Monday, July 16, 2012

Banking on Anxiety and Depression

Riding my bike to work on a summer Sunday morning is joining a love-fest, literally, although we tend to use the word love rather loosely.  Like I love my new tablet, or I love my new crocks.  But if you get out of the house in Chicago before it gets hot, then you're among the the getter-outers, a community of people loving their morning, people who plan their exercise.

And I'm forever ragging at you to become a part of one kind of community or another.

There's a breeze, too, and the flashing sign at the community bank tells me it is a balmy 81 degrees, my favorite temperature.  People are saying Hi, and they are smiling, bikers showing off cool bicycles, walkers their sneakers, runners, their bods.

We're all out at the bike path by the Chicago River, really a tributary that winds through parkland and splits the city by east and by west.  Nobody's impressed by the Chicago River, but the ducks like it, and lush trees that line it seem happy.  We get an occasional coyote or deer for excitement.

There's a Little League game going on, and one team is sporting shirts sponsored by Johnny's Ice House. You would think Johnny's is a place to pick up block ice on the way out of town for a road trip, but the Ice House is an indoor hockey rink.

But back up to 6:30 a.m. when I started writing this post.  I had been up only an hour, thinking about Daniel Smith and how to pitch his new book, Monkey Mind.
A definite flavor of the month,
Daniel Smith's Monkey Mind,
candy for professional
and layman alike.

There’s this saying: Early to bed, early to rise.  
And it works, too, assuming anyone could do that, get to sleep early.  

Sure, we could get to bed at 10:30.  But fall asleep?  Too much stim pounding at our brains.  FaceBook, Scrabble, YouTube, last week's Burn Notice calling our names.  Sometimes we even talk to real people at night. We have tea, make a stab at making love.

Taking a shower and getting ready for bed then, isn't a simple matter.  And falling out, as we say, dozing off, not a given, not unless we somehow manage to live caffeine-free lives and deliberately struggle through the day without a nap.  Although a catnap, 5-10 minutes won't affect us at night.  Doctors are masters at these. 

To wind it all down before eleven, the dogma is that it's good to avoid eating dinner after 7:00 p.m., and forego, maybe, late night ice-cream.  We should lay down, not sit, but lay down that weighted-head so the reticular formation in the brain stem gets a nice blood flow, feels dizzy with oxygen.  Best to do this with a good book, something that we can unconsciously drop that won't break.  

And yet, our bio-rhythms still may not cooperate.  

Driving somewhere last week, listening to a sleep expert on NPR, the talk was about how to figure out how many hours of sleep we really need per night.  There's a way to find this out:  

Go on vacation.
Go to sleep when tired note the time.  
Don’t set an alarm, wake up on your own and again, note the time.  
Repeat for a few days.  

As the body gets used to the idea that there's no need to get up to do something, it settles into a nice groove, doses itself—no Ambien necessary—to the proper sleep recipe, lending the sleeper a productive next day.

Ah, but I ask.  What about those who don’t need to set an alarm, who naturally wake up with the rooster.  Our expert would say that this is our natural rhythm.  But we know that early morning awakening is a symptom of depression!  Not always.

There is surely a greater truth, and more to resetting the clock than the vacation method.  It has to do with what's going on in our heads, in our minds.  These won’t necessarily shut down under any circumstances, even when we know our cycle.  

The "cycle" is affected by emotion, by thought.  We obsess, we cry.  We deliberate, we count.  Our angst is palpable.  Our hearts beat audibly, our breathing is short and words, countless words, invade our consciousness, usually self-deprecating words.

Wait.  Isn’t that anxiety? 

Well yes, as a matter of fact, it is.  

All that just to introduce the book that put me to sleep at 12:35 a.m. last night, two more pages to go.  It's a memoir by a guy who suffered from anxiety for almost all of his conscious life, a Simon and Schuster that reads like really, really, intelligent chick-lit,  In other words, gold.  

And I have it for you, literally.  Nina, the good publicist, sent me not one, not two, but three copies of Monkey Mind.  I get to keep one, obviously, to let my anxious mother, brother, sister-in-law, and all of the people I know with anxiety, read it.  

The other two are give-aways for the blog!

I’m thinking that the contest begins next Monday, July 23, 2012 at 8:30 a.m. Chicago time, which is Zone 6, Central Standard Time.  The first two readers to email me get copies of MONKEY MIND.  Write to  

You’ll be so happy you did.  Daniel Smith is a wonderful writer and you will recognize his story, the themes, the therapies.  You KNOW Daniel.  Maybe you ARE Daniel in another body.  I don’t know.  The story is so familiar and yet so unique, as is everyone's.  And you'll love the mother-father-son dynamics, naturally.   

Enough said.  I just can’t bring myself to spoil it, as I typically do with these things.

Other authors to make it to my bedside slush pile, because how else is a person supposed to sleep?  We talked a little about this one, ALMOST A PSYCHOPATH.  But I don't think I showed any pictures.
Ronald Schouten, MD, JD

James Silver, JD
Here are the guys who wrote it.  They do have a bit of that Law and Order aura, don't they?  For those of you who are considering forensic psych, James Silver and Ronald Schouten are a very good place to start.

For the rest of us,
Almost a Psychopath: Do I or Does Someone I Know) Have a Problem with Manipulation and Lack of Empathy? is better bedside reading than the DSM IV-TR for differentiating between people who merely enjoy playing with us (mischief) and those who can't help themselves, simply have to engage in criminal behavior.

