Every one of us has a mysterious double life.
For about two thirds of the time we are conscious beings, thinking about the world within and without, and negotiating our ways through the obstacles of life. For the other one third of the time we are nearly lifeless lumps of flesh, unconscious to everything but our own fantasies, as we lie flat in bed asleep. We all know that sleep is important for health. But for an activity that consumes about 8 hours of everyday of life, surprisingly little is thought about the act of sleeping, or the way our culture teaches us to sleep. Sleep behavior, like all human activities, is defined by our culture.
Sometimes, the practices taught by our culture can impact on the way our bodies function. As medical anthropologists, we research ways our cultural practices may be affecting our health. And we have found that the way we have been trained to sleep may be one of the most important causes of various diseases plaguing our society.
Of course, when you consider the culture of sleeping, it includes such isues as the length of time to sleep, and time of day for sleep. Do you take frequent naps or do you sleep 8 hours straight? Do you sleep at night or during the day?
Other issues concern sleepwear. Do you sleep nude, or with pajamas or lingerie? Do you sleep in your underwear? Should the sheets be natural fabrics, such as cotton or silk, or is polyester okay? What about the detergent and fabric softeners used in the sheets, pillow case, and pj's?
Should you eat before you sleep? What is the impact of watching television before sleep? Should you take sleeping pills to help you sleep?
These are some of the culturally defined issues that help determine how we sleep, all of which may have some potential impact on health. However, there is one cultural issue that tops the list of importance, and which may greatly determine your health status. It has to do with your sleep position. Are you sleeping on a firm, flat bed, face down, with your nose and eye compressed against the bed and pillow? Or are you on your back with your head slightly elevated, as is the case for many native cultures that use hammocks or other non-flat surfaces for sleep?
The reason we ask this last question is because the circulation to the head and brain is completely related to your body position when sleeping.
We all have had a time of experiencing dizziness or lightheadedness when getting out of bed too quickly. This effect is called orthostatic hypotension, and results from the fact that blood pressure falls when you lie down, and sudden raising of the head may temporarily deprive the brain of sufficient blood pressure, resulting in the dizziness or lightheadedness. The blood pressure soon rises, increasing the blood supply to the brain, as you feel normal again.
This phenomenon shows that the body's position, relative to gravity, influences head and brain circulation. You can also demonstrate this by doing a head stand, which many yoga practitioners do daily. Intracranial pressure rises dramatically, as blood rushes to the head, which becomes beet red, and the neck veins swell out, as blood pools in the venous system.
But apart from these examples, very little, if anything, is mentioned in medical physiology textbooks about gravity and its impact on circulation. Yet, you cannot fully understand brain circulation without considering gravity.
The effect of gravity on brain circulation is purely mechanical, and relates to the position of the head relative to the pumping heart. When we are standing up, the head is above the heart, so blood must pump against the force of gravity -- from the heart to the brain -- lowering the effective pressure with which the arterial blood is delivered to the brain. Meanwhile, drainage of blood from the brain to the heart is facilitated by the pull of gravity.
In contrast, when we lie down and are horizontal, the heart and head are now on the same plane. This eliminates the effects of gravity on brain circulation. Blood from the heart pumps powerfully into the head without gravity's resistance, increasing intracranial pressure. And blood returning from the brain to the heart must do so without gravity's assistance, causing a back-up of blood in the brain.
Essentially, intracranial pressure increases, and overall brain circulation diminishes, when you are lying flat compared to standing up.
Of course, the body is intelligent and has mechanisms for controlling brain pressure under different gravity situations. When the brain gets pressurized from lying down, there are various pressure receptors in the head and neck designed to lower blood pressure, thereby preventing too much brain pressure and the possibility of blowing a blood vessel or creating a cerebral aneurysm. This is why blood pressure is lower when we are sleeping, and horizontal.
But these brain mechanisms for adjusting pressure have their limits. As we go through the day in a vertical position, gravity relentlessly pulls our body's fluids downwards, which is why many people have swollen feet and ankles by day's end. Once we lie down, the gravity effect is lost, as fluid leaves the legs and returns to the head. So despite our brains normal defense mechanisms, throughout the night intracranial pressure increases and is highest in the morning, after hours of lying flat, and lowest at the end of the day, after hours of being vertical.
What happens when intracranial pressure is high from long periods of lying flat? The increased arterial pressure causes extra cerebral spinal fluid to form in the brain's ventricles, increasing intracranial fluid pressure. The ventricles swell and the cells of the brain become bathed in excess fluid, essentially causing brain edema. This edema would lower the available oxygen and sugar for brain cells. The lack of gravity assisted drainage from the brain would cause a back-up of blood in the venous system and collecting sinuses in the brain. The brain's circulation would become relatively stagnant, as the only force moving blood through would be the pushing force of the arterial pressure (which is greatly reduced after going through the cerebral circulation) and the sucking force of the heart's right atrium. And in addition to the brain swelling under the pressure, the eyes, ears, face, sinuses, gums -- the entire head -- will become pressurized and the tissues congested with fluid!
There is one field of medicine that avidly studies this effect of gravity on physiology. That sub-specialty is Space Medicine. Astronauts in space are in a zero-gravity field, and it is known that this causes blood to shift to the head and brain, causing increased brain pressure and accompanying migraines, glaucoma, Meniere's disease, and other problems associated with a pressurized, congested brain. To study the negative effects of zero-gravity here on Earth, these space scientists have people lie down flat! However, since medicine is so wide a field, with sub-specialists learning more and more about less and less, there is little exchange of ideas between space medicine and Earth-bound medicine. Otherwise, someone would have realized that lying flat is what we do when we sleep. If it causes problems for astronauts, then couldn't it cause problems for everyone else?
We found out about this Space research while we performed our own research into sleep positions as a possible cause of migraines. We hypothesized that sleeping too flat for too long each night could lead to brain pressure and fluid accumulation (edema) within the brain tissue, with associated hypoxia and hypoglycemia. The brain cannot function well without proper amounts of oxygen or sugar, and this condition would be at its worst in the morning, which is when most migraines occur.
