Tag Archives: anxiety

Anxiety – It’s not a ‘real’ disease until it is

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“I feel awful, doc”, one man said to me today. “I’m never going to call a cold ‘the flu’ again”, he said as he shivered away under three jumpers, aching and mildly delirious.

It’s the middle of winter here in Australia, and Influenza A is cutting a swathe through the community. Everyone who walks in with a stuffy nose thinks they have ‘the flu’, that is, until they actually get Influenza and they realise just how atrocious having the real flu is.

It’s the same with mental health and illness. So many people think think that anxiety or depression aren’t real diseases. They think that everyone gets a bit sad at times, or gets a bit stressed, so depression and anxiety aren’t real diseases, they’re just normal emotions, or what weak people experience because they don’t have the inner strength to cope.

Such stigma isn’t helped when people who like to think they’re experts in mental health write blogs which declare that “anxiety is a signal that we need to listen to, not an illness we need to manage. It is a reaction to life’s challenges, not a biological disease to be treated.”

Yes, that’s right people, pretend experts are quick to tell you that the debilitating condition you’re experiencing isn’t a real disease.

Saying “Anxiety isn’t a real disease, it’s just a warning sign, a normal part of life” is a bit like saying, “You don’t really have Influenza, you just have a cold. Harden up princess … you don’t need to be ventilated in ICU, it’s just a virus. I took some Vitamin C and I was better in just a couple of days. What’s wrong with you?”

Part of the problem is because of how we use the word “anxiety”, which can mean different things to different people. To a lot of people, being anxious is the same as being a little frightened. To others, it’s being really scared, but with good reason (like if you were confronted by a very venomous snake).

Medically speaking, anxiety isn’t just being frightened or stressed. After all, it’s normal to be frightened or stressed. A little bit of fear is protective. There are dangers all around us, and our brain is our “don’t get killed” organ. If we had no fear at all, we’d end up becoming road kill. A little bit of fear, in the right amount, for the right reason and in the right place and time, is actually very protective.

But to label all anxiety as normal, or to claim that anxiety is not a mental illness is obnoxious and ignorant.

That’s because anxiety at the wrong time and in the wrong amount can disrupt our day-to-day tasks and make it hard to live a rich and fulfilling life. At the extreme, anxiety disorders are as debilitating as any major illness.

There are six main disorders that come under the “anxiety disorders” umbrella, reflecting either an abnormal focus of anxiety or an abnormal intensity:
1. Panic Disorder (abnormally intense anxiety episodes)
2. Social Anxiety Disorder (abnormal anxiety of social interactions)
3. Post-traumatic Stress Disorder (abnormally intense episodes of anxiety following trauma)
4. Obsessive-Compulsive Disorder (abnormally intense and abnormally focussed anxiety resulting in compulsive behaviours)
5. Specific phobias (abnormally focussed anxiety on one particular trigger), and
6. Generalised Anxiety Disorder (abnormal anxiety of everything)

The common underlying theme of anxiety is uncertainty. Clinical psychologists Dan Grupe and Jack Nitschke from the University of Wisconsin wrote in Nature Reviews Neuroscience that “Anxiety is a future-orientated emotion, and anticipating or ‘pre-viewing’ the future induces anxiety largely because the future is intrinsically uncertain.” [1]

The fear of uncertainty that defines anxiety comes from genetic changes that affect the structure and function of the brain, primarily in the regions of the amygdala and the pre-frontal cortex. As a result of these changes, the brain processes information incorrectly.

For example:
> the brain thinks that threats are more likely and will be worse than they are,
> the brain spends more time looking for possible threats,
> the brain fails to learn what conditions are safe, which is aggravated by avoidance, and
> the brain assumes that unavoidable uncertainty is more likely to be bad than good.

It’s important to understand at this point that anxiety disorders aren’t the result of poor personal choices. They’re the result of a genetic predisposition to increased vulnerability to early life stress, and to chronic stress [2]. The other way of looking at it is that people who don’t suffer from anxiety disorders have a fully functional capacity for resilience [3,4].

