Recently, the Chicago CBS affiliate interviewed her briefly for a story about the signs of suicide, after the suicide of Chicago school board president, Michael Scott. Scott was among officials subpoenaed this summer in a federal investigation of admissions practices at Chicago’s selective enrollment high schools. He also was the subject of a Chicago Tribune investigation into a land deal and his key role on Chicago’s Olympics committee. He was found dead on Monday by a self-inflicted gunshot wound.

This time of year, many of us will be gathering to give thanks for what we do have in our lives — family, friends, and the ability to try and provide a better world for our children, and our children’s children. Efforts like Kathryn’s give us all renewed hope, and I give thanks that folks like her are in the world, spreading the word about the significant impact depression and suicide have on so many.

Watch the video Suicides Can Come Without Warning (preceded by a 30 sec. commercial)

Learn more about the International Foundation for Research and Education on Depression (iFred)

(Full disclosure: I sit on iFred’s advisory board, and I lost my best friend to suicide in my first year of graduate school.)

I have a vivid memory of walking around the neighborhood with Mark’s brother at night. The adults were sitting shiva and he had to get away. Suddenly he grabbed a fallen branch and wailed it on the trunk of a tree. Raw anger.

This family did heal. Before support groups or national days of recognition they talked about the conflicting emotions pain, anger, guilt. The same tape kept playing in everyone’s head:
If only… If only… They used therapy, the love of family, friends and good works, to find their way through. They found a way to forgive. 

Today is National Survivors of Suicide Day. Around the country there will be gatherings, rallies for awareness and support.

If you suspect someone you care for is thinking of suicide tell them out loud that you are worried for them and ask if they have thought of harming themselves. Get over your fear of offending them and imagine if they are dead tomorrow, will you regret not asking? If the answer is yes, then follow the guidelines provided by the American Foundation for Suicide Prevention. You won’t regret it.

via WBFO Surviving After Suicide of Family Member

Quebec woman Nathalie Blanchard poses on the beach in a Facebook photograph that convinced her insurance company that she was no longer depressed.

Nathalie Blanchard, a 29-year-old IBM employee from Quebec, took a long-term sick leave from her job after being diagnosed with major depression. Her doctor told her to try & have fun, and to take a sunny vacation to get away from her problems. She did just that while she received monthly sick-leave benefits from Manulife.

And she posted her vacation photos on her private Facebook profile.

But recently, the monthly payments stopped. So, Blanchard contacted her insurance company to see why she was no longer receiving her benefits:

When Blanchard called Manulife, the company said that “I’m available to work, because of Facebook,” she told CBC News this week.

She said her insurance agent described several pictures Blanchard posted on the popular social networking site, including ones showing her having a good time at a Chippendales bar show, at her birthday party and on a sun holiday — evidence that she is no longer depressed, Manulife said.

But can a series of photographs really demonstrate that someone is no longer depressed?

Blanchard confirmed that she’s happy “in the moment” that the photo is taken, but “before and after, [she has] the same problems”.

According to CBC news, the insurer has confirmed that they do indeed use Facebook to investigate their clients, but the company claims that it wouldn’t “deny or terminate a valid claim solely based on information published on websites such as Facebook”.

Claude Distasio, a spokeswoman for the Canadian Life and Health Insurance Association, tells CBC News that insurance companies “must weigh information found on…sites” like Facebook.

But how much weight should something like a photograph taken in a sunny locale carry? I think it’s fairly obvious to say that even folks grappling with major depression smile once in awhile. Sure, I personally struggle with anxiety, but I’m calm sometimes — placid, in fact, if you catch me at the right time. People dealing with agoraphobia are probably going to find themselves out in public on a good day. Does a photograph of an agoraphobic in a public area demonstrate that agoraphobia is no longer a problem? How about a photo of an insomniac, sleeping soundly? Making mental health judgment calls based off a mere photograph — a single, isolated, and brief moment of time — is a slippery slope.

Take a look at your own Facebook profile picture. Does it accurately portray your mood at the moment it was taken? How about your long-term disposition? Look at it analytically from an outsider’s perspective. If you suffer from a mental illness, is there evidence of that illness in the photograph? Is a photograph a valid measure of anything other than a visual record of a moment?

In the past few days, Meagan had found it increasingly hard to fall asleep, and noticed that her appetite was poor. From time to time, she found herself weeping or sighing, but not knowing what to do. She wondered if “maybe having a few drinks” might do her some good.

