Thursday, October 30, 2008

Reality Sandwich: Meditation for Life: The Spirit of Grieving

    Adam Elenbaas

In a recent scientific study conducted at the University of California Los Angeles, researchers examined the neurological processes surrounding short and long term grieving. The results, although partially speculative, provide an excellent backdrop for a conversation regarding meditation and its age old role in coping with sadness, depression and personal loss.

The study at UCLA examined 23 women who had lost a loved one within five years, eleven of whom still suffered from what psychologists call "CG" or "complicated grief": prolonged grieving resulting in depression, stress, fatigue, and lowered immune efficiency. While monitoring brain activity, researchers showed each woman pictures of her deceased loved one or words and phrases strongly associated with her deceased loved one. The results, as expected, showed that each woman in the study had social pain and grieving effects related to the images and words. But the interesting result was the commonality that all of the "complicated grievers" showed during the brain monitoring.

Each of the complicated grievers demonstrated high reward, pleasure, and addiction activity responses in the brain, in addition to the social grieving response. This finding suggests that brain interference could be responsible for "complicated grieving," and its fallout symptoms: fatigue, depression, stress, lowered immune efficiency and an inability to let go of the past. Some puzzling results, right?

Well, science is a funny thing. After all, it was the human mind that created the scientific method and rationalism, not the scientific method that created the rational mind. In other words, it's important to remember that human experience, in its full palette, inspired this kind of study in the first place. Therefore, interpreting the results of scientific data in a healthy conversation is the fertile ground where we might determine which seeds of cultural evolution are worth planting next. So what might this study imply about depression and how might it relate to meditation?

Let's make a few assumptions. Let's assume that being healthy and strong and "selfcentered" means that you are independently happy. In other words, you have established a healthy balance between the outside world (food, shelter, nature, clothing, jobs, people) and your inside world (emotions, thoughts, words, and actions). Now let's assume that people are thrown out of balance when they place too much emphasis on their internal world or the external world to create that sense of harmony and well being. In the case of the UCLA study, how would these assumptions about health filter out?

Let's say that your internal world feels terrible. You don't like who you are. You don't like your emotions, or they are too much to handle. Your mind moves too fast. You don't enjoy life. And you're always questioning what you say or why you said it. The immediate answer is often to look for another human or something outside to fix what is going on inside. It's not a terrible impulse. Sometimes it works. Sometimes when I'm feeling sad inside I will call a friend for a reminder that I am strong and special. Then something inside of me clicks over and I say, "Oh yeah, that's right. I am doing just fine." And in most of my friendships there is an equal balance of giving and taking from one another. We call each other for help about the same amount, or else we would start resenting each other.

But sometimes we get into relationships that are based around a constant and habitual need for something that we simply do not know how to do inside yet. It's as if we each have a muscle inside of us that must learn, as we grow up, to lift ourselves up when we need help and happiness. When this muscle has atrophied (because our parents didn't do a good job or because we got into a bad habit, or you believe in Karma, or sin, etc,) we often look for all of our strength in someone else, a relationship of some kind. It's human to need love, right?

On the surface this kind of relationship might seem perfectly normal. It might seem like love. When I'm weak my partner makes me strong and when my partner is weak I make them strong. However this isn't how it works. Instead it usually works like this: When I am weak my partner is strong, and when I am strong my partner is weak.

This unhealthy relationship looks like a seesaw. One person is always out of balance because of the other. This is not intimacy. Instead it is a constant and competitive swing between high and low that is most commonly associated with extreme behavioral disorders and addiction. Whereas the image of intimacy is more like a yoke of oxen. Life can be difficult and challenging. So it's important that if we're carrying a load, the ox on the left and the ox on the right have an equal amount of weight distributed between them. This means that each person has the same amount of internal muscle strength.

We often wonder why the divorce rate in our country is so high. Maybe it's because many relationships are unhealthy "seesaw" addictions instead of compatible teammates walking with equal weight distribution? And maybe when we see folks grieving for excessively long periods of time after losing a loved one it is because their relationship to that person was more like the see-saw addiction than a balanced relationship? In the wake of losing such a relationship a person might have to go through a prolonged period of sadness, just like a drug withdrawal.

How miserable would it be to withdraw from a person instead of appropriately mourning their passing? How confusing and painful. But it happens all of the time. So here's where meditation comes in. Because the obvious question to ask is, "How can we avoid these imbalanced relationships or how can we heal ourselves if we're coming out of an imbalanced relationship?"

I'm a meditation teacher, and I practice daily so perhaps I'm partial. But meditation is a way to develop the internal muscle that is needed to lift yourself off the mat when you feel like life is beating you up. Meditation has been proven to be of great help to people fighting or coping with behavioral disorders: people in AA or drug rehab, schizophrenics, terminally ill medical patients, and many others. By mediating and getting quiet inside we learn how to find happiness within ourselves, and we learn how to develop that internal muscle of self-love. As a healing technology, meditation is great for rehabilitating our wounds and could be a natural way for a person coping with prolonged grief to start reprogramming their mind and body to something new.

On the flip side, meditation is like preventative health care because strengthening that muscle makes it difficult to get into a co-dependent relationship in the first place (although the club might not be a fun place to meet people any longer, and you might become pickier about who you're thinking of spending your time with).

In closing it is interesting to think that since the dawn of time the indigenous peoples of our planet had ways of mending unhealthy relationships after death. In both the Hindu and Christian traditions, for example, early tribes and families had ritual times of mourning and releasing sadness. Beyond this it was thought of as inappropriate to mourn because it would tamper with the deceased soul's ability to travel forward beyond the earth. In fact, some cultures believed that excessive grieving trapped spirits on the earth and made them angry, causing a tribe to be haunted or cursed. In these situations special medicine men or religious authorities would sing songs and create additional healing rituals in order to detach a soul from the griever. Sometimes people would be sent into wilderness vision quest ceremonies to meditate for weeks and weeks in order to heal their minds and say a proper goodbye before they were allowed back into the community.

Is it so different today?

Newsday.com: Mental health, perspective in economic crises


BY TONI RAITEN-D'ANTONIO | Toni Raiten-D'Antonio is a private practice psychotherapist and professor of social services at the Hauppauge branch of SUNY Empire State College
October 30, 2008


Switch on the TV news and you hear about a Massachusetts woman facing foreclosure who committed suicide, and a man from Nebraska who abandoned his children because he was overwhelmed by his responsibilities.

Want more proof that people are coming unhinged over the economy? Check out the recent American Psychological Association study reporting a stark rise in headaches, stomachaches and muscle tension - all caused by money worries. Given the headlines, you might expect that psychotherapists are seeing sky-high anxiety in their patients. In my private practice the opposite is true.

While others fret and grieve, nearly all of the men and women I see for therapy are moving quickly through the shock of recent economic events to important realizations about themselves, their social environment and the truly important things in their lives. For them, the sudden decline of a retirement account or the impending loss of a home has been the equivalent of being diagnosed with a life-threatening illness. The initial shock is followed by intense self-reflection and a decision to create a new perspective on life that is, in every way, better.

In the analysis stage, I hear patients acknowledge that they have long been in a kind of trance, eagerly buying stuff - cars, houses, clothes, etc. - under the assumption that objects could make them feel good. Deep inside they had harbored doubts about this status-oriented way of life, but everyone they knew had fallen under the same spell, which was reinforced by an overheated consumer culture and a false sense of wealth based on credit.

Some even felt that all the getting and consuming was patriotic. Didn't the president ask us to go out shopping in response to 9/11?

Others recognized the shallow roots of happiness bought with home equity loans, but chose denial over defying the culture. Competition over who had the best stuff was rampant and "normal."

Now that the real estate and financial markets have collapsed, the spell is broken and thoughtful people are searching for a way to transcend the sense of crisis. They aren't looking for a solution in the mass media, which once encouraged us to find happiness in things and now demands we feel frightened and desperate. While they accept that certain things, like the Dow, are beyond their control, they find that true happiness lies with their relationships, creative pursuits, and caring for themselves and others.

In other words, they are pursuing mental health instead of material wealth.

One older woman put it to me this way: "Hug your kids. Feed your friends. Pet the dog."

A recently married younger woman said, "I'm finding out that coping with this is actually romantic. We're in it together, creating solutions. It actually feels good, in a weird way."

As my patients deal with the crisis, they give me hope that just like them, our society will set new priorities and grow wiser. This is what happened during the Great Depression, when people were forced to abandon materialism. The playful popular music and films of the time reflected this process, and it's there that one film buff who sees me for therapy finds inspiration.

Last week, she recalled how the good witch Glinda in "The Wizard of Oz" reminded Dorothy that she had always held the power to go home to Kansas - to find peace - within herself. Fortunately for us, we don't have to travel at all to realize the same truth.

