mental health

RECENT POSTS

Aaron Swartz And The Brain-Gut Connection

Two health-related points struck me in this disturbing but exceedingly smart piece in the current New Yorker about the “darker side” of Aaron Swartz, the gifted young Internet activist who hanged himself in his Brooklyn apartment in January. (The “dark” health aspects of the story were so powerful that I called an expert to find out more about the potent connection between disorders of the gut and the brain. See below.)

First, the depth of Swartz’ physical distress and heightened sensitivity to everything from food to music is astounding. Reporter Larissa MacFarquhar writes:

He disliked all vegetables and refused to eat them except in extremely expensive restaurants, such as Thomas Keller restaurants. He had ulcerative colitis, a serious digestive disorder similar to Crohn’s disease; he also thought that he was a “supertaster,” experiencing sensations of taste more intensely than regular people. Partly for these reasons, he ate only foods that were white or yellow. He ate pasta, tofu, cheese, bread, rice, eggs, and cheese pizza. He was phobic about fruit and wouldn’t touch it. He rarely drank alcohol and was careful to stay hydrated. He went through four humidifiers in his apartment in Brooklyn. He said that he left San Francisco because the air-conditioning was bad. He was a supertaster in matters other than food: things always seemed much better or worse to him than they did to other people.

[From Swartz' own writing]: I recently had to sit through a performance of Bach’s Well-Tempered Clavier at the Chicago Symphony Orchestra. . . . At first it was simply boring, but as I listened more carefully, it grew increasingly painful, until it became excruciatingly so. I literally began tearing my hair out and trying to cut my skin with my nails (there were large red marks when the performance was finally over). (2006)

The second issue that seemed particularly relevant to the entire tragedy is the severity of Swartz’ ulcerative colitis, a type of inflammatory bowel disease that affects the colon and rectum, with symptoms that can range from highly uncomfortable to seriously painful. In the piece, MacFarquhar quotes one of Swartz’ friends discussing the link between ulcerative colitis, depression and suicide:

NIH/wikimedia commons

NIH/wikimedia commons

A doctor relative last night told me that he’d had some very painful experiences with patients with ulcerative colitis committing suicide. Apparently co-morbidity with depression is common. I’ve been thinking about it a lot for the last twelve hours. I know during the scare in 2007 he had gotten very, very sick from his U.C. He definitely didn’t seem depressed right before his death, nor for a long time previously. He wasn’t doing normal depressed-people things (like withdrawing from friends and family), let alone suicidal-people things (like giving away his stuff). However, he did commit suicide, which weighs pretty heavily on the other side of the scale. My doctor relative told me that some of his ulcerative-colitis patients seemed to be doing much better until the moment when they suddenly committed suicide, and that there’s some speculation that U.C. can alter liver functioning, which in turn can cause other medicine to cause impulsive behavior like suicide.
Ben Wikler, a friend

I spoke with Suzanne Bender, a psychiatrist at Massachusetts General Hospital and the psychiatric liaison to the pediatric gastro-intestinal service at MGH. Every Thursday, Dr. Bender sees children and adolescents with GI problems that have not responded to typical treatments, and have also caused emotional distress. She says many of these patients only get relief from their GI symptoms once coordinated care is provided, between GI and Psychiatry.

“In general, the gut and the brain talk to each other quite a bit,” Continue reading

Unexpected Post-Fukushima Health Woes: Depression, Obesity

By Judy Foreman
Guest Contributor

Nearly two years ago, a giant earthquake off the coast of Japan sent a 13-meter high tsunami crashing into the Fukushima Daiichi nuclear power plant, causing meltdowns in three of the six reactors and ultimately, triggering an explosion. Thousands were killed by the tsunami and earthquake.

No one has died from radiation and in fact no radiation health effects have yet been observed among the public or workers, according to a December, 2012 statement from a United Nations expert committee.

But even as the actual health effects from radiation – at least so far – are turning out to be much less dramatic than many people feared, a host of other, less-feared but very real, outcomes are causing lasting trouble. These include mental health problems such as alcoholism, depression, anxiety and, in the case of children whose parents and teachers are too afraid to let them play outdoors, a rise in obesity.

VOA Photo S. Herman/wikimedia commons

VOA Photo S. Herman/wikimedia commons

It is a striking illustration of what often happens in public health. What we think we should be most afraid of is often, in reality, less dangerous than we think, while other things that we are blasé about, carry higher risks. We fully believe, for instance, that we are being killed by toxic stuff in our air, water and food and ignore the huge health risks from sedentary lifestyles.

What we think we should be most afraid of is often, in reality, less dangerous than we think, while other things that we are blasé about, carry higher risks.

