Posts

On This Day … 20 December

Published on by Andrew MarshallLeave a comment

People (Births)

  • 1917 – David Bohm, American-English physicist, neuropsychologist, and philosopher (d. 1992).

People (Deaths)

  • 1984 – Stanley Milgram, American psychologist and academic (b. 1933).

David Bohm

David Joseph Bohm FRS (20 December 1917 to 27 October 1992) was an American-British scientist who has been described as one of the most significant theoretical physicists of the 20th century and who contributed unorthodox ideas to quantum theory, neuropsychology and the philosophy of mind.

Bohm advanced the view that quantum physics meant that the old Cartesian model of reality – that there are two kinds of substance, the mental and the physical, that somehow interact – was too limited. To complement it, he developed a mathematical and physical theory of “implicate” and “explicate” order. He also believed that the brain, at the cellular level, works according to the mathematics of some quantum effects, and postulated that thought is distributed and non-localised just as quantum entities are.

Bohm warned of the dangers of rampant reason and technology, advocating instead the need for genuine supportive dialogue, which he claimed could broaden and unify conflicting and troublesome divisions in the social world. In this, his epistemology mirrored his ontology. Due to his Communist affiliations, Bohm was the subject of a federal government investigation in 1949, prompting him to leave the United States. He pursued his scientific career in several countries, becoming first a Brazilian and then a British citizen. He abandoned Marxism in the wake of the Hungarian Uprising in 1956.

Bohm’s main concern was with understanding the nature of reality in general and of consciousness in particular as a coherent whole, which according to Bohm is never static or complete.

Stanley Milgrim

Stanley Milgram (15 August 1933 to 20 December 1984) was an American social psychologist, best known for his controversial experiments on obedience conducted in the 1960s during his professorship at Yale.

Milgram was influenced by the events of the Holocaust, especially the trial of Adolf Eichmann, in developing the experiment. After earning a PhD in social psychology from Harvard University, he taught at Yale, Harvard, and then for most of his career as a professor at the City University of New York Graduate Centre, until his death in 1984.

His small-world experiment, while at Harvard, led researchers to analyse the degree of connectedness, including the six degrees of separation concept. Later in his career, Milgram developed a technique for creating interactive hybrid social agents (called cyranoids), which has since been used to explore aspects of social- and self-perception.

He is widely regarded as one of the most important figures in the history of social psychology. A Review of General Psychology survey, published in 2002, ranked Milgram as the 46th-most-cited psychologist of the 20th century.

On This Day … 19 December

Published on by Andrew MarshallLeave a comment

People (Births)

  • 1925 – William Schutz, American psychologist and academic (d. 2002).

People (Deaths)

  • 1915 – Alois Alzheimer, German psychiatrist and neuropathologist (b. 1864).

William Schultz

William Schutz (19 December 1925 to 09 November 2002) was an American psychologist.

Schutz was born in Chicago, Illinois. He practiced at the Esalen Institute in the 1960s. He later became the president of BConWSA International. He received his Ph.D. from UCLA. In the 1950s, he was part of the peer-group at the University of Chicago’s Counselling Centre that included Carl Rogers, Thomas Gordon, Abraham Maslow and Elias Porter. He taught at Tufts University, Harvard University, University of California, Berkeley and the Albert Einstein College of Medicine, and was chairman of the holistic studies department at Antioch University until 1983.

In 1958, Schutz introduced a theory of interpersonal relations he called Fundamental Interpersonal Relations Orientation (FIRO). According to the theory three dimensions of interpersonal relations were deemed to be necessary and sufficient to explain most human interaction: Inclusion, Control and Affection. These dimensions have been used to assess group dynamics.

Schutz also created FIRO-B, a measurement instrument with scales that assess the behavioural aspects of the three dimensions. His advancement of FIRO Theory beyond the FIRO-B tool was most obvious in the change of the “Affection” scale to the “Openness” scale in the “FIRO Element-B”. This change highlighted his newer theory that behaviour comes from feelings (“FIRO Element-F”) and the self-concept (“FIRO Element-S”). “Underlying the behaviour of openness is the feeling of being likable or unlikeable, lovable or unlovable. I find you likable if I like myself in your presence, if you create an atmosphere within which I like myself.”

W. Schutz authored more than ten books and many articles. His work was influenced by Alexander Lowen, Ida Pauline Rolf and Moshe Feldenkrais. As a body therapist he led encounter group workshops focussing on the underlying causes of illnesses and developing alternative body-centred cures. His books, “Profound Simplicity” and “The Truth Option,” address this theme. He brought new approaches to body therapy that integrated truth, choice (freedom), (self) responsibility, self-esteem, self-regard and honesty into his approach.

In his books one encounters the concept of energy cycles (e.g. Schutz 1979) which a person goes through or call for completion. The single steps of the energy cycles are: motivation – prepare – act – feel.

Schutz died at his home in Muir Beach, California in 2002.

Influences

While teaching and doing research at Harvard, the University of Chicago, the University of California at Berkeley, and other institutions, Schutz focused on psychology but also studied philosophy – in particular, the scientific method, the philosophy of science, logical empiricism, and research design (with both Hans Reichenbach and Abraham Kaplan). He also worked with Paul Lazarsfeld, the well-known sociologist and methodologist and Elvin Semrad, professor of psychiatry at Harvard Medical School and clinical director in charge of psychiatric residency training at the Massachusetts Mental Health Centre. For Schutz, Semrad was a key figure, “a brilliant, earthy psychoanalyst who became my main mentor about groups.”

An avid student, Schutz also learned T-group methodology (“T” for training) at the National Training Laboratories (NTL) at Bethel, Maine, psychosynthesis, a spiritually oriented technique involving imagery, devised by an Italian contemporary of Freud named Roberto Assagioli, psychodrama with Hannah Weiner, bioenergetics with Alexander Lowen and John Pierrakos, Rolfing with Ida Rolf, and Gestalt Therapy with Paul Goodman. In his own words, “I tried everything physical, psychological, and spiritual – all diets, all therapies, all body methods, jogging, meditating, visiting a guru in India, and fasting for thirty-four days on water. These experiences counterbalanced my twenty years in science and left me with a strong desire to integrate the scientific with the experiential.”

Alois Alzheimer

Alois Alzheimer (14 June 1864 to 19 December 1915) was a German psychiatrist and neuropathologist and a colleague of Emil Kraepelin. Alzheimer is credited with identifying the first published case of “presenile dementia”, which Kraepelin would later identify as Alzheimer’s disease.

