While a guest on "The Daily Show" in September, Bill Clinton reflected on the current state of national politics, especially the harsh relationship between the two major parties.
He noted that, unlike 30 years ago, most people in Congress now must travel home every weekend to raise money and they must stay out every weeknight to attend fundraisers. As a result, Clinton said, today's senators and representatives are chronically sleep deprived. He argued that this sleep loss might be contributing to the current spirit of ill-tempered incivility in Washington.
As Clinton said during the interview, "I know this is an unusual theory but I do believe sleep deprivation has a lot to do with some of the edginess of Washington today. You have no idea how many Republican and Democratic members of the House and Senate are chronically sleep deprived because of this [fundraising] system."
I've often argued in this blog that most people in our society do not get enough sleep. Insufficient sleep doesn't just make people sleepy, it affects their mood, concentration, and performance.
Research also has shown that sleep deprivation can have negative effects on our endocrine and immune systems. Inadequate sleep increases our appetite and thus may contribute to obesity, and it weakens our defenses against infections. Since sleep insufficiency is so widespread, it becomes a significant public health problem for society at large.
I'll continue to argue that we need to give sleep a higher priority in our lives because the quality of our lives ultimately depends on it. When we shortchange our sleep time, we also diminish our waking existence.
While we already knew that insufficient sleep was a big problem, Bill Clinton has added a fascinating new dimension to the societal consequences of sleep loss.
2007年12月21日星期五
Study says foster care benefits brains
Toddlers rescued from orphanages and placed in good foster homes score dramatically higher on IQ tests years later than children who were left behind, concludes a one-of-a-kind project in Romania that has profound implications for child welfare around the globe.
The boost meant the difference between borderline retardation and average intelligence for some youngsters.
Most important, children removed from orphanages before age 2 had the biggest improvement — key new evidence of a sensitive period for brain development, according to the U.S. team that conducted the research.
"What we're really talking about is the importance of getting kids out of bad environments and put into good environments," said Dr. Charles Nelson III of Harvard Medical School, who led the study being published Friday in the journal Science.
The younger that happens, "the less likely the child is to have major problems," he added.
The research is credited with influencing child-care changes in Romania, and UNICEF has begun using the data to push numerous countries that still depend on state-run orphanages to start shifting to foster care-like systems.
"The research provides concrete scientific evidence on the long-term impacts of the deprivation of quality care for children," UNICEF child protection specialist Aaron Greenberg said. "The interesting part about this is the one-on-one caring of a young child impacts ... cognitive and intellectual development."
That orphanages are not optimal for child development comes as no surprise. Earlier studies have found that thousands of children adopted during the 1990s from squalid orphanages in Eastern Europe, China and elsewhere continued to face serious developmental problems even after moving to affluent new homes with doting parents.
But questions remain. Were those abandoned or orphaned children who spent more time in orphanages less healthy to begin with? How much damage does neglect and lack of stimulation in the early months of life do? How long does that damage last?
In the study, U.S. researchers randomly assigned 136 young children in Bucharest's six orphanages to either keep living there or live with foster parents who were specially trained and paid for by the study. Romania had no foster-care system in 2000 when the research began.
The team chose apparently healthy children. Researchers repeatedly tested brain development as those children grew, and tracked those who ultimately were adopted or reunited with family. For comparison, they also tested the cognitive ability of children who never were institutionalized.
By 4 1/2, youngsters in foster care were scoring almost 10 points higher on IQ tests than the children left in orphanages. Children who left the orphanages before 2 saw an almost 15-point increase.
Nelson compared the ages at which children were sent to foster care. For every extra month spent in the orphanage, up to almost age 3, it meant roughly a half-point lower score on those later IQ tests.
Children raised in their biological homes still fared best, with average test scores 10 points to 20 points higher than the foster-care kids.
What does that mean as these children grow up? Just this week an anxious acquaintance cornered Nelson to ask what to expect of a child who spent nine months in a Vietnamese orphanage.
The boost meant the difference between borderline retardation and average intelligence for some youngsters.
Most important, children removed from orphanages before age 2 had the biggest improvement — key new evidence of a sensitive period for brain development, according to the U.S. team that conducted the research.
"What we're really talking about is the importance of getting kids out of bad environments and put into good environments," said Dr. Charles Nelson III of Harvard Medical School, who led the study being published Friday in the journal Science.
The younger that happens, "the less likely the child is to have major problems," he added.
The research is credited with influencing child-care changes in Romania, and UNICEF has begun using the data to push numerous countries that still depend on state-run orphanages to start shifting to foster care-like systems.
"The research provides concrete scientific evidence on the long-term impacts of the deprivation of quality care for children," UNICEF child protection specialist Aaron Greenberg said. "The interesting part about this is the one-on-one caring of a young child impacts ... cognitive and intellectual development."
That orphanages are not optimal for child development comes as no surprise. Earlier studies have found that thousands of children adopted during the 1990s from squalid orphanages in Eastern Europe, China and elsewhere continued to face serious developmental problems even after moving to affluent new homes with doting parents.
But questions remain. Were those abandoned or orphaned children who spent more time in orphanages less healthy to begin with? How much damage does neglect and lack of stimulation in the early months of life do? How long does that damage last?
In the study, U.S. researchers randomly assigned 136 young children in Bucharest's six orphanages to either keep living there or live with foster parents who were specially trained and paid for by the study. Romania had no foster-care system in 2000 when the research began.
The team chose apparently healthy children. Researchers repeatedly tested brain development as those children grew, and tracked those who ultimately were adopted or reunited with family. For comparison, they also tested the cognitive ability of children who never were institutionalized.
By 4 1/2, youngsters in foster care were scoring almost 10 points higher on IQ tests than the children left in orphanages. Children who left the orphanages before 2 saw an almost 15-point increase.
Nelson compared the ages at which children were sent to foster care. For every extra month spent in the orphanage, up to almost age 3, it meant roughly a half-point lower score on those later IQ tests.
Children raised in their biological homes still fared best, with average test scores 10 points to 20 points higher than the foster-care kids.
What does that mean as these children grow up? Just this week an anxious acquaintance cornered Nelson to ask what to expect of a child who spent nine months in a Vietnamese orphanage.
2007年12月19日星期三
Cancer Docs' Bedside Manner Often Lacks Empathy
Most cancer specialists do not respond to the emotional concerns of their patients with verbal expressions of empathy and support, a new study reveals.
The finding suggests that cancer patients' quality of life might be significantly improved if doctors were better trained to recognize and address patients' emotional concerns as they battle the disease.
"We audio-recorded doctor-patient interactions, and we analyzed them, and what we found is that when patients expressed negative emotions, doctors did not always respond empathetically," said study author Kathryn L. Pollak, an associate professor at Duke University Medical Center's Community and Family Medicine Department, in Durham, N.C.
Pollak's team published its findings in the Dec. 20 issue of the Journal of Clinical Oncology.
To assess the frequency of empathetic interactions in an oncology setting, the authors first surveyed 51 oncologists who were caring for a total of 270 cancer patients at Duke, the Durham Veterans Affairs Medical Center, or the University of Pittsburgh.
The physicians, mostly white and male, were questioned about their level of confidence in addressing patient concerns; their sense of how various communication approaches might affect a patient; and their general comfort level with psycho-social types of conversation.
As well, the doctors were asked if they felt they were more inclined toward the technological and scientific aspects of patient care or more disposed to focus on the social and emotional side of treatment.
The researchers also recorded almost 400 audiotapes of conversations that had taken place between physicians and patients.
All the patients had advanced-stage cancer, and their physicians indicated that they would not be surprised if they ended up dying from their illness within a year. Almost three-quarters of the patients were white, and they averaged a little over 60 years of age.
Most of the patients had established a relationship with their oncologist -- 90 percent said they had known their doctor for at least six months prior to the study.
According to the researchers, more than two-thirds of the physicians said they were oriented toward the technical aspects of patient care, but most were also highly confident in their ability to deal with patient concerns. Most of the doctors also believed they were comfortable with emotionally charged conversations.
Yet, after reviewing all the tapes, Pollak and her colleagues determined that cases in which doctors responded to patients' concerns with empathy were rare.
Fewer than 300 so-called "empathic opportunities" occurred during the almost 400 conversations. Such opportunities were defined as points at which a patient had verbally expressed negative emotions -- such as fear or worry -- to which the doctor could respond as he or she saw fit.
Female patients were more likely to express such feelings, particularly if their doctor was also female, the researchers observed.
When such emotions were expressed, almost three-quarters of the time doctors chose to "terminate" the conversation by offering, for example, blanket reassurance that time would solve the problem.
Occasions in which doctors would empathetically promote "continuation" of the conversation by encouraging elaboration and/or expressing some form of understanding or support were far less frequent, occurring little more than a quarter of the time.
Oncologists who offered more empathic statements were younger than those who didn't, and those who stayed longer to converse with the distressed patient were more likely to have described themselves as highly focused on the emotional dimension of patient care.
The research team concluded that oncologists need better education to recognize and respond appropriately to patients' emotions.
"Oncologists clearly care about their patients," said Pollak. "They wouldn't go into oncology if they didn't. But oncology is a really challenging field, and, in general, oncologists have not been trained in how to communicate with patients. So, it's a pretty difficult situation for them."
"The good news is that the ability to communicate is something that can be taught," she added. "I wouldn't say it's an innate skill. Many doctors who say they are less comfortable conveying emotions with patients suffer from a lack of training. What they need is to be taught how to verbalize how they feel, and there have been several programs around the world that have shown that this kind of communication training can produce good communicators."
Pollak noted that she and her team are now conducting a follow-up study to see how communication skills might improve if oncologists were given personalized CD-Roms to screen video of their own interactions with patient. Data from the study has yet to be analyzed.
Another expert agreed that training could only help.
"The emphasis in medical school is not usually focused on the emotional side of things," noted Kevin Ochsner, an assistant professor of psychology at Columbia University, New York City. "It's about being able to get the diagnosis right. But, in fact, it's as important to communicate that a patient's feelings matter and are an important part of the equation as it is to convey the probability that a certain procedure will or will not have a positive outcome."
"Empathy," added Ochsner, "is the social glue that knits people together because the ability to connect with one another emotionally and to understand the feelings of one another promotes rapport and bonding. So, making patients feel that they're heard will help them feel secure and less anxious. It helps regulate their emotions, and this has all kinds of important mental and physical health effects."
The finding suggests that cancer patients' quality of life might be significantly improved if doctors were better trained to recognize and address patients' emotional concerns as they battle the disease.
"We audio-recorded doctor-patient interactions, and we analyzed them, and what we found is that when patients expressed negative emotions, doctors did not always respond empathetically," said study author Kathryn L. Pollak, an associate professor at Duke University Medical Center's Community and Family Medicine Department, in Durham, N.C.
Pollak's team published its findings in the Dec. 20 issue of the Journal of Clinical Oncology.
To assess the frequency of empathetic interactions in an oncology setting, the authors first surveyed 51 oncologists who were caring for a total of 270 cancer patients at Duke, the Durham Veterans Affairs Medical Center, or the University of Pittsburgh.
The physicians, mostly white and male, were questioned about their level of confidence in addressing patient concerns; their sense of how various communication approaches might affect a patient; and their general comfort level with psycho-social types of conversation.
As well, the doctors were asked if they felt they were more inclined toward the technological and scientific aspects of patient care or more disposed to focus on the social and emotional side of treatment.
The researchers also recorded almost 400 audiotapes of conversations that had taken place between physicians and patients.
All the patients had advanced-stage cancer, and their physicians indicated that they would not be surprised if they ended up dying from their illness within a year. Almost three-quarters of the patients were white, and they averaged a little over 60 years of age.
Most of the patients had established a relationship with their oncologist -- 90 percent said they had known their doctor for at least six months prior to the study.
According to the researchers, more than two-thirds of the physicians said they were oriented toward the technical aspects of patient care, but most were also highly confident in their ability to deal with patient concerns. Most of the doctors also believed they were comfortable with emotionally charged conversations.
Yet, after reviewing all the tapes, Pollak and her colleagues determined that cases in which doctors responded to patients' concerns with empathy were rare.
Fewer than 300 so-called "empathic opportunities" occurred during the almost 400 conversations. Such opportunities were defined as points at which a patient had verbally expressed negative emotions -- such as fear or worry -- to which the doctor could respond as he or she saw fit.
Female patients were more likely to express such feelings, particularly if their doctor was also female, the researchers observed.
When such emotions were expressed, almost three-quarters of the time doctors chose to "terminate" the conversation by offering, for example, blanket reassurance that time would solve the problem.
Occasions in which doctors would empathetically promote "continuation" of the conversation by encouraging elaboration and/or expressing some form of understanding or support were far less frequent, occurring little more than a quarter of the time.
