This is good advice for those who forgo the formality of marriage to live together. This advice applies all romantic couples who have children, financial, and/or assets or other shared valued items.

freep.com | Detroit Free Press

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People go into these relationships out of love, but they don't use their heads," says Pamela Radzinski, a Southfield divorce and family law attorney.

Yet census data show the number of opposite-sex couples living together hit 6.8 million in 2008. That's up from 5 million in 2006 and up from less than a million some 30 years ago, reports USA Today, citing census data. Cohabiting couples make up roughly 10% of all opposite-sex U.S. couples, married and unmarried.

But if you want to live together in the state of Michigan without marriage, Radzinski advises people to get a written contract.

Though the notion may not sound romantic, Radzinski says she recommends that all couples get a non-marital agreement drawn up by an attorney before moving in together. It should cover issues such as division of property and assets, what will happen to children, and support for a nonworking partner in case of a breakup.

A contract is especially important in Michigan, where those living together don't receive the same protection as married couples, says Radzinski. She offers an example she's seen many times: The woman stays home, the man tells her he'll always take care of her -- until he leaves and she's left with nothing....

Sample cohabitation contract

Recently, a post at Anxiety and Depression Treatments Blog got my attention. It refers to a BBC NEWS article titled "Paranoia 'a widespread problem". The article is about a survey done in the UK by the Institute of Psychiatry at King's College London. The blog characterized the results as laughably high. Here is an excerpt from the BBC article.

One in three people in the UK regularly suffers paranoid or suspicious fears, clinical psychologists have found. A team at the Institute of Psychiatry at King's College London interviewed 1,200 people about whether they had thoughts about others doing them harm. They found levels of paranoia were much higher than previously suspected - and almost as high as those for depression and anxiety. The researchers say paranoia can cause real distress.

The study found that:

• Over 40% of people regularly worry that negative comments are being made about them
• 27% think that people deliberately try to irritate them
• 20% worry about being observed or followed
• 10% think that someone has it in for them
• 5% worry that there is a conspiracy to harm them

The article seems to imply up to 50% of those surveyed reported paranoid thinking. Without a context, indeed the bullet points above seem to say just that. I went to the Institute of Psychiatry at King's College London website and found a link to the article.

The study was based on an anonymous Internet survey of students at King’s College London, the University of East Anglia and University College London invited by e-mail to participate in a survey of ‘everyday worries about others’. The web based survey method was considered by the authors "to provide a safe environment for
survey participants to disclose suspicious thoughts. Internet research has been found to reach the same conclusions as laboratory-based studies (Birnbaum, 2001)." However, this method would very likely create conditions where an exaggerated response might be expected.

[The authors concede that] people who self-select for questionnaires of this type may be more prone to psychological disturbance, or the stigma of appearing so might skew the sample in the opposite direction. Thus, our investigation in a selected group indicates a need for more elaborate and more truly epidemiological studies.

One of instruments in use was included in tables with the resulting responses. So I responded to the survey honestly. Given my work, I meet a larger proportion of people with personality disorders who maybe worthy of suspicion than perhaps the average person might contact on a day to day basis. I remember the experience I had as an adolescent and college student where I was exposed to a disproportionate number of rebellious young people. I had every reason to be suspicious of many of my peers, so I suspect my current contacts through my practice might represent an experience in college in the upper third of peer stress. Indeed two-thirds of the respondents were women, perhaps more likely to experience the stress of peer pressure. Interestingly, the responses between men and women in the survey were reported to be not significantly different.

It is apparent in going through the Paranoia Checklist, that I experience a lot of suspicion in my life, but not as much stress about it as one might expect from a college student among peers. The authors had a similar concern.

There are also issues concerning whether the experiences assessed are actually unfounded; questionnaire studies may include an unknown proportion of paranoia that is realistic and therefore well judged and appropriate. It is also unknown whether any of the participants had received treatment for a psychiatric disorder, and what the level of substance use was in the group.

So the authors appropriately review all the possible problems with the survey, Their bullet points are clear and not misleading listing the limitations.