Tuesday, October 21, 2008

The Guardian: Pet Theories

 

American researchers have discovered that owning a pet can significantly reduce your risk of a common cancer. And that's not all, says Emine Saner

The Guardian,
Emine Saner 
The body of evidence supporting the notion that pet ownership is good for your health grew even fatter this month. A new study, published in Cancer Epidemiology Biomarkers and Prevention, found that keeping animals can cut the risk of developing the relatively common cancer of the immune system, non-Hodgkins lymphoma, by almost one third.
Hamster"The idea that pets and good health are associated goes back 20 years or more," says Dr June McNicholas, a psychologist who has researched the relationship between people and their pets. The catalogue of health plusses can't all be attributed to regular dogwalking however. When a study suggested that people who own pets have better cardiac health, says McNicholas, "one of the significant factors in people recovering well from a heart attack was owning a pet, but it wasn't just dogs. It applied equally to cats." Here are some of the many ways in which pets have been found to strengthen our constitutions.

Pets are good for cardiac health

The Baker Medical Research Institute in Australia studied 6,000 people and found that those who kept animals had lower blood pressure and lower cholesterol - and therefore, a lower risk of heart attack. Another study, conducted at the University of Minnesota and published earlier this year, concluded that cat owners were 40% less likely to suffer a fatal heart attack than people who didn't have a cat. Adnan Qureshi, the neurology professor who led the study of nearly 4,500 people, said he believed that people who stroked their cat experienced less stress and anxiety and therefore were at a lower risk of developing cardiovascular diseases.

Pets boost the immune system

This month, a study by researchers from Stanford University and the University of California found that regular exposure to a cat or a dog could reduce one's chance of developing non-Hodgkins lymphoma. It is thought that exposure to allergens - from cats and dogs - could boost the immune system.
The immune-boosting power of pets is something that McNicholas has also investigated. In 2002, she studied 256 primary school children and found that children aged from five to seven from pet-owning households attended school for three weeks more than those who didn't. "We found that children brought up with pets had more stable immune systems. There have been other studies which suggest that children born into a household that already has a dog or a cat are less likely to develop asthma. Moderate exposure [to allergens] will prime the immune system." Meanwhile, a study in Japan found that pet owners over the age of 65 made almost a third fewer visits to their GP than people the same age who didn't have pets.

Dogs can act as a health warnings

After 20 years working for the charity Hearing Dogs for the Deaf, Claire Guest was struck by the story of a colleague whose dog had repeatedly sniffed at a mole on her leg before it was diagnosed as a malignant melanoma. Guest went on to work with researchers at Amersham hospital in Buckinghamshire, to discover whether dogs could be trained to detect bladder cancer in urine samples, and found that they could.
Similarly, in 2006, a cancer research centre in California published a study which found that ordinary household dogs could be trained to detect early breast and lung cancer between 88% and 97% of the time, by sniffing people's breath - it is thought that these particular cancer cells give off miniscule traces of volatile odours that dogs can smell. The idea is that, once they have worked out which odours dogs are detecting and which cancers emit them, a diagnostic machine could be developed.
Guest also trains dogs to warn owners with Type 1 diabetes of an impending hypoglycaemic, or low blood sugar, episode - they usually alert their owners by jumping up. "We don't know exactly how the dogs do it, but again they pick up on scent because they sniff the person before deciding whether to warn them or not. Because they also have a relationship with their owner, they may be able to pick up on other signs."

Pets can improve self-esteem and decrease the likelihood of depression

"There have been studies that have suggested pet owners are more likely to have higher self-worth and are less likely to suffer loneliness and depression," says Dr Deborah Wells, senior lecturer in psychology at the University of Belfast, who has conducted several studies on the benefits of pet ownership. "Dogs seem to bring people the biggest benefits - you have to get out and walk them every day, and they can act as a social catalyst."
Wells says pets are particularly useful for children. "Pets can become like a therapist, for want of a better word. If children are bullied at school, or their parents are getting divorced, children will often tell their pets their problems whereas they wouldn't always talk to a person."
The charity Pets As Therapy has been running for 25 years and has 4,000 dogs and 106 cats, which visit 120,000 people in hospitals, hospices, care homes, day care centres and schools for children with special needs every week. "We started taking dogs into nursing homes, because elderly people had had to give up their pets when they went in and it was making them depressed and in many cases ill," says Maureen Fennis, the chief executive. "At one nursing home, there was a lady who used to say the visits were her reason for staying alive."
The routine and "normality" of having a pet can help people suffering a traumatic event, such as bereavement or a diagnosis of terminal illness. In one study, McNicholas found that people with animals to care for adjusted far better after the death of someone close than those without pets. "We live in a society where we do not like to cry in front of people," she adds, "but there are a large number of people who can cry in front of their pets" ·

Seattle Times: Mindfulness: Take charge of your mind and body

By Richard Seven, Seattle Times staff reporter

Boeing engineer Miryam Chavarria has, like the rest of us, reasons to stress. She is concerned about upcoming labor negotiations, the future of her job, and a chronic health condition she must manage. She even disregarded her husband's warning and peeked at their plummeting 401(k) bottom-line.

In times like these, she turns to her practice of mindfulness. It's a meditative approach that focuses attention on the present — not on what might happen or what she should have done.

"I thought it was a bunch of hocus-pocus at first," Chavarria says. "I had a rough first session, but I chose to stay with the meditation and it has caused a great transformation in me. I find I'm more myself, rather than what the world expects of me."

She doesn't meditate every day but takes time to take self-inventory, to become absorbed in rote chores like washing dishes and be relaxed yet purposeful during so-called down time, like waiting in a line.

To be in here-and-now has never been harder. Is your job to safe? How low can the retirement nest-egg shrink? Will this political sniping ever end? Will the sun ever again shine in Seattle? Will our teams ever win? The world gets more complex. Layoffs, the constant drip of bad news, 24-hour doomsday hype, and the diving stock hammers that home.

There can be a fine line between dealing with what's happening and dwelling on it. That's where practices like mindfulness might help. You don't need to head to a retreat to gain a little perspective.

Read the rest of the article here:

Living Mindfulness: take charge of your mind and body Seattle Times Newspaper

Wednesday, October 15, 2008

Monday, October 13, 2008

Blogger News Network: Governor Palin’s Mental Health Problems Surface


Posted on October 12th, 2008
by psburton in 2008 Election Coverage, Alaska News, All News, Arizona News, Blogosphere News, Breaking News, Op-ed, US Politics
Read 496 times.


In the wake of Governor Sarah Palin’s cheerful insistence the legislative report into the trooper gate probe cleared her of any wrongdoing. I join those who share concern the pressures of the campaign may be taking a negative toll on her mental health. Its an issue that obligates me to set aside partisan perspective and reach out with compassion to someone who is in obvious distress. After all when you come upon a person who is drowning, who amongst us stops to ask party affiliation before diving in to help.

Like every other blog pundit, I was waiting with baited breath to pounce when Sarah attempted to spin the damming legislative findings in the best possible light, but to my utter astonishment the poor woman stated she was delighted to learn the report cleared her. We would anticipate an individual in otherwise good mental health to express anger and perhaps outrage at being unfairly smeared by what she perceived as the findings of partisan political witch hunt.

But as any mental health expert would probably tell you, if a person in high public office is confronted with bi-partisan finding she abused the power of her office and violated public trust, and responds by happily reporting her thankfulness at being cleared. Its a strong indication of possible dissociative denial and time to set politics aside for a moment and see if we cant get Sarah some help. That she gave birth within the last year might suggest it’s related to postpartum depression, despite the ludicrous claims of scientologists. Modern mental heath professionals do wonders in helping those afflicted with a mental disorder to lead positive and fulfilling lives.

Of course we cant know till after an appropriate examination is conducted, whether it’s simply short term problems related to the chemical imbalances of postpartum depression or a more permanent condition like bi-polar disorder. But the good news folks is irregardless of what ever seems to be pushing our Sarah off the mental health reservation, help is available.

Of course the first step in finding out how we can help Governor Palin is discovering what’s wrong, a clinical evaluation would take only a few days and depending on the diagnosis, treatment could begin at once. And thankfully we no longer need to treat the majority of those afflicted with short or long term mental illness in a hospital setting.

Unless Sarah is suffering from a behavior disorder that can express itself in violent outbursts, I am confident mental health experts would agree she would be fit to resume her duties as Governor in a relatively short period and if she were to be elected vice president she would have access to the best mental health experts in the country 24/7.

As we explore the subject of Governor Palin's mental health problems, in retrospect perhaps we can see that some of her other statements on the stump reflect a person whose mental clarity seems clouded. Though generations ago mental illness like a Physical disability was something which could be an impediment to holding public office. Times have changed for the better. While F.D.R went to great lengths to hide his disability from the public and Senator Tom Eagleton was forced to with draw as George McGovern’s vice presidential running mate when it was revealed he had undergone treatment for depression.

