Some have value, some are fads, and some are simply bizarre. In , author Whitley Strieber wrote Communion, an allegedly non-fiction book describing his encounter with aliens whom he claimed had abducted and sexually molested him. After reading his book, dozens of people flocked to the fast-growing group of alien abduction therapists. John Mack, a well-known psychiatrist and Harvard professor, set the diagnostic criteria for alien abduction syndrome, which included nightmares, sleep paralysis, bruises, phobias, unexplained scars, and fear of the dark.
During this period, there was another spate of unusual encounters — an upsurge in cases of people allegedly suffering from years of satanic ritual abuse, which purportedly resulted in post-traumatic stress syndrome and multiple personality disorders. At the time, I was on the treatment staff of three psychiatric hospitals. Each of these hospitals had opened a special unit for people who had been satanically abused. All subsequently developed multiple personality disorder.
I listened carefully to the experts at the hospital as they explained the origin of these pathologies. However, I begin to be skeptical as I saw people coming in with a variety of mental disorders, all of which were declared to be caused by satanic abuse. In one hospital, treatment protocols dictated that all patients attend group therapy. During group therapy, they were encouraged to remember and disclose their satanic abuse and to share their multiple personalities. If these memories and personalities had not emerged prior to admission, the patients were encouraged to manifest them through the technique of sodium amytal regression.
I was astonished by how malleable people can be. With their high level of anxiety and need to fit in, it was easy to convince these patients that they had been abducted by aliens or satanically abused. Many patients left the hospital with much more severe pathology than they had had when they went in. As my co-author Kevin Randal pointed out, there is also a culture-bound bias in the diagnosis of these alleged maladies. There are few African-Americans, Hispanics, or Asians in the satanic abuse, or multiple personality population. One of the unexpected events that followed the release of this book was the anger and outrage it spawned.
I received a large volume of hate mail, filled with threats and animosity, from psychotherapists. Rather than disagreement or discourse, these mental health professionals were protective of their favored theories and outraged that anyone should disagree with their belief systems. This level of bias is unfortunately common enough that it is one of the primary reasons people do not receive objective diagnoses and effective treatments. By the way, since it seems that the number of abductions has declined significantly.
Psychotherapy may utilize insight, persuasion, suggestion, reassurance, and instruction so that patients may see themselves and their problems more realistically and have the desire to cope effectively with them. Therapy has helped thousands of people. If you are in private practice, you know that many of your clients are grateful for the help you have given them.
However, you also are aware that some of your clients did not get significantly better. At times, when people do not improve with treatment, we label them treatment resistant. Couples therapy and family therapy are useful in increasing the quality of family life. However, many mental health practitioners, marriage and family therapists are not taught to screen their families for medical illnesses.
As a result, one or more family members with a medical illness may display behaviors that are significantly disrupting to the family dynamic. Research on couples and family difficulties are often spawned by abnormalities in the immune system of one or more family members. Problem solving and empathy training will not fix these problems. When a mental illness is involved, we may send the person to a physician for a prescription of psychotropic medication.
This sometimes helps, but sometimes does not. In that event, rather than labeling the outcome treatment failure or treatment resistance , it is often more accurate to recognize the problem as the wrong diagnosis. It may well be that the outbursts of anger Mr. Johnson exhibits will not remit until the malfunction of his adrenal glands is addressed.
Ironically, even if overstressed adrenal glands must now be managed before Mr. Johnson can resolve his marital problems, the marital problems may have contributed to his existing condition. Stress hormones are higher in the conflicted couple even when they aren't arguing, and it represents a chronic pattern of stress in the marriages. The quality of a marriage is a strong predictor of physical health.
They found that couples who had divorced by ten years had already displayed a 34 percent higher rate of norepinephrine at the beginning of the study than couples who stayed married. Distressed marriages can cause effects on the immune system. These findings suggest that personal relationships become translated into health outcomes. The research also suggests that couples with high levels of conflict are more likely to present with physical illnesses. It is essential to avoid missing an underlying medical disorder.
Mental health providers should always ensure that the physical health of the patient has been thoroughly evaluated before psychotherapy has commenced. The brain is a component of the body. It interacts with every organ, system, and tissue. When the body is not working properly, it impacts the brain. Therefore, a mind that is not working properly is often a sign of a malfunction of the body. It has been known for decades that people with mental disorders die earlier that the average population.
In the last few decades, the mortality rate has increased. In the s, the mentally ill died years earlier than mentally healthy adults. By , however, the shortened life expectancy was 25 years. Many of these early mortalities are thought to be the result of the change in medications. Second generation antipsychotic medications have become more highly associated with weight gain, diabetes, dyslipidemia, insulin resistance, and metabolic syndrome. But while many researchers believe that the high mortality rate in mental disorders is caused by the psychoactive drugs given, others believe that the early demise is because of unknown physical disorders that were not looked for, detected, or treated.
Psychotherapy seldom begins with a complete physical. Yet research suggests that about half of all psychiatric patients have an undetected physical illness. This illness may or may not be the cause of the mental symptoms, but it must be taken into consideration. Research suggests that about 80 percent of physical illnesses are missed during initial mental health assessments. Most often this occurs because the clinician has not spent time taking a thorough medical history.
The danger here is that many people with emotional, mood, or thought disorders tend to seek out mental health services before they consider a medical assessment. It is not until they get worse or develop observable physical illness that they seek medical help. Unfortunately, by this time the disease has progressed to a serious level. Recognizing a medical problem that is contributing to a mental illness is difficult, but there are certain red flags that suggest physical causes.
