MANAGING STRESS IN OUR LIVES

Tuesday
Oct302018

IS LONELINESS AT THE HEART OF ADDICTION?

Recently I listened to a TED talk by Rachel Wurzman entitled: "How isolation fuels opioid addiction." She discribes her experience of having tics [Tourettes Disorder] that she calls "unvoluntary." Dr. Wurzman experiences her involuntary tics as unvoluntary meaning that she feels like she is doing the tic movement and not an external force. However, Dr. Wurzman recognizes that her tics are not related to her conscious intentions or attention. Dr. Wurzman then makes the point that we all have things that we do in healthy ways and other things that are not healthy and this can help us to understand what others are experiencing, including those with tic disorders and addiction. So, why is it important that we can understand each other? Dr. Wurzman goes on to talk about the opioid epidemic and it's connection to being lonely. She states that this epidemic is killing 91 people every day and it is getting worse. Dr. Wurzman understands that addiction is a medical, neurobiological problem and yet she feels that we can help people with addictions by changing how we respond to them. To change how we respond to people with addictions she feels that it is helpful if we understand how and why our brains cause behaviors like urges to use substances. Dr. Wurzman's research suggests that loneliness may be reinforcing the brains of addicts to seek comfort from substances as their striatum's are seeking things that have most frequently been associated with reducing their feelings of loneliness. These responses [seeking things] are like they are on autopilot, so that when there is a stimulus there is then a very rapid and automatic response from their brains. 

Importantly, according to Dr. Wurzman, feeling socially connected to others is part of what the striatum does. The experience of feeling pleasure in social interactions is modulated by opioid receptors in the striatum. If some one is experiencing intense loneliness the opioid receptors are sensitized so that anything that reduces this sense of loneliness, such as taking opioids, is intensely and very rapidly sought. Therefore, loneliness may keep people addicted and social connections may help people not be addicted. However, those social connections need to be strong enough to convince the striatum that it is safe to let go of the immediate and reliable relief that taking opioids [and other drugs] represents. Dr. Wurzman also believes that to establish powerful social connections, it is better to connect with each other not focused on one aspect of ourselves/others [like addictive behavors] but recognize how we all have unvoluntary or automatic type behaviors. This helps us to realize that we are connected to people who happen to have different unvoluntary or automatic type behaviors. 

After listening to Dr. Wurzman, I wondered about a connection between the social isolation experiences of people with addictions and those who suffer from Post Traumatic Stress Disorder [PTSD]. If so, then does the isolation theory apply to people who have PTSD? And how would this influence treatment of PTSD?

What do you think? 

Friday
Oct192018

WHAT CAN WE DO ABOUT SUICIDE?

Dr. Igor Galynker, who is the director of the Galynker Suicide Research Laboratory at the Icahn School of Medicine at Mount Sinai in NYC was quoted in Clinical Psychiatry News [Vol 46 No 8 August 2018] stating that "using suicidal ideation as a risk factor [for suicide] is flawed" as this will miss 75% of people who end up dying by suicide. He recommends using the patient's feeling entrapped and the clinicians own sense of the patient being at risk, instead. Dr. Galynker also noted that while hospitalizing suicidal patients can help them to feel more in control and mobilize support systems there is still a spike in suicides after hospitalization [250 x for women and 100 x for men]. Dr. Galynker also notes that according to the CDC, the suicide rate has been increasing since 2000 and has been increasing by 2% per year from 2006-2016. Additionally, Dr. Galynker also notes that suicide intent was disclosed by less than 25% of people who completed suicide. However, Dr. Galynker does see a benefit for safety planning such as limiting access to firearms, nets under bridges and smaller quantities of medications. He also mentions risk factors such as romantic rejection, terminal illness and humiliating failures in buisiness.

David Brent, M.D. in a paper entitled "Preventing Youth Suicide: Time to Ask How" in the Journal of the American Academy of Child Psychiatry.2010.09.017 identifies several risk factors for youth to become suicidal. These include: mood disorder, especially if linked with non-affective comorbidities [conduct disorder; substance abuse; etc.]; a previous suicide attempt, especially if the child is still depressed and suicidal; suicidal ideation combined with alcohol or substance abuse; other family members having been suicidal or completed suicide; family adversity such as abuse; and parental criticism for youth that are already self-critical [work by Wedig and Nock in the Journal of the American Academy of Child and Adolescent Psychiatry. 2007;46[9]:1171-1178 and in the same journal Nock. 2009;48:237-239].

Also, in the AACAP News [September/October 2018. Volume 49; Issue 5] Tracy Asamoah, M.D. writes about "Suicide in African Americans." She indicates that the rate for suicide in African American children had increased from ages 5-11 while it had decreased for white children [JAMA Pediatrics. 2012;169;673-677]. Also, the CDC Data and Statistics Fatal Injury Report for 2016 showed that while suicide rates for African American youth was less than that for white youth, the rate of increase in suicides was greater for African American youth. Primary factors for this include the under recognition of mental illness in these youth as problem behaviors are more likely to be punished versus treated, and the lack of resources for these youth in underserved communitieis.   

Wedig and Nock identified a risk factor and the possibility of an interventional approach to reduce the risk. Clearly reducing risk for suicide is important as well as efforts that focus on prevention of suicidal behaviors. Access to mental health treatment can reduce the risk of suicide. This will require that mental illness in African-American youth be recognized instead of seeing their behaviors as criminal and requiring punishment. In addition, access to preventative mental health services and screening tools can help reduce the suicidal behavior.  Unfortunately, these services are less available in underserved communities that have a higher percentage of African-American youth.