Meagan (a composite character) has a number of risk factors for feeling down or depressed. First, women have rates of serious depression about twice those of men, and are also at higher risk for a particular type of major depression called Seasonal Affective Disorder (SAD). In addition, the combined stresses of holiday chores, child care, and financial woes put Megan at risk for what is popularly known as “the holiday blues.” So does Meagan’s “anniversary reaction” over the death of her mother. But what do we really know about the “holiday blues,” beyond hundreds of anecdotes and Internet postings? How do the “blues” differ from SAD and other forms of major depression? And is the commonly-held notion that suicide rates soar during the Christmas and winter holiday season really valid? Some recent research sheds light on these questions, while also highlighting many “grey areas” in our knowledge.

Let’s deal with the “Christmas suicide” story first. From all the data we have gathered in the U.S. and parts of Europe, we can say confidently that this is a myth. In fact, we have evidence going back to the 19th century that suicide rates generally decline in the late fall and winter months, and spike upward in late spring and summer. The precise reasons for this pattern are not known, but the finding is consistent across many studies. In fact, data from Zurich, Switzerland, show that suicide rates begin to fall as early as late November, and remain lower until just after New Year’s Eve. That’s the good news, and ought to allay fears that Christmas, Chanukkah, Kwanzaa or other winter celebrations are times of high suicide risk. The not-so-good news, however, is that suicide rates appear to spike upward after New Year’s Eve — largely among men. Rates for women seem to return to baseline, without a major spike.

There are two main hypotheses to explain these patterns. The “broken promises” hypothesis holds that, during the holiday season, people have very high expectations. Like Meagan, many view the holidays as a time to put things right, experience the joy of family and friends, and perhaps to experience some kind of spiritual renewal. Unfortunately, many are disappointed when these hopes are dashed — and some who become very despondent may take their lives. In contrast, the “withdrawn support” hypothesis begins with the observation that the winter holidays are usually a time of increased contact with family and friends. Social contact and support are known to protect against the risk of suicide. But after New Year’s Day, social supports usually diminish rapidly. This is what I call the “picking up the wrapping paper phase,” and it may be the time some very vulnerable individuals decide to take their own lives. Why does the post-holiday increase in suicides affect men more than women, at least in Switzerland? It may be partly because women are better than men at maintaining post-holiday social support networks, but this remains speculative.

With all the annual hoopla over the “holiday blues,” it is surprising that so little solid research has been done on it. There seems to be no specific definition of the term, and — so far as I can tell — there are no well-designed epidemiological studies of the phenomenon in the U.S. That said, Dr. Jennifer Wider reports that nearly two-thirds of women surveyed by the National Women’s Health Research Center reported feeling depressed during the previous year’s winter holidays. I’m not aware of comparable data for men. However, Dr. Wider observes that often, during the holidays, the burdens of family caretaking fall mainly on the shoulders of women. Increased alcohol use during the holidays, combined with family stressors, may set many women up for the holiday blues. Of course, men are hardly immune to this condition, and are at higher risk for completed suicide.

Psychologist Dr. Herbert Rappaport believes that those he calls “fixers” — individuals intent on “making everything right” during the holidays — are especially prone to grief reactions after Christmas and Chanukkah. Fortunately, the “holiday blues” are usually short-lived, lasting a few days or perhaps a week or two in most cases. This differs from SAD, which tends to last weeks or months, and reappears winter after winter, regardless of social stressors. SAD, which affects perhaps 10 percent of the population, may be related to decreased daylight in the winter months, which in turn may reduce mood-boosting brain chemicals like serotonin. SAD is often characterized by excessive daytime sleep, substantial weight gain, inability to function, and persistent thoughts of suicide. Unlike the “blues,” SAD and other types of major depression require professional intervention.

Preventing the holiday blues involves four main strategies: keeping expectations realistic; delegating responsibilities; shoring up social supports; and avoiding excessive alcohol consumption. More detailed advice is found in several of the articles listed below. Finally, another good strategy, according to Dr. Hinda Dubin of the University of Maryland Medical Center, is to find ways of helping those less fortunate than oneself. Taking the focus off your own problems and aiding somebody truly in need may be the best gift you’ll ever get during the holiday season!

