Saturday, October 31, 2009

Graduate Studies


There was a very interesting article, The Ph.D. Problem, in Harvard Magazine detailing many of the problems in the pursuit of higher academic education. The content of the essay is disheartening, though not unrealistic.

While I remain cynical where politics of academia are concerned, research is an absolute necessity. This article focuses on the area of humanities, but general complaints (length of degree, job security, overspecialisation, exclusivity) about the process of graduate education could be applied to other departments.

“…if doctoral education in English were a cartoon character, then about 30 years ago, it zoomed straight off a cliff, went into a terrifying fall, grabbed a branch on the way down, and has been clinging to that branch ever since…the result of this is a kind of normalization of what in any other context would seem to be a plainly inefficient and intolerable process.”

(I actually think this is a metaphor that can be applied to chronic mental illnesses where unhealthy living is accepted because the normality of the distribution of life events has been shifted due to stagnation.)

“An estimate of the total elapsed time from college graduation to tenure [in humanities] would be somewhere between 15 and 20 years. It is a lengthy apprenticeship.”

“Job satisfaction is actually higher among Ph.D.s with non-academic careers than it is among academics, partly because spousal problems—commuting marriages—are not as great outside academia.”

“…there is a huge social inefficiency in taking people of high intelligence and devoting resources to training them in programs that half will never complete and for jobs that most will not get.”

Wednesday, October 28, 2009

External Validation


"Self-esteem is the greatest sickness known to man or woman because it's conditional."--Albert Ellis, Ph.D.

If you google external validation, you come up with a lot of hits asserting it’s a bad thing. Or at the very least, it’s not as good as ‘self-esteem’.

Nathaniel Branden, a psychotherapist who received his Ph.D in the 70’s, called external validation "pseudo self-esteem." He made the common argument of "true self-esteem" being derived from internal sources, such as self-responsibility and self-sufficiency. He defined true self-esteem as "...the experience of being competent to cope with the basic challenges of life and being worthy of happiness". (1)

Yet external validation is something children need. Adults with mental health problems (most famously, borderline personality disorder) may not have been nurtured in that area when they were children, or even as adults, and so might need such validation in their adult years.

External validation may be necessary in the development of self-esteem; Encouragement and approval most definitely do aid in building self-esteem traits.
Linehan, the famous validator, proposed six levels of validation: listening nonjudgmentally, accurate reflection, mind-reading, or articulating unspoken thoughts and feelings, understanding the historical background of a behaviour, confirming thoughts, behaviours and feelings based on current circumstances and radical genuineness, which requires the therapist to speak authentically to the patient and his/her family (2, 3).

Indeed, Linehan is such a proponent of validation for treatment, she developed DBT (dialectical behaviour therapy) which is grounded in two core concepts - validation and problem solving.

External validation is not bad. Nor is it dysfunctional or overrated. It is simply a necessary component in the development of self-worth and independence. I am not indicating one should constantly and pathologically seek out validation, but it is a process many individuals need to go through and those who are need not view their behaviour as something to be rid of, but to be open to the validation they are receiving.

The above is true of anyone; we all need to know we’ve done a good job or look nice in that new shirt. Compliments, which are a form of external validation, improve productivity and mood, generally making the world a better place.

References:

1. Branden, N. (1969). The psychology of self-esteem. New York: Bantam.
2. Linehan, MM (1997). Validation and psychotherapy. In A Bohart & C. Greenberg (Eds.) Empathy reconsidered: New Directions. Washington DC: APA
3. Woodberry, KA, Miller, AL, Glinski, J, Indik, J, & Mitchell, AG (2002). Family therapy and dialectical behavior therapy with adolescents: Part II: A theoretical review, American Journal of Psychotherapy, 56, 585-602.

Saturday, October 24, 2009

Emotion Regulation Handout 8 – Extended

This is another adaptation of a worksheet taken from the Skills Training Manual for Treating Borderline Personality Disorder by Marsha Linehan. The skills in this book, as well as any other CBT or DBT book, are not limited to BPD nor are they limited to people suffering from any disorder, but are useful to all people.

The handout is a very lengthy list of possible pleasant events you can incorporate into your schedule to be used in conjunction with the ‘Build Positive Experiences’ exercise.
You can find the list here.

The length of the list can actually have a reverse effect in some cases; some basic activities are on the list and this may lead to ‘I’m already doing positive activities so I don’t need to do any more’ type thinking. The goal, of course, is to increase positive events, regardless of what one may be doing currently.

