How to deal with Toxic Stress

“Unhappy childhoods will kill you as an adult.” –  Anon

 

Here is the article I promised on how to deal with Toxic Stress. The previous article described what Toxic Stress was and how you identify it. Just as a reminder.

The starting point was that there was a series of research programmes that identified the impacts of stress on us as we grow up.  Adverse Childhood Experiences, or ACEs as they are called, comes from the USA CEntre of Disease Control “CDC-Kaiser Adverse Childhood Experiences Study”, a groundbreaking public health study that discovered that childhood trauma leads to the adult onset of chronic diseases; depression and other mental illness; violence and being a victim of violence. The 10 ACEs the researchers measured can be summarised as follows:

  • Physical, sexual and verbal abuse.
  • Physical and emotional neglect.
  • A family member who is:
    • depressed or diagnosed with other mental illness;
    • addicted to alcohol or another substance;
    • in prison.
  • Witnessing a mother being abused.
  • Losing a parent to separation, divorce or other reason.

Of course, there are many other types of childhood trauma — such as witnessing a brother or sister being abused; witnessing violence outside the home; witnessing a father being abused by a mother; being bullied by a classmate or teacher. However, the point was, that only 10 types were measured. with 17,000 people in the survey and 19 years of data.,; it is pretty accurate from a stats perspective.

The study uncovered a stunning link between childhood trauma and the chronic diseases people develop as adults, as well as social and emotional problems. This includes heart disease, lung cancer, diabetes and many autoimmune diseases, as well as depression, violence, being a victim of violence, and suicide.

The good news is that the brain is plastic, and the body wants to heal.

The brain is continually changing in response to the environment. If the toxic stress stops and is replaced by practices that build resilience, the brain can slowly undo many of the stress-induced changes experienced early on.

There is well-documented research on how individuals’ brains and bodies become healthier through mindfulness practices, exercise, good nutrition, adequate sleep, and healthy social interactions.

And this is where I thought about the practices I have undertaken and the groups I have worked with; young people generally; people in treatment and finally; those young people I have worked with in prison.

Any treatment programme you undertake has to have the three core elements – physical, social and mental to ensure it works.

From a mental perspective, mindfulness is one of the NHS recommended programs. Just practicing mindfulness, without the other elements of leading a fuller life is fraught with failure.

You have got to take time to understand what the physical environment is contributing to your stress levels. Where you work; how you commute; how you take time out during the day.

Finally,  from a social perspective, do you have the friends and family relationships that you feel support and encourage you? Perhaps you might need to expand you social group. Join a  group that is looking to support its members in reducing stress. Perhaps joga. Perhaps a sport group? Whatever takes your fancy.

If you would like to take the Resilience Score and find out you would deal with stress, then go to:

http://acestoohigh.com/got-your-ace-score/
I leave you with the following quote:

 

“When we are true to ourselves, all that is toxic and burdensome simply falls away”  ― Dina Hansen

Toxic stress and its impact on you

“Unhappy childhoods will kill you as an adult.” –  Anon

 
We all know that how we are treated as children has a profound effect on us as adults. If you are surrounded by people that smoke; you are more likely to smoke. Likewise with drink and drugs. We also know that unhappy experiences in childhood – such as being bullied, abused or neglected – are more likely to lead to mental health issues in later life. On the flip side, if you are brought up in a loving, kind filled and inclusive family; you are more likely to reflect that yourself as an adult.

Driving home late the other evening; I was listening to a programme on the radio which literally made me stop the car to listen. I sat in rapt attention as I heard the presenter talk about the impact of childhood stress on adult life.

What was being discussed was that chronic stress and anxiety during childhood can trigger dramatic changes in the body which contribute to our risk of developing life threatening diseases like diabetes, heart disease, cancer and strokes. Chronic stress in childhood is also associated with a shortened life span. The term that is used to describe this is “Toxic Stress”.

Toxic Stress:

So what are some of the symptoms of toxic stress? These were some of the symptoms that doctors see in children that exhibit toxic stress. They include:

  • Wired and tense bodies.
  • They have a self perception of being wound up tight like a spring
  • Shallow and rapid breathing, somewhat like panting
  • Faster than normal heart rate
  • Feeling threatened and in constant danger
  • Stress levels that do not decrease with time, rather they are constant

What causes the stress and what is the impact on the child as it grows up?