What is Smile Mask Syndrome?

Published on by Andrew Marshall1 Comment

Introduction

Smile mask syndrome (Japanese: スマイル仮面症候群, Hepburn: sumairu kamen shōkōgun), abbreviated SMS, is a psychological disorder proposed by professor Makoto Natsume of Osaka Shoin Women’s University, in which subjects develop depression and physical illness as a result of prolonged, unnatural smiling.

Refer to Honne and Tatemae.

Background

Natsume proposed the disorder after counselling students from the university in his practice and noticing that a number of students had spent so much time faking their smiles that they were unaware that they were smiling even while relating stressful or upsetting experiences to him. Natsume attributes this to the great importance placed on smiling in the Japanese service industry, particularly for young women.

Smiling is an important skill for Japanese women working in the service industry. Almost all service industry companies in Japan require their female staff to smile for long periods of time. Natsume says that his female patients often talk about the importance of smiling when the topic of the conversation is on their workplace. He relates examples of patients saying that they felt their smile had a large effect on whether they were hired or not, and that their superiors had stressed the effect that good smiles had on customers. According to Natsume, this atmosphere sometimes causes women to smile unnaturally for so long that they start to suppress their real emotions and become depressed.

Japanese author Tomomi Fujiwara notes that the demand for a common smile in the workplace emerged in Japan around the 1980s, and blames the cultural changes wrought by the Tokyo Disneyland, opened in 1983, for popularising the demand for an obligatory smile in the workplace.

The smile mask syndrome has also been identified in Korea. Korean writer Bae Woo-ri noted that smiling gives one a competitive advantage over the others, and has become a necessary attribute of many employees, just like a “neat uniform”. Yoon-Do-rahm, a psychology counsellor, compared the current society, which is full of smile-masks, to a clown show; both are characterised by plentiful, yet empty and fake, smiles.

Smile mask syndrome can cause physical problems as well as mental ones. Natsume relates that many of his patients developed muscle aches and headaches as a result of prolonged smiling, and says that these are similar to the symptoms of repetitive strain injury.

What is Self-Discrepancy Theory?

Published on by Andrew MarshallLeave a comment

Introduction

The self-discrepancy theory states that individuals compare their “actual” self to internalised standards or the “ideal/ought self”. Inconsistencies between “actual”, “ideal” (idealised version of yourself created from life experiences) and “ought” (who persons feel they should be or should become) are associated with emotional discomforts (e.g. fear, threat, restlessness). Self-discrepancy is the gap between two of these self-representations that leads to negative emotions.

Developed by Edward Tory Higgins in 1987, the theory provides a platform for understanding how different types of discrepancies between representations of the self are related to different kinds of emotional vulnerabilities. Higgins sought to illustrate that internal disagreement causes emotional and psychological turmoil. There were several previous theories proving this concept such as the self-inconsistency theory, the cognitive dissonance theory, and the imbalance theory (e.g. Heider, 1958); however, Higgins wanted to take it one step further by determining the specific emotions that surfaced as a result of these internal disagreements. Previous self-imbalance theories had recognised only positive or negative emotions. The self-discrepancy theory was the first to assign specific emotions and affects to the disparity.

The theory proposes how a variety of self-discrepancies represents a variety of types of negative psychological situations that are associated with different kinds of discomfort. A primary goal of the self-discrepancy theory is to create an understanding of which types of contrasting ideas will cause such individuals to feel different kinds of negative emotions.

The structure of the theory was built based on three ideas. First classify the different kinds of discomfort felt by those people holding contrasting ideals experienced, as well as the various types of emotional vulnerabilities felt by the different types of discrepancies. Lastly, to consider the role of the different discrepancies in influencing the kind and type of discomfort individuals are most likely to experience.

Domains of the Self

The theory postulates three basic domains of the self.

DomainDescription
ActualActual self is one’s representation of the attributes that one believes one actually possesses, or that one believes others believe one possesses. The “actual self” is a person’s basic self-concept. It is one’s perception of their own attributes (intelligence, athleticism, attractiveness, etc.).
IdealIdeal self is one’s representation of the attributes that someone (oneself or another) would like one, ideally, to possess (i.e. a representation of someone’s hopes, aspirations, or wishes for one). The “ideal-self” is what usually motivates individuals to change, improve and achieve. The ideal self-regulatory system focuses on the presence or absence of positive outcomes (e.g. love provided or withdrawn).
OughtOught is one’s representation of the attributes that someone (oneself or another) believes one should or ought to possess (i.e. a representation of someone’s sense of one’s duty, obligations, or responsibilities). The ought self-regulatory system focuses on the presence or absence of negative outcomes (e.g., criticism administered or suspended).

Standpoints of the Self

Self-discrepancy theory initiates the importance of considering two different standpoints (or vantage points) in which “the self” is perceived. A standpoint on the self is defined as “a point of view from which you can be judged that reflects a set of attitudes or values.”

Own

An individual’s own personal standpoint.

Other

The standpoint of some significant other. Significant others may comprise parents, siblings, spouses, or friends. The “other” standpoint is what the self perceives their significant other’s standpoint to be.

Except for theories focusing on the actual self, previous theories of the self had not systematically considered the different domain of self in terms of the different standpoints on those domains. These two constructs provide the basis from which discrepancies arise; that is, when certain domains of the self are at odds with one another, individuals experience particular emotional affects (ex: one’s beliefs concerning the attributes one would personally like ideally to possess versus your beliefs concerning the attributes that some significant other person, such as your mother, would like you ideally to possess).

Discrepancies

Discrepancies create two major types of negative physiological situations: absence of positive outcomes, which is associated with dejection-related emotions, and the presence of negative outcomes which is associated with agitation-related emotions.

ActualIdealOught
OwnSelf-ConceptSelf-GuideSelf-Guide
OtherSelf-ConceptSelf-GuideSelf-Guide

Self-Concept

Actual/Own vs. Actual/Other

These self-state representations are the basic self-concept (from either or both standpoints). Discrepancies between own self-concept, and other self-concept can be described as an identity crisis, which often occurs during adolescence. Guilt is a characteristic result of discrepancy from the own perspective. Shame is a characteristic result of discrepancy from the other perspective.

