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Here it is short and sweet: If you eat fast food to any significant extent (you know who you are!), your risk of becoming depressed in the future increases (if you aren’t already depressed). If depression is a problem in your life, you should seriously consider reviewing your diet, eliminating any fast food you find and increasing your consumption of whole and fresh foods.

This is the major finding of yet another study on the relationship between diet and mood (depression in particular) – and here is a summary of the study, written for medial professionals: Junk Food Linked to Depression.

Here are the key points I see in this summary:

  • Using a “…prospective cohort design [which] affords the potential for investigating cause-effect relationships,” researchers followed a group of almost 9000 people over time, to look at the relationship between depression and consumption of “fast food” – quick take-out food, and commercial bakery items. At the beginning of the study, none “…of the participants had been diagnosed with depression or had taken antidepressants before the start of the study.”
  • ” Fast food consumption was defined as total consumption of hamburgers, pizza, and hot dogs/sausages. Commercial baked goods consumption was defined as total consumption of croissants, doughnuts, and muffins.”
  • A positive dose-response effect was found: The more food of this sort consumed, the greater the risk of becoming depressed in the future.
  • Consistent consumption of these foods produced an almost 40% increase in the chance of becoming depressed in the future.
  • “…the researchers note that even small quantities of fast food were linked to a significantly higher risk for depression.”
And from the article, here are some excellent summary statements:
  • “…the intake of this type of food should be controlled because of its implications on both health (obesity, cardiovascular disease) and mental well-being.”
  • “Limiting trans fatty acids content in several foods, avoiding the consumption of fast food and bakery, and increasing the consumption of other products such as vegetables, legumes, and fruits should be a primary goal for clinicians and public health makers…”
  • “…it is prudent for clinicians to assess and address the dietary as well as exercise habits of their patients, in addition to pharmacological and other established treatments.”

These findings are congruent with a number of previously published studies which document similar or related causal effects between diet and mood:

Trans-Fats Linked to Increased Depression Risk [2011.01.28] – “Consumption of trans-unsaturated fatty acids (TFAs or trans-fats) has been linked to a significantly increased risk for depression. On the other hand, olive oil, monounsaturated fatty acids (MUFAs), and polyunsaturated fatty acids (PUFAs) appear to have a protective effect and lower depression risk…”

More Evidence Confirms Diet’s Link to Mental Health [2011.10.14] – “…new studies from Australian investigators show that diet quality can have a significant effect on mental health outcomes and may potentially have a role in preventing and treating such common illnesses as depression and anxiety.” “…better diet quality was associated with better mental health in adolescents cross-sectionally and over time.” “…these findings suggest it may be possible to prevent teenage depression by ensuring adolescent diets are sufficiently nutritious, and improving diet quality may help treat depressive symptoms in this population.”

Clear Link Between Mood and Food [2012.03.20] – “New research shows there is a strong link between higher levels of nutrient intake and better mental health, thereby adding to the growing body of evidence demonstrating the critical role of diet in mood disorders.” A broad range of nutrients were monitored in the reviewed small-sample study of a clinical population (i.e., all individuals were adults living in the community and had been diagnosed with mood disorders), and consumption of all nutrients correlated positively with scores on the Global Assessment of Functioning scale very commonly used in psychiatric assessment.

Improvements in one’s diet are appropriately considered a significant preventive or treatment response with mood disorders – especially depression. Overall cost is likely to be less than that for other modes of response, and such action is ideal for self-management of mood. I do this myself (along with purposeful strenuous exercise – also validated by research as a highly appropriate response to risk or presence of mood disorders), as I want my mental function to be optimal at all times. I strongly urge others to consider doing it as well. It’s a smart move.

Life is now. Memories necessarily reference the not-now. Fantasies do so as well, and can refer to past, present, or future.

It strikes me that the great challenge of our lives is –

1. To learn to stay connected to our sensory present (our senses being our only way of having direct contact with our physical environment, including the real people in it, etc.). Part of this sensory present is the internal communications we receive about ourselves, both via proprioception (see here and here) by means of the internal dialogs natural to higher order function in our brains (e.g., “I want another brownie, but I don’t want any more calories, so…no thanks.”). Some of these dialogs involve activation of memories with which we are not yet finished, a problem for us, often.

2. To stay particularly in touch with our affective (feeling) response to anything to which we persistently attend, as this reveals our true values.

3. To see that our actions, when we choose to act, are congruent with these feelings.

Living well with these challenges creates, I think, true integrity – integration of the self in the fullest sense of the word.

“Living well” is a moving target, as we all live in the midst of a dynamic world, a rushing river of change. We must repeatedly check to see that we’re headed down the right road, and not toward some ditch. And what’s the matter with ditches? Well, that’s where pond scum lives! We may aspire to higher outcomes than that.

And so it is that every day has its work for us, and for this we do well to offer our gratitude in response.

All of us struggle with our sense of reality. Sometimes we cannot quite “see” what’s really happening. Other times we don’t question what we see so much as our ability to respond well to it.

In any case, a little thought clearly leads to the fact that our sense of our reality – encompassing both ourselves and what is around us – is something distinct from the reality itself. Unfortunately, it’s just not always easy to get a good sense of what’s really happening.

Consider for a moment, if this line of thought is a little murky for you, that all of science is simply an effort to address this problem – to get a better sense in our minds of what’s really happening “out there”. Science is hard work, which leads me to conclude that the problem it addresses is often not easily resolved.