 

ACE: stands for Adverse Childhood Experiences

These childhood experiences harm the children’s developing brains and bodies so profoundly that the effects show up decades later. They cause many chronic diseases, most mental illness, and are at the root of most violence.

“ACEs” comes from the USA centre for Desease Control CDC-Kaiser Adverse Childhood Experiences Study, a groundbreaking public health study that was carried out in 1997. The ACE Study has published over 77 research papers that time. Hundreds of additional research papers based on the ACE Study have also been published, across the globe, including a fantastic paper in the UK where 3,885 people nationally tok part that correlates to the statistics below. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4552010/

The original study used a survey and interviews with 17,000 people to identify and measure 10 adverse experiences that have a dramatic effect.They have continued to actively monitor those people throughout their lives for the past 19 years, updating and refreshing the results over time.

NOTE: The 17,000 ACE Study participants were mostly white, middle- and upper-middle class, college-educated, and all had jobs and great health care. In effect, mostly like you or I.

The 10 Adverse Childhood Experiences the researchers identified are as follows:

  1. Did a parent or other adult in the household often or very often… Swear at you, insult you, put you down, or humiliate you? or Act in a way that made you afraid that you might be physically hurt?
  2. Did a parent or other adult in the household often or very often… Push, grab, slap, or throw something at you? or Ever hit you so hard that you had marks or were injured?
  3. Did an adult or person at least 5 years older than you ever… Touch or fondle you or have you touch their body in a sexual way? or Attempt or actually have intercourse with you?
  4. Did you often or very often feel that … No one in your family loved you or thought you were important or special? or Your family didn’t look out for each other, feel close to each other, or support each other?
  5. Did you often or very often feel that … You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? or Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?
  6. Were your parents ever separated or divorced?
  7. Was your mother or stepmother: Often or very often pushed, grabbed, slapped, or had something thrown at her? or Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? or Ever repeatedly hit for at least a few minutes or threatened with a gun or knife?
  8. Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs?
  9. Was a household member depressed or mentally ill, or did a household member attempt suicide?
  10. Did a household member go to prison?

 

Impact on us all:

What made me sit up was some of the statistics and impact on us as adults. They included:

 

  • 64% of the population have 1 or more category and could be impacted healthwise.

 

  • One in eight people have 4 or more categories and if you are one, you will be,
    • are twice as likely to be smokers;
    • Seven times more likely to be alcoholics or to be binge eaters;
    • 460% increase in depression and
    • 1,200% more likely to commit suicide
  • If you have 6 or more categories, you will be:
    • 3,100 to 5,000% – yes these numbers are correct – more likely to commit suicide
    • 4,600% more likely to be a serious drug or alcohol user
    • You can take up to 20 years off your life. Yes. You could die 20 years earlier than normal

So why does toxic stress affect children so much?

When children are overloaded with stress hormones, they’re in flight, fright or freeze mode. They can’t learn in school. They often have difficulty trusting adults or developing healthy relationships with peers and often become loners, which re-enforces their sense of isolation. To relieve their anxiety, depression, guilt, shame, and their inability to focus, they turn to easily available tean solutions: excessive eating (rarely eating disorders such as anorexia nervosa), cigarettes, alcohol, and drugs. In addition, they take part in activities in which they can escape their problems; high-risk sports, many sexual partners, and even illegal activities such as drug dealing, stealing, mugging, joy riding, etc.

Using drugs or overeating or engaging in risky behavior leads to consequences. For example, smoking can lead to COPD (chronic obstructive pulmonary disease) or lung cancer. Overeating can lead to obesity and diabetes. In addition, there is increasing research that shows that severe and chronic stress leads to bodily systems producing an inflammatory response that leads to disease.

How can you counteract this?

Fortunately, the bodies ability to recover is remarkable. In addition, the brain is not fixed in its make up either. I will further explore how you can make positive changes in a separate article to follow up on this one.

