Negative self-views and self-appraisals are commonly associated with depressive symptoms. Individuals with major depression, as well as those with depression related to bipolar, often experience low self-esteem, feelings of worthlessness, and overall negative self-concept while in their depressive states. In contrast to these feelings, high levels of self-esteem, goal attainment, and motivation are often evident preceding or during manic episodes.

But according to the results of a new study led by Hana Pavlickova of the School of Psychology at the University of Wales Bangor, negative self-beliefs can also predict manic episodes in people with bipolar. Pavlickova theorized that the comorbidity of both positive and negative affect might exist during periods of no symptoms and also during periods when symptoms were present. Understanding how this overlap affects each mood state could help determine when manic or depressive episodes might occur and also could provide opportunities for intervention prior to those episodes.

For her study, Pavlickova evaluated 253 participants with bipolar several times over the course of 18 months. She looked at depressive and manic symptoms and how self-esteem, self-appraisals, internalization, externalization, and other behaviors influenced the symptoms.

The results revealed that self-esteem was most strongly associated with both mood states. In particular, low self-esteem was linked to depression and high self-esteem to mania. However, negative self-esteem, although highly predictive of depressive symptoms, also indirectly predicted manic episodes. Pavlickova discovered that although cross-sectional data indicated a direct association between negative self-esteem and depression, longitudinally, negative self-esteem was weakly but clearly associated with mania.

She explains this finding by suggesting that individuals with bipolar may overcompensate for feelings of negative self-worth by actively avoiding any depressive emotions and engaging in high levels of externalizing, which could provoke manic behaviors and symptoms. These results are novel in that they demonstrate the overlapping relationship of negative self-evaluations in bipolar. Pavlickova added, “In terms of clinical implications, the findings accentuate the importance of the therapeutic management of negative self-concept shared by both depression and mania in bipolar disorder.”

Reference:
Pavlickova, H., et al. (2013). Symptom-specific self-referential cognitive processes in bipolar disorder: A longitudinal analysis. Psychological Medicine 43.9 (2013): 1895-907. ProQuest. Web.

The ignorance about mental health issues that continues to exist among otherwise intelligent individuals is perplexing. In today’s modern world, with continuously increasing tolerance for human differences, many of yesterday’s taboos have become today’s facts of life. Issues from racism to sexual identity have been stridently tackled and, while much work remains to be done, we have come miles. The recent Supreme Court ruling regarding gay marriage is a perfect example of how far we have come.

However, there still remains what some have referred to as “the last taboo.” Namely, depression continues to be one of the most stigmatized mental health issues out there. This is ironic, given that by the year 2020, according to the Centers for Disease Control and Prevention, depression is estimated to be the second most common health problem in the world. Further, because of the unjustified stigma that still exists, a large percentage of those who experience depression will not be treated.

So, what is the missing piece to this puzzle? Why is the message not resonating with the greater population? Why is stigma still so prevalent in our society? As mental health practitioners and social advocates, what can we do to eradicate this social dilemma?

When it comes to obtaining treatment for medical ailments as benign as the common cold, people don’t think twice about running to the doctor, or the acupuncturist, and spending the money on treatments to feel better. So, why do so many who suffer from depression continue to hesitate, despite all of the treatment options available?

[fat_widget_right]In addition to the externalized stigma or discrimination toward those with mental health issues that exists in society, there comes internalized stigma, or self-shame. This makes the experience of mental health issues all the more devastating. Many times, it is the internalized shame that stops people from acknowledging psychological problems and receiving treatment, since many see it as akin to admitting that they are weak or damaged in some way.

According to the U.S. Preventive Services Task Force, a panel that sets treatment guidelines for primary care physicians, an estimated 6% of teens in the United States suffer from clinical depression, yet most go undiagnosed and, therefore, untreated. This information alone strongly indicates a dire need to raise awareness.

But where do we start?

How about with the media? Instead of programs like Criminal Minds perpetuating the stereotype of schizophrenia as a violent disease, let’s have some intelligent programming that humanizes mental health issues. What Will and Grace did for sexual identity, perhaps the same can be done for depression. Since we are a society so attached to the media, why not take advantage of the opportunity to educate people?

