I find it increasing disturbing what people find entertainment these days. I guess I shouldn't. It hasn't been that long ago that Romans turned out by the thousands to watch lions devour Christians. American TV audiences seem to relish watching people immersed in bugs or snakes. I remember watching "I Love Lucy" and loving her antics and cheering for her to get one over on Ricky.

But watching people under pressure engage in self-destructive behavior is not something I'd call entertainment. On British TV, audiences are watching a reality show highlighting people with alternative lifestyles, a history of mental illnesses and self-destructive behavior.

the Daily Mail

"Big Brother" is under fire from mental health groups once again after another vulnerable contestant was put into the reality TV house.

[...]Shahbaz threatened to kill himself live on television before quitting the show, Lea has tried to commit suicide and has undergone extensive plastic surgery because she was unhappy with her appearance, Nikki has suffered anorexia and Pete has Tourette's Syndrome.

[...]Although producers say all housemates are put through rigorous psychological testing before entering the house, Ms Richardon said they have failed to provide the foundation with information about which professionals are hired to assess the potential housemates and whether the screening procedures are adequate.

"If people do have mental health problems in real life they do get stigmatised and what seems to be happening is they are turning up more and more on reality television shows where they are put under immense pressure.

"What we are concerned about is pushing people too far for the sake of entertainment."

At first glance I agreed with the Iast comment. Then I remembered that these people are volunteers who are getting paid for their antics. While the MH Advocates are sputtering, are the "stars" of this show laughing all the way to the bank?

Over the years I've used the concept of "vulnerable" less and less when referring to persons with mental health difficulties. Truly persons with an active psychotic disorder are vulnerable and often unpredictable. And people who have a naive approach to trusting are vulnerable to exploitation. However, in most cases, the people I work with are not generally vulnerable. They may well be self-destructive, but most have survived more trauma than I can imagine enduring. They have faced and escaped the most sophisticated relationship manipulators and terrorists known. Many may well have identified with the aggressor and became manipulative themselves.

I would hardly call them vulnerable. Why would I presume to deny them the ability to choose how they make their money? Shouldn't people with a mental health problem have every right we all have?

I think so. But I would never watch this show. I know the history of pain for which outrageous behavior speaks.

Hat tip to ShrinkRap. Update: Here is a eloquently written alternative view that I sympathize with greatly.

Well if anti-depressants, in particular SSRIs work, how do they help? Contrary to the ads you see on television, we don't really know. A recently published article outlines the issues.

Although SSRIs are considered “antidepressants,” they are FDA-approved treatments for eight separate psychiatric diagnoses, ranging from social anxiety disorder to obsessive-compulsive disorder to premenstrual dysphoric disorder. Some consumer advertisements (such as the Zoloft and Paxil Web sites) promote the serotonin hypothesis, not just for depression, but also for some of these other diagnostic categories [22,23]. Thus, for the serotonin hypothesis to be correct as currently presented, serotonin regulation would need to be the cause (and remedy) of each of these disorders [24]. This is improbable, and no one has yet proposed a cogent theory explaining how a singular putative neurochemical abnormality could result in so many wildly differing behavioral manifestations.

In short, there exists no rigorous corroboration of the serotonin theory, and a significant body of contradictory evidence. Far from being a radical line of thought, doubts about the serotonin hypothesis are well acknowledged by many researchers, including frank statements from prominent psychiatrists, some of whom are even enthusiastic proponents of SSRI medications (see Table 1).

However, in addition to what these authors say about serotonin, it is also important to look at what is not said in the scientific literature. To our knowledge, there is not a single peer-reviewed article that can be accurately cited to directly support claims of serotonin deficiency in any mental disorder, while there are many articles that present counterevidence. Furthermore, the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is published by the American Psychiatric Association and contains the definitions of all psychiatric diagnoses, does not list serotonin as a cause of any mental disorder. The American Psychiatric Press Textbook of Clinical Psychiatry addresses serotonin deficiency as an unconfirmed hypothesis, stating, “Additional experience has not confirmed the monoamine depletion hypothesis” [25].

