Jan 17

Neuroplasticity (src:goconqr)For a long time, the brain of an adult was considered as a rigidly fixed, hard-wired organ. The latest scientific findings, however, show just the opposite, proving not only something that Buddhists have always known, but also illustrating why psychotherapy ‘works’ ‚Ķ and that many of our weaknesses might actually be more changeable than we had dared to hope.

One of the most fascinating areas of research in neurobiology is the one dealing with the so-called ‘neuroplasticity’, or ‘neural plasticity’. This term refers to the ability of synapses, nerve cells or entire areas of the brain to change and adapt depending on their use. Depending on the neural system referred to, it may also be called ‘synaptic plasticity’ or ‘cortical plasticity’. The basis for the discovery of the adaptability of the brain and nerve cells was the research of psychologist Donald O. Hebb (1904-1985).

Researchers at the University of Zurich showed for example that for someone who experienced a right humerus fracture and was restricted to use only his left hand, striking anatomical changes could be proven in specific brain areas after just 16 days: the thickness of several sections of the left brain hemisphere was reduced, while parts of the right hemisphere compensating for the injury increased in size. Also, the fine motor skills of the compensating hand had improved significantly.

Simple, but amazing results in tests confirm that even the basic act of imagination can enlarge areas of the human brain: brain researcher Pascual-Leone, for instance, asked volunteers to practice a simple piano piece and then analyzed the motor areas of their cerebral cortex. He found that the area which is responsible for controlling the finger movements had increased in size. So it appears that the popular comparison by teachers to see the brain as a muscle is actually not that far-fetched: if certain areas of our brain are continuously used and ‘exercised’, they seem to develop – and our skills and the information that can be stored in these cerebral areas will increase accordingly.

In another experiment, the subjects should just imagine to play the piano piece for a certain amount of time. The astonishing result: exactly the same areas of the brain had been found changing as in the volunteers who had actually practicioned the piece on the piano. So just by thinking or by mental training alone – by an activation of the involved neural circuits -, physiological changes of the brain can apparently be stimulated.
Quite an amazing story in this context is the one of painter Esref Armagan, who has been blind from birth. Nevertheless, he is able to create realistic images of buildings and landscapes that he knows only from descriptions. Although the visual areas of his brain had never received an external visual stimulus, the associated brain areas are as active as the ones of someone who can see: just by the descriptions of the objects he later paints on paper, his brain is recognizing mental images.

Mere imagination can seemingly have enourmous effects on our brain, and actually we already know such effects from psychotherapy : it’s range of methods allows to ‘try’ new behaviors and mental concepts in the client’s imaginagion or the therapeutic practice. Later on, they can ultimately be implemented in the life ‘out there’. Piece by piece, old and hindering concepts of thinking are replaced by others that can make us happier, more confident and help us to achieve our personal goals and needs in more successful ways than before. It explains why psychotherapy can achieve supportive effects even with severe mental illnesses and neurological disorders.

To Buddhists experienced in meditation, all this will not sound new at all: if someone is able to concentrate on one thought for a long time, negative thoughts can gradually be overcome. By overcoming those thoughts that cause mental suffering, however, a physiological and permanent adaptation of the brain circuits may be achieved that had caused these negative thoughts before. What can be achieved by the external and professional guidance of a trained psychotherapist, Buddhist monks can reach only by themselves through years of meditation practice.

Therapeutic effects of neuroplasticity have been documented after strokes, in pain treatment, in autism, for symptoms of paralysis, learning difficulties, phantom pain and many more (many of which are mentioned in detail in the videos and the bibliography linked below). Just as epigenetics, neuroplasticity seems to be an evolutionary factor by which humans can gradually adapt to the demands of the environment they live in.

Resources and links:


The Brain That Changes Itself – short documentary: Canadian psychiatrist and psychotherapist Norman Doidge about the adaptability of the human brain.