We can also begin in our school system, making mental health education a part of the curriculum. As has been discovered in other areas such as sex education, knowledge can be a powerful tool in prevention. Why is it that when we learned about Abraham Lincoln in social studies, or Walt Whitman in literature class, we learned almost everything about them except the fact that they experienced psychological problems? Why were these facts omitted from the textbooks and class lectures? We need to make stigma a thing of the past and teach our future leaders of tomorrow that it is okay to recognize, and seek treatment for, the experience of clinical depression and other mental conditions.

Before we begin with the masses, let us also first look at ourselves as therapists and mental health caregivers. We must look at our own core beliefs and biases, which can directly affect the work we do. We may be unknowingly perpetuating the stigma of depression and other psychological issues. Change must begin within the mental health community. To change others’ minds, we must first change our own.

References:

1. Depression statistics (2008). Retrieved April 3, 2009 from: http://depression.emedtv.com/depression/depression-statistics.html
2. Panel: All teens should be tested for depression. (2009). The Associated Press. Retrieved from: http://www.msnbc.msn.com/id/29945008/

I see many people who struggle with self-esteem issues. In fact, self-esteem issues and depression almost always occur together. Which one causes the other is not always clear, but the majority of people seem to have the self-esteem issues first.

People often tell me they want to die—because they “shouldn’t exist,” were “never wanted,” never “fit in,” are a “burden,” “don’t deserve anything,” or even have the feeling they “did something horrible” but don’t know what.

Generally, this viewpoint comes from something that happened when the person was very young. We now know that even embryos traveling down the fallopian tube are being affected by their environment in ways that have implications for physical and emotional health throughout the rest of their lives.

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To work with this, sometimes I ask people if they deserved to live (or die) when they were an embryo, then a fetus, then a newborn, etc. Most people see themselves as innocent and deserving to live at some point. Going through this exercise helps them see that there was a time they could have compassion for themselves, rather than blame or condemnation. For others, as we advance in age, we come to a place where they can no longer say they were innocent and deserved to live. That can lead us to the origin of the issue. If they can’t say they were good anymore after age 2, 4, 10, or whatever, then we look for what happened at that age to change that. Almost always, it was some kind of abuse or trauma.

For example, I saw a woman who wanted to die and believed she didn’t deserve to live, despite the fact she was a kind, giving, loving person. She was severely depressed and obsessed about suicide. She told me if therapy didn’t work, she was going to kill herself. One of the things I did was to take her through this exercise. She reluctantly conceded that she was innocent as an embryo, fetus, and newborn. When we got to 2, she said she deserved to die at that point. When we explored it, she said something happened then to change this, but she didn’t know what. Few people have conscious memories from that age, so early memories can be challenging to resolve.

But then she said she had an image, but she was sure it didn’t happen—”it couldn’t have happened.” The image was of a sexual assault from a family member. It was very specific and unusual. We processed the image as if it was a memory with EMDR, and she felt enormous relief. She no longer thought she was so bad that she didn’t deserve to live. She finally saw that she had done nothing wrong and the shame wasn’t hers. It belonged to the adult perpetrator.

Others blame themselves for their parents’ divorce, or for their parents’ lost lives after marrying each other only because of the pregnancy. People blame themselves for being the gender the parent didn’t want, for their mother dying in childbirth, or for their parent’s depression. When children try to make sense of something that feels terrible in their world, and no one helps them, they tend to think they caused the problem. So many innocent children grow up feeling guilt, shame, and self-hatred because of this. Sometimes, they don’t even remember why. Once they can connect their adult perspective with their child beliefs, they see that it’s unreasonable to punish themselves the rest of their lives because when they were too young to be responsible, their parents made the choices they did.

So if you think you are bad, disgusting, undeserving, unlovable, or inadequate, were you so as an embryo? A fetus? A newborn? An infant? A crawling baby? A walking toddler? A talking toddler? When did you become unforgivable, and why?

