DC Types Have Been Flocking to Shrinks Ever Since Trump Won.

And a Lot of the Therapists Are Miserable.

Britt Peterson
www.washingtonian.com
Originally published July 14 2019

Here two excerpts:

In Washington, the malaise appears especially pronounced. I spent the last several months talking to nearly two dozen local therapists who described skyrocketing levels of interest in their services. They told me about cases of ordinary stress blossoming into clinical conditions, patients who can’t get through a session without invoking the President’s name, couples and families falling apart over politics—a broad category of concerns that one practitioner, Beth Sperber Richie, says she and her colleagues have come to categorize as “Trump trauma.”

In one sense, that’s been good news for the people who help keep us sane: Their calendars are full. But Trump trauma has also created particular clinical challenges for therapists like Guttman and her students. It’s one thing to listen to a client discuss a horrible personal incident. It’s another when you’re experiencing the same collective trauma.

“I’ve been a therapist for a long time,” says Delishia Pittman, an assistant professor at George Washington University who has been in private practice for 14 years. “And this has been the most taxing two years of my entire career.”

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For many, in other words, Trump-related anxieties originate from something more serious than mere differences about policy. The therapists I spoke to are equally upset—living through one unnerving news cycle after another, personally experiencing the same issues as their patients in real time while being expected to offer solace and guidance. As Bindeman told her clients the day after Trump’s election, “I’m processing it just as you are, so I’m not sure I can give you the distance that might be useful.”

This is a unique situation in therapy, where you’re normally discussing events in the client’s private life. How do you counsel a sexual-assault victim agitated by the Access Hollywood tape, for example, when the tape has also disturbed you—and when talking about it all day only upsets you further? How about a client who echoes your own fears about climate change or the treatment of minorities or the government shutdown, which had a financial impact on therapists just as it did everyone else?

Again and again, practitioners described different versions of this problem.

The info is here.

No Support for Historical Candidate Gene or Candidate Gene-by-Interaction Hypotheses for Major Depression Across Multiple Large Samples

Richard Border, Emma C. Johnson, and others
The American Journal of Psychiatry
https://doi.org/10.1176/appi.ajp.2018.18070881

Abstract

Objective:
Interest in candidate gene and candidate gene-by-environment interaction hypotheses regarding major depressive disorder remains strong despite controversy surrounding the validity of previous findings. In response to this controversy, the present investigation empirically identified 18 candidate genes for depression that have been studied 10 or more times and examined evidence for their relevance to depression phenotypes.

Methods:
Utilizing data from large population-based and case-control samples (Ns ranging from 62,138 to 443,264 across subsamples), the authors conducted a series of preregistered analyses examining candidate gene polymorphism main effects, polymorphism-by-environment interactions, and gene-level effects across a number of operational definitions of depression (e.g., lifetime diagnosis, current severity, episode recurrence) and environmental moderators (e.g., sexual or physical abuse during childhood, socioeconomic adversity).

Results:
No clear evidence was found for any candidate gene polymorphism associations with depression phenotypes or any polymorphism-by-environment moderator effects. As a set, depression candidate genes were no more associated with depression phenotypes than noncandidate genes. The authors demonstrate that phenotypic measurement error is unlikely to account for these null findings.

Conclusions:
The study results do not support previous depression candidate gene findings, in which large genetic effects are frequently reported in samples orders of magnitude smaller than those examined here. Instead, the results suggest that early hypotheses about depression candidate genes were incorrect and that the large number of associations reported in the depression candidate gene literature are likely to be false positives.

The research is here.

Editor's note: Depression is a complex, multivariate experience that is not primarily genetic in its origins.

Promoting wellness and stress management in residents through emotional intelligence training

Ramzan Shahid, Jerold Stirling, William Adams
Advances in Medical Education and Practice ,Volume 9

Background: 

US physicians are experiencing burnout in alarming numbers. However, doctors with high levels of emotional intelligence (EI) may be immune to burnout, as they possess coping strategies which make them more resilient and better at managing stress. Educating physicians in EI may help prevent burnout and optimize their overall wellness. The purpose of our study was to determine if educational intervention increases the overall EI level of residents; specifically, their stress management and wellness scores.

