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Alternative Prescriptions and Mental Health

I came across this article in Medical News Today, which discusses how exercise can help with depression. None of that is a surprise, of course, and as I type this entry, I’m still gross from having come back from the gym, so yay!

Here’s the interesting part of the study: Individuals who did “prescribed exercise” showed a rise in endocannabinoid levels in their blood – something typically associated with improved mood. This did not occur with people who selected their own exercise.

Wait, what?

Why would that be? Two potential explanations from the article:

One explanation could be the small number of participants and the variation in intensity levels in the preferred-intensity session. Some participants completed the preferred session at a constant, light intensity, while others varied the intensity.

Another explanation for the difference in results between the preferred and prescribed exercise sessions could be that exercising at a level that someone else prescribes has a psychological as well as a biological effect.

It’s that second explanation I want to focus on. We know that anti-depressants often have a powerful placebo effect. Placebos occur, in part, because someone expects a treatment to work. That being said…we know that exercise does, in fact, help with the treatment of depression and other mental health challenges. So that can’t be a complete explanation.

This got me thinking – what if Doctor’s began to “prescribe” other therapies? Go for a damn walk. Meditate. Eat better. And I don’t mean just give it as advice, I mean take out a little prescription pad, write something down and hand it to the patient. Would the patient be more likely to treat that prescription with more care than they would regular advice? Would they actually spend time reducing their stress levels, or just taking ten minutes out of their day to put headphones on and meditate?

I don’t know. But I think that, when you combine aspects of the placebo effect (expecting a therapy to work) with scientifically proven therapy, you’re increasing your chances of success and recovery (again, not a Doctor here, just speculating).

This entire study and line of thought has made me wonder if we shouldn’t try to get Doctors and other health care professionals to look outside of the realm of traditional prescriptions and more into the world of prescribing lifestyle changes.

As you likely know, depression rates are rising across the Western world. We can’t just rely on therapy and medication to get ourselves out of this mess. Something has to change, and I think one aspect of that chance must be revamping the way we look at therapy. Maybe this idea of “alternative prescriptions” can help?

As always, let us know what you think in the comments below!

Suicide Prevention Hotline appears set to get a three digit number

Some ridiculously good news out of the federal government (yes, really) when it comes to mental health:

The Federal Communications Commission plans to move forward with establishing a three-digit number for the federally-backed hotline.

Thursday’s announcement from FCC Chairman Ajit Pai signals the culmination of one of the final legislative priorities of former Senate President Pro Tempore Orrin G. Hatch of Utah.

Pai said that he intends to follow a staff recommendation for establishing a three-digit dialing code, likely to be 9-8-8, to reach the network of the National Suicide Prevention Lifeline, currently 1-800-273-8255 (TALK). That program is funded through the Health and Human Services Department.

Why is this so important? Two things.

First is the obvious: It makes it easier for people to get the help that they need. A 1-800 number – even one with “TALK” in it – can be too easy to forget. The Suicide Prevention Hotline is a critical resource for people who are in crisis. Elevating that number, and making it easier for people to call, can help to direct people to the care that they need. This is particularly important for someone who is in a state of mind where suicide seems to be an option. A 1-800 number may be too difficult to dial. A three digit number – one like 911, which has been drilled into our brains since we were kids – is easier.

This is even more important because of the frequent conversations around suicide prevention whenever there is a high-level suicide. In the aftermath of one of these tragedies, there is often an increased effort to make people aware of this number. Think about it. How many times have you heard someone say words to the effect of, “You’re never alone. If you or someone you love is in crisis, call 1-800-273-TALK.”

Let’s keep in mind that this number is a national resource, and the volume of calls it receives is reflective of that. The national hotline will actually route your call to the nearest available center. For information on how many calls your state hotlines received, you can check out this report, which has statistics from July 2018- December 2018. For example, during this period, there were 30,346 calls made from Pennsylvania residents. For added context: In a three month period, .0023% of the state’s 12,810,000 residents called. Folks, that’s not a small number.

Second, and maybe more importantly: This decision elevates the national conversation about suicide prevention. Only important causes get three digit numbers: Emergency services (911), directory assistance (411) and local services (211) are the only ones in Pennsylvania. Making suicide prevention a three digit number will help to push suicide prevention to the top of the public agenda, and this is something we absolutely, desperately need to do. This is a good decision, and I cannot wait to see it finalized.

