In my 20 years living in the Boston area, I cheered on the runners on many occasions and now, even from far way, these events feel close to home.

Experiencing trauma can have a dramatic effect on our bodies and our minds.  And although it’s a different experience to witness a trauma on television, it still can affect us.

When you perceive a threat, the body activates the stress response. The stress response occurs in both your body and brain.

The body’s response to acute stress is a preparation for emergency.  Adrenaline and other hormones are released.  The body shuts down processes associated with long-term care.  When under immediate threat, digestion, reproduction, cell repair and other body tasks related to long-term functioning are unimportant.

Of immediate importance is survival.  Increased blood sugar can provide extra energy for muscles. Increases in cortisol counter pain and inflammation. Blood pressure increases. Blood is diverted from our extremities to our major muscles to provide us with extra strength. Increased endorphins can help us ignore physical pain.

You can see the effects of these changes to the body in many of the symptoms of stress, such as racing heart, dizziness, nausea, shortness of breath, shaking, feeling hot and flushed, and sweating.

But it is the impact of trauma on the mind that is often the most disturbing.  Traumatic events can leave us feeling unsafe.  They can disrupt our beliefs and assumptions about the world. Your sense of your ability to control your life may be shattered. You may question how much influence you have over your life and your life choices.

A trauma, such as the one the occurred at the Boston Marathon, can leave us distrustful of other people.  You may question your basic trust of other people in the world.  Trauma can affect your ability to be intimate with others and may impact your feelings of self-worth.  Those who survive the trauma often feel guilt and wonder why they lived when others were less fortunate.

As we grow, change and have varied experiences throughout life, our beliefs and assumptions typically evolve over time.  With trauma, those beliefs and assumptions that we use to make sense of the world around us change nearly instantaneously.

It’s common to experience a wide range of psychological symptoms, including intrusive thoughts, worry, difficulty sleeping, trouble focusing, bouts of crying, blame or self-judgment and lack of satisfaction.

The effects of trauma also can cause intense emotion, including extreme emotional fluctuations, unhappiness, anxiety, loneliness, anger, and irritability.

Multiple traumas or repeatedly being exposed to life-threatening events can have a further impact on your body and mind. Parts of the brain can become sensitized, causing you to be on high alert and to perceive threats all around, leaving you jumpy and anxious.

Other parts of the brain associated with memory can actually shrink, making it difficult to consolidate and form new memories.  Prolonged stress can effect the development of a number of health issues, including diabetes, obesity and hypertension. And repetitive stress affects our moods, brings on anxiety disorders, and affects our experience of chronic pain and our ability to control food intake.

But when horrible events occur, such as those that occurred at the 2013 Boston Marathon, we also see the generosity and caring that is a large part of human nature.

Countless individuals ran to help without a second thought.  First responders, medics, EMTs and even bystanders jumped into action to do what they could to save lives.  Runners crossed the finish line and kept on running straight to give blood.

As we deal with the impact of violence, we can also keep in our minds the heroes and the strength of the human spirit that brings us together when we are faced with senseless tragedy.

Image: Wikimedia Commons: Aaron “tango” Tang

With so many apps on the market, it’s hard to know which are useful.

Many are designed by software developers instead of psychologists, without scientific testing. They range from beneficial, to harmless but useless, to bordering on fraudulent.

The apps selected for this list make no hucksterish claims and are based on established treatments. Progressive Muscle Relaxation, for example, has been used for a century and is likely just as effective in this new medium. Knowledge from Cognitive Behavioral Therapy and Dialectical Behavior Therapy enrich two apps on this list. Others mix solid information with ingenuity.

Don’t forget to download the free PsychCentral app to keep up with the latest mental health information.

1. BellyBio

Free app that teaches a deep breathing technique useful in fighting anxiety and stress. A simple interface uses biofeedback to monitor your breathing. Sounds cascade with the movements of your belly, in rhythms reminiscent of waves on a beach. Charts also let you know how you’re doing. A great tool when you need to slow down and breathe.

2. Operation Reach Out

Literally a lifesaving app, this free intervention tool helps people who are having suicidal thoughts to reassess their thinking and get help. Recommended by followers of @unsuicide, who report that this app has helped in suicidal crises. Developed by the military, but useful to all. Worth a download even if you’re not suicidal. You never know if you might need it.

3. eCBT Calm

Provides a set of tools to help you evaluate personal stress and anxiety, challenge distorted thoughts, and learn relaxation skills that have been scientifically validated in research on Cognitive Behavioral Therapy (CBT). Lots of background and useful information along with step-by-step guides.

4. Deep Sleep with Andrew Johnson

Getting enough sleep is one of the foundations of mental health. A personal favorite I listen to all the time, this straightforward app features a warm, gentle voice guiding listeners through a Progressive Muscle Relaxation (PMR) session and into sleep. Features long or short induction options, and an alarm.

5. WhatsMyM3

A three minute depression and anxiety screen. Validated questionnaires assess symptoms of depression, anxiety, bipolar disorder, and PTSD, and combine into a score that indicates whether or not your life is impacted significantly by a mood disorder, recommending a course of action. The app keeps a history of test results, to help you track your progress.

6. DBT Diary Card and Skills Coach

Based on Dialectical Behavior Therapy (DBT) developed by psychologist Marsha Linehan, this app is a rich resource of self-help skills, reminders of the therapy principles, and coaching tools for coping. Created by a therapist with years of experience in the practice, this app is not intended to replace a professional but helps people reinforce their treatment.

7. Optimism

Track your moods, keep a journal, and chart your recovery progress with this comprehensive tool for depression, bipolar disorder, and anxiety disorders. One of the most popular mood tracking apps available, with plenty of features. Free.

8. iSleepEasy

A calm female voice helps you quell anxieties and take the time to relax and sleep, in an array of guided meditations. Separately controlled voice and music tracks, flexible lengths, and an alarm. Includes a special wee hours rescue track, and tips for falling asleep. Developed by Meditation Oasis, who offer an great line of relaxation apps.

9. Magic Window – Living Pictures

Not technically a mental health app, it makes no miraculous claims about curbing anxiety. However, there is independent research indicating that taking breaks and getting exposure to nature, even in videos, can reduce stress. This app offers an assortment of peaceful, ambient nature scenes from beautiful spots around the world.

10. Relax Melodies

A popular free relaxation sound and music app. Mix and match nature sounds with new age music; it’s lovely to listen to birds in the rain while a piano softly plays.

Do you have a favorite app not on the list?
Please share links in the comments.

Among active troops, suicide rates increased 18 percent from last year.  Rates among veterans were also at distressing levels, with a veteran dying by suicide every 80 minutes, according to an estimate from the Department of Veterans Affairs and reported in this month’s Monitor on Psychology.

When faced with a problem of these proportions, it is vital to understand what factors increase the likelihood of suicide and which interventions are the most effective.

In response, the Army has prepared training for soldiers and families — to help them recognize signs of suicidal behavior, and to inform them of interventions and ways to access support. And this past August, President Obama signed an executive order that strengthened suicide prevention efforts for service members and veterans.

