TIME Environment

Lead Didn’t Bring Down Ancient Rome—But It’s Still a Modern Menace

Roman aqueducts led to lead contamination
Aqueducts like this one contaminated Roman tap water with lead Moment via Getty Images

Lead levels were high in ancient Rome's tap water—but not high enough to cause the collapse of its civilization

You could fill a book with theories on why the ancient Roman Empire declined and fell—which, in fact, is what the 18th British historian Edward Gibbon did in his magisterial Decline and Fall of the Roman Empire. But if you don’t have time to read the 3,000 or so pages in Gibbon’s full work, here’s one very simple theory: it was lead. Canadian scientist Jerome Nriagu published an influential 1983 paper arguing that high levels of the neurotoxin lead—which contaminated water and other beverages through lead aqueducts and lead cups—caused mental disabilities and erratic behavior among members of Roman high society. Nriagu even reviewed the personalities and habits of Roman emperors between 30 B.C. and 22o A.D.—a list that includes notorious nutjobs like Nero and Caligula—and concluded that two-thirds of them suffered from symptoms of chronic lead poisoning. It’s hard to keep an empire going when your living god of an emperor has been brain-poisoned.

An empire brought down by one of its signature innovations, the aqueduct — it’s a theory that has stuck with the public, although experts have long been skeptical of its merits. It turns out that the theory was half-right: In a new study in the Proceedings of the National Academy of Sciences (PNAS), a group of French and British researchers report that the tap water in ancient Rome was indeed contaminated with lead, with levels up to 100 times higher than those found in local spring water at the time. But while Roman tap water might not have passed modern-day standards, it’s almost certain that the contamination wasn’t extensive enough to be responsible for the collapse of Roman civilization.

As lead author Francis Albarede of Claude Bernard University in Lyon told the Guardian:

Can you really poison an entire civilization with lead? I think it would take more than lead piping in Rome to do that.

Still, any amount of lead can pose a danger to the human brain, especially those of young children, so Rome’s contaminated water couldn’t have helped. In fact, the more researchers learn about lead, the more dangerous it seems—and the more important it becomes to get lead out of the environment. There’s a fascinating body of research, summed up in this excellent piece by Mother Jones‘s Kevin Drumm, that links the drastic drop in violent crime in the U.S. over the past two decades to the phasing out of leaded gasoline in the early 1970s, which greatly reduced lead levels in the environment.

The theory is that children in the 1940s, 50s and 60s were exposed to high levels of lead in leaded gasoline and lead paint. High blood lead levels are directly correlated with a loss of IQ points. But more than that, lead seems to particularly damage the parts of the brain linked to aggression control and executive function. Lead seems to affect boys more—and men, of course, make up the vast majority of violent criminals. When those lead-exposed boys became young adults in the 1970s and 80s, it wasn’t surprising that so many of them fell into violent crime. But once they aged out by the 1990s, that cohort was replaced by a generation of children who largely hadn’t been exposed to high levels of lead, and violent crime dropped.

But while most—though not all—American children are no longer exposed to high levels of lead, it’s still a major problem in poorer countries around the world. NGOs like the Blacksmith Institute are working to clean up lead contamination, though far more needs to be done. Lead may not have brought down the Roman Empire—you’ll need to go back to Gibbon for that—but two thousand years later, it’s still a public health menace.

TIME The Weekend Read

Face-to-Face With a Psychopath

Photo from Trapped, a series on mental illness in American prisons, intended to increase the dialogue about prison reform and the mental health crisis in America.
Photo from Trapped, a series on mental illness in American prisons, intended to increase the dialogue about prison reform and the mental health crisis in America. Jenn Ackerman

'Shock Richie' lived up to his name—but did he also point toward a new way of looking at the psychopathic mind?

My Sunday morning began with a 60-minute commute through the rain to the home of the maximum-security treatment program for Canada’s most notorious violent offenders. This was a special day as a new cohort of inmates was being transferred in to start treatment. I was excited about the chance to interview 25 new inmates and get them signed up for my research studies.

An inmate had exited his cell completely naked and started walking up the tier.I arrived at the housing unit before the inmates had left their cells. I entered the nurses’ station and fired up the coffeemaker. The inmates’ cells opened and they rushed for the showers or the TV room. It was football season and the East Coast games were just starting. The inmates crowded into the TV room. I leaned against the door frame, watching the TV to see if I could catch a glimpse of the latest highlights. And then suddenly there was tension in the air. I felt it on the back of my neck before I was even conscious of what was happening. The inmates milling around had slowed, the sound of their feet hit­ting the cold concrete floor halted, the TV seemed to get louder, and all of a sudden I was acutely aware of the steam from the hot coffee in my mug spiraling up toward my nose.

An inmate had exited his cell completely naked and started walking up the tier. I noticed him out of the corner of my eye. He passed the TV room, shower stalls, and empty nurses’ station and proceeded down the stairs to the doors that led to the outside exer­cise area. Some of the inmates turned slightly after he had walked by to take a look at him. Others tried not to move or look, but I could see they noticed. The inmates were as confused as they were anx­ious. What was he doing?

The naked inmate proceeded outside into the rain and walked the perimeter of the short circular track. He walked around the oval track twice. The TV room was on the second floor and the inmates had a good view of the track. Some of the inmates peered outside and watched him. Everyone was distracted; no one spoke. We were all in shock.

The inmate returned, still naked, and walked up the stairs to the second-floor tier and then down to his cell. The tension around the TV room grew. The inmate quickly emerged from his cell with a towel and proceeded to the showers. He walked down the middle of the tier as inmates slowly moved out of his way or retreated into their cells. Other inmates appeared to talk to one another, but they were clearly trying to avoid any direct eye contact with him. I no­ticed one of the biggest inmates had subtly slowed his pace so that he would not cross the path of the new inmate.

The naked inmate took a quick shower and returned to his cell; there was a slight swagger to his stride. He was not particularly big, but his physique was ripped.

I had to interview him. I took a gulp of coffee and then walked toward his cell.

The first name written on masking tape above his door was “Richard.”

“Good morning. I’m the research guy from the University of British Columbia. We are con­ducting interviews and brain wave testing on the inmates in treat­ment here. Would you be interested in hearing more about it?” I asked.

“Sure” came the reply out of the dark cell.

“All right, then. Why don’t you get dressed and grab a bite to eat, and I’ll come get you in about thirty minutes. We’ll do the interview downstairs in my office.”

I returned to the nurses’ station and had a couple more cups of coffee. I wanted to make sure I was fully awake when I interviewed Richard.

‘Shock Richie’ Pushes My Button

Richard had dressed in classic prison garb: blue jeans, white T-shirt, and dark green jacket. He sauntered down the stairs and through the covered outdoor walkway to the mess hall for breakfast. He returned to his cell after about 15 minutes. I couldn’t wait; I went down early to get him.

He followed me to my office and he plopped down in the chair opposite from me.

Over a minute later, we heard doors being slammed open in the distance and the unmistakable sound of running footsteps.Before I could get the consent form out of the drawer, he stared at me and said: “You ever need to push that red button?” He was refer­ring to the silver-dollar-sized button in the middle of the wall; when depressed, it signaled distress. A buzzer would go off in the guard bubble down the hallway.

We were both about the same distance away from the button. I realized that I might not be able to reach the button before he could get to me. My mind quickly turned to figuring out a new way to or­ganize the office so that I was closer to the button than the inmates being interviewed.

“No,” I replied. “In the five years I’ve worked here, I’ve never had to push the button.” I threw the five years in to let him know that I had some experience behind me.

Without saying another word, he leaped up and slammed his hand on the button. I didn’t have time to react. He returned to his seat as quickly as he had jumped up.

“Let’s see what happens,” he said calmly, leaning back into his chair.

Over a minute later, we heard doors being slammed open in the distance and the unmistakable sound of running footsteps.

I had thought about getting up and opening the door for the guards, but I would have had to pass by Richard to get to the door. So I just sat in my chair and waited. The guards’ response time felt glacial.

A key was jammed into my door and then it was flung open; two guards entered, panting and out of breath, and stared at us.

Richard turned calmly in his chair and said to the guards: “What’s the problem?”

“Someone pushed the alarm button,” the guard stammered. “Ev­erything okay?” His question was directed at me.

“Oh, I must have accidentally pushed it when I took my coat off,” Richard answered. “Everything is just fine; we are just doing the research interview here.”

“Okay,” the guard said. “Don’t do that again.”

I just nodded. I was having trouble speaking.

The guards pulled the door closed and Richard turned and looked at me.

“They call me Shock Richie,” he said. “And I’m going to shock you too.”

Mustering as much inner strength as I could, I replied: “I’m looking forward to it; I’m here to be shocked. Take your best shot.”

Shock Richie smiled.

Prison is never boring, I thought.

‘You ever tried to carry a body?’

We completed the consent form and then I started the Psychopa­thy Checklist interview with a question I would never ask any other inmate in my career.

“Why did you walk naked out in the rain?”

Nike probably never envisioned a psychopathic in­mate embracing their slogan ‘Just Do It’ in a manner quite like this.“Well, I arrived last night. You have to make an impression on the other inmates right away when you get shipped to a new place. I saw you standing there by the TV room. You noticed how all the other inmates got a bit nervous when I walked by. Even the big ones get nervous when you do shit like that. You just got to establish your­self right away. If you don’t, then inmates think they can test you.” He stared quite matter-of-factly at me; the emptiness in his eyes was unnerving.

“When I do stuff like that, inmates don’t know what to think. I’m unpredictable. Sometimes I don’t even know why I do what I do. I just do it.”

My mind was racing again. I completely agreed with his logic, albeit twisted; he had already established his dominance at this prison. He was going to score high on at least a few psychopathic traits. Nike probably never envisioned a psychopathic in­mate embracing their slogan Just Do It in a manner quite like this.

