TO WRITE: Gender and Social Stigma

A student recently suggested "patriarchy" as a writing topic. That's a heavy issue for me to get my mind around, so I tried to think of very specific ways I have been affected by this social scheme. While the differences between the treatment of men and women is enforced in truly frightening ways in some countries today, and while there are evidently still a few matriarchal cultures in existence, here in the US I feel I live in a patriarchal culture that tries to portray itself as egalitarian.

So how has that affected me? I brainstormed. I do think that in one job I was treated differently than a man would have been in terms of mentoring. Also, I took my husband's last name when I married -- though I use my maiden name as my often-included middle name to try to keep it present. I know I've been looked at oddly when alone in some public establishments, where a man, I suspect, wouldn't have been noticed. I'm sure there are lots more, big and small....

Play with this...

If you need to brainstorm at all, take 3-5 minutes to make a quick list of times you feel you were discriminated against because of your gender. Then write continuously for 20 minutes on one of them, describing what happened as a story with beginning, middle and end.

How did it feel to identify and write about this issue? Did you describe a trauma or a mere annoyance? Did writing about it change your mood at all? If the story felt upsetting, try rewriting it with a different (fictional) ending that you prefer. This can often feel empowering.

TO READ: Extend Your Life by Treating Your Depression?
It's long been known that if you follow a group of people -- half depressed and half not -- for several years, more of the depressed ones tend to die during that period. But now there's good news: A recent study shows that if you treat the depressed people, they live longer.

In the study, researchers took half of the depressed group, all over 60 years old, and treated them with either medication or psychotherapy. The other half went untreated. They found that the treated people were only half as likely to die during the study as they untreated group. (This was after controlling for age, sex, smoking habits, level of education and current physical illnesses.)

Although the scientists don't know why yet, the decrease in deaths came nearly all in the group of patients who also had cancer.

Here's yet another reason to treat your depression, either with meds or psychotherapy -- in addition to feeling less depressed, you may just live longer too.

For more info: Joseph J. Gallo, The Annals of Internal Medicine, May 15, 2007.

TO WRITE: Leaving on a Jet Plane... or Car or Bike or Boat
You're thrilled or you're dreading it ... you're dashing about or you're dragging your feet. No matter where you're headed out-of-town, no matter how you're getting there, going on a trip can be stressful and emotional. And if you're depressed already, it can feel overwhelming.

If I'm healthy when I'm about to fly or drive anywhere, I'm so excited that I underestimate the time required to prepare and pack. I forget until the last moment to take care of crucial phone calls or take out the trash. I'm often doing laundry at midnight before an early departure, because I must have some favorite outfit clean and ready-to-go. And then there are the decisions about what to pack, and how large a bag I'm really going to need for a weekend in the mountains or a three-week trip to Europe.

My husband, meanwhile, tosses some clothes in the nearest duffel bag and has time to read a magazine before we leave. (Sigh.)

Play with this...
Write continuously for 20 minutes on a voyage you've taken and your emotional and physical preparations. How did you feel -- whether you were off to trek in Nepal or take a day trip to the beach? And how did you get ready? Did one affect the other? If it was a less-than-great experience, can you plan something differently for next time? (I'm instituting a rule for myself that says I aim to depart 30 minutes before I actually need to. Just a mental game, but, with some luck my brain will buy into it.)

TO READ: My First Book is Being Published!
Like this blog? You're going to love this book.

I'm delighted to announce that I have just signed a contract with Ten Speed Press to publish a book I'm writing on the power of writing to ease depression.

The book (we're still fine-tuning the title) will be based on my experiences, the experiences of my creative writing students with mood disorders, and the scientific evidence of writing's many healing properties. It will describe some of the types of writing you can use to lift your mood, including freewriting, journaling, poetry, memoir, and even fiction -- and how you can write on your own or begin a writing group for people with depression. Lots of exercises -- to jump start your own writing -- and examples of students' writing -- for inspiration -- will be included.

Whether you're dealing with major depression or a difficult life transition, this book is designed to help you with techniques that can help heal your thoughts, emotions, and spirit.

If you'd like to be on my mailing list for early information and updates, please leave a comment.

The book will be available in May or June, 2008 -- just a year from now. My next few months will be spent writing like crazy! Hurray!