Participant and methods: 

Residents from pediatrics and med-ped residency programs at a university-based training program volunteered to complete an online self-report EI survey (EQ-i 2.0) before and after an educational intervention. The four-hour educational workshop focused on developing four EI skills: self-awareness; self-management; social awareness; and social skills. We compared de-identified median score reports for the residents as a cohort before and after the intervention.

Results: 

Thirty-one residents (20 pediatric and 11 med-ped residents) completed the EI survey at both time intervals and were included in the analysis of results. We saw a significant increase in total EI median scores before and after educational intervention (110 vs 114, P=0.004). The stress management composite median score significantly increased (105 vs 111, P<0.001). The resident’s overall wellness score also improved significantly (104 vs 111, P=0.003).

Conclusions: 

As a group, our pediatric and med-peds residents had a significant increase in total EI and several other components of EI following an educational intervention. Teaching EI skills related to the areas of self-awareness, self-management, social awareness, and social skill may improve stress management skills, promote wellness, and prevent burnout in resident physicians.

The research is here.

Who Is Experiencing What Kind of Moral Distress?

Carina Fourie
AMA J Ethics. 2017;19(6):578-584.

Abstract

Moral distress, according to Andrew Jameton’s highly influential definition, occurs when a nurse knows the morally correct action to take but is constrained in some way from taking this action. The definition of moral distress has been broadened, first, to include morally challenging situations that give rise to distress but which are not necessarily linked to nurses feeling constrained, such as those associated with moral uncertainty. Second, moral distress has been broadened so that it is not confined to the experiences of nurses. However, such a broadening of the concept does not mean that the kind of moral distress being experienced, or the role of the person experiencing it, is morally irrelevant. I argue that differentiating between categories of distress—e.g., constraint and uncertainty—and between groups of health professionals who might experience moral distress is potentially morally relevant and should influence the analysis, measurement, and amelioration of moral distress in the clinic.

The info is here.

When Doctors Struggle With Suicide, Their Profession Often Fails Them

Blake Farmer
NPR.org
Originally posted July 31, 2018

Here is an excerpt:

A particular danger for doctors trying to fend off suicidal urges is that they know exactly how to end their own lives and often have easy access to the means.

Wenger remembers his friend and colleague as the confident professional with whom he had worked in emergency rooms all over Knoxville — including the one where she died. That day three years ago still makes no sense to him.

"She was very strong-willed, strong-minded, an independent, young, female physician," says emergency doctor Betsy Hull, a close friend. "I don't think any of us had any idea that she was struggling as much personally as she was for those several months."

That day she became part of a grim set of statistics.

A harsh reality

An estimated 300 to 400 doctors kill themselves each year, a rate of 28 to 40 per 100,000 or more than double that of general population. That is according to a review of 10 years of literature on the subject presented at the American Psychiatry Association annual meeting in May.

The information is here.

Mental health practitioners’ reported barriers to prescription of exercise for mental health consumers

KirstenWay, Lee Kannis-Dymand, Michele Lastella, Geoff P. Lovell
Mental Health and Physical Activity
Volume 14, March 2018, Pages 52-60

Abstract

Exercise is an effective evidenced-based intervention for a range of mental health conditions, however sparse research has investigated the exercise prescription behaviours of mental health practitioners as a collective, and the barriers faced in prescribing exercise for mental health. A self-report survey was completed online by 325 mental health practitioners to identify how often they prescribe exercise for various conditions and explore their perceived barriers to exercise prescription for mental health through thematic analysis. Over 70% of the sample reported prescribing exercise regularly for depression, stress, and anxiety; however infrequent rates of prescription were reported for conditions of schizophrenia, bipolar and related disorders, and substance-related disorders. Using thematic analysis 374 statements on mental health practitioners' perceived barriers to exercise prescription were grouped into 22 initial themes and then six higher-order themes. Reported barriers to exercise prescription mostly revolved around clients' practical barriers and perspectives (41.7%) and the practitioners' knowledge and perspectives (33.2%). Of these two main themes regarding perceived barriers to exercise prescription in mental health, a lack of training (14.7%) and the client's disinclination (12.6%) were initial themes which reoccurred considerably more often than others. General practitioners, mental health nurses, and mental health managers also frequently cited barriers related to a lack of organisational support and resources. Barriers to the prescription of exercise such as lack of training and client's disinclination need to be addressed in order to overcome challenges which restrict the prescription of exercise as a therapeutic intervention.

