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Christine Stapleton on the Fort Hood Massacre: A disturbed psychiatrist, a gun and the reality of war

In our efforts to wrap our brains around a senseless event, we look for cause and effect. We desperately want to to see if we could have prevented it somehow. It's only human to wish to control. Unfortunately that process can mean demonizing the perpetrator, making him a monster, something, anything, 'not me.'

This morning I learned the gunman was a Muslim and a psychiatrist. While I have deep sympathy for the families of those killed and injured, I also have concern about possible backlash for Muslims and for mental health professionals as well.

Christine Stapleton, a reporter for The Palm Beach Post, expressed some of my concern in the wake of this horrible incident. As a therapist I have to be very aware of whether I am metaphorically putting the oxygen mask on myself first so that I am capable of helping others. The US military is just now beginning to incorporate state of the art diagnosis and treatment of Post-Traumatic Stress Disorder for our combat troops. How are our front-line caregivers cared for?

Here is Ms. Stapleton's article originally published today at Depression On My Mind. It's too soon to know the answers to the hard questions she poses, but it is good that we ask.

I will go to my therapist’s office this afternoon. I will sit in the waiting room and read an old magazine. Another client will walk from a hallway that leads to my therapist’s office, pass through the waiting room and leave. My therapist will poke her head out, smile and say: “I’ll be with you in a minute.” After a  few minutes she will come back and invite me into her office. I will walk in, notice Kleenex in the waste basket and sit on the couch beside the box of Kleenex.

After a few pleasantries I will start unloading the detritus of my soul. She always pays attention and looks interested. I am her last patient on Friday. I cap off her week of listening to the detritus of other peoples’ souls. I ask myself, who in their right freakin’ mind would do this for a living? Hour after hour, day after day, week after week, year after year, listening other peoples’ misery.

So I asked her. ”It does get to you,” she said and explained how she takes care of herself. Burnout is a big problem among mental health care providers, she said. Then I remembered Tony Soprano’s therapist who had her own therapist on The Sopranos. It never dawned on me that a therapist might have a therapist.

This morning I got to thinking about this after reading about the gunman and his horrible rampage at Fort Hood yesterday. His name is Maj. Nidal Malik Hasan and he is an Army psychiatrist. He also is Muslim. Before he opened fire and killed 12 and wounded 31 people yesterday he had been assigned to counsel soldiers returning from the battlefields with post traumatic stress disorder. Hour after hour, day after day, week after week he listened to the horrors and atrocities of war. The soldiers he counseled were emotionally raw - just off the battlefield.

The Challenge of Mental Health Care at Colleges

National Public Radio (NPR) broadcast two stories on what colleges and universities across the country are trying to do to take care of the mental health needs of their 
students.

More young people who live with the challenges of mental illness attend college. Advances in treatment including medication management, make secondary education possible for many who couldn't have even considered it before.

Like most new trends there's the good news and the bad news. 

The good news: Worthy young adults get to experience the advantage, challenge and adventure of college life.

The bad news: Many colleges and universities are not well prepared for the increased numbers of kids who need behavioral health support or services while at college.

These two stories, linked below, especially the one aired today, report on what many forward thinking institutions are trying to do to address the bad news.

Once again, society shows signs of finally letting go of the notion that mental illness is something to shove under the rug, out of sight. The risk is too high, and too many of us are directly or indirectly effected by continued ignorance. Thanks to NPR for their excellent reporting.

Colleges See Rise In Mental Health Issues

A Push For Colleges to Prioritize Mental Health

True Or False? 7 Myths About Depression

If depression doesn't effect you, chances are it effects or will effect someone you love. Preconceived notions of the nature of depression can make the depression worse. It isn't uncommon for people with depression to believe they should be able to snap out of it on their own. By the time they call me they feel like they've failed; not realizing that the depression literally has a mind of its own and seeking proper treatment sooner defeats it faster. Too often people believe that if only they were stronger they could get out of the pit on their own. Allowing such thoughts to go unchallenged is like allowing someone to kick you, hard, when you're already down.

This list of myths collected by John Grohol, PsychCentral founder and CEO, and his responses help to dispel some of these notions. He neatly explains why they are all false and what better, more sound thinking consists of:

1. Depression means I’m really “crazy” or just weak.

Depression can strike anyone, at any time — whether you’re “weak” or strong, it knows no bounds. Some of the strongest people I’ve met are people who’ve coped with depression in their lives.

