On chronic stress

This Jonah Lehrer piece from Wired is a long look at the work of Robert Sapolsky, a Stanford scientist who has focused on the stress and its role in human health. His conclusions are that stress is really bad for you...

Chronic stress, it turns out, is an extremely dangerous condition. And not just for baboons: People are as vulnerable to its effects as those low-ranking male apes. While stress doesn’t cause any single disease — in fact, the causal link between stress and ulcers has been largely disproved — it makes most diseases significantly worse. The list of ailments connected to stress is staggeringly diverse and includes everything from the common cold and lower-back pain to Alzheimer’s disease, major depressive disorder, and heart attack. Stress hollows out our bones and atrophies our muscles. It triggers adult-onset diabetes and is a leading cause of male impotence. In fact, numerous studies of human longevity in developed countries have found that psychosocial factors such as stress are the single most important variable in determining the length of a life. It’s not that genes and risk factors like smoking don’t matter. It’s that our levels of stress matter more.

Furthermore, the effects of chronic stress directly counteract improvements in medical care and public health. Antibiotics, for instance, are far less effective when our immune system is suppressed by stress; that fancy heart surgery will work only if the patient can learn to shed stress. As Sapolsky notes, “You can give a guy a drug-coated stent, but if you don’t fix the stress problem, it won’t really matter. For so many conditions, stress is the major long-term risk factor. Everything else is a short-term fix.”

... and that stress is caused by being of subordinate in social or career rank or status...

...While doctors speculated for years that increasing rates of cardiovascular disease in women might be linked to the increasing number of females employed outside the home, that correlation turned out to be nonexistent. Working women didn’t have more heart attacks. There were, however, two glaring statistical exceptions to the rule: Women developed significantly more heart disease if they performed menial clerical work or when they had an unsupportive boss. The work, in other words, wasn’t the problem. It was the subordination....
The British civil service comes with one...feature that makes it ideal for studying the health effects of stress: It’s hierarchical, with a precise classification scheme for ranking employees (in other words, it’s the human equivalent of a baboon troop). At the bottom are messengers, porters, and security guards. Just above them are the clerical officers, followed by staff scientists and other professionals. This last group implements the policies dictated by powerful administrators who run the governmental agencies. Marmot wanted to investigate how differences in status “in people who are neither very poor nor very rich” might lead to measurable differences in health.

The differences are dramatic. After tracking thousands of civil servants for decades, Marmot was able to demonstrate that between the ages of 40 and 64, workers at the bottom of the hierarchy had a mortality rate four times higher than that of people at the top. Even after accounting for genetic risks and behaviors like smoking and binge drinking, civil servants at the bottom of the pecking order still had nearly double the mortality rate of those at the top....

The same effect applies even to the rich and famous. A few years ago, Donald Redelmeier, an epidemiologist at the University of Toronto, led a study of Academy Award-winning actors. His hypothesis was that having an Oscar gave people more control over their stressful careers. Instead of being forced to accept bad roles or work on mediocre movies just for the money, these stars could pick and choose their parts. This creative control, in turn, would lead to improved health outcomes. Redelmeier compared the award winners to two groups: (1) actors who had appeared in the same film as a nominated actor and didn’t get a nomination and (2) actors who had been nominated for an Academy Award but never won. The results were clear: People with Oscars lived, on average, four years longer than their less-successful peers, which represented a 28 percent reduction in death rate. As Redelmeier notes, this longevity boost is roughly equal to the effect that would come from “curing all cancers in all people for all time.”

Interesting stuff, offering more than a little insight into how stress can lead to anxiety disorders, why anxiety disorders can get worse over time, and why learning to manage your stress is key to managing anxiety disorders.

On rumination depression and anxiety

Most of those with panic, anxiety, or depression know exactly what obsessive thinking is like. "Something's wrong with my heart. My heart's not beating right. It's skipping beats. Didn't that basketball player collapse on the court and die because his heart was skipping beats? What if I get to the supermarket, and collapse right their in the frozen foods aisle? I'll be so far from home! And what if nobody helps me? I know that's not really going to happen. But my heart's skipping beats -- what if it does? What if I have a heart attack, and collapse, and die?"

That kind of thing.

