The Joy of Self Esteem What Its Related to and What Its Not

First, for those of you who commented Wednesday, and for those of you who communicated with me over email, thank you for sharing your thoughts. I'm really honored to have these conversations with you.

Now. Self-esteem. The whole thing is kind of complicated. This won't be the only post I do on this topic. And before I get started, just a warning: If you look at my profile up there in the top righthand corner, it says "unapologetically empirical". That means I value good evidence over what-seems-like-it-should-be-true (most of the time, at least). Here's where I got my evidence for today's post: an article that reviews about 15,000 studies' worth of data on self-esteem.

Several decades ago, a few studies came out linking self-esteem to good outcomes for people. And some psychologists said, "America, self-esteem is where it's at."

Is anyone else vaguely creeped out by this?

We make people feel good about themselves and our problems are solved.  What's not to love about this idea?At least one state--California--spent tons o' money on initiatives meant to improve self-esteem. And then things got a little wild.  Folks started banning games of tag in school playgrounds and giving out prizes for nothing at all and tossing confetti at people.

And then researchers took a step back and ... did better research. And then a few others looked at all the studies together. Their findings?

Self-esteem is nice, but it ain't all that.


Sigh. These psychologists said, "Erm, America, we might have jumped the gun."

It turns out self-esteem is not strongly related to many outcomes. Not substance abuse. Not interpersonal success. For the things it is related to, there's no solid evidence that it CAUSES them. It's  related to depression but not considered a primary cause of it. It's also related to academic success ... but a close analysis suggests that success raises self-esteem, not the other way around. Interventions meant to increase student self-esteem haven't actually resulted in kids doing better in school.

High self-esteem does have its benefits. It's related to persistence in challenging tasks as well as happiness and emotional resilience. That's good stuff, and can really come in handy when you're a writer who's trying to make it to publication. People with high self-esteem rate themselves as prettier, smarter, more likeable, and generally shinier than others. It's not necessarily true, but it can keep you going, right? High self-esteem may be the fluffy buffer that protects some people from the slings and arrows of life (research results are actually mixed on this one).

Anyway, many of you said your self-esteem fluctuates depending on what's going on in your life--and depending on what part of your life we're talking about. Some of you are feeling discouraged, and you feel bad about yourselves. Some of you are really riding the rollercoaster right now, feeling different every day. Some of you are in a good place, and you're feeling fantastic about yourselves. Some of you are treading the middle path. Many of you tied that to your evaluations of your skill or success in one area or another. All that makes really good sense. What research seems to suggest is that events in our lives really have an affect on how we feel about ourselves, as much as or more than the reverse.

Self-esteem is a perception. It's not guaranteed, objective, verifiable reality. In fact, it sometimes veers sharply away from reality. You can be really good and still feel bad about yourself. You can suck and feel good. And feeling good feels GOOD. It's great, unless it holds you back from improving, which could be a huge problem for a writer. But if it lets you face the criticism, use it, and still be all right, that's the perfect place to be.

Like I said, there will be more on self-esteem and all its glorious complications. Next week, I'll be doing a post or two on bullying, and self-esteem's going to come up again.

Most of us have been taught about the importance of self-esteem from childhood, so do these results on self-esteem surprise you?

HELP!!!! I CANT SLEEP ITS INSOMNIA!

What is Insomnia?

Insomnia is difficulty getting to sleep or staying asleep for long enough to feel refreshed the next morning, even though you've had enough opportunity to sleep. 

With insomnia, you usually awaken feeling unrefreshed, which takes a toll on your ability to function during the day. Insomnia can sap not only your energy level and mood but also your health, work performance and quality of life.

How much sleep is enough varies from person to person. Most adults need seven to eight hours a night.Many adults experience insomnia at some point, but some people have long-term (chronic) insomnia. Insomnia may be the primary problem, or it may be secondary due to other causes, such as a disease or medication.

Types of Insomnia

There are two types of insomnia: primary insomnia and secondary insomnia.

• Primary insomnia: Primary insomnia means that a person is having sleep problems that are not directly associated with any other health condition or problem.
• Secondary insomnia: Secondary insomnia means that a person is having sleep problems because of something else, such as a health condition (like asthma, depression, arthritis, cancer, or heartburn);pain; medication they are taking; or a substance they are using (like alcohol).

Symptoms of Insomnia

These include:

• Difficulty falling asleep at night
• Awakening during the night
• Awakening too early
• Not feeling well rested after a night's sleep
• Daytime tiredness or sleepiness
• Irritability, depression or anxiety
• Difficulty paying attention, focusing on tasks or remembering
• Increased errors or accidents
• Tension headaches
• Distress in the stomach and intestines (gastrointestinal tract)
• Ongoing worries about sleep

Someone with insomnia will often take 30 minutes or more to fall asleep and may get only six or fewer hours of sleep for three or more nights a week over a month or more.

