Archive for July, 2009
The Body – Thoughts – Feelings Connection
The concept is really simple, yet profound. Your body, your thoughts and your feelings all exist in and are controlled by your brain. Altering one, or even better, two, will change the third. Let’s look at a panic attack for an example of how this would work.
During a panic attack the body feels like it is having a heart attack. Your chest constricts, your blood pressure rises, your skin temperature rises, your heart rate rises, your breathing becomes shallow and rapid, you have difficulty catching your breath. Your thoughts may race with fatalistic ideas; “I’m going to die”, “I’m having a heart attack”, “I’m going to go crazy”, “I can’t take this”, “I’m going to lose it”. Your emotions are that of terror and panic.
Let’s look at this. Emotions are the hardest to get hold of. They are nebulous and illusive. Thoughts are a bit easier, but your body is the easiest. Looking at the physical sensations your body experiences during a panic attack, which would be the easiest for you to control when panicked? Blood pressure and skin temperature may be tricky. But lungs are pretty easy. You can control how fast and how deep you inhale. So let’s start there. Slow your deepen your breathing. Do that for a minute or two. Now look at your thoughts. They are generated in your head. You can get control of them. Instead of allowing your mind to race along thinking, “I’m going to die!” or “I can’t take this!” get control of them and do some editing. Change it to: “I’m not going to die. I’m not having a heart attack. I’m having a panic attack. They last about 20 minutes, then it will be over. I can take it. I have taken it before and I will take it again. I just have to hang on until it passes.”
Now. How is that going to affect the panic? If you drag the body and mind into a calmer place, the emotions have to follow.
This can also work on depression. Granted, if the depression has a serious biochemical or genetic basis, medication may be required. But even with medication, if the body is sprawled in front of the television being stuffed with ice cream and potato chips and the mind is dragging along thinking, “My life sucks. It will never get any better. It’s always going to be like this.” depression is apt to follow and the medications are going to have a much harder time being effective.
Get the body up, give it a shower, dress it nicely and take it outside into the sunshine. Or take it to a funny movie. Or take it to visit that friend that always makes you laugh. Then edit your thinking. Change it to something more realistic: “My life doesn’t suck. I have these things in my life which are good (list several things). I have felt like this before and it does get better. It hasn’t always been like this and this will pass as soon as I do these things (make a list of things you have done before which have pulled you out of a depression and keep it handy). I’ve started taking my medication again and it usually takes 1-2 weeks to kick in. Then I will start to feel better.” Naturally, you will edit your thoughts to fit your life, these are merely examples. When you change what your mind is thinking and what your body is doing your emotions will have to follow.
Posted in GIGO: Garbage In Garbage Out – Taking Control of Your Mental Health
I worked with one client who complained of nightmares but failed to attribute the slasher movies she watched every night as the cause. When she stopped watching slasher movies, the nightmares mysteriously disappeared. Other clients come to me hopped up on coffee, “energy” drinks and other forms of caffeine and complaining of anxiety and insomnia. Granted, such simple solutions are not usually found to emotional distress, but I’m amazed at how often people fail to consider the effects of things they expose themselves to can have on their emotional well-being. Consider what you are putting into your head and how it affects how you feel. The older I get the more particular I am about what I expose myself to.
Media
Consider the movies, video games, television, music and internet sites to which you are exposed everyday. How does watching people eat roaches affect you? Do you mindlessly surf the internet or gravitate toward quality sites which contribute to your comfort, education, imagination or sense of humor? Does your music inspire you? Calm you? Depress you? Agitate you? Bore you? I worked with a divorcee once who listened to nothing but sad country songs which only further exacerbated his grief. By contrast, I worked with another divorcee who found that an old 1950′s sitcom made him roar with laughter and comforted him with its familiarity. He bought the entire set and watched it through his grieving to comfort himself. Do you choose your media experiences by what’s most popular, what other people think you should like, or do you choose what nurtures you?
People
What kind of people do you surround yourself with? Depressed people? Complaining people? Angry people? Self righteous people? Critical people? Happy people? Passionate people? Carefree people? Calm people? People who inspire you or people who suck you dry? Are you in an abusive relationship? Are you surrounded by drug or alcohol abuse or violence? Look around and see what influence the people around you have on your mental health. It might be time to make some changes.