For more information on coping with the “holiday blues,” see the following websites:

• Beating the Holiday Blues
• Managing the holiday blues
• Beating the Holiday Blues
• Nine Ways to Beat the Bah Humbugs
• Wrung-Out by Ringing-In the Holidays: Dealing with Post-Holiday Blues

So what does the Army do? Does it recognize the significance of this number with a solemn, sincere statement? No, instead it turns on the full denial PR machine:

“We are almost certainly going to end the year higher than last year,” General Peter Chiarelli, the Army’s vice chief of staff, told a Pentagon briefing.

“This is horrible, and I do not want to downplay the significance of these numbers in any way.” [...]

Chiarelli cautioned against generalizing about the causes of the suicides, or assuming links to combat stress on forces stretched thin by the wars in Iraq and Afghanistan.

So in one breath, General Chiarelli says he doesn’t want to downplay the significance of these numbers. In the next, he says we can’t generalize these numbers to any actual military combat missions that soldiers may be actively involved in. Huh?

With all due respect, perhaps General Chiarelli needs to take a course in logic or read more of the prior reports released about this increasing problem within the U.S. military. To not connect the dots between the never-ending wars in Iraq and Afghanistan (did no one study military history and the Russian invasion of Afghanistan?) is to be in a state of irrational and delusional denial. Sorry, General, but such statements make you sorely out of touch with your people and reality.

When you’re threatening court martial to moms who can’t find child care for their 10-month old before deployment and have psychiatrists shooting up your training bases because you don’t acknowledge the inherent conflicts in service amongst your ranks (or your officers don’t have the stomach to discharge someone they clearly saw as problematic), then yes, you have some serious problems. And yes, they are related to the two wars you are currently fighting.

As the article notes, the military’s suicide rate among active-duty soldiers was about 20 per 100,000, nearly double the national U.S. rate of 11.1 suicides per 100,000 people.

There is something significantly wrong there if twice as many people in your service are taking their own lives. This hasn’t always been the case. And rather than trying to whitewash the issue, you should be pulling out all the stops — and all significantly increasing the funding — to figure out how to stop the blood letting.

Read the full article: Army suicides set to hit new high in 2009

When I was nine, I figured that I was a young Christian mystic because I related much more to the saints who lived centuries ago than to other nine-year-old girls who had crushes on boys. I couldn’t understand how my sisters could waste quarters on a stupid video game when there were starving kids in Cambodia. Hello? Give them to UNICEF!

Now I look back with tenderness to the hurting girl I was and wished somebody had been able to recognize that I was very depressed.

Not that I would have accepted the help. I believed, along with all the other adults in my life, that my melancholy and sensitivity were part of my “special” make-up, that they were gifts to celebrate, not neuroses to treat. And should I take meds that helped me laugh and play and design cool barrettes like the other girls, well, then I would lose my depth.

On the PBS website “This Emotional Life”–a multi-platform project centered on a three-part series documentary to be broadcast in early 2010 hosted by Harvard psychologist and bestselling author Daniel Gilbert–psychologist Paula Bloom discusses the topic of being deep versus being depressed. On her blog post “Am I Depressed or Just Deep?,” she writes:

Sometimes, people confuse being depressed with being philosophical. If I had a dollar (well, maybe $2) for every time I hear “I am not depressed, I am just realistic”, “Anyone who isn’t depressed isn’t paying attention”, or “Life has no meaning and I am going to die, how can I be happy?” I could likely support a hardcore latte habit. Depression can have such an effect on your worldview.

There are a few basic existential realities we all confront: mortality, aloneness and meaninglessness. Most people are aware of these things. A friend dies suddenly, a coworker commits suicide or some planes fly into tall buildings-these events shake most of us up and remind of us of the basic realities. We deal, we grieve, we hold our kids tighter, remind ourselves that life is short and therefore to be enjoyed, and then we move on. Persistently not being able to put the existential realities aside to live and enjoy life, engage those around us or take care of ourselves just might be a sign of depression.



We all get sad sometimes, struggle to fall asleep, lose our appetite or have a hard time focusing. Does this mean we are depressed? Not necessarily. So how do you know the difference? The answer, as with most psychological diagnoses comes down to one word: functioning. How are you sleeping and eating? Are you isolating yourself from others? Have you stopped enjoying the things you used to enjoy? Difficulty focusing and concentrating? Irritable? Tired? Lack of motivation? Do you feel hopeless? Feel excessively guilty or worthless? Experiencing some of these things may be a sign of depression.

