The Story of a Sign

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NYTimes.com: Op-Ed Contributor - The Power of Negative Thinking

September 24, 2008
Op-Ed Contributor
The Power of Negative Thinking
By BARBARA EHRENREICH

GREED — and its crafty sibling, speculation — are the designated culprits for the financial crisis. But another, much admired, habit of mind should get its share of the blame: the delusional optimism of mainstream, all-American, positive thinking.

As promoted by Oprah Winfrey, scores of megachurch pastors and an endless flow of self-help best sellers, the idea is to firmly believe that you will get what you want, not only because it will make you feel better to do so, but because “visualizing” something — ardently and with concentration — actually makes it happen. You will be able to pay that adjustable-rate mortgage or, at the other end of the transaction, turn thousands of bad mortgages into giga-profits if only you believe that you can.

Positive thinking is endemic to American culture — from weight loss programs to cancer support groups — and in the last two decades it has put down deep roots in the corporate world as well. Everyone knows that you won’t get a job paying more than $15 an hour unless you’re a “positive person,” and no one becomes a chief executive by issuing warnings of possible disaster.

The tomes in airport bookstores’ business sections warn against “negativity” and advise the reader to be at all times upbeat, optimistic, brimming with confidence. It’s a message companies relentlessly reinforced — treating their white-collar employees to manic motivational speakers and revival-like motivational events, while sending the top guys off to exotic locales to get pumped by the likes of Tony Robbins and other success gurus. Those who failed to get with the program would be subjected to personal “coaching” or shown the door.

The once-sober finance industry was not immune. On their Web sites, motivational speakers proudly list companies like Lehman Brothers and Merrill Lynch among their clients. What’s more, for those at the very top of the corporate hierarchy, all this positive thinking must not have seemed delusional at all. With the rise in executive compensation, bosses could have almost anything they wanted, just by expressing the desire. No one was psychologically prepared for hard times when they hit, because, according to the tenets of positive thinking, even to think of trouble is to bring it on.

Americans did not start out as deluded optimists. The original ethos, at least of white Protestant settlers and their descendants, was a grim Calvinism that offered wealth only through hard work and savings, and even then made no promises at all. You might work hard and still fail; you certainly wouldn’t get anywhere by adjusting your attitude or dreamily “visualizing” success.

Calvinists thought “negatively,” as we would say today, carrying a weight of guilt and foreboding that sometimes broke their spirits. It was in response to this harsh attitude that positive thinking arose — among mystics, lay healers and transcendentalists — in the 19th century, with its crowd-pleasing message that God, or the universe, is really on your side, that you can actually have whatever you want, if the wanting is focused enough.

When it comes to how we think, “negative” is not the only alternative to “positive.” As the case histories of depressives show, consistent pessimism can be just as baseless and deluded as its opposite. The alternative to both is realism — seeing the risks, having the courage to bear bad news and being prepared for famine as well as plenty. We ought to give it a try.

Barbara Ehrenreich is the author, most recently, of “This Land Is Their Land: Reports From a Divided Nation.”

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Epilepsy Foundation: Mood Disorders and Victor Newman ...

I'm home today, sick with a cold, and I thought I'd tune in to the soap I watch occasionally.  Imagine my surprise when I realized that, two months later, "Victor" is still incapacitated with grief over the death of his latest wife ... he says he feels "empty" ... he's quitting everything and giving away everything else.  Hey, the dude is depressed and suicidal!  Could it be that the soaps are going to start bringing some intelligent script writing to mental illness?  So I turned to my trusty Google ... it's not much, but it's a start!

Viewpoint: Dr. John Barry discusses the impact of mood disorder in the life of "Victor Newman"

By John Barry, M.D.
Special to EpilepsyUSA
Posted: August 29, 2006

John
Barry, M.D., is an associate professor of Psychiatry and Behavioral
Sciences at Stanford University Medical Center. After reading a section
of the script for episodes of The Young and the Restless dealing with epilepsy, EpilepsyUSA spoke to him about the changes in mood of Victor Newman, the character diagnosed with temporal lobe epilepsy.

What can you tell us about mood disorder as it relates to epilepsy?

There
are a number of people with epilepsy who experience disagreeable
changes in their emotions. In fact, while the link between mood
disorders and epilepsy has been observed for more than 2,000 years, the
relationship between seizures and mood disorders has not been well
understood. Today, we don't have all the answers, but we do know mood
disorders occur more often in people with epilepsy than in the general
population.

Unfortunately, mood plays a critical role in the
ability of people to perform a variety of daily activities. People with
epilepsy may be experiencing a mood disorder when feeling anxious,
depressed, irritable, or have feelings of fear, panic, or pain that are
not easily explained by seizures or other medical causes. Depression is
the most common mood disorder experienced by people with epilepsy and
may affect up to a third of people with uncontrolled seizures.

While
some people become depressed, others may become irritable. Some people
have milder forms of depression that may also affect quality of life
and response to treatment. Anxiety, while not technically a mood
disorder, is another common emotion that occurs more often in people
with epilepsy. In order to improve the quality of life for people with
epilepsy, it's very important for both doctors and patients to be
familiar with the commonly encountered problems of mood disorders.

For
a lot of people with refractory seizures, the impact of mood disorders
on their lives is at least as important as their epileptic events.
Therefore, they should receive the same attention to treatment. If
someone has a mood symptom affecting their usual activities, they
should tell the doctor and consider seeing a mental health professional
to be screened for depression. It's important to realize that
antiepilepsy drugs (AEDs) and brain dysfunction can sometimes cause
similar symptoms and mimic depression. A health professional should be
able to sort out the cause of the feelings, however.

What can you say about the epilepsy symptoms associated with the character, Victor Newman?

The
doctor in the television program diagnosed the character with epilepsy
as having a simple partial seizure. However, because he has experienced
periods of unconsciousness, he may very well have complex partial
seizures instead.

Regardless of the character's diagnosis, I am concerned that viewers of the
program could believe that epilepsy creates a heightened sense of well
being. This is not what I see every day with people who are
experiencing the kind of mood disorders that are associated with
epilepsy.

While some of the first aid information presented in
the program appears quite accurate, the character's condition is not
very realistic and is certainly not very common. People with some forms
of epilepsy may experience auditory hallucinations, such as hearing
sounds as well as visual experiences. This may occur as an ictal event
or more commonly as a post-ictal phenomena, especially after a flurry
of seizures.

Could the character's mood disorder improve with his treatment for epilepsy and seizures?

Seizures
are the most obvious part of having epilepsy, but they may not be the
only part. A brain injury – such as a head injury, meningitis,
stroke, or brain tumor – that is causing the seizures may also
cause mood problems. A mood disorder, like depression, is likely to
decrease someone's quality of life. For example, symptoms that occur
with depression such as irritability and sadness may interfere with
social relationships, and trouble sleeping may even make seizures
worse. Depression can sometimes be very severe, leading to thoughts of
death or suicide. So, it's important for people experiencing these
symptoms to share their feelings with a health care provider because
there are many effective treatments for mood disorders associated with
epilepsy.

Some AEDs may help to improve mood, but their primary
purpose is to control the seizures. Other AEDs, however, may be
associated with depression or worsen an underlying depression.
Unfortunately, it's difficult sometimes to determine whether the
medication or the underlying brain dysfunction is responsible for
abnormal mood. Often times the temporal relationship of starting an AED
and the onset of a mood disorder will give a helpful hint.
Psychotherapy and medication are the mainstays of treatment. The goal
is to completely eliminate the symptoms.

If you were writing the story, how would you have portrayed the character?

The
portrayal of the character is unfortunate since a rare or unusual
appearance of a seizure disorder is being portrayed as the norm. First,
I would want the viewers to realize that having epilepsy is not a
desirable condition. Secondly, I see people with epilepsy every day and
many of them have very fascinating, admirable and interesting stories
that deserve to be told and do not require such a stretch of
imagination. For example, I might describe someone who has had a severe
head injury and developed epilepsy and their subsequent depression and
personal and family struggles to get care and find employment. The very
common and typical experiences of people with epilepsy are often
dramatic and display the immense concern and sacrifice that families
freely extend to one another. You don't have to make up such an unusual
symptom complex to find a fascinating story line. It's not necessary.
The real lives of people with epilepsy are often very dramatic without
any exaggeration. Alternatively, the major character could have
developed epilepsy in a more common fashion and sustained a steep
decline in his overall functioning that was ameliorated by effective
treatment.

What could happen next to the character?

If
the character continues to have seizures and refuses his medication, he
could have a generalized convulsion. In addition, if his mood symptoms
are a post ictal phenomena, certainly they may worsen and cause more of
a functional difficulty for both the character and his family. The
symptoms that he is having may not be so desirable at that point and
treatment may become more obviously necessary and agreed upon by the
character.