This blog post, which discusses the correlation between depression and obsessive thinking (a correlation that is, of course, just as strong between obsessive thinking and panic and anxiety), opens with a wonderful description by Sylvia Plath of depressive rumination: "I am terrified by this dark thing/That sleeps in me; All day I feel its soft, feathery turnings, its malignity." It goes on to say:

One theory is that ruminators have a particular cognitive style, a neuronal inflexibility that distorts the normal executive functioning of the brain. Two psychologists at the University of Colorado, Boulder, decided to explore this idea in the laboratory, to see if they could identify the specific deficit underlying such perseveration. Anson Whitmer and Marie Banich gave several hundred young adults a widely used test to measure their ruminative tendencies. The ones who scored high were not clinically depressed, but they did display this signature cognitive style.

Then the psychologists gave both the ruminators and those who scored very low on this trait a complicated mental test in which they were required to pay attention to certain stimuli, switch their attention elsewhere, suppress thoughts and replace them with new ones, and so forth. The idea was to sort out two ways that normal attention can malfunction. Sometimes we simply can’t shake an unwanted thought, hard as we try. At other times we cannot switch from one way of thinking to a newer, fresher way. These sound similar, but to the brain’s executive neurons they are distinct. The subjects were required to respond as rapidly as they could, in order to tap into these fundamental, unconscious processes.

The results, as reported in the June issue of Psychological Science, were plain. The ruminators, when compared to normal thinkers, had much more difficulty suppressing unwanted thoughts. Imagine trying as hard as you can not to think of the death of a loved one or a failed relationship--or trying to expel the embodiment of your melancholy--and failing; that’s the clinical equivalent of these lab results.

But Whitmer and Banich went one step further. They studied the same two cognitive processes in two other kinds of rumination, namely angry rumination and intellectual reflection. Angry rumination is, well, think of the rude guy who just cut you off in traffic—and the visceral feelings you still have, hours later. Reflection, as the word conveys, is good rumination; it’s peaceful and creative focus on an idea.

It turns out that, as different as they are emotionally, angry rumination and intellectual reflection are cognitively similar—and cognitively distinct from the distorted thinking of depression. Both involve difficulty switching to a new topic, rather than difficulty inhibiting a negative thought. In a sense, depressive rumination is an avoidance problem, while angry rumination and reflection are characterized by uncommon persistence in a way of thinking.

Fascinating stuff. Many thanks to the We're Only Human blog.

How to avoid having panic attacks on the subway

This is one dude's funny, self-deprecating look at his experiences with panic attacks on New York subway trains. The first one went like this:

out of nowhere, i started feeling really intense feelings that i couldn’t control, like more and more and more nervous and scared and i wanted to get off the subway so much but i couldn’t obviously because it was moving. then my legs started shaking and i was sweating and i could only see straight in front of me it felt like the universe was collapsing in my mind, and i was hyperventilating and i slid my headphones down to my neck and gently touched the arm of this middle-aged woman next to me who was also holding onto the pole. it felt like i couldn’t control my thoughts and they were spiraling towards a point where my mind would snap and/or i would actually die

so the woman whose arm i touched took one of her ipod earbuds out and suspiciously said “is everything okay?” like i think she thought i was like trying to get money from her or gonna bomb the train or something because i was nervous and sweaty and i look a little middle-eastern, and my hand was trembling, and i said to her “i don’t know what’s happening to me, i’m really sorry, i’m terrified, i don’t know why, can you talk to me please? just for like thirty seconds?”

But the panic attacks apparently didn't end there, and over time, to combat panic, the writer came up with the five techniques for managing his anxiety on the subway. (Actually, there are eight, but who's counting?) For instance, technique number one:

wear a bunch of rubber bands around your wrist and then when you start feeling terrified, pull them as far from your wrist as possible and then release them so they snap back against your wrist and it stings. this is a cheap solution that will distract you from the terror, but you will also confirm peoples’ suspicions that you have a mental illness

And technique number three-point-five:

try to envision where you are, but above ground, when you’re on the subway. like if you are on the C line for example, between Spring Street and Canal Street, think about that car wash on 6th Avenue that charges different prices for a carwash depending on the time of day, then think about that restaurant Lupe’s, then think about the Soho Grand hotel, then you’re at Canal! then do that all the way home. you will find that you know the city better than you thought you did

Clever stuff. Worth a read, for sure.
Also worth a read, or so I hoped when I wrote it five years ago: an account of my first subway panic attack.

Want to break the cycle of anxiety Hop on your bike

Just came across an recent article from a small-town paper about a local resident who's using cycling as a tool to fight anxiety disorders. And I quote:

STRATHMORE resident Justin Sacr can't drive a car for fear he has knocked down someone every time he hits a bump.

