The only way to nourish and fuel our bodies is through food, and multiple studies have shown the benefits of good nutrition on health. People who eat a diet composed of fruits and vegetables, whole grains, and lean proteins have lower blood pressure, better cholesterol, and decreased risk of obesity than those who follow a typical Western diet. There is a lot of research going on right now investigating the health effects of switching to a whole foods plant-based diet. A study comparing gut bacteria found that individuals following vegan and vegetarian diets had a more diverse selection of microbes in the intestines, which can lead to better health. Another study published in Clinical Nutrition this year found that people with high cholesterol had improvement in their cholesterol numbers when they followed a whole foods plant-based diet. Their cholesterol worsened when they switched back to a diet containing animal products and refined carbohydrates. We only get one body in life, so it makes sense to treat it well by fueling it with the healthiest, most nutritious foods.

What are the main risk factors for diabetes?

Type 2 diabetes is an acquired metabolic disease associated with insulin resistance and high blood sugars. Until relatively recently this was a disease of adults, but in the past few years more and more children have been diagnosed with type 2 diabetes as well, partly because of the increase in obesity. Risk factors for developing type 2 diabetes include being overweight or obese, carrying extra weight in the abdominal area, lack of regular physical activity, a family history of type 2 diabetes, and being diagnosed with prediabetes. Gestational diabetes during pregnancy is also a risk factor for developing type 2 diabetes later on. A person will not necessarily develop type 2 diabetes just by eating a lot of sugar, but a long-standing pattern of unhealthy eating, lack of exercise, and weight gain will certainly increase the risk of developing type 2 diabetes down the road.

Can diabetes be treated with lifestyle changes?

Lifestyle changes are vital in diabetes treatment! Medicines can help to lower blood sugar, but the underlying cause of type 2 diabetes is insulin resistance, which is exacerbated by weight and lack of regular activity. We know that people who exercise on a regular basis tend to have lower blood pressure, better cholesterol, and are more likely to be at a weight considered to be healthy, than people who don’t exercise often. Part of the reason for this is that exercise improves the body’s sensitivity to insulin. When we exercise, our bodies don’t have to work as hard to turn the food we eat into energy and fuel for our cells. Studies have shown that people with type 2 diabetes who exercise after a meal have lower blood sugar levels than those who don’t. Exercise and a healthy diet are important for everyone, but these elements are especially crucial for people who are looking to improve their health.

Which is worse: Fat or sugar?

Ooh – tough question. I would say both and neither. Both fats and sugars come in healthy and unhealthy forms. Omega-3, polyunsaturated, and monounsaturated fatty acids help lower cholesterol and decrease the risk of heart disease. These healthy fats are found in nuts, peanut butter, avocados, flaxseed, and olive, canola, and soybean oils. Some eggs contain omega-3 fatty acids as well, depending on whether the chickens that laid them were given supplementation. Unhealthy fats include saturated and trans fats. These types of fats are found in fatty cuts of meat, poultry skin, fried foods, high fat dairy products, processed and prepackaged foods, and solid oils such as shortening and lard.

Healthy sugars include those occurring naturally in fruits and vegetables. A good rule of thumb is to try to choose foods that are as close to their natural state as possible. For example, when you eat an apple, rather than drinking apple juice, you get the added benefits of the fiber from the apple, and vitamins from the skin. These added health benefits of eating whole fruits and vegetables allow the sugars to be absorbed more gradually by your body, and are lost when foods are processed.

What is one food you’d never eat and why?

Cracklins. This southern delicacy consists of fried pieces of pork fat and skin, flavored with Cajun spices. Although I’m sure they’re very tasty, they’re also oozing with saturated and trans fats, contain almost 500 calories per serving, and are high in sodium. You could eat an entire avocado and two slices of whole wheat toast for fewer calories. This alternative snack is not only delicious, it also comes with the added benefits of healthy fats, whole grains, and fiber.

If given the opportunity, is there anything you’d change about the current dietary recommendations?