Lisa Brenner, PhD and her colleagues are working on ways to prevent suicide among veterans and lower completion rates. Brenner, is a director of the Department of Veterans Affairs’ Mental Illness Research, Education and Clinical Center.

Service members and veterans face an array of stressors that might be linked to suicide, including lengthy and multiple deployments in the wars in Afghanistan and Iraq.  These wars also have left veterans wounded. Many of them have profoundly disabling head injuries.

Brenner reports that “among the U.S. military personnel who were injured while taking part in Operation Enduring Freedom and Operation Iraqi Freedom, between 10 and 20 percent suffered traumatic brain injuries.”

Brenner led a study examining suicide risk in 49,626 VA patients with a history of traumatic brain injury (TBI). She and her team found that overall, veterans with TBI have an increased risk of dying by suicide compared with veterans without brain injury.

Greater understanding of the effect of TBIs on suicide is needed. Research is beginning to suggest that mild brain injury is very different than moderate to severe injury, says Brenner.  Looking at these injuries separately will help begin to clarify their connection with suicidality.

Beyond research, evidence-based interventions for those with TBI are needed, Brenner said.

Although no studies have been done on ways to make suicide less likely among brain-injured veterans, a recent study in Australia found that it was possible to reduce hopelessness among adults with TBI through the use of cognitive-behavioral therapy.

Feelings of hopelessness strongly predict death by suicide, making this study significant in the search for effective evidence-based treatments.

Brenner and Grahame Simpson, the Australian researcher who carried out the earlier research, plan to tailor the therapy for use with U.S. veterans and will run an initial trial on several dozen participants to study its effectiveness.

However, they show that some abusers slipped through the cracks, others were given a second chance and include evidence of some failures to take proper steps to report suspected abuse to authorities.

The Boy Scouts have issued an acknowledgement that in some incidents their response was “insufficient, inappropriate and wrong” and have apologized for their mishandling of certain situations.

And let’s not forget that generations of boys have had healthy, positive, life-affirming experiences with the Boy Scouts.  This current report, which involves a small fraction of the millions of volunteers over the years, should not discount the positive aspects of the organization, the skills it has taught and positive values it has instilled in many boys

At the same time, are there lessons to be learned from the report?

It’s not possible to compare incidence and handling of sex abuse in the Boy Scouts to other, similar, organizations, because so few keep detailed records.  But these records give us an opportunity to review and, hopefully, apply lessons learned.

According to Jason Felch, an investigative reporter for the Los Angeles Times, in an interview by Neil Cohen on NPR, the files include handwritten notes from young men. The notes discuss abuse by troop leaders, provide detailed, although sometimes incomplete, accounts of allegations that have emerged over time, and contain some police reports about the allegations as well as discussions among Scouts officials regarding how best to handle allegations.

Awareness of  “acquaintance molestation,” which is what most frequently occurred in the Boy Scouts, crystallized with experts and the general population in the 1980s.  This data, dating from well before that, might help to better understand how these predators operate and is vital to preventing this type of abuse, which may account for as much as two-thirds of sexual abuse.

One aspect of sexual abuse revealed in these files is grooming behavior.  That is, innocent-appearing behaviors often set the stage for abuse.  Felch describes grooming behaviors as often involving predators allowing boys to break rules, then progressing to driving cars, drinking alcohol and watching pornography together.  They escalate to skinny dipping and sharing tents and then culminate in abuse.

Grooming behaviors make it less likely that a victim will report the abuse, because they feel culpable.

Although it’s unlikely that the Boy Scouts will be held criminally responsible for their handling (and in some cases, mishandling) of allegations of abuse, it is likely that many young men who experienced abuse will be triggered by the release of these documents.  It is common, in cases of sexual abuse, that victims face the abuse only years after it has occurred.

This type of abuse often has a lifelong impact on the victims, particularly if victims don’t receive support.  It can alter the course of a young person’s life, lead to other life problems such as various types of addiction, and can cause victims to participate in abuse themselves when they reach adulthood.

What can we learn from the Boy Scouts about stopping this sort of abuse? Kelly Clark, a lawyer who sought for these files to be open, says that child abuse thrives in secrecy.  Opening the files brings the abuse to light and hopefully allows other organizations to learn from it.  For example, in the files, Clark points out cases that were insufficiently investigated or those in which one boy came forward and a leader was removed, but no one questioned whether the abuse went further than that one boy.

The following is a link to the National Sexual Abuse Hotline, a confidential hotline offering counseling and information on rape and sexual abuse.

Although there is no sure fire way to prevent sexual assault, the hotline offers tips to help protect your children here.

So beneficial, in fact, that gaming may add up to 10 years to your life.

In her groundbreaking TED Talk, McGonigal presents the research behind her theory.

Live Longer, Be Happier

Perhaps more interesting than her proposition to live longer is McGonigal’s empathic awareness that some people are uncertain about even living past today. Two years ago, McGonigal experienced persistent suicidal thoughts following a concussion.

As she explains it, her brain started telling her, “You want to die. You are never going to get better. The pain is never going to end.” To heal her brain, McGonigal had been banned from all outside stimulation. She couldn’t play traditional video games, use the computer, leave the house, or even drink caffeine. All of these activities triggered her symptoms.

Even in the depths of her depression, however, McGonigal was still armed with what she knew about research on gaming. Playing games promotes creativity, determination, and optimism. Games encourage people to connect with others, strengthen relationships, and ask for help. These life-giving facets of human existence were the very same characteristics that her injury and suicidal thoughts seemed to be draining. McGonigal decided to cope how she knew best: She designed a game. The game itself was a simple role-playing recovery game titled “Jane: The Concussion Slayer.”

Feeling “SuperBetter” through Gaming

Since its inception and life-saving result, McGonigal has adapted the original recovery game into “SuperBetter.” This free and simple game, which is also an app, focuses on strengthening resilience through simple tasks that increase physical, mental, emotional, and social health. The tasks are easy, fun, and can usually be done in a few minutes. Rather than countering productivity, McGonigal challenges, playing games actually improves our ability to work harder, be happier, and live longer.

Logic leads us to believe that complex and costly problems demand equally complicated solutions. There are fewer problems as complicated and devastating as suicide. As research has demonstrated countless times, human behavior sometimes evades even the greatest attempts at logic. What if it’s true? What if Angry Birds or games like it could have the same healing effect as powerful medication and hours of therapy?

Researchers at East Carolina believe their 2011 study found just that. Among participants who were depressed, individuals who played casual games like Bejeweled Blitz demonstrated an average 57 percent reduction in symptoms. Even more impressive, these improvements remained over time. Researchers concluded that the games “caused physiological and biochemical changes consistent with positive changes in mood and anxiety.”

East Carolina researchers didn’t compare their findings to studies that have found similar relief from depression as a result of board games, outdoor recreation, or time spent with friends. Online games, like Angry Birds, FarmVille, and others, are simply forms of play. In excess, they can be problematic but at the end of many long, busy days, they may be the only form of play some people enjoy. Play — and gaming — has significant, evidence-based healing powers.

As McGonigal concludes, “Reality is broken. We need to make it work more like a game to fix it.”

