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“Your well-being must never become an afterthought. It must be your first act.”
― Rasheed Ogunlaru

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https://www.webmd.com/mental-health/how-does-mental-health-affect-physical-health#:~:text=Being%20in%20a%20good%20mental,Chronic%20diseases.

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Although the mind and body are often viewed as being separate, mental and physical health are actually closely related. Good mental health can positively affect your physical health. In return, poor mental health can negatively affect your physical health.

Physical Health Conditions That May Affect Mental Health

Your physical well-being also has an impact on your mental health. People with physical health conditions may also develop mental health conditions.

Psoriasis is a dermatological condition characterized by painful red sores on the skin. It is associated with acute stress and depression.

Individuals with psoriasis experience emotional and psychological distress that negatively impacts their overall health and quality of life. Stress and depression mainly come from anxiety, stigma, and rejection.

Being diagnosed with cancer or having a heart attack can also lead to feelings of depression or anxiety. Around one-third of people with serious medical conditions will have symptoms of depression, such as low mood, sleep problems, and a loss of interest in activities.

How to Take Care of Your Mental and Physical Health

If you want to improve your general well-being, you should take care of both your physical and mental health.

Here are some ways to take care of yourself physically and mentally:

Get regular exercise. Exercise is important for keeping physically fit, but it can also help improve your mood. A daily 10-minute walk may increase your mental alertness leaving you energetic and in a good mood.

Eat a proper diet. A diet high in fruits and vegetables and low in processed sugars or fats can make you feel better physically and mentally. Consider working with a qualified nutritionist to help you create a diet plan customized according to your needs.

Avoid alcohol and drugs. Although drinking and smoking may make you feel better in the short term, they can have a negative effect on both your physical and mental health.

Get enough sleep. A good night's sleep is around seven to nine hours for adults. You can also take a 30-minute nap during the day to feel more alert.

Try relaxation techniques. Meditation, deep breathing, and focusing your thoughts can all help when you are feeling stressed.

Develop good mental practices. Try to focus on positive emotions and events rather than negative ones.

Seek help from others. Talking with friends or family members can help you feel less stressed. Getting others to help with difficult situations can also reduce the burden you feel.

Effects of Mental Health on Physical Health

Your mental health plays a huge role in your general well-being. Being in a good mental state can keep you healthy and help prevent serious health conditions. A study found that positive psychological well-being can reduce the risks of heart attacks and strokes.

On the other hand, poor mental health can lead to poor physical health or harmful behaviors.

Chronic diseases. Depression has been linked to many chronic illnesses. These illnesses include diabetes, asthma, cancer, cardiovascular disease, and arthritis.

Schizophrenia has also been linked to a higher risk of heart and respiratory diseases.

Mental health conditions can also make dealing with a chronic illness more difficult. The mortality rate from cancer and heart disease is higher among people with depression or other mental health conditions.

‌Sleep problems. People with mental health conditions are more likely to suffer from sleep disorders, like insomnia or sleep apnea. Insomnia can make it hard to fall asleep or stay asleep. Sleep apnea leads to breathing problems, which can cause you to wake up frequently.

‌ Around 50% to 80% of people with mental health conditions will also have sleeping problems. Only 10% to 18% of the general population experience sleeping problems.

While conditions like depression, anxiety, or bipolar disorder may lead to sleep problems, sleep problems can also make existing mental health conditions worse.

Smoking. People with mental health conditions are more likely to smoke than those who do not have mental health conditions. Among smokers, people with mental health conditions are more likely to smoke a greater number of cigarettes.

People with depression have lower levels of the chemical dopamine. Dopamine influences positive feelings in your brain. The nicotine in cigarettes triggers the production of the chemical dopamine, so smoking may be used as a way to relieve symptoms of depression.

However, since nicotine only offers temporary relief, you may feel a recurring need to smoke, which may lead to possible addiction.

‌Access to health care. People with mental health conditions are less likely to have access to adequate health care.

It may also be more difficult for people with mental health conditions to take care of their physical health When you have a mental health condition, it can be hard to seek care, take prescriptions regularly, or get enough exercise.

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How Does Mental Health Affect Physical Health

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Although the mind and body are often viewed as being separate, mental and physical health are actually closely related. Good mental health can positively affect your physical health. In return, poor mental health can negatively affect your physical health. Your physical well-being also has an impact on your mental health.

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https://www.ted.com/playlists/468/how_to_overcome_your_fears

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Fear lives in the mind. So, how do we get it out of our heads? Follow in the footsteps of these speakers who have faced some of their deepest fears with strength and grace.

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https://www.helpguide.org/articles/healthy-living/joys-of-owning-a-cat.htm#:~:text=Scientific%20evidence%20also%20shows%20that,Prevent%20allergies.

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pets
Owning a cat can bring unconditional love and companionship to your life. Having a feline friend can also help to relieve stress and improve your heart health.

Owning a cat can be an extremely rewarding relationship. A cat has the ability to both calm your nervous system and provide an immediate outlet for fun and play. Although cats are independent animals who like to scavenge and explore on their own terms, they are also very affectionate with their owners and people they trust.

Most cats love to curl up in your lap at the end of a long day while you watch television or read a book. The simplicity of this act can cause an automatic release of all the right kinds of chemicals to your brain, allowing you to ease into the evening without the weight of the world on your shoulders. Any cat owner will tell you just how much their furry friend helps them to relax and unwind. While many people enjoy the company of dogs, a cat can be more of an acquired taste-but once acquired, it's a hard taste to lose.

Why cats make great pets

The versatility of cat ownership is one reason why so many people enjoy feline companionship. Cats make great pets whether you live in a big house or tiny apartment, and they provide all the fun and play of larger animal companions. If you're thinking of owning a cat, these are some of the key benefits:

Cats are low maintenance. Maybe cats' most alluring quality is that they are lower maintenance and cost less than dogs, who need walking, training, frequent grooming, and more toys and attention. Cats are also perfect for apartments or city living. They don't need tons of space to play and explore-nosing their way through the nooks and crannies of your kitchen will keep them occupied for hours.

They're quiet. Cats tend to meow when they're hungry, but you rarely have to worry about being woken up or distracted from a task by a cat begging for attention. This makes them an ideal pet if you're working from home or have youngsters napping during the day, for example.

They're independent. A cat will be there for you when you need them but they're also perfectly adept at entertaining themselves. Most don't need-or want-constant attention and you'll never have to endure guilt-inducing puppy eyes from a cat.

They keep your house pest-free. You probably already know that cats like to hunt rodents. But they're also natural insect killers, too, offering the kind of household protection that Venus flytraps promise but rarely deliver. Many cats thoroughly enjoy exterminating bugs such as house flies and spiders, almost like they're being paid for it.

They have long life spans. The most difficult stage of pet ownership is parting with your beloved companion. While you're still likely to outlive a cat, their longer lifespans mean you'll get to have more time with them-up to 20 years, in fact.

The health benefits of cats

While owning any pet can provide a myriad of health benefits, there are some benefits that are specific to cats. They can:

Lower stress and anxiety. Cat owners know how one session of petting or playing with their cat can turn a bad day into a good one. Scientific evidence also shows that a cat's purr can calm your nervous system and lower your blood pressure.

Improve your cardiovascular health. Cat owners have been reported to carry a lower risk for heart disease and stroke.

Prevent allergies. You always hear about cat hair being one of the most common allergens. However, if a child is exposed to cats within the first few years of life, they are more likely to develop an immune system that combats not only cat allergies but other kinds of allergens as well.

Reduce feelings of loneliness. Cats make great companion animals. They offer an unconditional love that can be equal to (or sometimes even greater than) many human friends and confidants.

Having fun with your cat

One of the great benefits of owning a cat is that you don't need much space to play and have fun together. Unlike large animals who need plenty of space to play fetch or run around, all you need with a cat is your living room and a little imagination. Beyond a ball of yarn, there are plenty of other ways to entertain and bond with a cat.

Play hide and seek. An old childhood sleepover favorite can now become you and your fluff ball's favorite pastime. Just hide a toy or an object that interests them under a blanket, and watch your cat scavenge.

Blow bubbles. One of the greatest joys of cat ownership is their never waning interest in the ordinary. Blowing bubbles might seem like an activity you left back in the schoolyard, but your cat will be so taken with the floating balls of mystery, it could reignite your interest. Cats love to try to catch and pop the bubbles, just be sure to ALWAYS use a non-toxic bubble solution.

Set up a food treasure hunt. Cats love the excitement of a challenge that keeps their minds sharp-and their stomachs full! Place treats in hard-to-reach spots in your home and watch as your cat works to retrieve them. Cats are so agile you even can set up obstacles for them to navigate. It might even inspire you to be more active!

Use an app. iPhone and Android applications offer games to keep your cat entertained, including catching fish or bugs as they appear on screen. See the Get more help section below for more information.

How to care for your cat

Although cats are more independent than many other pets, owning one is still a major commitment. They need a devoted owner to keep them as happy and healthy as possible. Cats need:

A fresh litter box. Most house cats are indoor cats, which means you will need a litter box. A litter box is convenient, but needs to be cleaned every day to avoid unpleasant odors. Pet stores offer litter formulas that make it easy to scoop out waste and control the smell.

Consistent grooming. Although a cat might not need the same amount of grooming as a dog, it still takes work to prevent your house turning into one big hairball. A weekly cleaning is usually enough, and you can find easy-to-use cat grooming tools at most pet stores.

A scratch pole. Many cats have a tendency to scratch and paw at drapes, furniture, and just about anything else that takes their fancy. Investing in a scratch pole or post will not only provide your cat with the scratching outlet they need, but also save you lots of money and frustration.

A well-balanced diet. Work with your vet to ensure your feline is getting a nutritional diet. Avoid overfeeding that can lead to obesity and other serious health issues. Also, be sure to keep their food and water bowls far away from their litter box to prevent any risk of contamination.

A safe environment. Cats are small, delicate animals that do well living mostly indoors. Although many cats love to roam free outside, other predatory animals and traffic, for example, can threaten their safety. Always monitor your cat's whereabouts and keep an ID tag on its collar. Having your pet microchipped will allow shelters and veterinarians to easily identify you as the owner should your cat get lost.

Tips to manage cat allergies

You might be interested in adding a cat to your family but the only thing holding you back is a runny nose and watery eyes. Although it's true that cats can trigger allergies, it might not instantly rule you out of owning a cat. Most allergies are caused by the animal's dander and some breeds generate much more than others. If you suffer from allergies, it's a good idea to spend time with different cats before adopting or buying. And if a friend or partner already owns a cat, there are still plenty of things you can do to help manage your allergy.

Restrict certain rooms in the house. If you suffer from a cat allergy, you may want to keep the cat out of your bedroom and restrict them to only a few rooms in the house, for example.

Wash your hands. After handling or petting your cat, be sure to wash your hands with soap and water before you touch your face or rub your eyes.

Use air purifiers. Air purifiers fight against cat allergies as well as other allergens that might be lingering in the air, such as dust mites. Using one may help you to live a healthy and happy life with your cat.

Be consistent about bathing. Giving your cat a bath can reduce dander, while also keeping your cat sleek and clean.

Use antihistamines. Consult your doctor or local pharmacist about the best antihistamine for your cat allergy. Common symptoms such as a runny nose can often be treated with oral medication, while puffy, watery eyes can frequently be treated with eye drops.

How to choose the cat that's best for you

Do your research first, and then choose your cat from a reputable breeder, shelter, or rescue group. Things to keep in mind while looking into adoption are:

Kitten or an adult? Kittens are able to adapt quickly to their surroundings, but will need house training and much more attention than an adult cat. An older cat might be a wise choice if you have a strict work schedule and don't have time to fully care for a kitten. On the other hand, an older cat may have health problems, which will require more visits to the vet.

Shedding concerns. Some cats shed more than others. For example, an American Bobtail or Cymric cat will shed much more than a Siamese cat.