Stay tuned....
-- Beth

TO WRITE: Those Really Big Questions in Life
In the writing group I lead at Stanford, I sometimes pass around a paper on which people can suggest topic ideas. Members' topics, like those I bring in myself, range from the very specific -- washing dishes, a childhood toy -- to the huge and abstract -- the meaning of life, for example.

Recently I noticed a large proportion of the group's ideas were of the "really big" variety. These issues sometimes require a few minutes of writing before you truly get your mind around them, but they tend to be very rewarding.

Play with this...
Write continuously for 20 minutes on one or both of these questions: Who do you think you are? What is reality, anyway?

Though you may need to start with broad concepts, try to bring your writing back to the personal level too, by using specific examples and using details gleaned from your senses.

Wait a day or so, then reread your piece. Have you learned anything about your own beliefs? Have your beliefs been strengthened? Drawn into question? Does this affect your perception of your depression at all?

TO READ: Groups Offer Comfort and Even Joy in the Mental Health Community
I have a lot of mentally ill friends. Maybe you do too. Twenty-one years ago, when I was diagnosed with major depression (which later became categorized as bipolar disorder) I personally knew only one person who I even suspected of having a mental illness. Now people with depression, bipolar disorder and other conditions are everywhere in my life!

I find that as we go through this life-altering experience, we tend to bond to one another for information and support. You may have noticed it in your life too. When you suddenly get a diagnosis, or a prescription, everything changes, and you need someone to turn to -- someone who's been there. That's why I believe the services provided by the National Alliance on Mental Illness (NAMI) and the Depression and the Bipolar Support Alliance (DBSA) (see links at right) are so vitally important. And I know that sense of connection and shared experiences is one of the reasons people seek out my writing class for people with mood disorders at Stanford.

Being immersed in the mental health culture may involve reading about depression or other conditions, recognizing that you have mentally ill friends or relatives, seeking education and camaraderie in support groups or therapy groups and, in a surprisingly high number of cases, holding paid or volunteer positions in mental health advocacy. (In addition to my writing group, I speak as a volunteer on mental health issues for two organizations.) And there is a great deal of comfort, release and joy in these communities.

This weekend I took part in the NAMIWalks for the Mind of America in San Francisco's Golden Gate Park. The positive vibes and goodwill were everywhere -- from the fact that there were 90-odd teams participating, to the cheers and thanks of volunteers as we finished our 5k walk, to the open-minded chats going on at the booths offering information, books, and items made by people with mental illness. I felt proud to be a part of helping make these illnesses more visible in our still-stigmatizing society.

If you're coping with depression and you're not familiar with NAMI and DBSA, do yourself a big favor and check them out for education on illnesses and treatments, emotional support for consumers and their families, resource lists, legislative and research updates, and especially to learn where there are support groups near you. You don't need to feel alone as you grapple with difficult thoughts and feelings.

TO WRITE: Oh, Those 'Parental Units'
Whether you feel your parents are the guiding lights in your life or people who cast dark shadows -- or, most likely, something in between -- there's no denying that parental relationships are crucial to shaping who we are. Think back to your growing-up years: How did you experience them, or the other person or people who raised you? Nearly all of us can point to both happy and painful childhood events. And what of your current relationships: Are your parents living? Do you have regular contact, rare contact, no contact? Do conversations mirror those of childhood, or have they evolved in some way?

These reflections can be eye-opening for anyone, but perhaps especially to people coping with depression. If you feel like it, consider the relationship, if any, between your parents and your difficult moods. Some people believe there is a direct cause-and-effect relationship; others find their parents their greatest support. There's no good or bad -- our parents are only one part of our lives and, as adults, we have already moved on considerably to shape ourselves, and we'll continue to change and grow.

WARNING: This can be an intense topic. Remember the "flip-out" rule -- if it feels too scary to go there, just don't go. Write on something else this week.

Play with this...
Choose one parent or guardian. Take 20 minutes of continuous writing to describe your past and present relationship with that person. Try to incorporate at least a couple of specific stories of events. Also consider how you might like to improve your view of that relationship today -- could you recognize your separateness and release some frustration or pain, for example? Can you feel thankful for any part of your interactions? You may want to share what you've written with a safe friend, partner or therapist. Remember: We are always evolving and becoming stronger as adults.