“You’ve been working here for five years?”

“Yes, since I started graduate school,” I replied.

“Interviewed lots of guys, right?”

“Yes, hundreds of them.”

“Well, you ain’t never met anyone like me,” he said.

“Really? What makes you so special?”

“I’ve done shit you can’t even imagine. I’m gonna shock you like I shock everyone,” he stated calmly. “Let’s get on with it.”

Richie enjoyed doing bad things. He was only in his late 20s when I interviewed him, but he had a rap sheet like no one I had ever interviewed before. As a teenager he had committed burglary, armed robbery of banks and convenience stores, arson for hire, and all kinds of drug-related crimes from distribution to forcing others to mule drugs for him. He would force women to hide plastic bag­gies of cocaine in their body cavities and transport them across bor­ders and state lines and on plane flights. One of Richie’s girls got a baggie stuck in her vagina. Richie used a knife to “open her up a bit” so he could retrieve his drugs. He said he didn’t use her again after that. When I asked him what he meant by that, he said that he didn’t use her for sex; she was too loose now, and she lost her nerve about carrying drugs.

Richie smiled as he told me a story of a prostitute he had killed for pissing him off. He actually seemed proud when he described wrapping her up in the same blanket he had suffocated her with so he could keep all the forensic evidence in one place. He put her in the trunk of his car and drove out to a deserted stretch of road bor­dered by a deep forest. Chuckling, he told me he was pulled over by a highway trooper because he was driving erratically as he searched for a dirt road to drive up so he could bury the body in the woods.

“So the cop pulls me over and comes up to the window and asks me if I have been drinking alcohol. I lied and said no. I told him that I just had to take a piss and I was looking for a place to go. But the cop gave me a field sobriety test anyways. I figured that if I didn’t pass the test, I would have to kill that cop. Otherwise, he might open the trunk and discover the body. The cop didn’t search me when I got out of the car, and I was carrying a knife and a handgun. I’m surprised that I passed that field test since I had had a few drinks that night. I was planning to beat the cop senseless and then I was going to put the girl’s body in the backseat of the cop’s car. Then I would shoot him in the head with his own gun and make it look like a suicide after he accidentally killed the prostitute while raping her in the backseat of his cruiser. Everyone would think it was just another sick dude.”

The irony of his latter statement was completely lost on Shock Richie.

The cop proceeded to point out a dirt road just up the way where Richie could pull over and take a piss. It was fascinating that Richie could remain calm enough not to set off any alarm bells for the cop that something was amiss. After all, Richie had a body decomposing in the trunk of the car. Yet apparently, Richie showed no anxiety in front of the cop. Most psychopaths like Richie lack anxiety and ap­prehension associated with punishment.

Richie turned up the dirt road the cop pointed out to him and drove in a ways. He pulled over, parked, and removed the body from the trunk.

“I had all these great plans to carry the body miles into the woods and bury it really deep so nobody would ever find it. But it’s f—ing hard to carry a body. You ever tried to carry a body?” he asked.

“No, I don’t have any experience carrying dead bodies,” I told him.

“Well, it’s a lot of work, let me tell you. So I only got about a hundred yards off the road and just into the trees before I was ex­hausted. Then I went back and got the shovel from the car. I started digging a huge hole.”

He looked up at me with those empty eyes and asked: “You know how hard it is to dig a hole big enough to bury a body?”

“No,” I answered, “I don’t have any experience digging holes to bury bodies.”

“Well, it’s harder than you might think.” He starts laughing. “I had all these great plans to carry her miles into the woods and dig this monster hole so nobody would ever find her.”

A couple weeks later, a couple of hikers discovered the body. Shock Richie read about it in the newspapers, but he was never charged with the murder.

Not His Brother’s Keeper

Richie admitted that he had no need for friends. He’d really never been close to anyone in his life. He preferred to do everything on his own. He also didn’t trust anyone.

I believed him. Richie had no friends in prison, he had no visitors, and all the other inmates said he could not be trusted and he knew not to trust them in return.

While he was having sex with the prostitute in the living room, she said she smelled something funny.He had lived a life supported by crime, never had any vocational training, and never made even a passing attempt at any other life­style. He made most of his big scores by taking down rival drug pushers. He would set up deals in different towns and then rob and sometimes kill the other person. Richie had no fear or hesitation with killing. Richie also had more than a dozen fake names and ac­companying identification.

For a long time he was a pimp. He used to corral runaways into working for him. He would get them hooked on drugs and then make them work the streets. He’d killed more than a few prostitutes. He saw people as objects, things to be manipulated; we were there just for his entertainment.

When Richie had been released the last time from prison, he was taken in by his older brother. His older brother was not a criminal. He was on the straight and narrow. After a few months of Richie bringing home prostitutes and doing drug deals at the house, his brother had told Richie he had to stop or he was going to kick him out. They argued, but Richie never tried to change his behavior. Fi­nally, his brother had had enough. He picked up the phone to call the police to have him arrested for drug possession. “I was high,” said Richie, “but not more than usual. I got the jump on him and beat him with the phone. While he was lying there dazed on the floor, I ran into the kitchen and grabbed a knife. I came back and stabbed him a few times.” He looked up at me intently to see if I was shocked.

“Continue,” I said.

“I figured that I would make it look like somebody had come over and killed him as part of a drug deal gone bad. Then I thought that maybe I should make it look like my brother had raped one of my girls and one of them had stabbed him.” By girls he meant the prostitutes in his “stable.”

After killing his brother, he went out and partied for a day or two. Then he came back home with a prostitute whom he planned to stab, and then put the weapon in the hand of his dead brother. He was going to put them both in the basement and make it look like his brother died quickly during the fight and the girl died slowly from stab wounds.

While he was having sex with the prostitute in the living room, she said she smelled something funny.

“You ever smell a body after it’s been decomposing for a couple days?” he asked.

“No,” I replied, “I don’t have any experience smelling decompos­ing bodies.”

“Well, they stink. I recommend getting rid of them fast.”

After having sex, he intended to lure the girl down into the base­ment. But the prostitute excused herself to use the bathroom and she jumped out the window and ran away. Later that evening the police showed up at his door and asked to come inside. Apparently, the prostitute recognized that odd smell to be that of a decomposing body. She had good survival instincts.

Richie told the cops he had been away from the house partying for a few days. He didn’t know that his brother had been killed. Con­fessing to being a pimp and drug dealer, Richie told the officers that he owed a lot of people a lot of money. He gave them a list of a dozen or so names of potential suspects.

The police eventually arrested Richie. Through his attorney, Richie received a plea deal. He pleaded guilty to manslaughter and was sentenced to many years in prison.

No More Little Richies?

Richie had a few more zingers he hit me with that day. He had indeed met my challenge. When I got home that evening, I opened a bottle of wine; it was empty before I knew it.

If Shock Richie’s brain has been abnormal since he was a child, is he responsible for his actions as an adult?Richie and I have both spent the last 20 years in prison. Richie as an inmate, me as a scientist trying to understand the mind and brain of the psychopath. Richie scored in the 99th percentile on Hare Psychopathy Checklist-Revised (PCL-R), the test we use to assess psychopathic traits. There are 20 psychopathic traits on the Hare PCL-R, including Lack of Empathy, Guilt and Remorse, Callousness, Irresponsibility, and Impulsivity. Richie fit the classic definition of all of those traits.

Richie was also the first psychopath to receive an MRI scan of his brain. Since that first MRI study my laboratory has scanned the brains of more than 3,000 other inmates, many of them psychopaths like Richie. This MRI data is the world’s largest forensic neuroscience repository and it is starting to yield some startling discoveries. We know for example, how Richie’s brain differs from the rest of us. His limbic system, the area of the brain that controls emotion and affect, is reduced in both brain structure and function. Additional research has found these same brain abnormalities in incarcerated youth with emerging psychopathic traits. Indeed, some scientists argue that emotional and behavioral antecedents to psychopathic traits can be recognized as early as age 6.

If Shock Richie’s brain has been abnormal since he was a child, is he responsible for his actions as an adult? Does Richie have the same free will as the rest of us?

Finally, the latest science of psychopaths has also illuminated a path that might remedy these problems before they even get started. Indeed, studies are showing that early treatment might prevent little Richies from ever developing.

Excerpts adapted from The Psychopath Whisperer: The Science of Those Without Conscience (Crown), by Dr. Kent Kiehl, available Apr. 22.

TIME psychology

Nine Hard-Won Lessons About Grief

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After journalist Jill Smolowe buried her husband, sister, mother and mother-in-law within the space of 17 months, she expected to fall apart. To her surprise — and relief — her grief bore no resemblance to the portrait of paralyzing despair depicted in American films, TV shows and memoirs. Here, she shares the coping strategies that helped her keep going:

1. Remain connected to your life. When a loved one passes away (or receives a dire diagnosis), your life undergoes a seismic shift. As your Old Normal totters, well-meaning friends and relatives reinforce your feeling of disconnect from your old life by assuming that the only topic you want to talk about is your worry and sorrow. Perhaps that’s true. But if you, as I did, find the concerned “How are you’s” more exhausting than comforting, direct the conversation toward more familiar terrain. “How do you read Putin’s moves in Ukraine?” “What is ‘conscious uncoupling,’ exactly?” Your heart may not be in it, but as the focus moves away from your distress, you may find your thoughts do, too. Even a few minutes respite can be replenishing.

2. Do not assume your sorrow will overwhelm you. Bereavement research of the last 20 years shows that a clear majority of mourners are quite resilient. They experience their grief as a constant oscillation between sadness and lighter moments. This helps them not only to endure their sadness, but also to experience pleasure even during the earliest days of loss. As for the five-stage cycle of grief so popular in our cultural script, it is a myth. Dismissed by bereavement researchers long ago, the cycle’s five stages (denial, anger, bargaining, depression, acceptance) were based on Elisabeth Kübler-Ross’s observations of the dying — not the people left behind.