A fascinating article last month in the journal Nature illustrates the point beautifully.

The Fukushima Health Management Survey, described in detail in the Nature article, found that the doses of radiation experienced by people evacuated from the nuclear zone were surprisingly low. For nearly all the evacuees, the exposure level was only about 25 millisieverts (mSv). That is considerably less than the 100-mSv level, at which risks from radiation, including cancer, are believed to increase. (A Sievert is a unit of ionizing radiation.)

And this is not the only research team to have found lower levels of radioactive pollution than feared. A World Health Organization project studied exposure to radiation in the six months after Fukushima. Continue reading

New, Anxiety-Inducing Billing Codes For Mental Health

stackmoney

Don’t miss this important heads-up on Healthcare Savvy: An anxious month for social workers, psychologists and psychiatrists. WBUR’s Martha Bebinger writes:

If you visit your therapist this month or next and he or she seems stressed out, it could be about money. Here’s why.

Therapists who accept health insurance submit a bill that includes a code for your visit. 90862 was, for example, a very common code for a medication adjustment visit to a psychiatrist. As of this month, almost all the mental health codes are changing and this is causing a lot of anxiety.

Therapists aren’t sure which code to use, and they aren’t sure how much they’ll be paid. Insurers say the new codes, which are reviewed and set by the American Medical Association, will likely mean lower reimbursement rates for therapists who don’t prescribe drugs. Insurers say they won’t cover some of the codes at all. Many therapists are angry and discouraged.

“The Governor and the President are asking for more emphasis on mental health, but then the coding requirements increase and the reimbursements go down,” says Jonas Goldenberg with the Massachusetts chapter of the National Association of Social Workers.

Sigh. Read the full post here.

Your Kid On Video Games: Creative Outlet Or More Like Crack Cocaine?

Don’t miss Carey’s excellent radio piece this morning on how her son Tully’s intense fascination with video games — some violent — might play out as he grows up. The piece also raises important questions about whether such testosterone-fueled games actually make kids more violent, or whether they help the children become more adventurous and creative, better problem solvers and critical thinkers.

I encourage you to listen to the full piece, including current 20-something gamers speaking about the upside of playing video games as children. Here’s a bit:

Tully started playing video games when he was still in preschool, first driving games because he was obsessed with cars, and then more elaborate games of exploration and battle.

His game-playing sparked the only major parenting conflict I’ve ever had with my husband, a software developer who’s worked on games and wanted to introduce Tully to their fun challenges. As a mother, I felt all my alarms going off: too much violence, too much screen time. At one point I even played the crack-cocaine card, as in: “You’re introducing our child to the media equivalent of crack cocaine!”

But then my attitude began to shift. Tully picked up reading early because he so wanted to decipher instructions on the screen. He started to spout historical facts. And he played one particular spelling game, “Bookworm,” that was undeniably violent but also clearly educational — and I loved it. You got a grid of letters, and the longer a word you spelled, the harder you got to clobber a mythical enemy. Continue reading

High Use Of Stimulants On Cape Cod, Researchers Report

In a novel study examining geographic variations in the use of “mental health” drugs — stimulants, antidepressants and antipsychotics — researchers from Yale identified clear regional “clusters” where use of these types of medications was elevated. Notably, “in a large area of the South centered on Tennessee, use of… [these drugs] is 40% higher than in the rest of the United States,” researchers found.

Also notable (if you have a New England bias) is what’s going on at the Eastern tip of the Bay State: Cape Cod, the researchers found, “had the highest use of stimulants at 16% of residents, compared to a mean of 2.6% of the population nationally.”

So what’s happening on the Cape that might be driving higher-than-average use of drugs such as Ritalin, Adderall, Focalin, Strattera, Vyvanse and other medications used to treat ADHD? Is it the fried clams? The hypnotic lull of the tides? The tough winters?

A portion of Cape Cod (NASA's Marshall Space Flight Center/flickr)

A portion of Cape Cod (NASA’s Marshall Space Flight Center/flickr)

Authors found extremes in other locales as well:

Antidepressant use was highest in Alexandria, Virginia where two in five residents received an antidepressant, compared to a mean of 10.4% nationally. Gainesville, Florida had the highest use of antipsychotics at a rate of 4.6% of residents, compared to a mean of 0.8% nationally.

This study doesn’t provide clear answers on why particular regions appear to be super-users of certain meds. Still, the authors suggest several factors:

“Access to clinical care and pharmaceutical marketing explains some of the geographic variation we observed,” Continue reading

When The Bullies Are Grown-Ups

Aaron Swartz (ragesoss/flickr)

Aaron Swartz (ragesoss/flickr)

Last night, our school principal briefed our Parent Teacher Organization on the program that will teach our children about bullying: Not to do it, to speak up if they see it happening and to be sure to tell an adult about it.

