Category Archives: Science

We Need to Grieve

Grief is a natural process, one which our culture pressures us to either avoid or process quickly with the assistance of therapy. I’ve been reading Anne Lamott’s book, Traveling Mercies: Some Thoughts on Faith; in one chapter she writes about her experience grieving the death of a dear friend as well as the dissolution of a romantic relationship:

All those years I fell for the great palace lie that grief should be gotten over as quickly as possible and as privately. But what I’ve discovered since is that the lifelong fear of grief keeps up in a barren, isolated place and that only grieving can heal grief; the passage of time will lessen the acuteness, but time alone, without the direct experience of grief, will not heal it. …I’m pretty sure that it is only by experiencing that ocean of sadness that we come to be healed — which is to say, that we come to experience life with a real sense of presence and spaciousness and peace.

I’ve been fortunate in my four decades to be spared the loss of a human beloved through death, but I have said goodbye to a number of cat companions. The last one was especially tragic for reasons I won’t enumerate here, but I did experience what Lamott is describing. Grief is harrowing, but in its way, the experience cleanses the soul.

Morning Headaches

From PsycPORT comes a summary, Morning Headaches Associated with Depression and Anxiety:

Morning headache affects one individual in 13 in the general population, Dr. Ohayon writes. Chronic morning headaches are a good indicator of major depressive disorders and insomnia disorders. Contrary to what was previously suggested, however, they are not specific to sleep-related breathing disorder, concludes Dr. Ohayon.

You can read the study, Prevalence and Risk Factors of Morning Headaches in the General Population, at Arch Intern Med. 2004;164:97-102.

(via The HeartMath Report)

The Motives of Suicide

An excerpt from an eloquent treatise on why suicide should not be dismissed as “merely” an act of irrational behavior. From the blog of Antonio Savoradin:

So I do ask, under such circumstances, in which the sufferer of depression is mocked, is disbelieved, is denied treatment, is blamed for his illness, is acused of selfish whining, is discriminated against for having accepted treatment, or is given inadequate treatment and told to hope for the best (“Here’s a script, follow directions. Expect serious nausea and other side-effects. Your hair won’t fall out, but you may never experience orgasm while taking these. Come back in 2 months if you don’t feel better.”)– all the while the symptoms he feels cannot be seen or measured — under such circumstances, if the depression is severe enough, is ending one’s life truly irrational? Are the circumstances, the “suicide’s situation,” less comprehensible than those leading to suicide for political purposes or to preserve honour, to save face?

There is no doubt depression in all its varieties affects the sufferer’s capacity to think with perfect clarity. But to dismiss a depressive’s suicide as merely the result of a thought disorder, without taking note of the awful conditions against which she has battled, is to do her a great injustice.

I’m not saying we shouldn’t do every single thing that is within our power to prevent a suicide when recovery is a plausible possibility. We should. We must. But let us also realise it is not so simple as saying “suicide is madness.” It is far far more than that. Sometimes suicide is despair; sometimes it is escape from pain; and sometimes it is rage.

How do you approach the severely depressed? You do not deny the reality of his prison. You say, I see the walls of your cell. I see the bars and the door and the lock. But there are many keys (we’re making more, as we speak) and we have to try them *all* if we must. We’ll tear the building down brick by brick if necessary. We know the pain –physical and psychic– is real. We’ll give whatever relief we can for as long as we must. And you have to mean it.

(via The Coffee Sutras)

Maybe It Is All In Your Head

Panic disorder is an incredibly intrusive ailment that can up-end one’s life. A recent study suggests it may result from abnormalities in the brain. From Panic Spells Are Traced to Chemical in the Brain:

People with panic disorder, according to scientists at the National Institutes of Health, have drastic reductions of a type of serotonin receptor, called 5-HT1A, in three areas of the brain. The findings, reported last week in The Journal of Neuroscience, lend credence to the suspicion that serotonin dysfunction plays a role in the disorder.

“This provides evidence for what we’ve been telling patients all along,” said Dr. Dennis S. Charney, chief of the mood and anxiety disorders research program at the institutes and an author of the paper. “Panic disorder is due to a specific abnormality in the brain, not a weakness in character.”