The first step is to go through the list and cross off any activities you know won't bring you any pleasure (for example, if you’re a vegetarian, hunting would be an activity you could remove). The list can also be used as an inventory for mastery skills; as you are editing the list, put an M next to any activity which you find particularly challenging.

Make sure you add in a few activities that are specific to you (e.g. buy new cactus for my collection). Add details to general activities (e.g. instead of ‘ride bike’ include ‘ride bike along beach,’ ‘ride bike to store’…; instead of ‘watch tv’ include ‘watch Show X, Episode 1’…)

Try using an office program (MSWord, Excel) to organise the activities into categories (e.g. exercise, art, social…). That way, if you are in the mood for a particular type of activity, you can locate it more easily. Also, manually rewriting the list will help the ideas stay in your head.

But there is always the problem of motivation and decision making during times of illness. So, try making the task a bit more random in order to alleviate this stress; print out your list and cut out each activity, and pull one (or two or three) out of an envelope each day. You may want a separate envelope for Mastery activities because in order for this method of randomness to work, you have to commit to whichever activity is chosen, no matter what, beforehand and since Mastery activities may be more challenging you may want to focus on those on days when you are feeling stronger.

At the very least, keep the list somewhere you can see it everyday to act as a reminder of possible activities.

Tuesday, October 20, 2009

Vitamin Water


Update here.


There was a commercial not too far back for which the advertisement said something along the lines of: why take your water and vitamins separately when you can take them both in one drink?


I was a bit offended that the marketing group would think people would find the task of taking a vitamin too arduous. More importantly, they were selling the product as something that’s good for you. However the colour of these drinks would indicate otherwise. Pretty, though.


The information below was obtained from various sources on the interweb and I suspect the values given are actually greater. I adjusted the per serving amounts to represent the actual amounts contained in a bottle (all conversions represent 591ml). Ingredients are in grams and vitamins are in percent daily values. Blank cells indicate no information was obtainable to myself.



Life Water

Dasani Plus

Aquafina Alive

Aquafina +

Glacéau

Coke


Calories

100

0

0

120

100

110

Fat

0

0

0


0

0

Sodium

87.5

62.5

162.5


0

30

Total Carbs

25

2.5

0


32.5

30

Sugar

25

0

0


30

0*

Fiber

0

2.5

0


0


Vitamin A





50


Vitamin C

100


100

250

200


Vitamin E

20

10

10

24

50


Vitamin B3

10

10

50

25

50


Vitamin B5




35



Vitamin B6

10

10

50

60

50


Vitamin B12

10

10


25

50



* Coke uses high fructose corn syrup as its sugar, as indicated by the carbohydrate content.


Ingredients in these beverages may also include fun things like artificial flavours, though some do use natural flavourings.


In summary, vitamin waters have varying vitamin content and may be high in sugar. The marketing scheme would have one believing the product is of a healthy nature. Yet, I believe any high sugar beverage (even juice) should be consumed in moderation so as to keep the kidneys functional. In fact, a cheaper alternative to some of these drinks would be to simply water down some juice.


The best way to get your vitamins is through food and supplements.


References: 1, 2, 3, 4, 5, 6







Monday, October 19, 2009

lolcats

It was a tough call, deciding between grad school and designing lolcats, but I think I made the right decision.

Thursday, October 15, 2009

Not Otherwise Specified – How Sick are You?


There is an article in the American Journal of Psychiatry titled ‘Increased Mortality in Bulimia Nervosa and Other Eating Disorders’ which compared mortality statistics between diagnoses of anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified.

There are limitations to this study and the author’s do a good job of recognising them, so I’m not going to critique the work. I do agree with them though that information such as duration of illness and comorbidity would be interesting to look at.

The highlight of this paper was that morbidity for EDNOS (eating disorder not otherwise specified) was comparable to other eating disorders.

This is where duration of illness information would come in handy. For patients without a severe eating disorder, obtaining treatment can be difficult. And what we’re left with, at the very least, is a persistent and un-treated (possible unrecognized) nutritional disorder which can lead to other medical problems.

There is also the issue of unresolved mental health problems which can further exacerbate eating disorders as well as increase other dangerous behaviours.

