Awhile back I discussed Eileen Flanagan’s book, The Wisdom to Know the Difference. If you’d like to learn more about her, visit her website at www.EileenFlanagan.com.

Therese: What are five clues you should be letting go of something?

Eileen:

1. You find yourself repeating the same complaint to different people.

We all get frustrated from time to time, but it’s not good for our mental or spiritual health to wallow in frustration. I remember once I got irritated with another mother at my kid’s nursery school after she did something that inconvenienced me. I complained to the first mother I ran into, and then the second. When I heard myself repeating the story for the third time, it hit me that I was making myself more agitated, not less. I was also putting poison in the community well. Someone had made an honest mistake, and I needed to get over it.

2. You’re churning over in your brain what you wish you (or someone else) had done.

You can’t change the past. Period. If you can’t stop thinking about something that has happened, reframe your internal conversation by asking what you have learned from the experience or what you want to do differently next time. Just replaying the same tape isn’t going to get you anywhere.

3. Your body is showing signs of anxiety.

Often our bodies give us clear messages about what is going on inside of us. For some people, anxiety manifests in not being able to sleep.

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I’m attending the 25th Annual Rosalynn Carter Symposium on Mental Health Policy today, and I’ll write more about the inspirational work this organization has been doing for 25 years shortly (not just in Georgia, but throughout the entire country). The people who are attending this symposium — as well as the Carter Center itself — have done much to improve mental health care in the U.S., but it’s not something you hear enough about. It’s heartening so many great minds coming together to share best practices and ideas for improvement (especially at this unique time in healthcare history). Not just policy wonks, but also physicians, mental health practitioners, administrators, consumers, CEOs, you name it — they’re all here. All talking about ways to improve people’s access to mental health care for common concerns like depression, bipolar disorder, anxiety, PTSD, ADHD and more.

In the meantime, I present to you some of the best postings from our blogs in the past week:

The Fort Hood Massacre: A disturbed psychiatrist, a gun and the reality of war

(Depression On My Mind) - I will go to my therapist’s office this afternoon. I will sit in the waiting room and read an old magazine. Another client will walk from a hallway that leads to my therapist’s office, pass through the waiting room and leave. My therapist will poke her head out, smile and …

Reclaiming Sexual Intimacy in Your Relationship

(Healing …

Several mom friends of mine have lately come down with a bad case of “empty-nest depression” — moms who just dropped off their youngest offspring to college, or moms having difficulty keeping busy now that the youngest is in kindergarten all day.

I googled the term “empty-nest depression” to see what I could find on this topic. I was surprised to see the Beyond Blue post I wrote in 2007 at the top of the search results. But, after reading it, I can see why it was so popular. I merely asked a question, and all of you answered it. On the comment box of that post are written different kinds of compassionate and insightful responses to my question: How do you treat empty-nest depression?

Beyond Blue reader Barbara initiated the discussion with this practical piece of advice:

I am a mother of five children; the oldest 29, the youngest 20 in college. My children all went off on their own around the age of 18. Those in college worked their way through school so only returned home for a weekend occasionally; not for summer vacation. I was involved in all their lives, but I hope, not as a smother mother.

During a long period of their growing years, I was suffering from major depression. My therapist encouraged me to find some work outside the home. He was aware how much emphasis and identity I had tied up in motherhood, and how deeply depressed I was. I

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Is the diagnosis of Asperger’s Syndrome — a mild form of autism mostly diagnosed in boys — heading the way of the dodo bird? A new article in the New York Times suggests that the new revision of the diagnostic manual — the DSM-V — is likely to do away with the diagnosis.

How can you just delete an entire diagnosis and do away with a diagnostic label that hundreds of thousands of clinicians use everyday and millions identify with? If you’re the American Psychiatric Association, the folks behind the latest DSM revision, you can pretty much do anything you want.

Before I get to Asperger’s, I have to note what’s really cringe-worthy in this article — how it completely misrepresents how mental disorders are diagnosed in practice today. Take this explanation, for instance:

Another broad change is to better recognize that psychiatric patients often have many health problems affecting mind and body and that clinicians need to evaluate and treat the whole patient.

Historically, [Dr. Darrel A. Regier, research director at the American Psychiatric Association] said, the diagnostic manual was used to sort hospital patients based on what was judged to be their most serious problem. A patient with a primary diagnosis of major depression would not be evaluated for anxiety, for example, even though the two disorders often go hand in hand.

Similarly, a child with the autism label could not also have a diagnosis of attention deficit hyperactivity disorder, because attention problems are considered secondary to the autism.

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Binge eating disorder is characterized by a person having frequent episodes of eating what others would consider an abnormally large amount of food, while at the same time feeling out of control — the personal feels like they are unable to control what or how much is being eaten.