Environment
What kind of surroundings do you find yourself in most days? Is your workplace cluttered and ugly? Is your home a mess? Are you surrounded by unpleasant sights, odors, sounds? Are you trapped all day in florescent lighting or a cubicle? Are you sitting in uncomortable furniture? Are you surrounded by garish colors? Do you have clutter everywhere? Stacks of paperwork piled high? Think about the physical environments in which you spend the majority of your time. What are they contributing to your state of your mind? Peaceful or stressful? Comfortable or cramped? Natural light or harsh glare? Quiet or noisy? Beautiful or ugly? Orderly or chaotic?
Food
I harp on healthy eating and its effects of mental health so much, I won’t bore you with a complete rundown on it again. Basically, the neurotransmitters which contribute greatly to your moods are manufactured by your body from the nutrients you eat. Energy levels, mental functioning and moods are all made worse by eating poorly. For a complete article on how to eat well for mental wellness, please see my article, “Eating for Mental Health“.
Making conscious choices about what you expose your mind and being to can greatly affect how you experience life. Exposing yourself to Garbage in (ugly sights, noxious odors, flat and artificial tastes, uncomfortable surroundings and unpleasant sounds) can only produce Garbage Out (sadness, anxiety, fatigue, irritability, frustration, hopelessness and general unhappiness). Control you input and change your output.
Bury Me in the Backyard
Please forgive the flip title, I just couldn’t resist.
This article caught my eye: Home Burials Offer An Intimate Alternative.
Is there more to say?
Thanks To All Of You
I cannot thank enough the many readers of this site who left such kind comments in response to my post on my second anniversary off-meds. I got several emails as well and I appreciate them too, especially since I was spending the day working as a poorly paid reporter and wondering where all that will end up soon. I’ll know soon.
I’m sure a few of you are well aware of the reduced volume of posts here. That’s happening only partly because I’ve been working close to full time the last two weeks or so. The other reason is because there simply hasn’t been much news on the mental health front, something I suspect is driven by Summer itself. I doubt that the lack of news lasts long, because it almost never does.
Anyway, I hope to have another item or two up later today.
Second Anniversary Off-Meds
As I did last year, I wanted to publicly note my anniversary–this year is the second–of being off-meds. Yes, that’s right: I’ve made it two years, despite the naysayers who told me I’d wind up dead or in the hospital, medicated to the gills. Looks like they were wrong. I’m in pretty good shape and haven’t had a lick of anything that would register on any clinical scale in a long time.
So two years after my psychiatrist talked me into going off the last of 18 years of psych meds, my case establishes one of four things: that I was a bad diagnosis back in 1989 and was never bipolar at all; that bipolar disorder burns out over time; that I’m a medical miracle of some kind; or, that I am a sick, delusional man, soon to be hospitalized. I lean towards the bad diagnosis and burns-out-over-time options myself.
Either way, I don’t consider myself bipolar any longer and I doubt that a single psychiatrist or psychologist would diagnose me with anything these days. Somehow that smells like victory.
Truly, I wish I had some wisdom about all of this, but since I don’t know of too many other cases like mine, I’m kind of on my own when it comes to extrapolating any meaning from all of this. Sure, I can say that I had years of medications that I didn’t need, but that’s easy to conclude. The bigger question is what do cases like mine mean for psychiatry itself. What do they mean for other patients? I wish I knew these answers but, for now, I just know that the questions are there.
Beyond Meds Goes On Hiatus
Most of you are familiar with the excellent blog Beyond Meds and the rough go its author, Gianna Kali, has had withdrawing from decades of psych meds. Kali has announced that she’s gone on a hiatus from blogging:
“I’ve stopped updating the blog to finish my detox and healing without the scrutiny of the public which has simply became too much. The end of withdrawal is generally recognized to be the most difficult and it’s been almost 6 years of withdrawal for me.”
For whatever reason, her site began attracting a bunch of stalkers and haters–mostly from the anti-psychiatry world, oddly enough–and it’s all become a bit much for her to deal with. I wish her well and look forward to her return someday.
I think her site is an important resource for people having issues with meds and withdrawal (I’ve learned a lot from her) and I think she deserves everyone’s respect.