It sounds like you have been a tremendous source of love, strength, and support for your girlfriend in her battle with depression. That takes incredible patience and compassion, but it can also take a toll on you. In cases of chronic depression, it is very common for partners to begin to feel more like caretakers than anything else. Very often, when one takes on the role of caretaker, it becomes such a consuming task that the caretaker loses touch with himself/herself. It’s a positive sign that you seem to have a solid sense not only of where she is, but also where you are. It also seems like you have come to the realization that this situation is not sustainable and that something must change. So the question, as you insightfully pose, is where do you go from here?

You’ve asked some really important questions about yourself: “Am I codependent?” “What’s my issue?” “What steps can or should I take?” These questions are as important as they are complicated. I strongly encourage you to begin your own therapy. Developing a strong therapeutic relationship with a clinician will afford you a much-needed opportunity to focus on yourself. You’ve managed to take care of your girlfriend and remain connected enough to yourself to come up with these questions. A trusted therapist will help you thoroughly explore these questions, develop insights, and create and implement a plan of action. You might also want to look for a caretakers’ support group. The burden on caretakers is significant, and there is great therapeutic value in realizing you are not alone. You’ve been shouldering a significant burden on your own for years; it sounds like you are ready to let someone help you carry the load.

You mention that your girlfriend’s medication does not seem to be helping her. The specific mention of medication but not therapy makes me wonder whether your girlfriend is in therapy. If she is not, I would suggest you encourage her to begin therapy, in addition to the medication treatment. Medication treats symptoms, but it doesn’t address all of the problems that often underlie depression. In order for her to have a chance at any kind of substantive change and lasting relief, she needs to be working on these issues in therapy. Also, it is very important that a psychiatrist, and not a general practitioner, be managing her medication. Psychiatrists are the experts in the medical treatment of depression, and they will be able to provide better care than a general practitioner.

Also, if her depression has lasted for years with no improvement, it might be time to look at changing the treatment plan. This could mean adding individual and/or group therapy to her treatment regimen, trying a new therapeutic approach, or making a change to her medication. Consider suggesting that she talk about these possibilities with her psychiatrist and therapist (if she has one). If, after years of treatment, she isn’t getting any better, something probably needs to change. Your girlfriend should know that she has the right to be an active participant in her treatment plan and to discuss changes to this plan with her clinicians.

You took a leap when you wrote in with your question. I hope you will take another one and find some support for yourself. This is a painful, complicated issue, and you deserve to have support as you work on figuring out what is best for you.

Respectfully,
Sarah

According to a new study led by Panayotes Demakakos of the Department of Epidemiology and Public Health at University College London, older people with depression walk slower than their peers who do not have depression. Gait speed, or the speed that a person walks, is influenced by a host of factors, including physical ability, range of motion, musculoskeletal health, and mental health. Although there has been some evidence that psychological conditions can affect gait by way of diminished physical health, there is little research focused on examining a direct link between gait speed and psychological health, and in particular, depression.

Demakakos wanted to explore how depression and gait speed were related and also to evaluate whether their influence was bidirectional. In particular, Demakakos wanted to find out if older individuals with depression had slower gait speeds than those without, and if slow gait speeds predicted depression in older individuals.

Using a sample of 4,581 individuals over age 60, Demakakos measured depressive symptoms and gait speed across a six-year period. The results revealed that people with slow gait speeds had a higher risk of developing depression in the two years following assessment than those with average gait speeds. Further, Demakakos also discovered that depressive symptoms were directly linked to slow gait speeds.

The results can be interpreted in many ways. First, as people age, they experience declines in physical health and mobility. These factors can decrease gait speed and by limiting physical ability, can eventually erode mental well-being and put people at risk for depression. Second, as depressive symptoms increase, physical mobility can become impaired, pain can increase and fatigue can set in, all of which combine to decrease walking speed.

The results presented here were consistent even after demographic factors such as marital status, socioeconomic status, and gender were taken into consideration. In sum, this study shows that gait speed could act as an early indicator for depression. Demakakos added, “These findings point to depression as a modifiable risk that needs to be targeted by disability prevention programs at older ages.”