Any thoughts you want to add? Let us know in the comments below!

 

Five years public: A reflection and a request

It’s Sunday evening as I type this, and it is a beautiful night. And, as Facebook was kind enough to remind me, it’s also a sad anniversary: Today, five years ago, we lost Robin Williams to suicide.

William’s suicide inspired a slew of memorials, sadness and outpourings of grief. It also reinvigorated a conversation about mental illness in American society that desperately needed to happen – and now, needs to continue. Williams had always struggled with mental illness and addiction, and had always been very open about his pain. Now, the extent of his demons were laid bare for all to see.

I was letting my dog out in the backyard when my wife texted me the news of William’s death and suicide. And it hit me hard. As I’ve said repeatedly, if a man like Robin William’s could lose his battle, what hope did I have?

Then, while scrolling through a Facebook status, this comment, from someone I defriended on the spot: “So sad Robin Williams committed suicide. He just needed more faith in Jesus!”

That comment crystallized it for me: People really were this dumb about mental illness.

And that resulted in this Op-Ed in the Allentown Morning Call, by State Representative Mike Schlossberg: Reflections on a Personal Journey with Depression.

From the op-ed, words I had never said publicly before:

It was October 2001 when I began my journey with depression. A freshman at Muhlenberg College, I had been sad before, but never like this. It was a hopelessness that felt like a black cloud smothering everything I did.

It felt like my future was a wall — that there would never be any brighter days. I didn’t know I was suffering from depression at the time, but I do remember I couldn’t see any hope. The words of friends and parents were largely irrelevant, and I didn’t understand how I would ever feel OK again. After suffering through that blackness for many weeks and months, I began to contemplate if suicide wasn’t the better option.

Monday’s tragic suicide of Robin Williams has left millions of Americans baffled. How could a man of such talent, humor and power choose to end his own life? The sad and tragic truth is that mental illness, depression and suicide know no boundaries.

My path to recovery began with Rick at the Muhlenberg College counseling center, who helped teach me how to change my thinking, cope with the stress of a new school and how to deal with a breakup with my girlfriend from New Jersey.

When it became clear words weren’t enough and the anxiety attacks began getting stronger, he recommended me to a psychiatrist, who put me on an anti-depressant and anti-anxiety pill, which I still take to this day. I type these words without any shame. Why would I be ashamed? Are any of you embarrassed to be taking Lipitor for your cholesterol or Prilosec for your heartburn?

My point is this: Millions of Americans suffer from mental illness, and millions recover. There is no shame in saying you are depressed, you are anxious, and you need help.

There are many real tragedies which flowed from Robin Williams’ death. First and foremost is the human one: A husband, father, artist and inspiration left us way too soon. But it can’t be forgotten that William’s death likely caused others to end their lives as well, as a direct result of the suicide contagion effect. One study attributed as many as potentially 2,000 suicides to William’s public suicide. This heaps unmitigated pain on a nightmare.

What studies like this don’t quantify is how many others, like me, chose to go public in the aftermath of William’s suicide. I was one of many, many people to do so – and I can’t imagine the collective, positive impact that all of us combined have made. Nothing occurs in isolation. My struggle and the hope that I hope I was able to inspire only came from William’s suicide.

So today, on this important five year anniversary for me, a request: Share your story, share your pain. It doesn’t require an op-ed or a Facebook status. But relieve yourself of the secret shame which may be surrounding you. It doesn’t have to be bottled up. If my experience as a public official has shown anything to me, it’s that the general public is much more understanding than I ever would have anticipated. Telling my story has improved my life in a million different ways, and many of them deeply personal.

Tell your story. Tell it loudly, proudly and publicly. Be part of the moment which saves someone else.

 

Mental illness and gun violence are barely related – it’s just a convenient scapegoat for cowards

As you know, it was a bloody week in America, with a massacre in El Paso and Dayton leaving 22 and 9 dead, respectably. It’s been another awful year in America when it comes to mass shootings – 255 in 217 days by August 5.