What do you think?
Are prescriptions for time spent gaming in the future of treatment for depression? How does gaming impact your mood?

For More Information

The Science Behind McGonigal’s TED Talk

Russoniello, C.V., O’Brien, K., & Parks, J.M. (2009). The effectiveness of casual video games in improving mood and decreasing stress. Journal of CyberTherapy and Rehabilitation, 2(1), 53-66.

This is my own voice almost eighteen years ago. In 1994, I subjected my late epileptic uncle to inhuman treatment and suffering.

Nearly two decades later, this voice continues to reverberate in my mind and ears. It haunts me like a ghost since I last attended a workshop on mental health and mental illness conducted by the Carter Center and the Ministry of Health & Social Wealth in Monrovia, Liberia.

Epilepsy, I learned, is not a mental illness. However, it is included and discussed as such because it is a brain sickness.

I was born to see my late uncle suffer from epilepsy. Matter of fact, the illness treated him very badly — so badly that I hated him for it.

I meted out the most severe treatment against him because of his condition. Among other things, I ‘drowned’ his head in a calabash of unfiltered water; I even publicly humiliated him. Evidently, whenever I chained him besides a fire or ‘drowned’ him in the water, he became violent. This violent response I understood as a lesson for him to steer clear of me and a motivation within him to want to die earlier to end his suffering at my hands.

Despite my harm toward him, he loved me the most among my brethren. This love I also translated into hate for him ‘because his loving me will bring him closer to me and cause my friends to chastise me.’ Before his death, I remember him saying, “You think I chose to be sick? It is God who put me in this condition. Suppose you keep treating me like this, then I pray to God to make one of your child (children) like me?”

This was something I hated to hear. So, I swiftly retorted. “Just shut up! Let God punish you for saying that! It’s not God who made you sick. In fact, you are not sick. You are crazy. Don’t lie on God. God knew you would have been a witch to disturb our lives. So, he changed your evil plans and made you crazy.”

My father resented it, but the love for a child (me), even compared to a brother’s, would not allow him to stop my mistreating his brother. Although he allowed it on the surface, deeper in his heart, I could read that he deeply resented it. And so my uncle passed away. While others cried, I rejoiced for my new peace of mind. So, the story ends.

Never did I remember all of this until three weeks ago at that mental health and mental illness workshop, where, after learning some causes, signs, preventive measures, types and treatment for mental illnesses, that I first expressed my guilt. Workshop facilitators, Dr. Janice Cooper and Karine McClean have consoled me not to feel guilty or blame myself. But I know they were only being diplomatic. Deep in my heart, since then, I have always felt guilty and blameworthy of my uncle’s death.

If this education had come much earlier, I know my uncle won’t have died the way he did. I am a Muslim and a very traditional person from the Mandingo tribe of mama-Africa. I believe in predestination. I believe one dies if it has been so appointed only by Allah, the Almighty. Yet, without my mistreatment, I believe my uncle would not have died in pains and an anguish that could not be revenged. Like me, many people would not have treated their epileptic and mentally ill relatives the way we did. I know I was not alone in this. As young persons, we held amateur meetings on how to treat our mentally-ill.

Had I known that an epileptic person is and can be as normal any other person; had I known that epilepsy can be treated; had I known that epilepsy is only a brain sickness and not necessarily a witchery; had I known that my chaining him besides a fire and ‘drowning’ him into water was what provoked the violent response from him and inflicted physical and psychological injuries on him; had I known that if I had been a little caring and understanding, he would have lived a little longer and never died in pains; had I known that part of keeping an epileptic person safe is keeping him or her away from fire and water and away from crowds … only if I had known …

Even more painful to me is that after the Carter Center training, I returned to my father to ask about the cause of my late uncle’s epilepsy. He told me for the first time in his and my lifetime that his brother’s condition was a result of a heavy tree falling on his head while they went on the farm in 1944. Out of curiosity and wanting to express my regret, I had to travel to Karnplay, Nimba County, my birthplace and the place that sad event occurred. Standing with my father beside the tree that fell on his brother 48 years before his death in 1992, I sobbed and regretted in sober reflection my past treatment. Had I known … Only if I had known …

So, after all, his epilepsy was not a witch. It was because of a natural disaster. I am so sorry!!!!

In any case, my new education is of no use now to my late uncle. But with it, never will I let another person die the way my uncle did. The education I have gotten is a sufficient tool to let others live and enjoy life as I do. I may not have the finances to take care of them, but transferring the education to a wider audience, I know, is even more powerful because ‘prevention is better than cure’ and because the right education is the most powerful weapon.

This new education was only revealed in a few hours over two successive days. Yet, the impact in my life has a tremendous effect — more than thirteen years of secondary education, four years tertiary education, and many tears of professional education because it affects me directly and society as well. As a society member, it is a moral responsibility on me and any other person to keep it cordial and cohesive and not discriminate or segregate. Hence, my own effort to educate people on mental illnesses.

This became even more important when we were taught at the workshop that “mental-illness is everybody’s business; that every medical illness has a mental condition attached.” Wow! This means one way or the other, we all have mental illnesses at some times. Worse, the population of Liberia one way or another saw and experienced the civil war, which can cause post-traumatic stress disorder (PTSD).

Various researchers have shown that 44 percent of all Liberians suffer PTSD. No one should be discriminated against for being mentally ill. Everyone must join in advocating for the right policies and budgetary support toward mental health and mental illnesses.

Budget makers as well as budget passers must ensure that appropriate policies and financial allocations are given programs on mental health because doing so will mean doing one of the single-most important good for all Liberia, ye mama-nature.

Mental health clinicians and support advocates have indicated that only less than one percent of the national budget is given toward mental health, which is a national shame. Mental health or mental illness is everybody’s burden at one point in time or another, considering what percent of our overall population is directly affected by this condition.

I strongly believe that reconciliation, for which the government has budgeted $5 million (in U.S. dollars) within the current draft national budget, will be difficult to achieve if a significant percentage of those who are supposed to be reconciled are people suffering from mental illnesses.

How does one reconcile when he or she is not even normal? Reconciliation comes from the mind and brain! If that mind is non-responsive, how does it decipher what is good as reconciliation, or bad as disunity and grudges? Palava hut reconciliation discussions are great ideas, of course. But these discussions are only good if the mind and brain speak well of them. If the opposite is what the minds and brains interpret about the palava hut discussions, then I see a challenge toward achieving reconciliation.

So, the issue of mental health or mental illnesses has many folds to consider: natural health of the population; achievability of reconciliation; citizens’ physical contribution toward national recovery processes; and their interpersonal relationships. All these can be achieved if the appropriate approaches, including policies and budgetary allotment, are taken toward mental health and mental illnesses.

Words cannot explain it all. But my heart at first was heavy for hurting my late uncle. Now, my heart has become light on the realization that not doing what I did then, many mentally ill persons can live normal lives.

As a journalist, at least I have a better advantage now than before. When I could only speak to a few persons before, I can now speak, through the pages of my newspaper and airwaves of radio stations, to a wider audience far and near. This opportunity I can’t let go. I have it, others don’t, and so I must make use of it. I am launching a Facebook page and a new column in the Public Agenda newspaper soon and on our website upon return from the interior.