2. Depression is a medical disease, just like diabetes.

While it has neurobiological components, it is no more of a pure medical disease than ADHD or any other mental disorder. Treatment of depression that focuses solely on its medical or physical components — e.g., through medications alone — often results in failure. Get to know the risk factors for depression.

3. Depression is just an extreme form of sadness or grief.

If [depression] were ordinary sadness or grief, most people would feel better just over time. In depression, time alone doesn’t help, nor does willpower (”Pull yourself up and stop feeling so sorry for yourself!”). Depression is overwhelming feelings of sadness and hopelessness, every day, for no reason whatsoever.

4. Depression just affects old people, losers and women.

While ... more women than men are diagnosed with depression, men suffer for it all the more since many people in society believe that men shouldn’t show signs of weakness (even a man’s own upbringing may reinforce such messages).  ...depression is not a normal part of the aging process. In fact, teenagers and young adults grapple with depression just as much as seniors do. ...successful people have also had to deal with depression, people such as Abraham Lincoln, Theodore Roosevelt, Winston Churchill, George Patton, Sir Isaac Newton, Stephen Hawking, Charles Darwin, J.P. Morgan and Michelangelo. ...being a loser is not a prerequisite to being depressed.

5. I’ll have to be on medications or in treatment for the rest of my life.

...most people who have depression do not need to be on medications for the rest of their lives (or be in treatment for the rest of their lives). In fact, a lot of research suggests that most people can be treated for depression successfully in as little as 24 weeks with a combination of psychotherapy, and if needed, medications.

6. All I need is an antidepressant to treat depression effectively.

Sorry, no, it’s not as easy as popping a pill. While certainly you can have an antidepressant medication quickly prescribed to you by your primary care physician, you’re unlikely to feel any beneficial effects from that medication for 6 or more weeks in most cases. In two-thirds of patients, that first medication won’t even work! Combined psychotherapy treatment with medication is the recommended gold standard for the treatment of depression. Anything else is going to be significantly less effective, meaning most people will suffer with their depressive symptoms longer than they need to.

7. I’m doomed! My parents (or grandparents or great uncle) had depression, ...isn’t it inherited?

While researchers continue to explore the neurobiology of mental disorders like depression, having a relative with depression only marginally increases your risk for getting depression (10 to 15%).

Read the entire article 7 Myths of Depression

Photo courtesy of Bern@t via Flickr

Glenn Close's Sister Speaks Out About Mental Illness

I had no idea Glenn Close, the actress whom I've admired ever since seeing her in The World According to Garp was a mental health advocate. Therese Brochard, of Beyond Blue, brought my attention to this:

"Mental illness is just part of the human condition," Glenn Close said today on "Good Morning America." Halleluia! A Hollywood response to all the scientology. Today Close spoke out for the first time on television about the legacy of mental illness in her own family: Her sister, Jessie, suffers from bipolar disorder, and Jessie's son has schizo-affective disorder.  

It is a brave thing both of them did, speaking openly about the challenges of bipolar disorder in the middle of the Grand Central Concourse. It was especially courageous for Jessie!

Read the entire article Glenn Close Tackles Mental Illness...Thank You!

Also read: Glenn Close Named Mental Health Advocate

The ABCs of SAD: Seasonal Affective Disorder

Around this time of year I begin to hear from people who have trouble with what we call Seasonal Affective Disorder (SAD).

"I always have trouble this time of year. It's the season. I can't take it."

What distinguishes SAD from regular run-of-the-mill depression is the time of onset, between September and October, when the days become significantly shorter in certain latitudes. The further away from the equator you live, the less sun there is in the winter. Behavioral scientists believe there is a change in brain chemistry in people susceptible to SAD. Something about how serotonin is processed messes up sleep cycles and mood.

Symptoms are:

~ Feeling sad, grumpy, moody, or anxious.
~ Losing interest in your usual activities.
~ Eating more and craving carbohydrates, such as bread and pasta.
~ Gaining weight.
~ Sleeping more and feel drowsy during the daytime.

People with SAD report feeling relief from symptoms around April or May, as the days' sunlight increases.