[...]The impact of the widespread promotion of the serotonin hypothesis should not be underestimated. Antidepressant advertisements are ubiquitous in American media, and there is emerging evidence that these advertisements have the potential to confound the doctor–patient relationship. A recent study by Kravitz et al. found that pseudopatients (actors who were trained to behave as patients) presenting with symptoms of adjustment disorder (a condition for which antidepressants are not usually prescribed) were frequently prescribed paroxetine (Paxil) by their physicians if they inquired specifically about Paxil [45]; such enquiries from actual patients could be prompted by direct to consumer advertising (DTCA) [45].

What remains unmeasured, though, is how many patients seek help from their doctor because antidepressant advertisements have convinced them that they are suffering from a serotonin deficiency. These advertisements present a seductive concept, and the fact that patients are now presenting with a self-described “chemical imbalance” [46] shows that the DTCA is having its intended effect: the medical marketplace is being shaped in a way that is advantageous to the pharmaceutical companies. Recently, it has been alleged that the FDA is more responsive to the concerns of the pharmaceutical industry than to their mission of protecting US consumers, and that enforcement efforts are being relaxed [47]. Patients who are convinced they are suffering from a neurotransmitter defect are likely to request a prescription for antidepressants, and may be skeptical of physicians who suggest other interventions, such as cognitive-behavioral therapy [48], evidence-based or not. Like other vulnerable populations, anxious and depressed patients “are probably more susceptible to the controlling influence of advertisements” [49].

The Corpus Callosum talks about the physician side of DTCA.

I personally have spent a lot of time in the office, with patients, trying to undo the misinformation contained in DTCA. It bothers me that I have to do that. I would much rather spend the time providing good education, not undoing bad education. I would prefer to not have to deal with direct-to-consumer advertising at all; but if we have to have it, companies really ought to be held to the standards that exist to ensure balance and accuracy.

So all we really know is that SSRIs are a happy pill. But this happy pill does have some interesting recently discovered properties: Antidepressants may boost brain growth!

Serotonin works as a chemical messenger by plugging into special sockets at the tip of brain cells. These serotonin receptors trigger a cascade of events. One of these events, the researchers suggest, is brain regeneration. In other words, drugs aimed at serotonin receptors make brain cells sprout. "Serotonin terminals may be especially prone to regenerative sprouting," Koliatsos and colleagues write. "We propose that this phenomenon ... may be the key structural effect of serotonin antidepressants." MORE

What this really has to do with treating depression is unknown. One can only deduce theoretically that more serotonin receptors is a good thing. Whether such growth is helpful or harmful is unknown.

Sunday I found a disturbing article in a blog that has a good reputation. Dr. Peter Breggin at The Huffington Post wrote about the FDA decision to require a "black box" warning on the anti-depressant medication Paxil because of the risk of suicide in the beginning of treatment. Dr. Breggin is the author of the book Talking Back to Prozac which is highly critical of the anti-depressant medication Prozac. In his post at Huffington's, Dr. Breggin makes statements that appeared designed to attract attention at the expense of misleading the reader. I've written about the problem with reading articles about mental health in the press. Essentially, reader beware, what you read many be misinforming you. Sometimes misinformation occurs in the interest of selling a publication. Science has it's own issue with chasing the money. Research is expensive and finding the means to fund it can be difficult. It's also a necessary process to advance a science. Psychotropic medications are extremely expensive to develop and submit to the FDA for approval. The FDA makes the decision to approve a medication based on research completed by the pharmaceutical companies who have a vested interest in the outcome. It's pretty clear that this procedure invites significant inappropriate salesmanship into the research process, but the alternative is likely even more expensive. The only alternative I can imagine would require a large government bureaucracy to manage a process that may be no less fraught with potential for corruption due to the millions of dollars at stake. I can't criticize a system when I can't imagine a working alternative.

Meanwhile, a comprehensive review of all studies of anti-depressant drugs submitted for approval to the FDA showed that when the studies are taken as a whole, anti-depressants don't work.