Oncologists who offered more empathic statements were younger than those who didn't, and those who stayed longer to converse with the distressed patient were more likely to have described themselves as highly focused on the emotional dimension of patient care.
The research team concluded that oncologists need better education to recognize and respond appropriately to patients' emotions.
"Oncologists clearly care about their patients," said Pollak. "They wouldn't go into oncology if they didn't. But oncology is a really challenging field, and, in general, oncologists have not been trained in how to communicate with patients. So, it's a pretty difficult situation for them."
"The good news is that the ability to communicate is something that can be taught," she added. "I wouldn't say it's an innate skill. Many doctors who say they are less comfortable conveying emotions with patients suffer from a lack of training. What they need is to be taught how to verbalize how they feel, and there have been several programs around the world that have shown that this kind of communication training can produce good communicators."
Pollak noted that she and her team are now conducting a follow-up study to see how communication skills might improve if oncologists were given personalized CD-Roms to screen video of their own interactions with patient. Data from the study has yet to be analyzed.
Another expert agreed that training could only help.
"The emphasis in medical school is not usually focused on the emotional side of things," noted Kevin Ochsner, an assistant professor of psychology at Columbia University, New York City. "It's about being able to get the diagnosis right. But, in fact, it's as important to communicate that a patient's feelings matter and are an important part of the equation as it is to convey the probability that a certain procedure will or will not have a positive outcome."
"Empathy," added Ochsner, "is the social glue that knits people together because the ability to connect with one another emotionally and to understand the feelings of one another promotes rapport and bonding. So, making patients feel that they're heard will help them feel secure and less anxious. It helps regulate their emotions, and this has all kinds of important mental and physical health effects."
Ear Infection May Not Need Antibiotic
If your child has an ear infection, it's important to take the child to a doctor for proper diagnosis and treatment. The pediatrician will determine if the infection is bacterial or viral.
Here are suggestions on how to treat your child's ear infection, courtesy of the American Academy of Family Physicians:
If the infection is bacterial, your doctor probably will prescribe an antibiotic.
If the infection is viral, an antibiotic won't treat it, so prescribing one may be counterproductive.
You can give your child a pain reliever, such as acetaminophen or ibuprofen. Don't give your child aspirin, unless the doctor says so.
Apply a warm heating pad to the ear to relieve pain.
The doctor may prescribe ear drops.
Here are suggestions on how to treat your child's ear infection, courtesy of the American Academy of Family Physicians:
If the infection is bacterial, your doctor probably will prescribe an antibiotic.
If the infection is viral, an antibiotic won't treat it, so prescribing one may be counterproductive.
You can give your child a pain reliever, such as acetaminophen or ibuprofen. Don't give your child aspirin, unless the doctor says so.
Apply a warm heating pad to the ear to relieve pain.
The doctor may prescribe ear drops.
Congress OKs Va Tech-inspired gun bill
Congress on Wednesday passed a long-stalled bill inspired by the Virginia Tech shootings that would more easily flag prospective gun buyers who have documented mental health problems. The measure also would help states with the cost.
Passage by voice votes in the House and Senate came after months of negotiations between Senate Democrats and the lone Republican, Sen. Tom Coburn of Oklahoma, who had objected and delayed passage.
It was not immediately clear whether President Bush intended to sign, veto or ignore the bill. If Congress does not technically go out of session, as Senate Majority Leader Harry Reid, D-Nev., has threatened, the bill would become law if Bush does not act within 10 days.
"This bill will make America safer without affecting the rights of a single law-abiding citizen," said the Senate's chief sponsor, New York Democrat Chuck Schumer.
One of the House's chief sponsors, Rep. Carolyn McCarthy, spoke in the full House about her husband, who was killed by a gunman on the Long Island Railroad in New York. "To me, this is the best Christmas present I could ever receive," said McCarthy, D-N.Y.
Rep. John Dingell, D-Mich., added that the bill will speed up background checks and reinforce the rights of law abiding gun owners.
Propelling the bill were the Virginia Tech shootings on April 16 and rare agreement between political foes, the Brady Campaign to Prevent Gun Violence and the National Rifle Association.
But other interest groups said that in forging compromise with the gun lobby, the bill's authors unintentionally imposed an unnecessary burden on government agencies by freeing up thousands of people to buy guns.
"Rather than focusing on improving the current laws prohibiting people with certain mental health disabilities from buying guns, the bill is now nothing more than a gun lobby wish list," said Kristen Rand, legislative director of the Violence Policy Center. "It will waste millions of taxpayer dollars restoring the gun privileges of persons previously determined to present a danger to themselves or others."
The measure would clarify what mental health records should be reported to the National Instant Criminal Background Check System, which help gun dealers determine whether to sell a firearm to a prospective buyer, and give states financial incentives for compliance. The attorney general could penalize states if they fail to meet compliance targets.
Despite the combined superpowers of bill's supporters, Coburn held it up for months because he worried that millions of dollars in new spending would not be paid for by cuts in other programs.
His chief concern, he said, was that it did not pay for successful appeals by veterans or other people who say they are wrongly barred from buying a gun.
Just before midnight Tuesday, Coburn and the Democratic supporters of the bill struck a deal: The government would pay for the cost of appeals by gun owners and prospective buyers who argue successfully in court that they were wrongly deemed unqualified for mental health reasons.
The compromise would require that incorrect records — such as expunged mental health rulings that once disqualified a prospective gun buyer but no longer do — be removed from system within 30 days.
The original bill would require any agency, such as the Veterans Administration or the Defense Department, to notify a person flagged as mentally ill and disqualified from buying or possessing a gun. The new version now also would require the notification when someone has been cleared of that restriction.
The bill would authorize up to $250 million a year over five years for the states and as much as $125 million a year over the same period for state courts to help defray the cost of enacting the policy.
Propelling the long-sought legislation were the April 16 killings at Virginia Tech. Student Seung-Hui Cho killed 32 students and himself using two guns he had bought despite his documented history of mental illness.
Cho had been ruled a danger to himself during a court commitment hearing in 2005. He had been ordered to have outpatient mental health treatment and should have been barred from buying the two guns he used. But Virginia never forwarded the information to the national background check system.
Passage by voice votes in the House and Senate came after months of negotiations between Senate Democrats and the lone Republican, Sen. Tom Coburn of Oklahoma, who had objected and delayed passage.
It was not immediately clear whether President Bush intended to sign, veto or ignore the bill. If Congress does not technically go out of session, as Senate Majority Leader Harry Reid, D-Nev., has threatened, the bill would become law if Bush does not act within 10 days.
"This bill will make America safer without affecting the rights of a single law-abiding citizen," said the Senate's chief sponsor, New York Democrat Chuck Schumer.
One of the House's chief sponsors, Rep. Carolyn McCarthy, spoke in the full House about her husband, who was killed by a gunman on the Long Island Railroad in New York. "To me, this is the best Christmas present I could ever receive," said McCarthy, D-N.Y.
Rep. John Dingell, D-Mich., added that the bill will speed up background checks and reinforce the rights of law abiding gun owners.
Propelling the bill were the Virginia Tech shootings on April 16 and rare agreement between political foes, the Brady Campaign to Prevent Gun Violence and the National Rifle Association.
But other interest groups said that in forging compromise with the gun lobby, the bill's authors unintentionally imposed an unnecessary burden on government agencies by freeing up thousands of people to buy guns.
"Rather than focusing on improving the current laws prohibiting people with certain mental health disabilities from buying guns, the bill is now nothing more than a gun lobby wish list," said Kristen Rand, legislative director of the Violence Policy Center. "It will waste millions of taxpayer dollars restoring the gun privileges of persons previously determined to present a danger to themselves or others."
The measure would clarify what mental health records should be reported to the National Instant Criminal Background Check System, which help gun dealers determine whether to sell a firearm to a prospective buyer, and give states financial incentives for compliance. The attorney general could penalize states if they fail to meet compliance targets.
Despite the combined superpowers of bill's supporters, Coburn held it up for months because he worried that millions of dollars in new spending would not be paid for by cuts in other programs.
His chief concern, he said, was that it did not pay for successful appeals by veterans or other people who say they are wrongly barred from buying a gun.
Just before midnight Tuesday, Coburn and the Democratic supporters of the bill struck a deal: The government would pay for the cost of appeals by gun owners and prospective buyers who argue successfully in court that they were wrongly deemed unqualified for mental health reasons.
The compromise would require that incorrect records — such as expunged mental health rulings that once disqualified a prospective gun buyer but no longer do — be removed from system within 30 days.
The original bill would require any agency, such as the Veterans Administration or the Defense Department, to notify a person flagged as mentally ill and disqualified from buying or possessing a gun. The new version now also would require the notification when someone has been cleared of that restriction.
The bill would authorize up to $250 million a year over five years for the states and as much as $125 million a year over the same period for state courts to help defray the cost of enacting the policy.
Propelling the long-sought legislation were the April 16 killings at Virginia Tech. Student Seung-Hui Cho killed 32 students and himself using two guns he had bought despite his documented history of mental illness.
Cho had been ruled a danger to himself during a court commitment hearing in 2005. He had been ordered to have outpatient mental health treatment and should have been barred from buying the two guns he used. But Virginia never forwarded the information to the national background check system.
2007年12月14日星期五
Seasonal Affective Disorder and Wellbutrin
During this time of year in the Northern Hemisphere, people sometimes complain of feeling down or depressed. For some of them, this may not just be a case of the holiday blues but a real condition called Seasonal Affective Disorder (SAD).
SAD was recognized as a type of depression at the same time that bright light therapy was shown to be an effective treatment for it. Generally, SAD is a mild-to-moderate depression that occurs at the same time of year - starting in the autumn months and persisting until spring. SAD tends to be more common in latitudes further away from the equator.
Although people with SAD usually do not suffer a severe depression, the fact that it occurs for several months each year leads to significant impairment for these individuals. During the winter months they may feel sluggish, lack motivation, and be less productive than other times of the year. Often, they feel that they are unable to get enough sleep and may gain weight each year during the winter.
Even though the precise cause of this pattern of depression is not yet known, some experts have speculated about the relationships between shortened daylight hours and changing levels of melatonin secretion and serotonin activity. However, we still do not know why certain people are more vulnerable to this type of depression.
The use of therapeutic light boxes has become the standard treatment for this pattern of depression. Several different antidepressants also have been shown to help. In 2006, the antidepressant Wellbutrin XL (bupropion hydrochloride extended-release tablets) was approved by the FDA for a new indication: treatment of recurrent major depressive episodes with the SAD pattern.
Three separate clinical trials demonstrated the efficacy of Wellbutrin XL when treatment is started during autumn (September to November in the Northern Hemisphere) and continued until the following March.
While Wellbutrin XL was safe and effective in the SAD studies, side effects that may occur with this medication include agitation, insomnia, and anxiety. And, as with other antidepressants, the FDA-approved label includes a warning about possible increased suicidal thinking in children taking antidepressants.
SAD was recognized as a type of depression at the same time that bright light therapy was shown to be an effective treatment for it. Generally, SAD is a mild-to-moderate depression that occurs at the same time of year - starting in the autumn months and persisting until spring. SAD tends to be more common in latitudes further away from the equator.
Although people with SAD usually do not suffer a severe depression, the fact that it occurs for several months each year leads to significant impairment for these individuals. During the winter months they may feel sluggish, lack motivation, and be less productive than other times of the year. Often, they feel that they are unable to get enough sleep and may gain weight each year during the winter.
Even though the precise cause of this pattern of depression is not yet known, some experts have speculated about the relationships between shortened daylight hours and changing levels of melatonin secretion and serotonin activity. However, we still do not know why certain people are more vulnerable to this type of depression.
The use of therapeutic light boxes has become the standard treatment for this pattern of depression. Several different antidepressants also have been shown to help. In 2006, the antidepressant Wellbutrin XL (bupropion hydrochloride extended-release tablets) was approved by the FDA for a new indication: treatment of recurrent major depressive episodes with the SAD pattern.
Three separate clinical trials demonstrated the efficacy of Wellbutrin XL when treatment is started during autumn (September to November in the Northern Hemisphere) and continued until the following March.
While Wellbutrin XL was safe and effective in the SAD studies, side effects that may occur with this medication include agitation, insomnia, and anxiety. And, as with other antidepressants, the FDA-approved label includes a warning about possible increased suicidal thinking in children taking antidepressants.
Suicide and Black Americans
For more than a century, scientists have studied the suicide rates among people of different demographic and ethnic groups. Age, sex, and race all appear to be important variables. The risk of suicide increases with age - it is low among children and highest among elderly people. Whites commit suicide more often than African-Americans. Men are more likely than women to kill themselves, although more women attempt suicide.