Health concerns. A healthy kitten or cat will have bright eyes and a shiny fur coat. Cat's that appear thin or overweight or have a nasal discharge may have health problems.

Personality and disposition. Just like people, cats can vary in their personality and character traits. Look for one that seems to be a good fit with you and your lifestyle. If you're hoping for lots of petting and stroking, for example, you may want to look for a cat that actively seeks attention from its handlers, rather than one that hisses or scratches. If you think you've found the right cat, try to make more than one visit with the animal if that's possible.

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The Joys of Owning a Cat - HelpGuide.org

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pets Owning a cat can be an extremely rewarding relationship. A cat has the ability to both calm your nervous system and provide an immediate outlet for fun and play. Although cats are independent animals who like to scavenge and explore on their own terms, they are also very affectionate with their owners and people they trust.

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https://study.com/academy/lesson/the-importance-of-motivation-in-an-educational-environment.html#:~:text=Motivation%20determines%20the%20specific%20goals,affects%20the%20choices%20students%20make.&text=Motivation%20will%20increase%20students'%20time,Motivation%20enhances%20cognitive%20processing.

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https://medium.com/@gjlewis/how-many-lives-does-a-doctor-save-4641349b7da0

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[This is cross posted on 80,000 hours: 1 2 3. Particular credit to Ben Todd for basically writing the third section.]

Doctors have a pretty solid reputation as do-gooders. There are regular news stories about how advances in medical science promise to help more people than ever before. Many of us have had the experience of being ill, seeing our doctor, and being made better.

So it seemed a pretty good career mve for a 17-year old wanting to make a difference. Like thousands of others, I applied to read medicine. This is what I wrote on my personal statement:

I want to study medicine because of a desire I have to help others, and so the chance of spending a career doing something worthwhile I can't resist. Of course, Doctors don't have a monopoly on altruism, but I believe the attributes I have lend themselves best to medicine, as opposed to all the other work I could do instead.

Was I right? Is medicine a good career choice for someone wanting to 'make a difference'?

We are going to try and answer this question, and try to estimate the impact one can expect to make becoming a doctor in the UK (which will be pretty similar to the impact made anywhere else in the developed world). We'll start by estimating the average direct impact of a doctor. To estimate this, we'll look at the total impact of medicine and then divide it by the number of doctors. Then we'll try and account for the fact that by becoming a doctor, I'll only cause there to be additional doctors. Since the first doctor will add far more to health than the hundredth, my impact will be less than the average direct impact. Then, we'll account for replaceability: that if I never went to medical school, someone else would have taken my place. We'll close and see how much good one does by deciding to go into medicine.

How much good does medicine do?

Life expectancy in the UK was around 47 in 1900; it is now 80. To what degree can medicine take credit for this vast improvement?

By the lights of most experts, not very much. During the last century the population in the developed world became better fed, wealthier, better educated, and living in safer and more hygienic environments, and these take the lion's share of responsibility for our longer lives. Consider this graph from Mckinlay and Mckinlay of the medical effects on US mortality. Note how total mortality falls dramatically despite the small proportion of GDP spent on health, and that dramatic increases in health spending do not accelerate this downward trend:

Despite this, it is likely medicine has some effect: data from the Netherlands show that there are 'bumps' in life-expectancy of those with a given disease that coincide with the advent of improvements in that diseases treatment. We really want to know is how big that effect generally is: is medicine 40% responsible for our better health? 4%? 0.04%?

One approach from Bunker is to compile an 'inventory' of medical care (including both prevention and cure) for the commonest diseases: look at medical trials to see what life expectancy effects a given treatment has, extrapolate these effects to the wider population with the disease, and then add them all up. Bunker gives the following estimates:

Medical care can be credited with 5 to 5.5 years of the increase in life expectancy since 1900...

... But Iatrogenic (medicine-caused) disease reduces life expectancy by 0.5 to 1 year.

Medicine also improves wellbeing: the average person has five more years free of disability.

Bunker's method is likely to overestimate the impact of medicine. The impact of a treatment in a clinical trial is known to be much higher than its effect in everyday clinical practice. However, it is the only quantified estimate available, so let's use it to try and work out how much good an individual doctor does.

How much good does a doctor do? A Fermi calculation

We do not know what it would be like to 'subtract away' all medical care from a population, but the 1900 population is not a bad surrogate: at this time, medicine was barely funded, unavailable to many and primitive. So 'amount of good done by medicine between 1900 until now' approximates 'amount of good done by medicine'.

We'll assume the benefits of medicine primarily consist of benefits to our health, though of course there might be others. We'll also assume that we're talking about doctors practicing medicine (providing care); medical research is a potentially high impact avenue beyond the remit of the current discussion.

We can use Bunker's estimates to perform a 'back of the envelope' calculation of how much impact on health an average doctor has. To do this we'll be using the Quality Adjusted Life Year (QALY) as our metric: one QALY is one year of healthy life.[1] According to Bunker, the average person gains about 5.25 years due to medicine, but loses 0.75 years due to medicine-caused disease. That makes for a net gain of 4.5 QALYs. But we also need to consider how much healthy life is added by treating disability. This is trickier, but a generous estimate is to equate the '5 free years of disability' to 2.5 QALYs.[2]

Totting those up means the total gain per person is seven QALYs. On average, each of us has seven more years of healthy life (either in length or in quality) thanks to our doctors.

Now let's look at things on a population level. Multiplying up by the 62.6 million population of the UK means medicine adds 438.4 million years of healthy life to the UK. We know there are around 2.7 doctors per 1 000 population in the UK, making around 172 000 total. So the 'share' per doctor is:
438 487 000 / 171 824 = 2552 QALYs

Taking stock

This doesn't look too bad: intuitively you could think of it as saving about 90 lives. But it turns out this figure is an upper bound.

1. We've used generous estimates for the amount of good done by medicine - most experts think it should be less than this.

2. We've ignored the fact that the increase in life expectancy in old age is probably associated with increased disability, and so the 4.5 years of increased life expectancy should not be counted at 'full value'.

3. Doctors cannot take sole credit for the impact of medicine: what about nurses, scientists, cleaners, managers?

More importantly, the figure we've worked out does not tell us how much difference I might expect to make by becoming a doctor. What we need to work out is the additional good done by an extra person becoming a doctor that wouldn't have happened otherwise.

This means taking into account two extra effects:

1. Diminishing marginal returns - some tasks performed by doctors have more impact than others. If there were one fewer doctor, the highest impact tasks they perform would be given to someone else, so the total impact wouldn't reduce proportionally with the number of doctors.

2. Replaceability - if I don't become a doctor, someone else will. So again, the difference I make is reduced.

We'll discuss these effects below, but they will mean that the impact of me becoming a doctor is much less than our estimate. In any case, I can do much more good by giving wisely. If I donate 10% of my salary to AMF, I'll protect about 20,000 people from malaria, saving about 6 times as many QALYs, and causing many other economic and education benefits.[3] I can do far more good with my chequebook then I can expect to accomplish with my stethoscope.

So the upper bound for the average direct health impact of a doctor in the UK, is around 2600 QALYs. We can think of this, very roughly, as saving 90 lives. This doesn't, however, show how much difference you make by becoming a doctor. Working this out requires a number of adjustments. One is that we need to work out the impact of additional doctors, instead of the average doctor.

There's already about 200,000 doctors in the UK. By becoming a doctor, let's suppose I increase the number of doctors to 200,001. And let's assume that all doctors in the UK are equally skilled (we'll relax this assumption later). The extra doctor won't produce a benefit of 2600 QALYs. That's because doctors perform a huge variety of tasks. Some of these do more for the UK's health than others. The NHS (to some extent) prioritises its distribution of resources so that the most effective tasks get done first. This is part of the remit of the National Institute of Clinical Excellence. So, if there's one extra doctor, the tasks they do will be less effective than those that are already being done. So we'd expect an additional doctor to have less impact than the 200,000 people who are already doctors. This is called diminishing marginal returns.

How can we take the figure for the average impact of a doctor and work out the impact of an additional doctor? One very rough way of estimating this is to look at the maximum the NHS is prepared to spend to save on QALY, and compare it to the average it spends. We know the maximum the NHS is willing to pay for a QALY is between £20 000 to £30 000. This suggests that extra money given to the NHS produces about 1 QALY per £25,000. Assuming that the NHS can freely spend between salaries and technologies and is fairly good at working out when it is more effective to spend money on either, then the marginal benefit of a doctor per year is their salary (£69 952) divided by the cut off (£25 000), making for 120 QALYs over a career.[4] However, this assumption is unlikely to be true. So let's try some better approaches:

Approach 1: Life expectancy versus number of doctors

Plotting the most recent values the world bank has (s ource), we get the following plot:

We see an 'r' shaped sort of trend: the life expectancy initially goes up briskly with an increase in doctors per capita, but this relationship levels off as the doctors per capita increases beyond 1 per thousand or so. So it looks like there are diminishing returns of adding more doctors. A similar picture emerges when other sorts of 'investment' in health are considered: see for example the plots of health spending per capita versus life expectancy, or GDP per capita versus life expectancy.

From here, we can begin to work out the marginal impact of adding 'one more doctor' to the UK: one adds a best-fit line to the data, and see what how much 'gain' there is in health when you move 'one more doctor' along that line from where the UK is now. This gives a final answer of 950 QALY s per medical career, just over a third of our original estimate for the impact of a doctor. (I've included the working out in a footnote for the interested.)[5]

This method of estimation isn't perfect. It looks at all countries, whilst we might want to use data only from developed countries to look at the impact of doctors in the UK. Much like our previous post, wealth remains a potential confounder: both life expectancy and doctors per capita correlate with gross domestic product, and it might just be that richer societies are able to buy better education, hygiene, nutrition, and other things that really do the work of making their inhabitants healthier, and they coincidentally buy more doctors too.

Approach 2: OECD health data and regression

We can try a different tack to try and accommodate these concerns. The OECD is a group of wealthy to fairly wealthy countries which maintain records of themselves along a variety of indicators. Amongst these are life expectancy, healthcare spending per capita, doctors per 1000 people, and gross national income per capita adjusted for purchasing power parity. We can regress these to a combined model to work out how large a contribution each of these factors make to improved life expectancy, and, once again, we can then work out how big an effect changing one of our variables (doctors per capita) by 'one more doctor' will change the life expectancy of the population. The final answer here is that the impact of one more doctor is around 670 QALYs. (Again, the full working in a footnote.)[6]

Approach 3: WHO disability adjusted life years

What about quality of life, and not just length? Although I tried to account for this by Bunker's estimates of how much good medicine does via removing disability, it would be nice to tackle the issue more explicitly.

The WHO keeps data on the burden of disability in a population, as DALYs per 100 000 people (a DALY is a measure of length and quality of life, it is the inverse of a QALY - more DALYs are a bad thing, as well as other differences summarized here). Plotting DALYs per 100 000 against doctors per 100 000 gives the following:

This graph looks like a mirror image of the life expectancy versus doctors per capita graph above. Although we cannot directly compare 'DALYs averted' to 'QALYs gained', using a similar technique to approach 1 (draw a line of best fit, work out how much gain one makes by moving 'one more doctor' along, and multiply appropriately) means each doctor averts 645 DALYs per career. This reassures us our figures are on the right track.

Conclusion

These estimates are necessarily very rough, though it's reassuring to find our three estimates in the same ball park. Splitting the difference between our three best estimates gives the impact of 'one more' medical career in the UK as about 760 QALYs, around a third of our estimate of the average doctor. Looking at the degree of noise in the data, I estimate the 95% confidence interval is about 600-920 QALYs.