Take the Risk

Social scientist David Allyn recently published a book about embarrassment: I Can’t Believe I Just Did That: How (Seemingly) Small Moments of Shame and Embarrassment Can Wreak Havoc in Your Life-And What You Can Do to Put a Stop to Them.

The New York Times featured Dr. Allyn’s work:

In a culture overpopulated with attention grabbers, midriff barers and superficial self-help gurus, what does Mr. Allyn have to offer? For one thing, he is a wicked observer of self-conscious people at their less than best. For another, his suggestions are meant to encourage both civic mindednesss and fun.

His credo? “There is too much caution in the world.”

So what does he think you should do at a movie theater where a bunch of unruly teenagers are ruining everyone’s viewing experience? “Call them on it. Tell them to knock it off or they’re out of there,” he said. And if you see someone who looks interesting and bored on a bus? Take a chance of being rejected and say hello. This tactic led to the production of a play he wrote and a teaching position at Princeton.

Now a visiting scholar at Columbia, Mr. Allyn, 34, would like to see more strangers communing with one another. At gyms, single people look as if they are at work, when they could be flirting. In Laundromats, they could be networking. At bars, they stare into space.

“People are managing their images all the time,” he said as he sat down for dinner at Matsuri, the cool new Japanese restaurant in Chelsea’s Maritime Hotel. “They’re scared of making fools of themselves. I would rather you say something stupid than be too cautious. I’m all for embracing embarrassment.”

He’s made an excellent point. I remember a time of my life when I was much more curious and receptive to people in general. I would comfortably strike up a conversation with someone on the bus. I smiled at people, made eye contact in the grocery story checkout line. If I was in a clothing store alone, I might ask another woman what she thought of a particular outfit I was trying on. If I was rebuffed, I didn’t take it personally. I don’t have a clear memory of anyone responding poorly to my friendly overture; it seems logical to conclude that this was a generally successful experience.

Somewhere along the way, I closed up. What causes this? Is it the pace of life, and the tendency to become entangled in the next task or a future worry? Is it respect for personal space and privacy gone too far? In the early 1980s I recall being fascinated with a woman on the bus who, every morning on her way to work, was ensconced with a Walkman. They were new and fairly expensive back then. I recall yearning to have portable music, and eventually I did buy one. While it was handy, it added another layer of disconnect in human relations. The walkman is ubiquitous now, and I think it’s to our detriment (along with cellphones and other gadgets intended to increase personal autonomy and connection but which, by their very technicality, complicate and obscure it).

Every day is a new opportunity to throw caution to the wind and engage our world. The process of becoming fully present is rooted in our willingness to connect.

Pregnancy and Pills

I’ve often wondered what doctors tell pregnant women who take medication for high blood pressure, diabetes, or other illnesses that are potentially life threatening if left untreated by medication.

From Dealing With Depression and the Perils of Pregnancy:

About 75 to 80 percent of women who go off antidepressants will relapse during the pregnancy, said Dr. Lee Cohen, director of the Perinatal and Reproductive Psychiatry Clinical Research Program at Massachusetts General Hospital. Some pregnant women with major depression have reported having suicidal thoughts or were unable to function at work or take care of their older children.

Depression in pregnancy is associated with poor eating, missing prenatal appointments and use of substances like tobacco and alcohol, Dr. Cohen said.

Missing prenatal visits alone is a strong predictor of problems, among them premature babies and low birth weights.

Depressed women also have a higher rate of obstetrical complications and preterm deliveries, and a review of 11 studies has shown that they have 45 percent more miscarriages, said Dr. Gideon Koren, a pediatrician and the director of the Motherisk program at the University of Toronto, a risk-counseling service for pregnant women.

In addition, being depressed during pregnancy is a strong predictor of postpartum depression, which can lead to poor mother-infant bonding and has been linked to emotional, behavioral and learning problems in the child.

In one study, Dr. Koren’s group followed women who called the Motherisk hot line, which receives about 5,000 calls a year regarding the use of psychiatric drugs. Of 34 women who called and said they had stopped taking an antidepressant, a benzodiazepine (used to treat anxiety) or both, all reported withdrawal symptoms and psychological problems. Eleven reported suicidal thoughts, and four of them were admitted to hospitals.

Estimates from various studies indicate that about about 12 percent to 20 percent of pregnant women are depressed, yet the diagnosis may go undetected. About 12 percent of women in the general population suffer a depressive disorder each year.

