globeandmail.com: Psychiatry: A specialty relegated to the basement

CAROLYN ABRAHAM
November 24, 2008 at 8:52 PM EST

Jai Shah could have been any sort of doctor he wished. Even before he graduated with honours from the University of Toronto's medical school, the 30-year-old Edmonton native had earned a master's degree in international health policy from the London School of Economics, published papers and worked for the Canadian Institutes of Health Research.

Praise follows him wherever he goes. Except for last fall – when he decided to specialize in psychiatry.

“A psychiatrist?” some of his supervisors said, “But you're smart! … You're taking the easy way out … Your patients will make your life hell … Your patients will make you depressed … What a waste of talent!”

Dr. Shah knew mentally ill people battle both their disorders and the social stigma their conditions carry. But it surprised him that psychiatrists confront a certain stigma, too.


“I'm sure the feedback has discouraged some young doctors from choosing this as their career,” said Dr. Shah, now at the Harvard Longwood Psychiatry Residency Training Program in Boston.

In fact, Susan Abbey, who heads the U of T first-year residency program in psychiatry, said the disparaging comments are “ubiquitous.”

“I don't think there's one of our incoming residents who hasn't been exposed to negative comments from family or friends or academic supervisors,” Dr. Abbey said.

Just as lawyers can face a barrage of bottom-feeder jokes, psychiatrists, both in film and real life, have long been seen as doctors of a lesser science. Even their own physician colleagues can view their patients as difficult and time-consuming. The negativity, experts say, is contributing to a national shortage of psychiatrists and shoddy care for mentally ill people.

Across the country, Canadians are unable to see a psychiatrist when they need one. A survey from the B.C.-based Fraser Institute released last month suggests the national median waiting time for psychiatric care this year is 18.6 weeks, longer than for any physical treatment.

A Canadian Psychiatric Association survey has found that even in emergency cases – where the CPA recommends a patient be admitted for acute care within 24 hours due to a “high degree of risk to self or others” – delays in some regions range from 57 hours to nearly five days.

“It's the patients who doubly suffer from the stigma,” Dr. Shah said. “First, from the social perception of their illness and then, on top of it all, from the shortage of treaters, and the gaps in care reflect the stigma within the medical profession and that contributes [to the social perception]… so it's a vicious circle.”

Studies suggest these attitudes take a toll on medicine's front lines: Mentally ill people have a tougher time finding a family doctor, are more likely to need urgent medical care and less likely to receive life-saving treatments. They're also more likely to die of conditions such as heart attacks, strokes and cancer.

At the same time, funding for mental-health research and psychiatric services has paled compared with monies doled out for physical ailments. Mental illness, meanwhile, is the No. 1 cause of disabilities in Canada and accounts for 20 per cent of all hospital admissions.

The inequities are so apparent that the Mental Health Commission of Canada has made it a top priority to fight stigma among health-care professionals, and this year the Canadian Medical Association, which represents the country's doctors, has launched a campaign to combat the stigma within its ranks.

“Doctors will be inclined to see mental illness differently than other medical illnesses … it's not like a broken bone, you don't see it clearly,” said CMA president Dr. Robert Ouellet. “We feel mental illness has not received its fair share of attention.”

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The Independent: Nervous breakdown: Happy survivors

Anyone can have a nervous breakdown – high-flyers included. But it doesn't have to mean the end of a contented life, says Sophie Morris


Out the other side: Emma Mansfield's bipolar condition makes her prone to frenetic activity and slumps

At 25, Emma Mansfield was a poster girl for successful young women. She lived in Bristol and loved her job as a producer of natural history programmes, which allowed her to travel all over the world. She had also met and fallen for a wonderful new boyfriend. She was in the pink, you might say, so the last thing she was expecting was to be dragged down into the deep blue storm of a nervous breakdown. "It was like somebody had pulled a rug out from under me," she remembers, eight years, another nervous breakdown and spells of clinical depression, psychosis and time in hospital later. "I didn't know what the hell was happening to me. I'd feel like I was being sucked down in this vortex, like in Harry Potter where the death-eaters suck out your soul."

The term "nervous breakdown" is neither medical nor scientific, but a shorthand for someone who can no longer cope in their normal life, explains Phillip Hodson, of the British Association for Counselling and Psychotherapy (BACP). "It describes someone who has gone through the tipping point. They have gone from stress and distress, to an over-stressed situation. It's the difference between, 'I'm very uncomfortable but I'm managing' to 'I'm so unhappy and fraught that I'm not functioning.'" Not functioning might manifest itself in strange behaviour such as stepping out in front of buses, flaring up at other people, having suicidal thoughts or going into states such as a trance, catatonia or gibbering."

Mansfield's breakdown unravelled over a few days. "I looked around me," she says, now 33, "and thought, I'm living in a city I don't know. I don't know many people. I don't go walking or riding any more. I don't have mates I can go for a cup of tea with or down to the pub with. This isn't very balanced. I had a dream I was being asphyxiated and made a decision that I had to deal with it."

A diagnosis of clinical depression followed and she suffered suicidal thoughts for a week. After undergoing a lot of therapy and a year on antidepressants, Mansfield realised her tale fitted the notorious pattern of too much, too soon, too quickly. "I was an extremely high flyer at a young age," she admits. "I think it all caught up with me. I came out of education and thought, well, life should be easy now. Actually, it's not. Life becomes even more challenging and complex."

Although Mansfield sought help early on, many sufferers of nervous breakdowns feel too ashamed to admit they are experiencing difficulties. Mental illness has a stigma, and admitting to one can be tantamount to scoring one's reputation with an indelible black mark. When well known personalities admit to struggling, the subject is demystified. More useful than clarifying a confusing topic, though, is the message that it is OK to have a breakdown, and that you can recover. It is not a life sentence.

Stephen Fry has spoken openly about his breakdown, a painfully public collapse when he walked out of a play in 1995 and disappeared for weeks. In Stephen Fry: The Secret Life of the Manic Depressive, he interviewed other sufferers including Carrie Fisher, Richard Dreyfuss, Robbie Williams and Jo Brand.

More recently, Alastair Campbell revisited his own breakdown of 1986, in the BBC programme Cracking Up. One interviewee was Ruby Wax, another of the few brave enough to speak out about depression and anxiety.

Why did Fry tip over when he was in a successful play? Mansfield was similarly flying high when crisis struck. She now believes the comfort of a loving relationship provided her with the space to confront issues she hadn't worked through, which presented themselves as depression. She comes from a supportive family and had suffered none of the physical, emotional or sexual abuse that often leads to mental illness, though she had sought counselling at university. "I always knew there were things I needed to work out," she explains, "such as taking everything very much to heart. I was open, but also quite vulnerable."

"Experiencing a nervous breakdown was terrifying – especially because I didn't know what had caused it. My breakdown was physical, emotional and psychological, it was as though my mind went into an enormous spin while my body, particularly my nervous system, was coping to process the incredible sensory and physical assault which accompanied the experience. I felt extremely anxious and fearful. I couldn't eat. I couldn't think. I was confused, disoriented and hyperventilating. I lost a lot of weight."

Mansfield confronted her deteriorating situation head on, switching her job and busy lifestyle for the countryside and a new job. First, though, she went to recuperate at her family home in Essex.

Eight long months there made her even more determined to move on with her life. "I knew I had to get to grips with my mental state and focus on what I wanted next."

She chose Cornwall as the place she could best "get to grips" with her state of mind. It was familiar from childhood family holidays. "The sea and the fresh air were what I needed more than anything."

Cornwall suited her. She had found Bristol isolating and overwhelming and she missed the sense of community and belonging of living in a small town or village. She found a job as an arts administrator at the Eden Project, and threw herself into the role. She discovered she was far more creative than a television career had allowed her to realise, but her dedication proved too much, leading to a second breakdown in the spring of 2006, much more serious than the first.

"It was a complete and utter nervous collapse," she recalls. "I couldn't eat or sleep for four or five days." She was admitted to hospital for five days and sedated, giving her space to calm down. "It is terrifying when you lose your mind. You think you know who you are and what you're doing, and all of a sudden your mind goes into spin drive. I experienced paranoia and psychosis."

"Psychosis," explains Phillip Hodson, "is where you may not be responsible for your actions. The obvious psychoses are things such as schizophrenia, mania and bipolar disorder."

In May, 32-year-old barrister Mark Saunders was shot dead by police after firing his shotgun from his Chelsea home. Last June, a Spanish insurance executive, Alberto Izaga, plunged into such a psychotic meltdown that he battered his two-year-old daughter to death. It is possible that both men were experiencing episodes of psychosis as part of a nervous breakdown.

Campbell entered a psychosis after a period of heavy drinking, where he thought he was being tested on his actions, and saw everything as part of this test. He was arrested and admitted to hospital, where he was heavily medicated. The episode left him depressed, but he rebuilt his life. He is proof that a nervous breakdown is a heavy burden, but not a life sentence.

Despite her experience of mental illness and knowledge of counselling and therapy, both as a patient and student, Mansfield had not seen her own burn-out coming. "I think I'd had enough," she says, as if she did nothing more but collapse on the sofa. It is her bipolar condition that makes her prone to frenetic activity – mania – followed by depressive slumps. "I'm very driven and self-disciplined," she observes, "so sometimes I don't realise how much energy I put into things until I need to go and lie down for two weeks."