The current dietary guidelines are a good place to start. They recommend eating a variety of fruits and vegetables, making at least half of our grains whole, and limiting saturated and trans fats, added sugars, and sodium. I wish they went a little further though, by emphasizing the health benefits of whole rather than processed foods, and offering alternative options for people looking to follow a plant-based diet. There are some really great dairy alternatives out there, including nut milks (almond, cashew, macadamia), soymilk, plant protein products, and tofu. Many of these are made without added sugar, and are fortified with calcium and vitamin D, so the nutritional content is quite similar to the animal-based versions.

What are your thoughts on the obesity epidemic in America?

Obesity is a growing problem in our country, and it’s going to keep getting worse unless we as a society make some major changes. Obesity is a multifactorial disease, with many different levels of influence. Personal dietary choices have a role of course, but so does the environment in which people live. If a family lives in a food desert, and the only place to buy groceries is the convenience store where one banana and a 6-pack of ramen noodles each cost $1, parents are veritably forced to choose the less healthy, but inexpensive and filling options to feed their children. Many children in the U.S. eat both breakfast and lunch at school through the federally subsidized National School Lunch Program. This program is underfunded, and as such is unable to provide the highest quality, most nutritious food for the children who need it most. There are so many barriers to optimal health that exist at societal and cultural levels; it’s going to take a lot of work to tackle obesity. It’s possible, but change will need to happen from the top down.

What advice do you give to patients who are trying to lose weight?

At the end of the day it’s all about math: Energy in = energy out. If we put more calories into our bodies than we burn, our weight will go up. Alternatively, if we burn more calories than we eat, our weight will go down. Metabolism plays a role, certainly, and we all know people who can eat a dozen donuts without gaining a pound, which is just not fair, but overall consistent, purposeful, portion control is the key to sustainable weight loss. Exercise helps, but it’s really hard to burn enough calories by exercising to offset what we eat. A typical adult woman walking on a treadmill for 30 minutes burns around 150 calories. As a comparison, a pint of Ben & Jerry’s Chunky Money contains 1,160 calories. You would need to spend nearly 4 hours on the treadmill to burn off that pint of deliciousness, and nobody has time for that. It makes more sense to limit your total calorie intake through portion control and careful meal planning. Everyone should have a treat now and then, just plan for them ahead of time and pay attention to the nutrition label including serving size.

What’s one thing you wish everyone knew about hormones?

It’s probably not your thyroid. Seriously though, endocrinology is an amazing branch of medicine. Since our glands make hormones that then flow into the bloodstream, they have effects on so many different parts of the body. Endocrinologists have to consider the entire person when making a diagnosis, and this makes the field both challenging and exciting.

As an endocrinologist, what are the most useful things you’ve learned?

Weight loss is hard, but possible. Diabetes sucks, but you are strong, so don’t let it take over your life. Everybody loves to talk about food. Patients and physicians work best as a team. Good health is priceless.


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Dr. Lisal Folsom is a board-certified physician who specializes in endocrinology, diabetes, and metabolism. She also provides gender-affirming hormone therapy for transgender individuals. Dr. Folsom’s medical research has been published in the academic journals Endocrine Practice, The Journal of the South Carolina Medical Association, Current Osteoporosis Reports, Journal of Adolescent Health, and Endocrinology & Metabolism Clinics. She has been practicing for nine years.

Sleep Deprivation: What Dreams May… Cure?

What happens to your mind and body when you’re sleep-deprived? Poor-quality sleep is linked to a variety of health conditions, including obesity and heart disease. Poor sleep leads to cognitive impairment and poor judgment. A lack of sleep can even lead to schizophrenia-like symptoms! Learn why sleep is essential for health and well-being.

By Cassie Jewell, LPC

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According to the American Academy of Sleep Medicine, about 10% of Americans struggle with chronic insomnia and up to 35% of Americans experience insomnia at least occasionally. I’m part of the 10%. I’ve spent countless nights tossing and turning, dreading the obnoxious sound of “quantum bells” (my cell phone alarm) as daylight slowly creeps in. Due to this, I’ve done quite a bit of research on the subject. (And as a clinician, it’s important for me to know the relationship between restful sleep and mental health so I can educate my clients.)

Sleep recharges us; it makes it possible for us to remember what we learned throughout the day.

