Tag Archives: research

digging for a voice: reflections

a few reflections on the essay on women philosophers in the last post.

one of the things i got from that course in women’s studies is a bit of a background in and also support for the concept of writing in and from the first voice, in writing from and about the particular: “what i do and think is really all i can know.” today i would add to that: “and what i feel.” i had a somewhat ambiguous relationship with feelings back then …

the idea that everything is autobiographical, as freud said, and that hence everything that is not autobiograpical is plagiarism (as almodovar said) is something that has become stronger with me over the years. i am, for example, continuously astonished how the novel i am slowly working on, which ostensibly plays in 18th and 19th century louisiana and west africa as well as present-day louisiana, keeps experiencing eruptions of my history, often in completely unconscious detail, even though those times and places are not ones that i inhabit.

i hadn’t made the connection until now but i think that this essay directly influenced two later papers, the psychotherapist in context: how the therapist’s personal life, roles and social context influence therapy, and research at the edge of awareness: the person of the researcher and nonrational aspects of qualitative research. both spring from the feminist point of view that we disregard the personal aspects of our work at our own peril.

a big challenge is how to take this autobiographical stance and not turn it into a self-obsessed, navel-gazing activity. humility seems to be fence that – hopefully – keeps me from falling into the abyss of narcissism. it’s not “i can only speak for myself so that’s all i’m interested in” but “i am the only person of whom i have true authority to speak.”

searching for my voice, investigating other women’s voices, has been, in part, a very private enterprise. in other ways, however, i also hope that my words can be companions to those of [others] … even though it seems that there are similarities between me and other people … i cannot presume to speak for them. i can only speak for myself, speak to them and sometimes maybe even with them. i can only say: this is my experience; and if yours is similar, let’s have them stand side by side and reinforce each other.

this really struck me. because this is so much about blogging. (again i’m wondering, was this essay the seed from which sprang my presentation at mental health camp, blogging yourself home?)

i cannot presume to speak for others. for example, colleen, tre tre and anastasia can speak for themselves quite well, as you can see.

but i as a blogger, i can speak TO them and comment – at nancy’s and her friends’ blog, for example, or marcella’s, or zee’s.

and sometimes we can speak and work together, like with catatonic kid , jeremy and john.

there’s more material in that essay – i’d really like to explore some more the significance of letting our voice out – but i’ll leave that for another post.

blogging yourself home – part 2

in my last MentalHealthCamp post, we started talking about what the word “home” means to us. the wordle image here illustrates what some of the commenters in that post said, as well as what was mentioned during the workshop at MentalHealthCamp.

what happens when you are in this good home, and you’re going through a phase when you don’t feel so good – and that can mean anything, from the blahs to an acute psychotic episode?

i’d like to tell you a bit about what leon tan says – on twitter, his name is @hyblis – who wrote a very good case history on myspace and blogging as self therapy.

it’s a study of someone he calls “jenny”, who used blogging first to come to terms with a difficult relationship and then after the breakup, with the suicide of her ex boyfriend.

“the internet provided a sort of safehouse from where i could speak freely for the first time” so perhaps here we have the notion of the good home as a safehouse

blogging as being home – general

  • writing is our cultural medium, quoting gillie bolton (i’d like to add that for many of us, the written word itself is “home”)
  • a blog has 24/7 availability
  • a blog is a storeroom of history, just like a home is

home – community

  • blogging is part of a progressively unfolding mixed reality social ecology – what we were doing at MentalHealthCamp, where virtual contacts met face-to-face, was a good example of this
  • blogging includes personal videos, lists of personal movies, music, books, images, songs, poetry, etc. – like the things you would have in your home; and people who feel attracted to them are people you can be at home with. this is part of a promise of listening, empathy, understanding and belonging to a wider community

home – community – people you are at home with

  • people who say “i get so what you mean”
  • people with whom you can exchange understanding, validation, support, encouragement, people with whom you can rehearse new ways of communicating
  • all things you would get from a therapist but the reciprocity would be much lower
  • reciprocity is one of our deepest needs, and something that is often lacking when someone has a diagnosis of mental illness
  • substantial and longer lasting that a psychotherapeutic relationship, which ends at treatment termination

