One of the researchers commented on the findings: “There was substantial overlap in the genetic risk for schizophrenia and bipolar disorder that was specific to mental disorders. We saw no association between the suspect gene variants and half a dozen common non-psychiatric disorders.” This is an important discovery — that some of the roots of schizophrenia and bipolar disorder may be very similar. This may also begin to partially explain why drugs — atypical antipsychotics — developed for schizophrenia also appear to work for bipolar disorder.

Furthermore, all three studies implicated an area of Chromosome 6, which is known to include genes involved in immunity. This area also has genes that seem to control how and when genes turn on and off. As the NIMH notes, this hotspot of association might help to explain how environmental factors affect risk for schizophrenia.

The other important finding from these studies was the huge impact of pooling data and resources in genetic research. Without large data sample sizes, genetics research often ends up at a dead-end. By being able to analyze over 30,000 genetic variants in over 3,000 people with schizophrenia and 3,000 people without, the researchers were able to draw conclusions based upon the data. A smaller sample size would’ve made such conclusions impossible.

Although the vast majority of the genetic causes of schizophrenia and bipolar disorder remain unknown (the current studies could account for only approximately 30 percent of the genetic risk), the current research is an important contribution to our real knowledge of how these disorders may be caused by gene variants. Also, these most recent findings won’t result in any new treatments for the disorders for many years to come. But scientists are truly excited about the findings, a somewhat rare thing when talking about genetics research.

With more genetics research like this underway, I suspect we’ll be seeing more breakthroughs similar to this one in the years to come. These studies inch us closer to understanding some of the potential contributing causes to these conditions, which could one day perhaps pave the way to new treatments for them.

Read the full article: Genetic Breakthrough for Schizophrenia and Bipolar

And so it is with any change in our lives. We can make the declaration, “Today, I’m going to start losing weight,” or “Today, I’m going to try and reply to every cognitive distortion by examining the evidence and answering it back.” But declarations are only starting points — they represent the beginning of our journey, not the end.

But declarations serve an important purpose — they place us (and others) on notice. Something is going to change. It may not change today, it may not change tomorrow, but I’m now committing myself to this course of action.

I suggest a declaration of independence from fear this Independence Day.

Fear is such a sneaky and invasive emotion. It prevents us from taking action in our lives when action is needed. It holds us down from trying something new, usually for little good reason other than not quite knowing what will happen (usually what actually happens is enjoyment, fun, or learning something new). It is the darkness behind the door that we’re so afraid to open, we just turn and walk away.

Fear is baffling. Psychologists refer to the “fight or flight” response to fearful situations, that we’ve been conditioned through our ancestors and genetics to either fight the trouble lying ahead, or run away from it. But we’re no longer hunting within a dark cave for our family’s dinner. We’re simply trying to live our lives in peace and quiet. And how do you fight something you can’t see — insecurity, depression, anxiety, PTSD, poor self-esteem? You don’t. You just run away from it.

And run we do. We try and run away from so many things in our lives. Our terrible childhoods. Our relationships that are just too hard to commit to working on and changing. Our responsibilities to others. Our commitment to raise our children with thoughtfulness and attention. Even ourselves and what we truly want out of our own lives.

Try as we may, however, our attempts to run away often fail. Like the sullen teenager who comes back home after a few nights away, we learn that life doesn’t really care what your want if you don’t stop to face your fears. Sure, you can get a divorce or dump your relationship that seems to be going nowhere positive fast. But was the problem with the other person, or the relationship itself? Such problems simply reappear later on, in another relationship, with another person. You ran away from the first one, but it did little good because the problem remains.

Fear teaches us that it’s natural to run, it’s okay – it’s what people do. But fear is wrong. Fear is a lone siren call to our darkest emotions, and we too often willingly respond to it. Like the siren call, however, fear shows us nothing positive, teaches us nothing that will help our lives in the future. It crashes us against the empty shores of our hearts and our minds.

This Independence Day, I suggest you start the process of putting fear aside in your life. It is a process, and it will take time. You have to learn to put aside your long-standing trust and commitment to your fearful thoughts and feelings, and replace them with thoughts of all that you can accomplish in your life if you stop “What if-ing” yourself and imaging all of that bad things that could happen. This is not an easy task and will take time. But the best things in life do take time and effort, and this is easily one of the best things you can do in your life.

Living a fearless life is living a full life, open to potential, opportunity, and joy. Declare your independence today!

24 Hours About Our Kids is a July 4th weekend marathon of Doctor Radio’s weekly child psychiatry and psychology show, exploring important topics that all parents and kids face today including ADHD, mood disorders, the effects of online social networking, issues related to coming out of the closet, Autism, depression and more.

About Our Kids is hosted by leading doctors from NYU Langone Medical Center, including Dr. Jess Shatkin, Dr. Lori Evans, and Dr. Alexandra Barzvi. Dr. Harold Koplewicz, Director of The Child Study Center, is a regular contributor to Doctor Radio. Dr. Shatkin will host this special.

On 24 Hours About Our Kids: Why Kids Behave the Way They Do, the doctors tackle many of the most important issues kids and parents are facing today, and provides expert insight and advice. Issues explored on this special include:

• Depression, anxiety and mood disorders: Dr. Harold Koplewicz tells parents how to spot the signs of a depressed teenager and what your immediate response should be. He will also explore kids’ attitudes - when are they just being moody and just being teens, and when are they seriously depressed? How to know the difference and spot and treat depression in kids.

• Using the internet for social networking, Facebook, MySpace - who are your kids talking to and becoming friends with, what every parent needs to know, and how to tell if they are becoming addicted. Plus video games and the amount of time your kids spend playing with them - what’s normal and what’s not?
• Autism and spectrum disorders and the controversy over vaccines - is there a connection? What are the latest therapies?
• ADHD - can your child grow out of it? Do medications work? How to diagnose and treat learning disabilities.
• OCD and anxiety disorders - when fear becomes anxiety and how both parents and kids can deal with this debilitating issue.
• Homosexuality and coming out - when does your child know, how do they tell you and what should you say? Guests include Doctor Radio host Dr. Virginia Sadock, renowned sex therapist, and a young man who shares his experiences growing up gay. What’s it like being a gay child being raised by straight parents, and what happens when a straight child is raised by a gay couple?
• Fears our kids face today - from the fear of test taking to social anxiety to the fear of failing and more.