How is SAD treated?  Best practices for the treatment of SAD includes:

~ Bright light treatment. For this treatment, you sit in front of a "light box" for half an hour or longer, usually in the morning. Light therapy works well for most people with SAD, and it is easy to use. You may start to feel better within a week or so after you start light therapy. But you need to stick with it and use it every day until the season changes. If you don't, your depression could come back.
~ Dawn simulation. For this treatment, a dim light goes on in the morning while you sleep, and it gets brighter over time, like a sunrise.
~ Antidepressants. These medicines can improve the balance of brain chemicals that affect mood. Consult with a board certified psychiatrist.
~ Counseling. Some types of counseling, such as cognitive-behavioral therapy, can help you learn more about SAD and how to manage your symptoms.

To learn more about SAD read:

WebMD on SAD

About the Winter Blues

Research Updates: Seasonal Affective Disorder Treatments

3 Mini Meditations For When Your Brain is Fried

At the end of a long day toward the end of a long week, I was sitting in my office trying to gather myself together so I could go home. There were emails to answer, phone calls to return, notes to finish and plans to make for the next day.

Did you ever see Hitchcock's The Birds? My brain resembled that room in the attic filled with frantic, flapping, nasty birds desperate for a way out. As soon as I started one thing I was pulled to do something else, then another. Result: Nothing was getting done. My usual ability to focus was fried. My solution was to give up, leave the mess on the desk and walk out.

Like Scarlet O'Hara I told myself I'd think about it tomorrow... after a good night's rest.

That's one way to deal with being stuck in mental over-drive. Better yet is a mini-meditation break as suggested by Ed and Deb Shapiro, authors of "Be the Change - How Meditation Can Transform You and the World." In an article in the Huffington Post they wrote:

...here are three mini-meditations, moments to just stop and breathe and remember why you are here. A moment to check yourself out, to look within, and to find what is really meaningful to you. You can get it together even when you think it is all falling apart.

Mini-meditations can be done on a train, walking down the street, at an airport, standing at a bus stop, in an elevator, while sitting in the bathroom (often the only place you can be alone!).

All it takes is a minute, one refreshing minute, to just stop and breathe, collect your thoughts and get back in touch with what's really important. Here's how:

1. Mini Breath Meditation 

Sit comfortably with your back straight. Take a deep breath and let it go. Begin to silently count at the end of each out breath: Inhale... exhale... count one, inhale... exhale... two, inhale... exhale... three. Then start at one again. Just three breaths and back to one. Simply following each breath in and silently counting. So simple. Do this as many times as you want, eyes open or closed, breathing normally.

2. Mini Walking Meditation 

You can do this walking along a country lane, a city street, in the office or the garden. You can walk slowly, normal or fast, whatever feels right. As you walk become aware of your walking, of the movement of your body and the rise and fall of your feet. Become aware of your breath and see if you can bring both your breathing and your walking together. Just walk and breathe with awareness for a few minutes.

3. Instant Letting Go 

Find a quiet place to sit, have a straight back, and take a deep breath and let it go. Then quietly repeat to yourself: "My body is at ease and relaxed... my heartbeat is normal... my mind is calm and peaceful... my heart is open and loving." Keep repeating this until you have let go of the tension and are at peace. Then take a deep breath and have a smile on your face!

Read more at: http://www.huffingtonpost.com/ed-and-deb-shapiro/3-mini-meditations-to-hel_b_315880.html?show_comment_id=32781100#comment_32781100

After dinner, I went to bed early. Those thoughts were still buzzing in my head so I tried mini-meditation #1. Before I got to my tenth breath, a window opened and the birds flew out. With a clear, clean room in my brain I could go to sleep. Lights out.

Read more at: http://www.huffingtonpost.com/ed-and-deb-shapiro/3-mini-meditations-to-hel_b_315880.html?show_comment_id=32781100#comment_32781100

Read the entire article: Three Mini-Meditations to Help You Through Your Day (or Night)

And here purely for your entertainment, the great Alfred Hitchcock on The Birds:

Photo courtesy of ladybugbkt via Flickr

10 More Ways to Lower Anxiety

Skimming through Real Simple magazine at the check out line of the supermarket, I came across Dr. Robert Leahy's “10 Ways to Cope with Anxiety.” Dr. Leahy is the director of the American Institute for Cognitive Therapy and the author of many books on the subject. His suggestions will help you calm your nerves: 

1) Repeat your worry until you're bored silly.