Happily we have moved past that type of thinking, If a candidate for President or vice President is ill, be it in mind or body, our instinct is to put aside political rhetoric and offer help and support. I simply couldn’t imagine any thing but an out pouring of understanding and prayer when Governor Palin acknowledges she is suffering and a swelling of public sentiment that becomes an encouragement to seek out appropriate treatment.

That’s my view, yours may be different

Friday, October 10, 2008

The Writer's Almanac: May Day



May Day

I've decided to waste my life again,
Like I used to: get drunk on
The light in the leaves, find a wall
Against which something can happen,

Whatever may have happened
Long ago—let a bullet hole echoing
The will of an executioner, a crevice
In which a love note was hidden,

Be a cell where a struggling tendril
Utters a few spare syllables at dawn.
I've decided to waste my life
In a new way, to forget whoever

Touched a hair on my head, because
It doesn't matter what came to pass,
Only that it passed, because we repeat
Ourselves, we repeat ourselves.

I've decided to walk a long way
Out of the way, to allow something
Dreaded to waken for no good reason,
Let it go without saying,

Let it go as it will to the place
It will go without saying: a wall
Against which a body was pressed
For no good reason, other than this.

"May Day" by Phillis Levin from May Day. © Penguin Books, 2008. 

Thursday, October 9, 2008

Psychminded.co.uk: Cognitive behavioural therapy is a quick fix

October 9, 2008
Dorothy Rowe: Cognitive behavioural therapy is a quick fix

The government has started recruiting thousands of more CBT-trained therapists in a bid to "cure" 450,000 people with depression and anxiety in England and Wales. But cognitive behavioural therapy is based on a desperate simplification of what lies at the heart of distress, argues Dorothy Rowe

.....

In mental distress the real problem always arises from some kind of threat or insult to the sense of being a person. This can be hard to uncover, and difficult to ameliorate. It is never amenable to a quick fix.

New Labour has always favoured the quick fix. Children can’t read and write? Set a national curriculum and test them. Methicillin-resistant Staphylococcus aureus (MRSA) a problem in hospitals? Deep-clean them. The fact that weighing piglets doesn’t fatten them, and that it’s people, not walls and floors, that pass on infections is irrelevant.

The next problem was that people who are depressed are unlikely to be good workers. Anti-depressants are expensive and inefficient, so let’s use the simplest of all the therapies, train people quickly and cheaply as therapists, and get these depressed people back to work.

If only life were that simple! Many experienced CBT therapists have found that it isn’t. About ten years ago, they discovered that they needed to take into account how the client saw the therapist, something that Freud had called it ‘counter-transference’. Next, some CBT therapists concluded that doing prescribed homework wasn’t enough to change those pesky dysfunctional cognitions. What was needed was mindfulness, something that the Buddha mentioned. Now what’s important is compassion, something that features in all religions. Although it’s possible now to do a Master’s degree in mindfulness, and to write academic papers on compassion, it’s not easy to put mindfulness and compassion into a CBT formulation.

Mindfulness is concerned with how we experience our individual existence. I try to write about this, but I always find that there’s a dearth of words in English to describe these powerful experiences. Compassion concerns those other powerful experiences when, in some extraordinary way, we’re able to make a connection with another person, even though each of us is trapped in our own world of meaning. Again, our language lacks the words with which to talk about these experiences.

All my work has been concerned with how we experience our sense of existence and our connections to other people, and how we make sense of our world. My first article on this was published in 1971, and I’m still writing about it because I can never come to the end of understanding what it is to be a human being. I continually see something new, or something that I’ve seen before, but now from a different angle. No one can ever be a trained therapist. You can acquire a certain amount of experience with which you might be let loose to engage in a conversation with a trouble person, but you never come to the end of discovering what you need to know.

CBT is a dishonest therapy in that it fails to acknowledge the basis on which it has been built. The use of the categories as set out in the DSM in the curriculum of the IAPT (Improving Access to Psychological Therapies) implies that the dysfunctional cognitions in depression are caused by that disorder. Many CBT therapists don’t acknowledge, or perhaps don’t know, that CBT is actually based on the proposition that what determines our behaviour isn’t what happens to us, but how we interpret what happens to us. This proposition has a secure base in what neuroscientists have discovered about how our brain operates. Neuropsychologist Chris Frith wrote, "Even if all our senses are intact and our brain is functioning normally, we do not have direct access to the real world. It may feel as if we have direct access, but this is an illusion created by our brain." He also wrote, "Another of the many illusions which my brain creates is my sense of self. I experience myself as an island of stability in an ever-changing world." [i]

What we experience isn’t the real world but the guesses which our brain has constructed about the world, using the interpretations of our past experience which our brain has stored. Since no two people ever have exactly the same experience, no two people ever see anything in exactly the same way. Our constant stream of interpretations in the form of thoughts, feelings or images develops a kind of whirlpool which we call our self or our sense of being a person. Whirlpools aren’t stable. Our self, the most important part of our existence, is made up of guesses that can be proved wrong by events. When this happens, we feel that our sense of being a person will vanish like a wisp of smoke in the wind, and we are terrified. We create all kinds of defences to prevent our self being annihilated. Some of these defences are what CBT therapists call dysfunctional cognitions.

When I was training as an educational psychologist in 1961, one of my teachers, Bess Kemp, told me the one thing that is always found in therapy. She said, "the presenting problem is never the real problem." In mental distress the real problem always arises from some kind of threat or insult to the sense of being a person. This can be hard to uncover, and difficult to ameliorate. It is never amenable to a quick fix.

Ref: [i] Making Up the Mind Blackwell Publishing, Oxford, 2007, p.40, p.169.

* Dorothy Rowe is a clinical psychologist and author of 15 books, including Depression: The Way Out of Your Prison and Beyond Fear. Her latest book, What Should I Believe? considers beliefs about death. Dr Rowe is Emeritus Associate of the Royal College of Psychiatrists

Wednesday, October 8, 2008

NYT: In ‘Sweetie’ and ‘Dear,’ a Hurt for the Elderly



October 7, 2008
By JOHN LELAND


Professionals call it elderspeak, the sweetly belittling form of address that has always rankled older people: the doctor who talks to their child rather than to them about their health; the store clerk who assumes that an older person does not know how to work a computer, or needs to be addressed slowly or in a loud voice. Then there are those who address any elderly person as “dear.”

“People think they’re being nice,” said Elvira Nagle, 83, of Dublin, Calif., “but when I hear it, it raises my hackles.”

Now studies are finding that the insults can have health consequences, especially if people mutely accept the attitudes behind them, said Becca Levy, an associate professor of epidemiology and psychology at Yale University, who studies the health effects of such messages on elderly people.

“Those little insults can lead to more negative images of aging,” Dr. Levy said. “And those who have more negative images of aging have worse functional health over time, including lower rates of survival.”

In a long-term survey of 660 people over age 50 in a small Ohio town, published in 2002, Dr. Levy and her fellow researchers found that those who had positive perceptions of aging lived an average of 7.5 years longer, a bigger increase than that associated with exercising or not smoking. The findings held up even when the researchers controlled for differences in the participants’ health conditions.

In her forthcoming study, Dr. Levy found that older people exposed to negative images of aging, including words like “forgetful,” “feeble” and “shaky,” performed significantly worse on memory and balance tests; in previous experiments, they also showed higher levels of stress.

Despite such research, the worst offenders are often health care workers, said Kristine Williams, a nurse gerontologist and associate professor at the University of Kansas School of Nursing.

To study the effects of elderspeak on people with mild to moderate dementia, Dr. Williams and a team of researchers videotaped interactions in a nursing home between 20 residents and staff members. They found that when nurses used phrases like “good girl” or “How are we feeling?” patients were more aggressive and less cooperative or receptive to care. If addressed as infants, some showed their irritation by grimacing, screaming or refusing to do what staff members asked of them.

The researchers, who will publish their findings in The American Journal of Alzheimer’s Disease and Other Dementias, concluded that elderspeak sent a message that the patient was incompetent and “begins a negative downward spiral for older persons, who react with decreased self-esteem, depression, withdrawal and the assumption of dependent behaviors.”

Dr. Williams said health care workers often thought that using words like “dear” or “sweetie” conveyed that they cared and made them easier to understand. “But they don’t realize the implications,” she said, “that it’s also giving messages to older adults that they’re incompetent.”

“The main task for a person with Alzheimer’s is to maintain a sense of self or personhood,” Dr. Williams said. “If you know you’re losing your cognitive abilities and trying to maintain your personhood, and someone talks to you like a baby, it’s upsetting to you.”

She added that patients who reacted aggressively against elderspeak might receive less care.

