"INSIDE OUT" GETS IT RIGHT!

I recently saw the movie "Inside Out" with my wife and two of our friends.  The mother of a 9 year old that I treat had recommended that I see the movie.  

The movie is about the feelings that a 11 year old girl named Riley has as she leaves behind her home in Minnesota and moves to San Francisco.  Her feelings are depicted by characters identified as sadness; anger; joy; fear; and disgust. Joy takes charge and attempts to keep Riley feeling happy.  Joy feels that she must contain and limit sadness so sadness doesn't infect the other feelings with sadness. Over the course of the movie it becomes clear to Joy that Riley needs her sad feelings to help her to cope with the move from Minnesota to San Francisco.  When she is able to feel her sadness, Riley is able to share her feelings with her parents about missing Minnesota.  This allows Riley to let go of her missing Minnesota and start to have feelings about San Francisco.  Dacher Keltner and Paul Ekman were hired as consultants for the movie and their piece on the op-ed page of the New York Times on July 5, 2015 indicated that they were disappointed that sadness was portrayed as limited and contained.  However, I think that the movie does a good job portraying what happens when we hold our feelings in and often then we are stuck not being able to let go of our worries and not able to move on.  When we hold our feelings in, our brains interpret this as a problem and then focus on trying to solve this problem.  We are therefore stuck and not able to let go of the worries.

Sadness is important as are all our emotions are.  To deny them or hold them in and not show them requires a lot of work from our brain and this occupies our brain and blocks us from experiencing our feelings and moving on with our life.  

It is also important to note that happiness was not one of the emotions that Riley was experiencing.  So, may be it is possible to feel sadness or any other emotion and still be happy.  What do you think?

WHAT WOLVES TEACH US ABOUT IT MEANS TO BE AN ALPHA MALE

An OP-ED piece in the June 6, 2015 New York Times by Carl Safina sheds important light on alpha male wolf behavior. In contrast to the notion that the alpha male is dominant and in control in the home and aggressive outside the home, the alpha (dominant) male wolf helps get food for the entire family all year, helps raise the pups and show kindness to other members of the family. Each wolf seems to lead by example, and by a quiet confidence devoting themselves to caring for and defending their families and respecting the females. Also, the (alpha) females, according to Doug Smith (project leader for the Yellowstone Gray Wolf Restoration Project), reports that female wolves make most of the decisions for the family including where to travel, when to rest and when to hunt. The female has an important role in the family and the females and males share many responsibilities. It seems that we have something to learn from wolf families, through the similarities of wolf and human families. Is this another example of a "lower species" being able to teach us, a "higher species", a thing or two.

 Families are important to wolves and humans. Each person and each wolf are members of a family and their happiness is in direct relation to the health of their families and this seems to be closely connected to how wolf-like their parents are.

FACING UNEMPLOYMENT CAN KILL YOU!

I recently read about a study that improved on previous single country studies that showed that unemployment increases the suicide rate. This new study (Nordt C et al. Modeling suicide and unemployment: A longitudinal analysis covering 63 countries. 2000-11. Lancet Psychiatry 2015 Mar; 2:239) found that suicide rates increase 20-30%, 6 months before unemployment rates increase. The suicide rates were highest when baseline unemployment rates were low and the suicide rates increased independent of country, age group and sex, and were not related to a worsening economy.

So it seems that anticipating losing one's job (suicide rate increases 6 months before unemployment increases) can lead to suicide. I have blogged about what makes up our sense of identity. Many people are heavily dependent on their work to define themselves. This could put them at risk if they were anticipating losing their jobs. An unfortunate example of this might be the recent suicides of two people in politics. Missouri Auditor, Tom Schweich, was a top Republican candidate for governor and was publicly campaigning against what he saw as corruption in (Missouri) state government when a political ad came out depicting him as incompetent comparing him to Barney Fife from the Andy Griffith TV show.  Schweich was also convinced that rumors were being spread that he was Jewish, potentially making it hard for him to attract conservative christian donors. Schweich then committed suicide.  Apparently, Schweich went from feeling like he would easily become the Republican candidate for governor to seeing his chances dwindle and that his political career might be over as well. A month later, Schweich's  media director Robert Jackson, also committed suicide. Jackson had called for the resignation of the Missouri Republican state chairman as Schweich had alleged that this person had been spreading rumors that Schweich was Jewish. The resignation did not happen and then another suicide. I wonder if Jackson felt that his political career was going to end and that it would be difficult for him to work in politics in Missouri.

