Mental Health Blogs

Imagine this scenario: You lost your job at the lumber yard early in 2009. Nobody is building new homes these days, and this slowdown has trickled down to suppliers all over the country. What’s worse, you’re dipping into savings just to make your own mortgage payments—on a house that has lost a big chunk of its value. In short, your American dream is in shambles.

It’s a dreary but all too familiar scenario. Now imagine further how you feel about this. Is worry your primary emotion? Are you anxious about your wife’s health, and the possibility of an expensive hospitalization? Are you fearful about depleting your kids’ college funds? Where will you all live if you lose the house?

Or are you mostly angry? After all, this situation is totally unfair, given how hard you have worked all these years. Who’s to blame? Those fat cat bankers are still drawing their obscene bonuses, while working guys like you are barely eking out a living. Someone’s got to pay for this mess.

Both fear and anger are understandable under these dire circumstances. But what are you going to do? Well, there‘s an election coming up later this year. Here’s your chance to at least take some action, to raise your citizen’s voice and be heard. How will you exercise this civic responsibility when you go to the polls in November?

We like to think that our democracy is rational, that as voters we educate ourselves on the issues and choose the candidate who best represents our views. Emotions, while natural, would seem to undermine this civic ideal, leading to cynicism and confused thinking and wrongheaded choices. But is it so simple? New research suggests that emotions can indeed skew voting behavior—but in surprising and nuanced ways.

University of Massachusetts scientists Michael Parker and Linda Isbell rigged an election to explore the interplay of specific emotions and voting. Not a real election, of course, but a hypothetical Democratic primary election for the Massachusetts state senate. They created two candidates, John Clarkson and Tom Richards, each with detailed positions on a dozen important public issues. The candidates’ positions are spelled out on the candidates’ Web sites, along with general information on each aspiring senator.

The researchers recruited a large number of volunteers, all Massachusetts residents, to act as voters in this election. They were directed to the Web sites, and told to peruse as much information as they liked, in any manner they wanted—and to consider whatever they needed to make an informed voting decision. Clarkson and Richards actually agreed on most of the issues, though they stated their views differently. The general information was vague, but made clear that each candidate was well qualified.

But here’s the rub: Before the voters started researching the issues and candidates, some were primed for fear and others for anger—much like the scenarios above. The idea was to see if these two basic human emotions shaped civic behavior in different ways. That is, did angry citizens size up candidates one way, and anxious voters a different way? And did these thinking styles translate into different behavior at the polls?

The answer is a resounding yea. As reported on-line in the journal Psychological Science, the worried voters were much more deliberate and organized in their thinking than were the angry voters, spending significantly more time exploring the candidates’ Web sites. What’s more, the anxious citizens actually voted for the candidates whose positions they agreed with; in other words, democracy worked the way it’s supposed to work. This may seem obvious, but it wasn’t to the angry citizens, for whom there was no apparent connection among issues and positions and ballot-box choices.

So what was influencing the angry voters, if not the issues of the day and the candidates promises? Apparently it was the vague general information that guided their choices. In the real world, that means things like basic name recognition, party loyalty, and simplistic political labels. The angry voters didn’t take the time to really concentrate on the issues and positions, and instead let these skimpy generalities guide them. It appears their anger was switching their brain from deliberate mode to automatic mode—to gut feelings more than rational analysis. The worried citizens had too much at stake to trust their gut.

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 watched the movie, “The Wanted” this past weekend and was horrified at what I saw. I’d read rumors that Angelina Jolie struggled with anorexia, but withheld judgment since it was only Hollywood rumor. Then I saw the movie. Angelina Jolie was so emaciated I couldn’t believe it. She was scary thin.

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Allan Frances chaired the APA task force that created DSM-IV. On Monday, he had an editorial in the Los Angeles Times called “It’s Not Too Late to Save Normal.”

Dr. Frances writes:

The first draft of the next edition of the DSM, posted for comment with much fanfare last month, is filled with suggestions that would multiply our mistakes and extend the reach of psychiatry dramatically deeper into the ever-shrinking domain of the normal. This wholesale medical imperialization of normality could potentially create tens of millions of innocent bystanders who would be mislabeled as having a mental disorder. The pharmaceutical industry would have a field day — despite the lack of solid evidence of any effective treatments for these newly proposed diagnoses.