Self-Guide

Actual/Own vs. Ideal/Own

In this discrepancy, a person’s view of their actual attributes does not match the ideal attributes they hope to develop. Discrepancy between these self-guides is characterised by dejection-related emotions such as disappointment and dissatisfaction. Actual/ideal discrepancies are associated with low self-esteem and characterised by the threat of absence of positive outcomes. Specifically, an individual is predicted to be vulnerable to disappointment or dissatisfaction because these emotions are associated with people believing that their personal wishes have been unfulfilled. These emotions have been described as being associated with the individuals’ own standpoint and a discrepancy from his or her hope, desire, or ideals. The motivational nature of this discrepancy also suggests that it could be associated with frustration because of these unfulfilled desires. Emotions such as blameworthiness, feeling no interest in things, and not feeling effective was also associated with this discrepancy. In addition, this discrepancy is also associated with dejection from perceived lack of effectiveness or self-fulfilment. This discrepancy is uniquely associated with depression.

Actual/Own vs. Ideal/Other

Here, one’s view of their actual attributes does not match the ideal attributes their significant other hopes or wishes for them. The ideal self-guide is characterised by the absence of positive outcomes, and accompanied by dejection-related emotions. More specifically, because one believes that they have failed to obtain some significant other’s hopes or wishes are likely to believe that the significant other is disappointed and dissatisfied with them. In turn, individuals will be vulnerable to shame, embarrassment, or feeling downcast, because these emotions are associated with people believing that they have lost standing or esteem in the eyes of others. Analysis of shame and related emotions have been described as being associated with the standpoint of one or more other people and discrepancies from achievement and/or status standards. Other analyses describe shame as being associated with concern over losing the affection or esteem of others. When people have a sense of the difference between their actual self and their social ideal self, an individual will experience feelings of shame and unworthiness. Shame that is often experienced when there is a failure to meet a significant other’s goals or wishes involves loss of face and presumed exposure to the dissatisfaction of others. Feeling lack of pride, lack of feeling sure of self and goals, feeling lonely, feeling blue, and feeling not interested in things was also associated with this discrepancy. This discrepancy is associated with dejection from perceived or anticipated loss of social affection or esteem.

Actual/Own vs. Ought/Other

This discrepancy exists when a person’s own standpoint does not match what they believe a significant other considers to be his or her duty or obligation to attain. Agitation-related emotions are associated with this discrepancy and results in the presence of negative outcomes. More specifically, because violation of prescribed duties and obligations is associated with punishment, this particular discrepancy represents the presence of negative outcomes. The individual experiencing this discrepancy will have an expectation of punishment; therefore, the person is predicted to be vulnerable to fear and feeling threatened, because these emotions occur when danger or harm is anticipated or impending. Analyses of such emotions have described them as being associated with the standpoint of one or more other people and discrepancy from norms or moral standards. The motivational nature of this discrepancy suggests that one might experience feelings of resentment. The feeling of resentment arises from the anticipated pain to be inflicted by others. The person might also experience anxiety because of apprehension over negative responses from others. This discrepancy is associated with agitation from fear and threat. In addition, it is also associated with agitation from self-criticism. Social anxiety is uniquely associated with this discrepancy.

Actual/Own vs. Ought/Own

A discrepancy between these self-guides occurs when one’s view of their actual attributes do not meet the expectations of what they think they ought to possess. This discrepancy is associated with the presence of negative outcomes and is characterised by agitation-related emotions such as self-dissatisfaction. An individual predicts a readiness for self-punishment. The person is predicted to be vulnerable to guilt, self-contempt, and uneasiness, because these particular feelings occur when people believe they have transgressed a personally legitimate and accepted moral standard. Analysis of guilt have described it as associated with a person’s own standpoint and a discrepancy from his or her sense of morality or justice. The motivational nature of this discrepancy suggests associations with feelings of moral worthlessness or weakness. Transgression of one’s own internalised moral standards has been associated with guilt and self-criticism because when people attribute failure to a lack of sufficient effort on their part, they experience feelings of guilt.

Ideal vs. Ought

Ideal self and ought self act as self guides with which the actual self aspires to be aligned. The ideal self represents hopes and wishes, whereas the ought self is determined through obligation and sense of duty. In terms of the ideal or ought discrepancy and specific to self-regulatory approach vs. avoidance behaviours, the ideal domain is predisposed to approach behaviour and the ought domain is predisposed to avoidance behaviour.

Another Domain of Self

In 1999 Charles Carver and associates made a new amendment to the theory by adding the domain of feared self. Unlike the self guides proposed by Higgins which imply an actual or desired (better) self, the feared self is a domain that measures what one does not desire to be. In many cases, this may have a different level of influence in terms of priority on the self than previous domains and self-guides. It is human nature to avoid negative affect before approaching positives.

Availability and Accessibility of Self-Discrepancies

Beliefs that are incongruent are cognitive constructs and can vary in both their availability and accessibility. In order to establish which types of discrepancies an individual holds and which are likely to be active and produce their associated emotions at any point, the availability and accessibility of self-discrepancies must be distinguished.

Availability

The availability of a self-discrepancy depends on the extent to which the attributes of the two conflicted self-state representations diverge for the person in question. Each attribute in one of the self-state representations (actual/own) is compared to each attribute in the other self-state representation (ideal/own). Each pair of attributes is either a match or a mismatch. The larger variance between the number of matches and the number of nonmatches (i.e. the greater the divergence of attributes between the two self-state representations), the larger the magnitude of that type of self-discrepancy that is available. Furthermore, the greater the magnitude of a particular discrepancy produces more intense feelings of discomfort accompanying the discrepancy when activated.

The availability of the self-discrepancy is not enough to influence emotions. In order to do so, the self-discrepancy must also be activated. The variable that influences the probability of activation is its accessibility.

Accessibility

The accessibility of a self-discrepancy depends on the same factors that determine the accessibility of any stored construct. One factor is how recently the construct has been activated. The more often a construct is activated, the more likely it will be used later on to understand social events. The accessibility or likelihood of activation, of a stored construct also depends on the relation between its “meaning” and the properties of the stimulus event. A stored construct will not be used to interpret an event unless it is applicable to the event. Thus the negative psychological situation represented in a self-discrepancy (i.e. the “meaning” of the discrepancy) will not be activated by an explicitly positive event. In sum, the accessibility of self-discrepancy is determined by its recency of activation, its frequency of activation, and its applicability to the stimulus event. The theory posits that the greater the accessibility of a self-discrepancy, the more powerfully the person will experience the emotion accompanying that discrepancy.