After the initial question, "How can I help? When a person does not respond to well-known treatments for a disorder, the most likely explanation is that they do not have the disorder. There is no known illness that is "treatment resistant. Efficacy studies suggest that about one-half of people with psychological problems will benefit from psychotherapies, psychotropics, or both. Family history is the quickest and cheapest way to sort that out. Most people are aware that their curly hair came from their grandfather and their big ears came from their mom, but they seldom see their dark moods, pessimism, and short tempers as traits handed down from their Uncle Phil.
Many families have long histories of mental problems, or medical disorders known to contribute to mental problems. For this reason, an intake interview should always include a personal and familial history of medical and mental illnesses. The absence of mental illness in a family is a signal that the malady in this person has a higher probability of being caused or exacerbated by a physical ailment. Roughly half of all lifetime mental disorders start by the mid-teens and three-quarters by the mid-twenties.
Those who develop mental disorders for the first time in late life are more likely to have medical conditions that contribute to or cause their problems. Significant changes occur with normal aging. Body mass, hormones, nutrient absorption, and vascular changes have profound impacts on brain function.
For example, people over fifty are more prone to depression caused by nutritional, arthritis, cardiovascular, and endocrine disorders. Most mental disorders develop slowly and get worse with time. Therefore, the sudden onset of a mental disorder is a red flag for biological abnormalities such as vascular disease, strokes, nutritional deficits, infections, hormone irregularities, tumors, or exposure to toxins. Although many mental disorders may fluctuate over time, volatility of symptoms is unusual. Fluctuation of mental status often indicates a dementia, delirium, or metabolic disarray.
Delirium can be caused by many medical disorders, particularly infections and inflammation. Bladder infections may have no overt symptoms other than delirium and may go undetected for months. Exposure to toxins may also present with waxing-and-waning mental symptoms. As discussed earlier, most mental disorders are diagnosed by their symptoms. For this reason, when a person displays classic symptoms of a mental illness, but also has symptoms that do not fit the criteria, medical problems should be considered.
People who work swing or night shifts tend to have more emotional problems. Sleep disorders, such as apnea, may go undetected for years or be misdiagnosed as attention deficit disorder or depression. Nutrition plays a significant part in all mental illnesses. A thorough dietary history is essential. Eating patterns also play a part in mood and behavior. For example, children who do not eat breakfast are more likely to be diagnosed with attention deficit hyperactivity disorder.
Get a thorough list of favorite foods, favorite brand name foods, and favorite beverages. Also, document any and all known food allergies or sensitivities. Be cognizant of any abnormalities in the motor system. This includes tics; disturbances of gait and balance; clumsiness; and problems with speech, language, or enunciation.
All of these suggest problems in the motor system. Undisclosed substance abuse may be the cause of the symptoms you observe. In many cases, the person using these substances will not disclose or admit substance abuse, which makes any diagnosis invalid or suspect. Others do not see the connection between the use of the substance and their problems. Others simply do not want to stop using it and, therefore, are reluctant to disclose the use of the substance.
Stopping a medication, changing medications, and experiencing interactive effects of medications can change mental status.
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In addition, as people age, medications may be metabolized differently. A medication they have been taking for many years may begin to cause problems. This is true not only of prescription medications, but also over-the-counter remedies. Polypharmacy has become a significant factor in mental health, particularly in elderly adults.
The world of nutritional supplements is exploding. It is likely that some of the people you see will be taking multiple supplements, such as vitamins, minerals, amino acids, herbal extracts and neuroactive fats, such as omega 3. Any one of these substances can cause metabolic changes. They may also interact with medications. Always ask about ointments, creams, cosmetics, hairsprays, and other chemicals in their environment. Travel, especially travel out of the country, can also cause exposure to unfamiliar toxins, parasites, and infections which may present as emotional, cognitive, and behavior disorders.
Asking about recent moves, home remodeling, and travel is essential. Moving is stressful. This experience alone can cause enough stress to destabilize a mind. Moreover, the new home or the neighborhood may also contain toxins and environmental loads that contribute to mental problems. Remodeling usually means exposure to paints, carpets, adhesives and other chemicals which can cause mental problems. Unfortunately, neurotoxicity is becoming a major contributor to both physical and mental illnesses. The high levels of contaminants in our environments can no longer be ignored.
Does their job expose them to toxins? At home, do they use insecticides, herbicides, fertilizers, or room deodorizers? Does your client have pets? Are the pets using flea sprays or other medications? Families who work in the agriculture industry have a high incidence of depression, anxiety, and sleep disorders often caused or exacerbated by pesticide exposure.
Although asking a person how much money they make may be inappropriate, socioeconomic status is a useful piece of diagnostic information. In general, low socioeconomic status increases the risk of psychological disorders. In fact, one of the most consistently replicated findings in social science research is the negative relationship of socioeconomic status with mental illness. Less income may result in living in a neighborhood which has higher crime rates and higher levels of toxins. It may dictate which groceries are purchased. Get a thorough history of visits to doctors and mental health clinicians.
What were the outcomes? Has there been a recent physical? A thorough physical is an essential part of diagnosing and treating any mental disorder. The difficulty here is that there are hundreds of maladies and metabolic anomalies that can cause mental problems. A general physical cannot assess all maladies. Unless a person is suffering from a common physical illness, it is not unusual that the correct medical diagnosis will be missed over a span of several years.