Reference:
Demakakos, P., Cooper, R., Hamer, M., de Oliveira, C., Hardy, R., et al. (2013). The bidirectional association between depressive symptoms and gait speed: Evidence from the English Longitudinal Study of Ageing (ELSA). PLoS ONE 8(7): e68632. doi:10.1371/journal.pone.0068632

Electroconvulsive therapy, sometimes called shock treatment, has been the subject of controversy for generations. Decades ago, ECT was sometimes administered involuntarily, but current ECT treatments are voluntary and much safer. ECT is one of the most effective treatments for treatment-resistant depression, but its results are unpredictable and the side effects can be troubling. Some people, for example, experience long-term memory loss after undergoing ECT.

Fortunately, if you’re experiencing treatment-resistant depression, ECT is only the most popular option, not the only one. Something as simple as a new therapist or medication could make a big difference, and if those don’t work, there are several other ways to compel your brain to stop making you feel depressed.

New Treatment Plan

ECT and treatments like it are therapies of last resort. If you’ve tried only one medication or therapist, it’s not time to give up just yet. Instead, try modifying your treatment plan or treatment team. If you’re doing interpersonal therapy, for example, you might try switching to a therapist who specializes in cognitive behavioral therapy. If your medication isn’t working or the side effects are too much to tolerate, it’s time to switch to something else. Educate yourself before you choose a treatment team, and ensure that the methods your treatment team is using have been proven effective.

Vagus Nerve Stimulation

A vagus nerve stimulator is a lot like a pacemaker for your brain. The device has to be surgically implanted, and uses tiny electrical shocks to stimulate your vagus nerve. This treatment has been used for years in people with epilepsy, and some doctors are now using it in people with depression. Studies are inconclusive about its effectiveness, but if you want to avoid ECT, VNS can be a less frightening option.

Transcranial Magnetic Stimulation

Transcranial magnetic stimulation uses an electrical coil to produce electrical activity in a targeted area of the brain. The effects are similar to ECT because TMS electrically stimulates the brain, but preliminary studies indicate that there might be fewer side effects with TMS. However, the Food and Drug Administration advised against the marketing of a TMS device in 2007, arguing that it had not been proven effective.

Experimental Treatments

Experimental treatments are not currently available or are available only to those participating in treatment studies. However, in a few years, some of these treatments might be available to the general public:

• Some studies have indicated that ketamine—a veterinary tranquilizer that is sometimes used recreationally—may help alleviate symptoms of depression and some other mental health conditions.
• Magnetic seizure therapy is similar to ECT because it induces a seizure in the brain. It does not, however, require an electric current to be administered directly to the brain.
• Deep brain stimulation has shown promise in the treatment of neurological conditions such as Parkinson’s. Much like vagus nerve stimulation, deep brain stimulation works by implanting a device in the brain that sends electrical impulses to areas of the brain that affect mood.

References:

1. Brief summary from the neurological devices panel meeting. (2007, January 26). U.S. Food and Drug Administration. Retrieved from http://www.fda.gov/AdvisoryCommittees/CommitteesMeetingMaterials/MedicalDevices/MedicalDevicesAdvisoryCommittee/NeurologicalDevicesPanel/ucm124779.htm
2. Hampton, T. (2006). Ketamine for depression. JAMA: The Journal of the American Medical Association, 296(12), 1458-1458. doi: 10.1001/jama.296.12.1458-a
3. Mayo Clinic Staff. (2011, August 23). Treatment-resistant depression. Mayo Clinic. Retrieved from http://www.mayoclinic.com/health/treatment-resistant-depression/DN00016
4. Treatment-resistant depression. (n.d.). WebMD. Retrieved from http://www.webmd.com/depression/guide/treatment-resistant-depression-what-is-treatment-resistant-depression

Losing a family member is one of the hardest things a person can experience. Many families pull apart and suffer extreme emotional distress after the loss of a child or parent. This is especially true if the loss is sudden and from an accident or suicide. But even anticipated deaths, like those resulting from terminal illnesses such as cancer, can cause immense emotional pain that some people cannot easily overcome.