Iraq, Afghanistan Vets Get Mental Health Diagnoses At 37 Percent Rate
An article in today’s New York Times reports on a study out of the San Francisco VA/UCSF that the prevalence of mental disorders among Iraq and Afghanistan War veterans is discouragingly high.
“The researchers found that 37 percent of those people received mental health diagnoses. Of those, the diagnosis for 22 percent was post-traumatic stress disorder, or PTSD, for 17 percent it was depression and for 7 percent it was alcohol abuse. One-third of the people with mental health diagnoses had three or more problems, the study found.”
War is surely Hell.
Seeing the World in Black and White
When the Chrysler car company released its new model Dodge Coronet in 1967, the theme of its ad campaign was the “White Hat Special.” Some of the ads featured cartoon cowboys riding around “keepin’ the prices low,” while others had the ubiquitous “Dodge Girl” in her signature white Stetson, chirping: “Only the good guys could put together a deal like this.”
These ads didn’t need any elaboration. Madison Avenue knew the potential buyers had all been raised on film and TV Westerns, and knew the symbolism of white hats. Roy Rogers, Gene Autry, the Lone Ranger—cinematic heroes wore white hats, and bad guys wore black. It was all very simple.
Simple, but maybe not all that original. The colors white and black have carried layers of moral meaning since long before American’ infatuation with cowboys and automobiles, and some scientists believe that those associations may be automatic and universal and ancient. Indeed, blackness and whiteness may be wired into our neurons, and tightly tangled up with notions of sin and virtue and cleanliness and dirt.
Two University of Virginia psychologists recently decided to explore this provocative idea in the laboratory. Gary Sherman and Gerald Clore wanted to know if common metaphors may be more than mere rhetorical devices, if in fact they might be deep embodiments of moral thinking. They decided to test the link between white and virtue (and black and sin) as part of this larger question.
To do this, the psychologists adapted a reaction-time test from the 1930s, called the Stroop Test. Readers may know this from the Internet, where it circulates as a kind of parlor game. It’s the one in which the names of colors are printed in different colors—say the word blue in yellow ink—and you must very rapidly indicate the ink color rather than the meaning. It’s hard, because our mind wants to read the word—and slow reaction time is taken as a sign of cognitive disconnect or conflict.
In Sherman and Clore’s version of the Stroop, volunteers read not the names of colors but words with strong moral overtones: greed and honesty, for example. Some of the words were printed in black and some in white, and they flashed rapidly on a screen. As with the original Stroop, a fast reaction time was taken as evidence that a connection was mentally automatic and natural; hesitation was taken as a sign that a connection didn’t ring true. The researchers wanted to see if the volunteers automatically linked immorality with blackness, as in black ink, and virtue with whiteness.
And they did, so quickly that the connections couldn’t possibly be deliberate. Just as we unthinkingly—almost unconsciously—“know” a lemon is yellow, we instantly know that sin and crime are black; grace and virtue, white.
Why would this be? Well, one possibility is that the metaphor is more complex, embodying not just right and wrong but purity and contagion, too. Think of the metaphor “new fallen snow”: It’s not only white, it’s virginal and unadulterated, like a wedding dress. And blackness not only discolors it; it stains it, taints its purity. With this in mind, the psychologists ran another experiment, adding this idea of contagion, feeling morally dirty. They deliberately primed some volunteers’ immoral thoughts by having them read a story about a self-serving, immoral lawyer, and compared them to volunteers primed for ethical thinking.
The idea was that people who were feeling morally dirty would be quicker to make the connection between immorality and blackness on the moral Stroop test, which is exactly what they found. And what’s more, they found this with much looser definitions of morality and immorality—including words like dieting, gossip, duty, partying, helping, and so forth. In other words, those primed for misbehavior linked blackness not only with crime and cheating but with being irresponsible, unreliable, self-centered slackers.
This is pretty convincing in itself, but the researchers wanted to look at the question yet another way. If the association between sin and blackness really does reflect a concern about dirt and impurity, then this association should be stronger for people who are preoccupied with purity and pollution. Such fastidiousness often manifests as personal cleanliness, and a proxy for personal cleansing might be the desire for cleaning products. They tested this string of psychological connections in a final study, again ending with the Stroop test.
