Monday, December 18, 2006

TO READ: Great Books on Depression and Other Mental Illnesses
I've just finished reading a couple of terrific books on mental illness issues and want to pass my thoughts on, while hoping you'll let me know of other new ones or old favorites.

The Unholy Ghost: Writers on Depression (edited by Nell Casey with an introduction by Kay Redfield Jamison; 2001, Perennial) is titled for a phrase poet Jane Kenyon used to describe her deep depression in Having It Out with Melancholy. Though it's not brand new, it was new to me when I picked it up recently, and I've found it fascinating. The book is a collection of essays by noted writers who have dealt with the illness, either personally, or as a spouse or family member.

While these writers seek to describe what many of us find indescribable about our experiences, they also tell their own very engaging stories of despair. Some of them relate these periods to their ideas about their own creative work, wishing that depression should be abolished if that were possible, or arguing that the illness is actually useful.

The Creating Brain: The Neuroscience of Genius (by Nancy C. Andreasen; 2005, Dana Press) was an exciting read for me as a biologist and as one deeply intrigued with the relationship of mental illness to creativity. In addition to considering what constitutes creativity and how the brain creates, among other issues, it includes a full chapter on Genius and Insanity: Creativity and Brain Disease. Many of you will also be quickly drawn in, I suspect.

Building on long-reported connections, Andreasen's careful study of writers reveals a dramatically higher rate of all mood disorders (80%) than in a carefully matched set of non-writers (30%). No writers in this study had schizophrenia. She is now studying whether scientists, or their family members, have higher rates of schizophrenia. She reports that during periods of instability, poets and painters are generally unable to create, but that during remissions they can draw upon these difficult experiences in their work. Also discussed is the fear of some writers and artists that psychiatric treatment of any kind might stifle their creativity.

Both of these books offer unique, valuable and very interesting takes on illnesses that are being written about more and more, but not always with new insights. What are you reading?
TO WRITE: Spirituality's Role in Mental Health
In my way of looking at the Universe, we are all "spiritual" people -- not necessarily "religious" or even consciously spiritual in day to day life -- but spiritual just the same. We all have relationships with our self, with the world around us, with the mysteries life offers, and I believe that the way we face these things defines our spirituality. This is a very liberal use of the word "spiritual," I realize, but stay with me here.

Whether you are a Muslim, Jew, Buddhist, Christian, Hindu, agnostic, atheist or other, you have certain views about how the world operates and about what you most deeply treasure in that world. And, whether you hold truth, kindness or other principles as your highest values, whether your worldview is shaped by a traditional religious background or not, I argue that your mental health is affected by your spirituality.

The majority of psychiatric inpatients note that religion gives meaning and purpose to their life, according to several studies. In a general patient survey, 75% would like their doctors to address spiritual issues as part of their care. Clearly these are vitally important issues for many of us.

Play with this...
Write for 20 minutes on your spiritual views and how they relate to your depression or other mental illness. For example, does being an atheist ground you when you're ill? Does your belief in God help you to keep going despite your symptoms? And have your mental health experiences changed your worldview? Exploring spirituality with respect to your mental illness may make you more consciously aware of your beliefs and may even provide you with a lifeline when difficult thoughts and painful feelings strike.

Monday, December 11, 2006

TO READ: This is Your Brain on Therapy
Scientists are learning more on a daily basis about how the brains of people with depression differ from those without it. But can those differences be used to predict how best to treat depressed people? According to recent research, they can.

Using functional magnetic resonance imaging (fMRI), researchers at the University of Pittsburgh School of Medicine measured activity in two key areas of the brains of depressed persons while they responded to different words. The words were chosen to have negative, positive or neutral associations, and the patients were asked to choose words that reflected their feelings when they felt depressed. Then each person participated in a 12-week program of cognitive behavioral therapy (CBT) for their depression, and their depression levels were measured again.

The results seem strong: Among the nine patients with a particular brain activity pattern (a decrease in activity in the subgenual cingulate cortex) when responding to negative words, seven recovered during CBT. Among the five people who did not show that pattern, only one responded to CBT. The positive and neutral words produced no changes related to mood improvement in CBT.

So, even given this small initial trial, fMRI seems to provide a predictor of which depressed people will respond to CBT, a structured therapy that teaches how to control emotional reactions and rumination. Learning how to identify depressed patients who are likely to benefit from CBT versus some other therapy could provide quicker, more effective treatment for all.