While migraines have been thought of as a pathological phenomenon, it is also possible that the migraine is the brain's defense mechanism to receive new blood along with sugar and oxygen. After all, the only way the brain can get what it needs is from the bloodstream, and during a migraine arteries to the head open up and send blood with force throughout the brain. Perhaps, we reasoned, the migraine is a type of emergency "brain flush", replacing old blood with new. If so, could we prevent migraines by having migraine sufferers sleep with their heads slightly elevated?
We tested our theory by having about 100 volunteer migraineurs sleep with the heads of their beds elevated, from 10-30 degrees. Head elevation, we theorized, would improve the brain circulation by providing some gravity assistance to drainage. Interestingly, we found that Space Medicine researchers discovered that brain circulation (and heart pumping) is optimal at a 30-degree head of bed elevation.
To our amazement, we found that the majority of the migraineurs in our study experienced relief by this simple sleep position change! Many had no new migraines, after being migraine sufferers for 30 or more years! The results were very fast, within a few days. And there were very interesting side effects, too. Our volunteers woke up more alert. Morning sinus congestion was significantly reduced for most people. Some reported that they no longer had certain allergies. Could we have discovered the real purpose and cause of migraines?
The implications of these findings were, frankly, astounding to us. So many diseases are related to increased brain pressure of "unknown" cause. Sleep position was never studied as the cause of this increased pressure. The implications go far beyond the prevention and treatment of migraines. Any condition that is related to brain pressure, and that is usually worse in the morning after a night of horizontal time, can be potentially related to this gravity and sleep position issue.
Keep in mind that the brain is the central nervous system controlling and modifying all bodily functions. If certain centers of the brain are congested and pressurized daily by sleeping too flat for long hours, those centers can malfunction. Depending on the way a person sleeps, the idiosyncrasies of their brain circulation, and other variables, different people might experience this brain pressure differently. For some, the respiratory centers of the hypothalamus might be particularly congested, resulting in Sudden Infant Death Syndrome (which has been associated with head and body position while sleeping), sleep apnea, or even asthma. Sleep apnea has been shown to be treatable with changes in sleep position.
Strokes are clearly associated with brain pressure, and usually occur at night or in the early morning, while sleeping. This is when brain pressure is highest.
Glaucoma is clearly caused by this mechanism. It is already known that eye pressure increases when the head is down, and decreases when the head is up. It is essential to note the head position when taking eye pressure readings because of this sensitive relationship between intraocular pressure and head position. Eye pressure is also highest in the early morning. Elevating the head while sleeping should be routine for glaucoma treatment and prevention.
Baggy eyes and sinus congestion seem to be related to head pressure. Just as the brain gets extra pressure when lying down, the head and face are pressurized, too. People with these problems usually find immediate relief by sleeping elevated 10-30 degrees.
Alzheimer's disease, we believe, might be the end disease caused by chronic brain congestion and pressure from flat sleeping. The cerebral ventricles of the Alzheimer's brain are expanded, suggesting a history of ventricular pressure, and generalized lesions along the ventricles may indicate areas of brain tissue that have deteriorated from this chronic pressure. Other research has already shown Alzheimer's is associated with increased brain pressure, but the cause has been considered unknown, as is the case with almost all brain pressure problems.
It should be noted that the blood-brain barrier cannot function properly when pressurized. Excessive intracranial pressure can cause leaks in this barrier by expanding the basement membrane, allowing heavy metals, e.g., aluminum and mercury, as well as viruses and bacteria, to enter the brain that would have otherwise been excluded. This may be why heavy metals have been associated with certain brain problems, such as Alzheimer's.
Attention Deficit Hyperactivity Disorder is also known to be associated with congestion of the "impulse center" within the brain that helps control behavior. We found several children with ADHD experience profound improvement of self control by elevating their heads while sleeping.
In addition to head position relative to gravity, we also have found side or belly sleeping can create problems. For example, we found several cases of carpel tunnel syndrome related to sleeping on the hands or wrists, and shoulder pain from sleeping on the side. And keep in mind that head pressure increases, and drainage diminishes, when the head is rotated to the side. Sleeping on the back avoids compression of limbs and internal organs.
It is also interesting to note that patients with asymmetrical problems will typically be worse on the side they sleep on. For example, eye pathology will be worse in the eye on the side of the face that is slept on most. Ear infections will be worse on the "down" ear. You can also tell the side a person sleeps on by observing the shape of the nose. Apart from injuries, the nose should be symmetrical, but becomes curved away from the pillow because of sleeping on the side of the face and pressing on the nose for hours each night. The nose will point away from the side that is most slept on.
Men should be told that side sleeping may result in testicular compression and possible dysfunction. And women who sleep on their sides or stomachs subject their breasts to compression and impaired circulation. Side sleepers may have more breast trouble on the side they sleep on.
We should forewarn the practitioner, however, that, while the effect of elevating the head while sleeping will be dramatic and transformative for many patients and should be considered essential to disease prevention strategies, the fact is that many people resist changing their sleep behaviors. They have been conditioned to sleep a certain way since birth. And even when they want to change their sleep position, it's difficult to ensure compliance when the subject is unconscious! It takes tremendous will power to alter sleep behavior. But it is well worth the trouble, as people usually see within a week of sleeping elevated.
We found the best methods for head elevation include using more pillows, using a foam wedge, placing blocks under the legs of the bed frame at the head of the bed, or using an adjustable bed. While the ideal position is with the head from 10-30 degrees elevated, 10 degrees elevation is fine to start with. The legs should be slightly elevated, too, and the person should try to stay on his or her back as much as possible. The ideal position is one you would be in if leaning back in a recliner chair. (Recliners would be fine to use, too, but they usually give poor lower back support.) Also, be aware that some people will find one degree of elevation more comfortable than another. People with low blood pressure may need their heads lower than those with higher blood pressure. Others may have some neck and shoulder discomfort from the new position. However, by experimenting with pillows under the arms, underneath the buttocks (which prevents sliding down the bed), and under the feet and legs, the patient should find a comfortable solution.
Also, when taking in to effect patient history, realize that neck injuries and tight neck muscles can impair venous drainage of the brain by compression of the jugular veins by the tight muscles. Neck massage and spinal adjustments may help improve overall brain circulation. We have had a few case histories where there was little or no improvement from head elevation, but the subjects had a history of neck injuries.