Peter Kramer, clinical professor of psychiatry at Brown University, devotes an entire book to this question. He wrote “Against Depression” in response to his frustration of repeatedly being asked the same question: “What if Prozac had been available in van Gogh’s time?”

In a New York Times essay, “There’s Nothing Deep About Depression,” which was adapted from “Against Depression,” Kramer writes:

Depression is not a perspective. It is a disease. Resisting that claim, we may ask: Seeing cruelty, suffering and death — shouldn’t a person be depressed? There are circumstances, like the Holocaust, in which depression might seem justified for every victim or observer. Awareness of the ubiquity of horror is the modern condition, our condition.

But then, depression is not universal, even in terrible times. Though prone to mood disorder, the great Italian writer Primo Levi was not depressed in his months at Auschwitz. I have treated a handful of patients who survived horrors arising from war or political repression. They came to depression years after enduring extreme privation. Typically, such a person will say: ”I don’t understand it. I went through — ” and here he will name one of the shameful events of our time. ”I lived through that, and in all those months, I never felt this.” This refers to the relentless bleakness of depression, the self as hollow shell. To see the worst things a person can see is one experience; to suffer mood disorder is another. It is depression — and not resistance to it or recovery from it — that diminishes the self.

Beset by great evil, a person can be wise, observant and disillusioned and yet not depressed. Resilience confers its own measure of insight. We should have no trouble admiring what we do admire — depth, complexity, aesthetic brilliance — and standing foursquare against depression. 

Kramer’s words are consoling to a depressive who spends 90 percent of her energy a day combating thoughts saying she is depressed because she lacks the stamina to be optimistic. In fact, the first time I read Kramer, I experienced profound relief. However, I still maintain that some of my depth caused by depression is a good thing. Not on the days where I’m in excruciating pain, of course. But should I have been one of those nine-year-olds who got excited about which color ribbon I could use to make my barrettes and wasted her quarters on Pacman … well, I wouldn’t be writing this blog.

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

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

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

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

During a long period of their growing years, I was suffering from major depression. My therapist encouraged me to find some work outside the home. He was aware how much emphasis and identity I had tied up in motherhood, and how deeply depressed I was. I totally rebelled because raising my children was my first responsibility. But an opportunity came my way that would allow me to use my musical talent one day a week at a school. For some reason, I agreed to do it. Later it went to two days, then three. I finally decided to return to college and finish my degree while still teaching three days a week. By that time, only my son was still at home. He found he loved karate so my husband and I juggled our schedules so that he would never come home to an empty house.

Gradually, and as my children needed me to step back from hands-on mothering, I found myself gaining a lot of satisfaction in my new life as a teacher. My children were proud of me, and were a very boisterous cheering section at my graduation.

Now my husband is on the road for weeks at a time, so my nest is really empty. I am happy that I started building for the future before the nest started emptying. My vow had been to be a stay at home mom like mine had been. But I now see how important it was to anticipate the changes that were inevitably in my future.

My suggestion to any woman currently suffering separation depression and loss of identity, is to remember that you have years ahead of you that can be quite fulfilling. After menopause, the energy that our bodies put into reproduction each month is over, and we often gain a new burst of it. I went back to college at age 50 and thoroughly enjoyed the challenge and the sense of accomplishment that earning my degree gave me. Also remember, that while your children have moved away to develop their own identity, they will eventually move back toward you, albeit in a new relationship. They will live on their own, but have a new appreciation for you, as you will for them.

Look at the skills that you developed and practiced as a mother and pick the brains of your friends for ways to incorporate them into a new life. It seems scary to step outside your comfort zone, but it is something that everyone has to do if they are to grow and find satisfaction in life.

Change is daunting for almost everyone. We like things to be familiar and easy to understand. Sometimes all we need is a bit of reassurance that someone else has been in our shoes, and managed to walk in them.

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

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

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

1. My past doesn’t dictate my future.

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

2. All things pass.

NOTHING is forever … which is a shame on the good days, but a lovely thing on the bad days. Moreover, this too shall pass. Everything does. Even the ice-cream truck in the summer. One minute it’s there, and then, bam! Gone to the next neighborhood. So much for the Klondike bars.

3. I will be okay.

Even if I do get sucked up right back into the Black Hole, I will survive it. I have before. I can rely on the reserves of strength and wisdom that got me out of there before (that is, in addition to some medication, in my case).