I find that my own personal sense of reality and myself is subject to many distortions. Rarely do these mental errors help me live better, feel better, or like myself more, in the long run. In fact, such mental errors can often lead to short-term disaster!

In a recent email to a client, I addressed this issue, asking what they needed to remember about themselves and their situation in order to limit such mental distortions as much as possible.  I then offered the following ideas which I personally have found it very useful to remember.

  • I care about the people in my life, and this is good for me and them.
  • I can interact with them in ways that add value to their lives and mine.
  • Direct control of my feelings is not possible (because feelings are an automatic brain response), but indirect control, through attending my physical health, my thoughts, and where I choose to direct my attention, is actually easy, and usually has a powerful effect.
  • There are many aspects of my present situation which are evidence of great good fortune in my life. I am foolish to allow my attention to dwell too long on misfortunes which come my way, unless it is to learn something useful to carry forward in my life.
  • Investing a small amount of time in experiencing and expressing gratitude for what I have can lead to immediate substantial gains in the quality of my state of mind.
  • Progress in any area of my life is almost always possible, if I’m willing to accept the fact of my having limited power and knowledge. It can be difficult to be a mere human being, with all the limitations inherent in this status, but acceptance of my limitations can free me to work at reducing them, through patient, focused effort.
  • Good mental health is strikingly like good physical health: it usually doesn’t just happen, but rather results from intelligent, directed, repeated efforts. Children usually see and react; adults see, then plan, then act. They get better results. It’s better to be an adult.

To get these statements, I just asked myself what is true about my situation in life, and what I need to remember, given these descriptive truths, in order to function well. The set of “reminders” above are the result. They are not a final set, to be sure, but I note that just reading them improves my state of mind.

So…the question NOW is simply…what do YOU need to remember, about yourself and your life, to function well? I’ll predict that time spent with this question will be rewarding for you. I’d be interested to know what you discover…

I’ve just fielded a question on the Talk page of the Wikipedia article on PTSD. It’s a good question (a couple, actually), and my answer might be useful to repeat here. The visitor asks why the article says this:

“Children may develop PTSD symptoms by experiencing bullying or sexually traumatic events like age-inappropriate sexual experiences.”

The concern is the reference to “age-inappropriate sexual experiences” rather than “rape”.  “Why does it say that instead of simply rape?  The Webster dictionary defines rape is having sex with who is below a certain age [http://www.merriam-webster.com/dictionary/rape%5B3%5D].  And what does age-inappropriate mean?  Would it be less dramatic if the person was their own age, instead of significantly older?”

My response (edited very modestly, for this venue):

I don’t have time to provide you with the reference citations which I’d like to offer, in responding to your questions, but  will respond using the knowledge I’ve acquired from many trustworthy sources in over 30 years of work in clinical and research psychotherapy, involving adults, adolescents, and children, many of whom had experienced what we call age-inappropriate sexual activity, often with negative consequences. I hope you’ll forgive my not backing up what I say with proper sourcing.

First, your questions are excellent ones. Please understand that casual language is often sloppy, and this won’t help us here. What the law, or the dictionary, defines as rape may well be different in important ways from a medical or psychological definition. The dictionary you cite appears to be giving a pseudo-legal definition. There is no “right” definition. Linguists write definitions (and dictionaries which contain them) on the basis of how people USE words. Philosophers and other thinkers are free, of course, to ”stipulate” definitions, as well. In formal, thoughtful writing, we usually stipulate definitions so that they help us with our thinking. They become tools, used to accomplish goals. That’s why legal people see “rape” differently than, say, anthropologists, or therapists. And note that even in groups of professionals in the same field, definitions can differ significantly.

So, let me begin by saying simply that from my perspective rape is always inappropriate (!), and is AGE-inappropriate when it involves a sexually immature individual. Note that physiological sexual maturity bares only a loose relationship to legal sexual maturity, and for good reasons (which I won’t take up here). If only some rape is ”age-appropriate”, as opposed to simply ”inappropriate”, it is also true that not all age-inappropriate sexual behavior is rape – which I think should be obvious, upon a little reflection. Inappropriate touching, for example, isn’t necessarily rape.

Age-inappropriate sexual experiences, in psychology/psychotherapy are those generally seen as those which involve an individual doing something sexual which is clearly not usual or expected for their age. This can be tricky to distinguish, however. Clearly, many, if not all, infants and children explore their sexual organs, and each others’, as well. This is normal, and generally harmless. At what point is something age-inappropriate occurring? There is no clear dividing line. It not dissimilar to the problem of distinguishing pornographic literature from erotic literature. I can offer no easy solutions to these problems.

That said, the key concept here is that sexual experiences involving children/adolescents who are not sexually mature ”can” have immediate and/or delayed long-term negative consequences. This is clearly cause for concern. It is very important to note that not only are not all sexual experiences children have inappropriate, not all of them cause any problem at all. Event consequences are driven by the degree of involvement, the nature of the act, whether or not there was coercion, how the child felt about it at the time, the reaction of adults who came to learn of the event, and so on. Many factors influence the consequences of a sexual experience involving a child.

We should never simply stipulate that something MUST be a problem (although this is commonly done in courtrooms). Rather, when we let the individual involved tell us of their experience and what it means to them, then we can know the real psychological consequences.

Well-meaning people can create a problem where none existed, with a child. Some individuals come through quite serious experiences with very little if any damage. Others are greatly hurt by what appear to be modest experiences. And, regardless of the consequences, those of us who come to learn of a given experience may have good cause for concern. It would be nice if we could view all this in simple terms, but I don’t think that would be accurate, useful, or intelligent.