The research is here.

Mental Health Crisis for Grad Students

Colleen Flaherty
Inside Higher Ed
Originally published March 6, 2018

Several studies suggest that graduate students are at greater risk for mental health issues than those in the general population. This is largely due to social isolation, the often abstract nature of the work and feelings of inadequacy -- not to mention the slim tenure-track job market. But a new study in Nature Biotechnology warns, in no uncertain terms, of a mental health “crisis” in graduate education.

“Our results show that graduate students are more than six times as likely to experience depression and anxiety as compared to the general population,” the study says, urging action on the part of institutions. “It is only with strong and validated interventions that academia will be able to provide help for those who are traveling through the bioscience workforce pipeline.”

The paper is based on a survey including clinically validated scales for anxiety and depression, deployed to students via email and social media. The survey’s 2,279 respondents were mostly Ph.D. candidates (90 percent), representing 26 countries and 234 institutions. Some 56 percent study humanities or social sciences, while 38 percent study the biological and physical sciences. Two percent are engineering students and 4 percent are enrolled in other fields.

Some 39 percent of respondents scored in the moderate-to-severe depression range, as compared to 6 percent of the general population measured previously with the same scale.

The article is here.

Suicidal Ideation, Plans, and Attempts Among Public Safety Personnel in Canada

R. N. Carleton and others
Canadian Psychology
First published February 8, 2018

Abstract

Substantial media attention has focused on suicide among Canadian Public Safety Personnel (PSP; e.g., correctional workers, dispatchers, firefighters, paramedics, police). The attention has raised significant concerns about the mental health impact of public safety service, as well as interest in the correlates for risk of suicide. There have only been two published studies assessing lifetime suicidal behaviors among Canadian PSP. The current study was designed to assess past-year and lifetime suicidal ideation, plans, and attempts amongst a large diverse sample of Canadian PSP. Estimates of suicidal ideation, plans, and attempts were derived from self-reported data from a nationally administered online survey. Participants included 5,148 PSP (33.4% women) grouped into six categories (i.e., Call Centre Operators/Dispatchers, Correctional Workers, Firefighters, Municipal/Provincial Police, Paramedics, Royal Canadian Mounted Police). Substantial proportions of participants reported past-year and lifetime suicidal ideation (10.1%, 27.8%), planning (4.1%, 13.3%), or attempts (0.4%, 4.6%). Women reported significantly more lifetime suicidal behaviors than men (ORs = 1.15 to 2.62). Significant differences were identified across PSP categories in reports of past-year and lifetime suicidal behaviors. The proportion of Canadian PSP reporting past-year and lifetime suicidal behaviors was substantial. The estimates for lifetime suicidal behaviors appear consistent with or higher than previously published international PSP estimates, and higher than reports from the general population. Municipal/Provincial Police reported the lowest frequency for past-year and lifetime suicidal behaviors, whereas Correctional Workers and Paramedics reported the highest. The results provide initial evidence that substantial portions of diverse Canadian PSP experience suicidal behaviors, therein warranting additional resources and research.

The research is here.

Burnout in mental health providers

Practice Research and Policy Staff
American Psychological Association Practice Organization
Originally published January 25, 2018

Burnout commonly affects individuals involved in the direct care of others, including mental health practitioners. Burnout consists of three components: emotional exhaustion, depersonalization of clients and feelings of ineffectiveness or lack of personal accomplishment (Maslach, Jackson & Lieter, 1997). Emotional exhaustion may include feeling overextended, being unable to feel compassion for clients and feeling unable to meet workplace demands. Depersonalization is the process by which providers distance themselves from clients to prevent emotional fatigue. Finally, feelings of ineffectiveness and lack of personal accomplishment occur when practitioners feel a negative sense of personal and/or career worth.

