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Endometriosis Linked To Heart Disease, And Why Lena Dunham Might Care

Earlier this year, the writer, actor and deliciously self-deprecating starlet Lena Dunham announced that health problems would prevent her from promoting her award-winning HBO series “Girls.”

“As many of you know I have endometriosis,” she wrote on Instagram (with the photo below). “I am currently going through a rough patch with the illness and my body (along with my amazing doctors) let me know, in no uncertain terms, that it’s time to rest.”

More recently, television host and cookbook author Padma Lakshmi cited her battle with endometriosis as “a major reason” her marriage to writer Salman Rushdie failed.  

“Once diagnosed, I was relieved to know that I wasn’t crazy and that there was a reason for all this pain,” Lakshmi writes in the introduction of a new book by her doctor, Tamer Seckin, “The Doctor Will See You Now.” “Endo is not a life-threatening disease, but it does take away your life.”

Now, it turns out, new research suggests endometriosis, which afflicts about 10 percent of all reproductive-age women in the U.S., may be even more damaging than previously thought — indeed potentially life-threatening. 

Doctors at Brigham and Women’s Hospital in Boston report that women with endometriosis — abnormal growth of uterine tissue outside of the uterus that can cause extreme pain and lead to infertility — have a 60 percent increased risk of coronary heart disease.

What’s more, the researchers found, the association between endometriosis and heart disease is strongest in women 40 or younger. Among them, there were 65 cases of heart disease per 100,000 women with endometriosis, compared with 19 cases in women without the condition.

“That’s a threefold increased risk” of having a heart attack, chest pain or requiring treatment for blocked arteries, said senior study author Stacey Missmer, director of Epidemiologic Research in Reproductive Medicine at Brigham and Women’s.

Many patients with endometriosis report that it can take years of suffering with the disorder before finally getting a proper diagnosis and adequate treatment. Even then, they say, their pain and distress is often minimized.

Linda Griffith, a professor at MIT and director of the institute’s Center for Gynepathology Research, said that even with growing awareness about the disorder, endometriosis isn’t always taken seriously. There’s still an attitude that endometriosis is “a women’s problem” she said, and that sufferers should simply “buck up” and deal with their “bad cramps.”

“To me, this study is a clarion call that we can’t just sit idly by,” said Griffith, who has undergone numerous surgeries for her own endometriosis. “This paper is important because the message is that women with this disease go on to have serious health problems, and their increased risk is high. …It should make people stop and think and stimulate more studies.” 

So what’s the connection between endometriosis and heart disease? Continue reading

WBUR Asks: Want To Nominate Someone As Your Fitness Inspiration?

Nintey-year-old retired Marine Col. Jonathan Mendes crosses the finish line at the end of the 2010 New York City Marathon, after 9 hours and 55 minutes. (USMC via Wikimedia Commons)

Nintey-year-old retired Marine Col. Jonathan Mendes crosses the finish line at the end of the 2010 New York City Marathon, after 9 hours and 55 minutes. (USMC via Wikimedia Commons)

Shhhhhh… We haven’t announced it officially yet, but we here at CommonHealth are working on a podcast that aims to apply the power tools of public radio — solid information, great storytelling and sound — to fitness. You know the umpteen Why To Exercise Today posts we’ve put up over the years? Kind of like those, only even better, and in the form of ear candy plus a daily email you’ll be able to sign up for in a few weeks.

As we begin the early stages of production, we’d love your help — and this is a chance to give props to someone you think deserves public recognition for what’s usually private effort. Is there someone you know who’s really your fitness inspiration? Who’s turned their health around, or just fights the good fight every day, as they’re able? Someone you’d like us to consider featuring in one of our podcasts or posts?

Let us know! Click here and fill out the Google form.

We welcome nominations of anyone you deem deserving, but there are a few types of folks we’re particularly looking for right now. People who…

• Seem to have zero free time but somehow manage to exercise anyway.

• Can talk about how exercise affects their weight, or their mood, or their energy levels.

• Can talk about how they overcome their own inertia and resistance.

• Actually enjoy weights and resistance training.