According to government statistics, people with binge eating disorder are considered clinically obese, but plenty of people can engage in binge eating while maintaining an average or less-than-obese weight. Binge eating disorder probably affects 2 to 3 percent of all adults.
People with a binge eating problem often experience:

• Eating much more rapidly than usual.
• Eating until uncomfortably full.
• Eating large amounts of food, even when not physically hungry.
• Eating alone out of embarrassment at the quantity of food being eaten.
• Feelings of disgust, depression, or guilt after overeating.

Binge eating disorder is a serious mental health concern that, left unchecked, can ruin a person’s life with the feeling of being out of control. The resulting weight gain can also contribute to a person’s poor self-image and self-esteem.

Group therapy is one treatment method used to help people who have binge eating disorder. There are many different kinds of group therapy available, and recently researchers (Peterson et al., 2009) compared three different types of group therapy treatment to gauge their effectiveness in treating binge eating:

• A traditional therapist-led psychotherapy group
• A therapist-assisted group (where the therapist played a secondary role in the group)
• A self-help group

Here’s how the researchers described these three groups: “In the therapist-led …

You really can’t help but be overwhelmed by the amount of focus these days on how a person looks. The people who are most harmed by this shallowness are women, especially young adults, as so many of their role models are “perfect and thin.” How can you have a healthy body image when the media constantly bombards us with messages telling us that the only good body image is a thin one?

So it is with great pleasure to bring you a new blog about just this very topic — body image, the skinny fad and learning how to attain freedom from the (weight) numbers and dieting. The blog is called Weightless:

As our new blogger, Margarita Tartakovsky, wrote in her introduction to her blog, “Weightless is about well-being, not weight; about fostering body image, regardless of your size. It’s about exposing women’s magazines, other mediums and so-called experts, when they’re touting unhealthy tips and promoting restrictive standards.

The goal of Weightless is to help women develop a better body image and work toward accepting themselves as they are, while being healthy and happy (fad diets and skinny-mini standards prohibited!); and to become sharp consumers, who can pick apart a commercial or magazine article and know which advice is helpful or harmful.”

Our Weightless blogger (who, I assure you, actually does weigh something) is a long-time writer for Psych Central, Margarita Tartakovsky. Her writing career began unofficially in second grade when she composed her first-ever …

A reader recently wrote to me about her overwhelming fear of relapse. She said, “I’m struggling now with it, obsessing over it, and I’m so, so scared. Do I want to crawl into the hole? I fear that. But I can’t. I can’t.”

First of all, thank you for being honest. Because so many of us know exactly how you feel. I’m there a lot of the time myself. Less than I was the two years following my hospitalizations, but there too much of the time.

Doctor Smith would continually remind me during those first fragile years after my big breakdown that a slight setback in my recovery didn’t mean that I was plunging into a full-fledged depressive episode again, and that it wouldn’t take another 18 months to recover, like it did after my breakdown. These hiccups are normal, she reminded me. Recovery is never static, predictable, or symmetrical. On the contrary, it’s often messy, unpredictable, and annoyingly erratic.

I use a couple of cognitive reminders today when I’m panicking about relapsing.

1. My past doesn’t dictate my future.

They are totally separate. Just because I have been through an excruciating depression in my past doesn’t mean I will return to the same painful place every time my thoughts go south. Think of it this way: your brain is constantly forming. It’s part plastic. Which means, what was isn’t necessarily what is or what will be.

2. All things pass.

NOTHING is forever … which is a shame on the …

Now that it looks like some form of health care reform will be passed this year — barring a catastrophe like Joe Lieberman — we have some idea of how the eventual act will affect mental health services. All of the plans now under consideration will mean some real improvements for mental health consumers, and there doesn’t seem much likelihood of these improvements being cut out before passage. However, it appears that individuals and employers will still have to purchase their insurance from private insurance companies, without competition from a strong public option like Medicare available for everyone. Nevertheless, the “reform” aspect of the bill would require private insurers to make some real changes in how they treat mental health issues.

Key Benefits

• Parity for mental health and substance abuse services. As it is now, when you see a mental health provider, your insurance company will probably pay him or her less for your visit than they would pay your GP or specialist for a similar service. They might require a higher copay from you for a mental health service than a GP visit. They might limit your total annual or lifetime benefits for mental health services. For instance, I have many chronic depression clients who need year-round supportive therapy, but their annual benefits run out in August or September. Most patients have to pay me a $30 or $40 copay from their own pockets, rather than the $10 or $15 that their GP charges.

  With

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So the other week I attended and presented at the First International e-Mental Health Summit 2009 in Amsterdam and already discussed some great online interventions for depression.