4. Have a plan.

Sometimes it helps to jot down some specific steps to take if you’ve just cried yourself through two boxes of Kleenex. A friend of mine knows it’s time to see her shrink when she doesn’t get out of bed for three days. My kids don’t really leave me that option, so my requirements are different: by the third day of crying incessantly I make an appointment to see Dr. Smith.

5. Be prepared.

You might not ever have a relapse. I hope you don’t. But if you suffer from chronic, and especially treatment-resistant depression, you can count on a few in your future. So be ready for the hurricane. For example, I always like to have at least two weeks worth of blogs uploaded in the blogging software that I can use in the event of a relapse. Some weeks I’m simply more productive than others, so I try to be like a communist country and even things out a little bit … taking the energy from the good weeks, and using them for the “my brain is a big fart” cycles.

What about you? How do you keep yourself from worrying about a relapse? Do you prepare yourself for one?

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

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

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

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

There are three reasonable explanations for this finding. The one the researchers believe is that what you eat can directly impact your mood over the long run. Another explanation is that people who are more prone to depression live a kind of lifestyle where eating processed food is a normal part of it (think of a person who is harried and stressed out and doesn’t know how to manage stressors in their life very well). “Physical activity” and education don’t really rule out the possibility of the second explanation.

And the third explanation is that people with depression eat less healthily. That also seems like a reasonable explanation for this finding. The news article doesn’t say whether they assessed depression at the onset of the study (which seems like a pretty reasonable thing to have done).

Honestly, I’m not sure eating more healthy is going to directly impact your mood. It will, however, impact your overall general health, which does have an impact on your mood. So even if it’s not a direct relationship, it’s something to think about next time you find yourself stopping into McDonald’s for the 5th time this month (or week!).

Read the full article: Depression link to processed food

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

Michelle: Here they are …

1. Compare yourself to others.

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

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

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

2. Use the 10-Year Question.

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

In the extremely rare cases where you answer “yes” and “yes,” go ahead and give the doing or fixing your best effort, and then move on. Most of the time, though, this little thought exercise will help dissolve your worry, or at least shrink it down to a more manageable size.

3. Take some time out.

Perfectionists overcommit–to others and to themselves. See if you can find a way out of an upcoming obligation (or two, or three) that you don’t really want to do but think you “should.” Also, look at your own to-do list and see what you can defer for now, or even take off your list entirely. To get my post on this, click here.

Now don’t just fill up this time with other stuff. There will always be more stuff. Allow it to be “white time” (analogous to white space) during which you have absolutely no agenda. Do whatever your body and spirit want–take a nap, go somewhere for a change of scenery, stretch, dance, meditate, walk on grass, finger-paint.

Perfectionism stems from an overly self-critical mind. Give your mind a break and let it rest. Nurture the other parts of you — they deserve it. Gradually, your mind will learn that the world doesn’t end if you leave it to itself for a little while.

4. Take one tiny but direct step.

It seems counterintuitive, but there’s a direct link between perfectionism and procrastination. You’d think perfectionists would want everything done neatly, thoroughly and on time, right? Instead, we often feel such pressure to do things perfectly that we overwhelm ourselves before we even start. Then we keep ourselves occupied with a million other things so that we always have a handy excuse for why we’re not doing Whatever It Is.

Try picking one very tiny thing and just doing it. Make the thing so small that it doesn’t intimidate you. But make sure it points directly toward something you want. Don’t browse the Internet for workout shoes–go outside and walk around the block. Just once. But do it. A single baby step is worth more than any amount of beating yourself up over not taking any action.

5. Ask yourself what you’d say to a friend.

I have a friend who calls me on this whenever she observes me going into overdrive. “If I were handling everything you are right now,” she asks me, “and I started criticizing you the way you’re criticizing yourself, would you stand there and take it? Or would you tell me to go fly a kite?” (pregnant pause) “Then why do you let you talk to yourself that way?”

It’s a good question, isn’t it?

Therese: What is your biggest obstacle in “practicing imperfection”? How do you get around it?

Michelle: I’m hyper-organized (is there a medical diagnosis for that? oh, yeah, OCD) and a diehard tweaker of systems. I can spend hours and hours searching for the “perfect” planner and then customizing it for every possible contingency, but then never actually using it.