I invite one and all to help rid society of misconceptions about mental illness and encourage society to pay more attention to and give care to the mentally ill. They, too, are us.

While survival rates for many cancers have improved, there are quality of life issues following the diagnosis, including the emotional difficulty of coping with the anniversary date.  Survival rates are measured in 1-, 5- and 10-year markers.  This often creates an emotional conflict as the diagnosis date approaches.  Each year provides a measure both of success and trepidation.  Diagnosis day is when the war on cancer begins in your body.  It is sometimes shortened to military lingo for the day an attack or operation is launched: D-Day.

As with most traumas, people can tell you the vivid details of their diagnosis. They remember the time, what was said, what they did, and what they felt.  D-day is etched in their psyche, and as the anniversary date approaches, so does the anxiety.

But one woman, Jen Cunningham Butler, has done something different. In honor of breast cancer awareness month I wanted to tell you her story.

“I called home to see if the biopsy results are in,” she says. “The doctor tells me to page him.  I do.  He tells me: You have breast cancer.”

“I was in my office about to walk out into the adolescent hum of opening night of the eighth-grade play,” she continues. “The seventh-grade ushers were waiting for me and their final instructions before parents and friends arrived. They needed me to help them, and I needed to drive home and tell my husband I had cancer. Dr Meyer had given me the number for Larry Shulman, head of breast oncology at Dana-Farber Cancer Institute. “In the event of an emergency please page me at…”

I hung up. Was this an emergency?

When I reached Larry he pulled up the pathology on his computer: “It’s invasive,” he told me. We agreed to speak the next morning to form a plan. I got ready to go out into the hall, trying to figure out what to do next.

It was Tuesday, March 8, 2005. 5:30 pm.

Over the next several days, weeks and months Jen lived in two different worlds of coping with work and home and the agony of additional biopsies, MRIs, CT scans then the surgery, the radiation, and the recovery.

“I could tell you of moments of jagged fear, the comfort of “to do” lists, the beauty of the people who steadied me,” she told me. “I could tell you how simply breathing became a gift of release and how the things I could do physically, like riding my bike (even though I was slow) with my cycling friends, calmed and settled me.”

But as D-day approached, Jen knew there was a predictability of anxiety based on what others had told her. But she was determined: “I needed to find a way to turn the day around.”

She did just that.

“Coming into that first-year anniversary, I thought about how much being strong, healthy and well meant to me. I thought about the doctors, nurses, radiation therapists and others who took part in my treatment. I thought about Ellen Moore, who listened to a healthy-looking young woman’s assertion that a very small lump was of concern and took it seriously. I thought about Dr. Meyer (if someone has to tell you that you have cancer, it should be him – professional, knowledgeable, kind, gentle, matter-of-fact).

“Ultimately, I decided that Diagnosis Day was a day to give back to the people who helped me through that time. They gave me my life, and I was grateful,” she said.  “As a teacher, every once in a while you get a letter or email saying, “You made a difference in my life.” The idea for Diagnosis Day undoubtedly came from that – from how we feel when a former student lets us know that the work we do is worthwhile. I knew I didn’t choose cancer, but I knew I could choose some parts of the journey.”

But Jen did much more than this.  She acted on her thoughts of gratitude for the team that worked with her, and became an ambassador of hope.  On March 8, 2006 she baked heart-shaped, individual chocolate cakes for the women in the radiation waiting room and wrote a note saying she was healthy and well a year out and hoped the same for them.

“I also bought presents for Dr. Meyer, Ellen Moore, Dr. Shulman, nurse Anne Kelly, and my wonderful surgeon, Dr. Beth-Ann Lesnikoski (with whom discussing options like “lumpectomy or mastectomy?” could feel like a conversation over coffee with an old friend). With the presents went notes that thanked each for their contributions to my care.”

Each year since 2005, March 8 has been a day of gratitude and service. She says there is still an undertone of shakiness as the day approaches, but the day itself has transformed.

“I go to Dana-Farber with presents for my doctors, radiation therapists and nurses and bring a tray of goodies and a note to the women currently in radiation. On year five, I wrote notes to the people who helped me in myriad ways, for the colleague who saw me emerge from my office that night in 2005 and took over the play ushers for me, to the school nurse who kept my confidences and helped me manage day-to-day life at work, to the friends who rode with me even though my pace didn’t match their training plans, to my husband who stayed true and kind and loving throughout. Each year is a little different. Each year I think of who or what continues to resonate. One year it was the Dana-Farber parking attendants who got a big bag of organic lollipops; their smiles and help during treatment meant more than they’ll ever know.”

But what struck me about Jen’s inspirational story was the fact that much of the good feeling she generated in herself and others was actually part of well-documented research on gratitude.  Jen had attended one of my Power of Positive Being workshops where I discussed the research on the gratitude visit.  Jen’s intuition about how to turn D-day around mirrored what we know about outcome studies in gratitude.  She came up to me after the workshop at Kripalu, a spiritual retreat in Western Massachusetts and the largest residential facility for holistic education and well-being in North America, and related her story.

In part two, I’ll discuss the research on gratitude and how Jen intuitively followed all of the principles scientists have determined help improve our well-being.  But for now I just want to celebrate a woman with courage: The courage to heal, the courage to change, and the courage to be grateful.

With over 150 active military suicides so far in 2012, if you’re in the U.S. military, you’re more likely to have died by your own hand than you were to have died in combat.

This, then, is apparently not a good time to be in the military.

Farah Mohamed, writing for McClatchy Newspapers, has the story.

Panetta made his comments while he was dragged before Congress to discuss the military’s budget.

He made his comments in response to questioning by Senator Patty Murray, who chairs the Senate Veterans’ Affairs Committee. In Murray’s home state of Washington, over 100 soldiers have had their post-traumatic stress disorder (PTSD) diagnoses reversed — denying them benefits and access to mental health care at the VA:

Some patients in Madigan have complained that their diagnoses were lessened or altered in an effort to save money and meet Army cutbacks, Murray said. Others, according to Murray, were accused of exaggerating their conditions and subsequently denied proper medical care.

“You can’t imagine what it’s like to talk to a soldier who was told he had PTSD,” said Murray. “His family was working with him, and then when he went to the disability evaluation system, he was told he was a liar or malingerer. He was taken out of it and he went out in the civilian world not being treated. That’s a horrendous offense.”

Ouch.

The VA is, generally, a great system. Every American would benefit if they had access to the level of care we offer our veterans (shhh — yes, this is a form of socialized medicine, but don’t tell anyone).

The problem arises because each VA hospital and system is run somewhat independently — like little fiefdoms. This means that the care you get at one VA may not resemble the care you get at another. Some VAs have stricter criteria for getting a diagnosis, while others are more lax.

This creates a level of inconsistency in both care and benefits that vets pick up on, because they now communicate across state boundaries thanks to the many online vet communities that exist.