To support this statement, he sites only two sources when there are literally thousands of articles out there that have different conclusions. Antonuccio et al (2002) makes some quite critical statements about the FDA approval process and questions the magnitude of efficacy of anti-depressant medications. His second source is his own book, Talking Back to Prozac. Antonuccio et al (2002) is not a research study. It is a commentary about a review of the literature in the same publication: Kirsch et al (2002). That particular volume of Prevention and Treatment is full of supporting and detracting articles about the Kirsch et al (2002) study. It's results are universally described as important, but they range in characterization from exaggerated and politically and financially motivated to underestimated. Most of the articles in Prevention and Treatment Volume 5 note that anti-depressant medications ARE shown effective in the Kirsch et al (2002) study. Even Kirsch et al (2002) conclude anti-depressants are effective, just not as much as one would like to see. One has to keep in mind that drugs affect individuals differently. While on average across large numbers of persons in the study, the magnitude of the drug effect may be relatively small, a sizable proportion of the individuals could have substantial benefit from medication. Dr. Breggin next makes a statement that implies taking prescribed anti-depressant medications have a following because it gives users a high like recreational drugs.

Of course, many people feel helped by antidepressants, as well as many other psychiatric and even recreational drugs. The placebo effect is enormous. In addition, the artificial euphoria or emotional flattening produced at times by antidepressants may provide temporary relief at the cost of rationality and effective dealing with life.

The uninformed reader very likely would be discouraged from using anti-depressant medications and misinformed that they make a person "high". Not only does this statement misinform and confuse, it adds to the stigma of mental illness by equating anti-depressants to recreational drugs. Next Dr. Breggin takes the argument to unsubstantiated scare tactics.

It's time to say again what I've been saying for too many years on end. The antidepressants aren't antidepressants. They are more likely to make a person worse than better. More tragically, these toxic agents push many people over the brink into suicide and violence.

He cites no evidence that anti-depressants are "more likely" to make a person feel worse. Even the article he cites says otherwise.

Meanwhile, the antidepressants are very difficult to stop taking. Withdrawal from antidepressants can lead to "crashing," with agitation, violence and suicide. Withdrawal from these noxious drugs should be done slowly with experienced clinical supervision. These drugs are not only unsafe to start--they are dangerous to stop. The best approach to antidepressants: Don't start taking them.

Now Dr. Breggin implies anti-depressants are effectively an addictive drug with a characteristic withdrawal syndrome. There is no evidence of this cited. I've not seen any literature that supports this assertion. In fact, one of the key requirements of an addictive drug is that a person develops a tolerance for the medication requiring an periodic increased dose. My clinical experience has not born this out. Instead, what I've seen across many patients, a life time course of medications requiring occasional adjustments, both up and down or a change to a different drug, typically attributed by the prescribing psychiatrists to changing body chemistry over time and age. That is not even close to the typical abuse pattern of patients addicted to, for example, benzodiazopines where they gradually increase their dose over a relatively short period of time supplementing the prescribed supply with illegally obtained prescription drugs, street drugs and alcohol. The increased incidence of suicide attempts during the medication trials is of concern. However, what this might be attributed to is unclear. I know from my clinical experience, many people report uncomfortable side effects, including flu-like symptoms and increased anxiety that have been known to make some patients worry about "going crazy". These side-effects may well be enough to induce a suicide attempt in someone who is already depressed and hopeless with suicide ideation. As I have stated before, medications are an important part of treating depression. But they should not always be the first attempt to intervene. Research has shown repeatedly that psychotherapy and medication used together has consistently the best outcomes. I suggested on April 1,

that the indications for anti-depressants be limited to (1) those people who show neuro-vegetative signs of depression, especially significant sleep deprivation due to insomnia or sleep disturbances and a significant loss of weight due to loss of appetite, (2) a moderate or high risk of suicide as indicated by a lethal and available plan, and (3) after a course of psychotherapy of say six sessions produced insufficient improvement in functional impairments in relationships, productivity at work, keeping up with chores, etc, that the therapist refers the patient to their physician for a medication evaluation.

It appears that the literature agrees with me. In a companion article by Irving Kirsch and Alan Scoboria (2002), the authors offer much the same advice:

In the meantime, what are the alternatives for treating patients? Imagine having a choice between four treatments. Treatment A produces a large therapeutic response but also a large number of adverse effects, including diarrhea, nausea, anorexia, sweating, forgetfulness, bleeding, seizures, anxiety, mania, sleep disruption, and sexual dysfunction. Treatments B and C produce therapeutic responses that are almost as great as those produced by treatment A, but without the adverse effects. In fact, the side effects produced by Treatment B are beneficial (e.g., better general physical health). However, the therapeutic effects of Treatments B and C have been evaluated in relatively few studies. Treatment D has been assessed in many comparative studies, in which it has been found to be as effective as Treatment A in the short term and more effective in the long term. It does not produce adverse effects. Given a choice between these alternatives, which would you choose?