"...take the troublesome thought that's nagging at you and say it over and over, silently, slowly, for 20 minutes. It's hard to keep your mind on a worry if you repeat it that many times."

This technique is called flooding by behavioral theorists. If you have the courage to do this, I recommend you think about your worries while practicing relaxation techniques to keep your body as calm as possible. Dr. Leahy calls this "the boredom cure."

2) Make it worse.

"When you try too hard to control your anxieties, you only heighten them. Instead exaggerate them and see what happens." 

This is a good one. When I suggest it to my patients I call it the 'Bring it on' technique or 'Fake it 'til you make it'. By inviting what scares you, you learn on your time that you can survive your fears instead of waiting to be bushwhacked by them.

Sports psychologists use this all the time. When I was terrified my horse would shy and dump me on the ground, my coach told me to stop trying to keep my mare from bolting. Instead she told me expect her to shy, to look forward to it. That attitude helped me relax and so did the horse.

3) Don't fight the craziness.

"You may...have thoughts that lead you to think you'll do something terrible...or that you're going insane... Remember – our minds are creative...every now and then 'crazy' thoughts jump out. Everyone has them."

Years ago, when I was exhausted, sleep deprived and in the grips of baby blues I had thoughts of throwing my screaming baby out the window. Those thoughts terrified me. Tearfully, I confessed my horrible thoughts to my mother who shrugged and said, "We all think something like that. You didn't act on it, did you?" She assured me I wasn't crazy, I could relax.

My patients are sometimes surprised when I suggest they allow themselves to imagine doing something outrageous like throwing a banana cream pie at their nasty boss. Unleashing out creative minds may be just what we need to de-stress.

Behavioral Economics: This Is Your Brain On Money

It doesn't take a genius to figure out that with recession-related anxiety saturating the very air we breathe, we might be a bit slow to trust our financial decisions.

For decades, economists did not find much merit in connecting psychology with finance. That changed  when a young economics professor from the University of Chicago, Richard Thaler, introduced himself to two Israeli psychologists, Daniel Kahneman and Amos Tversky. Together they are credited with founding behavioral economics.

Behavioral economics, and its close cousin, neuroeconomics, combines the disciplines of  neuroscience, economics, and psychology to study how people make financial decisions.

Using Psychology to Save You From Yourself, an NPR podcast, explains the origins and development of behavioral economics. Kahneman, a 2002 Nobel Prize laureate for economics, studied what he called "the illusion of validity," i.e. our judgment can be very wrong even though we are the last to acknowledge it.

For example, when a prospective employer is considering a candidate for a job they often weigh the job interview the heaviest in their decision making, a choice proven over and over again to be a mistake. Twice I hired people primarily on the basis of an impressive interview, only to let them go during the probationary period. Another time (after being burned) I hired the second runner up because her experience and credentials were the best. That person turned out to be golden.

Kahneman and Tversky pointed out lots of other errors humans commonly make in decision making, explaining why we can so easily be sucked in by clever marketing or most insidiously, credit card merchants. I found it fascinating to read their explanation of "anchoring bias":

It turns out that whenever you are exposed to a number, you are influenced by that number whether you intend to be influenced or not.

This is why, for example, the minimum payments suggested on your credit card bill tend to be low. That number frames your expectation, so you pay less of the bill than you might otherwise, your interest continues to grow, and your credit card company makes more money than if you had not had your expectations influenced by the low number.

Boy, does that make me feel silly. Every single time I pay my credit card bill, I have to remind myself that it's best to pay as much of the whole thing as I can, asap. But like bitter medicine I'd rather not and that low number beckons.

In the 1980's Thaler, Kahneman and Tversky:

...began to publish their ideas — an integration of psychological research and economics with this new flawed decision-maker at the center. But initially, mainstream economists largely rejected the work.

The main point of contention, says Thaler, was the suggestion that humans are less than perfectly rational when it comes to decision-making. For the majority of the 20th century, and for the most part even today, the human beings imagined by economists and placed at the center of their economic models have had a Spock-like rationality.

Well, I've always loved Mr. Spock but for better or worse, most of us are more like the flawed, romantic, all too human, Kirk.