CLINICAL IMPLICATIONS

• Having suspicious thoughts is a common experience and provision of this information may help reduce patient distress.
• Feelings of hopelessness and lack of control may contribute to the occurrence of more suspicious thoughts, whereas gaining distance from such thoughts and evaluating them may reduce such experiences.
• Not talking to others about suspicious thoughts, feeling vulnerable and behaving timidly with others may be factors in the development of paranoia.

LIMITATIONS

• An epistemologically representative sample was not recruited.
• The group mainly comprised young adults have higher rates of suspiciousness.
• Only cross-sectional associations between paranoia, coping strategies and social^ cognitive processes were examined.

The BBC article really does a poor job of conveying the information of the study. The reporter seemed to have latched onto the stigmatizing word paranoia and grabbed at statistics that sensationalized rather than communicated accurately the results of the study. In fact, there was some very interesting results that a worth considering in the context of the limitations of the study.

In the press release announcing the study to the public, the agency does a nice job of summarizing the results. The study I can fault at only one point. The authors began using the word paranoia in the discussion to refer to at least the upper end of the hierarchy of suspicious thoughts.

Approximately 10–20% of the survey respondents held paranoid ideation with strong conviction and significant distress. [...] If paranoia is an everyday phenomenon, which many people manage well, then it provides an opportunity to gain clinically useful information on optimal ways of coping.

Substitute the phrase "suspicious thoughts" for paranoia and the miscommunication goes away. The press grabbed the word "paranoia", guaranteed to grab attention with a catchy headline, as reflecting the primary focus of the research which was in fact focused on suspicious thoughts. With the ready access of research to the general public via the Internet, authors need to be aware of the potential misunderstandings of lay persons reading their articles.

MentalHealthCare.org.uk

The results indicate that suspicious thoughts are a weekly experience for many people. For example, 30-40% of participants had ideas that negative comments were being circulated about them. 10-20% of those who took part in the survey had paranoid thoughts that they firmly believed and which caused them significant distress. This suggests that there is a significant group of people in the population who suffer distress as a result of paranoid thoughts but do not seek treatment from mental health services.

The authors believe that this may be because many people feel uncomfortable talking about suspicious thoughts and fear being thought of as ‘paranoid’, a term which has stigma attached to it.

According to the survey people with frequent and distressing paranoid thoughts tend to deal with them by isolating themselves, giving up activities and feeling powerless or depressed. These so called coping strategies have been shown to be less effective than other strategies in reducing the distress caused by such thoughts.

People with less severe paranoid thoughts, however, tended to cope with their suspicious thoughts by keeping things in proportion (known as ‘not catastrophizing’), and by keeping enough distance from their thoughts to see them in an unemotional way. These techniques have been shown to be more effective than those used by people with more severe paranoid thoughts. It is not clear from this survey whether using a less effective coping method causes more paranoid thoughts or whether the paranoid thoughts make people more likely to use less effective coping methods.

The authors also found evidence that not talking to other people about suspicious and paranoid ideas can lead to a greater number of such thoughts. In addition people with low self-confidence are more likely to suffer suspicious and paranoid thoughts. The researchers believe that low self-confidence can produce feelings of being vulnerable to some form of attack and so lead to feelings of suspicion.

The researchers call for treatments for paranoia to take into account the findings of this survey. Firstly mental health professionals should accept that paranoia is a very common experience. Secondly people dealing with paranoid thoughts should be encouraged to talk about their experiences. Efforts should be made to improve the self-esteem of people with paranoid ideas, and they should be encouraged to feel in control of their situation. All of these techniques are used in Cognitive Behavioural Therapy, a psychological treatment that is increasingly being used to treat psychosis and schizophrenia, conditions that often involve paranoid thoughts.

Perhaps the most significant result of the study was initial suggestions in the data that suspiciousness belongs to a continuum including paranoia.

Our survey clearly indicates that suspicious thoughts are a weekly occurrence for many people: 30–40% of the respondents had ideas that negative comments were being circulated about them and 10–30% had persecutory thoughts, with thoughts of mild threat (e.g. ‘People deliberately try to irritate me’) being more common than severe threat (e.g. ‘Someone has it in for me’). In contrast, only a small proportion (approximately 5%) of respondents endorsed the checklist items that were the most improbable (e.g. that there was a conspiracy).

