Tag: depression

How to stay hopeful in a world filled with darkness

This week:

I spent most of Saturday crying on and off. It’s almost impossible not to. You keep reading and hearing how the world is coming apart at the seems, how things are getting so much worse, how toxic the political environment is.

Everything does seem hopeless. I get that. But it isn’t. While world events are overwhelming, and the darkness does often seem to be closing in, now, more than ever, those of us who are capable of having and expressing hope have an obligation to do so.

If world events seem overwhelming to you, here are a few ways you can try and draw some hope.

First: Concentrate on the good in the world, not the evil.

As it happened, the day of the Pittsburgh shootings, my family and I were going to an open house at a local Mosque. I did this Facebook live video while I was there:

The conclusion is this: Evil is loud. Good is soft. But there is still more good than evil. In the aftermath of the Pittsburgh shootings, hundreds rallied for peace. Pittsburgh blood banks put out a call for help after the shootings and were overwhelmed with donors. First responders did their job that day, heroically running into the Temple, and likely saving lives while doing so, even while four of their own were injured.

The world may seem broken, but that’s because evil screams and gets more attention. Don’t concentrate on that. There is so much good in this place. You don’t even have to look very hard.

Second: Find what you can control, and do something about it.

One of the hardest lessons for me in government and politics has been learning the limits of governmental power. And no, I don’t mean that in the sense of wanting government to be able to do more. I mean acknowledging that there are simply some things beyond our control. You get into government and politics because you want to help people, and then you realize that you can’t save everyone.

What all of us can do, however, is make a difference in certain areas, and that’s what I am referring to. What are you good at? What are you passionate about? Concentrate on that, not on all the evil in the world. Find where you can make a positive, tangible difference in someone’s life. For me, that’s been mental health and other areas of government and pubic policy I am passionate about. For you, that will almost certainly be something different, but find what it is and go for it.

Don’t give into the hopelessness. Find where you can make a difference, and make it.

Third: It’s okay to unplug and take care of yourself.

You can’t do good without taking care of yourself. Unplug for a few hours or a day or two. It’s okay. Don’t feel guilty. And if that guilt becomes overwhelming, remember: You’re no good to anyone if you burn out.

Fourth: Draw solace from the fact that there are millions of others like you.

I’ll refer you back to the blog entry I wrote a few weeks ago: Millions upon millions of Americans are deeply worried about the world in which we live. That doesn’t change the world, no. But it does create a base of people who agree with you – that things are scary, and that we have to work to make the world a better place.

Finally: Remember the arc of history.

Despite it all, humanity has made more progress in more areas than any of us could have ever dreamed. Progress is not inevitable. It zigs and zags. But, with the concentrated effort of a dedicated world, it does come. Concentrate on that, focus your efforts on the forward momentum of humanity, and we will be okay.

Using Facebook to diagnosis depression

I came across this article in Medical News Today, which reviews a study done in the medical journal Proceedings of the National Academy of Sciences. To make a long story short, the study reviews Facebook data and medical records, analyzing information posted by the more than 100 people who had been diagnosed with depression.

While there is ample evidence that social media can be a cause of depression (I have written about the topic before), this is the first time that I have ever seen published information which notes that social media can be used as a diagnosis tool for depression. That has some pretty interesting implications.

First, the study itself. Here’s one of the most important parts:

The scientists fed the information into an algorithm. In total, Eichstaedt [author of teh study] and colleagues analyzed 524,292 Facebook status updates from both people who had a history of depression and from those who did not.

By modeling conversations on 200 topics, the researchers determined a range of so-called depression-associated language markers, which depicted emotional and cognitive cues, including “sadness, loneliness, hostility, rumination, and increased self-reference” — that is an increased use of first-person pronouns, such as “I” or “me.”

The researchers found that the linguistic markers could predict depression with “significant” accuracy up to 3 months before the person receives a formal diagnosis.

Here’s a look at what words can be used to predict depression (none of this will be a surprise):

F4.large

Also notable is that more self-referential language is found more often in people with depression. That’s not really a surprise, as depression and narcissism are often linked.