A recent article in the Journal of the American Medical Association focused on recent trends among black Americans in the U.S. The study surveyed more than 5,000 black Americans - 3,500 African-Americans and 1,600 blacks of Caribbean origin. The data included the age of first suicidal ideation, and rates of suicide planning and suicide attempts. Overall, there has been an increase in suicidal thoughts and behaviors compared with surveys from the 1980s.
The researchers reported that 11.7 percent of these black Americans had suicidal ideations and 4.1 percent had made suicide attempts. These behaviors began most often in the late teen years and early 20s. Actual suicide planning occurred most often within the first year of the initial suicidal ideation.
Factors that increased the risk of suicidality - having suicidal thoughts or planning or attempting suicide - in this group included having a mental illness and a low education level. Blacks of Caribbean origin had higher rates than African-Americans.
An important finding of this study was that many of the suicidal black Americans never sought treatment for their emotional problems.
The key message is that mental health centers - and suicide prevention programs in particular - can now target people at high risk of suicide among late teen and early adult black Americans. Identifying and treating psychiatric disorders should definitely reduce suicidality. Of course, addressing societal stressors like poverty and unemployment should also have a positive influence in reducing suicides.
A recent article in the Journal of the American Medical Association focused on recent trends among black Americans in the U.S. The study surveyed more than 5,000 black Americans - 3,500 African-Americans and 1,600 blacks of Caribbean origin. The data included the age of first suicidal ideation, and rates of suicide planning and suicide attempts. Overall, there has been an increase in suicidal thoughts and behaviors compared with surveys from the 1980s.
The researchers reported that 11.7 percent of these black Americans had suicidal ideations and 4.1 percent had made suicide attempts. These behaviors began most often in the late teen years and early 20s. Actual suicide planning occurred most often within the first year of the initial suicidal ideation.
Factors that increased the risk of suicidality - having suicidal thoughts or planning or attempting suicide - in this group included having a mental illness and a low education level. Blacks of Caribbean origin had higher rates than African-Americans.
An important finding of this study was that many of the suicidal black Americans never sought treatment for their emotional problems.
The key message is that mental health centers - and suicide prevention programs in particular - can now target people at high risk of suicide among late teen and early adult black Americans. Identifying and treating psychiatric disorders should definitely reduce suicidality. Of course, addressing societal stressors like poverty and unemployment should also have a positive influence in reducing suicides.
Psilocybin Surprises
In my last entry, I wrote about the fascinating psilocybin research by Roland Gritffiths and his colleagues at Johns Hopkins.
They recruited people to take a dose of psilocybin, the active substance of hallucinogenic mushrooms, and then, on a different day, another substance (methylphenidate) for comparison purposes. The participants were then monitored for eight hours in a comfortable and supportive setting. Afterwards, the subjects described their experiences and completed a series of questionnaires. The results were surprising.
Among the questionnaires done seven hours after taking either substance were a hallucinogen-rating scale, a states-of-consciousness questionnaire, a mysticism scale, and the APZ. The APZ is an instrument that also measures altered states of consciousness and has categories such as "oceanic boundlessness," "dread of ego dissolution," and "visual restructuralization." The subjects rated their experiences much higher on these scales on days that they took the psilocybin.
The states-of-consciousness questionnaire included the items from the Pahnke-Richards Mystical Experience Questionnaire, a survey based on the following categories:
Internal unityExternal unityTranscendence of time and spaceIneffability and paradoxicalitySense of sacrednessNoetic qualityDeeply felt positive mood The combined scores of 22 of the 36 subjects met the criteria for a "complete mystical experience" on their psilocybin days. On days when the methylphenidate was taken, only four subjects' scores reached levels corresponding to a "complete mystical experience."
About two months following each of the sessions, the subjects were again surveyed, this time with questions that assessed possible persistent changes in attitude, mood, and behavior. They were also asked the following:
How personally meaningful was the experience?Indicate the degree to which the experience was spiritually significant to you.Do you believe that the experience and your contemplation of that experience have led to change in your current sense of well-being or life satisfaction? Here's what was surprising: One-third of the volunteers rated their psilocybin experience as being the single most spiritually significant experience of his or her life. Another 38 percent rated it as being among the top-5 most spiritually significant experiences of their lives. Longer-term follow-up assessments are now being done.
Do the results of this study suggest that people should use psilocybin frequently to gain spiritual and mystical experiences? Definitely not. The investigators are very clear in not recommending widespread use of the substance. They point out that this research was conducted in a safe and supportive environment and that the mental experiences could very well be different in other settings.
They also emphasize that some of the volunteers had negative experiences when taking the psilocybin. Almost one-third of the subjects, for example, reported experiencing "strong" or "extreme" fear at some point during their psilocybin session. During their sessions, six subjects displayed paranoid thinking or felt transient "ideas of reference" (that is, the belief that objects, events, or people are of personal significance - as when a person watching TV believes that the show is all about him).
But then, if not to encourage psilocybin use, why would researchers do these types of studies? Because such experiments may provide important information about brain chemistry, psychopharmacology, and the psychology of mental states.
They also might help lead to the development of medications for mental illnesses. Future studies could be done with people suffering with symptoms related to certain psychiatric disorders.
They recruited people to take a dose of psilocybin, the active substance of hallucinogenic mushrooms, and then, on a different day, another substance (methylphenidate) for comparison purposes. The participants were then monitored for eight hours in a comfortable and supportive setting. Afterwards, the subjects described their experiences and completed a series of questionnaires. The results were surprising.
Among the questionnaires done seven hours after taking either substance were a hallucinogen-rating scale, a states-of-consciousness questionnaire, a mysticism scale, and the APZ. The APZ is an instrument that also measures altered states of consciousness and has categories such as "oceanic boundlessness," "dread of ego dissolution," and "visual restructuralization." The subjects rated their experiences much higher on these scales on days that they took the psilocybin.
The states-of-consciousness questionnaire included the items from the Pahnke-Richards Mystical Experience Questionnaire, a survey based on the following categories:
Internal unityExternal unityTranscendence of time and spaceIneffability and paradoxicalitySense of sacrednessNoetic qualityDeeply felt positive mood The combined scores of 22 of the 36 subjects met the criteria for a "complete mystical experience" on their psilocybin days. On days when the methylphenidate was taken, only four subjects' scores reached levels corresponding to a "complete mystical experience."
About two months following each of the sessions, the subjects were again surveyed, this time with questions that assessed possible persistent changes in attitude, mood, and behavior. They were also asked the following:
How personally meaningful was the experience?Indicate the degree to which the experience was spiritually significant to you.Do you believe that the experience and your contemplation of that experience have led to change in your current sense of well-being or life satisfaction? Here's what was surprising: One-third of the volunteers rated their psilocybin experience as being the single most spiritually significant experience of his or her life. Another 38 percent rated it as being among the top-5 most spiritually significant experiences of their lives. Longer-term follow-up assessments are now being done.
Do the results of this study suggest that people should use psilocybin frequently to gain spiritual and mystical experiences? Definitely not. The investigators are very clear in not recommending widespread use of the substance. They point out that this research was conducted in a safe and supportive environment and that the mental experiences could very well be different in other settings.
They also emphasize that some of the volunteers had negative experiences when taking the psilocybin. Almost one-third of the subjects, for example, reported experiencing "strong" or "extreme" fear at some point during their psilocybin session. During their sessions, six subjects displayed paranoid thinking or felt transient "ideas of reference" (that is, the belief that objects, events, or people are of personal significance - as when a person watching TV believes that the show is all about him).
But then, if not to encourage psilocybin use, why would researchers do these types of studies? Because such experiments may provide important information about brain chemistry, psychopharmacology, and the psychology of mental states.
They also might help lead to the development of medications for mental illnesses. Future studies could be done with people suffering with symptoms related to certain psychiatric disorders.
Music on my Mind
This year, Christmas was especially musical in our home. My daughter got an electric guitar and my son an electric bass. And we all exchanged various musical CDs.
For me, though, this was an especially retro holiday season. I decided to buy myself a nice new turntable, even though new LPs are rarely produced any more. In my basement there are thousands of LPs I accumulated during the 60s, 70s, and early 80s. My children recently took an interest in the rock and roll vinyl. They still sound great. The new turntable also has given me the opportunity to listen to some obscure 20th century classical and jazz albums I had collected but not played for decades.
With music on my mind, I was interested in a New Year's Eve New York Times article about the relationship of music and the human mind. It focused on the work of Daniel Levitin, a musician, record producer, and cognitive psychologist. He directs the McGill University Laboratory of Music Perception, Cognition, and Expertise. He also is the author of a new book, titled "This Is Your Brain on Music."
The key questions on Levitin's mind are why music plays such an important role in our lives, and how our brains function to make music so memorable and emotional. He believes that by understanding music we will better appreciate essential aspects of being human. He thinks that music can reveal the "deepest mysteries of human nature."
Levitin's research has shown that music activates and coordinates many different areas of the brain involved in pleasure and emotion. Music even stimulates the more primitive structures at the base of the brain that coordinate movement and the perception of the body's position in space. Maybe that's why music and dance are almost inseparable.
It's no surprise, then, that music can be therapeutic. Many people have discovered on their own that they can feel better by playing their favorite "comfort music." Music therapy is used in many settings, from inpatient units for the criminally insane to outpatient senior programs. It has been shown to help people communicate, move, and think better. There are music therapy programs for people of all ages and abilities.
My daughter listens to music constantly. She says, "Music is amazing. I don't know why, but I just love it!" She's not alone, of course. We may not all enjoy or respond the same way to the same music, but for all of us, our deepest feelings may only be plumbed by some kind of music.
For me, though, this was an especially retro holiday season. I decided to buy myself a nice new turntable, even though new LPs are rarely produced any more. In my basement there are thousands of LPs I accumulated during the 60s, 70s, and early 80s. My children recently took an interest in the rock and roll vinyl. They still sound great. The new turntable also has given me the opportunity to listen to some obscure 20th century classical and jazz albums I had collected but not played for decades.
With music on my mind, I was interested in a New Year's Eve New York Times article about the relationship of music and the human mind. It focused on the work of Daniel Levitin, a musician, record producer, and cognitive psychologist. He directs the McGill University Laboratory of Music Perception, Cognition, and Expertise. He also is the author of a new book, titled "This Is Your Brain on Music."
The key questions on Levitin's mind are why music plays such an important role in our lives, and how our brains function to make music so memorable and emotional. He believes that by understanding music we will better appreciate essential aspects of being human. He thinks that music can reveal the "deepest mysteries of human nature."
Levitin's research has shown that music activates and coordinates many different areas of the brain involved in pleasure and emotion. Music even stimulates the more primitive structures at the base of the brain that coordinate movement and the perception of the body's position in space. Maybe that's why music and dance are almost inseparable.
It's no surprise, then, that music can be therapeutic. Many people have discovered on their own that they can feel better by playing their favorite "comfort music." Music therapy is used in many settings, from inpatient units for the criminally insane to outpatient senior programs. It has been shown to help people communicate, move, and think better. There are music therapy programs for people of all ages and abilities.
My daughter listens to music constantly. She says, "Music is amazing. I don't know why, but I just love it!" She's not alone, of course. We may not all enjoy or respond the same way to the same music, but for all of us, our deepest feelings may only be plumbed by some kind of music.
Antidepressants, Suicide, and Statistics
The link between antidepressants and suicide has been a popular topic in the news for the past few years. The obvious association is that antidepressants improve depression and therefore decrease suicidal thoughts, suicide attempts, and completed suicides.
But most of the media attention has been on whether antidepressants, especially the commonly prescribed selective serotonin reuptake inhibitors (SSRIs) might increase suicidal thinking in some people.
The news articles were prompted by statistics from research studies with these medications that suggested an increase in suicidal thinking among children. However, there were no actual suicides among the depressed children in these research studies, and the strength of the association between antidepressants and suicidal thinking was far from convincing.
Nevertheless, the FDA took the conservative and controversial step of issuing a warning that many antidepressants could possibly increase the risk of suicidal thinking. As a consequence of the warning, many medical experts worried that suicides among children might actually increase if doctors became reluctant to prescribe antidepressants.
A new, and in my opinion more accurate perspective on SSRI antidepressants and suicide appears in an article published recently in the American Journal of Psychiatry. The authors examined the suicide rate among children ages 5 to 14 years in several countries, including the U.S. They compared these suicide rates with data on the use of SSRI antidepressants.
The results showed that the suicide rate for children was lowest in those countries where the use of SSRIs was highest. The findings remained the same regardless of sex, race, income levels, and access to quality mental health care.
The United States was in this category of high SSRI use and relatively low childhood suicide rate. Overall, the U.S. childhood suicide rate was 0.7 per 100,000 suicides; however, in some countries it was as high as 1.7 per 100,000. The lowest rates of childhood suicide in the U.S. were in large cities like Chicago, New York, Boston, and Los Angeles.
