Mental Health Blogs

Archive for February, 2010

Today’s New York Times Magazine has a really interesting article by Jonah Lehrer called “Depression’s Upside.” Mr. Lehrer talks about a possible evolutionary purpose for Major Depression.

Mr. Lehrer writes:

The persistence of this affliction — and the fact that it seemed to be heritable — posed a serious challenge to Darwin’s new evolutionary theory. If depression was a disorder, then evolution had made a tragic mistake, allowing an illness that impedes reproduction — it leads people to stop having sex and consider suicide — to spread throughout the population. For some unknown reason, the modern human mind is tilted toward sadness and, as we’ve now come to think, needs drugs to rescue itself.

The alternative, of course, is that depression has a secret purpose and our medical interventions are making a bad situation even worse. Like a fever that helps the immune system fight off infection — increased body temperature sends white blood cells into overdrive — depression might be an unpleasant yet adaptive response to affliction. Maybe Darwin was right. We suffer — we suffer terribly — but we don’t suffer in vain.

So I didn’t like the article at the beginning; it relied on anecdotes–the woman who felt so much better with antidepressants that she’d grown complacent in a bad marriage, for example. It doesn’t capture all the patients I see, and any way you dice it, if you end up dead from suicide, your productivity comes to a halt. It seems to me that there are some people who suffer in ways that these anecdotes don’t explain. I suppose, however, even if we assume that depression is an unproductive, tormenting state, when it ends, is there something to be gained from having gone through it. Lehrer tells us, “Wisdom isn’t cheap, and we pay for it with pain.” I, personally, think there remains a differentiation between pain and major depression, and that perhaps one can grow through all sorts of suffering, and I’m all in favor of finding my own personal path to wisdom in ways that might not entail so much suffering. Just a thought.

But I ultimately, I liked the article because Lehrer, while clearly a proponent of the “don’t mess with evolution, less drugs, please,” school of thought, presents a balanced view. He gives Peter Kramer (Listening to Prozac) a voice, and talks about the objections to the viewpoint he puts forth. He describes a theory that depression is evolutionarily helpful because of the ruminative nature of the illness. He also cues us in that this is just one explanatory theory which remains unproven, and there are others. Lehrer continues:

Other scientists, including Randolph Nesse at the University of Michigan, say that complex psychiatric disorders like depression rarely have simple evolutionary explanations. In fact, the analytic-rumination hypothesis is merely the latest attempt to explain the prevalence of depression. There is, for example, the “plea for help” theory, which suggests that depression is a way of eliciting assistance from loved ones. There’s also the “signal of defeat” hypothesis, which argues that feelings of despair after a loss in social status help prevent unnecessary attacks; we’re too busy sulking to fight back. And then there’s “depressive realism”: several studies have found that people with depression have a more accurate view of reality and are better at predicting future outcomes. While each of these speculations has scientific support, none are sufficient to explain an illness that afflicts so many people. The moral, Nesse says, is that sadness, like happiness, has many functions.

The article finishes off with the idea that people in depressive states are better thinkers, they notice more, they work better. He talks about a study that shows that on gloomy days with dismal music playing, shoppers notice more trinkets by the cash register. Gloomy weather and oppressive music might set a low mood tone, but this seems a far cry from an episode of major depression, and not something that is generalizable to anything more than clouds and music and trinkets. There’s a second study mentioned of undergrads doing an abstract reasoning test that shows people with a “negative mood” perform or focus better; again, it falls short of being a comparison for major depression. The shrinks among us find it hard to imagine that ‘negative moods’ and Major Depression are all that linked. Everyone has negative moods. Not everyone has major depression.

What about the studies that link mood disorders and creative tendencies? This does seem likely, and we’re left to wonder (my own thoughts, not the article) if the intense experience of an episode of mood disturbance either fuels creativity by feeding it material or requiring a release, or if the genetics are wired such that mood disorders and artistic talents might be coded near one another.