The expected impact of becoming a doctor is now around 25 lives: still pretty good, but giving 10% to effective charities can produce a health benefit 25 times larger than that. This underlines the importance of thinking at the margin for those wanting to make the biggest difference they can. One should try to estimate not how much good a career does in general, but how much more good they can do if you get involved. In the case of first world medicine, it appears most of the highest priority interventions for improving health and wellbeing have already been done, and so the additional impact of one more doctor is not that large.

Our estimate, however, is still too generous. By becoming a doctor I won't increase the number of doctors by one. Rather, it seems I'll just take the job from someone else. I'll be replaceable. We'll look at this adjustment in the last post.

So, given diminishing returns, my going into medicine would save 600-920 QALYs, with my best guess at 760 QALYs. That's roughly equivalent to saving 25 lives.

But even this is too generous. If I become a doctor, I won't increase the total number of doctors by one. The NHS has a limited budget, so it can't just hire every qualified person who applies; medical schools have limited places by law, and there are more applicants who are 'good enough' than there are places. If I become a doctor, then I've just displaced someone else who would have taken the job.

If we also assume that doctors are equally skilled, then by becoming a doctor you'd have zero impact. You'd simply displace someone equally good. Fortunately, it's not as bad as this. First, doctors are clearly not equally skilled (as we'll look at later). But more importantly, by becoming a doctor, you do, in one sense, increase the number of doctors.

Supply-Demand Effect

If I become willing to work as a doctor, then I increase the supply of doctors. If more people are willing to be doctors, then the NHS can slightly decrease the wages for doctors.[7] If the wages are slightly lower, the budget can be used to hire slightly more doctors.

How this all balances out is studied by economists. If the labour market for doctors is in equilibrium, then increasing the supply of doctors by one doctor, will probably increase the number of doctors by about 0.6.[8]

In other words, if 10 new qualified people become willing to be doctors, then we'd expect 6 new positions to be created, and only 4 people who would have been doctors to fail to get a job (or a place at medical school). This means the impact of becoming a doctor is only 60% of our current estimate, i.e. about 450 QALYs.

Skill Level Effect

Finally, we have to correct this figure for the fact the doctors are not equally skilled. By becoming a doctor, you'll change the average skill level, and this effect adjusts our impact upwards. When several people attempt to become doctors, the NHS attempts to select the best ones. This means that if you become a doctor, the 0.4 doctors you'd expect to displace from the pool should be less skillful. So, you'll increase the average skill level. In the next section, I'll try to put an estimate on this factor. It's a little technical, so skip ahead to the summary if you don't want the details.

In an ideal world, as someone enters medicine the NHS would replace the worst doctors in the pool. So, by becoming a doctor, your effect on the pool would be to remove the worst 0.4 of a doctor and replace them with yourself. The worst doctor is likely to have zero output. So, now let's assume I'm an average doctor. If we add 10 doctors like myself, and lose 4 with zero output, then we've effectively gained 10 doctors of average output. So, we have to add another 4 doctors to our earlier estimate of 6. So then the supply-demand correction factor is cancelled out, and you have 100% of the impact of a marginal doctor.

This could easily be an underestimate. The worst doctor is likely to have negative impact. That's not because they're likely to directly do more harm than good, but because they might hamper the effectiveness of lots of team mates. In fact, if there are about 200,000 doctors, there's reason to expect the worst to roughly counteract the good done by an average doctor i.e. to have an output of '-1' marginal doctors.[9]

That would mean the by becoming an average doctor I'd displace harmful doctors, doing more good than our previous estimate. In fact in this case, the skill level effect would add another 0.8 doctors worth of impact.[10]

Unfortunately, the idea that I'll knock out the worst doctor is a large idealisation. In reality, selection processes are not perfect. Moreover, there's not always mechanisms to select across the entire NHS, and there's limits on who can be made redundant. So, it's very unlikely I'll knock out the worst doctor, which means the correction we've just worked out is an upper bound.

It's difficult to see how to estimate the efficiency of the NHS's selection procedures. But let's suppose, to get a rough idea, that instead of knocking out the worst doctor, I knock out doctors in the bottom decile. If you're an average doctor, then your output is probably more than 80% higher than the bottom decile. Then the correction factor is about 0.2 additional doctors worth of impact.[11] This is a very rough estimate, but it's bounded between 0 and 0.8. Zero is the case when the NHS is unable to select according to ability at all.

If you're a top-decile doctor instead of an average one, then the correction factor would be about 1. (The bounding range would be 0.8 to 1.6)

Also note that I've effectively assumed that doctor skill is uncorrelated with the potential of their position to create health benefits: on my model so far, a top decile doctor would have as much excess impact whether a GP, cardiothoracic surgeon, public health doctor or whatever else. Normally, the highest skilled people get put into the positions with the highest potential for impact (at least insofar as the selection process is efficient). It's not clear this holds to a large extent in medicine. The most effective activities of the NHS are often unsexy areas like providing vaccines or management. The most skilled doctors might be placed in the most difficult areas, rather than those with the highest effectiveness. Further, many doctors don't seem to seek to maximise their impact in job selection - there isn't even publicly available information to help doctors do this. So, my assumption could be reasonable. If this is the case, then there could be opportunities for skilled, altruistically motivated doctors to seek out the positions with the most potential for impact.

If there was a tendency for the highest ability people to be put into the most effective positions, then it would increase the impact of becoming a doctor, especially for highly skilled doctors, because the impact of their additional skills would be better leveraged. This correction seems likely to be significantly less than a factor of 2.[12]

We started with an upper bound for the average direct impact of 2600 QALYs

The impact of marginal doctors is only a third of the average direct impact, meaning the difference a doctor makes is around 760 QALYs, with a 95% confidence interval of 600-920 QALYs.

Supply-Demand Effect: The number of doctors only increases by 0.6, not 1

Skill-level adjustment: You're more skilled than your replacements: If you're of average skill, the number of doctors effectively increases by an extra 0.2, or in total 0.8, so your marginal impact is 600 QALYs. That's roughly saving 20 lives.

The skill-level adjustment is very rough. But it's likely to be in the range of an extra 0 to 0.8, depending on how effectively the NHS selects doctors according to skill. So, if you're an average doctor, crudely putting our two ranges together, your impact is in the range of 360 to 1300 QALYs, with a best guess of 600.

Skill-level adjustment if you're in the top decile of doctors: The number of doctors effectively increases by an extra 1.0, or 1.6 in total, so your impact is 1050 QALYs. The full range would be from 840 to 2000 QALYs.

We've assumed doctor skill is uncorrelated to the potential of their position to have impact.

Conclusion

So we've now got a much better estimate of how big a difference I will make working as a doctor: around 600 QALYs, or around 20 lives - one every two-and-a-bit years or so of my career. Giving 10% of my salary to effective causes that fight global poverty will add around 18 800 QALYs, a health impact about 30 times higher than what I do directly in my work.

I think my 17-year-old self would find that pretty galling. He'd signed up to medicine to save loads of lives, and he'd find it a bit of a downer to see this his entire medical career would likely do as much good as a £10 000 donation to the right charity. But that would be the wrong way of looking at things: instead, he should see that saving 17 lives is a vast amount of good, and being able to do 30 times more good on top of that is awesome.

It should also brighten up everyone else's day too. One does not have to be a doctor or an aid worker or any other 'archetypally moral' career to make a vast difference; it is within reach of most people in the developed world. So let's do it.

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This is cross posted on 80,000 hours: 1 2 3. Particular credit to Ben Todd for basically writing the third section.] Doctors have a pretty solid reputation as do-gooders. There are regular news stories about how advances in medical science promise to help more people than ever before.

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https://www.healthline.com/health/placebo-effect#takeaway

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In medicine, a placebo is a substance, pill, or other treatment that appears to be a medical intervention, but isn't one. Placebos are particularly important in clinical trials, during which they're often given to participants in the control group.

Because a placebo isn't an active treatment, it shouldn't have a significant effect on the condition. Researchers can compare the results from the placebo to those from the actual drug. This helps them to determine if the new drug is effective.

You may be familiar with the term "placebo" in reference to something called the placebo effect. The placebo effect is when an improvement is observed, despite an individual receiving a placebo as opposed to active medical treatment.

It's estimated that people experience the placebo effect. Keep reading to learn more about the placebo effect, how it may work, and some examples from research.

The placebo effect represents a fascinating connection between mind and body that still isn't completely understood. Below, we'll discuss some psychological explanations for the placebo effect.

Classical conditioning

Classical conditioning is a type of learning. It happens when you associate a thing with a specific response. For example, if you get sick after eating a specific food, you may associate that food with having been sick and avoid it in the future.

Because the associations learned through classical conditioning can affect behavior, they may play a role in the placebo effect. Let's look at a couple of examples:

If you take a specific pill for headaches, you may begin to associate that pill with pain relief. If you receive a similar-looking placebo pill for a headache, you may still report decreased pain due to this association.

You may associate the doctor's office with receiving treatment or feeling better. This association can then in turn influence how you feel about the treatment you're receiving.

Expectations

The placebo effect has a large root in a person's expectations. If you have prior expectations for something, they can influence your perception of it. Therefore, if you expect a pill to make you feel better, you may feel better after taking it.

You can generate expectations for improvement from many types of cues. Some examples include:

Verbal. A doctor or nurse may tell you that a pill will be effective at treating your condition.

Actions. You may feel better when you've actively done something to address your condition, such as take a pill or receive an injection.

Social. Your doctor's tone of voice, body language, and eye contact can be reassuring, making you feel more positive about the treatment.

Below, we'll explore three examples of the placebo effect from real studies.

Migraine

A assessed how the labeling of drugs affected episodic migraine in 66 people. This is how the study was set up:

1. Participants were asked to take a pill for six different migraine episodes. During these episodes, they were given either a placebo or a migraine medication called Maxalt.

2. The labeling of the pills was varied throughout the study. They could be labeled as placebo, Maxalt, or either type (neutral).

3. Participants were asked to rate pain intensity 30 minutes into the migraine episode, take their assigned pill, and then rate pain intensity 2.5 hours later.

Researchers found that the expectations set by the pill labeling (placebo, Maxalt, or neutral) had an effect on the pain intensity reported. Here are the results:

As expected, Maxalt provided more relief than placebo. However, placebo pills were observed to provide more relief than a no treatment control.

Labeling mattered! For both Maxalt and placebo, the rating of relief was ordered based off of labeling. In both groups, pills labeled as Maxalt were highest, neutral was in the middle, and placebo was lowest.

This effect was so strong that Maxalt labeled as a placebo was rated to provide about the same amount of relief as a placebo that was labeled as Maxalt.

Cancer-related fatigue

Fatigue may still be a lingering symptom in some cancer survivors. A looked at the effects of a placebo compared to treatment as usual in 74 cancer survivors with fatigue. The study was set up as follows:

1. For 3 weeks, participants either received a pill openly labeled as a placebo or received their treatment as usual.

2. After the 3 weeks, people taking the placebo pills stopped taking them. Meanwhile, those receiving usual treatment had an option to take the placebo pills for 3 weeks.

After the study concluded, the researchers observed that the placebo, despite being labeled as such, had an effect on both groups of participants. The results were:

After 3 weeks, the placebo group reported improved symptoms compared to those receiving treatment as usual. They also continued to report improved symptoms over 3 weeks after discontinuation.

People receiving treatment as usual that decided to take the placebo pill for 3 weeks also reported an improvement in their fatigue symptoms after 3 weeks.

Depression

A investigated the placebo effect in 35 people with depression. Participants weren't currently taking any other medications for depression at the time. The study was set up like this:

1. Each participant received placebo pills. However, some were labeled as a fast-acting antidepressant (the active placebo) while others were labeled as a placebo (the inactive placebo). Each group took the pills for a week.

2. At the end of the week, a PET scan measured brain activity. During the scan, the active placebo group got a placebo injection, being told that it may improve their mood. The inactive placebo group received no injection.