The authors of the article point out that this type of research never can prove a causal relationship, but can only measure the strength of an association. However, the findings certainly are consistent with what those of us who work in the field would expect.
But most of the media attention has been on whether antidepressants, especially the commonly prescribed selective serotonin reuptake inhibitors (SSRIs) might increase suicidal thinking in some people.
The news articles were prompted by statistics from research studies with these medications that suggested an increase in suicidal thinking among children. However, there were no actual suicides among the depressed children in these research studies, and the strength of the association between antidepressants and suicidal thinking was far from convincing.
Nevertheless, the FDA took the conservative and controversial step of issuing a warning that many antidepressants could possibly increase the risk of suicidal thinking. As a consequence of the warning, many medical experts worried that suicides among children might actually increase if doctors became reluctant to prescribe antidepressants.
A new, and in my opinion more accurate perspective on SSRI antidepressants and suicide appears in an article published recently in the American Journal of Psychiatry. The authors examined the suicide rate among children ages 5 to 14 years in several countries, including the U.S. They compared these suicide rates with data on the use of SSRI antidepressants.
The results showed that the suicide rate for children was lowest in those countries where the use of SSRIs was highest. The findings remained the same regardless of sex, race, income levels, and access to quality mental health care.
The United States was in this category of high SSRI use and relatively low childhood suicide rate. Overall, the U.S. childhood suicide rate was 0.7 per 100,000 suicides; however, in some countries it was as high as 1.7 per 100,000. The lowest rates of childhood suicide in the U.S. were in large cities like Chicago, New York, Boston, and Los Angeles.
The authors of the article point out that this type of research never can prove a causal relationship, but can only measure the strength of an association. However, the findings certainly are consistent with what those of us who work in the field would expect.
When Delusions Aren't So Delusional
Occasionally, I work with our psychiatry consultation service. When physicians throughout our hospital need help evaluating and caring for patients with psychiatric symptoms, we're the team they call.
These patients may be confused, depressed, agitated, or manic. Some have longstanding psychiatric disorders and others have new, temporary symptoms. Sometimes our contribution is simply to confirm that someone does not have a psychiatric disorder.
One recent morning, I was called to see a male patient because his medical team thought he might have schizophrenia or bipolar disorder. He was an older gentleman with serious medical problems, but was quite exuberant and talkative.
He excitedly described an extraordinary and unbelievable network of international intrigue linking major historical events over the past few decades. He outlined endless details of deception, cover-ups, covert operations, and conspiracies at the highest levels. It seemed to his doctors that he must have been delusional.
Was he psychotic in firmly believing all of these outrageous and impossible claims? Not at all. A delusion is a fixed, false belief. Nothing I could say would ever dissuade him from his view of reality. To be delusional, the beliefs must be idiosyncratic - that is, unique to that person. Yet all of this gentleman's claims are shared by many like-minded people who connect through the Internet.
He's part of a subculture that thrives on distrust and conspiracy theory. Although his wild beliefs and convictions may be entirely wrong, he is neither delusional nor psychotic. There was no reason to suspect a psychiatric disorder like schizophrenia or bipolar disorder.
But did this man's unusual behavior fit the criteria for another mental disorder? As we talked, he clearly expressed paranoid thoughts. For instance, he assumed that the FBI or Secret Service had sent me to evaluate him. Did he suffer from a paranoid personality disorder?
He did meet the requirements for a diagnosis of general personality disorder; that is, he had "an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture." That may include "ways of perceiving and interpreting self, other people, and events." But to have a personality disorder, the personality pattern must also lead to significant distress or impairment. That part wasn't true for this man.
It is true that this patient has a paranoid personality style, which means that he tends to view situations suspiciously and anticipates being exploited. However, these are enduring personality characteristics, not traits that developed suddenly. And they do not represent a diagnosis. In fact, many highly successful people have this type of personality style.
I concluded that this patient had no psychiatric diagnosis, although he did express unusual and seemingly unbelievable beliefs. But so do a lot of people.
These patients may be confused, depressed, agitated, or manic. Some have longstanding psychiatric disorders and others have new, temporary symptoms. Sometimes our contribution is simply to confirm that someone does not have a psychiatric disorder.
One recent morning, I was called to see a male patient because his medical team thought he might have schizophrenia or bipolar disorder. He was an older gentleman with serious medical problems, but was quite exuberant and talkative.
He excitedly described an extraordinary and unbelievable network of international intrigue linking major historical events over the past few decades. He outlined endless details of deception, cover-ups, covert operations, and conspiracies at the highest levels. It seemed to his doctors that he must have been delusional.
Was he psychotic in firmly believing all of these outrageous and impossible claims? Not at all. A delusion is a fixed, false belief. Nothing I could say would ever dissuade him from his view of reality. To be delusional, the beliefs must be idiosyncratic - that is, unique to that person. Yet all of this gentleman's claims are shared by many like-minded people who connect through the Internet.
He's part of a subculture that thrives on distrust and conspiracy theory. Although his wild beliefs and convictions may be entirely wrong, he is neither delusional nor psychotic. There was no reason to suspect a psychiatric disorder like schizophrenia or bipolar disorder.
But did this man's unusual behavior fit the criteria for another mental disorder? As we talked, he clearly expressed paranoid thoughts. For instance, he assumed that the FBI or Secret Service had sent me to evaluate him. Did he suffer from a paranoid personality disorder?
He did meet the requirements for a diagnosis of general personality disorder; that is, he had "an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture." That may include "ways of perceiving and interpreting self, other people, and events." But to have a personality disorder, the personality pattern must also lead to significant distress or impairment. That part wasn't true for this man.
It is true that this patient has a paranoid personality style, which means that he tends to view situations suspiciously and anticipates being exploited. However, these are enduring personality characteristics, not traits that developed suddenly. And they do not represent a diagnosis. In fact, many highly successful people have this type of personality style.
I concluded that this patient had no psychiatric diagnosis, although he did express unusual and seemingly unbelievable beliefs. But so do a lot of people.
Mystical Mushrooms
To my mind, one of the greatest mysteries is how our mental experiences relate to the chemistry of our brains. Researchers have discovered a tremendous amount about the complexity of synapses, neural circuitry, and neuroanatomy and psychologists explore the intricacies of human behavior and mental processes.
Still, a huge gap remains in our understanding of the brain and the mind. One way of approaching this brain-mind connection is to see how certain chemicals that influence the brain affect mental experiences.
Recently, I was very pleased to attend a lecture by Roland R. Griffiths, Ph.D., a professor of Behavioral Biology and of Neuroscience who is a leading Hopkins psychopharmacology researcher and expert on the effects of abused substances.
I was looking forward to his presentation because I knew that he would be speaking on his psilocybin research, which had received considerable national attention when it was published several months ago in the journal Psychopharmacology.
Psilocybin is the naturally occurring compound that is found in certain mushroom species and is associated with altered mental states when eaten. Although psilocybin is commonly described as a hallucinogen, it is more likely to cause illusions and altered perceptions. More prominent may be the users' sense of having a mystical experience.
Although there has been a tremendous amount of research on commonly abused substances, such as heroin, cocaine, and alcohol, no serious scientific investigations have been done with psilocybin for several decades. The compound seems to have its effect through interactions with particular serotonin receptors in the brain.
Griffiths and his colleagues devised a carefully designed plan to compare the effects of psilocybin with a very different psychoactive substance, the stimulant medication methylphenidate, which was used as an active-comparison compound, or control. They specifically recruited people with a spiritual orientation who had no history of mental illness.
The announcements of the study described it as examining "states of consciousness brought about by a naturally occurring psychoactive substance used sacramentally in some cultures." As part of the study's design, each subject came in for either 2 or 3 different 8-hour sessions that were separated by about 2 months; only one of these sessions involved the ingestion of psilocybin. The participants took the compounds in a comfortable laboratory setting with specially trained monitors by their side throughout all sessions. They were encouraged to close their eyes and direct their attention inward.
As I mentioned above, each of the 36 subjects in the study was given the psilocybin just one time. As expected, during those sessions when psilocybin was ingested, the participants did experience perceptual changes, intense subjective feelings, and, occasionally, some anxiety and paranoid thoughts. Seven hours after ingesting either the psilocybin or the methylphenidate, the participants each completed various questionnaires about their mental state.
Overall, the participants regarded the psilocybin use in this comfortable and controlled research setting as a positive experience. Especially interesting were their reports of a sense that the psilocybin produced in them a mystical experience. I'll describe more of the surprising results of the psilocybin study in my next entry.
Still, a huge gap remains in our understanding of the brain and the mind. One way of approaching this brain-mind connection is to see how certain chemicals that influence the brain affect mental experiences.
Recently, I was very pleased to attend a lecture by Roland R. Griffiths, Ph.D., a professor of Behavioral Biology and of Neuroscience who is a leading Hopkins psychopharmacology researcher and expert on the effects of abused substances.
I was looking forward to his presentation because I knew that he would be speaking on his psilocybin research, which had received considerable national attention when it was published several months ago in the journal Psychopharmacology.
Psilocybin is the naturally occurring compound that is found in certain mushroom species and is associated with altered mental states when eaten. Although psilocybin is commonly described as a hallucinogen, it is more likely to cause illusions and altered perceptions. More prominent may be the users' sense of having a mystical experience.
Although there has been a tremendous amount of research on commonly abused substances, such as heroin, cocaine, and alcohol, no serious scientific investigations have been done with psilocybin for several decades. The compound seems to have its effect through interactions with particular serotonin receptors in the brain.
Griffiths and his colleagues devised a carefully designed plan to compare the effects of psilocybin with a very different psychoactive substance, the stimulant medication methylphenidate, which was used as an active-comparison compound, or control. They specifically recruited people with a spiritual orientation who had no history of mental illness.
The announcements of the study described it as examining "states of consciousness brought about by a naturally occurring psychoactive substance used sacramentally in some cultures." As part of the study's design, each subject came in for either 2 or 3 different 8-hour sessions that were separated by about 2 months; only one of these sessions involved the ingestion of psilocybin. The participants took the compounds in a comfortable laboratory setting with specially trained monitors by their side throughout all sessions. They were encouraged to close their eyes and direct their attention inward.
As I mentioned above, each of the 36 subjects in the study was given the psilocybin just one time. As expected, during those sessions when psilocybin was ingested, the participants did experience perceptual changes, intense subjective feelings, and, occasionally, some anxiety and paranoid thoughts. Seven hours after ingesting either the psilocybin or the methylphenidate, the participants each completed various questionnaires about their mental state.
Overall, the participants regarded the psilocybin use in this comfortable and controlled research setting as a positive experience. Especially interesting were their reports of a sense that the psilocybin produced in them a mystical experience. I'll describe more of the surprising results of the psilocybin study in my next entry.
Sleep, Snoring, and Psychiatry
I'm writing from Orlando, where I'm attending a medical education conference on sleep apnea and snoring, sponsored by the University of Pennsylvania. Although sleep apnea (temporary cessation of breathing during sleep) is a common problem, some patients with psychiatric disorders are at greater risk than others for this serious sleep disturbance.
By far the most common form of sleep apnea is the obstructive type, where the airway becomes temporarily blocked. The other one is central sleep apnea, which happens when there is a decreased drive to breathe resulting from a cardiovascular or neurologic disorder. With obstructive sleep apnea, the person still attempts to breathe.
Obstructive sleep apnea is sometimes thought of as a complete stopping of breathing, but it really is a decrease in airflow to the lungs due to a partial or total collapse of the airway. The extent of this collapse is influenced by a person's airway anatomy and their body weight. Skinny and normal-weight people can have severe obstructive sleep apnea, but the risk is much greater among those who are obese.
Why are people with chronic mental illnesses at greater risk for obstructive sleep apnea? One reason is that they also tend to be overweight. Lifestyle and diet are very important influences on body weight, but the problem of excess weight can be worsened by some psychiatric medications, including certain antidepressants, antipsychotics, and mood stabilizers. I've seen some patients go from skinny to obese in just a few years. Under the best conditions, losing weight usually is a struggle, and weight loss usually requires a well-organized life and a lot of motivation.
Why worry about obstructive sleep apnea? Because it leads to both short- and long-term problems. Sleep apnea often causes disrupted sleep, which makes people sleepy during the day. And this excessive daytime drowsiness can be made even worse by the sedating effects of some psychiatric medications. Daytime sleepiness not only can be a nuisance that interferes with people achieving their goals, but it can also have catastrophic effects for people who are driving or doing activities that require concentration and attentiveness.