• Find ways to exercise despite their problematic location, or great ways to do it for free.

• Can talk about “falling off the wagon” of exercise and getting themselves back on.

• Have set themselves very gradual exercise goals, or found very simple rules.

• Can talk about how exercise affects their aging.

• Can share how their buddies/the social side help.

Thank you in advance! And please stay tuned — watch for word of “The Magic Pill.” (As in, exercise is the closest thing we have to one.)

Why To Exercise Today: Journal Warns Zapping Your Muscles At Gym Not Safe

Fitness training with electrical stimulation (Bodystreet/Wikimedia Commons)

Fitness training with electrical stimulation (Bodystreet/Wikimedia Commons)

Confession: I didn’t know this was already a thing. I thought it was still purely my fantasy: I lie down on a padded table and tell the electrode technician, “Please give me the equivalent of an hour of CrossFit.” Then I relax as my muscles and nerves are zapped into activity that approximates an actual workout, but sweat-free.

I’m filing that fantasy away with my hopes for a pill that will someday activate my brown fat so brilliantly that the need for actual exercise is utterly obviated. Because a letter just out in the journal BMJ warns that the relatively novel practice of “whole-body electrical stimulation” at the gym can land you in the hospital with rhabdomyolysis, or muscle breakdown.

(Of course, non-electric CrossFit can apparently lead to the dreaded “Uncle Rhabdo” too, if you really overdo it. Also, I should note that the electrical stimulation discussed in the BMJ letter is the kind used during a workout, not instead of one as in my fantasy.)

The letter, titled “It’s time to regulate the use of whole-body electrical stimulation,” opens with the background:

Transcutaneous electrical stimulation (ES) of human nerves and muscles has long been used as a non-pharmacological treatment for pain relief, and for rehabilitation after disuse. Whole body ES has recently emerged as an alternative form of physical exercise for improving fitness and health in healthy people. Despite limited scientific evidence on the safety and effectiveness of this form of exercise, several ES company sponsored fitness centers have recently been opened in different countries worldwide, making this technology easily accessible to the general population.

Now for the no-free-lunch part:

On 4 August 2015, a 20-year-old man presented to our hospital with severe muscle pain shortly after a session of gym based whole body ES exercise supervised by a fitness professional. Rhabdomyolysis was diagnosed, and he was treated with intravenous 0.9% saline for five days.

In Israel, a TV documentary publicized the potential risks of electrical stimulation, reporting that thousands of Israelis have tried it. The BMJ letter notes that several problematic cases have arisen and the Health Ministry issued an official public warning against the practice in January. The warning said bluntly: “The devices must not be used in gyms. Use without medical supervision could cause danger to health.”

The BMJ letter suggests that other health authorities follow suit. I asked its senior author, Dr. Nicola Maffiuletti, head of the Human Performance Lab at the Schulthess Clinic in Zurich, three quick questions by email:

Do you happen to know how common it has become for gyms to offer electrical muscle stimulation, and has it arrived in the United States yet?

Maffiuletti: “‘Whole body EMS’ is increasingly offered worldwide, also in the U.S. (there are three main brands that are distributed in more than 40 countries worldwide, including the U.S.). As an example, more than 500 centers have been opened in Spain in the last five years that offer whole body EMS. (Spain is one of the countries where EMS is more used.)”

What is the science on whether EMS actually works to replicate the effects of exercise? Is there any good research on that? How does the actual science compare with the marketing/advertising claims? Continue reading

Opinion: A Call For Protecting The Health Of Women Who Donate Their Eggs

Human egg and sperm (Spike Walker. Wellcome Images/Flickr)

Human egg and sperm (Spike Walker. Wellcome Images/Flickr)

By Judy Norsigian and Dr. Timothy R.B. Johnson

The egg market is growing.

As couples and individuals continue to rely on assisted reproductive technology to overcome infertility, to make parenthood possible for gay couples and for other reasons, the demand for eggs is increasing swiftly. Between 2000 and 2010, the number of donor eggs used for in vitro fertilization increased about 70 percent per year, from 10,801 to 18,306, according to a report in the Journal of the American Medical Association.

