Dr. B's Blog

TED Talk - Shame

Brené Brown has a way with words. This is her TED Talk about shame and how to address it. Shame is a particularly challenging emotion to understand, accept and deal with effectively. While we have our own way of dealing with shame within DBT, it's nice to hear how others approach it. 

(h/t Martha Golden during one of our groups.)

Churchill and the Stigma of Depression

This article is an interesting follow-up to the previous entry I made. I think that the author does an effective job teasing apart what works and for whom:

In the case of depression, the core stigma is that depression is a weakness, a moral failing. That depressed people are soft, weak, pitiable. This attitude is specific to depression – not even bipolar disorder is seen in the same way, let alone the other diagnoses. They have their own stigmas. Depression’s is weakness.

Now this is why Churchill is a good counterexample. Not just because he’s famous or ‘great’, but because he was famously tough. He faced down Hitler. He was blood, sweat and tears. In the most famous photos of him (and they are famous, out of all his photos, because they correspond to the mental image) he is almost unsmiling – but never despairing. Just resolute.

I think the key here is the notion of Churchill being a counterexample and not just an example of someone with mental health difficulties being successful. It's the notion of opposite action in, ahem, action. By that, I mean that we have someone dealing with the syndrome of depression. Withdrawal, isolation, self-doubt are all part of this syndrome. What we see in someone like Churchill is that he's working to act opposite to those action urges. 

Perhaps what makes a good role model is to highlight someone doing behaviors that are specifically opposite to the action urges we're trying to deal with. Again, some research is needed here, but two articles to start the conversation.

BBC: Do famous role models help or hinder?

Apparently, last week was mental health awareness week in the UK. I didn't realize it at the time I bookmarked this article

Churchill might tell me something about the art of statecraft, or Fry about the pressures of fame and the joy of words, but someone closer to home, with a life more like mine and challenges more like mine, will tell me far more about a life with mental health difficulty and how best to live it.

I always wonder what one "should" do with respect to role models in mental health and I think it probably comes down to individual characteristics about what makes most sense in treatment. I'm sure there's a research study or two about this issue so I'll see if I can track one down and post about it in the near future.

Please see this post for a follow-up.

"You are getting sleepy... Very sleepy...."

Among the patients I've worked with over the years, sleep difficulty is easily the most common secondary complaint to their presenting problems. And it's often one that's neglected or forgotten about amongst the many other issues going on. Many clients are on sleep medication and have found some relief from them, but I came across this book which claims that:

A number of studies have shown that drugs like Ambien and Lunesta offer no significant improvement in the quality of sleep that a person gets. They give only a tiny bit more in the quantity department, too. In one study financed by the National Institutes of Health, patients taking popular prescription sleeping pills fell asleep just twelve minutes faster than those given a sugar pill, and slept for a grand total of only eleven minutes longer throughout the night.

I'm not a psychiatrist so I don't know about the science of the meds. But if it works only because you think it should, what's really wrong with that?

GigaOm on mobile health

I'm a little partial to the use of mobile apps to help in mental health but so this article naturally caught my eye:

Over time, people will come to rely more on their phone to keep them healthy than they do on their actual doctor. Rather than going once a year for a check-up and to get a few basic tests done, you will be monitored day in and day out by your phone. This does not mean that doctors will go away, but it does mean that the role of the doctor will be forever altered. It also means that doctors will be empowered with a lot more data on what their patients are up to between visits, which will help them provide better care.

I don't for a minute think that I'm going to be able to replace my doctor (or think that you should replace yours!) but I do firmly believe that these devices will allow us to do more and better tracking of relevant therapy information allow for much more efficient use of therapy time and measures of progress. This, I'm my opinion, is a good thing.

Here's Mihaly Csikszentmihalyi talking about the concept of Flow. Flow is about being in the moment, without judgement. You melt into your experience and all other issues tend to fade away. It'd be a nice way to live your life, don't you think?

Perception

I always wondered how I could constantly be surrounded by imperfect clocks and their irregular second hands. The BBC reports:

You'll be in the middle of something, and flick your eyes up to an analogue clock on the wall to see what the time is. The second hand of the clock seems to hang in space, as if you've just caught the clock in a moment of laziness. After this pause, time seems to restart and the clock ticks on as normal.

Deep cracks, hidden damage

The Guardian reports on the continued psychological impact from the Fukushima disaster in Japan:

Twenty years after the 1986 reactor explosion in Chernobyl, the World Health Organisation said psychological distress was the largest public health problem unleashed by the accident: “Populations in the affected areas exhibit strongly negative attitudes in self-assessments of health and wellbeing and a strong sense of lack of control over their own lives. Associated with these perceptions is an exaggerated sense of the dangers to health of exposure to radiation.”

We live in a world with very short attention spans. It's kind of out of necessity that we move on quickly with so much going on in our lives but there are some things we can't forget about. This is not the place for political statements (and to be honest I don't know where I would fall on the issue of nuclear power anyway) but it's critically important to remember that the psychological impact of a traumatic event often stays hidden for months if not longer.

You've to move it move it.

My son has a birthday card he got from his grandparents. It's one of those annoying singing birthday cards that have no audio fidelity at all but makes a 4 year-old crack up. The song is I like to move it. (by a band I've never heard of called "Reel 2 Real".) Whatever the band's name is or the degree of annoyance of the song, it's a catchy tune and an apt title for this post. The NYT reports:

Each volunteer exercised for four months, while continuing to take an antidepressant. At the end of that time, according to the study published recently in The Journal of Clinical Psychiatry, 29.5 percent had achieved remission, “which is a very robust result,” Dr. Trivedi said, equal to or better than the remission rates achieved using drugs as a back-up treatment. “I think that our results indicate that exercise is a very valid treatment option” for people whose depression hasn’t yielded to S.S.R.I.’s, he said.

I like to think of early depression treatment as targeting one or more of the areas affected by Major Depressive Disorder:

  1. Cognitive
  2. Somatic (physical/energy levels)
  3. Sleep
  4. Emotional
  5. Motivational

There are others things that need to be targeted but the majority of patients in early treatment for depression have a lot of work to do one one or more of those areas and it's extremely relevant to their situation. It's nice to see something so clearly affected by depression, yet so incredibly simple to do, gets continued attention in the press and research literature.

 

Dr. Linehan talks about her own struggles.

Dr. Linehan has been an inspiration to many, including me, in trying to figure out how to deal with borderline personality disorder. I count myself among the fortunate few who have had an opportunity to be trained by Dr. Linehan and her "children" during my own training to be a DBT therapist. Does this revelation that she, herself, has struggled with borderline personality disorder change the way I think of her? Yes, but only in the most positive ways: I knew that she talked the talk, but now I know that she walks the walk. When I teach skills to my clients, I often use personal examples as illustrative. I don't have any illusions that my own personal struggles match in intensity their own, but I do think it's helpful to share how the skills I'm teaching have helped me. The stigma associated with chronic mental illness is real and difficult to deal with. Even more for those who already struggle with emotion regulation.

The NYT reports:

“That did it,” said Dr. Linehan, 68, who told her story in public for the first time last week before an audience of friends, family and doctors at the Institute of Living, the Hartford clinic where she was first treated for extreme social withdrawal at age 17. “So many people have begged me to come forward, and I just thought — well, I have to do this. I owe it to them. I cannot die a coward.”

You are no coward, Marsha. Thank you for your courage and your story.