I don’t know about you, but I’m hoping to be outside barbecuing on July 4th. But if I were a parent and has Sirius XM, I might tune into a few hours of this special to see what it was all about. Hopefully some parents will do just that, and maybe even learn a thing or two about mental health issues and their child.

“Girls as young as 7 are now treated for anorexia, more than 40 percent of girls in first, second and third grade wish they were thinner, and the number of reported cases of anorexia and bulimia is rising, according to the Seattle-based National Association of Eating Disorders.”

Like Nyhan — who’s “worried because in a few years this toddler will stand at the edge of the nation’s body-image vortex, swirling with size 00 jeans, underfed celebrities glorified in gossip magazines, the latest “America’s Next Top Model” and an unrelenting marketing drumbeat that skinnier is better” — many dads aren’t sure how to approach their daughters. They’re typically more comfortable coaching their sons on their baseball game and catching up with their boys on the latest sports stats.

That might be because dads don’t see themselves as that important to their daughters, writes father-daughter relationship expert Linda Nielsen in College Student Journal. However, a good relationship between dads and daughters can have many benefits for daughters, Nielsen said: Research has found that daughters who have healthy relationships with their dads tend to be more self-reliant, self-confident and successful and less likely to develop eating disorders.

What You Can Do

Building a better body image is just as critical as building a healthy self-image. Here are ways to help your daughter build both:

1. Remember you’re a role model.

The experts in Nyhan’s article note that “both mom and dad set examples when they talk about their own bodies, eat and watch movies and television.” So be aware of the messages you convey to your daughter.

2. Call out bad messages and help your child analyze advertising.

We’re surrounded by self-objectifying ads and a pop culture that promotes sexy, skinny images, even to young girls. Just recently, Calvin Klein — a fashion design company swimming in controversy because of its highly sexualized images — unveiled a shocking image in New York City’s Soho neighborhood. Conveniently (for Calvin Klein), you can’t just turn off the TV to avoid the ad; kids and parents have to endure it every time they walk by.

Sexualized images in advertising and in the media can lead to shame and anxiety and are associated with low self-esteem, eating disorders and depression, according to a report from the American Psychological Association.

You can counteract these consequences by talking about negative advertising and teaching your daughter to think critically about what she sees. Some questions you can start with: What do you think about this ad? How does it make you feel? What do you think are the company’s motives? What is it trying to sell?

Jean Kilbourne, an international expert on advertising and co-author of So Sexy So Soon: The New Sexualized Childhood and What Parents Can Do to Protect Their Kids, offers an extensive list of resources here. In this excellent article, Diane E. Levin, the book’s other co-author, discusses practical tips, including talking to your daughter about revealing clothing and sexualized advertising.
Canada’s Media Awareness Network also has advice on talking to your kids about advertising in general.

3. Check out expert resources.

The Dad Man is an excellent website that offers dads tons of tips on raising their daughters. Joe Kelly, who founded and maintains The Dad Man, on his blog lists 16 tips for dads to help their daughters foster a healthy self-image. Kelly adapted his tips from Margo D. Maine’s book, Father Hunger: Fathers, Daughters and the Pursuit of Thinness. You can find tips 1-6 here and 7-16 here. Here’s a snippet of the valuable advice:

Know what you don’t know. Learn about your daughter’s life. Don’t believe that your experience and hers are similar; in fact, you are years and cultures apart. Respect the differences.

Encourage her to identify and discuss her emotions and opinions. Let her disagree with you without withdrawing your affection. Show respect for the differences between you.

Teach her to say no and set limits. This will prepare her for situations that might compromise or even endanger her.

Help your daughter develop values other than consumerism. Share some of yours and create opportunities to enjoy nature, reading, the arts, sports, music, cultivation of friendships, volunteerism, or other activities.

Maintain a diet-free home. Encourage enjoyment of food, moderate exercise, and a healthy, balanced lifestyle. Rules about food only backfire and contribute to eating and weight problems.

4. Engage your daughter in “life.” Jezebel blogger Jennifer suggests going beyond body image. She writes:

“When I was growing up, my dad never told me what I could and couldn’t do, but he did let me know that he thought that, in his opinion, YM magazine portrayed women as stupid. (Not to mention trashy.) My dad’s opinions meant something to me. I never read YM.

When I was growing up, my dad talked to me non-stop about his love of the music of Diana Ross, Laura Nyro, Aretha Franklin, Joni Mitchell, and Carole King. My dad’s opinions meant something to me. That was the music I listened (and still listen) to, and those were the women I thought were really cool. But most importantly, both of my parents didn’t sit down and drill me about my “body image” — they were too busy asking me my opinions on what was going on in the news, what I was learning in school and nurturing everything from my interest in politics to my love of musicals. And guess what? I was too interested in life to be interested in what I weighed.”

5. Spend quality time.

Pick an activity that you both enjoy that doesn’t involve mom. Let this be your special time. As a little girl, my close friend used to tag along with her father, a biologist, in the field, helping him find specimens and collect data. He’d also regularly read science books to her (before she even knew what “science” meant) and ask her thoughts on various subjects. To this day, she talks about how influential these father-daughter experiences were and how they’ve shaped her interests and goals — she completed her master’s degree in evolutionary biology and is now an instructor at a state university. Oh, and she still tags along with her dad to do field work. Check out Time for some great stories about dads and daughters.

Boys and Body Image

Don’t forget that boys struggle with body image, too. They might not be as vocal about it, but unrealistic, unhealthy standards for boys proliferate. Big biceps, toned bodies and six-pack abs are today’s ideal, and can have various negative consequences.

Common Sense Media, an independent, nonprofit organization that helps parents review and find positive media experiences for their kids, includes on their site some useful tips—and some startling statistics:

• Nearly a third of teen boys try to control their weight through unhealthy methods, like taking laxatives or smoking.
• In a 2005 study, 1 in 8 boys ages 12 to 18 reported using hormones or supplements to change their appearance, improve muscle mass, or gain more strength.
• 1 in 20 teen boys said they used products, including growth hormones or steroids, at least once a week.

Remember that you play an integral and influential role in helping your kids build a positive self-image. Hope you had a great Father’s Day!

• @docjohng (our fearless leader)
• @aliciasparks (glamorous author, Celebrity Psychings editor, World of Psychology contributor)
• @dr_aletta (therapist/life coach, World of Psychology contributor)
• @summerberetsky (mental health writer, World of Psychology contributor)
• @channelNvideo (me, editor of Channel N, features extra neuro/psych videos and new media talk)
• @unsuicide (me again, a suicide prevention peer resource with positive, practical info and support)
• @psychcentral (feeds posts from all the blogs)

Therese Borchard and everyone else who makes this site so valuable, I hope you’ll get accounts too.

