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SAMHSA’s National Helpline | SAMHSA

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  • SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.

    Also visit the online treatment locator.

SAMHSA’s National Helpline, 1-800-662-HELP (4357) (also known as the Treatment Referral Routing Service), or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.

Also visit the online treatment locator, or send your zip code via text message: 435748 (HELP4U) to find help near you. Read more about the HELP4U text messaging service.

The service is open 24/7, 365 days a year.

English and Spanish are available if you select the option to speak with a national representative. Currently, the 435748 (HELP4U) text messaging service is only available in English.

In 2020, the Helpline received 833,598 calls. This is a 27 percent increase from 2019, when the Helpline received a total of 656,953 calls for the year.

The referral service is free of charge. If you have no insurance or are underinsured, we will refer you to your state office, which is responsible for state-funded treatment programs. In addition, we can often refer you to facilities that charge on a sliding fee scale or accept Medicare or Medicaid. If you have health insurance, you are encouraged to contact your insurer for a list of participating health care providers and facilities.

The service is confidential. We will not ask you for any personal information. We may ask for your zip code or other pertinent geographic information in order to track calls being routed to other offices or to accurately identify the local resources appropriate to your needs.

No, we do not provide counseling. Trained information specialists answer calls, transfer callers to state services or other appropriate intake centers in their states, and connect them with local assistance and support.

  • Suggested Resources

    What Is Substance Abuse Treatment? A Booklet for Families
    Created for family members of people with alcohol abuse or drug abuse problems. Answers questions about substance abuse, its symptoms, different types of treatment, and recovery. Addresses concerns of children of parents with substance use/abuse problems.

    It's Not Your Fault (NACoA) (PDF | 12 KB)
    Assures teens with parents who abuse alcohol or drugs that, "It's not your fault!" and that they are not alone. Encourages teens to seek emotional support from other adults, school counselors, and youth support groups such as Alateen, and provides a resource list.

    After an Attempt: A Guide for Taking Care of Your Family Member After Treatment in the Emergency Department
    Aids family members in coping with the aftermath of a relative's suicide attempt. Describes the emergency department treatment process, lists questions to ask about follow-up treatment, and describes how to reduce risk and ensure safety at home.

    Family Therapy Can Help: For People in Recovery From Mental Illness or Addiction
    Explores the role of family therapy in recovery from mental illness or substance abuse. Explains how family therapy sessions are run and who conducts them, describes a typical session, and provides information on its effectiveness in recovery.

    For additional resources, please visit the SAMHSA Store.

Last Updated: 08/30/2022

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why we think we are better than others - T&P

In theory, we like to think that we value diversity of opinion and respect other people's points of view, but in practice everything happens exactly the opposite. We tend to divide into groups and then firmly believe that others are wrong, simply because they are different. This psychological phenomenon is called the illusion of asymmetric insight and explains why some social groups consider themselves better than others, and any political struggle is reduced to a contest of intolerance. Journalist David McCraney explores the phenomenon.

In 1954, in eastern Oklahoma, two groups of children nearly killed each other. They lived in nature, played games, built dwellings, cooked food, were in the same territory, but did not suspect the existence of neighbors. Each group lived according to its own rules of conduct and solved the problems of survival in its own way. Each tribe consisted of 22 boys aged 11-12, selected by psychologist Muzafer Sherif to conduct a psychological and anthropological experiment. He placed the children in the Robbers Cave National Park in a scout camp in the middle of caves and forest thickets, divided into two parts. The boys within the groups had not known each other until they arrived at the camp, and the Sheriff assumed that, finding themselves in a new environment and away from the culture they knew, they would create a new one.

“Before we go to work, we put on a mask and a uniform. We have a suit for communicating with friends who do not share our beliefs, as well as a suit for the family. We alone are not like ourselves in the presence of a lover or friend. Like Superman, we dress up in a phone booth when we run into old school friends in the store.”