Studies estimate that anywhere between 21 percent and 61 percent of mental health practitioners experience signs of burnout (Morse et al., 2012). Burnout has been associated with workplace climate, caseload size and severity of client symptoms (Acker, 2011; Craig & Sprang, 2010; Thompson et al., 2014). In contrast, studies examining burnout prevention have found that smaller caseloads, less paperwork and more flexibility at work are associated with lower rates of burnout (Lent & Schwartz, 2012). Burnout results in negative outcomes for both practitioners and their clients. Symptoms of burnout are not solely psychological; burnout has also been linked to physical ailments such as headaches and gastrointestinal problems (Kim et al., 2011).

The following studies examine correlates and predictors of burnout in mental health care providers. The first study investigates burnout amongst practitioners working on posttraumatic stress disorder clinical teams in Veterans Affairs (VA) health care settings. The second study examines correlates of burnout in sexual minority practitioners, and the third study investigates the impact of personality on burnout. Finally, the fourth study examines factors that may prevent burnout.

The information is here.

What I’ve learned from my tally of 757 doctor suicides

Pamela Wible
The Washington Post
Originally published January 13, 2018

Here are two excerpts:

Physician suicide is a public health crisis. One million Americans lose their doctors to suicide each year.

Many doctors have lost a colleague to suicide. Some have lost up to eight during their career — with no opportunity to grieve.

We lose way more men than women. For every female physician on my suicide registry, there are seven men. Suicide methods vary by region and gender. Women prefer to overdose and men choose firearms. Gunshot wounds prevail out West. Jumping is popular in New York City. In India, doctors have been found hanging from ceiling fans.

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Patient deaths hurt doctors. A lot. Even when there’s no medical error, doctors may never forgive themselves for losing a patient. Suicide is the ultimate ­self-punishment. In several cases, the death of a patient seemed to be the key factor in pushing them over the edge.

Malpractice suits can be devastating. Humans make mistakes. Yet when doctors make mistakes, they’re publicly shamed in court, on TV and in newspapers (that live online forever). Many continue to suffer the agony of harming someone else — unintentionally — for the rest of our lives.

Academic distress kills medical students’ dreams. Failing medical-board exams and not getting a post-medical-school assignment in a specialty of choice has led to suicides. Doctors can be shattered if they fail to gain a residency: Before his suicide, Robert Chu, unmatched to residency, wrote a letter to medical officials and government leaders calling out a system that he said ruined his career.

The information is here.

Why are America's farmers killing themselves in record numbers?

Debbie Weingarten
The Guardian
Originally published December 6, 2017

Here is an excerpt:

“Farming has always been a stressful occupation because many of the factors that affect agricultural production are largely beyond the control of the producers,” wrote Rosmann in the journal Behavioral Healthcare. “The emotional wellbeing of family farmers and ranchers is intimately intertwined with these changes.”

Last year, a study by the Centers for Disease Control and Prevention (CDC) found that people working in agriculture – including farmers, farm laborers, ranchers, fishers, and lumber harvesters – take their lives at a rate higher than any other occupation. The data suggested that the suicide rate for agricultural workers in 17 states was nearly five times higher compared with that in the general population.

After the study was released, Newsweek reported that the suicide death rate for farmers was more than double that of military veterans. This, however, could be an underestimate, as the data collected skipped several major agricultural states, including Iowa. Rosmann and other experts add that the farmer suicide rate might be higher, because an unknown number of farmers disguise their suicides as farm accidents.

The US farmer suicide crisis echoes a much larger farmer suicide crisis happening globally: an Australian farmer dies by suicide every four days; in the UK, one farmer a week takes his or her own life; in France, one farmer dies by suicide every two days; in India, more than 270,000 farmers have died by suicide since 1995.

The article is here.