3. Tune into what you actually feel and need. When I lost Joe, my beloved husband of 24 years, I assumed that collapse would follow. The way I envisioned it, one day soon I would get into bed, pull the sheet over my head and not get up. To my surprise — and relief — that day never arrived. Instead, I continued to function much as I normally do, albeit with emotions more intense than usual. Within two weeks of Joe’s death, it became clear to me that sitting home only added to the weight of his absence. So, I went back to work. I resumed walks with friends. I attended my daughter’s crew regattas. Though my sorrow accompanied me everywhere, the effort helped me to get out of my head and reconnect with the parts of my life that remained intact.

4. If you don’t want to, don’t. This piece of advice, offered by three widowed acquaintances on separate occasions, proved a keeper. Early on, I let it guide my responses to social invitations. I also let it inform my responses to inquiries, both sincere and casual, about how I was doing. If I didn’t feel like talking about my grief, I didn’t. As weeks, then months went by, I came to understand that, for me, grief was an intensely private experience. If I was going to cry (as I did daily for many months), I preferred to do it when I was alone. My feelings of loss were too personal and too impossible to explain. Talking about them did not help.

5. People are not mind readers; tell them what you need. Friends want to be supportive, but they will lean on their own (often untested) preconceptions about grief if you don’t speak up. For me, the commiserating hugs, worried looks and somber conversations got old, fast. I let friends know that what I needed most was for them to talk to me about their lives, their kids, their work. That response felt awkward, even ungracious, at times. But later several friends told me that by giving them clear guidance, I made it “easy” for them to help me. (Note to friends: helping a grieving person to focus on her strengths, rather than her sorrow, can be very therapeutic.)

6. For those who aim to lend support, watch for cues, listen carefully. Heartfelt though it may be, an offer of “If there is anything I can do …” is tantamount to offering nothing. (Trust me. A bereft person doesn’t want be saddled with the task of making you feel useful.) Instead, be attentive. If your concerned “Tell me how you are” meets with a brisk “Fine, how was your vacation?” that’s a signal to change the channel. If you notice a grieving neighbor’s trashcans are still curbside two days after the garbage pickup, ask if she wants them returned to her porch — or better yet, just do it. If your phone messages aren’t being returned, try email. Mourners appreciate your concern, but they may not be ready to deal with it on your schedule.

7. Express your love and appreciation. If there was any silver lining in Joe’s death, it was that we had time to prepare. While we didn’t anticipate that he would die, we knew from the day of his leukemia diagnosis that death was a possible outcome. Over the next two and half years, we constantly expressed not only our love, but also our appreciation for each other and for the life we’d built together. I’d always known that Joe loved me, but his acknowledgments of things I’d done for him and sacrifices I’d made on behalf of our marriage would later prove consoling. Those conversations also provided opportunity to address our unresolved issues. After Joe died, my grief was unencumbered by either unfinished business or regret that I’d left something important unsaid.

8. Gratitude is a potent antidote. As I worked on Joe’s eulogy, it occurred to me that too often such loving sentiments are reserved for memorial services. I wanted the people whose kindness had touched or steadied me during Joe’s long illness to know what I valued most about their support. Now. Before it was too late. So, I began writing thank-you letters that detailed what exactly it was about each person’s support that had lightened my load. Each time I unbottled my gratitude, it helped me to recognize the many reasons I had to go on without Joe.

9. Know your loved one’s final wishes. During a particularly gruesome hospitalization, Joe told me, “There are some things I want you to know, in case I die.” He specified the items he wanted me to save for our daughter, and told me to discard the rest. He told me he wanted to be cremated and wanted a memorial service. And he told me, “You should remarry.” Though numbing in the moment, his stated wishes proved a gift. Weeks later when he died and I was in the blur of new grief, I didn’t have to second-guess his burial preferences. His detachment about his possessions enabled me to sift and discard as I chose. And his generous statement about marriage enabled me to move on without guilt, knowing that he wanted me to build a new life.

Jill Smolowe is the author of the new memoir Four Funerals and a Wedding: Resilience in a Time of Grief.

TIME sleep

It’s Time to Pay Attention to Sleep, the New Health Frontier

Woman asleep in bed
Getty Images

Your doctor could soon be prescribing crucial shuteye as treatment for everything from obesity to ADHD to mental health as experts say carving out time for sleep is just as important as diet and exercise

After being diagnosed with brain and lung cancer in 2011, Lynn Mitchell, 68, was averaging about an hour of solid sleep a night. Stressed about her treatments, she was paying for it in hours of lost sleep.

The brain cancer was already affecting her mobility—Mitchell was often dizzy and would lose her balance—but the lack of sleep was exacerbating things. Even walking became increasingly difficult. Exhausted in the mornings, she was practically incoherent. When her doctors recommend she see a sleep therapist, Mitchell was relieved at how benign it sounded in comparison to the chemotherapy she had undergone and the gene therapy trial she was undergoing, which had side effects like nausea and fatigue.

For about nine weeks, Mitchell worked with the sleep therapist to adjust her sleep habits. She got under the covers only when she was extremely tired. She quit watching TV in bed. She stopped drinking caffeinated coffee in the evening. She also learned breathing exercises to relax and help her drift off. It was all quite simple and common sense, and, most importantly, noninvasive and didn’t require popping any pills.

“It’s common knowledge that sleep is needed for day to day function,” says Dr. David Rapoport, director of the Sleep Medicine Program at NYU School of Medicine. “What isn’t common knowledge is that it really matters—it’s not just cosmetic.” Rapoport has long seen people seek sleep therapy because they’re chronically tired or suffering from insomnia, but an increasing number of patients are being referred to his center for common diseases, disorders, and mental health.

Researchers have known for some time that sleep is critical for weight maintenance and hormone balance. And too little sleep is linked to everything from diabetes to heart disease to depression. Recently, the research on sleep has been overwhelming, with mounting evidence that it plays a role in nearly every aspect of health. Beyond chronic illnesses, a child’s behavioral problems at school could be rooted in mild sleep apnea. And studies have shown children with ADHD are more likely to get insufficient sleep. A recent study published in the journal SLEEP found a link between older men with poor sleep quality and cognitive decline. Another study out this week shows sleep is essential in early childhood for development, learning, and the formation and retention of memories. Dr. Allan Rechtschaffen, a pioneer of sleep research at the University of Chicago, once said, “If sleep does not serve an absolutely vital function, then it is the biggest mistake the evolutionary process ever made.”

But to many of us, sleep is easily sacrificed, especially since lack of it isn’t seen as life threatening. Over time, sleep deprivation can have serious consequences, but we mostly sacrifice a night of sleep here and there, and always say that we’ll “catch up.” Luckily, it is possible to make up for sleep debt (though it can take a very long time), but most Americans are still chronically sleep deprived.

While diet and exercise have been a part of public health messaging for decades, doctors and health advocates are now beginning to argue that getting quality sleep may be just as important for overall health. “Sleep is probably easier to change than diet or exercise,” says Dr. Michael Grandner, a sleep researcher at the University of Pennsylvania. “It may also give you more of an immediate reward if it helps you get through your day.” Sleep experts claim that it is one of the top three, and sometimes the most, important lifestyle adjustments one can make, in addition to diet and exercise. And while there’s more evidence linking diet and exercise as influential health factors, sleep is probably more important in terms of brain and hormonal function, Grandner says. “Among a small group of [sleep researchers], it’s always been said that [eating, exercise, and sleep] are the three pillars of health,” says Dr. Rapoport.

In our increasingly professional and digital lives, where there are now more things than ever competing for the hours in our day, carving out time for sleep is not only increasingly difficult, but also more necessary. Using technology before bed stimulates us and interferes with our sleep, yet 95% of Americans use some type of electronics like a computer, TV, or cell phone at least a few nights a week within the hour before we go to bed, according to a 2011 National Sleep Foundation survey. “Many doctors, lawyers, and executives stay up late and get up early and burn the candle at both ends,” says Dr. Richard Lang, chair of Preventative Medicine at the Cleveland Clinic. “Making sure they pay attention to sleep in the same way they pay attention to diet and exercise is crucial.”

To some, sleep has become a powerful antidote to mental health. Arianna Huffington, president and editor-in-chief of the Huffington Post Media Group, advocates that sleep is the secret to success, happiness, and peak performance. After passing out a few years ago from exhaustion and cracking a cheekbone against her desk, Huffington has become something of a sleep evangelist. In a 2010 TEDWomen conference, Huffington said, “The way to a more productive, more inspired, more joyful life is getting enough sleep.” Research linking high-quality sleep with better mental health is growing; a 2013 study found that treating depressed patients for insomnia can double their likelihood of overcoming the disorder.

While 70% of physicians agree that inadequate sleep is a major health problem, only 43% counsel their patients on the benefits of adequate sleep. But there’s growing pressure on primary care physicians to address, and even prescribe, sleep during routine check-ups. In a recent study published in the journal The Lancet Diabetes & Endocrinology, the researchers concluded that health professionals should prescribe sleep to prevent and treat metabolic disorders like obesity and diabetes. And overlooking sleep as a major health issue can also have deadly consequences. It was recently reported that the operator of the Metro-North train that derailed in New York last year, killing four people and injuring more than 70, had an undiagnosed case of sleep apnea.

Sleep therapies can range from simply learning new lifestyle behaviors to promote sleep, to figuring out how to position oneself in bed. More drastic measures involve surgery to open up an airway passage for people suffering from disorders like sleep apnea. Sleeping pills can be prescribed too, to get much needed rest, but sleep therapists tend to favor other approaches because of possible dependencies developing.