For people without cognitive problems, elderspeak can sometimes make them livid. When Sarah Plummer’s pharmacy changed her monthly prescription for cancer drugs from a vial to a contraption she could not open, she said, the pharmacist explained that the packaging was intended to help her remember her daily dose.

“I exploded,” Ms. Plummer wrote to a New York Times blog, The New Old Age, which asked readers about how they were treated in their daily life.

“Who says I don’t take my medicine as prescribed?” wrote Ms. Plummer, 61, who lives in Champaign, Ill. “I am alive right now because I take these pills! What am I supposed to do? Hold it with vice grips and cut it with a hack saw?’”

She added, “I believed my dignity and integrity were being assaulted.”

Health care workers are often not trained to avoid elderspeak, said Vicki Rosebrook, the executive director of the Macklin Intergenerational Institute in Findlay, Ohio, a combined facility for elderly people and children that is part of a retirement community.

Dr. Rosebrook said that even in her facility, “we have 300 elders who are ‘sweetie’d’ here. Our kids talk to elders with more respect than some of our professional care providers.”

She said she considered elderspeak a form of bullying. “It’s talking down to them,” she said. “We do it to children so well. And it’s natural for the sandwich generation, since they address children that way.”

Not all older people object to being called sweetie or dear, and some, like Jan Rowell, 61, of West Linn, Ore., say they appreciate the underlying warmth. “We’re all reaching across the chasm,” Ms. Rowell said. “If someone calls us sweetie or honey, it’s not diminishing us; it’s just their way to connect, in a positive way.”

She added, “What would reinforce negative stereotypes is the idea that old people are filled with pet peeves, taking offense at innocent attempts to be friendly.”

But Ellen Kirschman, 68, a police psychologist in Northern California, said she objected to people calling her “young lady,” which she called “mocking and disingenuous.” She added: “As I get older, I don’t want to be recognized for my age. I want to be recognized for my accomplishments, for my wisdom.”

To avoid stereotyping, Ms. Kirschman said, she often sprinkles her conversation with profanities when she is among people who do not know her. “That makes them think, This is someone to be reckoned with,” she said. “A little sharpness seems to help.”

Bea Howard, 77, a retired teacher in Berkeley, Calif., said she objected less to the ways people addressed her than to their ignoring her altogether. At recent meals with a younger friend, Ms. Howard said, the restaurant’s staff spoke only to the friend.

“They ask my friend, ‘How are you; how are you feeling?’ just turning on the charm to my partner,” Ms. Howard said. “Then they ask for my order. I say: ‘I feel you’re ignoring me; I’m at this table, too.’ And they immediately deny it. They say, no, not at all. And they may not even know they’re doing it.”

Dr. Levy of Yale said that even among professionals, there appeared to be little movement to reduce elderspeak. Words like “dear,” she said, have a life of their own. “It’s harder to change,” Dr. Levy said, “because people spend so much of their lives observing it without having a stake in it, not realizing it’s belittling to call someone that.”

In the meantime, people who are offended might do well to follow the advice of Warren Cassell of Portland, Ore., who said it irritated him when “teenage store clerks and about 95 percent of the rest of society” called him by his first name. “It’s the faux familiarity,” said Mr. Cassell, 78.

But he mostly shrugs it off, he said. “I’m irked by it, but I can’t think about it that much,” he said. “There are too many more important things to think about.”

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Monday, October 6, 2008

NYT: Bailout Provides More Mental Health Coverage

October 6, 2008
By ROBERT PEAR


WASHINGTON — More than one-third of all Americans will soon receive better insurance coverage for mental health treatments because of a new law that, for the first time, requires equal coverage of mental and physical illnesses.

The requirement, included in the economic bailout bill that President Bush signed on Friday, is the result of 12 years of passionate advocacy by friends and relatives of people with mental illness and addiction disorders. They described the new law as a milestone in the quest for civil rights, an effort to end insurance discrimination and to reduce the stigma of mental illness.

Most employers and group health plans provide less coverage for mental health care than for the treatment of physical conditions like cancer, heart disease or broken bones. They will need to adjust their benefits to comply with the new law, which requires equivalence, or parity, in the coverage.

For decades, insurers have set higher co-payments and deductibles and stricter limits on treatment for addiction and mental illnesses.

By wiping away such restrictions, doctors said, the new law will make it easier for people to obtain treatment for a wide range of conditions, including depression, autism, schizophrenia, eating disorders and alcohol and drug abuse.

Frank B. McArdle, a health policy expert at Hewitt Associates, a benefits consulting firm, said the law would force sweeping changes in the workplace.

“A large majority of health plans currently have limits on hospital inpatient days and outpatient visits for mental health treatments, but not for other treatments,” Mr. McArdle said. “They will have to change their plan design.”

Federal officials said the law would improve coverage for 113 million people, including 82 million in employer-sponsored plans that are not subject to state regulation. The effective date, for most health plans, will be Jan. 1, 2010.

The Congressional Budget Office estimates that the new requirement will increase premiums by an average of about two-tenths of 1 percent. Businesses with 50 or fewer employees are exempt.

The goal of mental health parity once seemed politically unrealistic but gained widespread support for several reasons:

¶Researchers have found biological causes and effective treatments for numerous mental illnesses.

¶A number of companies now specialize in managing mental health benefits, making the costs to insurers and employers more affordable. The law allows these companies to continue managing benefits.

¶Employers have found that productivity tends to increase after workers are treated for mental illnesses and drug or alcohol dependence. Such treatments can reduce the number of lost work days.

¶The stigma of mental illness may have faded as people see members of the armed forces returning from Iraq and Afghanistan with serious mental problems.

¶Parity has proved workable when tried at the state level and in the health insurance program for federal employees, including members of Congress.

Dr. Steven E. Hyman, a former director of the National Institute of Mental Health, said it was impossible to justify insurance discrimination when an overwhelming body of scientific evidence showed that “mental illnesses represent real diseases of the brain.”

“Genetic mutations and unlucky combinations of normal genes contribute to the risk of autism and schizophrenia,” Dr. Hyman said. “There is also strong evidence that people with schizophrenia have thinning of the gray matter in parts of the brain that permit us to control our thoughts and behavior.”

The drive for mental health parity was led by Senator Pete V. Domenici, Republican of New Mexico, who has a daughter with schizophrenia, and Senator Paul Wellstone, the Minnesota Democrat who was killed in a plane crash in 2002. Mr. Wellstone had a brother with severe mental illness.

Prominent members of both parties, including Betty Ford, Rosalynn Carter and Tipper Gore, pleaded with Congress to pass the legislation.

Representatives Patrick J. Kennedy, Democrat of Rhode Island, and Jim Ramstad, Republican of Minnesota, led the fight in the House. Mr. Kennedy has been treated for depression and, by his own account, became “the public face of alcoholism and addiction” after a car crash on Capitol Hill in 2006. Mr. Ramstad traces his zeal to the day in 1981 when he woke up in a jail cell in South Dakota after an alcoholic blackout.

The Senate passed a mental health parity bill in September 2007. The House passed a different version in March of this year.

A breakthrough occurred when sponsors of the House bill agreed to drop a provision that required insurers to cover treatment for any condition listed in the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association.

Employers objected to such a requirement, saying it would have severely limited their discretion over what benefits to provide. Among the conditions in the manual, critics noted, are caffeine intoxication and sleep disorders resulting from jet lag.

Doctors often complain that insurers, especially managed care companies, interfere in their treatment decisions. But doctors and mental health advocates cited the work of such companies in arguing that mental health parity would be affordable, because the benefits could be managed.

Pamela B. Greenberg, president of the Association for Behavioral Health and Wellness, a trade group, said providers of mental health care typically drafted a treatment plan for each person. In complex cases, she said, a case manager or care coordinator monitors the patient’s progress.

A managed care company can refuse to pay for care, on the grounds that it is not medically necessary or “clinically appropriate.” But under the new law, insurers must disclose their criteria for determining medical necessity, as well as the reason for denying any particular claim for mental health services.

Andrew Sperling, a lobbyist at the National Alliance on Mental Illness, an advocacy group, said, “Under the new law, we will probably see more aggressive management of mental health benefits because insurers can no longer impose arbitrary limits.”

The law will also encourage insurers to integrate coverage for mental health care with medical and surgical benefits. Under the law, insurers cannot have separate cost-sharing requirements or treatment limits that apply only to mental illness and addiction disorders.

The law comes just three months after Congress eliminated discriminatory co-payments in Medicare, the program for people who are 65 and older or disabled.

Medicare beneficiaries pay 20 percent of the government-approved amount for most doctors’ services but 50 percent for outpatient mental health services. The co-payment for mental health care will be gradually reduced to 20 percent over six years.

The mental health parity law was forged in a highly unusual consensus-building process. For years, mental health advocates had been lobbying on the issue.