Nevertheless, the rarer and odder suspicions – characteristic of clinical presentations – occurred in tandem with the more common and plausible experiences. The rarer the thought, then the higher the total score indicated by its presence. There has been no previous examination of paranoia in this way. The findings indicate a hierarchy of paranoia [see diagram]: the most common type of suspiciousness is that of a social anxiety or interpersonal worry theme; ideas of reference build upon these sensitivities; persecutory thoughts are closely associated with the attributions of significance; as the severity of the threatened harm increases, the less common the thought; and suspiciousness involving severe harm and organisations and conspiracy is at the top of the hierarchy.

The implication is that severe paranoia may build upon common emotional concerns, consistent with a recent cognitive model of persecutory delusions (Freeman et al, 2002; Freeman & Garety, 2004). The interesting questions therefore concern the identification of the additional factors that contribute to the development of severe paranoia and whether there are qualitative shifts in experience at the top end of the hierarchy (note that individuals at the higher end of the hierarchy tended to endorse all their suspicious thoughts with high levels of conviction and distress). The survey findings also indicate that there is a continuous (exponential) distribution of total number of suspicious thoughts in the general population, although the thoughts appear in a hierarchical arrangement. No distinct subpopulation was identified. This therefore demonstrates correspondence to common mental health disorders such as depression and anxiety.

It's apparent similarity to depression is not a surprise. It has always struck me that depressive and paranoid thinking are special cases for obsessions based on the thematic content of the thought. This confirmation continues the cry for a medication focused on relieving the the compelling nature of obsessive thinking of all kinds. The driving repetition of the thought may have a major responsibility for danger to self and others. Repetitive themes of shame may well lead to suicide ideation and attempts. Obsessive thinking regarding persecution involving a particular person seems related foretell vengeful think and ultimately homicidal ideation and attempts. More traditional obsessive thinking is thematically focused on safety in the form of checking to confirm no hazard and compulsive cleaning to prevent exposure to germs. It makes less sense to me to separate diagnoses based on thematic content than structure and pattern of symptoms. Not surprisingly, Anafranil and the SSRIs have had notable success with obsessive symptoms and depression. I've only seen a few examples of paranoid thoughts treated by SSRIs, all as I recall were relatively successful. It would seem a more targeted medication related to repetitive thought patterns would be more fruitful in treating the obsessive symptom.

Freeman, D., Garety, P.A., Bebbington, P.E., Smith, B., Rollinson, R., Fowler, D., Kuipers, E., Ray, K., Dunn, G. (2005). Psychological investigation of the structure of paranoia in a non-clinical population. British Journal of Psychiatry, 186(5), 427-435.

King Crimson | 21st Century Schizoid Man Lyrics

Cats foot iron claw
Neuro-surgeons scream for more
At paranoias poison door.
Twenty first century schizoid man.

Blood rack barbed wire
Polititians funeral pyre
Innocents raped with napalm fire
Twenty first century schizoid man.

Death seed blind mans greed
Poets starving children bleed
Nothing hes got he really needs
Twenty first century schizoid man.

When I first heard of the study excerpted below, I immediately thought of King Crimson's screeching discordant guitar accompanying Greg Lake (more famous for his part in Emerson, Lake and Palmer) singing in angry, alienated tones about the coming 21st century when isolation and alienation will be pandemic. I had found that song disturbing and eventually difficult to listen to. Thus the LP has gathered dust ever since.

Miller McPherson et al from University of Arizona and Duke University wrote an article in AMERICAN SOCIOLOGICAL REVIEW, 2006, VOL. 71 (June:353-375) titled
"Social Isolation in America: Changes in Core Discussion Networks over Two Decades". This 2004 study replicated a 1985 survey using the General Social Survey (GSS) of about 1500 people drawn from a nationally representative sample. What they found stunned them.

The number of people who have someone to talk to about matters that are important to them has declined dramatically, and the number of alternative discussion partners has shrunk. In his groundbreaking study of social networks, "To Dwell among Friends", Claude Fischer (1982:125-27) labeled those who had only one or no discussion ties with whom to discuss personal matters as having marginal or inadequate counseling [close social, not professional] support. By those criteria, we have gone from a quarter of the American population being isolated from counseling support to almost half of the population falling into that category.