Tell an adult? With computer prodigy Aaron Swartz’s suicide still echoing in my mind, I wondered: But what if the bully is an adult? Harvard law professor Lawrence Lessig says that Swartz was “driven to the edge by what a decent society would only call bullying.” Civil rights attorney Harvey Silverglate tells WBUR’s David Boeri in his report today that the government “terrorized this young man.” Emily Bazelon, a senior editor at Slate, writes similarly that Swartz “was on the receiving end of blatant prosecutorial intimidation.”

Bazelon has a deep background in the legal world and is about to publish a book on bullying,  “Sticks and Stones: Defeating the Culture of Bullying and Rediscovering the Power of Empathy and Character.” So I asked if her research might shed any light on legal bullying. Does the current thinking on bullying among kids address what to do in a case like Swartz’s?

Her reply:

When it’s a prosecutor who is acting like a bully, schoolyard lessons aren’t really relevant. The power imbalance isn’t psychological or based on social status — it’s real, backed by the threat of prison or other criminal punishment. And it’s not something a defendant has any control over.

I do think there’s a lesson, though, about the role of the passive bystander —- and especially, bystanders, plural. Individual members of the public can’t change prosecutorial practices. But collectively, we can demand changes. Prosecutors work for the government—which means they work for us.

Those collective demands for changes seem to have begun. The Boston Herald reports on a petition to remove U.S. Attorney Carmen Ortiz: Continue reading

Around The World, Living Longer But Not Living Better

(Vedant Gulati/Wikimedia Commons)

(Vedant Gulati/Wikimedia Commons)

By Judy Foreman
Guest Contributor

A massive new study out today shows that around the world, people are living longer than they did 20 years ago, but there’s a catch: many of these extra years are spent in poor health — in some cases with conditions that might be preventable or treatable.

The collaborative project, published in a special issue of The Lancet and led by researchers at the University of Washington and a consortium including the Harvard School of Public Health and the Johns Hopkins Bloomberg School of Public Health, found that some of the old scourges of humankind — infectious disease and childhood illnesses — that were once the leading causes of death have decreased dramatically, even in many developing areas. Deaths among children under five used to be the biggest contributor to the world’s health burden; now it’s chronic diseases that cause severe pain, impair mobility or keep people from seeing, hearing and “thinking clearly,” as the university put it in a statement.

But as childhood deaths have decreased, there has been a troubling increase in deaths among young adults, those aged 15 to 49 – mainly because of violence and HIV/AIDS. And while malnutrition – including starvation – used to be the leading risk factor for death worldwide, now it’s the opposite that’s the big threat: poor diets and physical inactivity. In fact, dietary risk factors and physical inactivity now account for a whopping 10 percent of the world’s health burden, as excess weight and high blood sugar continue to soar.

We are living longer, but some of those “extra” years are years of pain, sickness, immobility, depression, anxiety and other forms of poor health.

As some health problems have lessened worldwide between the new study, called the Global Burden of Disease Study 2010 and its predecessor in 1990, others have soared, chief among them lower back pain and road accidents. The latest research, funded by the Bill and Melinda Gates Foundation, was a massive endeavor with 486 authors from 302 institutions and more than 30,000 survey participants in more than 100 countries. It resulted in seven scientific papers being published together.

In statistical terms, what’s happening is that although life expectancy from birth is still increasing all around the world, what might be called the “healthspan” is not keeping pace. In other words, we are living longer, but some of those “extra” years are years of pain, sickness, immobility, depression, anxiety and other forms of poor health. Continue reading

MIT Report Graphically Details Lives Of Students Under Pressure

From The Tech‘s special report on student stress at MIT

This student newspaper report, “Under Pressure” provides possibly the best data visualization ever of college stress — and leave it to MIT to do it. The ambitious and beautifully realized analysis of the MIT pressure cooker draws on the detailed responses of more than 3,100 students who opened up about their academic workload, social life, sleep habits and extracurricular activities.

It’s an incredible portrait of a “hosed” student body, kids who feel, at times, overwhelmed by the torrent of information coming at them and the competing, and cumulatively crushing, demands on their time. (One example: the survey found that 2:30 a.m. is the most common bedtime and 50 percent of students feel that they don’t get enough sleep.)