A neurological exam is useful, but rarely done unless a person has significantly unusual behaviors. Conditions that involve subcortical regions of the temporal lobe are commonly associated with delusions, unusual sexual behavior, and paranoia, but a routine physical will not include tests such as an EEG or brain scan. Abnormal lab results may suggest a medical cause of a mental symptom, but keep in mind that lab levels are norms, not people. Problems such as B12 deficiency and thyroid problems often occur even when labs come back normal and are, therefore, frequently diagnosed as mental illness.
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Subclinical abnormalities of calcium or magnesium may not reach levels that would be diagnosable as abnormal, but may cause significant problems in the central nervous system. Religion and spirituality play a significant part in mental health. Research shows that religiosity is correlated with brain structure. Research also shows that, in general, people with well-developed religious beliefs tend to be healthier than those who are not, while hyper-religiosity is sometimes tied to mental problems, particularly seizures, depression, mania, paranoia, and psychosis. Always ask if your client is or has ever been a smoker.
Smoking has long been linked to depression.
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It has been found that depressed teens are more than twice as likely to become moderate to heavy smokers. Teens that are not depressed, but become heavy smokers, are four times more likely to become depressed later in life. Nicotine also affects the locus coeruleus, located in the brain stem which regulates brain regions responsible for emotion and mood.
Researchers believe that it is the nicotine in tobacco that mimics the effects of drugs that produce antidepressant effects. Long-time smokers have approximately 60 percent lower levels of the protein tyrosine hydroxylase and 40 percent lower counts of alpha2-adrenoceptors in the brain. Tyrosine hydroxylase helps to manufacture noradrenaline and dopamine. It acts as a norepinephrine and dopamine reuptake inhibitor and nicotinic antagonist.
Be aware that Bupropion is known to cause seizures. There is also evidence that smoking can damage the thyroid, causing or worsening thyroid problems. Tobacco smoke contains cyanide, which in the body is converted to thiocyanate, which then acts as an anti-thyroid agent, directly inhibiting iodide uptake, interfering with hormone synthesis. You should also ask if their mother smoked during her pregnancy. There is also evidence that maternal smoking can affect the fetal brain.
Smoking during pregnancy is correlated with low birth weight, but it is also associated with low scholastic achievement, conduct disorder, and attention deficit hyperactivity disorder. In addition, maternal smoking during pregnancy is also associated with earlier age of offspring initiation of smoking and onset of regular smoking.
Since so many medical illnesses manifest themselves as mental illnesses, a thorough medical history is essential. If your client has known medical conditions at the time you see her, start there. Explore the known psychological symptoms that accompany this disorder. Unfortunately, a comprehensive physical exam is seldom done.
Psychotherapy and psychotropics are less expensive. The technical term for the presence of a mental disorder and medical disorder occurring together is comorbidity. What is missed is that, at times, the medical problem is the major cause of the mental disorder. For example, comorbidity is common in anxiety and depressive disorders, particularly in cardiovascular disease, skin problems, and diabetes.
Many medical conditions — including heart disease, breast cancer, prostate cancer, diabetes, alcoholism and Alzheimer's disease — have been shown to be passed down through families. Physical illnesses or vulnerability for illnesses runs in families. These illness patterns can be caused by genetics, but also are related to idiosyncratic family diets, lifestyles, exposure to toxins, geographic location, and socio-economic status. Look for early family deaths.
People with mental illness tend to die young, but so do their families. A prime example of a familial pattern of mental illness is the connection between heart disease and depression in families which is presented below. Relatives of people with early-onset major depression die younger than the normal population — an average of eight years younger than normal life expectancy. More than 40 percent of first-degree relatives die before reaching age There is also a five-fold increase in infant mortality rates. Older family members have a greater than average incidence of Alzheimer's. Is there a significant level of osteoporosis in the family?
Major depression commonly co-occurs with decreased bone mineral density. Family history, family medical records, death certificates, obituaries, and old family letters can be valuable sources for medical histories.
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Even old family photos can sometimes provide visual clues to diseases such as obesity, osteoporosis, and hair or skin problems. A thorough medical history can also give you data about family genetics and genetic fallout. Your shoulder bone connected to your neck bone. Your neck bone connected to your head bone. I hear the word of the Lord. Somatic Symptom and Related Disorders.
The problem in this category of diagnoses is that there is no scientific evidence that this can occur. The problem here is two-fold. As long as we label unusual maladies as psychosomatic of somatoform, we risk missing an underlying illness. Although tests can rule out specific maladies, there is no medical assessment that can diagnose the absence of illness.
Once this process begins, the doctor may dismiss symptoms that do not fit his preliminary diagnosis. But they quickly fall apart when a doctor needs to think outside their boxes, when symptoms are vague, or multiple and confusing, or when test results are inexact. In such cases — the kinds of cases where we most need a discerning doctor — algorithms discourage physicians from thinking independently and creatively. Instead of expanding a doctor's thinking, they can constrain it. Groopman also confesses in the beginning of his book that he has no idea how mental health practitioners make a diagnosis, because there is often complete absence of an observable physical abnormality to verify the pathology.
One-third of new referrals to neurology clinics have symptoms that are poorly explained by identifiable organic disease. It is not uncommon for a person who has an array of symptoms that do not fit any particular disease criteria to be labeled as having somatization disorder. The patient will then go doctor shopping, which will eventually get them the label of hypochondria. Oftentimes, the sufferer will eventually find a doctor who actually finds the undetected medical disorder, or the person will become so ill that it becomes clear that a medical disorder is the cause.
