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"After my first few weeks of teaching I became aware of the chasm in teaching styles between Japan and what I¡¯d experienced in the UK. Japanese classes involved far less debate or discussion, typically revolving around a teacher dictating, lecture style, for most of the fifty minutes. It wasn¡¯t uncommon to see students asleep at their desks and, providing they didn¡¯t snore, often the teachers would do nothing about it.

The Japanese emphasize working together as a collective. Coming from the UK, I saw this method of teaching less as a team-building exercise and more as a great way to rob the students of any individual empowerment, and this was something I grew to notice more and more during my time working in the Japanese education system. Schools churned out model citizens who followed the rules and rarely questioned authority, but robbed students of any rule-breaking,entrepreneurial spirit.....

The Japanese proverb you¡¯ll hear most is Deru kui wa utareru ¨C the stake that sticks out gets hammered down. No proverb sums up better Japan¡¯s adherence to group conformity and collectivism. To be cast out and avoided is unthinkable in a culture that prioritizes the needs of the group over those of the individual." Broad talks of a particularly intelligent girl, who wouldn't display it at all in class, not wanting to appear different to the others.

Conversation

"The Japanese use names far more frequently when talking to someone than an English person would (the word ¡®you¡¯ is considered almost rude in Japanese.)

Japanese culture has these long periods of silence, chinmoku (Éòüa),which are commonplace. It has its roots in Zen Buddhism, where silence is said to hold the secrets of existence. The Japanese proverb ¡®It is better to leave many things unsaid¡¯ captures the essence of chinmoku. Far from being awkward, in Japan silence is a natural part of daily interactions."

Green grass

There are very few lawns in Japan.? "Weirdly, the thing that threw me most was that I couldn¡¯t see a single patch of grass. Now that I¡¯ve lived here a few years, I¡¯ve realized that most people don¡¯t even notice this absence; in Japan, every patch of land is either a rice field, concrete or a forest-covered mountain. None of the houses we passed had lawns; instead, a mixture of gravel and carefully curated trees adorned the tiny gardens of each home. Even the local parks were predominantly comprised ofgravel and sand. I would later learn that less than 1 per cent ofschools in Japan had playgrounds featuring grass, and in feudal times only lords would have lawns, and these were ornamental, a visual feast for the eyes."

Health

(Wikipedia) Healthcare isn't free, but it's relatively inexpensive, In addition to having to pay monthy premiums into the public health insurance system, Japanese citizens pay 30% of their medical bills themselves - bills that are closely regulated by the state, so that they never become unaffordable.

(Chris Broad)

"The IV drip seemed to have worked its magic.? For the first time in a week, I didn't feel like death.?? Drips are a very popular treatment in Japan.?? Nearly every trip to the doctor has a complementary drip thrown in, like getting a free air-freshener at the carwash."

Fruit

"Ryotaro and I were delighted to visit Miyagi Ichigo World, literally ¡®Strawberry World¡¯, to taste the award-winning polished strawberries that now sell for up to $20 per berry. Yes, you read that correctly. Twenty dollars for a single strawberry. This may sound extreme, but they were relatively affordable by the standards of luxury fruit. Japan boasts the world¡¯s most expensive fruit to date in the form of the Yubari King melon. A record 5 million yen (32,270.87 dollars)? was spent on a pair of Yubari melons in an auction in 2019. It wasn¡¯t necessarily about size, though the melons were larger than average. It came down to the flawlessness of the outer skin; cultivated to be so meticulously round and smooth, it was almost as if the gods had handcrafted the fruit. And don¡¯t even get me started on the grapes; a bunch of Japanese Ruby Roman grapes sold for an astonishing $12,000 at an auction in 2020. I hope the winning bidder ate them slowly.That¡¯s $400 a grape."

Vincent Felitti and Robert Anda conducted an Adverse Childhood Experiences study. They sent 17,000 patients questionnaires about adverse childhood experiences.
70% responded. 75% of them were white and 75% of them had been to college. Their average age was 57.

They were surprised at the prevalence of childhood trauma in this generally well-off population. Many of them mentioned physical abuse or neglect, sexual abuse, emotional neglect, divorced or separated parents, or a family member in prison, mentally ill or with an addiction.
Over 25% were brought up in a household with an alcoholic or drug using parent. Over 25% were beaten as children.

The correlation between negative childhood experiences and negative adult outcomes stunned the researchers. Obesity, depression, early sexual activity, history of smoking and so forth. People with negative scores were 2X more likely to smoke, and 7x more likely to be alcoholics. They also had more health problems. Whilst many of the physical illnesses could be put down to bad lifestyles, this wasn't always the case. When they looked at patients with high negative scores who didn't drink too much or smoke and who weren't overweight - they found that their risk of ischaemic heart disease was still 360% higher than those with positive childhoods.