TO READ: Happy Faces Trigger Less in the Brains of Depressed People
When you're depressed, you know it's hard to put on a smile -- and it can even feel difficult to react to smiling people around you. Now brain research shows that depressed people do have real impairments in the ways they process happy faces.

In a recent study, depressed people were slower and less accurate at "processing" -- in this case, detecting the gender of -- happy faces than were healthy people, as shown by functional MRI. But after eight weeks on Prozac, and improvement in symptoms, this ability returned. On another task, responding to increasingly happy faces, the emotion-processing regions of the depressed brains were less active than they were in healthy people's brains. In this case, the difference was not improved by the antidepressant.

Being able to recognize and respond to other people's emotions is a crucial part of interpersonal relationships. These different responses demonstrate that it's not a personal failing to have trouble reacting to a friendly person when you're depressed, but a measurable neurobiological trait of the illness.

For more information: Am J Psychiatry 164:540-542, April 2007.

TO WRITE: Simple everyday routines
One way in which writing can help us see ourselves is by bringing the ordinary details of our life into clear view. For example, when you stop long enough to see a daily ritual broken down into its individual steps, you may appreciate it differently -- its intricacies, its roles, even its beauty. Consider this poem by former U.S. Poet Laureate Ted Kooser, who, incidentally, was a life insurance executive in Nebraska most of his life.

The Necktie
His hands fluttered like birds,
each with a fancy silk ribbon
to weave into their nest,
as he stood at the mirror
dressing for work, waving hello
to himself with both hands.

Play with this...
Write a poem about a simple routine task or ritual you do. As Kooser's poem shows, this action can be something quite small and ordinary. Describe the routine, considering its meaning to you, and various ways you could express its qualities to others. Take at least 10-20 minutes to write and revise your poem. (If you really prefer prose to poetry, use that, but try the poetic form first.) What does this everyday habit reflect about your life?

TO READ: Depression's Devastating Self-Criticism Explained
When serious depression kicks in, one often-heard complaint is, "I do everything wrong." Now researchers have brain-wave evidence about where this perception may come from. Results from one study show that depressed people make no more mistakes than healthy controls -- but that they truly are better at detecting their errors.

Scientists measured two types of brain waves as subjects did a simple signal-detection task, and found that depressed people were just as quick and accurate as the non-depressed. No slowness or concentration problems were noticed. However, both types of brain waves -- one called error-related negativity, which measures brain resources used in early detection of errors, and the other called error positivity, which indicates error detection -- are exaggerated in depressed people.

Those responses indicate that the depressed group used more of their brain resources to detect errors. Researchers suggest that when they make a mistake, depressed people are more likely to notice it than a healthy person would be. While this extra acuity might be a good thing in certain situations, it also may be responsible for the hyper-criticism often felt during the illness. Something to bear in mind when that I-can't-do-anything-right feeling kicks in!

For more info: American Journal of Psychiatry 2007 164:58.

TO WRITE: A Sound from Childhood
Memories, especially those from childhood, can often evoke strong emotions, as well as triggering even more memories. Instead of replaying the same old childhood stories in your mind (we all have some that we rely on to piece together the story of our life), try with this exercise about specific sounds to see what other details or experiences you may not have thought about for a while. "New" material can supply all sorts of creative undertakings. In addition, focusing on specific sensory experiences makes for strong writing.

Play with this...
First, brainstorm a list of five to ten specific sounds you recall from childhood. My list includes the zip when my father cast his fishing line from a canoe on a lake, and the blaring honk of the tornado alarm in elementary school. Next, choose one of these sounds -- preferably one you haven't thought about for a long time -- and write for 20 minutes about your experiences relating to it. Then consider how it felt to write this memory -- was it sad, funny, a relief, an "aha" experience? If a particularly difficult memory came up, give yourself a few more minutes to write an imaginary ending to the story that wraps things up in a way you'd prefer.

TO READ: Why Did I Have To Gain 80 Pounds on Antipsychotics?
Researchers may have solved the mystery of why so many people with bipolar, depression, schizophrenia and other illnesses who take certain antipsychotic medications tend to gain weight -- sometimes lots of it.

