Write Out of Depression

2009-10-08T11:47:00.000-07:00

Goodbye for Now, My Friends
I've enjoyed writing this Write Out of Depression blog for the last three years. It introduced me to many of you fascinating readers. It saw me through the writing and publishing of my book, Writing through the Darkness: Easing Your Depression with Paper and Pen, in June, 2008. And I hope it has provided some information, encouragement and intriguing writing ideas.

Now, however, it's time for me to move on to other things. I am working on a new book! I'll also continue to speak at conferences on mental illness and on writing, and to lead my writing group for people with mood disorders at Stanford.

Please go to my website www.WritingThroughTheDarkness.com to learn about me, my book, and my schedule. You can also email me at: EMSchaefer@aol.com. From the bottom of my heart, thank you for reading and for your comments and contributions. Goodbye for now.
--Beth

2009-08-26T11:08:00.000-07:00

TO WRITE: The Animals in Our Lives
To my great sadness, an important member of our household died this weekend: Our cat Onyx grew very ill and had to be put to sleep. Onyx was 21-years-old, ancient for a cat. As her name implies, she was black, and though she had a problem being overweight at one point in her life, she had become very thin and weak and had numerous medical issues.

As we drove home from the vet's office, my husband and I reminisced about the little furball she had been when we got her at eight-weeks-old, how she and her sister loved to sleep inside our shoes back then, how loudly Onyx could purr (you could hear her across the room), how she loved to be combed and have her ears rubbed, how in her shy period she would scramble under our bedspread when she heard the doorbell, how she would cheerfully (and loudly) great us, and how we all loved each other. I also recall how comforting it was to hold her on my lap when my depression pressed down on me -- perhaps she is what got me through sometimes. My heart aches for this long-time friend, but I am glad for her long and, I believe, happy life.

Play with this. . .
Do you have, or have you had, a pet? What does s/he mean to you? Is this creature a comfort when you are ill? How? Write continuously for 15 minutes on your pet, or your first pet, or another animal you've had a relationship with.

2009-07-31T16:44:00.000-07:00

TO WRITE: Is There a Book in You?
After giving a talk at the recent national NAMI (National Alliance on Mental Illness) conference about the healing aspects of writing in the treatment of mental illness, it happened again:
I was approached by several people who were interested in writing a book to tell the tale of their illness. Boy, do I know that feeling. I think that for some of us it's an innate reaction to the bizarre and hellish symptoms we've lived through and may still be facing. We want the world to understand us, to validate us, to stop stigmatizing us, and we want to process our own tale to make better sense of it for ourselves. I included parts of my own story in my book Writing through the Darkness: Easing Your Depression with Paper and Pen, and I'm now working on a memoir about the spiritual aspects of mental illness. It's healing for me, that's certain.

Whether or not you are inclined to write about yourself, many people feel there is a book in them that they'd like to write before they die. Do you want to record a family history for your grandkids? Detail all you've learned about a hobby or career? Chronicle a historic period you lived through?The following exercise is taken from Writing through the Darkness. Let yourself think big and go deep.

Play with this. . .
Imagine you were to sit down at the kitchen table and start writing or typing your first book. What would it be about? What would you really like to say to the world and leave behind in perpetuity?

Then consider this: What does your book topic tell you about what is important to you? Does your enthusiasm for writing about the ocean suggest you might want to spend more time at the beach? If you felt inclined to write a memoir, what events in your life would you like to get on paper?

2009-07-20T17:09:00.000-07:00

TO WRITE: Things Worth Saving
Why do we all get attached to particular physical objects? Whether it's an expensive car or a smooth stone in your pocket, nearly all of us feel a connection with certain items. Some of us even have trouble not "glomming on" to everything that comes our way.

With firestorm season beginning in California (not to mention the ever present threat of an earthquake in these parts), I wonder just what I'd save from my home if only given a couple of minutes. And how would that list expand if I had more warning?

After playing that mental exercise, I wonder how those priorities affect the way I look at my possessions in general. For example, why is it so hard to be ruthless when cleaning out a closet or drawer of old things that I don't use or care about, but which might be useful "someday"?

Play with this. . .
Writing quickly, jot down the items you'd save if you only had a few moments to get out of your home. (Assume that all people and pets are already safe.) Then enlarge your list to what you'd take if you had a couple of hours to pack. Next, write continuously for 10 minutes about what these lists tell you about how you live day-to-day and what you might like to adjust... Could properly backing up your computer leave you calmer? If you really treasure those old family photos, would you enjoy framing and hanging a few? If you discover that a certain book of poetry is very dear to you, do you want to make it a habit to read a page before bed each night?

I realized that I could give old t-shirts I haven't worn for years to Goodwill and that I'd love the empty space they left on the shelf. I also discovered that some of the meaningful greeting cards I've received and saved over the years would look great on my bulletin board and remind me of their kind words. Some things really are worth saving.

2009-07-05T17:08:00.000-07:00

TO WRITE: Going from Bad to Better
I left the blogosphere for a number of weeks recently due to some unexpected health problems, and I'm very, very pleased to be back. I'm also relieved that my problems were not of the mental/brain variety -- not only are those every bit as miserable, in my experience, but they are my personal nemesis, my challenge, my dark hole. No, I had gall bladder problems, including some complications, hospital time, and surgery. And I'm fine now.

All of this got me to thinking. . . what pulls you through when you are ill with mental/brain or other physical illness? I was blessed to have a supportive husband and insurance that covered most of the expenses, and I lucked into good doctors in the hospital and the OR. But I realized too that, despite a lot of pain, I wasn't as flustered as the staff seemed to think I'd be. The thing that left me on an even keel was all the depression, psychosis and suicidal times I've been through. I know what pain feels like. I have gotten through before, and I'll do it again. Mental illness has toughened me.

Play with this. . .

Writing continuously for at least 20 minutes total, describe a time you felt seriously ill in any way. Then describe what treatments, people, creative outlets, past experiences, rituals, mind-sets or other factors helped you through. Did you just need a certain amount of time to heal? Did hope or sheer determination help?

Finally, how can you apply these tools the next time you feel significantly depressed? It may be useful to keep a list of these resources in the back of your notebook or another safe place to refer to later. When you need such a tool, write about it for 10 minutes first to remind yourself how it feels, reengage with it, and plan how to put it to its best use.

2009-04-06T09:38:00.000-07:00

TO WRITE: Making Lists

Keeping a to-do list usually gives me a sense of comfort and efficiency; I know I'm probably not forgetting anything and I can prioritize my tasks and work my way through them. Plus it's a great feeling to check items off as I accomplish them.

But I've found many other uses for lists too, including in my writing and teaching. Lists are a wonderful way to get your mind to open up and search for possibilities that it hadn't noticed before, including writing topics. For example:

I sometimes ask students to write on a particular color (say, purple). If you don't know where to begin with such an assignment, try making a quick (don't overthink this!) list of things that are that color (lilacs, bruises, a stripe in the rainbow, a few people's eyes). Then choose one item and begin your writing with that. You may find a story about the fragrant vines in your garden or a memory of a childhood injury comes to mind.

When you want to approach a very large topic such as beauty or democracy or depression, jot down a list of related words first. For depression, I might come up with: medicines, loneliness, lack of joy, supportive friends, ECT, writing, sleep problems, work issues and more. Now begin with one of these listed topics. If the one that interests you right now is still very broad, you may need to repeat the process. The specific words and ideas you come up with in this way allow you to make your writing more meaningful for you and your reader, and they are a great way to start creating a lengthy piece.

Note that I've indicated that you should write your lists quickly. This is a time to really let your mind wander freely and brainstorm. If you're not sure why you thought of "jellybeans" when you looked for associations to "depression," put it down anyway and move on to the next item. After you've written your list for several minutes, you can look back at what this means; perhaps your sister brought you an Easter basket to cheer you one spring when you were low.

Play with this. . .
Here's an exercise from my book, Writing through the Darkness:
Quickly make a list of at least 25 things you're good at. They might range from kissing. . . to reading a map. . . to doing rocket science. Then choose one, large or small, and write for 20 minutes on that skill. Who taught it to you? What's the secret to it? Do you love doing it? How could someone else learn it?

2009-03-02T10:39:00.000-08:00

TO WRITE: Conversing with Depression

Let's continue our theme of writing dialog from the last post. I find it very powerful to deliberately have talks with other people or things in my mind, and especially to write down -- quickly and continuously! -- these interchanges as they happen, when unplanned, unexpected words, ideas or memories often appear as mysterious gifts.

I regularly imagine and record conversations with my own depression. More than simply reflecting on how I feel about being depressed, it lets me interact with my concept of the illness, get to know it, and get to know myself better.

Play with this. . .
How do you envision your depression or other troublesome emotion or situation? For example, is it a tornado that swirls around you? A monster that threatens from the closet? A black hole, a thief, a feeling of falling, or some animal like Winston Churchill's "black dog"? If you're not immediately sure, take about three minutes to quickly jot down at least five possible identities for that constellation of feelings, then re-read your list and choose one.

Next, writing quickly and continuously, create a dialog between yourself and your image of your depression. What have you always wanted to ask it about where it came from or what will make it quiet down or leave? What have you wanted to say to it in your times of anger? What does it want to tell you? Write this back-and-forth for 15 minutes. It may give you some clues or help resolve a little bit of your relationship with the illness, and it's a wonderful way to remind yourself that you are not your depression!

2009-02-15T15:10:00.000-08:00

TO WRITE: She Said, He Said
Many professional fiction writers claim that writing dialog is one of the toughest tasks they face. While making those back-and-forths sound convincing is important, dialog is also crucial because it is a place where the writer's imagination is laid bare. Good dialog offers new information and uncovers the nuances of a relationship. It doesn't beat around the bush.

Try writing some dialog yourself. Fictional situations and characters sometimes uncover thoughts and feelings you were only dimly aware of, and can help stretch your imagination in new ways.

Play with this. . .
Choose two "characters" who will talk with each other. They may be living people, historical figures, made-up creatures, objects, even places like cities or rivers. Some methods for choosing are:

Open a book and place your finger on any part of the page. Then choose the noun (person, place or thing) under or closest to your fingertip. Repeat to choose a second character.
Ask someone to name two nouns or two people at random.
Choose two body parts. You'd be surprised at what an eye and a liver have to tell each other.
Choose two feeling states to converse, such as depression, anger, perfectionism, anxiety, joy, confusion, relief.

Then, by writing freely and quickly and simply "taking dictation" in your mind, not planning, take 10 minutes to write a dialog. The conversation may be serious, deep, focused, silly or freewheeling. Reread what you've written and write for 10 more minutes on how it felt and what it might mean to you. Perhaps this clarifies some conflict you've been experiencing or gives you ideas for other "characters" you'd like to hear converse.

2009-01-30T13:41:00.000-08:00

TO WRITE: What Are You Doing Here?
In Chapter 5 of my book Writing through the Darkness: Easing Your Depression with Paper and Pen (info in profile) I describe benefits that come from using writing to examine your spiritual beliefs -- your understanding of the mysteries of the world around us and inside of us. (No, I'm not writing only to religious people here; it's different.)

By uncovering, defining and fully embracing our beliefs, we spiritual seekers can sometimes find a sense of meaning in life -- or in our depression. Indeed, I have known writing group members who come to feel that there is a reason, or even a benefit, to their depressed experiences, be it to learn and grow as human beings, to develop compassion and understanding, or to assist others in their healing. (p.61)

Furthermore, spiritual searching also carries health benefits. Many studies have demonstrated that people who consider themselves "religious" or "spiritual" or who attend religious services regularly: 1) have fewer illnesses, 2) live significantly longer, 3) specifically have less depression and, 4) have a greater likelihood of remission from depression. Practical applications of such findings to treatment of depression is under study too. For example, meditation, a component of many spiritual traditions, has been shown to be a useful adjunct to treatments for many health conditions, including depression. (p. 62)

Play with this. . .
Choose an issue that you consider what we call in my classes a "Big Question." For example, Who am I? What am I doing here? Where did we come from? What happens when we die? What is love? What is depression? Write continuously for 15 minutes on your question, being sure to include your personal feelings and experiences. Obviously there are no right or wrong ways to do this -- you don't need to hold to any particular belief system.

2009-01-18T14:50:00.000-08:00

TO WRITE: Off to a Great New Year. . . a Bit Late, but Less Stressed
Greetings! Happy 2009 to you. Happy MLK Day. Happy Inauguration Day. Happy Year of the Ox! I have not posted for a few weeks now, which I regret, but I don't think I could avoid it. As we're well aware, life gets hectic for many of us at the end of the year. And we've all heard about the high rate of Christmas-time depressions out there. Well, this year I think I caught that bug.

My depression wasn't terrible; I wasn't immobilized or suicidal or seeing and hearing things that no one else was seeing or hearing, as sometimes happens to me. But it felt like the real thing, not just the blues. I've been tremendously fortunate to have had little depression for the past two years, so this was scary -- the nasty self talk, the ache in the chest, the decreasing interest in things I love, the sadness, that feeling of futility.

But. . . I'm doing much better now. I credit a good psychiatrist and good therapist for this turn-around, as well as my ever present meds regimen, and my serious efforts to reduce the stress in my life. I backed out of some obligations and invitations (and the world did not end), and I'm working hard to change my attitude about the stresses in my life. (I'm Mom to a 1-year-old, and I'm trying to write, to do speaking gigs, to teach and do other volunteer work.) I am taking better advantage of some babysitting help, and I'm working at not waiting until my to-do list is done (it never is) before letting myself read a little for fun. Major paradigm shift.

Play with this. . .
Writing continuously for 10 minutes, take a hard honest look at what is causing stress in your life. You may be trying to overdo it, like I tend to do, or you may be stressed by the lack of structure or busyness in your life right now. Are you feeling a great deal of pressure about trying to regain your health? Are you, like me, putting a lot of energy into being frightened and bracing yourself for the worst when you mood dips even a bit?

Now, part two. . . Write continuously for 10 more minutes about what tiny steps you can take to relieve some stress in your life. Can you relax and have coffee with an acquaintance you want to know better? Can you spend fifteen minutes -- no more -- online looking at job sites if you are seeking work? Can you make your to-do list for today more reasonable? Don't overwhelm yourself with reducing stress -- this is like rushing to get to meditation class (something I've also done). Can you journal it out for a half-hour? Take small actions and congratulate yourself. I believe it's the only way to maintain my own health; perhaps it will help you too.

2008-12-23T20:10:00.000-08:00

TO WRITE: Holiday Ups and Downs
So how do you really feel about this holiday season? It can be confusing. Family, friends, partners and mall stores may all expect bliss; magazine articles on SAD and newspaper editorials on the economic downturn may feel like harbingers of depression. Not an easy time for folks with mood disorders. I know I can feel up one minute and down the next for no apparent reason. So perhaps our goal should be to maintain some sense of stability, equanimity, groundedness. But how?

Play with this. . .
Write continuously for 20 minutes on: What helps keep you on an even keel at this time of year? Write as if you are sending this to a friend who needs your advice. For me, writing itself -- including being alone and quiet for 20 minutes -- helps a lot. So do occasional naps (even short ones), eating protein instead of too many Christmas cookies, not watching too much TV or surfing the net too much, and giving charitable gifts in honor of family members instead of just buying gifts for the sake of buying. What helps you?

This holiday period is likely to have both ups and downs for each of us. I wish all of you moments of joy, periods of peacefulness, and the awareness that life will likely settle down some soon, so persevere even if it gets tough.
With warm regards,
Beth

2008-12-06T17:39:00.000-08:00

Amazing New Treatment Approved to Treat Depression
It really can be amazing! I know personally. . . .

What is it? The US Food and Drug Administration has now approved the use of a technique that uses strong magnets for "treatment resistant" major depression. This is great news for anyone who has not responded to at least two antidepressant trials and who would prefer not to be treated with the main alternative, ECT (electroconvulsive therapy or "shock treatments"), which can damage memory and carries some additional risks.