Professional Self-Care to Prevent Ethics Violations

Claire Zilber
The Ethical Professor
Originally published December 4, 2017

Here is an excerpt:

Although there are many variables that lead a professional to violate an ethics rule, one frequent contributing factor is impairment from stress caused by a family member's illness (sick child, dying parent, spouse's chronic health condition, etc.). Some health care providers who have been punished by their licensing board, hospital board or practice group for an ethics violation tell similar stories of being under unusual levels of stress because of a family member who was ill. In that context, they deviated from their usual behavior.

For example, a surgeon whose son was mentally ill prescribed psychotropic medications to him because he refused to go to a psychiatrist. This surgeon was entering into a dual relationship with her child and prescribing outside of her area of competence, but felt desperate to help her son. Another physician, deeply unsettled by his wife’s diagnosis with and treatment for breast cancer, had an extramarital affair with a nurse who was also his employee. This physician sought comfort without thinking about the boundaries he was violating at work, the risk he was creating for his practice, or the harm he was causing to his marriage.

Physicians cannot avoid stressful events at work and in their personal lives, but they can exert some control over how they adapt to or manage that stress. Physician self-care begins with self-awareness, which can be supported by such practices as mindfulness meditation, reflective writing, supervision, or psychotherapy. Self-awareness increases compassion for the self and for others, and reduces burnout.

The article is here.

How to Recognize Burnout Before You’re Burned Out

Kenneth R. Rosen
The New York Times
Originally published September 5, 2017

Here is an excerpt:

In today’s era of workplace burnout, achieving a simpatico work-life relationship seems practically out of reach. Being tired, ambivalent, stressed, cynical and overextended has become a normal part of a working professional life. The General Social Survey of 2016, a nationwide survey that since 1972 has tracked the attitudes and behaviors of American society, found that 50 percent of respondents are consistently exhausted because of work, compared with 18 percent two decades ago.

Where once the term burnout was applied exclusively to health care workers, police officers, firefighters, paramedics or social workers who deal with trauma and human services — think Graham Greene’s novel “A Burnt-Out Case,” about a doctor in the Belgian Congo, a book that gave rise to the term colloquially — the term has since expanded to workers who are now part of a more connected, hyperactive and overcompensating work force.

But occupational burnout goes beyond needing a simple vacation or a family retreat, and many experts, psychologists and institutions, including the Centers for Disease Control and Prevention, highlight long-term and unresolvable burnout as not a symptom but rather a major health concern. (Though it does not appear in the Diagnostic and Statistical Manual of Mental Disorders, which outlines psychiatric disorders, it does appear in the International Statistical Classification of Diseases and Related Health Problems, a classification used by the World Health Organization.)

“We’re shooting ourselves in the foot,” Ms. Seppala told me. “Biologically we are not meant to be in that high-stress mode all the time. We got lost in this idea that the only way to be productive is to be on the go-go-go mode.”

The article is here.

Stress Leads to Bad Decisions. Here’s How to Avoid Them

Ron Carucci
Harvard Business Review
Originally posted August 29, 2017

Here is an excerpt:

Facing high-risk decisions. 

For routine decisions, most leaders fall into one of two camps: The “trust your gut” leader makes highly intuitive decisions, and the “analyze everything” leader wants lots of data to back up their choice. Usually, a leader’s preference for one of these approaches poses minimal threat to the decision’s quality. But the stress caused by a high-stakes decision can provoke them to the extremes of their natural inclination. The highly intuitive leader becomes impulsive, missing critical facts. The highly analytical leader gets paralyzed in data, often failing to make any decision. The right blend of data and intuition applied to carefully constructing a choice builds the organization’s confidence for executing the decision once made. Clearly identify the risks inherent in the precedents underlying the decision and communicate that you understand them. Examine available data sets, identify any conflicting facts, and vet them with appropriate stakeholders (especially superiors) to make sure your interpretations align. Ask for input from others who’ve faced similar decisions. Then make the call.

Solving an intractable problem. 