So Joe says, “Hey, I just got diagnosed with PTSD after expressing my fears of loud noises and flashbacks I’d been having after having been involved in that attack that happened outside of Kabul.” Then Henry replies, “Wow, I was in the same attack, and have similar symptoms, but they denied I had PTSD at my VA.”

Which, unfortunately, goes right to the heart of the matter of the wild inconsistency of mental disorder diagnoses across the board. Scientifically-speaking, the interrater reliability of these puppies just stinks. This is a real-world example of the consequences of poor diagnostic reliability across differing VA hospital systems.

There are no easy answers to the problem, since the problem exists not only at a VA system-wide scale, but also more deeply at the level of the mental disorder diagnostic system itself.

Because when you tie benefits to diagnoses, suddenly diagnoses mean a whole lot more to an individual.

Read the full article: Panetta: ‘Huge gaps’ in military’s review of mental health cases (sorry, a horrible ad-laden site, I know)

The girl, Isabella Brademeyer, had already successfully passed through the security checkpoint at the Wichita, Kansas airport. But then she went over to hug her grandmother — her grandmother — who was still being processed by the TSA. The TSA pulled the grandmother, Lori Croft, out for a pat-down because she apparently set off the metal detector.

But c’mon… the little girl? She’s 4. She didn’t know any better.

That set off a flurry of activity among the TSA agents, who then insisted that the 4-year old also needed to undergo a patdown. Again… because she hugged her grandmother.

This demonstrates that the TSA is, at least at some airports, lost all touch with reality and common sense. There’s a time for procedure, and there’s a time to allow some common sense to enter into your thinking. That’s why the TSA employs human beings — not automatons. To think. To use their experience and their common sense to understand that just because a 4-year old child hugs her grandmother, that’s not a justification for an additional pat-down.

We have to remember, even though most Americans have a healthy fear of the TSA — the TSA works for us. When the TSA abuses its authority in this sort of manner, it’s up to the American people to call for action.

Sadly, the TSA is apparently deaf when it comes to listening to the concerns the family raised at the checkpoint:

But she said the family’s main concern was the lack of understanding from TSA agents that they were dealing with a 4-year-old child, not a terror suspect.

“There was no common sense and there was no compassion,” Croft said. “That was our biggest fault with the whole thing — not that they are following security procedures, because I understand that they have to do that.” [...]

Croft said Brademeyer tried to no avail to get TSA agents to use a wand on the frightened girl or allow her to walk through the metal detector again. She also said TSA agents wanted to screen her granddaughter alone in a separate room.

The TSA’s response? F*** compassion and common sense, we have our procedures to follow:

The TSA released a statement Tuesday saying it explained to the family why additional security procedures were necessary and that agents didn’t suspect or suggest the child was carrying a firearm.

“TSA has reviewed the incident and determined that our officers followed proper screening procedures in conducting a modified pat-down on the child,” the agency said.

Of course they did. If the question was, “Did the TSA follow its procedures in this incident,” the answer is always going to be, “Yes, we did.”

But that wasn’t the question. The question asked was, “Are these TSA procedures appropriate for children of all ages? Does the TSA allow their human being agents to use their experience, judgment and good common sense to override the procedure in cases where any objective observer would agree it would be appropriate to do so?”

The TSA doesn’t answer those questions because the answer is obviously, “No, the TSA does not allow TSA agents to substitute their good judgment and common sense for the procedures.”

Psychological Trauma Induced by the TSA Procedures, Agents

The problem is, when you set up an unbreakable set of procedures like this that nobody can question or substitute their own good judgment for, you’ve also set yourself up for abuses of common sense such as this.

And, just for good measure, you’ve ensured at least one 4-year old child is going to spend the next few weeks re-living the trauma your agents helped not only induce, but kept fanning:

“She was kicking and screaming and fighting and in hysterics,” Croft said. “At that point my daughter ran up to her against TSA’s orders because she said, ‘My daughter is terrified, I can’t leave her.’” [...]

Croft said that for the first few nights after coming home, Isabelle had nightmares and talked about kidnappers. She said TSA agents had shouted at the girl, telling her to calm down and saying the suspect wasn’t cooperating.

“To a 4-year-old’s perspective that’s what it was to her because they didn’t explain anything and she did not know what was going on,” Croft said. “She saw people grabbing at her and raising their voices. To her, someone was trying to kidnap her or harm her in some way.”

The TSA should apologize for the way their agents acted in this incident, and reprimand the agents responsible. There is no excuse for putting a 4-year old child through the psychological trauma these agents put the girl through. None.

Young children who experience events such as this often have nightmares for days, and sometimes even weeks on end. Because there apparently was no TSA agent trained in child development or management issues, nobody apparently understood this was a child who was scared to death of the agents. The TSA agents apparently, instead, shouted at an emotionally-upset child to “calm down” — a strategy any parent knows is unlikely to be effective or helpful.

There has never been a single documented case of a 4-year old being involved in any terrorist activity, anywhere, much less on United States soil. There was zero likelihood or probability this child had any connection to anything linked to terrorism. Zero. Every agent there knew that.

The only reason the agents acted the way they did was because TSA procedures demanded they do it. The TSA apparently does not allow its agents to use their own judgment or common sense to countermand procedure. History is littered with cautionary tales on why is is never a good thing to put procedure above all else. Even the TSA manager who eventually came to the gate to help with the situation wasn’t empowered to do much about the procedure — he still had to insist the 4-year old be patted down. (I imagined he explained his actions, “Dem’s the rules, ma’am. Keeping us all safe from space aliens and 4-year old potential terrorists.”)

Despite the TSA’s faulty thinking, airports are not a police state where you must follow authority no matter what. I call on the TSA to allow their agents to use their own good judgment and common sense in future incidents like this involving young children. There’s no excuse for the TSA to act like its child citizens are putting anyone at risk when flying.

Read the Associated Press article on the incident: TSA defends pat-down of 4-year-old at Kan. airport

 “You have to make the mind run the body.”
~General George S. Patton Jr.

A recently published article in the Journal of Clinical Psychology by Kearney, McDermott, Malte, Martinez, and Simpson (2012) may have broad implications for veterans suffering with symptoms of Post-traumatic Stress Disorder (PTSD). 

These researchers demonstrated that engagement in mindfulness-based stress reduction (MBSR) showed significant improvements after six months in reducing soldiers’ symptoms of PTSD, depression, behavioral activation (the ability to engage in activities to achieve a goal in spite of aversive symptoms), and self-acceptance. 

Forty-seven percent of the veterans in the study showed clinically significant improvements in their PTSD symptoms. This highlights the fact that sustainable symptom reduction may be possible by employing a mindfulness technique. MBSR and other mindfulness-based meditation practices may provide broad-based ancillary interventions in the treatment of PTSD that can complement the current psychotherapeutic and pharmacological practices.

PTSD is a particularly nasty collection of symptoms.  Some of the more difficult indications include hyperarousal, rumination about the event, depression and anxiety. In addition to the study noted above, other researchers (Vujanovic, Niles, Pietrefesa, Schmertz, & Potter, 2011) have also found a link between mindfulness meditation and reduced PTSD symptoms in veterans.  In both studies it appears that accepting one’s emotional pain appears to actually help alleviate that pain.