Of course, these alternatives are not merely hypothetical. Treatment A corresponds to SSRIs, and the list of side effects is drawn from those that have been shown to be produced by these medications. Treatment B is physical exercise, which has been reported to have lasting therapeutic benefits in the treatment of major depression. It may be nothing more than a placebo, but if so, it is one with desirable rather than adverse side effects. Treatment C is bibliotherapy, another low-cost treatment with demonstrated effectiveness and little danger of side effects. Treatment D is psychotherapy. As noted by Antonuccio et al (2002), "psychotherapy (particularly cognitive therapy, behavioral activation, and interpersonal therapy) compares favorably with medications in the short term, even when the depression is severe, and appears superior to medications in long-term comparative studies. Given these data, antidepressant medication might best be considered a last resort, restricted to patients who refuse or fail to respond to other treatments.

Part of the problem here is that treatment of depression in a clinical setting contains many components only one of which is medication. To test the effectiveness of a medication, a treatment group receives the medication and a control group receives a sugar pill. Both the treatment group and the control group receive the sort of care that is an integral part of a clinical setting. The part of the treatment that is not mediation is called "placebo". Rehm (2002) describes this placebo. The author lists life events, social support, hopeful expectations, and biochemical changes that accompany treatment and enhance immune function and biochemical balances that facilitate recovery from depression. Rehm also lists spontaneous remission and regression or random fluctuation in the measured factors of depression attributable to the instruments measuring them. These final two factors are essentially improvement that can't be attributed to anything else. While I understand the argument that without a placebo control, one can never hope to measure the effect of treatment attributable to medication alone. However, imagine if a patient picked up his medication from a grumpy, shaming pharmacist, do you think the medication would be as effective? I think not. The placebo effect is as integral a part of treatment as the medication. It's effects on treatment are not well known. The other problem is that the typical medication trial used for justifying the approval to the FDA is 6-8 weeks, mainly to contain the costs of research. Anti-depressant medications just come up to therapeutic levels in the blood in the fourth week. From my clinical experience, those four weeks of waiting for the therapeutic levels are quite uncomfortable for the sufferer. The client is waiting for relief from a miserable condition made even more so by the well known side effects of starting and ending anti-depressant treatment. By the end of the fourth week, the clients sense of equilibrium at best is improved but tenuous. Recovery continues over the next few weeks in a stutter-step fashion: one step forward, two steps back, two steps forward, one back. To measure effectiveness in the 6th to 8th week is not likely to show anything more than the beginings of therapeutic effect. Finally, as demonstrated convincingly in the recently released mega-study of anti-depressants called STAR*D2:

These results highlight the need for longer treatment duration and more vigorous medication dosing than is current practice in order to achieve optimal remission rates. Informed triage or critical decision points (i.e., the discontinuation of patients who experience minimal benefit after 6-9 weeks of treatment) allow for extended dosing for those who are benefiting, while curtailing extended treatment for those who experience minimal benefit after a substantial treatment period. The measurement-based care methods used in this study were easily implemented in actual practice. Controlled trials of this approach in practice are recommended.

And from my previous post on STAR*D2:

The important finding in the STAR*D Part 2 study was that persistence in seeking a combination or a change in medication increased remission rates. If one counts each medication trial as 6-8 weeks and add to this 12 to 16 weeks or more for psychotherapy to address complicating factors like anxiety, a history of mistreatment, abuse or trauma or substance abuse, it's reasonable to expect at least 16 weeks of concerted, persistent and painful effort to make progress with a resistant depression. Many sufferers are tempted to give up after the first attempt at treatment.

There is no reason to discourage use of anti-depressants. There is however reason to be concerned. I think the concern is sufficient to require frequent monitoring by the prescribing physician and consultation by a psychiatrist whenever there is suicide ideation. I complained to Huffington Post about this article. I encourage you to join me in encouraging Huffington Post to reconsider the content of this article by emailing them here.