A large part of reaping the benefits of sleep is knowing when you’re not getting the right amount. According to a 2013 Gallup survey, 40% of Americans get less than the recommended seven to eight hours a night. While the typical person still logs about 6.8 hours of sleep per night, that’s a drop from the 7.9 Americans were getting in the 1940s.

When it comes to adequate sleep, it’s much more personalized than previously thought. Some people feel great on five hours of rest, while others need ten. The best way to determine if you’re getting the right amount, doctors say, is to find out how many hours of sleep you need to be able to wake up without an alarm and feel rested, refreshed, and energetic throughout the day.

Since reforming her sleep habits, Mitchell has been clocking up to seven hours of shuteye a night for the past two months. “I’m alert in the morning, my balance is better, and I feel peppier,” says Mitchell. Getting enough sleep has helped her better deal with her cancers, and its symptoms. The best news is that she recently found out that her brain tumor is shrinking, and there are fewer cancerous spots on her lungs.

TIME Military

‘Busting My Ass, Defending Yours': Everyday, the Cost of War at Fort Hood

U.S. flags are pictured in front of the Central Christian Church in Killeen, Texas
U.S. flags are pictured in front of the Central Christian Church in Killeen, Texas, April 3, 2014. Erich Schlegel—Reuters

March was the first month without a U.S. casualty in Iraq or Afghanistan in over a decade. But the cost of war is still being borne on the home front.

On April 2, a junior enlisted soldier, Specialist Ivan Lopez, went on a shooting spree at the U.S. Army’s Fort Hood, next to the city of Killeen in central Texas. He killed three people and injured 16 others before taking his own life. Some of the first things we learned about Lopez were that he had apparently served for several months in Iraq in 2011, that his violence may have been motivated by a dispute with some fellow soldiers, that he was being treated for depression and anxiety (including with medication), and that he had legally purchased his weapon, a .45 caliber Smith and Wesson semiautomatic handgun, but violated Army rules when he brought it onto the post without registering it.

These scant details — the military status, the deployment, the diagnosis — seem to tell a familiar story: a soldier gone to war returns home mentally unhinged by what he has seen and done and unleashes that violence like a contagion on his family, his neighbors, his homeland.

This story is dangerous, though. Not because it gets any of the substance of this most recent tragic violence wrong, necessarily. Rather, its focus on isolated and dramatic violence distracts from the subtle, chronic, and widespread effects of war on the people who fight it. It draws crude links between experiences of war, mental anguish, and violence that stigmatize mental illness in general and soldiers in particular.

At best, it risks overlooking the routine, ongoing experiences of the community most directly affected by Wednesday’s events. At worst, it callously misrepresents the members of that same community and lets civilians off the hook for the effects of wars waged in our name.

‘My Other Car Is a Tank’

Americans are accustomed to thinking of war as a literally foreign entity, something that takes place on a distant battlefield on the other side of the world. Decades of an all-volunteer military have enabled this fantasy. The wars in Iraq and Afghanistan represent a major commitment of national purpose and resources, but less than one percent of the U.S. population has served in them. For those who have, though — people at Fort Hood and places like it — war isn’t confined to one time and place. Instead it’s ongoing and ubiquitous, its effects finding their way into the most mundane and intimate aspects of life. In the process war becomes “normal,” but not necessarily any easier to live with.

These slogans emphasize a mix of fierce purpose, wry self-awareness, and mild unease toward the broader civilian public.I spent 12 months at and around Fort Hood in 2007 and 2008, living near the base and learning about the everyday lives of soldiers and those close to them in the midst of ongoing war. Fort Hood is one of the biggest military bases in the world. Its population of around 50,000 soldiers and tens of thousands more military family members, civilian workers and contractors, and retiree veterans demographically and economically dominates the city of Killeen and the other towns neighboring the post.

Motels and chain restaurants run off the constant traffic of a military kept busy by war. Used car dealers, pawnshops, and payday lenders thrive amidst a captive market of young soldiers. The bumper stickers you see on cars sitting in traffic announce that “Half My Heart Is In Iraq” or that “My Other Car Is A Tank”; they declare “Busting My Ass, Defending Yours” or indicate with a wordless configuration of blue stars on a white background that the driver’s family members are deployed. These slogans emphasize the mix of fierce purpose, wry self-awareness, and mild unease toward the broader civilian public that many people I met there shared. Bars, dry cleaners, and big box stores are all adorned with yellow ribbons, “Support the Troops” banners, and the insignia of the 1st Cavalry Division, 3rd Armored Cavalry Regiment, 13th Sustainment Command, and the other units that call the base home.

The base itself is massive, spread out across 150,000 acres mostly devoted to ranges and training areas. Its main built-up area features classically bland, modernist government architecture, like the campus of a giant, sleepy state university, but decorated here and there with decommissioned war machines, old tanks, and helicopters. But just a few blocks away stretches its famous “ten miles of tanks” — the world’s biggest concentration of armored military vehicles (when they are not dispersed across the Middle East) in the form of a nearly 10-miles-long row of chain-link pens full of Abrams tanks, Bradley and Stryker fighting vehicles, and Humvees. They are all painted a uniform desert tan, and look just as at home parked on arid central Texas asphalt and limestone as they do in the deserts of Iraq.

Gate Ticker
Dana DeLoca/Courtesy of Kenneth T. MacLeish

There are other uncanny reminders of the nearness of violence too: On the way into town from the south, next to a billboard advertising a local lingerie shop changes with the seasons, the firearms store Guns Galore invites you to “CHOOSE FROM 1,200 GUNS ON DISPLAY” (news reports say both Lopez and Nidal Hasan, who killed 13 people and injured more than 30 at Fort Hood in a 2009 shooting spree, bought their guns there). Just inside the exit lanes of each gate of the post, giant signs enjoin drivers, “YOU SURVIVED THE WAR, NOW SURVIVE THE ROAD—DRIVE CAREFULLY.” Big red digital numerals indicate “[X] DAYS SINCE THE LAST TRAFFIC FATALITY” beside a blinking light that goes from red to amber to green as the number of safe days rises. I rarely saw the number of days go higher than 10 when I was there in ’07 and ’08 (though when I visited most recently in 2010, a few months after the first Fort Hood mass shooting, it was well into the green).

Jumping at Loud Noises

Fort Hood is the single largest point of departure and return for US forces deployed overseas, a central node in the U.S. wars in Iraq and Afghanistan. At the time of my research, Fort Hood was home to the 1st Cav and Fourth Infantry Divisions — brigades from each saw especially heavy combat as part of the 2006 Iraq War surge — as well as numerous smaller expeditionary units. The tremendous personnel demands of the wars necessitated a grueling rotational schedule that most of these units followed: 12-month tours frequently extended to 15 months and separated by 12 months or less of “dwell time” back in Texas.

She didn’t want to know what had instilled in her husband that lingering, disruptive sensitivity to signs of violence and danger.All this meant that going off to war was often less a one-time event than a repeated shuttling between home and Iraq, giving rise to a sense of both inevitability and uncertainty that loomed over the entire community. I remember my surprise when a friend who was waiting impatiently to learn when her husband, a career infantry noncommissioned officer (NCO), would return from his third deployment casually mentioned that he already expected orders to deploy again a year later. Decisions about policy and tactics may seem like abstract matters, but in such tiny but profound ways as this they show up in people’s everyday lives: The nation going to war means that some one, some person goes. Staying at war means they go again, and again.

I asked a friend I’ll call Jessica if her husband, I’ll call him Cal, a logistics NCO, seemed changed by his time in Iraq (I use pseudonyms to protect the privacy of the people who spoke with me). Cal had just finished a 15-month tour. When Jessica and I first met in 2007, his tour had just been extended, meaning he’d be home by Christmas instead of by Labor Day. She said she could tell that certain things bothered him more, that certain things stressed him out, even though he hid it well and didn’t talk about it. He could be pretty quiet anyway, so she didn’t worry about it much. She would sometimes notice how uncomfortable he seemed around crowds or loud noises — tense, jumpy, and extra quiet. She would ask him if a loud noise had bothered him, he would say yes, and she would leave it at that. I asked her what it made her think. She said she just didn’t want to think about what he might be being reminded of. She didn’t want to know what had instilled in him that lingering, disruptive sensitivity to signs of violence and danger.

People had different ways of responding to such things, though. Jessica told me about a close friend, also a spouse of a frequently deployed NCO. Every time this woman returned home from work or running errands when her husband was gone, as she rounded the carefully planned curve of her street in an Army housing subdivision, she would picture in her mind a car with government plates parked at her front door, and a couple of soldiers in shiny shoes and class A dress uniforms there to notify her that he had been killed. Every time. “Why would you think that?” Jessica wondered aloud to me. “Why would you do that to yourself?”

Army spouses like Jessica and her friend say that “they also serve” and invoke their status as “the silent ranks”: there is a state of war that happens in the sudden sense that your easygoing, imperturbable husband is silently crawling out of his skin as he stands next to you, or that violent death may reach you through the thing you value most and find you out of nowhere on the way home from the grocery store.

They and others told me stories of the terror that can come from the sound of a phone ringing or a knock at the door when a loved one is deployed, the discipline it takes to avoid watching or reading news about the war, the force of will required to ignore gossip and reign in rumor. Jessica kept herself on an even keel by assiduously not giving in to anxious fantasies, not thinking the worst, or indeed trying not to think about the whole thing at all — no simple feat. “I’d rather not go there,” she said. But there is nevertheless an inescapable “there” to go to: the brute fact of loved ones being sent into harm’s way over and over again, of the pain of their absence, of the changed and uncertain condition in which they return home.