According to one recent study published in The Journal of Women’s Health, 20 percent of women screened in the waiting rooms of obstetrical clinics scored in the depression range, with fewer than 15 percent of those in that category indicating that they had received any formal treatment for depression, like psychotherapy, medication or counseling.

Some mental health experts believe that doctors set a much higher threshold to medicate pregnant women suffering depression than they do for pregnant women suffering other diseases like high blood pressure, peptic ulcer disease, bronchitis and other infections.

“I think the categorical belief is that depression is something you get over rather than something you take medication for,” said Dr. Zachary N. Stowe, director of the Women’s Mental Health Program at Emory University in Atlanta.

“We have more research on the safety of antidepressants in pregnant women than any other class of drugs in the world,” Dr. Stowe said.

I would be interested in hearing from women who cope with depression who have been pregnant and faced with this decision. What was your experience? How did you make your decision? Would you make the same choice again?

You Are(n’t) Getting Very Sleepy

The New York Times published an article exploring the problem of insomnia and medications used to treat it. Apparently two new drugs will be released for prescription in the near future.

Estimates of the number of people with insomnia vary widely. About 40 percent of adult Americans have at least occasional trouble sleeping, according to the National Sleep Foundation, which promotes understanding of sleep disorders and research on them. Some insomnia is temporary, caused by job worries, for instance.

But an estimated 10 to 15 percent of adults have severe or chronic insomnia. Many cases appear to be caused by an underlying condition like depression or painful arthritis, and the best approach is to treat that underlying condition. But for perhaps 15 to 30 percent of those with chronic insomnia, no known underlying disorder can be found.

Several studies have shown that people with insomnia are more likely than others to become depressed.

Lack of sleep, though not always caused by insomnia, can interfere with social life, job performance and driving. At least one study has shown that sleep deprivation results in poor glucose metabolism, a hallmark of diabetes.

Still, scientists cannot yet point to any study showing that treating insomnia with sleeping pills staves off depression or other diseases. Yet some experts say understanding the dangers of insomnia is only a matter of time.

— Putting a Price on a Good Night’s Sleep

American culture tends to eschew sleep in favor of doing. Additionally, we are stretched thin with regard to scheduling work and a social life; seduced and hypnotized by the glass eye most evenings; and captive to our geography, driving long distances to complete mundane tasks. We live with conveniences that save us time but rob us of physical exertion.

I deal with periodic insomnia and have occasionally used a prescribed medication. Does it work? Yes, but I rediscovered that regular exercise along with reduction in caffeine induces sleepiness and improves the quality of my rest. Exercise has restored my equilibrium so well that I will not seek a renewal of that prescription. I am dismayed that, rather than encouraging people to increase physical activity and decrease the amount of junk in their diets (which would also abate the trend of obesity in our country), we will instead be encouraged by medical marketing to just take a pill. For those with hard-core insomnia, this may be necessary; unfortunately, I think many people will be prescribed something that they could otherwise do without.

Depression Treatment Study

The New York Times briefly reported the findings of a study which examines the effectiveness of therapy and medication on depression.

The cognitive therapy provided for the patients aimed to reduce depression by teaching them to recognize and derail negative habits of thought.

The study’s senior author, Dr. Helen Mayberg of the Rotman Research Institute of Toronto, said scientists had speculated that the therapy had a “top down” action on the brain: changes beginning in the cortex, the area dealing with higher reasoning, go on to affect other areas of more basic functioning.

By contrast, research has suggested that antidepressants work as “bottom up” agents, working first on areas like the limbic system that play a big role in memory and basic emotions.

This study helped explain why some people respond better to combined treatments — they affect areas in which there is little overlap.

The Legacy of a Suicide

From the New York Times, And Still, Echoes of a Death Long Past:

All deaths leave their mark. But studies suggest that the psychological legacy of a suicide may differ from that of other deaths.

“Suicide flies in the face of people’s beliefs abut how life is and how it operates,” said Dr. John Jordan, the author of a 2001 review of research on suicide survivors and the director of the Family Loss Project, a group based near Boston that conducts research and offers treatment to the bereaved.