And although there are no exact figures for how many young women engage in egg-retrieval-for-pay, the numbers are at least in the thousands. Many of these women are in their early 20s — often university students in need of cash to cover their tuition fees. But what most of these women, as well as the general public, don’t realize is that there are no good long-term safety data that would enable these young women to make truly informed choices.

Now, a number of women’s health and public interest advocacy organizations — including Our Bodies Ourselves, the Pro-Choice Alliance for Responsible Research and the Center for Genetics and Society — are studying women’s knowledge about egg retrieval and calling for more and better research about its risks.

Here’s an example:

One drug frequently used to suppress ovarian function (before the ovaries are “over-stimulated” to produce multiple eggs that can then be harvested and fertilized) is leuprolide acetate (Lupron). The U.S. Food and Drug Administration has not given approval for this particular use of the drug, and thus its use during egg retrieval protocols is “off label.”

In various surveys of younger women engaging in so-called egg “donation,” it appears that this fact about off-label use is rarely shared. Probably few, if any, of these young women know about the 300-page review of many Lupron studies that Dr. David Redwine submitted to the FDA in 2011. In this report, he documents a plethora of problems, some long term.

How can we encourage the collection of adequate long-term data about the extent and severity of egg retrieval risks? Given the strong anecdotal evidence of problems such as subsequent infertility, a possible link to certain cancers and more prevalent short-term problems with Ovarian Hyperstimulation Syndrome (OHSS) than previously reported in the literature, more well-done studies are needed.

Continue reading

Study: Despite Weight Gain, Quitting Smoking Improves Heart Health For Mentally Ill After A Year

(kenji.aryan/flickr)

(kenji.aryan/Flickr)

The health profile for people with serious mental illness is pretty grim. In general, they have a lower life expectancy — 25 years less than the general population — which is largely due to cardiovascular disease related to high rates of obesity and smoking.

But a new study by researchers at Massachusetts General Hospital found that after one year, seriously mentally ill patients who quit smoking — even though they gained about 10 pounds — had a lower risk of developing heart disease compared to those who didn’t quit. That’s the good news part of the research, published online in The Journal of Clinical Psychiatry. The bad news is that if those people — who already have high rates of obesity — continue to gain weight, it’s fairly likely they will develop a slew of other health problems, including cardiovascular disease, said the study’s lead author, Dr. Anne Thorndike, an assistant professor at MGH and Harvard Medical School.

“Quitting smoking is the single most important behavior change that anyone, [including] people with serious mental illness, can do to reduce their risk of developing cardiovascular disease,” Thorndike said in an interview. “But the weight gain is a red flag. The story’s not over at one year … If they continue to gain weight, all the health factors will worsen and contribute to higher rates of cardiovascular disease.”

Continue reading

Anguished Reflections Of A College Crisis Counselor: A Student ‘On The Rooftop’

(Romain Caplanne/Flickr)

(Romain Caplanne/Flickr)

By John Rosario-Perez
Guest Contributor

John Rosario-Perez (Courtesy)

John Rosario-Perez (Courtesy)

We live and die for the weekend. Nowhere is this more true than on college campuses, where students are in hot pursuit of the pleasure principle. Chasing excess is a sport as well as a rite of passage. But the 72 hours from Friday night to Monday morning can also be among the most perilous, a portal to despair with no exit. A college crisis clinician for eight years, I encountered many students who suffered the weekend as exiles.

Over time I listened to dozens of anguished stories, so many that I could almost predict their twists and turns. Some were as lurid as a tabloid headline. Others landed faintly on the ear, a circuitous tale with multiple digressions before arriving at the dreaded destination — pain. Their narratives fell under many rubrics — crushed idealism, first love gone awry, dreams vanquished by failure. Betrayal.

To the casual observer, such confidences might seem transient and overblown, hysterical laments tied to youthful indiscretions. But to those overcome by despair, isolation can often feel permanent and unending, a life sentence without reprieve.

2 AM

Their calls often come in the middle of the night. By force of habit, I sleep restively, my ear cocked in anticipation of the mobile pager’s trill. Each time it summons me, I try to suppress a vague sense of dread and the panicked feeling that I don’t really know what to do despite my years of experience. A rush of adrenaline gives me a heightened sense of alertness and danger but also of being put on the spot.