As can be anticipated at moments like these, Democrats and Republicans turned to their expected policy solutions to stop the bloodshed. Democrats argued for stronger gun control laws, including reinstating assault weapons bans and Emergency Protective Orders which could get the guns out of the hands of those who seek to use them to kill people or hurt themselves. Republicans tried to pivot to mental health and argue that the problem is just too dang complex to solve. In a speech after the shootings, President Trump said, “Mental illness and hatred pulls the trigger, not the gun” (whatever that means).

Other Republicans echoed these comments. Ohio Senator Rob Portman said, “Look at the mental health crisis in our country today, there aren’t enough laws…” South Carolina Senator Lindsey Graham said:

Here’s the thing – the whole argument that this is a mental health problem, not a gun problem – is rank, stinking bullshit.

I’ll start by quoting those who make the argument far more eloquently than I ever could. In a blistering press release which gained national attention, Dr. Arthur Evans, CEO of the American Psychological Association, blasted the notion that perpetrators of mental illness were behind the spike in mass shootings. Said Dr. Evans:

Blaming mental illness for the gun violence in our country is simplistic and inaccurate and goes against the scientific evidence currently available.

“The United States is a global outlier when it comes to horrific headlines like the ones that consumed us all weekend. Although the United States makes up less than 5% of the world’s population, we are home to 31% of all mass shooters globally, according to a CNN analysis. This difference is not explained by the rate of mental illness in the U.S.

“The one stark difference? Access to guns…

As we psychological scientists have said repeatedly, the overwhelming majority of people with mental illness are not violent. “

Evans went on to say that America desperately needs more gun control.

Former Presidential candidate Hillary Clinton also chimed in with a similar comment:

Indeed, experts have repeatedly blasted the notion that mental illness is tied to a rise in mass shootings. According to Adam Lankford, a University of Alabama criminologist who reviewed gun violence in 171 countries, access to guns is a far better predictor of gun violence than mental illness. The Secret Service has said, “Mental illness, alone, is not a risk factor” for predicting violence. The Washington Post notes that, in a 2018 analysis, 25% of active shooters had some sort of mental illness. A 2015 study on the same subject had that number at 22%.

This notion that it’s the mentally ill are the perpetrators of mass shootings is, generally speaking, unmitigated crap. Indeed, multiple studies have shown that the mentally ill are far more likely TO BE VICTIMS of violence, and gun violence – not the perpetrators of it. According to one study, the mentally ill are 3.6 times more likely to carry out an act of violence than the general population, but 23 times more likely to be that victim. The same study said that the vast majority of violent behavior occurs “due to factors other than mental illness.”

But hey, why let a good soundbite get in the way of avoiding a solution to a problem, right?

Oh. And one more thing. Republicans in Congress and at the state level have said that this is a mental health problem. So, naturally, they want to address it by increasing funding and access for people who suffer from mental illness, right?

Hahahaha.

President Trump and his Republican allies spent the first two years of his Presidency trying to eviscerate the Affordable Care Act, which has done a few little things for mental health care, you know, like improve access and reduce costs for people with mental illness…small stuff, I guess….

Let’s stop the bullshit: Trying to blame gun violence on the mentally ill is a convenient excuse for those who don’t want to actually deal with gun control. It’s not based in reality. And the rhetoric certainly isn’t matched up by the actions taken when it comes to improving mental health care.

Be smarter than they think you are. Don’t fall for this lie.

 

How mass shootings affect (everyone else’s) mental health

It’s Sunday morning as I type this, the day after a bloody day in America. Unless you live under a rock, you know why.

20 dead in El Paso, Texas.

9 dead in Dayton, Ohio.

The elected official in me – indeed, the human – is outraged. 29 dead YESTERDAY ALONE in mass shootings because America refuses, collectively, to take the policy steps necessary to deal with these tragedies. To act on responsible violence-protection measures which could stop this bloodshed. To condemn white supremacy as a society and rid ourselves of it, root and branch. To adequately fund mental health initiatives which could save lives.

Our cowardice will condemn us all.

Alright. That’s not even the rage-fueled reason I’m writing today, although Lord knows that I could go on for hours about it, and that people much smarter and eloquent than me can and are doing the same. The reason I’m writing today was inspired by this tweet:

Two thoughts: First, this is beyond awful. Second, yes. How many of us have had similar thoughts? You’re just at the mall with family and friends, having a grand old time, and suddenly brought out of your pleasant state by wondering, “Hey, if there’s a shooting, what do I do?”