While these medications may effectively treat symptoms such as hallucinations and delusions, that's a high price to pay. (I know -- I gained 80 pounds in a few months on one of these meds. Fortunately it's almost all come off now that I'm on a newer one instead.) Many people gain to the point that they become at risk for life-threatening conditions such as heart disease and diabetes.

Scientists knew that the link between brain cells and appetite seems to be an enzyme known as AMPK. Now, in a recent study at Johns Hopkins University, when researchers gave the antipsychotic medication clozapine to mice, their AMPK activity quadrupled. When the scientists chemically suppressed the mice's appetites, the AMPK levels lowered. But what mediates such a connection?

It turns out that histamine -- the substance responsible much allergic misery, as well as a protein which aids communication between cells -- plays a key role in the interaction between AMPK and appetite. By blocking histamine's effects, clozapine no longer led to AMPK spikes.

The results are exciting: This discovery may allow scientists to develop both a new generation of antipsychotic drugs that doesn't cause weight gain, and safe weight-loss drugs.

For more info: Proceedings of the National Academy of Sciences, online edition, February, 2007.

TO WRITE: A Cold Got You Down? Write About It!
I see low, deep gray clouds and the spattering of raindrops outside my window here in Northern California today. And the weather report says a big part of the country is getting snow on this day before tax day. Have the recent shifts in weather contributed to a spring cold for you, as it has many people I know? (So far, so good for me ... for this month.)

After you wake from your weekend nap and pop some more Benadryl, don't turn on the TV to numb your mind. Instead, consider curling up with a cup of hot tea and a blanket in your favorite chair and writing out just how miserable you are. You might just feel better. Your mind will engage and you may forget your sore throat for a while. And remember that writing has been demonstrated to improve immune functioning. I'm not claiming that writing will cure your cold -- but research does show that writing even 20 minutes a day for four days in a row about a difficult or traumatic experience leads to fewer doctor visits for months later. Now that's something to think about!

Play with this...
Describe how your body feels right now as if you're writing for someone who's never had a cold -- the aches, the fever, the lethargy, the stuffiness. OR describe a time you were sick as a child -- what were your symptoms? Who took care of you? How did the illness resolve? Write continuously for 20 minutes. When you look back at the pages you've filled, you'll see you have accomplished something today after all.

TO READ: Religion Shown to Help Depression for Many of Us
The data is overwhelming: Study after study shows that people who consider themselves religious or spiritual, especially those who attend weekly religious services, tend to be generally healthier and longer-lived than those who don't. And -- this rule of thumb holds true for depression in particular too. Interestingly, it's reported that 95% of Americans believe in God or a Universal Spirit. Along the same lines, a study of psychiatric inpatients found that 80% consider themselves religious or spiritual.

In terms of overall health, for example, one study which tracked more than 5,000 people from right here in Alameda County, CA, found that those who attended religious services at least weekly were 25 % less likely to die during the study than others. A huge 1999 study of 21,000 American adults found that by attending religious services more than once a week, people tended to extend their lifespan by up to seven years in general, and up to 14 years in African-Americans.

In terms of depression, the results are remarkable too. For example, in one study of 177 people (age 55-89) over one year, self-reported religiousity was correlated with less depression, and with recovery from depression in those who were initially depressed. Another study looked at depressed and medically ill men over age 60 for one year and found that, even after accounting for 27 other variables, religiousity was associated with both a greater likelihood of remission and a quicker remission from depression. In one review of 29 studies examining the relationship between depression and religious involvement, 24 found that religiously involved people had less depression and fewer depressive symptoms; five found no association.

Treatment of depressed religious people has been shown to be more effective in terms of post-treatment depression when religious content is added to standard cognitive-behavioral therapy and, in another study, when religious content is added to standard psychotherapy.

And what if you don't consider yourself a "religious" person? Good news: benefits of a spiritual but non-religious practice can still provide benefits that complement your medical treatment. Consider a regular yoga or meditation practice, for example. Also, giving to others through works and services can often provide a strong inner response. In addition, pay attention to your personal support network, and health habits such as drinking and smoking -- all of these have been shown to be improved by religious involvement, but don't rely on believing.

Remember -- spiritual beliefs should not be used to replace your medical care! Instead, appreciate how they can complement and augment one another in your efforts to feel better.