Midweek Mental Greening

If you’re interested in the connection between the environment and your mental health - and you enjoy writing or creating art - here’s a treat for you:

The Mental Health Association in Tompkins County, New York, is seeking submissions for its Summer 2009 issue of States of Mind, “Nature as Nurture: Mental Health and the Environment,” and if you don’t live in New York, don’t fret - I was fortunate enough to email with with States of Mind Editor Celia Smith who assured me the call for submissions is open to all interested parties; however, available slots are filling up fast and inclusion will be highly selective.

Plus, the deadline is…

….tomorrow! July 1, 2009!

Sounds like a challenge!

Acceptable entries include artwork (in a reproducible format that will translate well into a black-and-white format) and poems, stories, and personal accounts (between 700-1,000 words long) and you can submit them in one of three ways:

1. Via email to info@mhaedu.org. Note that you can either paste your poem, story, or personal account directly into the email or attach it as a .doc or .rtf format only.
2. Mail your entry to: Mental Health Association, Attn: Editor, States of Mind, 614 W. State Street, Ithaca, NY 14850.
3. Hand deliver your entry to the same address (which Ms. Smith points out is the best method for artwork).

If this deadline’s too soon for you, or you aren’t into writing or art, you can still benefit from others’ work. The completed issues should be printed in August and you can send a formal request for one along with $1.10 to cover postage to the address above.

Good luck to all who enter!

1) Correct me if I’m wrong. You began this search because you have been so devastated by the emotional toll that schizophrenia has already had in your family, which includes two of your sisters, your uncle, your grandmother, your great-great-great grandmother who came over from Ireland. And also because you are afraid to pass the mental illness on to the next generation. I know you are close with your nephew, that he is like a son to you, but have you made a decision not to have children because of the risk of passing the illness on?

Patrick: Yes, I made a point of not having children. And then I kept meeting women who were mad to have them. Or women who were running out of eggs and desperately wanted children. Given my family history, I was not the man.

Not that I would have made a bad father - I think I could be great one - but because I lived with the burden of believing that our bloodline might produce more madness and I could not bear to see another loss. I was on the horn of the same dilemma my mother had been on. Because she saw her own mother and her brother go stark raving mad, and because they were told there was nothing that could be expected to be done about it, my mother decided against having children.

Instead Mom set her sights on a career in the law, inspired by Shakespeare’s cross-dressing Portia from The Merchant of Venice. She was on her way to a high-powered legal career, sans children, and then her head was turned by my father. Dad was set on having his own big Irish Catholic brood. They saw two doctors–a family doctor in Boston who said it ran in families and cautioned against it–and a second specialist in New York that my father found. I’m sure the fix was in, because Dad did roll that way. He knew how to get his way. He talked Mom into having us, and when not one but two daughters, including her baby, stepped into the empty elevator shaft–the change was that dramatic–it killed my mother. She could not handle it. Of course, few could.

They say that genetics loads the gun and environment pulls the trigger. My own feeling is that my mother loaded the gun with her family’s errant gene bank, and my father pulled the trigger with the atmosphere of alcoholism he brought to the table.

Me, I didn’t fall far from the tree. I was behind the door when God was giving out the schizophrenic genes, but I was front and center for the alkie ones. I became a drunk and when I sobered up, finally, I found that the new ex-drunk me was determined to get answers. I was alcoholically clean but I had to get emotionally clean for my sanity.

My travels through Ireland validated many suspicions I had about the high levels of schizophrenia and alcoholism in the Irish and Irish-Americans. The British-fed famine promoted fetal malnourishment that can more than double rates in children. Also older fathers - because you were often 50 before you inherited the potato patch to become eligible - can also more than double rates. Late age of paternity was a direct consequence of the famine. But for me, personally, I could not take the chance because I am no spring chicken myself these days. The clear risk in children of older man was the final nail in the coffin for me. I must get snipped!

So fetal malnourishment and late age of paternity and alcohol abuse form the three legs of my three-legged stool of Irish madness. They didn’t cause it–the underlying susceptibility is there in all of us–but they inflamed it. I promise you.

2) I love your description of schizophrenia in the beginning of the book: “Schizophrenia is not a case of snapping back and forth between different personalities–a common misconception. Schizophrenia is the hearing of voices, but the hallucinations can be seen, felt, and smelled as well as heard. It’s fright night for life for many, an all-consuming terror that never ends.” Wow. What a description. What do you think the most common misconceptions are about the illness?

Patrick: There’s only one misconception that must be cleared up, and it’s a massive one. There is widespread ignorance about the experience of hearing voices, having verbal or auditory hallucinations, and this is the most common experience of schizophrenia. If we could just start thinking of schizophrenia as hearing voices, then this would clear up a lot of confusion right off the bat. People would begin to understand the experience from the point of view of the person having it.

Unfortunately, our ignorance has been abetted by fear. For so long, the idea of engaging therapeutically with verbal hallucinations has been viewed with boneheaded suspicion. This needs to change. The evidence is in. This one shift in attitude could open the flood gates to healing and recovery.

The correction has been firmly planted in Europe, the first glimmer of hope coming twelve years ago with the beginning of the Hearing Voices Network in Maastricht. Their meetings have since flourished in Europe. For some reason this more opened-minded attitude has taken much longer to reach and root itself in the United States. It will though–it’s absolutely inevitable like all irrepressibly good ideas.

The technique, known as “dialoguing,” was deemed irresponsible, even dangerous, by mainstream psychiatry. Now the ground has shifted beneath psychiatry’s feet and all but the most hidebound are open to the technique of encouraging so-called schizophrenics to dialogue with their voices. This places the key to their recovery within their own hands.

It’s encouraging to see that more and more psychiatrists are open to this kind of treatment. It’s nice to see the big tent attitude replace the tiny teepee. I don’t mind drug therapy and continued research, but to believe that medication is the sole answer requires a desperate poverty of imagination.

At one time, if you came in to see a psychiatrist and complained of hearing voices, he’d say “it’s nothing, take these pills.” I know this to be true from my own family. With my sisters, my uncle and my grandmother - who all have lived in the throes of verbal hallucination - we were told “it’s nothing, take these pills.”