The scientist and his colleagues dressed as camp staff and made observations without interfering with the natural process of group formation. Social hierarchies appeared very quickly - leaders and followers stood out among the boys. Norms formed spontaneously: for example, when one Rattlesnake boy injured his leg but did not tell anyone until late in the evening, this behavior became the norm in the group. New rituals also quickly emerged, with leaders in both groups establishing the practice of saying a prayer before meals. A few days later, their initially arbitrary suggestions became the order of the day. They came up with their own games and agreed on the rules. They started a project to clear the territory and established a chain of command. They created their own flags and developed tribal symbols.

Both groups soon began to suspect that they were not alone. They found cups and other signs of civilization where they hadn't gone before. This forced them to adhere even more strictly to new norms, values, rituals and other elements of a common culture. At the end of the first week, the Rattlesnakes found another tribe on the camp's baseball court. From that moment on, both groups were predominantly busy thinking about how they should deal with opponents. An unnamed group approached the staff with questions about outsiders. When they were told that they called themselves "Rattlesnakes", the group chose the name "Eagles" for themselves, after birds that eat reptiles.

Sheriff and his colleagues planned to pit groups against each other in competitive sports. They were interested in how the subjects would behave in conditions of limited resources. The fact that the boys began to compete for the baseball court was in keeping with the nature of the study. Scientists moved on to the second stage of the experiment - the tribes had to compete in baseball, tug of war, football, treasure hunting and other games. The winner was entitled to a prize: a medal or a knife. When the boys received the knives, some of them kissed them before hiding them from the other group. Sheriff drew attention to how much time each of the groups devoted to discussing the stupidity and clumsiness of the rivals. Every evening they were absorbed in defining the essence of their enemies, inventing offensive nicknames for them. The sheriff was struck by this example - after the appearance of competition, each of the groups wanted to establish itself in the opinion that the enemy was worse, and began to look at him as the worst. Everything they learned about each other turned into an example of how not to behave. If they noticed similarities, they simply ignored them.

The researchers continued to collect data and plan the next block of work, but it turned out that the boys had their own plans. The experiment began to spiral out of control. Several Eagles noticed that the Rattlesnakes flag had been left unattended on the baseball court. They tore it off, burned it, and hung the charred rag back. After a while, the Rattlesnakes saw what had happened and retaliated by stealing and burning the Eagles' flag. When the Eagles discovered the result, their leader challenged the enemy to a fight. The two leaders met one on one, but scientists intervened just in time. On the same night, "Rattlesnakes" in war paint broke into the houses of the "Eagles", overturned the beds and tore the mosquito nets. The staff intervened again as both groups began collecting stones.

The next day, the Rattlesnakes painted insults on the stolen jeans of one of the Eagles and hung them as a flag outside the enemy camp. The Eagles waited until the Rattlesnakes were distracted by food, and made a retaliatory raid, and then fled to their lodge to organize a defense. Camp personnel intervened again and dissuaded the Rattlesnakes from retaliating. The raids continued, as did personnel interventions. The two groups clashed in a mass brawl that the scientists had to break up. Fearing an accident, they pushed the borders of the tribal settlements away from each other. The experiment showed that in order to turn a children's summer camp into a setting for Lord of the Flies, it was enough to introduce competition for resources.

Lord of the Flies is the debut allegorical novel by English writer William Golding, published in 1954. It is considered one of the most important works of Western literature of the 20th century and explores the origins of the moral degradation of mankind on the example of the life of a group of children on a desert island.

It is interesting that such behavior boils daily in our own subconscious. We do not sharpen arrows, but we consider our position in society, our alliances and confrontations. We see ourselves as part of some groups and not others. Like those boys, we really like to spend time inventing offensive nicknames for strangers. How we see others is largely determined by what psychologists call the illusion of asymmetric insight. In order to understand what we are talking about, first we will consider how identities appear and why they are not quite real.