I also seem to have this need to “clear the decks” before starting on major projects. So no, I can’t possibly track my finances until I have all my stray papers filed so I can find them, which means going through the box of papers in the corner, which means pruning my file cabinet of outdated material to make room for the new, which means getting some WD-40 to fix the drawer because it’s almost stuck shut, which means a trip to . . . etc., etc.

One of my newest mantras has become “Just start somewhere.” I’ve realized (verrrry grudgingly) that the inbox of my life will never be empty. Things will never coalesce into a perfect starting point with neatly squared corners and no loose ends. So I continue giving myself pep talks about this. And slowly, very slowly, I’m noticing how small steps really do have a cumulative effect over time. That not everything has to be exactly the way I’d like it for me to experience progress.

My blog is a great example. I’ve never done anything like it before, and I’m completely intimidated by the technical aspects of it. I also wanted to have something like 20 posts in the hopper before I even launched, because I was afraid of getting writer’s block. But in April of this year I enlisted the help of some friends to set up the site, and just started writing.

Does the website look and function exactly the way I want it to? Nope. Are there sections I need to complete, or even create? Absolutely. Can I afford a professional site design at this point? Hah! But I didn’t let any of that keep me from starting, and I’m learning as I go. I’ve made some great online friends and received helpful feedback and advice, none of which would have happened if I hadn’t plunged in the deep end and just started somewhere. And I’m having fun!

So, in the spirit of October, I present to you (maybe Pfizer will pay me millions to write their next commercial?) … Depression Is Like a Pumpkin. Click through to view the video…

For decades, economists did not find much merit in connecting psychology with finance. That changed when a young economics professor from the University of Chicago, Richard Thaler, introduced himself to two Israeli psychologists, Daniel Kahneman and Amos Tversky. Together they are credited with founding behavioral economics.

Behavioral economics, and its close cousin, neuroeconomics, combines the disciplines of neuroscience, economics, and psychology to study how people make financial decisions.

Using Psychology to Save You From Yourself, an National Public Radio podcast, explains the origins and development of behavioral economics. Kahneman, a 2002 Nobel Prize laureate for economics, studied what he called “the illusion of validity,” i.e. our judgment can be very wrong even though we are the last to acknowledge it.

For example, when a prospective employer is considering a candidate for a job they often weigh the job interview the heaviest in their decision making, a choice proven over and over again to be a mistake. Twice I hired people primarily on the basis of an impressive interview, only to let them go during the probationary period. Another time (after being burned) I hired the second runner up because her experience and credentials were the best. That person turned out to be golden.

Kahneman and Tversky pointed out lots of other errors humans commonly make in decision making, explaining why we can so easily be sucked in by clever marketing or most insidiously, credit card merchants. I found it fascinating to read their explanation of “anchoring bias”:

It turns out that whenever you are exposed to a number, you are influenced by that number whether you intend to be influenced or not.

This is why, for example, the minimum payments suggested on your credit card bill tend to be low. That number frames your expectation, so you pay less of the bill than you might otherwise, your interest continues to grow, and your credit card company makes more money than if you had not had your expectations influenced by the low number.

Boy, does that make me feel silly. Every single time I pay my credit card bill, I have to remind myself that it’s best to pay as much of the whole thing as I can, asap. But like bitter medicine I’d rather not and that low number beckons.

In the 1980’s Thaler, Kahneman and Tversky:

…began to publish their ideas — an integration of psychological research and economics with this new flawed decision-maker at the center. But initially, mainstream economists largely rejected the work.

The main point of contention, says Thaler, was the suggestion that humans are less than perfectly rational when it comes to decision-making. For the majority of the 20th century, and for the most part even today, the human beings imagined by economists and placed at the center of their economic models have had a Spock-like rationality.

Well, I’ve always loved Mr. Spock but for better or worse, most of us are more like the flawed, romantic, all too human, Kirk.

What can we do to regain trust in our financial decision-making ability?

> One thing is to address our anxiety so that we’re using our higher brain to think and not letting the overly excitable reptilian brain rule.

> If you know it’s best to save a certain amount from your paycheck, set up an automatic deposit to go to a savings account. That way the decision is made once and you don’t have to convince yourself over and over, every single month.

> Knowing that it’s possible your first instincts may be wrong, like deciding to sell your stock at the bottom of a recession, it’s a good idea to get a second opinion; preferably from an expert, like from a certified financial planner.