Kirsch, I., Moore, T.J., Scorboria, A., Nicholls, S.S. (2002). The emperor's new drugs: An analysis of antidepressant medication data submitted to the U.S. Food and Drug Administration. Prevention & Treatment, 5 (1)

The personal aspect of stigma is the most damaging kind. As the old adage goes, an insult only hurts when the victim believes it at some level true. Similarly, stigma in the form of discrimination to the extent it limits someone's choices, certainly provokes a righteous and potentially empowering anger if directed in some constructive action. But if the victim at some level believes she is deserving, often she may suffer a damaging blow to self-esteem which may worsen anxiety or depression.

One of the most controversial practices in hospital mental health units is physical restraint. While there may have been a time it was used punitively, now it is a highly regulated practice that can only be used to protect the patient and others from injury. It requires thorough documentation by more than one staff member. A trained team in most situations can quickly restrain a patient without injury to anyone involved.

What restraint can't do is protect the individual from what she might feel about being restrained. The experience can truly be traumatic for some. People who have been assaulted can experience a flashback to the assault. Some who are are so confused as to believe they are about to be seriously injured or even murdered will react as if they have been traumatized. And they very likely remember the event very differently than anyone else present.

When a person is extremely agitated, frightened, and emotionally aroused, memory operates very differently. The emotional experience burns an emotion laden memory into a preconscious hair trigger response. This "body memory" can contribute to post traumatic symptoms and even post traumatic stress disorder.

I have participated in several restraints. All of them I witnessed and participated in were a last choice option to protect the patient and others, and the procedure was professionally handled. Regardless, some patients experienced the procedure as a trauma. It was an option no one wanted, but sometimes it was unavoidable. And I saw many a threatening patient quickly and effectively calmed by respectful words.

Sometimes, the best options are not without risk of harm. Often in these situations, the best choice is the one that does the least harm.

Dr. Maria, deeply affected by her own experiences in participating in restraint procedures, volunteered to be the practice "patient". This was a courageous decision and one that should be considered by everyone training to restrain.

intueri: to contemplate

“Hey,” I suggested in measured words, “can you restrain me? Just so I know what it’s like?”

[...]But my reason was true: I wanted to know what it was like. Particularly during my times in the ER, I have witnessed the nurses and security officers place assaultive patients (to others or themselves) into restraints and it consistently bothered me. It is a practice that no one enjoys—especially the patients. However, it is a not uncommon occurrence and, in order to better understand what the (terrifying? offensive? degrading? amusing? ineffective?) experience is like for my patients—those people for whom I sign my name to keep them in restraints—I wanted to know.

[...]The leather restraint belt encircled my waist first. Then my hands were cuffed to the bed at the level of my waist. In the meantime, I continued to kick at my captors, but to no avail. (I later learned that even though legs are stronger than arms, arms and hands tend to cause more injury than legs and feet, hence the order of restraint.) The cuffs then went around my ankles and there I was, restrained to the bed.

[...]It’s embarrassing, no doubt—no one likes to feel a complete lack of control in a situation. But I had thought that it was also a physically painful procedure as well, primarily because many people—particularly women—are usually screaming when they are being put into restraints.

Psychiatry has always been a step-child within medicine. The problem may well have been a product of the Freudian revolution in psychiatry that lasted one hundred years. Sigmund dared to ask if the mind functioned effectively like any other bodily system. At the time psychosomatic medicine was the the main stream, not a muddy concept wedded to psychiatry. Reducing stress was considered a central part of any treatment regime for illness. Suggesting the mind was part of the body was a revolutionary concept.

Freud began a whole new branch of medicine that explored the impact of experiences, relationships, and genetics in the development and pathology of the psyche and ultimately behavior itself.

A new psychiatrist blog Shrink Rap, pretty succinctly describes the stigma much of psychiatry feels for it's own revolutionary who dared take behavior out of the brain and put it in the mind, the relationship, and psychological development.

Most "psychiatrists" were actually neurologists then, and the field was decidedly heading in the what's-wrong-with-their-brain direction. Fifty years later, the first anti-psychotic drug was introduced. What happened in those first 50 years, and in the 50 years since?

The locus of pathology switched from the brain to the mind, from the individual neuron to the individual person. We were just starting to realize that psychiatric illness could occur through no fault of ones own (okay, maybe unprotected sex, but you see where I'm going), and then Dr. Freud comes along and we start looking at the mother or the father or Uncle Pete as the source.