“Survivors spend a great deal of time trying to figure things out,” Dr. Jordan said. “What was the person’s frame of mind? How could they have done this? Who is responsible for it? What does it mean?”

Some people pass through a normal grief process and heal quickly.

But studies suggest that suicide survivors often experience more guilt, rejection, shame and isolation than those who grieve other deaths. If they have spent years dealing with a relative bent on an escalating course of self-destruction, they may also feel relief.

Some studies have found that family members bereaved by suicide feel worse about themselves and are viewed more negatively by others. In a 1993 study, wives who had lost their husbands to suicide were seen as more psychologically disturbed, less likable and more blameworthy than wives whose husbands had died from heart attacks or in accidents.

Suicide survivors themselves have an elevated risk of suicide, and according to some studies are more vulnerable to depression, a risk factor for suicide. In a 1996 study, Dr. Brent and his colleagues found higher levels of depression in the siblings of adolescent suicide victims six months after the death, and in the mothers of the victims one year afterward, compared with a control group. At three years, the siblings were no more depressed than a control group, but the mothers were still having difficulty.

The issue of accountability, Dr. Jordan said, of who is to be held responsible for the death, often gnaws at suicide survivors.

Swiss Mental Health Trends

From the Swiss Info website: Mental Illness Sends Disability Claims Rocketing

Mental problems such as depression, neuroses, insomnia and panic attacks have risen sharply among the Swiss, conforming to an international trend.

The Federal Social Insurance Office says a third of disability claims are for mental health problems.

Swiss politicians are in disagreement over how to deal with the surge in claims, with some arguing many of the claims are bogus.

Mental health organisations claim one of the reasons for the rise in mental health problems is growing pressure in the workplace.

The number of people claiming disability benefit has doubled since 1990, from 130,000 to 220,000.

The percentage of disability claimants among the active population has grown from 3.1 per cent to 4.9 per cent.

There has been a particularly sharp rise in claims from people aged between 35 to 45 years.

Writing and the Brain

This is an excerpt from fascinating article on writing and its origins within the brain from Writing Like Crazy: a Word on the Brain by Alice Weaver Flaherty. It explores the biological and social factors contributing to the conditions of hypergraphia (the overwhelming urge to write) and writer’s block.

But how to explain — and help — people who know how to write, seem to want desperately to write, and yet do not? This question is, of course, a special case of what to do with creative block in all fields. The scourge of block, and its handmaid procrastination, have been documented since the ancient Egyptians, who had two separate hieroglyphs for the latter. Does writer’s block have a neurological basis that is the opposite of hypergraphia? Yes — in certain respects. Block is highly associated with depression, just as hypergraphia is with mania. And block shares with depression some features of frontal-lobe alteration, including lack of initiative and excessive self-criticism. There is evidence for a push-pull interaction between temporal and frontal lobes in creativity, an axis that turns sideways the 1970s theory of right brain-left brain interactions. While a link between block and depression seems to fly in the face of the conventional wisdom that professional writers often suffer from depression, the fact is that talented writers are actually more likely to be blocked than poor writers. (This is true outside of literature as well. The tremendous outpouring of Leonardo da Vinci’s ideas, for instance, was matched only by his long list of giant unfinished projects.) Most writers with depression do their writing not while depressed, but while on the edge of a mood change, or in a rebound euphoria. Indeed, many writers who carry the diagnosis of depression actually have mild bipolar disorder. This in part explains why writers can have odd combinations of block and hypergraphia simultaneously. For instance, the modern equivalent of Eliot’s Mr. Casaubon, blocked on his grand Key to All Mythologies, may instead turn out megabytes of e-mail messages and blogs a day.

Such genre specificity in block is more evidence that block is not a problem with cortical writing skills but with limbic drives. Yet many college programs fight block with cognitive strategies, such as making an outline and brainstorming, or with cognitive-behavioral therapy. While these are often appropriate, remembering that block is a brain state as well as a mental state can provide alternate approaches — and not necessarily involving drugs such as antidepressants or stimulants. For instance, a writer who finds that his creativity and productivity plummet around Thanksgiving and Christmas every year may blame his lack of motivation, or wonder if the stress of seeing his dysfunctional family twice in two months is what is doing it. Yet a significant winter dip in creative output has been documented by researchers for artists in general. It is most likely due to shorter day length, which triggers an unpleasant hibernation instinct even in those of us who don’t have full-blown seasonal affective disorder. The writer described here may therefore find setting a small light box on the table next to his breakfast cereal would have a more immediate benefit to his productivity than would working through issues with his mother — although the latter option, of course, may have other benefits.