The new treatment is TMS or transcranial magnetic stimulation. It involves placing a device that generates a strong but precise magnetic field against a particular site on the left side of the skull, and delivering magnetic pulses for 20 minutes, five days a week for two to four weeks. The patient is conscious during the procedure, which can be done in a psychiatrist's office. What does the patient feel? Not a thing. What side effects are there? None reported at all except occasional mild headaches that respond to over-the-counter meds. No memory loss!

TMS will soon become more widely available, which I feel is fabulous news. You see, TMS completely turned my life around -- after many years of requiring a series of ECT treatments when a suicidal depression struck every few months, I was allowed to try the experimental TMS. Now, I'm technically diagnosed as bipolar, though I mainly experience depression, so my TMS targeted a different area of the brain, this one on the right side. Nonetheless, my treatment was a resounding success, as the newly-approved one has now been for many with depression in clinical trials. By the second week of treatments, the profound depression lifted and I was merely very depressed, but functional. By the end of week four of the five-minute treatments I was well! Really well -- back to baseline.

Now I needed to repeat this four-week series every few months for a couple of years as the depression returned, but the intervals between series gradually grew longer. And I'm delighted to report that I have not needed TMS (or ECT) for over two years! I've had no serious depression symptoms, and I've gotten my life back after 14 years of being unable to work or have kids. I wrote a book last year (see profile), I published it this spring and have been promoting it and, most important, my husband and I adopted a child this summer. Obviously I'm a huge TMS fan.

I know that no treatment works for everyone, but I believe that having more alternatives to try is the key for those of us who've been through every drug trial and don't know where to turn. This is great news.

2008-11-26T10:30:00.000-08:00

Thanksgiving May Decrease Your Depression
It's true! And I'm not talking about the dopamine levels in turkey. In the last few years the new science of "positive psychology" has repeatedly shown that, "People who practice gratitude are more optimistic, report fewer physical symptoms of illness and pain, and lower levels of chronic stress and depression," as one researcher summarizes.

Sounds great, doesn't it? But note that you need to "practice" gratitude -- and that means writing it down. Aha! The key seems to be that we'll feel gratitude's positive effects not by thinking or even speaking about things for which we are thankful, but that these things must be written down.

TO WRITE. . .
The Thanksgiving season is the perfect time to start writing a daily list of three things for which you are grateful. They may be huge or tiny. I find it most helpful to write these as three sentences, "I, Beth, and grateful for...." You don't need to make a lengthy list or write for 20 minutes on any of these, although we sometimes do this in my classes. Just write down three things that make you feel thankful inside. To me, that feeling -- even if I can hold it for only a few seconds -- is incompatible with depression. So take three minutes and do it... now! A peaceful and joyful Thanksgiving to you all. --Beth

1) I, Beth, am grateful that I at last became a mom this year.
2) I, Beth, am grateful that it's raining out right now -- we need the water, and it smells fresh.
3) I, Beth, am grateful that I know that I'll have food available for dinner.

2008-11-10T10:12:00.000-08:00

TO WRITE: Coffee, anyone?
If you are living with a mood disorder, I'm betting you have a special relationship with caffeine. Depressed? You may down coffee, tea and colas all day long trying to get an energy boost. Bipolar? You may need to avoid the stuff like the plague to keep it from nudging you up into hypomania or mania. And what about the large numbers of us who just can't sleep reliably, or who sleep too much, or who feel sedated by meds? Chances are you have thought deliberately about your caffeine intake. I've certainly pondered mine over my third cup of java.

I've always assumed that caffeine helps me stay more alert and focused, especially when I haven't had all the sleep I need. But a new study of coffee's effects says: NO! A new study in the Nov. 3, 2008 Human Psychopharmacology journal tested people taking caffeine or a placebo, both when they were rested and when they were sleep deprived. While some brainwaves did look different, they concluded: "The findings do not support the use of caffeine as a means for enhancing human function or as an antidote to the negative effects of sleep loss."

Are the effects of caffeine different in those of us with a mood disorder? We don't know. And that placebo effect resulting from our common assumption that it helps or hurts may play a role too. But it's worth considering all the evidence.

Play with this. . .
Write continuously for 20 minutes about your sleep patterns and your alertness and how you cope with any sleep or alertness problems. Have you found practical solutions? Share them! This is a big factor in improving and maintaining our health.

2008-10-31T14:58:00.000-07:00

TO WRITE: Alternatives to Discrimination
I've been listening closely to advertisements for haunted houses this Halloween season. Last year an organization whose name I've gladly forgotten got national attention for creating a scary experience in what they called a mental hospital or psych ward, and for using numerous terms derogatory to the mentally ill, as well as trying to frighten people with the ideas of straight-jackets and unanesthetized electroshock treatments. Probably without thinking about what they were doing (I'll give them the benefit of the doubt here), they were painting mentally ill people as frightening, violent and dangerous. We are none of those things. Fortunately, after many letters and much protest, the group changed their theme entirely.

We've all probably felt some stigma around mental illness -- the comments from others that you should pull yourself out of your depression, or the dismissal of one's symptoms and oneself as "psycho." Very sadly, the worst result of the stigma around mental illness is that it causes many people to NOT seek treatment that could help them.

Play with this. . .
There are three sections to this exercise. First, write continuously for 10 minutes about any stigma you've been the object of for any reason -- your gender, race, ethnicity, sexual orientation, height, weight, age, etc. Then write for 10 more minutes on stigma you've experienced or observed pertaining to mental conditions. Finally, write for five more minutes on what you could tell yourself or that stigmatizer that would make you feel better about the situation -- perhaps pointing out to your boss or relative that you are coping with an actual illness and you are working hard to get well, or perhaps giving yourself a positive affirmation or self-talk to counter an uninformed or unkind comment.

2008-10-23T15:20:00.000-07:00

TO WRITE: Are you "bogged down"?
An email crossed my screen recently with a question that was attributed to, or arose from, Oprah's discussion of Eckhart Tolle's ideas: What makes you feel less bogged down?

That phrase "bogged down" makes me think of swampy muck tugging at my rubber boots; it makes me think of the poem Picture of Depression by Jo Bobbie in my book (p. 89). Both evoke good heavy images and feelings of depression -- ones that could help non-depressed people ("neurotypicals," as one student calls them) get a clue about how a real depression really feels.

Play with this. . .
Consider that weighty feeling of being bogged down, then consider its opposite -- feeling buoyant and agile and free to move and be yourself. Now write continuously (without stopping to think a lot about what word or idea is coming next) for 20 minutes on what lifts you from one state to the other; what makes you feel less bogged down? It might be a healthy meal, a chance to sit in nature and just think, a new part-time job, running a marathon, talking to a friend, counting your blessings or writing in your journal. You might be able to generate a list you can turn to later when you really need it. After you write, determine what one thing you can do for yourself right now to feel less bogged down, and do it.

2008-10-17T11:41:00.000-07:00

TO WRITE: What would you love to buy?
Economically, times are looking very grim for most of us right now. And, whether we want to face it yet or not, the holiday season -- with all it's frenzied buying and extra expenses -- is fast approaching. Does all this money talk sound overwhelming? Today I invite you to set aside those stressful issues and think about you.

Play with this. . .
Write continuously for 20 minutes on the question: What would you love to buy if you could? For me, an eagerly awaited new book is a favorite treat, so I might simply purchase more books if I had unlimited shopping resources. Your tastes may run to larger items -- a new house? car? a tropical island? Or perhaps you'd like to buy a gift for a loved one?

After you write, reflect on why this item is important to you. Is it something you really could go out and acquire today? If so, go for it, and see how wonderful you feel. If it's unattainable until you win the lottery, consider why you'd like it and brainstorm on whether there's a smaller alternative that could provide the same pleasure.

2008-10-02T11:46:00.001-07:00

TO WRITE: Are Women and Men REALLY Different?
Gender differences have been discussed, and sometimes enforced, for eons, continuing in this election season, including tonight's VP debate. How real are these differences? More crucially, how important are they?

I'm observing all sorts of interesting things in this arena now that I have an 11-month-old daughter. Friends tell me they couldn't affect their girls' love of princess dresses even though they tried; men seem less likely to ask to hold the baby even when they beam contentedly when the offer is made and they reach out; strangers with a kind comment for the little one are unsure how to deliver it if s/he's wearing gender-neutral clothing below her short baby hair.

Play with this. . .
Write continuously for 20 minutes starting with: The real difference between men and women is... Or start with the differences between girls and boys. What differences have you observed recently? What conclusions have you drawn? Do you treat women and men differently? Do others role-cast you, and how does that feel? Is it advantageous or problematic to have differences? And do gender roles have any influence on your depression?

2008-09-18T22:22:00.000-07:00

TO WRITE: The Power of Peers
I returned this week from the national conference of the Depression and Bipolar Support Alliance, held in Norfolk, Virginia. The theme of the meeting was "The Power of Peers," and the lectures I attended, the response to the one I presented, and the conversations I had with fellow attendees all underlined for me the importance of this concept. Many at the conference were leaders of local DBSA chapters around the United States; some were peer counselors, peer trainers or peer advocates for mental health parity. Most were also living with depression or bipolar disorder themselves, or had a close family member with one of these illnesses.

I was impressed. I heard from people who focus on reducing the stigma around mental health, from a comedian teaching others with mood disorders to do stand up too, and from good souls who have managed to get Medicare to cover peer counseling for mental illnesses in some places. It felt good to be among so many who have a lot on their plate just dealing with their health challenges, but who then go further and help others who are struggling too. Keynote speaker, renowned author and Johns Hopkins psychiatry professor Kay Redfield Jamison proclaimed to great applause: "If you've survived mental illness, you have an obligation to give back."

Play with this. . .
Part 1: Write continuously for 15 minutes on how your peers help you. Do you attend a support group and feel listened to each week? Has a neighbor or friend-of-a-friend ever reported that she has depression too, and that you can call if you need to? What have you read that supported you in understanding your illness and gave you coping ideas (perhaps Jamison's An Unquiet Mind, for example)?

Part 2: Write continuously for 15 minutes again, but now look at how you help your peers with a mood disorder. For example, I'm encouraging people to begin their own writing groups more and more lately, as I've benefited so much from leading mine for these last 10 years. But simply sharing your writing with a peer can provide an enormous support too -- discovering we're not alone in our experiences offers powerful support and healing too. Are there other ways you "give back"?

2008-09-04T09:26:00.000-07:00

TO WRITE: What are you looking at?
I'm discovering that what everyone told me is true -- being a mom is a non-stop job. But, oh, are we having fun! And even when a break presents itself, like naptime for baby (when Mom can write a quick blog posting) or when Dad arrives home from work (and plays with baby) I'm finding it hard to stop watching her. After dinner the other evening, as daughter played happily on the floor by herself, Dad and I thought we would take an opportunity to have an adult conversation; instead we realized we were both silently staring at her with smiles on our faces, intrigued with her games.

Play with this. . .
Write continuously for 20 minutes starting with: My eyes were glued to. . . Write a memory of a time you couldn't stop watching something, or write some fiction, creating a short story of someone's visual obsession.

Then, at several times during the day, consider where you focus your attention. Are these the places you'd like to be staring at, or would you like to home in on other, perhaps more "positive," images?

2008-08-27T21:59:00.000-07:00

TO WRITE: The Youngest, the Oldest

OK, so I've got babies on the mind. . . humor this new mom. (See earlier post today.) As my beautiful little one seems to do something new everyday -- she is soooo close to crawling -- I'm terribly impressed by her rapid developments. Our accrued learning over a lifetime is amazing.

Play with this. . .
Describe the youngest person or the oldest person you've known. What stories do you recall about this person? What have you learned from her or him? My paternal grandmother, who I knew well, lived in reasonable health to 97 years of age. In China we met a 96-year-old man who was fascinating in his physical flexibility and apparent health. He said daily tai-chi was his secret. On the other hand, the youngest person I've known well since I've been an adult is definitely my new daughter, just turned 10 months old. I'm adoring watching all the changes she's made in just the month we've known her, and I know I'll learn a tremendous amount as we evolve as a family. I think that reflecting on all three of these people will be a help when I'm feeling really low.

2008-08-27T17:03:00.000-07:00

TO READ: I'M BACK -- HAVING RECEIVED A GREAT BLESSING!!

After a several-week hiatus on two continents, I'm thrilled to be back in the blogosphere . . . and delighted to report that my husband and I are now proud parents of a 10-month-old baby girl! We spent two weeks going through the adoption details in China (after three years of going through adoption details in the U.S.), then made our way home just as the Olympics began there. All three of us are adjusting well and snuggling a lot, playing on the floor a lot, and dealing with wakings at 2am. Couldn't be better, even with having to just snatch a minute here and there to answer email, write blogs, take a shower. . . .

A few years ago I would not have thought there was a chance in the world that I'd ever become a parent as I had hoped. I was in the hospital too much, getting too much ECT, obsessed with harming myself; I was seeing and hearing things. I was too ill with my depression to work, study, or function very well socially, much less be responsible for another person's life too. And then there were all the issues around how my meds might affect a pregnancy, and how a pregnancy might affect my moods. But, lo and behold, a solution arrived as my recovery progressed these last three years or so. I feel tremendously grateful to the Universe for this opportunity, and it makes me want to say to everyone that there IS hope for better things, even when your health is very poor. Persevere, educate yourself, try different things and remember you are valuable. And write -- for clarity, understanding, peace and planning your recovery. Write.

2008-07-16T10:25:00.000-07:00

TO WRITE: How Does Writing Save YOU?
I make a big claim in my book: Writing saved my life.

Other things saved my life too when I was going through years of life-threatening depressions: Medical treatment (a supportive psychiatrist, lots of meds, lots of ECT, experimental transcranial magnetic stimulation, hospital stays) also saved my life. . . and good people (my husband, my mother, a couple of great bipolar friends) saved my life. Without all three, I'm not at all sure I'd have made it.

Author Alice Walker has also been rescued by writing. She says, "Writing saved me from the sin and inconvenience of violence." Clearly, writing can aid many of us in surviving of life's most difficult trials. Some use writing to touch their spiritual core, some use it to recover from pain, others use it to plan their recovery.

Play with this. . .
Writing continuously for 20 minutes, reflect on why you write. Go deep. What would your life be like if you never did any personal writing such as journaling or crafting poems for yourself? Even if you don't find life-altering reasons for writing, you may find that writing helps you organize your thoughts and plan your day, or perhaps writing allows you to calm and soothe yourself after a difficult experience.

After you've written about writing's importance in your life, go ahead and give yourself 10 more minute (at least!) to write on what you need to write on today. . . . What's happening in my life? How am I feeling? What do I remember? What am I looking at right now? Have fun with this, and remember, this writing thing can help in very profound ways.

2008-07-02T10:35:00.000-07:00

TO READ: What If Writing Hurts?

A reader commented recently that sometimes writing about difficult experiences or issues left her feeling as though she were reliving that awful time. Is this ever true for you? What can you do to make your writing experience both productive and positive? Lots of suggestions follow.

First, let me reiterate my three "rules" for writing to ease depression (These are discussed in more detail in Writing through the Darkness). Boiled down, they are:

1) Write continuously for the whole time you've allotted yourself. (10 or 20 minutes to start.)

2) Write for yourself. (Perfection and careful arguments are not required.)

3) If a topic feels too threatening, don't write on it today.

About #3: As you write more often, you'll learn to challenge yourself while still retaining safe boundaries. If something feels overwhelming, wait. Write on something else less charged for now. You may want to talk to a therapist or close friend about the issue and digest it before trying it again next week or next month when it feels less scary. Trust your instincts and be safe first.

Other thoughts on writing on tough issues (Again, loads more on this in the book). . .

-- It's most useful to write about both thoughts and feelings in a single session, not just one or the other.

-- Try writing about the event in the form of a story: A character runs into a problem; the character tries (perhaps several times) to solve the problem; the character somehow solves it or resolves the situation (even if that means deciding to wait for now).

-- Don't let yourself ruminate endlessly on one particular problem if you're not making progress with it. Let it go for now and write on other topics and come back to it in a week or a month.

-- Talk with a therapist about the issue to see if you can break the logjam in your thoughts and find some new perspective.