The main point of this post is simply this – pretend experts are everywhere, and they are usually various combinations of ignorant, stupid or lazy. They might try and tell you that your debilitating anxiety isn’t really a mental illness, but they’re usually the ones who have never experienced just how atrocious a true anxiety disorder is. Don’t listen to them, no matter how many equally ignorant followers they have on social media. Just like Influenza can make you really sick but there is treatment, so it is with an anxiety disorder – the anxiety disorder may be much harder to get through, but with the right treatment and support, you can get through it.

~~~

If you are struggling with anxiety or depression, help … real help … is available. See your general practitioner or psychologist, or if you’re in crisis and you need to talk to someone urgently:

In Australia
> you can call either Lifeline on 13 11 14, or
> BeyondBlue provides a number of different support options
> the BeyondBlue Support Service provides advice and support via
>> telephone 24/7 (call 1300 22 4636)
>> daily web chat (between 3pm–12am) and
>> email (with a response provided within 24 hours) via their website https://www.beyondblue.org.au/about-us/contact-us.
In the US
> call the National Suicide Prevention Lifeline by calling 1-800-273-TALK (8255).
In New Zealand
> call Lifeline Aotearoa 24/7 Helpline on 0800 543 354
In the UK
> Samaritans offer a 24 hour help line, on 116 123
For other countries, Your Life Counts maintains a list of crisis services across a number of countries: http://www.yourlifecounts.org/need-help/crisis-lines

References
1. Grupe DW, Nitschke JB. Uncertainty and anticipation in anxiety: an integrated neurobiological and psychological perspective. Nature reviews Neuroscience 2013 Jul;14(7):488-501.
2. Duman EA, Canli T. Influence of life stress, 5-HTTLPR genotype, and SLC6A4 methylation on gene expression and stress response in healthy Caucasian males. Biol Mood Anxiety Disord 2015;5:2.
3. Wu G, Feder A, Cohen H, et al. Understanding resilience. Frontiers in behavioral neuroscience 2013;7:10.
4. Russo SJ, Murrough JW, Han M-H, Charney DS, Nestler EJ. Neurobiology of resilience. Nature neuroscience 2012 November;15(11):1475-84.

Fake science is no joke

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Happy Easter everyone.

I went to church this morning, and came home to get a lamb ragu going in the slow cooker, and thought I would just hop onto Facebook to see what was going on in the world. I was greeted with this:

“Your body literally treats negative thoughts like an infection.” Dr Peter Amuaquarshie

Oh dear … oh dear, oh dear, oh dear …

Easter is meant to be about redemption, about hope, about God’s great love for us. Clearly #TheDrLeafShow isn’t any of that.

Unfortunately, this is more pseudoscience from Dr Leaf and her cabal.  And while it might also be April Fools Day, fake science is no joke.

Dr Peter Amua-Quarshie has been in cahoots with Dr Leaf since the beginning of her teaching. He has supplied most of the illustrations for Dr Leaf’s ministry over the years, so I’m sure he’s profiting handsomely from Dr Leaf’s enormous sales and influence.

It’s so sad to see academics trade their integrity and sell their soul for the sake of the ill-gotten gains of popular pseudoscience.

Your body doesn’t “literally” treat negative thoughts like an infection. Our thoughts have literally no bearing on our immune function. In research work that has intentionally studied thought separately to stress, thought has not been associated with any significant changes in stress or health behaviour [1]. It’s also been confirmed that thought alone does not lead to detrimental biological changes, such as significant changes in immune function [2].

If anything, it’s the other way around – our immune system and our thoughts respond to physical changes in our bodies internal milieu. For example, an adrenaline surge causes us to feel fear and engage in fight or flight behaviours, and to respond quickly to injury, the balance of our immune system’s cells and cytokines changes to prepare for possible injury.

Another example, a physical infection from a microbe of some kind (bacterial or virus) causes a flood of chemical mediators called cytokines to float around the blood stream. This inflammatory response leads to an immune system that is better able to fight off infection, but it also changes our feelings and our thoughts – this flood of cytokines is the reason why we feel tired, achey and miserable when we’re sick.

Having “negative thoughts” is not the same as having an infection. Infections are disease states, whereas “negative thoughts” are normal and more often than not, beneficial. It’s normal to feel sad. It’s normal to feel angry. It’s normal to feel disgusted or embarrassed. These feelings are adaptive. Without them, we wouldn’t grow or change. Without them, we couldn’t have a rich, full life.

Dr Leaf claims that her goal is to “equip and empower you to use your mind to overcome labels and mental ill health (depression, anxiety, etc) to live a more fulfilled and successful life.” It’s a bit hard to do that by promoting fake science.

For his part, Amua-Quarshie should know better. He’s a teaching academic by trade and has a medical degree from the University of Ghana, after all. Unfortunately, it appears that Dr Amua-Quarshie has been exiled from mainstream academia, leaving a full-time position as an Adjunct Professor (lecturer) at the University of Wisconsin-Stout in Menomonie, Wisconsin and is now working as a lecturer in a school for chiropractors (Parker University, Dallas, Texas).

Though that’s more of an aside. The bottom line here is that Dr Leaf might claim that she wants people to overcome ‘labels and mental ill health’ but she isn’t going to do that by promoting such obvious mistruths that mislead people into fearing normal, adaptive human emotions. She isn’t promoting a more fulfilled and successful life, she’s promoting imbalance. She’s promoting false hope.

I know it’s April Fools, but believe me, this is no joke.  Fake science is misleading and harmful.  If Dr Leaf really wants people to live a more fulfilled and successful life, she should refrain from using it.

References
1. Doom, J.R. and Haeffel, G.J., Teasing apart the effects of cognition, stress, and depression on health. Am J Health Behav, 2013. 37(5): 610-9 doi: 10.5993/AJHB.37.5.4
2. Segerstrom, S.C. and Miller, G.E., Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychol Bull, 2004. 130(4): 601-30 doi: 10.1037/0033-2909.130.4.601

The lost art of joy – Rest

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So Christmas 2017 has come and gone for those of us just to the right of the International Date Line. How did you fare? Was your Christmas a day of joy?

Now we’re in the post-Christmas hangover, the come down from the sugar and ethanol excesses of the day before. In Australia, New Zealand and the UK, we call December 26th “Boxing Day”, although it doesn’t have anything to do with pugilism. The name most likely derives from the giving of Christmas “boxes”, a tradition which may date back to the Middle Ages when church members would collect money for the poor in alms boxes which were opened on the day after Christmas in honour of St Stephen, the first Christian martyr, whose feast day falls on 26 December. The tradition may even be older than that, possibly dating back to the Christianised late Roman empire. Either way, at some point St Stephen’s Day became associated with public acts of charity.

In modern Australia, the boxes that are usually associated with Boxing Day are the boxes you put all the loot you’ve acquired in the post-Christmas sales into. So it’s a bit of an irony that what was once a day of giving to those less fortunate have become about acquiring more things for yourself.

But I digress.

The post-Christmas sales are traditionally a day of high-stress chaos as throngs of enthusiastic shoppers crowd the malls again, to fight for car parking spaces, tables at cafes, space to walk around, and toilet cubicles. Hours of this at a time can suck the positivity out of even the hardiest of shoppers.