I think we can speak for most families in saying, we don’t mind the pills, if they work, but we do mind the blind indifference to auditory hallucinations. If somebody comes to you with a broken nail, the very last response should be “it’s nothing.”

It’s sad to think that so many lifetimes have been lived on the sharp end of “it’s nothing,” but at least we now live in enlightened times. Even if America has yet to accept the hearing voices movement as warmly as it has been received by our more progressive European cousins, it’s just taking a bit longer. The key thing here is that psychiatry on both sides of the water now see things differently.

Click here to visit Patrick’s website.

Eric Kandel, writing for Newsweek, makes the at-least-annual appeal that scientists are making “certain advances in genetics” which give “us new reasons for optimism” in understanding the biological basis for mental illness. As someone who’s been tracking the progress of such genetic advances over the past two decades, I have to say, I remain squarely skeptical.

It doesn’t help that Kandel’s own arguments are exercises in circular logic:

One major advance has been the discovery that there is much more variability in the genome than had been anticipated, and that this takes the form of copy number variation (CNV). These are duplications or deletions of segments of a chromosome, often involving several or tens of genes, that enhance or depress the actions of specific genes. A well-known example of a CNV is the extra copy of chromosome 21 resulting in Down syndrome. It has recently been discovered that this type of variation is extremely common in everyone’s genome.

If there’s “much more variability in the genome,” guess what? That means finding specific meaningful, predictable variations is all the more challenging. If the extra copy of chromosome 21 is “extremely common,” how come Down syndrome isn’t so much more common?

We’ve highlighted previously altered genes that may increase the risk of schizophrenia, for example. But not a year goes by where more such research highlights other genes or other gene variations. I mean, we’ve been talking about this for years. What’s changed recently?

Nothing. If anything, new research shows just how complicated gene research is. If hundreds of gene variations could be indicted in a “simple,” less-serious mental disorder like attention-deficit disorder, imagine the complexity of more debilitating disorders like depression or bipolar disorder.

Kandel also makes this claim you’ve probably heard before:

Scientists are also making progress in finding the biological markers for depression, anxiety, and obsessive-compulsive neurosis. Markers are essential to understanding the anatomical basis of mental disorders, diagnosing them objectively, and following their response to treatment, as well as perhaps preventing psychosis in those at high risk.

Progress? Well, if you call understanding how extraordinarily complex the human genome is, compared to what we thought it was 10 years ago, yeah, I guess you could call that “progress.” But honestly, researchers are not significantly closer to finding genetic markers for depression, anxiety and OCD than they were a decade ago. Think of our understanding of brain disorders and genetics similar to that of unpeeling an onion. The size of a giant watermelon. Or the moon.

But the strangest point made by Kandel is that the effectiveness of psychotherapy is now “proven” because of brain imaging studies which have been called into question:

The most convincing scientific progress in psychiatry in the past decade has had little to do with genomics. It is the rigorous, scientific verification that certain forms of psychotherapy are effective. [...] Insofar as psychotherapy works and produces stable, learned changes in behavior, it can cause stable anatomical changes in the brain. We are now beginning to measure such changes with brain imaging.

Who cares? We don’t need brain imaging to understand that psychotherapy works. I guess all those decades of psychology research showing the effectiveness of psychotherapy were for naught until we had the sheer magic of brain imaging.

While I believe understanding human genetics and the neurological basis of mental disorders is important, invaluable work, I think articles like Kandel’s sort of miss the point. This work is slow and arduous, and for every one step forward, we take two steps back. Indeed, we are making progress, but it is not progress one can easily track or summarize in a mainstream news article of this nature.

In the treatment of mental disorders, we have plenty of approaches that work just as well as (and, in fact, work better than) any medical treatment for a medical disease. (Honestly, Kandel should look at the research behind the vast majority of surgical procedures to see the lack of rigorous scientific data that he’s demanding for mental illnesses.)

Genetics may one day hold some sort of key to our understanding of mental disorders. But that’s a line that’s been repeated hundreds of times over the past two decades, and one that seems no truer today than it did in 1989.

Read the full entry: A Biology of Mind

Microblogging service Twitter is maximizing in popularity. Though there are naysayers who don’t understand the medium and dismiss it as shallow and narcissistic (just like early blog critics did), Twitter is used in many vital ways. For every snarkster who writes about her lunch, there’s an account like Brainline sharing serious medical info. Musicians set up impromptu concerts while professors analyze journalism, and people organize flash mobs for celebrity tributes or political protests. There are job postings, science fiction flashforward zines… I could go on, but the point is: there are many, many “tweeps” with useful, revealing and cool accounts. Plenty are about psychology and mental health. It was very difficult to narrow this list to just ten, so I used these criteria:

• NO marketing (including “free” e-books, how-to guides, etc.)
• not just “broadcasting” or re-feeding, follows others and reads their feeds
• interacts with friends and followers, replies to people
• shares more than just factoids, quotes, or pop psych aphorisms
• active but not overactive
• not too off-topic, talks mostly about psychology, psychotherapy and/or mental health
• humour, taste, talent, good writing and personality
• poise, swimsuit competition, and how they’ll bring about world peace

Kidding about that last one, but — here are the psych tweep pageant winners:

10. @mtabraham “Professional Counselor - my goal is to help people be more successful through mindful awareness and self acceptance.” Terri Abraham is a very active tweep sharing positive thoughts and info on mindfulness therapy and spirituality. Chatty and responsive even with thousands of followers.

9. @loveisthecure5 “Borderline Personality Disorder Awareness Movement Leader.” I love Love is The Cure because it’s a movement that’s completely peer-driven without being disorganized. Volunteer-based with a sleek professional sheen, there’s no crankery or misinformation. It’s positive, directly supportive, promotes awareness while fighting stigma, and offers cool volunteer opportunities through building a network. LITC rocks!

8. @deborahserani “Psychologist, Professor and Author.” Dr. Deb has maintained a blog for years and has transitioned to Twitter very nicely. She shares cool links on a wide variety of psychology-related subjects.

7. @therapyonline “A wide lens is cast at the Online Therapy Institute ranging from email and chat to videoconferencing and Second Life.” DeeAnna Merz Nagel maintains this popular account with a focus that’s business-to-business for professionals who offer online therapy. She manages to share lots of intriguing info while straddling a thin line between professional organization and marketer - without falling into the dark side.