Unfortunately, if the character decides to start
taking his medication as prescribed and then reverts back to his
less-desirable personality, we're really sending the wrong message
about people with epilepsy. It's just not what happens in the real
world. Most of the initial seizures experienced by people who develop
epilepsy are neutral in their presentation and may be even "invisible"
to most others. They are certainly not associated with such an enviable
sense of calm and peacefulness that is being portrayed here.

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Anger in the Age of Entitlement: Emotional Reality

By Steven Stosny in Anger in the Age of Entitlement

Emotional reality, unlike physical reality, is created rather than observed. By and large, people create the emotional reality in which they live. Unfortunately the choice of which reality we create is usually made by default, a kind of habitual automatic pilot derived from temperament, metabolism, and experience. The human brain filters information within its default choices, processing that which conforms to them and excluding that which deviates from them. The result can keep us pretty much stuck in a rut.

When we try to make changes in emotional reality, we tend to think in terms of problems and challenges, as if these were rocks to be removed from a garden. This approach often fails because the emotional reality we create is more like a broad cityscape than a particular rock or garden within the city. Emotional reality is general; problems and solutions are specific.



In creating the reality of intimate relationships, for instance, we tend to choose among the following cityscapes:

• A dark, cold, nameless place, where no one is welcomed and no one missed
• A boring, listless, meaningless terrain of low energy and little conviction
• A place of threat and alarm, where there is little respect or affection, only attempts to manipulate or dominate
• A place of light, promise, and connection.

Meaningful and lasting change requires alteration of the entire cityscape, not merely rearranging a few rocks within a garden somewhere in the city. For example, consider the common relationship problem of pursuer-distancer, where one person wants more closeness than the other can tolerate. Removing rocks from the garden of love would likely take you into therapy, where you would try to improve communication, reduce fear of abandonment and engulfment, learn intimacy techniques, or delve into childhood issues. You would find these efforts to be of limited value when the fault lies in the cityscape of the relationship, rather than in the details of the garden.

Create Light, Promise, and Connection
The key to lasting positive change lies in creating mental states of connection. That's right; you create connection in your head. (It doesn't even require that another person create it with you, as so many parents of estranged children or survivors of deceased loved ones know.) You choose to feel connected or choose to feel disconnected. The choice you make will go a long way to determining the response you get from loved ones. Coincidentally, you will more easily solve relationship problems connected than disconnected. The alternative - you cannot feel connected until you solve the problem - devalues the connection.

When you choose to feel connected and forsake excuses to feel disconnected, you create a cityscape of light and promise. You see then that there is enough power in the human heart to light up the world.

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The Onion: Area Father Remembers When He Thought Killing Family, Self Was Crazy

September 19, 2008 | Issue 44•38


SCHAUMBURG, IL— Father of five Don Knutsen, 39, can still recall a time not too long ago when he would have instantly dismissed the thought of lacing his family's lunch with Rohypnol and burning the house down with everyone inside as "crazy." "Just a year ago, that would have seemed pretty out there, all right," Knutsen told reporters as he tried to settle down his overexcited four-year-olds, Beth and Rogan, while his wife, Maude, informed him that the light in the bathroom was still broken. "These days, I usually don't make it to five o'clock before I notice we have five gallons of gas just sitting there in the garage." Although he does not currently have the time or money to seek counseling, Knutsen said he will certainly contact the authorities if he begins having murder-suicide fantasies in which his family does not die painlessly.

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Ovidia: What's with the raisins, anyway?

I've blogged a couple of articles now that offer the raisin exercise from "The Mindful Way Through Depression" as an introduction to mindfulness practice. And frankly, I'm a little puzzled. What's the deal with raisins, anyway?

OK, I'm not that crazy about them. But even so ... other than their cunning little wrinkles, if they're not singing and dancing, there's just not that much to a raisin to recommend it, especially when you're just beginning to explore mindfulness practice.

So let me offer an alternative suggestion: Bliss chocolate. Now THIS is something to be mindful of. For one thing (especially compared to raisins), it's expensive. That in itself is a good reason to pay attention and not just gulp it down. Then they're individually wrapped. If you're in a certain mindspace, it can be kind of enjoyable to take your time unfolding the foil, trying to see if you can get it off the candy without ripping it, noticing if it's folded right-over-left or left-over-right ...

You get it unwrapped and you're left with this fairly heavy square of chocolate. Pop it in your mouth but don't chew. Decide if it's more comfortable to have in your mouth smooth-side-up or smooth-side-down. Read the ingredients on the bag. According to the website, milk chocolate is "A combination of chocolate liquor (not alcohol), cocoa butter, sugar and milk or cream. Milk chocolate must contain at least 10% chocolate liquor and at least 12% total milk ingredients." Can you taste the cocoa butter? The milk? The cream?

How long does it take to melt in your mouth?

Uh oh.

Maybe now is a good time to be mindful of the lessons we learned as children, at the feet of a wise old owl ...
No wonder they don't use chocolate to teach mindfulness.

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The Irish Times: A mindful distraction for pain and depression

ASHOK JANSARI

CAN THE WAY you chew a raisin affect the way you experience pain? Trials at St James's and AMNCH (Tallaght) Hospitals in Dublin are beginning to look at how "mindfulness meditation" can be used to help people cope with a diverse range of problems including chronic pain, depression, anxiety, cardiac difficulties and even psoriasis.

"Mindfulness is a secular form of meditation . . . [and] . . . is useful for anyone going through stress and strain in life, which is probably everybody," explains Dr Noirin Sheahan, who has been practising mindfulness meditation for 20 years.

"In 2004, I realised that it was being used clinically . . . [and] . . . about a year ago, a consultant in pain medicine, Dr Connail McCrorey, asked me to teach his patients with chronic pain mindfulness," says Sheahan.

So what is mindfulness meditation? To most, these words conjure up images of Eastern spirituality, incense sticks and chanting. However, while the roots of it are indeed in Hindu and Buddhist philosophies, it's use in its present form started with the work of a US molecular biologist.

Dr Jon Kabat-Zinn, a researcher who specialised in the mind-body interaction, had been practising Zen Buddhism for many years. He realised that "what he had learned in terms of coping with the difficulties in life . . . could be applied in society as a whole outside of Buddhism", according to Sheahan.

"He felt that the place where the difficulty of life is most manifest is in hospitals where people are trying to cope with disease, chronic illness, maybe even terminal illness." As a result, "he developed an eight-weeks course . . . [in which] there is no chanting, no candles, incense, etc."

The first session begins with the simple task of chewing a raisin. Most people chew and swallow it without any real memory of it having been in their mouth.

The eight, two-and-a-half-hour, weekly training sessions involve learning a state of "relaxed alert attentiveness", says Sheahan.

For the past year, patients referred to McCrorey for help with pain brought on by a range of problems including arthritis, fibromyalgia, cancer and injuries following accidents have been referred to Sheahan, with ages ranging from 18 to 70.

Although in its early stages, results already look promising, which backs-up published findings for patients with chronic pain.

"Kabat-Zinn found that [the patients'] level of pain was reduced after a mindfulness course . . . and it also reduced anxiety and depression." These results were maintained for up to four years, according to Sheahan.

Mindfulness has been combined with conventional Cognitive Behavioural Therapy in the UK for treating depression and anxiety. This model (known as MCBT) has also been used with very positive results at St James's.

Intriguingly, Kabat-Zinn has found that the rate of healing in patients with psoriasis undergoing ultraviolet treatment was quicker for those engaged in mindfulness practice.

•To find out more about mindfulness meditation, contact Dr Noirin Sheahan at nsheahan@stjames.ie.

• Ashok Jansari is based at the University of East London and was on placement at The Irish Times as a British Association for the Advancement of Science Media Fellow

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The Princeton Packet: WELLNESS: Cultivating mindfulness

By Deborah Metzger
Princeton Center for Yoga & Health


Daunted by meditation?

You can learn a great deal about it simply by eating a raisin. Read on.

If the thought of meditation conjures up sitting in a lotus position for hours or chanting something unintelligible with our knees aching and our legs falling asleep, let’s dispel that myth right now.

The fact is that most of us cannot sit still for even a nanosecond without “time traveling” in our minds — those concerns about the future, those lingering thoughts about the past, that itch that comes up within seconds and just won’t quit.

Let’s let go of any notion that we “can’t” meditate.

One technique that we teach at the Princeton Center for Yoga & Health (PCYH) is Mindfulness Meditation, which trains the mind to focus so that we can live our lives more fully. It’s about doing things and noticing that you’re doing them.

Mindfulness practices aid us in stopping and focusing our minds. Mindfulness helps us to turn down all the noise in our heads — the guilt, anger, doubts, and uncertainties that upset us moment to moment. It is a technique that encourages us to stop and smell the roses. Developing our ability to stop helps us to reduce the amount of stress in our lives and be more available to the present moment. It creates opportunities to see reality as it is and to experience life in its fullness.

Though it sounds simple, mindfulness takes practice, and the longer we practice, the easier the process becomes.