This is good news for the toolbox needed to treat PTSD — because there is also evidence that being unable to accept and adequately regulate trauma-activated emotional responses may cause poor interpersonal relationships (Roth, Newman, Pelcovitz, ver der Kolk, & Mandel, 1997). In turn, poor relationships may make using the more traditional exposure-based treatments (such as desensitization) a risk for exacerbating symptoms (Cloitre, Koenen, Cohen, & Han, 2002).  What is valuable about mindfulness techniques is that they can be practiced independently after training.

Mindfulness meditation has largely been derived from Buddhist practices known as the eight-fold path.  Of the eight, mindfulness is specifically devoted to enhancing the ability to focus our attention. Developed to cope with human suffering, it involves a cultivation of private experiences with the aim of nurturing calmness.  The primary goal is to help achieve self-acceptance.  According to Pema Chodron (2001), an American Tibetan Buddhist nun (or Ani), there are four components of this self-acceptance: commitment; awareness; willingness to experience emotional distress; and attention to the present moment.

Over the years, a number of researchers have shown that meditation practices — including cultivating self–acceptance and the tolerance for emotionally distressing experiences — both reduce stress and increase well-being (Kabat-Zinn, 1990, 1994; Simpson, et al., 2007; Thompson, & Waltz, 2008; Smith, et al., 2011).  But the question has always been if these changes are sustainable.  At least one study has indicated that they are.

Researchers Michael A. Cohna and Barbara L. Fredrickson (2010) demonstrated that, after an initial meditation practice was introduced, subjects sustained positive experiences for fifteen months. Although veterans were not part of the investigation, this was one of the first studies to show a link between meditation and sustainable positive experiences.

Acceptance-based therapies such as mindfulness provide an alternative to traditional Western approaches for dealing with pain (Folette, Palm and Pearson, 2006).  As Ekman, Davidson, Ricard and Wallace (2005) have pointed out, mindfulness is used to tolerate emotional distress rather than to try to control or overcome negative feelings. In other words, trying to control or avoid negative emotions may not be the most effective way to manage them.

It also appears that mindfulness may facilitate resilience.  In another study, Jha, Stanley, Kiyonaga, Wong and Gelfand (2010) found that providing military personnel mindfulness training (MT) might help to guard against functional impairments in stressful contexts.

The more mindfulness meditation is researched, the more it appears to be able both to prevent and correct trauma, particularly for military veterans.

In the past few years the Army has invested in training soldiers to be psychologically as well as physically fit. The Master Resilience Training (MAT) program (Reivich, Seligman, & McBride, 2011) has a series of modules designed to help soldiers maximize their potential and cope with combat stressors.  Meditation is specifically identified as a technique to be taught as part of the larger resilience effort and part of Comprehensive Soldier Fitness program.

Self-acceptance through mindfulness meditation is an ancient tool that is needed now more than ever, but it is no easy task. In the words of Pema Chodron: “The most fundamental aggression to ourselves, the most fundamental harm we can do to ourselves, is to remain ignorant by not having the courage and the respect to look at ourselves honestly and gently.”

References
Chodron, P. (2001). The places that scare you: A guide to fearlessness in difficult times. Boston: Shambhala.

Ekman, P, Davidson, R. J., Ricard, M., & Wallace, B. A. (2005). Buddhist and psychological perspectives on emotional well-being. Current Directions in Psychological Science, 14(2), 59–63.

Follette, V., Palm, K. M., & Pearson, A. N. (2006). Mindfulness and trauma: Implications for treatment. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 24(1), 45-61.

Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life (1st ed.). New York: Hyperion.

Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. New York: Dell Publishing.

Kearney, D. J., McDermott, K., Malte, C., Martinez, M., & Simpson, T. L. (2012). Association of participation in a mindfulness program with measures of PTSD, depression and quality of life in a veteran sample.Journal of Clinical Psychology,

Roth, S., Newman, E., Pelcovitz, D., van der Kolk, B., & Mandel, D. (1997). Complex PTSD in victims exposed to physical and sexual abuse: Results from the DSM-IV field trial for posttraumatic stress disorder. Journal of Traumatic Stress, 10(4), 539–555.

Simpson, T., Kaysen, D., Bowen, S., MacPherson, L., Chawla, N., Blume, A., . . . Larimer, M. (2007). PTSD symptoms, substance use, and vipassana meditation among incarcerated individuals. Journal of Traumatic Stress, 20(3), 239-249.

Smith, B. W., Ortiz, J. A., Steffen, L. E., Tooley, E. M., Wiggins, K. T., Yeater, E. A., . . . Bernard, M. L. (2011). Mindfulness is associated with fewer PTSD symptoms, depressive symptoms, physical symptoms, and alcohol problems in urban firefighters.Journal of Consulting and Clinical Psychology, 79(5), 613.

Thompson, B. L., & Waltz, J. (2008). Self‐compassion and PTSD symptom severity.Journal of Traumatic Stress, 21(6), 556-558.

Vujanovic, A. A., Niles, B., Pietrefesa, A., Schmertz, S. K., & Potter, C. M. (2011). Mindfulness in the treatment of posttraumatic stress disorder among military veterans. Professional Psychology: Research and Practice, 42(1), 24.

This month we had the pleasure of speaking to EDMR creator Francine Shapiro, Ph.D., whose book, Getting Past Your Past: Take Control of Your Life with Self-Help Techniques from EMDR Therapy, was recently published.

In our interview, Shapiro shares more about the book along with how she discovered EMDR, how it works and the research that supports it.

Click through to read an excerpt from the interview.

1. How did you discover EMDR?

I discovered the effects of the eye movements that are now used in EMDR therapy one day as I was taking a walk. I noticed that disturbing thoughts I had been having had disappeared and when I brought them back they didn’t have the same “charge.” I was puzzled since I hadn’t done anything deliberately to deal with them.

So I started paying careful attention and noticed that when that kind of thought came up, my eyes started moving rapidly in a certain way and the thoughts shifted out of consciousness. When I brought them back they were less bothersome.

So, I started doing it deliberately and found the same results. Then I experimented with about 70 people. During that time I developed additional procedures to achieve consistent effects.

I tested the procedures in a randomized study that was published in the Journal of Traumatic Stress in 1989. Then I continued the development of the procedures and published a textbook on EMDR therapy in 1995.

2. Can you give us a glimpse into an EMDR session with a client with PTSD?

EMDR therapy is an eight-phase approach. It begins with a history-taking phase that identifies the current problems and the earlier experiences that have set the foundation for the different symptoms, and what is needed for a fulfilling future.

Then a preparation phase prepares the client for memory processing. The memory is accessed in a certain way and processing proceeds with the client attending briefly to different parts of the memory while the information processing system of the brain is stimulated.

Brief sets of eye movements, taps or tones are used (for approximately 30 seconds) during which time the brain makes the needed connections that transform the “stuck memory” into a learning experience and take it to an adaptive resolution. New emotions, thoughts and memories can emerge.