One such exhausting undertaking is Mansfield's new book, The Little Book of the Mind, a touching and informative encyclopaedia of mental illness, which attacks the stigma around diseases of the mind. It follows The Little Book of Cornwall, about her adopted county.

Mansfield advises anyone who thinks they might be experiencing some sort of mental illness to visit their GP and get the six free therapy sessions on offer, though she admits that most problems take much, much longer to resolve.

Mansfield thinks herself lucky, because she found the resilience to fight her illnesses. She has left the Eden Project and works with young people, coaching them to write for the local newspaper, runs several choirs and arranges music. She can walk her dog in the fresh air whenever the mood takes her. "It all depends," she says, "on whether you think you can change your life."

'The Little Book of the Mind' is published by Lovely Little Books, £6.99. Available in Waterstone's

Ambigamy: Thanksgrieving: Cheer up 'cause it's downhill from here (a musical op-ed)

By Jeremy Sherman, Ph.D. on November 25, 2008 in Ambigamy

When we're down, people sometimes try to cheer us up with reminders that other people are much worse off than we are. Comparing misfortune to good effect also applies to our future selves. We should all cheer up because compared to who we'll be in our declining years we're doing great. Along with AARP cards, one perk senior citizens get is the occasional amusement of consoling some youngster who is distressed to be growing so old. I wrote this song after just such an experience, me at 51 consoling a 36 year old who was distressed about aging.

Enjoying the happiness we get depends upon our ability to manage our interpretation of wellbeing as either a complement to, or substitute for future happiness. If my happiness today is a complement to happiness tomorrow--if it sets up an expectation that I'll be happy then because I'm happy now-then unhappiness tomorrow will be disappointing. If my happiness today is a substitute for happiness tomorrow--if it sets up an expectation that I might not be happy tomorrow then I won't be as disappointed. Happy today I like to remind myself that when I'm old I'll be able to look back and say, "I had my turn."

Buddha is often interpreted as saying that you should work to have no expectations, which, to me makes no sense. Expectations are absolutely essential to life. It's all about expectation management. So here's my Thanksgrieving gift (see last years at loving ingratitude) an uplifting ditty for us, the temporarily-abled.

Here I sing it and play a seven-string fretless bass solo along with my four piece virtual jazz combo: http://www.mindreadersdictionary.com/downhillfromhere.mp3

Downhill from here

Sure your things are sagging
You can see you're in decline
A glimpse into the mirror shows
The ravages of time

Just remember that compared to now
the future's looking sour
And looking back in decades
this will have been the finer hour.

At the rate that things are going
yes our future looks austere
Cheer up ‘cause it's downhill from here.

If you notice your ability
To jump and skip is slipping
And much of your agility
Is going, don't be trippin'

Compared to 20 years from now
You're agile and you're well
Viewed from future wheelchairs
Today you're a gazelle.

At the rate that things are going
Yes, our future looks austere
Cheer up ‘cause it's downhill from here.

I'm a forward thinking pessimist
It makes my days much brighter
Tomorrow will be heavier
today is therefore lighter

Life's decline is certain
Of what's left this time's the best
Enjoy it now it's bound to be
much better than the rest

If the crowd is suffocating you
in the rat race to success
and your edge is always slipping
and you cannot take the stress

Just remember that the pile of product's
only getting deeper
And your grandkid's competition
will certainly be steeper.

At the rate that things are going
our futures looks austere
Cheer up ‘cause it's downhill from here.

ABC News: Florida Teen Live-Streams His Own Suicide

Abraham Biggs, 19, Was Egged On by Fellow Bloggers, Cops Say
By EMILY FRIEDMAN

Nov. 21, 2008 —

A Florida teenager who used a webcam to live-stream his suicide Wednesday was reportedly encouraged by other people on the Web site, authorities told ABCNews.com.

"People were egging him on and saying things like 'go ahead and do it, faggot,' said Wendy Crane, an investigator at the Broward County Medical Examiner's office.

Abraham Biggs, 19, of Pembroke Pines, Fla., had been blogging on an online body-building message board and had linked to his page on Justin.tv, a live video streaming Web site, where the camera rolled as he overdosed on prescription pills, according to Crane.

Biggs, who had reportedly been discussing his suicide on the forums, also posted a suicide note on a body-building forum, which has since been taken down, in which he wrote, "I hate myself and I hate living."

"I have let everyone down and I feel as though I will never change or never improve," Biggs wrote in the posting. "I am in love with a girl and I know that I am not good enough for her. I have come to believe that my life has all been meaningless. I keep trying and I keep failing. I have thought about and attempted suicide many times in the past."

The video and blog postings have since been removed from the sites, but Crane, who has seen both, said that at first viewers thought the suicide was a hoax.

"The bloggers said that Biggs had threatened to kill himself before and had faked it, so at first they didn't believe him," said Crane. "Gradually, as you read the blog further into the day the bloggers start commenting on how Biggs isn't moving."

Crane said comments on the thread included an exchange about whether the image of Biggs' motionless body was a still photograph or a video, and eventually resulted in one of the site's visitors calling the police, who tracked down the teen through his computer IP address.

According to Wired magazine, online viewers watching the video ranged from "OMG" -- Internet slang for oh my god -- and LOL -- an abbreviation for laughing out loud.

Blog Posts

On a blog where Biggs wrote about his suicidal thoughts, which has since been removed, commenters wrote, "hahaha hahahahha hahahahahah ahhaha." Wired reported that someone else wrote: "Instant Darwinism ..." to which a fellow commenter wrote: "f**king a nicely put." Others called the teen a "coward," "faggot" and a "dick."

In the Web stream, Crane said viewers saw a piece of a door frame -- which had splintered from the police kicking in the teen's bedroom door -- hit Biggs, who is curled up on his bed and facing away from the camera.

"Then you see a police officer go in and check on him, and then the EMS pronounced him dead," said Crane.

Biggs was pronounced dead at 3:30 p.m. Nov. 19 -- about 12 hours after he had begun blogging about his suicide.

The official cause of death was suicide combined with drug toxicity. Crane said that benzodiazepines and opiates were found near the body, but a blood toxicology to quantify just how much Biggs consumed is still under way.

Crane said that at least one of the prescription drugs was in Biggs' name.

Michael Seibel, the CEO of Justin.tv, posted a blog entry on the site titled "A Moment of Silence."

"Justin.tv staff would like to take a moment to recognize and reflect upon the tragedy that occurred within our community today," wrote Seibel. "We respect the privacy of the broadcaster and his family during this challenging time."

Reached by telephone, Biggs' father, Abraham Biggs Sr., told ABCNews.com that he was shocked to learn of his son's death.

"He was a good kid. Everyone knows him," said Biggs. "We live together and everything was fine -- I'm so surprised."

Biggs' father was not home at the time of his son's suicide, and the father told ABCNews.com that he was not aware that his son used Justin.tv.

Biggs had struggled with depression, according to his father, and had been prescribed medication for bipolar disorder. Benzodiazepine is commonly prescribed as a sleep aid or an anti-anxiety medication.

Even so, Biggs had been "doing better," according to his father and had been attending daily classes at Broward College, where he was pursing a career as a paramedic.

Internet Provides Outlet to Suffer in Public

"I am upset that Justin.tv streamed this live," said Biggs. "I have not seen it, and I do not intend to look at it.

"There seems to be a lack of control as to what people put out on the Internet," he said. "There's a lot of garbage out there that should not be, and unfortunately, this was allowed to happen."

David Griner, a social media strategist for Luckie & Company, said that while public deaths are not new, online chatrooms provide an especially accessible forum for those debating suicide.

"The social Web tends to create a sideshow atmosphere, like public executions in the 1700s," said Griner. "The anonymity and lack of personal connection bring out the worst in people."

Griner points out that there have been several other online suicides, and some have been faked as well.

In February 2008 a girl who identified herself only as "90 Day Jane" wrote an anonymous blog chronicling the days leading up to her death. The blog turned out to be a hoax, and "Jane" later described it as an "art project."

The United Kingdom had an online suicide in March 2007, when 42-year-old Kevin Whitrick hanged himself while others watched. According to the BBC, some onlookers tried to stop him while others urged him on.

"The explosion of high-speed Internet access in the past few years has made it so that almost anyone can broadcast a live video in front of a global audience," said Griner. "It's impossible for sites like Justin.tv to monitor everything that's going on, so that puts the burden on the community to help stop bad things from happening."

Griner believes that those who encourage suicidal people are simply a sad reality of an unrestricted World Wide Web. Even so, some potential suicides are prevented on the Internet as well.

"You'll always have the morbid jerks who yell 'Jump!' when someone's on a rooftop, and you'll always have people threatening suicide in a public venue," said Griner. "And while it's easy to focus on the abundance of bloodthirsty trolls online, the bright side is that the Internet also gives more decent people the opportunity to intervene and try to save a life."

"Most times, they just need someone to talk to, and the Internet is the only forum they have."