We typically begin our Mindfulness Based Stress Reduction (MBSR) and Mindfulness Based Cognitive Therapy (MBCT) programs with a raisin-eating exercise. It’s an easy introduction to the practice.

Try this. Take a raisin (yes, just one) and hold it in the palm of your hand or between your finger and thumb. Imagine that you have just dropped in from Mars and have never seen an object like this.

Look at this raisin. Let your eyes explore every part of it, examine the highlights where the light shines, the darker crevasses, the folds and ridges, and any unique features.

Feel the weight of it. Turn the raisin over between your fingers. Notice its texture, its “topography.” Hold the raisin to your ear. Squish it a bit. Does it make a sound?

Hold the raisin beneath your nose. With each inhalation, drink in any smell, aroma or fragrance that may arise, noticing as you do this if anything interesting is happening in your mouth or stomach.

With awareness, slowly bring the raisin up to your lips, noticing how your hand and arm know exactly how and where to position it, perhaps noticing that saliva starts to secrete just as you bring the object toward your mouth.

Gently place the object in the mouth, without chewing, noticing how it gets into the mouth in the first place. Spend a few moments exploring the sensations of having it in your mouth, exploring it with your tongue.

When you are ready, prepare to chew the raisin. Then, very consciously, take one or two bites into it and notice what happens, experiencing any waves of taste that emanate from it as you continue chewing. Resist the urge to swallow. Notice the sensations of taste and texture in the mouth and how these change over time, as well as any changes in the object itself.

When you feel ready to swallow the raisin, see if you can first detect the intention to swallow as it comes up, so that even this is experienced consciously before you actually swallow.

Finally, swallow the raisin — see if you can feel the raisin going down toward your stomach — even entering your stomach — and noticing, perhaps, what it feels like to be one raisin heavier.

Sense how the body as a whole is feeling after completing this exercise in mindful eating. Notice your thoughts.

Notice that there is nothing magical about mindfulness. Most of us do a lot of different things when we’re eating —read, talk, watch television. Notice how slowing down and really tasting your food helps bring you into the present moment.
Often, when we do one task, we are already thinking about the next task. So, relax, slow down. Stop and smell the roses — or taste a raisin.

PCYH will offer its two eight- week programs in Mindfulness Based Stress Reduction (MBSR), beginning Sept. 15, and Mindfulness Based Cognitive Therapy (MBCT), beginning Sept. 12. T

MBSR provides training in meditation, mindful-yoga, and relaxation to mobilize your mind/ body resources to work with stress, pain, and illness in new ways that can promote growth and healing. MBCT is a groundbreaking depression treatment that has been scientifically shown to cut the rate of relapse in half.

The Princeton Center for Yoga & Health is located at 50 Vreeland Drive in the Montgomery Professional Center. For more information, call 609-924-7294 or visit www.princetonyoga.com.

PCYH founder and director Deborah Metzger, ACSW, RYT, is a certified advanced Kripalu Yoga teacher, a Phoenix Rising Yoga Therapist, and a licensed social worker, holding an MSW from the University of Pennsylvania.

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Health 24: Living with Mental Illness

Ilse Pauw is a holder of the Carter fellowship for mental health journalism from the Carter Center in Atlanta. This is part of her series of articles on mental health and stigma.

Living in a quandary

"Living with mental illness means living with a set of questions," says 43-year-old Sanette. "Will I get ill again? Am I still ill?

"You are in a quandary: you wonder, should I tell them and trust them or not? And how will they react? I don't think that people who haven't had a mental illness can even imagine what it must be like living like this."

Sanette is one of the 25% of South Africans with mental illness who worry over questions such as these every day.

According to Sanette, the warning signs of mental illness were present in her childhood. She describes herself as having been a "dark and highly-strung child" who had a hovering depression, and who was obsessed with thoughts about death and dying. She was a top achiever at school, but led an inner life of fear and anxiety about which no one knew.

After university, she spent a year working as a waitress in Germany. That was when she had her first severe depressive episode. The depression worsened when she was on her own in London. Years later her psychiatrist speculated that this might have been her first manic episode.

"My time in London was very scary. I felt so incredibly alone and frightened. My body and head just conked in; it felt as if the whole world was tumbling down on top of me. I believed that people around me – complete strangers – thought that I was an awful person and wanted to punish me."

Things got so bad one day, that she went to the nearest cinema and paid to see three movies in a row.

"I knew that for as long as I stayed there, I would be safe, and that I would be protected from the world. I was petrified that I would cause harm by blowing up buildings or setting the embassy on fire. I would check, and check, and check again to make 100% sure that I wouldn't do anything careless."

Sanette phoned her mother who, from Sanette's incoherent speech, noticed that something was terribly wrong. Her mother tried to persuade her to come home, but she refused, and instead signed up for a Kontiki tour through Europe.

"I was very lucky that I somehow had the right people around me during that time. Two South Africans on the tour probably sensed that something was wrong, that I was vulnerable. They looked after me. I was on autopilot: I knew that I just had to hang in there and survive until I could go home."

Back home

Back in South Africa, her mother took her to a doctor who prescribed an antidepressant.

"I felt like such a failure. Your gap year is supposed to be fantastic. Mine was a huge flop. I was a nightmare as a waitress; I couldn't handle travelling on my own; The relationship I had had during that year had failed; and on top of it, I returned to South Africa: fat, depressed, and on Prozac.

"I had anxiety attacks and shared a bed with my mother because I was so petrified of what was happening to me, and because I couldn't understand what was going on."

Work life

Sanette had to start her first job two weeks after her arrival. She says that this was, in retrospect, a good move, because she was forced to face the world again.

She eventually resigned from her job at a newspaper and started writing for a magazine in Johannesburg where she is still working today.

Sanette had started drinking at university, but only started drinking heavily during her time in Europe. Since then, her drinking got steadily worse and she started combining alcohol with painkillers, sleeping pills and appetite suppressants.

Her behaviour was at times inappropriate and bizarre. She would, for example, send out lengthy text messages in the early hours of the morning to people she hardly knew. She sometimes spent the entire weekend alone in her house, with only alcohol and pills to keep her company.

Sanette has been hospitalised twice with the dual diagnosis of bipolar mood disorder (BMD) and substance dependence.

Disclosure

"I am very fortunate that I can always be open with my parents. They have been very supportive throughout, no matter how much my behaviour might have shocked them. I'm also fortunate that there are a couple of close friends I can trust.

"You can't tell everyone everything. I have great friends and am a spontaneous person but I have to filter out the really gory detail when I'm in the company of friends who are very religious."

After her first admission, she felt it necessary to tell two or three of her colleagues about her illness.

"I wish I had only spoken to one of them. People just like to talk too easily. By disclosing, you make yourself vulnerable and open to criticism and unhappiness."

Dr Ulla Botha, psychiatrist at Stikland Hospital, agrees: "Stigma and discrimination are real issues in the life of a person with a past or present mental illness. Misconceptions, fear and misunderstanding all contribute to discrimination.

"People who have disclosed, often report that they are treated differently, that they are not taken seriously, are not offered the same opportunities, and that they find it more difficult to find jobs."

Out of the closet

When Sanette had to be admitted a second time, it was easier for her to tell her boss and some of her colleagues that she wasn't coping and that she needed "time out".

"As a journalist it might have been easier for me to 'come out of the closet'. In a creative field such as journalism, it is more acceptable to be eccentric, to drink too much at times, be outspoken and to party."

She feels fortunate that most of her immediate colleagues who know about her illness have been supportive, or try to be. But even with them, it can get tricky at times.

"Everybody can be forgetful, or at times not concentrate as much as they should, or submit work which is not up to their usual standard. My illness is always in the back of people's minds. If anything happens, I get asked whether I'm okay, or whether it happened, because I wasn't well at the time. I feel that I need to be extra careful and to watch myself all the time. My colleagues don't need to do the same."

Acceptance

"Even though I've come to accept my illness, I'm still secretive in a way. I don't have a problem with my colleagues knowing that I was depressed, but I'll never say that I'm bipolar. I also don't have a problem saying that I'm on antidepressants - antidepressants have become fashionable. But to tell someone that you are on mood stabilisers or antipsychotics is just a whole different ball game," says Sanette.

"This is not uncommon," says Botha who has done extensive work on mental health and stigma. "Certain illnesses are regarded as being more 'acceptable' than others. Many people are ashamed to admit that they are on psychiatric medication because of stigma. They feel that they need to lie about it or hide the medication. The tragedy is that many people who need to be on treatment stop taking it."

Growing stronger

Nowadays, Sanette sometimes suffers the odd setback, but she usually feels strong, positive and in control.