The Tech survey was inspired by Lydia K., an MIT junior who blogged about her own stressful “meltdown” and persistent dread that no matter how smart she was, she was never quite smart enough. The piece triggered an unprecedented response from students at MIT and around the country; MIT’s president Rafael Reif wrote an open letter to The Tech urging everyone at MIT to read Lydia’s piece.

In response, The Tech launched its project on stress: 3,191 MIT undergraduate and graduate students responded to the survey — about 29 percent of the total student population and 35 percent of the undergrads. Among its findings: “The average MIT student sleeps only about 6.5 hours a night, and 52 percent of them have, at one point, felt like they don’t belong at the Institute.” Here’s a bit of the editorial introducing the special issue:

The Institute is a tough place. The classes are hard, the homework is hard, and the tests are hard. It’s difficult to step back and get any perspective, and when things are going bad, competition between peers makes things worse. If you dare lament the amount of work you have, chances are that your neighbor will challenge you and say that he has even more.

Does this competition sound familiar? It should. The “I’m so hosed” game has become a cultural phenomenon at MIT, one that perpetuates the “hardcore” attitude Continue reading

MIT ‘Meltdown’ Blog Resonates With Stressed-Out Students

Lydia K.’s “meltdown” hit hard shortly after she began her junior year at MIT.

“Toward the end of September,” Lydia blogged, “I became noticeably stressed out. I stopped talking to people, I stopped cleaning my room, and I got very lonely. It culminated in an hour-long cry session after a benign meeting with my biology professor about a class presentation.”

An MIT undergrad blogs about the intense stress of college life when “no matter how hard you work…you’re not good enough.”

A 20-year-old self-described “perfectionist” who was born in Moscow and started high school-level classes in 7th grade, Lydia had also stopped sleeping, spent much of her time working alone in a basement and, though feeling ill, was ignoring her symptoms. She’d recently missed a week of classes after recovering from a medical procedure and was struggling to catch up.

One night while working on a project that wasn’t quite coming together, Lydia — a computer science and molecular biology major and a paid blogger for the MIT Admissions Department — decided to take a break and blog about her troubled, under-pressure state of mind. Though the instructions from Admissions were, she said, to keep it “PG and pretend that you’re writing for your grandmother” Lydia decided to go for emotional truth and honesty. Here’s a taste:

“I don’t think many people understand what we mean when we say that MIT is hard. It’s not just the workload.

There’s this feeling that no matter how hard you work, you can always be better, and as long as you can be better, you’re not good enough. You’re a slacker, you’re stupid…There’s stress and there’s shame and there’s insecurity. Sometimes there’s hope. Sometimes there’s happiness. Sometimes there’s overwhelming loneliness.”

Lydia’s raw, revealing portrait of intense undergraduate angst and the enormous pressure to succeed that burdens so many students at MIT and beyond became an instant hit. Shortly after its publication, there were hundreds of comments from alumni, faculty and students from MIT and colleges across the country.  (One example, from Quynh: “This is beautiful. You have put into words what I’ve felt constantly since stepping foot on this campus but unable to express. Thank you.” And from Random Harvard Student: “I go to Harvard, and this article perfectly hits on how I feel sometimes. Thank you so much for writing such a beautiful piece that makes me feel less pathetic about crying after coming back from a lab where I understood absolutely nothing.”)

The piece got more than 4,000 “likes” on Facebook and over 40,000 views, more than most admissions blogs, according to Admissions Dean Stuart Schmill, who added that Lydia’s “meltdown” “is not the type of post you’d usually find on an admissions website.”

MIT’s President Rafael Reif responded with an open letter in the student newspaper, The Tech, citing Lydia’s “powerful account of her feelings of academic strain and anxiety” and calling for a deeper conversation about some of the problems she raised. Continue reading

Study: Depression Tops List Of Risk Factors Linked To Higher Health Costs

(ndanger/flickr)

Not only is depression a powerful, debilitating condition, it’s also expensive, according to new research published in the journal Health Affairs.

According to the new study, “depression leads a list of 10 risk factors linked to more than one-fifth of employer and employee health spending.” Researchers, including Ron Goetzel, a research professor and the director of Emory University’s Institute for Health and Productivity Studies, and vice president of consulting and applied research for Truven Health Analytics, matched health spending for 92,000 employees at seven organizations over three years with a list of ten common risk factors.

Here’s what they found, according to the news release:

They discovered that 22.4 percent of the $366 million spent annually by the seven employers and their employees was attributed to the ten risk factors, all of which could be addressed by a combination of the appropriate health care and behavioral interventions.

High risk for depression led the list. The additional annual medical expenditure for an employee with depression was $2,185 higher –or 48 percent more — than for a worker without depression. Continue reading