It doesn’t have to be this way though. The cure for post-Christmas languor doesn’t have to be more stress, but if anything, Boxing Day could easily be a day of rest.

Making time to rest is an important part of maintaining good health. Forms of deep relaxation, such as meditation, not only relieve stress and anxiety, but also improve mood. Deep relaxation can also decrease blood pressure, relieve pain, and improve your immune and cardiovascular systems. Relaxation doesn’t always mean sleeping (although good sleep also helps to maintain a good mood and good health overall) or just things like meditation. Rest and relaxation can involve having a laugh, which decreases pain, promotes muscle relaxation and can reduce anxiety. Rest and relaxation can involve taking the time to simply connect with friends without having to work hard to try and impress them. Even something as simple as a hug from a good friend, or patting your dog or cat, can be relaxing and mood lifting. Remember, R+R involves anything that makes you feel better at the end than it did at the beginning.

So, there’s still joy to be found, even in the post-Christmas hangover. This can be done as they did traditionally, by giving to those less fortunate, or in taking the time to relax and unwind from the celebration of Christmas, or even in the simple connection of a hug from a friend.

The lost art of joy – Move!

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What’s your vision of bliss? Massage? Sitting by the beach with a pina colada? Enjoying a sumptuous dinner with friends?

Most relaxation fantasies don’t involve sweat.

So it’s almost a bit counter-intuitive that exercise is one of the most frequently associated habits of happy people. Although maybe it’s not so counter-intuitive, as there is strong anecdotal evidence of the “runner’s high” – the feeling of euphoria that some people feel after a session of vigorous exercise, the “endorphin buzz” that ironically doesn’t have anything to do with endorphins!

Endorphin buzz or no, exercise is certainly one way of enhancing the joy in your life. I previously wrote about the work of George MacKerron from the University of Sussex, who used an app he created to map the correlation of happiness to activity and location. Using the hundreds of thousands of data points from the tens of thousands of users, he found that the times that people recorded the highest levels of happiness and life satisfaction were during sexually intimate moments (on a date, kissing, or having sex). Number two was during exercise.

Physical fitness is good for us. I’ve never seen a study that shows exercise to be a bad thing. Ultimately, it’s not how fat you are that’s important for your longevity, it’s how fit you are, and the way to get fit is to exercise. Physical exercise isn’t just good for the body but good for the brain as well. While the exact pathways are still being determined, there’s good evidence that moderate regular physical activity improves the balance of pro- and anti-inflammatory mediators in the body and in the brain. In the brain, this improves the overall function of our brain cells. Exercise is also thought to increase the production of a growth factor called BDNF which helps the brain cells grow new branches and improves their ability to form new pathways, which in turn, has been shown to improve mood disorders like anxiety and depression.

Exercise is great, but not everyone is ready to suddenly get up and run a half-marathon, me included. These days, I’m like a walrus on tranquillisers. I’m certainly not about to jump up and go for a jog. Some people have physical injuries or conditions that limit their capacity for physical exercise.

So how do you find the balance between maximising the joy-enhancing effects of exercise while not pushing yourself so far and causing yourself some unhappiness?

Simply, move more.

Where are you at with you’re level of exercise right now? If you could turn it into a scale from 1 to 10 (where 1 is completely sedentary, and 10 is your ideal version of regular exercise), what would you rate? The next question is, what’s one thing you could do to go one point closer to 10? So let’s just say that you walk 200m from your house to the bus stop in the morning, and the same on the way home at night. For you, that might be a 3/10. What else could you do to make that 3 turn into a 4?

You don’t have to go for vigorous two-hour walks or run up every set of stairs you come across to be happy. Just move, and move that little bit more. That will help build joy in your life.

But I’m normally a rational person …

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She shifted uncomfortably in her seat, her uneasy hands fidgeting together, her eyes flitting around as she tried to focus on the wall across from her, unable to find a target for her empty gaze.

“But … I’m normally a rational person,” she said, finally putting words to the thought that had been evading her for half a minute.

She was a woman in her mid thirties, with a comfortable job, a family and a mortgage in the suburbs.  We were halfway through a standard GP consult, and we had already discussed and resolved something trivial before she finally plucked up the courage to change tack and reveal the hidden agenda she’d hoped to discuss all along.

“I’m anxious all the time.  I try so hard, but I can’t seem to stop thinking about all the things that could go wrong.”

I empathised.  I’ve been there too – I’ve lived through times when my anxiety disorder was so debilitating that I wouldn’t call someone on the phone for fear of dialling the wrong number.  Or when I was so depressed that I couldn’t see anything positive for the future, when nearly every thought I had was saturated with moribund darkness.

I was anxious as a teenager, but I was depressed as an adult.  I’d been through medical school and I had attained by GP fellowship when my depression took hold.  During the four years or so that I spent with the black dog, I was constantly haunted by the same narrative that now haunted my patient … “I’m a rational person, why am I thinking like this?”

The fact I had fellowship level medical training intensified my mental self-flagellation, “I know all about depression.  I understand CBT.  I know I’m ruminating on catastrophic thoughts.  So why can’t I stop them?  If only I could think more positively, I’d be so much better.”

I found myself in a self-defeating spiral, often called the struggle switch, where I thought I knew how to climb out of my psychological mire, but all I achieved in trying to climb out was to sink further in, making me feel more defeated, even more of a failure.  It was a very difficult time which I thought would never end.

Eventually it lifted, like a heavy fog thinning in the morning sunlight, but it certainly wasn’t the result of anything clever I did.  So why did my rational brain keep filling my mind with irrational thoughts?

The answer lay in a paradigm shift away from the long held beliefs that we were taught at medical school and in our general practice training.  We’ve been lead to believe for so many years that our thoughts were the key driver of our behaviour, but it turns out that it’s actually the other way around, our behaviour is but one of a number of key driver of our thoughts.

The foundation of CBT is the notion that challenging maladaptive thoughts helps to empower behavioural change.  Except that research suggests that cognitive therapy specifically targeting problem thoughts offers no extra improvement over behavioural therapy alone.

Herbert and Forman confirm this when they point out that, “proponents of behavioral activation point to the results of component control studies of CT, in which behavioral activation or exposure alone is compared to behavioral activation (or exposure) plus cognitive restructuring. The majority of these studies have failed to demonstrate incremental effects of cognitive restructuring strategies.” [1]

This fact has been further confirmed by a number of meta-analyses [2] and by a large randomised controlled trial comparing behavioural therapy and cognitive therapy side by side with medication for depression [3].