ABC 7 News : Family outraged, distraught over teen's cyber suicide

The family of a college student who killed himself live on the Internet say they're horrified his life ended before a virtual audience, and infuriated that viewers of the live webcam or operators of the Web site that hosted it didn't act sooner to save him. Only after police arrived to find Abraham Biggs dead in his father's bed did the Web feed stop Wednesday - 12 hours after the 19-year-old Broward College student first declared on a Web site that he hated himself and planned to die.

"It didn't have to be," said the victim's sister, Rosalind Bigg. "They got hits, they got viewers, nothing happened for hours."

Biggs announced his plans to kill himself over a Web site for bodybuilders, authorities said. He posted a link from there to Justin.tv, a site that allows users to broadcast live videos from their webcams.

A computer user who claimed to have watched said that after swallowing some pills, Biggs went to sleep and appeared to be breathing for a few hours while others cracked jokes.

Some members of his virtual audience encouraged him to do it, others tried to talk him out of it, and some discussed whether he was taking a dose big enough to kill himself, said Wendy Crane, an investigator with the Broward County medical examiner's office.

Some users told investigators they did not take him seriously because he had threatened suicide on the site before.

Eventually, someone notified the moderator of the bodybuilding site, who traced Biggs' location and called police, Crane said. The drama unfolded live on Justin.tv, which allows viewers to post comments alongside the video images.

As police entered the room, the audience's reaction was filled with Internet shorthand: "OMFG," one wrote, meaning "Oh, my God." Others, either not knowing what they were seeing, or not caring, wrote "lol," which means "laughing out loud," and "hahahah."

His father, Abraham Biggs Sr., told The Miami Herald he didn't want to watch the video.

"We were very good friends," he said. "It's wrong that it was allowed to happen."

An autopsy concluded Biggs died from a combination of opiates and benzodiazepine, which his family said was prescribed for his bipolar disorder.

"Abe, i still wish this was all a joke," a friend wrote on the teenager's MySpace page, which he described himself as a goodhearted guy who would always be available for his pals, no matter what time of day.

In a statement, Justin.tv CEO Michael Seibel said: "We regret that this has occurred and want to respect the privacy of the broadcaster and his family during this time."

It is unclear how many people watched it happen. The Web site would not say how many people were watching the broadcast. The site as a whole had 672,000 unique visitors in October, according to Nielsen.

Biggs was not the first person to commit suicide with a webcam rolling. But the drawn-out drama - and the reaction of those watching - was seen as an extreme example of young people's penchant for sharing intimate details about themselves over the Internet.

Montana Miller, an assistant professor of popular culture at Bowling Green State University in Ohio, said Biggs' very public suicide was not shocking, given the way teenagers chronicle every facet of their lives on sites like Facebook and MySpace.

"If it's not recorded or documented then it doesn't even seem worthwhile," she said. "For today's generation it might seem, 'What's the point of doing it if everyone isn't going to see it?'"

She likened Biggs' death to other public ways of committing suicide, like jumping off a bridge.

Crane said she knows of a case in which a Florida man shot himself in the head in front of an online audience, though she didn't know how much viewers saw. In Britain last year, a man hanged himself while chatting online.

Miami lawyer William Hill said there is probably nothing that could be done legally to those who watched and did not act. As for whether the Web site could be held liable, Hill said there doesn't seem to be much of a case for negligence.

"There could conceivably be some liability if they knew this was happening and they had some ability to intervene and didn't take action," said Hill, who does business litigation and has represented a number of Internet-based clients. But "I think it would be a stretch."

Condolences poured into Biggs' MySpace page, where the mostly unsmiling teen is seen posing in a series of pictures with various young women. On the bodybuilding Web site, Biggs used the screen name CandyJunkie. His Justin.tv alias was "feels_like_ecstacy."

Bigg described her brother as an outgoing person who struck up conversations with Starbucks baristas and enjoyed taking his young nieces to Chuck E. Cheese. He was health-conscious and exercised but was not a bodybuilder, she said.

"This is very, very sudden and unexpected for us," the sister said. "It boggles the mind. We don't understand."

Anger in the Age of Entitlement: Emotional Abuse (Overcoming Victim Identity)

By Steven Stosny in Anger in the Age of Entitlement

In terms of your health, happiness, and deepest values, one of the worst things that can happen is to live with a resentful, angry, or emotionally abusive partner. The worst thing you can develop, in terms of your health, happiness, and deepest values, is an identity as a victim.

Victim identity destroys personal power and undermines the sense of self. It makes you falsely identify with "damage" done to you or with bad things that have happened to you. The cry I hear over and over again from those who live with resentful, angry, or emotionally abusive partners is, "I don't like the person I've become."

Once emotional abuse occurs in a relationship, it becomes necessary not only to stop the abuse but to overcome victim identity through a strong identification with your inherent strengths, talents, skills, power, and appreciation of the self as a unique, ever-growing, competent, and compassionate person. This is accomplished through an emphasis on healing, growth, and empowerment, not by reviewing checklists of behaviors that qualify you as a victim or by reading lengthy descriptions of the resentful, angry, or abusive behavior and attitudes of your partner.

Detailed descriptions of your possible symptoms or of your partner's angry, abusive behavior are not only unnecessary for your recovery, they can cause harm by encouraging victim identity. If you live with an abusive person, you know better than any self-help author or advocate that your relationship has put thorns in your heart. You don't need a description of the thorns to know how much they hurt. You need to learn how to take them out and heal the wounds in ways that prevent scarring.

Perhaps the most insidious thorn in the heart that comes from living with a resentful, angry, or emotionally abusive partner is the feeling that you cannot be well until your partner changes. This understandable but tragic assumption is the first thorn you must remove from your heart. You deserve to heal and grow, whether or not your partner does.

Although a sense of fairness and justice tells you that your abusive partner ought to be the one to make changes, your pain tells you that you need to become the fully alive person you are meant to be. (Pain is not a punishment; it motivates behavior that heals, improves, and protects.) This means that you have to remove the focus from your partner and put it squarely on you. Renewed compassion for yourself will lead directly to a deeper compassion for your resentful, angry, or abusive partner. With that compassion you will demand meaningful, lasting change, for you will appreciate the enormous harm he does to himself when he hurts you. One of two things is likely to result from your reclamation of self and your compassionate demands on your abusive partner. You may be able to stop walking on eggshells and step into a deeper relationship with a more compassionate, loving partner. But if he chooses not to do the hard work of breaking abusive habits, for his sake, for the sake of your children, and for your own sake, you will no longer tolerate his resentful, angry, or abusive behavior. From your core value, you will stop walking on eggshells, one way or the other.

As you experience the enormous depth of your core value, the last thing you will want to do is identify with being a victim, or a survivor, for that matter. You want to outgrow walking on eggshells, not simply survive it, and you do that only by realizing your fullest value as a person.

In Practice: Chicken and Egg

By Peter D. Kramer in In Practice

Does depression cause brain differences, or do brain differences cause depression? A scientist whose past research pointed to the latter conclusion has just published findings that reverse the direction.

The prevailing contemporary model for depression suggests that in vulnerable people, repeated stress gives rise to adverse changes in the brain; depression is itself a stressor. The primary evidence for this hypothesis comes from rodent studies, where early deprivation and later mild stress cause what look like mood changes - and shrinkage in areas of the brain that correspond to our hippocampus and prefrontal cortex. Human studies have tended to be correlational: patients who have suffered more days of mood disorder have more differences in brain volume. These findings are ambiguous. Perhaps a person with a small hippocampus is more prone to depression.

Evidence for the second theory, in which small hippocampal size creates vulnerability, came from the laboratory of the German psychiatrist , Thomas Frodl. He found that over the course of a year, chronic depression did not predict hippocampal change, but small hippocampal size predicted chronicity of depression. That's what makes a new study particularly intriguing. Looking now at a three-year interval, Frodl has found that depression does lead to loss of volume in critical regions of the brain.

The study contrasted 38 patients hospitalized for depression with 30 matched controls and used MRI scans coded by new software technology that distinguishes changes throughout the brain, not just in areas pre-selected by researchers. Over the next three years, the patients, and not the controls, showed a "decline in gray matter density" in the hippocampus, prefrontal cortex, and elsewhere. There was no part of the brain where the depressed patients showed increased volume or density. Patients whose mood disorder had remitted showed less volume decline. Overall, Frodl concluded, this prospective study in humans supports the findings from animal models in which stress and depression-like disorders cause brain change.

In the just-published study, antidepressants did not have a separate effect - it was getting better that conferred some protection. But the month before, in September, Frodl contributed an analysis showing that in some patients who took antidepressants for the whole of three years "hippocampal volumes increased significantly." A critical interactive factor may have been hippocampal size at the start of treatment. (It should be said that this study had a high attrition rate; its conclusions are necessarily speculative.) In the September paper, Frodl concluded that "a relatively small hippocampal volume may be a vulnerability factor for a bad treatment response in major depression."

Both may be true: depression attacks the hippocampus, and a small hippocampus impairs resilience. In Against Depression, I wrote that the evidence favored this combined hypothesis - so the theory is not new. But Frodl's current research does point to movement in the field toward the conclusion that depression or stress in the presence of depression injures the brain. That model suggests a need for vigorous early intervention and extended treatment. Recovery seems to offer some protection. Although the evidence is hardly clear-cut, long-term antidepressant use may as well.