 
Further resources available:

BBC Radio show that prompted this article – Unhappy Child, Unhappy Adult:

http://www.bbc.co.uk/programmes/b070dksr

Great TED talk on How childhood trauma affects health across a lifetime from Pediatrician Nadine Burke Harris:

http://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime?language=en

New York Times article:

http://opinionator.blogs.nytimes.com/2013/10/30/protecting-children-from-toxic-stress/?_r=0

ACE – Adverse Childhood Experiences (ACE) Study

http://www.cdc.gov/violenceprevention/acestudy/
I leave you with the following quote:

“When we are true to ourselves, all that is toxic and burdensome simply falls away”  ― Dina Hansen

How your brain is affected by stress

“Whatever may be the tensions and the stresses of a particular day, there is always lurking close at hand the trailing beauty of forgotten joy or unremembered peace.”  Howard Thurman, Meditations of the Heart

 
I like to understand the theory and the science behind how we think, act and how our brains work. One of the biggest changes I have made over the past two years has been to take up Mindfulness and practice this as often as possible. I have read a number of articles on the benefits of Mindfulness and one of the biggest benefits is helping to reduce stress.

So, let’s start with understanding what stress is?

Stress is caused by two things. Firstly, it is linked to whether you think situations around you are worthy of anxiety. And the second is to how your body reacts to your thought processes. This instinctive stress response to unexpected events is known as ‘fight or flight’.

“Fight or Flight” responses are the base animal like tendencies you see in nature. The zebra sees a lion in the bush. Their instinctive reaction is to flee. A gorilla sees another gorilla and his first reaction is to fight. We have exactly the same base responses to situations. These are hard-wired reactions to perceived threats to our survival.

Stress happens when we feel that we can’t cope with anxiety and this creates unmanaged pressure. We experience it almost any time we come across something unexpected or something that frustrates our goals. When the threat is small, our response is small and we often do not notice it among the many other distractions of a stressful situation. Many day-to-day situations can set it off – a change of home, a difficult boss at work, relationship issues, divorce, demanding children, traffic jams, being late for an event, etc. Almost anything can create a stressful situation.

The more often we are exposed to these types of stresses, the more overactive our fight or flight response becomes until we find ourselves operating at fever pitch level. Constantly prepared for battle, perceiving potential threats everywhere. That is why people who are over stressed not only show physiological symptoms such as high blood pressure, rapid heart rate or shallow fast breath; they can seem overly sensitive or aggressive. Today many of us don’t take enough physical exercise to ‘burn off’ the effects of our response and we’re left with stress build up. We learn to control our reactions, but this does not counteract the stress response.

With a stress response, the body influences the brain and the brain influences the body.

So if we experience a danger for the first time then that’s going to make us feel stressed and we will both remember the stressful situation, the trigger and we will remember the response. There have been numerous studies where people who are frightened of something; or who have experienced a stressful situation in the past; are exposed to the experience and their responses are measured. Even without the actual object being present, it is possible to elicit the response with just a picture or even the name of the object.

Think for a moment if you are frightened of something – a spider, a snake, swimming, anything. Now see how you feel when you imagine it. That is remembered stress response.

Since this is something you have “learned” through experience, it is also something you can learn to manage, deal with and hopefully reduce.

If you were to speed up your breathing on your own, you’d probably start to feel a bit more aroused and on edge. And, equally, if you calm the breathing down, you’re kind of forcing your body into a more relaxed state and you will then experience probably fewer negative thoughts as a result. When we’re stressed, our brains almost come up with negative thoughts to try and explain why we’re stressed. However, if you can just calm those thoughts and reactions down, then that’s going to have a beneficial effect on your levels of stress and mental state as well.

Your brain reflects the way that you think throughout your life. You shape it by your thoughts and your behaviors. If you play the piano for eight hours a day, then the parts of the brain responsible for helping you to play the piano will get larger. If you’re thinking stressful thoughts for the whole day then those parts of the brain are going to get larger and other parts of the brain will deteriorate. So the task is to change the way you think about situations and use techniques to help “quieten” down those stressful thoughts.

One program that was founded in the USA by Doctor Jon Kabat-Zinn, is the Mindfulness-Based Stress Reduction Program. Started in the mid-1970’s, over 40,000 people have completed the eight-week program and there are MBSR programs running in over 30 countries. As the name says, it is Mindfulness – Based – Stress – Reduction.