Of course, there will be times when people feel lightheaded and need to lie down to get more blood to the head. It might also be better for people to sleep less at night and to make up for lost sleep with a nap, or a siesta, during the day. That would avoid extremes of high and low brain pressure. But our culture makes it necessary for most people to do all their sleeping at once. Sleeping, after all, is a cultural issue. The point is to be aware of how you feel, and realize that your body position relative to gravity may be a key factor affecting health and disease.
We are continuing to research this effect of gravity and sleep position on health, and encourage practitioners to communicate their patients' experiences with us. We also highly encourage you to read our book, Get It Up! Revealing the Simple Surprising Lifestyle that Causes Migraines, Alzheimer's, Stroke, Glaucoma, Sleep Apnea, Impotence, and More! (ISCD Press, 2001), where we discuss the profound implications of this theory, including a lengthy list of references about brain pressure and various diseases and the effect of gravity on brain circulation. After you see the evidence, you will probably be as amazed as we are that sleep research has been ignoring this critical aspect of sleep.
Sleeping too flat each day may be the greatest lifestyle mistake people are making in our culture. Some of the worst diseases of our time may be all in our bed!
Sunday, November 22, 2009
Saturday, November 21, 2009
Battling The Stigma of Mental Illness
It's difficult enough to cope with mental health issues without having to cope with other people's ideas of who you are. Yet people with mental health disorders of all kinds continue to be viewed by many Americans as being weak-willed, having a character flaw, or worse-being "crazy," incompetent, or even violent. Such misperceptions are part of the stigma of mental illnesses.
Defined as a mark of shame, disgrace or disapproval that is imposed on people with a mental illness by others, stigma may have many consequences, including rejection by family, broken friendships, low self-esteem or job discrimination. Reversing negative perceptions of anxiety disorders has been a long-term goal of the Anxiety Disorders Association of America. "People with anxiety disorders have in the past been perceived as the 'the worried well,' but this is misleading, anxiety disorders are real illnesses," says Jerilyn Ross, M.A., L.I.C.S.W., President and CEO of the ADAA. "If we say someone is 'just very shy' in social situations or 'is imagining things' when having a panic attack, we stigmatize them as individuals and deny their suffering."
Stigma HurtsUnfortunately, stigma is still with us in the 21st century. A landmark study by the Indiana Consortium for Mental Health Services Research (ICMHSR) looked at public attitudes toward mental illnesses between 1950-1996 and concluded that, "there is little evidence that the stigma of mental illness has been reduced in contemporary American society." And stigma hurts. That same historical study showed that even in the late '90s, "levels of social rejection remain distressingly high" for people with a mental illness:
•The number of people who associate mental illnesses with antisocial behavior doubled between 1950 and 1996.•68% would be "definitely" or "probably unwilling" to have someone with a mental illness marry into their family.• 58% would be "definitely" or "probably unwilling" to work closely on the job with someone with a mental illness.• 56% would be "definitely" or "probably unwilling" to spend an evening socializing with a person with a mental illness.
But while surveys can be useful in gauging attitudes of society at large, it is the effect of stigma on individual lives that most concerns researchers like Otto F. Wahl, Ph.D., Professor of Psychology at George Mason University in Fairfax, Virginia. "If we are going to truly eradicate stigma, we need to have a more concrete, practical and personalized understanding of its effects-that is, how stigma makes people feel and how it affects treatment and recovery," he says.
Dr. Wahl has collected the experiences of almost 1,400 consumers of mental health services to get a first-hand account of the effect of stigma. The results, compiled in the book Telling is Risky Business: Mental Health Consumers Confront Stigma, demonstrate how deeply some are wounded by stigma (see box, below). For example, the survey revealed that those with a mental illness often or very often avoided telling others that they have a mental illness (47%); worried that others will view them unfavorably (56%); have been treated unfairly (46%); and have been shunned or avoided by others (26%).
In addition to the social effects, stigma can have negative and long-lasting consequences on self-esteem. "Stigma may become internalized, and the individual may come to share the same beliefs as others and view themselves in similarly disparaging ways," says Dr. Wahl. Indeed, stigma can be worse than the illness itself. "There's no doubt many struggle with a double burden-the disabling effects of their condition and the equally disabling effects of prejudice," says Jean Arnold, co-creator of the National Stigma Clearinghouse.
The Role of the MediaThe media remain the public's most influential source of information on mental illnesses. Unfortunately, many of the stories and programs we hear and read contain inaccuracies and denigrate those with mental illnesses. "The media, especially television, are a very powerful socializing agent," says Dr. Wahl, who has studied media depiction of mental illnesses. "Because almost every household in America has a television set, everyone-rich, poor, educated, uneducated, urban, rural-gets the same message about mental illnesses. Thus, the negative messages and violent images can become pervasive throughout society."
Negative socialization regarding stigma may begin at an early age. Until 2000, no studies had been published on the mental health content of children's programming. The first, a study of children's television programming in New Zealand and the U.S., concluded "the frequent and casual use of fundamentally disrespectful vocabulary [such as 'nuts,' 'wacko,' and 'freaky' in episodes reviewed] demonstrate for children that such expressions are acceptable or even funny.
Particularly disturbing is the media's perpetuation of the mentally ill as violent and dangerous. "Mental illness is a common theme in movies, television, plays and books," says Ms. Arnold, whose clearinghouse keeps tabs on instances of stigma in the media. "Regrettably, many of those portrayals are extremely negative and skewed toward making people with mental illnesses seem violent." Over 70% of major characters with a mental illness in prime time television dramas are portrayed as violent; more than one fifth are shown as killers. The typical newspaper depiction of individuals with mental illnesses shows them to be psychotic, unemployed, transient, and dangerous-not as happy, productive members of a family or community.
Changing these stereotypes will take time, but Dr. Wahl offers three strategies for the future:1. educating those responsible for media depictions of mental illnesses, such as screenwriters and news reporters;2. reaching future writers, editors and producers through training curricula; and3. engaging in grassroots advocacy to create pressure on media organizations to change media stereotyping.