So therapies aimed at fixing thinking works equally as well as therapies aimed only at promoting therapeutic action.  However, when thinking therapies are added to behaviour therapies, they add no extra benefit over and above the behaviour therapies alone [2].  This suggests that action is the driver of the therapeutic effects of psychological therapy.  If thinking were the driving force of psychological change, the addition of cognitive therapy to behaviour therapy should have an incremental effect.

That cognitive therapy works equally well as behavioural therapy may be related to their fundamental similarities. Dobson et al explains, “Behavioural Activation is implemented in a manner that is intended to both teach coping skills and to reduce future risk. The same is true for Cognitive Therapy, which adds an emphasis on cognitive change, but otherwise takes a similar skills-training approach.” [3]  In other words, cognitive behavioural therapy is just behavioural therapy with bling.

Herbert and Forman summarise it nicely, “The ideas that thoughts and beliefs lead directly to feelings and behavior, and that to change one’s maladaptive behavior and subjective sense of well-being one must first change one’s cognitions, are central themes of Western folk psychology.  We encourage friends to ‘look on the bright side’ of difficult situations in order to improve their distress. We seek to cultivate ‘positive attitudes’ in our children in the belief that this will lead to better academic or athletic performance. Traditional cognitively-oriented models of CBT (e.g., CT, stress inoculation training, and rational emotive behavior therapy) build on these culturally sanctioned ideas by describing causal effects of cognitions on affect and behavior, and by interventions targeting distorted, dysfunctional, or otherwise maladaptive cognitions.” [1]

I understand this is going to ruffle some feathers, and not everyone is going to be keen to dispense with CBT just yet, but I hope this gets us thinking about thinking at the very least.

For me, coming to an understanding that my thoughts were just the dashboard and not the engine helped me to pay less attention to them and to focus my healing energies on what was really important, taking values based action rather than just fighting with my stream of thoughts.

And it’s helped me to empathise differently with my patients and reassure them that you can still be a rational person even if your thoughts don’t always seem to follow suit.

References
[1]       Herbert JD, Forman EM. The Evolution of Cognitive Behavior Therapy: The Rise of Psychological Acceptance and Mindfulness. Acceptance and Mindfulness in Cognitive Behavior Therapy: John Wiley & Sons, Inc., 2011;1-25.
[2]       Longmore RJ, Worrell M. Do we need to challenge thoughts in cognitive behavior therapy? Clinical psychology review 2007 Mar;27(2):173-87.
[3]       Dobson KS, Hollon SD, Dimidjian S, et al. Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression. Journal of consulting and clinical psychology 2008 Jun;76(3):468-77.


KINTSUKUROI CHRISTIANS – Available at Koorong, Amazon, iBooks and other good book retailers

Kintsukuroi Christians

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When I was a kid growing up, there wasn’t much that my father couldn’t repair.

Dad was extremely gifted with his hands, a talent that I certainly didn’t inherit. He was able to take a problem, come up with a practical solution in his mind’s eye, then build it out of whatever scraps of wood, metal or plastic he could lay his hands on. It was the ultimate expression of frugality and recycling that comes from a limited income and four growing children.

Dad was also able to resurrect nearly everything that broke in our house. Plates, cups, teapots, toys, tools … it seemed there wasn’t anything that couldn’t be fixed by the careful application of Araldite.

Araldite, for those unfamiliar with it, is some sort of epoxy resin that, in the right hands, possesses mystical properties of adhesion. It would stick anything to anything.

Dad’s gift for repairing things with Araldite meant that a lot of our things were patched up. Some of our most loved possessions were the most cracked. Despite being glued together several times, each item was still functional. Maybe not as pretty as it may have once been, but still useful, and more importantly, still treasured. Each time the Araldite came out, it taught me that whilst all things have the capacity to be broken, they also have the capacity for redemption.

There’s an ancient Japanese tradition that shares the same principles. For more than 400 years, the Japanese people have practiced kintsukuroi. Kintsukuroi (pronounced ‘kint soo koo ree’) is the art of repairing broken pottery with gold or silver lacquer, and the deep understanding that the piece is more beautiful for having been broken.

The edges of the broken fragments are coated with the glue made from Japanese lacquer resin and are bonded back into place. The joints are rubbed with an adhesive until the surface is perfectly smooth again. After drying, more lacquer is applied. This process is repeated many times, and gold dust is also applied. In kintsukuroi, the gold lacquer accentuates the fracture lines, and the breakage is honoured as part of that piece’s history.
Mental illness is a mystery to most people, shrouded by mythology, stigma, gossip or Hollywood hype. It’s all around us, affecting a quarter of the population every year, but so often those with mental illness hide in plain sight. Mental illness doesn’t give you a limp, a lump, or a lag. It affects feelings and thoughts, our most latent personal inner world, the iceberg underneath the waters.

On the front line of medicine, I see people with mental health problems every day, but mental health problems don’t limit themselves to the doctor’s office. They’re spread throughout our everyday lives. If one in four people have a mental health problem of one form or another, then one in four Christians have a mental health problem of one form or another. If your church experience is anything like mine, you would shake hands with at least ten people from the front door to your seat. Statistically speaking, two or three of them will have a mental illness. Could you tell?

It’s a fair bet that most people wouldn’t know if someone in their church had a mental illness. Christians battling with mental illness learn to present a happy façade, or face the judgment if they don’t), so they either hide their inner pain, or just avoid church altogether.
Experiencing a mental illness also makes people feel permanently broken. They feel like they’re never going to be whole again, or good enough, or useful, or loved. They’re often treated that way by well-meaning but ill-informed church members whose idea’s and opinions on mental illness is out-of-date.

The truth is that Christians who have experienced mental ill-health are like a kintsukuroi pot.

Mental illness may break them, sure. But they don’t stay broken. The dark and difficult times, and their recovery from their illness is simply God putting lacquer on their broken pieces, putting them back together, and rubbing gold dust into their cracks.
We are all kintsukuroi Christians – we’re more beautiful and more honoured than we were before, because of our brokenness, and our recovery.

I’m pleased to announce that my book, Kintsukuroi Christians, is now available. I’ve written this book to try and bring together the best of the medical and spiritual.
Unfortunately, good scientific information often bypasses the church. The church is typically misled by Christian ‘experts’ that preach a view of mental health based on a skewed or outdated understanding of mental illness and cognitive neuroscience. I want to present a guide to mental illness and recovery that’s easy for Christians to digest, adopting the best spiritual AND scientific perspective.