Finally, a study from 2016 [Walker R, et al. A Longitudinal Study of Racial Discrimination and Risk for Death Ideation in African American Youth. Suicide and Life-Threatening Behavior. 2016; 47: 86-102] found that experiencing racial discrimination was correlated with death ideation and depressive and anxiety symptoms. Therefore, it is important to be aware of the impact of racial discrimination and disenfranchisement on risk for suicidal thought and also on the access to mental health services. This highlights the critical role that supporting families and extended families and local communities as they will help to empower youth, who are at risk for suicidal behavior, to seek and make use of treatments.

What do you think?

 

Tuesday
Sep252018

IS IT BETTER TO SHARE THAN TO KEEP?

One of my patients said the above as he was reflecting on how much he has benefited from attending alcoholics anonymous meetings. He felt that he had recieved a lot from others attending the meetings and had also gained a lot by sharing his story with others. I then said that I believed that it was not possible to worry about the past if you are sharing your life with others. My patient said that this seemed right to him and yet I wasn't sure about it. So, why would sharing our lives with others make worrying about the past impossible?

Maybe it is because if you are sharing with others you are listening to them without your own reactions and this allows you to feel connected to them and you are more likely to share with them as they listen to you. It could also be that listening is like sharing as you are sharing the othe person's life experience as you listen. So, maybe if we feel connected to others it is harder for us to worry about the past. If that it so, does it mean that we worry about the past because we feel isolated from each other and the worrying is our effort to feel connected to others? Yet worrying does not seem to actually connect us to others.

What do you think?

Tuesday
Sep252018

I'M AGAINST FASCISM/ I'M IN FAVOR OF ENCOURAGING AND SUPPORTING EVERY HUMAN

I would hope that all of us [humans] would be against fascism. So what is fascism? It seems like it is a way to justify controlling others [supposedly] for their own good. That, of course, is impossible as I believe that taking control from people is never for their own good. Fascism purports to promote the nation but it really seems to support sa favored race over the rest of the population. This often means that a few people under the leadership of a dictator will exert control over the rest of the people in their country purportedly for the good of those people. To maintain this type of control over others, the leaders need to completely suppress any form of opposition. They become bullies to sustain their power.

So what is attractive about fascism? Well, there is a promise to take care of those who support the fascist leaders as these leaders act like they know what is best for the people in their country. People are freed from having to make decisions and are often forbidden from acting independently in any manner. The problem with this seems to be that people need to make decisions for themselves and be responsible for themselves. They have difficulty functioning as humans if they don't. This might be why Fascist governments don't last as the people revolt. 

What evidence is their that we need to make decisions for ourselves and be responsible for ourselves? Is it really better to encourage and suport others versus telling them what to do?

What do you think?

 

Sunday
Aug192018

WHAT IS THE SOURCE OF EVIL?

Assuming that evil does exist, I believe that when anyone judges someone else or sterotypes others or thinks/discusses prejudicial ideas or in any way acts to separate theirselves from others, they are acting in a way that is potentially evil or are beginning of a process that will clearly become evil. [I am not referring to the dictionary definition of evil as profoundly immoral and malevolent.]

The above definition of evil might seem kind of wierd or wrong, however my patients have taught me that what I mentioned above is correct. Every time one of my patients [or myself] non-specifically criticize or judge others it is wrong. It is wrong because it separates us from those people and as humans we are meant to be connected to each other. 

So, how can any of this be clarified much less validated. One way I validate this information is by having the opportunity daily to learn from my patients how they relate to others when they are being judgmental compared to when they are able to stop being judgmental [reduce it by a lot] and how that impacts the quality of their relationships. Over and over I have seen this change correlated with significant improvements in their relationships to others [including their families] and their own level of happiness. They are much less stressed and are able to not dwell on the past as much. 

So now I appear to be promoting giving up judging others as a way to reduce stress and increase satisfaction with our lives and our happiness. Well, I am. Now what do others say? I searched for information and found an article in Psychology Today from October 24, 2014 by Barbara Markway, Ph.D. entitled  "10 Reasons To Stop Judging People."  The 10 reasons are: 1. don't blame yourself as we are "hard wired to have fight/flight/or frozen" reactions and it is "natural" to judge others; 2. be mindful so you are self aware enough to catch yourself before you say something judgmental; 3. depersonalize the situation as you remind yourself that it is really not about you but likely reflects the conflict that the other person is having; 4. Look for basic goodness in others. We "naturally scan for the negative," but the positive is there; 5. Repeat "just like me." This reminds us that we are more like each other than different and actually from the same subspecies; 6. Reframe what you are hearing to consider that it really is not personal [about you]; 7. Be willing to look at your own behavior as this may be the source of  your upset with someone else; 8. Educate yourself about the other person and see if they may be disabled in some way; 9. Give the other person the benefit of the doubt. We generally all do the best we can; 10. Feel good about yourself and you will be less likely to judge others.  A final comment by Dr. Markway states that judging other defines us, not others. There are many other articles and research that appears to support that we are happier if we do not judge others.

I disagree with Dr. Markway about her stating that it is natural to judge others and that we naturally scan for the negative about others.  I believe that we have learned to cope with our own insecurities by judging others and being critical of them. So, judging and criticizing others is not natural. But why then do we do these things? Many of us have had experiences when other people acted in ways that we felt overwhelmed and threatened. Then, to keep from feeling even more overwhelmed, we learn to judge others and be critical of them so we won't be fooled into trusting them.  We also try to keep things from getting worse by taking on responsiblity for others. These coping strategies may keep things from getting worse but they also alienate us from others that can lead to depression and anxiety.  

So, what can be do to stop coping by judging others and criticising them? It helps to be aware that we are doing this and then choosing [outloud] to stop doing it. We then will be able to learn that it is safe to stop judging and criticizing others and that we will actually feel calmer and less stressed if we do.

What do you think?