But wouldn't someone know it if they had sleep apnea? Not necessarily. Since the apnea events occur during sleep, those affected are unaware of them. The events disrupt sleep, but not enough to wake the person up. And if people do wake up, they usually don't know what caused the awakening. Occasionally, people with sleep apnea awaken with a gasping sensation. Most simply are aware that something is wrong with their sleep, since they still feel tired and unrefreshed upon awakening.
Even if people are unaware of their own sleep apnea, their bed partners may be very aware of the problem due to the sounds of loud snoring interrupted by extended pauses and followed by deep, sometimes gasping breaths.
If you think that you or the person you sleep with may have sleep apnea, a health care professional can help determine whether a sleep study is appropriate. The benefits of treatment can be dramatic, especially in promoting increased energy and alertness. These gains can be especially meaningful for psychiatric patients who may feel sleepy and sluggish, and believe that they are drifting backwards in their lives.
By far the most common form of sleep apnea is the obstructive type, where the airway becomes temporarily blocked. The other one is central sleep apnea, which happens when there is a decreased drive to breathe resulting from a cardiovascular or neurologic disorder. With obstructive sleep apnea, the person still attempts to breathe.
Obstructive sleep apnea is sometimes thought of as a complete stopping of breathing, but it really is a decrease in airflow to the lungs due to a partial or total collapse of the airway. The extent of this collapse is influenced by a person's airway anatomy and their body weight. Skinny and normal-weight people can have severe obstructive sleep apnea, but the risk is much greater among those who are obese.
Why are people with chronic mental illnesses at greater risk for obstructive sleep apnea? One reason is that they also tend to be overweight. Lifestyle and diet are very important influences on body weight, but the problem of excess weight can be worsened by some psychiatric medications, including certain antidepressants, antipsychotics, and mood stabilizers. I've seen some patients go from skinny to obese in just a few years. Under the best conditions, losing weight usually is a struggle, and weight loss usually requires a well-organized life and a lot of motivation.
Why worry about obstructive sleep apnea? Because it leads to both short- and long-term problems. Sleep apnea often causes disrupted sleep, which makes people sleepy during the day. And this excessive daytime drowsiness can be made even worse by the sedating effects of some psychiatric medications. Daytime sleepiness not only can be a nuisance that interferes with people achieving their goals, but it can also have catastrophic effects for people who are driving or doing activities that require concentration and attentiveness.
But wouldn't someone know it if they had sleep apnea? Not necessarily. Since the apnea events occur during sleep, those affected are unaware of them. The events disrupt sleep, but not enough to wake the person up. And if people do wake up, they usually don't know what caused the awakening. Occasionally, people with sleep apnea awaken with a gasping sensation. Most simply are aware that something is wrong with their sleep, since they still feel tired and unrefreshed upon awakening.
Even if people are unaware of their own sleep apnea, their bed partners may be very aware of the problem due to the sounds of loud snoring interrupted by extended pauses and followed by deep, sometimes gasping breaths.
If you think that you or the person you sleep with may have sleep apnea, a health care professional can help determine whether a sleep study is appropriate. The benefits of treatment can be dramatic, especially in promoting increased energy and alertness. These gains can be especially meaningful for psychiatric patients who may feel sleepy and sluggish, and believe that they are drifting backwards in their lives.
Demonic Voices
I was speaking with a patient in one of our outpatient programs last week. He excitedly told me that he was on his way to a psychiatric hospital right after our meeting.
I was puzzled until he added that he was going there for a job interview. He's about to complete a mental health counseling degree at a community college. Immediately, I was struck by the extraordinary progress he has made — from being virtually overwhelmed by his schizophrenia to living very effectively with this disease.
I first met this man over 10 years ago during a series of psychiatric hospitalizations for severe psychotic symptoms associated with his schizophrenia. He was tortured by what seemed to be the voice of God saying terrible things to him.
His auditory hallucinations drowned out the daily life around him and he was overwhelmed with bizarre and frightening delusional thoughts. At times, he wanted to end his life to escape the pain of these incessant unreal experiences.
His psychotic experiences seemed so real that he could not accept the fact that he had a psychiatric disorder — and thus he saw no reason to take any medications. Usually, once in the hospital he would take medications, hoping to be discharged sooner; it often worked because his symptoms did improve. Once back home, however, he would discard his prescriptions and stop taking his medications. Before long, he'd be back in the hospital as the psychotic symptoms became more pronounced.
I'm not sure what helped him turn the corner to taking his medications regularly and staying out of the hospital for longer periods of time. It has been many years now since his last psychiatric admission. Perhaps it was a combination of maturity, faith, support from his wife, education, intensive involvement with the outpatient mental health program, and the right combination of medicines. I suspect all were important to him.
In fact, he was functioning so well that I assumed his symptoms were gone. When I asked him about auditory hallucinations, I was surprised when he responded that he continued to experience the demonic voices.
What was different now was that he had learned to differentiate what was real from what was a symptom of his illness. His schizophrenia wasn't cured, but it was under control. That's like having diabetes — the disease is never cured, but it can be managed with education, support from family and friends, effective outpatient treatment, lifestyle changes, and adherence to medications.
I was puzzled until he added that he was going there for a job interview. He's about to complete a mental health counseling degree at a community college. Immediately, I was struck by the extraordinary progress he has made — from being virtually overwhelmed by his schizophrenia to living very effectively with this disease.
I first met this man over 10 years ago during a series of psychiatric hospitalizations for severe psychotic symptoms associated with his schizophrenia. He was tortured by what seemed to be the voice of God saying terrible things to him.
His auditory hallucinations drowned out the daily life around him and he was overwhelmed with bizarre and frightening delusional thoughts. At times, he wanted to end his life to escape the pain of these incessant unreal experiences.
His psychotic experiences seemed so real that he could not accept the fact that he had a psychiatric disorder — and thus he saw no reason to take any medications. Usually, once in the hospital he would take medications, hoping to be discharged sooner; it often worked because his symptoms did improve. Once back home, however, he would discard his prescriptions and stop taking his medications. Before long, he'd be back in the hospital as the psychotic symptoms became more pronounced.
I'm not sure what helped him turn the corner to taking his medications regularly and staying out of the hospital for longer periods of time. It has been many years now since his last psychiatric admission. Perhaps it was a combination of maturity, faith, support from his wife, education, intensive involvement with the outpatient mental health program, and the right combination of medicines. I suspect all were important to him.
In fact, he was functioning so well that I assumed his symptoms were gone. When I asked him about auditory hallucinations, I was surprised when he responded that he continued to experience the demonic voices.
What was different now was that he had learned to differentiate what was real from what was a symptom of his illness. His schizophrenia wasn't cured, but it was under control. That's like having diabetes — the disease is never cured, but it can be managed with education, support from family and friends, effective outpatient treatment, lifestyle changes, and adherence to medications.
Don't Lose Sleep Over the Time Change
This is the first year that the switch to Daylight Savings Time is occurring early. For years, we adjusted our clocks on the first Sunday in April but now we'll be making the switch on the second Sunday in March (March 11). The change is expected to have an economic benefit, since it's hoped that the longer daylight hours will lessen energy consumption.
Losing one hour of sleep may not seem like much, but most people aren't getting enough sleep anyway. (A National Sleep Foundation poll in 2002 showed that the nation's adults averaged just under seven hours of sleep nightly.) Therefore, the coming time change this weekend could make a bad situation worse. The only upside is that some people may be able to sleep in on Sunday morning, when the change will occur.
Lack of sleep makes people feel fatigued, sleepy, unmotivated, and sometimes irritable. It can cause poor concentration that may lead to dangerous errors and accidents. Some research suggests that the rate of traffic accidents is slightly greater on the Monday following the time changes in the fall and spring. Even though we get an extra hour of sleep in the fall, time changes cause some people to experience a reaction similar to jet lag because they have difficulty adapting to the sudden time shift.
My advice: Stock up on sleep. Don't stay up too late on Friday night (March 9) and don't get up too early on Saturday the 10th. Do the same thing Saturday night and Sunday morning. Finally, if you allow plenty of time for sleep Sunday night you should feel fully awake come Monday morning.
Be alert, though, and watch out for all those other sleep-deprived people who won't have followed this advice.
Losing one hour of sleep may not seem like much, but most people aren't getting enough sleep anyway. (A National Sleep Foundation poll in 2002 showed that the nation's adults averaged just under seven hours of sleep nightly.) Therefore, the coming time change this weekend could make a bad situation worse. The only upside is that some people may be able to sleep in on Sunday morning, when the change will occur.
Lack of sleep makes people feel fatigued, sleepy, unmotivated, and sometimes irritable. It can cause poor concentration that may lead to dangerous errors and accidents. Some research suggests that the rate of traffic accidents is slightly greater on the Monday following the time changes in the fall and spring. Even though we get an extra hour of sleep in the fall, time changes cause some people to experience a reaction similar to jet lag because they have difficulty adapting to the sudden time shift.
My advice: Stock up on sleep. Don't stay up too late on Friday night (March 9) and don't get up too early on Saturday the 10th. Do the same thing Saturday night and Sunday morning. Finally, if you allow plenty of time for sleep Sunday night you should feel fully awake come Monday morning.
Be alert, though, and watch out for all those other sleep-deprived people who won't have followed this advice.
Poisoned Pills
One of our psychiatry outpatients — a man in his 40s with schizophrenia — is reluctant to take his medications because they are poisoned. They aren't, of course, but he's afraid they might be.
This has been a recurring theme with him for years. Even though he's been in and out of psychiatric hospitals since his late teens, he's not certain he has a psychiatric disorder. He isn't against taking all medications; he's just afraid to take whatever pills are in his possession at any particular time because he can't trust that someone hasn't put poison in them. He doesn't seem to have other delusions or hallucinations. He's just fixated on this poisoned-pill delusion.
In spite of his unease and worry about his medications, most of the time he has trusted us and the pharmacy enough to take them. Overall, his treatment has allowed him to function fairly well living in a community group home staffed with a care provider.
He has his own bedroom and the use of several other rooms in the house. Regular meals are served to him and the other five residents. The care provider manages the medications and helps make sure everyone gets to their scheduled appointments. The residents come and go as they please.
My patient was looking pretty good when I saw him at our center a few weeks ago, although I became concerned when he again asked about switching pharmacies. And so I was disappointed, but not really surprised, when last week his care provider reported that he seemed to be doing much worse.
Now he appears distressed and distracted by things that are not apparent to anyone else. He's not sleeping well and spends hours at a time in his room talking to himself. He's no longer at ease with his housemates.
I'm worried that his persistent concern about being poisoned has once again led him to stop taking his prescribed antipsychotic medications and, as a result, that he's experiencing a return of other psychotic symptoms. Clearly, the quality of his life has deteriorated. I'm hoping we can help him recover before things get worse and he ends up being hospitalized again.
The patients themselves ultimately choose whether they take their prescribed medications; rarely are they court-ordered to do so.
Sometimes the use of orally dissolvable tablets or long-acting injections can be helpful. The dissolvable tablets prevent people from "cheeking" pills and later spitting them out. The injections can be given every two to four weeks and sometimes replace the need for pills. Still, some cooperation is necessary.
The best that health care providers can do is to educate patients about their illnesses, work with them to develop a plan that promotes a stable life, provide appropriate therapies, and inform them about the risks and benefits of any medications we recommend.
This has been a recurring theme with him for years. Even though he's been in and out of psychiatric hospitals since his late teens, he's not certain he has a psychiatric disorder. He isn't against taking all medications; he's just afraid to take whatever pills are in his possession at any particular time because he can't trust that someone hasn't put poison in them. He doesn't seem to have other delusions or hallucinations. He's just fixated on this poisoned-pill delusion.
In spite of his unease and worry about his medications, most of the time he has trusted us and the pharmacy enough to take them. Overall, his treatment has allowed him to function fairly well living in a community group home staffed with a care provider.
He has his own bedroom and the use of several other rooms in the house. Regular meals are served to him and the other five residents. The care provider manages the medications and helps make sure everyone gets to their scheduled appointments. The residents come and go as they please.
My patient was looking pretty good when I saw him at our center a few weeks ago, although I became concerned when he again asked about switching pharmacies. And so I was disappointed, but not really surprised, when last week his care provider reported that he seemed to be doing much worse.
Now he appears distressed and distracted by things that are not apparent to anyone else. He's not sleeping well and spends hours at a time in his room talking to himself. He's no longer at ease with his housemates.
I'm worried that his persistent concern about being poisoned has once again led him to stop taking his prescribed antipsychotic medications and, as a result, that he's experiencing a return of other psychotic symptoms. Clearly, the quality of his life has deteriorated. I'm hoping we can help him recover before things get worse and he ends up being hospitalized again.
The patients themselves ultimately choose whether they take their prescribed medications; rarely are they court-ordered to do so.