--Always try to end a tough writing session with even a few minutes on a positive topic -- try three quick minutes on the most relaxed you've ever felt, what you would do with $100 if you found it on the street today, or the most soothing image you can imagine.

Good luck, and remember to follow your instincts and make caring for yourself the number one priority with your writing.

2008-06-24T15:14:00.000-07:00

TO READ: Is Exercise the Answer?
If it wasn't clear to me before that the obesity-depression relationship is a big issue for many of us, it is after your comments on my recent post on the topic. But what do we do about it?

As everyone knows, diets can be very tough. And if you're already depressed, you may be fighting with low motivation to eat more healthy stuff and less junk food. You may also be one who turns to comfort food when your mood drops, despite knowing that those calories add up quickly. It's not easy for me today, but earlier in my life I diet easily, drop a few pounds, then forget about it. Now, with bipolar disorder (mostly depressions) and its attendant medications, I'm really struggling. I still haven't gotten off all my Clozaril pounds, despite being off of that drug for years. Sigh. But. . .

Then there's the other side of the issue: exercise. Unfortunately I nearly stopped my exercise program last year as I focused on writing my book. And boy could I feel it. Several weeks ago, however, I got back on that horse, joined a small women's gym near home, and I've been taking exercise classes there. The classes work for me because they obligate me to be there at a certain time, so I can't procrastinate the entire day long. After the first two, I came home, sat down, and literally didn't know if I could get up a few minutes later. But, those sore exhausted muscles at least told me I was doing something.

The exercising is getting a bit easier now, and those jeans are in fact fitting a little better already. But can it really help me overcome my weight gain? And do I have to diet too? Hundreds, if not thousands, of studies demonstrate that regular exercise is the key to preventing and healing nearly every ailment. And we all know that those endorphins it produces are mood-lifting. We know we should do it, but it's still tough when you're depressed.

What do you do about exercise -- and how does exercise interact with your depression and your meds? Does it help you lose or maintain weight? Does it help you feel less depressed? More energetic? Proud of yourself? Let me know what you think -- I can use all the opinions I can get as I still have to push and push to get my shoes on and get to those aerobics classes three times a week.

2008-06-13T10:32:00.000-07:00

TO READ & WRITE: Shockingly Great News!
We're still stunned. But happily stunned. My husband and I are in the very, very long process of adopting a little girl. . . .

As you may have read here in early April, our hearts were broken when, after receiving an assignment to a lovely 18-month old whose photos we fell in love with immediately, we learned that her medical report showed that she was not healthy, as we had been led to understand. Instead, she was at serious risk of severe health and developmental problems and in fact should have been considered a "special needs" child. We were neither trained nor authorized for an SN child. Our adoption agency very firmly recommended that we not accept this assignment. And after days of research, multiple medical experts' reports, counseling and soul-searching, we made the gut-wrenching decision to refuse the assignment. We did this with the understanding that she would be quickly adopted by a special needs family. (And we remained at the top of the list for a new referral.) We continue to mourn her -- she will always be in our hearts.

Now, two months later, we have received a new assignment. On Tuesday we learned that her file had arrived; on Wednesday morning it had been translated and completely reviewed and approved by the adoption pediatrician; at that point only were we ready to make the dash to San Francisco to see the file and the precious photos of our new daughter-to-be. She's gorgeous! She's eight-months-old and looks healthy and alert.

We are very, very happy. And we are still feeling stunned too. Parts of our hearts are, even now, guarded until she is in our arms at home. It's been an unbelievable 72 hours in our house. But shock that after three years this could really come true, and that we could possibly be so fortunate, is slowly ebbing -- and joy is rising, pure and clear.

TO WRITE: Shocked!?!
I've just written about the amazing swirl of emotions I've been in in the last few days since receiving our adoption assignment. Shock has been a big one. After three years of working toward this and waiting and waiting and one serious problem, our wish seems within reach. We hope we'll have our little daughter in our arms within the next couple of months. Yet I'm surprised.

I suppose I've guarded my heart and turned off a lot of feelings over this time, just in order to write my book, keep my mood stable, and basically function. But still, I'm rather shocked at how shocked I am, and I'm slowly working this through so that I can focus more completely on more important emotions, like being thrilled.

Play with this. . .
Write for 20 minutes about a time you were shocked by something. It may have been a good big surprise, or something less welcome. How did you feel at the time? And were you still feeling it later? How have you processed it, or is it still a pressing issue for you?

2008-06-07T15:14:00.000-07:00

TO READ: Depression and Obesity. . . and Depression

"Theory and research suggest that obesity and depression may be causally linked," says the summary of a new study in the journal Clinical Psychology: Science and Practice. If you are living with depression, chances are that you've already made that connection on your own -- after all, while some of us tend to eat (and sleep) less when we're depressed, there is also a substantial proportion of us who tend to eat and eat and sleep and sleep to try to ease the pain.

I happen to be an eater and sleeper; I especially crave carbohydrates (i.e., cookies and scones from Starbucks) when I'm way down. And, despite being a healthy weight until taking an atypical antipsychotic (which shall go unnamed) a few years ago when absolutely nothing else was helping, I'm now 20-30 pounds above where I'd like to be. It was much worse for awhile -- I gained 80 pounds in less than a year on this stuff. Very fortunately, when I finally got off of it to try a newly-released alternative, 40 pounds evaporated on its own. I've dieted to get rid of some of the rest, but it comes and goes and comes and stays -- and it's somewhat "depressing." And it often does feel like there's a chicken-and-egg quality to the situation.

So when I saw this research study suggesting that depression can lead to obesity and obesity can lead to depression, I took note. Long-term studies show that obesity predicts later depression. The authors propose that this may be due to either health or appearance issues. Meanwhile, there's some data showing that depression increases the risk of obesity, likely due to lack of exercise, negative thoughts or lack of social support. The suggestions for treating both of these include, not surprisingly, "behavioral activation" (diet and exercise) and cognitive-behavioral therapy -- but the scientists emphasize that no one's really studied how to treat both together yet.

What do you think? If you're living with both these conditions, which came first, and to what do you attribute the other? If you've recovered from one or both of these, how did you do it? I myself consider my bipolar disorder (mostly depression) well-managed now, but when I'm even slightly down, I judge myself harshly for my excess pounds. I can imagine these problems going either way.

For more info: Clin Psychol Sci Prac 15:1-20, 2008.

2008-06-02T16:56:00.000-07:00

TO WRITE: Waiting and waiting. . . and waiting

I just spent a good five minutes on hold with a national company I do business with before hanging up in disgust. (I know, I know, you've spent 15, 20, 30 minutes in such situations. Still, I say anything over 10 seconds starts to get miserable.) And why don't they just play some dignified classical music instead of old Neil Diamond hits of the '70s?

Waiting can be tough, whether its for customer service or for something much more serious -- getting a call about an adoptive child (We're still waiting!) or a hint of relief from severe, chronic depression symptoms.

Play with this. . .
A writer friend of mine recently challenged her students to write on the question: What are you waiting for? Take 20 minutes to answer that one, writing continuously without stopping to edit yourself a lot.

Are you waiting for the confidence to register for that class you've been wanting to take? Is it the nerve to ask him or her out to dinner? Is it the energy to pick up your pen and write? Are you waiting for that last 20 pounds to disappear? After you've written, take five minutes more to consider what you might be able to do to either make the waiting end sooner or to better get through it. In my experience, my mental health depends upon this.

2008-05-22T11:18:00.000-07:00

TO READ: My Internet Radio Interview

Here's an email I sent out to friends, family, colleagues and students about my radio interview -- which is today! If you'd like to join my mailing list, please send your name to: EMSchaefer@aol.com. Thanks!

Dear friends,

I'm thrilled to announce that thanks to the help and support of many of you, my book, Writing through the Darkness: Easing Your Depression with Paper and Pen, has been released and is now available!

If you've wanted to learn more about how writing can ease depression, I invite you to tune in to a live, nationally-syndicated Internet radio show today, Thursday, at 3:20pm PST. I will be interviewed on World Talk Radio, which is accessible through the Internet at http://www.modavox.com/WTRStudioA/. If you are not available at that time but are interested in getting a podcast of the presentation, you will be able to do so following the show by clicking http://www.modavox.com/WTRStudioA/HostModaviewForWTR.aspx?ShowId=440&BroadcastId=31517&ScheduleTime=15.

Many of you have already witnessed the power of writing. If there are others who you feel would be interested in this message, please forward it to them so they can tune in to the show or visit my website at www.writingthroughthedarkness.com.

Thank you and be well!
Beth

2008-05-19T19:07:00.001-07:00

TO READ: My Book is Available!
I'm delighted to let you know that my book, Writing through the Darkness: Easing Your Depression with Paper and Pen, is now widely available, both online and in bookstores. (If your bookstore doesn't have it, ask for it!) The official publication date is not until June 1, but lots of folks are telling me that they're finding it at various locations -- one chain bookstore I visited this week told me they'd already sold out of it and were ordering more, which of course does a new author's heart lots of good. To order online, go to my website, www.emschaefer.com, and click on the "order this book" button. Or, just go to www.Amazon.com.

Writing through the Darkness is a practical guide to using creative writing to help heal depression. For over 20 years I've coped with severe depressions due to my bipolar disorder. I've tried at least 25 medications, years of psychotherapy, over 100 electroconvulsive (shock) therapy treatments, transcranial magnetic stimulation, as well as acupuncture, herbs, energy adjustments, meditation regimens and more. But I discovered that writing was my friend, companion and, at times, my savior, through it all.

I've been leading a creative writing group for people with depression, bipolar disorder and other conditions for ten years now. Along the way I've studied the research on how writing can help us emotionally and how other authors and poets have naturally been drawn to it to cope. Writing through the Darkness is my offering of this healing tool to you. I hope you will find it encouraging and informative as you learn new ways to ease the pain of depression. Please let me know what you think!

2008-05-15T16:23:00.000-07:00

TO WRITE: Your Gang
What organizations or informal groups do you belong to? If you're like me, you can name quite a few. I'm a member of NAMI and DBSA, several writing associations, a gym, charitable organizations, alumni associations, on and on.... Then there are the less formal groups: two writing groups, a group of church friends interested in multiculturalism, my old high school gang of four close friends, a book group, and, of course, my family and my neighbors.

It all looks a bit daunting as I start to list them here. But I think most groups I am a part of do offer some benefits. Some provide a sense of camaraderie, a sense of shared purpose, educational opportunities, or -- most critically -- friends and support.

Play with this. . .
Take about three minutes to quickly jot a list of groups or organizations to which you belong. Then take three more minutes to list those you've belonged to in the past -- remember, your fifth grade class counts, as do any religious or business affiliations you've had. Now write continuously on one to three of these items, considering what your emotional experiences are or were there. Did you feel uplifted and aided in a depression support group? Did your softball team provide friendship when you needed it? Did your high school graduation class offer enjoyment, or was it all a burden?

Finally, how could you improve your life in terms of the groups you belong to now? Could you audit a class or find a few folks who like museums? Personally, I'm feeling stretched way too thin right now, so I'm trying to take leave of a few volunteer activities and focus more on things like the writing group I lead and the one I write in. I'm also realizing there may be times in the future when I'll benefit from a mood disorders support group again -- one of my saviors in past times. Try to be creative and keep all your options open.

2008-05-14T18:39:00.000-07:00

TO READ: Unipolar and Bipolar Depression -- Differences
Many of us, psychiatrists included, tend to assume that a depression is a depression -- whether it's a unipolar one (ie, "major depression") or due to the depressed phase of bipolar disorder. But a recent report says that's not so.

British researchers compared 593 people with major depression and 443 with bipolar disorder, looking at their depression symptoms and the course of their illness. The findings showed several distinctions. Bipolar depressions tended to more often have:

* the presence of psychosis (ie, delusions or hallucinations)

* daily mood variation

* hypersomnia (sleeping too much) during depressive episodes

* more shorter depressive episodes

These are all features you may want to keep an eye on and discuss with your mental health care provider because treatments for the two illnesses do differ.

For more information: The British Journal of Psychiatry (2008) 192:388-389.

2008-05-09T16:20:00.000-07:00

TO WRITE: Coming Out the Other Side

Thank you to all the kind souls who offered sympathy and solace in response to my recent "What a Disappointment" posting. Today's news: It's getting better.

We're still waiting for a new adoption assignment, which could anytime. I'm still a bit sad and fatigued from it all. But -- I am not having a depression. Hurray! My fears that this situational depression would trigger a severe neurochemical one that would take me to a hell hard to escape from have not materialized. And now even the situational depression is gradually healing, and I'm slowly finding myself able to look forward more easily.

A very wise person pointed out that I may need to pay special attention to doing physical, sensory activities during this time, and that has paid off. Rather than letting myself stare into space or sleep too much, I've been pushing myself to journal about the situation, to read for pure pleasure, to shop, to prepare simple meals, to talk to friends. It's grounding.

Play with this. . .

Write continuously for 20 minutes on what "grounding" activities could help you through your next difficult period. Could you exercise or just walk, paint or take photos, visit a bookstore or cafe, go to a museum? And what about writing? Research indicates that writing about a tough situation can help us organize it in our mind, get it out emotionally, and even change our behavior -- and can boost immune system function. Why wouldn't you include it in your box of healing tricks? Let me know what works for you.

2008-05-06T08:50:00.000-07:00

TO READ: My New York Times Online Letter
Last week's science and health page of the New York Times (It comes out on Tuesdays and often has great brain, psychology, and mental health articles -- and it's free online.) had a book review entitled "Quieting the Demons and Giving Art a Voice." It described two new books on aspects of creativity and mental illness. I'm sure I'll read both soon, and likely enjoy them, but one of the conclusions drawn from both is that depression silences people's creative voice.

But no! My new book, Writing through the Darkness: Easing Your Depression with Paper and Pen (available online now; in bookstores June 1), provides evidence that in fact creative writing can be used to help work through even a deep depression. So I wrote back, and my letter appeared in this morning's NYT online edition: http://www.nytimes.com/2008/05/06/health/06weblett-ARTANDMENTAL_LETTERS.html?ref=science

Check it out, and you can also link from the letter back to the original article. I'd love to hear what you think. I believe it's crucial that people with depression, bipolar, or other mental illnesses -- especially those newly-diagnosed -- understand that this does not spell the end of their creative life. Although it certainly will present new challenges, I believe our creative life can actually be fed by our mental difficulties if approached correctly. And I believe our creativity can help heal us too.

2008-04-29T15:08:00.000-07:00

TO WRITE: What a Disappointment
I'm back after a several-day hiatus brought on by a severe disappointment. As I described recently, my husband and I have been waiting for our assignment to a specific child we will be able to adopt very soon. The great news: We got darling photos and a report on an 18-month old little girl. The awful news a few days later: Her medical reports indicated she was at risk for very serious neurological and developmental disabilities. Our lives crashed.

Long story short: After days of research, second and third medical opinions, consultations, counseling and soul-searching, we declined to adopt the child. Our adoption agency strongly recommended that course of action, saying that she would very soon be adopted by a family trained and authorized for a special needs child, which we are not. Meanwhile, we'll be assigned another little one soon.

I've felt as depressed lately as I have in over a year, and my husband and I have been terrified that I'll really slide seriously. However, we got away from the Bay Area and spent several days hiking in the Sierras last week. Near a river rushing with melting snowpack, with wildflowers coming up everywhere, we created a small ritual, telling this child we'll never meet that we love her and won't forget her, and letting her go. And we began to heal.

Play with this. . .
Think of a significant disappointment you've faced in the past. Write continuously for 20 minutes, describing the situation and your thoughts and feelings about it. (Remember, describing both your thoughts and feelings has been shown to be more healing than just writing about one.) Then describe how you have coped with that disappointment. Did you talk with someone, take some concrete action, let time slowly soften the feeling?

Keep in mind too that you have survived and, by the very fact that you're here, it's clear that you've coped or you're coping with the situation. That thought has helped me lately. It hurts sometimes, but I'm still moving on. -- Beth

2008-04-15T09:56:00.000-07:00

TO WRITE: Who are You on Meds?
This morning's New York Times features an essay asking: If you've grown up on antidepressants, or even been on them a long time as an adult, do you still have a sense of who you are?