To be perfectly honest, none of the above should be very surprising. Extended use of terms that indicate pain, distress or rumination would obviously indicate someone who is in a crisis. What is interesting, however, is that you can actually use these terms on social media to predictably and reliably diagnosis depression. That, to me, is fascinating. It is yet another tool in the toolbox for diagnosis depression, and as numerous studies have shown, depression remains massively under diagnosed, with some estimates showing that up to 2/3 of all individuals with depression are undiagnosed.

Empirical data confirms it: “Trump Anxiety Disorder” is real

Let me add a disclaimer here: This one is going to be difficult, because I’d like to approach the subject below as a legitimate mental health issue, not a political one.

I’ve written about this before, but a new Politico article, along with some of the data in it, has pushed this topic back to the surface.

From the article:

 The American Psychiatric Association in a May survey found that 39 percent of people said their anxiety level had risen over the previous year—and 56 percent were either “extremely anxious” or “somewhat anxious about “the impact of politics on daily life.” A 2017 study found two-thirds of Americans’ see the nation’s future as a “very or somewhat significant source of stress.”

All of this has led to the creation of – and I can’t believe I’m typing these words – “Trump Anxiety Disorder.” According to Dr. Jennifer Panning, that disorder is defined by, “increased worry, obsessive thought patterns, muscle tension and obsessive preoccupation with the news.”

Additional research has shown that the election resulted in people having a more difficult time having “open and honest” conversations and damaged relationships.

On a personal level, this jives with not only my experience, but conversations I’ve had with others. Years ago, I remember speaking with my therapist about how I was very stressed by the state of world affairs, and I commented that I knew how ridiculous that sounded. He looked at me as if I had three heads. “That’s not ridiculous at all. Almost all of my patients have said that.”

I was so, so relieved. And as I have relayed this story to others, they are relieved as well – it’s not just them! At all!

So, what is there to do about this? Yeah, on that one, I have very little. Unplugging and setting boundaries is important, but the best way I have been able to keep my focus in the age of Trump is this: Concentrate on where you can make a difference. Focusing on the non-stop news cycle (CNN/MSNBC/FoxNews are the worst things on the planet) will drive you nuts, no matter who you are. Concentrate on the areas where you can make a positive difference, and go from there.

That’s the best advice I can give. If you have anything better, please leave it in the comments below!

Do mental health apps work?

One of the things I have seen a lot of lately is apps that claim to be able to help you improve your mental health and get treatment. There are a bunch out there – this includes apps like What’s Up, Mood Kit and MY3, among many, many others.

Here’s the important question: Do they work?

I bring this up because there’s been a bit of controversy with one app, BetterHelp. The App says that it will hook users up with licensed therapists. The controversy, however, emerged with many YouTubers who had engaged in sponsored ads with BetterHelp.

As long as the sponsorship is transparent, I don’t personally see an issue, but problems emerged with BetterHelp itself. First, it’s terms of services explicitly couldn’t guarantee placement with a qualified, licensed professional:

We do not control the quality of the Counselor Services and we do not determine whether any Counselor is qualified to provide any specific service as well as whether a Counselor is categorized correctly or matched correctly to you. The Counselor Services are not a complete substitute for a face-to-face examination and/or session by a licensed qualified professional.

Umm…..that’s a major, major problem. That’s beyond not acceptable. Any app that claims it will provide mental health professionals to users has a moral obligation (and I hope a legal one!) to ensure that the counselors themselves actually are licensed professionals, or at least disclose in a VERY publicly way when they are not.

This entire incident got me wondering about these apps. How good are they? Do they work? Are they substitutes for seeing a counselor in a face to face setting?

First, the obvious: Answers to the questions I posed above will vary widely. It all depends, of course, on the quality of service offered.