We all know that basic sleep hygiene is essential (i.e. having a regular sleep schedule, refraining from watching TV or reading in bed, avoiding alcohol before bedtime, etc.) And if you struggle with insomnia, you’ve probably heard of sleep medications and supplements like Ambien, trazodone, or melatonin. We also know how vital sleep is to health and wellness. Sleep significantly impacts mood, energy levels, and overall well-being. Sleep recharges us; it makes it possible for us to remember what we learned throughout the day.

Knowing how crucial sleep is for both physical and mental fitness, I set out to explore what happens when we don’t get enough. What exactly does a lack of sleep do to a person? I sifted through the research to learn more about the impact of sleep deprivation. This post explores how sleep deprivation affects physical health, perceptions, memory, and critical thinking.

SLEEP AND YOUR PHYSICAL HEALTH

Sleep deprivation is associated with signs of aging

Sleep deprivation has been linked to aging skin. One study found that poor-quality sleepers had more fine lines, uneven pigmentation, and reduced elasticity.

It makes sense that chronic sleep deprivation is associated with signs of aging; sleep is needed for overall rejuvenation (mind and body), which includes skin cell renewal. For smooth and supple skin, high-quality sleep is essential.

Snoring and sleep deprivation are linked to obesity

A 2016 study looked at the relationship between sleep characteristics and body size/weight. Snoring was associated with having a higher BMI, a larger waist, and more body fat. (It should be noted that snoring doesn’t cause obesity; the two are simply related.)

Poor sleep quality and shorter durations of sleep were linked to larger body size and more body fat. The relationship between sleep and obesity is further explored in the next few paragraphs.

Sleep deprivation is related to weight loss and appetite

If you’re dieting, you’re more likely to lose body fat when you’re getting adequate sleep. Researchers studied participants who slept for either an average of seven and a half hours or five and a quarter hours per night over a 14-day period. Calorie consumption was the same; participants lost similar amounts of weight. However, when participants slept more, they lost more body fat; in fact, about half of the weight they lost was fat. Sleep-deprived participants lost only a pound of fat; the other five pounds were fat-free body mass. Furthermore, it was found that sleep helps with appetite control; this is due to ghrelin, a hormone that stimulates appetite and promotes fat storage. Sleep-deprived participants had higher levels of ghrelin.

If you’re watching what you eat, incorporate healthy sleep habits to maximize your efforts; adequate sleep is needed for optimal weight loss.

Sleep affects our food choices

Other studies have examined specific the ways sleep deprivation affects food choices and calorie intake. Sleep deprivation is associated with especially poor food choices the day following poor-quality or no sleep. One study found that sleep deprivation led to strong cravings for junk food. The researchers measured increased activity in the part of the brain that responds to rewards, but decreased activity in the “decision-making” part of the brain. Study participants choose unhealthy items (i.e. pizza, donuts) over fruits and vegetables.

Another study looked at total calorie intake; sleep-deprived participants consumed an extra 385 calories per day. They also ate higher-fat foods. Additionally, researchers found that a sleep-deprived person purchased items that were higher in calories when grocery shopping.

A 2016 study looked at the relationship between sleep deprivation and the consumption of high-calorie, sugar-sweetened caffeinated beverages in a sample of 18,000 adults. It was found that adults who averaged less than five hours of sleep per night were more likely to consume sugary drinks like soda or energy drinks than their well-rested counterparts. The researchers weren’t able to determine whether drinking caffeinated beverages caused people to sleep less or whether being sleep-deprived caused people to crave more sugar and caffeine; it’s likely that both are true.

Without high-quality sleep, it’s difficult to lose body fat.

Regarding obesity, sleep deprivation plays a significant role. A lack of sleep causes us to feel hungry. We crave junk foods and consume more calories. At the same time, sleep deprivation promotes fat storage while decreasing our energy levels. Without high-quality sleep, it’s difficult to lose body fat.

If you struggle with chronic insomnia, make an active decision to make healthy eating a habit; you’ll be less likely to submit to your cravings. Visit the grocery store only when you’re well-rested. Know that you may not feel like exercising; practice determination. Be mindful to counter some of the health risks associated with sleep deprivation.