In the book, I look at some scientific basics. Our mental world is based on the physical world. Our mind is a function of the brain, just like breathing is a function of our lungs. Just as we can’t properly understand our breathing without understanding our lungs, so it is that if we’re going to understand our thinking and our minds, we are going to have to understand the way our brain works. So the first part of this book will be an unpacking of the neurobiology of thought.

We’ll also look at what promotes good mental health. Then we’ll look at what causes mental illness, specifically looking at the most common mental health disorders. I will only look at some of the most common disorders to demonstrate some general principles of psychiatric illnesses and treatments. This book won’t be an encyclopaedia, and it doesn’t need to be. I hope to provide a framework so that common and uncommon mental health disorders can be better understood. I also discuss suicide, which is sadly more common than most people realise, and is rarely discussed.

I know mental illness is difficult, and we often look at ourselves or others as though the brokenness is abhorrent, ugly and deforming.
My hope is that through Kintsukuroi Christians, you’ll see the broken pieces are mended with gold, and realise that having or recovering from a mental illness doesn’t render someone useless or broken, but that God turns our mental brokenness into beauty.

Kintsukuroi Christians is available to purchase from good Christian bookstores around the world including:

Kooyong = https://www.koorong.com/search/product/kintsukuroi-christians-christopher-pitt/9780994596895.jhtml

Amazon US = https://www.amazon.com/Kintsukuroi-Christians-TURNING-MENTAL-BROKENNESS/dp/0994596898/

Amazon UK = https://www.amazon.co.uk/Kintsukuroi-Christians-TURNING-MENTAL-BROKENNESS/dp/0994596898/

Smashwords = https://www.smashwords.com/books/view/720425

~~

Mental illness can be challenging. Sometimes learning about mental illness can bring up difficult feelings or emotions, either things that you’ve been through yourself, or because you develop a better understanding of what a loved one is going through or has been through. Sometimes old issues that have been suppressed or not properly dealt with can bubble up to the surface. If at any point you feel distressed, I strongly encourage you to talk to your local doctor, psychologist, or pastor. If the feelings are so overwhelming that you need to talk to someone quickly, then please don’t delay, but reach out to a crisis service in your country

In Australia
Lifeline 13 11 14, or
BeyondBlue
Call 1300 22 4636
Daily web chat (between 3pm–12am) and email (with a response provided within 24 hours)  https://www.beyondblue.org.au/about-us/contact-us.

USA = National Suicide Prevention Lifeline 1-800-273-TALK (8255)

New Zealand = Lifeline Aotearoa 24/7 Helpline 0800 543 354

UK = Samaritans (24 hour help line) 116 123

For other countries, Your Life Counts maintains a list of crisis services across a number of countries: http://www.yourlifecounts.org/need-help/crisis-lines.

Black is the new black – Mental illness touches more of us than we realise (or want to admit)

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I rarely get sick.

I say this while superstitiously touching my wooden desk to try and avoid putting the mockers on myself.  Thankfully, I have a fairly robust immune system and, after years or working in hospital paediatrics and general practice, and having been sneezed at or coughed on multiple times a day, I have been exposed to just about every variation of the cold virus and influenza possible.

Even for those of us with an immune system as solid as a prize bull, we still get sick every now and then.  We all get upper respiratory viruses so commonly that we just consider it a normal part of life.  Most people will take some paracetamol or ibuprofen and keep going.  Some people will go to their GP, and while a most will (… should …) come away some simple reassurance, occasionally some will need a prescription medication for a nastier bacterial infection.  An even smaller percentage will need admission to hospital because of a much more severe infection.

I read an interesting blog this week on Psychology Today by Dr David Rettew.  Its provocative title was, “Is Mental Illness the Rule Rather Than the Exception?”

The blog discussed the study being carried on in Dunedin which has been following a cohort of a thousand people for the last thirty-five years.  This particular study looked for common factors that were shared by those people who had never been affected by a certifiable psychiatric disorder.  What was interesting was that only seventeen percent of the people in that cohort had NOT been affected by a mental illness at some point in that thirty-five-year time frame.

Now for the average Australian, there are some obvious kiwi jokes going begging here (like, I’d be depressed too if I had to live in New Zealand, or how can someone tell if a sheep is really depressed or not, etc. etc.).  All jokes aside, seventeen percent of people not affected … that’s a remarkable figure.  In researching my latest book (soon to be released …) I had come across the figure of fifty percent of people had a lifetime prevalence of any mental illness.  That’s one in every two, and chances are that if you weren’t the person affected, you would know someone who was affected, but the Dunedin figures are even higher.  If you can accurately extrapolate them, four out of every five people will be affected by mental illness at some point in their lives.

The inevitable response from modern psychiatry’s critics is entirely predictable – there will be claims that the DSM5 is simply making diseases out of normal human life experiences, that our humanity is being pathologised and over-medicated for the benefit of big Pharma.

But as Rettew points out in a separate blog post, something may be such a common occurrence as to be considered part of the normal human experience but it can still be a pathology.  The common cold is so common that it’s a normal part of life, but it’s still a disease.

Whether four out of every five people will be affected by mental illness or one out of two, whatever the number, the idea that most of our population will be afflicted with a mental illness at some point in their lives isn’t necessarily a negative thing.  As Rettew also discusses, we don’t arbitrarily change the definitions of physical illnesses to match how many people we think should suffer from them, and neither should we arbitrarily change the diagnostic boundaries of mental illness so less people appear mentally unwell.

We need to accept that, at times, people will be functionally impaired to varying degrees because of mental illness just like people will be functionally impaired by physical illness.  We need to treat mental illness with the same respect as we would physical illness.

In the same way that not all physical illnesses require medication, neither do all mental illnesses.  By and large, most mental illnesses that people suffer from will be short lived and self-limiting, the psychiatric equivalent of having a cold.  Some people will need treatment for their mental illness, but usually this takes the form of structured behavioural therapy like ACT or CBT.  Occasionally, people will need to take a medication and very occasionally, some people will need to be hospitalised because of their mental illness.

For too long, mental illness has been viewed from an extreme perspective – mental illness is uncommon and severe. The nuances of mental illness have been lost or ignored in the white noise of ignorance and sanctimony.  The lack of subtlety and understanding has failed us as a community.  When treated early, mental illness has a much better prognosis, but the stigma, fear and misunderstanding perpetuated by the all-or-nothing approach has left a lot of people without treatment and therefore with worse outcomes overall.

If people were to realise that most of us will be touched by mental illness at some point, then perhaps there would be more understanding and less judgement, something that would lead to less suffering because of mental illness.

That would only be a good thing.