The American population has lost discussion partners from both kin and outside the family. The largest losses, however, have come from the ties that bind us to community and neighborhood. The general image is one of an already densely connected, close, homogeneous set of ties slowly closing in on itself, becoming smaller, more tightly interconnected, more focused on the very strong bonds of the nuclear family (spouses, partners, and parents). The education level at which one is more connected through core discussion ties to the larger community than to family members has shifted up into the graduate degrees, a level of education attained by only a tiny minority of the population. High school graduates and those with some college are now in a very family-dominated social environment of core confidants.

[...]Having a network dominated by family members still increases one's contact with other ages and the other sex, while it makes the interpersonal environment more homogeneous with regard to race.

[...]Americans are still stratified on education and race. Higher education people have larger networks of both family and non-family members, and their networks have more of the range that tends to bring new information and perspective into the interpersonal environment. Non-whites still have smaller networks than whites.

[...]Our final estimates, corrected for response problems and demographic shifts, are that (1) the typical American discussion network has slightly less than one fewer confidant in it than it did in 1985 [about 3 in 1985, down to 2 in 2004], and (2) that in 2004 an adult, non-institutionalized American is much more likely [nearly 50%] to be completely isolated from people with whom he or she could discuss important matters than in 1985.

This is a major social change. Most people talk about personal matters only to a family member, a spouse is the common choice. Most no longer have a best friend outside of the family. Meanwhile, divorce is more common than it's ever been. I think close relationships are most likely to shape attitudes and values. Since we tend to share values with our family members, we have fewer inputs of diverse viewpoints and behaviors, especially from people we respect. People place greater importance and stress on the few close relationships they have to meet their social needs.

There is less diversity in our social support system especially of a cultural nature. Therefore we are exposed to a narrower range of ideas and our opinions are less likely to be as broadly based as they have been in the past. Americans are less likely to understand other cultures or tolerate a divergent lifestyle.

Support networks have become more like a closed system. Closed systems are known for their rigid rules of conduct, intolerance towards nonconformity, and oppression of divergent behaviors. They also are known to be inflexible to outside changes, less likely to adapt smoothly to environmental changes, responding instead with stereotypic oppressive responses to members attempting to find a better solution. The cost of nonconformity too often is a loss of access to the close social support needed to cope and adjust to a rapidly changing social environment.

Just when life in America is getting more complicated, Americans are losing some of their creative flexibility. Much has been said of the rising hours on the job, the prevalence of two income families, and the frequent job changes and inter-city migration. Income and buying power peaked in the 1990's during the surge of information industries. Enthusiastic growth gave way to oversupply and the so called "dot com" crash. The number of six figure incomes dropped precipitously. People are still working longer hours, but now it's to maintain or retrieve lost income or make up for higher costs of living.

The social retrenchment is understandable from this perspective. People are focused more in income security, less on social ties. Many people recognize they are just a few months of unemployment away from homelessness. It's as if American families are circling their wagons to cope with an increasing cost of living and stagnating incomes.

Why is it that Americans seem to lack an understanding of the importance of social support? Perhaps most evident in urban and suburban settings, people are now seeing a wider diversity of cultures and behavior patterns than ever, at a time when they have a lessor capacity to integrate this knowledge.

Sullen isolating attitudes are most evident on public transportation. Few people talk on buses, eye contact is avoided. Clearly people are afraid of meeting new acquaintances. News accounts of heinous violent crimes create an appearance of danger in meeting strangers. With people increasingly intolerant of divergent behavior, strangers who do find themselves in conflict expect a problem and lack the skills needed to find a win-win solution to the conflict. Too often, both parties go away feeling like the loser or at least frustrated with an impasse. While the danger of violence and crime is still relatively uncommon and presenting a low risk to the average city dweller, clearly, people believe they are at risk and they protect themselves by walling themselves off from new acquaintances, especially if they are different.