Insurers and employers, which had resisted earlier versions of the legislation, came to the table in 2004 at the request of Mr. Domenici and Senators Edward M. Kennedy, Democrat of Massachusetts, and Michael B. Enzi, Republican of Wyoming.

Each side had, in effect, a veto over the language of any bill. Insurers and employers, seeing broad bipartisan support for the goal in both houses of Congress, decided to work with mental health advocates. Each side gained the other’s trust.

“It was an incredible process,” said E. Neil Trautwein, a vice president of the National Retail Federation, a trade group. “We built the bill piece by piece from the ground up. It’s a good harbinger for future efforts on health care reform.”

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The Hour: Calming your thoughts through mindfulness

BY HOWARD COHEN
McClatchy Newspapers


MIAMI -- Our worries.

They're crescendoing like the finale of Beethoven's "Ninth": Bailouts, buyouts. Recession, depression.

Enter the meditative practice of mindfulness. Born of Buddhist roots, it's increasingly recognized as a measure to calm the mind's chatter and elevate the brain's thinking and organizational processes.

Mindfulness seminars. Mindfulness books. Even the medical mainstream is taking note -- the Sept. 17 issue of the Journal of the American Medical Association had a piece titled "Mindfulness in Medicine."

"The uncertainty of tomorrow creates a lot of the angst or discomfort," says Scott Rogers, director of the Institute for Mindfulness Studies in Miami Beach. "People are looking more and more to bring a little bit of 'ahhh ...' Not just stress reduction, but allowance and acceptance."

Mindfulness is built around the premise of disengaging from overly emotional responses and extraneous thoughts that clutter the mind's ability to think clearly. By using techniques such as breathing, visual imagery and meditation to slow down and focus on the present, the theory goes, a person can tap into a higher level of awareness. The more acute awareness is the byproduct of more active brain waves brought on by meditation, studies have shown.

Simply put, it's going from worrier to warrior, says Rogers, 45, a lawyer who conducts seminars for other lawyers and school groups.

"We want to move into a place where the outside world will do whatever it's going to do without us going through the roller coaster of emotions," Rogers says. "We want to maintain this more alive, vigilant, present way of being that is somewhat independent of how things are going."

Dr. Patricia Isis runs a mindfulness seminar at South Miami Hospital and says her weekly classes fill immediately. "People are stressed to the max," she says.

"Mindfulness is an opportunity to be awake and aware as much as possible from moment to moment in this one wild and precious life of ours," she says.

The mindfulness practice has ties to sports psychology, says Dr. Janet Konefal, the assistant dean for complementary integrative medicine at the University of Miami.

"Most of the research about this self talk comes from coaches and psychologists involved in sports," she said. "They're interested in how athletes talk to themselves and how that can make the difference and be cutting edge."

Olympics swimmer Michael Phelps, for one, is renowned for envisioning every race before he dives into the water. He focuses on the time he wants to achieve -- down to the hundredth of a second -- and the exact stroke count per lap he needs to achieve his goal. He credits this focus with winning a gold medal in the 200-meter butterfly at the Beijing Olympics last month despite a goggles failure that impaired his vision.

There is a growing body of evidence that this type of mental discipline and meditative practice can carve new pathways in the brain. It's a concept called neuroplasticity and it's just the opposite of what scientists had believed for years -- that the brain's nerve cells were set in childhood and didn't change.

Research has shown otherwise. A 2005 study published in the Proceedings of the National Academy of Sciences measured the brain waves in a group of Tibetan monks schooled in Buddhist meditative practices from centuries ago. The researchers at the University of Wisconsin found that when the monks meditated -- especially the ones most skilled in meditative practices -- their brain waves, as measured by brain-scanning machines, recorded much greater and more powerful activity than previous standards of healthy people. The Dalai Lama sent the monks to the Wisconsin lab.

Rogers recounts an experiment conducted by Harvard Medical School two years ago. A group of pianists were instructed to play a five-finger scale repeatedly to a metronome's steady beat. For five days the volunteers played the same pattern for two hours. The volunteers were hooked to a machine that sent a brief magnetic pulse into the motor cortex of their brains. This allowed scientists to gauge brain activity.

After a week of practice, scientists found that the motor cortex devoted to these finger movements took over surrounding areas in the brain, thus creating new pathways.

The experiment was repeated, but this time the volunteers were instructed to imagine themselves playing the piano. Hands never touched keys. The results were the same: The brain still cut new pathways.

"Twenty years ago, they would have said this is absolutely impossible," Rogers says. "In stroke victims this is hugely significant because we now know parts of the brain that we thought were localized -- this part for vision, hearing, the moving of the hand -- won't repair itself.

"Now we know this other portion of the brain can take on the necessary function to work with the arm. This has totally changed how we work with stroke victims. That part is not growing back but another part of the brain says, 'I can do that."'

Even earlier, in 1982, researcher Jon Kabat-Zinn studied patients with medical pain of six months to 48 years' duration who agreed to receive training in mindfulness-based stress reduction. The 51 participants who completed the program -- 88 percent of the 58 total enrolled -- said their perceived pain decreased significantly. In fact, half reported a reduction of 50 percent or greater, the Sept. 17 Journal of the American Medical Association reports.

Actor Alan Alda, at a recent appearance in Coral Gables for Books & Books, told an anecdote about how he used the "being present" technique of mindfulness to alleviate the pain of having a fingernail torn off in a fluke accident in an airplane bathroom. He says he went into a state of becoming fully aware of everything -- the sights, the sounds, even the throbbing in his finger, "and the pain went away," Alda insisted.

Andee Weiner, a grandparent and mother of three grown children in Miami, turned to mindfulness after a heart attack in 2006. She enrolled in an eight-week Mindfulness-Based Stress Reduction course at South Miami Hospital, a program based on the teachings of Kabat-Zinn, author of "Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness" (Delta; $20).

"I had no expectations because I had never done this before," said Weiner, 59. "It's one of the best things I've done for myself. A year and nine months later, I can't believe how it's enhanced my life. I have found myself to be more proactive in my medical care and trusting my instincts with a better understanding."

Weiner cites several examples of how mindfulness works for her: "I can be in traffic and instead of having nasty thoughts I can bring myself into a state where I focus on my breathing and those thoughts leave me. Or, I'm sitting in a doctor's office and instead of getting agitated while I'm waiting, I'm not agitated, my blood pressure is not sky high and I let go of a lot of baggage."


Techniques

There are several mindfulness techniques anyone can practice, anywhere. Here are some:

Scott Rogers, director of the Institute for Mindfulness Studies in Miami Beach, offers these techniques to help reduce stress and stay centered:

4-7-8 hand-breathing exercise


--Inhale and open your hands to the count of four.

--Hold breath and stretch fingers to the count of seven.

--Exhale and close your hands to the count of eight.


Every step my heart beats

Slow down and feel the foot as it presses the ground, getting in touch with your heartbeat on each stride. Next, incorporate the thought of a loved one's heartbeat beating in time with your pace. It can be a child, pet, partner. "This brings us a connectedness to the moment," Rogers says.

Accept your thoughts as natural

"There is a myth about meditation that you are quieting your mind. The mind's job is to be all over the place. It's about accepting wherever your mind is and bringing it back to the moment," says Dr. Patricia Isis, mental health counselor with South Miami Hospital. "The reality is our minds are fairly active most of the time and that's why people think they can't meditate."

Adds Rogers, "It's said we have about 50,000 to 60,000 thoughts a day and most of those are thoughts that we had yesterday and the day before.

"Just a small number are really relevant to what's taking place. If we can tone down the chatter, we get rid of the static," Rogers says.

"Mindfulness is catching the mind as it wanders. That's perfectly OK. We have a mind that wanders and is likened to a puppy dog. 'Stay here.' It walks off. 'There you are, you wandered."' Just bring it back to the moment.

Ambigamy: Five steps to Optimal Illusion: The path to sophisticated self-deception


By Jeremy Sherman, Ph.D. on October 03, 2008 in Ambigamy


Self-deception - the sweetest and sourest taboo: There's no more reliable way to stimulate a rich discussion than to get catty about other people's self-deceptions. And there's no better way to curdle a conversation than to accuse someone of self-deception to his or her face: Self-deception is the other guy's folly. We're above it. Or, at least, we think so for a while.

Here's a back-of-the-napkin sketch of how we come to terms with our own potential for self-deception:

Stage 1- naïve: We come into the world with no notion of deception, let alone self-deception. Gradually, however, it dawns on us that people lie, and sometimes even lie to themselves. This makes us wary. We learn to spot other people's self-deception.

Stage 2-Exempt by contempt: We get pretty good at spotting other people's self-deception. We assume that because we can spot their deceptions and they can't, we must be experts on spotting deceptions. As experts, when we inspect our own thoughts presumably with the same scrutiny we apply to others we don't notice any self-deception. So we must be exempt. The more contempt we feel for other people's self-deceptions, the more expert and exempt we feel.