6. @shiftstigma “Shift believes that people with a history of mental health problems should have the same chances and opportunities as everyone else.” For anyone concerned about stigma - which is anyone involved with mental health - this awesome UK charity keeps an active Twitter account with lots of thought-provoking info and a friendly, accessible tone. Unlike so many organizations on Twitter that are disappointingly aloof broadcasters, they reply to followers and initiate conversations too.

5. @iopsychology “I/O Psychologist who studies motivation, apathy, gossip, and metacognition.” Industrial-Organizational Psychology grad student/TA at Michigan State University. Gordon B. Schmidt writes about research and shares the work of other tweeps and bloggers in the field, but also takes the time to compliment a friend’s puppy.

4. @drdavidballard “Head of Corporate Relations and Business Strategy at the American Psychological Association. Business, psychology, technology, health and productivity.” Dr. Ballard is Tweeting on behalf of a organization so you won’t find personal opinions on things that aren’t professionally relevant, but he is thought provoking, interactive, shares great news links and he writes, well, like a pro.

3. @drkathleenyoung “Licensed Clinical Psychologist Treating Trauma in Chicago.” Her practice (and Twitter & blog focus) is on PTSD, domestic violence, sexual assault, trauma in general which you might think would make for a bleak feed but she’s very upbeat, encouraging, active and interactive. Shares useful info and talks to lots of tweeps whether professional or civilian.

2. @kidtherapist “Children’s Therapist and Author of Kids Awareness Series Books.” Kara T. Tamanini’s feed is an awesome mix of personality, community, well-aggregated professional quality info, and friendly interaction. I adore her account, and I’ll bet the kids that she treats adore her too. Enthusiastic and on point.

1. @drkkolmes “Clinical psychologist in private practice specializing in anxiety, depression, relationships, sexuality and the intersection of technology and mental health.” Very in tune with the net culture zeitgeist, Keely Kolmes has spoken about online mental health at SXSW and MentalHealthCamp. She challenges paradigms and explores boundaries in questions like: Should you “friend” your therapist? Read her blog? Should a therapist Google a client? A 21st century psychologist who’d top any new media mental health list, she unquestionably deserves the crown from us.

Should the winners not be able to fulfil their tweeting duties, here are the runners-up:

@countersuicide Shares crisis resources, suicide prevention info and news. Unlike the professional suicide prevention orgs on Twitter, this heroic volunteer directly interacts with people in crisis online. Crucial and literally lifesaving.
@apahelpcenter From the American Psychological Association, not very interactive but oodles of valuable info.
@marielhemingway My fave mentally healthy celebrity on Twitter, she offers lots of love, positivity and tips for healthy living.

Did I miss someone who you think is a winner? Please share your picks in the comments.

The forgiveness and flexibility of my youth has officially gone bye-bye.

So I’ve begun to ask myself what the energetic 80-year-olds that swim at the Naval Academy with me are doing differently than the lifeless elderly folks at the senior center I occasionally visit. And, yes, I’ll occasionally pretend to be Barbara Walters and ask nosy questions about what they are doing right (or wrong, but I don’t quite word it like that).

Here are a few observations from my unscientific study, three characteristics or things in common the winners have:

1. They like to laugh.

Yep, nearly all of them have a marvelous sense of humor. And this is consistent with a Norwegian study that suggests folks who can laugh at life’s ups and downs live longer. For example, the study, which was presented at a meeting of the American Psychosomatic Society and reported by USA Today, followed a subgroup of 2,015 cancer patients for seven years, and found that the people who could laugh more easily and had a healthy sense of humor were 70 percent less likely to die than the poker-faced guys.

2. They are involved.

Yep. Each and every one of them was engaged in some type of project: babysitting their grandkids, participating in some writers’ group, working on a literacy campaign, or playing a part in the local theatre group. All the vibrant folks had some passion or life mission that got them up in the morning and gave them reason to wake up another day.

3. They watch what they eat and they exercise.

I was so hoping that this would not be the case, because I am aware that maintaining your weight gets more difficult with every year you hike down from that peak. Metabolisms slow and appetites grow, because energy starts disappearing like coal, and you can’t burn off the calories that used to crank up your metabolic rate. And will power? Well, it’s where the energy is … gone. Many studies have found that exercise keeps the mind in shape as well.

Well, that gives me plenty to work on this week. I don’t know about you.

Do you have any of your own observations?

It’s been a rough week in the entertainment world, with the loss of three stars in music, Hollywood and television. With the passing of Michael Jackson (music, mostly in the 1980s), Farrah Fawcett (movies), and Ed McMahon (The Tonight Show and Star Search), the world has lost some significant talent. Each, in their own way, contributed something special and unique to their field.

You couldn’t have grown up in the 1980s and not been affected by Michael Jackson’s music (regardless of whether you liked him or not, doubtless one of your friends or girlfriend/boyfriend did). The later recriminations against Michael Jackson and his alleged interest in young boys no doubt will tarnish his otherwise popular rock career. Farrah Fawcett was, for better or worse, an icon of female sexuality in the 1970s and carrying over a little into the 1980s. And Ed McMahon was the perfect sidekick to Johnny Carson on The Tonight Show, but was in the news more recently for being broke despite his lucrative career. He also hosted the popular-at-the-time TV talent show, Star Search.

Our own Alicia Sparks has the coverage over at Celebrity Psychings: Jackson, Fawcett, McMahon: Coping With The Loss Of American Icons.

The human mind thrives on novelty. What was once a source of pleasure can become tedious after a time. Though our lives are full, boredom lurks around every corner because we innately long for new experiences. Yet boredom by its very nature is passive. In this idle state of mind, we may feel frustrated at our inability to channel our mental energy into productive or engaging tasks. We may even attempt to lose ourselves in purposeless or self-destructive pursuits. While this can be a sign of depression, it can also be an invitation issued from your mind, asking you to challenge yourself. Boredom can become the motivation that drives you to learn, explore the exotic, experiment, and harness the boundless creative energy within. 



In Hindu and Buddhist traditions, boredom is perceived as a pathway to self-awareness. Boredom itself is not detrimental to the soul–it is the manner in which we respond to it that determines whether it becomes a positive or a negative influence in our lives.

A bored mind can be the canvas upon which innovation is painted and the womb in which novelty is nourished. When you identify boredom as a signal that you need to test your boundaries, it can be the force that presses you to strive for opportunities you thought were beyond your reach and to indulge your desire for adventure.