We put on a mask and uniform before going to work. We have a suit for communicating with friends who do not share our beliefs, as well as a suit for the family. We alone are not like ourselves in the presence of a lover or friend. Like Superman, we change in a phone booth when we run into old school friends at the store or in line for movie tickets. But as soon as we part, we change back and explain to the one who was with us at that moment why we behaved so strangely. He understands, because this pretense is not alien to him.

This is not a new concept. The idea that there are different personalities in different circumstances has long been known, but we don't often talk about it. The idea is so old that the very word person comes from the Latin word persona, which the Greeks used to designate actor's masks. This concept—actors and performance, persona and mask—has been rethought repeatedly throughout history. Shakespeare said: "The whole world is a theater, and people are actors in it." William James said that a person has as many essences as people know him. Carl Jung especially valued the concept of personality and said that this is what a person is not really, but what he is, according to himself and others. It's an old idea, but we, like everyone else, stumble upon it in our youth, forget for a while, and suddenly remember again during our lives when we feel like poseurs or deceivers. But that's okay, and if you never step aside and feel ridiculous when you put on your social mask, then you're probably a psychopath.

“It annoys us that our parents want to be friends with us on Facebook. What will they think of us? In life or in a photo, this desire to hide some sides of yourself in one group and show them in another seems natural. We are ready to be vulnerable, but not all at once and at the same time”

Social media distorts the picture. In them we are geniuses of public relations. We can not only create alternative personalities for forums, websites and digital smoking rooms, but also control the image of this person in each of these resources. Witty tweets, photos of our gourmet delights in the kitchen, funny memes, a new place we visited - it all tells the story of who we want to be, who we should be. Is someone clicking on these links? Is anyone smirking at this video? Is anyone picking on grammatical inaccuracies in our answers? We ask these questions even if they don't rise to the surface of our consciousness.

The recent noise about the excessive availability of personal information and the loss of privacy is excessive. As internet citizens, we know that we always hide the truth about our identity—our true fears, sins, and vulnerable secret desires—in exchange for meaning, purpose, and connections. In a world where we can control everything that is presented to the public, "real" depends on who we assume is on the other side of the screen. We are annoyed that our parents want to be friends with us on Facebook. What will they think of us? In life or in a photo, this desire to hide some sides of yourself in one group and show them in another seems natural. We are ready to be vulnerable, but not all at once and at the same time.

We put on social masks just like any person since ancient times. Groups also have masks. Political parties develop platforms, companies give employees manuals, and countries write constitutions. Every human community, every institution, from the Pride Parade to the Ku Klux Klan, strives for integrity by developing norms and values ​​that help separate insiders from outsiders. It is noteworthy that, having become involved in some institution or ideology, we are simply unable to look at the outside world except through this distorted lens, called the illusion of asymmetric insight.

How well do you know your friends? Do you see how they lie a little to themselves and others? Do you know what is holding them back, do you know their hidden and underestimated talents? Do you know what they want, what they are most likely to do in a given situation, what they will argue about, and what they will turn a blind eye to? Do you notice how they start posing when they feel vulnerable? Do you know the perfect gift for them? Have you ever said with confidence, “You should have been there. Would you really like it” - about something that you enjoyed for them, as if by proxy?

Research shows that you are likely to feel all of this and more. For you, your friends, family members, colleagues and pals are translucent. You easily stick labels to them. You look at them as an artist, a grumbler, a freeloader and a workaholic. “What-what did he do? Ah, well, no wonder." You know who will go with you to watch the shooting stars, and who will not. You know who to ask for advice about spark plugs, and who to ask about growing vegetables. You think you can step into their shoes and predict their behavior in almost any situation. You are convinced that everyone but you is an open book. Of course, studies show that they have the same opinion about you.