Making ProgressNot all the news is bad. First, anecdotal and some empirical evidence exists that the media is changing their portrayals of mental illnesses. A 1999 content analysis comparing newspaper coverage of mental illnesses in 1989 and 1999 showed the ratio of negative depictions to positive ones to be 2:1 in 1999, down considerably from a 4:1 ratio in 1989. "However that still means that mental illnesses and people with mental illnesses are being portrayed in a negative light twice as often as a positive one," says Dr. Wahl, one of the study's authors.
Second, on a broader scale, the ICMHSR survey revealed that Americans' understanding of mental illnesses has broadened over the last five decades to encompass a wide range of disorders, including anxiety, depression and substance abuse. The public also sees a combination of factors-life stressors, genetics and chemical imbalances-as the cause of mental illnesses rather than a bad character or bad parenting. "Another positive trend affecting both patients and the public is a hopeful attitude toward recovery, says Jean Arnold. The ICMHSR survey showed that Americans increasingly recognize that mental health problems will improve if treated.
Third, the number of anti-stigma reports, conferences and organizations is on the rise. "There's been more activity on this issue in the last five years than in the previous 20," says Ms. Arnold. "For example, when we started the National Stigma Clearinghouse, there really wasn't any other organization monitoring media coverage of mental illnesses. Now the clearinghouse website has links to 40 different groups that give a high priority to fighting prejudice and discrimination."
Combating StigmaBy its nature, stigma puts people into categories. This conveniently relieves one of the burdens of seeing people as individuals and treating them as such. Thus, fighting stigma is best achieved by personalizing it. This means speaking up about its effects on you as someone with an anxiety disorder, speaking out when you hear incorrect or negative statements, and speaking with others to find common ground for recovery and advocacy efforts (see below, "What You Can Do to Fight Stigma"). "We took this approach in the Clearinghouse," says Ms. Arnold. "For the first time, we gave people a voice and a way to take concrete action. And it's very satisfying indeed to respond to the stigmatizer." Between 1990 and 1996, the Clearinghouse published 64 monthly reports with hundreds of examples of stigma submitted by media watchers. This watchdog function has been taken over by National Alliance of the Mentally Ill's Stigma Alerts program and the National Mental Health Association's Stigma Watch.
Although much of the research conducted on stigma relates to schizophrenia, bipolar disorder and depression, mental health advocates encourage thinking of stigma as an issue that touches all of us. Anxiety disorders, for example, occur very frequently with other psychiatric illnesses, including depression and substance abuse. "Stigma applied to one person or one psychiatric disorder is a stigma applied to everyone with a mental illness," says Ross. "And it's up to each of us to fight it where we can."
For more information on fighting stigma:
•Anxiety Disorders Association of America's Advocacy Centerwww.adaa.org
•National Association for the Mentally Illwww.nami.org
•National Mental Health Association's Stigma Watchwww.nmha.org/newsroom/stigma/index.cfm
•National Mental Health Awareness Campaignwww.nostigma.org
•National Stigma Clearinghousehttp://community-2.webtv.net/stigmanet/STIGMAHOMEPAGE/index.html
Defined as a mark of shame, disgrace or disapproval that is imposed on people with a mental illness by others, stigma may have many consequences, including rejection by family, broken friendships, low self-esteem or job discrimination. Reversing negative perceptions of anxiety disorders has been a long-term goal of the Anxiety Disorders Association of America. "People with anxiety disorders have in the past been perceived as the 'the worried well,' but this is misleading, anxiety disorders are real illnesses," says Jerilyn Ross, M.A., L.I.C.S.W., President and CEO of the ADAA. "If we say someone is 'just very shy' in social situations or 'is imagining things' when having a panic attack, we stigmatize them as individuals and deny their suffering."
Stigma HurtsUnfortunately, stigma is still with us in the 21st century. A landmark study by the Indiana Consortium for Mental Health Services Research (ICMHSR) looked at public attitudes toward mental illnesses between 1950-1996 and concluded that, "there is little evidence that the stigma of mental illness has been reduced in contemporary American society." And stigma hurts. That same historical study showed that even in the late '90s, "levels of social rejection remain distressingly high" for people with a mental illness:
•The number of people who associate mental illnesses with antisocial behavior doubled between 1950 and 1996.•68% would be "definitely" or "probably unwilling" to have someone with a mental illness marry into their family.• 58% would be "definitely" or "probably unwilling" to work closely on the job with someone with a mental illness.• 56% would be "definitely" or "probably unwilling" to spend an evening socializing with a person with a mental illness.
But while surveys can be useful in gauging attitudes of society at large, it is the effect of stigma on individual lives that most concerns researchers like Otto F. Wahl, Ph.D., Professor of Psychology at George Mason University in Fairfax, Virginia. "If we are going to truly eradicate stigma, we need to have a more concrete, practical and personalized understanding of its effects-that is, how stigma makes people feel and how it affects treatment and recovery," he says.
Dr. Wahl has collected the experiences of almost 1,400 consumers of mental health services to get a first-hand account of the effect of stigma. The results, compiled in the book Telling is Risky Business: Mental Health Consumers Confront Stigma, demonstrate how deeply some are wounded by stigma (see box, below). For example, the survey revealed that those with a mental illness often or very often avoided telling others that they have a mental illness (47%); worried that others will view them unfavorably (56%); have been treated unfairly (46%); and have been shunned or avoided by others (26%).
In addition to the social effects, stigma can have negative and long-lasting consequences on self-esteem. "Stigma may become internalized, and the individual may come to share the same beliefs as others and view themselves in similarly disparaging ways," says Dr. Wahl. Indeed, stigma can be worse than the illness itself. "There's no doubt many struggle with a double burden-the disabling effects of their condition and the equally disabling effects of prejudice," says Jean Arnold, co-creator of the National Stigma Clearinghouse.
The Role of the MediaThe media remain the public's most influential source of information on mental illnesses. Unfortunately, many of the stories and programs we hear and read contain inaccuracies and denigrate those with mental illnesses. "The media, especially television, are a very powerful socializing agent," says Dr. Wahl, who has studied media depiction of mental illnesses. "Because almost every household in America has a television set, everyone-rich, poor, educated, uneducated, urban, rural-gets the same message about mental illnesses. Thus, the negative messages and violent images can become pervasive throughout society."