Causes of Insomnia

Common causes of Insomnia include:

• Stress. Concerns about work, school, health or family can keep your mind active at night, making it difficult to sleep. Stressful life events — such as the death or illness of a loved one, divorce, or a job loss — may lead to insomnia.
• Anxiety. Everyday anxieties as well as more-serious anxiety disorders, such as post-traumatic stress disorder, may disrupt your asleep. Worry about being able to go to sleep can make it harder to fall asleep.
• Depression. You might either sleep too much or have trouble sleeping if you're depressed. Insomnia often occurs with other mental health disorders as well.
• Medical conditions. If you have chronic pain, breathing difficulties or a need to urinate frequently, you might develop insomnia. Examples of conditions linked with insomnia include arthritis, cancer, heart failure, lung disease, gastroesophageal reflux disease (GERD), overactive thyroid, stroke, Parkinson's disease and Alzheimer's disease.
• Change in your environment or work schedule. Travel or working a late or early shift can disrupt your body's circadian rhythms, making it difficult to sleep. Your circadian rhythms act as an internal clock, guiding such things as your sleep-wake cycle, metabolism and body temperature.
• Poor sleep habits. Poor sleep habits include an irregular sleep schedule, stimulating activities before bed, an uncomfortable sleep environment, and use of your bed for activities other than sleep or sex.
• Medications. Many prescription drugs can interfere with sleep, including some antidepressants, heart and blood pressure medications, allergy medications, stimulants (such as Ritalin), and corticosteroids. Many over-the-counter (OTC) medications — including some pain medication combinations, decongestants and weight-loss products — contain caffeine and other stimulants.
  

• Caffeine, nicotine and alcohol. Coffee, tea, cola and other caffeine-containing drinks are well-known stimulants. Drinking coffee in the late afternoon and later can keep you from falling asleep at night. Nicotine in tobacco products is another stimulant that can cause insomnia. Alcohol is a sedative that may help you fall asleep, but it prevents deeper stages of sleep and often causes you to awaken in the middle of the night.
• Eating too much late in the evening. Having a light snack before bedtime is OK, but eating too much may cause you to feel physically uncomfortable while lying down, making it difficult to get to sleep. Many people also experience heartburn, a back flow of acid and food from the stomach into the esophagus after eating, which may keep you awake. 

Insomnia and Aging

Insomnia becomes more common with age. As you get older, you may experience:

• A change in sleep patterns. Sleep often becomes less restful as you age, and you may find that noise or other changes in your environment are more likely to wake you. With age, your internal clock often advances, which means you get tired earlier in the evening and wake up earlier in the morning. But older people generally still need the same amount of sleep as younger people do.
• A change in activity. You may be less physically or socially active. A lack of activity can interfere with a good night's sleep. Also, the less active you are, the more likely you may be to take a daily nap, which can interfere with sleep at night.
• A change in health. The chronic pain of conditions such as arthritis or back problems as well as depression, anxiety and stress can interfere with sleep. Older men often develop noncancerous enlargement of the prostate gland (benign prostatic hyperplasia), which can cause the need to urinate frequently, interrupting sleep. In women, menopausal hot flashes can be equally disruptive.
• Other sleep-related disorders, such as sleep apnea and restless legs syndrome, also become more common with age. Sleep apnea causes you to stop breathing periodically throughout the night. Restless legs syndrome causes unpleasant sensations in your legs and an almost irresistible desire to move them, which may prevent you from falling asleep.
• More medications. Older people typically use more prescription drugs than younger people do, which increases the chance of insomnia caused by a medication.

Sleep problems may be a concern for children and teenagers as well. However, some children and teens simply have trouble getting to sleep or resist a regular bedtime because their internal clocks are more delayed. They want to go to bed later and sleep later in the morning.

Risk Factors

Nearly everyone has an occasional sleepless night. But your risk of insomnia is greater if:

• You're a woman. Women are much more likely to experience insomnia. Hormonal shifts during the menstrual cycle and in menopause may play a role. During menopause, night sweats and hot flashes often disturb sleep. Insomnia is also common with pregnancy.
• You're older than age 60. Because of changes in sleep patterns and health, insomnia increases with age.
• You have a mental health disorder. Many disorders — including depression, anxiety, bipolar disorder and post-traumatic stress disorder — disrupt sleep. Early-morning awakening is a classic symptom of depression.
• You're under a lot of stress. Stressful events can cause temporary insomnia. And major or long-lasting stress, such as the death of a loved one or a divorce, can lead to chronic insomnia. Being poor or unemployed also increases the risk.
• You work night or changing shifts. Working at night or frequently changing shifts increases your risk of insomnia.
• You travel long distances. Jet lag from traveling across multiple time zones can cause insomnia.