The most comprehensive answer I could find was in this paper, published in March 2018. The answer varies, of course, but in sections, it seems to be yes:

  • Depression: ” A meta-analysis of 18 randomized controlled trials (RCTs) covering 22 mobile apps revealed that using apps to alleviate symptoms and self-manage depression significantly reduced patients’ depressive symptoms compared to control conditions (g=0.38, P<0.001).” However, the apps work best when depression is mild to moderate, not severe.
  • Anxiety: “A meta-analysis of nine RCTs that evaluated the effects of smartphone-delivered interventions on symptoms of subclinical and diagnosed anxiety disorders revealed that users experienced reductions in total anxiety after using anxiety treatment apps (g=0.33, P<0.001). Additionally, anxiety-focused mobile apps delivered the greatest reductions in anxiety symptoms when paired with face-to-face or internet-based therapies. In fact, replacing outpatient patient-therapist sessions with a mobile app resulted in no significant loss of treatment efficacy.”
  • Schizophrenia: “Self-reported patient experience survey results revealed high adherence, positive user experience, and broad-ranging clinical benefits.”

Wow. So, yes, theoretically, these can work!

I have two additional thoughts. First, hey, if it works, it works. The mental health practitioner shortage is, in my opinion, the greatest crisis affecting mental health, and if apps can help close that gap at an affordable rate, it’s worth using.

Second. however, is this: It has to be a real app, with high quality and scientifically based therapies and design. In the digital day and age, it can be all too easy to design a subpar treatment program that can scam users out of money and provide no clinical benefit. I hope, in the long run, that the federal government will step in and better regulate these apps in order to protect users from negative experiences that can damage their mental health and sap their limited resources.

Do you have any experiences with mental health apps that you want to share? Please let us know in the comments below!

A mental health hero: Jason Kander

Last week, a brave politician made national news by dropping out of a high profile Mayoral race. That man is Jason Kander, and he’s someone worthy of our attention and praise.

Kander is the former Missouri Secretary of State. In 2016, he ran for the U.S. Senate as a Democrat, and in a tough year for Democrats, he came within three points of defeating incumbent Senator Roy Blunt. Kander ran an amazing campaign and aired one of the best ads of 2016, in which he talked about his army background and support for universal background checks while assembling a gun…blindfolded.

Kander’s military story is equally impressive: He volunteered for the Missouri and volunteered for a tour in Afghanistan in 2005, serving as an intellegence officer.

Kander’s political star was on the rise, and until last week, Kander was a candidate for Mayor in Kansas City. That changed with this heartbreaking note, in which Kander discussed his battle with depression, PTSD and suicidal ideation:

About four months ago, I contacted the VA to get help. It had been about 11 years since I left Afghanistan as an Army Intelligence Officer, and my tour over there still impacted me every day. So many men and women who served our country did so much more than me and were in so much more danger than I was on my four-month tour. I can’t have PTSD, I told myself, because I didn’t earn it.

But, on some level, I knew something was deeply wrong, and that it hadn’t felt that way before my deployment. After 11 years of this, I finally took a step toward dealing with it, but I didn’t step far enough.

I went online and filled out the VA forms, but I left boxes unchecked — too scared to acknowledge my true symptoms. I knew I needed help and yet I still stopped short. I was afraid of the stigma. I was thinking about what it could mean for my political future if someone found out.

Kander dropped out of the race and has since been silent on social media. I assume – and sincerely hope – he is getting the care he needs and deserves.

Broadly speaking, the stats on veterans, mental health and suicide are horrifying:

  • According to a 2014 report by the Department of Defense, there were 1,080 suicide attempts (245 suicides) among active-duty service members for all armed services in calendar year 2013.

  • A recent study of 52,780 active-duty members of the U.S. Air Force found that 3 percent of male participants and 5.2 percent of female participants reported suicidal ideation in the previous year. Of the participants that reported suicidal ideation, 8.7 percent also reported a recent suicide attempt.

  • Veterans who screened positive for PTSD were 4 times more likely to report suicidal ideation than veterans who did not, and the likelihood of suicidalideation was 5.7 times greater in veterans who screened positive for PTSD and two or more comorbid disorders.

Those who take care of us – our first responders and military veterans – deserve better. And I sincerely hope that Kander’s story helps to push this issue.

It takes people like Kander – national political rock stars – discuss their pain, to destigmatize an issue, and to help more people get help. I can only imagine how many veterans are looking at Kander and thinking, “Me, too,” and then hopefully getting the help they need. Kander’s words will have a larger impact than I think most of us could ever hope to have.

Most importantly, best wishes to Kander. I cannot imagine what demons he faces – what pain he took on – in the name of protecting America. He, and countless other veterans and first responders – deserve our love, and our resources, to heal. I am so grateful to all of them for their bravery.