And the treatment? Lie on a couch and talk. About whatever comes to mind. Four times per week. For seven years.

The result? Worsening of stigma. Marginalization of Psychiatry from Medicine. Diversion of research interest and resources from the cell to the self. The "psychiatric reduction" and non-parity in health insurance coverage.

Truly, the Freudian revolution led to some dead ends. Psychoanalysis at four times a week for seven years was never a practical model less treatment, more indulgence of the rich. It's initial intensive and expensive approach could never have helped the average person. And psychoanalytic therapy evolved into more practical formats. And Freud's rejection of sexual abuse as the precursor of hysteria helped continue many more years of oppression and discrimination of women without much hope of real help for recovery from it's trauma.

While nowadays, cognitive-behavior therapy gets all the press for effectiveness, it is in fact merely a description or operational definition of much of what is psychotherapy rather than a robust theory in it's own right. The theory suffers from the drying effects of reductionistic empiricism, devoid of the richness of psychological development, relationships, and a workable understanding of how some of the most pathological behavior, the most treatment resistant symptoms, such as chemical dependency, self-defeating or self-abusive behavior, persist regardless of their consequences.

It may well be true that the preoccupation of psychiatry with development sapped virtually all of it's creative energy and likely delayed the early development of psychotropic medications. And it's true the stigma of mental illness was exacerbated by psychiatry's stepchild status within the medical fraternity.

But to blame Freud for stigma is entirely too simplistic. The moralistic culture simply couldn't tolerate a challenge to the idea that a person's value to the world is predetermined. And to assert that psychiatry was set back for 100 years seems a bit narrow minded and certainly blaming the primary victim of stigma within the profession for it's puritanistic detractors. The current focus of psychiatry on medication and the absence of psychiatrists providing therapy is more a reflection of the dominating effects of a pandering pharmaceutical industry that has much of the world convinced we can solve most problems easier, cheaper and more effectively with a pill.

Rene Descartes (1596-1650) in his concept of Mind/Body Dualism, conceived of the mind or soul as pure thought, separate and distinct from the body with limited interactions. Since then, western science has tended to see diseases of the body as something wholly different from diseases of the mind, as if we are all separated at the neck.

Medicine shares it's roots with psychology, the ministry in ancient shamanism or traditional healers.

For thousands of years, people believed that stress made you sick. Up until the nineteenth century, the idea that the passions and emotions were intimately linked to disease held sway, and people were told by their doctors to go to spas or seaside resorts when they were ill. Gradually these ideas lost favor as more concrete causes and cures were found for illness after illness.

In the last 15 years, there has been significant progress in reconnecting us at the neck. The traditional medical disease model conceives of an external agent, like a bacterium, invading the body and causing an illness that is curable with a specific treatment, such as an anti-biotic. That idea has been gradually giving way to a much more complex or systemic view of illness. Most every "invading external agent" is already present in the body, most of the time, even in the absence of illness. Increasingly, stress, especially chronic stress has been associated by research with suppression of the immune response that fights illness. In other words, it takes both a bug, limitations in the body aggravated by stress to make us ill.

Reuters Health has put together a comprehensive review of the effects of stress on illness. Of course there is the well known tendency we all have to "treat" our own bad feelings by indulging in unhealthy habits including high-fat and high-salt diets, tobacco use, alcohol abuse, and a sedentary lifestyle. The research continues to pile up associating stress with various disorders and illnesses. Stress has been linked to:

• women may experience diminished sexual desire and an inability to achieve orgasm in women
• temporary impotence in men
• insomnia, generally keeping the stressed person awake or causing awakening in the middle of the night or early morning.
• onset of depression or anxiety
• weight gain, weight loss, eating disorders, anorexia nervosa and bulimia nervosa
• premenstrual syndrome may be more intense than in those without the syndrome.
• Fertility
• 50% higher risk for miscarriage, lower birth weights and increased incidence of premature births, both of which are risk factors for infant mortality, influence the way in which the baby's brain and nervous system will react to stressful events, increased adrenal hormone levels or resistance in the arteries, that may interfere with normal blood flow to the placenta
• loss of concentration at work and at home and may become inefficient and accident-prone. acute stress impairs short-term memory, particularly verbal memory. Effect of Chronic Stress on Memory shrinkage in the hippocampus, the center of memory
• In children, inhibit learning
• Aging In one study older people with low stress hormone levels tested as well as younger people in cognitive tests: those with higher stress levels tested between 20% and 50% lower
• stress, not indoor pollutants, may actually be a cause of the so-called sick-building syndrome, which produces allergy-like symptoms, such as eczema, headaches, asthma, and sinus problems, in office workers.
• excessive itching, hives, psoriasis, acne, rosacea, and eczema
• hair loss often occurs during periods of intense stress, such as mourning
• periodontal disease, which is disease in the gums that can cause tooth loss
• serious cardiac events angina, heart rhythm abnormalities and heart attacks, artery-clogging blood clot, and even death from such events in people with heart disease.
• raising blood-cholesterol levels
• at least temporarily, cause inflammation and damage to cells
• development of insulin-resistance, a condition in which the body is unable to use insulin effectively to regulate glucose (blood sugar). Insulin-resistance is a primary factor in diabetes
• hypertension (high blood pressure) which can lead to a higher risk for stroke
• blunt the immune response and increase the risk for infections leading to colds or flu, bacterial and virus infections, even ulcers
• herpes or HIV viruses may be more susceptible to viral activation
• HIV-infected men with high stress levels progress more rapidly to AIDS
• chronic immune deficiencies causing eczema, lupus, and rheumatoid arthritis
• prognosis and progression of cancer
• gastrointestinal distress like diarrhea, constipation, cramping, and bloating, reflux (heart burn), flare-ups of multiple sclerosis, Irritable Bowel Syndrome, Crohn's disease or ulcerative colitis
• In women, chronic stress may reduce estrogen levels, which are important for cardiac health
• Chronic pain caused by arthritis and other conditions may be intensified by stress
• triggers Tension-type headache migraine, often long after the stress is relieved

And if that isn't enough, Anxiety Relief and Stress Management today, has an article describing only a few examples of how illness can hide itself as what appears to be anxiety or depression.

• Diabetic patients have 2-3 times more depression than is found in the general population
• Undetected and undiagnosed thyroid disorders, often mimic Generalized Anxiety Disorder, cognitive disorders, and symptoms of depression, such as lack of energy, fatigue, and some mild tremor.
• Problems with adrenal disorders also cause depression, anxiety, hypomania/mania and even psychosis. Symptoms often found in psychiatric disorders such as apathy, loss of interest in pleasurable activities, nausea, vomiting and weakness are also seen in these endocrine disorders.
• loss of libido in both men and women may not necessarily signal anxiety or depression, but a testosterone deficiency

The verdict is clearly in, we are connected at the neck. The mind resides in the brain and it is a prominent part of the body. How about that for common sense?

This is really disturbing. Fortunately lawyers tend to be a contentious bunch so there will be lots of fur and paper flying about this. There is no justification of this sort of invasion of privacy unless there is a history of risk to self or others. Then there is an obligation for a thorough review.

This is discrimination, nothing less.

Markham's Behavioral Health

Connecticut's State Bar Examining committee is now asking attorney applicants to the state bar if they have been treated for depression along with other major psychiatric disorders like schizophrenia, and bi-polar illness acording to an article on Lawyer.com. This is already done in Colorado, Florida, Delaware, and Kentucky.

If Abraham Lincoln were alive, he would encounter several difficulties gaining admittance to the Connecticut Bar -- assuming he deserved his reputation both for honesty and for 'melancholia.' That's because the state's Bar Examining Committee has re-introduced depression as one of the conditions listed on the mental health section of the bar application. Depression made the list in July 2000, but public outcry led to its removal -- until now.

The amended question 35 for the July 2006 application is one of several changes that has reignited a fiery reaction from opponents, who view the wording of the CBEC's mental health inquiry -- which includes a request for psychiatric records -- as an unconstitutional invasion of privacy.

shrinkette

You go on. You go on. You bring the person you love inside you. That is how you cope. You make him or her live within you. The whole experience I had with my children is in me. It is nowhere else I can see. I can see a photograph, I can feel sad, I can read a poem, but the experience of having them within myself is what matters.

Sometimes there is just nothing more to say.