Stage 3-I once was lost, but now I'm blind: Sooner or later. we catch a glimpse of our own potential for self-deception. Maybe we overhear someone at stage 2 giving us a taste of our own medicine. Maybe we catch ourselves. Now we have to come to terms with it - and come to terms we do. We surrender. We admit that we had a potential for self-deception. We give ourselves credit for seeing it. We're no longer exempt by contempt. But we were brave enough to face our self-deceptions, which gives us a different, more sophisticated exemption. OK, so we used to be lost. We didn't know ourselves. But we learned. Now we know ourselves. Pat. In this stage, we talk about other people's self-deceptions. But we tell self-effacing stories about our own past follies, too.

Stage 4-Eternally nonexempt: We discover that even with the exceptional self-knowledge we acquired in stage 3, we still lie to ourselves. It turns out that self-deception isn't a onetime thing: No matter how skeptical we get with ourselves, we just can't keep up. No matter how much we pursue the truth, it will never catch us. Now we're wary of ourselves. In stage 4, talking about self-deception is a bummer. It's a rare person who gets past stage 3, because stage 4 is so little fun.

Stage 5-Optimal illusion: If there's no escaping self-deception, then maybe it's not all bad. What is it, anyway? Is it self-deceptive to hope and pray and believe that of the many ways a situation could turn out, it will turn out well? Of course not. But if it turns out poorly, you'll wonder why you kidded yourself. And the folks stuck at stage 2 will snigger about you behind your back. But maybe they're wrong. Maybe the trick isn't eliminating self-deception, but learning how to use it well. Here, we embrace optimal illusion:

The trick isn't being an orthodox realist or an orthodox dreamer, but, rather, getting the right mix of the two, absorbing and ignoring reality checks in the right combination in order to keep ourselves motivated, focused, and flexible, our feet on the solid ground to keep from falling, our heads in the air to improve our chances of achieving lift-off. It's not an easy balance to achieve. In fact, it's unachievable - optimal illusion is a lifelong pursuit.

Not everybody gets to all five stages. And we don't graduate from one to the next; rather, we expand our repertoire, adding the stages as we go and changing the frequency with which we visit each. Even the best optimal illusionists get catty sometimes, as though they are still at stage 2. Sometimes, laughing at other people's folly is the optimal illusion, the best way to resist surrendering to their alternative viewpoint.

Without cattiness, it may be impossible to climb to the higher stages. Cattiness sharpens our claws. As they grow, they curl back in on us, causing the sharp self-inflicted pain from which we learn.


OPTIMAL ILLUSION

Jeremy Sherman

Can musicians feel the music
though they know the notes by name?

Can athletes play a death match
though they know it's just a game?

Could Vargas feel the heat and lust
from a pinup he had painted?

When materialists know it's glandular
do their love affairs get tainted?

When you know it's lights on silver screen
do the movies seem more pallid?

If you see through God to his creator
does your creed become less valid?

No, apparently we're able to both see through and
believe

What an awesome gift from God is this, our power to
self-deceive.

Embracing the Dark Side: The medical view of depression: good for patients, or just for doctors?


By Jenna Baddeley in Embracing the Dark Side


It is popular these days to explain depression as a medical problem caused by chemistry: an imbalance of serotonin and other neurotransmitters. Many mental health care providers favor this explanation of depression's causes, supposedly because it destigmatizes the illness and shifts blame away from the patient. The problem is, it may benefit providers more than patients.

When depressed people seek treatment, they want relief from their psychological pain, but they also want their experience, their concerns, to be acknowledged. In other words, what they are looking for is to be empathized with, not just not to be blamed. Unfortunately, there is good evidence that doctors aren't very good at responding empathically to their patients' concerns. A recent study reported in the popular press found that the physicians responded empathically to only 10% of patients' concerns. They frequently discussed biological processes and medical treatment options in lieu of empathizing.

The truth is, one of the most difficult parts of a healthcare provider's job is having to listen to patients reveal heart-wrenching problems and the strong negative emotions that accompany them. Psychiatrists are alone among medical doctors in that hearing and treating emotional problems is precisely their line of work. They sometimes deflect the difficulty by asking canned diagnostic questions, explaining biological causes, and prescribing medications. In such encounters, it is hard to imagine that the depressed patients -- who typically feel alienated and vulnerable to begin with -- are being listened to as if their human experience mattered. And that is troubling. As mental health treatment providers, we are privileged to receive confidences that our clients might not give even to some of their closest friends. When we retreat to a view of our clients as clusters of symptoms to be differentially diagnosed or neurotransmitter systems to be rebalanced, we dishonor our clients' personhood and we miss an opportunity to provide care in the fullest sense of the word.

Friday, October 3, 2008

Psychology Today: Seven Deadly Sentiments

Psychology Today: Seven Deadly Sentiments
Evolutionary psychology helps us understand why we are ashamed of having forbidden thoughts that make us feel like lousy people. It tells us that these shameful feelings are hardwired—strategies that led to success on the Pleistocene savanna.

By: Kathleen McGowan, Ken Gordon


In our confessional culture, it is socially acceptable—even fashionable—to disclose your sexual predilections, your husband's problem with painkillers, your penchant for high colonics. Our hypertherapeutic society lets it all hang out.

But plenty of feelings remain in the closet. In the privacy of our own heads, we cringe with dread when we meet someone in a wheelchair, wish our aged relatives would hurry up and die, smirk over our friends' bad taste and think babies are ugly and annoying. Meanwhile, we assure ourselves—and one another—that we're really very nice people.

Evolutionary psychology holds that these shameful feelings are hardwired—strategies that led to success on the Pleistocene savanna. If that's so, then why are they so hard to admit to? "Given that these emotions are shaped by natural selection and are innate, or at least pretty deep, why do we expend so much effort in denying them?" asks Dylan Evans, an evolutionary psychologist at the University of Bath in the United Kingdom.

It's a good question. The persistence of forbidden feelings fascinated Freud, and provided the raw material for his controversial theory of repression and the all-powerful unconscious. Both psychoanalysis and Catholic absolution are rooted in the idea that confession can strip taboo thoughts of their crippling power. Whether or not you believe in Freud (or the Virgin Mary), one thing is for sure: Our efforts to banish or explain away these unmentionables can't keep them from roaring back—and making us feel terrible as a result.

Acting on a nasty impulse may be cause for shame. But why feel so guilty about a feeling that remains a mere fancy, harmlessly stashed away in your brain? Evans theorizes that this guilt really stems from the fear of exposure. We're braced for discovery, even though we haven't really done anything. "If you're discovered doing something wrong, and you immediately feel terrible about it, the offense is mitigated," he says. "So you better be ready to display guilt if someone discovers you."

Read more ...

Thursday, October 2, 2008

Mindful Sex: Female Sexual Desire Disorder


By Dan Pollets on October 01, 2008 in Mindful Sex

A recent study looked at the benefit of giving women who are on anti-depressants Viagra to improve their low sexual desire and poor arousal. In light of the findings, let's consider the very complicated issue of sexual desire disorder in women. Sexual desire disorder in women is in fact an extremely common condition. Studies report that having too little sexual desire is the sexual dysfunction most frequently seen among women, reported by 10 - 51% of women surveyed in various countries. Women reporting low sexual desire also report low levels of arousal and sexual excitement and infrequent orgasms. This all adds up to a lot of women feeling sexually dissatisfied with the experience.

Getting back to the Viagra study (see Journal of American Medical Association, 8/08), there were promising results in that the group that received Viagra (in comparison to the placebo control group) showed significant improvement in arousal and orgasm. However, there was no improvement in sexual desire. There does not currently exist a pill that can be taken that would have the effect of increasing a woman's desire for sex. This finding begs the question of how to define sexual desire in women, how desire is experienced differently given gender, and what are other important factors that influence sexual desire in women. I hope to provide some clarity to these issues in this brief article.

Defining Desire Disorder Contextually


It should be no surprise to women readers that if the standard of comparison regarding sexual desire is a man's desire, most women would come up short. Spontaneous sexual desire is a rarity in women. Further, the desire for sex independent of a number of other considerations; for instance, biological, psychological and interpersonal (relational) is highly unusual in women. In fact, sexual desire is an infrequent reason for engaging in sex in women in established relationships. Women give many reasons for engaging in sex; for instance, the desire for emotional closeness, to please one's partner, to communicate intimately - all independent of a purely biologic drive. This biological sex drive in men, in contrast, might manifest as sexual fantasizing, yearning and looking forward to sexual experience, and "spontaneously" thinking about sex.