I know my mood is dramatically better, my thoughts less self-critical and morbid and out-of-touch, on my medication. But after more than 20 years on the stuff, who am I? There are things I notice: It 's very hard for me to feel really excited happiness (perhaps due to my mood stabilizer?) and I physically am unable to cry except in the most extreme situations (Have all those antidepressants pumped me up that much?). But I wonder if there's more.

According to the article, by Richard A. Friedman, M.D., we know very little about the long-term effects of these medicines. The studies generally focus on people's reactions for only 4-12 weeks. The longest maintenance study so far has been on Effexor, and lasted two years. (It was better than a placebo at preventing relapses.)

Play with this. . .
Writing continuously for 20 minutes, compare what you notice about yourself on and off medicines. Consider your moods, your thoughts, your feelings, your bodily symptoms, and how long you've taken these drugs. Do your meds affect you ability to work or study, or your relationships? And do they affect your "sense of who you are"?

Hopefully, you'll conclude that you're heading in the direction that is healthiest for you. If not, talk with your mental health care provider.

2008-04-07T15:04:00.000-07:00

TO READ: Genetic Testing for Bipolar
How would you feel if your psychiatrist could simply run a blood test to diagnose bipolar disorder? Recent research describes early studies that do just that. According to a National Alliance on Mental Illness (NAMI) press release, University of Southern California scientists have identified 10 specific genes involved in mood state. Using blood tests to determine whether each gene is active, and correlating this information with 29 bipolar patients' mood states, they found that eventually they could actually predict moods.

So what do you think? Is this what we've been seeking all along -- a definitive diagnosis that might mean more accurate and faster-working treatments? Or do you worry about that information falling into the wrong hands? And would this genetic information lead to more stigmatization (ie -- you're definitely "mentally ill") or less (ie -- it's clearly a biological issue, not a character weakness)?

According to NAMI, MSNBC.com did a poll of 10,000 readers and found that 83% thought a blood test would be a good idea since it could help patients get appropriate treatment. I suspect a poll of 10,000 people with mood disorders would yield much more mixed results.

2008-04-04T10:04:00.000-07:00

TO WRITE: A Turn for the Better
I'll keep things short and simple and sweet today. . . I'm nervously listening for the phone to ring with a call from the adoption agency saying they've got our first photos of our daughter-to-be! At that point my husband and I will dash to San Francisco to get them. Today (hopefully, hopefully) will be one of the best days of our lives!

Which brings me to today's topic -- an optimistic one that my Stanford group wrote on this week. They wrote very briefly, but their responses were so powerful that I assigned them to write more on this as homework.

Play with this. . .
Here's the prompt: Life took a turn for the better when. . .

Quick! Write down the first thing that comes into your head. Write on it for just three minutes.

Then, write continuously and powerfully for 20 more minutes on this life-changing thing or person or event. And enjoy! (I think my life might just "take a turn for the better" today -- and you can bet I'll write on it!)
--Beth

2008-04-02T17:06:00.000-07:00

TO READ: Blogging to Beat Depression?
Millions of us blog these days. Among other things, blogging offers an opportunity to create a diary that includes emotions, as well as events, to share with others. But is blogging, like some other forms of writing, able to help ease depression?

Australian researcher James Baker of the Swinburne University of Technology says yes -- but for a surprising reason.

Baker has found that, in fact, people who begin blogs tend to be "more distressed emotionally" than others. As he told an ABC Online interviewer last month, new bloggers show "high levels of stress, anxiety, depression. They are also more likely to vent emotionally and self blame a bit as far as coping."

However, when Baker surveyed about 130 people, 60 of whom then started a blog, he discovered that two months later the bloggers had changed. They were "a bit happier overall . . . a little bit less distressed," he reported, "but the big difference was that people who actually started a blog felt more socially integrated." This feeling of connection comes from the fact that bloggers are making personal material public, receiving comments, and developing a sense of an online community.

He suggests that, ironically, perhaps people's private postings can help them become more connected to the outside world and, along with that, less depressed.

Sounds a lot like the findings I report in Writing through the Darkness: sharing what you've written is often an important part of the healing process. So, whether you're currently journaling, writing poetry, or, hopefully, doing the exercises suggested in this blog, consider sharing them, either online or person-to-person.

2008-03-27T15:26:00.001-07:00

TO WRITE: A Farewell
I'm reading Natalie Goldberg's new book on memoir writing, Old Friend from Far Away. (If you've been reading long, you know I'm a big fan.) As in many of her books, she offers lots of writing topics and ideas, and this one's from her today, with my paraphrasing.

Write a goodbye letter to someone. It could be after a divorce, when a friend moves across the globe or a relative dies. Tell them every last thing you have to say -- this is your last opportunity. You may have complaints, praises, specific awful incidents or glowing memories to share. Get it all out. As Natalie almost always adds: "Ten minutes. Go."

Then (and this is Beth again), consider how you feel. Stirred up, relieved, sad, glad, depressed, lighter? Are there other people, leaving or not, that you'd like to write to? Letters, of all different kinds, can be a powerful way of releasing pent up emotions and ideas. Let yourself go when you write them -- you can decide later whether to rip them up, burn them or send them.

2008-03-25T17:33:00.000-07:00

TO READ: No Shame around Depression

I've always felt that the way to combat the stigma around depression and other mental health conditions is to talk about them. These are illnesses, not character flaws. So I was delighted to read this week that, although she unfortunately suffered depression in her 20s, Harry Potter author J.K. Rowling makes no apologies for it.

"The funny thing is, I have never been remotely ashamed of having been depressed. Never. What's to be ashamed of? I went through a really rough time and I am quite proud that I got out of that," the Seattle Post-Intelligencer quotes her as telling a British college magazine. Now that's the attitude we need see and hear more of.

Rowling, 41, said that after separating from her first husband and finding herself a single mom and struggling new writer, she experienced depression and suicidal thoughts. She reported that she sought treatment because of her daughter.

So take heart. As more and more of us are coming out with our mental health conditions, the world does gradually make progress at learning they are simply a no-fault part of life. As so many peers have said to me, no one would tell us to "pull yourself together" if we had heart disease or a kidney stone; why should a brain disorder be treated differently? Thanks for your example, Ms. Rowling.

2008-03-20T16:54:00.000-07:00

TO WRITE: Your Sleep Life
Sleep is a crucial, and often disturbed, part of life for those of us coping with depression. Whether problems are due to medications or the condition itself is not always clear. And the symptoms we experience can vary from slightly disturbing to exasperating to just plain weird.

I'm blessed in some ways, I suppose, because I rarely have insomnia. No, my sleep life leans quite the opposite way, leaving me wanting -- sometimes absolutely needing -- to sleep two to four to even six hours more than what most people consider a good night's sleep.

I've had many bizarre and unsettling sleep experiences when depressed, or even months after my mood has recovered. On one first-generation antidepressant, for example, I regularly sat up and opened my eyes during the night to watch amazing and often funny scenes play out in front of me. When I enthusiastically urged my husband to look at these hallucinations, he would have to talk to me or shake me a bit to wake me from my strange state.

Play with this. . .
Write continuously for 20 minutes about your sleep life. Do you have lots of wonderful dreams? An occasional frightening one? Do you need extra medicines to help you get a few hours of rest, or do you feel nearly narcoleptic when you're depressed? Do you find you have unusual thoughts just as you fall asleep or wake up? How does your sleep, or lack thereof, effect your mood? And how do you feel about all this -- angry, frustrated, bemused, relieved? Don't think too much, just let it rip and see where this topic takes you.

2008-03-20T15:19:00.000-07:00

TO READ: "Against Happiness" ??
I was amazed to read that a new book, Against Happiness: In Praise of Melancholy, by Eric G. Wilson, actually lauds the experience of sadness or "melancholia" to the extent that it asserts that antidepressants should be used only for severe depressions, not for mild to moderate cases. He's got to be kidding, right?

Against Happiness, clearly titled as a comeback to Peter Kramer's book Against Depression, was reviewed in last Sunday's New York Times by National Public Radio star Garrison Keillor. According to Keillor, Wilson argues that America is so focused on happiness that melancholia -- which he believes is the the source of much great art, poetry and music -- is disappearing.

I've not yet read the book, and I'm not sure I will, for frankly I find this argument depressing. I've written about creativity and the writing-depression connection in my book, Writing through the Darkness: Easing Your Depression with Paper and Pen (to be released in June, 2008). Indeed there are correlations between bipolar disorder and artistic creativity, and much lesser correlations between depression and creativity. Who knows, maybe a lot of art and literature has in fact been born of low moods? So maybe, one can argue, melancholia (which Wilson sees as "turbulent," while depression itself is "passive"), has a certain benefit for society as a whole. (By the way, I know I've certainly had both passive and turbulent clinical depressions, so I don't buy this distinction.) But if it causes suffering that could be abated, I say get rid of depression.

If mild and moderate depressions are not treated, they can become severe depressions. And if a person wants her or his melancholia treated, and a qualified professional believes it appropriate, by all means it should be treated. (If a person is merely transiently sad, an antidepressant isn't going to do the trick anyway.) If a person doesn't want such treatment, and some artists don't, at least at times, I respect that. But to argue, as Wilson does, as cited by Keillor, "The greatest tragedy is to live without tragedy," is to romanticize depression. A romantic aura around what are biological brain disorders stigmatizes these conditions, and stigma contributes to many people's reticence to seek treatment.

Even if melancholia/depression does lead to some creativity, I can't believe it has cornered the market on human innovation. If human suffering can be alleviated, it would be very sad not to do it.

See: Eric G. Wilson, Against Happiness: In Praise of Melancholy (Sarah Chrichton Books/Farrar, Straus and Giroux); Garrison Keillor, Woe Be Gone, New York Times, March 16, 2008.

2008-03-12T16:23:00.000-07:00

TO WRITE: Organizing Your Life
As I write this, I am surrounded by piles of papers covering my desk. Some are messy, some relatively neat; some are short, others tall; some were born today, at least one is a year old, I'm embarrassed to say. I've been meaning to straighten up, sort, file and toss -- really.

While I'm sure I'm not alone with my paperwork problem, we all have much larger things to organize too. Like our life in general. How are your priorities? (What are your priorities?) Are you using your time, money, talents and energies the way you'd like? Are there activities you're dreaming about but not getting to?

Personally, I'm trying right now to find more time for myself in my schedule. I'm leading my writing group, attending another, taking yoga classes, doing marketing work for my upcoming book, starting to prepare for the arrival of our adopted baby in a few weeks, trying to write, etcetera, etcetera -- and I'm spending way too much time on other volunteer work, especially the omnipresent meetings it involves. So, I'm getting out of a few things. I've felt reluctant, even ashamed, to say "No" to several things lately but, have discovered that it's actually empowering! I can decide how to spend my time and, frankly, the world won't fall apart without me being involved in every decision.

Play with this. . .
Write continuously for 20 minutes about something you'd like to organize in your life, whether it's one bathroom drawer or your entire calendar. How would it feel to just begin your organizational task? How could you break it down into manageable components? (I was intrigued to find recently that more than one person in my writing group proposed this topic on an anonymous suggestion sheet. I suppose we do tend to feel disorganized and out of control when we're depressed.)

Then consider how you would feel after organizing something. For me, a clean desk is like a new start on life. Maybe you too would feel empowered, free, or pleased to accomplish something tangible. If you're depressed right now, start small -- just delete three bulk emails you're not going to bother reading anyway, or toss out some junk mail that's accumulated on the kitchen counter. Voila!

2008-03-07T16:28:00.000-08:00

TO READ: Antidepressants Don't Help Most Patients?
Could we have been misled by the "non-publishing" of studies that show poor results for common antidepressants? New research combining both the "good" and "bad" results of many studies on antidepressants' effectiveness suggests so. The new data says the medicines are no more beneficial to most patients than a placebo pill, and only help certain severely depressed people.

Irving Kirsch of the University of Hull, in the United Kingdom, along with colleagues from the US and Canada, studied Prozac, Effexor, Serzone and Paxil. They used a statistical "meta-analysis" to combined the data from all the trials submitted to the US Food and Drug Administration. Data from some of these studies had never been published, and some included what might be considered disappointing results.

The scientists found that patients with moderate depression responded almost equally well to the drugs versus a placebo. In addition, "Drug–placebo differences . . . are relatively small even for severely depressed patients." The severely depressed people seemed to respond to medicine somewhat better, but this was attributable to the fact that they responded worse to the placebo.

For additional info: see PLos Medicine (a peer-reviewed journal of the Public Library of Science) for February 26, 2008.

2008-03-04T10:28:00.000-08:00

TO WRITE: Just Wastin' Time
Here in the U.S. many people feel that there's something "wrong" about just sitting and letting the mind wander for a while sometimes. There are things to do! This idea is so prevalent that many believe they shouldn't even do one thing at a time, but must multi-task. Now that I'm feeling considerably less depressed lately, I find myself succumbing to this thinking at times too. But honestly, if I stop to think, I feel that occasional time spent reflecting on the day and composing my thoughts or "spacing out" is a wonderful activity.

If you're depressed, chances are good that even accomplishing the simplest activities may seem overwhelming -- whether it's making it to the office on time or just getting your teeth brushed. When I've been in such states, I tend to chastise myself for not getting off the sofa and acting; I ruminate about what others are getting done. But from a now-healthy perspective, I see I should sometimes let myself relax and doze freely or flip through a magazine without guilt. I'm not arguing that we shouldn't fight like tigers to get well, but that now and then, guilt-free "wasting" time is healthy.

Play with this. . .
Write continuously for 20 minutes starting with "When I waste time. . ." You may want to consider what you do, when you do it, and for how long. How do you feel about it at the time or afterward? Would you like to adjust the amount or frequency of your "wasting" time, or perhaps your attitude toward it? (Maybe you want to go for a walk or stare at the wall for a half hour before you write this. . . .)

2008-02-27T17:23:00.000-08:00

TO READ: Today's the Day
I'm very excited to announce to my readers that today my book, Writing through the Darkness: Easing Your Depression with Paper and Pen, went to press!

Copies will be in bookstores in June. If you find this blog interesting or useful, I think you'll find this book valuable. It's a writing guide that provides a menu of approaches -- freewriting, memoir, poetry and storytelling -- to help cope with the pain and confusion and stigma that surround depression. I also describe my own journey through bipolar depressions, and the exciting research that's been done on the writing-depression connection. Many of the wonderful members of my creative writing group for people with mood disorders that meets at Stanford University have contributed encouraging comments and samples of their work. I hope you'll check it out in June.

-- Beth

2008-02-27T17:02:00.000-08:00

TO WRITE: Freedom
I'm reading The End of America by Naomi Wolf, and it's scaring the heck out of me. Wolf's studies indicate that there are ten changes that occur in countries just before they move from a democracy to a fascist state, and that the U.S. is going through all ten right now. Sound alarmist? I thought it would too, but her evidence and her arguments seem very strong so far.

Especially after having lived for several months in the Soviet Union when I was a teen, I value my American freedoms tremendously. For example, we're allowed to say and write what we want, basically. But there are lots of other types of freedom I value too. How about the freedom of spending my life outside of the walls of a mental institution, except under extreme circumstances, when I want to be there anyway? (Granted, we have short forced hospitalizations for those deemed to be putting themselves or others at risk -- what's known as a "5150" here in California.) How about the freedom to decide on how I'll treat my depression? How about the freedom to pursue what I want to do with my time and resources?

Play with this. . .
Write continuously for 20 minutes starting with: "The freedoms I have. . ." You might describe your freedom to wear the clothes or hairstyle you want, the freedom to read what you want, or the freedom to explore the entire Internet, if you are in a country that allows those things. Or you might explain your feelings about a freedom you feel you lack.

Then consider how your freedoms affect your psychological life. Does thinking about them make your life feel a little less confined? How do your thoughts of freedom affect the emotions and thoughts you allow yourself to feel and share?

2008-02-21T17:30:00.000-08:00

TO WRITE: Gimme a Hand
When we're depressed and it's hard to function, it's natural to wish for some help from our doctors, family and friends. That's one reason support groups for mood disorders are growing in popularity, and presumably one reason they've been proven to improve the course of members' depression.