Like any medicine, or program, or event a physical activity, MBSR, takes time. It is not an instant wonder answer. That is why it takes at least eight weeks for the program to be completed and for you to notice the effects. For me, I noticed the changes after about week four. For others, it can be quicker of slower. However, you can see the benefits in both your own mind; how you deal with life’s situations and finally, the mind begins to quieten. Those rushing thoughts begin to slow down.

If you want to listen to a couple of really great podcasts on stress and the brain, I’d recommend the following:

https://hbr.org/2013/12/reduce-stress-with-mindfulness/

Harvard Business School – Reduce Stress with Mindfulness

http://www.mindful.org/what-stress-does-to-your-brain/?utm_source=Mindful+Newsletter&utm_campaign=5314fba02b-MF_Weekly_Feb_9_20161_9_2016&utm_medium=email&utm_term=0_6d03e8c02c-5314fba02b-21359661

Mindful Magazine – What stress does to your brain?

 

I leave you with the following quote:

“The reason many people in our society are miserable, sick, and highly stressed is because of an unhealthy attachment to things they have no control over.”

Steve Maraboli, Unapologetically You: Reflections on Life and the Human Experience

Standing in line and Mindfulness

“He said that life boils down to standing in line to get shit dropped on your head. Everyone’s got a place in the queue, you can’t get out of it, and just when you start to congratulate yourself on surviving your dose of shit, you discover that the line is actually circular.” ― Scott Lynch, The Republic of Thieves

 

Queueing or standing in line. We all do this. Whether it is at the supermarket, with the option for you to queue and be served by a checkout assistant or to serve yourself at the self checkout point. At  the retail shop, where you are going to buy that “fantastic and must have” new item of clothing.  At the petrol station, where you have to queue to fill your car up with fuel and then have to queue again to be able to pay. In a traffic jam, where people continually lane jump in the vain hope that they will “beat the queue”. Or even at a restaurant, where you queue to be seated, you queue to be served and finally, you queue to even pay for the service that you have queued for. And it was this last example that fired my need to write this article.

I came across the following statistic: Britons will spend almost six months of their life queuing, according to research published in 2009. The average adult wastes a five hours and 35 minutes queuing each month, with standing in line at the supermarket taking up the biggest amount of time.

A number of coincidences occurred to me at the same time that made me think and reflect about how I deal with queueing, or standing in line, waiting my turn.

Queue time distortion:

There was a BBC radio item on why people perceive that the queue they standing in moves more slowly than the one nearest to them. According to a new book, “Why Does the Other Line Always Move Faster?”, we experience time differently when engaged in a task, as opposed to waiting. So, when shoppers pick the a line to stand in, they fail to notice the fastest line because they are busy thinking about packing bags and paying for their goods. But while waiting to be served, they spot the other lines moving faster.

Author David Andrews said: “Our minds are rigged against us. Regardless of time actually spent, the ‘slowest’ line will always be the one we are standing in.” He added, that probability also plays a part; if there are three queues, there is a two-in-three chance that the others will move faster than yours. One way to cut queuing time is to pick the line with the most men, according to experts at the University of Surrey. They found men were more impatient than women and more likely to give up on a queue if it was too slow. Other tips include picking a line on the left, because most people are right-handed and will naturally veer to the right. This is an advantage for me, as I am left-handed. I also tend to keep in the left-hand lane when driving down the motorway which tends to move more quickly.

Secondly, Queue Mindfulness:

This video from Sharon Salzberg arrived in my inbox via the Wildmind website free news feed. It describes a simple practice of bringing mindfulness and kindness into the act of queueing, as we say in the UK.

This is something I do a lot. I have found that standing in a queue and practicing a short breathing exercise really helps me to keep grounded and calm. I also find that practicing mindfulness when I am in a traffic queue really helps. Too often I see people literally explode when waiting in a queue. Shouting and gesticulating their frustration. Sharon goes one step further and suggests a forgiveness exercise. I will give this a try as well.