Those with particularly high scores for negative childhoods were 30x more likely to have attempted suicide than those with positive scores. Men with very high cores for negative childhoods were 46x more likely to have injected drugs than men with no negative history.

The main culprit for all the above is stress, or at least the body's reaction to stress.
Robert Sapolsky, a neuroscientist, says that like all mammals we evolved to react to brief and acute stress. Instead most stress today comes from mental processes, ie from worrying about things. this can be highly destructive, especially in infancy and childhood.

Suniya Luther also did research with middle class children with problems like alcohol misuse, smoking, cannabis, harder illegal drugs, elevated levels of depression and anxiety and chronic academic difficulties.

She concluded that with regard to the ones showing maladjustment it was caused by:
*Low levels of maternal attachment.
* High levels of parental criticism.
*Minimum after school adult supervision.
*Isolation from parents.
* Excessive achievement pressure.
*However alongside this emotional disconnection, parents were often unusually indulgent of their children's bad behaviour.
*The children also lacked challenges in their lives, because their parents protected them from the sort of experience that can lead to character growth, instead they were over-indulged.

***

Michael Meaney from McGill University did research with rats.

When mother rats lick their pups to calm and reassure them after something stressful has happened (like being handled by a human), tests showed that their stress hormones quickly subsided.
Meaney tested the rats when they were about 100 days days old. Rats who received adequate attention from their mothers as pups were a lot more adventurous than those who didn't receive adequate attention. In fact they excelled in every test they were given. Rats who received less attention from their mothers were much more anxious and nervous when faced with new situations.

***

Clancy Blair, a researcher in psychology, found that environmental risks like family turmoil or chaos, or overcrowding, only affect children when their mothers were inattentive or unresponsive. When the mothers were responsive these drawbacks didn't seem to matter.

***

Similarly John Bowlby and then Mary Ainsworth in the 1960s and 70s found that babies whose parents responded readily and fully to their cries in the first few months of their life, were, at one year, more independent and intrepid than the children of parents who had ignored their cries. In pre-school the pattern continued.

**

Alan Sroufe and Byron Egeland tested this further. They conducted a long term study on low-income mothers and their children. They recruited 267 mothers when they were pregnant. All had incomes below the poverty line. 80% were white, 63% were unmarried and 50% were teenagers. They followed them for 30 years.

Sometimes attachment relationship changed over the course of childhood, but for most of the children their well-being at one year of age was highly predictive of a wide range of outcomes in later life.

Secure attachment:
More socially competent throughout their lives.
Able to be attentive and engaged in class and rarely acted out.
No behaviour problems.
More curious and self-reliant.
Calmer.
Better able to deal with challenges.

Anxious attachment:
Did badly at pre-school
Were labelled as dependent by their teachers.
More often also labelled as mean, anti-social or immature.

However if a mother with poor attachment issues gets the right type of intervention she can become a mother who forms a secure attachment with her child.

Ridiculous marking to impress Ofsted 191

Special meetings to help teachers do anything?to achieve the highest academic standards with their pupils, in an effort to placate Ofsted. 207/8

Michael Gove, when Education Secretary 212

Making exams more 'rigorous' 233

Knife Arch deterrent, after someone is stabbed at school 239

The government misleads about funding schools. 259

Portugal:

All drugs - from cannabis to crack - were decriminalized in 2001. The new law stipulated that recreational drug users "should, above all, not be labelled or marginalized", and addicts should be approached by the state exclusively "to encourage him or her to seek treatment." It was no longer a crime to possess enough drugs for ten days personal use. 238

The attitude was that the 90% of drug users have no problem at all and should be left alone, whilst the 10% who are addicts need help. 240

The programme is build on the belief that people with problems use drugs as a symptom of suffering and we have to reach the reasons that make addicts want to be out of their heads much of the time. The trauma needs to be worked on, and people need to find different ways of handling it. Over the year and a half of being treated for addiction, the team will try to build a safe, trusting environment, where you can do something you have been running away from for years - express your emotions, and tell your story truthfully.