Quirky Little Things: Imposter!

By Jesse Bering, Ph.D. in Quirky Little Things

I don't know what it says about me that as a thirteen-year-old boy my favourite television show was The Golden Girls, but like many fans I was saddened earlier this year to learn of the death of Estelle Getty, who played the sassy Sicilian octogenarian Sophia Petrillo in this long-lived series. Given her obvious talent and inimitable delivery on screen, you might be surprised that Estelle Getty felt like a fraud as an actress. Here's what she said in a 1988 interview with Entertainment Tonight:

"I'm awed every day of my life. I think, this is Bea Arthur, this is Betty White. This is a big hit #1 show in the country. I'm afraid. I live with fear as a constant companion. Can I do this week after week? Am I good enough? Will I be able to pull it off this week? Will I be able to fool them again? And every day I'm a little scared. And every Friday I'm scared out of my wits. I keep thinking, I can't believe I'm in this. Wait till they find out I can't do it."

Now, I've never been on an '80s television series, nor has my name been stitched into the fabric of popular culture as a beloved character actress, but I have a pretty good sense of what Estelle Getty is talking about here. Years ago I interviewed for a position on the faculty of psychology at Harvard University. My selection committee comprised Steven Pinker, Susan Carey, and Elizabeth Spelke and in terms of stature in the field of psychological science, Pinker is something like the equivalent of Bea Arthur and Carey is a good analogy for Betty White. (Comparing Spelke to Rue McClanahan requires a bit more shoehorning, but you get the idea.) One of the reasons I botched the interview was because I couldn't get over the fact that I'd actually pulled this much off. I mean, come on, these are all-star celebrity researchers, bona fide superheroes of psychology who'd achieved posterity. And I'm a third-rate academic from Ohio who'd cavalierly graduated at the bottom of his high school class, earned a PhD from a university most people have never heard of, and who'd been toiling away in obscurity at the University of Arkansas as an assistant professor. Like Estelle Getty at her initial casting call, I felt like a charlatan, a ruse, a fake at Harvard. An impostor. Actually, I suspect I was, since in the end they didn't offer me the post.

But what Estelle and I describe is a psychological experience known as the impostor phenomenon (IP), defined by Georgia State University psychologists Joe Langford and Pauline Clance as, "believing that one's accomplishments came about not through genuine ability, but as a result of having been lucky, having worked harder than others, or having manipulated other people's impressions." Here are some more basic facts about IP:

• Impostors attribute their successes to attributes unrelated to the actual talent required for their success, such as personal charm or attractiveness. Some people who experience IP are especially prone to 'chameleon-type' behaviours, modifying their attitudes and actions in ways that foster approval from onlookers. (I inherited from my salesman father a rather chronic but often disingenuous smile, which seems to have a mind of its own.)

• Although early research suggested women are more likely than men to feel like impostors given the lower expectations of success for the former, subsequent studies revealed no difference between the sexes. However, IP appears to express itself differently in men and women. Women tend to be less "playful" (doing things just for fun) and less sociable. Female impostors are also usually extra cautious and averse to risks, whereas men who experience IP tend to score high in impulsivity, express a strong need for change and a low need for order. (Suffice it to say that I've bought and sold 7 houses over the past 4 years and I haven't balanced my check book since 1994.)

• People who experience IP don't simply have low self-esteem in general, but only negative feelings about the self in relation to their particular area of success. And introverts - who are often shy, anxious and lacking in confidence - are more likely than extroverts to feel like phonies, presumably because they're less expressive and more prone to keeping their 'private self' hidden from others. (You may think you know me....)

• When impostors do fail, their reaction displays a stereotypical pattern: they withdraw from the task, blame themselves for the failure, and experience anxiety and shame. Impostors often need to come across as smart or intelligent in front of an audience; women impostors view intelligence as a fixed entity (either one's clever or not, no room for argument) rather than a malleable quality.

• An impostor's sense of worth and importance is unusually dependent on others' feedback. (This one reminds me of 17th century Baroque painter Caravaggio, a bad-tempered genius who allegedly once tore up one of his masterpieces at a slight word of criticism.) Langford and Clance say that impostors "have a strong need to protect themselves from narcissistic injury."

• Impostors often resort to self-deprecation and avoid the attention of others. (Have I told you yet how much I dislike myself? In any event, I hope you're not reading this.)

Estelle Getty wasn't an impostor, of course. She was a brilliant, Emmy-Award winning actress. I suspect deep down I'm not entirely a phony either, though if were to begin talking about my successes I'd just turn my own stomach with nauseating lines of braggadocio, and if there's anything I can't stand more than an impostor, it's a braggart. Ugh, it's a no-win situation for us impostors, isn't it.

Beliefnet.com: 10 Ways to Transform Toxic Thoughts

If you've ever felt the way anger or fear can electrify the atmosphere in a room, you'll know what Sandra Ingerman means by 'toxic thoughts.' The author, a family therapist and shaman practitioner, believes our thoughts and emotions transmit an invisible but palpable energy that can affect our mental and physical well-being. 'Psychic punches,' she writes, are as real as physical violence.

Click here for ten simple ways to protect yourself from negative thoughts and learn to radiate positive energy.


Text by Sandra Ingerman, adapted from her book, 'How to Heal Toxic Thoughts: Simple Tools for Personal Transformation'"

Time: Defending Nebraska's Child Abandonment Law

By Karen Ball / Lincoln

Nebraska never wanted the attention that came with the heart-wrenching reports of sobbing children at hospitals and desperate parents leaving kids, little ones and unruly teenagers alike, under the state's new "safe haven" law. "We were being ridiculed every day," says state Sen. Dianna Schimek of Lincoln, "but I have no apologies because something good will come of this. We uncovered something that we need to address. And it's not just Nebraska — it's widespread."

The Nebraska Legislature's Judiciary Committee met in a special session Monday to begin rewriting a law that has resulted in an epidemic of abandoned children — some parents driving from Florida, Arizona and Georgia to leave off their problem kids. Most states allow a parent to leave an infant at a fire station or hospital without fear of prosecution, but because Nebraska's law did not define "child," 34 kids have been dropped off at Omaha hospitals since September. None were infants. The rest of America was stunned. But, as the special session proceeded, some legislators defended the intent of the law.

While Gov. Dave Heineman is pushing to limit a rewritten law to newborns of 72 hours, some lawmakers argue the abandonments have exposed an urgent need to fix gaping holes in state mental health services, which they claim fail to assist families with little resources to help problem children. Sen. Annette Dubas introduced an alternate bill that would retain "safe haven" for parents with kids age one to 15 through June 2009, so that the Legislature could address the broader issues come January. "Do not forget those struggling families," she urged her colleagues.

Some lawmakers were angered at what they see as a callous response from Heineman's administration — that state welfare agents appear to be accusing parents of too easily abdicating responsibility. "It's been very disturbing, how judgmental you've been," Sen. Amanda McGill scolded the state's Health and Human Services chief, Todd Landry. "You've had plenty of time to make these judgmental statements to the press" but not to return phone calls from desperate parents, she said. Landry argued that the state offers many lifelines, that services are available. "So all a parent has to do is call a hotline?" Sen. Steve Lathrop asked skeptically. "What is the harm," he asked repeatedly, of allowing distraught parents to bring older kids in?

But the voices that appear to have won the day were those of the abandoned. "I'll be good — I'll be good, I promise," one child begged as the mother walked away, Ann Schaumacher of Immanuel Hospital in Omaha told the Judiciary Committee. "It is not the right place for relinquishment to occur," Schaumacher said of the emergency room abandonments. Some hardened adolescents show no emotion at all, she recalled. An older teen was left by a mother who simply said, "I can't do it anymore." "These children will never be the same, and that's the tragedy of this law," said Schaumacher, who, like most hospital representatives, argues that the law should be limited to newborns and infants.

Near the end of a four-hour-plus hearing, Lyman "Scott" Wostrel gave a grown man's choked testimony of the experience of abandonment. His mother gave him up at 14, he said, in urging lawmakers to limit the law to newborns. "It doesn't matter what a person says. The action speaks — I don't love you. Any kid can figure that out," he said.

At the end of the work day, the Judiciary Committee voted to send a measure to the floor of the full unicameral legislature on Tuesday and Wednesday that amended the governor's bill to extend the law to children as old as 30 days. (Some legislators wanted the limit to be as much as a year or more.) Chairman Brad Ashford said he expected vigorous debate and further amendments. A 24-hour cooling off period will then go in effect before a final vote comes Friday.

Even though Governor Heineman is likely to have the law pared back to apply only to infancy, the broader issue of childhood mental illness did have its hearing. A majority of the kids abandoned had a history of mental illness — 90% of the parents or guardians had sought state services for them before. Many had at least one parent in jail. One big hole in the safety net, said Dr. Jane Theobald, an Omaha psychiatrist and representative for the Nebraska Psychiatric Association, is that there are simply not enough facilities for troubled youngsters. A teenager who attempts suicide might stay at a general medical hospital for days, waiting for an opening in a mental health facility that may or may not come. "I've sent kids out of state or four hours away for a bed. That's typical, not the exception."