The wisdom in these words is especially important to depressives and addicts. Because the depressed person often looks to a person, place or thing, to take away her pain, and an addict does the same to numb himself, or to avoid the uncomfortable feelings hidden underneath the addiction. In his book “The Addictive Personality,” author Craig Nakken writes:

Any addictive relationship begins when a person repeatedly seeks the illusion of relief to avoid unpleasant feelings or situations. This is nurturing through avoidance–an unnatural way of taking care of one’s emotional needs. At this point, addicts start to give up natural relationships and the relief they offer. They replace these relationships with the addictive relationship.

In other words, addicts, even if they have given up the addictive object, remain vulnerable to swapping the right and peaceful and sometimes-boring path with an exciting one that could get them into lots of trouble.

Boredom, then, is the door to addiction, distraction and danger or creativity, innovation, and growth.

The trickiest part is that first move. Beginning a healthy alternative. Signing up for a club. Registering for the new class. Trying a new program.

I have been inspired lately by my seven-year-old boy, David.

Two weeks ago he could barely swim from one end of the pool to the other. After some nudging on my part, he agreed to be on the swim team.

I watched him closely at that first practice, which must have felt incredibly scary. Not only was the water frigid, the other seven-year-olds all seemed a bit more advanced–they knew how to breathe correctly and float on their backs. Some even knew how to dive.

But David didn’t give up. He followed the other guys to the end of the pool, imitating them. And when the coach asked if anyone didn’t know how to do backstroke, he didn’t freak as I remembering doing as a kid. He simply learned it on the spot.

Guess what? He won first place in his heat for a freestyle race, and he competed in a backstroke event! Now he has a new love … swimming, and his excitement is palpable.

Observing David try something new–seeing him go way out of his comfort zone–has inspired me to do the same. I researched some Master’s swimming programs, and showed up for my first practice last Sunday.

That morning I felt like a nervous kid on her first day of school. I had no idea which lane to hop in, or how I was supposed to time myself, or the right way to do some of the drills. But despite some confusion, I did find my groove halfway through, and was glad I had taken the risk.

Boredom gives us the opportunity to stretch ourselves, to motivate us to grow in surprising ways, and, as the DailyOm meditation said, “to harness the boundless creative energy within.”

So that the same energy doesn’t end up in distraction and addiction.

That’s a legitimate question, and one asked by the previous head of the other modern DSM revisions (III, III-R and IV), Dr. Allen Frances in an upcoming Psychiatric Times article:

The secretiveness of the DSM-V process is extremely puzzling. In my entire experience working on DSM-III, DSM-III-R, and DSM-IV, nothing ever came up that even remotely had to be hidden from anyone. There is everything to gain and absolutely nothing to lose from having a totally open process…

You’d have to ask Dr. David Kupfer, the head of the DSM-V revision process, or the American Psychiatric Association, the folks responsible for the update, but they aren’t talking. We last wrote about this issue in November 2008, and apparently little has changed in the past seven months.

Dr. Doug Bremner has the continuing saga of the groups of dozens of professionals and researchers who have been sworn to secrecy in their work on revising this important book. But even more disturbing is that people are so upset about being called out on the lack of openness and transparency in the process, they are now using intimidation and “blacklisting” to try and silence the DSM critics:

Add to Dr. Kupfer’s [the head of the DSM-V revision] strategy of: 1) keep everything a secret; 2) make members sign confidentiality agreements; 3) allow no note taking; 4) ignore outside experts and comments; we can now add, 5) intimidate and ostracize academic psychiatrists whom you can’t ignore.

Dr. Bremner was dis-invited by email in co-authoring a research paper on an unrelated topic because of some very indirect criticism he posted in a previous blog entry. The email came from “someone on the DSM Anxiety, OCD, PTSD and Dissociative Disorders committee:”

What was particularly chilling about this episode is that the email was copied to all the members of the committee, implying that I was now persona non grata and should be shunned by what are in fact my peers in the anxiety disorders and trauma community of academic psychiatry.

Reasoned and thoughtful criticism is the hallmark of science. The whole point of publishing in a peer-review journal isn’t just to get the information out there — it’s to get it out there in a form that other scientists and researchers can understand and reproduce (if they want), so the entire field can move forward in their knowledge. That also means criticizing the work when it is lacking, cannot be reproduced, or has obvious flaws in methodology or logic.

Sadly, academics who can’t take criticism are more common than you might imagine. And the more senior you become in a particular research field, it seems the less able you are to take criticism or feedback.

Sure, it can be difficult to see your methods or procedures being dissected or criticized on a blog, such as Dr. Bremner’s. But that comes with the territory.

But Dr. Bremner’s case is not necessarily unique. You anger the wrong people in a passing sentence in a blog entry, and you can be denied professional opportunities. Dr. Carlat suffered a similar fate not because of something he wrote on his blog, but because a commenter wrote something critical of the DSM-V process that Dr. Carlat did not remove quickly enough to the satisfaction of those in power at the American Psychiatric Association. It seems that if you publicly criticize the DSM-V process, you are going to anger folks at the American Psychiatric Association.

These episodes — and the amount of politics one must play — are key reasons I have little interest in academia. If I have to worry about every word I write might be mis-portrayed or misunderstood by someone who could deny me a future professional opportunity, I’d just quit writing. (Of course, things I’ve written have likely denied me certain opportunities anyway, but at least my career doesn’t depend on them.)

I’m not certain this is what Dr. David Kupfer, the head of the DSM-V revision process, had in mind when he originally implemented these policies of secrecy surrounding the revision of the DSM. Perhaps he thought it was in the APA’s best interests to keep it as private a process as possible, but in this era of increasing openness and transparency, the APA made the worst decision possible.

Dr. Kupfer could still redeem himself, if he had any interest in doing so. So I’d like to call on Dr. Kupfer and the American Psychiatric Association to answer these issues, and explain to the public — the folks who will suffer for better or worse as a result of the DSM-V — why such an important reference manual is being updated in such secrecy.

Philip Dawdy over at Furious Seasons also has a good summary of these two issues, which is also worth the read.