Sometimes the use of orally dissolvable tablets or long-acting injections can be helpful. The dissolvable tablets prevent people from "cheeking" pills and later spitting them out. The injections can be given every two to four weeks and sometimes replace the need for pills. Still, some cooperation is necessary.
The best that health care providers can do is to educate patients about their illnesses, work with them to develop a plan that promotes a stable life, provide appropriate therapies, and inform them about the risks and benefits of any medications we recommend.
Critical Choices: Compliance, Cocaine, and Childbirth
One of the chronically mentally ill young women in our outpatient program is pregnant and due to deliver at any moment. Hers is considered a high-risk pregnancy because of her medical conditions and a history of substance abuse.
The obstetricians wanted to induce her delivery a few days ago, but she wouldn't cooperate. Fortunately, as the mother of several children, she is familiar with labor and knows what to expect when delivering a baby. We're certain that she'll be willing to go to the hospital when the time inevitably arrives.
We're delighted when some of our patients have desired pregnancies. But for others it can be challenging and frustrating — sometimes because of medication issues and sometimes because they don't care for themselves so well.
Naturally we are concerned that they get good obstetrical care. We also work with them to stabilize their mental health while minimizing the potential harmful effects that any of her medications might have on the growing fetus.
Juggling these two goals can sometimes be a delicate balance. Some medications are known to be safe during pregnancy and a few have significant risks.
Most are in between. I've previously written about the Food and Drug Administration's A, B, C, D, and X pregnancy categorization for medications. It is a useful guide but it is based on limited information.
We always have special concern for the unborn children. We know that sometimes these patients make bad decisions that have bad consequences for them. My patient's relapsing cocaine use is a good example. So is her inconsistency in taking medications and her poor dietary habits. Her health has suffered as a result.
While patients can make choices, obviously the newborns cannot. The best we can do is help the mothers live as stably and as healthily as possible. If some medications are necessary, we'll aim for the safest selections and doses.
We'll transport the patients to the outpatient program for regular prenatal visits and make sure their refrigerators at home are stocked with appropriate foods. We'll coordinate with the hospital's labor and delivery services and, after the baby is born, arrange for extra care at home.
We also recognize that the postpartum period — the first few weeks to months after delivery — is a time of greater risk for depression and mania in women with mood disorders. In fact, such women often have their first episode of a mood disorder during the postpartum period.
The relationship between pregnancy and mental health is complex. My friend, Stephanie Durruthy, M.D., has written a book for the public, titled, "The Pregnancy Decision Handbook for Women with Depression: 70 Important Questions to Consider". Among the topics she discusses are expectations about pregnancy, depression symptoms and diagnoses, risk factors for women developing depression, financial considerations, treatment options, medication concerns, and planning for life with the new baby.
We're hopeful about the future of our patient's new baby. We've helped her make plans for the baby's care, and we'll make sure that our patient has the resources she will surely need. The biggest problem may be her choice not to take advantage of them.
The obstetricians wanted to induce her delivery a few days ago, but she wouldn't cooperate. Fortunately, as the mother of several children, she is familiar with labor and knows what to expect when delivering a baby. We're certain that she'll be willing to go to the hospital when the time inevitably arrives.
We're delighted when some of our patients have desired pregnancies. But for others it can be challenging and frustrating — sometimes because of medication issues and sometimes because they don't care for themselves so well.
Naturally we are concerned that they get good obstetrical care. We also work with them to stabilize their mental health while minimizing the potential harmful effects that any of her medications might have on the growing fetus.
Juggling these two goals can sometimes be a delicate balance. Some medications are known to be safe during pregnancy and a few have significant risks.
Most are in between. I've previously written about the Food and Drug Administration's A, B, C, D, and X pregnancy categorization for medications. It is a useful guide but it is based on limited information.
We always have special concern for the unborn children. We know that sometimes these patients make bad decisions that have bad consequences for them. My patient's relapsing cocaine use is a good example. So is her inconsistency in taking medications and her poor dietary habits. Her health has suffered as a result.
While patients can make choices, obviously the newborns cannot. The best we can do is help the mothers live as stably and as healthily as possible. If some medications are necessary, we'll aim for the safest selections and doses.
We'll transport the patients to the outpatient program for regular prenatal visits and make sure their refrigerators at home are stocked with appropriate foods. We'll coordinate with the hospital's labor and delivery services and, after the baby is born, arrange for extra care at home.
We also recognize that the postpartum period — the first few weeks to months after delivery — is a time of greater risk for depression and mania in women with mood disorders. In fact, such women often have their first episode of a mood disorder during the postpartum period.
The relationship between pregnancy and mental health is complex. My friend, Stephanie Durruthy, M.D., has written a book for the public, titled, "The Pregnancy Decision Handbook for Women with Depression: 70 Important Questions to Consider". Among the topics she discusses are expectations about pregnancy, depression symptoms and diagnoses, risk factors for women developing depression, financial considerations, treatment options, medication concerns, and planning for life with the new baby.
We're hopeful about the future of our patient's new baby. We've helped her make plans for the baby's care, and we'll make sure that our patient has the resources she will surely need. The biggest problem may be her choice not to take advantage of them.
The Risk of Freedom
We're worried that one of our patients may be dead. Over a month ago, he simply wandered away from his day program and was never seen again.
Sometimes patients leave our programs suddenly, but we're confident they'll manage just fine. They may take a bus to another city, decide to live on the streets for a while, or move to California to be near an imagined celebrity lover.
But this patient wasn't like that. He barely managed a life that kept him within the confines of his apartment and the local convenience store. Members of our staff would periodically take him to a larger supermarket for more sensible grocery shopping. He'd take care of the doughnut shopping on his own, though. He'd bathe when we bribed him. Sometimes he'd take his medications.
Although our patient was likeable, he never appeared relaxed or comfortable around others. Yet he always smiled when we came to visit. We would sit for a while and have wide-ranging conversations with him. He especially enjoyed talking about sports. His eyes would brighten as he recited the current standings or described highlights from recent games.
At first glance he looked like a regular guy. But after a few minutes with him, it would be clear to anyone that he was not entirely regular. He had odd speech mannerisms. Bizarre beliefs would sometimes emerge.
Decades ago, someone with this sort of chronic psychotic illness would be confined to a psychiatric institution for years if not for life. State psychiatric hospitals housed thousands of patients. That changed with the development of antipsychotic medications in the 1950s and the deinstitutionalization of many of these patients in the 1960s.
The Community Mental Health Act of 1963 established a nationwide network of community mental health centers to care for the tens of thousands of discharged psychiatric patients and the others newly diagnosed.
Reintegrating these patients into local communities was an admirable goal for both therapeutic and social reasons. Inevitably, some patients fell through cracks in the system and became homeless. Resources are not equally available in all communities. State hospital beds were cut drastically and entire hospitals closed. As a result, some areas are experiencing a shortage of beds for patients who require hospitalization.
Vast numbers of people with chronic psychiatric illnesses lead satisfying and productive lives in our communities, living with family members, in supervised settings, or on their own. With this freedom now enjoyed by so many, however, come some risks. For a few, the results can be tragic.
When we first noticed our patient was missing, we sprung into action. For weeks, we checked regularly with the local Missing Persons office, hospitals in the region, and the city morgue. We're still hoping that one day he'll miraculously wander back into our office. Or we may get a call from a distant police department or emergency room telling us he's on the next bus home.
Sometimes patients leave our programs suddenly, but we're confident they'll manage just fine. They may take a bus to another city, decide to live on the streets for a while, or move to California to be near an imagined celebrity lover.
But this patient wasn't like that. He barely managed a life that kept him within the confines of his apartment and the local convenience store. Members of our staff would periodically take him to a larger supermarket for more sensible grocery shopping. He'd take care of the doughnut shopping on his own, though. He'd bathe when we bribed him. Sometimes he'd take his medications.
Although our patient was likeable, he never appeared relaxed or comfortable around others. Yet he always smiled when we came to visit. We would sit for a while and have wide-ranging conversations with him. He especially enjoyed talking about sports. His eyes would brighten as he recited the current standings or described highlights from recent games.
At first glance he looked like a regular guy. But after a few minutes with him, it would be clear to anyone that he was not entirely regular. He had odd speech mannerisms. Bizarre beliefs would sometimes emerge.
Decades ago, someone with this sort of chronic psychotic illness would be confined to a psychiatric institution for years if not for life. State psychiatric hospitals housed thousands of patients. That changed with the development of antipsychotic medications in the 1950s and the deinstitutionalization of many of these patients in the 1960s.
The Community Mental Health Act of 1963 established a nationwide network of community mental health centers to care for the tens of thousands of discharged psychiatric patients and the others newly diagnosed.
Reintegrating these patients into local communities was an admirable goal for both therapeutic and social reasons. Inevitably, some patients fell through cracks in the system and became homeless. Resources are not equally available in all communities. State hospital beds were cut drastically and entire hospitals closed. As a result, some areas are experiencing a shortage of beds for patients who require hospitalization.
Vast numbers of people with chronic psychiatric illnesses lead satisfying and productive lives in our communities, living with family members, in supervised settings, or on their own. With this freedom now enjoyed by so many, however, come some risks. For a few, the results can be tragic.
When we first noticed our patient was missing, we sprung into action. For weeks, we checked regularly with the local Missing Persons office, hospitals in the region, and the city morgue. We're still hoping that one day he'll miraculously wander back into our office. Or we may get a call from a distant police department or emergency room telling us he's on the next bus home.
Virginia Tech Massacre: Beyond the Obvious
Here's what's obvious:
The shooter was severely disturbedWe're all horrified and shocked by the atrocityThe survivors need love, support, and maybe counselingNot so obvious:
Why he did itWhy he did it Why he did itI'd like to be able to say that I understand why he methodically killed one innocent person after another, why he was driven to these ultimate acts of violence, and why he saw his own life as dispensable.
If we could understand it, maybe we could predict it and prevent it. One can easily speculate about anger, relationships, alienation, and clues from his writings. It is hard to resist thoughts of mental illness or a drastically disordered personality. But how could someone envision such horror that robs lives in their prime, full of such potential, and loved by family and friends? Did he want help? If he could look back at the day, would he do it again?
More people may die in a single market bombing halfway around the world, but there was an extraordinary senselessness about this massacre. The terrorist has a purpose, warped as it may be. The terrorist kills and dies for his or her beliefs. What could the Virginia Tech shooter have believed?
Fortunately these campus shootings are rare events. That's partly why they are unexpected and unpredictable. None of that helps the loved ones of the victims. At least there is a strong positive community spirit that will enhance the healing process.
The shooter was severely disturbedWe're all horrified and shocked by the atrocityThe survivors need love, support, and maybe counselingNot so obvious:
Why he did itWhy he did it Why he did itI'd like to be able to say that I understand why he methodically killed one innocent person after another, why he was driven to these ultimate acts of violence, and why he saw his own life as dispensable.
If we could understand it, maybe we could predict it and prevent it. One can easily speculate about anger, relationships, alienation, and clues from his writings. It is hard to resist thoughts of mental illness or a drastically disordered personality. But how could someone envision such horror that robs lives in their prime, full of such potential, and loved by family and friends? Did he want help? If he could look back at the day, would he do it again?
More people may die in a single market bombing halfway around the world, but there was an extraordinary senselessness about this massacre. The terrorist has a purpose, warped as it may be. The terrorist kills and dies for his or her beliefs. What could the Virginia Tech shooter have believed?
Fortunately these campus shootings are rare events. That's partly why they are unexpected and unpredictable. None of that helps the loved ones of the victims. At least there is a strong positive community spirit that will enhance the healing process.
The VA Tech Shooter: What Was He Thinking?
Cho Seung-Hui seemed determined to kill as many people as possible before his time ran out. We may never understand why he committed such an atrocity, but he did provide us with some insights into his thinking with his very disturbing videos, photos, and writings. We may not be able to make an accurate psychiatric diagnosis based on the available information, but it certainly is possible to describe aspects of his mental state.
I suspect that millions of people shared the shock and horror that I felt on viewing his images and hearing his words. These eerie messages from the now-dead killer were a surprising revelation that compounded the revulsion of the initial killing spree. Although it may not matter in the end for the victims, it seems even more despicable that his shootings were not spontaneous, but rather premeditated, elaborately planned, and, apparently part of his fantasy world.
The reports of his earlier warped and violent school projects and the material he mailed on the day of the massacre show his intense anger, arrogance, threatening paramilitary persona, and his extraordinary sense of paranoia. In his mind it was not so much him against the world, but, rather, the world against him. He believed he was a martyr and he wanted the world to know it.