‘To Know If You’re Crazy’

The Army has a massive medical system meant to treat the physical injuries that such circumstances produce as well as their mental impacts. Anywhere from 15 to 50 percent of U.S. service members who served in Iraq and Afghanistan are estimated to suffer from post-traumatic stress disorder (PTSD), and even more from related conditions like depression and anxiety. But what exactly becomes of veterans with these conditions is another question, especially given the tremendous overburdening of the Army medical system and the pressure it is under to keep soldiers healthy, able-bodied, and ready to deploy. The Army’s own medical command estimated that a soldier with PTSD could cost the military $1.5 million over the course of a lifetime. There are numerous examples over the last 10 years of individual and concerted efforts by military and Veterans Health Administration personnel to minimize or deny PTSD diagnoses or to rediagnose soldiers with other, non-service-connected afflictions for which the military will not bear as much financial responsibility.

At worst, medicalizing the routine work of war provides yet another way for civilians to fear and pity soldiers without actually understanding them any better.The medical system that cares for ill and injured soldiers also places them under careful scrutiny, trying to distinguish if their pains and complaints are real and if they are worthy of care and compensation. So soldiers themselves often have an ambivalent relationship to a PTSD diagnosis — not least because they know how readily the Army can bend it to suit its purposes, but also because the diagnosis may not accord terribly well with how soldiers think about their war experiences.

Since 2004, all soldiers have been screened for PTSD and other mental illnesses when they return from deployment with questions about whether they participated in combat, were shot at, saw friends get injured, felt afraid that they might be hurt or killed, experienced intrusive memories or dreams, and so on. But soldiers know that answering affirmatively to any of these questions can, at the very least, keep them tied up with doctors and counselors when all they want to do is go on leave and see their families. Even worse, it could stick with them in their medical records, rendering them (officially or unofficially — it happens both ways) unsuitable for their jobs, ineligible for a security clearance, or unfit for promotion.

Aside from these structural disincentives, there is a more basic contradiction at work in these screening questions. The point of the questions, an infantry NCO I’ll call Ernie, who had led countless combat patrols in eastern Iraq, told me, is “to know if you’re crazy,” but the things they are asking after — seeing dead bodies, feeling afraid — were from his perspective simply normal parts of going to war. It is only on contact with the civilian world that the experience of soldiering is made to seem crazy. Ernie told me stories of firefights, near-miss IED strikes, and the gruesome aftermaths of car and suicide bombers — all the things that civilians know are part of war, and may even be comfortable consuming as entertainment, but which we are rarely comfortable hearing about in real life.

Doing and seeing these things and leading his fellow soldiers through them was all part of Ernie’s job, though. “Everything you go through, you go through with the same people you see day in and day out,” Ernie said. “So when you’re talking about it, it’s perfectly normal because you were doing the same shit I was doing, so you’re talking about it like it’s nothing.” In this catch-22, Ernie seems to be saying, it is not war but the experience of diagnosis that makes you “crazy,” both fitting you with the label and upending your own sense of what’s normal.

This process — by which a normal, routine experience comes to be understood as a sign of medical or psychiatric pathology — is what anthropologists refer to as medicalization. Medicalization can be a boon to people afflicted with a previously unnamed or unrecognized condition, giving them access to care and legitimating their suffering. This has unquestionably been the case with PTSD, which names a very real set of symptoms that often go unrecognized and provides at least some hope of care and treatment.

But medicalization can simultaneously have stigmatizing or pathologizing effects of its own, especially when it comes to mental illness diagnoses: Subjectively normal feelings become signs of illness, dysfunction, madness. Reducing soldiers’ experiences to nothing more than individual psychological phenomena in this way makes it all the easier to ignore how our ways of waging war make their suffering inevitable, not exceptional. At worst, medicalizing the routine work of war provides yet another way for civilians to fear and pity soldiers without actually understanding them any better.

Empathizing With a Ticking Bomb

And so we are left with the “war makes you crazy” story that is being offered as an explanation for this week’s shooting. In the understandable search for answers, questions about Lopez’s mental illness were among the first to be asked. The Army was quick to provide answers and the media quick to pass them on. But to what end? The New Yorks Times’s online headlines for the story on Thursday, for instance, announced that Lopez suffered from depression and was being treated by a psychiatrist. We also learned that he was “being assessed” for PTSD and had been prescribed medication, though the only drug named was the sleep aid Ambien. It was also revealed that Lopez had served in Iraq.

Seeing mental illness as a potential source of violence magnifies the stigma already attached to it.The implication was clear that deployment, military status, and above all mental illness and psychopharmaceuticals could somehow explain his murderous actions. Of course it is tempting to turn to mental illness now, as has also been the case with other incidences of both military violence (like Robert Bales’ massacre of Afghan civilians) and domestic mass shooting in the U.S. (Newtown, Appleton, Aurora) over the past several years. Diagnosing Lopez and other mass shooters seems to provide a comfortingly rational scientific explanation for a terrifyingly irrational act. But while particular details of some mass shootings may seem to justify such assumptions, on the whole the connections between mental illness and mass violence are slim to nonexistent.

This is the case with conditions more typically (though wrongly) associated with violence in popular imagination, like schizophrenia, but just as much with the depression, anxiety, and PTSD mentioned in connection with Lopez. People with severe mental illnesses are in fact far more likely to be the victims of violent crime, and those with severe depression potentially a far greater risk to themselves than to those around them. Psychiatrist Jeffrey Swanson has pointed out that mass shootings are incredibly rare events, and that focusing on their links to mental illness entails creating “common evidence” out of “uncommon things.” In the case of Fort Hood, we might also add that the very “common things” that are the source of regular suffering there disappear from view: the impact of long wars, long deployments, and insufficient resources only enter public perception at these moments of uncommon violence.

Even worse than this misunderstanding, however, is the fact that perpetually referring to mental illness as a potential source of violence magnifies the stigma already attached to it. In a military setting like Fort Hood, where many soldiers and those close to them already struggle to find care, sympathy, and assistance for their mental suffering — perhaps even more so in the wake of recent events — the damaging impact of such stigma is only made worse. The notion of stressed-out veterans as over-medicated “ticking bombs” primed to “go postal” — exactly as Lopez is alleged to have done — is often deployed with good intentions to emphasize the real and urgent need for better military health care, as will doubtless happen now, too.

But this rhetoric itself only serves to reproduce the stereotype of what my friend Stan, an Iraq War vet and veterans advocate, refers to as the “crazy vet” stereotype, according to which those touched by war are damaged, vulnerable victims — and also prone to deadly violence. Even as the stereotype pathologizes all soldiers, it focuses attention on a very narrow range of extreme behaviors, actually making it harder to see the broad and far-subtler range of burdens that war inevitably lays on those whose job it is to produce it.

Regardless of one’s perspective on this war, or war in general, the “crazy vet” can both confirm our worst fears about war and justify our outrage about it without prompting us to face these more everyday violences. This haze of pity, anxiety, and fear that swirls around many images of service members is fueled by popular culture, from Vietnam War films to breathless news reports like the ones we are reading this week. But a “ticking bomb” can never be the object of our empathy our understanding — it only tells us to run the other way.

The Stories We Tell About War

One of the things I found in my research is that the stories we tell about war tend to confirm what we think we already know. They often do this at the expense of the people who actually make war, letting us pretend that the violence of war is an exception rather than its essence. Allowing spectacular mass violence like this week’s shooting to be the thing that prompts public concern about the constant stresses faced by soldiers, vets, their families — and anyone who lives with ongoing war — does exactly this.

If we want people afflicted with mental illnesses to be well cared for, we need to talk about their suffering in ways that do not marginalize or pathologize it. And if we truly care about soldiers, veterans, and those close to them, we need to put aside the stereotypes that pop culture, military publicity, media saturation, and “common sense” offer us.

We need to listen to the “normal” experiences of making war — not least so that we may better hear the stories of those in pain in the wake of this most recent violence.

Kenneth T. MacLeish is an assistant professor at Vanderbilt University’s Center for Medicine, Health and Society. He is the author of Making War at Fort Hood: Life and Uncertainty in a Military Community (Princeton University Press, 2013), from which this essay is adapted.

TIME mental health

When Popularity Backfires: Climbing the Social Ladder Can Lead to Bullying

Kids who gain the most status middle and high school are targets of a lesser-known pattern of aggression

There are certain truths that we have come to accept about the social hierarchy in middle and high schools – the popular kids rule the halls, while the less conventional ones, who dress, think or act differently, are marginalized at the bottom. And indeed, studies have documented how most of the victims of bullying are those who occupy the lower rungs of the social ladder — in 2011, nearly 30% of students aged 12 years to 18 years reported being bullied, either in school or via the internet, according to the National Center for Education Statistics.

But a new study suggests that social outcasts aren’t the only targets of bullying and aggression, and that increasing one’s social status can lead to being ostracized, teased, and threatened. “This second pattern of aggression is among kids who are relatively popular targeting their rivals, and this tends to escalate until they climb to the very top rung of the social ladder,” says Robert Faris, associate professor of sociology at the University of California Davis.

MORE: ‘Microaggression’ Is the New Racism on Campus

Faris was interested in understanding bullying at a deeper level, to identify “hotspots” of conflict and aggression in school-based hierarchies. He and his colleague Diane Felmlee, professor of sociology at Pennsylvania State University, investigated whether there were other reasons for students’ aggression toward one another, such as using it as a tool for social climbing.

Their results, published in American Sociological Review, suggest that kids get bullied not only when they don’t fit in, but also when they are simply trying to avoid being victims by moving up the social ladder. “As social status increases, the involvement in aggression–both as perpetrator and now as victims–also tends to go up until they get to the very top, when things start to reverse,” says Faris.

MORE: How Bullying’s Effects Reach Beyond Childhood

To detect this phenomenon, Faris and his co-author Diane Felmlee, professor of sociology at Pennsylvania State University, studied more than 4,200 students in eighth, ninth, and tenth grades during the 2004 to 2005 school year. In the fall, at the beginning of school year, they asked the students to record their five closest friendships. With that information, the researchers created a social map resembling a bird’s nest. Those with the shortest paths to the most students were given higher ranks on the social status scale. This exercise was repeated in the spring of the same academic year so Faris could compare changes in status against students’ reports of being victimized, which included verbal insults, physical aggression, being the target of damaging rumors, and continued and relentless harassment.