Diseases such as Lupus, multiple sclerosis, Lyme disease, parasites, or intestinal infections are often misdiagnosed as mental illness. All of these are discussed below. Or this assumed causal link may not exist at all: Concomitant events are not necessarily causally related. Medical conditions diagnosed as conversion disorders. The new description of somatic symptom disorder in DSM-5 represents a big step forward, because the decision has been made to use, for classification, a positive criterion, namely maladaptive reaction to a somatic symptom, instead of the earlier negative criterion.
The primary cause of conversion disorder is purportedly a traumatic event or stressful situation that leads the patient to develop bodily symptoms as symbolic expressions of a preexisting psychological conflict. In fact, these events are often correlated, but keep in mind that correlation is not cause-and-effect. A study of 34 children who developed pseudo-seizures showed that 32 percent of the children had a history of depression or sexual abuse, and 44 percent had recently experienced a parental divorce, death, or violent quarrel.
But familial studies have also shown that conversion symptoms in first-degree female relatives are up to 14 times greater than in the general population, suggesting a genetic predisposition to these symptoms. The surgeons found that she had been repeatedly raped as a child by her father, who stifled her cries by smothering her with a pillow. In the adult population, conversion disorder may be associated with mobbing, a term that originated among European psychiatrists and industrial psychologists to describe psychological abuse in the workplace.
One American woman who quit her job because of mobbing was unable to walk for several months. Adult males sometimes develop conversion disorder during military basic training. One problem with this diagnosis is that conversion disorders seem to be culture bound. Mental health practitioners in the Middle East and Asia have reported that symptoms of conversion disorder in the DSM-5 and ICD do not fit with the symptoms of the disorder most frequently encountered in their populations.
Most conversion symptoms afflict the left half of the body. Researchers hypothesize that a dysfunction in the right amygdala and parietal lobe circuits are the cause of the disorder. Brain damage in these areas often causes conversion symptoms and body image distortions. Some studies suggest that changes in these areas could be caused by traumatic events, which result in changes in body image, perception, and behavior.
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Unfortunately, there is no way to prove that a conversion disorder is caused by psychogenic trauma. Before this diagnosis is rendered, clinicians should make sure the client has had a complete medical workup. Conversion disorders may be signs of hypoglycemia, an undetected neurological disorder, or a seizure disorder. Researcher Iraj Derakhshan found in 79 consecutive patients with conversion disorder, 76 percent had unilateral cerebral abnormalities found in brain scans, while abnormalities on EEG assessments were found in 78 percent.
Symptoms of Hypochondria. Hypochondria is the interpretation of bodily symptoms as signs of a serious illness. Frequently the symptoms are normal bodily functions, such as coughing, pain, sores, or sweating. Although some people will be aware that their concerns are excessive, many become preoccupied by the symptoms. Typically, this will trigger frequent visits to doctors. They often are preoccupied with the belief that they have a serious illness, and have a penchant for bodily functions.
They often ruminate about illnesses, have an unrealistic fear of infection, and have a fascination with medical information. They may spend a great deal of time on the Internet looking at diseases, symptoms, and treatments. Hypochondria is classified as an anxiety disorder. There is little doubt that hypochondria is a viable diagnosis. However, it is also clear that many people given this diagnoses actually suffer from an undetected medical condition.
For example, Lyme disease is often misdiagnosed as hypochondria. In many cases, a family history will reveal that many family members suffer from similar maladies. Charles Darwin and five of his seven children were diagnosed as suffering from either hypochondria or depression. It appears that the man who created the theory of natural selection and inherited traits may have had a familial genetic predisposition for mental illness.
The world of gene testing is exploding. Today, there are dozens of companies that can detect genetic predispositions to illness. As a result, new treatments are emerging which can alter gene expression. This is the world of genomics. All health practitioners need to have a working knowledge of this breakthrough. The mapping of the human genome has revealed a multitude of genes which are highly correlated with the presence of mental illnesses. DNA is a series of molecules linked together in a microscopic spiral called a chromosome.
Humans have 23 chromosomes, and every cell in our body has two versions of each of the 23 chromosomes — one from each parent. This combination is called a diploid genome. The human genome contains a total of 30, genes. Females have two X chromosomes, while males have one X and one Y chromosome.
We inherit half of our genetic profile from each parent. Both males and females retain one of their mother's X chromosomes, but females retain their second X chromosome from their father. Since the father retains his X chromosome from his mother, human females have one X chromosome from their paternal grandmother and one X chromosome from their mother. It is for this reason that many of us resemble our parents, not only in appearance, but in personality, demeanor, social skills, and coping skills.
In addition, we also may inherit genes that can cause or increase the risk of medical disorders. The interplay between fraternal and maternal genes has consequences for mental illnesses as well. It has long been established that most people with mental disorders have a genetic predisposition to their woes. We know this because mental disorders run in families. However, it is now evident that the predispositions to certain medical disorders are predictors of mental disorders in family members, and that family genetics contribute to mood, behavior, and mental well-being.
These discoveries have revealed that a fundamental cause of many human maladies is how these two sets of genes interact. Ninety-nine percent of all human DNA is identical, but that one-percent difference is often the root cause of mental disorders. The complete mapping the human genome has allowed researchers to scan DNA for genes that may cause, contribute to, or even prevent mental disorders.