~~~~~

If you think you might be affected by mental illness or if you would like to know more, see your local GP, family physician or psychologist.  On line information can be found at many reputable sites including Beyond Blue – https://www.beyondblue.org.au

60 seconds – Dr Leaf and Anxiety

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Dr Caroline Leaf, communication pathologist and self-titled cognitive neuroscientist, says that “A chaotic mind filled with rogue thoughts of anxiety and worry sends out the wrong signals and affects you right down to the level of your DNA!” She also says that “Toxic thinking destroys the brain!”

In other words:

Anxiety → Toxic thought → DNA changes +  Brain damage

But that’s not what science says. According to modern research, anxiety disorders are the result of a genetic predisposition to increased vulnerability to early life stress, and to chronic stress [1]. The other way of looking at it is that people who don’t suffer from anxiety disorders have a fully functional capacity for resilience [2,3].

In other words:

DNA changes + External stress → Anxiety

Dr Leaf’s teaching is backwards. Perhaps it’s time she turned it around.

References

[1] Duman EA, Canli T. Influence of life stress, 5-HTTLPR genotype, and SLC6A4 methylation on gene expression and stress response in healthy Caucasian males. Biol Mood Anxiety Disord 2015;5:2
[2] Wu G, Feder A, Cohen H, et al. Understanding resilience. Frontiers in behavioral neuroscience 2013;7:10
[3] Russo SJ, Murrough JW, Han M-H, Charney DS, Nestler EJ. Neurobiology of resilience. Nature neuroscience 2012 November;15(11):1475-84

Dr Leaf and Anxiety

Dr Caroline Leaf and the struggle spiral

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In Proverbs 12:25, the incredibly wise King Solomon wrote that, “Worry weighs us down; a cheerful word picks us up.”

Today, Dr Leaf posted to her social media stream that “An undisciplined mind is filled with worries, fears and distorted perceptions – These lead to degeneration of the mind and body.”

Well, that’s about as uplifting as a lead balloon.

Dr Caroline Leaf is a communication pathologist and a self-titled cognitive neuroscientist.  I’m sure her heart was in the right place when she posted her latest jewel of wisdom, but it may not be as encouraging or as helpful as she may have intended.

The biggest problem is her opening premise, “An undisciplined mind is filled with worries, fears and distorted perceptions”.  So … that’s not really accurate. The normal human mind is filled with worries, fears and distorted perceptions. It really doesn’t matter whether you discipline your mind or not, you won’t shift these ‘negative’ thoughts.

That’s because we’re meant to experience appropriate levels of fear and worry.  They’re a survival mechanism.  Without a certain amount of fear, we’d end up as a Darwin Award.  And as human beings, we’re naturally inclined to so many different cognitive biases that there’s a very long list (although ironically, those with the strongest confirmation bias will probably be the least likely to accept this).

By erroneously linking normal cognitive function to the concept of mental ill-discipline, Dr Leaf is simply setting people up for an unrealistic struggle with their normal psyche as they unnecessarily try to discipline it.

And for the people who really do struggle with excessive or inappropriate worry, fear or incorrect perceptions – i.e. people who suffer from formal anxiety disorders – this sort of statement is misleading because again, their issue isn’t mental ill-discipline. Anxiety is the result of a genetic predisposition and increased vulnerability to stress.

The second part of Dr Leafs meme is as unhelpful as the first.  For a start, it’s not true that worries, fears and distorted perceptions cause degeneration of the mind and body.  There may be a correlation between stress and some long term health problems, but correlation does not equal causation.  As Cohen and colleagues noted, “Although stressors are often associated with illness, the majority of individuals confronted with traumatic events and chronic serious problems remain disease-free.” [1]  Dr Leaf’s claim seems little more than a scare tactic, which can only lead to increased anxiety not increased motivation.

The important things to remember here are:
1. Experiencing worries, fears and distorted perceptions is normal, and not something that can be changed by disciplining your mind.  Don’t fall into the trap of trying to treat something that isn’t a disease.
2. If you do suffer from an anxiety disorder, don’t blame yourself.  That sets up a spiral of struggle.  Thoughts are just words. They have no power over you unless you engage with them.  Instead of trying to repress every worry and every fear, allow your thoughts to bubble away in the background, and instead, focus your energy on taking values based committed action which will ultimately help you live a life of meaning, not just struggling.

References

[1]     Cohen S, Janicki-Deverts D, Miller GE. Psychological stress and disease. JAMA: the journal of the American Medical Association 2007;298(14):1685-87.

The Prospering Soul – Christians and Anxiety

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When you say the word “anxiety”, it can mean different things to different people. To a lot of people, anxiety is the same as being a little frightened. To others, it’s being really scared, but with good reason (like if you have to give a speech and you’re afraid of public speaking).

Medically speaking, anxiety isn’t just being frightened or stressed. After all, it’s normal to be frightened or stressed. God made us so that we could experience fear, because a little bit of fear is actually protective. There are dangers all around us, and if we had no fear at all, we’d end up becoming lunch for a wild animal, or road-kill. So there’s nothing wrong with a little bit of anxiety – in the right amount, for the right reason.

But anxiety in the wrong amount or for the wrong reason, can disrupt our day-to-day tasks and make it hard to live a rich and fulfilling life. That’s the anxiety that we’ll be talking about today.