It seems that the threat of losing one's job can lead to suicide.  This risk is another reminder to all of us of the potential impact of stress in our lives.  Please talk to family or friends or someone that you trust when you start to feel stressed.  Feeling isolated makes stress worse. 

IS THERE A WAY FOR DIFFERENT TREATMENTS TO WORK TOGETHER TO SUCCESSFULLY TREAT PTSD?

I was recently reading about research into ways to lower stress in adults with long-term PTSD (post traumatic stress disorder) Markowitz, et al. Is exposure necessary? A randomized clinical trial of interpersonal psychotherapy (IPT) for PTSD. Am J Psychiatry 2015 Feb 13; (e-pub).  The study compared IPT to exposure therapy (ET) to relaxation therapy (RT).  They studied 110 unmedicated adults with long-term PTSD who were not receiving psychiatric treatment.  These adults received 14 weeks of IPT (focusing on the emotional and interpersonal impact of their traumas), or 14 weeks of ET, or 14 weeks of RT.  Results indicated a greater but not statistically significant symptom reduction with ET, but the over all response rate was 63% for IPT, 47% for ET, and 38% for RT.

What excites me about these results is that three different types of treatments were helpful in reducing PTSD symptoms.  It makes me think about a continuum from an initial focus on relaxation techniques and then exposure therapy followed by interpersonal therapy.  The relaxation skills could help people pace their treatments so that they do not experience retraumatization. I also wonder if IPT might need to be used before ET or intermittently after ET has begun.  It does seem that it is important to identify the traumatic experiences and then be able to purposefully think about them without re-experiencing the stress connected to them. Being able to do this successfully would seem to be more likely if people with PTSD had access to all three of these treatments as well as pharmacotherapy.

LISTENING REVISITED

Recently I was reading a number of studies about physicians listening to their patients.  On average physicians wait from 12 to 20 seconds before they interrupt their patients.  After this interruption, physicians may ask questions but often will not give their patients an opportunity to share more of their concerns, although will ask their patients questions about symptoms related to what the physician believes is the diagnosis.  I have recently blogged about the importance of going to your appointment with your physician prepared with a list of all your medications (and supplements); a list of your symptoms; etc.  I may have needed to emphasize that it might be necessary to be very assertive with your physician by insisting that you have time to discuss your symptoms and to ask questions.

So why is listening so important?  Well, it is likely that it is only by listening to you that your Doctor will know how to help you. Listening is also a very good way for all of us to be empathically connected to others.  I realized the connection between listening and empathy while hearing some of my patients describe trying to help others deal with a loss and their feelings of grief.  Frequently my patient would tell me that they didn't know what to say and ended up "only listening."  Over and over I heard "all I did was listen."  I asked my patients how the person who was experiencing the loss responded to being listened to.  My patients reponded that they said they were grateful that they listened to them.  Then I heard another patient describe helping someone cope with loss by telling them "I know how you feel" and "we are nevere burdened by more than we can handle" and "I know lots of people who have gotten through this."  It seemed clear to me that these statements were about how my patient was coping and not about the person experiencing the loss.  In an effort to be helpful, my patient was responding sympathetically and not empathically. My patient was attempting to join the other person in coping with the loss instead of being supportive of that person, the way my patient wanted to be.  My patient realized that the person going through the loss was actually angry with my patient. We then discussed that value of listening as we are not telling the other person what to do or how to react and instead we are being present with them as they share their thoughts and feelings.  I have also found that if we actually listen without our own agenda getting in the way, we will then know what to say or do after we have listened.  I believe that this is because we are not getting in the way of our brain by focusing more on our own reactions and feelings.  We [our brain] knows what to say or do and will provide this for us if we let it.  

Wierd but seems to be true.  Try it.