Lawmakers sympathetic to the parents and guardians of older, troubled children note that Omaha is, after all, home to the original Boys Town of Father Flanagan fame. In the city, there's a statue of one young boy carrying another on his back, with the words chiseled underneath, "He ain't heavy, Father, he's m' brother." During the Great Depression, parents would scrape together bus fare and hang a sign, "Take Me to Boys Town,' around their child's neck. Tysheema Brown, the Atlanta woman who drove 1,000 miles to Omaha to drop off her 12-year-old son, had been taken to Boys Town herself as a teenager. She had tried to get a spot for him in a similar Georgia institution for six months and failed. On that long drive she reportedly told her son what was happening; she reasoned later he would not hate her because she believes she is sparing him from a jail cell.

Father Steven Boes, president of Boys Town, didn't bother to attend Monday's hearing because he thinks little can be done on the big issues of mental health. He says he'll be back in Lincoln in January "to strike while the iron is hot" when legislators are scheduled to debate privatizing behavioral services for troubled adolescents. Meanwhile, Boes had good news for Tysheema Brown. The priest said he's working with Georgia alumni to get her housing and find her son a spot, hopefully in Omaha.

Don Marquis: "The Lesson of the Moth"

By Don Marquis, in "archy and mehitabel," 1927


i was talking to a moth
the other evening
he was trying to break into
an electric light bulb
and fry himself on the wires

why do you fellows
pull this stunt i asked him
because it is the conventional
thing for moths or why
if that had been an uncovered
candle instead of an electric
light bulb you would
now be a small unsightly cinder
have you no sense

plenty of it he answered
but at times we get tired
of using it
we get bored with the routine
and crave beauty
and excitement
fire is beautiful
and we know that if we get
too close it will kill us
but what does that matter
it is better to be happy
for a moment
and be burned up with beauty
than to live a long time
and be bored all the while
so we wad all our life up
into one little roll
and then we shoot the roll
that is what life is for
it is better to be a part of beauty
for one instant and then cease to
exist than to exist forever
and never be a part of beauty
our attitude toward life
is come easy go easy
we are like human beings
used to be before they became
too civilized to enjoy themselves

and before i could argue him
out of his philosophy
he went and immolated himself
on a patent cigar lighter
i do not agree with him
myself i would rather have
half the happiness and twice
the longevity

but at the same time i wish
there was something i wanted
as badly as he wanted to fry himself

archy

MSNBC.com: Pacemaker for brain may ease mental illness

  MSNBC.com

Obsessive-compulsive symptoms improved, but some had major side effects
The Associated Press


NEW YORK - The same kind of deep brain stimulation used to treat some patients for Parkinson’s disease also helped a few people suffering from obsessive-compulsive disorder, French scientists reported.

Their study involved only 16 patients, but in four of them, symptoms nearly disappeared. However, many patients had serious side effects, including one case of bleeding in the brain.

The treatment involved an experimental brain pacemaker, and it reduced repetitive thoughts and behaviors in some of the patients — just as it blocks tremors for some Parkinson’s sufferers.

Read more...

The Last Psychiatrist: Those Five Days Matter More Than Anything, Except The Other Days

Guys, remember that time when you were 24 and you were on the subway, and you saw that girl with the glasses reading a book wearing a black leather coat, and you were obsessing over whether to go up to her or not but then your stop came, and you were like, screw it, she'll probably mace me, so you got off and went to the library to study for your chem exam?

You chose wrong.

In the Atlantic appears First Person Plural, an article about the growing evidence that identity is more complex than a simple collection of traits and beliefs.

The view I'm interested in... accepts that brains give rise to selves that last over time, plan for the future, and so on. But it is radical in that it gives up the idea that there is just one self per head. The idea is that instead, within each brain, different selves are continually popping in and out of existence. They have different desires, and they fight for control--bargaining with, deceiving, and plotting against one another.

Examples from the article include the hidden zero effect, in which choices are made differently depending on how far in the future are the payoffs. We can't imagine well who we will be in that future, so we choose what is better for the person in the now.

Personality also changes according to situation; even the most thuggish teenager is not the same around his buddies as he is when having tea with Grandma.... In the 1920s, Yale psychologists tested more than 10,000 children, giving them a battery of aptitude tests and putting them in morally dicey situations, such as having an opportunity to cheat on a test. They found a striking lack of consistency. A child's propensity to cheat at sports, for instance, had little to do with whether he or she would lie to a teacher.


With rare exception (of personality structure), who we are has a lot to do with what's going on at that moment. Hence the Nausea-- the feeling when you understand that there is no "you"-- at any moment you can decide to do or be anything. You didn't murder that guy because you're not a murderer. You didn't murder him because, well, it didn't come up.

II.

Yet there are an abundance of studies showing character traits are inherited; that behaviors are often predictable; and our own daily experience that there is at least a common thread to our identity. What of that?

Bad faith. It appears there's a commonality because, simply, we are not tested. But, more accurately, one is never tested; only parts of his identity are tested at a time. That's why the loving family man who then becomes a Nazi is still a loving family man-- that part was never strained. He is a good person and a bad person. Multiple selves.

The question is not whether traits are heritable-- they are-- the question is what self you are going to let dominate.

III.

Here's an example, from Barron's:

But such gloomy sentiments aren't a reason to get out of the stock market... Consider that $1 invested in stocks from February 1966 through May 2007 would have grown to $16.58 in that period. That's a 7% annual return.

Awesome, and by awesome I mean what a complete waste of one's life.

Somehow people demote investment income over any other kind of income. It's important to go to work every day, or clip a coupon, but it is nigh impossible to people to open a Roth. The money, I guess, doesn't seem real.

That's money; but if I grabbed the average teenager and told him his life and happiness would grow at 7% a year, he'd probably kill himself. 7% to the young is basically telling them not to even bother. To be young means you still have hope, that your energy and talents will eventually payoff, in a big way. The difference between a mature adolescent and an immature adolescent is not their expectation of massive success-- they both think they're going to rule the world-- but how they see it happening. Mature kids see a steady climb to awesomeness; immature kids see it happening one day, all at once, at some arbitrary point in the future. I know this because I see them in Starbucks, laptops open, staring out the window. I was one of those kids, too.

7% a year financial growth isn't good, it's a pacifier, a hoax (it serves, therefore, the same social function as psychiatry.) Furthermore, it can be wiped out in one week. If you bought and held over the past ten years, you made nothing. It was all a waste. Don't believe me? Go ask a retiree.

And you shouldn't accept 7% growth in your life, either. Every day must be a struggle for self-improvement in the service of improvement of the world.

IV.

Well, it turns out it is much worse than all that. Barron's again:

By contrast, investors who were out of the market in the five best days each year during that span were left with only 11 cents.

The implications for money management are obvious, but for life they're nauseating: if you take out the five most significant days of each year, then you are basically a completely different person. By money analogy, taking out those five best days made you massively worse off. You would have been better off not even going through the year. Studying for the chem exam always seems like a good idea, but there's an opportunity cost. And you have to measure that opportunity in real time, because in retrospect it will be too late.

The old generally think themselves exempt from this, but they are not; a day can alter their entire existence and legacy. November 4 will change how we remember John McCain forever. Nothing beside remains.

Who you are is a product of your experience, and also a product of the experiences you did not have. You didn't talk to that girl, now that's part of you-- you are the guy who was too scared/angry/self-absorbed/whatever to talk to her, and that is an entirely different guy then the guy who does talk to her and it works; and an entirely different guy from the one who gets maced. That was one of the most important days of your life, and you didn't even know it. Which brings me to the real point: every day is the most important day of your life, and you don't even know it.

there are worse things than
being Alone
but it often takes decades
to realize this
and most often
when you do
it's too late
and there's nothing worse
than
too late.

-- Charles Bukowski

Stress Remedy: Nothing to Fear, but Fear Itself?

By Jay Winner, M.D.  in Stress Remedy

Now
is a perfect time to reflect on FDR's first inauguration speech - when
the economic situation was far worse than it is now (excerpts as
follows):
"This great Nation will endure as it has endured, will
revive and will prosper. So, first of all, let me assert my firm belief
that the only thing we have to fear is fear itself-nameless,
unreasoning, unjustified terror which paralyzes needed efforts to
convert retreat into advance..." "In such a spirit on my part and on
yours we face our common difficulties. They concern, thank God, only
material things... Only a foolish optimist can deny the dark realities
of the moment. Yet our distress comes from no failure of substance. We
are stricken by no plague of locusts. Compared with the perils which
our forefathers conquered because they believed and were not afraid, we
have still much to be thankful for... We now realize as we have never
realized before our interdependence on each other; that we can not
merely take but we must give as well..." (When you get the chance, I
recommend you read the whole speech here.)

Timely messages from this great speech include:
1. This great nation will endure as it has through all sorts of extreme challenges.
2. Fear itself is a key factor in making the economic problem worse.
3. Despite the hard economic times, we have much to be thankful for. (See my previous post Investing in Stress Reduction for more info on this.)
4. We must stand together to solve the problems.