It’s a lengthy article, but well worth the time to read.

Suicide Within the Ranks

Having lunch with a colleague today, the talk veered toward Iraq and our country’s involvement. He mentioned that at least 17 American troops have committed suicide since April. He’d heard it on television news, so I did a Google news search. The only report as of the time of this post was published by Utusan Malaysia Online.

Since April, the military says, at least 17 Americans – 15 Army soldiers and two Marines – have taken their own lives in Iraq. The true number is almost certainly higher. At least two dozen non-combat deaths, some of them possible suicides, are under investigation according to an AP review of Army casualty reports.

No one in the military is saying for the record that the suicide rate among forces in Iraq is alarming. But Lt. Gen. Ricardo Sanchez, the top American military commander in Iraq, was concerned enough, according to the Army Surgeon General’s office, to have ordered a 12-person mental health assessment team to Iraq to see what more can be done to prevent suicides and to help troops better cope with anxiety and depression.

Army spokesman Martha Rudd said the assessment team returned from Iraq two weeks ago, but that it will take several weeks to come up with recommendations. Until then, she said, no one on the team will have anything to say to the press.

Whether the suicide rate among the troops should be considered high is impossible to say because there is nothing to compare it with, experts say. What would be considered a “normal” rate for an all-voluntary military force of men and women on extensive deployments to the Middle East, under constant pressure from guerrillas who use terror tactics?

The wife of one soldier who committed suicide, out of concern for him and at his request, asked his commanding officer to send her husband home for a short while for Christmas. She described that in the five years of their marriage, they had spend fewer than 18 months of it together. She’s raising three children, going to school, and working at Walmart, and her youngest daughter has never even met her father.

The best response she got was that the Army was doing everything it could to meet her request, but there was no guarantee her husband would be giving leave for the holidays. Not long after, he committed suicide via an overdose of Tylenol. (Yes, that can happen. Toxic doses of Tylenol irremediably destroy the liver.)

If the U.S. intends to keep military personnel in Iraq for the long haul — and it appears this is the case — they must increase their services to help troops deal with the effects of constant mortal tension, anxiety, and trauma of existing in a hostile environment. It’s bad enough that families endure financial hardships, such that they resort to using expired coupons to make purchasing food and household items affordable.

These soldiers and families deserve better.

Pope John Paul II on Depression

As reported at Beliefnet.com:

It is important, he said, to recognize that depression can be a response to messages of the media that “exalt consumerism, the immediate satisfaction of desires and the race to an ever better material well-being.”

Depressed people need to regain “self esteem, faith in their own capacity, interest in the future and the will to live,” John Paul said. They need to be part of “a community of faith and life in which they can feel themselves welcomed, understood, sustained and, in a word, worthy of loving and being loved.”

“On the spiritual route,” he said, “reading and meditating on the Psalms, in which the sacred author expresses his joy and anguish in prayer, can be of great help. Reciting the Rosary permits finding in Mary a loving mother, who teaches how to live in Christ. Taking part in the Eucharist is a source of interior peace both through the effect of the word and the bread of life and through becoming part of an ecclesial community.”

The causes of depression are many. Spiritual emptiness certainly contributes to it. However, let us not forget that research indicates there is a physical aspect to depression as well. Depression is not a failure of will. It is an illness which affects body and soul.

Thoughts On Grief

I am moved to quote from Markham’s Behavioral Health, a blog I regularly read. David has had intense personal experience with grief, and something he said made an impression. So I’m sharing here, but I encourage you to read his entire post.

Grief is not something to avoid, or something to “work through” and then it will be all better. No, grief is something we have to sit with, accomodate ourselves to. It has moved in to stay and it will be with us all of our days so we might as well get used to it.

And I agree with George Bernard Shaw’s quote today that life does not cease to be funny when people die any more than it ceases to be serious when people laugh. I wonder how George came to understand that. He seems to me to be a very wise man.

May strength and solace accompany all those who grieve the death of loved ones.