"I work closely with my psychiatrist, whom I trust and respect. I try to lead a healthy lifestyle: I eat healthily, exercise regularly and have cut down on substances. I always hated exercise, but now I'm starting to enjoy it. I'm trying to find new ways of feeling good." - (Ilse Pauw, Health24, September 2008)

Related articles:

To tell or not

The cruellest loss

My secret life

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globeandmail.com: The shadow of depression

September 16, 2008 at 4:50 AM EDT

It is hard to believe that a highly treatable illness could stop the prodigious voice of the U.S. novelist, short-story writer and essayist David Foster Wallace, just 46 when he took his own life last Friday by hanging himself. His suicide is a reminder of the depredations of mental illness, and in particular of how depression can still be, in spite of medical advances, an overpowering and potentially fatal disease.

His entire career, it seems, was conducted in the shadow of this illness. For 20 years, according to his father, he took medication for depression. A 1996 profile of him in the New York Times Magazine reported that he had tried to commit suicide at least once. Like any good writer he made his illness into material; depression is omnipresent in his 1,079-page tour de force, Infinite Jest.

Mr. Wallace's short story The Depressed Person begins, "The depressed person was in terrible and unceasing emotional pain, and the impossibility of sharing or articulating this pain was itself a component of the pain and a contributing factor in its essential horror." His achievements, in light of his illness, seem all the more remarkable.

While his work was notoriously demanding of readers (it most resembles that of the postmodernist Thomas Pynchon) and not always entertaining or satisfying in the ways many readers have come to expect good fiction to be, there is no denying the originality and scope of his talent.

Mr. Wallace made his mark early, publishing The Broom of the System, his first novel, at age 24, followed by a short-story collection, Girl with Curious Hair, and then at just 34 the colossal Infinite Jest, which helped him earn a MacArthur Foundation "genius grant" of $230,000. "Wallace is, clearly, bent on taking the next step in fiction," Sven Birkerts wrote in the Atlantic Monthly. "He is carrying on the Pynchonian celebration of the renegade spirit in a world gone as flat as a circuit board; he is tailoring that richly comic idiom for its new-millennial uses."

Whether he would have been the same artist without his illness is not known; perhaps he would have produced a whole shelf of 1,000-page novels, or perhaps he would have turned to a less lonely profession. To note that he overcame depression to create works of originality and beauty, and that depression ultimately overcame him, is to stand in awe both at his singular achievements and the remorseless power of the disease.

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SFGate: Nonfiction review: 'Acedia & Me' and writing

Paula Priamos, Special to The Chronicle

Acedia & Me
A Marriage, Monks, and a Writer's Life
By Kathleen Norris
Riverhead Books; 334 pages; $25.95

What prompts a professor on sabbatical to waste precious time by hosing down his house rather than work on his book? Why would a teen girl resolve not to make her bed in the mornings because she knows she'll be sleeping in it later that night?

According to Kathleen Norris, these odd rationalizations are described by an old monastic term, acedia, or mental sloth. For Norris, who's written such widely regarded works as "The Cloister Walk" and "Amazing Grace," appraising the importance of faith and the Christian vernacular is familiar ground. In her meditative memoir "Acedia & Me: A Marriage, Monks, and a Writer's Life," she scrutinizes the intricacies behind acedia, these destructive mental detours of the mind, leading the reader through her own lifelong struggle.

Retreat to South Dakota

It may strike the reader as strange that a husband and wife, both of whom suffer from depression, would choose to move away from the frenetic energy of New York City to the stillness of a small town in South Dakota. It would be a culture shock for anyone. But for Norris and her husband, David, it is the ideal place. They hole up in her grandparents' old farm house and write, just write. Depression, Norris contends, is closely related to acedia, with the exception that one is a treatable ailment and the other is a vice.

With no children to worry about, not even a television set to serve as a distraction, this solitary way of life works well for Norris and her husband, or at least it does for a while. Norris also seeks the local monastery for "intellectual stimulation," which makes the difference for her. David, however, soon suffers a mental breakdown.

Although Norris and her husband are fully aware of drug treatments for depression, "we believed that our ups and downs were part of the creative process, and we didn't want to risk being flattened emotionally, which could stunt our work." Not seeking treatment comes at a high price for David. He vanishes for days, sending Norris what appears to be a suicide note that results in his having a short hospital stay.

While her husband has a dodgy relationship with religion, particularly Catholicism, Norris is deeply rooted in Christianity and monastic principles. She turns to them during her husband's mental breakdown, as well as during his later terminal illness. In times of affliction, the repetitive act of prayer serves as a form of healing, her spiritual salve. "Throughout this crisis, the psalms had been my constant companions, calming me and helping me endure."

Repetition is a process that Norris must also confront when it comes to her writing. "As a writer I must begin, again and again, at that most terrifying of places, the blank page." Through the ebb and flow of daily routine, she sometimes finds herself creatively stagnant. What some in her situation might call writer's block, she recognizes as a "gestation" period where "new writing then begins to emerge."

Successful at giving care

The most tender and substantive sections of the book are when Norris recounts caring for her husband, who suffers for years with complications from lung cancer. In search of a warmer climate, the two of them relocate to her home state of Hawaii. She never thought herself capable of motherhood, but she succeeds in her role as her husband's around-the-clock caregiver and is by his side reading a prayer when he dies. She recognizes that "as with prayer and poetry, so with love; it has not ended for me because I have lost the love of my life."

"Acedia & Me: A Marriage, Monks, and a Writer's Life" takes a soulful trek through the contemporary writings of Joan Didion and Saul Bellow to the great thinkers of all time, among them St. Thomas Aquinas and fourth century Christian monk Evagrius Ponticus. But it is in those moments when Norris relies on her own words, her own story, that the reader experiences the real spiritual awakening.

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UUWorld.org: Love Can't Fix Everything

I knew the gunman who killed two in a Knoxville church, but I don't need an explanation for his actions. I need stories of heroes and kindness and compassion.

By Meg Barnhouse

I was sitting with a group of Unitarian Universalists talking about the shooting in Knoxville’s Tennessee Valley Unitarian Universalist Church when one person said of the shooter, “He just never had any love.” Never one to err on the side of gracious silence, I snapped, “He most certainly did have love. I know one of the women who loved him, and she loved him fiercely.”

I met Jim David Adkisson several times, once at a wedding in his back yard, and then at SUUSI, the UU summer camp in Virginia, in 1996. His then-wife Liza used to attend the Tennessee Valley UU Church. I am a card-carrying liberal, and I think what David (we called him Jabbo) did was evil. I don’t think he is evil, but the horror he perpetrated on the Tennessee Valley and Westside UU congregations was.

I can’t explain his opening fire during a worship service by saying he wasn’t loved. Five women loved him enough to marry him. I used to look forward to UU summer camp so I could sing with Liza. She loved him fiercely, as I said. They used to talk about how they were soul-twins. He had a family who loved him, too, and he loved them. His mom, his dad, his sister who was a nurse: They loved him. He had good, loyal friends, too. Unfortunately, some of those friends loved drinking and doing cocaine with him.

The day I went to my friend Catharine’s wedding in Jabbo and Liza’s back yard was a lovely day. The wedding was fun, with lots of music and laughing, great tattoos on most of the guests, and lots of drinking. I lit the fireworks during the wedding, stone cold sober, of course.

Fast forward ten years of hard drinking and drug use, losing Liza because of his threats to end her life and his, the paranoia that is the hallmark of cocaine abuse, loss of job after job, the self-righteous scapegoating of “liberals and gays” encouraged by right-wing blowhards, the twist in his heart every time he drove past his ex-wife’s church, and you have, I think, the storm that struck Unitarian Universalists on July 27.

I wish I had a solution to the ills of society. All I have here is a small addition to the conversation among liberals about people who do evil things. Jabbo had lots of choices and lots of chances. Maybe it was brain deterioration from the substance abuse, maybe it was the right-wing hate mongering, maybe it was poor impulse control resulting from a chemical imbalance he was born with. Whatever advantages and disadvantages he started with, he participated with his sovereign free will in making himself what he is today. I think this is more respectful of him and his inherent worth than to imply that he couldn’t help what he did, that he was on some kind of predestined track to disaster.

Sometimes there is brokenness that just can’t be fixed. I’m sorry to say that, but as a minister who worked in the mental health field for twenty years before working full-time at a church, I know that love can’t fix everything. Anyone who has been partnered with someone who becomes increasingly isolated in their own reality, who is ill and refuses treatment, or who is in the grip of addiction—anyone who has tried to love someone enough so they get well—knows that.

Love cannot always be sweet and outreaching. Sometimes love must be challenging. Sometimes it is more loving to leave someone than to stay. It sends them a powerful message that what they are doing is not OK.

Our churches, likewise, can’t help or fix everyone. Living in a covenant community is hard work, and it necessitates our staying on our medication, by which I mean staying in as right a mind as is possible for us. Sometimes a person is not in a place in their life when they have the mental, emotional, and spiritual resources to be part of a covenant community. Covenant communities can be hard on their members, too, because they don’t always work the way they say they want to work. You have to have a certain sturdiness to bear that.