The essence of paranoia is the persistent expectation of being slighted. Paranoid individuals tend to be vigilant in analyzing situations with the assumption that they will be wronged in some way. They filter their perceptions of interactions with others to fit their distorted view of the world. Paranoid thinking as a personality style certainly does not predict that the person will become threatening or violent, although it may influence the intensity and direction of their anger. More worrisome is the paranoia present in the form of paranoid delusions, which may occur as a type of psychotic symptom due to a psychiatric disorder or with certain types of substance abuse. By definition, delusions are false beliefs. People with paranoid delusion often have thoughts of being persecuted.
Considering his illogical and somewhat disorganized thinking, and his extreme paranoid thoughts, it is difficult to resist the conclusion that he suffered from a psychotic disorder. There is no defense for his actions. But we can seek understanding in the attempt to come to terms with what cannot be undone and with the hope that in some way it might help prevent future violence.
I suspect that millions of people shared the shock and horror that I felt on viewing his images and hearing his words. These eerie messages from the now-dead killer were a surprising revelation that compounded the revulsion of the initial killing spree. Although it may not matter in the end for the victims, it seems even more despicable that his shootings were not spontaneous, but rather premeditated, elaborately planned, and, apparently part of his fantasy world.
The reports of his earlier warped and violent school projects and the material he mailed on the day of the massacre show his intense anger, arrogance, threatening paramilitary persona, and his extraordinary sense of paranoia. In his mind it was not so much him against the world, but, rather, the world against him. He believed he was a martyr and he wanted the world to know it.
The essence of paranoia is the persistent expectation of being slighted. Paranoid individuals tend to be vigilant in analyzing situations with the assumption that they will be wronged in some way. They filter their perceptions of interactions with others to fit their distorted view of the world. Paranoid thinking as a personality style certainly does not predict that the person will become threatening or violent, although it may influence the intensity and direction of their anger. More worrisome is the paranoia present in the form of paranoid delusions, which may occur as a type of psychotic symptom due to a psychiatric disorder or with certain types of substance abuse. By definition, delusions are false beliefs. People with paranoid delusion often have thoughts of being persecuted.
Considering his illogical and somewhat disorganized thinking, and his extreme paranoid thoughts, it is difficult to resist the conclusion that he suffered from a psychotic disorder. There is no defense for his actions. But we can seek understanding in the attempt to come to terms with what cannot be undone and with the hope that in some way it might help prevent future violence.
The Best Medicine is From Within
Recently I visited one of our older patients at his home. I hadn't seen him for several months because he had been hospitalized and then was on a rehabilitation unit.
His psychiatric diagnosis is bipolar disorder, and he is stable on his medications. Mental illness has not been a major problem for him over the past few years. He also manages fairly well with blindness.
The real difficulty has been his deterioration due to multiple sclerosis. Just a few years ago, he was able to get around fine. Now he is unable to walk and has trouble with bladder and bowel control. His physical condition is much worse than it was the last time I saw him.
In spite of his deterioration, I was not surprised to see the broad smile on his face. He always has seemed to have such a positive attitude, and on this visit, he was no different. He delighted in telling me about his view of life, and how he feels that his spirituality and sense of humor are his best medicines. He said that people should accept their total situations and that adversity is the stepping stone to wisdom.
I wish I knew why this man has such a positive attitude. Was he born with these personality characteristics, or did he discover some way of being that has helped him cope with his difficulties? Is it something that others can learn? Are there therapies that can guide people to such a joyful reconciliation with their condition? I wish I knew, because I'd like to help others achieve it, too.
I left his house feeling inspired. I could see that he is able to rejoice in his abilities and not dwell on his disability. I think he did more for me than I did for him that day.
His psychiatric diagnosis is bipolar disorder, and he is stable on his medications. Mental illness has not been a major problem for him over the past few years. He also manages fairly well with blindness.
The real difficulty has been his deterioration due to multiple sclerosis. Just a few years ago, he was able to get around fine. Now he is unable to walk and has trouble with bladder and bowel control. His physical condition is much worse than it was the last time I saw him.
In spite of his deterioration, I was not surprised to see the broad smile on his face. He always has seemed to have such a positive attitude, and on this visit, he was no different. He delighted in telling me about his view of life, and how he feels that his spirituality and sense of humor are his best medicines. He said that people should accept their total situations and that adversity is the stepping stone to wisdom.
I wish I knew why this man has such a positive attitude. Was he born with these personality characteristics, or did he discover some way of being that has helped him cope with his difficulties? Is it something that others can learn? Are there therapies that can guide people to such a joyful reconciliation with their condition? I wish I knew, because I'd like to help others achieve it, too.
I left his house feeling inspired. I could see that he is able to rejoice in his abilities and not dwell on his disability. I think he did more for me than I did for him that day.
Bipolar Disorder: Over- and Under-diagnosed
It seems odd that bipolar disorder can be diagnosed both too often and not enough. Many people who actually have bipolar disorder are never diagnosed with a mental disorder or are incorrectly labeled with another disease, such as schizophrenia.
On the other hand, the diagnosis of bipolar disorder tends to be used too liberally, often for people with no real mental disorder. The National Institute of Mental Health estimates that about one percent of the adult U.S. population, or more than two million individuals, actually have bipolar disorder.
Bipolar disorder involves a disturbance of mood. People with bipolar disorder may have episodes of depression, but to be diagnosed with bipolar disorder they must also have at least one episode of mania or its less intense form, hypomania.
If mania is thought of as the opposite of severe depression, then it might seem appealing. In reality, however, mania is a severe condition that can have a devastating impact on one's life.
Episodes of mania may include feelings of elation, increased energy or restlessness, irritability, distractibility, poor judgment, excessive spending, increased sexual drive, and a sense of needing little or no sleep. During a manic episode, a person may have unrealistic beliefs, delusions, racing thoughts, disorganized thinking, and a sense of having special powers.
Much of the confusion about and misdiagnosis of bipolar disorder is due to its hallmark sign of mood swings. It is true that bipolar disorder patients may switch back and forth between episodes of depression and mania, but the episodes usually are sustained — lasting one week or longer.
Many people who do not have bipolar disorder feel as though their moods swing up and down repeatedly throughout the day, or some react to situations with intense emotions. For this reason, they or others may assume they have bipolar disorder when they do not.
Diagnosis is further complicated when people with or without bipolar disorder have other mental disorders. For example, the effects of drug abuse can resemble aspects of bipolar disorder. In such cases, the diagnosis of bipolar disorder may be used inappropriately.
On the other hand, people who do have bipolar disorder may never be evaluated for a mental disorder, so will never be diagnosed. They resist seeking help or assume their symptoms are due to their life circumstances or personality. Their mood extremes and unusual thoughts and behaviors are never explained.
And some patients with true bipolar disorder are incorrectly given other diagnoses. During manic episodes, some people express bizarre delusional beliefs and act in a completely disorganized manner, similar to schizophrenia. Still others with bipolar disorder have complex histories that are not typical of the classic depression-mania alternations.
Bipolar disorder is a treatable condition. It is important to identify who has it and who doesn't. If you think you're one, check with a psychiatrist. Effective treatment can help prevent serious consequences.
On the other hand, the diagnosis of bipolar disorder tends to be used too liberally, often for people with no real mental disorder. The National Institute of Mental Health estimates that about one percent of the adult U.S. population, or more than two million individuals, actually have bipolar disorder.
Bipolar disorder involves a disturbance of mood. People with bipolar disorder may have episodes of depression, but to be diagnosed with bipolar disorder they must also have at least one episode of mania or its less intense form, hypomania.
If mania is thought of as the opposite of severe depression, then it might seem appealing. In reality, however, mania is a severe condition that can have a devastating impact on one's life.
Episodes of mania may include feelings of elation, increased energy or restlessness, irritability, distractibility, poor judgment, excessive spending, increased sexual drive, and a sense of needing little or no sleep. During a manic episode, a person may have unrealistic beliefs, delusions, racing thoughts, disorganized thinking, and a sense of having special powers.
Much of the confusion about and misdiagnosis of bipolar disorder is due to its hallmark sign of mood swings. It is true that bipolar disorder patients may switch back and forth between episodes of depression and mania, but the episodes usually are sustained — lasting one week or longer.
Many people who do not have bipolar disorder feel as though their moods swing up and down repeatedly throughout the day, or some react to situations with intense emotions. For this reason, they or others may assume they have bipolar disorder when they do not.
Diagnosis is further complicated when people with or without bipolar disorder have other mental disorders. For example, the effects of drug abuse can resemble aspects of bipolar disorder. In such cases, the diagnosis of bipolar disorder may be used inappropriately.
On the other hand, people who do have bipolar disorder may never be evaluated for a mental disorder, so will never be diagnosed. They resist seeking help or assume their symptoms are due to their life circumstances or personality. Their mood extremes and unusual thoughts and behaviors are never explained.
And some patients with true bipolar disorder are incorrectly given other diagnoses. During manic episodes, some people express bizarre delusional beliefs and act in a completely disorganized manner, similar to schizophrenia. Still others with bipolar disorder have complex histories that are not typical of the classic depression-mania alternations.
Bipolar disorder is a treatable condition. It is important to identify who has it and who doesn't. If you think you're one, check with a psychiatrist. Effective treatment can help prevent serious consequences.
Antidepressants in Young People: Still Controversial
The FDA has revised the label warning on antidepressant medications after reports that they may increase suicidal thinking in young adults through age 24, especially during the first two months of taking them. The previous warning related only to children and adolescents.
The new FDA warnings resulted from an advisory committee review of 295 research studies of antidepressants that included more than 77,000 people with major depression. It showed no change in suicidal thinking in adults ages 25 to 64, and a reduction in suicidal thinking among those older than 64.
This new "black box" warning — the highest level of caution for approved medications — has been added to all 36 medication brands that are antidepressants or include an antidepressant as part of a combination pill. But I am not convinced that such a warning will have the intended result of preventing suicides among the young.
Research studies have shown a slight increase in thoughts about suicide in young people taking antidepressants compared with those taking a placebo. About 4 percent of depressed children and adolescents who took antidepressants showed some evidence of suicidal thinking, compared to 2 percent for the placebo group. There was, however, no increase in suicide attempts or deaths among those taking the antidepressants.
The FDA cautionary statements about antidepressants and suicidal thinking have been very controversial among health care providers treating depressed young people. It is obvious that untreated depression leads many people not only to experience suicidal thoughts but actually to kill themselves.
The suicide rate for children and adolescents had been decreasing over a long period of time but now the rates are rising again. The new warnings might actually discourage people from taking antidepressants and could increase the suicide rate.
The best solution in my view is to continue treating young people who have major depression with antidepressants, while monitoring them closely for any new thoughts of self injury. The benefits of these medications vastly outweigh the risks.
The new FDA warnings resulted from an advisory committee review of 295 research studies of antidepressants that included more than 77,000 people with major depression. It showed no change in suicidal thinking in adults ages 25 to 64, and a reduction in suicidal thinking among those older than 64.
This new "black box" warning — the highest level of caution for approved medications — has been added to all 36 medication brands that are antidepressants or include an antidepressant as part of a combination pill. But I am not convinced that such a warning will have the intended result of preventing suicides among the young.
Research studies have shown a slight increase in thoughts about suicide in young people taking antidepressants compared with those taking a placebo. About 4 percent of depressed children and adolescents who took antidepressants showed some evidence of suicidal thinking, compared to 2 percent for the placebo group. There was, however, no increase in suicide attempts or deaths among those taking the antidepressants.
The FDA cautionary statements about antidepressants and suicidal thinking have been very controversial among health care providers treating depressed young people. It is obvious that untreated depression leads many people not only to experience suicidal thoughts but actually to kill themselves.
The suicide rate for children and adolescents had been decreasing over a long period of time but now the rates are rising again. The new warnings might actually discourage people from taking antidepressants and could increase the suicide rate.
The best solution in my view is to continue treating young people who have major depression with antidepressants, while monitoring them closely for any new thoughts of self injury. The benefits of these medications vastly outweigh the risks.
John Nash and a Beautiful Mind on Strike
John F. Nash, Jr., won the Nobel Prize for economics in 1994 for his early work in developing game theory, but he is best known for being diagnosed with paranoid schizophrenia and for being the subject of the film "A Beautiful Mind," which won an Academy Award for Best Picture in 2001.
Thousands of attendees at the 2007 annual meeting of the American Psychiatric Association in San Diego crowded into a huge hall to see John Nash in person and to listen to him present a lecture.
There was a standing ovation as he walked up to the podium. He proceeded to read a lengthy speech that was difficult to follow at times. He had a somewhat awkward manner and tended to speak in a monotone. However, there was a little humor in his talk.
The focus of Dr. Nash's lecture was what he called "minds on strike," which he described as minds not doing their duty of thinking in an acceptable fashion. In his wide-ranging remarks, he talked about the nervous system, evolution, economics, and a grand design for terrestrial species.