What can we do to regain trust in our financial decision-making ability?

> One thing is to address our anxiety so that we're using our higher brain to think and not letting the overly excitable reptilian brain rule.

> If you know it's best to save a certain amount from your paycheck, set up an automatic deposit to go to a savings account. That way the decision is made once and you don't have to convince yourself over and over, every single month.

> Knowing that it's possible your first instincts may be wrong, like deciding to sell your stock at the bottom of a recession, it's a good idea to get a second opinion; preferably from an expert, like from a certified financial planner.

Photo courtesy of bitzcelt via Flickr

8 Anxiety Reducing Tools to Put in Your Money Management Toolkit

These suggestions may be classics but it's amazing how many people have no idea.

Before I got lucky and married a man who knew a thing or two about money management, I was one of the clueless masses. Imagine my amazement when he suggested we design a budget. A what?

Then he asked me to keep a journal and write down every penny I spent. He'd been doing this since he was nine! Honest! Did he came from Planet Money or something? It was a painful education, like My Fair Lady; John in the Henry Higgins role and me, Eliza Savelittle. When I threatened to rebel we agreed to see a financial planner. She may have saved our marriage.

You don't have to learn the hard way. The Journal of Financial Planning put together this starter list:

1. Create a Budget and Track Your Expenses

"Most clients are usually very surprised at the amount of money that they can't account for," said Richard S. Gardner, CFP®, of Lionheart Financial Planning, Inc., "I then ask them to write down every expense and purchase they make for a month by carrying a notepad with them. At the end of the month, they usually have a good idea how much money is being wasted at the local Starbucks or McDonalds and are willing and able to get their discretionary spending under control to help set funds aside for their more important goals."

2. Build an Emergency Fund

"I require my clients have an emergency fund equal to at least six months, though 12 months is best in this environment, of non-discretionary expenses such as mortgage, loans, utilities, groceries, and insurance premiums before I will set up any kind of investment portfolio for them," said Gardner. "This helps keep them out of credit trouble if things don't go as planned or someone loses a job and they don't have to resort to credit cards, loans, or tapping retirement accounts for funds."

3. Learn How to Save and Spend

Gardner suggests the best way to learn how to save is to have funds deducted directly from your paycheck or deposit account and redirected to savings vehicles. "It's the old 'out of sight, out of mind' adage," he said. 

In addition, Gardner says learning to be money smart can start when children are young. "I routinely provide basic financial education to the children of clients. This education teaches them how to open and maintain a checking and savings account, track expenses and live within their means. I find that most kids, especially teenagers, are more receptive than we adults give them credit for..."

4. Understand Your Relationship to Money

If you can't get a handle on your spending, it might make sense to schedule an appointment with a local psychologist who deals regularly with money issues.

Our relationship to money can be very complicated and many of us find it uncomfortable to talk about it. This is an area I've worked in for many years, with individuals and couples, most recently due to the recession. If you think your attitude toward money could be getting in the way of managing it wisely, give me a call.

Nervous About Your Finances? National Financial Planning Week is Here to Help!

This week is National Financial Planning Week. Regionally and across the country events are taking place to help us face our financial anxieties. Locally in the Buffalo/Erie County area:

~ "Establishing a Family Budget and Debt Management Plan" a presentation and discussion will be held at the Clearfield Branch Public Library on Hopkins Rd. in Williamsville

TODAY Monday, October 5th and Friday, October 9th from 4-6 p.m.

~ "Establishing a Family Budget and Debt Management Plan" will also be presented at the Merriweather Branch Public Library on Jefferson St. in Buffalo

Thursday October 8th from 5-7 p.m.

AND

"Understanding & Surviving the Current Economic Crisis"

Back by popular demand Amy Jo Lauber, CFP and I will present our seminar at the Clearfield Library on Thursday, October 8th from 2-4pm.

It's a fun, dynamic talk where we address both the financial and emotional side of personal finance.

All events are free of charge (and sales pitch).

Amy Jo will also be a guest on "The Financial Guys" radio talk show Saturday October 10th from 2-3:30pm on WBEN. She will talk about what to ask a financial planner, what s/he will ask you, and what the financial planning process is all about.

All week there will be posts here about the psychology of money.

Check out the Financial Planning Association's informative website.

Photo courtesy of Roby via Flickr