Tuesday, October 22, 2013

Seeing Red Over Pink

October sure is a busy month for awareness pushers. Depression, domestic violence, brain injury, ADHD, bullying, AIDS, breast cancer. Not fun stuff. The focus is meant to help educate, encourage early diagnosis, reduce stigma, connect to treatment. All well and good.  Maybe.

There's been some backlash on the huge swamp-us-in-pink Breast Cancer Awareness.  Psychotherapist and author Harriet Lerner addressed it in her Psychology Today column,  "Don't Think Pink."   I disagreed with part of the post-- I frankly don't mind public events like the "bras over the river" that create community along with awareness-- but like Dr. Lerner, I'm put off by the commercialization of this disease. I don't need pink M&Ms to remind me that breast cancer matters.  I don't like processed food makers pushing raspberry flavored energy drinks under the guise of fighting cancer.  And I absolutely agree that we need to increase focus on environmental risk factors and how to decrease them.  There's no doubt pharmaceutical  research saves lives.  But it would be far more efficient to put some money into preventing disease. 

The whole pink-ribbon deal is sketchy, at best.  Christopher Zara, International Business Times"Breast Cancer Awareness Month was originally cooked up as a corporate marketing blitz by Imperial Chemical Industries, now part of the pharmaceutical giant AstraZeneca.  The company, at the time, had an obvious interest in reaching the marketplace: It sold both carcinogenic pesticides as well as numerous cancer-treating drugs. 'It was the perfect profit cycle,' said Karuna Jaggar, executive director of the nonprofit Breast Cancer Action. 'They sold chemicals that cause the disease and then the treatments for the disease.' ”

Then there's the forced cheeriness of the month, which seems to insist that cancer is an exciting self-awareness journey.  Well, sure it is.  But it also is horrible, and hard.  And to have to plaster a smile on your face and endure endless chipper cliches lest you be accused of causing your own illness due to your poor attitude-- well, that is an extra circle of hell.  

Writer Barbara Ehrenreich challenged this perky weirdness in her Guardian article, "Smile, You've Got Cancer".   "In the mainstream of breast cancer culture, there is very little anger, no mention of possible environmental causes, and few comments about the fact that, in all but the more advanced, metastasized cases, it is the "treatments", not the disease, that cause the immediate illness and pain. In fact, the overall tone is almost universally upbeat. The Breast Friends website, for example, features a series of inspirational quotes: "Don't cry over anything that can't cry over you"; "When life hands out lemons, squeeze out a smile"; "Don't wait for your ship to come in… swim out to meet it," and much more of that ilk."  Now, in addition to having cancer, you can feel guilty that you aren't embracing it.

But cancer isn't a grand adventure.  Sometimes, true, it brings unexpected positive side effects:  deeper relationships, a sense of what's important, a call to grace.  My friend Annie exemplified these attributes in amazing, beautiful ways.  And in the end, a year ago, she was willing and ready to die, and did so unafraid and at peace.

But just a few weeks before, we'd walked on a beach while she admitted to me she'd been unable to discuss planning for her death at all. Even though her doctors had told her that "at best, you'll see your son into 4th grade, and maybe if you're lucky, to the Spring." She'd not made a will, discussed her hopes for her family's life without her, or in anyway allowed herself to think-- except in brief, guilty moments-- that her stage four cancer was a serious problem.   To do so, she worried, would be akin to asking for death, for being ok with leaving her sons, her husband.  Annie was atypical.  She was one of the most evolved, loving and positive persons I've had a chance to meet.  But she was also human.  And she needed, at least that day we walked, a chance to tell another part of her story-- that she was scared and sad.  "But I know I need to stay positive to remove whatever block I must be having to being healthy".  I asked her if she thought a two year old with leukemia was "blocked".  "What negative thoughts cause a five year old's brain tumor? Things happen, Annie," I told her.  "We can't control everything. "

Annie's death occurred when she was in a place of peace, surrounded by family and friends.  But if she had struggled against it, I would have loved her all the same, and I wouldn't feel she wasn't brave for it.  The reality of cancer is not cheery.  Photographer Angelo Meredino captured this in a heart-wrenching series of photographs of his girlfriend during her illness. 

If cancer has touched your life, or that of someone you love, it's not enough to buy a packet of pink Swiffer refills.  Throw some of that money and energy into programs that assist persons affected directly.  Volunteer for hospice.  Learn more about environmental causes of cancer and agitate for research and change.  And if you want to donate to a breast cancer organization, consider the Breast Cancer Fund, which is actively working toward prevention.  You won't get a pink plastic water bottle, but you might make a real difference.

Thursday, October 3, 2013

October is Depression Awareness Month

Feeling the bite of the black dog?

It's probably no coincidence that October is national Depression Awareness Month.  The days of decreasing light are paralleled with increases of calls to my office of people seeking support for anxiety and depression.