Neuroplasticity and Rehabilitation   by Sarah A. Raskin
The Brain That Changes Itself   by Norman Doidge
The Mind and the Brain: Neuroplasticity and the Power of Mental Force   by Sharon Begley
Books about Neurobiology   (german)

(Sources: N. Langer et.al, Effects of limb immobilization on brain plasticity in: Neurology, Jan 17, 2012;
Image sources: goconqr.com, persoenlichkeits-blog.de)

Blog entry first released in 08/2010 in german language (‘Neuroplastizit√§t’); continuously updated, last update: Jan 18, 2012)

Dec 31

To a high extent, the work of a psychotherapist consists of the treatment of the various forms of depression, so I’ve always tried to improve my understanding of this particular form of mental disorder – and of its most extreme form, the idea to commit suicide. So I’ve continuously gathered data on suicide – here you will find a compendium of the information I found, a sort of overview of the currently known facts and figures on this subject.

Frequency

It is estimated one million people a year die by suicide, which equals about one every 40 seconds – but that number may actually be even significantly higher, since the official numbers released by many countries are too low. Suicide thus contributes at least 1.5 percent of the global deaths and is the tenth leading cause of death. In 2006, 140,000 people had taken their lives, that equals 11.1 per 100,000 people. People under 25 years of age are most vulnerable (there was no significan change compared with previous years), and the elderly (where a significant decline in suicides was found).

Trends in some OECD countries, graph: OECD

Regional differences: within Europe, the rates in the northern countries are generally slightly higher than in the southern ones. An effect of latitude on the suicide rate was found in Japan, suggesting an influence of the daily duration of sunshine. Nevertheless, other countries can have significantly different rates of suicide compared to Japan at the same latitudes, like Great Britain or Hungary for example. Suicide is a significant problem in the former Soviet states, and more than 30 percent of suicides worldwide occur in China, where 3.6 percent of all deaths are attributed to suicide.
Regarding the impact of light/solar radiation by correlating the suicide rate with the number of hours of sunshine a day, a seasonal clustering of cases of suicides could be proved in 2011 in a study by the Medical University of Vienna that was published in the journal “Comprehensive Psychiatry”.

Particularl attention deserves South Korea where in recent years, the suicide rates have increased drastically, namely by 172% to 21.5 per 100,000. The number of suicides by men has almost tripled from 12 per 100,000 (1990) to 32 per 100,000. With 13 of 100,000, the suicide rate among women is also the highest. The OECD attributes the rise in suicides on the economic decline, dwindling social integration and the disintegration of traditional family bonds. But it may be doubted whether this is really something that extraordinary compared to Mexico (+43%), Japan (+32%) and Portugal (+9%), which also reported an increase in the suicide rate. In Hungary, the suicide rate has declined by 41 percent, but the country, with 21 suicides per 100,000, is still second only to South Korea. Finland’s numbers are also above average with a high suicide rate of 18, followed by France (14.2), Switzerland (14), Poland (13.2) and Austria (12.6, 27/100,000 in men, in women 10/100,000). Germany, where the number of suicides compared to 1990 decreased by 37 percent, with 9.1 in the lower third. Apart from Great Britain (6.1) and Mexico (3.1) the situation appears on the Mediterranean people to do well. In Spain (6.3) and Italy (4.8), far fewer people kill themselves than in other OECD countries. And the Greeks are drawn the least to commit suicide: here, just 2.8 per 100,000 kill themselves

Conflicting data on the so-called happiness research was revealed by a remarkable study analyzing the correlations between life satisfaction and suicidal tendencies. In a comparison with the average satisfaction of people according to the “World Values ‚Äč‚ÄčSurvey” and the suicide rates according to the WHO, the suicide rate is not only very high in the Scandinavian countries in spite of their high satisfaction but also in Iceland, Ireland, Switzerland, Canada or the U.S. The conclusion of the study was that the relation between high life satisfaction and high suicide rates was independent of harsh winters, religious and cultural differences in different countries (more)

One possible explanation for this ostensible contradiction could be that in an environment where many other people are ‘happy’, own discontent, own suffering is felt more strongly. If there is also despair of beign able to achieve a change, certain personality types may see suicide as a way out.