Negative socialization regarding stigma may begin at an early age. Until 2000, no studies had been published on the mental health content of children's programming. The first, a study of children's television programming in New Zealand and the U.S., concluded "the frequent and casual use of fundamentally disrespectful vocabulary [such as 'nuts,' 'wacko,' and 'freaky' in episodes reviewed] demonstrate for children that such expressions are acceptable or even funny.
Particularly disturbing is the media's perpetuation of the mentally ill as violent and dangerous. "Mental illness is a common theme in movies, television, plays and books," says Ms. Arnold, whose clearinghouse keeps tabs on instances of stigma in the media. "Regrettably, many of those portrayals are extremely negative and skewed toward making people with mental illnesses seem violent." Over 70% of major characters with a mental illness in prime time television dramas are portrayed as violent; more than one fifth are shown as killers. The typical newspaper depiction of individuals with mental illnesses shows them to be psychotic, unemployed, transient, and dangerous-not as happy, productive members of a family or community.
Changing these stereotypes will take time, but Dr. Wahl offers three strategies for the future:1. educating those responsible for media depictions of mental illnesses, such as screenwriters and news reporters;2. reaching future writers, editors and producers through training curricula; and3. engaging in grassroots advocacy to create pressure on media organizations to change media stereotyping.
Making ProgressNot all the news is bad. First, anecdotal and some empirical evidence exists that the media is changing their portrayals of mental illnesses. A 1999 content analysis comparing newspaper coverage of mental illnesses in 1989 and 1999 showed the ratio of negative depictions to positive ones to be 2:1 in 1999, down considerably from a 4:1 ratio in 1989. "However that still means that mental illnesses and people with mental illnesses are being portrayed in a negative light twice as often as a positive one," says Dr. Wahl, one of the study's authors.
Second, on a broader scale, the ICMHSR survey revealed that Americans' understanding of mental illnesses has broadened over the last five decades to encompass a wide range of disorders, including anxiety, depression and substance abuse. The public also sees a combination of factors-life stressors, genetics and chemical imbalances-as the cause of mental illnesses rather than a bad character or bad parenting. "Another positive trend affecting both patients and the public is a hopeful attitude toward recovery, says Jean Arnold. The ICMHSR survey showed that Americans increasingly recognize that mental health problems will improve if treated.
Third, the number of anti-stigma reports, conferences and organizations is on the rise. "There's been more activity on this issue in the last five years than in the previous 20," says Ms. Arnold. "For example, when we started the National Stigma Clearinghouse, there really wasn't any other organization monitoring media coverage of mental illnesses. Now the clearinghouse website has links to 40 different groups that give a high priority to fighting prejudice and discrimination."
Combating StigmaBy its nature, stigma puts people into categories. This conveniently relieves one of the burdens of seeing people as individuals and treating them as such. Thus, fighting stigma is best achieved by personalizing it. This means speaking up about its effects on you as someone with an anxiety disorder, speaking out when you hear incorrect or negative statements, and speaking with others to find common ground for recovery and advocacy efforts (see below, "What You Can Do to Fight Stigma"). "We took this approach in the Clearinghouse," says Ms. Arnold. "For the first time, we gave people a voice and a way to take concrete action. And it's very satisfying indeed to respond to the stigmatizer." Between 1990 and 1996, the Clearinghouse published 64 monthly reports with hundreds of examples of stigma submitted by media watchers. This watchdog function has been taken over by National Alliance of the Mentally Ill's Stigma Alerts program and the National Mental Health Association's Stigma Watch.
Although much of the research conducted on stigma relates to schizophrenia, bipolar disorder and depression, mental health advocates encourage thinking of stigma as an issue that touches all of us. Anxiety disorders, for example, occur very frequently with other psychiatric illnesses, including depression and substance abuse. "Stigma applied to one person or one psychiatric disorder is a stigma applied to everyone with a mental illness," says Ross. "And it's up to each of us to fight it where we can."
For more information on fighting stigma:
•Anxiety Disorders Association of America's Advocacy Centerwww.adaa.org
•National Association for the Mentally Illwww.nami.org
•National Mental Health Association's Stigma Watchwww.nmha.org/newsroom/stigma/index.cfm
•National Mental Health Awareness Campaignwww.nostigma.org
•National Stigma Clearinghousehttp://community-2.webtv.net/stigmanet/STIGMAHOMEPAGE/index.html
Friday, November 20, 2009
Principled Living
People without principles are like boats without rudders and cars without steering wheels. Their direction in life is aimless and their decisions are haphazard. However, when principles occupy the center of your life, they help you arrive quickly at the right decision when opportunities open or crises loom.
When your life is centered on pleasing other people, the important thing to you is what others want. When it's centered on possessions, the important thing is what you have.When it's centered on activities, the important thing is what you do.
But when your life is centered on principles, you are being true to yourself. Your principles can be like a compass, quickly pointing in the right direction when a crisis arrives. A principle is like an anchor, providing a source of steadiness amid tumultuous circumstances. And they can be like the nozzle of a hose-directing the stream of your thoughts and efforts in a purposeful way while concentrating their power on the things that matter.
Successful people don't lie awake at night agonizing over decisions and the direction of their lives. They simply consult their principles. They make decisions that are in harmony with these principles. They don't second-guess themselves and seldom reverse themselves.
You can choose the principles you want to guide you by first identifying the values you hold dear. First, think of the roles that are important to you in your family life, vocational life, community life, and religious life. Now think of the people, activities, and qualities you value in each role.
For each value, write a supporting principle. Make it personal. State it in the form of a sentence describing yourself as you would like to be, in the light of these values. Do this for each of the roles that are important to you. For example, if one of your values is financial prosperity, you might write as your supporting principles:
I never miss an opportunity to upgrade my career qualifications.
I take intelligent risks in investing my time and resources.
I look for ways to enhance the perceived value of my products or services in the eyes of potential customers or clients.
When you have identified the principles you want to guide your life, use them in measuring each possible career and role choice. When you have found a pursuit that conforms to your basic principles while allowing you to do what you do best and enjoy most, you will have found your ideal calling.