You thoughts?

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We’ve had 80 (?) inches of snow here this year. Unheard of! Who moved that Mason-Dixon line? It was enchanting at first, and I felt like I was on vacation: fires, hot cocoa, no where to go, watch a movie, eat good food, for a day or two here and there I couldn’t get to work and no one wanted to see me. Snow Day!

Ah, but the enchantment ended. The bushes are flattened. The gutter are draped across my house leaving rotted beams exposed. The snow is in ugly blackened mounds everywhere, and as it gradually melts, there are tracks of mud pretty much every where.

And today’s forecast: snow. Yesterday they were saying 5 to 10 inches. Two patients have called to cancel (Shrink response: Call me in the morning after you look out the window). So far, so good. Hoping the gutter guys can come today.

Enough hot cocoa. Enough days off. Enough trying to reschedule everyone. Enough shoveling, Enough salt tracked onto the wooden floors. Enough. Enough. (I know, it could be much worse).

Here’s to 75 and sunny, somewhere?

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I become misanthropic every February. I avoid social gatherings, and really just want to hole up at home. I always assumed it was the dark evenings and slippery sidewalks and general misery of venturing outside. But truth be told, I don’t want guests visiting me either. Not until the crocuses come through.

Or not until cold and flu season is over, more accurately. New research suggests that my anti-social ways may have little to do with friendliness or lack of it. Indeed, my attitudes and actions may be self-protective, part of an ancient, hard-wired psychological immune system, shaped over eons to help humans steer clear of germs.

Think of it from an evolutionary point of view. Group living conveyed many survival benefits for early humans, but it also carried risks—most notably the spread of harmful disease. The body’s immune system is very good at fighting off germs, but it’s a costly system to operate. In the parlance of immunology, people are vectors, and another way to avoid sickness is simply to avoid disease carriers in the first place. In this sense, extraversion is costly and introversion is adaptive—especially during flu season.

That’s the theory at least, which psychologist Chad Mortensen of Arizona State University has been investigating in his lab. He and his colleagues wanted to see if exposure to germs—or at least the idea of germs and illness—would change people’s basic perceptions about themselves as social beings. To test this, they showed a group of volunteers a slide show about germs and contagious disease, while control subjects watched a slide show about architecture. Afterward, all the volunteers completed a personality inventory, which includes measures of extraversion, agreeableness and openness to experience. Finally, the researchers assessed each volunteer’s feelings of vulnerability to disease— basically, how much they fret about getting sick.

They anticipated that the volunteers with disease on their minds would see themselves as more reclusive. And that’s just what they found. The infection-minded volunteers saw themselves as less gregarious than did controls, and the hypochondriacs in the group also saw themselves as less open-minded about people and less cooperative. In other words, the more intense the volunteers’ worry about infection, the less they desired the company of others.

That’s striking in itself. But attitudes and self-perceptions are only an effective defense if they change people’s actual behavior. So in a second experiment, the scientists came up with an ingenious way to measure actual avoidance. As before, they primed only some of the volunteers with worries about infection and illness. Then they exposed all the volunteers to pictures of faces, while measuring their arm movements. Very subtle pushing away is an indicator of social avoidance, as when we push away something undesirable; flexing similarly indicates acceptance. As expected and reported on-line in the journal Psychological Science, those primed to fret about germs were more avoidant; and the chronic hypochondriacs were the most avoidant by far.

So that’s a pretty nifty defense mechanism. Or at least it was a one time. But these evolved tendencies are often blunt instruments, and this hard-wired bias against germs may go awry in the modern world. For example, sensitivity to disease threats can be indiscriminate, causing people to judge and avoid not only sick people but also obese people and people with disabilities. And because people who are unfamiliar pose an especially potent threat of unknown diseases, the psychological immune system might also foster xenophobia toward foreigners, anti-gay attitudes, and right-wing authoritarianism. That’s a big price to pay, just to dodge a sore throat and sniffles.