therapeutic aspects

  • it would be silly to say that blogging can completely replace face to face therapy; just like it would be silly to say that virtual friends can completely replace friends in flesh and blood
  • but blogging, and particularly blogging as writing, is a therapeutic tool that can be used very effectively
  • blogging can help a person gain or regain confidence and trust
  • blogging as writing can be a form of catharsis, a safe re-experiencing and cleansing of deep and often traumatic emotions
  • peers replaced the clinician in giving guidance and inspiration and helping choosing topics for writing

i realize that what i have been saying so far is looking at blogging through rose-coloured glasses. i don’t want to deny the fact that the blogging community can also be difficult – in fact, one of our presenters, terra, talks about that – but for the purpose of this presentation, i’d like us to focus on what we each individually and as a group can do to make our blogs and our blogging community a good home.

once we have a good home, a home that is comfortable, relaxed, safe, a home rich in history and treasures, a home in which we are anchored, then we can launch ourselves, just like jenny did.

at this point in the workshop, i said that i wanted to open this up for discussion in a short while. before we did that, however, i gave participants a moment of reflection – i think reflection is very important both for creative writing and for our mental health – and invited them to do a bit of reflective writing, or maybe we should call it imaginative writing.

so i’d like to do this here, too. write a paragraph or two about mental health. maybe you already know what you want to write, and if not, here are some ideas. you can write your reflections wherever you wish – but of course i’d be delighted if you added it as a comment or even blogged about it. here are some ideas:

  • a good home, a good community is a place where everyone is accepted, “no-one is left behind.” what does a community look like when it is free of stigma?
  • if you wrote a completely anonymous blog, what would you write about? what risks would you take?
  • if mental illness was a treasure chest not a burden, how would you describe the treasures?
  • create a friendly conversation with a mental illness – depression, anxiety, bipolar, etc.
  • if you had all the time and money in the world, how would you contribute to your community – online and/or offline?

addiction, genetics and early brain development

image of a fetus.  what is its brain development?in a comment yesterday on my article on some research on adult children of alcoholics, CP stressed the importance of genetics in alcoholism.

i would like to contrast that with another point of view. gabor mate offers this theory in his book in the realm of hungry ghosts: close encounters with addiction

brain development in the uterus and during childhood is the single most important biological factor in determining whether or not a person will be predisposed to substance dependence and to addictive behaviours of any sort, whether drug-related or not.

this is shown, among others, by dr. vincent felitti, chief investigator in a landmark study of over 17,000 middle-class americans.

mate goes on to say that

to state that childhood brain development has the greatest impact on addiction is not to rule out genetic factors. however, the emphasis placed on genetic influences in addiction medicine … is an impediment to our understanding.

he makes the case that there are four important brain systems in addiction, and that they are all exquisitely fine-tuned and changed by the environment – and particularly by the environment that a human being experiences in the womb and in the first few years of life:

  • the opioid attachment-reward system (involving endorphins)
  • the dopamine-based incentive-motivation apparatus
  • the self-regulation areas of the prefrontal cortex
  • the stress-response mechanism (involving a decrease of opioid and dopamine receptors)

in other words, during pregnancy and the first years of life – and to some degree, on to teenage years – the brain grows and develops, sometimes at a dizzying rate (at times 250,000 neurons are added every minute!) the vast majority of brain development occurs during pregnancy, however. so what is often attributed to genetics can already have happened during pregnancy.

attachment – how we bond with others – is intimately linked to our reward system. going for addictive substances or activities is a misplaced attempt to reward oneself.

motivation is what gets us going. most of the time, we need an incentive to motivate us. if the right connections weren’t made in the brain when we were small, we might find addictive behaviours or substances more motivating than anything else.

our mood, levels of motivation, energy levels, and ability to withstand adversity need to be in a certain, well-tuned balance in order for us to function well. this is related to homeostasis, a type of inner thermostat or self-regulator that keeps all of these elements on a relatively even keel. again, this homeostasis depends on the brain having “learned” about it. if it’s out of kilter, we can do things like self-medicating with drugs – a (usually unconscious) attempt at reaching homeostasis. this is also closely related to our stress response mechanism.