The results were unambiguous. As reported on-line in the journal Psychological Science, those who expressed the strongest desire for an array of cleaning products were also those most likely to link morality with white, immorality with black. But here’s the really interesting part: The only products with this power were Dove soap and Crest toothpaste, products for personal cleanliness; things like Lysol and Windex did not activate the sin-blackness connection. In short, concerns about filth and personal hygiene appear central to seeing the moral universe in black and white.
For more insights into the quirks of human nature, visit the “We’re Only Human” blog at www.psychologicalscience.org/onlyhuman. Selections from the blog also appear regularly at Newsweek.com and in the magazine Scientific American Mind.
The Monkey’s Dilemma
So it’s an op-ed piece in the New York Times called The Meaning of Life and Roger Cohen speculates on all sorts of things in a monkey’s world: food and deprivation, happiness and longevity, caloric deprivation and bitterness, and quality versus quantity of life.
It’s an Op-Ed piece, it’s not a scientific study, though Mr. Cohen is pretty certain that the calorie-deprived monkeys in the study who lived longer were not the happy ones. There’s Owen the well-fed primate and Canto who’s I don’t usually like speculation– can we give the Monkey an MDI (Monkey Depression Inventory: Roy get on it!)?
“Which brings me to low-cal Canto and high-cal Owen: Canto looks drawn, weary, ashen and miserable in his thinness, mouth slightly agape, features pinched, eyes blank, his expression screaming, “Please, no, not another plateful of seeds!”
Well-fed Owen, by contrast, is a happy camper with a wry smile, every inch the laid-back simian, plump, eyes twinkling, full mouth relaxed, skin glowing, exuding wisdom as if he’s just read Kierkegaard and concluded that “Life must be lived forward, but can only be understood backward.””
And why are monkeys on our psychiatry blog? Mr. Cohen goes on to write:
“My mother died of cancer at 69. Her father lived to 98, her mother to 104. I said my mother died of cancer. But that’s not true. She was bipolar and depression devastated her. What took her life was misery.
We don’t understand what the mind secretes. The process of aging remains full of enigma. But I’d bet on jovial Owen outliving wretched Canto.”
I’ll leave it at that.
Traffic and Weather
I’m taking a 7th inning stretch, moseying into my colleague’s office to say hi. She’s aggravated because patients aren’t showing up.
“Do I charge them?” she asks.
“For sure! Charge ‘em!”
I’m in a take-no-prisoners mood, who knows, why, but have spent a good deal of the day working without a break. And the day started at the hospital, checking on my father. Every morning this week is at the hospital, which I don’t mind, but I’ve been driving there, which is bad enough, and hate the parking lot, going around and around and around and around and around.
And there’s no time to get home after the visit to change clothes to ride my bike to the office. There just isn’t time to waste.
So in general, I’m a little out of sorts. And some of the crank, for sure, is my father’s because he’s the helpless one lying around in a hospital bed.
I haven’t even told my colleague this, none of it, because (a) there hasn’t been a lot of time to talk, and (b) I don’t want to talk about it. That’s what a blog is for anyway.
She says, “Charge them? How do I charge them? Should I call them up on the phone right now?”
“Don’t be silly! When you can talk to me? You’ll get a call for another appointment and will say, ‘By the way, you know you owe me for the last visit. You didn’t show.’
And your patient will say, ‘Oh, drat! I forgot!’ or will spill out some excuse. Then you’ll give that little speech we give.” (Most professionals have a variation of this one.)
Sure, I understand, but you’re supposed to at least call, we had a deal, even if you’re sick, or have a funeral you have to go to, and you stole another patient’s time, because there’s always someone who wants a cancellation. But no one could take your spot because it wasn’t open cuz that didn’t happen. That’s why we charge, it’s why I charge. Makes people more sensitive to other people the next time.
“You deliver the lecture,” I tell her, “get paid and are no longer resentful and grumpy. The world is beautiful again.”
“I’ll try it,” she says.
She might, but she probably won’t charge. We social workers can be all mush.
ANOTHER STORY
So today I say to FD, “I’ve had it with driving. I’m riding my bike to the hospital and from there I’ll ride it to work. I’ll leave early so there’s plenty of time.”
He’s skeptical, “Uh, that adds 11 miles to your bike ride.”