Complications of Insomnia

Sleep is as important to your health as a healthy diet and regular exercise. Whatever your reason for sleep loss, insomnia can affect you both mentally and physically. People with insomnia report a lower quality of life compared with people who are sleeping well.

Complications of insomnia may include:

• Lower performance on the job or at school
• Slowed reaction time while driving and higher risk of accidents
• Psychiatric problems, such as depression or an anxiety disorder
• Overweight or obesity
• Irritability
• Increased risk and severity of long-term diseases or conditions, such as high blood pressure, heart disease and diabetes
• Substance abuse

Seeking Treatment for Insomnia

If you're having sleep problems, you'll likely start by talking to your primary care doctor.These are some of the things you can do as you prepare to do so:

• Ask if there's anything you need to do in advance, such as keeping a sleep diary. In a sleep diary, you record your sleep patterns — bedtime, number of hours slept, nighttime awakenings and awake time — as well as your daily routine, naps and how you feel during the day.
• Make a list of any symptoms you're experiencing, including any that may seem unrelated to the reason for the appointment.
• Take key personal information, including new or ongoing health problems, major stresses or recent life changes.
• Make a list of all medications, vitamins, or herbal or other supplements that you're taking, including dosages. Let your doctor know about anything you've taken to help you sleep.
• Take your bed partner along, if possible. Your doctor may want to talk to your partner to learn more about how much and how well you're sleeping.
• Make a list of questions to ask your doctor, to make the most of your appointment time.

Some basic questions to ask your doctor include:

• What is likely causing my insomnia?
• What's the best treatment?
• I have these other health conditions. How can I best manage them together?
• Should I go to a sleep clinic? Will my insurance cover it?
• Are there any brochures or other printed material that I can have? What websites do you recommend?

Lifestyle and Home Remedies

No matter what your age, insomnia usually is treatable. The key often lies in changes to your routine during the day and when you go to bed. Good sleep habits promote sound sleep and daytime alertness. These tips may help.

Basic tips:

• Exercise and stay active. Activity helps promote a good night's sleep. Get at least 20 to 30 minutes of vigorous exercise daily at least five to six hours before bedtime.
• Check your medications. If you take medications regularly, check with your doctor to see if they may be contributing to your insomnia. Also check the labels of OTC products to see if they contain caffeine or other stimulants, such as pseudoephedrine.
• Avoid or limit naps. Naps can make it harder to fall asleep at night. If you can't get by without one, try to limit a nap to no more than 30 minutes and don't nap after 3 p.m.
• Avoid or limit caffeine and alcohol and don't use nicotine. All of these can make it harder to sleep. Avoid caffeine after lunchtime. Avoiding alcohol can help prevent restless sleep and frequent awakenings.
• Don't put up with pain. If a painful condition bothers you, make sure the pain reliever you take is effective enough to control pain while you're sleeping.
• Stick to a sleep schedule. Keep your bedtime and wake time consistent from day to day, including on weekends.

At bedtime:

• Avoid large meals and beverages before bed. A light snack is fine. But avoid eating too much late in the evening to reduce the chance of gastroesophageal reflux disease (GERD) and improve sleep. Drink less before bedtime so that you won't have to urinate as often.
• Use your bed and bedroom only for sleeping or sex. Don't read, work or eat in bed. Avoid TV, computers, video games, smart phones or other screens just before bed, as the light can interfere with your sleep cycle.
  
• Make your bedroom comfortable for sleep. Close your bedroom door or create a subtle background noise, such as a running fan, to help drown out other noises. Keep your bedroom temperature comfortable, usually cooler than during the day, and dark. Don't keep a computer or TV in your bedroom.
• Hide the bedroom clocks. Set your alarm so that you know when to get up, but then hide all clocks in your bedroom, including your wristwatch and cellphone, so you don't worry about what time it is.
• Find ways to relax. Try to put your worries and planning aside when you get into bed. A warm bath or a massage before bedtime can help prepare you for sleep. Create a relaxing bedtime ritual, such as reading, soft music, breathing exercises, yoga or prayer.
• Avoid trying too hard to sleep. The harder you try, the more awake you'll become. Read in another room until you become very drowsy, then go to bed to sleep.
• Get out of bed when you're not sleeping. Sleep as much as you need to feel rested, and then get out of bed. If you can't sleep, get out of bed after 20 minutes and do something relaxing, such as reading. Then try again to get to sleep.