(image by hive)

blogathon: metabolism and circadian rhythm

missing link found between circadian clock and metabolism

two new research studies have discovered a long sought molecular link between our metabolism and components of the internal clock that drives circadian rhythms, keeping us to a roughly 24-hour schedule.

the missing link is a well-studied mammalian protein called SIRT1, which was previously known to be switched on and off in accordance with cells’ metabolic state and is perhaps best known for its potential life-extending properties.

“we all have noticed in an intuitive manner that the body requires more energy at certain times of day,” said paolo sassone-corsi of university of california, irvine. “that’s why we have lunch or dinner”there is a cyclicity in feeding behavior and energy requirement. that suggests there must be a link between the clock and metabolism. now, in SIRT1, we have found a molecular connection between the circadian machinery and metabolism.”

“while it remains a matter of speculation, the findings suggest that drugs that inhibit or activate sirt1 might have an effect on the clock” …

the physiology and behavior of mammals are subject to daily oscillations driven by an endogenous circadian clock … the circadian timing system is composed of a central pacemaker in the brain and subsidiary oscillators in most peripheral tissues. while light-dark cycles are the predominant cue for the brain’s pacemaker, cyclic feeding behavior has a strong effect on clocks operating in many other tissues …

the findings also open a door on the possibility that epigenetics might influence behavior, sassone-corsi added, with potential implications for understanding the obesity epidemic.

“genetics can’t be the answer because the incidence is on the rise,” he said. “something else must be going on and perhaps epigenetic regulation is the key. in broad terms, that’s where we’re going.”

(if you like to read about the more obscure scientific stuff, read the whole article here)

while my ability to remember scientific facts is, well, let’s say below par, i am nevertheless fascinated by this kind of research. as i’ve mentioned in an earlier post about obesity and nutrigenomics, i think that fields of study like epigenetics and nutrigenomics will make a real difference in terms of how we look at nutrition, weight gain, and ultimately eating disorders.

canadian mental health association

this is an entry for my participation in the 2008 blogathon, a 24-hour marathon of blogging. please support the cause and donate – however much, however little – to the canadian mental health association (vancouver/burnaby branch). to donate, email me or use this URL: www.canadahelps.org/CharityProfilePage.aspx?CharityID=d2252. you should be able to get there by clicking the link; if not, just copy and paste the link into your browser. it will take you to the appropriate location at canada helps.

thank you for visiting, reading, commenting and, if you can, donating!

blogathon: choosing a therapist

canadian mental health association
this is an entry for my participation in the 2008 blogathon, a 24-hour marathon of blogging. please support the cause and donate – however much, however little – to the canadian mental health association (vancouver/burnaby branch). to donate, email me, use this URL: www.canadahelps.org/CharityProfilePage.aspx?CharityID=d2252. you should be able to get there by clicking the link;if not, just copy and paste the link into your browser. it will take you to the appropriate location at canada helps. thank you!

there are many different approaches to psychotherapy and effective practitioners come from a wide diversity of backgrounds.

if you are looking for a therapist or are thinking about changing therapists, knowledge of some basic facts and key questions can simplify matters. this article is meant to assist you to decide which therapy and therapist are likely to work best for you and your situation.

what we know about therapy

  1. research shows that psychotherapy works overall, and why it works. the basic facts are:
  2. psychotherapy is significantly more effective than a placebo treatment, and its effects are generally lasting. however, there is a wide variation in individual results and improvement cannot always be guaranteed.
  3. the effectiveness of therapists varies considerably, regardless of their professional background or specialty.
  4. the therapist needs to enthusiastically believe that their therapy will help you.
  5. good therapy gives you a sense of hope and expectation of change for the better.
  6. good therapy helps you develop practical ways forward.
  7. it is very important for your success that you feel you have a good working relationship with the therapist, that you feel comfortable with the therapist as a person, as we as with her/his methods.
  8. success depends greatly on your active participation in therapy and your openness and readiness to change.
  9. it is helpful to have some idea of tangible goals and how you might like to use therapy to achieve them.
  10. good therapy is sensitive to your viewpoint and adapts its methods to your individual circumstances rather than imposing the “right” way of a particular approach.
  11. good therapy helps to utilize and develop your own abilities and resources.
  12. compared to points 1-11, which specific therapeutic models and techniques are used play a small role in the effectiveness of therapy. no one type of therapy has been shown to be consistently superior to others.
  13. therapeutic models and techniques are helpful in structuring therapy when they fit your views of the situation and of how it might be helped.
  14. psychotherapy is not like a medical procedure: success does not depend on diagnosis of the problem or adherence to a prescribed treatment.
  15. psychotherapy is at least as effective as medication for most common psychological problems, has fewer side effects, and makes you less prone to relapse.
  16. the eventual outcome is very likely to be successful if you perceive some improvement within the first few sessions. the longer therapy goes on without any progress, the less the likelihood of eventual success.
  17. valid methods exist to assess your perceptions of the way therapy is conducted and its effectiveness. these can provide valuable feedback to improve the therapy.