The theory does not propose that individuals are aware of the accessibility or availability of their self-discrepancies. However, it is obvious that both the availability and accessibility can influence social information processing automatically and without awareness. Thus, self-discrepancy theory simulates that the available and accessible negative psychological situations embodied in one’s self-discrepancies can be used to provide meaning to events without being aware of either the discrepancies or their impact on processing. The measure of self-discrepancies requires only that one be able to retrieve attributes of specific self-state representations when asked to do so. It does not require that one be aware of the relations among these attributes of their significance.

Self-discrepancy theory hypothesizes that the greater the magnitude of a particular type of self-discrepancy possessed by a person, the more strongly the person will experience the emotion associated with that type of discrepancy.

Application and Use

Self-discrepancy theory becomes applicable when addressing some of the psychological problems individuals face with undesired self-image. The theory has been applied to psychological problems faced by college students compromising their career choice, understanding clinically depressed students, eating disorders, mental health and depression in chronically ill women and even developing self-confidence in athletes. Self-Discrepancy Theory inherently provides a means to systematically lessen negative affect associated with self-discrepancies by reducing the discrepancies between the self domains in conflict of one another. Not only has it been applied to psychological health, but also to other research and understanding to human emotions such as shame and guilt. The self-guided pressure society and ourselves induce throw an individual into turmoil. The theory finds many of its uses geared toward mental health, anxiety, and depression. Understanding what emotions are being aroused and the reasoning is important to reinstate psychological health.

Procrastination

Studies have correlated the theory and procrastination. Specifically, discrepancies in the actual/ought domain from the own perspective, are the strongest predictor of procrastination. Avoidance is the common theme. The actual/ought self-regulatory system responds through avoidance. Procrastinators also have an avoidance relationship with their goals.

Depression

Depression is associated with conflict between a person’s perceived actual self, and some standard, goal or aspiration. An actual/ought discrepancy triggers agitated depression (characterised by feelings of guilt, apprehension, anxiety or fear). An actual/ideal discrepancy triggers dejected depression (characterised by feelings of failure, disappointment, devaluation or shame).

Emotions

Higgins measured how individuals experienced self-discrepancies by having individuals reminisce and remember about “negative events or personal self-guides, including hopes, goals, duties, and obligations, and measure what will help increase the kind of discomfort that the individual experiences. The study found the “absence of an actual/own and ideal/own discrepancy” is associated with the emotions “happy” and “satisfied” and the “absence of an actual/own and ought/other discrepancy” is associated with the emotions “calm” and “secure”.

New Findings

Since its original conception in 1987, there have been a number of studies that have tested the legitimacy of self-discrepancy theory. Some of their findings do in fact contradict certain aspects of the theory, while another finds further evidence of its validly. These studies give insight into the research that has been done regarding self-discrepancy theory since its original conception in 1987.

Conducted in 1998, “Are Shame and Guilt Related to Distinct Self-Discrepancies? A Test of Higgins’s (1987) Hypotheses”, brought into question the correlations between specific discrepancy and emotional discomforts laid out by self-discrepancy theory. Researches believed that there was no way to tie a unique emotional discomfort to one internal discrepancy, but rather that various internal discrepancies result in a variety of discomforts. The study was carried out and the hypothesis was confirmed based on the results. The findings displayed no evidence suggesting a direct tie between specific discomforts and type of internal discrepancy.

“Self-discrepancies: Measurement and Relation to Various Negative Affective States”, also brought into question the core aspect of self-discrepancy theory – The correlation between specific discrepancies and the emotional discomforts that result. This study went one step further, also testing the validity of two methods used to observe internal discrepancies; “The Selves Questionnaire” or “SQ” along with the “Adjective Rating List” or “ARL”. The study found a strong relationship in results from both methods, speaking to their validly. The results, though, did bring into question the original research done by Higgins, as there were no ties found between specific internal discrepancies and unique emotional discomforts. One of the researchers in this study wrote “Overall, these findings raise significant concerns about the relevance of self-discrepancies as measured by the SQ and ARL and fail to support the main contentions of self-discrepancy theory”.

“Self-discrepancy: Long-term test–retest reliability and test–criterion predictive validity”, published in 2016, tested the long-term validity of self-discrepancy theory. Researchers found evidence to support the long-term validity of the self-discrepancy personality construct along with anxiety and depression having a direct relationship with internal discrepancies.

What is ‘Honne’ and ‘Tatemae’?

Published on by Andrew Marshall1 Comment

Introduction

In Japan, “honne” refers to a person’s true feelings and desires (本音, hon’ne, “true sound”), and “tatemae” refers contrastingly to the behaviour and opinions one displays in public (建前, tatemae, “built in front”, “façade”). This distinction began to be made in the post-war era.

A person’s honne may be contrary to what is expected by society or what is required according to one’s position and circumstances, and they are often kept hidden, except with one’s closest friends. Tatemae is what is expected by society and required according to one’s position and circumstances, and these may or may not match one’s honne. In many cases, tatemae leads to outright telling of lies in order to avoid exposing the true inward feelings.

The honne-tatemae divide is considered by some to be of paramount importance in Japanese culture.

Refer to Smile Mask Syndrome.

Causes

In Japanese culture, public failure and the disapproval of others are seen as particular sources of shame and reduced social standing, so it is common to avoid direct confrontation or disagreement in most social contexts. Traditionally, social norms dictate that one should attempt to minimise discord; failure to do so might be seen as insulting or aggressive. For this reason, the Japanese tend to go to great lengths to avoid conflict, especially within the context of large groups. By upholding this social norm, one is socially protected from such transgressions by others.

The conflict between honne and giri (social obligations) is one of the main topics of Japanese drama throughout the ages. For example, the protagonist would have to choose between carrying out his obligations to his family/feudal lord or pursuing a clandestine love affair.

The same concept in Chinese culture is called “inside face” and “outside face”, and these two aspects also frequently come into conflict.

Effects

Contemporary phenomena such as hikikomori seclusion and parasite singles are seen as examples of late Japanese culture’s growing problem of the new generation growing up unable to deal with the complexities of honne-tatemae and pressure of an increasingly consumerist society.

Though tatemae and honne are not a uniquely Japanese phenomenon, some Japanese feel that it is unique to Japan; especially among those Japanese who feel their culture is unique in having the concepts of “private mind” and “public mind”. Although there might not be direct single word translations for honne and tatemae in some languages, they do have two-word descriptions; for example in English, “private mind” and “public mind”.

Some researchers suggest that the need for explicit words for tatemae and honne in Japanese culture is evidence that the concept is relatively new to Japan, whereas the unspoken understanding in many other cultures indicates a deeper internalisation of the concepts. In any case, all cultures have conventions that help to determine appropriate communication and behaviour in various social contexts which are implicitly understood without an explicit name for the social mores on which the conventions are based.

