Having lived sans cable for the past five years or so, when I’m in the mood for some network entertainment I usually turn to Netflix and usually delve head first into a series. Mad Men, the hit AMC series about advertising men in the 60s, is my latest vice, and I’ve been going gang-busters through the first few seasons recently. I never knew I would be so fascinated by the lifestyles of the 1960s, but I can’t get enough! While keeping in mind the fact that everything is amplified for television, I’m riveted by the complicated gendered relationships between men and women, the parenting styles, the political climate, and, of course, the portrayal of mental health. Oh, and the hairstyles. I love those.

What’s so fascinating about Mad Men is that it offers a glimpse into how far we’ve come – and haven’t come – in our social development. Mental health is no exception. When Betty Draper notices numbness in her hands and discovers that this could be psychosomatic, she urges her husband Don to allow her to attend therapy. Don is at first incredulous about the idea of his wife confiding in a stranger to solve her seemingly physical ailment, but when the problems continue he relents. What we soon discover, however, is that Don is keeping close tabs on his wife’s sessions, getting a full report from her psychiatrist after each meeting.

My jaw literally dropped when I saw this exchange transpire, but then I reminded myself just how long fifty years is in the world of mental health. It was only in 1996 that former President Clinton enacted the Health Information Portability and Accountability Act – HIPPA – that provided protection for individuals’ health information being communicated. Just to be clear, in today’s world, one would need to give explicit permission for a partner to receive information about one’s treatment. And detailed information about one’s sessions would virtually never be revealed.

In fact, a lot has changed in the world of mental health since the days of Betty and Don Draper. To put in context, here are some of the developments in the past fifty years:

1966 – Alcohol abuse and dependence were finally recognized as a major public health issue, and federally-funded organizations were developed to research these illnesses. We’re still trying to establish the the exact causes of alcoholism, and genetic research is helping us understand it’s biological roots.

1970 – The FDA approved the use of lithium to treat mania. This revolutionary drug drastically reduced the number of days spent in inpatient hospital. It’s also credited with sharply reducing the number of suicides in areas where it was prescribed.

1976 – The number of people in psychiatric hospitals was dropping dramatically as an emphasis on treating individuals in their own communities developed. While giving individuals tools for community-living was important, many patients were pushed out on to the streets still ill-equipped to manage their illness. Some became victims of trauma – individual and institutionalized.

1978 – Many people still claimed that autism was caused by refrigerator mothers, parents that offered a “genuine lack of maternal warmth.” While we still aren’t clear on the causes of autism today, we’re generally agree cold moms are not to blame.

1986 – Homosexuality was removed from the Diagnostic and Statistical Manual (the Bible for mental health practitioners) as a diagnosis. It took this long despite compelling research in the 1940 and 1950s by the likes of Alfred Kinsey, Evelyn Hooker, and others. No one ever claimed that the American Psychiatric Association was speedy on these things.

1989 – Former President Bush signed a proclamation establishing the 1990s as the Decade of the Brain. The 90s saw an enormous boon in research on genetics and the brain. By 2000, genetic researchers had finished mapping human genes. The goal is to help identify specific genes and how they are associated with various illnesses. [Are eating disorders brain disorders?]

2002 – New Mexico allows psychologists (not, psychiatrists – click here if you’re not sure of the difference), to prescribe psychotropic medication. Hotly debated, but the future may hold more prescription privileges for appropriately trained psychologists.

2008 – The Mental Health Parity and Addiction Equity Act was passed. This landmark legislation required  insurance companies that offer mental health benefits to provide coverage on-par with medical coverage. Unfortunately there are still many insurance companies that are trying to sneak around this, and eating disorders are often not covered.

2010 – Nourishing the Soul was born! (Sorry, had to add that in there!)

As you can see, while advances in mental health may seem to progress at a snail’s pace in real time, in the context of our history we’ve made great strides in this field. And what has universally propelled this forward movement has been the willingness of invested parties to speak up. Whether as a clinician speaking up on behalf of your patients, as a concerned family member advocating for your loved one, or as a consumer of mental health services sharing your struggle, putting these issues at the forefront has meant everything.

So on World Mental Health Day 2011, I urge you to use your voice to keep the momentum going. This week, write a blog post about the role of mental health services in your life, share your story with a friend who might need to hear it, or even lobby in Washington. Whatever you do, remember that mental health is health, and it takes our voices make sure it gets the respect and recognition that it deserves.

For more World Mental Health Day posts, head over to PsychCentral. How are you recognizing the importance of mental health in your life today?