Sleep deprivation is related to heart disease, hypertension, and stroke (especially if you’re a woman)

In addition to obesity, sleep deprivation is associated with heart disease, high blood pressure, diabetes, and stroke. A lack of sleep takes a toll on the heart. In a recent study, researchers looked at 24-hour shift workers. It was found that sleep deprivation led to a significant increase in cardiac contractility, blood pressure, and heart rate. Furthermore, study participants experienced thyroid changes and an increase in cortisol (the stress hormone).

Research also indicates that chronic sleep deprivation and disrupted sleep are linked to an increased risk of developing or dying from coronary heart disease or stroke. Diabetes and hypertension are associated with sleep deprivation as well.

A lack of sleep may impact women more than men. Researchers found that women who got less than eight hours of sleep per night were at a higher risk of heart disease and other heart-related problems when compared to men who got the same amount of sleep.

Chronic sleep deprivation is related to reduced immune function

Have you ever noticed that you heal slowly or get sick more often when you’re sleep deprived? According to research, chronic sleep deprivation is associated with reduced immune function. If you’re not regularly getting at least six to seven hours of sleep, you’re more susceptible to illness. Your immune system won’t be as effective at eliminating viruses and bacterial infections.

Chronic sleep deprivation is associated with bone loss

Sleep even affects your bones. One study found that chronic sleep deprivation was associated with a loss of bone mass (in rats, at least). The rats underwent sleep restriction measures for three months. A lack of sleep led to significant decreases in bone density, volume, and thickness.

SLEEP AND YOUR BRAIN

Sleep deprivation is associated with increased pain sensitivity

The first part of this post examined sleep’s impact on physical health; the next half will explore how sleep affects the mind, including the way we sense and perceive the world around us. Research indicates that sleep deprivation and/or disruption increase sensitivity to pain. Interestingly, in one study, stimulants like caffeine had the ability to “normalize” the pain sensation (meaning it would feel the way it would with adequate sleep).

Sleep and chronic pain seem to be intricately connected, but the relationship is not fully understood; up to 88% of individuals with chronic pain report sleep issues and nearly 50% of individuals with insomnia have chronic pain..

A lack of sleep affects the way you hear and process sounds

In addition to the sensation of touch, sleep deprivation affects the perception of sound. A lack of sleep impairs central auditory processing (CAP). CAP is crucial for aspects of hearing such as language comprehension, identifying sounds, and recognizing patterns.

In one study, participants took a longer time identifying sounds after being deprived of sleep for 24 hours. It appeared there was a “transfer delay” (from hearing to identifying and then interpreting). To be effective, CAP requires alertness and concentration.

Sleep deprivation affects the formation of memories

We know that sleep deprivation causes cognitive impairment; the brain can only store so much information before it must recalibrate. During sleep, memories are encoded; the brain “consolidates” memories by strengthening them and transforming them from short-term into long-term memories. Without sleep, long-term memories can’t form. Short-term memories are lost and/or altered. Even procedural memories are impacted by sleep deprivation. A lack of sleep leads to forgetfulness and an inability to retain new information.

Sleep affects the way we interpret emotions

Sleep deprivation impairs your ability to interpret facial expressions. A recent study found that a lack of sleep made it difficult for participants to recognize the facial expressions of happiness or sadness. Interestingly, the ability to detect anger, fear, surprise and disgust was not affected. This suggests we’re biologically wired to recognize the emotions related to survival. The researchers hypothesized that the brain preserves functions that perceive life-threatening stimuli while sacrificing functions associated with empathy, bonding, and friendship.

“Real life” implications: If you’re majorly sleep-deprived, you could misinterpret the intentions of others, negatively impacting relationships with co-workers, family, friends, and others. Furthermore, you could read people wrong or miss important social cues; you might not respond appropriately or you could seem lacking in empathy.

When someone is sleep deprived, they’re slower to adopt another’s perspective

In addition to perception and memory formation, sleep deprivation impacts decision-making skills and thoughts, including the ability to accurately assess a situation.

If you have chronic insomnia, you might experience interpersonal problems.