Among the problematic consequences of age-inappropriate sexual behavior which we deal with in clinical psychotherapy are these:

* Lose of a child’s sense of safety: Loss of control over what’s done with your body is at the least unpleasant, and at worst traumatic. It may be difficult to feel safe in the world for some time after such an event.
* Loss of trust of key individuals in a child’s life: A sexually inappropriate relative becomes an untrustworthy relative. Children need families they can trust. A sexual abuse incident is one way to lose a functional relationship with a sibling, or a parent, or a grandparent. This can have long term consequences.
* Outright psychological trauma: When there substantial levels of fear involved, and the child is unable to resolve these feelings. enduring trauma may result. This is how once acquires PTSD.
* Premature sexualization of the child: This is the problem non-professionals usually forget or ignore or have no awareness of. Children introduced to sexual experiences before they are ready or desirous of them, may come to think that sex is a part of emotional intimacy. This may lead them to be sexual with other children, or other adults, in unwanted and unacceptable ways, and in ways that can damage others as well. I once knew a very pretty, charming 10 year old girl who had been removed from a succession of foster homes because she couldn’t keep her hands where they belonged. She had been “prematurely sexualized”. She thought what she was doing was OK, and her behavior led to repeated social rejection. This sort of thing is far more common than most people realize, and definitely one of the reasons why we’re concerned about age-inappropriate sexual behavior. It can lead to an child’s experiencing themselves as unacceptable to others in general, which can lead to depression, self-medication with various psychotropic substances, and other long-term damaging consequences.
* Disturbance to individuals associated with the child: Even when inappropriate sexual experiences are not a problem for a child, they can be for others. I dealt with a 9 year old boy once whose parents were quite upset because his female babysitter (age 13 – and not a relative) had climbed into bed with him late at night. They couldn’t imagine that he wasn’t somehow injured by this experience – clearly (one would think!) age-inappropriate sexual behavior. It turned out that he was only annoyed. He couldn’t make sense of what she was doing, and got up, went downstairs, and slept on the family sofa. Problem solved. All I had to do was calm down the parents, so they wouldn’t continue to disturb their son.

This is not intended to be a complete list, but I do believe it addresses most major issues.

Relative to a hypothetical age-inappropriate sexual experience, you ask “Would it be less dramatic if the person was their own age, instead of  significantly older?” It could well be, although “drama” is not the issue, as I’m sure you realize. The problem with older individuals is their misbehavior can lead to a needless and inappropriate distrust of all older people. Also, older individuals are likely to initiate more mature (and thus age-inappropriate) activities with younger individuals. At the same time one must note that in most cultures it is deemed appropriate for young, sexually mature hetersexuals to pair off such that the male is older than the female – one major research effort determined that the age difference deemed ideal by many cultures was about 3.5 years (with the male being older).

I will conclude my remarks by saying that I’m concerned about the tendency in some families, communities, and schools, to pathologize the normal. Two six year old girls simulating intercourse, because they are curious and cannot make sense of why adults would do this, do not really need a semi-hysterical, or punitive, or any other negative reaction from adults. I could cite other cases, many of them not so easy to think about…and that’s my point. A thoughtful examination of an event is a far wiser response than is a knee-jerk negative reaction of any kind. I prefer to act from knowledge rather than pre-drawn conclusions based on some principle rather than good data. It think that we don’t yet have all the knowledge about age-inappropriate sexual experiences that we’d like to have. The situation is clearly better than it has been in the past, without doubt, but we’re not finished out work, so to speak.

I hope my responses are useful to you. Thanks for your great questions!

Many of the people I work with as a psychotherapist have been very seriously impacted by their life histories.They did not ask for this. It’s like a rock that falls out of the sky, striking them for no discernible  reason. It’s our task to go forward and make their lives work better. Sometimes rather simple tools yield powerful results, as I relate here.

The problem: getting control of intrusive symptoms

Many of my clients have Post-traumatic Stress Disorder. This is usually quite treatable, but success in treatment often isn’t simple. Sometimes I’m faced with a client whose symptoms interrupt their life so much that it makes ongoing treatment difficult if not impossible. This is (obviously) a show-stopper. We simply must moderate the impact of those symptoms if we are to get treatment launched (which will, of course, we expect to make the symptoms go away).

An example: I have a client whose depression, social isolation, high degree of distractibility, and intermittent flashbacks all result in their having real difficulties in remembering appointments, much less actually showing up for them. Symptoms of their disorder are effectively blocking treatment, so we must achieve real symptom management if we’re to accomplish anything significant.

The intervention: tracking symptom intrusion events

So, we recently started formally tracking commitments he makes – for phone calls with me (in which I do brief counseling), as well as psychotherapy appointments. We use an online Google Docs spreadsheet to track both individual commitments he makes AND, should he fail to keep a commitment, the disruptive symptom(s) which impacted him and caused the problem. The purpose of this is help us both focus on identifying and improving management of specific symptoms which are making his life dysfunctional. To both of us, this direct, straightforward, utilitarian approach appears to be working.

It’s about behavior change, not moral re-tooling

There’s also an important implicit message being conveyed here: when you don’t keep a promise, there’s a reason. Something’s happening in your brain which is not serving you well. It’s not about moral failure, or flawed character, or anything remotely related to that outdated, conceptually limited, seventeenth century way of thinking about human behavior. It’s just a programming glitch, pure and simple. We need to isolate the “bug” in the brain program, and fix it. Since we cannot directly access the program, we go at it indirectly, using known psychological principles[1]. This is indirect access is not ideal, but it’s the only access we have, and its good enough – it will get the job done.