But there's another aspect to this concept of people helping people. When we help someone else we tend to feel much better too. Think about it: How did you feel last time you held a door for someone struggling with packages? How do you feel when someone close says, "Thank you," for listening to their problems or assisting them with some task? I know I immediately feel good about myself -- the complete opposite of the way I usually feel when I'm depressed.

Play with this. . .
Write continuously for 20 minutes about a time when you helped someone else. Have you ever given information to someone newly diagnosed with depression, for example? Have you ever given a little money to someone who really needed it? Done any volunteer work?

Then describe how it felt. Maybe it diminished your depression for even just a minute? Is it something you'd like to try to do more of?

2008-02-13T18:29:00.000-08:00

TO WRITE: It's a Secret!
Whether you want to admit it or not, you know you've got some. . . . Today I'm thinking of the new hiding place I found for the heart-shaped box of chocolates my husband's not supposed to see until tomorrow. (He recently discovered the behind-the-desk spot I'd used for birthday and Christmas gifts for years.)

Of course, you may have larger issues from the past looming unsaid, or you may have tiny guilty pleasures. You may have secret aspirations too. (Who says writers can't be superheroes or ballerinas on the side?)

Play with this. . .
'Fess up. Remember that this, like any writing, can be hidden, discarded or destroyed as soon as it's finished, so go ahead and let it all out. Write continuously for 20 minutes starting with In my secret life, I. . . .

Then read what you've written and see how you feel. Has a burden been lifted, or perhaps a new idea hatched? Or do you realize that you're really craving a pint of ice cream and an afternoon of soap operas? Let me know what you discover.

2008-02-05T18:03:00.000-08:00

TO WRITE: A Fear

We've all got fears, large or small, significant or pretty trivial, relating to things likely or unlikely to occur. For example, while I'm fortunate to have no major phobias, I am not comfortable with snakes. I can touch, or even hold, someone's pet serpent for a moment, but the idea of suddenly coming across a snake when hiking makes me squeamish, even if I know it's unlikely to be a poisonous one. Still, I do hike, so it hasn't got complete control over me.

A much larger, more significant and, sadly, more likely object of fear for me is the possible return of my severe depression. I know how wrenching, debilitating and even life-threatening that can be. I try to guard against making too much of the issue, but the thought of its return, or the feel of just a small symptom, can strike terror in me.

Play with this. . .
Write continuously for 20 minutes about something you are afraid of. It might be a tiny issue or a life-altering one. What is it? How does the thought of it feel emotionally and in your body? Have you ever faced this thing head-on? Would you want to?

Then write for five more minutes, considering: If someone were to help you with this fear, what should she or he do? Maybe reassurance is what you need. Maybe someone to hold your hand on that plane trip. Maybe a therapist or psychiatrist could help you gradually acclimate to a scary situation. For me, an occasional reminder before hiking that most snakes really are much more afraid of me than I am of them is probably what is called for. Oh, and maybe sturdy hiking boots too.

2008-01-30T17:30:00.000-08:00

TO WRITE: Dream a Little Dream
We have them multiple times every night, researchers say -- but what do we really know about our dreams? I agree with the standard wisdom about remembering more of those slippery experiences: keep a dream journal by your bedside and record whatever you recall immediately when you wake, even if it's just an image or a feeling. Indeed, when I've practiced this for even a few days, I've found that I begin to remember more and more of my nighttime adventures.

Then, of course, there's the issue of what to do with these often bizarre movies with emotions. Many types of psychotherapies use dreams in various ways, but I think it's really up to you to use these journeys as you see fit. They may amuse, frighten, inspire, explain, or call you to action. But usually -- usually -- I feel better after I've written a dream down and examined it.

Play with this. . .
Write continuously for 20 minutes about a dream you've experienced. It might be from last night or a long time ago; it might feel trivial or life-altering. Describe what happened, including all of the sensory details you were aware of. Then see if any connections or ideas occur to you.

For example, I often find that I dream about my life at the moment in the form of a house -- a simple or complex layout of rooms, a messy or tidy interior, maybe worries I should be spending more time in the office or the kitchen. There's the common dream theme about taking a trip too -- maybe the road suggests your life journey? But you may make completely different connections to these sorts of events and symbols, and that's what is most important for you.

After you've written about your dream and your impressions about it, write for five more minutes about whether there are any ideas about your waking life that you'd like to take away from this exercise -- maybe even insights about handling your depression or the happenings around it.

2008-01-22T10:27:00.000-08:00

TO WRITE: The Poetry of Nature

As I write this I can see that the rounded line of hills that runs up and down San Francisco's East Bay region is changing color. Last week they were the color of straw. Then they looked like wet, dirty straw after several days of rain. And now they are a dusty green as they begin their annual transformation into glorious emerald green. I sometimes miss the Midwestern seasons I grew up with, but I treasure this metamorphosis each winter too.

Writing and poetry about nature is, of course, plentiful in our times and has been in many historical and ancient societies too. The Haiku form of poetry virtually always uses the natural world for its topics, in fact. (It's three lines long -- five syllables, seven syllables, and five syllables, respectively, in case you're trying to remember it right now.)

Play with this. . .

Choose a detail from the natural world -- you may want to go for a walk for inspiration, or even carefully look at a houseplant if you can't get out. Now write a list of at least ten words or phrases that come to mind when you think of this detail. (My list from the hills' color included: straw, emerald, dusty, trickling streams, blades of grass, tall weeds, my sneezing, the horizon, overseeing the bay, climbing rocky trails.)

Now use some items from this list to write a poem about the detail you originally chose. You may want to create a Haiku, or you might do a free verse poem by simply writing some sentences or phrases, and playing with where you "break" or end each line. If any analogies come to mind as you do this, you might include them too. For example, I might compare the hills' colorful transformation to my own recovery, or the seasons' inevitable return to my friend K's constant support.

Poetry can be a powerful means of expression and healing, and some people find it their favorite. Even if you're hesitant at first, give it a try and see what you come up with. Of course it's definitely fair game to alter it, adjust it and play with it later until you're happy with your poem. Just have fun.

2008-01-15T10:44:00.000-08:00

TO WRITE: The Term "Mental Illness"

Many of us -- whether we live with depression, bipolar disorder or another psychological condition -- have strong feelings about being labeled "mentally ill." Personally, I'm OK with it at this point, twenty-plus years into my bipolar disorder. But there was a time when that term made me very defensive and conjured up images of complete non-functioning. Fortunately, most of us do function to some degree most of the time, yet this descriptor is often used, particularly by those in the medical fields, I find.

As one trained as a biologist, I think I may actually prefer being "mentally ill" because it indicates that my condition is physiological as well as psychological. That doesn't mean I'm excused from the hard work of striving for recovery, but it helps remind me that it's not all my "fault."

One member of my writing group at Stanford prefers that we discuss our "mental health" rather than our "mental illness," and I think this can be very helpful too, because it is so much more positive -- and because it is more inclusive of those suffering, for example, from a depression that is situational, but not clinical.

Play with this. . .
Have you ever had the term "mentally ill" used to describe you? How have you felt about it? If you bristle at it, do you have another suggestion? And how important do you think this language is in perpetuating or countering stigma?

I'm curious about what you come up with -- leave a comment if you like. And consider whether it might be helpful to discuss with your loved ones or doctor the language used about your health.

2008-01-08T10:56:00.000-08:00

TO WRITE: Nurturing Yourself

Another new year! Happiness and health to you in 2008. We (Americans at least) tend to get wrapped up in resolutions for improving our life this time of year. Most of them aren't a lot of fun -- dieting, more time at the gym, etc. But I suggest you consider a resolution to nurture yourself more, whatever that might mean to you. Everyone needs some time to rekindle the inner flame, and when I'm dealing with depression I need it all the more. But I know that when you're under that cloud it can be very hard to see what might ease your pain.

Play with this...

Write continuously for 15 minutes starting with "I am nurtured by..." and describe the things that come to mind. If you get stuck, return to that sentence stem again and again. These can be big things or small things -- I know people who love candles and hot baths; others like a walk in nature; others crave a chat over coffee with a particular friend or mentor; I love a period of time designated for nothing but reading for pleasure; and of course there's writing! If you're really in a low mood, can you promise yourself a one-hour break from thinking negative thoughts about yourself? After you've brainstormed ideas in writing, reread your piece and, in five minutes more writing, determine what step you can take this week toward being kind and nurturing to yourself.

2007-12-18T10:00:00.000-08:00

TO READ: Joyous Holidays!
To those of you kind readers and writers who celebrate Christmas, I send greetings for a merry one.

To all, I wish a new year filled with ever-better health and new satisfactions.

Writing will be an important part of maintaining my mental health in the new year; I hope it will assist you as well.

Here's to 2008!
Love,
Beth

2007-12-18T09:46:00.000-08:00

TO WRITE: Caring, creating, believing, living. . .
I recently came across the following quote from author and Holocaust survivor Elie Wiesel:

"The opposite of love is not hate, it's indifference.
The opposite of art is not ugliness, it's indifference.
The opposite of faith is not heresy, it's indifference.
And the opposite of life is not death, it's indifference."

Play with this. . .
What can I add to this stunning statement? I suggest you use it as your writing prompt in one of three ways: Write in response to the quote; write a letter to the author of the quote; write from one word/phrase/sentence that you choose from the quote.

Personally, I think I'll write on the subject of indifference itself, and where I notice it in my life and particularly in my depression. Writing about this quote in any way should help break down the indifference that may stifle us at times.

2007-12-11T09:31:00.000-08:00

TO WRITE: The Rewards of Using Your Brain
An article in today's New York Times describes how people who use their minds frequently in intellectual and social ways have much lower rates of Alzheimer's disease and dementia. The idea is that by challenging our brains we build up "cognitive reserve" -- extra nerve cells and the connections between them. Then as we age and the likelihood of brain pathology increases, these extra neurons can compensate, leaving us more able to recall names and dates and think well in general. (Remember, those of us with mood disorders already have some structural changes going on in our brains, so this might be extra important for us.)

There are many activities believed to be useful in building cognitive reserve. Doing crosswords and Sudoku puzzles, learning a new language, working with computers, attending plays and concerts, working and traveling have all been identified as activities of older people who have clear thinking. Even knitting can be helpful, it's thought -- as long as you continue to challenge yourself with new techniques and patterns rather than repeating the same old things all the time. You need to introduce new mental challenges in order to reap the benefits.

Play with this. . .
What is the most rewarding thing you do with your brain? If you're taking a class or going to the museum with friends or playing challenging board games, terrific. If you're not, well. . . maybe you should increase the amount of writing you do each week?

For now, describe in writing the most rewarding things you've done with your brain in the past, and what you're doing now. Then consider any activities you might want to explore, including what writing projects you might want to work on. Is now the time to write the first scenes of that screenplay you've been mulling over? What about pulling out that notebook of poems and adding to it? As they say, this is another case of "use it or lose it."

2007-12-04T11:06:00.000-08:00

TO WRITE: Your Memory
The New York Times ran a story this morning about chimpanzees who have better short-term memories than humans. Wow. We arrogant humans like to think we're better than all the rest in the thinking department. But when chimps and humans played a computer game in which numbers in randomly placed squares were flashed at them, and they were asked to indicate the squares in numeric sequence, the chimps bested us when the numbers were flashed very quickly. Their short-term memories were stronger.

Memory is being studied a lot lately, perhaps because so many baby-boomers are reaching an age when they begin noticing problems finding words and names. But we with mood disorders know a lot about memory problems already. If the depression doesn't cause difficulties in recall, it seems to be the medicines we take or, in some cases, the ECT we've had.

Play with this. . .
Describe your own memory function. Do you have any problems? Have they changed since you were younger, or perhaps since you've been ill or had certain treatments? Do you have any stories or examples? And how is the memory of those you know -- has this affected your relationship with aging parents, for example? Try to write continuously for 20 minutes; if you feel you've "finished" before that time is up, go ahead and descibe one of your own very vivid memories.

2007-11-26T17:23:00.000-08:00

TO WRITE: An Old Friend. . .
During a Thanksgiving trip to my state of origin, Wisconsin, last week, my husband and I had lunch with one of my dearest old friends. Julie and I have known each other since we were in the sixth grade. We walked to school together, since we lived only a block apart, played in the high school band and orchestra together, roomed together for a year in college, and traveled together to Europe. Although we're half a continent away from each other now, we still manage to keep in touch with email, birthday cards, and a visit every now and then.

The three of us talked incessantly and laughed loudly during our entire couple of hours together, as though we'd been apart a few days, rather than a year and a half. And it occurred to me that perhaps the reason this relationship has stood the test of time is not so much the history we have in common, but the way we interact. Each of us questions the other intensely, and we are all good listeners. We genuinely care what goes on in the life and the mind of each other. We spent time brainstorming ways for Julie's new business idea to get off the ground, but my husband got to tell of his latest work adventures too; I got to discuss my writing and we all lamented the slowness of our pending adoption.

While some old friendships have, of course, faded over the years, I feel blessed to have several of these rewarding relationships that have matured over time. They bring joy and a sense of solidity to my life -- these friends are people I have chosen to have relationships with, and our shared history provides comfort and a sense of place.

Play with this. . .
Write continuously for 20 minutes about an old friend -- whether or not you are still in contact. Was it your first-grade jump-roping partner? Your high school best buddy or prom date?

Describe your relationship as it was then, and what you gained from it. If you still know the person, how has the relationship changed and how has it remained the same? If you no longer have contact, consider whether he or she is someone you'd like to look up and talk with.

2007-11-19T10:17:00.000-08:00

I'M BACK!

Dear readers and writers,

I thank you all for your patience as this blog has been on hiatus for several weeks. My happy news is that the manuscript for my book, Writing through the Darkness: Easing Your Depression with Paper and Pen, is done! It took quite a few long days and long nights near the end to finish it, but now it's out of my hands, except for reviewing a copy edit. It will be published in June by Ten Speed Press.

The other really wonderful news is that I did not become sick, in mind or body, during these stressful weeks. I don't know why, but I do believe that the personal writing I did during breaks from the book writing was a big help in managing my depression. Hopefully your writing is sustaining you as well, and some new writing ideas from me will help stimulate us all.

I'm grateful for you all. Happy Thanksgiving!

Beth

And, in the meantime, some news...

NEW WEBSITE TO CHECK OUT: www.mcmanweb.com is the site of John McManamy, a writer who focuses on bipolar research. I get his twice-monthly online newsletter, where he describes cutting-edge science in a way understandable by all. You can subscribe for free on his site, as well as checking into several other interesting features. I recommend it, whether you're living with bipolar or depression.

NEW WRITING OPPORTUNITY: www.bphope.com is the site for the magazine bp (that's "bipolar"). I subscribe to the paper version of the magazine, and recommend it, as long as you're willing to look past some ads for psych meds. On the site, you will also find several opportunities to write and have your words published in various ways. A regular feature asks you to offer your opinion on a current topic. Move quickly: if you write in now about what you are thankful for, you may make it into their 11/21 online Thanksgiving edition. While you're at the site, you can also sign up for their Hope & Harmony Headlines email list. AND...

DEPRESSION MAGAZINE TO DEBUT SOON: According to bphope.com, a new magazine for coping with depression and anxiety, esperanza, is coming soon. You can sign up for the premiere edition there too.

2007-09-28T20:12:00.000-07:00

So what can you do with your writing?
"KL" left a comment yesterday saying that s/he has written a book/journal on her/his bipolar experience, and asking what to do with it. Here are some thoughts....

1) Have you shared any of it with others close to you? This is a very personal decision, of course, but you may want to think about how it would feel to allow others to read or listen to some of your words. In some cases, this can help a loved one, friend, doctor or therapist to better understand your experiences and concerns, and can even help you connect with those people. If you're feeling uncertain about this, think about starting by just sharing a page or two of your writing. Also, it may feel safest to begin by sharing with your mental health care professional, then discussing how it would be to share with others.