The manual, prepared by the American Psychiatric Assn., is psychiatry’s only official way of deciding who has a “mental disorder” and who is “normal.” The quotes are necessary because this distinction is very hard to make at the fuzzy boundary between the two. If requirements for diagnosing a mental disorder are too stringent, some who need help will be left out; but if they are too loose, normal people will receive unnecessary, expensive and sometimes quite harmful treatment.

Okay, I have a confession to make here: I don’t keep a copy of the DSM in my office. I own an edition which I’ve opened a couple of times while writing our book. I don’t care what the precise diagnostic criteria are: mostly I know them, but I’m left with the fact that if you wander into my office saying you’re tormented and suffering or having trouble functioning, I’m going to treat you. And if I prescribe medications, it’s mostly based on symptoms. Totally? No, because if there’s history of mania (I know those symptoms) or any sense that the diagnosis might be bipolar disorder, I’m going to go pretty gently with the antidepressants, just because I’ve notice that people with tendencies towards mood instability (whether or not it meets criteria for full mania) do better if the antidepressants are kept to a minimum. I hear we over-diagnose, but I’m going to comment that absolutely no one has ever come to see me for simple, uncomplicated grief or a normal reaction to a stressor– people just don’t define this (and let’s hope it stays that way) as a reason to run to a psychiatrist. And everyone’s favorite diagnostic complaint: Shyness vs. Social Anxiety Disorder. 18 years of practice and how many patients have come with a chief complaint of isolated social anxiety? Zero. And how many patients in my practice carry the diagnosis of Social Anxiety Disorder? Zero. Over-diagnosis of mood and anxiety disorders in general? Of course– maybe we’re treating people who previously would have just suffered. Or maybe we’re forced to assign a reimbursable diagnosis because V Codes (phase of life and relational disorders) can’t be reimbursed. It all gets to be circular reasoning.

So who’s placing bets on whether I purchase the DSM-V?

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I really have a problem with the recent surge in diagnosing children with Bipolar Disorder. The children I see with this diagnosis are often the victims of serious issues at home, issues which may even include abuse. Some struggle with PTSD and the mood swings which are inherent in a traumatized individual are attributed to “Bipolar Disorder” and medicated.

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I’m talked out on the subject of whether or not psychiatric illnesses exist and whether or not psychiatric treatments work. I went to work today. I think I’ll go again.
For the sake of completion, here’s Louis Menand writing in The New Yorker, “Head Case.” Click the link and read away.

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Listen to our latest podcast at mythreeshrinks.com or subscribe to our rss feed. Email us at mythreeshrinks at gmail.

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Psychiatry’s getting blasted this week: we don’t know what we’re doing, our diagnoses are not valid or reliable, our treatments no better than placebo and we maxed out in the 1960’s with imipramine. Yesterday’s NYTimes Magazine article on The Upside of Depression (see my post) implies that we’re derailing evolution by treating what may be an adaptive condition, and The Wall Street Journal says Psychiatry Needs Therapy ! Edwarder Shorter writes:
Psychiatry seems to have lost its way in a forest of poorly verified diagnoses and ineffectual medications. Patients who seek psychiatric help today for mood disorders stand a good chance of being diagnosed with a disease that doesn’t exist and treated with a medication little more effective than a placebo.

What’s a shrink to do with this? Perhaps the diagnoses we make are wrong and the meds we use are ineffective, but at the end of the day, the patients seem to get better. Maybe it’s my charm (hmmm, there’s a thought) or the concurrent psychotherapy, or some other non-specific factor…maybe the cognitive dissonance that you have to believe that anything you’re paying a small fortune for has to be working.

So do read Shorter’s article and tell us what you think.

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Listen to our latest podcast at mythreeshrinks.com or subscribe to our rss feed. Email us at mythreeshrinks at gmail.

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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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Listen to our latest podcast at mythreeshrinks.com or subscribe to our rss feed. Email us at mythreeshrinks at gmail.

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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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