A few more details about Austria: in Salzburg, the Crisis Intervention Center (‘Kriseninterventions-Zentrum’; of others, I don’t have any data) recorded a significant increase in patients in their teens in 2010. In Austria, about twice as many people die by their own hand than after traffic accidents every year. In 2002, 1.551 chose to commit suicide, including 50 children and adolescents aged ten to 20 years. Self-injuries in children are also on the rise. At the whole of Austria, the suicide rate of the early 1960’s has risen sharply until the mid-1980’s – to 24 suicides per 100,000 of the population. Since then, the rate decreased and it is now (as already mentioned above), at 13 per 100,000 per year. This equals about 1,300 suicides per year.

However, there are growing doubts within the Austrian scientific community as to the accuracy of these statistics, and I want to outline them a bit further to help you, the reader, understnad the underlying problems of suicide studies: fewer and fewer autopsies are performed as in Austria, which decreases the possibility to distinguish suicides from natural deaths. Thus, in countries with the highest autopsy rates as in the Baltic states or Hungary, the suicide rates are generally higher than in countries with low autopsy rates. Similarly, in countries where autopsy rates are declining, at the same time there are also increasingly fewer registered suicides (Source: Archives of General Psychiatry 2011 (Link). So with statistics like these, there is always reason to question whether such statistics can be trusted at all.

More gender-related details: is in the developed countries, the gender ratio of suicides is roughly 2-4 (men) : 1 (women) and seems to be increasing. Asian countries show a smaller ratio, but it seems to be increasing as well. Only China has more women than men dying from suicide.

Risk factors for suicide

Among the many factors that may raise the risk of suicide, the most important known ones currently seem to be:

  • male gender (OECD: 17.6 per 100,000 males, 5.2 for women)
  • a history of self harm
  • psychiatric disorders and / or
  • Alkohol-/Medikamentenmissbrauch
  • upbringing and education
  • suicide depictions in the media
  • smoking

Genetics and Neurobiology

Autopsies of suicide victims showed changes in central neurotransmission functions, such as the serotonin system (mood-regulating hormones). Low cholesterol concentrations are associated with higher suicide risk, but the risk is greater if the lower cholesterol level was reached with diets rather than by using statins. The authors suppose that this may stem from the fact that dieting people have a higher risk of mental problems, but so far, there was no corroborating evidence for this theory. Furthermore, family histories of suicide at least double the risk for girls and women. Although the evidence is scanty here as well, a number of researchers suggest that high levels of aggressive behaviors and impulsiveness may also be associated with an increased risk of suicide. Especially in young boys, suicide rates increase over the years of their growing up, while a higher suicide risk because of hereditary components was primarily detected on the maternal side.

Professional guilds

Suicide rates are higher among non-workers (unemployed, retired etc.) than among employed persons/professionals. Higher rates are also partly linked to mental illness, which in turn has a connection with unemployment.

Among the professionals, however, some groups show an increased risk: medical practitioners have a high risk in most countries, and doctors (and related jobs in the health professions) generally have the highest risk. Nurses also have a high risk. Particularly in these groups, the easy access to venoms seems to be an important factor influencing the high rates. Anesthesiologists are particularly vulnerable among physicians because narcotic drugs are used in many suicides. Several other high-risk professions are dentists, pharmacists, veterinarians and farmers.

Age Groups, Ethnicity, ..and Seasons

In most countries, suicide rates are highest amongst elder people, however, in the past 50 years, the rates among the younger population has increased as well, especially in men. Suicides are committed most frequently in spring, especially among men as well. People born during spring or early summer have an increased risk of suicide, especially women. Americans of European descent have higher suicide rates than Americans of Latin American or African origin, with this difference increasingly leveling out amongst young African Americans due to the increased suicide rate among young African Americans slowly. Indigenous groups such as Aborigines in Australia and Native Americans also have higher suicide rates, possibly due to cultural, social exclusion and greater alcohol abuse.