At the time of this writing, despite the explosion of genetic research, only a small number of these genes have been identified. But even though gene research in mental illness is still in its infancy, a person can still gather some information about their genetic risk of physical and mental illness simply by looking at his family tree. Moreover, looking at the family history of certain maladies can predict other problems in family members.
These familial problems can be said to be family fallout. It has long been known that mental problems run in families. What is not well known is that the children and relatives of people who have mental or medical illnesses are also prone to other illnesses. The people you work with will tell you about their mental symptoms, but they will seldom disclose their physical maladies.
Furthermore, without prompting, they will not discuss the medical problems of their family. Genetic penetrance is the likelihood that a certain gene will result in a specific disease. In , researcher Roger Webb, at the University of Manchester in England, showed that the risk of fatal birth defects is higher in the children of parents who have been hospitalized for mood disorders. There is even more risk is associated with maternal schizophrenia.
Moreover, children of mothers who had previously been admitted to a hospital for any type of psychiatric diagnosis had significantly higher risk of death from birth through early adulthood. The risk of infant death among children with two mentally ill parents was significantly higher than that associated with having only one affected parent. Families with fathers or mothers who have a history of psychiatric hospitalizations also double the risk of sudden infant death syndrome SIDS compared with the general population.
If both parents were hospitalized, the risk of SIDS was increased by almost seven-fold. There is evidence that SIDS may be in part caused by abnormalities of serotonin in the brainstem. There is strong evidence of a genetic transmission of recurrent major depression. In fact, having a family member with major depression increases a person's risk eight-fold. Heritability is considered to be about percent. A history of depression in a parent is the strongest risk factor for depression in a child.
Researcher Myrna Weissman at New York State Psychiatric Institute found high rates of psychiatric disorders — particularly anxiety disorders — in the grandchildren of families with two generations of major depression. Fifty-nine percent of these grandchildren, with a mean age of twelve years, were suffering from a psychiatric disorder. A twin study found a 46 percent concordance of depression in identical twins and 20 percent in fraternal twins. Interestingly, in this study, shared family environment had no impact on depression.
This high level of mortality in families with depression may be linked to heart disease. A significant number of studies show a relationship between depression and cardiovascular problems. Studies report the prevalence of major depression in cardiac patients as between 17 percent and 27 percent in hospitalized patients. Serotonin may play a part in depression, but is also contributes to cardiovascular disorders. Serotonin plays a role in platelet aggregation, and platelet serotonin levels correlate negatively with severity of depression.
In a clinical study University of Pittsburgh, blood platelet serotonin levels were 39 percent lower in patients who had made a suicide attempt. Recently, scientists have discovered a gene that contributes to depression, called the serotonin transporter gene. Two forms of the gene have been discovered, described as the short and long gene form. Some studies suggest that inheriting the short form of the gene doubles the risk of depression, but recent studies found no correlation. Those who carry two copies of the short version of the gene are also more prone to alcohol abuse.
It has long been known that bipolar disorders also have a high genetic predisposition. The genetic penetrance of bipolar disorder is about 70 percent. What is not as well known is that bipolar disorder has also been genetically linked to cystic kidney disease , a disorder in which cysts growing in the center of each kidney cause them to malfunction.
In one study, out of seven members with medullary cystic kidney disease, five had bipolar I disorder, one had unipolar depression, and one had a hyperthymic phenotype. The biology of stress is all about mobilizing biology resources for intense, life-saving activity, like running like hell from a predator, or eek fighting one. The curse of being human is that the same emergency biology can be triggered by abstract concerns, no predators required. But stress and anxiety are still preparing us for an emergency. Why would that help? Why would urgent action be relaxing in any way?
Just as we are biologically programmed to prepare for perceived threats, we are also programmed to de -escalate the stress response after the excitement is over. This is why exercise is an effective outlet for frustration, which is well-known to measurably reduce the stress-response. When your mind and heart and breath are racing, it can be difficult to switch to a measured, slower, deeper breathing pattern.
So find a box to put it in. Look for a rectangle like the side of a building, or a doorway. It may help your focus to anchor the breathing pattern to something you can see. Each side of the box represents a breath in or out, or a pause: breath "up" the left side, hold across the top, breathe down the right side, hold across the bottom, and so on. Breathing regularity and overall slowness is a good start, but extending exhalation is even better for a specific biological reason: exhalation is literally more relaxing than inhalation.
That is how we are wired. Whenever you inhale, you turn on the sympathetic nervous system slightly, minutely speeding up your heart. And when you exhale, the parasympathetic half turns on, activating your vagus nerve in order to slow things down this is why many forms of meditation are built around extended exhalations. You could make a simple change to the box breathing method described above: instead of holding after inhalation, you can distribute the breaths around the sides of the box like this: breathe in, breathe out, breathe out, hold it out.
Anxiety often involves racing thoughts, which are even more obvious when you attempt a meditative exercise such as focus on your breathing. So use metronome to first match and then tame your mental tempo. Thanks to smart phones, almost anyone can conveniently download a free metronome app — no need to actually go shopping for a metronome.
Basically, count to several times, a little slower each time, using a metronome instead of willpower. By all means tap your foot or a finger or some other gesture as well. Make it musical. Obviously you can fiddle with the variables here: for instance, you could take smaller steps, or spend longer at each tempo. But if you systematically match a slower and slower metronome pace, your racing thoughts are likely to stop racing.