The official description of anxiety reflects this idea of the wrong amount of anxiety about the wrong things: “… marked symptoms of anxiety accompanied by either general apprehension (i.e. ‘free-floating anxiety’) or worry focused on multiple everyday events, most often concerning family, health, finances, and school or work, together with additional symptoms such as muscular tension or motor restlessness, sympathetic autonomic over-activity, subjective experience of nervousness, difficulty maintaining concentration, irritability, or sleep disturbance. The symptoms are present more days than not for at least several months and result in significant distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning.” (This is taken from the beta-version of the latest WHO diagnostic guidelines, the ICD-11, but has yet to be formally ratified).

There are six main disorders that come under the “anxiety disorders” umbrella, reflecting either an abnormal focus of anxiety or an abnormal intensity:
1. Panic Disorder (abnormally intense anxiety episodes)
2. Social Anxiety Disorder (abnormal anxiety of social interactions)
3. Post-traumatic Stress Disorder (abnormally intense episodes of anxiety following trauma)
4. Obsessive-Compulsive Disorder (abnormally intense and abnormally focussed anxiety resulting in compulsive behaviours)
5. Specific phobias (abnormally focussed anxiety on one particular trigger), and
6. Generalised Anxiety Disorder (abnormal anxiety of everything)

The common underlying theme of anxiety is uncertainty. Grupe and Nitschke wrote, “Anxiety is a future-orientated emotion, and anticipating or ‘pre-viewing’ the future induces anxiety largely because the future is intrinsically uncertain.” [1]

The dysfunctional approach to uncertainty that underlies anxiety is in turn related to genetic changes which affect the structure and function of the brain, primarily in the regions of the amygdala and the pre-frontal cortex, which then alters the processing of our brain in five different areas:
> Inflated estimates of threat cost and probability
> Hypervigilance
> Deficient safety learning
> Behavioural and cognitive avoidance
> Heightened reactivity to threat uncertainty

In simpler language:
> the brain thinks that threats are more likely and will be worse than they are
> the brain spends more time looking for possible threats
> the brain fails to learn what conditions are safe, which is aggravated by
> the brain over-using avoidance as a coping mechanism, and
> the brain assumes that unavoidable uncertainty is more likely to be bad.

It’s important to understand at this point that anxiety disorders aren’t the result of poor personal choices. They are the result of a genetic predisposition to increased vulnerability to early life stress, and to chronic stress [2].

The other way of looking at it is that some people are blessed with amazing tools for resilience [3, 4].

It’s not to say that our choices have no impact at all, but we need to be realistic about this. Everyone will experience stressful situations at some point in their lives, and everyone will also make dumb choices in their lives. Some people are naturally better equipped to handle this, whereas some people have genes that make them more vulnerable. It’s wrong to blame yourself, or allow other people to blame you, for experiencing anxiety, just as it’s wrong for other people to assume that if one person can cope with the same level of stress, then everyone else should too.

It’s not to say that you shouldn’t fight back though. Just because your facing a mountain doesn’t mean to say you can’t climb it. It will be hard work, and you’ll need good training and support, but you can still climb that mountain.

Managing anxiety is very similar to managing depression like we discussed in a previous post. Following the tap model, there’s overflow when there is too much going into the system, the system is too small to handle it, and the processing of the input is too slow. So managing anxiety involves reducing the amount of stress going into the system, increasing the systems capacity through learning resilience and coping skills, and sometimes by improving the systems processing power with medications.

Reducing the input – stress management

Sometimes the best way of coping with anxiety is to reduce the stress that’s fanning the flames. It mightn’t seem to come naturally, but as we discussed in the last chapter, there are a few basic skills that are common to all stress management techniques that can form the platform of ongoing better skills in this area.

Engaging the “vagal brake” as proposed by the “Polyvagal Theory” [5] is as important in anxiety as it is in depression. By performing these techniques, the activity of the vagus nerve on the heart via the parasympathetic “rest-and-digest” nervous system is increased, which not only slows down the heart, but enhances the activity of other automatic parts of our metabolism. Some of the techniques allow a relaxed body to have a relaxed brain which can cope better with whatever is confronting it. The full list will be a blog for another time, but the simplest technique is to breathe!

It’s really simple. Sit in a comfortable position. Take slow, deep breaths, right to the bottom of your lungs and expanding your chest forward through the central “heart” area. Count to five as you breathe in (five seconds, not one to five as quickly as possible) and then count to five as you breathe out. Keep doing this, slowly, deeply and rhythmically, in and out. Pretty simple! This will help to improve the efficiency of your heart and lungs, and reduce your stress levels.

Remember, B.R.E.A.T.H.E. = Breathe Rhythmically Evenly And Through the Heart Everyday.

Increasing capacity – coping and resilience

Like with depression, anxiety responds well to psychological therapies which help to increase coping skills and enhance our innate capacity for resilience. And like depression, anxiety improves with CBT and ACT [6, 7], which enhance the activity of the pre-frontal regions of the brain [8]. For anxiety, CBT teaches new skills to handle uncertain situations, and to re-evaluate the chances of bad things happening and what would happen if they do. ACT puts the train of anxious thoughts and feelings in their place, and teaches engagement with the present moment, and a future focusing on values, and accepting the discomfort of uncertainty by removing the distress associated with it.

Practicing each of these skill sets is like practicing any other skill. Eventually, with enough practice, they start to become more like a reflex, and we start to cope with stress and anxiety better automatically.

Increased processing – Medications

Sometimes, to achieve long-term successful management of anxiety, a little extras help is needed in the form of medication. Like depression, the main group of medications used are the Selective Serotonin Reuptake Inhibitors (or SSRI’s for short). Medications appear to reduce the over-activity of a number of brain regions collectively called the limbic system [8], which are involved with many innate and automatic functions, but in its simplest form, the limbic system controls many of our emotions and motivations, including fear, anger and certain aspects of pleasure-seeking [9]. So essentially, SSRI’s help the anxious brain to make better sense of the incoming signals.

There are other medications commonly used for anxiety treatment, collectively called benzodiazepines. Most people wouldn’t have heard that term before, but would have heard of the most famous member of the benzo family, Valium. Benzos are like having a bit too much alcohol – they slow down the activity of the brain, and induce a feeling of relaxation. When used appropriately (i.e.: in low doses and in the short term), they can be helpful in taking the edge off quite distressing feelings of anxiety or panic. But benzos are not a cure, and after a while, the body builds a tolerance to them, where a higher dose is required to achieve the same effect. Continued long term use eventually creates dependence where a person finds it difficult to cope without them.