So, looking at my client who has trouble keeping promises, we are not going to do a moral analysis of the situation. We’re going to use our best knowledge to make sense of it, and to change what’s happening. Since we understand (I hope – see note 1 below) that a psychological principle CANNOT be Mosaic (absolute or deterministic)  in nature, just what IS it? It’s a pragmatic description of what is likely to happen in a situation, to the best of our knowledge. It’s a probability statement, a kind of “bet”, if you will.

Watched pots boil faster – how the eyes of a group can help an individual

The key psychological principle on exhibit here is social facilitation.[2] It has been noted in psychology, for over 100 years, that people perform better when observed. Modern updates on this note that this is true, generally, with simple behaviors, but can be quite the opposite with complex behaviors.

What I’m trying to do with my client is increase his sense of being observed, both by me and by him (but not by anyone else, as the Google Docs spreadsheet is not accessible to the public), with the expectation that the mere fact of increased observation will improve BOTH his and my management of his intrusive symptoms.

For every intrusive symptom we’ve identified, I’ve suggested to him (IN the online spreadsheet) a simple cognitive-behavioral management intervention. Because the interventions are simple, they ought to be better utilized when his sense of being observed increases. It’s a reasonable bet. Whether the bet pays off or not will be tracked in the spreadsheet. Both he and I contribute to the spreadsheet. His participation is critical. It’s visible manifestation of his very real motivation to get his life in order. He defaulted on a promise last night, and he himself entered that fact into the spreadsheet (it was his first such default, by the way, since we started spreadsheet tracking).

So, this shared spreadsheet functionality make it possible for him to be more visible to himself, and we’re already seeing improved results – dramatically so. Awareness tends to confer increased choice (another practical psychological principle). Because his behavior is improving, his hope for real change in his life is growing. It’s all a simple thing to do, but has already had a  large effect on his life.

An event in progress

We are early in this intervention effort. It may yet fail, even if it surely hasn’t so far. If it does, we’ll simply assess the situation, redesign interventions, re-engage, and continue tracking outcomes.

Today, however, I’m totally pleased with our results. Our use of the Internet as a private computer network may be a little unusual, but…it’s working. and that’s no small thing – not to my client, and certainly not to me. I like to win. We’re winning.

Notes

1. I need to explain what I mean by “known psychological principles”. I am NOT referring to  “principles” that are Mosaic in nature (i.e., those which have the authority of Moses, of “Ten Commandments” fame). While the existence of such principles have long been asserted, to assert is not to validate. Saying that, I must clarify that in our times truth is NOT validated by reference to authority, but by demonstration in the real world. Obviously, not everyone accepts this, but the scientific psychology/psychotherapy community does, and it is from that point of which which I write.

In the nineteenth century, our best thinkers thought we’d finally located  principles of at least near-Mosaic quality –  in the magnificent Newtonian universe of mathematically describable mechanics and thermodynamics. But, with the emergence of Einstein’s relativity and quantum physics (with which Einstein never made his peace), that all fell apart. This new world-view, essentially in place by the early 20th century, is with us still.

Educated people now generally now that we live in a world imbued with uncertainty (probability), not principles (determinism) of the old sort. “Principles” exist only in the simplicity of casual speech and informal thought, the real world does not appear to offer such principles. One can certainly assert the existence of a “principle”. That’s easy enough. It’s demonstrating its validity – its truth – that always proves surpassingly difficult.

People who exuberantly talk about their “principles” and their “values” as if their veracity were beyond doubt are exhibiting intellectual dishonesty. They give us the conclusion of an argument (thought process), but not the argument itself. It’s as if I said, “I’m simply going to believe that what Newton described to us his Principia is true. Because I trust this document, I know that the world is inherently mechanical, because the Principia says so! Mechanistic determinism is true, else Newton wouldn’t have devoted so many pages to its description!” As a medieval philosopher might dryly say, “non sequitor” – nonsense.

The question here is not whether a mechanical view of the universe is good and true, but whether the assumption that Newton got it right in his Principia is supported (and it is not, in the argument I give here). The “values” crowd invariably makes a gratuitous assumption sabout some source document or idea, then deductively derive propositions from that assumption. It’s child’s play, and we’re not going to do that with real people in the real world. What we think has consequences, so we’d better get it as right as we possibly can – demonstrably right.

2. The referenced article is brief, but well summarizes the concept.

I just had an email exchange with a junior at a local college. Stress is a particular concern with this individual, and they’ve had both major challenges and major successes with stress in recent months. Today, they’re telling me that they are feeling “…a bit under the weather”. My response:

Yeah, used to happen to me a lot, too, in college. Why? Stress, pure and simple. It’s a high stress environment, which is one reason why you’ll be SO happy to be finished with it, eventually! Stress impacts our immune system negatively. Folks in college, where they’re exposed to all known pathogens in the universe (!), must be especially wary of this effect. Sooner or later it’ll “take ya down.”