For more information, please visit the following websites:

http://sleepfoundation.org/sleep-disorders-problems/insomnia

http://www.webmd.com/sleep-disorders/guide/insomnia-symptoms-and-causes

http://www.nhs.uk/conditions/insomnia/pages/introduction.aspx

http://www.mayoclinic.org/diseases-conditions/insomnia/basics/definition/con-20024293

The friendzone and its self absorbed inhabitants

Once upon a time there was a girl. Let's call her Anthilofloraptus, because I can call her Anthilofloraptus because this is MY STORY. Anna, for short. Anna was a nice girl. She was pretty, smart, funny, and lovely. Anna had a lot of friends, and some of whom she was quite close to. One of those friends was a boy called Jakubromorph. Jack, for short. Anna and Jack were really good friends. Some might even call them best friends. They laughed together, they confided in each other, and they debated on whether Matt Smith and Karen Gillan WERE, indeed, secretly married. One day, in this troublesome tale of mine, Anna and Jack were joking around eating lumps of cheese and watching youtube videos of cats falling down slides when Anna turned to Jack and said, with all sincerity, "You know, Jakubromorph, you really are like the brother I never had." BLESS ANNA. How CUTE of her. How lovely, how genuine, how showing of their friendship. 

BUT SOFT, what light through my window breaks on the floor (or something. hope they have insurance. call autoglass)? Jack apologises and says he has to leave. Fair enough, maybe his grandmother is on fire. Anna shrugs it off. That night, she logs into Facebook and sees THIS:

Jakubromorph 'Jack for short' Halluzitath FRIENDZONED. Don't come moaning at me when you get treated like shit by other boys. You manipulated me and you're selfish. Have a nice life.

Oh dear oh dear. Jack didn't speak to Anna ever again, because she didn't want to be with him.

WHAT A SHAME. WHAT A TOTAL. UTTER. SHAME.

"Friendzoning is when you are expected to support a girl you really like while she searches for a smarter, richer, and more handsome boyfriend. There is little you can do to get out without feeling like a dick. All in all, one of the meanest things a girl can do."

The term 'friendzone' makes me itch, and I despise it. I'm gutted that you, boys who are spouting out friendzone bile, are in the 'zone' of 'friends' because, shit man, being friends is awful. Being someone to rely on, care for, joke with, have days out with, share with, is total crap. I'm really sorry this has happened to you all. Tossers. Maybe I'm reading too much into this term, and of course feelings can't be helped (apparently. i don't really take feelings that seriously. maybe i'm not sentient. new wave of human. what? oh yeah. friendzoning), but I see red every time I see complaints about being friendzoned. 'Girls are not machines that you put kindness into until sex falls out.' If you're only being nice to a girl, and therefore not being yourself around her, in order to have your way with her, then that's kind of shitty. You're not being nice to her because you feel like she deserves it. You're being nice to her in order to get something out of it. Whereas, in fact, she doesn't owe you anything. She doesn't owe you her body because you've been nice to her. Fuck off. It instantly devalues anything a woman can offer which isn't sex.

I'm not having a go at all boys/men who are gutted that a girl they like just want to be friends. That's natural and happens all the time. Rejection sucks, in all forms. To you, if you're not angry at the girl, I'm sorry. I'm sure you're a great guy for someone, but just not the right guy for her romantically. I hope you appreciate her feelings and continue to be a really great guy and develop an even more brilliant friendship. I'm having a go at those who after realising the girl doesn't want a relationship, proceed to chat a load of shite about her; about how she's a manipulative bitch who leads people on and just uses them to moan at. A girl exercising her right to say no doesn't mean she's putting you in a zone away from everyone else and just using you as a pet with a fence to separate you.

The term can be used both ways, but it's generally used by men, inherently making it a sexist term. Expected rejection reactions for men and women are different. Girls are supposed to be self-deprecating, and wonder what's not right about themselves. Too fat, too clingy, too not willing, too short. But men, generally (and i hate generalising, so i'm sorry, but i think it fits) are quick to blame the girl. There's something wrong here.