To a stressed-out leader facing a chronic challenge, it often feels like their only options are to either (1) vehemently argue for their proposed solution with unyielding certainty, or (2) offer ideas very indirectly to avoid seeming domineering and to encourage the team to take ownership of the challenge. The problem, again, is that neither extreme works. If people feel the leader is being dogmatic, they will disengage regardless of the merits of the idea. If they feel the leader lacks confidence in the idea, they will struggle to muster conviction to try it, concluding, “Well, if the boss isn’t all that convinced it will work, I’m not going to stick my neck out.”

The article is here.

Burnout at Work Isn’t Just About Exhaustion. It’s Also About Loneliness

Emma Seppala and Marissa King
Harvard Business Review

First published June 29, 2017

More and more people are feeling tired and lonely at work. In analyzing the General Social Survey of 2016, we found that, compared with roughly 20 years ago, people are twice as likely to report that they are always exhausted. Close to 50% of people say they are often or always exhausted due to work. This is a shockingly high statistic — and it’s a 32% increase from two decades ago. What’s more, there is a significant correlation between feeling lonely and work exhaustion: The more people are exhausted, the lonelier they feel.

This loneliness is not a result of social isolation, as you might think, but rather is due to the emotional exhaustion of workplace burnout. In researching the book The Happiness Track, we found that 50% of people — across professions, from the nonprofit sector to the medical field — are burned out. This isn’t just a problem for busy, overworked executives (though the high rates of loneliness and burnout among this group are well known). Our work suggests that the problem is pervasive across professions and up and down corporate hierarchies.

Loneliness, whether it results from social isolation or exhaustion, has serious consequences for individuals. John Cacioppo, a leading expert on loneliness and coauthor of Loneliness: Human Nature and the Need for Social Connection, emphasizes its tremendous impact on psychological and physical health and longevity. Research by Sarah Pressman, of the University of California, Irvine, corroborates his work and demonstrates that while obesity reduces longevity by 20%, drinking by 30%, and smoking by 50%, loneliness reduces it by a whopping 70%. In fact, one study suggests that loneliness increases your chance of stroke or coronary heart disease — the leading cause of death in developed countries — by 30%. On the other hand, feelings of social connection can strengthen our immune system, lengthen our life, and lower rates of anxiety and depression.

The article is here.

A Teachable Ethics Scandal

Mitchell Handelsman
Teaching of Psychology

Abstract

In this article, I describe a recent scandal involving collusion between officials at the American Psychological Association (APA) and the U.S. Department of Defense, which appears to have enabled the torture of detainees at the Guantanamo Bay detention facility. The scandal is a relevant, complex, and engaging case that teachers can use in a variety of courses. Details of the scandal exemplify a number of psychological concepts, including obedience, groupthink, terror management theory, group influence, and motivation. The scandal can help students understand several factors that make ethical decision-making difficult, including stress, emotions, and cognitive factors such as loss aversion, anchoring, framing, and ethical fading. I conclude by exploring some parallels between the current torture scandal and the development of APA’s ethics guidelines regarding the use of deception in research.

The article is here.

There’s a Right Way and a Wrong Way to Do Empathy

By Sarah Watts
The Science of Us
Originally published May 18, 2017

Here is an excerpt:

When we talk about empathy, we tend to talk about it as an unqualified good thing. Research has shown that empathy is associated with kindness and helping behaviors, while its absence, clinically referred to as psychopathy, is associated with manipulation and criminal deviance. Empathy, some scientists have concluded, allows us to function well with others and survive as a species.

But what people often don’t talk about is how even a good thing like empathy can still be emotionally draining. Empathic people who easily take on other people’s feelings can spend their days feeling overwhelmed, hurt, and heavyhearted. Empathy, in other words, can be downright stressful. So would it be fair to say that sometimes it’s unhealthy?

A paper published earlier this month in the Journal of Experimental Psychology set out to answer exactly that. According to the authors, there are “two routes” to empathy. The first is imagining how someone else might feel in a given circumstance, called “imagine-other-perspective-taking,” or IOPT. The second is actually imagining yourself in the other person’s situation, called “imagine-self-perspective-taking,” or ISPT. With IOPT, you acknowledge another person’s feelings; with ISPT, you take on that person’s feelings as your own.