These thoughts are disturbing, intrusive, unpleasant, and slightly necessary. While the odds of any of us actual being involved in a mass shooting remain low (despite the rise in recent years), the possibility always exists, and it makes sense for all of us to be prepared and aware of the potential danger.

But society has now evolved to the point where, to an extent, we are all wondering about mass shootings. Every time I drop my kids off at school, I wonder about it. It’s in the back of my head, and depending on world events or my mood, it may be front and center. How many of you feel the same?

I would never claim that the pain of any of us not involved in a shooting like this is anywhere near the trauma of someone who was directly involved, so please don’t misunderstand. But, the elected official in me wants to make sure that we are clear about the damage that guns are doing to ALL OF US in society, and that they have changed the way we live in America to a constant state of fear and, as the tweet above puts it, a “low level anxiety.”

I can think of at least two broad and real examples. First, to those of us who are already prone to anxiety/stress and already likely thinking the worst, it gets your guard upon a near constant, low-level basis. It gives you a very real fear to focus on, and that, in turn, can pull you out of a sense of joy or relaxation you are feeling.

Second, and I’d say more damaging, is the impact these mass shootings has on kids. I was speaking with a group of guidance counselors a few weeks ago, and they were telling me how many students they speak with – on a regular basis – who are terrified that they will become a victim of a mass shooting. Again, as bad as things are in America, the odds of that happening are still low. However, the rise in shootings, the nature of our interconnected world and the ubiquity of technology magnify the odds of this occurring. This is particularly true for children or teenagers who don’t have the skills to know that the odds of this happening are still relatively slim. As a result, kids are scared to go to public, safe places – and this includes schools. What kind of damage will this have on them as they grow? As they attempt to learn or find safety and comfort?

We don’t have to live this way. And if we’re ever going to find the courage to actually not live this way, we have to acknowledge the impacts which gun violence has on every member of society, beyond those who are directly effected. The touches everyone of us.

 

Does hypnosis help – long term – with depression and anxiety?

All of us who suffer are constantly on the lookout for alternative ways to cope with depression and anxiety. As I was putzing around on Facebook the other day, the thought occurred to me: Is hypnosis one of those methods?

I’ve written in the past about the benefits of trying to relax throughout the day. One such way I’ve done so is by listening to ASMR videos, even if they are just running in the background. I’ve also always found guided relaxation videos/tapes to be very calming, and again, that sort of inspired this particular entry for me.

First, let’s review what hypnosis is, and what it isn’t. Hypnosis will not make you cluck like a chicken. It will not train you to become an assassin. It will not make you do anything you don’t want to do.

Hypnosis – true hypnosis, not the exaggerated, movie kind – is defined as heightened concentration, focus and openness to suggestions. While it is often associated with going into a state of deep relaxation, it is not to be confused with going into a coma-like state. Hypnosis patients are fully aware of what is going on, they are just put into a more relaxed state.

I did a little bit of digging about the available research when it comes to depression, anxiety and hypnosis. Healthline refers to hypnosis as a “complimentary therapy” which can be used to treat depression with minimal side effects, but cautions that it shouldn’t be the only type of therapy which a person uses. WebMD does the same, while noting that hypnotherapy can be used for the purposes of suggesting new (and more productive behaviors) or analyzing past traumas. However, both pages noted that hypnotherapy can be associated with the process of implanting false memories – as such, it should be avoided by people who may be sustainable to those, like individuals who suffer from dissociative disorders. Meanwhile, the Anxiety and Depression Association of America goes more in-depth in terms of how hypnosis can compliment cognitive behavioral therapy, describing how hypnosis can be used to generate images about what someone wants or needs.

In terms of specific research, I found a couple of papers. One 2010 study noted that there was a relative “dearth” of actual research on hypnosis’ effect on depression and anxiety, but that it was easy to imagine, conceptually, how hypnosis could be helpful for these disorders. Most interesting is a 2016 study, which made the rather startling claim that hypnotherapy was actually more effective than Cognitive Behavioral Therapy. That’s…interesting. It’s a finding that I’d argue would have to be replicated in order to be believed, but that’s quite the claim!