For more insights into the quirks of human nature, visit the “Full Frontal Psychology” blog at True/Slant. Excerpts from “We’re Only Human” appear regularly in the magazine Scientific American Mind. Wray Herbert’s book, On Second Thought: Outsmarting Your Mind’s Hard-Wired Habits, will be published by Crown in September.

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I’m reading the August, 2009 edition (yes I am a little bit behind in my reading) of Yoga Journal and I am reminded again of all the benefits yoga has to offer in the struggle for mental health and peace of mind.

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I apologize for the lack of posting here the last two weeks, but we rolled out signature petitions for I-1068–aka The Marijuana Reform Act of 2010–last week and it’s been hell on wheels the last few weeks. I am the campaign director of Sensible Washington and a co-author of I-1068. Last week I worked 93 hours, unpaid. Our campaign is all-volunteer and while no one in the professional political observer class gives us a chance of getting the 241,153 valid signatures we need by July 2 to get on the November ballot, we think the enthusiasm level among regular citizens for our initiative is substantial and that we have a fighting chance. We expect to turn in 320,000 signatures by July 2.

Our main campaign website is here and if you’re on Facebook you can add our fan page and follow what’s going on. If you’re a registered voter in Washington State, we want your signature!

Among others, I-1068 is endorsed by Seattle Chief of Police (Ret.) Norm Stamper.

With luck, I may be back to semi-regular posting in the near future, but until my hours back off to, say, 70 hours a week I am simply unable to do much of anything non-campaign related including eating and sleeping.

But I will be back. Guaranteed.

I hope you are all well and appreciate the many emails I’ve gotten the last few days.

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I’m up and it’s only 2:30 a.m., happen to catch a glimpse of myself in the mirror. In a shiva house the mirrors are covered, for the most part, for that first week of mourning following the passing of a first degree relative. There are all kinds of superstitious reasons, frankly I’m not interested in them. All I know is that one of the towels fell off the bathroom mirror and there I am, looking at me, and it isn’t pretty.

Has it aged me, losing my father? Or should we say, wizened me. Both right. It is a new experience, not at all like I thought it would be. It feels as if I’ve been hit in the back of the head with a baseball bat, still, over a week later, and that I’m in some kind of daze. It is surreal, detached.

We call it Bereavement, a V code, V62.82. Thankfully I have very few of the symptoms that distinguish bereavement from Major Depressive Episode. I haven’t got the guilt over what I didn’t do, no morbid preoccupation with death, no marked psychomotor retardation (although driving has been a little scary, haven’t quite got the coordination back). No hallucinations, although my dreams, really scary.

And sure, it’s hard to sleep, and it is very early in the morning. I throw on a heavy FBI sweatshirt, one that my youngest son bought on his senior trip to Washington, DC, take a tour downstairs to the kitchen. I haven’t been home in a few days, have stayed overnight with my mom. It is traditional to choose a site for visitation, so my brother and I, without ever discussing it, have been at her home for the week, receiving visitors.

It is the flip of being a therapist, ideally. Being a therapist is all listening, or 80% listening, 20% feedback. Being a mourner, in my tradition, is talking or sitting quietly, but the mourner is the initiator. You don’t impose your stuff on a mourner. Visitors come to sit with you for seven days, keep you company. It’s about consolation, paying condolences.

You talk about whatever you want to talk about, so if you don’t want to discuss your father you don’t have to. But this is your chance, so to speak, to honor his memory, to publicize his goodness, his life experience.

We learn about life from the obituaries, at a certain age, and the eulogies.

I’m sitting near the toy box, see toys on top, not inside, remember putting them there, picking them up from the living room. My daughter came in for the funeral of her grandfather with her almost toddler, and after she left I didn’t want to put it all away. I look at the toys and it feels as if her visit was years ago.