Suicide Methods

Quite generally, men prefer more violent means of suicide (for example, by strangulation or shooting themselves), and women ‘softer’ forms (self-poisoning), which is probably the explanation for the sharp difference in successful suicides between men and women (see above) and the suicide attempts that both sexes undergo in about equal rates. Different cultures show different preferences in methods, in South Asia for example, women typically burn themselves. Access to specific methods could be the factor that finally leads to putting suicidal thoughts into action. In the U.S., firearms are used for by far the most suicides, with the risk of using them for this purpose being the highest where guns are found in households. In the rural areas of many developing countries, the ingestion of pesticides is the most common method, which reflects the toxicity, easy availability and the lack of storage. At up to 30 percent of suicides worldwide, pesticides are involved.

Comorbidities und Connections with Mental Disorders

Mental health problems are a major factor in suicides. It is believed that of about 90 percent of people who kill themselves, they suffered from a kind of psychiatric disorder. Depression increases the risk to the 15- to 20-fold, and about 4% of patients suffering from depression die by suicide – but only about 20-30% of depression are recognized (!). But even for those, in most cases many years are passing to the correct diagnosis, and then, still, less than 50% of the diagnosed patients ever starts looking for a psychotherapy and/or receives pure pharmacological support. This means that most people suffer on a chronical basis, but don’t search – or can’t find – adequate help.

Clinical signs of suicide where depression was involved, are patients with previous self-harm, hopelessness and suicidal tendencies. About 10-15% of patients with bipolar disorder die by suicide, but the risk is highest at the beginning of the disease. About 5% of schizophrenia patients also die by suicide. Alcohol abuse, anorexia, attention deficit-hyperactivity disorder (ADHD) and body dysmorphic disorder (KDS) all increase the risk of suicide. Especially the last example explains in part why the risk increases in women after breast-enlarging surgeries.

Physical health also plays a role, but with some strange results. Surprisingly, people with higher body mass index (BMI) have a significantly greater risk of depression, however, their risk of suicide is lower (15% decrease in suicide risk per 5 kg per square meter of body surface area increase in BMI). The reasons for this are unknown. Cancers, particularly of the head and neck, HIV / AIDS, multiple sclerosis, epilepsy and several other diseases also increase the risk of suicide.

Other factors that increase the risk of suicide include physical abuse and sexual abuse over the childhood, or events that affect the entire population (such as natural disasters or the deaths of celebrities). After the death of Diana, the Princess of Wales, in 1997, the suicide rate rose by 17%, most clearly in her age group. War involvements reduce suicide rates, possibly due to the social cohesion that is generated in the communities. People who have suffered a loss by suicide, are themselves at increased risk, and suicide clusters may occur in communities or through Internet contacts. The authors add: ‘A significant proportion of the evidence shows that certain types of media that report on or present suicidal behavior, may influence suicidal behavior and self-harm in the general population.’

A ‘hot potato’ in the psychiatric community are recent studies showing that even antidepressants can induce suicidal thoughts not only in adolescents, but also in adults. I already posted a few articles related to these studies in this blog.

(Sources for the aforementioned numbers: Health at a Glance 2009: OECD Indicators; MedAustria)

Suicide und Self-Injury

In addition to rising suicide rates, there is also an increase in self-harm among young people, as pedagogues report in many Western countries. The reasons for this may be traumatic experiences in early childhood. The brain has a high plasticity and very vulnerable to external factors during this stage of development. Serious diseases, sexual abuse, neglect and lack of communication in bringing up – often caused by hours in front of the television or computer games – are also considered to be significant risk factors for later suicide attempts. They may also cause children and adolescents to harm themselves physically. Burned skin from cigarettes or scratches from knifes or razor blades must be understood as a cry for help.