what to ask your therapist

the following are key questions when you first contact a prospective therapist. in addition to enquiring about practical details (times, duration, location, cost and so on), you can ask them these questions.

  • what is your philosophy of therapy?
  • how do you think change happens?
  • how important will my contribution to therapy be?
  • will we collaborate on deciding what we do?
  • how and when will we assess progress?
  • how many sessions do you average per client?
  • how easy will it be to end therapy or spread out sessions as i progress?
  • what do you think of medical diagnoses and drug treatments?
  • can i seek other means of help at the same time?

once you have answers to these questions,

  • compare the answers you receive with your own views and the research findings.
  • find a therapist that is a good fit with them.
  • remember that successful therapy builds on your abilities and resources, and depends much less on the therapist’s theoretical views or assessment of the problem.

in fact, just thinking about some of these questions yourself can already move you forward in your healing process.

when to move on

how you feel about the working relationship with the therapist, as well as anticipating any, even the smallest, improvement are very important to success. you may want to consider finding or requesting another therapist if:

  • you do not like or trust your therapist.
  • you think that your therapist does not like you, understand you, or is insensitive to your point of view.
  • you think that the therapist’s agenda is different from yours.
  • you think that your therapist is pessimistic about helping you.
  • the therapist discounts other sources of help which you have found beneficial.
  • you feel uncomfortable with the therapist’s theories or techniques.
  • you are not getting sufficient opportunities to provide feedback and influence the course of therapy.
  • the therapist sticks to their approach regardless of your opinions or suggestions.
  • you do not feel any benefit within a handful of sessions, even after talking to your therapist about discomfort or lack of progress.
  • you have doubts about medication and it is recommended early on by your therapist. consider more than just medical and drug companies’ information. ask for specific information and explanations regarding the use of medication, and make sure you understand them. know about the limitations, probable side effects and likely duration of medication even if you believe it is the right choice for you.

(this is an adaptation of a tip sheet by the talking cure in scotland inspired by the work of one of my therapeutic “heroes”, scott miller.)

anorexia in men

male anorexia is a topic that is not talked or written about very much. anorexia in men is reminiscent of males with a history of sexual abuse, another topic that is underdiscussed, underreported and undertreated. perhaps one thing that they both have in common is a perception of weakness (a very real problem in anorexia, as we’ll see in a later post on this topic). while our ideas and concepts around gender are becoming more and more fluid, at base, the societal image of the male is unfortunately still one that needs to show unequivocal strength, will and power.

here are some findings from a study of male anorexia.

anorexia nervosa is a serious problem that affects over one million males yearly. it is often misdiagnosed and overlooked completely in clinical, medical and school settings because of the misperception that it is a disorder exclusively present in females. the DSM-IV largely contributes to this misnomer due to the gender-biased criteria. for example, one criterion is cessation of monthly periods.

the purpose of this study was to identify the etiology (i.e. causation and history) and clinical characteristics of male anorexia and devise a more comprehensive definition of anorexia nervosa that encompasses both males and females.

an additional purpose was to develop an instrument that identifies risk factors associated with anorexia nervosa in males and aid mental health and medical practitioners in making this diagnosis.

the assessment of anorexia nervosa in males questionnaire (AANMQ) was developed for this study to assess an expert panel’s clinical observations regarding potential misdiagnosis and treatment gaps among males with anorexia nervosa. this panel included one male anorexic, one parent of an anorexic male, and eight mental health and medical practitioners who were selected based on personal and clinical experiences working with male anorexics.