For both boys and girls who began the school year in the 50th percentile, for example, but moved to the 95th percentile, the chances that they were targeted for some type of aggression increased by 25% compared to those who remained in the 50th percentile.

The students also answered questions about their anxiety, depression, anger, attachment to the school, and how socially central they felt in the school network. Not only were the socially mobile and relatively more popular students victimized more than the socially stable teens, they were also more sensitive to the effects of bullying. They reported higher rates of anxiety, depression, and anger, and lower rates of feeling central to their social group. Faris suspects that may result from the fact that these students have invested more time and self-esteem in their social status, and feel they have more to lose if they are ostracized.

MORE: The Myths Of Bullying

Girls were disproportionately the target of this alternate type of bullying. The highest rates of such aggression occurred between girls, and boys were also more likely to target girls who were moving up socially than boys who were doing the same.

“One of the things we hope to call attention to is the group of people whom we don’t often think of as being bullied,” says Faris. While much of the aggression may not fit the classic definition of bullying, the verbal taunting and the ostracizing, both in the real world and online through social media, can have devastating consequences. And understanding that its victims may not always fit the commonly accepted criteria of outcasts who don’t fulfill social norms can lead to more effective ways of recognizing and even reducing bullying behavior – of all types – in schools.

TIME psychology

How to Raise Happy Kids: 10 Steps Backed by Science

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Getty Images

Eric Barker writes Barking Up the Wrong Tree.

When you ask parents what they want for their kids, what’s usually the most common reply? They want their children to be happy.

Via Raising Happiness: 10 Simple Steps for More Joyful Kids and Happier Parents:

the well-being of children is more important to adults than just about anything else–health care, the well-being of seniors, the cost of living, terrorism, and the war in Iraq. More than two-thirds of adults say they are “extremely concerned” about the well-being of children, and this concern cuts across gender, income, ethnicity, age, and political affiliation.

Now there’s tons of info on raising smart kids and successful kids, but how do you raise happy kids?

Sometimes it’s hard to balance what’s best for children with what makes them happy — but the two don’t have to be mutually exclusive.

Happier kids are more likely to turn into successful, accomplished adults.

Via Raising Happiness: 10 Simple Steps for More Joyful Kids and Happier Parents:

…happiness is a tremendous advantage in a world that emphasizes performance. On average, happy people are more successful than unhappy people at both work and love. They get better performance reviews, have more prestigious jobs, and earn higher salaries. They are more likely to get married, and once married, they are more satisfied with their marriage.

So looking at the science, what really works when it comes to raising happy kids?

Step 1: Get Happy Yourself

The first step to happier kids is, ironically, a little bit selfish.

How happy you are affects how happy and successful your kids are — dramatically.

Via Raising Happiness: 10 Simple Steps for More Joyful Kids and Happier Parents:

Extensive research has established a substantial link between mothers who feel depressed and “negative outcomes” in their children, such as acting out and other behavior problems. Parental depression actually seems to cause behavioral problems in kids; it also makes our parenting less effective.

And this is not merely due to genetics.

Via Raising Happiness: 10 Simple Steps for More Joyful Kids and Happier Parents:

…although the study did find that happy parents are statistically more likely to have happy children, it couldn’t find any genetic component.

So what’s the first step to being a happier you? Take some time each week to have fun with friends.

Via Raising Happiness: 10 Simple Steps for More Joyful Kids and Happier Parents:

Because laughter is contagious, hang out with friends or family members who are likely to be laughing themselves. Their laughter will get you laughing too, although it doesn’t even need to in order to lighten your mood. Neuroscientists believe that hearing another person laugh triggers mirror neurons in a region of the brain that makes listeners feel as though they are actually laughing themselves.

More scientific methods for increasing your happiness here.

Step 2: Teach Them To Build Relationships

Nobody denies learning about relationships is important — but how many parents actually spend the time to teach kids how to relate to others?

(Just saying “Hey, knock it off” when kids don’t get along really doesn’t go far in building essential people skills.)

It doesn’t take a lot. It can start with encouraging kids to perform small acts of kindness to build empathy.

This not only builds essential skills and makes your kids better people, research shows over the long haul it makes them happier.

Via Raising Happiness: 10 Simple Steps for More Joyful Kids and Happier Parents:

Multiple sclerosis (MS) patients who were trained to provide compassionate, unconditional positive regard for other MS sufferers through monthly fifteen-minute telephone calls “showed pronounced improvement in self-confidence, self-esteem, depression, and role functioning” over two years. These helpers were especially protected against depression and anxiety.

More on creating good relationships here.

Step 3: Expect Effort, Not Perfection

Note to perfectionist helicopter parents and Tiger Moms: cool it.

Relentlessly banging the achievement drum messes kids up.

Via Raising Happiness: 10 Simple Steps for More Joyful Kids and Happier Parents:

Parents who overemphasize achievement are more likely to have kids with high levels of depression, anxiety, and substance abuse compared to other kids.

The research is very consistent: Praise effort, not natural ability.

Via Raising Happiness: 10 Simple Steps for More Joyful Kids and Happier Parents:

The majority of the kids praised for their intelligence wanted the easier puzzle; they weren’t going to risk making a mistake and losing their status as “smart.” On the other hand, more than 90 percent of growth mind-set-encouraged kids chose a harder puzzle.

Why? Dweck explains: “When we praise children for the effort and hard work that leads to achievement, they want to keep engaging in that process. They are not diverted from the task of learning by a concern with how smart they might — or might not — look.”

More on praising correctly here.

Step 4: Teach Optimism

Want to avoid dealing with a surly teenager? Then teach those pre-teens to look on the bright side.

Via Raising Happiness: 10 Simple Steps for More Joyful Kids and Happier Parents:

Ten-year-olds who are taught how to think and interpret the world optimistically are half as prone to depression when they later go through puberty.

Author Christine Carter puts it simply: “Optimism is so closely related to happiness that the two can practically be equated.”

She compares optimists to pessimists and finds optimists:

  1. Are more successful at school, work and athletics
  2. Are healthier and live longer
  3. End up more satisfied with their marriages
  4. Are less likely to deal with depression and anxiety

More on how to encourage optimism here.

Step 5: Teach Emotional Intelligence

Emotional intelligence is a skill, not an inborn trait.

Thinking kids will just “naturally” come to understand their own emotions (let alone those of others) doesn’t set them up for success.

A simple first step here is to “Empathize, Label and Validate” when they’re struggling with anger or frustration.

Via Raising Happiness: 10 Simple Steps for More Joyful Kids and Happier Parents:

Molly: “I am SO SO SO MAD AT YOU.”

Me: “You are mad at me, very mad at me. Tell me about that. Are you also feeling disappointed because I won’t let you have a playdate right now?”

Molly: “YES!! I want to have a playdate right NOW.”

Me: “You seem sad.” (Crawling into my lap, Molly whimpers a little and rests her head on my shoulder.)

Relate to the child, help them identify what they are feeling and let them know that those feelings are okay (even though bad behavior might not be).

More on active listening and labeling (and how hostage negotiators use this) here.

Step 6: Form Happiness Habits

We’re on step 6 and it might seem like this is already a lot to remember for you — let alone for a child. We can overcome that with good habits.

Thinking through these methods is taxing but acting habitually is easy, once habits have been established.

How do you help kids build lasting happiness habits? Carter explains a few powerful methods backed by research:

  1. Stimulus removal: Get distractions and temptations out of the way.
  2. Make It Public: Establish goals to increase social support — and social pressure.
  3. One Goal At A Time: Too many goals overwhelms willpower, especially for kids. Solidify one habit before adding another.
  4. Keep At It: Don’t expect perfection immediately. It takes time. There will be relapses. That’s normal. Keep reinforcing.

More on developing good habits here.

Step 7: Teach Self-Discipline

Self-discipline in kids is more predictive of future success than intelligence — or most anything else, for that matter.

Yes, it’s that famous marshmallow test all over again. Kids who better resisted temptation went on to much better lives years later and were happier.

Via Raising Happiness: 10 Simple Steps for More Joyful Kids and Happier Parents:

…preschoolers’ ability to delay gratification–to wait for that second marshmallow–predicts intelligence, school success, and social skills in adolescence. This is at least in part because self-discipline facilitates learning and information processing. In addition, self-disciplined kids cope better with frustration and stress and tend to have a greater sense of social responsibility. In other words, self-discipline leads not just to school success and sitting nicely at the dinner table but to greater happiness, more friends and increased community engagement.

What’s a good way to start teaching self-discipline? Help kids learn to distract themselves from temptation.

Via Raising Happiness: 10 Simple Steps for More Joyful Kids and Happier Parents:

One way to do it is to obscure the temptation–to physically cover up the tempting marshmallow. When a reward is covered up, 75 percent of kids in one study were able to wait a full fifteen minutes for the second marshmallow; none of the kids was able to wait this long when the reward was visible.

More on increasing self-discipline here.

Step 8: More Playtime

We read a lot about mindfulness and meditation these days — and both are quite powerful.

Getting kids to do them regularly however can be quite a challenge. What works almost as well?

More playtime.

Via Raising Happiness: 10 Simple Steps for More Joyful Kids and Happier Parents:

Most kids already practice mindfulness — fully enjoying the present moment — when they play. but kids today spend less time playing both indoors and out… All told, over the last two decades, children have lost eight hours per week of free, unstructured, and spontaneous play…

Playtime isn’t just goofing off. It’s essential to helping kids grow and learn.