“It seems to us that the other person must be somehow defective, otherwise he would see the world the same way as we do — correctly. The illusion of asymmetrical insight obscures our ability to see those we disagree with as deep and complex. We tend to see ourselves and the groups to which we belong in all the variety of shades, but others and their groups as homogeneous and defined only by primary colors, without details and halftones

In 2001, scientists Emily Pronin and Lee Ross The university and a group of other researchers conducted a series of experiments to understand why people see each other in this way. In the first experiment, they asked people to think of their best friend and rate how well they thought they knew him or her. They showed participants a series of images of an iceberg hidden underwater to varying degrees and asked them to choose the image that matched how much they knew their friend's "true nature". They were asked to what extent the true nature of a friend is hidden and visible to others? Then they were asked to answer similar questions about themselves. To what extent is their own iceberg exposed to their friends? Most people described their view of a friend as profound. They saw most of the iceberg above the water. In the opposite situation, it seemed to them that the understanding of a friend was not so deep, and most of their own iceberg was hidden.

The same researchers asked people to describe the moments when they felt most like themselves. The majority, 78%, described something internal, unobservable, such as the feeling they experienced when they saw their child succeed, or the excitement they feel from applause after performing in public. When asked to describe in which areas, in their opinion, the personalities of their friends or relatives are most revealing, people spoke about inner experiences only 28% of the time. On the contrary, they most often talked about actions. We cannot see the internal state of others, which is why we usually do not use these words when describing someone's personality.

As the researchers moved from individuals to groups, they found that the illusion of asymmetric insight was even more terrifying. They asked the participants to identify themselves as either liberal or conservative on one occasion, and on the other as pro-abortion and anti-abortion. Each group filled out questionnaires about their own beliefs and those of the other side, then they rated how deep they felt their opponents' knowledge was. Both groups were convinced that they knew more about their opponents than they did about them. The same was confirmed in the experiment with groups divided according to the principle of attitude towards abortion. The illusion of asymmetrical insight makes us believe that we know more about others than they do about us. Moreover, we know more about them than they know about themselves. This also applies to the groups to which we belong.

Researchers have explained how people become hostages to the illusion of naive realism when they are convinced that their thoughts and views are true, accurate and correct. If someone thinks differently from them or disagrees with them in one form or another, it is only as a result of bias, someone else's influence or their own imperfection. It seems to us that the other person must be somehow defective, otherwise he would see the world just like we do - correctly. The illusion of asymmetrical insight obscures our ability to see those we disagree with as deep and complex. We tend to see ourselves and the groups to which we belong in all the variety of shades, but others and their groups as homogeneous and defined only by primary colors, without details and halftones.

“The moment we feel in that warm comfort of belonging to a team, a tribe, a group—be it a party, an ideology, a religion, or a nation—everyone who does not belong to that group, we instinctively perceive as outsiders.”

Two tribes of children in Oklahoma formed into groups because man has always done so. For all primates, survival and well-being depend on the group, and for humans more so than for others. Creating groups is part of our nature. Sharif's experiment with the boys at Robber's Cave showed how quickly and easily this happens, how our innate desire to make and follow norms will manifest itself even in a cultural vacuum. But there is also a dark side. As psychologist Jonathan Haidt puts it, our minds group us, set us apart from other groups, blind us to see the truth. The moment we feel in that warm comfort of belonging to a team, a tribe, a group—be it a party, an ideology, a religion, or a nation—anyone who does not belong to that group is instinctively perceived as outsiders. Just as soldiers come up with derogatory nicknames for enemies, every culture and subculture has a collection of definitions for outsiders who, by nickname, are more conveniently perceived as a single collective.

In a political dispute, it often seems to us that the other side simply does not understand our point of view, and if the enemy could see the situation with our help, he would understand everything and, of course, would join us. He just doesn't understand what's going on, because if he did, he wouldn't be able to think like that. We, on the contrary, are sure that we understand his point of view and simply find it erroneous and consider it simply stupid. Thus, each side is convinced that it understands the other side better than the enemy understands both them and itself.