Like so many other nights, I rouse myself from half-sleep and strain to collect myself in the dark. The phone lies on the bedside table, but my fingers, as reluctant as an arthritic’s, resist reaching for it. After speaking with the campus police, I dial a number.

“Hello. You called the crisis line?” I ask. “How can I help you?”

“It’s my roommate, Kevin. I’m not sure, but I think he’s suicidal,” a trembling voice says. “What should I do?” Continue reading

Mass. Hospitals Seeing Surge In Heroin-Related Visits

Opioid-related hospital visits are “skyrocketing” in Massachusetts, with heroin-related visits jumping by 201 percent between 2007 and 2014, according to Health Policy Commission figures discussed Wednesday.

Opioid-related hospital visits have increased from around 30,000 in 2007 to more than 55,000 in 2014, with non-heroin opioids accounting for the bulk of the trips, an analysis by the commission found.

“These are not deaths,” said Katherine Record, the commission’s deputy director of Behavioral Health Integration and Accountable Care. “These are patients who had successful health care intervention….and the rate of those patients, is skyrocketing, as you can see.”

Record said there has been “huge growth” in heroin-related hospital visits. “Heroin has gotten cheaper and more accessible, and as we clamp down on the availability of pills, which is a good thing, it does force patients to turn to heroin, so we need to be thinking about that as well as prescription control,” she said.

Preliminary findings from the analysis, presented at a meeting of the commission’s Quality Improvement and Patient Protection Committee, showed the rate of hospital visits varies significantly across the state, with Pittsfield, Holyoke, Springfield, Worcester, Boston, Lynn and Leeds, a village in Northampton, representing “hot spots” with higher rates of opioid-related inpatient admissions.

Continue reading

Related:

Even Before Pregnancy, Your Health Matters: Mom’s Obesity Linked To Higher Risk Of Baby’s Death

(Ernesto Andrade/Flickr)

(Ernesto Andrade/Flickr)

You know how it goes: The moment the pregnancy test is positive, you give up alcohol, you cut out coffee, you try to make every bite count and limit your weight gain to healthy norms. You’re suddenly responsible for two.

That’s the usual strategy. But new data suggest that perhaps it’s time to rethink that logic — it could be, by the time you get that pregnancy test result, you’re already late for the train.

Why? According to a recent study based on a sweeping analysis of more than 6 million births, there appears to be a robust link between a woman’s weight even before she gets pregnant and her baby’s risk of dying in her first year.

The numbers are small, but the researchers say they are significant:

Among normal-weight moms, about four in 1,000 babies die after birth; among moderately obese moms, that rises to nearly six babies per 1,000 and among morbidly obese moms, it’s more than eight babies per 1,000 live births.

(To be precise, “normal weight” for a 5-foot-4 tall woman before she’s pregnant is defined from 110-144 pounds; moderately obese is considered 175-204 pounds, and morbidly obese is 235 pounds or more.)

Obesity And Infant Deaths

Eugene Declercq, the study’s lead author and a professor at the Boston University School of Public Health, puts it this way: If you are truly obese, with a Body Mass Index of 40 or above before pregnancy, your baby has a 70 percent higher mortality risk compared with a normal weight woman. (This holds true even after controlling for a wide array of risk factors in the study, including race, ethnicity, education, insurance coverage, diabetes and hypertension, he said.)

“Since this involves pre-pregnancy obesity it emphasizes the importance of thinking of women’s health in general and not just when they’re pregnant, which has too often been the case.”

– Eugene Declercq

It’s the persistent association between BMI and infant mortality that makes the research compelling, Declercq said: As BMI increases above normal, the infant death rate increases consistently too.

“This links up women’s health and kids’ health in a really important way,” Declercq said in an interview. What it suggests, he adds, is that pre-pregnancy BMI still had a pretty strong relationship to both neonatal mortality (death in the first 28 days) and post-neonatal mortality (death in the first 28-365 days). “No matter how you cut it, that relationship is robust.”