I’m still planning on talking about additional online interventions for other mental disorders, but am waiting for the conference folks to publish the presentations on their website because the abstract book doesn’t always contain the valuable bits of information I need to properly summarize a topic area.

In the meantime, I thought I’d mention Beacon. Beacon is a website that has gone to the trouble of indexing and rating over 70 different online interventions in the following categories:

• Alcohol (3/3)
• Bipolar disorder (3/0)
• Depression (24/11)
• Eating disorder (anorexia or bulimia) (6/5)
• Generalized anxiety disorder (4/1)
• Obsessive compulsive disorder (1/1)
• Pain (5/2)
• Panic disorder (8/6)
• Phobias (2/0)
• Post traumatic stress disorder (PTSD) (4/3)
• Social anxiety (3/3)
• Stress (7/3)
• Tinnitus (1/1)
• Weight and Obesity (2/2)

The first number listed is the total number of online interventions the online researchers have found. The second number listed is the number of interventions that have at least some research backing for them (some interventions have very good support, and are so duly noted at Beacon). So for example, there are 24 online interventions indexed …

We know that people who are depressed don’t eat as well as people who don’t have depression. So not surprising to anyone, diet and what we eat remain linked to depression. But despite new research, we still don’t know which way the relationship goes — does diet cause depression, or do people with a certain lifestyle or with depression eat poor diets?

They split the participants into two types of diet - those who ate a diet largely based on whole foods, which includes lots of fruit, vegetables and fish, and those who ate a mainly processed food diet, such as sweetened desserts, fried food, processed meat, refined grains and high-fat dairy products.

After accounting for factors such as gender, age, education, physical activity, smoking habits and chronic diseases, they found a significant difference in future depression risk with the different diets.

Those who ate the most whole foods had a 26% lower risk of future depression than those who at the least whole foods.

By contrast people with a diet high in processed food had a 58% higher risk of depression than those who ate very few processed foods.

There are three reasonable explanations for this finding. The one the researchers believe is that what you eat can directly impact your mood over the long run. Another explanation is that people who are more prone to depression live a kind of lifestyle where eating processed food is a normal part of it …

This week I have the pleasure of interviewing Michelle Russell, who writes the fantastic blog, “Practice Makes Imperfect.” Since we talk about perfectionism a lot on Beyond Blue — because it’s so related to depression — I thought she’d be a perfect guest to interrogate on this topic.

Therese: What are five ways a person can tackle perfectionism?

Michelle: Here they are …

1. Compare yourself to others.

I know, this probably sounds surprising when the prevailing wisdom says not to. But we perfectionists need frequent reality checks.

Think about whatever has you firing on all cylinders and what you’re hoping to achieve. A report with absolutely no errors? A living room fit to be featured in House Beautiful? A body like the cover model on that fitness magazine at the checkout stand?

Now notice how many people are doing quite well, thankyouverymuch, without raising the bar so high. People really do have satisfying relationships in non-model bodies, successful careers despite the occasional typo or misjudgment, and comfortable, happy homes with undusted mantelpieces. It’s good to look around and remind ourselves of this from time to time.

2. Use the 10-Year Question.

If you catch yourself ruminating about something you think you’ve done or might do less than perfectly, ask yourself, “Ten years from today, will I even remember this, let alone care about how well it was done or whether it was done at all?”

In the extremely rare cases where you answer “yes” and “yes,” go ahead and give the doing or fixing your

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Yes, that’s Elvira, Mistress of the Dark. Also my long time nemesis. I hate her. She stole my perfectly good name and turned it into a joke. On her About Me page she says, “When you hear the name Elvira only one person comes to mind…”

Excuse me? And what does that make me? Chopped liver?

You might be thinking, “Gee, Elvira, why would it scare you to be associated, even loosely, with a slutty, Vampira wannabe in a cheap wig?

[Yes. Before Elvira there was Vampira (circa 1953), the first ever late night horror film hostess. She was featured in that wonderfully campy Tim Burton film 'Ed Wood', with Johnny Depp as the cross dressing Mr. Wood.]

Anywho…

I don’t really mind that much…anymore…but once upon a time I dreaded hearing my name mispronounced and dis-respected. It hurt to hear people call me things like Velveeta cheese. God! Couldn’t my name at least sound like a classy cheese, l don’t know… Bree?

It doesn’t take a psychologist to figure out why I would get defensive, not to say persnickety, or snotty, but maybe those, too. Your name is your badge of honor, your coat of arms, your flag. I went through years and years, ever since I could talk, correcting people about how to say and spell my name. [Does Growing Up With a Difficult Name Build Character?] If you have a difficult name you know exactly what I’m talking about.

But I’m not touchy …