What is useful is learned, and what is now useless (the negative reactions, emotions and thoughts) is discarded. A rape victim, for example, may begin with feelings of shame and fear, but at the end of the session report: “The shame is his, not mine. I’m a strong resilient woman.”

Continue reading the interview in our library…

* By 2020, behavioral health disorders will surpass all physical diseases as a major cause of disability worldwide.

* Of the more than 6 million people served by state mental health authorities across the nation, only 21 percent are employed.

* More than half of adolescents in the United States who fail to complete high school have a diagnosable psychiatric disorder.

* Between 2009 and 2011 states cumulatively cut more than $1.8 billion from their budgets for services for children and adults living with mental illness.

* In 2009, there were an estimated 45.1 million adults aged 18 or older in the United States with any mental illness in the past year. This represents 19.9 percent of all adults in the U.S.

*Serious mental illnesses cost society $193.2 billion in lost earnings per year.

* The annual total estimated societal cost of substance abuse in the U.S. is $510 billion.

* In 2008, an estimated 9.8 million adults aged 18 and older in the U.S. has a serious mental illness.

With our economy still in the toilet, states and federal government threaten to cut even more dollars in mental health funding, which would result in less or no access to mental health treatment and services for countless Americans. Ultimately the cuts steal the one thing that keeps those of us struggling with chronic mood disorders alive: hope.

Yesterday a group of mental health advocacy organizations hosted a joint symposium titled “Mental Health Hope: Lost People, Lost Dollars, Lost Hope” at the Reserve Officers Association in Washington, D.C. to raise awareness about the imminent threat and impact of such budget cuts. Actress Glenn Close and her sister Jessie, former second lady Tipper Gore, and a handful of prominent doctors and directors of behavioral care centers addressed the symposium moderated by the award-winning journalist Cokie Roberts.

I very much wanted to be there to take notes myself — and to meet my best friends Glenn, Tipper, and Cokie for a cup of coffee — but ironically I couldn’t attend because I need to work so many hours at my day job in order to pay for my mental health care, most of which is not covered by my health insurance plan. Thus, this is an issue I feel very passionate about, and urge you to pay closer attention to yourselves.

“Too often policymakers only see the immediate savings of cutting budgets to mental health services,” said John M. Oldham, M.D., President of the American Psychiatric Association. “We want to emphasize that these programs are already providing significant savings within the health care system and in other sectors of society, by increasing employment and workplace productivity, and by decreasing homelessness, substance use, and overcrowding in emergency rooms.

Mark Covall, President and CEO of the National Association of Psychiatric Health Systems, added:

The work we have done to increase access and quality of care for those in need will be severely threatened without the resources to keep the programs going. We’re already struggling to deal with increased demand due to the down economy. If we see any further cutbacks, the result will be incredibly costly for the wider community.

Actress Glenn Close launched her anti-stigma campaign, Bring Change 2 Mind, to educate the public about mood disorders after watching her sister, Jessie, battle an undiagnosed bipolar disorder for years, and helping her nephew, Calen, who lives with schizoaffective disorder, get the care he needs.

“Access is critical,” Glenn wrote in an op-ed piece published yesterday on the website Politico.com, “because more of us are affected and in need of support than most people realize. Close to 60 million Americans live with a diagnosable mental illness, and one in four families has a relative living with mental illness”

For more information about the symposium, please visit: www.mentalhealthhope.com.

Meta-analyses are helpful to researchers, clinicians and laypeople alike, because they help distill the entire research literature on a specific topic into an easily digested summary.

In this research update, we look at cognitive behavioral therapy (CBT) for childhood posttraumatic stress disorder (PTSD), effective treatments for depression in a mother surrounding the birth of her child, and a look at anxiety symptom prevention with cognitive-behavioral interventions.

The first meta-analysis (Kowalik et al., 2011) looks at the world of childhood post-traumatic stress disorder (PTSD). According to the researchers, there is no clear “gold standard treatment for childhood posttraumatic stress disorder (PTSD).”

An annotated bibliography and meta-analysis were used to examine the efficacy of cognitive behavioral therapy (CBT) in the treatment of pediatric PTSD as measured by outcome data from the Child Behavior Checklist (CBCL).

The efficacy of CBT in the treatment of pediatric PTSD was supported by the annotated bibliography and meta-analysis, contributing to best practices data. CBT addressed internalizing signs and symptoms (as measured by the CBCL) such as anxiety and depression more robustly than it did externalizing symptoms such as aggression and rule-breaking behavior, consistent with its purpose as a therapeutic intervention.

In other words, cognitive behavioral therapy works for the treatment of childhood PTSD. It seemed to works best for anxiety and depression related to PTSD, rather than for symptoms like rule-breaking or aggression.

Next up, we have a look at perinatal depression. Perinatal depression encompasses a wide range of mood disorders that can affect a woman during pregnancy and after the birth of her child. It includes prenatal depression, the “baby blues,” postpartum depression and postpartum psychosis. Between 15 and 20 percent of all women experience some form of pregnancy related depression or anxiety.

Sockol et al. (2011) conducted a meta-analysis to determine the efficacy of pharmacologic and psychological interventions for treatment of perinatal depression.

The researchers found 27 research studies that looked at these kinds of treatments for perinatal depression, including open drug trials (n=9), quasi-randomized trials (n=2), and randomized controlled trials (n=16) assessing change from pretreatment to posttreatment or comparing these interventions to a control group.

What did they find?

There was significant improvement in depressive symptoms from pretreatment to posttreatment, with an uncontrolled overall effect size (Hedges’ g) of 1.61 after removal of outliers and correction for publication bias. Symptom levels at posttreatment were below cutoff levels indicative of clinically significant symptoms.

At posttreatment, intervention groups demonstrated significantly greater reductions in depressive symptoms compared to control groups, with an overall controlled effect size (Hedges’ g) of 0.65 after removal of outliers.

What was most effective? Well, the researchers found that individual psychotherapy was superior to group psychotherapy. In this meta-analysis, the researchers found that psychotherapy focused on interpersonal therapy interventions was more effective than interventions focused on cognitive-behavioral interventions.

Finally, we look at whether cognitive-behavioral therapy (CBT) helps in the prevention of anxiety symptoms. Zalta (2011) conducted a systematic review that identified 15 independent pretest-posttest randomized or quasi-randomized efficacy trials for analysis.

At posttest (the end of the research study), groups which had CBT treatment demonstrated significantly greater symptom reduction compared to control groups. (The researcher reported weighted mean effect sizes (Hedges’ g) of 0.25 for general anxiety, 0.24 for disorder-specific symptoms, and 0.22 for depression after the removal of outliers.)

But for some reason, the effects didn’t seem to last. They appeared to diminish over 6- and 12-month follow-up.

Further analyses indicated that individually administered media interventions were more effective than human-administered group interventions at preventing general anxiety and depression symptoms.

References

Kowalik J, Weller J, Venter J, Drachman D. (2011). Cognitive behavioral therapy for the treatment of pediatric posttraumatic stress disorder: a review and meta-analysis. J Behav Ther Exp Psychiatry, 42, 405-13.