If nothing else, again – I think hypnotherapy can be deeply relaxing. Guided imagery (a process similar to hypnotherapy) can be effective for relaxing and for stopping anxiety attacks in their tracks. Heck, I remember my therapist once designing a guided imagery recording for me. So yeah, I think hypnotherapy can be useful – when done by a licensed therapist and in conjunction with any other medical professional you may have.

What about you – any experiences with hypnotherapy, positive or negative? Let us know in the comments!

 

What is “depression fog,” and what can you do about it?

If you suffer from depression, you probably read the world “depression fog,” and instantly went, “Yep, I gotcha.” Depression fog is one of the many, many lousy symptoms of depression.

For the unaware, imagine the way a migraine scrambles your brain, or a hangover. It’s basically that: Cognitive dysfunction caused by your mood. Depression fog – or “brain fog” – alters your ability to think and function. It can alter a slew of cognitive and physical functions, including critical thinking, reaction time, memory and more.

You just feel sleepy. Like you just woke up.

As noted by the above Healthline article, depression fog can make it hard for you to pay attention to things. You can’t remember things as well as you normally can. You have trouble concentrating and always feel tired.

I’d add a component of depression fog which I don’t think is adequately covered in the reading that I did on the subject: Guilt. When you can’t function as well as you wish you were, you often berate yourself: “Why aren’t I thinking right? God, why do I suck so badly?!?!” And then you get more depressed…and then the brain fog gets worse…and the spiral continues.

How do you get past the fog? In my experience, this is difficult to do without treating the underlying depression. For me, on the instances when the fog has descended, I’ve felt better as my mood has improved. The two are unquestionably linked. However, there are some treatment options which specifically address brain fog. For example, according to the above Healthline article, a recent study found that the drug Modafinil can be effective at treating cognitive dysfunction.

Other treatments, again, are the same as ones which you use to manage depression and your physical health: Get enough sleep, eat well, get exercise, etc.

I’d add two things: Go easy or go hard.

Again, this is just me talking here, so take everything I am about to say with an entire shaker of salt. But when I’m down, I sometimes just crave my bed. That can be a really good thing, or a really terrible thing. I mean, on one hand, going easy on yourself can be deeply therapeutic, but it can also inspire a ton of guilt and inadequacy. I suppose that part depends on your mood or chemistry. And I have to say – I always get scared when it comes to going easy on myself. I’m always so worried that if I just lie down in bed I will never, ever want to get out of it.

Everyone has their own brain chemistry, wants and needs. So, to that end, I’d make two suggestions. First, if you think that you can chill in bed without hating yourself, do it. Relax. Read a good book. Watch a good movie. Rest up, and then see how your mind is functioning.

Or, if you’re like me, tell your body: “No. I will not surrender to this. I’m going hard” – and then drag your butt to the gym. And fee proud of yourself afterwards.

My two cents, but as always, I’d love to hear yours. How do you fight the brain fog? Let us know in the comments below!

 

The importance of the human touch to prevent suicides

I wanted to talk a little more today about a study which – if the findings are replicatable – could go a long way towards proving that the best way to prevent suicide may be simply showing that you are someone who cares.

The study itself took place in Australia and was run by Dr. Gregory Carter of the University of Newcastle. Carter and his team sent suicide-attempt survivors a postcard eight times over a 12 month period.

The postcard didn’t say much, and it wasn’t fancy. On the front, it had a cartoon dog with a letter in its mouth. On the back was this message: “Dear X, It has been a short time since you were here at the Newcastle Mater Hospital and we hope things are going well for you. If you wish to drop us a note we would be happy to hear from you.” the card also had contact information for two doctors and the hospital.

The results? The group who received the card showed a 54% reduction in future suicide attempts, but the effort worked only for women.

Intuitively, this makes sense, of course. It’s no surprise that social contact and relationships are a preventative factor when it comes to suicides. And showing someone that you care can, of course, make a huge difference. How many times have you heard of a case where someone came back from the edge simply because there was one person who cared deeply about them?

This isn’t a silver bullet, of course. But it does reiterate a basic and sensible human truth: We can pull people back from the edge if we just show them that they care, that they matter, and that there are ways to get help if they are feeling down.