2) If you're thinking about sharing your work with a wider audience by publishing it in some form, you'll probably have the most luck by starting with small portions of your book, and by looking at specialized mental health publications or websites. The Awakenings Project (link at the right side of this page) accepts submissions of writing by mental health care consumers such as us for publication in their literary journal Awakenings. I've published some poetry there, and they put out a lovely magazine/journal. See the site or contact them about when the next issue will be published.

Keep your eye on the NAMI and DBSA websites and publications too (links at right). They sometimes offer contests for writing about mental illness. (Darn! NAMI's ended today.) (I think DBSA is still accepting art and film on depression and bipolar in a related contest.) Also, these two organizations often accept consumer's writing about their illness experience for their state or local newsletters, so get on the list for those or call and ask if they'll take submissions. I published an article in the California NAMI newsletter several months ago.

If you check around mental health websites, I think you'll find some places to share your words too, whether by publishing articles or by more informal journal postings. This can be a nice way to communicate with others coping with mood disorders. NOTE: If you find any good sites like this, please let me know! I'll be researching this soon for my upcoming book, Writing through the Darkness: Easing Your Depression with Paper and Pen, due out in spring next year. (OK, I had to get in a plug!)

Finally, you can start looking at publishing articles drawn from your journal in general-audience publications. Again, your best bet is to start with smaller ones, and work your way up.

KL and others, let me know what you do with your writing. It can be so valuable in helping both you and others you might decide to share it with.

Best regards,
Beth

2007-09-25T10:04:00.000-07:00

TO WRITE: Is That Really Reasonable?
I believe I'm a reasonable person most of the time. OK, reasonably reasonable. But what is "reason"? A student offered this writing topic the other day, and I was intrigued, especially about reason's role in our mental health.

Is reason just what you used to solve geometry problems in high school? I don't think so. I believe reason -- thinking things through -- comes into play at every moment of our lives. And I believe it affects our depression too. The thoughts we use to interpret the world we live in, and the decisions we make on how to act all require reason as well as emotion.

Using reason to battle depression: Cognitive behavioral therapy (CBT) is known to relieve depression by helping a person to identify her immediate thoughts about something, to evaluate them, and to change them if they are unrealistic. When I learned about it, for example, I saw that I tend to do "either-or thinking" -- that is, I see things in black and white sometimes. Once I knew this, I could begin to change it, to use reason to replace distorted thinking patterns with more realistic, healthier ones. In my case, I could tell myself, "This event isn't all good or all bad; it has elements of both, so I don't need to be so extremely upset about it." Working this out could leave me feeling less disturbed or depressed.

Play with this. . .
Do you rely on reason or emotion more when you interpret a difficult event you're involved with? How about when you think about your own role in that event? Write continuously for 20 minutes, describing how you logically reasoned your way through, or reacted with a gut feeling, when something occurred that seemed depressing.

Then reflect: Were you satisfied with the balance of reason and emotion you used to react? Is that balance typical for you? Do you want to adjust it at all? Note: If you want to further explore this issue, there are some great workbooks on CBT available at bookstores, or you could ask your health care professional about a referral to a CBT-trained therapist.

2007-09-18T09:47:00.000-07:00

TO WRITE: A Gift You've Given
I've never handed my mom $5 million, or given my husband the keys to a Ferrari, much as all three of us might like that. Still, I have given lots of Christmas and birthday presents over the years. And I hope I have given more than that too. What comes to mind when you ponder gifts you've given to someone?

Was there something chosen with great thought? Something handmade? Something old and sentimental? A personal letter or card with kind words?

When I look at gifts from a larger perspective, I hope I've helped a few people to learn things in my various teaching positions. If you're a teacher of any kind, you've certainly got this covered. I think I've helped a few younger people, such as nephews, to see more of the world and discover their own ideas and thoughts. If you're a parent, you've surely given enormously of this gift.

Play with this. . . .
Write continuously for 20 minutes on a gift you've given someone. Tell the story of what happened and how it felt during and after the giving. Also consider what it meant to the recipient, how it was received, and what it meant to you.

After you write, identify how you feel. Pleased? Proud? Unsure? Disappointed? Angry? How does this make you feel about giving in the future? Perhaps there are unsaid complements you'll want to write and send. Perhaps you'll find you have been hurt and you want to stop giving to this person. You may want to write for another 10 minutes or so on these feelings and plans.

2007-09-04T10:06:00.000-07:00

TO WRITE: An "Aha!" Moment

We've all had them, though for me they don't come quite as often as I'd like: moments of sudden clarity, insight, or understanding.

For me, these flashes often occur either during a dream, or just as I'm awakening from some important-feeling dream. I suppose that mysterious sub-conscious mind is working overtime to get the message up to the surface where I can identify it. But I've also had "aha" moments when studying complicated calculus formulas or biochemical cycles. Somehow, sometimes, that period of long, arduous concentration pays off when it all clicks.

For those of us battling mood disorders, it's always important to be open to new insights about what troubles us and what we can do about it. For example, it took me a long time to figure out why I frequently belittled myself about a particular past event -- then it dawned on me one day that perhaps another person bore some responsibility there too. This was a moment of great relief for me, as well as a time of bewilderment: Why didn't I think of that before?

Play with this. . .
Write continuously for 20 minutes on a time you felt a moment of clarity or insight. What was it about? Did something special trigger it? How did it feel?

Then consider: What does this incident tell you about yourself or the particular ways your unique mind thinks and feels? Was the flash you described useful for you? Are there any ways you could replicate the situation in order to invite more such insights? (Personally, I think I will return to my old habit of recording my dreams in the mornings!)

2007-08-28T10:23:00.000-07:00

TO WRITE: What do you believe in?
You probably believe in loads of things. . . that we need parity for mental health insurance; that our friends should understand that we have an illness, not a weakness; that fudge brownie ice cream is the best; maybe that there are monsters under the bed.

Here's your chance to convince me, or the reader of your choice, of those deep-seated feelings and ideas. Consider your spiritual beliefs, your political positions, your feelings about depression, your relationships, your activities, your basic wants and likes. Are there any old childhood beliefs that come to mind? Any places where you differ greatly from those around you?

To play with. . .
You can start by writing a list of 100 things you believe in (yes, that's 100), as suggested by Kathleen Adams in her book Journal to the Self. Or, if ideas are already flooding your mind, feel free to simply start writing about these beliefs. Don't get too cerebral - some of the statements that come up might be startling or feel contradictory, and this is fine. Just let yourself write passionately. Write continuously for 20 minutes and convince me of how you feel on these topics.

Then reread your writing. What do you find - any surprises in your list? Any surprises in how passionately your felt? And are there any ways you might use this information to make small or large changes in your life? Perhaps this exercise will help trigger a discussion with someone close to you, or help you make a life decision.

2007-08-21T09:57:00.000-07:00

TO WRITE: Being Alone

Personally, I need alone time--sometimes a lot of it. It keeps my mood more stable, my stress level lower, I can be more creative, and a few more items typically get checked off my to-do list when I have it. And I'm usually happy alone.

Of course, I'm something of an introvert, and I understand from extroverted friends that their alone time isn't always necessary or even welcome. Unlike mine, their inner fires are stoked by being with people, whether one-on-one or at the big parties I sometimes dread.

All of us must also deal sometimes with loneliness, a related state.

Play with this...
Write continuously for 20 minutes on being alone. Do you embrace it or merely tolerate it when it occurs? Do you feel invigorated or lonely? If lonely, is it just for an hour or so, or do you feel it in terms of your larger life issues?

When you've considered these issues, what can you learn about yourself? Are there changes you can make in how you spend your time? Would a few minutes with a cup of coffee before the family wakes up make it a better day? Do you want to work at getting involved with more people and groups? Are there old friends you'd like to make contact with? Large or small, sometimes changes such as these can have a significant effect on our moods.

2007-08-14T10:45:00.000-07:00

To Write: Seeing the World Anew

"We must learn to see the world anew." -- Albert Einstein

I'm always intrigued to see what this true genius had to say about daily life as well as about quantum physics, and this quote recently caught my eye. I'm curious about whether his special insight extended to the "real world." In this quote, I think it did, whether he intended it to or not. I have no idea if this line was referring to a Unified Theory or to the experience of everyday awakening to what is around us. Regardless, it seems beautiful, even spiritual, advice.

What would I like to see anew in my world? Small things, like the little gifts on my desk right now -- the heart paperweight from Mom, the silly magnet from brother Mark about me drinking too much coffee. People thought about me and chose these tokens just to fit me. I see that I could appreciate these important people more.

I'd like to see lots of bigger things anew too, of course. I take for granted the tan foothills outside my window, when I could be embracing their presence and hiking their trails much more often. And bigger still, I want to savor and be open to my current good health. Though I don't want to dwell on previous difficult years, I do need to compare and remind myself frequently of the joy and opportunities I have today when I'm able to think and write and laugh. Furthermore, I should look at my life anew, especially when so many others are hungry or at war. I did nothing to deserve being is this place with so many benefits -- the fates landed me here. If I look at these things anew, I feel many things, but gratefulness in particular.

Play with this...
What does this Einstein quote mean to you? Do you think of being open-minded to scientific theories or artistic expression or solving world problems, or do your thoughts tend toward your daily life and the things and people in it? How does your current state of health or illness play into this? Is there any way you could frame this situation to see it anew in a more positive light -- perhaps through what you've learned on your journey? Write continuously for 20 minutes and see what you see anew in your words.

2007-08-07T10:46:00.000-07:00

TO WRITE: "Positive Psychology" Interventions for Depression
In the last few years, the new field of "positive psychology" has been sweeping through college classrooms, huge research studies, popular books, and the cover of Time magazine. This innovative approach to the ways we think and feel is aimed at increasing happiness, whereas traditional psychology has decreased unhappiness.

Dr. Martin Seligman of the U. of Pennsylvania is a pioneer in positive psychology. His website --authentichappiness.org -- states that, "Positive psychology interventions... lastingly decrease depression symptoms." Now this is worth pursuing!

In one study, he found that people who rated "severely depressed" on a written test improved in one week to the mild-to-moderate level of symptoms. In fact, 94% of these people decreased in depression! So what did they do?

Play with this...
Each night for one week, write down three things that went well that day and why they went well. That's all.

If you want, take the depression symptoms questionnaire on the authentichappiness.org website before and after, and see what your own mini-experiment finds. (There are many other interesting questionnaires you can take there for free, including those measuring character strengths and routes to happiness.)

At he end of the week, I suggest you write for 10-20 minutes on how you feel now compared to before you began, and what you think of this "Three Blessings" exercise. Is it useful for you? Did you enjoy it, or was it a drag? Do you think you'll continue this practice?

NOTES: Do NOT use this technique to replace your current treatments! Don't throw away your medicines. This study, as I have read it, had not yet been done with controls, and there was NO diagnosis of major depression made -- they only studied "depression symptoms."

2007-07-31T10:10:00.000-07:00

TO WRITE: Being outside
Have you noticed? It's summer! (OK, at least here in the U.S. -- if you're in the midst of winter where you are, just adapt this for your clime.) It's sunny and bright here in Northern California this morning, and I'm thinking it might be fun to walk to the nearly regional park after class today. But the half-written chapter on my desk will probably call me back.

Are you celebrating the weather by spending time at the beach, the lake, the strip of grass outside your door? Are you a forest person, a desert person, a mountain person -- or would you really rather sit in the living room with a book? (That's OK too.)

Personally, while I love the snowy winters I grew up with in Wisconsin -- up to a point -- I get most excited when it's a bit warmer, like this, and I can hike on a forested mountain trail. Watching for wildflowers and animals as I climb beside a gurgling stream with tall pines overhead is as wonderful as it gets for me.

Play with this...
Choose some type of outdoor space and write continuously for 20 minutes, beginning with "In a forest, I am. . . " (fill in whatever word is appropriate for the site you have in mind). This might be a spot you love or hate or are afraid in, one you're near everyday, or one you dream of visiting.

Then consider: How does it feel to write about this location? What can you do to feel well emotionally based on this writing? Does it confirm that you're a contented indoor type who despises mosquitoes, or does it trigger ideas about where to stroll this afternoon or camp this weekend?

2007-07-24T10:16:00.000-07:00

TO WRITE: Responsibility
"Responsibility"means many things -- I know, I admit I looked at the thesaurus after a student recommended this topic. My first thought had been about "taking" responsibility, being the conscientious one who steps forward and is accountable when a task needs to be done. But we also use the word when we lay blame ("Kids, who is responsible for this mess?"), or assign trustworthiness ("Beth would never make a mess; she's very responsible").

What does responsibility mean to you? For me, in the larger sense, it indicates a sense of rightness, of standing up for what I believe in, even in the face of intense opposition. It is an inner compass that reminds me of what truly matters to me -- like ending the war; like trying to live more sustainably; like treating people fairly.

Play with this. . .
Write continuously for 20 minutes on the topic of "responsibility" and what it means to you -- whether it's finding a baby sitter you're comfortable with, or protesting for civil rights, or taking proper care of your mental health.

After you write, consider what your thoughts and feelings on this topic indicate about you. Do you feel overly responsible for things? Do you tend to shirk duties? Are there ways you would like to manifest more responsibility for certain areas in your life? All of these issues play into my self-image, and thus my mental health, I'm sure. Are there ways you could adjust "responsibility" in your life and improve your mood in the process?

2007-07-17T10:05:00.000-07:00

TO WRITE: Wishes and Dreams
Are you a shopaholic? A collector? Do you dream of a different home, more money, a new job?
Even if you don't consider yourself very materialistic, I think all humans have wishes about things they'd like. A way to end the war? Enough food for everyone? Peace of mind?

I know my list includes items big and small. I had my eye on a new laptop for quite a while before buying it, but going to the mall depresses me (really). And it's very hard for me to watch TV news without aching for ways to mend all our problems. There are many days when just an extra hour of time to work or to read for pleasure would be fantastic.

Play with this:
Write continuously for 20 minutes starting with the phrase: If only I had...
You can come back to this phrase in your writing as many times as you like.

What sorts of items did you come up with? Are any of them readily attainable? Are any worth planning and working toward? Do any of them give you insight into your mental health? You may even want to write another 10 minutes on the answers to these questions.

2007-07-09T17:00:00.000-07:00

TO WRITE: If I Weren't Doing This...
Do you work? Even if your depression has interrupted your work life, you may identify with a certain occupation you once held. Whether you're a corporate VP right now or a mechanic on sick leave, a retired salesperson or a former astronaut -- or even if you've never been paid to work --you've had jobs. Weren't you a student in high school? Have you been a homemaker, a gardener, a cook? Have you ever mowed the lawn or helped a child or walked a dog?

Now that you've thought about what you've done in the past, consider what things you'd love to do in the future. Imagine you could do anything, starting tomorrow -- whether or not you think you have the experience or education for it. What occupation do you dream of?

My friends may be surprised to learn that I've always secretly yearned to be a long-haul truck driver. I suppose the solitude to think as I watch the miles of America roll by somehow calls to me. It's certainly unlike anything I've done professionally before!

Play with this...
Write continuously for 20 minutes on: An alternate occupation I'd love to try....

Let the sky be the limit (or don't, and go for that astronaut job). How about a sculptor or a real estate mogul? An Olympic swimmer or -- oh, the irony! -- a psychiatrist? Describe how it would feel to be working, where you would go each morning, what you dream of doing on the job.

After you re-read your writing, consider how your mood might be affected by this new position. Are there healthy aspects of this type of work that you could implement now? Is this dream job something you might want to actually pursue -- and what steps would you need to take? Does your writing shed any light on how you've felt about work you've done in the past or are doing now? Is there any other job you'd also love to investigate? Write that one out too!

2007-06-26T08:52:00.000-07:00

TO WRITE: Darkness and Light
In English, we use the words "dark" and "light" to describe a myriad of things, including paint on the walls, lamps, our thoughts, and our moods. But have you ever considered the concept more broadly?

For visual artists, the degree of light in a work is often a key aspect of the piece as a whole. Should the landscape painting feature a sunrise or be under ominous cloud bank? What do the shades of color in an abstract work indicate? What mood is implied by the shadows of a portrait?