Photo courtesy of bitzcelt via Flickr

Ever since I was discharged from the inpatient psychiatric program at Johns Hopkins, I have kept a mood journal where I daily record the amount of hours I sleep, my mood (rating it a fantastic and serene no. 1 to a frazzled, and I’m-headed-back-to-the-community-room no. 5), any foods that have triggered hyperactivity or irritability (such as a triple espresso and half of a chocolate-mousse pie), my anxiety level, any medication and vitamin/supplement changes, and a list of things I’m obsessing about: weight, job, friends, sisters, yada yada yada.

My journal looks like my house: messy … dangerously messy. I scribble something down and then Katherine gets a hold of the pad and draws a mermaid, or a big X through the object of obsession. In other words: it’s not a good system. Not at all. And it can’t really do the job of picking up patterns in order predict relapses. The information is too unorganized for that.

So ….

I decided to try the Optimism Software that my blogging buddy James Bishop has designed. Keep in mind that I am a technological moron, and had to ask him about 10 times how to download it. (If I can do it, you can definitely do it.) But after it was on my desktop and I could open it and start inputting my dysfunctional habits, I decided he was a genius.

Because it is much more than a software.

It’s a way of making you a more active part of your recovery.

For example, in that last month I’ve been using the software, I have become more disciplined about my sleep hygiene. I go to bed at 9:30 every night, and I get up at 5:30 in the morning. Knowing that I have to track my sleep in Optimism makes me less apt to act on the “This is brilliant! Let’s stay up all night!” thoughts that come in right as I’m about to shut down for the night.

I’m also more aware of the contents that I put into my mouth. I wouldn’t go so far as to say that James’s software makes me eat better. (He would be very wealthy if this was the case.) But knowing that I have to record the items that tease my mood (pancakes with lots of maple syrup, double chocolate-chip cookies, mochas, fruit pops) make me more aware of the connection between the two (cookies and mood). And, I’m thinking that this awareness will eventually translate into more will power. At least that’s the plan.

The act of recording your diet, sleep, exercise, and stressors makes you more accountable. James writes:

Optimism prompts you to keep a detailed record of all things that affect your state of mind. By monitoring patterns in your life you can identify negative influences that you need to avoid, early warning signs that your health is deteriorating, and the inputs and activities that benefit you most. Simple charts highlight cause and effect relationships that you might normally miss, and you can develop a Health Plan to follow and update as you learn more about the things that positively and negatively affect you.

Go to FindingOptimism.com to find out more or to download a free trial.

I should also note that Optimism is now available in an online-version as well, and they are working on an iPhone version too for your mobile phone.

Optimism is “an action plan” for your mental health — it can be just the thing you might need to help keep you going toward your goals in therapy, life, or just changing behaviors or habits that are no longer working for you.

The best way to try out Optimism to see if it holds any value for you is to download the free 7-day trial and commit to using it during those 7 days. You may be surprised that such a simple idea can translate into such a big deal in your life!

-Dr. John Grohol

Glenn has launched a nonprofit organization called BringChange2Mind, which she hopes will raise awareness about mental illness, strip mood disorders like bipolar disorder and schizophrenia from their unfair stigma, and lend support and information to the mentally ill and their families.

Katie Escherich of ABC News writes:

Jessie, the youngest of the four Close siblings, was diagnosed with bipolar disorder nine years ago at the age of 47, “after living with it probably her whole life,” said her sister. Bipolar disorder affects some 5.7 million American adults, according to the National Institute of Mental Health.

The actress said her sister was always a “wild child,” and Jessie now says she knew for most of her life that something was wrong. Both sisters said a lack of understanding of mental illness when they were growing up played a part in Jessie’s delayed diagnosis.

“You don’t talk about depression or alcoholism or mental illness. …I think that’s probably true in a lot of families,” her sister said. “We didn’t have the vocabulary, we didn’t have the knowledge.”

With medication, Jessie Close’s symptoms have been brought under control, and family members realize how fortunate it is that they can afford good care. She has experienced side effects, including fatigue and weight gain, and finding a balance between staying stable and staying creative took time. Jessie, a writer, said, “It’s worth it.”

“We’re getting more and more sophisticated medication,” Glenn Close said. “We need to keep people with mental illness living full and productive and creative lives.”

Go check out BringChange2Mind.org!

And a humongous hug to Glenn Close!!!