excerpts from the panel’s findings and literature review include these characteristics:

  • experts and literature agreed that a distorted body image is characteristic of male anorexia, patients and family did not
  • most did not feel that distored body image resulted from a “psychotic-like” mental orientation
  • all agreed that anorexia is accompanied by depression. other mental health difficulties that were proposed by some were borderline, obsessive compulsive, avoidant, and dependent personality disorders, posttraumatic stress disorder, and anxiety
  • some of the professionals felt that alcohol abuse was part of the problem but most, including patients and their families, felt that was not the case
  • similarly, some of the professionals found drug abuse to be a problem but patients and family had not experienced it
  • there was no consensus as to whether sexual identity was an accompanying problem
  • in terms of physical health consequences, male anorexics seem to experience the same as females, e.g. cardiac and kidney problems, electrolyte imbalances, impaired metabolism, osteoporosis, and gastrointestinal difficulties.

another topic discussed was noncompliance with treatment.

the mental health professionals reported the male anorexic, much like his female counterpart, is often a non-compliant patient who denies having a problem, is resistant to treatment, fails to follow-up on outpatient appointments, and is deceptive in his report of what he eats.

the medical group was divided in their responses to non-compliance and the manner in which it is displayed. the RN and pediatrician both agreed that the anorexic is seldom an accommodating patient but that this is a recognizable feature of the illness.

the psychiatrist and the dietician, however, report that the male anorexic patient is often desperate for treatment and willing to work on his issues. the dietician further remarked that female anorexics are “pleasers” and will “eat their way out of the hospital” only to return again, but male anorexics appear more eager to deal with underlying issues that contribute to the anorexic behavior.

the members of the patient/family group reported noncompliance was not applicable to their experience with any treatment staff in either an inpatient or outpatient basis.

the latter seems logical – if noncompliance had been an issue, the patients and families probably would not have participated in the study in the first place.

in the next instalment on this topic i will give you a summary of the questionnaire and talk some more about the issue of weight itself.

cancer: families, communication, self-development, fatigue

pea blossomthe last two frozen pea friday entries were a bit more introspective and heavy. today’s post is heavy, too, but only on science. i wanted to see what solutions health psychologists are looking at in terms of frequently occurring problems for cancer patients,e.g. how to talk about cancer, how cancer impacts family life, cancer and personal development, and the fatigue that comes with cancer.

cancer and family life

i was quite moved by this slide show about cancer and the family by dr. lea baider, a pioneer in psycho-oncology in israel (actually, it’s a lecture but i couldn’t get the audio part to play on my laptop). she asks hard questions such as “how can couples incorporate cancer into their relationship?” and uses beautiful illustrations from art and literature. she uses kafka’s short story “fellowship” to make us sensitive to the intrusion of cancer into family life:

we are five friends, one day we came out of a house one after the other, first one came and placed himself beside the gate, then the second came, or rather he glided through the gate like a little ball of quicksilver, and placed himself near the first one, then came the third, then the fourth, then the fifth. finally we all stood in a row. people began to notice us, they pointed at us and said: those five just came out of that house.

since then we have been living together, it would be a peaceful life if it weren’t for a sixth one continually trying to interfere. he doesn’t do us any harm, but he annoys us, and that is harm enough; why does he intrude when he is not wanted? we don’t know him and don’t want him to join us. there was a time, of course, when the five of us did not know one another, either, and it could be said that we still don’t know one another, but what is possible and can be tolerated by the five of us is not possible and cannot be tolerated with this sixth one.

in any case, we are five and don’t want to be six. … but how is one to make all this clear to the sixth one? long explanations would almost amount to accepting him in our circle, so we prefer not to explain and not to accept him. no matter how he pouts his lips we push him away with our elbows, but however much we push him away, back he comes.

talking about cancer

understanding the difficulties people have with talking about cancer may assist not only the person with cancer but health professionals and those who care for cancer patients. it may help them figure out how support from friends and family may be most beneficial. these were the findings of a study by rosemary chapman, a PhD student at loughborough university.

even managing normal everyday greetings such as being asked ‘how are you?’ could be problematic for someone with cancer. sometimes, responding with how they actually are may create a problem for the person they are talking to since that person is wondering how should they react. consequently, the person with cancer is often faced with an additional predicament; how do they deal with other people’s difficulties of not knowing what to say or how to respond?