The researchers also wondered whether pre-pregnancy obesity was related to a specific cause of death: notably, prematurity, congenital abnormalities or SIDS. As it turned out, obesity was a problem in all of those categories.

“The really powerful finding would have been if all of the higher rates of infant mortality were explained by a single cause of death, but that wasn’t the case here,” Declercq said. “The implication, essentially, is it’s not one thing we have to worry about — obesity is a multifaceted problem in terms of outcomes.”

An ‘Alarming’ Rise In Obese Women

And clearly, the implications are broad. The American College of Obstetricians and Gynecologists recently reported an “alarming” increase in the number of obese women of reproductive age in the U.S.: More than half are overweight or obese.

“A major hope in initiating this project was to get the focus on women’s health throughout her life course and not just when she’s pregnant,” Declercq said.

Lizzie, a 32-year-old chiropractor in Medford, Massachusetts, who asked that her last name not be used, says although she’s not obese, she’s definitely above her ideal weight.

Recently, Lizzie’s ob-gyn told her that if she wants to get pregnant (which she does), losing 10 to 20 pounds would be a good idea. “Even though I knew it intellectually, it was very hard to hear,” Lizzie said in an interview. “What bothered me the most was she said it but didn’t give me anything else, she didn’t talk about what I should do, no specifics about exercise or nutrition.”

With a family history of diabetes and a sister who had gestational diabetes during pregnancy, Lizzie says she’s trying to lose weight before conceiving, but it’s not easy.

“I desperately don’t want to repeat what my sister went through,” she said. “But it’s been a challenge … I’m a big sugar person — that’s my downfall, and a daily struggle.”

A Fraught Discussion

Actually getting women to lose weight before they’re pregnant is far easier said than done, says Dr. Naomi Stotland, a co-author of the recent Declercq study, and an ob-gyn at University of California San Francisco.

About half of pregnancies are unplanned, she says, which makes it hard to get the message across at the right time.

In addition, says Stotland, also on the faculty at San Francisco General Hospital, pressuring women to lose weight can be tricky for both doctors and patients. “Even if a physician is motivated to talk about it, the woman might not be in the right place to hear it.” she said.

For example: If a patient has an appointment to get birth control, it may not feel appropriate for the gynecologist to say, ‘Hey, maybe think about losing weight for that future, theoretical birth you’re not planning to have any time soon,’ she said. Also, doctors’ own issues about weight complicate the matter: Thin doctors often feel awkward and non-compassionate urging patients to slim down, and overweight doctors feel they have little credibility, Stotland said.

A small 2010 study of pregnant overweight and obese women, called “What My Doctor Didn’t Tell Me,” concluded that women often don’t feel their doctors are providing appropriate or helpful (or any) information on weight.

A Too-Accessible McDonald’s

And the complications only increase when poverty is also in the mix, says Dr. Nidhi Lal, a primary care doctor at Boston Medical Center. She says in her practice, which includes hundreds of reproductive age women, with about 30 to 40 percent who are overweight or obese, access to healthy food is a major obstacle because many live in so-called “food deserts” where nutritious food is scarce and fast food and convenience stores proliferate.

“McDonald’s and Dunkin’ Donuts and 7-11’s are more accessible and affordable than shopping at Stop and Shop or Market Basket,” Lal said.

She said there are often deep misconceptions about food and pregnancy. For instance, some women assume that they need to start eating for two as soon as they start planning a pregnancy. “And these are women who are already overweight to begin with,” she said.

And there are cultural issues too.

“Women who are raised in the U.S. want to be thin, but they don’t always have the resources to get there and so they’re reluctant to talk about body weight,” Lal said. “They think I’m judging them or not being empathetic.” Women from certain other cultures, she says, prefer being heavy: “It’s a sign of attractiveness and prosperity.”

For doctors, then, it’s a tough path to navigate.

“It really requires a relationship of trust, a very non-judgmental kind of communication,” Lal said. “I try to make my patients well informed, tell them as many facts as I can: ‘This is why I want them to do this and how it can effect their pregnancy outcomes’ — a mother will do anything for the her baby. I try not to be negative, and say, ‘Oh no, you gained weight.’ It takes a lot pre-visit planning.”