Although research in this area is extensive, another type of loss that can have similarly negative effects has not been examined nearly enough. When a person loses a sibling, the results can be equally as devastating, and in fact, some believe even more difficult than losing a parent or other family member. Siblings often represent the longest friendship and closest relationship many people have had.

When a sibling dies, the effect can be traumatic and even life-threatening if the death is sudden. People can become easily depressed when they are overwhelmed with grief. These emotions, if not reconciled, can put someone at risk for suicide.

Mikael Rostila of the Centre for Health Equity Studies at Stockholm Univesity in Sweden wanted to see if sibling death resulted in increased suicide in surviving siblings. To assess this, Rostila looked at population data between 1981 and 2002 on over 1.7 million Swedish adults between the ages of 25 and 64.

The analysis revealed that women who lost a sibling were 1.5 times more likely to commit suicide in the two decades following the death than those who did not experience the loss of a sibling. Men were 1.28 times more likely to commit suicide. And if the sibling death was the result of a suicide, the rate increased to 3.19 times for women and 2.44 times more risk for men.

Other types of deaths, such as cancer, resulted in much lower suicide rates in surviving siblings and there were relatively no differences by gender for these suicides. Additionally, Rostila did not find any association risk for suicide based on length of time since the sibling death. This research provides new and much needed insight into the effects of a sibling death on surviving siblings. Rostila added, “The mechanisms linking the death of a sibling and completed suicide among the bereaved person need to be further investigated.”

Reference:
Rostila, M., Saarela, J., Kawachi, I. (2013). Suicide following the death of a sibling: A nationwide follow-up study from Sweden. BMJ Open 2013;3:e002618. doi:10.1136/bmjopen-2013-002618

Studies on depression have shown that negative affect is a strong risk factor for depressive symptoms. Rumination, the process of thinking about negative events and distressing situations, can increase negative affect and make people more vulnerable to depressive episodes.

Neil P. Jones of the Western Psychiatric Institute and Clinic at the University of Pittsburgh in Pennsylvania wanted to add to the existing research on depression and rumination by looking at how goal failure, an event that can lead to negative emotions, influences affect. In his study, Jones examined the emotional reactions of 93 college students after they completed an exercise that required they write about their past failures related to prevention and promotion goals.

Promotion goals are hopes, dreams, and desires while prevention goals are classified as more obligatory and necessary goals pertaining to safety and security. Jones theorized that chronic failure to achieve the goals would lead to higher levels of rumination and increased depression and even anxiety in the participants. The results provided partial support for Jones’ theory.

First, the participants who wrote about chronic promotion goal failure reported higher levels of dejection. Surprisingly, even though they did not perceive themselves failing chronically at prevention goals, they still felt dejected when they wrote about any prevention goals they did not achieve. In other words, negative associations with promotion goals created an overall sense of dejection which led directly to increased rumination.

Jones found no association between goal failure and rumination, except when dejection was present. This was particularly interesting and suggests that there may be a protective mechanism at play, allowing some individuals who are exposed to goal failure to regulate their emotional reactions to the exposure so that they do not feel dejected and engage in negative rumination.

Jones believes these results extend existing research on the relationship between goal failure, affect and depressive symptoms. “Our findings are also consistent with our previous work demonstrating that dispositional tendencies to ruminate combined with chronic perceived promotion goal failure are associated with increased depressive symptoms,” added Jones.

Reference:
Jones, Neil P., et al. (2013). Cognitive Processes in Response to Goal Failure: A Study of Ruminative Thought and its Affective Consequences. Journal of Social and Clinical Psychology 32.5 (2013): 482-503. ProQuest. Web.

Those of you who’ve read my chapter in the anthology Goddess Shift: Women Leading for a Change know that I have had plenty of personal experience with depression, and that I have a unique relationship with it. I believe this has been an enormous help to me in helping others with depression. So I thought it might be useful to share some of what I do when I get depressed.

What resolves depression is grieving losses and traumas, changing brain chemistry, changing life circumstances, and time. What I have written below is more about what I do to cope during the process of resolution. This is not a complete list, by any means, but it is key for me and I hope you find it useful for you or someone you know.