In one of my favorite writing books, Wild Mind, author Natalie Goldberg discusses with a friend how everything can have these attributes, including watermelon (light, they conclude), friendship (very dark and scary), Minnesota (real dark), and death (light and dark). "As we talked more, dark transformed," she writes. "Dark became good and bad. It became energetic, fertile, less scary, more desirable."

Play with this...
Write continuously for 20 minutes, starting simply with the topic of "darkness and light," and see where it takes you. Really let your mind go, beyond the traditional categories we tend to use. What do the concepts mean to you, how do you apply them, and how could you think about them differently? And is friendship or watermelon dark or light for you?

Then read what you've written. What ideas or words are the most exciting to you? Start with one of those and write 20 more minutes, going deeper into your mind. Afterward, consider carefully how this kind of writing feels to you. Were you surprised where you writing went? Did it begin to flow automatically, without effort? And -- how did this feel to you emotionally? Whatever you find, keep what you've learned in mind when you write in the future.

2007-06-18T19:03:00.000-07:00

TO WRITE: The Wisdom of Youth
What did you know when you were a kid? A lot, you probably thought at the time, if you were like me. But what do you now think as you look back on your childhood days? Our experiences were limited, but perhaps our wisdom was right on. And what does our state of knowing back then say about our mood now?

Play with this. . .
Write continuously for 20 minutes on: In fifth grade, I thought....
Did you have strong beliefs about how the world worked when you were ten or so? (I was seriously questioning both the existence of God and the need for school.) As you left elementary school and headed for junior high, did you have misconceptions that in retrospect are funny or surprising? (Did you know where babies come from?) What views did you hold about yourself and your family? What were your plans for the future? (Any firemen or veterinarian wannabes out there?)

Looking back at your writing, consider how your mood was then -- already showing signs of depression, or still innocently happy? If depressed, try writing some more on this period of your life, but consciously change the circumstances you describe so that you are pleased with the result. If you were in good spirits as a kid, are there any lessons there for you now, such as specific activities that brought you joy, and that might again?

2007-06-11T14:37:00.000-07:00

TO WRITE: Caffeine and Alcohol
Whether or not you take medicines for your depression or other mental disorder, there are legal substances that may play a big role in your life and health. We know that alcohol abuse can devastate the lives of entire families. But even if your intake is moderate, do alcohol or caffeine affect the way you live?

Students in my writing classes usually have quick and definitive responses and stories about this issue -- usually because they respond differently to these common substances than they did before they became depressed or began taking meds. For some of us, many cups of coffee are needed to get through the day; for others, a sip of tea in the morning will mean a sleepless night. And, while some patients -- and their physicians -- feel they should completely avoid alcohol's potential mood-changing properties, others enjoy an occasional drink without a problem.

Play with this...
Write continuously for 20 minutes about your feelings about caffeine and/or alcohol. Do you use either? Why or why not? Have they affected your life adversely? Has your attitude toward them changed with your depression? And would you like to change your intake patterns for either?

2007-06-04T16:17:00.000-07:00

TO WRITE: What's to Become of Us?
I've got to give credit to an unknown student for this one too, a fascinating question to write on: Where do you think we're going in our evolution?

If you're a biologist, like me, your thoughts may go immediately to Darwin and genetics and survival of the fittest. If you're a sci-fi buff, you might be thinking in more high-tech terms. If you're a mystic, perhaps your ideas about death and beyond come in to play on this one. And if you're a global warming expert...?

Play with this...
Without thinking too much beforehand, write continuously for 20 minutes on where you think the human race is going evolutionarily. You can create a serious and thoughtful freewrite, or let your imagination go and write a fictional account of the future.

Afterward, consider what mood you were in when you wrote this piece. We're probably all likely to sound more pessimistic when depressed. But does consciously trying to write more optimistically help to improve your mood? There is evidence that the different ways we tell stories can affect our thinking and even behavior, so it doesn't seem outrageous as a hypothesis. If your writing sounded "down," try a rewrite and see what you think.

2007-06-04T15:52:00.000-07:00

NOTE TO FAITHFUL READERS:
You may notice that there's no "TO READ" article posted this week.... The TO READ feature will probably appear rather sporadically through the next several months as I focus on writing my book, The Power of Writing: Easing Your Depression with Paper and Pen, to be published in spring 2008 by Ten Speed Press. I'll continue to post a TO WRITE writing exercise each week. And I'll likely come across depression-related topics on occasion that I just can't wait to share. Thanks for your understanding. Keep in touch! --Beth

2007-05-29T09:17:00.000-07:00

TO WRITE: Gender and Social Stigma

A student recently suggested "patriarchy" as a writing topic. That's a heavy issue for me to get my mind around, so I tried to think of very specific ways I have been affected by this social scheme. While the differences between the treatment of men and women is enforced in truly frightening ways in some countries today, and while there are evidently still a few matriarchal cultures in existence, here in the US I feel I live in a patriarchal culture that tries to portray itself as egalitarian.

So how has that affected me? I brainstormed. I do think that in one job I was treated differently than a man would have been in terms of mentoring. Also, I took my husband's last name when I married -- though I use my maiden name as my often-included middle name to try to keep it present. I know I've been looked at oddly when alone in some public establishments, where a man, I suspect, wouldn't have been noticed. I'm sure there are lots more, big and small....

Play with this...

If you need to brainstorm at all, take 3-5 minutes to make a quick list of times you feel you were discriminated against because of your gender. Then write continuously for 20 minutes on one of them, describing what happened as a story with beginning, middle and end.

How did it feel to identify and write about this issue? Did you describe a trauma or a mere annoyance? Did writing about it change your mood at all? If the story felt upsetting, try rewriting it with a different (fictional) ending that you prefer. This can often feel empowering.

2007-05-29T08:55:00.000-07:00

TO READ: Extend Your Life by Treating Your Depression?
It's long been known that if you follow a group of people -- half depressed and half not -- for several years, more of the depressed ones tend to die during that period. But now there's good news: A recent study shows that if you treat the depressed people, they live longer.

In the study, researchers took half of the depressed group, all over 60 years old, and treated them with either medication or psychotherapy. The other half went untreated. They found that the treated people were only half as likely to die during the study as they untreated group. (This was after controlling for age, sex, smoking habits, level of education and current physical illnesses.)

Although the scientists don't know why yet, the decrease in deaths came nearly all in the group of patients who also had cancer.

Here's yet another reason to treat your depression, either with meds or psychotherapy -- in addition to feeling less depressed, you may just live longer too.

For more info: Joseph J. Gallo, The Annals of Internal Medicine, May 15, 2007.

2007-05-22T10:20:00.000-07:00

TO WRITE: Leaving on a Jet Plane... or Car or Bike or Boat
You're thrilled or you're dreading it ... you're dashing about or you're dragging your feet. No matter where you're headed out-of-town, no matter how you're getting there, going on a trip can be stressful and emotional. And if you're depressed already, it can feel overwhelming.

If I'm healthy when I'm about to fly or drive anywhere, I'm so excited that I underestimate the time required to prepare and pack. I forget until the last moment to take care of crucial phone calls or take out the trash. I'm often doing laundry at midnight before an early departure, because I must have some favorite outfit clean and ready-to-go. And then there are the decisions about what to pack, and how large a bag I'm really going to need for a weekend in the mountains or a three-week trip to Europe.

My husband, meanwhile, tosses some clothes in the nearest duffel bag and has time to read a magazine before we leave. (Sigh.)

Play with this...
Write continuously for 20 minutes on a voyage you've taken and your emotional and physical preparations. How did you feel -- whether you were off to trek in Nepal or take a day trip to the beach? And how did you get ready? Did one affect the other? If it was a less-than-great experience, can you plan something differently for next time? (I'm instituting a rule for myself that says I aim to depart 30 minutes before I actually need to. Just a mental game, but, with some luck my brain will buy into it.)

2007-05-21T15:49:00.000-07:00

TO READ: My First Book is Being Published!
Like this blog? You're going to love this book.

I'm delighted to announce that I have just signed a contract with Ten Speed Press to publish a book I'm writing on the power of writing to ease depression.

The book (we're still fine-tuning the title) will be based on my experiences, the experiences of my creative writing students with mood disorders, and the scientific evidence of writing's many healing properties. It will describe some of the types of writing you can use to lift your mood, including freewriting, journaling, poetry, memoir, and even fiction -- and how you can write on your own or begin a writing group for people with depression. Lots of exercises -- to jump start your own writing -- and examples of students' writing -- for inspiration -- will be included.

Whether you're dealing with major depression or a difficult life transition, this book is designed to help you with techniques that can help heal your thoughts, emotions, and spirit.

If you'd like to be on my mailing list for early information and updates, please leave a comment.

The book will be available in May or June, 2008 -- just a year from now. My next few months will be spent writing like crazy! Hurray!

Stay tuned....
-- Beth

2007-05-15T09:18:00.000-07:00

TO WRITE: Those Really Big Questions in Life
In the writing group I lead at Stanford, I sometimes pass around a paper on which people can suggest topic ideas. Members' topics, like those I bring in myself, range from the very specific -- washing dishes, a childhood toy -- to the huge and abstract -- the meaning of life, for example.

Recently I noticed a large proportion of the group's ideas were of the "really big" variety. These issues sometimes require a few minutes of writing before you truly get your mind around them, but they tend to be very rewarding.

Play with this...
Write continuously for 20 minutes on one or both of these questions: Who do you think you are? What is reality, anyway?

Though you may need to start with broad concepts, try to bring your writing back to the personal level too, by using specific examples and using details gleaned from your senses.

Wait a day or so, then reread your piece. Have you learned anything about your own beliefs? Have your beliefs been strengthened? Drawn into question? Does this affect your perception of your depression at all?

2007-05-14T13:56:00.000-07:00

TO READ: Groups Offer Comfort and Even Joy in the Mental Health Community
I have a lot of mentally ill friends. Maybe you do too. Twenty-one years ago, when I was diagnosed with major depression (which later became categorized as bipolar disorder) I personally knew only one person who I even suspected of having a mental illness. Now people with depression, bipolar disorder and other conditions are everywhere in my life!

I find that as we go through this life-altering experience, we tend to bond to one another for information and support. You may have noticed it in your life too. When you suddenly get a diagnosis, or a prescription, everything changes, and you need someone to turn to -- someone who's been there. That's why I believe the services provided by the National Alliance on Mental Illness (NAMI) and the Depression and the Bipolar Support Alliance (DBSA) (see links at right) are so vitally important. And I know that sense of connection and shared experiences is one of the reasons people seek out my writing class for people with mood disorders at Stanford.

Being immersed in the mental health culture may involve reading about depression or other conditions, recognizing that you have mentally ill friends or relatives, seeking education and camaraderie in support groups or therapy groups and, in a surprisingly high number of cases, holding paid or volunteer positions in mental health advocacy. (In addition to my writing group, I speak as a volunteer on mental health issues for two organizations.) And there is a great deal of comfort, release and joy in these communities.

This weekend I took part in the NAMIWalks for the Mind of America in San Francisco's Golden Gate Park. The positive vibes and goodwill were everywhere -- from the fact that there were 90-odd teams participating, to the cheers and thanks of volunteers as we finished our 5k walk, to the open-minded chats going on at the booths offering information, books, and items made by people with mental illness. I felt proud to be a part of helping make these illnesses more visible in our still-stigmatizing society.

If you're coping with depression and you're not familiar with NAMI and DBSA, do yourself a big favor and check them out for education on illnesses and treatments, emotional support for consumers and their families, resource lists, legislative and research updates, and especially to learn where there are support groups near you. You don't need to feel alone as you grapple with difficult thoughts and feelings.

2007-05-08T09:38:00.000-07:00

TO WRITE: Oh, Those 'Parental Units'
Whether you feel your parents are the guiding lights in your life or people who cast dark shadows -- or, most likely, something in between -- there's no denying that parental relationships are crucial to shaping who we are. Think back to your growing-up years: How did you experience them, or the other person or people who raised you? Nearly all of us can point to both happy and painful childhood events. And what of your current relationships: Are your parents living? Do you have regular contact, rare contact, no contact? Do conversations mirror those of childhood, or have they evolved in some way?

These reflections can be eye-opening for anyone, but perhaps especially to people coping with depression. If you feel like it, consider the relationship, if any, between your parents and your difficult moods. Some people believe there is a direct cause-and-effect relationship; others find their parents their greatest support. There's no good or bad -- our parents are only one part of our lives and, as adults, we have already moved on considerably to shape ourselves, and we'll continue to change and grow.

WARNING: This can be an intense topic. Remember the "flip-out" rule -- if it feels too scary to go there, just don't go. Write on something else this week.

Play with this...
Choose one parent or guardian. Take 20 minutes of continuous writing to describe your past and present relationship with that person. Try to incorporate at least a couple of specific stories of events. Also consider how you might like to improve your view of that relationship today -- could you recognize your separateness and release some frustration or pain, for example? Can you feel thankful for any part of your interactions? You may want to share what you've written with a safe friend, partner or therapist. Remember: We are always evolving and becoming stronger as adults.

2007-05-03T17:04:00.000-07:00

TO READ: Happy Faces Trigger Less in the Brains of Depressed People
When you're depressed, you know it's hard to put on a smile -- and it can even feel difficult to react to smiling people around you. Now brain research shows that depressed people do have real impairments in the ways they process happy faces.

In a recent study, depressed people were slower and less accurate at "processing" -- in this case, detecting the gender of -- happy faces than were healthy people, as shown by functional MRI. But after eight weeks on Prozac, and improvement in symptoms, this ability returned. On another task, responding to increasingly happy faces, the emotion-processing regions of the depressed brains were less active than they were in healthy people's brains. In this case, the difference was not improved by the antidepressant.

Being able to recognize and respond to other people's emotions is a crucial part of interpersonal relationships. These different responses demonstrate that it's not a personal failing to have trouble reacting to a friendly person when you're depressed, but a measurable neurobiological trait of the illness.

For more information: Am J Psychiatry 164:540-542, April 2007.

2007-05-01T10:59:00.000-07:00

TO WRITE: Simple everyday routines
One way in which writing can help us see ourselves is by bringing the ordinary details of our life into clear view. For example, when you stop long enough to see a daily ritual broken down into its individual steps, you may appreciate it differently -- its intricacies, its roles, even its beauty. Consider this poem by former U.S. Poet Laureate Ted Kooser, who, incidentally, was a life insurance executive in Nebraska most of his life.

The Necktie
His hands fluttered like birds,
each with a fancy silk ribbon
to weave into their nest,
as he stood at the mirror
dressing for work, waving hello
to himself with both hands.

Play with this...
Write a poem about a simple routine task or ritual you do. As Kooser's poem shows, this action can be something quite small and ordinary. Describe the routine, considering its meaning to you, and various ways you could express its qualities to others. Take at least 10-20 minutes to write and revise your poem. (If you really prefer prose to poetry, use that, but try the poetic form first.) What does this everyday habit reflect about your life?

2007-04-30T12:19:00.000-07:00

TO READ: Depression's Devastating Self-Criticism Explained
When serious depression kicks in, one often-heard complaint is, "I do everything wrong." Now researchers have brain-wave evidence about where this perception may come from. Results from one study show that depressed people make no more mistakes than healthy controls -- but that they truly are better at detecting their errors.

Scientists measured two types of brain waves as subjects did a simple signal-detection task, and found that depressed people were just as quick and accurate as the non-depressed. No slowness or concentration problems were noticed. However, both types of brain waves -- one called error-related negativity, which measures brain resources used in early detection of errors, and the other called error positivity, which indicates error detection -- are exaggerated in depressed people.

Those responses indicate that the depressed group used more of their brain resources to detect errors. Researchers suggest that when they make a mistake, depressed people are more likely to notice it than a healthy person would be. While this extra acuity might be a good thing in certain situations, it also may be responsible for the hyper-criticism often felt during the illness. Something to bear in mind when that I-can't-do-anything-right feeling kicks in!

For more info: American Journal of Psychiatry 2007 164:58.