Read Dr. Bremner’s article: DSM-V Shadow Team: Retaliations & Beware of Consequences

Read Dr. Carlat’s article: The APA, Power and the Exclusion of Dissent

Read Philip Dawdy’s take on it: Psychiatrists Attacking Psychiatrists For Blogging On Disclosure Controversies

In a recent BusinessWeek.com article, Peter Coy writes:

They eat from the same dishes and sleep in the same beds, but they seem to be operating in two different economies. From last November through this April, American women aged 20 and up gained nearly 300,000 jobs, according to the household survey of the Bureau of Labor Statistics. At the same time, American men lost nearly 700,000 jobs. You might even say American men are in recession, and American women are not.

What’s going on? Simply put, men have the misfortune of being concentrated in the two sectors that are doing the worst — manufacturing and construction. Women are concentrated in sectors that are still growing, such as education and health care.

Yep. That’s what’s going on in my home. No one needs architects right now because the housing market got flushed down the toilet with the rest of the construction business. My job as a mental health professional? As my former boss liked to say, “When times are good, business is good. When times are bad, business is better!” So I’m working more, and Eric is working less. We essentially traded places.

Like all major adjustments, the transition has included its share of awkwardness. That’s why I’m going to share a few tips that have worked for us.

1. Say thank you. Often.

Honestly, what has helped us most during these months are our brief emails to each other. I will often write him a note like this: “I appreciate your picking the kids up from school today and for folding the laundry. You are a wonderful father, and I’m glad the kids get this time with you.” He often sends me an email like this: “Thanks for working so hard and for being so productive. I’m glad your career is going somewhere.”

2. Respect each other.

I remember the bridal shower I attended where each person in the room had to share one piece of marriage advice. A woman who had been married for 40 years said this: “Be nice to each other.”

It was so simple, and yet so profound.

My writing mentor Mike always reminds me to “err on the side of compassion.” So right when I’m about to storm into the kitchen… or the location of the mayhem … and tell Eric to stop shouting at the kids, and tell the kids to stop driving their dad insane, I will take a few deep breaths, say to myself that they are fine, that this stuff happened all the time when I was with them … it’s just that Eric couldn’t hear it from his office down the road. Moreover, I can’t go stomping into his turf, because I need to respect him and the job he’s doing.

3. Communicate clearly.

This is probably the hardest step. First, I think it’s important to know when NOT to say anything: when you are hungry, angry, lonely, or tired (HALT, I learned in 12 step meetings). So, in the three minutes you have after lunch, there’s your window of opportunity!

John Grohol outlines some great tips for better communication in his post, “9 Steps to Better Communication Today”:

• Stop and listen. When we’re knee deep within a serious discussion or argument with our significant other, it’s hard to put aside our point for the moment and just listen.
• Be open and honest with your partner. Being open means talking about things you may have never talked about with another human being before in your life. It means being vulnerable and honest with your partner, completely and unabashedly.
• Pay attention to nonverbal signals. Most of our communication with one another in any friendship or relationship isn’t what we say, but how we say it.
• Communicating is more than just talking. To communicate better and more effectively in your relationship, you don’t only have to talk. Some couples also find that using email or another method is easier to discuss emotional issues rather than trying to do so face-to-face.

4. Stay flexible. And give.

Eric and I have an advantage here. Both of our jobs are very flexible. To a certain extent, we make up our schedule. But we didn’t land these jobs in a stroke of good luck. We made conscious decisions all along, to go with the more flexible job over the higher-paying one. I know that Eric could easily work for a prestigious Washington, D.C.-based architecture firm, commuting to the city on top of long hours. He opted instead for a flexible position around the corner because he knew that working was important to me, too, and that if he took a D.C. job I wouldn’t be able to keep a finger in my career.

In that vein, I like to think of this time … when he doesn’t have much work and I do … as giving back to him … as a way of thanking him for the choices he has made in the past for me and for our family. Staying flexible, for us, means thinking as a family, not necessarily as an individual.

5. Revisit priorities and commitments.

Eric and I never call a “commitments” or “priorities” meeting.” We’re far too disorganized for that. However, we do analyze our priorities quite often… usually after running into some of our friends that seemed much less stressed out than we are.

We revisit our commitments.

• We don’t want to hire a full-time nanny or au pair.
• We don’t want to use full-time daycare.
• We would both like to continue working.

Since we don’t have a lot of outside help from our families, that makes our goals very difficult to attain. Something, ultimately, has to give: our marriage, our jobs, time with kids, or all the housekeeping and domestic tasks in which June Cleaver excelled.

We chose D: the plants, the laundry, the stains on the walls.

As long as we keep on remembering that we chose this route–we chose this set of priorities, and we chose them together as a couple–then the stress over us becomes less debilitating.

6. Think outside the box.

It’s important to know that you have options today, especially given all the technology available. If you’ve been laid off and can’t get another job like the one you just had, that doesn’t mean you can’t use your talents, skills, and services in a slightly different capacity … part-time or full time.

I’ve seen folks pursue a part-time job at the bookstore, dally in graphic design, wait tables … anything that gets them out of the house and generates a few bucks. Think for a moment: Is there any way you can use your skills as a consultant? Can you ask some of the contacts you’ve made over the years if there is a service you can provide? Be creative. Broaden your view. Open your mind to a new way of working.

7. Make some rules. Get a system.

Eric and I did have to adopt some appropriate procedures for processing the reams of paper sent home in the kids’ school bags, not to mention all the emails about soccer practice, Cub Scout meetings, and community news. For about three months, whenever I’d get an email from the school, I presumed he was handling it. He thought I had it. Thus, we missed out on the summer homework we were supposed to order, soccer signups for next fall, and oh, those damn letters of the alphabet we were supposed to cut out every week.

“Okay, we need a system,” I said, after I got reprimanded from Katherine’s teacher on not cutting out letters D through X. “From here on out, you put all the papers about school stuff on my desk. And I will presume you are handling all the emails unless you forward something to me. Does that work?”

It did work. Not full proof, you know, but good enough.

8. Don’t forget to laugh.

As I discussed in my post “9 Ways Humor Heals,” a sense of humor is absolutely crucial here because humor combats fear. And when you don’t know how you are going to pay your next bill … or find another job, fear can take over your life. Laughter forces a few steps–some much-needed distance– between a situation and our reaction. We all would do well to follow the advice of Leo Buscaglia: “When you get to the end of your rope, tie a knot and hang on. And swing!”

In my CI career I fired three highly recommended specialists because they were rude poopy heads. Thankfully I’ve also had wonderful physicians who literally saved my life and my mind. Not uncommonly for people with chronic illness, the path to find a good-enough doctor is an odyssey.