In the course of his research, Sharif managed to reunite the boys to some extent. He told them that the vandals had broken the camp's water supply. Both groups united and jointly repaired the water supply. Later, he arranged for one of the trucks to stall, and the boys all pulled it together until it started. They never fully became a single group, however, hostility decreased to a level that allowed them to go home on the same bus. It seems that peace is possible in the face of a common problem, but for now, perhaps, we will still remain in our small groups. We think this is correct.

The truth is that we all succumb to the illusion of asymmetric insight, but as part of the modern world, more tightly connected horizontally, not stopping for a minute, we will be forced to overcome this illusion more and more often. We will have more and more opportunities to meet with those who do not belong to our tribe and form our own opinion about them. Our ancestors rarely had to come into contact with people of opposing views by means other than weapons, so our natural instinct is to assume that anyone who does not belong to our group is wrong for this very reason. Remember, we are not all that smart, and what seems to us insight is often an illusion in reality.

Alexithymia: an emotional gap hiding under the mask of normality

Alexithymia is a psychological state of a person, in which a person, having lost the ability to determine and display his own emotions, is forced to try to look normal in the eyes of others. Psychiatrist Saito Satoru talks about this disorder in his own practice, as well as the characters in the 2016 Akutagawa Prize-winning novel The Minimarket Man ( Kombini ningen , by Murata Sayaka).

In psychiatry there is a term "alexithymia". It consists of the negative prefix "ἀ" and two stems: "λέξις" (word) and "θυμός" (feelings, emotions). This term describes a psychological state where a person is unable to evaluate and describe their own emotions. In order to have a holistic view of one's own life, the individual must be aware of and distinguish what he feels. However, there are people who are incapable of this - they do not understand in what situations this or that emotion arises in them. Features of alexithymia appear in such people in those moments when they are overcome by anger, sadness, or any other strong feeling that they are not able to define and express.

In fact, with the exception of babies, there are practically no people in modern society who would cry or scream, completely without restraint. It is understood that an adult member of society should control himself and not show such primitive emotions outwardly. And if he is not able to restrain himself, then he needs treatment.

Young people striving to conform to the notions of "normality" learn from the older generation to suppress the expression of emotions. Over time, some of them lose the ability to recognize their own feelings. Suppressed anger, sadness become the cause of psychosomatic diseases and hypochondriacal disorders. Hypochondriacs are characterized by a clear manifestation of somatic symptoms in the absence of any significant pathological abnormalities. As a result of an anxious set and constant concern about health, the functions of the heart, gastrointestinal tract and other autonomically innervated systems can be disturbed. And this, in turn, leads to the development of arterial hypertension, peptic ulcer, etc. That is why hypochondria is considered a psychosomatic disease.

However, with alexithymia, not only negative emotions are blurred, but also positive ones - a person is not able to experience such feelings as joy or inspiration. The loss of the ability to experience pleasure is called anhedonia. This disorder is characterized by a loss of motivation for activities that the individual enjoyed in the past. The development of anhedonia is an important indicator in the diagnosis of pathological depression.

Under the guise of normality

I have my own psychiatric practice in Tokyo, and I encounter people suffering from depression and hypochondria on a daily basis at work. During the first meeting, most of them show no signs of suffering or despair. And I have to pull off their mask of normality, under which they hide their illness, which needs treatment.

Cover of "Convenience Store Man" (illustration courtesy of Bungei Shunju)

I thought about this when I read the novel "Convenience Store Man" for which Murata Sayaka recently won the Akutagawa Prize. Indeed, in this story we are talking about a person suffering from alexithymia. The heroine, a woman named Kokura Keiko, worked for 18 years as a saleswoman in the same minimarket ( combi) - it is on her behalf that the story is being told. She made it a rule never to show her feelings or express judgment. Instead, she has created a "patchwork personality" by copying the behavior and adopting the habits and mannerisms of the women around her (mostly work colleagues), whom she considers correct and admires for their style. This effective and convenient strategy allows it to adapt to its own environment. The moment she arrives at work shortly before the start of her shift and changes into her work uniform, Keiko becomes a function, a convenience store man. Now all that is required of her is to perform the prescribed duties for the appointed time, using the skills she has learned and the judgments she has borrowed appropriate to the occasion. The school years of the heroine passed under the endless complaints of parents who were dissatisfied with their individualistic daughter, and constant pressure from school teachers. As an adult, she is grateful for the opportunity to hide her identity under a faceless uniform.