3. The two groups switched pill types for another week. A second PET scan performed at the end of the week.

4. All participants then received treatment with antidepressant medications for 10 weeks.

Researchers found that some individuals experienced the placebo effect and that this effect impacted their brain activity and response to antidepressants. The results were that:

A decrease in depression symptoms was reported when people were taking the active placebo.

Taking the active placebo (including the placebo injection) was associated with PET scans that showed increases in brain activity in areas associated with emotion and stress regulation.

People who experienced increased brain activity in this area often had an improved response to the antidepressants used at the end of the study.

While the placebo effect has been observed in many scenarios, there's still a lot about it that we don't understand. Studies are ongoing and we learn more every year.

One of the big questions is the connection between mind and body. How are psychological factors like expectations affecting what's going on inside us?

We know that the placebo effect can lead to the release of various small molecules like neurotransmitters and hormones. These can then interact with other parts of the body to cause changes. However, we still need to work out more details about the specifics of these complex interactions.

Additionally, the placebo effect seems to have a significant impact on some symptoms, such as pain or depression, and not others. This brings up more questions.

A placebo is a pill, injection, or thing that appears to be a medical treatment, but isn't. An example of a placebo would be a sugar pill that's used in a control group during a clinical trial.

The placebo effect is when an improvement of symptoms is observed, despite using a nonactive treatment. It's believed to occur due to psychological factors like expectations or classical conditioning.

Research has found that the placebo effect can ease things like pain, fatigue, or depression. However, we still don't know the exact mechanisms in the body that are contributing to this effect. Scientists are currently working to answer this question and more.

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Placebo Effect: What It Is, Examples, and More

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In medicine, a placebo is a substance, pill, or other treatment that appears to be a medical intervention, but isn't one. Placebos are particularly important in clinical trials, during which they're often given to participants in the control group. Because a placebo isn't an active treatment, it shouldn't have a significant effect on the condition.

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how the news changes reality

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the power of our mind

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https://au.reachout.com/articles/dealing-with-bad-world-news

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https://www.verywellmind.com/prevalence-of-phobias-in-the-united-states-2671912

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Phobias are the most common mental disorders in the U.S. according to the National Institute of Mental Health (NIMH). Approximately 10 percent of people in the U.S. have specific phobias, 7.1 percent experience social phobias, and 0.9 percent have agoraphobia. Whether you're terrified of spiders, heights, or speaking in public, you are not alone.

It's possible that these numbers are low since mental disorders are often under-reported in the U.S. This can be attributed to many factors, including a stigma associated with mental illness and lack of adequate funding for treatment. These disorders can be disabling, which demonstrates the importance of proper diagnosis and treatment. The good news is that these conditions can be treated effectively once you seek help.

What Are Phobias?

A phobia is an overwhelming, irrational, and persistent fear that leads to avoiding the object or situation. It can be a fear of a specific thing or of a social setting.

Researchers are uncertain exactly what causes phobias. However, genetics, culture, and life events seem to play a role. Whatever the cause, phobias are treatable and can often be overcome with cognitive-behavioral therapy (CBT).

Symptoms of Phobias

Phobic symptoms can occur through exposure to the fear object or situation, or sometimes merely by thinking about it. These include:

Dizziness, trembling and increased heart rate

Breathlessness

Nausea

A sense of unreality

Fear of dying

Preoccupation with the fear object

In some cases, these symptoms can escalate into a full-scale anxiety attack.

Prevalence of the Most Common Phobias

Prevalence is the measure of the proportion of a population who has a certain condition. Here are the statistics and prevalence rates of some common phobias:

Social Phobia

Social phobia is now called social anxiety disorder. It is a fear of social situations where you will be with unfamiliar people or may be scrutinized. Those with this disorder fear being embarrassed or humiliated in these situations. The fear of speaking in public is a specific type of social phobia.

Social phobia generally appears for the first time in adolescence, at 13 years of age.

Approximately 15 million American adults, or 7.1 percent of the adult population, and 5.5 percent of the teenage population are affected.

About 30 percent of those with social phobia have a severe case.

Only about 40 percent of people with social phobia are being treated. More than a third of those with this disorder wait for 10 years or more before they seek treatment.

Only slightly more women than men have a social anxiety disorder.

Specific Phobias

Specific phobias are grouped into five major categories-animal type, natural environment type, situational type, blood-injected-injury type, and "other" type.

NIMH and the Anxiety Disorders Association of America say the most common specific phobias are of closed-in places, heights, escalators, tunnels, highway driving, water, flying, dogs, animals, insects, thunder, public transportation, injuries involving blood, and dental and medical procedures.

Specific phobias generally appear in early childhood, around age 7.

An estimated 9.1 percent of Americans, more than 19 million people, have a specific phobia, and many people have more than one specific phobia.

The prevalence of specific phobias in teenagers is higher at 15.1 percent.

More than twice as many women as men have specific phobias.

Agoraphobia

Agoraphobia is the fear of situations in which escape is difficult. If you have this phobia you might avoid being alone outside of your home, being in a crowded place, or traveling by car, bus, or airplane.

Agoraphobia is commonly associated with panic disorder. Agoraphobia without panic disorder is relatively rare, affecting only 0.9 percent of the American population, or 1.8 million people.

Over 40 percent of those who have agoraphobia have a severe case.

Less than half of the people with this condition are receiving treatment.

The average age of onset is 20 years old.

The prevalence for teenagers from age 13 to 18 is 2.4 percent.

A Word From Verywell

While feeling anxiety about speaking in public or encountering a snake is common, phobias can be disabling. If you experience anxiety attacks or you can't do activities you want to do because of your fears, help is available. Phobias are treatable and often you can get permanent relief.

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What are your concerns?

Other Inaccurate Hard to Understand

Article Sources

Agoraphobia. National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/agoraphobia.shtml.

Social Anxiety Disorder. National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/social-anxiety-disorder.shtml.

Specific Phobias. Anxiety Disorders Association of America. https://adaa.org/sites/default/files/phobias_adaa.pdf.

Specific Phobia. National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/specific-phobia.shtml.

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Do You Know How Many People Have Phobias in the U.S.?

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Phobias are the most common mental disorders in the U.S. according to the National Institute of Mental Health (NIMH). Approximately 10 percent of people in the U.S. have specific phobias, 7.1 percent experience social phobias, and 0.9 percent have agoraphobia. Whether you're terrified of spiders, heights, or speaking in public, you are not alone.

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https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/health-anxiety-what-it-and-how-beat-it

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The illness you fear might not be the illness you have. I recently conducted an online support group for people with all sorts of health fears, from cancer and heart disease to ALS and MS. Each shared their worries about moles on the skin, irregular heart palpitations, and numbness and tingling. Although their specific fears varied, they all had one thing in common; none of them had ever been diagnosed with a series illness and they all related to the following scenario:

Dina felt great after getting a clean bill of health from her physician but as she tried to fall asleep, she dwelled on one statement he made, Tumors can grow at any time. Come back in six months if you're concerned. Questions raced through her mind as she tossed and turned, Why did he tell me that? If there was nothing wrong, why would he say come back in six months? What if he missed something? Why do I keep getting headaches and dizziness? Dina felt so anxious she got out of bed and searched the web for answers. As she reread the same articles about symptoms of brain cancer, she began to feel lightheaded. Why do I keep feeling this way? Do I really have brain cancer? Is this really happening?

The good news was, Dina did not have brain cancer or a brain tumor.Dina had health anxiety.There are two types of health anxieties: Somatic Symptom Disorder and Illness Anxiety Disorder, formally known as hypochondriasis.Many people with health anxiety are often unable to function or enjoy life due to their fears and preoccupations.They obsess over bodily functions (breathing, heartbeat), physical oddities (skin blemishes), and physical discomfort (headaches, stomach aches, lightheadedness).They might worry about a specific organ (brain, heart) or a disease they heard about on the news or at work (MS, diabetes).They are preoccupied with the belief that they have, or are in danger of contracting, a serious illness. Many will purse doctors and tests repeatedly for reassurance, but are reluctant to seek mental health treatment since they believe their condition is medically based.
Why does health anxiety persist despite reassurance from doctors?
Although some refuse to be examined by their physician due to their fear of discovering the worst, seeking reassurance from doctors, insisting on repeated medical tests, and visits to urgent care, are more common in health anxiety. Being reassured by the doctor that there is no serious medical illness brings relief -- temporarily. The vicious cycle quickly resumes as new thoughts and physical sensation surface, followed by googling and self-diagnosis, misinterpretations of news in the media, anxiety, and more visits to doctors to resolve the uncertainty. The cycle ignites with each new alarming thought or symptom.
The False Alarm
Car alarms are set off when a criminal breaks in but imagine how problematic it would be if the siren blared each time a pedestrian walked by.The car alarm would be misinterpreting innocent people as dangerous criminals.

With health anxiety there is the misinterpretation of discomfort and normal bodily sensations as dangerous. The body is very noisy. Healthy human bodies produce all sorts of physical symptoms that might be uncomfortable, unexpected, and unwanted, but not dangerous.

Normal sensations in the body that can produce fear and worry include changes in visual acuity, heart rate, blood pressure, saliva levels, depth of breathing, balance, and muscle tone,just to name a few.These are normal and harmless bodily changes, but when a person believes they are symptoms of a terrible disease, it causes anxiety.The sensations are real, but the beliefs are false.
Why do people misinterpret sensations in their body and overestimate danger?
Sometimes misinterpretation is due to assumptions about an illness. For example, "My cousin died of cancer. It's only a matter of time until I get it." Or, viruses sped easily. People in Africa are dying of Ebola. It could easily spread to the U.S. People with health anxiety might hold rigid definitions of good health, perhaps believing that any discomfort whatsoever means bad health.

Anxiety is a protective mechanism and scanning the body for an illness seems like the right thing to do to protect ourselves. However, when we are preoccupied with something, we tend to notice it. Last month when I was looking to purchase a new car, I suddenly began to notice every car on the road; the make, model, and the color.Previously, I didn't pay attention. Looking for symptoms makes you notice subtle sensations you might otherwise ignore. When you become preoccupied with bodily sensations, those sensations become amplified and last longer.
This is when it gets tricky.
Each scan of the body produces uncertainty and doubt, giving the imagination opportunity to create stories.As you imagine the worst, your body's alarm system sounds off in the form of symptoms of anxiety (racing heart, tightness in the chest, difficulty breathing, jitters, tingling, lightheadedness, nausea, stomach discomfort, sweating, headaches, etc.) giving your imagination additional fuel to create great works of fiction.The symptoms are real. The thoughts are false.
The Most Effective Treatment is Cognitive-Behavioral Therapy
Since it is possible to suffer with anxiety and a serious medical condition, medical problems must be ruled out with a thorough physical exam. Once this is accomplished, Cognitive Behavioral Therapy (CBT) is the most effective treatment for any form of anxiety including health related anxiety.

CBT is a therapy model that focuses on our cognition, the way we think, and our behaviors, the way we act. The main concept behind CBT is that our thoughts about a situation (the fear of ALS) effect how we feel (afraid and anxious) and how we behave (holding out our hands to see if they are trembling). We tend to assign meaning to specific situations (tingling means we have MS). It's not the actual situation causing our anxiety, but the meaning - accurate or not. And, when you have anxiety, you give your thoughts a lot of meaning, and thus, a lot of power.

CBT aims to help you overcome fears by correcting irrational thoughts and changing problematic behaviors. By acquiring a certain mindset, you can learn to approach anxious situations differently and learn to tolerate discomfort and uncertainty. Illness anxiety can be overcome with the help of a skilled anxiety specialist and CBT. A You can find a therapist in your state on the ADAA website. nd for additional information on Illness Anxiety watch my free ADAA webinar.
Additional Resources:

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Health Anxiety: What It is and How to Beat It

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The illness you fear might not be the illness you have. I recently conducted an online support group for people with all sorts of health fears, from cancer and heart disease to ALS and MS. Each shared their worries about moles on the skin, irregular heart palpitations, and numbness and tingling.