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1. Stay in bed, and give in to the exhaustion and lack of motivation.

This is a tricky call because spending time in bed, sleeping, isolating, crying, etc., can sometimes be the worst thing for depression, and can exacerbate and prolong it. Sometimes the best thing I can do to cope with depression is to keep busy. My mother used to tell me when I was growing up that when she got depressed, she’d clean out a closet. Many of us have noticed that when we have to keep functioning—keep parenting, working, or whatever—we actually get through the depression better. When busy is what helps, I try to accomplish something satisfying.

On the other hand, depression can be a sign that we need rest. Though giving up and not functioning can be the exact opposite of what’s helpful at times, other times it can be exactly what is needed for my brain to begin to heal. If I have the time the sense that I need a break from life, I will try this. It doesn’t necessarily make me feel better, and may even make me more aware of the pain I’m in. But I use the time to rest, think, write in a journal, and express my feelings, and within a few hours or days I am usually more ready to join life. Sometimes I’m ready because I feel better, and sometimes just because I’m bored with lying around. If it doesn’t go that way, I force myself to get up and join life and try to heal another way. The call on whether to rest or get busy has to come from experience with yourself, intuition, and experimenting.

2. Force myself to exercise.

Exercise is one of the hardest things to do when I’m depressed, and yet it is one of the absolute proven ways to feel better. Few people when they’re depressed love getting up and exercising, but most people feel better after they do it. You probably already know it does all the right things for brain chemistry, and can be as effective as medication. The trick is not to think about it. As soon as I start to think about it, I talk myself out of it. I have to “just do it” without thinking about it. The form or exercise should be rewarding in itself—walking amid nature, in interesting parts of the city, or with a friend, dancing, Zumba (if that’s your thing; it’s not mine), or cycling—whatever involves movement and increased heart rate for a sustained period of time.

3. Fantasize about something so amazing that it might give me pleasure.

My mind is my best friend. It can comfort me, figure out solutions to problems, entertain me, and take me traveling anywhere in the world or anywhere I can imagine, even if it doesn’t exist. I can virtually travel to the ocean, listen to the waves wash rhythmically to the shore, and feel the blue, salty water lap at my feet, the sand squishing between my toes. I can take care of dying people in India, go canyoning in France, raft in Idaho, live in an RV, go to Sundance, live on a farm, study painting at a retreat in Vermont … OK, these are random things and maybe not what you want to fantasize about, but something might give you a little pleasure or relief, and if you let your mind explore, you might find what it is for you. It’s free; you can do it anytime, and your mind responds to what you imagine the same way it does to what you see.

4. Look for pleasure through my senses.

Pleasure is incompatible with depression. Anywhere I can find pleasure, as long as it doesn’t hurt me or anyone else, it’s a good thing. The gift of being alive is our bodies, and that means our senses and our emotions. I remind myself of that and consider what would feel good: a hot bath, gently scratching my head, walking, smelling cinnamon, stroking my cat, tasting something delicious, hugging someone I love, lying on pine needles, putting my hand over my heart and feeling the warmth and protection from that, singing to music I love … whatever harmlessly gives me pleasure—even a little—I go toward that.

5. Talk to someone about whatever I need to complain about.

This is one of the most important options for me, but also one of the harder ones to arrange. People have to be available, capable, and in the mood. Fortunately, I cultivate people who can and want to do this well when I need it, including my own therapist.

I would love to hear from you about what helps you when you are depressed.

We all know an adrenaline junkie: the friend who jumps out of airplanes for fun, the sibling who spends her time traveling to war-ravaged countries, or the co-worker who spends her weekends speeding on a motorcycle. Adrenaline rushes are readily available at just about every turn. A number of factors can affect whether a person ends up a risk taker or a quiet homebody, but there’s evidence that a little risk-taking now and again is good for almost everyone.