While in 1950, only 40% of people who attempted suicides were under 45 according to the WHO, we were already at 55% in 2004. A reason for depression occurring at earlier stages of life might be the earlier onset of puberty and the decaying of family structures. If there is healthy communication within the family, and if common concerns and problems can be expressed and discussed, it is much easier for young people to overcome a crisis.

(Source: Der Standard, 06/2004)

How can suicided be prevented?

Suicide preventionThe claim to be able to prevent suicides would be a difficult one to fulfill because of the large number of factors that are involved until it actually comes to a suicide attempt. Strategies could be aimed at high-risk groups or trying to reduce the risks for the population as a whole. Firstly, any person with depression should be checked for suicide risk by professionals specifically asking about suicidal thoughts and plans. This shows the importance of specific training and sensitivity of physicians who are often enough the only ‘professionals’ many depressive persons might have contact to at the first place. Studies from the Nordic countries show a decline in suicide rates by 20 to 30% after general practitioners were trained to recognize depression properly and to help patients to get appropriate therapy (psychotherapy and supportive pharmaceutical measures).

In cases of high or imminent suicide risk, immediate action is necessary, including vigilance and monitoring of those affected, possibly through hospitalization. In addition, potential tools that may be used for suicide attempts have to be removed and an aggressive treatment of the associated psychiatric disorder be initiated.

A restriction of access to potentially lethal substances or tools can indeed help to prevent suicides. The introduction of security cameras on bridges and increased control of firearms, as well as the safer storage of pesticides and poisons (especially in rural areas of developing countries) has been proven to significantly reduce the risks. Education programs to improve the mental well-being as well as stricter control of the media reporting of suicides could also have preventive effects. On the objection that persons who wish to commit suicide would find ways and means to realize their goal in any case it may come as a surprise that for example when switching from toxic coal gas to non-toxic North Sea gas in the UK, the suicide numbers declined dramatically, while, for example in Japan right after the release of two films that were romantically idealizing the issue of suicide, the corresponding numbers increased significantly. Helsinki had the world’s highest suicide rate in the 90s and was able to cut it to 18 per 100,000 through prevention programs.

Because on the internet – in addition to advice and instructions for suicide in ‘suicide forums’ – a new trend had been detected in Japan to arrange collective suicides online, the government of South Korea (which had recently suffered the world’s largest increase of suicides, see above) will block related Internet sites, and there are also plans to make it more difficult to find information about suicide on Internet portals by blocking specific keywords such as suicide, ‘how can I die’, ‘collective suicide’, ‘suicide techniques’ and others. In addition the government plans to create a legal basis for the police to request the personal information of Internet users from their service providers who promote suicide or offer advice to persons willing to undergo suicide.

The challenges to prevent suicides in developing countries requires special attention, as most of the suicide-related research is done in developed countries, while the highest suicide rates are in fact found in developing countries. On nation-wide measures it is also worth mentioning that after a recent meta-analysis of randomized studies ([1], [2]) had suggested that the risk of death and suicide in people with mood disorders receiving lithium has been reduced by 60 percent, researchers have brought up the idea of adding small doses of Lithium to tap water.

Family members and the social environment in general also have an essential role. Relatives may be the first ones who can notice that someone might isolate himself or is depressed. It is of utmost importance to recognize these signs (see article about presuicidal syndrome) and to talk to the affected person about it. Nevertheless, the options and means of family members and friends are often limited – it is therefore important to involve external help (a psychotherapist, counselor, psychiatrist or at least a family doctor) if one feels overwhelmed or feels no longer able to reach the person.

Treatment of Depression

That psychological treatment can prevent a suicide in many cases is a well known fact that has been proven in numerous studies. The World Health Report 2001 already reported, quoting several studies, that some mental disorders may be chronic and of long duration, but that with proper treatment, those suffering from mental disorders can now lead a productive life and participate in their communities. Up to 60% of people suffering from severe depression can get well with the right combination of psychotherapy and antidepressants. I’ve written a detailed article on this topic in the publications section of my German-language website, which specifically describes and comments the latest standards for the treatment of depression.