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https://academic.oup.com/brain/article/134/4/1244/340497

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'One can feel well but one can never know one is well' wrote the philosopher Kant, acknowledging his own inclination towards hypochondria. Told that he does not have an ulcer, one of Woody Allen's neurotically anxious film counterparts simply retorts 'they haven't found one yet'. The hypochondriac may be in good health but remains tormented by supposed symptoms and the certainty of the illnesses to which they point. In Mark Haddon's novel A Spot of Bother (2006), the central character finds a small lesion on his hip and plunges into hypochondriac panic; though diagnosed as no more than discoid eczema, he knows the spot is a fatal cancer. That tests indicate nothing wrong brings no relief to the hypochondriac; indeed, so-called health is a very doubtful state of affairs, which was Kant's point. None of which makes hypochondriacs altogether welcome at their medical centre, arousing as they can impatience and professional unease with their unshakeable conviction that something is amiss. M, the title character of Graham Swift's story 'The Hypochondriac' (1985), turns up repeatedly at his local surgery always to be reassured that all is well, until ordered never to return. Subsequently informed that M is seriously ill, his doctor delays a home visit, finally arriving to find that M has died in hospital-but of what? Autopsy reports 'could reach no certain conclusions about the causes of M's death', which is a tribute to his hypochondriac identity: his hypochondria was justified and medical science failed him.

The medical term today is 'hypochondriasis', leaving 'hypochondria' as the lay term for more or less excessive health anxiety. The current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) includes hypochondriasis among the somatoform disorders, defining it as preoccupation with fears of having, or the idea that one has, a serious disease based on misinterpretation of one or more bodily symptoms. Hypochondriacal concerns may be transient, prompted by specific circumstances (bereavement, for example); equally they may appear in the course of another mental condition (depression, for example). Where the concerns are primary and continue for over 6 months, the diagnosis of the specific mental disorder can be made. The iconic figure of the hypochondriac is the imaginary invalid fearfully obsessed with his health and his doctors depicted in Molière's comedy Le Malade imaginaire (1673), or in Daumier's 1841 lithograph of a haggard-faced sufferer anxiously taking his pulse ( Fig. 1). Naturally enough, hypochondria has been linked to undue fear of death; hypochondriacs, as Darwin's grandfather Erasmus put it, are 'attended by so much fear, or expectation, of dying as to induce them to think of nothing but their own health'.

The hypochondriac seeks reassurance, yet reassurance is felt as rejection. Doctors have accredited knowledge, but hypochondriacs know better, and come armed with information gathered from available medical or pseudo-medical sources. One of Webster's New World Dictionary's 2008 'words of the year' was 'cyberchondria', meaning anxieties about common symptomatology based on internet searches. A Microsoft study of the same year found that searches for such things as headache were as likely to lead to pages describing serious conditions as benign ones, with a consequent escalation of unfounded medical concerns. That commercial internet services now offer individuals genome sequencing and identification of disease-causing mutations can only bring new hypochondriac possibilities. Typically, the hypochondriac multiplies consultations, doctor-shopping for the ideal physician who will take his or her condition seriously, rather than dismissing it as 'nothing wrong', and thereby demonstrating obvious medical incompetence. The physician must face the hypochondriac's fears and take responsibility for deciding there is no cause for concern, with the worry that nevertheless there might be. Moreover, the risk exists of iatrogenic illness: diagnostic investigations-'just to be sure'-may lead to induction of a disorder, reinforcing the patient's hypochondriac convictions.

Brian Dillon's Tormented Hope opens with the lived experience of the hypochondriac, written from personal knowledge. His first book, In the Dark Room (2005), told of an unhappy childhood, the death of both parents while in his teens and his mother's years of pain from scleroderma. Becoming obsessed with his own health, he developed 'a prodigious medical imagination' and took his supposed illnesses round numerous surgeries and hospitals. In Tormented Hope, he turns to 'nine hypochondriac lives', with chapters on each to exemplify aspects of 'the hypochondriacal character'. Neither a history of hypochondria, nor an investigation into 'what makes a hypochondriac', the book is intended for the general reader, telling the hypochondriacal stories of James Boswell, Charlotte Brontë, Charles Darwin, Florence Nightingale, Alice James (sister of novelist Henry and psychologist-philosopher William), Daniel Paul Schreber (famously studied by Freud), Marcel Proust, Glenn Gould and Andy Warhol. Disarmingly, Dillon admits that the lives were chosen according to no exact criteria, save that their stories seemed compelling. All nine 'wrote' of their health, many indeed keeping meticulous records and Dillon draws on published diaries, letters, memoirs, novels, films even, as well as on existing biographies. The chapter-per-life format forbids substantial treatment, yet Dillon captures nicely the feel of these lives, mixing reflections on hypochondria with novelistic story-telling and scene-setting-recounting the precautions surrounding Proust's breakfast croissant, or imagining the sun streaming into James's bedroom and the fussings of her nurse when a renowned physician calls.

Hypochondria has been known as an illness for over two thousand years. First an anatomical term, the word referred (and still does) to the right and left regions of the upper lateral portion of the abdomen and the viscera situated therein ('hypochondria' being the plural term, 'hypochondrium' the singular, used for the whole area). The Greeks linked a pathology of these regions to the physiological theory of the humours and to a form of melancholia, a morbid entity with digestive symptoms caused by an abundance of 'black bile', the atrabile that was one of the cardinal humours of the humoral doctrine underlying ancient and medieval physiology. The Oxford English Dictionary's first recorded anatomical use of 'hypochondria' in English comes from a mid-16th century physician writing of a medicine that 'healeth flatulentnes of Hypochondria'; while the word's use for a morbid state of mind, characterized by general depression and lowness of spirits, appears in the following century. Broadly speaking, the history of hypochondria is the movement from a physical or physiological condition to a mental or psychological one, though different kinds of explanation often overlap.

For Robert Burton in The Anatomy of Melancholy (1621; Fig. 2), the 'hypocondries' were one of the seats of melancholy. A frontispiece added to the third edition (1628) depicts the several types of the melancholic, among them Hypocondriacus shown in conventional melancholic pose, potions from his apothecary scattered around him: 'Hypocondriacus leanes on his arme/Winde in his side doth him much harme/And troubles him full sore', as a poetic 'Argument' explained in subsequent editions. As expected, the 'Causes of Hypochondriacall or Windie Melancholy' lie in the abdominal viscera, with symptoms that include 'sharp belchings', 'fulsome crudities', 'heat in the bowels', 'comely fits', 'turbulent dreams' and many more. Burton's account is from within the theory of the humours; there may be psychological effects-fear and sadness-but they stem from excess of black bile and disorder of the hypochondria. Some few decades later, Thomas Willis replaced humoral physiology with an anatomical consideration of the brain and nerves, seeing 'hypochondriacal affects' as being largely 'convulsions and contractions of the nervous parts'. Physical and mental symptoms-'distractions of the spirit'-go together. Thomas Sydenham, Willis's contemporary, made hypochondria a matter of the 'animal spirits', those conducting agents between mind and body whose action could be affected by either: lack of 'firmness' of the spirits brings 'disturbance and inconsistency of both mind and body'.

The 18th century saw a growth in works devoted to hypochondria and related disorders, with differing accounts of the interactions between the mental and the physical. In Bernard de Mandeville's Treatise of the Hypochondriack and Hysterick Passions ( 1711) a long-afflicted 'hypochondriaticus confirmatus' with gastro-intestinal symptoms is assured that 'disorders of the chylifications' are the cause of his hypochondria. Nicholas Robinson's A New System of the Spleen, Vapours and Hypochondriack Melancholy: Wherein all the Decays of the Nerves, and Lownesses of the Spirits, are mechanically Accounted for ( 1729), as the title suggests, regards psychological processes as the expression of events in the nerves and fibres making up the brain, this providing the basis for a 'mechanical' explanation of hypochondria. While Robinson is a determined somatist, the trend is towards ideas of nervous organization that suggest the influence of mind on body. For Robert Whytt in his Observations on the Nature, Causes, and Cure of those Disorders which have been commonly called Nervous, Hypochondriac, or Hysteric, to which are prefixed Some Remarks on the Sympathy of the Nerves ( 1765) nervous disorders follow from either 'a too great delicacy and sensibility of the whole nervous system' or 'an uncommon weakness, or a depraved or unnatural feeling, in some of the organs of the body'. The delicate balance of fibres between the nerves and the brain forms connections and correspondences that make organs or body parts sympathetic with each other. Such 'sympathy of the nerves' explains how changes in the body can be produced by 'the several passions in the mind', hypochondria resulting from the interaction of the two, a matter, so to speak, of pathological sympathy.

Burton mentions the case of a student who believed himself made of glass and lived in fear of being shattered, a case given major literary expression in Cervantes' novella El Licenciado Vidriera (1613). For Burton and others, it exemplified hypochondria as madness; as it still did two centuries later when Samuel Taylor Coleridge cited the 'glass graduate' in his classification of hypochondriasis as a 'division of madness', that of 'being out of one's senses' (distinct from 'derangement of the understanding' 'being out of one's wits'). The 18th century had largely separated hypochondria from insanity; it might affect the intellectual faculties but seldom resulted in lunacy. If Samuel Johnson could talk of his hypochondria as madness, Boswell insisted it was not-'the mind itself was ever entire'. Coleridge's out-of-one's-senses hypochondriasis continues, however, in the 19th-century conception of 'delusional hypochondriasis' linked to a disturbance of brain function. For the psychiatrist Sir George Savage (1892), hypochondria covered a disorder 'varying from slight over-sensitiveness to insanity with marked delusions and actively suicidal tendencies'. Today DSM-IV-TR keeps hypochondriasis distinct from delusional disorders: it lacks 'delusional intensity', though there is 'often a thin line between preoccupation and fear which is a conviction and that which is a delusion'.

If hypochondria is associated with a particular nervous sensibility, special qualities can be attributed to the hypochondriac. Sir Richard Blackmore, author of A Treatise of the Spleen and Vapours: or, Hypocondriacal and Hysterical Affections (1725), describes hypochondriacs as having 'quick Apprehension and Vivacity of Fancy and Imagination', as well as possessing superior intelligence (the philosopher Hume called hypochondria 'the Disease of the Learned'). So much so that moderate forms of the condition are 'rather desirable than hurtful' and best not treated. Johnson thought this a foolish notion; Boswell, his biographer, agreed, while nevertheless consoling himself and his fellows with the thought that their 'sufferings mark our superiority'. The idea was found too in the most celebrated 18th-century work, George Cheyne's The English Malady: or, A Treatise of Nervous Diseases of all Kinds, as Spleen, Vapours, Lowness of Spirits, Hypochondriacal, and Hysterical Distempers, &c (1733). Intended for 'common intelligent readers', especially sufferers like Cheyne himself, it was something of a bestseller. Health is again a matter of 'strong Spirits and firm Fibres'; ill health one of 'Weakness of Nerves', with mental disorders stemming from a somatic disorder of the nerves. Cheyne thus always focused on the hypochondria, sure to find that 'the Stomach, Guts, Liver, Spleen, Mesentery or some of the great and necessary Organs, or Glands of the lower Belly were obstructed, knotted, schirrous, or spoil'd'. The English were notably prone to hypochondria and other such 'distempers' as a result of such factors as damp air and unhealthy towns, but crucially too of the wealth and abundance of the contemporary society. Everything, from rich food to the growth of 'Contemplative and Sedentary Professions', made for the prevalence of nervous disorders amongst 'People of Condition'-these disorders testifying indeed to their distinction; to their class.