While working one’s way through the college obstacle course, its wise to take the following recommendations as seriously as you can. I trust their effectiveness highly:

  • At any time need to lower your stress level, do a large sigh, in which you release as much muscle tension as possible. At the end of the sigh, sit in a little mental “quiet spot” for a few moments, being as still as possible internally. Practice not-doing for a few moments. Then return SLOWLY to the task at hand. Focus and move on. Repeat often, as this will train you brain to “settle down” more reflexively.
  • Sleep is the great healer. It “…knits up the raveled sleeve of care” – that’s how Shakespeare puts it. So, sleep MORE than you think you need. It’s putting money in the bank. Nap as often as you feel the need, and AT LEAST ONCE DAILY, preferably for 90 minutes. New research just out reports that people who do this LEARN MORE, recall more, etc., etc. A great payoff for something that also has distinct intrinsic rewards. I try to do this at least once daily. Lately, I’m getting up to 9.5 hours of sleep daily. I feel WAY better. Think I’m on to something? Care to try it yourself???
  • Exercise is the great normalizer, and second only to sleep (and proper eating) as a source of stress relief. By exercise I mean either aerobic (walking briskly or running or swimming, etc.) or resistance (weight room work or equivalent) exercise. Both give you simple tasks to do (“simple” is good), and an opportunity for a mental break. Probably more importantly, both cause fatigue in the large muscles of your body. Fatigued muscles relax, and relaxed muscles actually cause negative feelings in the brain to shut down. That’s stress relief of the most fundamental sort. But wait – there’s more: real exercise induces good, deep, healthy sleep. In college, when I started exercising right after finals, I stopped getting sick (which, until then, was highly likely).
  • Mind your mind: Remember your successes. You have many. You’ll have more. They’re what you’re working for. To get them, you MUST have some failures as well. Welcome then. They teach you what does NOT work – essential knowledge, and what you cannot (yet) do. If you’re not failing some of the time, you’re playing it safe or being lazy. So, work to accumulate those necessary failures, and the successes will come as sure as tomorrow’s sunrise.

For years, my own recipe for recovery or self-rescue from periods of intense stress has been very simple and quite fool-proof: eat, exercise, sleep. It simply always works.

Worth a try, eh?

Since about November, 2008, I have been slowly working to improve the Posttraumatic stress disorder article at WikiPedia. It’s been fun, though at times inordinately time-intensive. Much of the article awaits my planned revisions, and I’m the only MHP (mental health professional) working on it, at the moment. As far as I can tell, I’m the only one who ever has. (More about that later…)

A few of the article’s sections are looking rather good. Medication (which took me 3 days!) is great, and Epidemiology is about 90% there. Other sections aren’t bad, but lack adequate references, or need their references checked (people can be incredibly sloppy). Some need a complete rewrite. Overall, the whole article needs some basic reorganization, which it’s about to get.

Wikipedia has enormous exposure on the Internet. It’s among the top 5 most-visited sites on the Internet. Of those, it’s the only one that’s non-profit. Its influence on a large segment of Internet users and various organizations and publications is truly impressive, and well surveyed here.

It’s also enormous. Nine years old, it currently has 14 million articles. Not words. Articles. Whew. Someone has a lot of free time, yes? In truth, I think it’s more about the passions of a small group of individuals, and the desire to share, than about free time.

It’s written collaboratively. You can go write there, if you like, but…you’ll have company. You’ll have to learn to work cooperatively, and to take the time to learn a little of the culture. There definitely are some rules and traditions you’re expected to play along with. Pretty much all good stuff, to be sure, but with some particulars you do need to know.

A certain amount of it appears overly influenced by popular culture, and an almost (heck – distinctly, at times!) adolescent point of view. But, for all that, there are reams of articles there which are very carefully written, meticulously documented, and flagrantly informative, if I may put it that way. A recently published study found its accuracy compared quite well with that of the Encyclopedia Britannica.[1]

When needing some quick information about some serious topic, Wikipedia is often the first place I turn. If nothing else, the references and links at the end of an article will quickly point me to some excellent information sources. But I usually get  much more than that.

Still, quality varies broadly, so it’s best that you know a little about your subject before reading a Wikipedia article, so you can filter the rocks out of the humus.

So, when I found that one of my clients with PTSD was reading about it there, I reviewed the article, and I was both intrigued and bothered. Some material in the article was excellent, but other major parts were poorly written, dubiously sourced (i.e., using shabby references), or simply irrelevant. I was annoyed. After some thought, I decided to try to fix it. But…I was totally new to Wikipedia, so I started slowly.

I hung out at the article’s Talk page for a while, and wrote some rather long and detailed answers to various questions. Suitably warmed up, I began contributing to the article itself. Slowly it dawned on me that I basically had no competition. There is only one other health care professional  involved with the article, at times, but he’s not a mental health professional, much less an anxiety disorders specialist. So, as it turns out, as long as I do my work according to accepted conventions (write clearly, make sense, and source major assertions with obvious authoritative references), I’m not challenged.  And, because of Wikipedia’s exposure and influence,  I’m feeling like I’m making a real contribution. At the very least, I can begin to stop worrying about what my clients might be learning about PTSD at Wikipedia!

So why am I so alone, as a major contributor to the article? I can only conjecture. In my personal experience, my MHP peers are a very caring, committed, and somewhat narrowly focused group of folks. Granted, work + family = little free time for many people, but that doesn’t tell the whole story. Many MHPs don’t write much, if anything at all. Many are not exactly enthralled by research-oriented psychotherapy. Few have much interest in community education or outreach issues. So, who’s left? Apparently, not many people at all.

I recently appealed for help on an Internet Discussion list I started some years ago. It has about 200 members, and a number of them are quite serious folks. I got no takers. OK…I guess I’m on my way to being the sole professional source for Wikipedia’s PTSD article. I do hope to have company at some point. It can only work to improve the article. However, I’ll stay with it until it meets my standards, which are definitely demanding. How demanding? Well, my Masters thesis in Counseling Psychology ran 385 pages, and I was told I’d written a dissertation. Didn’t get a Ph.D. for it, though.