Many people are living in fear that is made worse by constant
consumption of news media. I am not a financial expert, so I would not
presume to know the future course of our economy. (The financial
experts, on the other hand, can correctly predict market direction
almost 50% of the time.) We do, however, need to look at the
motivations of the media who advise us. Keep in mind that one of the
main goals of media is to keep you consuming it. If you quickly change
the channel to another station, they don't make money. Watching people
talk about financial "concerns" will likely not keep your eyes glued to
the tube as much as talk of a financial "crisis."

Since
this is a psychology blog, let's look at one more aspect of "the only
thing to fear is fear itself." What is the fear of fear? In the extreme
it can cause variety of psychological problems. For instance, people
with agoraphobia may be so afraid of having a panic attack that they
limit their activities. At its worst, a person with this disorder, may
be too fearful to leave his house.

This fear of fear speaks to an issue pertinent to us all. It is an
example of a what in Dialectical Behavior Therapy is called a secondary
emotion. When an event happens, we may have a primary emotion. For
example, if you break up with a significant other, you may have the
primary emotion of being sad. If you think that you shouldn't be so
sad, you may get sad about being sad. Being sad about being sad, angry
about being angry, or fearful of being fearful are all examples of
secondary emotions. These secondary emotions may prolong feelings of
sadness, anxiety and anger. To avoid being stuck in any of these
emotions, let go of thoughts of how your primary emotion should be
different. Welcome how you feel, and the primary emotion relatively
quickly comes and goes.

As we accept our feeling of fear, the fear does not last as long.
Fear is an embodiment of our ancient fight-or-flight response. The
adrenaline is released from our adrenal glands and heightens ones
ability to physically react. This adrenaline response can be
experienced in a number of ways including fear and worry. This fear and
worry can be thought of as "distress" or bad stress. The adrenaline
response can also be experienced as excitement or enthusiasm which can
be thought of as "eustress" or good stress.

Interestingly, if you say the word "eustress' out loud, it sounds a
lot like "use stress." Indeed, by using the adrenaline, you can convert
the distress to eustress. When you feel stressed, you can try relaxing
to classical music. Alternatively, let go of thoughts of how you should
feel different, and then use the energy to rock out to the Black Eyed
Peas! Even if you don't use the additional adrenaline to dance or run,
you can enjoy the feeling of it flowing it through your veins!

Heeding to FDR's great words, will help you weather these difficult financial times.
Learning to experience your primary emotions without resistance, will help you weather all sorts of emotional storms.

Jay Winner, M.D. is the founder of the Stress Reduction Program at Sansum Clinic

and the author of Take the Stress Out of Your Life: A Medical Doctor's Proven Program to Minimize Stress and Maximize Health.

The Mystery of Happiness: Self-love precedes the love of others

By T. Byram Karasu, M.D. in The Mystery of Happiness
 

T. Byram Karasu, M.D. is Silverman Professor of Psychiatry at Albert Einstein College of Medicine.

Self-love is benign self-compassion, not malignant self-centeredness, which unfortunately we call narcissism. Narcissism refers to a metaphor that describes a particular state of mind in which the world appears as a mirror of the self. It is used as an expression of unprincipled self-preoccupation. Even at that level of reading, as Thomas Moore says, "Narcissus falls in love with his image [and] discovers by his own experience that he is lovable." We tolerate better, and in fact find warmness in, such self-love when we see it in children.

This positive view of the myth of Narcissus tells a story of transformation through self-love. The word narcissism derives from the classical Greek myth, in which the main character, a youth called Narcissus, falls in love with himself. The child, in fact, is so beautiful that not only he but everyone else is in love with him. In his self-absorption, he is unable to relate to anyone, never mind being able to love another. The closest he gets to anyone is to a nymph (ironically called Echo), who can only repeat what she hears. She becomes a mere voice reflecting him. Isolated and unengaged, he gazes at his own image in the water and yearns only for himself. As he reaches down to touch his reflection, he disappears into the abyss of the waters of the river Styx. Ultimately what remains in his place is a flower, a yellow-centered daffodil with white petals--The narcissus. Although Western psychology generally interprets the myth as Narcissus drowning in his own pathology, in fact the story has less to do with being destroyed by one's self-preoccupation than with the ultimate salvation inherent even within the most desperate of us. It is the story of transformation from one form of nature to another-a boy who becomes a flower. In such a transformation, the boy becomes a part of a larger whole.

In self-love, there is a potential for being part of the whole. In this sense, self-love engenders a feeling of union with the rest of nature. It is a mutual self-love, a form of communion among the creatures. This is a merciful self-love, healthy narcissism and, far from being pathological, it is very much needed as a basic ingredient for attachment to and love of others.

From The Art of Serenity

Mind over natter ... sorta ...

Going through a breakup.

It hurts.

Racing thoughts ... obsession sessions ... ruminating ... the whole deal.

Aha, think I -- I should be practicing mindfulness.

So I picture myself lying on soft, green grass of a quiet field.

I picture my thoughts and feelings as soft, puffy clouds ... just moving across the blue, blue sky.  Try letting them appear ... and move across the sky ... and disappear, unjudged ... untouched by me....

Suddenly, the clouds begin to change shape.  They become ... airplanes ... airplanes with the rotund contours of World War II planes in Warner Brothers cartoons.  More and more clouds become airplanes ... and then they start dropping bombs on me -- hundreds of tiny bombs falling from the sky and exploding all around me as I lie on the grass.

Hmmm, I think.  That's pretty funny. Not particularly mindful, granted, but still, actually pretty funny.

Then I remember what my therapist said the last time we talked.  What should I do, I asked, when I am trying to sit with thoughts and feelings without following them ... but without running away from them, either?

Ask yourself, he said, What do I need to do to take care of myself right now?

Answer: laugh.
Answer: invent funny methaphor to impress therapist.
Answer: Remember to ask the question.

Done and done.

Medical News Today: Serious Mental Illness Linked To Increased Risk Of Stillbirth And Newborn Deaths

Mothers with any form of serious mental illness are more likely to have children who are stillborn or who die within the first month, finds research published ahead of print in the Archives of Disease in Childhood (Fetal and Neonatal Edition).

But the links between the causes of stillbirth and newborn death depend on the type of mental illness the mother has, the research shows.

The researchers looked at 1.45 million live births and 7021 stillbirths over a 25 year period from 1973 to 1998 in Denmark, to investigate links with serious mental illness.

But the chances of stillbirth and newborn death from any cause were considerably greater for babies whose mothers had been admitted to hospital for mental illness at any point before the birth of their child, than mothers who had never been admitted.

Read more .....

The Sydney Morning Herald: Depression's silent victims

November 8, 2008


One Saturday, a few months before the mental collapse that would end John Brogden's political career, the then NSW opposition leader and his wife decided they were overdue for some family time, so they scheduled a day's outing.

"We got picked up by the car and driver," Lucy Brogden recalls. "John and the driver sat in front. There was me in the back with the baby seat, and a staffer on the other side."

Then began a bizarre South Coast road trip that started with an official morning tea at Sylvania. It progressed to lunch with Liberal Party people at Cronulla - for Mr Brogden. Mrs Brogden fed her toddler son and ate in the car with the driver. Next it was on to Kiama for afternoon tea with dignitaries, before a dinner in Nowra, with party people again.

When Mrs Brogden looks back on the mounting intensities of the time, she always returns to that day in early 2005 - its ugly caricature of leisure a telling portrait of her complicity in their unsustainable life. She was, she says, like the classic boiling frog: as the water gradually heated up around her, she found her stress threshold climbed higher than she could have imagined.

Her husband was bingeing on work, overeating then consuming nothing but Diet Coke for up to week at a time, and alternating extreme sleepiness with phases of insomnia. It could not have been clearer that he had big problems. There were times of relative normality but over the years the situation escalated. "I could see he was spiralling out of control," Mrs Brogden says. "But that's part of the issue people have. They're losing their own self-awareness.

"The more I pushed him, the deeper he went into denial … a young outwardly successful man … to put up his hand and say, 'I think I'm depressed, I think I'm suffering from a mental illness' - it's a pretty big call."

The partners of people suffering from psychological disorders are a new frontier in the work of depression groups, amid growing recognition of the immense effect of the condition on their lives, and the role they can play in helping their loved one recover.

Graeme Cowan, a survivor of depression, earlier this year conducted a survey of 351 people caring for a mentally ill partner or relative, recruited through the websites of Sydney's Black Dog Institute, beyondblue and the Queensland Alliance of Mental Illness and Psychiatric Disability.

Top of their list of concerns were feeling rejected by their depressed love one, the negative effect on their sex life, exasperation and a desire for the person to snap out of it, and feeling that the loved one was no longer the person they thought they knew.

They also complained that their role was poorly acknowledged. Few formal resources were aimed at carers and there was a reluctance by some doctors to discuss the situation with anyone other than the patient.

Read more ...

BBC NEWS: Depression treatment trial launch

Ruby Wax on Mindfulness

Hundreds of volunteers are being urged to take part in trials for a treatment for depression known as Mindfulness.