Video: Standing In Line STREET LOVING KINDNESS with Sharon Salzberg

https://www.youtube.com/watch?v=k-4nPiKkttw

Wildmind website for you to subscribe to their daily Mindfulness news items:

http://www.wildmind.org/about/why-wildmind
Oh, and as for the picture of the cows. Well, they too wait to be milked in the morning and evening. Plus imagine yourself in that queue! I leave you with the following quote:
“An Englishman, even if he is alone, forms an orderly queue of one.” ― George Mikes

Kindness, Resilience and Mindfulness

“When you wake up in the morning, tell yourself: The people I deal with today will be meddling, ungrateful, arrogant, dishonest, jealous, and surly. They are like this because they can’t tell good from evil. But I have seen the beauty of good, and the ugliness of evil, and have recognized that the wrongdoer has a nature related to my own—not of the same blood or birth, but the same mind, and possessing a share of the divine……….  ― Marcus Aurelius, Meditations

 
At work, we recently ran whole organisation management meeting day. I am not sure if you do these in your place of work, but in ours, we have a day where we bring together all of the managers, supervisors and team leads from across the division, to share key messages and also help develop and share common programmes of activity across all the teams. Our theme was all around leadership and employee engagement.

We try to get external speakers along to these events. It makes them more interesting and also, helps to provide a different perspective on the day. FOr our event, we invited Dr Risk Norris, who is a visiting Consultant Psychologist at a Hospital in the Midlands where he counsels clients suffering from stress, anxiety and depression. He has also written a book on positive thinking Think Yourself Happy – the simple 6-step programme to change your life from within. So my interest, both work-related, as well as from a counselling perspective was peeked.

Hs talk was around leadership and he introduced the results of a Gallup survey on “Productive Culture at Work”. The top ten items people rated were listed and he asked us to choose the single most important one, that most people rated, above everything else. The list is below. Take a moment and you choose.

The Gallup “Productive Culture Survey”,

  1. know what is expected of me at work
  2. I have the materials and equipment I need to do my work well
  3. At work, my manager gives me the opportunity to do what I do best everyday
  4. I receive recognition or praise for good work from my manager
  5. My manager seems to care about me as a person
  6. My manager encourages my development
  7. At work, my manager takes my opinions into account
  8. My co-workers are committed to doing quality work
  9. I talk with my manager about my progress
  10. My manager gives me opportunities to learn and develop

 

Did you choose one?

Now, you might be surprised, or not; that THE most important aspect that people rated was……. drum roll, please………………………

 

 

Number 5. My manager seems to care about me as a person.

 

Kindness

The idea of caring for someone else. Not the artificial “have a great day” variety. But genuine, honest kindness in another human being. Something that is at the heart of the Loving Kindness meditation practice that I practice. Caring for your colleagues at work has long been discussed, but few managers actually engage with their staff and care. I checked out the latest global engagement survey results from Gallup and they make for really sad reading. Check them out below.

http://www.gallup.com/poll/165269/worldwide-employees-engaged-work.aspx

Only 13% of employees worldwide are engaged at work, according to Gallup’s 2013 142-country study on the State of the Global Workplace. In other words, about only one in eight workers, are psychologically committed to their jobs and likely to be making positive contributions to their organizations. Even if you read the latest UK reports, employee engagement is in the low 30% mark in the UK.

This means, that for most people, 70% or more, feel disengaged at work. Work, that is the greatest part of their lives. No wonder, stress, depression and loneliness are on the increase. You can talk about employee engagement programmes. You can send managers on training courses and retreats. However, it is the everyday acts of kindness that we show to each other that make the difference. Genuine, honest individual acts of kindness.

Resilience

The question is, is the ability to stay focused on the present moment in a non-judgmental way a powerful catalyst for resilience? New research from India points to a partial answer: Mindfulness breeds resilience.

That’s the conclusion of researchers Badri Bajaj and Neerja Pande. Writing in the journal Personality and Individual Differences, they confirm that psychological resilience is more pronounced in mindful people. The researchers also provide evidence that this highly useful quality produces many of the practice’s much-touted benefits.

They describe a study featuring 327 undergraduates (236 men and 91 women). The students completed a series of surveys measuring their mindfulness, life satisfaction, emotional state, and level of resilience—the ability to cope in difficult situations, and bounce back from adversity.

Mindfulness—or a lack thereof—was measured by their responses to 15 assertions, such as “I tend to walk quickly to get where I’m going without paying attention to what I experience along the way.” To gauge their resilience, participants were presented with 10 self-descriptive statements, including “able to adapt to change,” “can stay focused under pressure,” and are “not easily discouraged by failure.” They responded to each on a five-point scale (“not at all” to “true nearly all of the time”).