As species evolved on Earth into more complex organisms, he said, there arose a need for a differentiation of roles. He tied this together with appropriate social behaviors, noting that society is the collective of individuals interacting with nature.
Nash pointed out that even non-standard behaviors may involve roles that are important for society, and he offered the clergy as an example. He suggested that medical doctors do not produce food, but ultimately are important for society, as well.
Nash went on to discuss insanity from an economic standpoint, noting that because insane people might not be able to perform their expected social roles, their minds are unable to function properly for society and are, therefore, "on strike." He said that his mind, for instance, had gone on strike repeatedly; however, his message was one of hope because he left open the possibility of the mind functioning properly again.
He did speak about his own delusions and suggested that these beliefs were as real as anything else he had experienced. The delusional thoughts came to him as naturally as other information. He had both paranoid and grandiose delusional thoughts.
At his most delusional, he believed that there was a conspiracy and that he was being monitored in a police-state world like that described in George Orwell's novel "1984." He believed that family members who had aided in having him placed in psychiatric hospitals were simply duped by the authorities. He also sensed that he was a very important person, and he noted that when he was awarded the Nobel Prize, history finally caught up with his grandiose delusion.
Especially interesting were his thoughts about mental health counselors. During the years that his psychotic symptoms were very pronounced, he believed that if he could communicate with a real angel, then everything would be clarified for him. He now thinks that someday a very complex computer program will be able to simulate a counselor and be useful for some therapy sessions.
At the end of his remarks, he argued that nature favors diversity. The inevitable result of diversity in human behavior is that the human being is vulnerable to insanity. It is a price that society pays for progress in other ways.
An important lesson of John Nash's life is that genius does not protect one against mental illness.
Thousands of attendees at the 2007 annual meeting of the American Psychiatric Association in San Diego crowded into a huge hall to see John Nash in person and to listen to him present a lecture.
There was a standing ovation as he walked up to the podium. He proceeded to read a lengthy speech that was difficult to follow at times. He had a somewhat awkward manner and tended to speak in a monotone. However, there was a little humor in his talk.
The focus of Dr. Nash's lecture was what he called "minds on strike," which he described as minds not doing their duty of thinking in an acceptable fashion. In his wide-ranging remarks, he talked about the nervous system, evolution, economics, and a grand design for terrestrial species.
As species evolved on Earth into more complex organisms, he said, there arose a need for a differentiation of roles. He tied this together with appropriate social behaviors, noting that society is the collective of individuals interacting with nature.
Nash pointed out that even non-standard behaviors may involve roles that are important for society, and he offered the clergy as an example. He suggested that medical doctors do not produce food, but ultimately are important for society, as well.
Nash went on to discuss insanity from an economic standpoint, noting that because insane people might not be able to perform their expected social roles, their minds are unable to function properly for society and are, therefore, "on strike." He said that his mind, for instance, had gone on strike repeatedly; however, his message was one of hope because he left open the possibility of the mind functioning properly again.
He did speak about his own delusions and suggested that these beliefs were as real as anything else he had experienced. The delusional thoughts came to him as naturally as other information. He had both paranoid and grandiose delusional thoughts.
At his most delusional, he believed that there was a conspiracy and that he was being monitored in a police-state world like that described in George Orwell's novel "1984." He believed that family members who had aided in having him placed in psychiatric hospitals were simply duped by the authorities. He also sensed that he was a very important person, and he noted that when he was awarded the Nobel Prize, history finally caught up with his grandiose delusion.
Especially interesting were his thoughts about mental health counselors. During the years that his psychotic symptoms were very pronounced, he believed that if he could communicate with a real angel, then everything would be clarified for him. He now thinks that someday a very complex computer program will be able to simulate a counselor and be useful for some therapy sessions.
At the end of his remarks, he argued that nature favors diversity. The inevitable result of diversity in human behavior is that the human being is vulnerable to insanity. It is a price that society pays for progress in other ways.
An important lesson of John Nash's life is that genius does not protect one against mental illness.
'Shock' Treatment Effective Against Depression
Kitty Dukakis, wife of former governor of Massachusetts Michael Dukakis, the 1988 Democratic nominee for president, presented an inspiring and informative lecture at the 2007 annual meeting of the American Psychiatric Association in San Diego.
She talked of her many years of suffering with major depression and how grateful she was to have found an effective treatment.
Michael Dukakis, who accompanied his wife, spoke of the miraculous treatment that brought her back from depression. They both discussed the unfortunate public misunderstanding of and stigma against the treatment that finally helped her — electroconvulsive therapy (ECT).
She previously had disclosed her problems with depression, alcohol, and diet pills in the 1990 book, "Now You Know." Now, along with journalist Larry Tye, she has written a book that combines her personal story with an historical and scientific review of electroconvulsive therapy. In "Shock: The Healing Power of Electroconvulsive Therapy," the authors present her real experiences as a patient.
Dukakis experienced repeated episodes of depression and never found persistent improvement with antidepressant medications. Finally, after 17 years of ineffective treatment, she was urged by her psychiatrist to try ECT. It was remarkably successful, and she continues to have series of treatments every nine to 12 months.
Often, ECT is imagined by the lay person as a grotesque and torturous treatment, such as was depicted in movies like "One Flew Over the Cuckoo's Nest." As a consequence, many people do not realize that ECT is the most effective and reliable treatment for depression and that it is a relatively safe procedure. About 100,000 patients receive ECT treatment in the U.S. each year. Most often, it is done on an outpatient basis.
ECT today is a highly controlled treatment. Patients are given very short-acting intravenous medications that produce brief anesthesia and muscle relaxation. Modern equipment and procedures reduce the risk of side effects.
The treatment involves applying a brief electrical charge through electrodes carefully placed on specific parts of the head. The electrical stimulus initiates self-limited seizure activity in the brain, but there is little muscle activity because of the medications.
Unfortunately, stigma associated with depression and ECT often leads to patients not being offered the treatment or being too fearful to consider it. Kitty and Michael Dukakis want ECT to be available for more patients as an alternative approach when antidepressants are insufficient.
Let Kitty Dukakis share with you her unbiased account of her experiences. She describes both the good and bad effects of ECT. She did have some memory loss, but overall feels that ECT saved her life.
She talked of her many years of suffering with major depression and how grateful she was to have found an effective treatment.
Michael Dukakis, who accompanied his wife, spoke of the miraculous treatment that brought her back from depression. They both discussed the unfortunate public misunderstanding of and stigma against the treatment that finally helped her — electroconvulsive therapy (ECT).
She previously had disclosed her problems with depression, alcohol, and diet pills in the 1990 book, "Now You Know." Now, along with journalist Larry Tye, she has written a book that combines her personal story with an historical and scientific review of electroconvulsive therapy. In "Shock: The Healing Power of Electroconvulsive Therapy," the authors present her real experiences as a patient.
Dukakis experienced repeated episodes of depression and never found persistent improvement with antidepressant medications. Finally, after 17 years of ineffective treatment, she was urged by her psychiatrist to try ECT. It was remarkably successful, and she continues to have series of treatments every nine to 12 months.
Often, ECT is imagined by the lay person as a grotesque and torturous treatment, such as was depicted in movies like "One Flew Over the Cuckoo's Nest." As a consequence, many people do not realize that ECT is the most effective and reliable treatment for depression and that it is a relatively safe procedure. About 100,000 patients receive ECT treatment in the U.S. each year. Most often, it is done on an outpatient basis.
ECT today is a highly controlled treatment. Patients are given very short-acting intravenous medications that produce brief anesthesia and muscle relaxation. Modern equipment and procedures reduce the risk of side effects.
The treatment involves applying a brief electrical charge through electrodes carefully placed on specific parts of the head. The electrical stimulus initiates self-limited seizure activity in the brain, but there is little muscle activity because of the medications.
Unfortunately, stigma associated with depression and ECT often leads to patients not being offered the treatment or being too fearful to consider it. Kitty and Michael Dukakis want ECT to be available for more patients as an alternative approach when antidepressants are insufficient.
Let Kitty Dukakis share with you her unbiased account of her experiences. She describes both the good and bad effects of ECT. She did have some memory loss, but overall feels that ECT saved her life.
2007年12月13日星期四
Brooke Shields and Postpartum Depression
Each year at the American Psychiatric Association annual meeting, the American Psychiatric Foundation hosts an interview with a public figure regarding his or her experience with mental illness.
The guest at this year's meeting in San Diego was Brooke Shields, who has written about her ordeal with postpartum depression in the book, "Down Came the Rain."
She described for the audience how much she had craved having a baby and the experience of motherhood. She and her husband had struggled for pregnancy and repeatedly experienced hope and failure with in vitro fertilization.
Life was especially stressful when she finally was able to maintain the pregnancy with her first child. Her father recently had died. She worried about miscarriage because of her previous failures. Ultimately she required an emergency cesarean section, and the baby was jaundiced and needed a hip brace.
Although Brooke had high expectations of maternal bliss, her experience was the exact opposite. At first she felt nothing for the baby. Then came a growing sense that she was a failure as a mother - her most important role. She told the gathered group that she had felt more affection at age 15 for the baby in the movie, "The Blue Lagoon," than she did for her own long-awaited child.
Everyone told her that it was just the baby blues and that things would get better soon. Instead, they got much worse. She told the pediatrician that she had made a great mistake in having a baby and that she needed an exit plan due to her complete failure as a mother.
However, she felt insulted and angry at the suggestion that it might be postpartum depression. It was a long time before she agreed to try an antidepressant. In her mind she had lost the baby, but didn't want to lose her husband, too. She said that she took the medicine only to prove that everyone was wrong and the medication wouldn't make any difference.
The antidepressant did help, but she soon stopped because she was feeling a little better and she assumed she no longer needed it. But it wasn't long before she began to feel even more depressed. She had thoughts of ending her life. She could not block out visions of harming the baby.
One day she decided to crash her car, but didn't do it because her daughter was with her. Eventually she again took antidepressant medications and recovered fully. She finally realized that the antidepressants were life-saving for her.
With her second baby three years later she was able to benefit from her past experience and new insights. She took an antidepressant preventively. All went well and she was able to feel the maternal love she had expected the first time.
Brooke Shields felt that being in the public eye heightened her feeling of failure at being a mother, but she later made good use of her celebrity to educate others about depression. She has been a hero in the mental health field for disclosing her past despair and confusion so that others could benefit.
She has worked to raise the public awareness about postpartum depression so that women can understand their own symptoms and so that others in their lives can be persistent in making sure that they get appropriate evaluation and treatment.
The guest at this year's meeting in San Diego was Brooke Shields, who has written about her ordeal with postpartum depression in the book, "Down Came the Rain."
She described for the audience how much she had craved having a baby and the experience of motherhood. She and her husband had struggled for pregnancy and repeatedly experienced hope and failure with in vitro fertilization.
Life was especially stressful when she finally was able to maintain the pregnancy with her first child. Her father recently had died. She worried about miscarriage because of her previous failures. Ultimately she required an emergency cesarean section, and the baby was jaundiced and needed a hip brace.
Although Brooke had high expectations of maternal bliss, her experience was the exact opposite. At first she felt nothing for the baby. Then came a growing sense that she was a failure as a mother - her most important role. She told the gathered group that she had felt more affection at age 15 for the baby in the movie, "The Blue Lagoon," than she did for her own long-awaited child.
Everyone told her that it was just the baby blues and that things would get better soon. Instead, they got much worse. She told the pediatrician that she had made a great mistake in having a baby and that she needed an exit plan due to her complete failure as a mother.
However, she felt insulted and angry at the suggestion that it might be postpartum depression. It was a long time before she agreed to try an antidepressant. In her mind she had lost the baby, but didn't want to lose her husband, too. She said that she took the medicine only to prove that everyone was wrong and the medication wouldn't make any difference.
The antidepressant did help, but she soon stopped because she was feeling a little better and she assumed she no longer needed it. But it wasn't long before she began to feel even more depressed. She had thoughts of ending her life. She could not block out visions of harming the baby.
One day she decided to crash her car, but didn't do it because her daughter was with her. Eventually she again took antidepressant medications and recovered fully. She finally realized that the antidepressants were life-saving for her.
With her second baby three years later she was able to benefit from her past experience and new insights. She took an antidepressant preventively. All went well and she was able to feel the maternal love she had expected the first time.
Brooke Shields felt that being in the public eye heightened her feeling of failure at being a mother, but she later made good use of her celebrity to educate others about depression. She has been a hero in the mental health field for disclosing her past despair and confusion so that others could benefit.
She has worked to raise the public awareness about postpartum depression so that women can understand their own symptoms and so that others in their lives can be persistent in making sure that they get appropriate evaluation and treatment.
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