For more info: Am J Psychiatry. 2006; 163:735-738.
TO WRITE: Changing Perspectives in Your Writing
In his book Writing to Heal, James W. Pennebaker reports that recent research demonstrates the importance of the writer's perspective or voice when writing about traumatic issues. People who derive the most benefit from writing on a difficult topic for several days in a row are those who can switch from writing exclusively about their own thoughts and emotions to writing about how others who were involved might have experienced and thought about the trauma.

This change in perspective can be accomplished by writing in the "first-person" voice versus the "third person" voice. (If these terms make you cringe about a failed fifth-grade grammar test, fear not. The first person uses "I, me, we," as in: I ordered a pizza for us to have for dinner. The third person uses "she, he, her, him, they," as in: She ordered a pizza for them to have for dinner.)

Play with this...
Think of an annoying event in your life -- not a massive trauma -- that you've been worrying over. Now write continuously about the event and your reaction to it for 10 minutes from your usual first-person perspective. ("I threw up my hands when...")

Now read over what you've just written. Then write on the same topic, covering the same basic information, for 10 minutes from the third-person. You'll sound like an outside observer. ("She threw up her hands when...")

Now read over your second writing and compare how these two pieces felt to write. (Writing in the third person may feel awkward at first, but does get more comfortable with practice.) Did it give you a sense of distance from the problem? Was that useful to you? This technique can be particularly helpful when you are later approaching a serious trauma through writing.

Thursday, December 07, 2006

TO READ: Reading Books as a Depression Treatment
Bibliotherapy, also known as "guided self-help," has been studied for several years as a treatment for mild to moderate depression. In bibliotherapy, people with depression are assigned to read a self-help book such as David Burns' Feeling Good, instead of, or in addition to, treatment with psychotherapy and/or antidepressant medicines. The results are impressive.

Numerous controlled studies have been conducted and, in at least some, researchers have concluded that a four-week self-study period with an appropriate book was as effective as individual psychotherapy, participation in a cognitive behavioral therapy group, or taking an antidepressant -- and bibliotherapy worked faster. In a three-year follow up study, the beneficial effects of bibliotherapy were sustained.

Can reading really alleviate depression? There are some specifics to keep in mind. The book must contain real information on how to recover from depression. Typically the books used CBT-based approaches. (Peter Lewinsohn's book Control Your Depression was also found useful; Victor Frankl's Man's Search for Meaning led to no improvement.) In some studies the reading was conducted between psychotherapy sessions that reinforced the importance of the books and their exercises. Also, bibliotherapy has not been applied to severely depressed patients.

As you may suspect, bibliotherapy provides a vastly more economic way to treat mild to moderate depression. Some researchers have suggested that conducting bibliotherapy on the Internet may be effective, and cost effective, as well.

For more info, see: Smith, et al, (1997), J. consult. clin. psychol., 65, 2.
The Wall Street Journal, August 9, 2005, p. B1.

Monday, December 04, 2006

TO WRITE: Focus the Power of Your Writing
For the past eight years, I've led a creative writing class for people with mood disorders, meeting weekly at Stanford University's Psychiatry Department. While we often explore our mental health issues through writing and sharing, we write on other topics as well.

Why bother writing about sand or your favorite meal or a photograph of a cheetah? Many reasons, I believe. For example, these exercises help us "warm up" as we begin a two-hour writing session; students report they are calming, clarifying, thought-provoking; and reading their pieces aloud helps validate writers' thoughts and feelings in a safe community. But these unusual topics also make us better, stronger writers by developing our use of techniques including: memory, the senses, and vivid detail. These three things are among those many authors (of fiction and non-fiction) emphasize when teaching others to hone their writing craft.

Writing about your family car when you were a child requires you to: Dig into your memory banks, which may lead you to long-forgotten stories as well. Describe the way the car looked and perhaps sounded as it backfired, felt as it hit a bump, or smelled of popcorn after a drive-in movie. And it encourages you to stretch yourself to come up with vivid details that will really bring the reader into your experience -- how Mom's beehive hairdo almost touched the ceiling, how big brother whined as he begged to be allowed to drive.

All these techniques help writers to better develop a narrative and to develop changes in perspective. Both these things have been found in studies to be more likely to effect health changes when writing about trauma -- something we're likely to address in the second in-class exercise of the day.

Play with this...
Write a description of your high school gym teacher. Try to use all of your senses as you look back to recall him or her. Use vivid details as much as possible to elucidate his/her character. What stories do you recall? Help an imagined reader really know this person.