The 33-year-old has lived with anxiety and obsessive compulsive disorder since age 14 and, because of the phobia, his bicycle has become a 'lifeline'.

"I cycle to work every day. It has been a blessing in disguise because exercise helps me a lot," he said.

"It releases chemicals in your brain, like antidepressants, but in a natural way. It helps with your thoughts. You might look normal on the outside, but on the inside you're going through hell."

From experience: This guy's spot on. Cycling can have a hugely positive impact on your quality of life if you deal with anxiety. It's an especially good way to battle the shrinking-of-your-world of agoraphobia. The lightheaded feeling and elevated heart rate? That's what's supposed to happen when you exercise. Just push yourself to go a bit farther out of your comfort zone each time out. You'll feel better about yourself, more able. Guaranteed.

On securely falling back into the pit

Slipping back into a depressive period when you’ve been so stable for a good few years is like receiving a letter to warn you of your fate and then descending into hell with a parachute. 

It’s gentle, expected, and eerie. You know this place, you recognise these feelings, and you’re not so scared and alone as you were before. 

If I wasn’t depressed, I’d be frustrated that I am, once again, depressed. I’d be angry and confused as to why I’ve found myself back being hopeless and helpless after doing so well for so long. But I’m depressed, so I’m not feeling that at all. I’m just looking at those feelings having a strop over the other side of room and thinking, “I can’t be arsed to feel that tbh, it’s too much effort and I just don’t care.”

Finally being back in the senseless pit after feeling its slow, frustrating, confusing, and irritable presence for some weeks is almost a relief. Is that wrong?

I expected this. My life for the first four months of this year was training for, and then running, a marathon. Have I mentioned, etc. I knew the abrupt change to my lifestyle after it was over would be tricky, if not tough. I knew I’d be moving flat immediately after (for a month - we have a long changeover which hasn’t actually been as much of a relief as we wanted) and I knew I’d be last-minute fundraising and preparing for the MoonWalk (15 miles through London at night) which is this Saturday, just three weeks after the London Marathon, because really why not. 

I also knew I’d be going on holiday to Salzburg with my mum between moving flats and doing the MoonWalk, and Riga with Ryan the weekend after our final move-in weekend, which is also his birthday. 

The above is all happening within the same month. I knew this. I know this. It is not a surprise, and nor is this location back to the pit. All of that is a lot for anyone to deal with, let alone a person who is a little fragile. 

I’d heard of the post-marathon blues. Feeling down after a marathon is totally normal and expected, but I didn’t really notice it. I didn’t have time to, I was busy. But my fitness level and diet changed immediately, and I know that what you put into your body, and what you do with your body, affects your mood, so maybe that could be a reason I’m back here at Flat 0, 3 Cries A Night Road, Boredom, DPR SSN. 

Or maybe it’s the fact that on top of everything above, I’ve had to cope with one cancer scare and one cancer diagnosis this week, a frustrating ex-landlady and even more frustrating companies who aren’t making this flat move any easier for us. 

I’m also on my period. Maybe it’s that. 

I could spend hours, days analysing why I feel like I’m living deep inside my body unable to communicate, use my senses, make much sense of what’s happening around me, or care. About anything. But there’s not much point. The point now is to deal with it and wait the bullshit out. I know it won’t last, I know things will get better. I know all this. There are a lot of things I know about my mental health now, and I'm grateful and privileged to know them. 

I know I’m in a depressive episode when:

• My anxiety behaviours are nowhere to be seen.
• Any attempt at self care is met with boredom and effort.
• I can’t concentrate/am clumsy/make constant mistakes.
• I don’t enjoy anything. I wasn't particularly enthralled about going on holiday.
• I cry at everything.
• I have a constant buzzing noise in my ears.
• My tongue feels numb.
• I can’t talk to anyone. I don’t know how. The connections in my brain are fucked.
• I see very little point in doing anything. 
• I sleep a lot. 
• I hear nothing on the outside but everything inside my body. Food digesting, skin cells growing.
• I just. Don’t. Care.