At least for a while. It is a near certainty that humans can benefit from the same kind of interaction, and massage is basically just ritualized, formal social grooming, without the parasite eating. Or you could pay for a cuddling service. Or, ahem, certain other services. The common denominator here is touch. Myths about massage abound : 45 it does not flush lactic acid out of cells, or increase circulation , 46 or reduce inflammation. Even in the unlikely event that massage actually does reduce cortisol levels, the physiology of stress is much too complex to assume cortisol reduction is in itself a meaningful, good thing.
While many benefits of massage are still disconcertingly uncertain and hotly debated by some , there are two truly proven ones. We made an interesting discovery concerning the effect of the treatment on state anxiety. When a series of massage therapy sessions was administered, the first session in the series provided significant reductions in anxiety, but the last session in the same series provided reductions that were almost twice as large.
This pattern was consistent across every study we were able to examine, which strongly suggests that experience with massage therapy is an important predictor of its success, at least where anxiety is concerned. To put it another way, it is possible that the greatest benefits come about only when a person has learned how to receive massage therapy.
So this should be a no-brainer: getting a massage is a better idea than taking meds in almost every possible way. Here is one of the best examples, in my opinion:. The abdominal lift is a classic yogic exercise, best known as a longevity exercise for its stimulating effect on the internal organs.
It is also a powerful abdominal strengthener including the rarely exercised transversus abdominis , is vital for mastering many breathing techniques, and makes all other breathing exercises easier. One abdominal lift takes about one minute, and three of them is a good dose of calming, although I recommend five for tough cases. Lightning bolts.
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Leap into the air with a big breath, and as you come crashing and stamping down, blow out hard and flick your arms and hands straight downwards, as though throwing lightning bolts into the ground. Ten of these, followed by some stillness, is hard to stay anxious through. Crane Spreads Wings Stand with your feet together, hands folded across your chest, hunched over. Close up again. Repeat several times. The anxiety pattern can also be broken by exercises drawn from many western traditions, such as Reichian body work or cognitive therapy.
Here are two more examples:. Mental Propaganda. Worrying is a mental rut. Cognitive therapy suggests building new pathways with specific, deliberate mental alternatives. Write down a positive set of thoughts that are a specific alternative to the worrying pattern.
Read them out loud in your head five times. Why is this a calming exercise? Because your mind and body are one system. It was quite carefully crafted, and it reassured me to craft it. Simply working on it was as much a part of the self-therapy as re-reading it. The challenge of thinking about and expressing good and reassuring thoughts was quite helpful. Round Breathing. Twenty-five fast, deep clear breaths, without pausing at the top or the bottom, can calm you more completely — bring you back into your body — than most people will feel after any amount of meditation.
For much more information, see The Art of Bioenergetic Breathing. Before you diagnose yourself with depression or low self esteem, first make sure you are not, in fact, just surrounded by assholes. More formally stated, as psychologist Dr. For instance, we know that macaques with low social status are treated very harshly and it has measurable effects on their immune systems: they are inflamed, they get more infections.
And clearly their problem is that they are just surrounded by asshole macacques. This is the kind of thing I mean when I cautiously counsel people to do their best to solve problems in their lives as a very basic defense against both anxiety and pain. Consider the tragic example of domestic violence: surrounded by one asshole in particular. Simply install Generalized-Anxiety Home-Security System sensors on your front door, and then on your bedroom door, and then on the kitchen door, and then on the bathroom door, and then on the closet doors, and then maybe put another one on your bedroom door, just to be safe.
You can never be too safe! You can also never be truly safe. The first human test of pre biotics — not the much more familiar pro biotics — for anxiety and stress was conducted in Prebiotics are basically food for the bacteria in your guts, which have a strange-but-true relationship with your nervous system. There are many caveats about this evidence, of course. A detailed analysis of the paper by Examine. Curcumin is the active ingredient in the bright yellow southwest Indian spice, turmeric.
Never in the history of calming down has anyone ever calmed down by being told to calm down
Curcumin has a larger evidence base [Examine. These results constitute the only really good science news about any kind of treatment for delayed onset muscle soreness — there is no other treatment for it but the passage of time. Now it just needs to be replicated. They are probably not sufficient for most patients to justify the cost and hassle of supplementation. Just be aware that straight curcumin may not be effective.
So, for most people, caffeine is just a good thing. And, ironically, this may be true even though caffeine is also a mild pain-killer. Caffeine makes us hyper, and that can be somewhat exhausting. We pump more adrenalin, wear ourselves out, and lose sleep: risk factors for pain. Chronic, excessive caffeine abuse — perhaps a vicious cycle of self-medication, caffeine every morning, alcohol every night?
People in chronic pain are often already anxious and sensitized ; regardless of why, artificial stimulation may be the last thing they need. Booze has similar issues. Reader Kira Stoops sent me this interesting anecdote about her experience with quitting caffeine:. I took one pill, the smallest dose, and shot through the roof. Chakrabarty is particularly interested in the examining the challenge ecocriticism poses to postcolonial studies and the project of liberation that has been crucial to that field. A third wave of ecocritics may also be emerging, influenced by object-oriented ontology.
Critics such as Timothy Morton turn away from the more sociological ambitions of the second wave and attempt to imagine the earth without reference to its human subjects. This has consequences for both the scale and the temporality of environmental narratives. Recent debates within ecocriticism about the relation of an arguably global nature to national or regional culture also influence accounts of cli-fi as a genre. Ann Kaplan argues that the cli-fi narrative, whether literary or filmic, is embedded in a trauma-laden sensibility that is recognizably American, and Heather Houser explores the ways that the affectively moving figure of the ill protagonist embeds eco-consciousness in culturally specific accounts of bodily vulnerability.