The Australian National University’s Centre for Mental Health Research is one of the unsung heroes in the development and research of programs to treat depression online, for both adults and teens. What they have done over the past decade is not exactly rocket science, and yet, surprisingly, most people have never heard of one of their free online programs. They’ve taken cognitive behavioral theories and techniques and translated them into online tutorials and programs. Then they did something a lot of organizations (and virtually all companies) fail to do — they did solid, randomized controlled trials to show their designed interventions work.

Their simplest intervention is an educational website about depression called BluePages. Yes, it offers the usual array of information about depression symptoms and treatments, but they’ve gone a step further and provided an evaluation of what treatments work for depression by evaluating the clinical research. Most interesting is that the BluePages website itself has clinical evidence backing its usefulness.

A more involved intervention offered by the same researchers from the CMHR is the MoodGYM training program. This is a web-based, self-guided program based upon cognitive-behavioral and interpersonal therapy techniques that is intended to help people with depression. MoodGYM is comprised of 6 modules.

We’ve mentioned MoodGYM previously in relationship to another online depression program and reported on the previous research about MoodGYM. MoodGYM has eight published research citations (some of which are noted in the references to this entry), and a few of them are randomized controlled trials.

MoodGYM is not for the faint of heart, however. In many ways, it is just as in-depth as a face-to-face clinical intervention and therefore takes nearly as much time and effort. And that’s one of its drawbacks — few people stick with the program to fully benefit from its positive effects. Despite this challenge, over 34,000 people visit MoodGYM every month and they have over 200,000 registered users. MoodGYM is reaching a lot of depressed people who want help for their depression, but can’t (or won’t) see a professional for it.

Another self-help program presented at the e-Mental Health Summit 2009 was Beating the Blues, a UK-based program composed of 8, 50-minute weekly sessions conducted on a computer or online. This program is available for free to most people living in the UK; it’s meant to be “prescribed” by a general practitioner. In the early research data presented at the conference, for those who completed the program, researchers saw a decrease of approximately 50 percent in patients’ outcome measure scores — they got significantly, clinically better after completing the program.

The Beating the Blues program suffered from the same problem that seems to plague all self-help programs — poor followup and completion by participants. Out of the people referred to the program in the research discussed by Kate Cavanagh of Newcastle University, only about 37 percent actually completed it. This leaves a lot of room for improvement for non-completers.

As Helen Christensen, the Director of the Australian National University’s Centre for Mental Health Research noted in her presentation to the conference, web-based interventions are attractive for many reasons. Their costs actually decline the more we can get people to use them, which is one of the few treatment interventions that can be said for. They are easy to make available and administer to the entire population, and they don’t require a professional’s oversight in a one-on-one environment.

She also mentioned a few ways of combating the drop-out problem in these programs. One is to start designing online interventions that are tailored for the individual. For instance, a teen might see a more entertainment-oriented, video-based program while an older adult might be more comfortable with text-based images and information. Voluntary reminders administered via your mobile phone, Twitter, Facebook or email might also be helpful. Incentives for completing major steps in the program — for instance, each module in the MoodGYM — might also help drive a person to finish the intervention.

I’ve touched upon only a few of the online depression interventions now available presented at the conference (another self-help program for the Netherlands was called Colour Your Life). The key point is that there are many of these kinds of online interventions available that directly treat mild to moderate depression — the most common form of depression that affects the greatest amount of people. If you’re suffering from depression, I encourage you to try out one of these free online depression programs. Help may be, literally, just a click away.

References:

Cavanagh, K.; Shapiro, D. A.; Van Den Berg, S.; Swain, S.; Barkham, M. & Proudfoot, J. (2006). The effectiveness of computerized cognitive behavioural therapy in routine care. British Journal of Clinical Psychology, 45(4), 499-514.

Griffiths, K.M. & Christensen, H. (2007). Internet-based mental health programs: A powerful tool in the rural medical kit. The Australian Journal of Rural Health, 15(2), 81-87.

Griffiths, K.M. Christensen, H. Jorm, A.F., Evans, K. & Groves, C. (2004). Effect of web-based depression literacy and cognitive-behavioural therapy interventions on stigmatising attitudes to depression: Randomised controlled trial. British Journal of Psychiatry, 185(4), 342-349.

O’Kearney, R., Kang, K., Christensen, H. & Griffiths, K. (2009). A controlled trial of a school-based Internet program for reducing depressive symptoms in adolescent girls. Depression and Anxiety, 26(1), 65-72.