Gender terms could also make a difference. Today hypochondriasis is common in both males and females. The recognition of hypochondria as a condition affecting females appeared early on, at the same time that hypochondria and hysteria were also gender differentiated, the latter continuing to be seen as particular to females. Johnson's Dictionary (1755) conventionally defines hysteria as linked to disorders of the womb, hence female; though already a century earlier Willis had drawn the two together as disorders of the brain, while Sydenham had described them as alike 'as one egg is to another'. In Johnson's own century, Blackmore and Whytt considered them 'the same malady', though they also maintained hysteria's relation to females, whose nervous system was 'generally more moveable than in men'. Hypochondria was associated with males, but female hypochondriacs were recognized. Of the three hypochondriac young adults of Jane Austen's Sanditon (1817), for example, two are female.

Treatments were various. Burton ended the 'Anatomy' with the precept 'Be not solitary, be not idle'. Johnson thought the antidote was employment, though Boswell also favoured 'the reading of lives' and the pleasures of the metropolis. The Methodist John Wesley recommended quicksilver in the morning and elixir of vitriol in the afternoon, while Blackmore advocated 'the most violent vomits'. William Buchan's bestselling Domestic Medicine ( 1769) unhelpfully prescribed 'cheerfulness and serenity of mind', earning justifiable scorn from the hypochondriac Coleridge. In the 19th century, rest cures were popular, the more especially when attempts to locate corresponding brain lesions for hypochondria failed. Today, no specific psychotherapy has been identified for the condition, cognitive behavioural therapy being only moderately effective; pharmacological treatment using selective serotonin reuptake inhibitor (SSRI) antidepressants has known some success.

Dillon's lives run from the 18th to the 20th centuries. His case is that hypochondria for these individuals was 'a kind of calling, almost a vocation', structuring their lives in a way that allowed them time and space: 'At once crippled and cosseted by fear, the hypochondriac suffered in order to work, to write or to discover in solitude.' This idea of 'creative malady' stems originally from the book of that title by the physician Sir George Pickering, who examined the positive role of psychoneurotic illness in six talented lives (Dillon's Darwin, Nightingale and Proust among them). Dillon narrows the focus to hypochondria, proposing the 'ambitious, if perilous, conjecture' of an intimate link between the health anxieties of his subjects and their creative or intellectual labours. The lives share much as regards invalidism and suffering, though the meaning, reality and evidence of hypochondria as a diagnosis shifts in each case-'what exactly was the matter with ...?' is a recurrent-and undecided-question from life to life.

Dillon introduces his creative hypochondria thesis with the textbook example of self-diagnosed hypochondriac James Boswell. Born with 'a melancholy temperament', Boswell was early seized by 'a terrible hypochondria' with which he struggled thereafter; that he should write the life of Johnson was fitting given the latter's own 'vile melancholy' and 'horrible hypochondria'. Boswell's melancholy came with the classic digestive symptoms, his hypochondria both a physical condition and a state of 'disordered imagination' to be resisted. To which end he developed what Dillon characterizes as a 'fraught, compulsive, hypochondriac relation to time', forever making lists and timetables, filling his days with writing commitments, including monthly essays for the London Magazine written indeed in the persona of 'The Hypochondriack'. The obsession with time served to control his hypochondria, shaking him from lethargy; but the hypochondria itself produced the obsession, generated his literary activity.

The other lives follow apace. The young Charlotte Brontë found life 'a continual waking Night-mare', with no repose for her 'morbid nerves' ('sensation for them is all suffering'). Hypochondria, her word, continued over the years: intense depression, headaches, dyspepsia, troubled eyesight. Her novels reflect this: the autobiographical Villette (1853), for example, has a 'low-spirited' heroine who is similarly diagnosed, only too familiar with 'that strangest spectre, Hypochondria'. Dillon reads Brontë's hypochondria as her means of removing herself from family and social duties: 'by falling ill ... she can find for herself the right kind of solitude, in which to invent her future self'. Darwin, back in England after the years on the Beagle, developed a range of symptoms, primarily gastro-intestinal, and embarked on an invalid existence. In 1849, he spent time at Dr James Gully's fashionable Water Cure Establishment in Malvern, where his condition was diagnosed as 'nervous dyspepsia' consequent on excessive mental exertion and attendant bad circulation. The cold water treatment to improve circulation and relieve the inflamed nerves of the stomach was effective enough for Darwin to endure it at home, submitting to daily drenchings in his garden, despite which his ill health continued; whether or not this was psychosomatic remains a matter of debate. Darwin himself, drafting The Origin of Species and dreading public controversy, declared his work to be the cause, 'of the main part of the ills to which my flesh is heir', though physical conditions-notably Chagas and Crohn's diseases-have been proposed to explain his symptoms. The point, however, is not so much physical or mental as both together: somatic conditions and psychoneurotic disorder; or strategy, since the outcome was the isolation he needed. Illness was, in Pickering's phrase, 'a social weapon', shielding him from public life.

The same goes for Florence Nightingale, described by Lytton Strachey as employing 'the machinery of illness' against the world; by Pickering as 'a beautiful case of a psychoneurosis with a purpose'. A young female given to depression and low self-opinion, she found her saving mission in the Crimea. Home again, she collapsed with severe cardiac symptoms, recovered, but remained depressed, afflicted by nausea, insomnia, laryngitis and palpitations. She too began years of reclusive invalidism, conducting her vigorous campaigns for hospital improvements from her bed, cut off from time-wasting social demands. If this was a strategy, she was nevertheless genuinely ill, probably suffering from chronic brucellosis, the myriad symptoms of which were easily attributable to 'neurasthenia'. Dillon judges her 'the most ambitious of high Victorian hypochondriacs'; saintly perhaps, but also 'a monster of self-belief, self-delusion and expertly deployed enfeeblement'. After which it comes as something of a surprise to find Alice James celebrated as 'a curiously fearless kind of hypochondriac', worried less about what might be found wrong with her than about the ministrations of her physicians, who she was pleased to record nevertheless acknowledged her 'abnormally sensitive nervous organization'. Given which, her position as a female, and this in a family of eminent males, took its toll. Biographers see her as turning victimization into a career, expressing anger through intractable illness, which brother Henry indeed declared 'the only solution for her of the practical problem of life'. Treated for neurasthenia, she had what she called 'violent attacks of hysteria' and 'squalid indigestions', suffered spinal pain, and saw her life as a battle between body and will. She made illness, Dillon argues somewhat awkwardly, an intellectual and artistic work 'comparable, in the domestic sphere, with the public labours of her brothers'; her hypochondria allowed her 'to be just ill enough not to have to face the creative and emotional void at the heart of her short life'. When finally diagnosed with cancer, she gained an end to medical uncertainties and the relief of something concrete, to which she responded with such self-possession that Dillon declares to be itself pathological.

Proust thought of writing a book about doctors, which he could well have done given the number he consulted and his distrust of them. He suffered from asthma, was hypersensitive, and intensely hypochondriac, mostly confining himself to bed in his cork-lined room. One partial exception to his distrust was the neurologist Edouard Brissaud, whom Proust did think vastly intelligent, though a poor doctor-'[he] thinks ... one should live on trional'. For Brissaud, author of a book on the subject, asthma was a neurosis; Proust agreed, not doubting that his asthma and other ailments were linked to his nervous disposition. Dillon concludes that through invalidism he responded to his illnesses by living them as justification for the isolation needed to write A la recherche du temps perdu, the novel whose language and matter are grounded in his hypochondriac sensitivity.

Glenn Gould and Andy Warhol shared acute hypochondria. Gould kept a diary of his imagined symptoms, noting blood pressure, digestion, flatulence, spots on the tongue, whatever his anxiety suggested. Public recitals were abandoned for the safety of his home recording studio where he could create the best environment for his work, while avoiding the health hazards of the outside world; hypochondria thus became a condition of his artistic fulfillment. Warhol, who claimed three nervous breakdowns as a child, was obsessed with his health and appearance, longing for a 'good body', but tormented by his 'bad' one, a body open to illness, infection, ageing, in which he could never feel at home. Dillon sees in his films particularly a kind of diagnosis of his 'style of hypochondria'. In Sleep (1963), for example, Warhol's camera-eye contemplates for over five hours a sleeping naked man, a projection on screen of the longed-for, at-one-with-itself body, the positive to the negative in the hypochondriac two-bodies split that structures Warhol's life and art, determining their chronic concern with beauty and death.

Written testimonies aside, what these eight lives have in common are combinations of symptoms, physical illnesses and nervous conditions with psychosomatic effects, illustrating versions of 'the hypochondriacal character', from the hypochondria of melancholy and depression to that of acute health anxiety. But what of the ninth? Pickering had Freud as one of his lives; Dillon takes the German jurist Daniel Paul Schreber, on whose Memoirs of My Nervous Illness (1903) Freud based an analysis of him as 'a case of paranoia'. Schreber returns us to delusional insanity, to 'glass graduate' hypochondria, and Freud, indeed, came to understand hypochondria not in terms of neurosis but rather in those of paranoid psychosis. Paranoiacs 'almost invariably' become convinced that one or more bodily organs have been assaulted or removed; a conviction Freud described as the production of an 'organ speech' in which organs take on the representation of the underlying unconscious material. Amongst other things, Schreber believed that his stomach had been stolen, that his spinal cord was being pumped out, and that he was being turned into a woman by God (his rigidly controlling and demanding father, object of unconscious conflicts and desires). Not that Schreber regarded his mind as anything other than perfectly healthy, save for 'some unimportant hypochondriacal ideas'; another delusion, and one that unwittingly falls in with Freud's insistence on hypochondria as a matter of more than a few neurotic health anxieties (DSM-IV-TR, it can be noted, recognizes a 'monosymptomatic hypochondriacal psychosis' among its delusional disorders). Schreber is thus different from Dillon's other lives: his condition did not free him, it confined him in asylums. That the Memoirs are an extraordinary record of his delusional paranoia, praised for their qualities as imaginative literature-for Schreber they were quite simply the truth-does not make him another hypochondriacal character like Brontë or Gould, another instance of creative malady. The Memoirs were themselves part of the delusional condition and that condition was not strategically negotiated in the interests of some separate purposeful pursuit, was quite apart from the hypochondria that Dillon explores in his other lives.

Hypochondria has now become the lifestyle of a world in which we are forever enjoined to look good, live healthy, be happy; a world, in other words, in which we are to be permanently anxious. Dillon hails Warhol as 'our hypochondriacal precursor': his living in one body while longing for another gives apt enough expression of our situation in an age of media-fuelled health preoccupations and body-image vigilance. The French surgeon René Leriche famously defined health as 'life in the silence of the organs'. Hypochondria in its historical understandings has always been an emphatic loss of such silence. What we have today is a range and diversity of hypochondriac manifestations; as clinical condition, yes, but then much more too as culturally extensive anxiety and preoccupation; to which Dillon's book itself bears witness even while helping us through the presentation of its chosen lives better to understand hypochondria on its past and present terms.

References

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Hypochondria: medical condition, creative malady

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'One can feel well but one can never know one is well' wrote the philosopher Kant, acknowledging his own inclination towards hypochondria. Told that he does not have an ulcer, one of Woody Allen's neurotically anxious film counterparts simply retorts 'they haven't found one yet'.

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https://scopeblog.stanford.edu/2014/12/11/finding-cures-for-the-most-challenging-diseases/

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The recent Ebola outbreak and the subsequent race to find a vaccine and other treatment options has brought the topic of drug development back in the public spotlight. But despite the millions of dollars spent on these efforts and the technological advances in biomedical sciences in the last 20 years or so, the process is still time-consuming and prone to failure. A recent feature story from National Journal (which also appears on The Atlantic's website today) describes the work of several scientists trying to find cures or treatments for some of the most challenging diseases, from infectious diseases, like AIDS and Ebola, to chronic diseases such as Alzheimer's.