I make a stab at reading from a novel, American Wife, by Curtis Sittenfeld, a wonderful treatment of Laura and George Bush, but can’t concentrate. There are a few newspapers on the table, but the words don’t penetrate. Something about winter Olympics and bobsleds. And of course, Tiger Woods. I think, I should blog about Tiger. Then I think, I should blog about my father.

He buried my brother 40 years ago to the day of his death. Isn’t that amazing? Someone says to FD, Sometimes you get a glimpse of how things are actually run. It’s not all random.

Here are some of the things I said at the funeral:

My father was such a complicated man that I can’t tell you if he would want me to make you cry, or not. I think not, because he was such a social guy. He would be happy to see such a nice crowd.

He simply had this magnanimous warmth, he greeted everyone as if he’d been waiting all week for you to stop by. Always someone knocking at the front door window, the telephone always ringing. Almost always for my Dad.

Last Wednesday morning, we’re in the ER. He’s in terrible pain. They put a gown on him, hook him up to an IV, his clothes are in a plastic bag. He’s on oxygen.

“You never saw me like this,” he says to me, for the hundredth time since he’s been so ill. This has been his mantra for months, now, “You never saw me like this.”

Every day it surprises him, embarrasses him that he’s weak, short of breath, and he’s embarrassed about it. Like many men of his generation who did not experience the hunger of the concentration camps, being physically weak is unfathomable. It isn’t who we are, he would say, for he encouraged us to take good care of ourselves, always. You eat right, lots of garlic, you sleep right. Your body cooperates. He has to remind me; this isn’t him.

And I tell him that it’s okay. I know who he is.

A story: Kovel, Poland: the end of the Russio-Poland War, 1920. Bands of marauding Cossacks, White Russians; they’re raiding towns everywhere, especially the ones with Jews. They pillage and rape and kill babies with their bayonets, toss them into the air.

My grandfather is running an errand, probably buying something for the farm. My grandmother is in bed nursing my infant father. A gang of these animals bursts in on her. They see my grandmother, a beautiful woman, probably all of twenty, nursing. One says something, probably in Russian, to the others. They argue, banter back and forth. They stare at her, they look at my father, they look at one another. The toughest one says something. They shrug. And they leave.

My grandfather returns from the store, he hears what has happened, and he packs a few things, takes this little family to the forest at the outskirts of town for as long as it takes until the hooligans move on to another.

But you know, a small town family, they’re always waiting for another gang of Cossacks.

Probably in response to my grandmother’s fears, and being the oldest son, my father takes the protector role in life when he can, which is how I see him as a kid, watchful. Bigger than life, really. I’m a naturally fearful person, irrationally afraid of home invaders, as you know. But if he’s home, I’m not afraid.

There are too many stories, a blog is just a blog. Okay, just a little more.

Things not everyone knows:

He was charitable, he couldn’t say no, especially not if people asked him for something directly. A total softy, if you looked my father in the eye, respected him for who he was, he would give you the universe if he could find a way. And honestly, he believed he owned that, too, that the world was created for him.

Which is how we’re supposed to think.

He would teach that it’s what’s inside that counts, not what you have. It’s not acquiring things, it’s living that counts, living fully. This in the heart of of the suburbs, a very material world.

The world is not going to be the same, not for a lot of people, without my father.

therapydoc

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I’m reading a great book on scapegoating, “Scapegoating in Families: Intergenerational Patterns of Physical and Emotional Abuse”. The author, Vimala Pillari, does a beautiful job of describing the process by which this pattern is passed from generation to generation. I don’t think it is in print any longer in print, but I bought it used from Amazon. Enjoy.

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Is it just me, or does everyone seem to be a victim these days? Even White males are now claiming to be persecuted. The problem with having a victim mentality is that it fosters depression. Is it any wonder that depression rates are skyrocketing?

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Perhaps the most disturbing movie I’ve ever seen.