Notes

1. Jim Giles (December 2005). “Internet encyclopedias go head to head”. Nature 438: 900–901. doi:10.1038/438900a. http://www.nature.com/nature/journal/v438/n7070/full/438900a.html.

I recently added the following section (notes are at end of the post) to the Posttraumatic stress disorder article at WikiPedia (see my next post, for more on this). The information is completely up to date, and rather interesting – although probably only to other MHPs who treat significant numbers of clients with PTSD, which is my specialty –

Proposed changes to current DSM-IV criteria

(Note: the “DSM” is the Diagnostic and Statistical Manual of the American Psychiatric Association – the compendium of established mental illness diagnoses which mental health professionals in the USA, and a few other places, use. The fifth major revision is in preparation, and will be published soon. It’s a Big Deal, at least for some of us.)

On February 10, 2010, the American Psychiatric Association placed online for comment the draft diagnostic criteria for mental illness diagnoses which are proposed for the upcoming DSM-V. After a public comment period closes on April 20, 2010, the criteria will be field tested for two years, prior to final revisions and publication in May of 2013.[1]

The draft PTSD diagnostic criteria contain some noteworthy changes:[2]

  • Criteria A (prior exposure to traumatic events) is more specifically stated, and evaluation of an individual’s emotional response at the time (current criteria A2) is dropped.
  • Several items in Criteria B (intrusion symptoms) are rewritten to add or augment certain distinctions now considered important.
  • Special consideration is given to developmentally appropriate criteria for use with children and adolescents. This is especially evident in the restated Criteria B – intrusion symptoms. Development of age-specific criteria for diagnosis of PTSD is ongoing at this time.
  • Criteria C (avoidance and numbing) has been split into “C” and “D”:
    • Criteria C (new version) now focuses solely on avoidance of behaviors or physical or temporal reminders of the traumatic experience(s). What were formerly two symptoms are now three, due to slight changes in descriptions.
    • New Criteria D focuses on negative alterations in cognition and mood associated with the traumatic event(s), and contains two new symptoms, one expanded symptom, and four largely unchanged symptoms specified in the previous criteria.
  • Criteria E (formerly “D”), which focuses on increased arousal and reactivity, contains one modestly revised, one entirely new, and four unchanged symptoms.
  • Criteria F (formerly “E”) still requires duration of symptoms to have been at least one month.
  • Criteria G (formerly “F”) stipulates symptom impact (“disturbance”) in the same way as before.
  • The “acute” vs “delayed” distinction is dropped; the “delayed” specifier is considered appropriate if clinical symptom onset is no sooner than 6 months after the traumatic event(s).

Finally, the inclusion in the DSM-V of a Developmental Trauma Disorder is still under discussion, at the time of the draft publication.[3]

Notes

1. Gever, John (10 February 2010). “DSM-V Draft Promises Big Changes in Some Psychiatric Diagnoses”. http://www.medpagetoday.com/Psychiatry/GeneralPsychiatry/18399. Retrieved 10 February 2010.

2. “309.81 Posttraumatic Stress Disorder – proposed revision – rationale”. http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=165#. Retrieved 11 February 2010.

3. “Conditions Proposed by Outside Sources”. http://www.dsm5.org/ProposedRevisions/Pages/ConditionsProposedbyOutsideSources.aspx. Retrieved 11 February 2010.

I’ve been a vegetarian (meat – no, eggs and cheese – yes) for over 35 years, for well thought out moral, environmental, and health reasons. I very rarely talk about it. I basically do not proselytize on this subject. That changes, now, and here. I’m going to talk about it, and I want you to think about it. Suddenly, it matters, as you’ll see.

EATING AS A MENTAL HEALTH ISSUE?

A long time ago, someone who’d been born into luxury and comfort and safety discovered that no one can really escape the fact that life hurts. All of us come to sickness, pain, loss, and death. Or, as it is said that he put it: All of us come to unavoidable suffering. (This person, of course, was Siddhārtha Gautama, more commonly known as “the Buddha“, this being an honorific term translating approximately as “sage”, “wise one”, “enlightened one”.

One of the more interesting things about the Buddhist moral tradition is its concern for the suffering of all beings. In our own time, formal mental health intervention is one of the ways we deal with human suffering, along with medical/surgical interventions, etc. At various times, the tide of human suffering has advanced and retreated. It’s about to advance, again, it appears, and what we eat has something to do with this, as you’ll see.

CLIMATE CHANGE AND STRESS

The fast-approaching climate change crisis has already begun affecting people in the lowlands of Bangladesh and some of the island nations of Polynesia, due to threatened and actual rises in sea levels, and increased frequency of typhoons (we call them hurricanes in the USA).

Imagine the impact on your life if rising water chased you permanently from your home, without hope of return in your lifetime or that of your children. You’ll become a climate change refugee. Where will you go? What will happen to your way of life, to the hopes you had for your children?

At the purely human level, this is about exorbitant levels of stress. In sociology, it is well known that in stress-impacted families domestic violence rates go up, sexual abuse rates go up, divorce rates go up, mental illness rates go up. and so on. That’s quite an impact for something that can be traced to small changes in the percentages of certain gases in our planet’s atmosphere.

Now imagine that this mental health challenge is quite significantly related to what you eat, daily. As it turns out, this is true. It’s highly likely that the oceans will rise around four feet in the next century. That will impact coastlines all over the world, because it’s on coastlines where most of the world’s population lives. The impact of storms will be very much increased.