I know the things that will help me are:

• Constant communication from friends where:
• replies aren’t expected 
• how I’m feeling isn't mentioned
• stupid jokes are made
• random hairdresser-style nonsense is babbled 
• you RT my shit even if it's not funny 
• Food, whether I want it or not.
• Water, whether I want it or not.
• Hugs, but only if I want them. 
• Little verbal communication.
• Fresh air to try and kickstart my senses again. Even if it’s sticking my head out the window.
• Listening to good music. I listen to music way more when I'm like this. Send me good music.
• Just waiting it all out until the ladder appears for me to climb out the pit.

I’m still ok. I’m not in crisis, nor do I need serious support. I’m still stable. This experience of the pit is a very different one to the years I spent in it before. I’m still strong, important, and brave. I’m still incredibly aware of my sense of self; my mental health has just slipped between a gap in the fence. I’m a little fragile, a little unable, and just a little bit exhausted. 

I’m going to make myself comfy down here.

---

If you're struggling with your mental health and need support, you can visit:

• The Mix, if you're under 25. Call their free helpline on 0800 808 4994.
• Mind. Call their infoline on 0300 123 3393 or text 86463.
• Samaritans if you're having suicidal thoughts. Call 116 123.

Dr Kevin Yaos feature on CBS News discussing Trigeminal Neuralgia

source-asap science

SF Giants baseball player on disabled list with anxiety

I've talked in the past on PANIC! about pro athletes being sidelined by panic and anxiety. Here in San Francisco, it's happened again, to Giants infielder Aubrey Huff:

San Francisco Giants baseball player Aubrey Huff has been put on the 15-day disabled list because of anxiety, according to the team’s manager, Bruce Bochy...

Huff has had his share of troubles. He is currently going through a divorce and his father was murdered when he was 7. His career has been floundering this year. And on Saturday, while playing second base  for the first time, Huff did not cover second base on what could have been a key double play. Some described the play as "embarrassing."

Any and all of these events could lead to anxiety and panic attacks for certain individuals, experts said.

This is a bummer for Huff, and I hope he feels back on solid ground soon. And bravo to him for being public about what he's going through:

"Without interviewing Mr. Huff, it is impossible to know the precise nature of his anxiety," said Dr. Una McCann, director of the Anxiety Disorders Clinic at Johns Hopkins Medical Institute. "However, I'm impressed that he was so open about the diagnosis, since psychiatric illnesses continue to be stigmatized."

"Be being forthright about his problem, he did a real service for all those other patients with anxiety disorders who feel they need to hide their diagnoses or are embarrassed to speak about them," said McCann. 

Aubrey Huff's my new favorite Giant.

And the Hits Just Keep on Coming

In a previous post, I described how the drug company giant AstraZeneca agreed to pay about $198 million to settle lawsuits alleging that its promotional material neglected to mention the significant risk of getting diabetes from its anti-psychotic drug, Seroquel. In another post, I described how The U.S. Department of Justice fined the company $520 million for off-label marketing of the very same drug.

With stories like this coming with almost nauseating regularity, the company has now agreed to pay the District of Columbia and 37 other states $68.5 million for, once again for off-label marketing of Seroquel (for sleep disorders and anxiety, among other conditions) and failure to warn of potentially serious side effects such as weight gain, elevated blood sugar and diabetes.

In settling this last suit, the company of course once again denied any wrongdoing at all but said it was paying it off to get the complainants off of its collective back.  They did agree, however, to start doing what they claim they were already doing in the first place: having their drug representatives refer only to the FDA-approved indications of the drug and avoid focussing discussions with doctors on disembodied symptoms alone.

The company also said they had already set aside money for settling these sorts of lawsuits, so apparently this expense will not show up on any financial reports that they send to their shareholders.  And for the company, despite the seemingly large sums involved, the fines are chump change compared to what the drug brings in.  Just a minor cost of doing business.

As I have also frequently blogged about, and written about in my book, PhARMA's shady promotion of antispsychotic medication has been a big factor in the explosion of phony bipolar "spectrum" diagnoses.

The Insects Are Going to Sit On Us

My husband heard on NPR the other day that there are 200 million insects for every human on the planet.

"Just suppose," says he, "That they all got wise, and that they decided to gang up on us. It would be 200 million to one!"

I thought about this, and said, "Yes, even 200 million butterflies would win against one frail human. They could all flap their wings in unison. What about 200 million blackflies or mosquitoes? What if they decided to fight us? They would win!"

"Who said anything about fighting?" said my husband. "All they'd have to do is sit on us."

You see now why I have an anxiety disorder.

I thought, "What a great idea for a new book!" so I wrote one immediately.