Depression is a life-threatening disruption that takes on a life of its own.  This graphic shows some of the connections.  It's not perfect, but shows some of the self-feeding flow of stress (psychological or physiological).  Wish I could cite the source.  It's been reprinted a lot and the few citations I find lead to dead ends.  

I've been in practice a long time.  In a town with a population of 50,000 and over 40 therapists, you'd think I'd run out of clients.  But I get 5-10 requests a week even with a phone recording saying my practice is full.  Most of my colleagues also are full.  And every year,  demand seems to increase.
What's up? 

I have a few ideas.  I have lots to say on each of them, but we'll start with the bullet points, and I'll talk in more detail in future posts.

1)  Complexity of life has increased geometrically, and with it, stress.
 a)  Work patterns have changed.  We work more, have fewer vacations, and work leaks into domestic life in ways unprecedented in history.
 b)  We are interrupted more:  by auditory and visual stimulation, by devices and demands.  There are constant challenges to our attention and rest.
 c)  Increased information leads to anxiety
      1)  We are fed ceaseless bad news about isolated events to the point we feel in constant threat.
      2)  We are exposed to countless choices that drown out intuition and lead us to second-guess if we
            are good enough or have made the ultimate best decision.

2)  Eating, sleeping and light exposure patterns of humans have changed dramatically.  Each of these affects our circadian and hormonal rhythms in ways our evolution has yet to accommodate.
  a)   24 hour food availability changes long-term human patterns of seeing food as sustenance into              sources of comfort or entertainment, leading to obesity and hormonal challenges.
  b)   Availability of cheap, heavily marketed and nutritionally thin foods appeals to instant
        dopamine rewards; robs us of vitamins and minerals that protect our physical and mental health.
  c)  Constant artificial light, night shifts, 24 hour stores, etc profoundly disrupt sleep cycles.

3)  Social connection and support are decreased.
   a)  Communities have lost their centers.  People go out less, and when they do, they engage less with each other and more with their devices.  Natural support communities such as   churches are weaker (see 1-- no one has time).
    b)  This generation reports having fewer friends and spending less face-time with those they have.
    c)  Multi-generational family connections are less valued.  More people live away from where they were born, and they move more often and more widely than in previous generations. 

In a nutshell:  lots of us are stressed out, overstimulated and overworked, underconnected, and not sleeping, exercising or relaxing as much as our body needs to come even close to the demands of modern day life.  We are anorexic not of food, entertainment or choice, but we are vastly underfed of love, support, rest and community.

It's no wonder we get depressed and anxious.

You know who fares well in times like these?  Sociopaths.  Through a quirk in their genetic evolution, they lack empathy and don't rise high on many other emotional scales either.  They don't get angsty about much that doesn't effect their personal and immediate bottom line.  We're getting good case presentations on this genotype with the current Middle School Machinations of the country's political parties.  They don't seem to be losing a lot of sleep over the jobs that folded overnight because they are in a pissing war with the president. 

But those of us who through religious or humanitarian ethos feel it is our job to be kind, to be just, to help those who cannot help themselves, to protect the earth for future generations, who put people before profit... we're feeling the pain big time.  As William Blake said:  "Can I see another's woe, and not be in sorrow too?"  Yes, apparently some can.  Watch out for them.  They are dangerous.

The more oyxtocin-dipped among us tend to be in sorrow.  Throw some complex stress, lousy sleep and poor support, and sorrow morphs into full-fledged depression.  The predisposition may have always been there, but the cultural nudges are throwing it right off the cliff.

There are interventions for depression.   Like cancer, it's a serious disease and the treatments aren't comfortable or easy, whether we're talking about talk therapy, CBT, mindfulness training or medicine.
Flawed as the approaches are, they beat the disease.  I'll be listing resources in each post.  Some you can do easily on your own.  Some that seem easy, aren't at all if you are really gone into the cycle.  Then it helps to have a coach, counselor, best friend, doctor, religious leader--somebody you trust-- hold you up when your backbone's slipping. 

But:  Don't give in.  Fight the cycle.  Choose one of the three areas mentioned and come up with a plan to intervene.  Improve your sleep, reach out for support or connection, simplify your obligations and reduce as much complexity as you can.  More details to follow.

For catch up reading, here's a few past blogs about depression.  Feel free to comment or to email me with questions.  We'll be talking more soon.
Jana


http://www.janasvoboda.org/2011/02/delving-into-blues.html

http://www.janasvoboda.org/2011/03/fading-blue-gene-cognitive-behavioral.html

http://www.janasvoboda.org/2012/04/rip-mike-wallace-newsman-and-depression.html

http://www.janasvoboda.org/2011/03/fading-blues-ii-understanding-and.html

http://www.janasvoboda.org/2012/04/marked-for-depression-maybe-implant.html

http://www.janasvoboda.org/2011/03/more-bytes-on-black-dog.html