In the USA, large areas of Florida may become to dangerous to live in. New Orleans, Washington DC, New York City, and other major population centers will become at high risk for catastrophic storm damage. Many parts of the world, including in our own country, will have to deal with millions of climate change refugees.

A one meter rise (four feet) in ocean level is estimated to probably create 20 MILLION climate change refugees in Bangladesh. Where will they go?

THE RELATIONSHIP BETWEEN WHAT WE EAT AND CLIMATE CHANGE

Now, let’s talk about what we eat. To put it plainly, what you choose to eat can have a huge impact on the mental health of others (as well as your own health), through the mediating factor of climate change. I want you to understand the relationship better.

Here is an article in which a British Lord, a well-informed, well-placed fellow, says some things to say about the relation between industrial meat production and climate change, something about which we’re going to be hearing much more in the near future.

The point he makes is that among the lifestyle changes we need to seriously consider are some that have nothing directly to do with fossil fuel consumption. With industrial meat and milk production, methane gas is the problem, not carbon dioxide. (This is more generally known as “natural gas” – yeah, the stuff people can cook and heat with.)

This aspect of the climate change crisis – the methane produced by the meat/dairy industry – is not well known…yet. I’ve know about it for about a year.

METHANE IS NOT YOUR FRIEND!

Here are some basic facts you should know about methane as it relates to climate change, with some quality documentation:

  • Methane is lighter than air, and is naturally produced in a variety of ways, including the decay of organic matter in low- or no-oxygen environments. One of those environments is the digestive tracts of rumiant animals (cattle, etc.) Such animals produce “16% of the world’s annual methane emissions to the atmosphere”, [1]
  • “The livestock sector in general (primarily cattle, chickens, and pigs) produces 37% of all human-induced methane”. [2] (quoted in [1])
  • “Methane is a relatively potent greenhouse gas with a high global warming potential… Methane in the atmosphere is eventually oxidized, producing carbon dioxide and water. As a result, methane in the atmosphere has a half life of seven years.” [1] (The core reference used here is [3])

OTHERS DIE SO THAT YOU CAN EAT AS YOU LIKE

An additional aspect of this mess, which is worth mentioning, is that to produce one pound of edible protein from a cow, that cow must consume 22 to 26 pounds of vegetable matter. Feed that matter (or similar crops more suitable for human consumption) directly to people, and you can feed roughly 20 people instead of one. [4] Now you know one of the two reasons I stopped eating meat over 30 years ago.

This doesn’t matter, of course, if you think that the death of a little brown/black kid from nutritional inadequacy (it sounds so benign, yes?) doesn’t matter as much as the death of a little white child. Most people don’t have to think about this, of course, thanks to the blessings of the “out of sight, out of mind” phenomenon.

But…I’m asking you to think about it. At some point the relationship will become unavoidably obvious. Imagine the impact on your mental health if you have someday to realize that you could have done something about this problem, personally, but just walked on past the opportunity, as if it didn’t matter.

START SMALL…KEEP GOING

A final thought: It doesn’t have to be either/or. Simply reducing the amount of meat you eat will be helpful. You can walk slowly toward omitting it entirely from your diet. And you should know this: the concern expressed in Lappe’s book [4] for correct mixing of vegetable proteins to simulate meat protein turns out to be unnecessary. I gave that up a long time ago, and just eat a variety of vegetarian protein sources. My health is,  and has been, excellent. Dr. Andrew Weil confirms the legitimacy of this more relaxed view of the protein sufficiency of vegetarian diets. [5]

It’s easier than you think to do the right thing – for the health of your body, for your eventual mental health, and for the mental health of large numbers of people you’ll never meet. You can do this simple think yourself, and tell others about it. You might even send them here to read this.

References

[1] “Methane” (Wikipedia article). Downloaded 2009.10.26 from http://en.wikipedia.org/w/index.php?title=Methane&oldid=322309918 – mostly a chemistry article, but with some good summaries and references relevant to the industrial meat/methane issue.

[2] Livestock’s long shadow: environmental issues and options. Food and Agriculture Oorganization of the United Nations
Rome, 2006. Downloaded 2009.10.26 from http://www.fao.org/docrep/010/a0701e/a0701e00.HTM A PDF download version of this is available here: ftp://ftp.fao.org/docrep/fao/010/a0701e/A0701E.pdf (for broadband use only – it’s a large file).

[3] Chapter 2 of: Climate Change 2007: The Physical Science Basis. Contribution of Working Group I to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change. This is a section of the most recent publication of the Intergovernmental Panel on Climate Change of the United Nations Environment Program (UNEP) and the World Meteorological Organization (WMO). This group of 500+ scientists of international stature was established “… to provide the world with a clear scientific view on the current state of climate change and its potential environmental and socio-economic consequences.” (http://www.ipcc.ch/organization/organization.htm)

[4] Frances Moore Lappe. (1991). Diet for a Small Planet. New York: Ballentine. This is the book, originally published in 1971, which turned me into a vegetarian. I bought a copy on the way out of town, leaving the University of Colorado with a fellow graduate student to go deer hunting in Montana. I went along as a  “participant-observer”. I helped skin and dress 5 deer. The amount of sheer wastage we produced was staggering to me. I had no idea meat production involved such waste, and this was only in the butchering part of the process. It was an incandescent experience. The book gave me the rationale for my diet-change, but this experience gave me a good part of the motivation. I’ve never looked back, in 35+ years. What’s to miss?