Via Raising Happiness: 10 Simple Steps for More Joyful Kids and Happier Parents:

Researchers believe that this dramatic drop in unstructured playtime is in part responsible for slowing kids cognitive and emotional development… In addition to helping kids learn to self-regulate, child-led, unstructured play (with or without adults) promoted intellectual, physical, social, and emotional well-being. Unstructured play helps children learn how to work in groups, to share, negotiate, resolve conflicts, regulate their emotions and behavior, and speak up for themselves.

No strict instructions are necessary here: Budget more time for your kids to just get outside and simply play.

More on the power of playing (for kids and adults) here.

Step 9: Rig Their Environment For Happiness

We don’t like to admit it, but we’re all very much influenced by our environment – often more than we realize.

Your efforts will be constrained by time and effort, while context affects us (and children) constantly.

What’s a simple way to better control a child’s surroundings and let your deliberate happiness efforts have maximum effect?

Less TV.

Via Raising Happiness: 10 Simple Steps for More Joyful Kids and Happier Parents:

…research demonstrates a strong link between happiness and not watching television. Sociologists show that happier people tend to watch considerably less television than unhappy people. We don’t know whether TV makes people unhappy, or if already unhappy people watch more TV. But we do know that there are a lot of activities that will help our kids develop into happy, well-adjusted individuals. If our kids are watching TV, they aren’t doing those things that could be making them happier in the long run.

More non-television happiness activities are here.

Step 10: Eat Dinner Together

Sometimes all science does is validate those things our grandparents knew all along. Yes, family dinner matters.

This simple tradition helps mold better kids and makes them happier too.

Via Raising Happiness: 10 Simple Steps for More Joyful Kids and Happier Parents:

Studies show that kids who eat dinner with their families on a regular basis are more emotionally stable and less likely to abuse drugs and alcohol. They got better grades. they have fewer depressive symptoms, particularly among adolescent girls. And they are less likely to become obese or have an eating disorder. Family dinners even trump reading to your kids in terms of preparing them for school. And these associations hold even after researchers control for family connectedness…

More on the power of family dinners here.

Sum Up

Here are the ten steps:

  1. Get Happy Yourself
  2. Teach Them To Build Relationships
  3. Expect Effort, Not Perfection
  4. Teach Optimism
  5. Teach Emotional Intelligence
  6. Form Happiness Habits
  7. Teach Self-Discipline
  8. More Playtime
  9. Rig Their Environment For Happiness
  10. Eat Dinner Together

We’re often more open to new methods when it comes to work and careers, but ignoring tips when it comes to family is a mistake.

The most important work you and I will ever do will be within the walls of our own homes.

- Harold B. Lee

I hope this post helps your family be happier.

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Related posts:

Good Parenting Skills: 7 Research-Backed Ways to Raise Kids Right

How To Have A Happy Family – 7 Tips Backed By Research

Parent myths: How much of what your parents told you was wrong?

This piece originally appeared on Barking Up the Wrong Tree.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME psychology

Happy St. Patrick’s Day: The 4 Scientific Ways to Become Luckier

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It sounds crazy at first: How can you possibly become luckier?

But it turns out luck isn’t chance and magic. There’s a science behind it.

Richard Wiseman studied very lucky people to figure out what they had in common.

In his book, Luck Factor, he explains the four principles you can use to increase luck in your life.

1) Maximize Opportunities

It makes intuitive sense: if you lock yourself in your house, how many exciting, serendipitous things are going to happen to you? Not many.

Via Luck Factor:

Lucky people create, notice, and act upon the chance opportunities in their lives.

Certain personality types are luckier because they tend to create scenarios that maximize opportunities and thereby increase luck.

Who is more lucky?

  • People who are extroverted: More time with others, more interesting possibilities.
  • People who aren’t neurotic: Tense, anxious people are less likely to notice and take advantage of opportunities.
  • People who are open to new experiences: If you resist the new, you’re probably not going to have many interesting things happen.

Are you an introverted neurotic who only listens to oldies and watches reruns? That’s okay.

In the end, it’s your behavior that matters. By acting more extroverted, less neurotic and more open, you can increase luck.

If you do what you’ve always done, you’ll get what you always gotten.

2) Listen To Hunches

Lucky people act on their intuitions across many areas of their lives.

Via Luck Factor:

Lucky people make successful decisions by using their intuition and gut feelings… Almost 90 percent of lucky people said that they trusted their intuition when it came to personal relationships, and almost 80 percent said it played a vital role in their career choices… About 20 percent more lucky than unlucky people used their intuition when it came to making important financial decisions, and over 20 percent more used their intuition when thinking about their career choices.

Lucky people take more steps to boost their intuition as well.

They’re more likely to respond to problems by meditating, clearing their mind, coming back to the problem later or finding a quiet place to think about it.

Again, this isn’t something innate or unchangeable. Want to increase luck in your life? Go with your gut more often.

3) Expect Good Fortune

Plain and simple — it’s optimism.

You’re more likely to try new things, follow through on opportunities and have them succeed if you believe they’ll work out well.

Via Luck Factor:

On average, lucky people thought that there was about a 90 percent chance of having a great time on their next holiday, (and) an 84 percent chance of achieving at least one of their lifetime ambitions…

Lucky people have “grit.”

Via Luck Factor:

Lucky people attempt to achieve their goals, even if their chances of success seem slim, and persevere in the face of failure.

What do you need to do? Be optimistic. Persevere. Funny as it sounds, believe you’re lucky and you’re more likely to actually be lucky.

4) Turn Bad Luck Into Good

Lucky people aren’t always lucky — but they handle adversity differently than unlucky people.

Via Luck Factor:

  • Lucky people see the positive side of their bad luck.
  • Lucky people are convinced that any ill fortune in their lives will, in the long run, work out for the best.
  • Lucky people do not dwell on their ill fortune.
  • Lucky people take constructive steps to prevent more bad luck in the future.

How do you respond to disappointment?

Giving up, getting gloomy and locking yourself in the house won’t help the world offer you better opportunities.

Imitate lucky people when things don’t go your way.

These Principles Work

Not only did Wiseman find that lucky people had these qualities in common, he was able to make unlucky people more lucky by having them apply the ideas.

Via Luck Factor:

In total, 80 percent of people who attended Luck School said that their luck had increased. On average, these people estimated that their luck had increased by more than 40 percent.

Not only were they luckier, particpants also scored higher on life satisfaction after trying Wiseman’s principles.

So making yourself lucky can also make you happy. Now that’s good fortune.

And if you enjoyed this post, share it with friends. We could all use some good luck. :)

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This piece originally appeared on Barking Up the Wrong Tree.

TIME psychology

How To Be More Satisfied With Your Life – 5 Steps Proven By Research

Happy Family
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I’ve posted a lot about the research around how to be happier. But being satisfied with your life is something a little different.

Daniel Kahneman, Nobel Prize winner and author of Thinking, Fast and Slow, gave a TED talk where he explained the two pretty well:

Happiness is being happy in your life. We experience it immediately and in the moment.

Life satisfaction is being happy about your life. It is the happiness that exists when we talk about the past and the big picture.

There’s plenty of information about the former — but what about the latter?

What can we do to not just be happy in the moment, but to feel satisfied with our lives?

Here’s are five things research says can make a difference for you:

Friends

Having a lot of close friends boosts life satisfaction by nearly 20%.

Via 100 Simple Secrets of the Best Half of Life:

Having more close friendships was associated with a 19 percent greater life satisfaction and a 23 percent greater sense of optimism. – Richburg 1998

In fact, having a better social life can be worth as much as an additional $131,232 a year in terms of life satisfaction.

Like your neighbors? That’s a double digit boost in life satisfaction too.

Via 100 Simple Secrets of the Best Half of Life:

Positive feelings about neighbors have been found to be associated with a 16 percent greater life satisfaction and a 25 percent lower likelihood of experiencing feelings of loneliness. – Prezza et al. 2001

Why does religion — any religion — make people so much happier?

It’s the friends that a religious community provides. A group of ten supportive friends seems to be the magic number.

Via The Secrets of Happy Families: Improve Your Mornings, Rethink Family Dinner, Fight Smarter, Go Out and Play, and Much More:

After examining studies of more than three thousand adults, Chaeyoon Lin and Robert Putnam found that what religion you practice or however close you feel to God makes no difference in your overall life satisfaction. What matters is the number of friends you have in your religious community. Ten is the magic number; if you have that many, you’ll be happier. Religious people, in other words, are happier because they feel connected to a community of like-minded people.

But it’s not all about what you get from friends; giving is extraordinarily powerful too.

Are you mentoring a young person? It’s 4 times more predictive of happiness than your health or how much money you make.

Via 100 Simple Secrets of the Best Half of Life:

Age, income, and health are four times less likely to predict whether a person is happy than is whether the person feels he or she is having a positive effect on a younger person. – Azarow 2003

(More on how to make and keep friends here.)

Have A Life Story

Research shows that meaning in life comes from the stories we tell ourselves about our lives.

Ever tried writing that story down? People who do are more than 10% happier with their lives.

Via 100 Simple Secrets of the Best Half of Life:

People who wrote about the history of their lives were 11 percent more likely to feel happy with their lives and 17 percent more likely to feel optimistic about the future. – Yamada 2000

Knowing your family tree gets you a bump in satisfaction as well.

Via 100 Simple Secrets of the Best Half of Life:

People who were interested in their family and ethnic histories were 6 percent more likely to feel satisfied with their lives. – Mowrer and McCarver 2002

Children who know the stories of those who came before them have higher self-esteem and a sense of control over their lives.

Via The Secrets of Happy Families: Improve Your Mornings, Rethink Family Dinner, Fight Smarter, Go Out and Play, and Much More:

Marshall and Robyn asked those questions of four dozen families in the summer of 2001, and also taped several of their dinner table conversations. They then compared the children’s results to a battery of psychological tests and reached some overwhelming conclusions. The more children knew about their family’s history, the stronger their sense of control over their lives, the higher their self-esteem, and the more successfully they believed their families functioned.