Basic social skills and emotion management never have been taught formally. Traditionally, emotion management and social skills were taught at home in resolving conflict with siblings under the tutelage of a stay-at-home mom. Now, however, most kids have their first social exposure in day care settings supervised much more loosely by a largely paraprofessional staff with little training beyond what they learned from their own childhood. At home, children are largely parented by the flickering screen while parents take care of routine chores until they join the children to rest in front of the TV. Its no wonder children have so much difficulty with conflict and grow up afraid of making new friends.

What is the solution? TheEditorInChief at Anxiety, Addiction and Depression Treatments has the traditional response to "Fixing America's Loneliness Problem".

As Dr. Putnam remarks in the Times' coverage, the number of friends we have is a strong indicator of how long we'll live. And while most strong friendships are cultivated in face-to-face interaction, our technologies offer us the ability to maintain ties when distance and reduced availability of time have forced a wedge between acquaintances.

Trends will not change on their own and maintaining friendships may not be easy work. But as with anything worth having, we must be willing to work for our friendships. Take a moment to think about those who you may still hold dear, despite what time and distance may have done to your connection. Each of those people is only an email, or heck, even a text message away. By taking up the tools that our new age has given us, we don't have to live lives of loneliness. We have the option to stay in touch, and as broadband expands and computer processors increase in strength, we will be able to see one another face to face again very soon on web cams and broadband phone calls. Hold onto your family. Ask those close to you about the things that really matter. Don't be afraid to reach out. You might be surprised at how ready those around you, or indeed, on the other side of the continent, are to answer you call.

Truly most of us can only hope to have an impact one person at a time, so the above suggestions are sound advice. But as a society we need to respond to what increasingly is looking like a deterioration of social conditions in America. People are increasingly isolated with no indication that this trend will reverse. A broad based shift in responsibility of teaching social and emotion skills must be recognized and dealt with planfully and competently. Ignoring this shift and claiming mothers should stay home with their children will not make it so. Incomes have stagnated and mom's salary is needed now more than ever just to maintain housing and food. Neglecting this new responsibility brings more chaos to the streets, increasing isolation, and the more inflexible stereotypic and counter productive responses will become. Families, functioning like closed systems are not very successful at adjusting to change, they too often fly apart and cease to function as a viable source of support for it's members. Too many end up on the margins of our society, vulnerable to crime victimization and criminal behavior.

Daniel Goleman in his book Emotional Intelligence, called for teaching emotion management in schools. Emotion management must be taught side by side with basic social skills, beginning at the child's first contact with other children. Parents have never received any formal training, day care providers and elementary school teachers have seemingly too little. Yet changes are beginning to come. Goleman reports on a number of curriculums written and pilots run with good research results. My wife, a paraprofessional staff in the local elementary school, teaches a regular class titled "Character Ed" where the values of integrity and conflict resolution are taught in creative ways using multi-media guaranteed to capture the attention of the youngsters. But more is needed. Schools and day care providers have yet to accept their responsibility to teach social and emotional skills. Taxpayers are not in the mood to fund a new expanded curriculum. But the alternatives are unacceptable.

Pay now, invest in future generations, or the chaos in the streets will come to your neighborhood soon. Let's avoid the tragic future of 21st Century Schizoid Man.

Hat tip to Crooked Timber for the link.

Abuse in relationships is way too common, often because we are not taught when we are young to identify relationships going awry. If you are in a relationship that sounds like this, consider the wisdom of continuing.

The Sacramento Bee

He wants to spend an excessive amount of time alone with you and he encourages you to flake on your friends, ditch school or skip practice. It can seem like a romantic gesture, but it's not. One partner's insistence on being the sole focus of the other's time and attention is a key warning sign of abuse, as the victim is slowly isolated from family, friends and favorite activities, experts say.

He scrutinizes every detail of your life, including your friends, your hangouts and even your wardrobe. His controlling attitude means your cell phone is constantly in use, since he's always checking up on you. "In the early stages it gets misread as, 'Well, gosh, they care about me so much, they care about every little thing I'm doing,' " says Linda Hoos, an attorney for Break the Cycle. But it's not a measure of his affection, Hoos says, it's a way to assert his control.

Even if you've never so much as flirted with another guy since you started dating, he's always accusing you of cheating.

More here.