I hear folks say that if Jabbo had come to a UU church, he would have been helped. My friends, he came to UU summer camp as his argumentative, gun-loving, right wing, liberal-blaming self, and he was argued with, of course. He was derided for being part of the Boy Scout organization and for his right-wing views. He felt disrespected and shunned.

We love to think of ourselves as open-minded, but it’s hard for us to be open-minded toward certain people and their views. Maybe it’s just me that has a hard time, but I think I’m not alone in this. I argued with him, too. I do affirm the worth and dignity of every person, but I never promised to affirm the worth and dignity of every idea. Some ideas are oppressive and not well thought out. They lead to violence and injustice and really bad behavior. I try to argue with respect and kindness, but it’s hard when the person you’re talking to acts like a jerk. If I were the Dalai Lama or a UU saint, I would be able to, and I hope that will come in the future, but I am sure not there yet.

I understand wanting to find an explanation for his choice to shoot liberals while a group of their children were performing the show “Annie Jr.” If we can explain it, maybe we feel we have some control in the situation, some understanding of ways to prevent it happening to us. Life is dangerous. It is hard and sweet and adventuresome, full and mysterious, and way, way beyond our control. We do what we can.

I lived in Israel for a time, where we all stayed alert to odd behavior, abandoned packages, money lying on the sidewalk that might be wired to explode when you picked it up, people sweating in the cool air, wearing long coats in the summertime. We are all part of the world, even in our churches, and we need some people to be alert so the rest of us can relax our guard when we gather.

I would like to understand all of the reasons why a person would do something evil, but that’s not a pressing need for me. I’m not sure we’ll ever understand. I think the capability for destruction is within all of us, given certain pressures.

What I do need is to hear stories of courage and kindness. I need the heroes, like Greg McKendry, the usher who people say stepped in front of Jabbo to protect others and died as a result, like the men who wrestled Jabbo to the ground and kept him there. John Bohstedt, one of those men, was playing Daddy Warbucks. He tied Jabbo up with the Daddy Warbucks costume’s suspenders.

I need to hear about the UUA Trauma Response Ministry Team, which has received nothing but the highest marks for its swift, sensitive, and extraordinarily competent work with the traumatized and grieving people.

I need to hear about the churches of Knoxville, liberal and conservative evangelical churches, whose members pitched in with love and compassion, bringing food and caring for people as they gathered.

I need to hear the story of the hotel clerk who gave my friend Jim McKinley, minister of the UU Fellowship of Hendersonville, North Carolina, a discount at his Knoxville hotel when the parking lot attendant saw his Unitarian Universalist license plate holder.

I need to hear about the mayor of Knoxville, who ordered city workers to clean up the crime scene quickly so the congregation could reclaim the sanctuary.

Most of all I love to hear the story of how the cast of “Annie Jr.,” after debriefing with the trauma team, came to Chris Buice, minister of the Tennessee Valley UU Church, fifteen minutes before a worship service on the Monday after the shooting. They asked if they could sing “Tomorrow” again. Jim McKinley and Clark Olsen, who were there, described the children singing with tears on their cheeks, people with lit candles in their hands, unable to clap at the end, lifting the flames high and stamping their feet, whooping and shouting for those kids, for that song, for the knowledge that tomorrow will come.

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McSweeney's Internet Tendency: Welcoming Remarks Made at a Literary Reading, 9/25/01.

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Every year, we wonder what might be appropriate on this day, and we can never think of anything more appropriate than this piece, which Mr. Hodgman originally delivered at a literary reading shortly after September 11, 2001.

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Good evening.

My name is John Hodgman. I am a former professional literary agent, which on a good day is a pretty small thing to be, and these days feels rather microscopic. Before I was a professional literary agent, I thought it would be a good idea to be a teacher of fiction in a college MFA program because it is easy and you are adored all the time and of course it pays a lot of money.

I used to have a lot of bright ideas.

I even had two lessons planned out, which, by all accounts from MFA programs that I've heard, is one more than you need. The first would address the comfort of storytelling. I would explain to my adoring students that stories hold power because they convey the illusion that life has purpose and direction. Where God is absent from the lives of all but the most blessed, the writer, of all people, replaces that ordering principle. Stories make sense when so much around us is senseless, and perhaps what makes them most comforting is that, while life goes on and pain goes on, stories do us the favor of ending.

Not a very original idea, but one that seemed more or less reasonable before something happened that showed us how perversely powerful stories can be when told into the ears of desperate and evil men, and showed as well how sadly challenged stories are in providing comfort now. What happened on Tuesday was enormous, sublime in the darkest sense of the word, so large as to overwhelm our ability to describe it, to sense it except in parts, and certainly to order it and make it make sense. In the immediate aftermath, we have only our very personal flash memories, but personalizing an event that has touched so many and so cruelly, announcing by byline our own survival, feels shamefully self-involved. To convert this experience into metaphor, into symbolic gesture, feels almost offensive when we are still pressed by such an urgent reality that is ongoing and uncontainable by words.

I have heard a lot recently about the role of writing, song, music, painting, in the tragic blank space in our souls that this event has left behind. Of course, this preoccupation is largely a result of an unconscious bias of the media. If pig farmers had as much currency with NPR as literary novelists, we would be hearing just as much about the healing power of bacon. And knowing that power well, I can say that it is certainly comparable to the reading of a sensitive short story as far as comfort goes; and yet both fall far below the direct aid that is being passed from person to person, below Chambers Street, in our homes, on the phone with strangers, with an actual touch, in the actual, nonsymbolic, unannotated world of grief in which we live. The great temptation is to be silent, forever, in sympathy.

The second lesson plan that I had in those days was a very lazy assessment of storytelling's function, beginning in the oral tradition, when it served a civic purpose aside from getting you invited to cocktail parties. As I would explain to my adoring students, storytelling served initially in every culture three purposes: to inform, as in relay news and record history, to instruct, as in pass down a set of moral guidelines, and to entertain. We are, as regards this event and its unfolding, all too well informed. And as for entertainment: when I thought this was a bright idea, it was when I was younger and war seemed so far away. But I realize now that those in history whose lives were short and mean and threatened by sword and disease gathered and told stories not as leisure, but as desperately needed distraction, and reassurance that they were not alone.

So if art cannot contain or describe this event, and if for now the suffering is too keen to be alleviated by parable ... if stories are for the moment not as critically needed, as courage, as medicine, as blood, as bacon, they can at least revert to this social function. As time goes on, this will all pass away into memory, into a story with a beginning and a middle and finally an end. And that transition from the real into fable will bring its own kind of comfort and pain. Now, though, we may gather and distract one another, take comfort in our proximity, and know that we are, at this moment, safe.

Not many of my ideas seem bright anymore, and I am not a teacher. I am only humbled: to be here, to be alive.

That is all.

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In Practice: Of Human Frailty

By Peter D. Kramer in In Practice

Early in my career, when I served as head of ambulatory psychiatry for a group of hospitals here in Providence, Rhode Island, I happened to take a trip to Israel. In Jerusalem, I found myself explaining my job to a skeptical audience. What were outpatient services? a woman wanted to know. Who needed them?

Searching for a case that would put me on solid ground, I began to tell the story of a young man injured in an industrial accident. Nerves serving his arm had been avulsed, that is, they had been tugged in way that made the arm useless and painful. The man had become depressed and had not returned to work . . . and here the woman interrupted me. Why had he become depressed?

I could see her point. We were in a country where young men and women went to war and lost limbs all the time, a country whose citizens remembered an era where Jews suffered more grievous injury, so that mere loss of limb might be deemed a small thing.

Some people who turned to our clinics did become depressed, I told the woman, when they could no longer function as they once had, when they considered themselves less attractive, less useful, and less whole than they once had been.

My challenger nodded in understanding, although an understanding was not what we had come to. I suspect she thought that Americans were constitutionally weak or that I must be dealing with a subpopulation whose members were emotionally fragile and so might need help after all. I was certain that she did not share my opening premise, that a sudden injury might be an obvious trigger for a marked change in mood and overall wellbeing.

I thought of this encounter when I came across an article in the current Annals of Surgery. Douglas Zatzick, a psychiatrist at the University of Washington, and other researchers analyzed data on thousands of patients in dozens of American hospitals and trauma centers. Looking at men and women who arrived at the facilities with a traumatic injury and survived a year, the researchers found a PTSD rate of 20.7% and, independently, a depression rate of 6.6%. Patients with one mental illness were three times as likely to be out of work; two diagnoses made a return to work five or six times less likely.

Might these figures look different in a different culture? Perhaps, but frailty is a condition of our existence; our beliefs about our toughness tend to draw on myth more than objective truth.

I was once on television by remote with the news anchor Brian Williams, and he strayed from the topic at hand to ask about post-traumatic stress disorder. Why, Williams wanted to know, was there so much less of it in World War II, with what his colleague Tom Brokaw had called “The Greatest Generation?”