[5] Weil, Andrew. (2001). Eating Well For Optimum Health: The Essential Guide to Bringing Health and Pleasure Back to Eating. New York: Harper.

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(This post was written at the suggestion of two people who commented on . Leaving therapy – so what’s the problem?)

Sometimes therapy ends, and it’s not your (the client’s) idea at all. I have no statistics on how often this happens, and I don’t know how this happens, when it does.  I do know that sometimes therapists move to another  location, or financial support for the therapy ends, or maybe a spouse moves, taking you to another location for reasons not deriving from anything you planned.

While I cannot address all situations, perhaps I can address some of them.

THERAPIST TERMINATES YOU

This can happen if they come to believe that they are not the one to be providing services, or if they don’t think you are getting enough out of it, or are in therapy for reasons other than that you are wanting, and able, to do meaningful work. In any case, it not at all a common event. I’ve never done it. I don’t think I have much to say that might be useful, in this case, except that the best thing to do, if you want to continue, is find another therapist – and to learn as much as you can about the reasons for the termination, so you can make use of the information, if possible.

FUNDING ENDS

The involvement of “managed care” brings in 3rd party service utilization reviewers, whose job it is to minimize spending of money for treatment. This makes sense if one seeks to maximize profits, or maximize service coverage to a population under conditions of limited funding. In terms of meeting the clients need, it is less likely to make sense.

Regrettably, sometimes utilization reviewers do not really understand the situation they are reviewing, or do not accept the therapists assessment of it, or have an evaluation process they must follow which drives their decision for them. The result, in all cases, is that you’re leaving before you want to.

This is a difficult situation – certainly for you and likely for your therapist too.  There are a number of ways in which you can try make the best of it. If it were me, I’d seek out books that seems to address my problems, and I’d journal a lot – talking to yourself on paper is a proven method for self-therapy, as is “bibleotherapy”. Several studies have shown these methods, if well done and conscientiously applied, to be just as effective as traditional therapy. That’s right – just as effective.

The problem is that you have to manage yourself. There’s no one to lead you through the process. A major key to susccess here is motivation. People can do incredible things when motivated. So, seize the opportunity, and simply declare to yourself that you will NOT be defeated by circumstances. Then start reading, and writing, and WORK at it. Act like your life depends on it. It does, yes?

THE PROBLEM OF SITUATIONAL INJUSTICE

Being, in effect, kicked out of therapy against your will is probably hardest for those who have a real sense of not having been treated fairly by life, and many people have good reasons for thinking that this is their lot.

OK. Life isn’t fair. Almost everyone I can think of, including me, has reason for complaint. But, the problem is that if y9u get stuck in the complaint, nothing really happens. You have to get to the next stage: converting your protest into self-supportive action. What that might be is well beyond anything I can address here, but the general idea is the real point I want to stress: You stop being a victim of circumstances the day you decide to. You do this by changing your response to circumstances over which you have no control.

If the world isn’t giving you what you need, find a way to get it for yourself, or at least to get something for yourself. Consider Beethoven, the great German Classical/Romantic composer. He wrote 9 symphonies, and by his third, he was obviously going deaf. It’s essentially a worst-case scenario. What did he do? He did what he could to get treatment, and it didn’t work. He also continued writing music, for years and years, hearing it only in his head. He got something for himself, and in so doing gave us all much more. He did the best he could with what he had. What else was there to do? You must do the same, if you hope to achieve a sense of happiness.

SELF-SUPPORT

You got into therapy to get something for yourself – an act of self-support. If therapy is no longer available to you, you simply continue this action, with what IS available to you, and there’s always something.

I recall a wonderful story I heard once about a meditation student. He was becoming discouraged. He worked hard but didn’t think he getting where he wanted to go with his meditation practice. He consulted his teacher, and was simply told that what he needed to do was go out into the area where he lived, find discouraged people,  and encourage them!

This sounds a bit absurd, initially, but it’s actually very clever. It’s often easier to do something for others than for yourself, but in this case, encouraging others is likely to give the student ideas about how he might encourage himself. But there’s more: by being helpful to others, he’s giving sustenance to his own sense of self worth.

DO WHAT YOU CAN DO, NOT WHAT YOU CANNOT

You cannot change the national health system, or how your insurance company operates, or the fact of your having to live with a limited budget. So, don’t throw yourself against a rock – an immovable object. If you want to advocate for systems change, do it! But be realistic. And while you’re working to change the world, work also promote your own health in every way you can think of. THAT you CAN do.

In doing this, you give yourself PRIMARY SELF RESPECT, something I’m much in favor of. You must be the first person who offers you support and encouragement. If it’s hard, do it anyway. Persist, and it’ll become easier, like anything else you practice.

One way you can work to improve your situation is to join a self-help group. Some can be found  on the Internet, and other will be advertising localling in your region – or you might start one. The challenge with these groups is to be wary of advice from people who really don’t understand your problem. So, even if you work with a group, you should be reading and writing (journaling) on your own, to help you “keep your own counsel”.

DO NOT DEFEAT YOURSELF

Life itself is struggle. Your struggle to advance your own mental health is just a part of that. In challenging circumstances, the first rule is not to defeat yourself, which is what you do if you give up. It takes maturity, and courage, to continue working when the world is not supporting your effort very much. If your mental health is at stake, the matter is serious, and it likely that your continued effort is justified. People who struggle usually make progress, though it may not at all be linear progress.

So, remember: there’s always something you can be doing to help yourself. Identify it, and go to work. Be resolved to be defeated only by that which you cannot control, not by your failure to engage with that which you do control.