The final way to help manage anxiety is prayer. Like for depression, there is limited scientific information on the effects of prayer on, although a small randomised controlled trial did show that prayer with a prayer counsellor over a period of a number of weeks was more effective than no treatment [10].

Though given that anxiety is a future orientated emotion, excessively anticipating possible unwelcome scenarios and consequences, it’s easy to see why prayer should work well for anxiety. Trusting that God has the future in hand and knowing “that in all things God works for the good of those who love him, who have been called according to his purpose” (Romans 8:28) means that the future is less uncertain. The Bible also encourages us, “Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God. And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus.” (Philippians 4:6-7) When we give the future to God, he will give us peace in return.

Again, like in the case of depression, it’s sometimes hard for Christians to understand how strong Christians can suffer from anxiety in the first place. After all, we’ve just read how God gives us peace. And the Bible says that the fruit of the Spirit is peace (Galatians 5:22).

So when you’re filled with the opposite, when all you feel is overwhelming fear, it makes you feel like a faithless failure. Christians without anxiety assume that Christians with anxiety aren’t living in the Spirit. And it’s the logical conclusion to draw after all – if the fruit of the Spirit is peace, and you’re not filled with peace, then you mustn’t be full of the Spirit.

But like depression, when you look through the greatest heroes in the Bible, you see a pattern where at one point or another in their lives, they went through physical and emotional destitution, including mind-numbing fear … Moses argued with God about how weak and timid he was (Exodus 3 and 4), Elijah ran for his life in panic and asked God to kill him, twice, over the period of a couple of months after Queen Jezebel threatened him (1 Kings 18 and 19). Peter had spent three years with Jesus, the Messiah himself, hearing him speak and watching him perform miracle after miracle after miracle. But Peter denied his Messiah three times when he was confronted with possible arrest (John 18).

For the same pattern is also seen in King David, Gideon, and a number of other great leaders through the Bible. The take home message is this: it’s human nature to suffer from disease and dysfunction. Sometimes it’s physical dysfunction. Sometimes it’s emotional dysfunction. It’s not a personal or spiritual failure to have a physical illness. Why should mental illness be treated any different?

As the stories of Moses, Elijah and Peter testify, being a strong Christian doesn’t make you impervious to fear and anxiety. Hey, we’re all broken in some way, otherwise why would we need God’s strength and salvation? Having anxiety simply changes your capacity to experience God’s peace. As I said in the last chapter, closing your eyes doesn’t stop the light, it just stops you experiencing the light. Being anxious doesn’t stop God’s peace, it just makes it harder to experience God’s peace.

In summary some anxiety, at the right time and at the right intensity, is normal. It’s not unhealthy or sinful to experience some anxiety. Anxiety at the wrong time or at the wrong intensity, can disrupt our day-to-day tasks and make it hard to live a rich and fulfilling life. Anxiety related to a dysfunctional approach to uncertainty, and is a future-orientated emotion because anticipating or ‘pre-viewing’ the future induces anxiety largely because the future is intrinsically uncertain. Anxiety disorders can be debilitating.

Like depression, anxiety disorders can be managed in four main ways, by reducing the amount of stress coming in with stress management techniques, by increasing capacity to cope with psychological therapies like CBT and ACT, and sometimes by using medications, which help the brain to process the uncertainty of each situation more effectively. Prayer is can also useful to helping to manage anxiety.

Christians are not immune from anxiety disorders, and it’s important for the church to understand that Christians who suffer from anxiety are not weak, backsliding or faith-deficient. Having anxiety is not because of making poor choices. Though if you have anxiety, trust in the promises of the Bible, that God has the future under control.

References

[1]        Grupe DW, Nitschke JB. Uncertainty and anticipation in anxiety: an integrated neurobiological and psychological perspective. Nature reviews Neuroscience 2013 Jul;14(7):488-501.
[2]        Duman EA, Canli T. Influence of life stress, 5-HTTLPR genotype, and SLC6A4 methylation on gene expression and stress response in healthy Caucasian males. Biol Mood Anxiety Disord 2015;5:2.
[3]        Wu G, Feder A, Cohen H, et al. Understanding resilience. Frontiers in behavioral neuroscience 2013;7:10.
[4]        Russo SJ, Murrough JW, Han M-H, Charney DS, Nestler EJ. Neurobiology of resilience. Nature neuroscience 2012 November;15(11):1475-84.
[5]        Porges SW. The polyvagal perspective. Biological psychology 2007 Feb;74(2):116-43.
[6]        James AC, James G, Cowdrey FA, Soler A, Choke A. Cognitive behavioural therapy for anxiety disorders in children and adolescents. The Cochrane database of systematic reviews 2013;6:CD004690.
[7]        Swain J, Hancock K, Hainsworth C, Bowman J. Acceptance and commitment therapy in the treatment of anxiety: a systematic review. Clinical psychology review 2013 Dec;33(8):965-78.
[8]        Quide Y, Witteveen AB, El-Hage W, Veltman DJ, Olff M. Differences between effects of psychological versus pharmacological treatments on functional and morphological brain alterations in anxiety disorders and major depressive disorder: a systematic review. Neuroscience and biobehavioral reviews 2012 Jan;36(1):626-44.
[9]        Sokolowski K, Corbin JG. Wired for behaviors: from development to function of innate limbic system circuitry. Frontiers in molecular neuroscience 2012;5:55.
[10]      Boelens PA, Reeves RR, Replogle WH, Koenig HG. A randomized trial of the effect of prayer on depression and anxiety. Int J Psychiatry Med 2009;39(4):377-92.

If you’re suffering from anxiety or any other mental health difficulties and if you want help, see your GP or a psychologist, or if you’re in Australia, 24 hour telephone counselling is available through:

 Lifeline = 13 11 14 – or – Beyond Blue = 1300 22 4636