In 2015, researchers hypothesized that sleep deprivation would impair the capacity to recognize sarcasm. Study results didn’t support the hypothesis, but the research generated an unexpected outcome. It was found that someone who was sleep-deprived was slower to adopt another person’s perspective. Implications? If you have chronic insomnia, you might experience interpersonal problems.

Sleep deprivation affects our moral judgment

Sleep deprivation affects moral judgment. In one study, participants were sleep deprived (awake for 53 continuous hours) and then faced with moral dilemmas. They had difficulty solving the dilemmas and making appropriate judgments. Other studies support this as well; a lack of sleep is related to decreased moral awareness. When you’re faced with a tough decision, especially one that involves ethics or morals, be sure to get adequate sleep. You can’t always trust your moral compass.

Sleep deprivation is linked to impaired decision making

Moral decisions are taxing if you’re sleep deprived… the opposite is true with risky ones. Sleep deprivation alters areas in the brain that assess positive and negative outcomes; sensitivity to rewards is enhanced while attention to negative consequences is diminished.

If you haven’t slept, tough decisions can wait.

Researchers found that when gambling, sleep-deprived individuals were more optimistic about their odds of winning. Another study found that sleep deprivation made it difficult for study participants to come to a quick decision when pressured. Sleep-deprived participants also made more mistakes. If you haven’t slept, tough decisions can wait.

A lack of sleep affects optimism

If you’re not getting enough sleep, you could lose your ability to remain positive-minded. Research indicates that individuals with insomnia have lower rates of self-esteem and optimism. In 2017, researchers found that sleep-deprived study participants were less likely to focus on positive stimuli. An inability to think positively is also a symptom of depression.

A lack of sleep can lead to schizophrenia-like symptoms

Sleep deprivation can lead to perceptual distortions, cognitive disorganization, and anhedonia (an inability to feel pleasure).In a 2014 study, participants experienced psychosis after staying awake for 24 hours. The sleep-deprived individuals reported attention deficits and being more sensitive to light, color, and brightness. They exhibited disorganized speech, which is a common symptom of schizophrenia. Participants also reported an altered sense of time and smell. Some of them actually believed they were able to read thoughts; others noticed an altered body perception. Implications? If you miss a night (or two) of sleep, don’t be surprised when you hear voices or when your reality is somewhat altered.

In conclusion, sleep deprivation, especially when it’s chronic, is detrimental to your health. Based on my review of the research, poor-quality sleep can adversely impact your skin, your weight, your cardiovascular system, your immune system, and your bones. (It should be noted that I barely skimmed the surface of an immense body of scientific data on sleep.)

Sleep is also related to brain health. Sleep deprivation impairs sensory perceptions, memory formation, the ability to assess your environment, moral awareness, critical thinking skills, and mood. Sleep deprivation can even induce psychosis.

If you’re like me (the one out of 10 Americans with chronic insomnia), in addition to practicing good sleep hygiene, go ahead and Google “CBT for sleep.” Research suggests that for some, CBT is more effective and longer-lasting than sleep medication. Do a little bit of research. CBT is not a quick fix for insomnia, but it’s worth a try; and your health and wellness are definitely worth it!

References

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American Academy of Sleep Medicine. (2007, March 2). Sleep Deprivation Affects Moral Judgment, Study Finds. ScienceDaily. Retrieved March 10, 2018 from www.sciencedaily.com/releases/2007/03/070301081831.htm

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Chapman, C., Nilsson, E., Nilsson, V., Cedernaes, J, Rångtell, F., Vogel, H., Dickson, S., Broman, J., Hogenkamp, P., Schiöth, H., &, Benedict, C. (2013). Acute sleep deprivation increases food purchasing in men. Obesity, DOI: 10.1002/oby.20579

Deliens, G., Stercq, F., Mary, A., Slama, H., Cleeremans, A., Peigneux, P., &, Kissine, M. (2015). Impact of acute sleep deprivation on sarcasm detection. PLoS ONE, 10(11). e0140527. http://doi.org/10.1371/journal.pone.0140527

Diering, G., Nirujogi, R., Roth, R., Worley, P., Pandey, A., &, Huganir, R. (2017). Homer1a drives homeostatic scaling-down of excitatory synapses during sleep. Science, DOI: 10.1126/science.aai8355

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