A similar discord of Japanese true own feeling and the pretension before public is observed in yase-gaman, a phrase whose meaning literally translates as “starving to [one’s] skeleton”, referring to being content or pretending to be so. Nowadays, the phrase is used for two different meanings, expressing the samurai virtue of self-discipline, silent moral heroism, or ridiculing stubbornness, face-savingness.

On This Day … 18 December

Published on by Andrew MarshallLeave a comment

People (Deaths)

  • 1990 – Joseph Zubin, Lithuanian-American psychologist and academic (b. 1900).

Joseph Zubin

Joseph Zubin (09 October 1900 to 18 December 1990) was a Lithuanian born American educational psychologist and an authority on schizophrenia who is commemorated by the Joseph Zubin Awards.

Zubin was born 09 October 1900 in Raseiniai, Lithuania, but moved to the US in 1908 and grew up in Baltimore. His first degree was in chemistry at Johns Hopkins University in 1921, and he earned a PhD in educational psychology at Columbia University in 1932. In 1934 he married Winifred Anderson (who survived him) and they had three children (2 sons, David and Jonathan, and a daughter, Winfred). At his death on 18 December 1990, he had seven grandchildren. In addition, his great-grandson is Adam Chapnik, counsellor of the Abbey Unit at Massachusetts Audubon Society’s Wildwood Camp.

Zubin was President of both the American Psychopathological Association (1951-1952) and the American College of Neuropsychopharmacology (1971-1972) and received numerous awards for his work. In 1946 he was elected as a Fellow of the American Statistical Association.

What is Habit Reversal Training?

Published on by Andrew Marshall1 Comment

Introduction

Habit reversal training (HRT) is a “multicomponent behavioural treatment package originally developed to address a wide variety of repetitive behaviour disorders”.

Behavioural disorders treated with HRT include tics, trichotillomania, nail biting, thumb sucking, skin picking, temporomandibular disorder (TMJ), lip-cheek biting and stuttering. It consists of five components: awareness training, competing response training, contingency management, relaxation training, and generalisation training.

Research on the efficacy of HRT for behavioural disorders have produced consistent, large effect sizes (approximately 0.80 across the disorders). It has met the standard of a well-established treatment for stuttering, thumb sucking, nail biting, and TMJ disorders. According to a meta-analysis from 2012, decoupling, a self-help variant of HRT, also shows efficacy.

For Tic Disorders

In the case of tics, these components are intended to increase tic awareness, develop a competing response to the tic, and build treatment motivation and compliance. HRT is based on the presence of a premonitory urge, or sensation occurring before a tic. HRT involves replacing a tic with a competing response – a more comfortable or acceptable movement or sound – when a patient feels a premonitory urge building.

Controlled trials have demonstrated that HRT is an acceptable, tolerable, effective and durable treatment for tics; HRT reduces the severity of vocal tics, and results in enduring improvement of tics when compared with supportive therapy. HRT has been shown to be more effective than supportive therapy and, in some studies, medication. HRT is not yet proven or widely accepted, but large-scale trials are ongoing and should provide better information about its efficacy in treating Tourette syndrome. Studies through 2006 are:

“characterized by a number of design limitations, including relatively small sample sizes, limited characterization of study participants, limited data on children and adolescents, lack of attention to the assessment of treatment integrity and adherence, and limited attention to the identification of potential clinical and neurocognitive mechanisms and predictors of treatment response”. (Piacentini & Chang, 2006, p.227).

Additional controlled studies of HRT are needed to address whether HRT, medication, or a combination of both is most effective, but in the interim, “HRT either alone or in combination with medication should be considered as a viable treatment” for tic disorders.

Comprehensive Behavioural Intervention for Tics

Comprehensive Behavioural Intervention for Tics (CBIT), based on HRT, is a first-line treatment for Tourette syndrome and tic disorders. With a high level of confidence, CBIT has been shown to be more likely to lead to a reduction in tics than other supportive therapies or psychoeducation. Some limitations are: children younger than ten may not understand the treatment, people with severe tics or ADHD may not be able to suppress their tics or sustain the required focus to benefit from behavioural treatments, there is a lack of therapists trained in behavioural interventions, finding practitioners outside of specialty clinics can be difficult, and costs may limit accessibility. Whether increased awareness of tics through HRT/CBIT (as opposed to moving attention away from them) leads to further increases in tics later in life is a subject of discussion among TS experts.

Reference

Piacentini, J.C. & Chang, S.W. (2006) Behavioral Treatments for Tic Suppression: Habit Reversal Training. Advances in Neurology. 99, pp.227-233.

An Overview of Global Mental Health

Published on by Andrew Marshall1 Comment

Introduction

Global mental health is the international perspective on different aspects of mental health.

It is ‘the area of study, research and practice that places a priority on improving mental health and achieving equity in mental health for all people worldwide’. There is a growing body of criticism of the global mental health movement, and has been widely criticised as a neo-colonial or “missionary” project and as primarily a front for pharmaceutical companies seeking new clients for psychiatric drugs.

In theory, taking into account cultural differences and country-specific conditions, it deals with the epidemiology of mental disorders in different countries, their treatment options, mental health education, political and financial aspects, the structure of mental health care systems, human resources in mental health, and human rights issues among others.

The overall aim of the field of global mental health is to strengthen mental health all over the world by providing information about the mental health situation in all countries, and identifying mental health care needs in order to develop cost-effective interventions to meet those specific needs.

The Global Burden of Disease

Mental, neurological, and substance use disorders make a substantial contribution to the global burden of disease (GBD). This is a global measure of so-called disability-adjusted life years (DALY’s) assigned to a certain disease/disorder, which is a sum of the years lived with disability and years of life lost due to this disease within the total population. Neuropsychiatric conditions account for 14% of the global burden of disease. Among non-communicable diseases, they account for 28% of the DALY’s – more than cardiovascular disease or cancer. However, it is estimated that the real contribution of mental disorders to the global burden of disease is even higher, due to the complex interactions and co-morbidity of physical and mental illness.

Around the world, almost one million people die due to suicide every year, and it is the third leading cause of death among young people. The most important causes of disability due to health-related conditions worldwide include unipolar depression, alcoholism, schizophrenia, bipolar depression and dementia. In low- and middle-income countries, these conditions represent a total of 19.1% of all disability related to health conditions.