Lal also tries to get her whole medical team involved, including consults with a nutritionist and prenatal nurse. Still, she adds: “It is hard to do everything in an empathetic manner in 15 to 20 minutes because despite what you say, they have their own sense of success and failure. Some are very discouraged because they are doing what they can but some things they can’t control.”

But the problem isn’t going away. A slew of recent studies suggest that obesity before and during pregnancy can cause enduring health woes.

A study published in January found that children born to mothers with a combination of obesity and diabetes before and during pregnancy may have up to four times the risk of developing autism spectrum disorder compared to children of women without the two conditions.

And late last year, the American College of Obstetricians and Gynecologists, calling obesity the “the most common health care problem in women of reproductive age,” issued new recommendations on obesity and exercise during pregnancy. It cited a list of problems associated with obesity mainly during pregnancy, including a higher risk of miscarriage, premature birth, stillbirth, birth defects, cardiac problems, sleep apnea, gestational diabetes, preeclampsia and venous thromboembolism, or blood clotting in the veins.

‘I’m Just A Fried Clams Girl’

But telling women to change their personal behavior in an across-the-board manner sometimes gets public health officials in trouble.

For example, there was a massive backlash against the Centers for Disease Control and Prevention when, earlier this year, it issued a blanket warning that sexually active woman of childbearing age and not using birth control should stop drinking alcohol — completely.

So, hitting the right tone when it comes to talking to women about their weight is key.

“Conveying the message is tricky since I wouldn’t want it to be another case of blaming mothers,” Declercq, the researcher, said. “Since this involves pre-pregnancy obesity it emphasizes the importance of thinking of women’s health in general and not just when they’re pregnant, which has too often been the case.”

Interestingly, his study, published online last month in the journal Obstetrics and Gynecology, also found that established recommendations from the Institute of Medicine on weight gain during pregnancy were largely not being followed. Those recommendations suggest that obese women limit weight gain to between 11 and 20 pounds during pregnancy, regardless of the severity of the obesity. However, there was essentially the same infant mortality risk among obese women who followed those guidelines compared to those who didn’t, the study found.

That finding raises several questions: Do the guidelines need rethinking? Or is there something about the genetics of obese women that persists through pregnancy even if some amount of weight is lost?

This study didn’t address those issues, but one thing is clear for any future public health efforts: Women remain far more motivated if they think they’re doing something for their babies, Declercq said. The trick is to get them to think about their own health as deeply as their kids’ — and well in advance.

Take Amy, a mom from Arlington, Massachusetts, who gave birth to three children through IVF (and also asked for confidentiality). Between pregnancies, she says, it got harder to lose the weight. Now, while considering a fourth child, she says she should lose about 22 pounds.

Like many moms, Amy is vigilant about feeding her children healthy meals, but when it comes to her own diet: “I can’t overcome my cravings for meatball subs…I don’t really enjoy eating a salad.” She said that while some people find pleasure in “racing cars or smoking” her downfall is high calorie foods. “You know what you’re supposed to do, but actually doing it is the hardest part,” she said. “If I have the choice between romaine lettuce and fried clams? I’m just a fried clams girl.”

Commentary: Getting Off Psych Meds Was The ‘Hardest Thing’ She’d Ever Done

By Dr. Annie Brewster

By the time Laura Delano was 25, she was taking five psychiatric drugs: an anti-depressant, an anti-psychotic, two mood stabilizers and an anti-anxiety medication.

But after years entrenched in the mental health system, and defined by her psychiatric diagnoses, Laura finally got off the medications and, as she says, began “recovering from psychiatry.”

For background: Laura grew up in a wealthy Connecticut suburb in a family of high achievers. She was a nationally ranked squash player and student body president. But in her teen years, life got more complicated as she struggled with questions about her own identity.