Go for it!
When your life is centered on pleasing other people, the important thing to you is what others want. When it's centered on possessions, the important thing is what you have.When it's centered on activities, the important thing is what you do.
But when your life is centered on principles, you are being true to yourself. Your principles can be like a compass, quickly pointing in the right direction when a crisis arrives. A principle is like an anchor, providing a source of steadiness amid tumultuous circumstances. And they can be like the nozzle of a hose-directing the stream of your thoughts and efforts in a purposeful way while concentrating their power on the things that matter.
Successful people don't lie awake at night agonizing over decisions and the direction of their lives. They simply consult their principles. They make decisions that are in harmony with these principles. They don't second-guess themselves and seldom reverse themselves.
You can choose the principles you want to guide you by first identifying the values you hold dear. First, think of the roles that are important to you in your family life, vocational life, community life, and religious life. Now think of the people, activities, and qualities you value in each role.
For each value, write a supporting principle. Make it personal. State it in the form of a sentence describing yourself as you would like to be, in the light of these values. Do this for each of the roles that are important to you. For example, if one of your values is financial prosperity, you might write as your supporting principles:
I never miss an opportunity to upgrade my career qualifications.
I take intelligent risks in investing my time and resources.
I look for ways to enhance the perceived value of my products or services in the eyes of potential customers or clients.
When you have identified the principles you want to guide your life, use them in measuring each possible career and role choice. When you have found a pursuit that conforms to your basic principles while allowing you to do what you do best and enjoy most, you will have found your ideal calling.
Go for it!
Thursday, November 19, 2009
Depression: A Problem That Affects The Whole Body
While many people do go through times in their lives when they feel disheartened, sad and stressed. Depression is much more than feelings of sadness. If feelings turn into hopelessness, suicidal thoughts or last for more than a few days, you may be suffering from depression. Depression is a problem that affects the body as a whole and can lead to a variety of other problems, as well. There are a variety of medications and therapies that can help people who are dealing with depression, but, sometimes, it is important to identify the cause of the depression first.
There are a variety of different causes for depression and different causes will require different treatments.GeneticsOne cause of depression may actually be in your genes. Many studies have shown that depression can be a genetic problem that is inherited. Often, bouts of depression will run in the family and if the genetics are studied, there are slight variations in genetic make-up that seem to correspond with the problems of depression and Bipolar Disorder in particular.
External ProblemsMany times, there are external problems that are actually the cause of depression. Many times, depression can start out as grief for a loved one or frustration over a chronic illness. Often, dealing with losing a job or the breakup of a relationship can cause people to go into depression as well. Financial stress is another external problem that can lead to depression. It is important to note that, many times, it is a combination of these external problems with other problems that lead to an episode of depression.
Chemical Imbalances: Another cause of depression can be a chemical imbalance within the body. The chemicals in the brain are very important and having too much or not enough of these chemicals can lead to psychological problems, including depression.
Two specific neurotransmitters that seem to be connected with depression are norepinephrine and serotonin. Cortisol, which is a hormone produced in the body, has also been linked to depression and often, too much cortisol is found in people who are suffering from depression.
Depression is a serious problem and no matter what is causing depression in your life or in the life of someone you love, it is important that you get professional help. There is help available for those who are dealing with depression and often, the type of help will be determined by the cause of depression. It is important to know that you are not alone and that there is assistance for those dealing with this difficult disease.
There are a variety of different causes for depression and different causes will require different treatments.GeneticsOne cause of depression may actually be in your genes. Many studies have shown that depression can be a genetic problem that is inherited. Often, bouts of depression will run in the family and if the genetics are studied, there are slight variations in genetic make-up that seem to correspond with the problems of depression and Bipolar Disorder in particular.
External ProblemsMany times, there are external problems that are actually the cause of depression. Many times, depression can start out as grief for a loved one or frustration over a chronic illness. Often, dealing with losing a job or the breakup of a relationship can cause people to go into depression as well. Financial stress is another external problem that can lead to depression. It is important to note that, many times, it is a combination of these external problems with other problems that lead to an episode of depression.
Chemical Imbalances: Another cause of depression can be a chemical imbalance within the body. The chemicals in the brain are very important and having too much or not enough of these chemicals can lead to psychological problems, including depression.
Two specific neurotransmitters that seem to be connected with depression are norepinephrine and serotonin. Cortisol, which is a hormone produced in the body, has also been linked to depression and often, too much cortisol is found in people who are suffering from depression.
Depression is a serious problem and no matter what is causing depression in your life or in the life of someone you love, it is important that you get professional help. There is help available for those who are dealing with depression and often, the type of help will be determined by the cause of depression. It is important to know that you are not alone and that there is assistance for those dealing with this difficult disease.
How To Stop Panic Attacks
There is a lot of advice on how to stop panic attacks naturally; e.g. deep breathing, no caffeine or nicotine, a good night's sleep, regular exercise, etc. But, although they all have a part to play, they don't address the critical element in how to stop panic attacks naturally, which is your 'fear' of another attack. You will learn here why you need to eliminate your fear in order to prevent further attacks.
Why is your fear of another attack so important in stopping panic attacks (anxiety attacks)?
Someone who suffers anxiety attacks will also have higher general anxiety levels than the average person. When the average person is faced with a normal, everyday stressful situation, they are able to deal with it. But when someone with higher-than-normal levels of anxiety is faced with such a stressful event, that stress can push their already heightened anxiety levels over the top, resulting in an anxiety attack.
Now the attack symptoms are just so devastating that no one who has ever had one wants a repeat performance. So they carry around this -- sometimes unconscious -- fear that they might have another attack at anytime. This adds to their already higher-than-normal anxiety so that the next stressor that occurs triggers another panic attack. This is a vicious anxiety cycle, and, your fear is the key element.
How can I break out of this vicious cycle of anxiety?
Because the cycle can be described like this... anxiety >> attack >> fear >> increased anxiety >> attack >> fear >> increased anxiety >> etc., you can see that by eliminating your fear you 'break' the anxiety cycle. When you do this, you stop panic attacks and, because you aren't adding to your general anxiety anymore, you can get on with curing your general anxiety.