In all three groups ‘medical’ causes were the leading cause of death; it would be interesting to do a detailed study of this area in order to determine if there was a higher instance of nutrition related deaths (e.g. diabetes) and if ‘traumatic’ deaths were related to behaviour.

Another article advocating for DSM V recognition of EDNOS.

A note on Dietitians and the help they can offer.

Tuesday, October 13, 2009

Shakespeare and Psychiatry



I came across an older editorial examining Shakespeare’s insight into schizophrenia. “Bark has proposed that in Shakespeare’s King Lear, Edgar, in his guise as Poor Tom, had chronic schizophrenia.”

The original article references one author who argues “nowhere in Shakespeare’s works is schizophrenia to be found…” I am not versed in either Shakespeare or the details of schizophrenia so do not feel qualified to comment on how much of his character’s personality was simply inventive (or lazy) characterisation.

A 1986 article: “…a review of that behaviour in the light of DSM-III suggests a high degree of clinical accuracy…”

A 2006 study found references to melancholy, delusions and hallucinations, but did not find any clinical evidence in Shakespeare’s works of schizophrenia. This study only examined five of Shakespeare’s characters.

The author of a German article says, “Shakespeare's idea of epilepsy is closer to popular stereotypes than has hitherto been assumed.”

This paper highlights King Lear's use of the term ‘epileptic’ which is supposedly the first written form of the word (though Shakespeare probably referenced the word from other texts), but it appears to refer to the pock-marks of syphilis.

I also found a newer article saying, “In the first three decades of American psychiatry, no figure was cited as an authority on insanity and mental functioning more frequently than William Shakespeare.” The article claims he was cited very frequently in the Journal of Insanity. "There is scarcely a form of mental disorder," wrote Amariah Brigham (superintendent of the New York State Lunatic Asylum and the first editor of AJI) in the lead article of the journal's first issue, that Shakespeare "has not alluded to, and pointed out the causes and method of treatment."

One book states Shakespeare would often visit madhouses and “Hamlet shows many characteristics of manic-depressive illness…”

A 2009 essay: “It could be argued that Lear’s mental state is brought about by his daughter’s actions and exposure to the elements…However, although it is clear that his condition is exacerbated through the course of the play, there is evidence to suggest that he is not of sound mind from the outset.”

Monday, October 12, 2009

Child Rearing Metaphor



Oftentimes, therapies are aimed towards changing emotions. And while change is necessary, there seems to be a slight negative slant on the perception of emotions (though as I read through some CBT text, I am noticing that the same terminology could also be used to describe a child – ‘getting in the way’).

What I find these texts lack is a means of personally connecting with the process of understanding and changing.

The metaphor is quite simple; Treat your emotions, as sensitive and fragile and competent as they are, like you would a child (in order for this metaphor to work you must like children. If there are unresolved issues resulting in this not being the case, than choose something else such as a puppy).

Put your emotion first. If you start feeling anxious, stop and deal with the situation instead of putting it off until later when your emotion may become more difficult to manage.

Set boundaries for your emotions. Let them cry for a certain amount of time. Let them speak their mind without necessity of action. Allow them to punch a pillow, but not a wall (or a person).

Listen. If your emotion is anger and it wants to hurt someone, stop and ask it why. Let your emotion tell you what it really wants.

Comfort your emotions. Empathise (without becoming affected) and sympathise. Find ways to ease their discomfort.

Discipline your emotions. When they overreact or over-respond (say, if your sadness results in self harm), let them know such behaviour is an inappropriate or ineffective response. If you feel ‘punishment’ is called for, then choose a punishment that corrects maladaptive behaviours (if your sadness resulted in staying in bed all day, than force your sadness the next time it occurs to get out of bed).

Teach/ Educate your emotions. Make sure they understand why maladaptive behaviour is damaging and ensure they learn more effective responses. Use language that is clear and easy to comprehend (in some depressions, cognitive processes are diminished and there may be a need to use simpler language than you would on an unaffected day).

Monitor your emotion’s media exposure. Perhaps there is an overabundance of depressive television being watched (e.g. the sad story that was The Sarah Connor Chronicles. Sorry, Summer Glau. But I still love you). And watch for ideas that are being passed on in vulnerable states as well as direct emotional content.

But all of this is done under the umbrella of love. This might sound a bit cheesy, but I mean to distinguish between discipline as punishment and discipline as teaching, etc. That said, raising a child, like nurturing an emotion, is a complex and difficult endeavour which has numerous variations in the details of how exactly it is carried out. In fact, this metaphor, to me, seemed overly simplistic and I thought I must be missing something so I Googled “raise child” and wikiHOW has a ten step manual which is strikingly similar.