A strange gender gap: Men, women and writing about depression

As part of my marketing efforts for Redemption, I’ve been reaching out to other author’s in similar book categories, which means other Young Adult books which deal with mental health, depression and anxiety. These efforts are how you’ve seen some of the other Six Question entries.

The other day, I noticed something strange:

Let me give some backup here to that tweet: I just went back through my notes on other authors. I identified 115 authors who also had books in this category. Of those 115, only 18 were men; 89 were female, and another 8 either had names that could have been either gender or used initials (which often than not, means they are a woman – see J.K. Rowling, who went with her initials because her publishers were trying to disguise the fact that she’s a woman).

Anyway, that difference is massive: 115 authors, and a mere 16% are men!

What the hell is going on here?

This is just a hunch, but I think what I’ve found is a microcosm of society as a whole: Women are much more willing to discuss mental illness and emotions than men. According to research, both men and women are more likely to be viewed more negatively when they suffer from “gender atypical” mental health disorders. Additionally, according to a 2015 study, men are more likely to have negative attitudes towards health seeking, which results in a less significant uptake in using mental health services.

This blows me away. I mean, it shouldn’t – none of this is surprising, and intuitively, I think most of us recognize that women are more comfortable seeking help and discussing emotional topics than men.

There are so, so many issues facing women today. I’m so glad that, as a member of the human race, we are doing a better job at discussing vitally important issues like women’s equality and safety. But I think one of the things we don’t do a good enough job of – and my above observation would seem to back up this assertion – is discussing how these gender stereotypes also hurt men.

Please, please do not misunderstand me here – I am not saying, “Boohoo, but what about the white man, life is so hard for us, we are so discriminated against!” That simply isn’t true, and it is abundantly clear that other minorities and women have much, much tougher obstacles to overcomes than any white man does. It is also apparent that we, as a society, must do a better job at creating a more level playing field and changing our culture as it pertains to women and minorities.

But, I think it’s important to note that men can also be the victims of gender stereotyping and expectations – and clearly, this is one such example. What I would hope this observation would make us realize is that we must do a better job of working towards true equality in society – and men have many, many ways to benefit from achieving that ideal as well.

TMS Update: Is this what feeling better feels like?

So, it’s been about six weeks since I started Transcranial Magnetic Stimulation. As I type this, I’ve had about 26 sessions, with another ten or so to go.

How am I feeling? Is it working? Better. And yes. It is working. And I feel reasonably convinced at this point that it’s not just the placebo effect.

Let me discuss the second part of that question first, because I think it’s almost the most important. Why do I think it’s not a placebo effect? Because life is NOT perfect. I think – I don’t know, but I think – that if this was a mere placebo effect, I’d be sitting here, flying through the sky. Life would feel perfect. There would be birds and sunshine and candy everywhere and all that crap. Then, eventually, the effect would wear away, and I’d crash hard.

Simply put, that isn’t true. Everything doesn’t feel perfect. I’ve still gotten depressed about things, upset. Most of the time, it’s been normal life events. On a couple of days I’ve still woken up really down, but that feeling fades easier than it did before treatment. Simply put, things aren’t magical.

So then, let me tackle the question in the title: Is this what feeling better feels like? Maybe? I can’t answer that question definitively yet, because I don’t know . Look, I’ve been on anti-depressants and in treatment, as needed, since I was 18. I’m 35. Half my life. So I’m not quite sure what “normal” is.

Here’s what I do know. Since I started TMS and began to feel it’s positive impacts:

  • I’ve been enjoying things more. A lot more. A couple of examples:
    • As I’ve long since established I am a big computer game nerd. I play these games more, and I just like them more. I’ve had more fun playing them.
    • I was with my wife and my kids at a local food fair. I’m sitting there, eating this big ole Taco Salad. My son is leaning on me, eating Mac & Cheese. He’s snuggling in. I’ve got my little boy, good food, happy environment, great music. I felt good. I felt lucky. My phone was firmly in my pocket. I felt like I was in the moment. That didn’t happen before.
  • I wake up in the morning without this impending sense of dread. Without feeling like there’s a ceiling over my head, pressing down. It just feels like the world has less pressure. I still feel stressed, still feel overwhelmed. But the world doesn’t feel like it is filled with nearly as much darkness.
  • I’ve been less snappy. Less grouchy.
  • I’ve had an easier time concentrating and getting things done. My motivation is higher.
  • You know that myth about the depressed writer? Bull. Depression does help give you insight and experience for writing, but if it’s too severe, you ain’t writing. And I’ve had a much, much easier time writing lately.