However, when Keiko suddenly realizes that those around her feel sorry for her - a single woman who worked as a saleswoman in a minimarket for 18 consecutive years - she becomes extremely worried. At this moment, she meets a new minimarket employee, a man who is the complete opposite of her. He is convinced that society has turned its back on him and that everyone is hounding and persecuting him. So he doesn't even try to appear normal, and very soon he is fired from the convenience store. Keiko invites him to stay with her. At first glance, it seems that they are a very harmonious couple, but their relationship is built on a cold calculation. For a workaholic Keiko, this is an opportunity to create the appearance of a romantic relationship; for a lazy man, life with Keiko is an excellent hiding place from the injustice of a cruel world. But their life together upsets the fragile mental balance that Keiko has maintained and strengthened in herself throughout all these eighteen years.

The caustic remarks of her roommate expose her spiritual emptiness, the gaping emptiness of her personal space, which Keiko had refused to notice for so many years. Refusal, denial is a primitive psychological defense mechanism, a subconscious attempt to ignore the problem, the existence of which is obvious to any outside observer. And the one who denies the obvious looks infantile and eccentric in the eyes of others.

Realizing the hopelessness of his situation, Keiko quits his job and ceases to be a "man of the convenience store". She has no choice but to lie all day under the covers, on the futon, which she spread out inside the closet. I call this phase "bed addiction" and I believe that it is the starting point for the development of other types of addiction: from drug or alcohol addiction to sexual addiction. In fact, both addictive behavior and "show normality" are desperate attempts to get out of the quicksands of the emotional vacuum.

This story has a somewhat happy ending - Keiko starts working at the convenience store again. But I do not think that this will make many readers laugh too much, as they notice the connection between excessive obsession with work and the meaninglessness of the heroine's personal space.

Refusal to feel

"Bed addiction" is essentially a regression to the so-called "primal sleep" - a dream-like state characteristic of infants. This is exactly the state that heroin addicts so passionately desire to achieve. A similar process of regression is also experienced by recluses.0067 hikikomori . Every day this quagmire sucks in hikikomori more and more, and getting them out of it is not an easy task.

Here it is important to pay attention to one point. A baby who falls asleep while nursing and wakes up to find that he has been taken from his mother's breast will feel restless, angry, flushed and crying.

Older babies (between a year and a half) also live in a world of basic emotions such as anger, anxiety, depression or sadness. But adults hikikomori are deaf to these emotions. At first they themselves refuse to feel anything, and then they simply lose this ability and fall into a state of alexithymia.

Break free from the spell of "normality"

Such people sometimes come to my clinic for help, mistaking their condition for depression. For example, a housewife came to me who told me that after graduating from university she got a job at a firm right away, but worked for only a year, because office work seemed boring to her. She then found a part-time job at a sadomasochistic (SM) club, a place she liked so much that she worked there for four years. Shortly before she turned thirty, she resigned from the club, judging that sooner or later she would have to do it anyway. Some time later, after an active search for a suitable party ( konkatsu ) she got married, had a baby, and began to lead a "normal" life as a housewife. And then she suddenly found that she spends most of the day in bed or in close proximity to it.

Her husband - a typical sissy, who also suffers from atopic dermatitis - quickly realized that his wife would not take care of him to the same extent as his mother did, and divorced her. At the time of her visit to me, about a month had passed since the divorce.

I think some of my colleagues would have diagnosed this patient with depression or adjustment disorder and would have given her antidepressants. But I noticed how strong her desire to be, or at least seem normal.

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