{Image Credit :: wolvesandrabbits}

She’s only half the woman that she once was, but don’t tell her that.

At 28, my friend Laura has long lost almost half of what was once her highest weight. She hasn’t been to that point in almost ten years, dropping the pounds in desperate attempt to forestall what she perceived to be inevitable rejection come move-in day of her freshman year of college. Her self-proclaimed fat clothes are not shoved in the back of her bulging closet; they are long discarded – adorning Goodwill-goers and those with bodies far larger than Laura herself.

But Laura doesn’t see herself as the size six with killer triceps. When she looks in mirror, she is flooded with memories of sitting alone at the community center, drinking her diet coke and feeling hot and uncomfortable in the black tafetta dress her mom finally found on sale in the Women’s department. “Black is so slimming!” she was told. “Right,” she thought. “And so are vertical stripes. But I refuse to go there.”

She recalls watching the other girls dance with bright, carefree smiles adorning their perfectly made-up faces. And Laura is angry – though she’s not sure if it’s at the girls for fitting into the strapless sequined dresses that she’d been eyeing for months or at herself for letting Dunkin Donuts distract her from her low-carb, low-fat, high-anxiety diet once again.

But Laura is no longer that girl, though her mental image of herself retreats to that dark place whenever her anxiety starts to build. She can’t understand why, years after she has shed the weight and has built what she considers a healthy lifestyle, she remains stuck in a 16-year-old’s mind.

Speaking with may individuals who have lost a significant amount of weight, the disconnect between their new bodies and their old minds becomes strikingly apparent. Despite years upon years passing, many still describe themselves as feeling, at their core, like a fat pig.

Do memories of being overweight ever fade?

According to NPR’s Peter Sagal, the answer is no. Even physically fit as a 3:27 marathoner, he grapples with the concept of not being fat. “Mirrors are not to be believed,” he said in a Runner’s World piece. “You stand in front of them, knowing that you can’t trust yourself as an arbiter of truth, so you turn from side to side, thinking that maybe, if you snap your head around quickly enough, you can actually see yourself as others see you.”

Like Sagal, those who have become thin through regular and intense exercise often continue to feel that they are the mercy of their athletics. Sure I’m skinny, you’ll hear. But that’s because I run thirty miles a week. The implication of course is that if by some horrible stoke of luck  they weren’t able to exercise, they would return to the large life as quick as you can say tendonitis. They are, they believe, fat people in thin disguises.

Why is it so hard to adopt a new mental image of yourself? One reason might be that our brains are actually wired for distortion when it comes body image, as recent research suggests.

Another reason is that often the feelings associated with our body size are visceral – the transcend all reason and are rooted in a place far more powerful than intellect. Those who have found themselves struggling with weight, particularly as children, often form an identity around this. If not given other messages, we often learn, in part due to the weight discrimination rampant in our society, to approach others from a place of disempowerment and of shame.

At the heart of the matter is not fear of simply having an arbitrary numerical value on a scale rise again – it’s a fear of a loss of human connection, of feeling powerful and capable and strong, of rejection. And in an ironic twist of fate, fear and stress are connected to weight gain.

Learning to let go of a restrictive view of ourselves is a task for all of us – whether we have lost, gained, or maintained our weight throughout out lives. When the stories that have defined are lives are no longer working for us, it’s time to write new ones.

Have you ever found yourself caught in memories of a body you no longer have?

Sarah has struggled for more years than she can remember with eating disorders. Her long periods of restriction, punctuated by episodes of binging and purging, have resulted in her developing an irregular heartbeat, weak kidneys, and medical bills that only exacerbate the feelings of anxiety that she has fought since she was a child. As her weight has fluctuated, so has her self-worth. She has lost countless relationships, years of education, and her career to this disorder. Now nearing thirty, Sarah is in treatment once again, this time determined to unravel the knotted threads of her disorder. She knows how; she now wants to know why.

The question of why when it comes to eating disorders has fueled hundreds of research studies, books, conference presentations, and late-night arguments between parent and child. And as society begins to recognize that eating disorders are lethal and are are increasingly impacting the most vulnerable among us – children and older adults – we are beginning to have the resources to answer that question.

But we’re not there yet.

On a listserv that I subscribe to, there was recently a lively discussion around the idea of calling an eating disorder a “brain disorder.” While no one was refuting the fact that eating disorders do involve brain functioning – heavily, in fact – there was discussion about the utility of referring to eating disorders in this way.

So what do we mean when we call an eating a brain disorder?