Mental Health by (Select) Country

Africa

Mental illnesses and mental health disorders are widespread concerns among underdeveloped African countries, yet these issues are largely neglected, as mental health care in Africa is given statistically less attention than it is in other, westernised nations. Rising death tolls due to mental illness demonstrate the imperative need for improved mental health care policies and advances in treatment for Africans suffering from psychological disorders.

Underdeveloped African countries are so visibly troubled by physical illnesses, disease, malnutrition, and contamination that the dilemma of lacking mental health care has not been prioritised, makes it challenging to have a recognised impact on the African population. In 1988 and 1990, two original resolutions were implemented by the World Health Organisation’s (WHO) Member States in Africa. AFR/RC39/R1 and AFR/RC40/R9 attempted to improve the status of mental health care in specific African regions to combat its growing effects on the African people. However, it was found that these new policies had little impact on the status of mental health in Africa, ultimately resulting in an incline in psychological disorders instead of the desired decline, and causing this to seem like an impossible problem to manage.

In Africa, many socio-cultural and biological factors have led to heightened psychological struggles, while also masking their immediate level of importance to the African eye. Increasing rates of unemployment, violence, crime, rape, and disease are often linked to substance abuse, which can cause mental illness rates to inflate. Additionally, physical disease like HIV/AIDS, the Ebola epidemic, and malaria often have lasting psychological effects on victims that go unrecognised in African communities because of their inherent cultural beliefs. Traditional African beliefs have led to the perception of mental illness as being caused by supernatural forces, preventing helpful or rational responses to abnormal behaviour. For example, Ebola received loads of media attention when it became rampant in Africa and eventually spread to the US, however, researchers never really paid attention to its psychological effects on the African brain. Extreme anxiety, struggles with grief, feelings of rejection and incompetence, depression leading to suicide, PTSD, and much more are only some of the noted effects of diseases like Ebola. These epidemics come and go, but their lasting effects on mental health are remaining for years to come, and even ending lives because of the lack of action. There has been some effort to financially fund psychiatric support in countries like Liberia, due to its dramatic mental health crisis after warfare, but not much was benefited. Aside from financial reasons, it is so difficult to enforce mental health interventions and manage mental health in general in underdeveloped countries simply because the individuals living there do not necessarily believe in western psychiatry. It is also important to note that the socio-cultural model of psychology and abnormal behaviour is dependent on factors surrounding cultural differences. This causes mental health abnormalities to remain more hidden due to the culture’s natural behaviour, compared to westernised behaviour and cultural norms.

This relationship between mental and physical illness is an ongoing cycle that has yet to be broken. While many organisations are attempting to solve problems about physical health in Africa, as these problems are clearly visible and recognisable, there is little action taken to confront the underlying mental effects that are left on the victims. It is recognised that many of the mentally ill in Africa search for help from spiritual or religious leaders, however this is widely because many African countries are significantly lacking in mental health professionals in comparison to the rest of the world. In Ethiopia alone, there are “only 10 psychiatrists for the population of 61 million people,” studies have shown. While numbers have definitely changed since this research was done, the lack of psychological professionals throughout African continues with a current average of 1.4 mental health workers per 100,000 people compared to the global statistic of 9.0 professionals per 100,00 people. Additionally, statistics show that the “global annual rate of visits to mental health outpatient facilities is 1,051 per 100,000 population,” while “in Africa the rate is 14 per 100,000” visits. About half of Africa’s countries have some sort of mental health policy, however, these policies are highly disregarded, as Africa’s government spends “less than 1% of the total health budget on mental health”. Specifically in Sierra Leone, about 98.8% of people suffering from mental disorders remain untreated, even after the building of a well below average psychiatric hospital, further demonstrating the need for intervention.

Not only has there been little hands-on action taken to combat mental health issues in Africa, but there has also been little research done on the topic to spread its awareness and prevent deaths. The Lancet Global Health acknowledges that there are well over 1,000 published articles covering physical health in Africa, but there are still less than 50 discussing mental health. And this pressing dilemma of prioritizing physical health vs. mental health is only worsening as the continent’s population is substantially growing with research showing that “Between 2000 and 2015 the continent’s population grew by 49%, yet the number of years lost to disability as a result of mental and substance use disorders increased by 52%”. The number of deaths caused by mental instability is truly competing with those caused by physical diseases: “In 2015, 17.9 million years were lost to disability as a consequence of mental health problems. Such disorders were almost as important a cause of years lost to disability as were infectious and parasitic diseases, which accounted for 18.5 million years lost to disability,”. Mental health and physical health care, while they may seem separate, are very much connected, as these two factors determine life or death for humans. As new challenges surface and old challenges still have not been prioritised, Africa’s mental health care policies need significant improvement in order to provide its people with the appropriate health care they deserve, hopefully preventing this problem from expanding.

Australia

A survey conducted by Australian Bureau of Statistics in 2008 regarding adults with manageable to severe neurosis reveals almost half of the population had a mental disorder at some point of their life and one in five people had a sustained disorder in the preceding 12 months. In neurotic disorders, 14% of the population experienced anxiety and comorbidity disorders were next to common mental disorder with vulnerability to substance abuse and relapses. There were distinct gender differences in disposition to mental health illness. Women were found to have high rate of mental health disorders, and Men had higher propensity of risk for substance abuse. The Survey of Mental Health and Well-Being (SMHWB survey) showed families that had low socioeconomic status and high dysfunctional patterns had a greater proportional risk for mental health disorders. A 2010 survey regarding adults with psychosis revealed 5 persons per 1000 in the population seeks professional mental health services for psychotic disorders and the most common psychotic disorder was schizophrenia.

Bangladesh

Mental health disorder is considered a major public health concern and it constitutes about 13% of the Global Burden of disease and severe mental health disease may reduce each individual’s life expectancy by about 20%. Low and middle-income countries have a higher burden of mental health disorder as it is not considered as a health problem as other chronic diseases. Being a low-income country, in Bangladesh, mental health issues are highly stigmatised.

A community-based study in the rural area of Bangladesh in 2000-2001 estimated that the burden of mental morbidity was 16.5% among rural people and most were suffering from mainly depression and anxiety and which was one-half and one-third of total cases respectively. Furthermore, the prevalence of mental disorders was higher in women in large families aged 45 years.

Care for Mental Health in Bangladesh

A study conducted in 2008 stated that only 16% of patients came directly to the Mental Health Practitioner with a mean delay of 10.5 months of the onset of mental illness, which made them more vulnerable in many ways. 22% of patients went for the religious or traditional healer and 12% consulted a rural medical practitioner with the least delay of 2-2.5 weeks.