For more info see: www.mayoclinicproceedings.com/inside.asp?AID=1338&UID and www.mcmanweb.com/article-102.htm

TO WRITE: Could a "Laughter Club" Beat Out Prozac?
Is it hard to laugh when you're depressed? Well, consider doing it in a group. That old saw about laughter being the best medicine is being enthusiastically applied in Shanghai. China Daily reported that this month faculty members at Fudan University began inviting students to "laugh away their cares and concerns" by joining the Heartfelt Laughing Club.

Members, inspired by observations that laughter is powerful - and contagious - typically meet in parks early in the morning. They raise their arms high and begin laughing loudly, then silently with mouth closed, then open, in an effort to ease everyday stresses. Sometimes the laughter is combined with yoga and meditation. Chinese psychologists leading the Fudan group discovered that others follow the humor-filled practice too: There are more than 80 laughter clubs in India, and several thousand around the world!

Do you think they could be on to something?

Play with this ...
Even if it's been a while since you've giggled much, recall some times you have. Did you laugh yourself silly at Bugs Bunny as a kid? Or was it that time you and friends played a prank on a teacher? For me, watching Monty Python or Saturday Night Live with my gang of pals in high school comes to mind.

Write the story of a funny - no, hilarious - thing you once laughed at. How did it start, how did you react, did you feel different afterward? Are similar events still amusing to you now, or have your tastes changed? And what might make you laugh today - could you rent a video, play with the dog, rehash a family mishap with your sister? As usual, give yourself 20 minutes to write continuously about the laughter in your life. And leave a comment to let us know what works for you!

TO READ: Approaching a Genetic Understanding of Depression
Scientists continue to chip away - and sometimes blast away - at the mystery of depression. And they're making progress. In a major step forward, a consortium of psychiatric researchers announced last month the identification of a region on chromosome 15 that has "a very good chance" of ultimately explaining why some people develop depression.

You probably know that both genetic and environmental factors are believed to be responsible for depression. A better understanding of specifically which genes (there are thought to be several) in our DNA place us at risk for depression would constitute a major research breakthrough: If scientists can locate the key genes, they can determine how they affect the brain and, as a result, can develop more effective therapies for the illness.

Two studies reported in the February American Journal of Psychiatry were conducted by groups at six universities, led by Stanford professor Douglas Levinson, M.D. First these researchers studied 650 families in which two or more members had experienced multiple bouts of severe depression that began in childhood or early adult life. They scanned the entire genome and found areas of "linkage" between depression and DNA markers in several areas. Then they homed in on the most suspicious region, which lies on chromosome 15.

What they found, after studying more than 88 DNA markers in that area, was what Levinson called "one of the strongest genetic linkage findings for depression so far."

The consortium is now studying more than 2,000 people to identify specific genes in the regions, including on chromosome 15, that look most likely to carry variations that increase depression risk.

TO WRITE: What We See and What We Don't
Many writers claim that observation is what their work is really all about. Author and writing teacher Natalie Goldberg says, "Writing is 90% listening."

But it's not just the writer surreptitiously monitoring the lovers at the next restaurant table for plot ideas and dialog. In fact, every human needs to observe his life and the world around him and try to fit the two together. Observing and reflecting are key, whether it's deciding when it's safe to step off a curb, or determining when to change careers. For people living with depression, observing the situations that make us feel worse or better, and the reactions we have to those stimuli, can be a powerful tool. We can use this technique both in the present and in retrospect.

Play with this...
Write continuously for 20 minutes, starting with the following prompt, and see what you discover.
Looking back, it was obvious...

TO READ: Changing the Structure of Your Brain
Wow, am I reading a great book right now! Train Your Mind, Change Your Brain by the wonderful science writer Sharon Begley, is billed on the cover as, "How a new science reveals our extraordinary potential to transform ourselves," and, "A groundbreaking collaboration between neuroscience and Buddhism."

Sound confusing? Well, I suppose anytime you get the Dalai Lama to write a foreword for a book on nerve cells in the brain, it's unusual, that's true. And neuroscience is typically thought of as a daunting field. Despite those things -- or maybe because of them -- I'm telling everyone I know to read this book! It's absolutely fascinating and it's very accessible.