Laura Delano weaned herself off psychiatric drugs and says she shed her identity as a “professional mental patient.” (Courtesy)

Laura Delano weaned herself off psychiatric drugs and says she shed her identity as a “professional mental patient.” (Courtesy)

She felt burdened by social and academic expectations, and started to act out. She cut herself as a way to “control” her out-of-control world, and was ultimately sent to a psychiatrist by her parents. At 14, she was diagnosed with bipolar disorder and prescribed powerful psychiatric drugs, including the mood stabilizer Depakote and Prozac.

The medication side effects led to additional problems and “symptoms,” which in turn led to more medications, Laura says, and she began to lose herself. She felt defined by the diagnoses she continued to collect: bipolar disorder, borderline personality disorder, substance abuse disorder and binge eating disorder.

Laura’s early 20s were marked by multiple psychiatric hospitalizations and ultimately a suicide attempt. Her only identity was a self-described “professional mental patient.”

But then things began to change.

Over five years ago, Laura weaned herself off psychiatric drugs and shed her diagnostic labels. For her, this has been a spiritual journey involving the cultivation of self-acceptance, self-love and honesty. “It is the hardest thing I have ever done,” says Laura, now 32. But she feels happier, more connected and more engaged in the world. Here’s a bit more from our interview:

“When you are told that your brain is broken — basically the seat of your soul, your mind, the part of you that shapes everything about who you are — when you’re taught to believe that that’s broken, and that you can’t trust yourself, you can’t trust your emotions, you can’t trust your mind, I mean it instills in you just a profound fear. Over all these years I developed this relationship of faith in the mental health system and no faith in myself, and tremendous fear of myself. And so unpacking that has been at the heart of this whole journey, realizing, ‘Wait a minute…If I’m not broken and if the struggles I’ve gone through aren’t symptoms of an illness, what are they? Maybe they are actually important and meaningful…maybe they are telling me something.’ I began to listen to my pain, and to listen to my darkness and it [has]  brought me back to this spiritual journey which I think was beginning way back when I was thirteen… Who am I? How do I fit into this world? What are the stories I have been taught to believe about how you’re meant to live your life, and what it means to be normal and worthy and acceptable…”

Personally, I’m moved by Laura’s story. As a practicing internist, I often rely on psychiatric diagnoses and medications. In my clinical practice, I have seen psychiatric medications reduce suffering and save lives. But it’s been useful to step back and reconsider my filter on these issues.

From day one of medical training, we are taught to fit our patients into neat diagnostic categories whenever possible. The goal of our patient interactions, we learn, is to sift through and distill all that we see and hear in order to home in on a diagnosis. This categorization can be helpful in directing our care, of course, but it can also be limiting, and even dangerous. Rarely does a diagnosis fit perfectly, yet all too often in our culture one’s diagnosis becomes indistinguishable from one’s identity.

Labels have power. With mental illness, diagnostic criteria are particularly difficult to define and identify. Truthfully, our current understanding of the brain and the biochemistry behind mental illness is limited. There are no clear markers to measure and quantify. Instead, we must rely on subjective interpretation of behavior.

And yet, psychiatric labels abound. It is estimated that one in four adults, or approximately 61.5 million individuals, and one in five teens between the ages of 13 and 18, meet criteria for a diagnosis of mental illness within a given year.  Continue reading

How Unconscious Fear Of Death May Skew Your Judgment — In Life And 2016 Politics

(Simeon Muller/Unsplash.com)

(Simeon Muller/Unsplash.com)

It’s “the worm at the core” of your life: the knowledge that you will die. And who can blame you if you assiduously push the worm to the back of your mind, right?

But then along come three experimental psychologists who cook up all kinds of crafty tests to analyze exactly what the worm is doing to you. They take Ernest Becker’s 1973 classic, “The Denial of Death,” and go all empirical with it, gathering actual data on how fear of death seems to affect people, from romance and shopping to war and, yes, 2016 politics.

So even though you may not want to look death in the face, you might want to peek at what the psychologists found in their research spanning hundreds of studies over 25 years. Because really, even though you may need your denial to get through the day, it’s arguably insane to spend a life pretending away its central fact. At the very least, you can try to understand what all that denial is doing to you.

Skidmore College professor Sheldon Solomon, co-author of the team’s new book, “The Worm At The Core: On The Role of Death In Life,” spoke recently at Boston’s Museum of Science, and I damped down my own denial and asked him about mortality.