Can drug-based treatment break the anxiety cycle?
Not really, because these drugs -- e.g. tranquilizers, antidepressants, beta blockers, etc. -- are concerned with controlling and managing your 'mood' in the main. Only you can face your fear of panic attacks head-on and remove it.
How can I eliminate my fear and stop panic attacks naturally then?
The key is to confront your fear and gain control. Don't let your fear determine the outcome. There are ways to do this, and they might take some practice, but, there are techniques you can use to help you, one of which is the 'ONE MOVE' technique that is highlighted below.
Why is your fear of another attack so important in stopping panic attacks (anxiety attacks)?
Someone who suffers anxiety attacks will also have higher general anxiety levels than the average person. When the average person is faced with a normal, everyday stressful situation, they are able to deal with it. But when someone with higher-than-normal levels of anxiety is faced with such a stressful event, that stress can push their already heightened anxiety levels over the top, resulting in an anxiety attack.
Now the attack symptoms are just so devastating that no one who has ever had one wants a repeat performance. So they carry around this -- sometimes unconscious -- fear that they might have another attack at anytime. This adds to their already higher-than-normal anxiety so that the next stressor that occurs triggers another panic attack. This is a vicious anxiety cycle, and, your fear is the key element.
How can I break out of this vicious cycle of anxiety?
Because the cycle can be described like this... anxiety >> attack >> fear >> increased anxiety >> attack >> fear >> increased anxiety >> etc., you can see that by eliminating your fear you 'break' the anxiety cycle. When you do this, you stop panic attacks and, because you aren't adding to your general anxiety anymore, you can get on with curing your general anxiety.
Can drug-based treatment break the anxiety cycle?
Not really, because these drugs -- e.g. tranquilizers, antidepressants, beta blockers, etc. -- are concerned with controlling and managing your 'mood' in the main. Only you can face your fear of panic attacks head-on and remove it.
How can I eliminate my fear and stop panic attacks naturally then?
The key is to confront your fear and gain control. Don't let your fear determine the outcome. There are ways to do this, and they might take some practice, but, there are techniques you can use to help you, one of which is the 'ONE MOVE' technique that is highlighted below.
Saturday, November 7, 2009
Insomnia & Dialectical Behavioral Therapy
Many people advocate CBT or Cognative Behavioral Therapy for insomnia. But I am in a program using DBT or Dialectical Behavioral Therapy to help me get some zzzz's. I started in Boston at Harvard, and now am at a program for 5 more weeks close to my home on Tues, Wed and Thurs from 9:30 AM until 12:30 PM. It is working quite well. Got up today at 7:30 on a SATURDAY went to bed at midnight without the use of drugs. So what is DBT? It was first credited to Dr. Marsha Linehan who came uo with the principles of DBT for Borderline Personality Disorder patients, but it is now used for Bipolar and yes SLEEP! And it works!! I am amazed, I was the biggest skeptic.
DBT combines standard cognitive-behavioral techniques for emotion regulation and reality-testing with concepts of mindful awareness, distress tolerance, and acceptance largely derived from Buddhist meditative practice. DBT is the first therapy that has been experimentally demonstrated to be effective for treating BPD. Research indicates that DBT is also effective in treating patients who represent varied symptoms and behaviors associated with spectrum mood disorders, including self-injury. Linehan created DBT in response to her observation of therapist burnout after repudiating patients’ motivation to cooperate in successful treatment. Her first core insight was to recognize that the chronically (para)suicidal patients she studied had been raised in profoundly invalidating environments and required a climate of unconditional acceptance (not Carl Rogers’ humanistically "positive" version, but Thich Nhat Hanh’s metaphysically neutral one) in which to develop a successful therapeutic alliance. Her second insight concerned the need for a commensurate commitment from patients to (be willing to) change—subject to their skillfulness in the present moment--based on 'radical acceptance' of their dire level of emotional dysfunction.
Linehan united commitment to the core conditions of acceptance and change through the Hegelian principle of dialectical progress, in which thesis + antithesis → synthesis, and proceeded to assemble a modular array of skills for emotional self-regulation, drawn from Western (e.g., CBT and an interpersonal variant, “assertiveness training”) and Eastern (e.g., Buddhist mindfulness meditation) psychological traditions. Arguably her signal contribution was to elide the adversarial paradigm implicit in the hierarchical modernist therapeutic alliance, using the deconstructive spirit of Hegel and the Buddha to substitute a postmodern alliance based on intersubjective tough love.