I’d also argue that this shows that all of us have a role to play when it comes to suicide prevention and helping people get through their darkest moments. To be clear, again, none of us are responsible for someone who ends their own life – but all of us can be part of a solution. Care for each other. Follow up with friends who are showing warning signs of depression or suicide. Ask if they are okay. You don’t have to have the solution. But just being a caring human can, apparently, go a long way towards preventing someone from taking their own life.

 

Oregon students can now take mental health days

So, in my political world, I’m a pretty progressive guy. One of the states which I have always watched closely has been Oregon. Oregon has been a progressive success story of epic proportions: From the environment to minimum wage increases to abortion rights to gun control to expanding economic opportunity to all residents, Oregon has led the way. 1

And then, I came across this story: Teens in Oregon can now take mental health days as an excused absence from school. It was done largely to address the stigma which surrounds mental health. According to Debbie Plotnik of Mental Health America:

“The first step to confront this crisis is to reduce the stigma around it. We need to say it’s just as OK to take care for mental health reasons as it is to care for a broken bone or a physical illness.”

The law specifically states that students can have up to five absences in a three month period – and anything more requires a written excuse to the principal.

In response to concerns that the law would make it easier for students to get out of school, Haily Hardcastle, one of the teenagers involved with the lobbying for the law, said, that students would take time off with or without the law – but the new law may encourage students to take their own mental heath more seriously, and would require schools to recognize mental health in their attendance policies.

Oregon’s rate of suicide is 40% higher than the rest of the nation.

I’m…I’m really intrigued by this. It does seem like a lot of days. And I wonder how this effort would interact with other attempts to remedy chronic absences – something that we really struggle with in my home school district of Allentown. But, I believe that Mrs. Hardcastle’s comments are correct – a kid is gonna take a day off if they want to, and if we can encourage them to discuss why, maybe we can help save their life.

Regardless, I’m extremely intrigued, and I’m hoping to pursue this one more. And if you have any feedback, I’d love to hear it!

 

Netflix removes controversial suicide scene from 13 Reasons Why

13 Reasons Why is a Netflix series based on the popular book by Jay Asher. The book deals with the aftermath of the suicide of Hannah Baker, who then sends tapes to people involved in her life, detailing the reasons behind her suicide.

The show was then turned into a hit Netflix series, which generated a ton of controversy for a variety of reasons, chief among them being the graphic depiction of Baker’s suicide, which features Baker, in the bathtub, slitting her wrists, crying in pain and ultimately bleeding to death.

I’d written about the show before, and mainly in terrible terms: It’s premier had been tied to a rise in suicide among 10-17 year olds, and the graphic depictions of Baker’s suicide seemed to violate every best practice of reporting on suicide.

Netflix – in response to the controversy – has changed the season finale of Season One, which featured this scene: It has now been been completely removed. In a statement, Netflix said:

“We’ve heard from many young people that 13 Reasons Why encouraged them to start conversations about difficult issues like depression and suicide and get help — often for the first time. As we prepare to launch season three later this summer, we’ve been mindful about the ongoing debate around the show. So on the advice of medical experts, including Dr. Christine Moutier, chief medical officer at the American Foundation for Suicide Prevention, we’ve decided with creator Brian Yorkey and the producers to edit the scene in which Hannah takes her own life from season one.”

As the Hollywood Reporter noted, a variety of anti-suicide groups praised the removal in a joint statement.

The damn shot should never have aired. In prior statements, show creator Brian Yorkey had said that they didn’t want to make suicide look peaceful and thus glamorize it. I get that. And – if you assume that they were operating with the best of intentions – I get that they were trying to make it seem realistic and less abstract.

But, as Vox notes, that’s exactly the problem:

The theory is that for people who struggle with suicidal ideation, anything that can make suicide feel more familiar to them and cause them to keep thinking about it can be dangerous. That’s part of what leads to suicide contagion, the phenomenon in which media coverage of a death by suicide can lead more people to die by suicide.

As I argued in my entry earlier in the week, we have to be very, very careful with how we discuss suicide, lest we inadvertently plant the idea in someone’s head that suicide is somehow acceptable or “freeing.” While the type of discussion which occurred here is different than the blog entry I was writing about, the concept is the same: Be careful in how you discuss suicide, particularly given the way it could impact the most vulnerable of people.

I’m glad Netflix did this. But the show has generated controversy because their is evidence to suggest that it is correlated with more people dying by suicide. That’s a major problem, and they need to do better.