A taste of what he said: “Whenever people are reminded of death, they love people who share their beliefs and they hate people who are different. They sit closer to people who share their beliefs and they sit further away from anyone who looks different. And if we give people in a laboratory setting an opportunity to physically harm someone who’s different, after people are reminded of their mortality they become much more hostile and vicious.”

Here’s our conversation, lightly edited:

How would you summarize your central idea?

What we would say, in a proverbial nutshell, is that one way of thinking about what makes human beings unique is the fact that while we share with all forms of life a basic inclination toward self-preservation, we are arguably unique because of our big forebrain, which gives us the capacity to think abstractly and symbolically, to dwell on the past and anticipate the future.

“We wouldn’t be able to stand up in the morning. We’d just be quivering blobs of biological protoplasm cowering under our beds.”

– Sheldon Solomon

And because of that we’re smart enough to realize that like all living things, we will someday die; that we could die at any time, for reasons we cannot anticipate or control; and that like it or not, we’re animals, breathing pieces of defecating meat, no more significant or enduring than lizards or potatoes.

And our claim is — and this is based on Ernest Becker, who won a Pulitzer Prize for his book, “The Denial of Death” — that if that’s all we thought about, ‘I’m gonna die! I could walk outside and get hit by a comet! I’m a cold cut with an attitude!’ then we wouldn’t be able to stand up in the morning. We’d just be quivering blobs of biological protoplasm cowering under our beds.

And what we believe, following Becker, is that the way that human beings come to terms with the potentially debilitating existential terror that’s engendered by the awareness of death is to embed ourselves in culturally constructed beliefs about the nature of reality — what the anthropologists call culture.

Prof. Sheldon Solomon speaks at Boston's Museum of Science. (Courtesy of David Rabkin/Museum of Science)

Prof. Sheldon Solomon speaks at Boston’s Museum of Science. (Courtesy of David Rabkin/Museum of Science)

What culture does is to give us a sense that life is meaningful and that we’re valuable. It tells us where we came from, it tells us what we’re supposed to do while we’re alive. It gives us some hope of immortality in the hereafter, either literally — through the heavens, the afterlives and souls of all the world’s great religions — or symbolically: We may know we’re not going to be here forever but we’re still comforted by the fact that some vestige of of our existence will persist nevertheless — perhaps by having children, or by amassing great fortunes, or by doing something noteworthy in the arts or sciences.

And so the argument is that what makes us unique is that we know that we will someday die, and this gives rise to potentially paralyzing terror that we reduce by believing that we’re people of value in a world of meaning. And whether we’re aware of it or not — and most of the times we’re not — everything that we do, for the most part, is in the service of maintaining a sense that life has meaning and that we have value in order to reduce death anxiety.

So that fear of death is insidiously affecting our behavior all the time…

Absolutely. Because otherwise this might be right but trite. If it were obvious, then maybe we would all know this and be talking about it. But I think what makes these ideas both subtle as well as potentially profound — and profoundly interesting — is that the argument is that most of us don’t think about death all that much. And the reason is that we’re comfortably ensconced in a cultural worldview that is sufficient to allow us to stand up every day.

But your team’s work picks apart what those effects are experimentally.

That’s correct. Ernest Becker won a Pulitzer Prize for “The Denial of Death” and these are all his ideas. And people just said, ‘Well, this is shocking nonsense.’ Or, ‘This is interesting but speculative and can’t be tested.’ So 35 years ago, right out of graduate school — we’re experimental social psychologists, my buddies Jeff Greenberg, Tom Pyszczynski and I — we said, ‘Well, why can’t we try and test these ideas?’

The very first study we did was with municipal court judges in Tucson, Arizona. We divided them randomly into two groups. And we just told the judges we wanted them to look at a typical court case and assign bond for an alleged prostitute. What we did was to randomly divide the judges into two groups, where one of them was reminded of their mortality by answering two open-ended questions: Just describe your thoughts and feelings about your own death. And: Jot down what you think will happen to you physically when you die. Continue reading