Learning to be mindful, to focus, to breathe will help make the application of the modules be more effective. It is paramount to your success in reducing stress and coping.Remember: Sometimes the skills will not work. This is when you need to quickly go to the Distress Tolerance module and take taking a vacation from the situation that you are in, practice radical acceptance, do a lot of self soothe, and distract activities. The key to success is the practice of DBT skills.Overview of DBT skills (4 basic modules)
1. MINDFULNESS (Wise Mind)Using the What Skills:
Observe
Describe
Participate
Using the How Skills:
Non-judgmentally
One-mindfully
Effectively
2. INTERPERSONAL EFFECTIVENESSUsing Objectiveness effectiveness: (Dear Man)
D Describe
E Express
A Assert
R Reinforce
M Mindful
A Appear Confident
N Negotiate
Using Relationship Effectiveness: (Give)
G Gentle
I Interested
V Validate
E Easy Manner
Self-respect effectiveness: (Fast)
F Fair
A Apologies (no Apologies)
S Stick to value
T Truthful
3. EMOTION REGULATIONUsing Reduce Vulnerability: (Please)
P & L Treat Physical Illness
E eating
A Altering Drugs (no drugs unless it is medication to be taken as prescribed by your doctor)
S Sleep
E Exercise
Using Build MasteryBuild Positive experiencesBe mindful of current emotionOpposite to emotion action
4. DISTRESS TOLERANCEU
Using Crisis Survival: Distraction with Wise Mind Accepts
A Activities
C Contributing
C Comparisons
E Emotions - use opposite
P Pushing Away
T Thoughts
S Sensations
Using Self Soothe with five senses:
Taste
Smell
See
Hear
Touch
Using Improve the moment:
I Imagery
M Meaning
P Prayer
R Relaxation
O One thing at a time
V Vacation
E Encouragement
Using Pros and ConsUsing Accepting Reality:WillingnessTurning your mindRadical Acceptance
For more about DBT I recommend two work books: Dialectical Behavior Therapy Skills Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation, & Distress Tolerance on amazon.com at: http://www.amazon.com/Dialectical-Behavior-Therapy-Skills-Workbook/dp/1572245131/ref=sr_1_1?ie=UTF8&s=books&qid=1257605235&sr=8-1
The Dialectical Behavior Therapy Skills Workbook for Bipolar Disorder: Using DBT to Regain Control of Your Emotions and Your Life also on amazon at: http://www.amazon.com/Dialectical-Behavior-Therapy-Workbook-Disorder/dp/1572246286/ref=sr_1_2?ie=UTF8&s=books&qid=1257605235&sr=8-2
Websites:
http://www.dbtselfhelp.com/
DBT combines standard cognitive-behavioral techniques for emotion regulation and reality-testing with concepts of mindful awareness, distress tolerance, and acceptance largely derived from Buddhist meditative practice. DBT is the first therapy that has been experimentally demonstrated to be effective for treating BPD. Research indicates that DBT is also effective in treating patients who represent varied symptoms and behaviors associated with spectrum mood disorders, including self-injury. Linehan created DBT in response to her observation of therapist burnout after repudiating patients’ motivation to cooperate in successful treatment. Her first core insight was to recognize that the chronically (para)suicidal patients she studied had been raised in profoundly invalidating environments and required a climate of unconditional acceptance (not Carl Rogers’ humanistically "positive" version, but Thich Nhat Hanh’s metaphysically neutral one) in which to develop a successful therapeutic alliance. Her second insight concerned the need for a commensurate commitment from patients to (be willing to) change—subject to their skillfulness in the present moment--based on 'radical acceptance' of their dire level of emotional dysfunction.
Linehan united commitment to the core conditions of acceptance and change through the Hegelian principle of dialectical progress, in which thesis + antithesis → synthesis, and proceeded to assemble a modular array of skills for emotional self-regulation, drawn from Western (e.g., CBT and an interpersonal variant, “assertiveness training”) and Eastern (e.g., Buddhist mindfulness meditation) psychological traditions. Arguably her signal contribution was to elide the adversarial paradigm implicit in the hierarchical modernist therapeutic alliance, using the deconstructive spirit of Hegel and the Buddha to substitute a postmodern alliance based on intersubjective tough love.
Learning to be mindful, to focus, to breathe will help make the application of the modules be more effective. It is paramount to your success in reducing stress and coping.Remember: Sometimes the skills will not work. This is when you need to quickly go to the Distress Tolerance module and take taking a vacation from the situation that you are in, practice radical acceptance, do a lot of self soothe, and distract activities. The key to success is the practice of DBT skills.Overview of DBT skills (4 basic modules)
1. MINDFULNESS (Wise Mind)Using the What Skills:
Observe
Describe
Participate
Using the How Skills:
Non-judgmentally
One-mindfully
Effectively
2. INTERPERSONAL EFFECTIVENESSUsing Objectiveness effectiveness: (Dear Man)
D Describe
E Express
A Assert
R Reinforce
M Mindful
A Appear Confident
N Negotiate
Using Relationship Effectiveness: (Give)
G Gentle
I Interested
V Validate
E Easy Manner
Self-respect effectiveness: (Fast)
F Fair
A Apologies (no Apologies)
S Stick to value
T Truthful
3. EMOTION REGULATIONUsing Reduce Vulnerability: (Please)
P & L Treat Physical Illness
E eating
A Altering Drugs (no drugs unless it is medication to be taken as prescribed by your doctor)
S Sleep
E Exercise
Using Build MasteryBuild Positive experiencesBe mindful of current emotionOpposite to emotion action
4. DISTRESS TOLERANCEU
Using Crisis Survival: Distraction with Wise Mind Accepts
A Activities
C Contributing
C Comparisons
E Emotions - use opposite
P Pushing Away
T Thoughts
S Sensations
Using Self Soothe with five senses:
Taste
Smell
See
Hear
Touch
Using Improve the moment:
I Imagery
M Meaning
P Prayer
R Relaxation
O One thing at a time
V Vacation
E Encouragement
Using Pros and ConsUsing Accepting Reality:WillingnessTurning your mindRadical Acceptance
For more about DBT I recommend two work books: Dialectical Behavior Therapy Skills Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation, & Distress Tolerance on amazon.com at: http://www.amazon.com/Dialectical-Behavior-Therapy-Skills-Workbook/dp/1572245131/ref=sr_1_1?ie=UTF8&s=books&qid=1257605235&sr=8-1
The Dialectical Behavior Therapy Skills Workbook for Bipolar Disorder: Using DBT to Regain Control of Your Emotions and Your Life also on amazon at: http://www.amazon.com/Dialectical-Behavior-Therapy-Workbook-Disorder/dp/1572246286/ref=sr_1_2?ie=UTF8&s=books&qid=1257605235&sr=8-2
Websites:
http://www.dbtselfhelp.com/
Sunday, November 1, 2009
What Music Are You On?
Everytime you watch television it is impossible to escape the commercials for psychiatric medications. Although they calmly list the terrifying side effects as they show a man and a woman skipping through the woods they actually think we're not listening...we are. Medications are sometimes nescessary for various reasons; but I do not feel it should be your first line of defense by any means.
So instead of asking someone what medication they are on, ask them what music they are on? Why? Because music is a natural healing method. Music helps with anxiety, depression, grief and even physical ailments. Weather it's classical, rock, jazz, blues, raggae or rap music heals. And also, their are no nasty side effects; accept for hearing loss if u crank up ur Bose too loud!!
Jackie
So instead of asking someone what medication they are on, ask them what music they are on? Why? Because music is a natural healing method. Music helps with anxiety, depression, grief and even physical ailments. Weather it's classical, rock, jazz, blues, raggae or rap music heals. And also, their are no nasty side effects; accept for hearing loss if u crank up ur Bose too loud!!
Jackie
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