The article is here.

There is something rotten inside the medical profession

Anonymous
kevinmd.com
Originally published January 26, 2017

In the year it has taken for me to finish my medical residency as a junior doctor, two of my colleagues have killed themselves. I’ve read articles that refer to suicide amongst doctors as the profession’s “grubby little secret,” but I’d rather call it exactly how it is: the profession’s shameful and disgusting open secret.

Medical training has long had its culture rooted in ideals of suffering. Not so much for the patients — which is often sadly a given, but for the doctors training inside it. Every generation always looks down on the generation training after it — no one ever had it as hard as them, and thus deserve to suffer just as much, if not more. This dubious school of thought has long been acknowledged as standard practice. To be a good doctor, you must work harder, stay later, know more, and never falter. Weakness in medicine is a failing, and if you admit to struggling, the unspoken opinion (or often spoken) is that you simply couldn’t hack it.

In the cutthroat, often brutalizing culture of medical or surgical training many doctors stay stoically mute in the face of daily, soul destroying adversity; at the worst case, their loudest gesture is deafeningly silent — death by their own hand.

The blog post is here.

Forgiveness can improve mental and physical health

By Kirsten Weir
The Monitor on Psychology
January 2017, Vol 48, No. 1
Print version: page 30

Here is an excerpt:

One common but mistaken belief is that forgiveness means letting the person who hurt you off the hook. Yet forgiveness is not the same as justice, nor does it require reconciliation, Worthington explains. A former victim of abuse shouldn't reconcile with an abuser who remains potentially dangerous, for example. But the victim can still come to a place of empathy and understanding. "Whether I forgive or don't forgive isn't going to affect whether justice is done," Worthington says. "Forgiveness happens inside my skin."

Another misconception is that forgiving someone is a sign of weakness. "To that I say, well, the person must not have tried it," says Worthington.

And there may be very good reasons to make the effort. Research has shown that forgiveness is linked to mental health outcomes such as reduced anxiety, depression and major psychiatric disorders, as well as with fewer physical health symptoms and lower mortality rates. In fact, researchers have amassed enough evidence of the benefits of forgiveness to fill a book; Toussaint, Worthington and David R. Williams, PhD, edited a 2015 book, "Forgiveness and Health," that detailed the physical and psychological benefits.

Toussaint and Worthington suggest that stress relief is probably the chief factor connecting forgiveness and well-being. "We know chronic stress is bad for our health," Toussaint says. "Forgiveness allows you to let go of the chronic interpersonal stressors that cause us undue burden."

While stress relief is important, Enright believes there are other important mechanisms by which forgiveness works its magic. One of those, he suggests, is "toxic" anger. "There's nothing wrong with healthy anger, but when anger is very deep and long lasting, it can do a number on us systemically," he says. "When you get rid of anger, your muscles relax, you're less anxious, you have more energy, your immune system can strengthen."

The article is here.

Why are doctors burned out? Our health care system is a complicated mess

By Steven Adelman and Harris A. Berman
STAT News
Originally posted December 15, 2016

Here is an excerpt:

Burnout and dissatisfaction with work-life balance are particularly acute for adult primary care physicians — the central figures in our unsystematic health care “system.” A system that was already teetering in 2011 has been stressed by the addition of 20 million covered lives by the Affordable Care Act. It’s little wonder that in Massachusetts, where near-universal coverage has filled up the offices of primary care physicians, malpractice claims against them are rising. Patients and physicians alike complain about the unsatisfying brevity of office visits, and many harbor intense feelings of antipathy towards cumbersome electronic health records and growing administrative burdens.

We believe that to alleviate the stress and burnout in the medical professions, we must pay attention to system factors that lead to what we call the “occupational health crisis in medicine.” We recently surveyed 425 practicing physicians and health care leaders and executives, seeking their opinions on the importance of eight approaches to transforming health care. We presented the results this fall at the International Conference on Physician Health.

The article is here.