What is important to note is that while studies find that a larger percentage of women report that they infrequently felt sexual desire, the majority reported that once engaged in sexual activity, they were capable or arousal (lubrication, engorgement, orgasm) and reports of discontent were less frequent. In other words, women can have low spontaneous desire but once engaged in the sexual experience can become aroused and actually enjoy the experience. This being true, the challenge then is how to overcome the initial hurdle so as to land in bed where good things can happen.

What are the implications of this research for the sexual relationship and relationship in general? A woman with low sexual desire can feel shame and feelings of inadequacy. Conflict can be ignited between partners as the result of infrequent sex and lack of female initiation. Men will complain that they "always" have to be the one that initiates and this get to be laborious. Men often fantasize, possibly fed by ample images and scenarios from readily available pornography of the always available, insatiable, and sex hungry and very carnal "hotee." This wish of men to have their long term partners initiate sex and thereby match up to their fantasy may be unrealistic and in conflict with female sexual physiology and psychology. The research demonstrates that women do not experience strong sexual desire independent of environmental and relational cues. They will not initiate based on inner biological drive but will respond to a set of circumstances that are associated with romance, pleasure and intimacy. Sorry men. However, the good news is that once conditions are favorable it appears that most women can become aroused and orgasm just fine. This fact calls for better attention in the sexual dance to "fore-fore play," the relationship dynamics, lowering stress levels and increasing romance in order to generate the "heat" if you will. This argument has a familiar ring to it.

Factors Relevant to Female Sexual Desire

Rosemary Basson (see Footnote 1) has written extensively about the topic of female sexual desire and here I am indebted to her work. If the search for one causative agent or pill that would create increased levels of sexual desire in woman is bound to fail, what are the specific conditions or factors the research has deemed relevant to or correlated with increasing a woman's sexual desire or interest in sex. What would be treatment implications?

The research suggests that a woman's accessibility to sexual experience is particularly dependent on the context of a given sexual interaction which includes the quality of intimacy and feeling about the relationship she is having with her partner. Other important factors which interact include the woman's psychological and medical health, sexual and cultural contexts. Let me briefly describe these relevant factors.

Emotional Intimacy

The overall sense of emotional closeness, capacity to trust, and ability to communicate and be validated in this communication is highly related to a woman's availability and openness to become sexual. The adage that men seek out sex in order to feel close while women must feel close in order to become sexual might have some truth in it. It is therefore impossible to accurately assess low sexual desire in a woman without attending to the quality of relationship and level of emotional intimacy. The delight in an exquisite dinning experience takes into consideration the setting, the service, the presentation of the food (appearance) as well as the actual taste. It also helps the overall enjoyment of the evening to find your dinning partner attractive and a good conversationalist. So men, ramp up your romance and seduction skills and you might ignite more "fire."

Mental Health

The less a woman struggles with issues such as low self esteem, poor body image, depression, anxiety, and history of sexual/physical/emotional abuse the greater the possibility that sex will be sought and enjoyed. Depression is strongly associated with reduced sexual function. Unfortunately and ironically, anti-depressants prescribed to treat depression, especially SSRIs (Zoloft, Prozac, Paxil, etc.) typically have side effects which reduce sexual desire and arousal. This is why the Viagra study mentioned has some promising implications. Viagra could be the counterweight to the sexual side effects.

In terms of sexual history, women who have a history where they were abused sexually or physically will retain aspects of the negative conditioning and can associate danger and threat with sexual intimacy. The messages that one absorbed about sexuality in the family of origin or religious training can also impact on adult sexuality. Growing up in a house that is hyper-religious and extremely repressive where, for example, masturbation is deemed sinful, will lead to certain conclusions about sexuality goes - none of it particularly helpful for healthy intimacy. Clearly, overall mental health mental health must be looked at in the assessment of female sexual desire disorder.

Sexual Context

This factor refers to how the sexual activity itself is being experienced. This can include the feeling that her partner is being seductive and romantic, how much time is being taken in foreplay to assure arousal, and the skill level, if you will, the couple demonstrates in the giving and receiving of pleasure. In other words, how smooth and coordinated is the sexual dance between. An important consideration is the sexual communication between so that the need for necessary stimulation to augment arousal is signaled and responded to either verbally or non-verbally (non-verbal might be more graceful). This aids arousal and increases pleasure. Obviously, if the sexual experience is highly pleasurable there will be future positive anticipation (expectation of reinforcement). A basic law of learning is that any behavior that is highly reinforced has a greater probability of occurring in the future. If there is selfishness or the lack of mutual satisfaction due to poor communication interplay between partners sex will become at the very least unsatisfactory and obligatory. We would not expect great future sexual desire in this case.

Obstacles to Mindful Sex

Another popular adage says that men are "unitaskers" and women "multitaskers." Men have an easier time focusing on the "hunt" and can block out distracting stimuli. Women, on the other hand, are evolutionarily wired to mind the home, kids, food, and community and are juggling many roles. Their awareness is often focused on many simultaneous demands. Being able to let go of all the distractions and become truly present for sex a formidable challenge for many women. Perceived stress correlates poorly with a woman's availability to become sexual. Concerns about the children, being interrupted; family difficulties, and unwanted pregnancy can make activating sexual desire and being fully present difficult at best. Basson (2006) makes the point that women might go along with the sexual demand of her partner and not take responsibility for her own enjoyment and then come to expect a poor outcome or low satisfaction of her sexual relating. This of course leads to avoidance or sex being a low priority. It has been helpful in my practice to teach women who are so distracted and stress basic Mindfulness techniques and meditation skills. Encouraging couples to discuss a more equitable sharing of domestic tasks and child care responsibility also makes sense in order to reduce the burden and lower stress levels.

Biological Factors

Physical or biological factors can of course influence sexual desire and arousal. We have mentioned depression. Other chronic illnesses that affect sexual desire include diabetes, neurological disorders (e.g. MS), vascular disease, high blood pressure, and renal failure. If there is disease in the ovaries and/or low levels of androgen production (testosterone) there will low desire and poor arousal. Recent studies have attempted to demonstrate the importance of low testosterone levels in women and low desire. However attempts to replace testosterone have not been met with great success. There continues to be a lack of a safe pharmacologic intervention which would supplement for low androgen levels and shows clinical efficacy. The problem of finding a safe and reliable "magic bullet" is complex and there are many factors other than biological that are impacting desire. This being said, there is an important role for drug treatment and there are drugs that are being tried for women who present with low desire and arousal issues and who also have low androgen levels. These include L-Arginine amino acid cream, DHEA (natural precursor to androgen production), and testosterone therapy. What is clear is that women looking to boost testosterone levels should work with their physicians closely so that the hormone can be monitored. These drugs can have unwanted side effects.

Clinical Implications

Sexual desire disorder is a difficult and common problem. Experiencing the loss of desire and then avoiding sex can lead to feelings of shame and inadequacy. It can also be a threat to the marriage or relationship evoking conflict and hurt feelings and a general sense of losing control over one's life and existence. Low sexual desire in women is a puzzle to be solved by the sex therapist and sexual medicine physician. It has been my experience that men are much more straightforward and treatment often ends with giving the "little blue pill" and/or testosterone replacement. Dr. Sandra Leiblum, a noted sex therapist who has written much on the subject said, "A woman's lack of sexual interest is often tied to her relationship with her partner. The important sex organ (for women) is between the ears. Men need a place to have a sex - women need a purpose."

The important point in all this is that it is impossible to assess and treat a woman for low sexual desire out of context. This context includes her emotional and psychological status, sexual history and biology. The level of emotional intimacy or satisfaction in the relationship is crucial as is the precise quality of the give and take in the sexual act that leads to increasing pleasure and arousal. All this calls for comprehensive evaluation: both from a sex therapist who can focus on psychological and relational data and a sexual medicine physician (urologist, OB/GYN, endocrinologist who is specially trained). Certainly low sexual desire can threaten the health and well-being of the relationship and lead to many unfortunate psychological effects. A holistic and multi-factorial perspective on the problem is what is needed to accurately assess and treat such a complicated issue.

(1) Rosemary Basson, Sexual Desire/Arousal Disorders in Women. In S.
Leiblum, Principles and Practice of Sex Therapy, 4th Ed., 2006

Stepcase Lifehack : The Pefect Mess

The Perfect Mess
by Dustin Wax
In an interview with Michael McLaughlin published in The New Writer’s Handbook (2007), Eric Abrahamson, co-author of A Perfect Mess: The Hidden Benefits of Disorder, says "Your mess is perfect when it reaches the point at which, if you spent any more or any less time organizing, you would become inefficient."

When we see a perfectly clean, organized office, with it’s sleek glass-topped desk and a white MacBook centered perfectly atop the desk’s vast emptiness, we might find it cold, sterile, oppressive even. It’s not a coincidence that the Death Star’s halls are clean, white — and cold!

On the flip side, when we see an office with a desk buried under mountains of paperwork, with trash bins overflowing and computer cables snaking haphazardly across the room, we often find it overwhelming, disgusting even — and rarely think well of its owner!