The question caught me off guard, but I replied that there had, I believed, been high levels of “war neurosis,” and that the subsequent community mental health movement had been shaped by military doctors’ responses to that disorder in the War. Later that week, I sent Williams data on the problem, but only recently have I come across a compact, forceful overview of the extent of the problem.

Allan Horwitz and Jerome Wakefield, in The Loss of Sadness (a book I have criticized on other grounds), write that in the Second World War nearly a million American soldiers suffered “neuropsychiatric breakdowns.” In combat divisions, a quarter of soldiers were hospitalized for psychiatric reasons, and the figure soared to 70 per cent among those exposed to long stretches on the front lines. According to a contemporary estimate, the average soldier would suffer a breakdown after 88 days of continuous combat; by 260 days, the psychiatric casualty rate reached 95 per cent.

It would be interesting to read studies of responses to trauma in other countries. But I suspect that American workers, like American soldiers of the Greatest Generation, are reasonably sturdy. The problem is that as humans, we’re just not made to withstand very high levels of stress, whether chronic and relentless or acute and intense.

Note of coming events: The press reports today on research showing that the new antipsychotic medications are no more (and perhaps less) effective than older medicines in treating psychosis in children. For unknown reasons, the American Journal of Psychiatry has not yet uploaded the research paper onto its Web site. I hope to comment on this issue once I have had a chance to see the underlying study.

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UWM Daily Cardinal: Mental health demands more campus attention

By: Ryan Dashek /The Daily Cardinal - September 15, 2008

The UW-Madison system needs to focus more time and funds on the mental well-being of their students


From the most experienced fifth-year senior to the newest of freshmen, we all have felt at one time or another the stress and rigors of college life bearing down on us. Whether we are stressing over financial situations, what our goals for the future may be, relationships, or even that term paper due this Friday you haven’t even started yet, college is a tumultuous time that heavily impacts our minds and mental states. That being said, it should be a top priority for our university (any university or college, in fact) to have mental treatment and counseling readily available to all students for free, or at least at very affordable prices. The fact that a recent UW System audit found that student mental health needs were growing at a much faster rate than the resources available is, therefore, a cause for great concern. The UW System needs to address this issue now before it grows out of control or situations arise in which students are put at risk.

According to the audit, which ran at the end of summer, roughly 6.3 percent of all UW System students attended therapy sessions over the course of the last academic year. UW-Madison, however, experienced the highest percentage, with about 9.1 percent of students receiving counseling or treatment last year. And yet, some students wait as long as a week before they finally begin to receive therapy. This is simply unacceptable. To have allowed the student mental health system to have become so bogged down is reproachable, and the UW System as a whole needs to act now. What is even worse, though, is that as demand for student services rise, more people seeking treatment will be forced to wait longer and longer. Needless to say, the longer people are forced to wait, the greater the danger they may pose to either themselves or others.

Unfortunately, the UW System has no plans in the immediate future for alleviating the strain on the student mental health services. Yet, shouldn’t other projects take a backseat to student health care and safety? Can’t a new lab or library wait a year, while money is instead allocated toward programs that increase the health and well-being of students? Even if the UW System offers no solutions, then UW-Madison should at least tackle the problem head-on itself. After all, Madison does have the greatest percentage of total student population seeking out mental health treatment options, and we need to ensure that these students are able to receive immediate help.

According to the American Psychiatric Association, the second leading cause of death amongst college students is suicide. A survey conducted in 2004 by the American College Health Association stated that 14.9 percent of all college students had been diagnosed with depression. College life takes a very serious toll on students’ mental wellbeing. As more students experience anxiety, drug addiction, depression and other serious mental illnesses every year, our universities need to be adequately equipped to handle the growing numbers. Even though demand has consistently increased over the last several years, the number of counselors at each UW school across the state has remained the same. This is a very serious issue that must be dealt with now, before it grows out of hand.

Waiting for more funds is not an option. Quick fixes such as increasing the amount of group counseling and employing trained students to help are good options for temporary aid on the strained student services, but more permanent solutions need to be planned and executed. The mental health of students cannot wait, and to hesitate would be to put the safety and health of all UW students at risk. The UW System needs to act now, before it is too late.

If you think that you or a friend may be experiencing symptoms of depression, anxiety, extreme stress or any other mental illness, check out the University Health Services website at www.uhs.wisc.edu or call them at (608) 265-5600 for general information.

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The Wilkes University Beacon: Suicide expert offers insights in Issues in Education series

Q & A with Dr. J.J. Rasimas
LeeAnn Searfoss
Issue date: 9/14/08 Section: Lifestyles


According to Margarita Tratakovsky, the National Institute of Mental Health reports that "75 percent of all individuals with an anxiety disorder will show symptoms before the age of 22."

In a recent presentation to the American Psychological Association, psychologist Dr. David Drum reported on a comprehensive survey he conducted that indicates, "Six percent of undergraduates and 4 percent of graduate students reported seriously considering suicide within the 12 months prior to answering the survey...[Thus] at an average college with 18,000 undergraduate students, some 1,080 undergraduates will seriously contemplate taking their lives at least once within a single year."

Last Thursday, renowned suicide and mental health expert, Dr. J.J. Rasimas, offered a lecture, "Suicide: Public Health Challenges and Opportunities," as part of the Issues in Education series. Rasimas is a graduate of Wyoming Seminary College Preparatory School in Kingston, PA, as well as the University of Scranton and Penn State University. Rasimas agreed to sit down and speak with The Beacon to offer some insights into his career and dedication to educating on the issue of suicide.

The Beacon: How did you arrive at the current point in your professional career?

Rasimas: It was during medical school that I transitioned over from oncology to being interested in mental health. I was still very interested in cancer and the other illnesses that we were treating, but I thought going into medical school was about making people's lives better. While there, I met a lot of people who were really sick and they still had great lives, and vice versa, people who weren't really sick but had miserable lives. I wondered 'what is this about?' and I felt that psychiatry offered a chance to answer a major question for clinical care and research... I retooled halfway through my residency at Penn State University and went to psychiatry at the Mayo Clinic. I then found my way to the National Insitute of Mental Health, working in clinical research.

The Beacon: Since your move the National Insitute of Mental Health, what have you focused on?

Rasimas: It's a half-and-half position. I take care of patients, as well as researching, teaching, and taking my own classses to learn and grow both as a person and as a medical professional. The half that is clinical is liaison clinical psychiatry. That is a name for meeting with patients whose primary problem is medical or psychiatric and if they, at the same time, have trouble with depression, anxiety, or an adverse reaction to a medicine that clouds their thinking. We try to figure out which parts are biological, which parts are due to their illness, and which part we can treat independently as a mental health problem.

The other half is scattered among a few different things. Included in these are researching certain groups of patients with psychiatric issues to better understand mental illness, as well as using my time at National Institute of Mental Health to help people get research funded to better understand the nature of suicide and those who attempt it. Suicidal folks are the toughest people to study, because they are not always willing participants in their care. People with thoughts of suicide are not looking for help, and all doctors want to do is help. It's an interesting situation.

The Beacon: Because of your obvious professional background, you make a perfect fit for this lecture series. What is your purpose with today's talk?

Rasimas: The more we have public stories that really disturb us about what happens on college campuses--places like Virginia Tech--where mental health issues go unnoticed, the need to do outreach to individuals in similar situations becomes critical. This is an opportunity to come and talk about some of the problems associated with research and also point out some of the things we are not doing as well as we could about making help available to those who are in distress. It's an opportunity to enhance awareness to the problems that are already addressable.

The Beacon: Since your main outreach this afternoon is college-aged students, are there any specific things young people can do to address such a devastating topic when they are either approached or have these feelings themselves?

Rasimas: In the wake of some of the troubles we've seen highly publicized, it became very clear that there were a lot of folks who were very concerned about students but felt paralyzed. They felt paralyzed by everything from school policies to the confidentiality of friendships. I know that just talking about the problem for half an hour or so in front of one college audience is not going to change all the college policies that make it difficult to get people into treatment and care. But still, silence is the most dangerous of any response that we could possibly have. The lack of a relationship, the lack of recognition, silence, stepping away, being so fearful that there is nothing done is more dangerous than anything else we could ever do. The thing that keeps people in the world is relationships. It's what we're here for. We are not here to be islands within ourselves.

The Beacon: Are there any thoughts or advice you would like to leave your college audience?

Rasimas: I would want you all the question why there is an illness out there that kills more people your age than every other major medical illness out there. This has not been on the front page or radar and our resources are not going towards it. I would want all of you to question why that is. As you move on after college, you should have people seriously look at your age group and say, "How much do you really care about us being alive?" Because if you make it through this time period, you are the leaders for the next generation. Suicide is one of the biggest threats to those surviving young age.