Sockol, L.E., Epperson, C.N., Barber, J.P. (2011). A meta-analysis of treatments for perinatal depression. Clin Psychol Rev, 31, 839-49. doi: 10.1016/j.cpr.2011.03.009.

Zalta, A.K. (2011). A meta-analysis of anxiety symptom prevention with cognitive-behavioral interventions. J Anxiety Disord, 25, 749-60.

I mean, even those who claim they are normal may, in fact, be the most neurotic among us, swimming with a nice pair of scuba fins down the river of Denial. Having my psychiatric file published online and in print for public viewing, I get to hear my share of dirty secrets—weird obsessions, family dysfunction, or disguised addiction—that are kept concealed from everyone but a self-professed neurotic and maybe a shrink.

“Why are there so many disorders today?” Those seven words, or a variation of them, surface a few times a week. And my take on this query is so complex that, to avoid sounding like my grad school professors making an erudite case that fails to communicate anything to average folks like me, I often shrug my shoulders and move on to a conversation about dessert. Now that I can talk about all day.

Here’s the abridged edition of my guess as to why we mark up more pages of the DSM-IV today than, say, a century ago (even though the DSM-IV had yet to be born).

Most experts would agree with me that there is more stress today than in previous generations. Stress triggers depression and mood disorders, so that those who are predisposed to it by their creative wiring or genes are pretty much guaranteed some symptoms of depression at confusing and difficult times of their lives.

I think modern lifestyles — lack of community and family support, less exercise, no casual and unstructured technology-free play, less sunshine and more computer — factor into the equation. So does our diet. Hey, I know how I feel after a lunch of processed food, and I don’t need to the help of a nutritionist to spot the effect in my 8-year-old son.

Finally, let’s also throw in the toxins of our environment. Our fish are dying… a clue that our limbic systems (brain’s emotional center) are not so far behind.

Maybe the same amount of people have genes that predispose them to depression as in the Great Depression. But the lifestyle, toxins, and other challenges of today’s world tilts the stress scale in the favor of major depression, acute anxiety, and their many relatives.

Of course we can’t forget today’s technology and cutting-edge research of psychologists, neuroscientists, and psychiatrists. Because of medical devices that can scan our brains with impressive precision and the arduous work of scientific studies done in medical labs throughout the country, we know so much more about the brain, and its relationship with other biological systems within the human body: digestive, respiratory and circulatory, musculoskeletal, and nervous. All of that is a very good thing, as is knowledge and awareness.

A few years ago, psychiatrist and bestselling author Peter Kramer penned an interesting article for Psychology Today rebutting the claims of popular authors — spawning a new genre of psychological literature — that doctors are abusing their diagnostic powers, labeling boyishness as “ADHD,” normal sadness and grief as “major depression,” and shyness as “social phobia.” Because of their rushed schedules and some laziness, doctors are narrowing the spectrum of normal human emotion, slapping a diagnosis on all conditions and medicating people who would be better served with a little coaching, direction, and psychotherapy.

As I explained in my piece, “Are We Overmedicating? Or Is Our Health Care System Inadequate?,” I believe the problem is far more complicated than overmedication. I’d be more comfortable labeling it “really bad health care.” And if I had to pick a culprit, I’d point my finger at our health care insurance policies, not the doctors themselves. But I don’t even want to get into that, because it causes my blood pressure to rise and I’m trying really hard lately to live like a Buddhist monk.

What I liked about Kramer’s article is that he doesn’t deny that there are more diagnoses today, and yes, some people may feel the damaging effect of stigma. However, more often than not, diagnosis brings relief and treatment to a behavior, condition, or neurosis that would otherwise decay certain parts of a person’s life, especially his marriage and relationships with children, bosses, co-worker, and dare I say in-laws? Kramer writes:

Diagnosis, however loose, can bring relief, along with a plan for addressing the problem at hand. Parents who might have once thought of a child as slow or eccentric now see him as having dyslexia or Asperger’s syndrome—and then notice similar tendencies in themselves. But there’s no evidence that the proliferation of diagnoses has done harm to our identity. Is dyslexia worse than what it replaced: the accusation, say, that a child is stupid and lazy?

People afflicted by disabling panic or depression may fully embrace the disease model. A diagnosis can restore a sense of wholeness by naming, and confining, an ailment. That mood disorders are common and largely treatable makes them more acceptable; to suffer them is painful but not strange.

Then Kramer asks this question: What would it feel like to live in a world where practically no one was normal? Where few people are free from “psychological defect?” What if normalcy was a mere myth? He ends the article with this poignant paragraph:

We are used to the concept of medical shortcomings; we face disappointing realizations—that our triglyceride levels and our stress tolerance are not what we would wish. Normality may be a myth we have allowed ourselves to enjoy for decades, sacrificed now to the increasing recognition of differences. The awareness that we all bear flaw is humbling. But it could lead us to a new sense of inclusiveness and tolerance, recognition that imperfection is the condition of every life.

Amen to that.

We should do all that we can to ensure these folks come back to a country who welcomes them home, is thankful for their service, and provides them with all the necessary health and mental health care humanly possible. That’s our duty, as ordinary citizens, to recognize the sacrifice these men and women have made.

I’d also like to take a moment to recognize a number of organizations that were present this year at the 26th annual Rosalynn Carter Symposium on Mental Health Policy this year, who offer help and mental health services to returning veterans.

The first of these is Give an Hour, an organization begun in 2005 to help connect returning soldiers with needed mental health care within their community. Mental health professionals commit to donating one hour per week to help see a vet, at no cost to the veteran. It’s a simple idea that has made a very powerful impact.

Care for the Troops is dedicated to helping the mental health of returning soldiers and their families, through providing information and training to families and professionals about the unique issues and problems faced by military families.

The U.S. Department of Veterans Affairs has a whole host of suicide prevention programs, including the VA Ace card (PDF, modeled after the Army’s ACE card).

The purpose of ACE is to help Veterans, their family members and friends learn that they can take the necessary steps to get help. The acronym ACE (Ask, Care, Escort) summarizes the steps needed to take an active and valuable role in suicide prevention. The VA ACE Card is a pocket guide, supported by the VA ACE Brochure which provides more in depth information.

One of my favorite national organizations, the Depression and Bipolar Support Alliance (DBSA), offers a Peer Support Training for Veterans program, which helps people understand the recovery process. They’ve collaborated with over 14 VA facilities to help educate vets and clinicians, and have trained hundreds of veteran peers who learn the skills necessary to run effective support groups and programs in their communities.

Last, I have to mention Zero to Three, a nonprofit devoted to helping people understand the lives of infants and toddlers. They have some great resources focused on helping people understand the special needs of a military family in raising their very young children and infants.

Take a minute to learn more about each of these organizations, and support them in any way that you can.

Watch Wartorn on HBO Tonight

This Veterans Day, Thursday November 11, at 9:00 p.m., HBO will broadcast “Wartorn, 1861-2010,” a documentary about combat and post-traumatic stress, from the Civil War to today. Executive produced by James Gandolfini, the film chronicles the lingering effects of battle and PTSD on military personnel and their families throughout American history, bringing urgent attention to the invisible wounds of war.