It is also felt that addicts need a better life, where the need to anaesthetise yourself isn't there. Once you have progressed through a centre, the government will prioritise getting you a decent job with a decent wage. So the government gives a hefty tax break to anyone who employs a recovering addict. Almost always, when the year is up, the employer keeps the person on as an employee.243

If however you are not ready to move away from using drugs, you will be given a different kind of support. For instance some people are given methadone. The government employed street teams of psychologists to fan out across the country to look in all the old ruined houses and broken crannies where the most hard-core addicts live, and to offer them help. At first, these team approached modestly, offering clean needles, and collecting the dirty old ones. Over time, in these exchanges, they formed relationships. They gave advice on where you should inject yourself to stay as safe as possible, and on how to avoid disease. Then, discreetly, they started to explain that there was a way out, if you wanted it.

Sometime they were only planting a seed that would take years to grow, sometimes people wanted help fast.... The face of authority was changing. Where once there were police with batons to beat you, there are now psychologists offering help.

In some instances people are offered access to therapeutic communities, where they live for a year or so, regularly see a psychologist and are given methadone everyday.

Many people feared a big increase in the amount of drugs used now that drugs were no longer criminalized.

Two highly respected and impartial bodies have studied the outcomes: the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), and the British Journal of Criminology.
They discovered there has been a slight increase in overall drug use, from 3.4% to 3.7% of the population.

But Portugal started with a low rate of use, except for heroin, and it stayed low compared to other countries. The EMCDDA found Portugal in ninth lowest out of twenty-eight European countries when it comes to cannabis use, fifth lowest when it comes to amphetamines, and fifth lowest when it comes to ecstasy.

Over a decade after full decriminalisation, Portugal has, they found "a level of drug use that is, on the whole below the European average and much lower than its only European neighbour, Spain. 249 (NOTE CC: Spain also practises a policy of decriminalisation of drugs, although dealing, as in Portugal, is illegal.)

The Portuguese Ministry of Health says that the number of problematic drug users has literally been halved, from 100,000 to 50,000.

The British Journal of Criminology confirms that the number of problem drug users is down, though their statistics are less generous, from 7.6 people per thousand to 6.8 , whilst confirming that injecting drug use has indeed been almost halved - from 3.5 injectors per thousand people to 2. They added that "Portugal is the only one of these nations to have exhibited declines in problematic drug use." 249

Since the drug policy revolution, Portugal has had two governments of the left, and two governments of the right. All have kept the decriminalisation in place. None of the political parties wants to go back. 251

It's important to understand the limits of the Portuguese experiment. They have decriminalised the personal possession but not the sale of drugs. Under this system, you mostly still have to go to criminals and their gangs in order to obtain the drugs. 253

Antabuse/Disulfiram and Willpower 97

This is an effective deterrent for those who wake up in the morning determined not to drink, but by the evening have lost their resolve. It turns out that willpower is not an infinite human resource. It's more like exercising a muscle, and it can get tired the more we use it.

Depression and Addiction 78

Schuckit, a professor of experimental psychology, did a study of depressed men. They went into hospital for 4 weeks, during which time they received no treatment for depression, other than stopping alcohol. After one month of not drinking, 80% no longer met criteria for clinical depression.
This finding implies that for the majority, clinical depression was the result of heavy drinking and not a co-occuring depressive disorder. Of course there are explanations for these results....but the robust findings are remarkable given that standard treatments for depression, whether medications or psychotherapy, have a 50% reponse rate.

Depression and Anxiety 45

Anxiety is significantly more prevalent and impairing in high-income countries than in low or middle income countries.
The number of new cases of depression worldwide increased 50 % between 1990 and 2017. The highest increases in new cases were seen in regions with the highest income, especially in North America.

Dopamine 49

Dopamine is a neurotransmitter. It may play a bigger role in the motivation to get a reward than the pleasure of the reward. Genetically engineered mice unable to make dopamine will not seek out food, and will starve to death even when food is placed just inches away from their mouth. Yet if the food is put directly into their mouth, they will chew and eat the food, and seem to enjoy it.
With repeated exposure to the same or similar pleasure stimulus, in initial deviation to the side of pleasure (on the pleasure/pain see-saw) gets weaker and shorter and the after-response to the side of pain gets stronger and longer. A process scientists call neuro-adaptation. With repetition, we need more of our drug of choice to get the same high we initially got.
Needing more of a substance to feel pleasure, or experiencing less pleasure at a given dose is called tolerance.
People on high doses of opioid therapy (OxyContin, morphine, fentanyl etc) for chronic pain, find that their pain gets worse and worse over time. Why? Because exposure to opioids had caused their brain to resent its pleasure-pain balance to the side of pain. Now they find that their original pain was worse, and they had new pain in parts of their body that used to be pain free.
This phenomenon, widely observed and verified by animal studies, has come to be called opioid-induced hyperalgesia. Algesia means sensitivity to pain. What's more, when these patients tapered off opioids, many of them experienced improvements in pain.
55
Neuroscientist Nora Volkow and colleagues have shown that heavy, prolonged consumption of high-dopamine substances eventually leads to a dopamine deficit state. She compared the brains of healthy controls v the brains of people who had given up taking heavy drugs 2 weeks ago. In the healthy controls the reward and motivation part of the brain was able to light up (indicating high levels of dopamine neurotransmitter activity. In the people who recently gave up drugs that part of the brain was showing little or no activity.
57
In the two years in which I compulsively consumed romance novels, I eventually reached a place where I could not find a book I enjoyed. it was as if I had burned out my novel-reading pleasure centre, and no book could revive it.