Effects on the Brain

Risk-taking causes real changes in the brain, which might account for why risk-takers quickly seem to become adrenaline addicts. Major risks release adrenaline, which can lead to a quick rush, and dopamine, which causes intense feelings of pleasure. While these chemicals contribute to a powerful high in most people, the feelings can be especially addictive to people who are struggling with feelings of sadness or depression. Over time, risk-taking can function much like a drug. Risk-takers may need bigger risks to get the same rush, and mundane daily activities can start to seem boring and painful.

Personality

Personality plays a major role in an individual’s propensity for risk-taking behavior. While it might seem like those who worry excessively don’t make for ideal risk-takers, some studies indicate that people who score high on neuroticism – a combination of anxiety, moodiness, and worry – are more likely to become risk-takers. The data is not conclusive, though, and some studies have found that risk-takers actually score lower on measures of neuroticism than the general population.

Personality can also affect the kinds of risks a person is willing to take. The dedicated smoker might be terrified of heights, driving, or illness, without ever recognizing that smoking is a risky behavior. Some adrenaline junkies have a preferred risk-taking behavior, and this could be correlated with personality. People who love novelty, for example, might travel to dangerous locations, while people who are highly physical might get their adrenaline rush from rock climbing or mountain biking.

Culture and Peers

Cultural influences play a huge role in whether or not people are willing to take risks. As travel – particularly to remote locations – has become a part of the educational path of middle class students, more and more students are willing to travel to potentially risky locations. Peer pressure plays a huge role in risk-taking, and study after study has shown that people are more likely to take risks in a group setting.

Benefits of Risk-Taking

While some risky behaviors might not be worth their potential consequences, risk-taking in small doses is almost universally beneficial for your brain and mental health. Novel experiences can help to ward off depression and reinvigorate a stale relationship. Risk-taking is often a necessary prerequisite for starting a new business or launching a new career, and the excitement associated with uncertainty can be a powerful antidote to boredom and even depression. Because dopamine produces a natural high, risk-taking behaviors can help you get a positive mood and a new perspective without the risks associated with drug use.

References:

1. Adrenaline rush: The science of risk. (n.d.). Museum of Science, Boston. Retrieved from http://www.mos.org/imax/adrenaline-rush
2. Gardner, M., & Steinberg, L. (2005). Peer Influence on Risk Taking, Risk Preference, and Risky Decision Making in Adolescence and Adulthood: An Experimental Study. Developmental Psychology, 41(4), 625-635. doi: 10.1037/0012-1649.41.4.625
3. Park, A. (n.d.). Why we take risks — it’s the dopamine. Time. Retrieved December 30, 2008, from http://www.time.com/time/health/article/0,8599,1869106,00.html

Surprisingly, studies show that some of the seemingly less dramatic kinds of experiences, such as neglect, in childhood actually do more harm than overt abuse such as physical violence. Neglect isn’t talked about as much as physical, sexual, or even verbal abuse, and depressed adults who experienced neglect in their childhoods often wonder why they’re depressed.

Even when people think about neglect, they picture parents who are too drunk or high to take care of their children, who prioritize adult sexual relationships over their children, or who don’t care about their children and thus don’t bother to feed them or provide clothes and other necessities. They may imagine parents who are irresponsible and who forget or don’t know how to take care of their children’s needs. All of this happens, but it can happen without such extreme dysfunction.

Sometimes neglect can happen even when parents are trying to be responsible, when they simply don’t have the resources to parent fully. For example, when one parent leaves and the other has to work two jobs to provide food and shelter, they may have to leave the kids to fend for themselves or let the older ones to do the best they can to parent the younger ones. I’ve had clients from families in which this happened when the older one was as young as 3, taking care of a baby or two.

But neglect can also happen in families in which one or both parents are depressed, have demanding jobs, or have so many children that there isn’t time to meet all of their needs. It can happen when one of the parents, siblings, or grandparents is chronically or gravely ill or dealing with mental issues. Often this requires the rest of the family to put most of their time, energy, and attention into that person. It can even happen in families that value individuality and independence. Thinking they are teaching these values to their capable children, parents may overlook concrete and emotional needs even capable children have.