The first disease the article highlights is a rare disorder called progeria, which causes young children to age prematurely. Recent breakthroughs in treatment have come from a team led by Francis Collins, MD, PhD, who is more famous for leading the Human Genome Project and now serves as director for the National Institutes of Health. Collins worked briefly on progeria early in his career and the combination of Collins's work and genomics made it possible for his team to crack the genetic secret of the rare disease: that it was caused by a single genetic mutation. That finding led to a treatment that extended the lives of patients with progeria by several years. But it also points to some of the overwhelming challenges of chasing down cures and treatments:

The doctors and scientists hunting for new cures and treatments work in a constant state of tension. They operate in a tremendously high-stakes environment, pouring years of their lives into research as the people who inspire them continue to suffer and even die. Drug hunters face failure after failure, almost never followed by success. Decades of work flame out. Promising ideas turn into dead ends. For every 10,000 compounds they explore, scientists wind up with just one drug approved by the Food and Drug Administration. Even when medical science moves as fast as it can-and today, it's moving faster than ever before-it's still an agonizingly slow process.

"As much as we say that failure is part of what we do-if you're not failing, you're probably not doing science that's very interesting-it still hurts," Collins says. "It is frustrating, because you want to come up with the answer. You want to save lives. That's what we all get into this medical research area to try to achieve, and yet the challenges are immense. And we make progress, oftentimes, in very small baby steps, even though what we're hoping for are big leaps."

The research that's gone into discovering a treatment for Alzheimer's is also illustrative. In 2012, two different therapies that targeted the disease's characteristic ameloid plaques failed in human clinical trials. It was a difficult blow to the researchers, but going back to the drawing board revealed another approach:

Although failure is frustrating and expensive, drug hunters say the key to progress is to fail well. A well-designed study that's conducted properly should teach you something, even if the outcome isn't what you wanted. "Some of the greatest insights I've ever had were failures-and some pretty big failures," [ Ron DeMattos, a research fellow and group leader at Eli Lilly] says. "We're going to fail thousands of times."

In this case, the lesson was to start earlier. When Lilly's scientists dug a little deeper into their data, they realized that their drug had produced a decent benefit for trial participants who had "mild" Alzheimer's. Every time they cut the data a different way, they remained convinced they were seeing real progress earlier in the disease.

The feature also describes recent work on Ebola and malaria vaccines, and delves into the history of AIDS drug development. One of the challenges, though, is money. Although research funding for the NIH surged in the 1990s, it's been relatively flat in the past decade and sequestration has eaten into that budget even more. The feature describes the surprising number of variables goes into treatment and how they come together, or don't.

Previously: Stanford researchers develop a new biosensor chip that could speed drug development, Crowdsourcing cost of drug development, Why drug development is time consuming and expensive (hint: it's hard), Re-engineering the drug-development process to speed medical advances

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Finding cures for the most challenging diseases

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The recent Ebola outbreak and the subsequent race to find a vaccine and other treatment options has brought the topic of drug development back in the public spotlight. But despite the millions of dollars spent on these efforts and the technological advances in biomedical sciences in the last 20 years or so, the process is still time-consuming and prone to failure.

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https://www.portstluciehospitalinc.com/what-is-mental-health-awareness-and-why-does-it-matter/

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Port St. Lucie Hospital, Inc. | Florida Mental Health Services

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What Is Mental Health Awareness and Why Does It Matter? - Port St. Lucie

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Mental health awareness can make a big difference for people with mental illnesses. Learn what you can do to help and find help in Florida!

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https://www.nhs.uk/mental-health/conditions/agoraphobia/overview/#:~:text=Agoraphobia%20is%20a%20fear%20of,travelling%20on%20public%20transport

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https://www.prnewswire.com/news-releases/new-survey-shows-more-than-half-54-of-us-teens-think-life-would-be-better-without-social-media-275721231.html

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While 92 percent of teens are social media users, with photo- and video-driven sites being among the most popular with this group, more than half (54%) say that their teen years would be better without social media. Additionally, 40 percent of social-media using teens feel that their appearance is judged more closely on these popular networks than in person, and 40 percent believe it's more difficult to express the image they want others to have of them on social media. Even so, of these teens (87%) regularly post "selfies" to social media, though 56 percent admit they worry about their looks most days.

The survey also found that a majority of self-conscious teens want to improve their chances of fitting in and boosting their confidence by changing their appearance.

An overwhelming majority (96%) of US teens who are not satisfied with their smile are insecure about their appearance.

About 30 percent of them are most self-conscious about their teeth.

Over 47 percent of those who post selfies on social media think about whether their smile looks good before uploading a picture of themselves.

Braces seem to be an area of particular angst with teens. While the study suggests a desire for teens to improve their smile, braces may have a negative impact along the way. More than nine in ten (92%) US teens who have never worn metal braces say that wearing brackets would keep them from fitting in, and one in four (25%) believe they would be teased. Forty-one percent (41%) think it is embarrassing for most teens to wear metal braces. However, there is a solution that can boost confidence while helping teens achieve an improved smile at the same time - Invisalign Teen clear aligners.

The Teen Confidence study revealed that just 8 percent say that wearing Invisalign Teen clear aligners would be embarrassing for most teens, while 41 percent think this humiliation would be caused by wearing metal braces. And straightening teeth with Invisalign Teen clear aligners can actually help boost self-esteem.

Forty-seven percent (47%) of Invisalign Teen users surveyed had a boost of self-esteem in the process of treatment compared to just 22 percent of those in metal braces.

The Invisalign Teen Confidence survey polled 3,577 US teenagers ages 13-17 and 2,118 US mothers of teens ages 13-17, plus an oversample of 101 mothers of teens ages 13-17 who wear or have worn Invisalign clear aligners, using an e-mail invitation and online survey between June 19 th and July 17 th, 2014.

This online survey also revealed:
Teens are worried about their appearance and would like to alter their appearance:

94 percent of teens think their appearance influences their popularity.

Body shape or weight (38%) and skin type (21%) are common things insecure teens are most self-conscious about, with nearly 2.4 million teens most self-conscious about their teeth

Close to nine in ten teens (87%) wish to alter their appearance. One quarter (25%) of them would like to improve their teeth, which is almost twice as many as those who would alter another facial feature.

Complete view of survey findings can be accessed here.
About Align Technology, Inc., Makers of the Invisalign Clear Aligner System
Adults and teens now have a modern choice for straightening their teeth. No more wires and brackets required - Invisalign and Invisalign Teen aligners are the clear alternative to metal braces that uses a series of virtually invisible and removable aligners that gradually move teeth over time. The benefits include: no food restrictions, no interference with sports or other activities, and teeth get straightened without most people knowing they are in treatment. Learn more at www.invisalignteen.com and find a trained Invisalign doctor at www.invisalign.com.
About Kelton
All Invisalign products are designed, manufactured and marketed by Align Technology, Inc. (ALGN). Today the Invisalign product family includes Invisalign Full, Invisalign Teen, Invisalign Assist, Invisalign Express and Vivera Retainers. Invisalign and Invisalign Teen are trademarks of Align Technology, Inc. Align Technology develops innovative, technology-rich products such as the Invisalign system and the iTero scanner and services. Visit www.aligntech.com for more information.

Kelton is a leading global insights firm serving as a partner to more than 100 of the Fortune 500 and thousands of smaller companies and organizations. Utilizing a wide range of customized, innovative research techniques and staff expertise in marketing, branding, PR, media, and business strategy, Kelton helps drive our clients' businesses forward. For more information about Kelton please call 1.888.8.KELTON or visit www.keltonglobal.com.

Photo - http://photos.prnewswire.com/prnh/20140919/147214

Logo - http://photos.prnewswire.com/prnh/20120221/LA56603LOGO-b

SOURCE Align Technology, Inc.

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New Survey Shows More Than Half (54%) Of US Teens Think Life Would Be Better Without Social Media

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While 92 percent of teens are social media users, with photo- and video-driven sites being among the most popular with this group, more than half (54%) say that their teen years would be better without social media.

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https://www.mindtools.com/selfconf.html

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Take a look at the table below, which compares confident behavior with behavior that's associated with low self-confidence. Which thoughts or actions do you recognize in yourself?

As these examples show, low self-confidence can be self-destructive, and may manifest itself as negativity.

Self-confident people are generally more positive - they value themselves and trust their judgment. But they also acknowledge their failures and mistakes, and learn from them.

Why Self-Confidence Matters

Self-confidence is vital in almost every aspect of our lives, yet many people struggle to find it. Sadly, this can become a vicious cycle: people who lack self-confidence are less likely to achieve the success that could give them more confidence.

For example, you may not be inclined to back a project that's pitched by someone who's visibly nervous, fumbling, or constantly apologizing. On the other hand, you're persuaded by someone who speaks clearly, holds their head high, and answers questions with assurance.

Confident people inspire confidence in others: their audience, their co-workers, their bosses, their customers, and their friends. And gaining the confidence of others is one of the key ways to succeed. In the following sections, we'll see how you can do this.

How to Appear More Confident to Others

Picture anyone you know that you think of as highly confident - what characteristics do they have that make you think this? It's most likely one or more of these things:

the way they speak (tone, how they project their voice, words),

their energy and enthusiasm,

how expert or knowledgeable they are about something.

You can show self-confidence in your behavior, your body language, and in what you say and how you say it.

Projecting a positive image to others can help you to improve your self-confidence. It's not simply a matter of "faking it" - if you project with confidence, others are more likely to respond well, and this positive feedback will help you to believe in yourself.

Body Language

If you're presenting, spreading your hands apart with palms slightly toward your audience shows openness and a willingness to share ideas.

Face-to-Face Communication

Engaging with people is important, so maintain eye contact while you talk. This shows that you're interested in what the other person is saying, and that you're taking an active part in the conversation. Don't fidget or look away while the conversation continues, as this can make you appear distracted or anxious.

Build Expert Power

You are likely to appear (and feel) confident when you know what you're talking about. With a wealth of knowledge on a subject, you'll be more prepared to answer questions and speak on the spot.

If you lack confidence because of a gap in your expertise, work on finding out more information. Are there any relevant webinars or events you could attend? Is there a course you could take? Or perhaps you could find a mentor. See our article, Building Expert Power, and our Skillbook for more tips on this.

Rebuilding Confidence at Work

Changes to the way they work and long periods away from work negatively impact many people's confidence. One study found that over a third of people returning to the workplace after a year or more away experience a loss of confidence in their own ability. [3] You might struggle to make your voice heard in meetings, or feel lost or isolated without the company of your colleagues while working from home, for example.

People with low self-confidence often feel that they don't deserve to be happy, and that it's somehow justifiable for others to treat them badly. While the feeling may be very real, the belief is certainly not!

Three Ways to Build Your Confidence

While there are quick fixes to address acute issues with your self-confidence, building confidence in the long term requires making some changes to your lifestyle and forming robust plans. Here are three ways to do that:

1. Build Confident Habits

To develop and improve your self-esteem, aim to develop good habits - and break bad ones! Regular exercise and a healthy diet can dramatically improve your physical and mental health. And studies have shown that getting a good night's sleep is linked with increased optimism and self-esteem. [4]

2. Review Past Achievements

Your self-confidence will increase when you're able to say, "I can do this, and here's the evidence." As part of your Personal SWOT Analysis, you'll have identified things that you're good at, based on your past achievements.

3. Set Confidence-Boosting Goals

Setting and achieving goals - and seeing how far you've come - are key ways to develop self-confidence.

When you've identified the major goals you want to achieve, clarify the first steps you need to take. Make sure that they're small steps, taking no longer than an hour to do. This will get the ball rolling and improve your confidence through the achievement of appropriate goals.

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How to Build Self-Confidence - Preparing Yourself for Success

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Self-confidence isn't innate. Discover three ways to build your confidence for the long term, as well as practical steps you can take right now.

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https://www.healthline.com/health/glossophobia#:~:text=Glossophobia%20isn't%20a%20dangerous,feelings%20of%20discomfort%20and%20anxiety.

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What is glossophobia?