So we start with the ferry ride to Shutter Island where two federal agents are headed to a a particularly creepy hospital for the criminally insane to search for an escapee— a mother who drowned her three children and who has now “evaporated” from her locked cell. The story revolves around the haunted character of Teddy Daniels (Leonardo DiCaprio) whose flashbacks and dreams pave the story: his role in the liberation of a Nazi death camp & the horrifying death of his young wife in a fire. The movie is dark, it is set on an island during a hurricane, in a hospital built during the Civil War, with Ben Kingsley in a bow tie playing the polite but devious head psychiatrist. In every scene, things are falling: rain, snow, papers swirling, ashes, unknown particles. It’s compelling and confusing, all at the same time. The plot twists and weaves, and by the end the reality was a bit of a jumble. What really happened? We didn’t agree, and when we caught dinner after, the couples at the next table were having the same discussion.

Not exactly a positive view of psychiatry, but this one was so much about the twists of the plot, that it hardly seems worth worrying about the portrayal of our profession. And “disturbing” : the storyline itself was not terribly disturbing, but the images of dead children left me very unsettled. I’ll leave the full analysis to ClinkShrink….and no plot spoilers here.

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Lockup doc gave us the head’s up that KevinMD is also talking about the legalization of marijuana for medical uses. He has good discussion of the issues up, do check it out: Medical Marijuana has Doctors Asking Questions. How’d he know I was asking about this?

The summary comes from HCPLive:

In January, New Jersey became the 14th state in the nation to legalize marijuana use for certain chronic illnesses. Other states where the use of medical marijuana is permitted include Alaska, California, Colorado, Hawaii, Maine, Michigan, Montana, Nevada, New Mexico, Oregon, Rhode Island, Vermont, and Washington; around a dozen more states are weighing pending bills.

The New Jersey law is the most restrictive in the nation and authorizes prescribed marijuana for only a handful of chronic illnesses, such as multiple sclerosis, cancer, glaucoma, epilepsy, Crohn’s disease, AIDS, muscular dystrophy and Lou Gehrig’s disease. Unlike other states, physicians in New Jersey will not be able to prescribe medical marijuana for anxiety, headaches, or chronic pain.

It goes on to discuss the lack of evidence to support uses for medical marijuana, and the obstacles to research:

Despite the Obama administration’s relaxation on prosecutions, many researchers are still having difficulty getting approval to conduct studies that involve smoking marijuana. Requests to conduct the studies must go through the National Institute on Drug Abuse (NIDA), which controls supply from a plantation at the University of Mississippi, the only federally approved source of marijuana. NIDA routinely turns down study requests unless they are designed to evaluate the potential harm from smoking marijuana. The Drug Enforcement Agency has also declined petitions from researchers requesting permission to grow their own marijuana for use in studies.

The article notes that there are some continued issues:

Most states with medical marijuana laws allow employers to refuse employment to individuals who use medical marijuana. In some states, like Colorado, the laws are ambiguous and employers are unclear as to whether they can forbid employees to use medical marijuana outside of work. Schools are also grappling with the issue, as well, with more high school students—particularly in areas with less restrictive medical marijuana laws—receiving prescriptions for marijuana, increasingly to treat ADHD. In addition, some facilities that perform organ transplants acknowledge denying transplants to patients who use medical marijuana.

In the absence of any proven benefits from smoking marijuana, physicians in the 14 states where it is legal may want to discuss some of the pros and cons with their patients prior to issuing a prescription. Patients need to be aware of the potential impact of medical marijuana on all facets of life and should be wary of letting the anecdotal hype surrounding medical marijuana use dissuade them from first trying a proven treatment option.

View the discussion on HCPLive.com.

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On another note, Rach asked us to post the following:

Stan Kutcher at Dalhousie University (Halifax, NS) is asking Canadians for feedback on how to improve infant, child and youth mental health services via an anonymous survey.

https://surveys.dal.ca/opinio/s?s=7808

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