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Telegraph.co.uk: Max Pemberton on teenagers’ alarming lack of knowledge concerning mental health issues

Finger on the pulse

Last Updated: 12:01am BST 15/09/2008


'There's no way I'm talking to you," snarls Mark and turns his head away. I swallow hard and try a different approach. "OK," I begin, "it's only a chat. I promise if after five minutes you don't want to talk any more, I'll go away."

Silence. He pulls the covers over his head. I stand motionless by his bed, unsure what to do next.

"Why don't you want to talk to me?" I say. He pulls the covers off his head. "Because I know the sorts of things you lot will do to me." I look at him perplexed. "You'll lock me in a mental hospital," he says. "You'll think I'm mad, but I'm not."

Mark is 16 and has just been diagnosed with cancer. I sit down and explain that no one thinks he's mad and that psychiatrists don't just go round locking people up. I explain that the ward staff are worried about him and it's my job to talk to him about how he's feeling and to try and help.

Of all the jobs I have done, my current post has to be one of the most harrowing. For the past month, I have been working in child and adolescent psychiatry, and part of the job is covering the children's cancer ward.

It's heartbreaking. The grief of the parents, the distress of the children and the feelings of impotence from the cancer specialists are palpable.

In this job there's no hiding behind ordering investigations or prescribing medication. My very raison d'être on the ward is to talk about cancer; to speak about the unspeakable. I admit to finding this very difficult at times.

But, surprisingly, one of the hardest aspects is overcoming the fear and lack of knowledge about mental health issues from both patients and their parents at a time when they have so much to contend with.

This is borne out by a study conducted by Great Ormond Street Hospital, published last week, which found that almost half of school children surveyed could not name a single mental illness. Boys between the ages of 12 and 14 were least likely to be able to name one, and even those that fared the best - 17- and 18-year-old girls - got most of their knowledge from celebrities discussing their own problems in the media.

It revealed a shocking amount of ignorance, despite mental illness being relatively common in young people: around one in 15 deliberately self-harms, with more than 25,000 admitted to hospital each year due to the seriousness of their injuries. More than one per cent are diagnosed with severe depression.

I think this level of ignorance is a reflection of society as a whole. The stigma attached to mental illness is still prevalent. It represents losing control, unpredictability and social deviance. It's spoken about in whispers; a dark, sinister secret. It is one of the last taboos and as a result, adults rarely discuss it in any detail, which further helps to propagate myths and misunderstandings. Is it any wonder that children are lacking knowledge?

Often when I broach the topic of mental health with my patients, I'm met with blank expressions, or ideas that seem to have been lifted straight out of One Flew Over The Cuckoo's Nest. Given that one in four of us will experience a mental illness, surely part of a child's education should include mental health, just as physical well being is now promoted.

"You promise you won't put me in a mental hospital," asks Mark. I nod. He looks down at the floor then back up at me.

"Well, sometimes I feel really sad…" he begins.

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The Denverchannel.com: Legal Document Gives Voice To Mental Health Patients

Psychiatric Advance Directives Tell Doctors How Patients Want To Be Cared For

POSTED: 11:54 pm MDT September 13, 2008
UPDATED: 12:06 am MDT September 14, 2008
]
According to the National Institute of Mental Health, mental disorders are common in the United States and internationally. More than 26 percent of Americans ages 18 and older suffer from a diagnosable mental disorder in a given year. That translates into about 58 million adults, including 13 million adults struggling with severe mental illness.

Many people suffer from more than one mental disorder at a given time. In fact, nearly half of those with any mental disorder meet the criteria for two or more disorders.

The burden of mental illness on health and productivity is vast. Research collected by the Global Burden of Disease study conducted by the World Health Organization, the World Bank and Harvard University shows mental illness, including suicide, accounts for more than 15 percent of the burden of disease in established market economies such as the United States. This is more than the disease burden caused by all cancers.


Some common types of mental illness include the following:

• Anxiety disorders: This category includes generalized anxiety disorder, post-traumatic stress disorder, obsessive compulsive disorder, panic disorder, social anxiety disorder and specific phobias.
• Mood disorders: The most common mood disorders are depression and bipolar disorder.
• Psychotic disorders: Schizophrenia is an example of a psychotic disorder.
• Eating disorders: Anorexia nervosa, bulimia nervosa and binge eating disorder are the most common.
• Impulse control and addiction disorders: These may include acts like gambling and kleptomania.
• Personality disorders: Examples include antisocial disorder and paranoid personality disorder.

Many mental health patients worry they will not be able to communicate their wishes in the event of an emergency. Now, a legal document known as a psychiatric advance directive (PAD) may help. The document is designed to instruct health care professionals, family members and friends about how mentally ill patients are to be cared for when they are incapacitated.

Patients can give instructions on what medications or treatments to use and what hospital is preferred. Like a living will, most PADs require two witnesses and notarization. A 2006 survey conducted by researchers at Duke University Medical Center found less than 15 percent of patients have completed PADs. Researchers also found use of the documents reduced the use of coercion during a mental health crisis and improved patient-doctor relationships. While this document can be helpful, doctors can override parts of it if they believe there is a better treatment for the patient.

Completing a PAD is free. The documents are available in about 25 states throughout the country. To find out more about how you or a loved one can create a psychiatric advance directive, log onto NRC-PAD.org

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I Sit By The Window by Joseph Brodsky

I said fate plays a game without a score,
and who needs fish if you've got caviar?
The triumph of the Gothic style would come to pass
and turn you on--no need for coke, or grass.
I sit by the window. Outside, an aspen.
When I loved, I loved deeply. It wasn't often.

I said the forest's only part of a tree.
Who needs the whole girl if you've got her knee?
Sick of the dust raised by the modern era,
the Russian eye would rest on an Estonian spire.
I sit by the window. The dishes are done.
I was happy here. But I won't be again.

I wrote: The bulb looks at the flower in fear,
and love, as an act, lacks a verb; the zer-
o Euclid thought the vanishing point became
wasn't math--it was the nothingness of Time.
I sit by the window. And while I sit
my youth comes back. Sometimes I'd smile. Or spit.

I said that the leaf may destory the bud;
what's fertile falls in fallow soil--a dud;
that on the flat field, the unshadowed plain
nature spills the seeds of trees in vain.
I sit by the window. Hands lock my knees.
My heavy shadow's my squat company.

My song was out of tune, my voice was cracked,
but at least no chorus can ever sing it back.
That talk like this reaps no reward bewilders
no one--no one's legs rest on my sholders.
I sit by the window in the dark. Like an express,
the waves behind the wavelike curtain crash.

A loyal subject of these second-rate years,
I proudly admit that my finest ideas
are second-rate, and may the future take them
as trophies of my struggle against suffocation.
I sit in the dark. And it would be hard to figure out
which is worse; the dark inside, or the darkness out.


Joseph Brodsky

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The Bangkok Post: The Mindfulness Cure

We Thais like to claim that we are peace-loving Buddhists. Yet, we've blown it many times before with violent clashes and crackdowns in previous political crises. Whether or not we fail again this time around, depends very much on how Buddhist we really are.

COMMENTARY by Sanitsuda Ekachai


Take a deep breath. Watch it leave the nostrils. Watch it come back in. Feel the sensation. See the difference. Watch the constant change. Try do it for at least 10 minutes to let the calm set in.

Indeed, we need to instil our inner calm more than ever to prevent ourselves from getting carried away in the emotional rollercoaster of our dangerously unpredictable politics.

As the nation sinks deeper into political divisiveness, we also need to build inner strength that will help pull us out of the quagmire of hatred and violence.

We Thais like to claim that we are peace-loving Buddhists. Yet, we've blown it many times before with violent clashes and crackdowns in previous political crises. Whether or not we fail again this time around, depends very much on how Buddhist we really are.

Forget our political leadership that has no sense of shame. Forget money politics, authoritarian bureaucracy, destructive development policies, and the unjust social structures that perpetuate oppression and suffering on the ground.

Not that they are not important. On the contrary.

Those are the sources of conflict rooted in our society's inequality and moral breakdown. They are also powerful forces ready to destroy anyone in their way. That is why we need to be well-equipped mentally for the challenge.

Samak Sundaravej or not, new general elections or not, we will certainly slide into the same political instability again, if the root causes of injustice are not fixed. To fix them without being overwhelmed by anger and greed of the moment, however, we need to build within ourselves a deep reservoir of calm.

We need an insight that all things - including ourselves, our perceived enemies and our imperfect world - are under the same laws of interconnectedness and change. That we are under the same cycle of samsara of birth, old age, illness and death.

More importantly, we need to learn the art of letting go. Not only of status and possessions, but also of our beliefs and the false sense of self or ego.

Otherwise, in our quest for change, we will be lost in greed, anger, hatred and a sense of moral superiority - which have turned countless ideologues into fascists.

As Buddhists, the first step towards cultivating calm and insight is by returning to ourselves, our breath.