Comedian Ruby Wax says she benefited from the techniques, which is explained as a way to teach people to approach their problem in a different way.

She has visited Bangor to speak about it, and universities in the Gwynedd town and Oxford are joining forces to seek 150 volunteers from each area.

It is claimed the treatment could also help people with chronic pain.

"The way in which we react to stressful or emotional situations we face can cause further stress," said Rebecca Crane, director of training at Bangor University for Mindfulness Research and Practice.

"Mindfulness is effective in reducing this extra layer of difficulty and struggle," she added.

"The acceptance of pain reduces the struggle we experience around the pain and so reduces the stress.

"This can often have the effect of reducing the actual experience of pain," she added.

Professor Mark Williams from the University of Oxford (and formerly Bangor University) said people suffering from depression could learn skills to stay well.

Early signs

"Sir Winston Churchill famously described it as his 'black dog'", he said.

"People who have had one major attack of depression are more likely to experience further episodes.

"Our research, however has shown that they can learn skills to stay well," he added.

Key to this was recognising the warning signs early enough, and then be able to stand back and not be sucked in by negative feelings, he said.

"It takes some effort to learn how best to do this, but it can be done," he added.

Ruby Wax said of her experience: "Under stress the only way I can reduce my anxiety, both physically and mentally, is by practising Mindfulness.

"My heart rate lowers, I can breathe again and my mind becomes clear so I can deal more effectively with the situation," she added.

Anyone interested in taking part in the trial is invited to contact either Bangor University or the University of Oxford.

washingtonpost.com: It Isn't About the Trash Can

By Christine B. Whelan
Special to The Washington Post


Picture this: You're staring at the kitchen trash and feel a surge of frustration. You just saw your partner stuff one more thing into the already overflowing bin without making a move to empty it. Ready to pick a fight, you're about to lash out with an angry indictment of your partner's overall worth as a human being. Then you stop.

You've been taking classes in something called mindfulness, so you take a deep breath and step back. You identify and feel your emotions, and then let them pass. You find the real source of your frustration: It's not the trash; it's that you don't feel appreciated around the house. Instead of an opening volley of obscenities, you consider how to resolve the broader issue.

Sound too New Age-y to work in your household? It might be worth a try: Researchers at major universities are exploring the benefits of Buddhist mindfulness techniques to help families increase feelings of closeness and decrease relationship stress -- and the results are promising. Just as the latest Hollywood incarnation of the Incredible Hulk keeps his green-hot anger under control with daily meditations, so are some people learning to manage emotions in their relationships.

In mental health terms, mindfulness is the awareness that emerges from focusing on the present and the ability to perceive -- but not judge -- your own emotions with detachment; it enables you to choose helpful responses to difficult situations rather than reacting out of habit. While Western thought separates religion and science, Buddhists see mindfulness as both a spiritual and psychological force.

Mindfulness isn't simply about calming down, and it's certainly not about giving in. It's about recognizing that you're tired as you go home on a crowded Metro train, so that when somebody bumps into you, you decide to say, "Excuse me!" instead of pushing back. It's about picking an effective way to discipline your teenager for staying out until 3 a.m. rather than responding like an angry child yourself.

Read more ...

Comfort Queen: Comfort During Fearful Times

I finished reading Acedia and Me by Kathleen Norris last night and I want to shout (I guess blogging is my shouting), “This book could change your life!”

Acedia - what the hell is that? I’d never heard of it before. Kathleen defines it as:

…as the spiritual aspect of sloth. The word literally means not-caring, or being unable to care, and ultimately, being unable to care that you can’t care. Acedia is spiritual morphine, but it does more than mask pain. It causes us to lose faith in ourselves and in our relationships with others.”

We are awakening from a time of collective spiritual morphine stupor. We sank into a profound state of weary not caring — not everybody, not all the time but a lot of us. Now we feel the breath of hopeful possibility, the brush of optimist trust upon our hearts and to help that goodness grow into sustainable action, we need to name the demon that has beset us (excuse the demon talk but it feels right, especially after reading the book).

There is such power in naming. Reading Kathleen’s struggles with acedia woven with early Christian theology and reflections on contemporary life, I kept having that electrifying feeling of being known. Of “Oh me too, me, too.” I kept having to stop and read sections aloud to Bob.

One reason I wrote this book was to explore my suspicion that much of the restless boredom, frantic escapism, commitment phobia, and enervating despair that plague us today are the ancient demon of acedia in modern dress. When we look at acedia’s root meaning, as not caring, we can see it as a social problem, and perceive that the sloth it engenders is anything but an insignificant physical laziness. It may even manifest as hyper-activity, but it is more like the activity of a hamster on a treadmill than action that will enhance the common good.

I was very glad to find the late playwright Wendy Wasserstein’s observation that “When you achieve true slothdom, you have no desire for the world to change. True sloths are not revolutionaries,” she adds, but “the lazy guardians at the gate of the status quo.” The question she raises is one I think we have to ask ourselves: “Are these hyperscheduled, overactive individuals really creating anything new? Are they guilty of passion in any way? Do they have a new vision for their government? For their community? Or for themselves?” She suspects that “Their purpose is to keep themselves so busy, so entrenched in their active lives, that their spirit reaches a permanent state of lethargiosis.” Lethargy, acedia: in some ways I think they define American culture today. The plethora of 24-hour news sources are perfect carriers of the disease, bombarding us with so much “information” that we can no longer distinguish between what is important and what is not, and discern what we truly need to care about.”

We live in a time where traditional ways of making meaning have mostly vanished. Heck, it used to be surviving was our meaning, then we had close (murderous) tribal ties and work that had a final product that could be touched, eaten, bartered. We had religion.

But in the post-modern world, we’re not even sure we believe in meaning. We often don’t have a community with whom to share our questions of “What the hell am I doing with my life?” We fall prey to a questioning of our life’s purpose that eats away at our souls and our ability to get out of bed. And when we do try to find our purpose, it can easily turn into a narcissistic quest that ends up feeding the acedia.

The concept of acedia has always been closed linked with that of vocation. Acedia was, and remains, the monk’s most dangerous temptation, as it makes the life he has vowed to undertake seem foolish, if not completely futile… Artists can feel a similar disconnect… Acedia is a danger to anyone whose work requires great concentration and discipline yet is considered by many to be of little practical value. The world does not care if I write another word, and if I am to care, I have to summon all my interior motivation and strength.”

I’m in this boat, summoning all my strength to create a life, and work, that feels worthwhile. Have you ever felt that way? What do you think the link between acedia and fear is — I think it’s the petri dish fear grows in.

Sydney Morning Herald: Anxiety can drain your spirit during troubled times

Greg Barns
November 6, 2008


Over the past decade the lid has been lifted on depression. Organisations such as Beyond Blue and the Black Dog Institute, among others, have shone a light on those feelings of darkness and despair that invade so many lives and which impair them. But depression is not simply about feeling blue. It can be linked to anxiety. People who seem upbeat each day might be physically and mentally drained inside by the relentless drumbeat of gloom and fear about themselves and their sense of security.

If you ask the average person to describe the symptoms of depression, unless they have acute medical knowledge themselves, they will generally use phrases such as "feeling sad" or "feeling low". Perhaps it is because the word "depression" conjures these feelings and perceptions.

A British Medical Journal survey in 1996 confirmed that the perception in the community is that depression is mainly about feelings of sadness or a lack of energy. Among survey participants, the reported noted, "when the discussion moved on to depression itself, most mentioned the symptoms of weepiness, irritability, feeling low, inability to cope, and loss of appetite".

The anxiety sufferer can often be labelled as "stressed out" or a "constant worrier" by colleagues and friends whereas the person who is gloomy, teary and lacks energy can be more readily understood as a person suffering from depression.

The Australian Bureau of Statistics reported last month that one in five Australians in 2007 suffered mental illness and of those 14 per cent suffered some form of anxiety disorder or frequent panic attacks. Yet according to research released in 2006 by drug company Pfizer and the Anxiety Disorders Alliance, 61 per cent of Australians have little or no knowledge about anxiety disorders.

Perhaps this is because some anxiety, and even panic, can be useful to all of us. If we are threatened by an intruder in our homes, then the anxiety we feel can enable us to react quickly to protect ourselves. And anxiety about exams or a presentation we have to undertake in front of our peers in the workplace can also be useful in enhancing our performance.

But if we spend some time each day for a period of weeks, months or even years regularly worrying about things, or have a general sense of unease, then the anxiety has become a disorder.

And while anxiety disorders can include everything from panic and phobias to post-traumatic stress disorder, the common garden variety manifestation of this illness is generalised anxiety disorder or GAD. The inherent difficulty with GAD is that it is hard to diagnose and for individuals to recognise they have it, and for others to understand what it entails.

As one English GAD sufferer, Jane Phillimore, put it in 2001, "what's remarkable about GAD is that, unlike post-traumatic stress disorder or phobias where the symptoms and focus of anxiety are easily recognised, it is hard to define. Sufferers worry about anything and possibly everything. This makes it sound like nothing more than an extension of the everyday worry all human beings experience. And GAD may start there.