Laura Hillenbrand, author of the fabulous book Seabiscuit: An American Legend, was diagnosed with Chronic Fatigue Syndrome but not before she was put through all kinds of humiliation by physicians who out of ignorance did not listen to her.

“The doctor I found waved me into a chair and began asking questions and making notes, pausing to rake his fingers through a hedge of dark hair that drifted onto his brow. He ran some tests and found nothing amiss. He told me to take antacids. A few weeks later, when I returned and told him that I was getting worse, he sat me down. My problem, he said gravely, was not in my body but in my mind; the test results proved it. He told me to see a psychiatrist.”

Ms. Hillenbrand was 20 years old. At 5′ 5″ her weight had dropped to 100 pounds. She suffered from chills, fevers, exhaustion, swollen lymph nodes and dizziness. Being young and alone, she followed doctor’s orders and went to the recommended psychiatrist. After a thorough assessment:

“He wrote my internist a letter stating that he would stake his reputation on his conclusion that I was mentally healthy but suffering from a serious physical illness.”

Her doctor’s reaction?

“‘Find another psychiatrist,’ my internist said over the phone, a smile in his voice.”

Ms. Hillenbrand went through two more doctors before she found her good-enough one at Johns Hopkins. He listened to her, read all her documentation and correctly diagnosed her condition.

Recently a client of mine asked how to tell if she had a good doctor. If I were you, I said, I would look for these three basic qualities:

• Expertise, knowledge, intellectual curiosity and all the right credentials.
• Warm, receptive, a good listener and communicator. The bedside manner thing.
• A well-run office, with smart, efficient support & medical staff.

You know you’ve hit the jackpot when your doctor rates high on all three. I’ve had two doctors like that in my life, both gifts from heaven. Several were really awful. Picture this….

Scene 1: Doctor’s examining room, midtown Manhattan. Thirty-something, I sit on the examining table, my legs dangle over the side. I wear a paper shmata. My husband is standing next to me. The tall physician in his crisp lab coat faces us.

Doctor: I believe you have lupus.

Me: [I don't say anything. I'm too busy crying.]

Doctor: [With a wise-guy sneer] Why are you crying? It could be worse.

My husband and I get up and leave, never to return.

Scene 2: (A couple of years later in Buffalo, NY) Doctor’s examining room. I sit on the examining table, my legs dangle over the side, wearing that same stupid paper thing they have the nerve to call a gown.

Doctor: Clearly the disease has progressed. There’s not much we can do except hope the medication turns it around.

Me: [I don't say anything. I'm crying.]

Doctor: [Nervously] You seem anxious. There’s no reason to be anxious. Maybe you should see a psychiatrist.

Me: [Angry] You’re telling me the disease is unchecked and you wonder why I’m anxious?

The first doctor I fired. The second I kept. It was a close call but I kept him. Let me explain.

In the scenarios above, the first doctor, a rheumatologist, flunked because he not only sucked at communication, he lacked intellectual curiosity. Underneath my distress I didn’t think I had lupus, I didn’t know what I had but it wasn’t lupus. He didn’t care. He wasn’t going to discuss it with me. He was already thinking about his next case. Deal breaker.

Doctor number two, also a rheumatologist, had all the right credentials, a super-sharp mind and the curiosity of Sherlock Holmes. He was more scientist than clinician. Doc 2 probably communicated great with lab rats; it was people he couldn’t handle. His nursing and office staff were tops, always accommodating and respectful of my time. He would listen to me as long as I reported ‘just the facts’ like Mr. Spock; I was a ‘fascinating case’ (how many times have you heard that old line?) and thus worthy of his attention.

Keep him or let him go?

My options weren’t as great in Buffalo as they were in New York City. There were maybe two other rheumatologists in the area capable of dealing with my condition and they were both trained by Doc 2.

A few more things to keep in mind:

• If you are in doubt, interview several doctors as if they were applying for a job and you are the employer. If you don’t feel comfortable with your doctor or what s/he is telling you, get a second opinion. Don’t even worry about hurting anyone’s feelings. They are professionals and can handle it. If they can’t and give you a hard time, run, do not walk, to the nearest exit.

• Only the actual physical examination needs to be done in the examining room with you in a hospital gown. Any good-enough doctor would allow you to change into street clothes and sit comfortably in a chair for the important post-exam conversation.
• If you want the best, search for your doctor among the medical faculty of a teaching hospital. Medical centers tied to a medical school, teaching hospitals are where the medical students and residents do their training. The faculty who teach and supervise there know the latest diagnostic procedures, tests and treatments because they have to teach it. Putting up with the gaggle of med students (who make Doogie Howser look like a geezer) is worth it as long as your doctor hears you.
• A good-enough doctor will admit when he/she doesn’t have the answer but will work with you to figure out a plan, maybe even try something experimental if you’re willing.
• Trust your gut. Filter out what others say, focus on what your physician is saying and make your own judgment. Don’t micromanage your doctor, but don’t just be a Yes person either.
• A good listening doctor can show compassion without getting all touchy-feely. If you need someone to pet you and say “Poor baby,” (and we all do) go to your mother, a friend or your spouse. Don’t expect it from your doctor.
• Remember that doctors, just like the rest of us, are not perfect. If you found one who is good-enough, celebrate and get to work.

So I kept Doc 2, even though he had the social IQ of a kumquat. He was a leading expert on my disease and as long as our conversations focused on that we were good. We decided on an experimental treatment that (knock on wood) worked. He’s a big reason I’ve been in remission this long. Go figure.

An addendum: Since first publishing this article I realize I’m so close to this subject I may think I’m communicating the subtleties of developing a working relationship with our doctors and I missed a few points. First, Doc 2 was not a warm fuzzy guy, but he wasn’t nearly as bad as Doc 1, e.g. he was not condescending and he did hear me. His lack of warmth was not a deal breaker for me while it could have been for someone else. There is no right or wrong here. We did have a ‘talk’ to air out the relationship so we could understand each other and move forward. Secondly, I failed to mention that having a good therapist during the entire diagnostic process and after was important to me. It wasn’t the referral to a psychiatrist that was amiss for either Laura Hillenbrand or me. It was the idea that our not-so-good doctors were implying that we were mentally/emotionally out of control and they couldn’t handle that. This subject is a post all by itself. And thirdly, this post was inspired by the comments from Five Rules For Living With Chronic Illness. Thank you for your comments, questions and stories.

Photo courtesy of wenzday01 via Flickr