Glossophobia isn't a dangerous disease or chronic condition. It's the medical term for the fear of public speaking. And it affects as many as four out of 10 Americans.

For those affected, speaking in front of a group can trigger feelings of discomfort and anxiety. With this can come uncontrollable trembling, sweating, and a racing heartbeat. You may also have an overwhelming urge to run out of the room or away from the situation that is causing you stress.

Glossophobia is a social phobia, or social anxiety disorder. Anxiety disorders go beyond occasional worrying or nervousness. They cause strong fears that are out of proportion to what you're experiencing or thinking about.

Anxiety disorders often get worse over time. And they can interfere with your ability to function under some circumstances.

When faced with having to give a presentation, many people experience the classic fight-or-flight response. This is the body's way of preparing to defend itself against perceived threats.

When threatened, your brain prompts the release of adrenaline and steroids. This causes your blood sugar levels, or energy levels, to increase. And your blood pressure and heart rate rise, sending more blood flow to your muscles.

Common symptoms of fight-or-flight include:

rapid heartbeat

trembling

sweating

nausea or vomiting

shortness of breath or hyperventilating

dizziness

muscle tension

urge to get away

Although the fight-or-flight response worked well when humans had to fear enemy attacks and wild animals, it isn't effective in a meeting room. Getting to the root of your fear may help you take effective steps to manage it.

Many people who have a strong fear of public speaking fear being judged, embarrassed, or rejected. They may have had an unpleasant experience, like having given a report in class that didn't go well. Or they're been asked to perform on the spot with no preparation.

Though social phobias often run in families, the science behind this isn't understood. A reported that breeding mice that show less fear and anxiety resulted in offspring with less anxiety. But more research is needed to assess whether social phobias are hereditary.

Testing conducted by the National Institute of Mental Health found that the brains of people with social anxiety have a heightened response when negative comments were read to them. The affected areas were those responsible for self-evaluation and emotional processing. This heightened response wasn't seen in people without the disorder.
Learn more: Social anxiety disorder "
If your fear of public speaking is severe or interfering with your everyday life, consult your doctor. They can work with you to develop a targeted treatment plan. Options for treatment plans include:

Psychotherapy

Many people are able to overcome their glossophobia with cognitive behavioral therapy. Working with a therapist can help you identify the root cause of your anxiety. For example, you may discover that you fear ridicule, rather than speaking, because you were mocked as a child.

Together, you and your therapist will explore your fears and the negative thoughts that go with them. Your therapist can teach you ways to reshape any negative thoughts.

Examples of this might include:

Instead of thinking "I can't make any mistakes," accept that all people make mistakes or have omissions when presenting. It's okay. Most of the time the audience isn't aware of them.

Instead of "Everyone will think I'm incompetent," focus on the fact that the audience wants you to succeed. Then remind yourself that your prepared material is great and that you know it well.

Once you've identified your fears, practice presenting to small, supportive groups. As your confidence grows, built up to larger audiences.

Medications

If therapy doesn't relieve your symptoms, your doctor may prescribe one of several medications used to treat anxiety disorders.

Beta-blockers are usually used to treat high blood pressure and some heart disorders. They also can be helpful in controlling the physical symptoms of glossophobia.

Antidepressants are used to treat depression, but they also can be effective in controlling social anxiety.

If your anxiety is severe and affecting your daily life, your doctor may prescribe benzodiazepines like Ativan or Xanax.

There are some strategies that you can use in combination with tradition treatment or on their own.

For example, you might find it beneficial to take a public speaking class or workshop. Many are developed for people who have glossophobia. You may also wish to check out Toastmasters International, an organization that trains people in public speaking.

Here are some other tips to help you navigate public speaking situations:

In preparation

Know your material. This doesn't mean you should memorize your presentation, but you should know what you want to say and have an outline of the key points. Give special focus to the introduction, because this is when you are likely to be most nervous.

Script your presentation. And rehearse it until you have it down cold. Then throw away the script.

Practice often. You should continue practicing until you're comfortable with what you're going to say. Then practice more. Your confidence will increase as you realize that you know what you're going to say.

Videotape your presentation. You can note if changes are needed. And you may be pleasantly surprised at how authoritative you look and sound.

Work audience questions into your routine. Jot down a list of questions you might be asked and be prepared to answer them. When appropriate, plan to involve the audience in your presentation by asking questions.

Just before your presentation

If possible, practice your material one last time before heading out to give your presentation. You should also avoid food or caffeine before speaking.

Once you've arrived at your speaking location, get familiar with the space. If you're using any equipment, such as a laptop or projector, make sure everything is working.

During your presentation

Keep in mind that 40 percent of the audience fears public speaking, too. There's no need to apologize for being nervous. Instead, do your best to accept that stress is normal and use it to be more alert and energetic.

Smile and make eye contact with any audience members you encounter. Take advantage of any opportunity to spend a few moments chatting with them. Be sure to take several slow, deep breaths to help calm you down if needed.

Mark Twain said, "There are two types of speakers. Those who get nervous and those who are liars." Being a little nervous is normal. And you can overcome glossophobia. In fact, with a little practice, you may learn to enjoy public speaking.

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Overcoming Glossophobia: Causes, Treatment, and More

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What is glossophobia? Glossophobia isn't a dangerous disease or chronic condition. It's the medical term for the fear of public speaking. And it affects as many as four out of 10 Americans. For those affected, speaking in front of a group can trigger feelings of discomfort and anxiety.

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https://www.psycom.net/facing-your-fear

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Psycom.net - Mental Health Treatment Resource Since 1986

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It is human nature to avoid emotions that scare us. Who wants to walk directly into what promises to be a painful experience? Except that by continually avoiding looking at the 'boogeyman' within, you become hostage to the monster. Typically this involves hiding from any potential stressor that might cause upset and engaging in endless distractions. Alas you are also hiding from potential challenges that can lead to growth and joy. Plus, you can't hide forever from fear. It's going to strike despite your best efforts to suppress it. And it is likely that it will strike at a time when you most need emotional equanimity.

The good news is that once you face your fear-and give the boogeyman air-rather than shove it into a distant compartment of your brain, it begins losing the ability to rule you and dictate your decisions.

Recent Studies on Anxiety and Fear

Earlier this year the journal Science published a study ¹ conducted by researchers from the École Polytechnique Fédérale de Lausanne (EPFL) using mice that showed how the brain actually has to re-experience a fear in order to extinguish it. The rodents were initially put into a small box and give a mild shock. Over a long period, the researchers returned the mice to the box but didn't administer shocks. Initially, the mice froze but with repeated exposure to the box, and no additional shocks, they eventually relaxed.

For humans repeated exposure to the event(s) that created the trauma can help the anxiety subside. For example, the treatment for fear of flying is often exposure therapy that involves slowly and repeatedly being exposed to the object that is feared in a controlled environment.

Article continues below

For example, the person who is immobilized at the thought of flying might, in an exposure therapy treatment, might begin by reading a story about a plane crash, and gradually work up to going to an airport without boarding a plane, then boarding a plane without taking off, then finally taking a short flight...

With repeated exposure in a safe place, such as a therapist's office, to the event(s) that created the trauma, the anxiety level subsides.

Facing Your Fear

My patient *Doreen suffered one of the worst traumas imaginable-her twin sister committed suicide. Fourteen months later another tragedy occurred: *Beth, a cousin to whom Doreen had once been extremely close, jumped off a bridge to her death. Doreen dreaded-and feared-the mourning process. She was afraid of losing herself to overwhelming grief. Instead of dealing with her emotions, she found what felt like the perfect coping mechanism: non-stop solo travel to the far corners of the globe. During her rare periods at home, she felt lonely, but found numerous reasons to not attempt forging friendships.

After one particularly adventurous trip, she slumped into my office. "Sherry, I hiked in the Amazon and had a session with a shaman and yet it felt so hollow. I wanted to share the experience with someone...with Beth."

Doreen's distress convinced her that it was time to stay home for a few months (her bank account would thank her!) and devote herself to what she feared most: facing herself.

I suggested she might make new connections through a social networking website called meetup. A few times she registered for an activity, but at the last minute experienced anxiety symptoms so intolerable that she stayed home.

During one session, I asked, "Why does letting someone become close scare you so much?"

She closed her eyes and after a few minutes' of contemplation said, "If I let myself be vulnerable, it will kill me when the person leaves."

"Why do you assume the person will leave?"

"My sister and Beth left-everyone does."

"And yet here you are still standing. You survived the worst that could happen. How could attending a pottery painting event be harder?"

The next day she registered for a group hiking event. At our next session she confessed the morning of the hike she experienced such severe anxiety symptoms -sweating palms, shaking lips, heart palpitations-so uncomfortable, she almost didn't go. "I told myself, ' Sherry says fear is a momentary emotion. If I run from it I'll feel worse later. '"

She had such a fabulous time on the hike she impulsively volunteered to arrange the group's next outing. Doreen recalled, "As soon as I got home I got so anxious that I reached for the phone to rescind my offer but I made myself breathe and continued to go about my day."

Soon Doreen had an active social life for the first time in years. Yes, she still experienced anxiety, but now she had coping mechanisms that allowed her to find relief and overcome the anxiety. "I'm still really afraid of losing people, but I'm more afraid of ultimately never finding what I really crave-community."

Tips to Work Through Your Fear and Live Your Life

If you are experiencing overwhelming fear or anxiety, especially a phobia, please consider working with a therapist. Additionally, here are some suggestions that have helped many of my patients work through being hostage to their own fears:

Allow yourself to sit with your fear for 2-3 minutes at a time. Breathe with it and say, "It's okay. It feels lousy but emotions are like the ocean-the waves ebb and flow." Have something nurturing planned immediately after your 2-3 minute sitting period is completed: Call the good friend waiting to hear from you; immerse yourself in an activity you know is enjoyable and engrossing.

Write down the things you are grateful for. Look at the list when you feel you're in a bad place. Add to the list.

Remind yourself that your anxiety is a storehouse of wisdom. Write a letter, "Dear Anxiety, I am no longer intimidated by you. What can you teach me?"

Exercise. Exercise can refocus you (your mind can only focus on one thing at a time). Whether you go on a short walk, head to a boxing gym for an all-out sweat session, or turn on a 15-minute yoga video at home, exercise is good for you and it will ground you and help you feel more capable.

Use humor to deflate your worst fears. For instance, what are some ridiculous worst-case scenarios that might happen if you accept an invitation to deliver a speech to a crowd of 500 people? I might pee in my pants at the podium *** I will be arrested for giving the worst speech in history *** My first boyfriend (girlfriend) will be in the audience and heckle me.

Appreciate your courage. Doreen would tell herself during difficult times, "Every time I don't allow fear to keep me from doing something that scares me, I am making myself stronger and less likely to let the next fear attack stop me."

Perhaps the most important coping tool is to be kind to yourself. What advice would you give to a best friend about those negative inner voices that whisper: Be afraid. Don't try anything new? Do as you advise others-don't listen to the negativity; be your own best friend.
* Names have been changed

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Facing Your Fears: Tips to Overcoming Anxiety and Phobias

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It is human nature to avoid emotions that scare us. Who wants to walk directly into what promises to be a painful experience? Except that by continually avoiding looking at the 'boogeyman' within, you become hostage to the monster. Typically this involves hiding from any potential stressor that might cause upset and engaging in endless distractions.

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https://work.chron.com/importance-doctors-society-19333.html

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Doctors' roles in society extend far beyond individual patient health. Doctors help prevent disease by educating patients about basic health. They have the standing to push back against medical misinformation circulating online. They can shape and carry out government public health policy.

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https://www.healthdirect.gov.au/motivation-how-to-get-started-and-staying-motivated

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Motivation: How to get started and staying motivated

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To make changes to your life, you need motivation. Learn why motivation’s important, how to get and stay motivated, and where to get help to achieve your goals.