"But it can escalate into a disabling disorder in which outwardly ordinary, normally successful people are crippled by inner lives of intense distress," Phillimore wrote in The Observer on October 14, 2001.

So how do we recognise the GAD sufferer? Let me answer that as someone who has regular bouts of anxiety, as well as feeling blue. The person who regularly, if not on a daily basis, fears that things are out their control, has a sense of unease about their life, fears a catastrophic event is about to befall them, and who worries endlessly about things said to them or about them by others when there is no rational basis for their doing so - this is probably an individual who is suffering from GAD.

An acute attack of GAD is emotionally and physically destabilising and exhausting. When someone worries about doom and gloom being just around the corner day-in and day-out over a lengthy period, this leads to feeling constantly tired and rundown physically, and it can mean being inattentive and distracted when with you are with other people, even individuals to whom you are emotionally close.

Perhaps those in government and in health groups such as Beyond Blue need to focus their awareness campaigns on highlighting that GAD is a serious mental illness that affects millions.

For individuals pre-disposed towards anxiety, it is in troubled and uncertain times like these that this can turn into a full-blown illness. We need help as a community to recognise the symptoms.

NPR: Happiness: Is A Priority On Well Being

by Philip Reeves




Morning Edition, November 6, 2008 · The tiny Himalayan nation of Bhutan has crowned its 5th king in an elaborate Buddhist ceremony. It was the new king's father who pioneered the concept of "gross national Hapiness." Meaning there's more to a country than economic growth — spiritual and mental well-being matter just as much to people.

The Writer's Almanac: "Lessons" by Pat Schneider

I have learned
that life goes on,
or doesn't.
That days are measured out
in tiny increments
as a woman in a kitchen
measures teaspoons
of cinnamon, vanilla,
or half a cup of sugar
into a bowl.

I have learned
that moments are as precious as nutmeg,
and it has occurred to me
that busy interruptions
are like tiny grain moths,
or mice.
They nibble, pee, and poop,
or make their little worms and webs
until you have to throw out the good stuff
with the bad.

It took two deaths
and coming close myself
for me to learn
that there is not an infinite supply
of good things in the pantry.

"Lessons" by Pat Schneider from Another River: New and Selected Poems. © Amherst Writers and Artists Press, 2005.

The Last Psychiatrist: The Sex-Starved Wife

On the one hand, you have articles in th Economist saying people are spending less time at work and more at home, on the other hand Time writes about the sex-starved wife. If they're both home more and at work less, why aren't they naked?

The answer isn't porn.

Sex is a good proxy for a lot of things. The Time article offers a number of explanations for why a man might have a lower libido than his wife, but not the correct one: narcissism. In women, narcissism manifests itself as a greater libido, and in men, a lesser one.

You might think this is backwards, but it isn't. The wife is more involved with every part of the relationship-- the money, the jobs-- his and hers-- the troubles, everything-- that the man has no way to construct an artificial identity she'd believe. He can't pretend he's anything-- suave, a major force at work, a successful investor, whatever-- because she knows his reality in text message speed. She talks to her husband not once, but four or five times a day. What's he going to say she doesn't already know? Even legitimate successes are subdued because they are not at all surprises.

Here's the mistake: women say, "but I get turned on by him anyway, he doesn't have to impress me, he has me." And my unscientific poll of... some... women suggests they are more sexually open and experimental than ever. So what's wrong? And so maybe the wife thinks she's not hot enough? And catchers his glances at the waitress, the porn on the computer.

Well, the problem with his libido isn't how hot she is. He's a narcissist: the problem is his libido is that it depends on how hot he is.

It's what women used to go through. He looks in the mirror, sees a gut-- he doesn't feel sexy, he can't imagine she would find him sexy, so the libido falls. In the past he could at least draw confidence from the fact that he has a good job; but now he doesn't have a "good " job, it's an okay job, one that pays the bills, but not something that you can build an identity with. And anyway she has one just as good. What's his appeal?

Read more ...

Anger in the Age of Entitlement: Post Election Stress Disorder

By Steven Stosny in Anger in the Age of Entitlement

National elections are tough times for those of a bi-partisan nature, not to mention a blogger who comments on the negative effects of emotional pollution. I'd like to think that we are the silent majority, those of us who long for civility and respect in the discourse of decent people presenting their vision and plans for the nation. After all, poles say that the public is fed up with negative campaigning with its misleading and often downright false advertising. We're appalled at the costs of this election cycle, which exceeds that of the Revolutionary War and the duration that nearly doubles our participation in World War I.

This election has been so disappointing because it held out promise to be better. Both candidates really seemed above personal and negative attacks. The use of the military word, "campaign," to describe political contests is apt; the first casualty in war and politics is truth.

The maelstrom of the election has been personal for me, as my dearest friends and closest relatives are at the extreme - though not radical or reactionary - ends of the political spectrum. My inbox is bombarded by negative points about the policies and characters of both candidates and their running mates. Passionate arguments that would not, to be kind, pass peer review on their merits are put forth by good and bright people. I understand that certainty is an emotional, not an intellectual state that requires limiting the amount of information considered and that political campaigns are designed to exploit bias rather than reveal it. Still, I wonder how they can be so certain about such enormously complex problems. But then I am probably confusing personal tastes and biases with an objective and informed analysis of problems. Political passions are closer to, "I don't know anything about art, but I know what I don't like." And I am no better for trusting those who are the most certain the least.

Part of my post election stress disorder may be due to the fact that I'm vastly overworked. I specialize in couples living in resentment, anger, or emotional abuse. Two conditions greatly increase demand for my services: economic crises and national elections. When they occur together, it's like a perfect storm of family contention. I have written previously in this blog about how so many people download and recycle the negativity in their environment and ultimately take it out on the closest people to them. A web of emotions connects us all, for better or worse. I long for a politician to realize that to make the country stronger, we must love the people closest to us, respect and tolerate the differences of everyone, and let compassion spread through the web of emotion that connects us all, for the better.

Comfort Queen: Comfort During Fearful Times

November 5, 2008

I said I would share a story today about the power of moving the body… what was I thinking?

Today is how-can-anyone-not-be-voting day?

Today is how can anybody-get-any-work-done-day?

Today is I-get-why-democracy-is-worth-dying-for-day.

Today is history-making.
Today is hope-making.

Today may be the day in which we collectively begin to turn away from fear-mongering and begin to have a relationship with our real fears. Which will, hopefully, allow us to create real solutions.

No matter which candidate you are voting for, no matter what voting shenanigans take place, no matter how long the lines, no matter that the archaic electoral college still exists, millions of people have enough faith that their opinion matters that they are casting a ballot.

Not one voter, however, will be killed for voting. No one will not be shot at. No one will lose their job. No one will have their children or family tortured.
No one.

As often in my life as I have felt shame at being an American because of choices our government has made or the lies our leaders have told or my own complicity in not marching in the streets when those things happen, more often I have felt gratitude.

Gratitude that I can complain about those choices and lies, that I can write a blog, newsletter or article that is not censored, that I can send a slip of paper through the mail (we have mail-only voting in my county) without retribution.

I have even more gratitude that my child can walk safely to school, that I can walk the streets day or night without fear, that I can buy food, that I can sleep at night without wondering if someone will burst through my door and kill everyone I love.

We may be profoundly poorer in the coming months and years, in dollars and international good will, and it is entirely possible we will become vastly richer in self-determination, integrity and the deep remembrance that each of can truly make a difference when we remember we have a choice.

When we remember our fears do not define us.

Today, I cry with gratitude and hope for the ideals of our country. Flawed and dented as they may be, they are ideals each person who casts a vote today is living.

They are ideals worth overcoming our fears for, whatever those fears may be.

To the power of voting, the glory of freedom and the remembrance that remaining awake to our choices is our first and most challenging duty.

Tomorrow, the great story! Promise.

Wow! I'm not depressed anymore! But wait, this blog is about depression so ...

Ok, so I have to think about the ramifications of this email on my depression (or lack thereof) but in the meantime, it's too good not to pass along!

Therese Borchard is the author of Beyond Blue on Beliefnet ... and I thought she was the coolest even BEFORE this email arrived!

-------- Original Message --------

Subject:	Blog.com's Top 10 Mental Health Blogs
Date:	Tue, 4 Nov 2008 09:24:41 -0500
From:	Therese Borchard

Hi folks,

I've been asked by the blog directory/website, blogs.com, to select the 10 best mental health blogs. I picked yours! I'll send you the link when it's up. Best, Therese

1. Finding Optimism

http://www.findingoptimism.com/

2. Bipolar Beat

http://blogs.psychcentral.com/bipolar/

3. We Must Not Think Too Much

http://wemustnotthinktoomuch.blogspot.com/

4. Furious Seasons

http://www.furiousseasons.com/

5. The Trouble with Spikol

http://trouble.philadelphiaweekly.com/

6. Postpartum Progress

http://www.postpartumprogress.typepad.com/

7. Coping with Life

http://www.coping-with-life.com/

8. Storied Mind

http://www.storiedmind.com/

9. If You’re Going Through Hell Keep Going

http://www.mcmanweb.com/

10. McMan’s Depression and Bipolar Web

http://www.mcmanweb.com/