it occurs to me that that’s at least part of the explanation for why i keep posting about cancer – it’s about opening the doors of communication, so that we can figure out how we can better support those among us who have this horrible disease (after all, one out of every four north americans is touched by cancer, either themselves, or a close family member or friend).

cancer and personal development

annette l. stanton, PhD, of the university of california-los angeles … discussed how some individuals cope by finding benefit in this adverse circumstance. some individuals look for the positive aspects in their life while experiencing stressors and look for good things that can be learned from that experience. they try to “grow” as a result of the stressful experience. in a sample of 92 women after treatment for breast cancer, 83% found benefits from their experience of breast cancer, and 46% found they related better to others after their experience with breast cancer.

as many of you know, one of my interests is journaling for healing, so this was good to hear:

dr. stanton … and her colleagues recently published the results of a randomized, controlled trial in which 60 early stage breast cancer patients were randomly assigned to write over 4 sessions about either: (1) their deepest thoughts and feelings regarding breast cancer; (2) positive thoughts and feelings regarding their experience with breast cancer; or (3) facts about their experience with breast cancer. after 3 months, those in the first 2 groups who wrote about their emotions had fewer medical appointments for cancer-related illness than those in the control group who wrote about breast cancer facts.

cancer and fatigue

cancer patients suffering from symptoms of fatigue might find some relief through regular exercise and psychological counseling to deal with stress, a review found.

fatigue is one of the most common symptoms of patients with cancer and those undergoing treatment with radiation and chemotherapy. according to the american cancer society, 90 percent of patients in cancer treatment experience fatigue that can range from “mild lethargy to feeling completely wiped out.”

the reviewers evaluated 41 studies. of these, 17 looked at activity-based interventionsin which patients either performed supervised or home-based exercises three to five times a week.

twenty-four studies evaluated psychological interventions. there were a variety of types of interventions, including techniques such as weekly telephone counseling about how to conserve energy and group therapy to teach skills like stress management and relaxation training.

jacobsen and his colleagues found that 44 percent of the activity-based trials and 50 percent of the psychological studies that were of good quality reported significant, if not earth shattering, results. patients who received either of the two types of interventions reported less fatigue than patients in the control groups did, the researchers concluded.

jacobsen concluded the results only provide “limited support” for the use of these types of nonpharmacological treatments to manage cancer fatigue.

steven passik, associate attending psychologist at the memorial sloan-kettering cancer center, said that although there is currently limited research that interventions such as counseling or exercise have a strong benefit on fatigue, patients prefer to try these methods rather than take more medications.

“some of the main barriers of managing cancer fatigue have proven to be a lack of communication from health care providers to patients about how to battle fatigue, as well as an overall reluctance of many patients to take any more drugs to treat the symptom.”

it seems to me the next thing that researchers could look at would be the effect of a combination of mild exercise and counselling on reducing fatigue.

this post is written in support of all my friends who have cancer, and in support of fellow twitterer susan reynold’s frozen pea fund, a cancer fund created especially for bloggers and social media fiends.

(the image of the pea blossom struggling along the fence is by lillian bennett)

frozen pea friday: psychological research on breast cancer

it’s friday, and frozen pea post time – my weekly post on cancer. today, i’ve put together a guest post about psychological research regarding breast cancer over at GNIF brain blogger. you won’t be surprised to hear that social support contributes to higher survival rates.

two observations are more counter-intuitive, though: it is unclear to what degree being married helps with survival rates. also, surprisingly, it looks like minimizing is a good coping strategy. the authors of the studies supporting this do not go into much of a description of what is meant by minimizing and indeed, it is a coping strategy that tends not to be discussed much in detail. i suspect that is because psychologists and therapists tend to be suspicious of it – after all, we’re big on validation, which, at least on the face of it, looks like the opposite of minimizing.

minimizing refers to downplaying the impact of an event or experience, e.g. downplaying one’s pain level, the degree to which one is incapacitated, etc.

perhaps minimizing comes with a “glass half full” attitude, and that helps with better survival rates?

what do you think – should i look some more into this?