By mindfully observing our breathing and change in body sensation, we will realise by ourselves the power of our own thoughts; how mild feelings can spiral out of control into strong and violent emotions when we let ourselves get swept away in the stream of thoughts that are rooted in past resentment and fear for the future.

We will also find how illusive our thoughts are; how they change from one matter to another by themselves without any logical sequence; and how they stop so suddenly when our awareness catches them.

It is the same with emotions. Watch them mindfully to see how they arise, subside and pass away. Watch them flare up again when triggered by thoughts or words loaded by values, prejudices, hopes and fears, only to pass away again.

Like all things, emotions do not last. They change when conditions change. Such is the law of impermanence.

Such insight miraculously fills us with hope and loving kindness. Through experiencing the constant flux of change within, we know for certain that there is no such thing as a dead end. All is subject to change. And we can influence the change and steer clear of hurting others by being mindful of our thoughts, our words and our actions.

The current political crisis boils down to a clash of burning anger, greed and hatred. The structural inequality and injustice that sustains it also boils down to greed, anger and attachment to ego, from not knowing that nothing lasts.

If we are true Buddhists, if we want real change through peace, we must open our hearts, welcome differences and change with loving kindness.

Start with mindfulness.

Start with ourselves.

Take a deep breath.


Sanitsuda Ekachai is Assistant Editor (Outlook), Bangkok Post.

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People.com: Kirsten Dunst: 'Now I Love Me'

By Maureen Harrington


Kirsten Dunst says she's "learned a lot" after checking into rehab earlier this year for depression and is now in a different place in her life.

"Everyone goes through a hard time in their life," Dunst says in the October issue of Harper's Bazaar. "They just don't have to do it in front of tons of people and with our media the way it is. I did, and I'm lucky that I had the resources and the money to take care of myself."

She adds: "Now, I'm great."

Though she hesitates to go into details about her stint at Cirque Lodge, a rehabilitation center in Utah, Dunst says prior to going to rehab she was "enormously co-dependent."

"I wasn't taking care of myself emotionally. I wasn't expressing my anger," she says. "I was making nice all the time."

She even got words of wisdom from an old pal – Tom Cruise. The actress keeps a plastic-framed copy of L. Ron Hubbard's Scientology Code of Honor in her home, which was recently given to her as a gift from her former Interview with the Vampire costar.

The 26-year old is not a Scientologist but appreciates the advice; something she can use as she develops her own projects, including a documentary called Why Tuesday? about the electoral process. She also stars in the upcoming comedy How to Lose Friends & Alienate People.

On the home front she's busy, too. The actress is selling her LA home and says she will be in her apartment in New York City, which she purchased in 2007, in a year. And her love life?

"Listen, I'm happy single or not single," she says. "Now I love me, so I'm okay."

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O Magazine: Six Ways to Stop Dwelling on It

By Naomi Barr

It's 5 p.m., the deadline for an important work project is at 6, and
all you can think about is the fight you had with the next-door
neighbor this morning. You're dwelling, says Susan Nolen-Hoeksema, PhD,
a professor of psychology at Yale and author of Women Who Think Too Much.
"It's natural to look inward," she says, "but while most people pull
out when they've done it enough, an overthinker will stay in the loop."


Ruminating regularly often leads to depression. So if you're prone to
obsessing (and you know who you are), try these tactics to head off the
next full-tilt mental spin cycle…

Stop Obsessing

1. Distract Yourself

Put
on music and dance, scrub the bathtub spotless, whatever engrosses
you—for at least 10 minutes. "That's about the minimum time
needed to break a cycle of thoughts," says Nolen-Hoeksema, who's been
studying rumination for more than 20 years. Or choose something to
focus on. "A friend told me that she once started counting the number
of times the speaker at her conference said 'like,'" Nolen-Hoeksema
recalls. "By the time he finished, she'd stopped ruminating."

2. Make a Date to Dwell

Tell
yourself you can obsess all you want from 6 p.m. to 7 p.m., but until
then, you're banned. "By 6 p.m., you'll probably be able to think
things through more clearly," says Nolen-Hoeksema.

3. Three Minutes of Mindfulness

For
one minute, eyes closed, acknowledge all the thoughts going through
your mind. For the next minute, just focus on your breathing. Spend the
last minute expanding your awareness from your breath to your entire
body. "Paying attention in this way gives you the room to see the
questions you're asking yourself with less urgency and to reconsider
them from a different perspective," says Zindel Segal, PhD, co-author
of The Mindful Way Through Depression.

4. The Best and Worst Scenarios

Ask yourself…


"What's the worst that could happen?" and "How would I cope?"
Visualizing yourself handling the most extreme outcome should alleviate
some anxiety, says Judith Beck, PhD, director of the Beck Institute for
Cognitive Therapy and Research in Bala Cynwyd, Pennsylvania. Then
consider the likelihood that the worst will actually occur.


Next, imagine the best possible outcome; by this point, you'll be in a
more positive frame of mind and better able to assess the situation
more realistically.

5. Call a Friend

Ask a friend or relative to be your point person when your thoughts start to speed out of control.

6. How to Move On

Say, "Oh, well."


Accept that you're human and make mistakes—and then move on, says
Dr. Beck. Be compassionate. It's harder than it sounds, so keep
practicing.

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Beyond Blue: Sticky Thoughts

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Rover 411: Is Your Dog Presidential?

We are looking for the dogs that look most like our candidates for The "My Dog Looks Like Obama or McCain" Photo Contest.

Now - September 8, 2008:
Date extended to September 15, 2008!

Submit photos. Select photos will be displayed on the site.

Click here for contest rules or
Click here to submit your photo


                                    September 22 - October 22, 2008:

Rover 411 members vote for their favorite photo.

October 25, 2008:

Winners will be announced at the Rover 411 Grand Opening Event. Details
to follow.

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Life As Art: Sports Grief, Roller Coasters, and Sarah Palin’s Speech

By Shelley H. Carson, Ph.D. in Life as Art
It's a dull ache in the throat and stomach, accompanied by a sudden sinking feeling. I started noticing these physical symptoms of melancholy last week but couldn't put my finger on the cause until I reread a Psychology Today blog on Sports Grief by colleague Steven Kotler that first appeared on June 25th. Then I realized that my symptoms coincided with the onset of the NFL season...and that my subclinical case of sports grief (I'm a diehard Patriots fan) had been rekindled by sights and sounds ("Are you ready for some football?") that in previous seasons used to ignite excited anticipation in me. And as if reliving the unimaginable (to Patriots fans and Vegas odds-makers) disaster that occurred in Super Bowl XLII weren't enough, now Patriots fans have another cause to grieve: our hero, the exalted Tom Brady, is out for the season!

My husband laughs at me because I take sports so seriously. But, psychologically, becoming emotionally involved in sports is serious and important business. I see it as a form of exposure therapy. Sports grief allows us to taste the physical and emotional changes that are associated with true grieving. It helps us rehearse for the inevitable personal losses that will come during our lives, so that we are better able to manage our emotions and continue to function in the face of real adversity. The thrill of victory in sports, on the other hand, helps strengthen the neural pathways of our brain's reward system, so that we are primed to experience joy in the future. All in all, I see sports fanaticism as a type of emotional regulation training.

Just as sports grief can train us to tolerate loss and sadness, other events can help us learn to tolerate fear and anxiety. Take roller coasters, for example. Many people who won't ride roller coasters do not abstain because they feel the ride is unsafe. Rather, they're afraid of feeling fear. Psychologists call this fear of fear anxiety sensitivity. But if you allow yourself to go ahead and ride the roller coaster, you learn that you can be gripped by fear, ride it out, and return to baseline none the worse. The next time you get on the ride (or face another fear-invoking event), you'll be less afraid of your own fear.

Another way to learn fear and anxiety tolerance is to witness other individuals successfully handling anxiety. We saw a great deal of this during the Summer Olympics, but perhaps the greatest recent example was Sarah Palin's speech at the Republican National Convention. You didn't have to agree with her politics to understand that this woman was facing a do-or-die moment. Prior media coverage had placed incredible importance on her performance, and most reports suggested that, with no experience on the national (let alone the international) stage, she wasn't up to the task. I was already feeling embarrassed for her as she walked to the podium (I mean you'd have to go back to my ‘70's high school yearbook to see other examples of that hair-do). I felt my own pulse increasing as she began to talk. (It's so hard to watch when you expect someone fall on their face.) Somewhere in the middle of the speech, I realized that I was no longer feeling embarrassment but was feeling the thrill of victory...not because I agreed with the political ideology but because I was witnessing a heroic triumph over negative expectations. Palin's delivery of that speech modeled anxiety tolerance for all of us in the face a serious personal challenge.

So what do sports defeats, roller coasters, and Palin's speech have in common? We can use all of them to gain practice experiencing and coping with negative emotions. And next time your wife (or husband) complains that you're taking sports too seriously, reply that you're merely working on your emotional regulation skills.

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