Neglect can cause children to miss learning the skills they need to be fully functional adults. When kids have to teach themselves how to handle life, they often don’t learn the best ways. Neglect can cause children to feel profoundly lonely and empty. It can make it more difficult for them to form friendships, causing them to feel even lonelier and preventing opportunities to develop social skills. They may feel like they don’t fit in anywhere, and learn to cope alone. Perhaps most insidiously, neglected children often conclude they aren’t worth parental attention and care, or that their needs aren’t important or just aren’t ever going to get met. These beliefs, carried into adulthood, undermine the ability to develop loving, respectful, equally powerful relationships.

Not through parents’ intention or direct action or message, but through lack of action, children can turn in on themselves—blaming themselves for how bad they feel. They can grow up with these invisible wounds, not even associating them with their parents, who may be loving, well-intentioned people.

Clearly, there is a huge range of severity of neglect, depending on factors such as how young the child is when it begins, how extensive it is, whether there’s a basic foundation of love and respect from parents, whether there are other adults who provide at least some of what the child needs when parents don’t, what other abuse is involved, and whether other resources are available.

How people cope with neglect also varies, just as it does with abuse and trauma. Neglected children may cope by clinging and being dependent; by giving up and lacking motivation or hope; by withdrawing and resisting human contact; or by acting out with crime, dangerous sex, etc. They may experience depression, anxiety, self-attacks, eating issues, or addictions. Any or all of these results of the neglect can follow the child into adulthood.

If you don’t understand why you’re depressed and think you had good parents and no trauma, consider what you might not have had. Did you struggle with anything your parents didn’t protect you from or help you with—even things like unrealistic standards for yourself? Did you have to take care of yourself more than your friends had to take care of themselves, or that you would expect of your children, nieces, nephews, or godchildren? Did your parents show no interest in things that were important to you? Did you have to work at getting your parents’ attention? Did you get physically or emotionally hurt because your parents weren’t paying attention? Do you feel like your needs aren’t important? Do you not expect to have them met? Check in with yourself, your journal, your therapist, and maybe your siblings to see if you can find ways your parents weren’t there for you that others are for their kids … and look at how it affected you.

When a psychiatric client is in remission, it usually means that he or she is no longer experiencing clinical levels of symptoms related to the original issue. For instance, people with depression may be classified as being in remission when they have more periods of positive affect than negative affect, when they do not ruminate and when their eating and sleeping patterns return to normal. However, according to a recent study led by Rico S. C. Lee of the Clinical Research Unit of the Brain and Mind Research Institute at the University of Sydney in Australia, individuals who meet clinical thresholds of remission may not simultaneously achieve cognitive levels of remission.

Research in the area of cognitive remission is scant. Some studies show that cognitive deficits rebound at the same time symptoms decrease, while others reveal that clients who are in remission from symptoms still report feeling impaired in specific areas of their lives. To determine if cognitive deficits persisted in the absence of clinical symptoms, Lee assessed the cognitive capacities of 93 young adults with psychosis, depression, or bipolar at baseline and approximately two years later. The results revealed a direct relationship between cognitive and functioning and later impairment. In this study, the participants who had stronger cognitive abilities at baseline had higher rates of employment, better qualities of life, fewer disabilities, and more satisfaction in relationships than those who had cognitive impairments.

Visuospatial, working, and verbal memory, along with the ability to switch attention at baseline, were all predictive of better global functioning two years later. Lee noted that cognitive functioning at baseline did not predict symptomology at baseline or later on, and baseline symptoms did not predict later symptom severity or cognitive functioning. This suggests that clinical symptoms and cognitive functioning affect the course of these illness in unique and independent ways. Lee added, “Taken together, these results strongly suggest that a traditional, or sole, focus on symptom factors is inadequate in characterizing prognosis and recovery.”

Reference:
Lee, R.S.C., Hermens, D.F., Redoblado-Hodge, M.A., Naismith, S.L., Porter, M.A., et al. (2013). Neuropsychological and socio-occupational functioning in young psychiatric outpatients: A longitudinal investigation. PLoS ONE 8(3): e58176. doi:10.1371/journal.pone.0058176