Here are some of the things I've learned so far, boiled down and boiled down again. When I was a college student, and even when I was a graduate student in biology, it was taken as a given that whatever brain cells you were born with were what you got for good -- no exceptions. This was simply a basic rule of neuroscience. But... Begley describes a whole host of recent experiments that show how that belief is hooey. Instead, the incredible changes our brains can make -- the "neuroplasticity" of the brain -- will amaze you. For instance, in people blind from birth, you might imagine that the enormous visual cortex part of the brain would sit silent, since no visual input can get in through the eyes. No! In fact, instead of lying dormant, the visual cortex actually switches jobs to help the person hear certain tones and rhythms more acutely than sighted people can. In other words, it helps them compensate. Similarly, the brain region believed to only be able to process auditory stimuli can, in deaf people, be recruited to help the visual cortex to gain even more information from peripheral vision than usual, thus helping a deaf person to notice and react to changes in the environment more quickly.

What these kinds of experiments mean is that we can change our brains. By attending to particular things in our environment, we can cause regions of nerve cells in the brain to grow, to shrink, to adjust their function, even to change jobs completely. So, if you take up the violin, even as an older adult, your brain's motor cortex in the region controlling your left (fingering) hand, will grow. It takes attention and practice, but our minds really can change the structure and the electrical and chemical activity in our brains! That's consciousness changing matter.

I'm only half-way through the book, but I'm hooked. So stay tuned for an upcoming discussion of what happens when neuroscientists study the brains of Buddhist monks who have meditated for years, and learn what these discoveries mean for the treatment of OCD and depression.

TO WRITE: How Do You Care for Yourself?
Last time I circulated a notepad asking for writing topic suggestions in our class meeting at Stanford, I got an amazing mix of responses. We've already written using several of them as our jumping-off point -- from "joy" to "patriarchy" to "I'm afraid of" to imagining being "rich beyond dreams."

But one topic that comes up very regularly on such lists is how to manage your moods. And on this page, the topic of "self-care" came up specifically. Everyone who has coped with a mood disorder, even for a short time, has probably gravitated toward some activities that feel self-soothing or calming or activating or encouraging, depending on what you need at that time. When I'm depressed, reading a novel or writing about the situation over a big cup of coffee at Starbucks helps considerably. It doesn't remove the depression, but it reminds me that there are still things I can enjoy - even if only a little bit - and that I have the ability to seek out those things. And, in my case, the jolt of caffeine doesn't hurt either.

Play with this...
What self-care techniques can you recommend to others? Does walking the dog help you bond with her and get some exercise? Does herbal tea help you get a much-needed good night's sleep? And what about writing -- you may not feel up to crafting a poem, but does a good freewrite in your journal ease your burden a bit? Write continuously for 20 minutes on self-care and see what you discover -- then share your findings with a friend who could use them, and perhaps pick up a few tips from her too.

TO READ: Gamma knife surgery - could it help depression someday?
A former writing student recently made me aware of a "knife-less" brain surgery technique which is becoming widely used around the world. Called gamma knife surgery, it destroys tiny bits of brain tissue by focusing beams of cobalt radiation on, for example, a brain tumor. The gamma knife can be used even for deep brain sites and, unlike conventional radiation treatments or surgery, can be focused with one-tenth of a millimeter precision, so healthy tissue is largely unaffected.

Sounds very impressive to me. Now vascular malformations, both cancerous and benign brain tumors, epilepsy and other conditions are being treated with the gamma knife on over 60,000 patients each year, according to one web site.

But what about depression? I surfed and web-surfed some more, but haven't come across any studies on using gamma knife surgery in this realm. Yet. One site discusses using it for obsessive-compulsive disorder and even vaguely suggests using it for depression in the future....

But where in the brain would it be used? As this blog has described several times, more and more evidence is stacking up that says brain structures - not just the flow of neurotransmitters - are changed in depression. Perhaps one of these sites could be treated. Often the confusing point in these cases is that we don't know whether those structural changes cause, or are caused by, depression. The other approach would be to simply focus on brain regions now understood to regulate emotions and mood. But identifying the precise areas to target is still too difficult. Still, it sounds as though researchers are starting to consider the possibilities of gamma knife surgery for psychiatric illnesses. One more potential future treatment to keep an eye on.

For more info: www.sciencedaily.com, www.sd-neurosurgeon.com