A word of caution: This is intended only as a metaphor and not as a facilitator for dissociation.

Thursday, October 8, 2009

Vitamin F – Essential/Omega Fatty Acids



I wanted to title this article ‘Vitamin O’ for omega, but is seems that way back in the day before they knew these were fats, they were called vitamins so I thought I would honour history.

Essential fatty acids come in different forms. The first is DHA (DocosaHexaenoic Acid), EPA (EicosoPentaenoic Acid), DPA (Docosapentaenoic acid), and ALA (alpha- linoleic acid). DHA and EPA are found primarily in fish oils. ALA is mostly found in plants and which is converted by the body into DHA or EPA. DPA is found in breast milk and seal oil. There are two basic categories of essential fatty acids- omega-3 and omega-6.

Some of the food sources of omega-3 are raw nuts, seeds, legumes, grape seed oil and flaxseed oil. Sources of omega-6 fatty acids include fish, canola oil, and walnut oil. Be cautious of mercury and PCB intake when consuming fish oils (supplements tend to refine their oils in order to removes these products, but check the label).

Deficiencies may be indicated by hair loss, eczema, and damage to the kidneys, heart and liver. Behavioral disturbances are also noted when deficient. The immune system can become less efficient with resultant slow healing and susceptibility to infections.

All following studies indicate further research in their results:

“…there is convincing evidence that add-on omega-3 fatty acids to standard antidepressant pharmacotherapy results in improved mood. There is no evidence that fatty acid monotherapy has a mood-elevating effect, with a possible exception for childhood depression.” (1)

“While it is not currently possible to recommend omega-3 PUFA as either a mono- or adjunctive-therapy in any mental illness, the available evidence is strong enough to justify continued study, especially with regard to attentional, anxiety and mood disorders.” (2)

“…positive effects of omega-3 as an adjunctive treatment for depressive but not manic symptoms in bipolar disorder.” (3)

“The available evidence suggests that omega-3 fatty acids are a potential treatment of depressive disorders, but not mania.” (4)

“…the possible positive effects of omega-3 supplementation and fish consumption against sudden cardiac death in patients with schizophrenia.” (5)

I could find very little evidence about negative effects of supplementation on mood disorders. Indeed, all of the studies could find no major side effects. Yet, my bottle of vitamins specifically warns against use for people who have mania or schizophrenic. I looked at about five other brands and could find no warnings other than for bleeding disorders and pregnancy. After much searching, I found one website which warned against possible induced mania (I suppose given the antidepressant qualities of EFAs, this makes sense. I consulted with a pharmacist and she gave a similar answer, but nothing specific). If any readers have more information on this, please share.

Side effects: gastrointestinal discomfort, may act as an anticoagulant, high blood sugar, or allergic reactions.

More specific side effects of Omega-3 indicating bleeding problems: easy bruising or bleeding; black, tarry stools; bright red blood in the stool; or vomiting of blood (signs of gastrointestinal bleeding). Signs of a hemorrhagic stroke (bleeding in the brain), such as vision or speech changes, weakness or numbness in an arm or leg, or a severe headache.

References: 1, 2, 3, 4, 5

Friday, October 2, 2009

Towards Treatment of Suicidality

If you or someone you know is suicidal, please contact someone.
1 800 SUICIDE

There has been some research lately looking into what criteria can differentiate those at risk for suicide to those who are not but who share the same psychiatric diagnosis.

An article in Psychiatric News touches on this research and their results.

“Some of the variables are childhood adversity, medical illnesses, impulsivity, aggression, and certain personality disorders…”

“…comorbidity is very important in suicide attempts…”

“Not getting help, especially the right kind of help, can also predispose people to suicide.”

More importantly, the article mentions a research project aimed to understand why people recover from suicidal behaviour.

“…connection with other people has been a major lifeline in every story she has received so far…”

The project is a website where people can share their stories of recovery, people who thought they would never get better, which I think provides an arena for hope (as well as future treatments). What I like particularly about this study is that it makes some of the stories available to the public because, as always, the more awareness we bring to mental health issues, the more likely we are to overcome stigmas and develop new treatments (and get government support and funding for these treatments which is seriously lacking).