Clear, informative. These professors are among a handful writing for the Almost series at Harvard (publisher, Hazelton), featuring the almost syndromes.  Some of us have clusters of features of different disorders but not enough bullet points to qualify for the big prize, a diagnosis.  We can't brag, technically, "I AM a psychopath," for example, but we can say we're awfully close.

It is difficult to host a disorder, especially the Axis I disorders like the mood disorders, anxiety, substance abuse, and anorexia.  It is an entirely different problem being the host, and infecting/affecting others.  By definition, some disorders do this, make everyone else miserable, too, not just the host-- especially the Axis II or personality disorders.  That's why it is good to read up on them.

If you're a therapist and you read Almost a Psychopath you'll find your gangbangers, the ones who want to change, and the reformed drug addicts and alcoholics who used to knock down old ladies for their purses.  You'll find the people you treat, and you will surely see them with a new set of eyes.  Of course if you are a relationship therapist, you might pat yourself on the back and say, Hey!  We already do that!  We're up to speed on the therapy!  And what a feeling that can be.

John Coates, The Hour Between Dog and Wolf

The fellow on our left couldn't handle success, couldn't be satisfied as a successful economist and hotshot trader.  He had to become a neuroscientist.  Those overachievers, seriously.

The book, The Hour Between Dog and Wolf is an everything-you-ever-wanted-to-know about the arousal systems in our bodies.  We're triggered (I know, shocking) and we behave.  Our senses, ourselves.  But if you haven't taken enough biology or psychology courses, and you want a taste of this and a good story, how real traders behave on real trading floors, why, then this one's for you.

And here I thought it was all about gambling, but a little more calculated,with a little more thought.  And it is about gambling and risk, the moment, if not the hour, of supreme clarity that motivates the trader to make the trade, to make millions in a moment.  Or lose them.  Who wouldn't want to read about this?

Because I'm not a medical doctor and because Professor Coates clamors on quite a bit about testosterone, I asked my in-house medical expert to read a few chapters to give me his spin.  FD relates the following:

Coates is saying that as the market becomes volatile, hormones (of stocks and commodities traders) are released, among them testosterone.  Coates feels that is is testosterone that drives the bigger risks. Could be a good thing, but could be bad that this is the case, but guys, especially, have to be in touch with their bodies, occasionally reel in their drives.  We've been saying this all along, you know.

The problem with the theory, according to FD, a theory presented as truth, is that testosterone is a slow acting hormone that isn’t released in sudden surges and it doesn’t yield immediate effects. 

People take testosterone for bone mass and muscle growth, and they have to take it long term regularly for months for effect. 

So what is it that turns the dog into a wolf?  We want to know!

Culture, more than anything else, FD is thinking, and adrenaline.  

Our hormonal systems are given plenty of print in the The Hour Between Dog and Wolf, a nice Xmas gift fo the stock broker in the family.  It even gives time, if not equal time, to the women on the floor.  Theoretically, they should be less successful, no, more successful.  Wait until the people at NOW get their hands on the book.

Bill Knaus, Ed.D, the mind behind
 The Cognitive Behavioral Workbook for Depression, 2nd ed.

Depression: The Guide for the Newly Diagnosed is a short little book, the type you need for your office waiting room.  It always amazes me how people who might have suffered from depression for years, truly don't understand the disorder.  All the more so, the newbies to the dark cloud.  Lee H. Coleman's little paperback can change all of that.

I think we’ve already given Bill Knaus a shout-out, The Cognitive Behavioral Workbook for Depression, 2nd ed.  Bill’s an edpsych doc, so of course he wants to educate.  And like most mortals, he has suffered from depression. A patient who read it berated me for not mentioning this fact to her.  Without knowing that Bill has suffered, why would she read him?  How could he relate?

Fine, so now you know.  

Excuse me.  The pool is about to open.  I gotta go change.



Mound Builder said...

Quick comments... Based on my sleeping habits when I am on vacation, I think I probably am tired more of the time than I quite realize. When on vacation, I seem to sleep more, dream better, and even take naps in the late afternoon!

I recently read The Psychopath Test. I'm not sure what to say about it. I found it interesting. I'm not sure that I feel any better equipped to detect psychopaths. As long as I've known about psychopaths, that idea has seemed disturbing, that there could be people who would be so charming, who could appear so normal, and that they could and would happily take advantage and would groom people just for their own ends. I have wondered if it is psychopaths who rise to power that accounts for some of the worst things that happen in work places, marriages and other relationships, and even within countries that seem to be especially corrupt and violent. How to get that kind of person out of positions of power?

therapydoc said...

Silver and Schouten make that point, that not everyone who makes it is honest. Charm is seductive, however and we believe what we want to believe about people. Reality doesn't matter. First and foremost, we're emotional social creatures.

Anonymous said...

Thanks for sharing your thoughts on THE HOUR BETWEEN DOG AND WOLF for the book tour!

Tzipporah said...

Regarding sleep and vacation--I have to wonder just how accurate a test that is. I, for instance have always been the type that if let be would sleep 12 hours in a row at least once a week. Of course then I wake up dizzy, nauseous and feeling like I have a hang over for the rest of the day and then I am unable to sleep the following night. So that could be from the lack of sleep I normally get... okay I'm sure it is. But, the issue is if you go on vacation for just a couple of days and like me you tend to get way less sleep than you "need", you might find the first few days of the experiment will leaving you thinking that you naturally need 14 hours of sleep a night. It might be better (if in some dream world this was actually possible) you could try this experiment out over the course of two weeks.

therapydoc said...

Great point. I'd like to see the research, how they really conducted the study. But like you said, who has the time, and if you go on vacation, don't you want to get up and DO things?

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