Raymond Malewitz makes a similar argument about the emergence of cli-fi out of American literary regional aesthetics, and Heidi Hansson demonstrates the impact of a Canadian Arctic sensibility on the genre. Climate fiction, by their account, largely renders national and generic traditions irrelevant, opening up to a planetary scale. Critics have asked whether the genre inevitably envision apocalyptic destruction of the human species, carbon-based life, or the planet as a whole.
Or does it mainly anticipate—whether eagerly or anxiously—the demise of economic, political, and social arrangements that have triggered climate change? What kind of posthuman or postcapitalist world can the genre imaginatively call into being? The movement of ecocriticsm, in other words, urges readers to recognize the subliminal commitment of cli-fi to utopian invention as well as its most readily perceptible commitment to apocalyptic terror.
These two gestures take on different weights in various incarnations of climate change fiction, but both are recurring and essential features in the genre. At the same time, other features of the post-apocalyptic scene so prevalent in cli-fi can be traced back to Silent Spring. The people had done it themselves. Atwood describes a horrific plague released upon a corporate-dominated system of food and reproduction by a zealous avenger, while Bacigalupi sets his novel in a near-future Thailand that houses one of the only remaining seed banks capable of introducing non-mutated foods back into the commodity chain.
While the influence of Thoreau and Carson grounds cli-fi firmly in a narrative of post-apocalyptic survival, the genre also shows the influence of writing in the utopian tradition. Although a minor classic since its publication in , The Drowned World has been reclaimed and reissued in the 21st-century context. While holed up in a deluxe apartment building floating like an island above a flooded London, Kerans encounters a sexy Vogue -reading straggler, a crew of barbaric Afro-Caribbean scavengers headed by a crazed white leader, and the remnants of other phases of his own techno-military expedition.
After a series of undersea explorations that double as journeys through the unconscious and into the instinctual limbic system, Kerans ventures off alone, braving a perilous jungle stocked with giant iguanas, bats, and crocodiles—his destination the deadly Equator. The oddly persistent figure of cannibalism also marks for Ballard the limit point of the human, because cannibalism encodes not only the horrific sacrifices associated with survival plots but also the endangerment of the very possibility of coexistence in a human community.
This scene suggests that the social and psychological regressions toward the primitive that have been triggered by the high temperatures in the flooded world have eroded the foundations of reason and any morality premised on human species-feeling. This legacy suggests that, where it culminates in cannibalism, the apocalyptic sensibility of climate-change fiction may be recognizing its own anxious ongoing attachment to a much-sullied model of Western civilizational so-called superiority. These have become essential touchstones of climate change fiction as a genre in all of its various manifestations.
If science fiction proper has often been concerned with either extrapolating technological development from existing social conditions or providing alternate histories that reimagine the supposed inevitability of the present, then cli-fi has deviated from those norms. The near-future, post-apocalyptic scenarios so prevalent in the genre often assume that the turning point for change occurred before our own historical moment, and consequently they frequently rely on archaic images, such as the drowned city.
The use of these flood motifs in cli-fi also affects the temporality of the genre, shifting it away from the future orientation or alternate presents of science fiction. Cli-fi is consistently concerned with a temporality that is retrospective, looking back to a change that has already begun to occur and to which humans and other species must adapt. Cli-fi rarely, if ever, allows its protagonists a chance to mitigate those effects, let alone alter the conditions for their occurrence as in time travel narratives.
John Connor cannot go back in time to battle the climatological Terminator. The terminus may not be prevented through manipulations of temporality in this genre. Instead, as Srinivas Aravamudan explains, the temporality of cli-fi is catachronistic. To this way of thinking, the turning point, such as it is, in climate fiction is an event that went unnoticed in the recent past but whose effects permeate the present and future. This sensibility raises the specter of a world in which only weak forms of human progress and control are possible, and consequently a renewed emphasis on the plasticity of the human body and its vulnerability to environmental change arises.
This catachronistic temporality is expressed in the recurring figure of the Last Book. When it is most effective, this gimmick intensifies a sense of gothic foreboding about the present, because it catachronistically unites contemporary practice with a future on the brink of extinction. This identification with a future loss differs significantly from the ponderous revelations of, say, the discovery of the half-buried Statue of Liberty in Planet of the Apes.
The substance of the revelation in cli-fi is not that our own liberal, progressive civilization is doomed by a transition we have yet to experience but ought to anticipate; it is, rather, that we may already inhabit a post-apocalyptic future without even realizing it. We are no longer who we thought we were, if we thought we were modern, human, and progressive. Consequently, as Aravamudan suggests, cli-fi reveals a complex preoccupation with posthuman modifications to the body. Here again, the genre draws on sci-fi fascination with cyborgs, robotics, and technological extensions of the biological body.
These mainly manifest in the figure of the human with alterations to the genetic code, a figure imagined—at least by Atwood and Bacigalupi—as a potential survivor of the social collapse triggered by climate change. In The Wind-up Girl , Bacigalupi investigates the technologically enhanced body most explicitly. Then, a hidden capacity for instinctive super-speed is revealed.
Both of these adaptations were designed by a genetic engineer. The malleable, plastic aspects of DNA make it susceptible to both conscious design and open futurity. It is instead the malleability of the human biological organism itself, its susceptibility to failed or incomplete human projects to adapt to environmental change. This cli-fi version of a posthuman plasticity generates some tension with the residue of heroic hypermasculinity that, Jeanne Hamming has persuasively argued, characterizes the imaginary of American science-fictional techno-thrillers in particular.