(More on how to shape the story of your own life here.)

Have Goals

People with goals are nearly 20% more satisfied with their lives.

Via 100 Simple Secrets of the Best Half of Life:

People who could identify a goal they were pursuing were 19 percent more likely to feel satisfied with their lives and 26 percent more likely to feel positive about themselves. – Krueger 1998

Those who are passionate about something score higher across the board on positive psychological indicators.

Via Ungifted: Intelligence Redefined:

Elderly individuals who were harmoniously passionate scored higher on various indicators of psychological adjustment, such as life satisfaction, meaning in life, and vitality, while they reported lower levels of negative indicators of psychological adjustment such as anxiety and depression.

Goals doesn’t mean you need to win an Oscar or make a million dollars.

A consistent amount of minor success produces much more satisfaction than occasionally bagging an elephant.

Via The 100 Simple Secrets of Successful People:

Life satisfaction is 22 percent more likely for those with a steady stream of minor accomplishments than those who express interest only in major accomplishments. – Orlick 1998

Not seeing the success you’d like? Don’t give up. Having grit was associated with more life satisfaction.

Via 100 Simple Secrets of the Best Half of Life:

The capacity to continue trying despite repeated setbacks was associated with a more optimistic outlook on life in 31 percent of people studied, and with greater life satisfaction in 42 percent of them. – Meulemann 2001

(More about setting goals the right way here.)

Money Isn’t The Answer

The more materialistic people are, the less satisfied they are with their lives.

Via 100 Simple Secrets of the Best Half of Life:

Among participants in one study, those whose values were the most materialistic rated their lives as the least satisfying. – Ryan and Dziurawiec 2001

Spending more money on gifts made holidays less enjoyable.

Via 100 Simple Secrets of the Best Half of Life:

Among parents studied, greater expenditures for family gifts actually reduced satisfaction with family holidays by 2 percent. – Kasser and Sheldon 2002

Having meaning in your life increases life satisfaction twice as much as wealth.

Via 100 Simple Secrets of the Best Half of Life:

Those with a modest income who felt there was meaning in their lives were twice as likely to experience life satisfaction as were those who were wealthier but who felt that their lives lacked a sense of meaning. – Debats 1999

(More on the things proven to increase happiness here.)

Keep Growing

No, I don’t mean eat more cookies.

Have you seen changes in what you believe over the past few months? That’s a good thing.

Via 100 Simple Secrets of the Best Half of Life:

People over forty who could identify at least one change in their viewpoints or behavior in recent months were 8 percent more likely to feel hopeful about the future and 5 percent more likely to say they were generally in a good mood. – Grossbaum and Bates 2002

Older people who continue to read and learn are much more satisfied with their lives.

Via 100 Simple Secrets of the Best Half of Life:

People over the age of fifty who said they continued to learn about topics that interested them were 18 percent more likely to feel satisfied with their lives and 43 percent more likely to feel vital. – Helterbran 1999

Keeping an open mind pays huge dividends as the years go by.

Via 100 Simple Secrets of Happy Families:

Studies focusing on the ability of people to maintain happiness as they age reveal that an openness to change in both family life and work life is associated with a 23 percent greater likelihood of maintaining high levels of life satisfaction. – Crosnoe and Elder 2002

But don’t change everything — maintaining strong core values is important.

Via 100 Simple Secrets of the Best Half of Life:

A willingness to compromise on trivial matters was associated with 62 percent more positive social relations, but a willingness to compromise on matters of values and personal vision was associated with 34 percent less life satisfaction. – Bargdill 1998

(More on how to make sure you never stop growing and learning here.)

Sum Up

Keep in mind the 5 ways to increase life satisfaction:

  1. Friends
  2. Have Goals
  3. Have A Life Story
  4. Money Isn’t The Answer
  5. Keep Growing

I really think that fifth one is key. If you can’t learn, you can’t improve.

As the Stoic philosopher Seneca once said:

As long as you live, keep learning how to live.

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Related posts:

Here are the things proven to make you happier

What 10 things should you do every day to improve your life?

4 Lifehacks From Ancient Philosophers That Will Make You Happier

This piece originally appeared on Barking Up the Wrong Tree.

TIME ADHD

Doctor: ADHD Does Not Exist

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Over the course of my career, I have found more than 20 conditions that can lead to symptoms of ADHD, each of which requires its own approach to treatment. Raising a generation of children — and now adults — who can't live without stimulants is no solution

This Wednesday, an article in the New York Times reported that from 2008 to 2012 the number of adults taking medications for ADHD increased by 53% and that among young American adults, it nearly doubled. While this is a staggering statistic and points to younger generations becoming frequently reliant on stimulants, frankly, I’m not too surprised. Over my 50-year career in behavioral neurology and treating patients with ADHD, it has been in the past decade that I have seen these diagnoses truly skyrocket. Every day my colleagues and I see more and more people coming in claiming they have trouble paying attention at school or work and diagnosing themselves with ADHD.

And why shouldn’t they?

If someone finds it difficult to pay attention or feels somewhat hyperactive, attention-deficit/hyperactivity disorder has those symptoms right there in its name. It’s an easy catchall phrase that saves time for doctors to boot. But can we really lump all these people together? What if there are other things causing people to feel distracted? I don’t deny that we, as a population, are more distracted today than we ever were before. And I don’t deny that some of these patients who are distracted and impulsive need help. What I do deny is the generally accepted definition of ADHD, which is long overdue for an update. In short, I’ve come to believe based on decades of treating patients that ADHD — as currently defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) and as understood in the public imagination — does not exist.

Allow me to explain what I mean.

Ever since 1937, when Dr. Charles Bradley discovered that children who displayed symptoms of attention deficit and hyperactivity responded well to Benzedrine, a stimulant, we have been thinking about this “disorder” in almost the same way. Soon after Bradley’s discovery, the medical community began labeling children with these symptoms as having minimal brain dysfunction, or MBD, and treating them with the stimulants Ritalin and Cylert. In the intervening years, the DSM changed the label numerous times, from hyperkinetic reaction of childhood (it wasn’t until 1980 that the DSM-III introduced a classification for adults with the condition) to the current label, ADHD. But regardless of the label, we have been giving patients different variants of stimulant medication to cover up the symptoms. You’d think that after decades of advancements in neuroscience, we would shift our thinking.

Today, the fifth edition of the DSM only requires one to exhibit five of 18 possible symptoms to qualify for an ADHD diagnosis. If you haven’t seen the list, look it up. It will probably bother you. How many of us can claim that we have difficulty with organization or a tendency to lose things; that we are frequently forgetful or distracted or fail to pay close attention to details? Under these subjective criteria, the entire U.S. population could potentially qualify. We’ve all had these moments, and in moderate amounts they’re a normal part of the human condition.

However, there are some instances in which attention symptoms are severe enough that patients truly need help. Over the course of my career, I have found more than 20 conditions that can lead to symptoms of ADHD, each of which requires its own approach to treatment. Among these are sleep disorders, undiagnosed vision and hearing problems, substance abuse (marijuana and alcohol in particular), iron deficiency, allergies (especially airborne and gluten intolerance), bipolar and major depressive disorder, obsessive-compulsive disorder and even learning disabilities like dyslexia, to name a few. Anyone with these issues will fit the ADHD criteria outlined by the DSM, but stimulants are not the way to treat them.

What’s so bad about stimulants? you might wonder. They seem to help a lot of people, don’t they? The article in the Times mentions that the “drugs can temper hallmark symptoms like severe inattention and hyperactivity but also carry risks like sleep deprivation, appetite suppression and, more rarely, addiction and hallucinations.” But this is only part of the picture.

First, addiction to stimulant medication is not rare; it is common. The drugs’ addictive qualities are obvious. We only need to observe the many patients who are forced to periodically increase their dosage if they want to concentrate. This is because the body stops producing the appropriate levels of neurotransmitters that ADHD meds replace — a trademark of addictive substances. I worry that a generation of Americans won’t be able to concentrate without this medication; Big Pharma is understandably not as concerned.

Second, there are many side effects to ADHD medication that most people are not aware of: increased anxiety, irritable or depressed mood, severe weight loss due to appetite suppression, and even potential for suicide. But there are also consequences that are even less well known. For example, many patients on stimulants report having erectile dysfunction when they are on the medication.

Third, stimulants work for many people in the short term, but for those with an underlying condition causing them to feel distracted, the drugs serve as Band-Aids at best, masking and sometimes exacerbating the source of the problem.

In my view, there are two types of people who are diagnosed with ADHD: those who exhibit a normal level of distraction and impulsiveness, and those who have another condition or disorder that requires individual treatment.

For my patients who are in the first category, I recommend that they eat right, exercise more often, get eight hours of quality sleep a night, minimize caffeine intake in the afternoon, monitor their cell-phone use while they’re working and, most important, do something they’re passionate about. Like many children who act out because they are not challenged enough in the classroom, adults whose jobs or class work are not personally fulfilling or who don’t engage in a meaningful hobby will understandably become bored, depressed and distracted. In addition, today’s rising standards are pressuring children and adults to perform better and longer at school and at work. I too often see patients who hope to excel on four hours of sleep a night with help from stimulants, but this is a dangerous, unhealthy and unsustainable way of living over the long term.

For my second group of patients with severe attention issues, I require a full evaluation to find the source of the problem. Usually, once the original condition is found and treated, the ADHD symptoms go away.

It’s time to rethink our understanding of this condition, offer more thorough diagnostic work and help people get the right treatment for attention deficit and hyperactivity.

Dr. Richard Saul is a behavioral neurologist practicing in the Chicago area. His book, ADHD Does Not Exist, is published by HarperCollins.

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