The paradox is that hedonism, the pursuit of pleasure for its own sake, leads to anhedonia, which is the inability to enjoy pleasure of any kind.
My patients with addiction describe how they get to a point where their drug stops working for them. They get no high at all any more. Yet if they don't take their drug, they feel miserable. The universal symptoms of withdrawal from any addictive substance are anxiety, irritability, insomnia and dysphoria.
A pleasure-pain balance tilted to the side of pain is what drives people to relapse even after sustained periods of abstinence. When our balance is tilted to the pain side we crave our drug just to feel normal (ie get a level balance.)
Here's the good news. If we wait long enough, our brain (usually) re-adapts to the absence of the drug and we re-establish our baseline homeostasis: a level balance. Once our balance is level, we are again able to take pleasure in everyday simple rewards. 60

Once we get the anticipated reward, brain dopamine firing increases well abou tonic baseline. But if the reward we anticipated doesn't materialize, dopamine levels fall well below baseline. Which is to say, if we get the expected reward, we get an even bigger spike. If we don't get the expected reward, we experience an even bigger plunge.

How does cue-induced craving translate to our pleasure-pain balance? The balance tips to the side of pleasure (a dopamine mini spike) in anticipation of future reward, immediately followed by a tip to the side of pain (a dopamine mini deficit) in the aftermath of the cue. The dopamine deficit is craving and drives drug-seeking behaviour.

Dopamine Fast 79

(For instance stopping drinking, social media activity or gambling for a month.)
I never suggest a dopamine fast to individuals who might be at risk to suffer life-threating withdrawal if they were to quite all of a sudden (eg severe alcohol, benzodiazepine or opioid dependence.) For those patients, medically monitored tapering is necessary.
Sometimes, patients ask if they can swap one drug for another: cannabis for nicotine, video games for pornography. This is seldom an effective long-term strategy.
Any reward that is potent enough to tip the see-saw balance towards pleasure can itself be addictive, thereby resulting in trading one addiction for another (cross addiction) Any reward that is not potent enough won't feel like a reward, which is why when we're consuming high-dopamine rewards, we lost the ability to take joy in ordinary pleasures.
A minority of patients (about 20%) don't feel better after the dopamine fast. That tells me that the drug wasn't the main driver of the psychiatric symptom and that the patient likely has a co-occuring psychiatric disorder that will require its own treatment.

Gastric Bypass Surgery 98

One in four gastric bypass surgery recipients develops a new problem with alcohol addiction.
Most people who are obese have an underlying food addiction, which is not adequately addressed with surgery alone. These people don't get the behavioural and psychological interventions they need to help them change their eating habits. Hence many of them resume eating in unhealthy was, expand their now smaller stomachs, and end up with medical complications and the need for repeat surgeries. When food is no longer an option, many switch from food to another drug, like alcohol.

Genetic Inheritance & addiction 20

The risk of addiction increases if we have a biological parent or grandparent with addiction, even when we're raised outside the addicted home.

Honesty 205

I am convinced as a parent that I can and should emphasize honesty as a core value in raising my children.
For me honesty is a daily struggle There's always a part of me that wants to embellish the story just the slightest bit, to make myself look better, or to make an excuse for bad behaviour. Now I try hard to fight that urge.
Although difficult in practice, this handy little tool - telling the truth - is amazingly within our reach. Anyone can wake up on any given day and decide, "Today I won't lie about anything." And in doing so, change their lives for the better
224 If we are open and honest with our children about our struggles, we create a space for them to be open and honest about their own. We must also be ready to admit when we are wrong in our interactions with them and with others. We must embrace our own shame and be willing to make amends.
234 Honesty promotes awareness, enhances intimacy, and fosters a mindset of plenty.

Medication problems in the long term.

