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 TherapyDocATgmail.com.  

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.


therapydoc

The Waiting Room

When book publicists (they still print them, you know) notice your blog, they send you an email: "I came across your blog. . .”). They are hoping you will advertise their book, of course. The good thing is you get to read new books for free, don’t even have to worry about late fees, like you do at the library. It is a win-win. The downside is making the time to review them.

I always say, “If I don’t like the book, I won’t review it,” and they are totally cool with that. One publicist actually wrote me back, however, to say, “No. We’re interested in your honest opinion.” In other words, bad publicity is better than no publicity at all.

What is fascinating is that this, a blog, is the equivalent of a waiting room. You, dear friends, represent people waiting to see the doctor.

The room is a little different than your average waiting room, holds many, many, many more people. Everyone is waiting for good content, and most won't wait very long.

I tell a new patient before the first visit, “Wait in the waiting room. You can’t miss it when you walk into the building, and it is huge, you’ll get a seat.” This puts everyone at ease. But this waiting room has even more chairs.

Traditionally, doctors get free magazines, good ones, too. Why? Because hundreds of patients pass through and have to do something to pass the time while waiting. And each and every one of the magazines has a subscription card in the centerfold, even the family fun throw-aways.  The subscription cards are very useful as bookmarks for real books, in any case. (Not to mention the cool things you'll find to do for family fun, I'm serious.)

Thus the waiting room is a marketing tool. Sending a doc a free magazine is advertising on the cheap, and this is the way it will be, should be, and why print journalism will never die. Unless everyone gets a Kindle or a Nook for free, just waiting to see the doctor.

So have a seat.

Two books, one wet and one dry, both excellent.

(1) Dry, but full of good things:
Changing Behavior, by Georgianna Donadio, SoulWork Press (you have to love that, SoulWork).

 

And the pictures are simply fabulous, all Picasso-esque. The book measures large, 11” x 8.5, and that should change. Not a beach book. But it isn't supposed to be. It is a means of promoting the National Institute of Whole Health, and a good one, at that. I like the descriptions of the brain, How It Is wired, Made Easy, if such a thing is possible, and it isn't. But it is much more interesting than the one that high school seniors read in AP psych.

And I love the behavioral engagement, Pure Presence paradigm. We talk about empathy on this blog, how to zero in on the emotions of others, how not to insult, how to engage, to meet, connect to people, really. But here is a set of rules for doing that. Or if you prefer, a list of the elements, variables, that go into establishing a better listening (hence engaging) environment.

The thinking is that if you don’t

(a) Find relationships sacred, worthy of reverence and respect,
(b) Use eye contact properly,
(c) Inquire without probing,
(d) Feel compassion, and least show some,
(e) Focus,
(f) Accept
(g) Let go of control

you can’t connect, not as well as you could otherwise. Pure presence compises more than those seven. I think there are twelve steps. Wouldn’t you know.

(2) Wet:

I’m watching Law and Order with my son, it’s late, and I have warned him to pay attention because I’ll probably fall asleep for the last twenty minutes and will want a recap on what happened, but make it to the end.

There is a spoiler, sorry, no other way to write this one.

The story is about two boys in foster care. Their parents are addicted or in jail or both. One kills the other (the spoiler).

The killer is gorgeous, blond, sweet, barely pubescent face. He doesn’t smile, he shows remorse, and at some point he even tells the truth. Yes, he murdered, and yes, he has done it before and believes he may do it again. He wants to be locked up. Should he be tried as an adult, or given the reprieve of juvie?

The defense takes the position that he has an XYY chromosome. He inherited DNA that is associated with criminals. He’s doomed to be an overly aggressive young man, maybe old man.

Harvard University sent me this little gem of a book, Almost a Psychpath . Maybe they know I’m obsessed with why people hurt other people, and helping them change. It is the harder part of being a systems therapist, complicated, but rewarding. Almost a Psychpath reinforces that notion that differentiating the true psychopath from one who is almost a psychopath is one of degree.

A psychopath, to make it short, is, one who couldn’t care less who he hurts to get what he wants, has no compunction about stealing, lying, maiming, even killing to take care of number one. He hurts without remorse, on instinct behaves in ways that benefit no one but himself.

“She shouldn’t have made me angry,” is the typical excuse for abusing an intimate partner. It is never his fault, always the fault of someone else for crossing him.

The examples in the book send chills. Better than Law and Order. I'll be writing more about it soon.

therapydoc