2007-04-24T09:53:00.000-07:00

TO WRITE: A Sound from Childhood
Memories, especially those from childhood, can often evoke strong emotions, as well as triggering even more memories. Instead of replaying the same old childhood stories in your mind (we all have some that we rely on to piece together the story of our life), try with this exercise about specific sounds to see what other details or experiences you may not have thought about for a while. "New" material can supply all sorts of creative undertakings. In addition, focusing on specific sensory experiences makes for strong writing.

Play with this...
First, brainstorm a list of five to ten specific sounds you recall from childhood. My list includes the zip when my father cast his fishing line from a canoe on a lake, and the blaring honk of the tornado alarm in elementary school. Next, choose one of these sounds -- preferably one you haven't thought about for a long time -- and write for 20 minutes about your experiences relating to it. Then consider how it felt to write this memory -- was it sad, funny, a relief, an "aha" experience? If a particularly difficult memory came up, give yourself a few more minutes to write an imaginary ending to the story that wraps things up in a way you'd prefer.

2007-04-23T16:23:00.000-07:00

TO READ: Why Did I Have To Gain 80 Pounds on Antipsychotics?
Researchers may have solved the mystery of why so many people with bipolar, depression, schizophrenia and other illnesses who take certain antipsychotic medications tend to gain weight -- sometimes lots of it.

While these medications may effectively treat symptoms such as hallucinations and delusions, that's a high price to pay. (I know -- I gained 80 pounds in a few months on one of these meds. Fortunately it's almost all come off now that I'm on a newer one instead.) Many people gain to the point that they become at risk for life-threatening conditions such as heart disease and diabetes.

Scientists knew that the link between brain cells and appetite seems to be an enzyme known as AMPK. Now, in a recent study at Johns Hopkins University, when researchers gave the antipsychotic medication clozapine to mice, their AMPK activity quadrupled. When the scientists chemically suppressed the mice's appetites, the AMPK levels lowered. But what mediates such a connection?

It turns out that histamine -- the substance responsible much allergic misery, as well as a protein which aids communication between cells -- plays a key role in the interaction between AMPK and appetite. By blocking histamine's effects, clozapine no longer led to AMPK spikes.

The results are exciting: This discovery may allow scientists to develop both a new generation of antipsychotic drugs that doesn't cause weight gain, and safe weight-loss drugs.

For more info: Proceedings of the National Academy of Sciences, online edition, February, 2007.

2007-04-14T14:22:00.000-07:00

TO WRITE: A Cold Got You Down? Write About It!
I see low, deep gray clouds and the spattering of raindrops outside my window here in Northern California today. And the weather report says a big part of the country is getting snow on this day before tax day. Have the recent shifts in weather contributed to a spring cold for you, as it has many people I know? (So far, so good for me ... for this month.)

After you wake from your weekend nap and pop some more Benadryl, don't turn on the TV to numb your mind. Instead, consider curling up with a cup of hot tea and a blanket in your favorite chair and writing out just how miserable you are. You might just feel better. Your mind will engage and you may forget your sore throat for a while. And remember that writing has been demonstrated to improve immune functioning. I'm not claiming that writing will cure your cold -- but research does show that writing even 20 minutes a day for four days in a row about a difficult or traumatic experience leads to fewer doctor visits for months later. Now that's something to think about!

Play with this...
Describe how your body feels right now as if you're writing for someone who's never had a cold -- the aches, the fever, the lethargy, the stuffiness. OR describe a time you were sick as a child -- what were your symptoms? Who took care of you? How did the illness resolve? Write continuously for 20 minutes. When you look back at the pages you've filled, you'll see you have accomplished something today after all.

2007-04-09T14:39:00.000-07:00

TO READ: Religion Shown to Help Depression for Many of Us
The data is overwhelming: Study after study shows that people who consider themselves religious or spiritual, especially those who attend weekly religious services, tend to be generally healthier and longer-lived than those who don't. And -- this rule of thumb holds true for depression in particular too. Interestingly, it's reported that 95% of Americans believe in God or a Universal Spirit. Along the same lines, a study of psychiatric inpatients found that 80% consider themselves religious or spiritual.

In terms of overall health, for example, one study which tracked more than 5,000 people from right here in Alameda County, CA, found that those who attended religious services at least weekly were 25 % less likely to die during the study than others. A huge 1999 study of 21,000 American adults found that by attending religious services more than once a week, people tended to extend their lifespan by up to seven years in general, and up to 14 years in African-Americans.

In terms of depression, the results are remarkable too. For example, in one study of 177 people (age 55-89) over one year, self-reported religiousity was correlated with less depression, and with recovery from depression in those who were initially depressed. Another study looked at depressed and medically ill men over age 60 for one year and found that, even after accounting for 27 other variables, religiousity was associated with both a greater likelihood of remission and a quicker remission from depression. In one review of 29 studies examining the relationship between depression and religious involvement, 24 found that religiously involved people had less depression and fewer depressive symptoms; five found no association.

Treatment of depressed religious people has been shown to be more effective in terms of post-treatment depression when religious content is added to standard cognitive-behavioral therapy and, in another study, when religious content is added to standard psychotherapy.

And what if you don't consider yourself a "religious" person? Good news: benefits of a spiritual but non-religious practice can still provide benefits that complement your medical treatment. Consider a regular yoga or meditation practice, for example. Also, giving to others through works and services can often provide a strong inner response. In addition, pay attention to your personal support network, and health habits such as drinking and smoking -- all of these have been shown to be improved by religious involvement, but don't rely on believing.

Remember -- spiritual beliefs should not be used to replace your medical care! Instead, appreciate how they can complement and augment one another in your efforts to feel better.

For more info see: www.mayoclinicproceedings.com/inside.asp?AID=1338&UID and www.mcmanweb.com/article-102.htm

2007-03-30T15:18:00.000-07:00

TO WRITE: Could a "Laughter Club" Beat Out Prozac?
Is it hard to laugh when you're depressed? Well, consider doing it in a group. That old saw about laughter being the best medicine is being enthusiastically applied in Shanghai. China Daily reported that this month faculty members at Fudan University began inviting students to "laugh away their cares and concerns" by joining the Heartfelt Laughing Club.

Members, inspired by observations that laughter is powerful - and contagious - typically meet in parks early in the morning. They raise their arms high and begin laughing loudly, then silently with mouth closed, then open, in an effort to ease everyday stresses. Sometimes the laughter is combined with yoga and meditation. Chinese psychologists leading the Fudan group discovered that others follow the humor-filled practice too: There are more than 80 laughter clubs in India, and several thousand around the world!

Do you think they could be on to something?

Play with this ...
Even if it's been a while since you've giggled much, recall some times you have. Did you laugh yourself silly at Bugs Bunny as a kid? Or was it that time you and friends played a prank on a teacher? For me, watching Monty Python or Saturday Night Live with my gang of pals in high school comes to mind.

Write the story of a funny - no, hilarious - thing you once laughed at. How did it start, how did you react, did you feel different afterward? Are similar events still amusing to you now, or have your tastes changed? And what might make you laugh today - could you rent a video, play with the dog, rehash a family mishap with your sister? As usual, give yourself 20 minutes to write continuously about the laughter in your life. And leave a comment to let us know what works for you!

2007-03-29T14:42:00.000-07:00

TO READ: Approaching a Genetic Understanding of Depression
Scientists continue to chip away - and sometimes blast away - at the mystery of depression. And they're making progress. In a major step forward, a consortium of psychiatric researchers announced last month the identification of a region on chromosome 15 that has "a very good chance" of ultimately explaining why some people develop depression.

You probably know that both genetic and environmental factors are believed to be responsible for depression. A better understanding of specifically which genes (there are thought to be several) in our DNA place us at risk for depression would constitute a major research breakthrough: If scientists can locate the key genes, they can determine how they affect the brain and, as a result, can develop more effective therapies for the illness.

Two studies reported in the February American Journal of Psychiatry were conducted by groups at six universities, led by Stanford professor Douglas Levinson, M.D. First these researchers studied 650 families in which two or more members had experienced multiple bouts of severe depression that began in childhood or early adult life. They scanned the entire genome and found areas of "linkage" between depression and DNA markers in several areas. Then they homed in on the most suspicious region, which lies on chromosome 15.

What they found, after studying more than 88 DNA markers in that area, was what Levinson called "one of the strongest genetic linkage findings for depression so far."

The consortium is now studying more than 2,000 people to identify specific genes in the regions, including on chromosome 15, that look most likely to carry variations that increase depression risk.

2007-03-20T11:32:00.000-07:00

TO WRITE: What We See and What We Don't
Many writers claim that observation is what their work is really all about. Author and writing teacher Natalie Goldberg says, "Writing is 90% listening."

But it's not just the writer surreptitiously monitoring the lovers at the next restaurant table for plot ideas and dialog. In fact, every human needs to observe his life and the world around him and try to fit the two together. Observing and reflecting are key, whether it's deciding when it's safe to step off a curb, or determining when to change careers. For people living with depression, observing the situations that make us feel worse or better, and the reactions we have to those stimuli, can be a powerful tool. We can use this technique both in the present and in retrospect.

Play with this...
Write continuously for 20 minutes, starting with the following prompt, and see what you discover.
Looking back, it was obvious...

2007-03-19T13:57:00.000-07:00

TO READ: Changing the Structure of Your Brain
Wow, am I reading a great book right now! Train Your Mind, Change Your Brain by the wonderful science writer Sharon Begley, is billed on the cover as, "How a new science reveals our extraordinary potential to transform ourselves," and, "A groundbreaking collaboration between neuroscience and Buddhism."

Sound confusing? Well, I suppose anytime you get the Dalai Lama to write a foreword for a book on nerve cells in the brain, it's unusual, that's true. And neuroscience is typically thought of as a daunting field. Despite those things -- or maybe because of them -- I'm telling everyone I know to read this book! It's absolutely fascinating and it's very accessible.

Here are some of the things I've learned so far, boiled down and boiled down again. When I was a college student, and even when I was a graduate student in biology, it was taken as a given that whatever brain cells you were born with were what you got for good -- no exceptions. This was simply a basic rule of neuroscience. But... Begley describes a whole host of recent experiments that show how that belief is hooey. Instead, the incredible changes our brains can make -- the "neuroplasticity" of the brain -- will amaze you. For instance, in people blind from birth, you might imagine that the enormous visual cortex part of the brain would sit silent, since no visual input can get in through the eyes. No! In fact, instead of lying dormant, the visual cortex actually switches jobs to help the person hear certain tones and rhythms more acutely than sighted people can. In other words, it helps them compensate. Similarly, the brain region believed to only be able to process auditory stimuli can, in deaf people, be recruited to help the visual cortex to gain even more information from peripheral vision than usual, thus helping a deaf person to notice and react to changes in the environment more quickly.

What these kinds of experiments mean is that we can change our brains. By attending to particular things in our environment, we can cause regions of nerve cells in the brain to grow, to shrink, to adjust their function, even to change jobs completely. So, if you take up the violin, even as an older adult, your brain's motor cortex in the region controlling your left (fingering) hand, will grow. It takes attention and practice, but our minds really can change the structure and the electrical and chemical activity in our brains! That's consciousness changing matter.

I'm only half-way through the book, but I'm hooked. So stay tuned for an upcoming discussion of what happens when neuroscientists study the brains of Buddhist monks who have meditated for years, and learn what these discoveries mean for the treatment of OCD and depression.

2007-03-12T17:23:00.000-07:00

TO WRITE: How Do You Care for Yourself?
Last time I circulated a notepad asking for writing topic suggestions in our class meeting at Stanford, I got an amazing mix of responses. We've already written using several of them as our jumping-off point -- from "joy" to "patriarchy" to "I'm afraid of" to imagining being "rich beyond dreams."

But one topic that comes up very regularly on such lists is how to manage your moods. And on this page, the topic of "self-care" came up specifically. Everyone who has coped with a mood disorder, even for a short time, has probably gravitated toward some activities that feel self-soothing or calming or activating or encouraging, depending on what you need at that time. When I'm depressed, reading a novel or writing about the situation over a big cup of coffee at Starbucks helps considerably. It doesn't remove the depression, but it reminds me that there are still things I can enjoy - even if only a little bit - and that I have the ability to seek out those things. And, in my case, the jolt of caffeine doesn't hurt either.

Play with this...
What self-care techniques can you recommend to others? Does walking the dog help you bond with her and get some exercise? Does herbal tea help you get a much-needed good night's sleep? And what about writing -- you may not feel up to crafting a poem, but does a good freewrite in your journal ease your burden a bit? Write continuously for 20 minutes on self-care and see what you discover -- then share your findings with a friend who could use them, and perhaps pick up a few tips from her too.

2007-03-12T10:33:00.000-07:00

TO READ: Gamma knife surgery - could it help depression someday?
A former writing student recently made me aware of a "knife-less" brain surgery technique which is becoming widely used around the world. Called gamma knife surgery, it destroys tiny bits of brain tissue by focusing beams of cobalt radiation on, for example, a brain tumor. The gamma knife can be used even for deep brain sites and, unlike conventional radiation treatments or surgery, can be focused with one-tenth of a millimeter precision, so healthy tissue is largely unaffected.

Sounds very impressive to me. Now vascular malformations, both cancerous and benign brain tumors, epilepsy and other conditions are being treated with the gamma knife on over 60,000 patients each year, according to one web site.

But what about depression? I surfed and web-surfed some more, but haven't come across any studies on using gamma knife surgery in this realm. Yet. One site discusses using it for obsessive-compulsive disorder and even vaguely suggests using it for depression in the future....

But where in the brain would it be used? As this blog has described several times, more and more evidence is stacking up that says brain structures - not just the flow of neurotransmitters - are changed in depression. Perhaps one of these sites could be treated. Often the confusing point in these cases is that we don't know whether those structural changes cause, or are caused by, depression. The other approach would be to simply focus on brain regions now understood to regulate emotions and mood. But identifying the precise areas to target is still too difficult. Still, it sounds as though researchers are starting to consider the possibilities of gamma knife surgery for psychiatric illnesses. One more potential future treatment to keep an eye on.

For more info: www.sciencedaily.com, www.sd-neurosurgeon.com

2007-03-05T16:23:00.000-08:00

TO WRITE: Are You Friendly with Your Little Pink Tablets?
If you take antidepressants - or mood stabilizers, antipsychotics, anti-anxiety drugs, sedatives, stimulants or any other of the panoply of psych meds - how do you feel about them? For many people with depression, that handful of tablets and capsules that it sometimes seems we gobble like candies can be hard to get down. That is, while we know intellectually that these drugs are helping us, or at least could help us, many of us still have mixed emotions about taking them.

Have you ever wondered what exactly those pink or white or turquoise or yellow pills are doing once you swallow them? Scientists still can't fully explain how they operate to change our thoughts and our entire mood. How does that mystery leave you feeling? At different times I've felt dumbfounded, nervous, grateful, embarrassed, angry, resentful and relieved to reach for my regular doses from those amber bottles.

Play with this...
Write continuously for 20 minutes describing your feelings about taking medicines for psychiatric reasons. What emotions did you feel initially? Have they changed at all? How do you feel when you take your prescribed dose today? And would you feel any differently if these were drugs you were taking for some non-psychiatric ailment? Untangling such thoughts and feelings may provide some insight into our attitudes toward our depression and our life situations as well as our treatments.

2007-03-05T15:15:00.000-08:00

TO READ: Drug Combo for Resistant Depression
Has your depression - or you - been dubbed "hard to treat"? Been through drug after drug without success? A new study looking at treatment with the combination of antidepressants Effexor (venlafaxine) and Remeron (mirtazapine) looks encouraging.

Irish psychiatrists just reported a study of 32 patients (44% men) who had been through an average of 2.5 drug trials without depression relief. Impressively, after 4 weeks on this combination of meds, 44% had responded; after 8 weeks, 50% responded; and at a 6-month follow-up, 75% of those still taking the meds had significantly responded.

The down-side? No "serious" side-effects were reported, but 19% of patients felt sedated and 19% experienced weight gain. Five of the 32 quit the trial because of these effects. Remember to keep trying if your depressive symptoms haven't been helped by meds yet - just because one drug or combination doesn't work for you doesn't mean others won't!

For more info: Journal of Psychopharmacology, Vol. 21, No. 2, 161-164 (2007).