Arguably the most important observation since this started has been from my wife. She was skeptical when TMS first started. She told me last week that she didn’t think it would work, and part of her almost wishes she didn’t know I was doing it so she wouldn’t risk being fooled by a placebo effect as well.

Why? Because she noticed the difference too. She told me the other day, unprompted, that she sees it’s working. She sees that I am happier. And my wife is smarter than me! So if she is noticing this, it makes me more convinced that this thing really is working.

Are things perfect? Hell no. They never will be.

But they are unquestionably better.

—

DISCLAIMER: First, again, I’m not a doctor or medical professional – I’m a damn politician and writer. I’m certainly doing my best to write an accurate description, but if you have any questions or concerns, please contact a medical professional. Second, this probably goes without saying, but I’m going through this treatment like any other normal person and paying with my insurance. I am not receiving any compensation or consideration whatsoever for sharing my experiences. However – and again, this is just me writing – I’ve had my TMS from the TMS Center of the Lehigh Valley. I am grateful for their skills, professionalism and willingness to work with my rather insane schedule. I highly, highly recommend them if you are local to the area.

Science Fiction and Mental Health:The Lost Opportunity

In the course of writing my book, I made an assumption – one which I would ultimately find to be incorrect: That mental illness and science fiction would be very popular subgenres. They are not. I’ve been surprised by this. In fact, thus far, I’ve only been able to find one other book which intermixes mental health, science fiction and young adult – Portals by Kristy Acevedo. That’s a REALLY great book, by the way – if you liked Redemption, you’ll like Portals – Kristy Acevedo was kind enough to do a blog interview with me. That’s here.

I thought the two genres would go much better together. The reason? The sheer freedom of it. I’ve written two books now – Tweets and Consequences (which was a non-fiction look at social media, politicians and epic failures) and Redemption. Obviously non-fiction is a little bit more limiting. But, even fiction can be very constraining. If you write a regular YA book, for example, you are limited by the realities of the genre. For example, It’s not a good or consistent book if your YA character suddenly grows wings and flies away.

Science fiction and fantasy, of course, are different. All bets are off. You set up your world, it’s limits, and then you go from there. In Redemption, I created a Lord of the Flies-like world – on a space ship – and we were off to the races. The extremes of the world in Redemption allow me to explore the mental illness of the main character, Ash. Clearly, it’s science fiction, but the constraints of the world are still pretty similar to this one. As such, I get the opportunity to explore mental illness in a whole new light, but one that is simultaneously interesting/entertaining (at least, I hope!) and relevant to the reader.

Portals does a similar exploration – it creates a fantasy world with aliens from the future who are trying to save the world. The main character has debilitating anxiety issues, and the extreme stress of the world has major impacts on her mental health, her limits, and what she learns about herself and those around her.

But again, I’ve been surprised. I haven’t seen a ton of interaction between these subjects, and that, in my estimation, is a lost opportunity. Science fiction allows you to break traditional boundaries. I’ve actually always thought that the best science fiction just takes advantage of the weird elements it creates. Star Wars isn’t about space, it’s about good vs. evil. Star Trek (which one reviewer on the Amazon page was kind enough to compare Redemption to!) isn’t about the damn United Federation of Plants, it is about social justice and an exploration of the galaxy and the human psyche. It seems like mental illness and it’s related topics would be a perfect fit for this universe, but alas, unless I have been mistaken, this is not a topic which has seen much interaction.

Am I wrong? I’d love to be wrong. If I am wrong, please correct me – leave your best book recommendations in the comments below!

TMS Update

Well, as I type this I am 10 sessions into the 30 session Transcranial Magnetic Stimulation sessions. 1/3 of the way there. Woohoo!