If a girl is told that she is only seen as a friend, that's it. In a way, I have quite a bit of respect for the boy when a girl is told that. That shows the boy doesn't want to get into her pants because he can, because she wants it. In another way, it's sad that the girl tries to be really really nice and acts differently around him to make him like her. No. Stop. You're doing it wrong. But when a girl says that to a boy, she's a total and utter bitch for letting him be nice to her. For letting them be on the same level, instead of being submissive to him. No, she just doesn't find you attractive. So boo you. You can only ever put YOURSELF in the 'friendzone'. Suck it up, and move on. She owes you nowt, she appreciated your apparent loveliness and shouldn't be vilified for not wanting a relationship. You're not the victim, and I can guarantee she feels a bit shit for not feeling the same way. But what do you want her to do? Pretend? No. LET IT GO.

Just because you're a 'nice guy' doesn't mean you deserve any girl you want. That's not an entitlement. It's just a part of the bullet point list of what a girl looks for in a guy. Funnily enough, forced niceness doesn't appear. If you like a girl like that, then let your intentions known instead of waiting for her to succumb to your front. Don't find fault in a girl who thought she had an honest friend. She's your friend, she LIKES YOU. You're not in the 'friendzone', you're in a FRIENDSHIP. You know, that good thing. She's done nothing wrong, you arrogant and egotistical knobhead.

Don't make girls feel guilty. It's not cool. I only dig the friendzone if it's got an electric fence and piranhas. I hope you can swim.

Pharma Still Up to its Old Tricks

It looks as though big Pharma is still up to one of its most disturbing practices: not publishing or making public studies that show that its products might be ineffective. As described by my colleague Peter Parry later in this post, we had thought this problem was successfully addressed back in 2010.  

Apparently not.

And do not think this problem is unique to psychiatric medications. 

Of course, as I have pointed out several times in this blog, recruitment and assessment of subjects for many research studies these days has become so warped by financial incentives that many of the studies, published or not, are not worth the paper they are printed on to begin with. 

And some studies are purposely designed to mislead readers into believing that certain generic drugs, particularly antidepressants, are not effective when in fact, when used properly for the right patients, they are among the most effective drugs in all of medicine. But that's a 'hole 'nuther issue.

To get back to the issue at hand:

From Medscape, 10/29/13: 

An analysis of nearly 600 registered clinical trials published online October 29 in BMJ has shown that 29% remained unpublished 5 years after completion, that no results were available in ClinicalTrials.gov for three fourths of those unpublished trials, and that industry-funded trials were nearly twice as likely to go unreported as studies that had not received industry funding.

Previous studies have shownthat published trials contain less than half of the patient-outcomes data contained in company-controlled documents.

Dr. Jones and colleagues from the University of North Carolina, Chapel Hill, conducted a cross-sectional analysis of trials that had at least 500 participants and had been prospectively registered with Clinical Trials.gov and completed before January 2009. 

Their analysis included 585 registered trials, 171 of which (29%) remained unpublished. These unpublished studies included nearly 300,000 participants.

"By focusing our investigation on studies with at least 500 participants, we greatly limited the possibility that non-publication of trials in this cohort was due to rejection of manuscripts by journals or a lack of time or interest on the part of investigators or sponsors," the authors write.

The non-publication rate was 32% for industry-funded trials and 18% for those without industry funding (P = .003), and 78% of the unpublished trials also had no reported data in ClinicalTrials.gov.

From Peter Parry (on the webpage TheConversation.Edu.Au):

Dr. Peter Parry

A large proportion of drug trials, particularly those sponsored by pharmaceutical companies, never get published, skewing our picture of drugs' effectiveness and safety.

Research published in 2010 showed results unfavorable to sponsored drugs are less likely to be published, or selectively published to put a favorable spin on poor results.  And internal pharmaceutical industry documents released from court cases show concealment of data is a widespread practice.

A colleague and I assessed such documents about psychiatric medications from five pharmaceutical companies. The papers suggested widespread overstatement of benefits and understatement of adverse effects. Other researchers have found similar problemswith different drugs.

In response, some medical journals voluntarily agreed to publish only studies registered on a website of the US National Institutes of Health, ClinicalTrials.gov. At least studies with unfavorable results would not be buried by drug companies. But the BMJ article confirms that many registered studies still don’t get published.

The AllTrials initiative aims to make the (de-identified) results and methodology of drug trials available to independent researchers so journals can publish in-depth articles based on all of the full data.

In 11 months, the campaign’s petition has gathered over 59,000 individual signatories and over 400 medical and health-care organizations. These include many British medical colleges and learned academic medical science institutions, such as the Cochrane Collaboration and the British National Institute for Health and Clinical Excellence (NICE).

Although the campaign is progressing slower outside the United Kingdom, it is managing to get some traction internationally.

The World Association of Medical Editors (WAME), the South African Medical Research Council and the Canadian Agency for Drugs and Technology in Health have signed.

Maybe there is still hope this problem can be rectified.