For most of us, there’s a “sweet spot”, somewhere between the Death Star and the garbage dump, where everything we need (and nothing we don’t) is close at hand, where the minimal amount of work yields the maximum gain. Where that sweet spot is will, naturally, be different for each of us — and finding it is often made difficult by confusing clutter with messy perfection, or by confusing laziness with efficiency.

The Oppression of Organization

Too much organization, especially for creative people, can be stifling. One reason is that organization often stems not from our particular workspace needs but from moral and social judgments imposed on us (and internalized) externally. That is, we feel the need to organize to meet social standards that may not have anything to do with our own needs.

Messiness in Western society is associated with a lot of negative things. Clutter, disorder, messiness is associated with dirt, disease, and filth. Messiness is considered inhuman, uncivilized — remember Mom telling you your room was a “pig sty”?

It’s also associated with laziness, the greatest of sins in a Western mindset guided by the Protestant work ethic. While we might feel that our work takes priority over cleaning up, there’s a part of us that will always feel that we should be doing it all — that not cleaning up is a sign of sloth, no matter how much other work we’re getting done in the meantime.

Messiness is also a class issue. Middle-class reformers have always advocated lives of zen-like simplicity to their working-class charges. (In the 1910’s and ’20s, they would set up model homes in poor tenements showing workers and immigrants how a “proper” home should be kept — plain furniture, no curtains, open cupboards, hardwood floors, and bare walls were the norm, in contrast to the mish-mash of overstuffed furniture, cheap posters and wall calendars, heavy curtains, and multiple rugs the immigrants and workers preferred.) Wealthy people look down on the nouveau riche who stuff their homes with Baroque furniture, Persian rugs, and glod-trimmed everything. Non-clutter is the foundation of Apple’s success — among well-off, professional, upper-middle-class social elites (and their emulators).

But there’s a cost for this kind of neatness, a point of diminishing returns beyond which more time spent organizing and cleaning means less time spent getting work done. This is especially true when workers (and I’m including the work of family, home life, and hobbies here as well as the work we do for our jobs) “borrow” systems that are advocated by professionals as “gospel” but do not truly reflect the individual’s working life or personality. As it happens, a great many highly organized people are no more able — and even less able — to find the things they need, when they need them, than the chronically messy.

The Cluttered Mind

On the other hand, keeping up some kind of order is not without value. As every craftsperson knows, tools and supplies that are tossed around haphazardly become broken or damaged, which means they aren’t able to do their work even when they can find their equipment. Spending time looking for some item you need right now is no fun, and surely inefficient.

Messiness can also indicate underlying psychological blocks. People who refuse to clean up after themselves or to put things “in their place” might well be acting out retained resistances to an overbearing parent or schoolteacher whose daily involvement in their lives is long past. Or they may be using their mess as an excuse to not get things done — because they don’t know what to do with themselves if they finish. Or they may act out of the unconscious fear that if they got everything in order, they’d have to start dealing with more troubling aspects of their lives.

And messiness can be anti-social. Having a messy office can keep you from working well with others, even if you have no trouble working in it. Having a messy home can prevent you from inviting others into it — or others from accepting such invitations. Our mess can become a barrier to — or, in some cases, insulation from — interacting with the rest of the world.

Making the Perfect Mess

The trick, then, is to find the balance point between too much organization and too little.

The trick, then, is to find the balance point between too much organization and too little. Where, exactly, that balancing point is will differ for each person, depending on their personality, their career, their family life, who they interact with, and a variety of other factors. There are, though, a few questions you can ask yourself to figure out where that balance point is for you and what kind of work you might need to do to reach it. You might want to think them through a few times for different contexts (e.g. office, kitchen, living area, garage/toolshed, etc.)

What are your organizing strengths? What do you do extremely well? Are there areas where you’re very organized, maybe related to a hobby or other specific activity? For instance, I play guitar, and all my musical equipment is always in one of two places, everything gets put back when I’m done, everything is well-maintained.

  • What are your organizing weaknesses? In what part of your life are you always scrambling? What activities are the least efficient for you? In my case, I’m a bad filer — there’s something in me that says I can only file when I’m done with something, so if there’s a chance I might use it, it needs to stay out.
  • What do you like most about whatever space you’re thinking of?
  • What do you like least about that space?
  • How would you feel if the space was completely clean? How would you feel if it were in complete disarray
  • What three things do you regularly need that you can’t find?
  • What could you do to make those three things more findable?
  • What in your life do you have no problem finding? What is it that you always put back in an assigned place, or always know where it is even if it’s in a cluttered place? What is it about that thing or those things that make knowing its/their whereabouts important to you?
  • What are the first three things you would clean if you knew an employer or client would be visiting you tomorrow?
  • What piece of cleaning have you been putting off for a while? Why do you think you’ve resisted cleaning up just that one area?
  • What are the tools you always need to have within arm’s reach?
  • What else is within arm’s reach that you rarely or never use?
  • How would you describe your space to someone you’d hired to help you get organized?
  • How would you organize your space if you had been hired to organize it?

Like I said, there are no right or wrong answers, here. The idea is to help you find that comfortable medium, where the things you need are at hand and the things you don’t need are out of the way but still findable. I think most of us spend a lot of energy maintaining a “mental map” of our space, and I strongly believe in “off-loading” some of that work to well-designed systems — but there’s no use in doing that if you end up spending the same amount of mental energy maintaining your mental map of how the system works!

Instead, if you can figure out the “sweet spot”, you can focus on “nudging” your system back towards it. This is far preferable to the kind of worry and anxiety the prospect of a “clean sweep” can create in us. Don’t, however, confuse comfort with effectiveness — we humans can get used to just about anything (there are people who mentally collapse when removed from prison, hostage situations, even concentration camps!) but that doesn’t mean that it’s the most effective way for us to live.

Take some time to ask — and answer — the hard questions to produce an organizational system that works most effectively for you. That means that it does the most it can do with the least amount of energy — both in physical labor and in mental anguish.

Wednesday, October 1, 2008

MarketWatch: New Study Says rEEG(R) Can Slash Cost of Mental Health Treatments


Builds on Mounting Evidence of rEEG's Benefits to Treatment-Resistant Patients
Last update: 9:45 a.m. EDT Oct. 1, 2008
COSTA MESA, CA, Oct 01, 2008 (MARKET WIRE via COMTEX)


CNS Response, Inc. today released a report from Analysis Group, a national economics consulting firm, which shows the dramatic savings CNS's technology can bring to payers. The technology, called referenced-EEG(R), is a personalized reference lab test that guides physicians to psychiatric medications that work based on a biomarker database. Physicians using rEEG(R) can cut payer costs by avoiding drug treatments that fail. The Analysis Group study is the first that models the cost impact of rEEG(R) to payers.

The Analysis Group study focused on treatment-resistant (TR) patients, who add significantly to treatment costs -- more than $8,000 annually, according to a 2004 study by investigators Howard Birnbaum and Paul Greenberg of Analysis Group. "This patient group is so costly because they have almost double the office visits, more than three times the outpatient claims and nearly four times the inpatient claims of patients who are not treatment-resistant," noted Dr. Birnbaum. Without the evidence-based guidance provided by rEEG(R), physicians typically resort to "trial and error" in choosing among the over 100 FDA-approved drugs for treating psychiatric disorders.

The study authors found that a sample health plan with 20 million members utilizing rEEG(R) for its 80,000 patients with treatment-resistant mental disorders would save up to 40 percent in behavioral care costs, and approximately $212 million annually in direct health care costs. An even greater savings in reduced absence and productivity losses brings the total to over $550 million, illustrating that the impacts of treatment failure are not limited to behavioral health costs, but are in fact even greater for health plans, disability plans, and employers.

"We spend over $30 billion on retail prescription drugs each year for behavioral disorders, but for many these medications don't work, or lose their effect over time. The myth is that these costs are limited to behavioral care," said George Carpenter, President of CNS Response. "The reality is that these patients drive four times higher spending for regular medical care, almost seven times more in prescription costs, and represent the majority of lost work days for employers. Patients have ordered over 5,000 rEEG(R) tests to date, in many cases paying on their own, and their insurers gained the benefit. This report and budget impact model present clear evidence of the direct savings for payers reimbursing rEEG(R) testing for their most costly plan members."

These latest economic results come on top of clear evidence from a series of clinical studies on rEEG(R) in treatment-resistant patients. The patients studied suffered from a range of disorders including depression, bipolar, attention-deficit hyperactivity disorder and anxiety and did not show significant improvement from initial or subsequent treatment regimens. By helping physicians prescribe more effective, individualized medications, rEEG(R) consistently -- and often dramatically -- improved the patients' quality of life.

"rEEG(R) is a win for everyone," said Carpenter, "the patient, the physician and the payer."

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