My new book THE INSECTS SAT ON US is a YA Paranormal Romance, in which our heroine Brittanee meets Jordan, a football player, but their romance is ruined when they are both sat upon by aphids, earwigs, and termites. It is complete at 32,345 words, which is as far as I got before I was sat upon by a cloud of moths, who ruined my typing skills. I am sending it to you, agent, who are now likely being sat upon by locusts and boll weevils. I don't expect a response, but if you should reach out to some editors you know before they, too, are sat upon by mites and beetles, this book may yet stop the plague which is now upon us.

THE INSECTS SAT ON US is like a cross between ARE YOU THERE, GOD? IT'S ME MARGARET and THE BIBLE. And maybe with a bit of LITTLE HOUSE ON THE PRAIRIE and TWILIGHT and some Kafka and Dante thrown into the mix. It would be best to accept this book because I think now that the insects have become my friends, and will sit on those who spurn me. They will sit with alacrity! They will sit with their antennae fierce and erect! Do not cross them.

Respectfully and now totally controlled by insects, who are cooking my supper and braiding my hair,
The Party Pony

K24 Alfajiri Discussion on Suicide YouTube 360p

Panic on YouTube

This is from a YouTube poster KevinGetsHealthy, and features a real, live panic attack on camera. It's freaking intense. Show it to anyone in your life who believes panic can be managed by "just sucking it up."

I absolutely applaud this kid for posting this, and for believing so forcefully that people with panic are frequently not weaker but stronger people than most, for having the courage to live relatively normal, active lives despite the challenges they face in doing so.

And then there's this: "Almost hit a cop, once." Throwaway line of the week.


This is another vid from KevinGetsHealthy's YouTube channel, in which the star discusses how to prevent agoraphobia. Unfortunately, as far as I'm concerned, he's got a confused understanding of what causes agoraphobia, the chronic avoidance behaviors that can result from panic disorder. He says, "One of the big problems people have with panic attacks is looking for what causes them and falsely identifying it...This is what causes agoraphobia." He says, "People...have [a panic attack] in a car...and they go, Cars may cause my panic attacks. It's worth not driving to not have panic attacks." As though you have the power to consciously decide what triggers will cause your agoraphobic behavior.

In my experience, as in my understanding of the science behind agoraphobia, agoraphobic fears do not originate in conscious thought, but rather are an unconscious response to the places and situations that trigger them. As neuroscientist Joseph LeDoux writes:

...the brain has multiple memory systems, each devoted to different kinds of memory functions. For traumatic memory, two systems are particularly important. For example, if you return to the scene of an accident, you will be reminded of the accident and will remember where you were going, who you were with, and other details about the experience. These are explicit (conscious) memories mediated by the hippocampus and other aspects of the temporal lobe memory system. In addition, your blood pressure and heart rate may rise, you may begin to sweat, and your muscles may tighten up. These are implicit (unconscious) memories mediated by the amygdala and its neural connections. They are memories in the sense that they cause your body to respond in a particular way as a result of past experiences. The conscious memory of the past experience and the physiological responses elicited thus reflect the operation of two separate memory systems that operate in parallel.

...In fear conditioning, the subject receives a neutral stimulus in connection with some unpleasant event. As a result of its past association with the unpleasant event, the neutral stimulus acquires the capacity of elicit protective reactions in anticipation of danger. If you were bitten by your neighbor's dog yesterday, the sight of the beast today (and for some time to come) will certainly put you on guard, causing you, for example, to freeze dead in your tracks, or perhaps to run away, and will also lead to a host of physiological responses.

...Neuroanatomists have shown that the pathways that connect the emotional processing system of fear, the amygdala, with the thinking brain, the neocortex, are not symmetrical -the connections from the cortex to the amygdala are considerably weaker than those from the amygdala to the cortex. This may explain why, once an emotion is aroused, it is so hard for us to turn it off at will.

You don't get the option of deciding what locations and situations will or won't cause your agoraphobic fears. Rather, your body experiences the symptoms of fear, and then your conscious mind identifies a certain location or type of situation as having caused that sense of fear. Even the kid in this video acknowledges this, whether he realizes it or not, when he recognizes, "Going back to places where I've had panic attacks makes me nervous, physically, there's a physical reaction to them," and again when he says, "I had a few [panic attacks] while checking my email, and I had a rough time checking my email after that, which is weird." Clearly, this was a fear that arose outside his consciousness.

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