As predicted, the researchers found “individuals with higher mindfulness have greater resilience, thereby increasing their life satisfaction.” “Mindful people … can better cope with difficult thoughts and emotions without becoming overwhelmed or shutting down (emotionally),” they write. “Pausing and observing the mind may (help us) resist getting drawn into wallowing in a setback.”

Put another way, mindfulness “weakens the chain of associations that keep people obsessing about” their problems or failures, which increases the likelihood they will try again. in addition, mindfulness also promotes self-compassion, which leads to higher levels of happiness.

 
I leave you with the following quote……. it is the second half of the quote that started this article.

…….. And so none of them can hurt me. No one can implicate me in ugliness. Nor can I feel angry at my relative, or hate him. We were born to work together like feet, hands, and eyes, like the two rows of teeth, upper and lower. To obstruct each other is unnatural. To feel anger at someone, to turn your back on him: these are obstructions.” ― Marcus Aurelius, Meditations

 

What’s been missing in my Mindfulness practice?

“You’ll miss the best things if you keep your eyes shut”. – Dr. Seuss, I Can Read With My Eyes Shut!

As I have written before, I practice Mindfulness on an almost daily basis. I have been practicing and experiencing the benefits for the past eighteen months. I have found the ability to be fully aware in the present moment really uplifting, both at work and also at home. I have been calmer, more peaceful and more engaged with life in general.

However, just recently, in fact, this past month, I have felt that I have not been as present as I was before. I have felt disconnected and more “stressed”.

Was it work related? I was given a “wonderful work opportunity” just before Christmas. It is a very compressed project that would have normally taken three months to complete and instead try to do in one month. This has meant 8am to 6pm conference calls every day of every week since the New Year and a lot of work related pressure. Nope, it is not that.

Was it social related? I am just about to start a new volunteer role in the scouting movement, so have been spending a raft of time thinking and planning the new role. In addition, I attended the first scouting meeting of the year and I missed the first group Mindfulness session of the year. So, what that the cause? Nope.

Was it family related? We are looking to save to go on a foreign holiday this year as an expanded family group, which means we are trying to plan a trip for ten people and at the same time try to economize and budget for the holiday. Nope, it has not been that either.

Finally, is it because it has been dark, wet and miserable so far this year and I have not walked and exercised as much. Nope.

I now know what it is. I changed my morning Mindfulness routine slightly and instead I have been practicing a basic breathing mindfulness practice. I have not practiced the Metta Bhavana, or Development of Lovingkindness practice for over a month.

The practice helps us to actively cultivate positive emotional states towards ourselves and others so that we become more patient, kind, accepting, and compassionate. It covers:

  • lovingkindness
  • compassion (empathizing with others’ suffering)
  • empathetic joy (rejoicing in others’ wellbeing and joy)
  • and equanimity (patient acceptance of both joy and suffering, both our own and others’).

That at is why I have felt disconnected and more “stressed”. I have forgotten the five major premises of the practice, that of:

The practice is in five stages. We cultivate the practice for:

  • Loving kindness to ourselves
  • Loving kindness to a good friend / loved one [at one stage late last year, it was a whole group of people]
  • Loving kindness to a “neutral” person — someone we don’t have any strong feelings for
  • Loving kindness to a “difficult” person — someone we have conflicts with or feelings of ill will towards
  • Finally, Loving kindness to a all sentient beings

I have restarted the practice and can already feel the benefits. f you practice Mindfulness, I’d love to hear if you too have seen the impact of the Loving Kindness Meditation practice and its positive results on yourself.

I leave you with the following quote which really touched me when I came across it:

 

“We leave you a tradition with a future.

The tender loving care of human beings will never become obsolete.

People even more than things have to be restored, renewed, revived, reclaimed and redeemed and redeemed and redeemed.

Never throw out anybody.

Remember, if you ever need a helping hand, you’ll find one at the end of your arm.

As you grow older, you will discover that you have two hands: one for helping yourself, the other for helping others.

Your “good old days” are still ahead of you, may you have many of them.”

Sam Levenson, In One Era & Out the Other