Patients with anxiety and insomnia who take benzodiazepines and other sedative-hypnotics daily for more than a month may experience worsened anxiety and insomnia.
Patients with pain who take opioids daily for more than a month are at increased risk not only for opioid addiction but also for worsened pain. (opioid-induced hyperalgesia.
Medications like Adderall and Ritalin prescribed for attention deficit disorder promote short-term memory and attention, but there is little or no evidence for enhanced long term improvement. Public health psychologist Gretchen LeFever Watson has written "Compelling new evidence indicates that ADHD drug treatment is associated with deterioration in academic and social-emotional functioning.
Recent data show that even antidepressants may lead to tolerance and dependence, and possibly even make depression worse over the long haul, a phenomenon called tardive dysphoria.

Mental Illness & addiction 20

Mental illness is also a risk factor for addiction, although the relationship between the two is unclear: Does the mental illness lead to drug use, does drug use cause or unmask mental illness, or is it somewhere in between.

80 Co-occuring psychiatric disorders should be treated concurrently with any form of addiction (or withdrawal from an addictive substance), Managing addiction without also addressing other psychiatric disorders typically leads to bad outcomes for both.

Mental illness in wealthy countries 37

Over the past 3 decades, I have seen growing numbers of patients who appear to have every advantage in life - supportive families, quality education, financial stability, good health - yet develop debilitating anxiety, depression and physical pain.

Moderation 86

Emerging evidence suggests that some people who have met criteria for addiction in the past, especially those with less severe forms of addiction, can return to using their drug of choice in a controlled way In my clinical experience, this has been true.

Older women and alcohol. 20

Between 2002 and 2013 diagnosable alcohol addiction rose by 50% in older adults (over the age of sixty-five) and 84 percent in women, two demographic groups who had previously been relatively immune to this problem.

Pain 148
Hormesis is a branch of science that studies the beneficial effects of administering small to moderate doses of noxious and/or painful stimuli such as cold, heat, gravitational changes, radiation, food restriction and exercise.
Intermittent fasting has become somewhat popular as a way to lose weight and improve well-being. Not long ago fasting behaviours would have warranted the label "eating disorder, but in many circles it is considered normal and even healthy.
Exercise increases many of the neurotransmitters involved in positive mood regulation. Just walking for 30 minutes a day can effect mood, anxiety, cognition, energy and sleep, & has a more profound effect than any medication.
ECT is still practised today to good effect, although much more humanely than it used to be, with muscle relaxants paralytics to prevent painful contractions. Anaesthetics allow patients to remain asleep and mostly unconscious throughout the procedure. So, although not painful as such, ECT provides a hormetic shock to the brain, which in turn spurs a broad compensatory response to reassert homeostasis.

Prohibition verses Availability 20

Increased access to addictive substances may be the most important risk factor facing modern people. We all fall prey to the vortex of compulsive overuse. For instance the cigarette-rolling machine invented in 1880, made it possible to go from 4 cigarettes rolled per minute to a staggering 20,000
Prohibition - the ban on selling alcoholic beverages in the US from 1920 - 1933, led to a sharp decrease in the number of Americans consuming and becoming addicted to alcohol. Rates of public drunkenness and alcohol-related liver disease decreased by half during this period.
There were unintended consequences of course, such as the creation of a large black market run by criminal gangs. But the positive impact of Prohibition on alcohol consumption and related morbidity is widely under-recognised.
The reduced drinking effect of Prohibition persisted through the 1950s. Over the subsequent thirty years, as alcohol became more available again, consumption steadily increased.
By the 1990s, the percentage of Americans who drank alcohol increased by almost 50 percent, while high-risk drinking increased by 15 percent.

Trauma: Social Upheaval: Poverty

These also contribute to addiction risk. Drugs become a means of coping and lead to epigenetic changes - heritable changes to the strands of DNA outside of inherited base pairs - affecting gene expression in both an individual and their offspring.

Victimhood versus taking responsibility. 186

Patients who tell stories in which they are frequently the victim, seldom bearing responsibility for bad outcomes, are often unwell and remain unwell. They are too busy blaming others to get down to the business of their own recovery. By contrast, when my patients start telling stories that accurately portray their responsibility, I know they're getting better. Even when people have been victimized, if the narrative never moves beyond victimhood, it's difficult for healing to occur.
One of the jobs of a good psychotherapy is to help people tell healing stories. Even if we can take responsibility for the event itself, we can take responsibility about how we react to it in the here and now. We are then empowered to move forward with your lives.

White Working Class & death via addiction. 30

Middle-aged white Americans without a college degree are dying younger than their parents, grandparents and great-grandparents. The top three leading causes of death in this group are drug overdoses, alcohol-related liver disease and suicide.