Well, if we’re being technical – and perhaps simplistic – a brain disorder is a disorder that affects and/or involves the brain. Yup, eating disorders do both.

Leading researchers in the field are conducting fascinating studies that reveal just how much brain mechanisms are related to eating disorders. Walter Kaye at the University of San Diego is one such individual. He has headed numerous studies examining how serotonin and dopamine affect eating disorders and exploring how changes in blood flow and oxygen use of the brain during eating. The results of Kaye and numerous others suggest that eating disorders are brain disorders – they irrefutably involve neurobiological functions.

The value of such information is, truly, incredible.

For one, it helps individuals who struggle with these illness and their families loosen the grip of blame that so often accompanies eating disorders. How many times have the victims heard, “Just give it up and stop already,” as if they decided one lazy afternoon to destroy their health and happiness? Recognizing eating disorders as brain disorders also pushes forward the slow process of pressuring legislators and insurance executives to treat them as the serious and life-threatening illnesses they are.

However, some caution, and perhaps rightfully so, that calling eating disorders brain disorders could minimize other important factors that contribute to these disorders, such as family dynamics and cultural influences. They worry that calling them brain disorders puts them in the category of other illnesses that are so often treated by throwing a pill at the problem. They fear that people with eating disorders will feel less empowered and less hopeful if they believe that their disorder represents a brain malfunction.

Thus, as with all language, perhaps we must be mindful of the associations that certain words hold. Because here are the facts:

Eating disorders are brain disorders, but they can also be environment disorders, family disorders, relationship disorders, and culture disorders (all of which admittedly involve the brain as well).

Eating disorders are brain disorders, but that doesn’t mean that they are cured by a pill.

Eating disorders are brain disorders, but they require treatment with a comprehensive team approach.

Eating disorders are brain disorders, but recovery is possible and requires the individual’s (very) hard work.

What do you think of calling an eating disorder a brain disorder?

{Image Credit :: Daniela Hartmann}

Pleasure…

For some of us, the sight and sound of that word elicits images of lazy Sunday afternoon wiffle ball games or sugary cones dripping with rich chocolate ice cream. But for many with a history of disordered eating, the word conveys something much more frightening – even threatening.

You see, the idea of pleasure isn’t as simple as green tea and long walks. In fact, it involves some pretty complicated brain circuitry and neurotransmitters.

[And why do mental health professionals wonder why they don’t get invited to parties? Perhaps it’s because we think too much about things like pleasure and make them far more complicated than needed. But bear with me…]

As I spelled in this post, researchers have found that people with eating disorders likely have altered levels of dopamine, one of the main chemicals responsible for pleasurable feelings. In individuals with anorexia or a history of the illness, Walter Kaye found that there was increased dopamine activity. This results not in a constant state of euphoria, unfortunately, but rather an avoidance of pleasure. Basically, it would be too intense for these individuals to experience pleasure, so they stay away from it altogether. Joy can hurt.

And what about for the rest of us? If our dopamine is in check, then why the heck do we work so much and play so little? Why do we avoid things and places and experiences and relationships that would bring us pleasure?

My belief is that we’re terrified of truly experiencing pleasure. But why?

Neuroscientist Kent Berridge at the University of Michigan has developed a new theory on pleasure. His experiments suggest that what we feel when our brain circuitry feels “pleasure” is actually “desire.” So the experience we have when we think we are liking something is actually a feeling of wanting.

So what’s so bad about wanting? [And what’s with all the questions today, Ashley?]

As humans, it’s threatening to be in want. It means we perceive ourselves as lacking something, and that something could be important (like for this season of Glee to never end… or shelter).

But beyond that, it can feel downright dangerous to want, particularly for women. We are taught in our early homes and in our communities to keep our needs and desires in check. We are taught that we want too much and we sometimes get the message (whether through abuse, neglect, or something more subtle) that our needs just can’t or won’t be met.

So we learn to fear our hunger – literally and figuratively. We don’t know what to do with that gnawing desire and so we turn it inward. But rather than dissipate, it grows inside us aches and burns until we are forced to look at it. We yearn for pleasure.

To be truly healthy means sitting with the fear that comes with wanting.  And it means to learn to feed that hunger for pleasure in all the ways that we can – physically, emotionally, and spiritually.

How do you experience pleasure?

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This post was written as part of the Self-Discovery, Word by Word series. This month the series is hosted by the fantastic Joy Tanksley who chose the word PLEASURE.

{Image Credit :: Justin Solomon}