Canada

According to statistics released by the Centre of Addiction and Mental Health (CAMH) one in five people in Canada experience a mental health or addiction problem. Young people of ages 15 to 25 are particularly found to be vulnerable. Major depression is found to affect 8% and anxiety disorder 12% of the population. Women are 1.5 times more likely to suffer from mood and anxiety disorders. WHO points out that there are distinct gender differences in patterns of mental health and illness. The lack of power and control over their socioeconomic status, gender based violence; low social position and responsibility for the care of others render women vulnerable to mental health risks.[citation needed] Since more women than men seek help regarding a mental health problem, this has led to not only gender stereotyping but also reinforcing social stigma. WHO has found that this stereotyping has led doctors to diagnose depression more often in women than in men even when they display identical symptoms. Often communication between health care providers and women is authoritarian leading to either the under-treatment or over-treatment of these women.

Women’s College Hospital has a programme called the “Women’s Mental Health Programme” where doctors and nurses help treat and educate women regarding mental health collaboratively, individually, and online by answering questions from the public.

Another Canadian organisation serving mental health needs is CAMH. CAMH is one of Canada’s largest and most well-known health and addiction facilities, and it has received international recognitions from the Pan American Health Organisation and WHO Collaborating Centre. They do research in areas of addiction and mental health in both men and women. In order to help both men and women, CAMH provides “clinical care, research, education, policy development and health promotion to help transform the lives of people affected by mental health and addiction issues.” CAMH is different from Women’s College Hospital due to its widely known rehab centre for women who have minor addiction issues, to severe ones. This organisation provides care for mental health issues by assessments, interventions, residential programmes, treatments, and doctor and family support.

Middle East

Israel

In Israel, a Mental Health Insurance Reform took effect in July 2015, transferring responsibility for the provision of mental health services from the Ministry of Health to the four national health plans. Physical and mental health care were united under one roof; previously they had functioned separately in terms of finance, location, and provider. Under the reform, the health plans developed new services or expanded existing ones to address mental health problems.

United States

According to the WHO, in 2004, was depression is the leading cause of disability in the United States for individuals ages 15 to 44. Absence from work in the US due to depression is estimated to be in excess of $31 billion per year. Depression frequently co-occurs with a variety of medical illnesses such as heart disease, cancer, and chronic pain and is associated with poorer health status and prognosis. Each year, roughly 30,000 Americans take their lives, while hundreds of thousands make suicide attempts (Centres for Disease Control and Prevention). In 2004, suicide was the 11th leading cause of death in the United States (Centres for Disease Control and Prevention), third among individuals ages 15-24. Despite the increasingly availability of effectual depression treatment, the level of unmet need for treatment remains high. By way of comparison, a study conducted in Australia during 2006 to 2007 reported that one-third (34.9%) of patients diagnosed with a mental health disorder had presented to medical health services for treatment. The US has a shortage of mental healthcare workers, contributing to the unmet need for treatment. By 2025, the US will need an additional 15,400 psychiatrists and 57,490 psychologists to meet the demand for treatment.

Treatment Gap

It is estimated that one in four people in the world will be affected by mental or neurological disorders at some point in their lives. Although many effective interventions for the treatment of mental disorders are known, and awareness of the need for treatment of people with mental disorders has risen, the proportion of those who need mental health care but who do not receive it remains very high. This so-called “treatment gap” is estimated to reach between 76-85% for low- and middle-income countries, and 35-50% for high-income countries.

Despite the acknowledged need, for the most part there have not been substantial changes in mental health care delivery during the past years. Main reasons for this problem are public health priorities, lack of a mental health policy and legislation in many countries, a lack of resources – financial and human resources – as well as inefficient resource allocation.

In 2011, the WHO estimated a shortage of 1.18 million mental health professionals, including 55,000 psychiatrists, 628,000 nurses in mental health settings, and 493,000 psychosocial care providers needed to treat mental disorders in 144 low- and middle-income countries. The annual wage bill to remove this health workforce shortage was estimated at about US$4.4 billion.

Interventions

Information and evidence about cost-effective interventions to provide better mental health care are available. Although most of the research (80%) has been carried out in high-income countries, there is also strong evidence from low- and middle-income countries that pharmacological and psychosocial interventions are effective ways to treat mental disorders, with the strongest evidence for depression, schizophrenia, bipolar disorder and hazardous alcohol use.

Recommendations to strengthen mental health systems around the world have been first mentioned in the WHO’s World Health Report 2001, which focused on mental health:

  • Provide treatment in primary care.
  • Make psychotropic drugs available.
  • Give care in the community.
  • Educate the public.
  • Involve communities, families and consumers.
  • Establish national policies, programs and legislation.
  • Develop human resources.
  • Link with other sectors.
  • Monitor community mental health.
  • Support more research.

Based on the data of 12 countries, assessed by the WHO Assessment Instrument for Mental Health Systems (WHO-AIMS), the costs of scaling up mental health services by providing a core treatment package for schizophrenia, bipolar affective disorder, depressive episodes and hazardous alcohol use have been estimated. Structural changes in mental health systems according to the WHO recommendations have been taken into account.

For most countries, this model suggests an initial period of investment of US$0.30 – 0.50 per person per year. The total expenditure on mental health would have to rise at least ten-fold in low-income countries. In those countries, additional financial resources will be needed, while in middle- and high-income countries the main challenge will be the reallocation of resources within the health system to provide better mental health service.

Prevention

Prevention is beginning to appear in mental health strategies, including the 2004 WHO report “Prevention of Mental Disorders”, the 2008 EU “Pact for Mental Health” and the 2011 US National Prevention Strategy. NIMH or the National Institute of Mental Health has over 400 grants.

Stakeholders

World Health Organization (WHO)

Two of WHO’s core programmes for mental health are WHO MIND (Mental health improvements for Nations Development) and Mental Health Gap Action Programme (mhGAP).

WHO MIND focuses on 5 areas of action to ensure concrete changes in people’s daily lives. These are:

  • Action in and support to countries to improve mental health, such as the WHO Pacific Island Mental Health network (PIMHnet).
  • Mental health policy, planning and service development.
  • Mental health human rights and legislation.
  • Mental health as a core part of human development.
  • The QualityRights Project which works to unite and empower people to improve the quality of care and promote human rights in mental health facilities and social care homes.