How’s it going so far? Well…maybe better? Honestly, yeah, starting at the beginning of the 2nd week, it did start to feel like I was feeling a bit better, but let me define what I mean. Birds did not start singing. The sky is not the bluest it has ever been. Depression is still there. Life is not perfect.

But, to some extent, I have to say, it does feel like things have gotten a bit better. My life hasn’t dramatically improved, but there does seem to be a bit less…pressure. Like, the ceiling of depression which pressured down on me seems a bit lighter. That’s the best way I think I can put it.

To be clear, this may be placebo. The readings that the Doctor gave me showed that depression probably wouldn’t start to improve until week four. When I mentioned this to him, he said some people did feel better in week two, but for many it was longer, and it is certainly possible that this is just placebo. So I guess we will see!

Some other notes:

  • For me, there are no side effects. Even the slight headaches that during the treatment have become more tolerable. I haven’t taken a Tylenol before a treatment since it started, and my head has not hurt a soon as the treatment has ended.
  • You really do build a resistance to the minor pain caused by the treatment. Of the ten times I’ve had it, I’ve fallen asleep three of them, which is kind of funny.
  • I went through the math in my head the other day. As I said in the last entry on this subject, the magnet taps your head for four seconds, then rests for twelve. During the four seconds in which you get tapped with the magnet, it makes contact 40 times. A session is twenty minutes, so you get tapped 3,200 times a session. Multiply that by the 30 sessions, and congratulations, you’re getting smacked by a magnet 96,000 time over six weeks!

Only 64,000 taps to go!

The futility of gratitude – and why it’s so important

I had an interesting realization in therapy the other day, and it led to this blog entry. Stay with me for a second.

My therapist and I were talking about trying to change my mindset from both a depression and anxiety perspective. I think a great deal of anxiety comes from a fear of “not being able to handle” any given situation – be that going to school, work, travel, whatever. I’m not quite sure what “not being able to handle” means, save for turning into a blubbering ball of sad and fear, but whatever. Now, by and large, that’s a silly fear. There’s no such thing – not really – as “not being able to handle” something. Sure, there are some life events and experiences that go better than others, but short of dying, you get through life.

This sort of fear in stressful situations can manifest itself in many ways. One of them is that it causes a shift in mindset. You no longer engage in new experiences to enjoy them or learn from them – instead, you do so in order to say “I survived” them. This mindset can be damning for so many reasons. You start an experience not looking to enjoy it, but to get through it. This kind of bunker-mentality can absolutely destroy your ability to get any joy. To try new things. To adventure or gain new experience. Indeed, it makes you afraid, and it makes you far less willing to be adventurous. You live in a constant state of looking over your shoulder, wondering when the anxiety attack will hit. Wondering when you will get cripplingly sad. Wondering what goes wrong next.

This way of thinking, of living – survival versus gratitude – can be absolutely crippling. And it leads me to the point of today’s entry: I don’t want to just survive. I want to thrive. I want to learn and to live. Don’t you?

How do you do that? Hahaha, yeah come on, you know I don’t have an answer. I only have a piece of one. That’s this: Try to change the way you approach new situations. Approach them from a perspective of gratitude and gaining new experience. Instead of entering an anxiety-provoking situation from the perspective of, “Oh, God, how am I gonna get through this?” ask yourself, “Okay, what can I learn from this?” or better yet, “How can I be grateful for this experience?”

Now, I titled this entry, “The futility of gratitude” because I am not an idiot. When you are depressed or anxious and someone tells you to “Be grateful,” you probably want to punch that person in the face. Grateful? For the crippling fear and sadness? That’s madness.

But, that’s exactly why it’s so important.

The only way to break anxiety and depression is to change the way you think. The way you process thoughts and emotions. And the only way to do that is to shift your mindset. So, just try this. Try, every now and then, asking yourself this question: “How am I learning from this new and difficult situation?” or “What can whatever I am experiencing right now teach me so I don’t encounter these problems in the future?” Fear is only crippling is it denies you the chance to grow, to learn. And there’s no such thing as an experience you can’t handle.

So, try to ask yourself that. Try to ask yourself what you can be grateful for. What you can learn. Shift your mind, and maybe you can shift your emotions too.