He is John Connor and the Terminator rolled into one. Traces of this ultramasculine and robotically unflappable scientist-hero appear in many places in cli-fi. His final conversion into a parody of a survivalist hard-body, building a fortified bunker in a former bank and living off the profits of his earlier predictions, makes sense mainly as a satiric play on the heroic adventurer so amply envisioned by Crichton. Along with cannibalism, widespread heterosexual rape is repeatedly imagined in cli-fi as a consequence of climate-induced social breakdown. This is especially true in a burgeoning counter-tradition of feminist and queer-positive contributions to the genre.
How an imagined post-apocalyptic society manages sexual violence reveals a good deal about how that author envisions if she does the potential for social rebuilding, one capable of resolving conflict, resisting exploitation, and redirecting brutality. Post-apocalyptic sexual violence presents a new cycle of environmental damage in microcosm, particularly in feminist cli-fi.
To distinguish the post-apocalyptic concept of right behavior from the old, a new justice is necessary in order to recognize, punish, and prevent abuses. Once the violent Painballers are finally executed, their remains are symbolically disposed, and the recording of the disposal forms the first episode of the last book. New sexes and new social relations can be redesigned from the remnants of the old. Rather than stressing regulatory mechanisms, he depicts a more open-ended and pansexual multiplicity as part of the posthuman condition.
Pansexuality is, by implication, an expression of a less exploitative and production-oriented relation to nature. Sexual violence in The Wind-Up Girl is mainly associated with forms of heterosexual prostitution and enslavement that aim to reinforce human dominion over the nonhuman and masculine dominion over the feminine. The concentration on flesh as in many scenes in which Emiko is groped or manhandled encapsulates that desire to grip, control, and drive another organism. These two celebrated works of cli-fi represent two major efforts to move beyond the residue of science fictional hypermasculinity and toward a more speculative multigender universe.
At different registers, the invisible yet expressed code and the social meaning of the gendered body become sites for novelty; they emblematize efforts to transform the human—albeit with unpredictable effects. This theme is one cli-fi shares with sci-fi, but in this genre it fuses the potential for transformative modification to the human with the catachronistic effects of an environmental transformation already underway.
The conventions of cli-fi are already so well established that they have invited satire. In particular, the dystopian conventions of climate-themed films have attracted attention. The media studies scholar E. Ann Kaplan argues in Climate Trauma that the white male scientist-hero provides the default perspective for these narratives.
His fear drives him to calculate the odds of disasters obsessively and develop a complex crush on a female classmate who suffers bravely from a condition that could kill her at any moment. This would-be quest quickly inflates to self-satirizing proportions, as Mitchell and a friend advance toward and then retreat from the farm in mock-heroic fashion—first in a gaudily painted canoe and then less glamorously by bus. The satirical inversion is completed when our hero learns, by postcard, that his idol has become an environmental lawyer, taking up the battle that he has renounced in his isolated bunker.
He becomes a mystical father figure for the Crakers he genetically engineers, thus risking a repetition of the patriarchal religiosity that generated his own intense reactions. Through satiric exaggerations of the powers of organization and financial resources of the activist wings of the environmental movement, Crichton imagines a scenario in which shadowy extremists use explosives to damage Antarctic ice sheets, trigger deadly flooding, and launch a massive tidal wave.
The narrative heart of the novel does not consist of its confusing and misleading speeches that attempt to rebut the scientific consensus on the existence and anthropogenic nature of climate change. The implicit argument of these satires and the explicit thesis for scholars such as Ursula Heise 27 is that cli-fi has too readily restricted itself to a limited set of persons, sites, moods, and effects. In criticism devoted to environmental literature and the novel more generally, realism has for several decades been under fire for its purportedly antipolitical comfort with dominant social conditions.
In The Truth of Ecology , for instance, critic Dana Phillips argues that a predilection for description among realist authors offers at best a clumsy tool for recording perceptions of the natural world, and at worst a misguided confusion of literary technique with scientific method. Like some of the cli-fi satirists, Phillips doubts the effectiveness of this preoccupation and calls for a wilder and more aesthetically innovative approach to writing about ecological systems.
Despite these important critiques, authors of cli-fi have indisputably remained interested in literary realism, testing its history, merits, and flexibility for purposes of the present. Sometimes the results are perhaps too familiarly Dickensian. But some versions of their work also explore alternative geographies and temporalities and push forward to imagine human experiences of the earth in a distinctly contemporary variant of the realist framework.
The swarm is described repeatedly, and the plot turns on its reinterpretation, thus fusing description and narration. Local residents interpret the swarm in light of biblical scripture before trying to capitalize on it financially; television journalists cover it as a sensational human interest story; a visiting lepidopterist and his research team see it as evidence of climate change; and a migrant family from Mexico view the butterflies as a sad reminder of their destroyed home.
The protagonist conventionally shifts perspective on her home and the visiting swarm, moving from the eschatological and short-term financial interpretation toward the scientific. In a classic realist gesture, then, the protagonist abandons illusions—including a romantic attraction to the Caribbean-born scientist—in favor of a more grounded project of self-improvement, a project coupled with a broadening of perspective that allows her to place her own history and ideals on a more global but still unseen map.
A Friend of the Earth in particular alternates between a dystopian near future and a somewhat romantically described eco-activism in the s.