Mental Health Gap Action Programme (mhGAP) is WHO’s action plan to scale up services for mental, neurological and substance use disorders for countries especially with low and lower middle incomes. The aim of mhGAP is to build partnerships for collective action and to reinforce the commitment of governments, international organisations and other stakeholders.

The mhGAP Intervention Guide (mhGAP-IG) was launched in October 2010. It is a technical tool for the management of mental, neurological and substance use disorders in non-specialist health settings. The priority conditions included are: depression, psychosis, bipolar disorders, epilepsy, developmental and behavioural disorders in children and adolescents, dementia, alcohol use disorders, drug use disorders, self-harm/suicide and other significant emotional or medically unexplained complaints.

Criticism

One of the most prominent critics of the Movement for Global Mental Health has been China Mills, author of the book Decolonising Global Mental Health: The Psychiatrisation of the Majority World. Mills writes that:[7]

This book charts the creeping of psychology and psychiatry across the borders of everyday experience and across geographical borders, as a form of colonialism that comes from within and from outside, swallowed in the form of a pill. It maps an anxious space where socio-economic crises come to be reconfigured as individual crisis – as ‘mental illness’; and how potentially violent interventions come to be seen as ‘essential’ treatment.

Another prominent critic is Ethan Watters, author of Crazy Like Us: The Globalisation of the American Psyche. A more constructive approach is offered by Vincenzo Di Nicola whose article on the Global South as an emergent epistemology creates a bridge between critiques of globalisation and the initial gaps and limitations of the Global Mental Health movement.

A recent review presents a simple summary outlining the key characteristics of the global mental health landscape and indicating the diversity existing within the field. This review demonstrates how the area is not confined to the limits of the local-global debate, which has historically defined it.

On This Day … 17 December

Published on by Andrew MarshallLeave a comment

People (Births)

  • 1930 – Dorothy Rowe, Australian psychologist and author (d. 2019).
  • 1931 – James McGaugh, American neurobiologist and psychologist.

Dorothy Rowe

Dr. Dorothy Rowe (née Conn; 17 December 1930 to 25 March 2019) was an Australian psychologist and author, whose area of interest was depression. Born; Newcastle, NSW. Died Sydney, NSW.

Rowe came to England in her forties, working at Sheffield University and was the head of Lincolnshire Department of Clinical Psychology. In addition to her published works on depression, she was a regular columnist in the UK.

She spent her time working with depressed patients and, through listening to their stories, came to reject the medical model of mental illness, instead working within personal construct theory. She believed that depression is a result of beliefs which do not enable a person to live comfortably with themselves or the world. Most notably it is the belief in a “Just World” (that the bad are punished and the good rewarded) that exacerbates feelings of fear and anxiety if disaster strikes. Part of recovering is accepting that the external world is unpredictable and that we control relatively little of it.

In July 1989 Rowe made an extended appearance on the British television discussion programme After Dark alongside, among others, Steven Rose, Frank Cioffi, The Bishop of Durham and Michael Bentine.

The BBC were required to apologise to Dorothy Rowe in 2009 after the production editing of her radio interview misrepresented her views on the impact of religion in providing structure to people’s lives.

James McGaugh

James L. McGaugh (born 17 December 1931) is an American neurobiologist and author working in the field of learning and memory. He is a Distinguished Professor Emeritus in the Department of Neurobiology and Behaviour at the University of California, Irvine and a fellow and founding director of the Centre for the Neurobiology of Learning and Memory.

Education and Positions

McGaugh received his B.A. from San Jose State University in 1953 and his Ph.D. in psychology from the University of California, Berkeley, in 1959. He was briefly a professor at San Jose State and then did postdoctoral work in neuropharmacology with Nobel Laureate Professor Daniel Bovet at the Istituto Superiore di Sanitá in Rome, Italy. He then became a professor at the University of Oregon from 1961 to 1964. He was recruited to the University of California, Irvine, in 1964 (the year of the school’s founding) to be the founding chair of the Department of Psychobiology (now Neurobiology and Behaviour). He became dean (1967-1970) of the School of Biological Sciences and Vice Chancellor (1975-1977) and executive Vice Chancellor (1978-1982) of the university. In 1982, he founded the Centre for the Neurobiology of Learning and Memory and remained director from 1982 to 2004.

Early Research Findings

McGaugh’s early work (in the 1950s and 1960s) demonstrated that memories are not instantly created in a long-term, permanent fashion. Rather, immediately after a learning event, the memory is labile and susceptible to influence. As time passes, the memory becomes increasingly resistant to external influences and eventually becomes stored in a relatively permanent manner, a process termed memory consolidation. McGaugh found that drugs, given to an animal shortly after a learning event, influence the subsequent retention of that event. The concept of such “post-training” manipulations is one of McGaugh’s greatest contributions to the field of learning and memory because it avoids many potential confounds, such as performance effects of the drug, that may occur when a drug or other treatment is given prior to the training.

Over the ensuing decades, McGaugh and his research colleagues and students extended the findings into a long-term investigation of emotionally influenced memory consolidation. As most people realise, they have stronger memories for long-ago events that were emotionally arousing in nature, compared with memories for emotionally neutral events (which may not be remembered well at all). McGaugh’s research examined how emotional arousal influences memory consolidation. In particular, he has found that stress hormones, such as epinephrine and cortisol, mediate much of the effects of emotional arousal on subsequent retention of the event. These hormones, in turn, activate a variety of brain structures, including the amygdala, which appears to play a key role in modulating memory consolidation. The amygdala, when activated, influences a variety of other brain structures, including the hippocampus, nucleus accumbens and caudate nucleus that process different aspects of memory. It is through this “orchestration” of brain structures that memories are eventually formed and stored, though the exact nature of memory storage remains elusive.

What is Flualprazolam?

Published on by Andrew MarshallLeave a comment

Introduction

Flualprazolam is a tranquiliser of the triazolobenzodiazepine (TBZD) class, which are benzodiazepines (BZDs) fused with a triazole ring.

Background

It was first synthesised in 1976, but was never marketed. It has subsequently been sold as a designer drug, first being definitively identified as such in Sweden in 2018. It can be described as the 2′-fluoro derivative of alprazolam, or the fluoro instead of chloro analogue of triazolam, and has similar sedative and anxiolytic effects.

Flualprazolam is banned in Sweden, also is illegal in the UK. In December 2019, the World Health Organisation recommended flualprazolam for international scheduling as a Schedule IV medication under the Convention on Psychotropic Substances.