“No way,” I say. “And anyway, it’s all bike trail.”
For the most part it is bike trail by the river, meaning easy riding, and the only real danger is urban cougar, the feline species, and an occasional tricyclist. (By this we mean child on a tricycle, not someone on an antidepressant).
“You’ll see how far it is. It’s going to be tough. I can drive you, do what I have to do, then pick you up at the hospital. Then you can drop me off at work and have the car,” he continues.
“Senseless. It’s a beautiful day. Birds gotta’ sing, girl’s gotta’ fly.”
And it is fine, it truly is, for the first mile and a half. I’m very out of shape, have had no time this summer to get on my bike most days, and when I have done it, it’s been slow going. I’m not the person I was even a year ago. Enjoy your youth, my friends.
But I get to the hospital, no worse for the wear, and lock up my bike, take off my helmet and take a deep breath. I’m a half an hour late and for sure have missed the doctors. I want to talk to one of them, at least. Anyone on the team will do.
I get up to my father’s room and he’s rearranging the hoses and tubes that are sticking out of his arms so that he can sit down comfortably in his recliner. The drips are full of diuretics to get the excess water out of his body. The kidneys aren’t working, the heart’s not working, nothing’s exactly doing what it’s supposed to do. He’s braced himself for disaster and has been very philosophical.
“The food here is good, but I’m not hungry.”
“You’re sick,” I say.
“Yeah.”
“And it’s sickening, right, being sick, so how could you have an appetite? It would be weird to have an appetite, I feel.”
He laughs and shows me the paper and pencil review he’s given the nurses and the doctors so far. He has been very positive, very happy with his care-givers.
“I love it,” I say. “You know, there are people who won’t give a positive review. No matter what, they will find something wrong with the people who are just trying to get through their day, trying to be helpful.”
“And those people are wrong!“ he confirms quietly. “They should write a good review anyway.” He would tip even the worst waitress. “Even if they’re terrible you tell their bosses how good they are. Then they’re not so terrible. They get better.”
Right, Dad.
We banter about nothing, and I realize that if I don’t get back on my bike I’ll be late for work and can’t let this happen. Mom will take the next shift pretty soon, anyway. I buy a bottle of water at the snack bar before leaving.
The ride to the office is LONG (about seven miles, FD is right on the money) and I have a sandwich in my backpack and I’m thinking maybe I should stop and eat or have a drink. There are plenty of park benches calling my name, but worry that if I do, and something happens, maybe a flat tire, I’ve wasted time eating and drinking. I hate being late. And I’m not hungry, anyway.
But I get to work in plenty of time and my fish (2 baby maroon clowns) are thrilled to see me. I feed them and they think they’ve died and gone to heaven. There are patients who have been calling all morning long on the office line, my cell phone, too, that I should call back, so I get to that. Eeeny, meeny, minee moe.
By 5:30 my back hurts and I reach for the Advil, pop open some email, too. One says in the subject line, ‘I’m venting.’ Why not? What’s a therapist for?
There’s one more appointment to go, a 5:45. I get the call.
“Doc?”
“Yup, where are you? Caught in traffic?”
“Yes, how did you know?”
“I’m a genius.” (I don’t say this)
The city has been impossible, one of the allures of biking. Chicago has a short summer and construction begins and we end, so to speak, with the good weather. It is possible to spend the best hours of the day behind the wheel.
“Oh, a little birdie told me.”
“By the time I get to your office our time will be up,” he moans, remorsefully.
“We can talk on the phone,” I tentatively suggest.
“Okay!”
“But you’re in traffic, I just remembered, and I want you to pay attention to the road.” And I’m thinking, I can leave! I can go home!
“Can we reschedule?” he asks.
“Lemme look.”
I find him a spot next week, knowing there’s money lost here. I tell him, “I’m not charging you.”
“Thanks!” He’s so happy.
“Have a great night.”
Fact is, I could have charged him, and he would have gladly paid me. But he is powerless here and I am happy here and why would we punish either of us for either of those things? Hey, and he’s called.
I pack it up and am out the door. It’s threatening rain, but you know, it’s that light summer rain that doesn’t bother you, the kind that sort of wakes you up, reminds you what it’s like to be a kid again, not worried about things like rain.
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