(Further sources: APA, AZ, Der Standard 03.06.04, The Lancet Vol. 373, Issue 9672, p.1372-1381, 18 April 2009, Telepolis [1], see also links to sources right within the article.
This blog entry was first published in 12/2009; continuously updated as soon as I get aware of new facts. Last updated: 12/2012).

more blog articles about suicide

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Dec 29

Today, I stumbled upon an impressive and moving interview with the survivor of a suicide attempt that was published in a newspaper article in September 2000. In a state of presuicidal constriction / presuicidal syndrome, Kevin Hines jumped of the Golden Gate Bridge and survived this jump only by extremely fortunate circumstances .

Photo © Seattle Times

Bild © Seattle Times

Today he can talk about it and works in a helping profession (nurse). In his spare time, he tries to inform and educate others about the importance of an accurate and professional medical and psychotherapeutic treatment of mental illness. ‘I’d feel lucky if with my horrific experience, I can just keep only one person from taking his own life,’ he says in the NZZ interview with G. Sachse. Indeed, during the (time-limited) course of a presuicidal syndrome that may define one of the worst stages of depression but also of paranoid delusions, the way the affected person perceives, experiences and thinks about what is going on may be much different than under normal circumstances, and it may also be linked differently than usual with one’s emotions and behavior. At the end, the affected person may see no other way out than to take his/her own life. Only after the abating of the syndrome, other options can be perceived and imagined again – that is why in times of crisis it is so vital to seek professional help right away (eg by doing an emergency-call, calling in for a crisis appointment at a psychotherapist, vitising a psychiatric clinic etc.) just to overcome the most difficult time. At least, friends or other acquaintances should be called up – the idea is to “play for time”, to aim at getting over this barely endurable phase by all means, at least to get through until the next morning. If, unexpectedly, you as the suffering person would still not feel better at that time, you should contact a trusted physician. Consider, however, that for periods of serious depression, it is actually recommended to consult a qualified psychiatrist or psychotherapist, even if it has not yet already come to suicidal thoughts, or if these thoughts have already subsided – to avoid them from coming up again by treating the underlying depression.

In conversations with clients who have dealt with phases of suicidal constriction, they repeatedly confirmed how happy they were about having ‘survived’ the critical phase once they had stabilized again and how lucky they felt that they didn’t end their life before. Sometimes, they had experienced completely unexpected positive events in the time since their deepest phases of depression, but more generally, their life had taken a positive turn since they had continued with their psychotherapy, an upturn that was not forseeable.¬†“Give life a chance” – this common slogan (that is usually used in a different context) shouldn’t be forgotten especially in the phases of life where it apparently can’t get any lower.¬† As we know from economic sciences, it is systemically inherent that after a low point, it can only go upwards again. What could be worse in life than a stage in which there doesn’t seem to be any way out other than death? As paradoxical as it may sound, after successfully having weathered the worst hours of a particular night, life will most probably already feel at least an iota better the next morning. Talking to someone (especially one with a person who is professionally trained to assist in difficult phases of life), it is usually possible to develop completely new perspectives, perspectives that can give life a positive turn on a long-term scale.

To avoid being misunderstood: this is certainly not always an easy or quick process – but properly accompanied and instructed, the majority of people succeed at the end.

Further information:

Depression – Mythen und Fakten rund um eine ‘Zeitkrankheit’ (Artikel R.L.Fellner; german language)
Vier Sekunden bis zum Aufprall (NZZ Interview mit Kevin Hines 2009; german)
Lethal Beauty РA jumper [..] makes a new life  (San Francisco Chronicle 2005)
(Blog entry first published in German language (‘Gedanken eines Suizidversuch-√úberlebenden’) in 03/2009, published on English website: 12/2011)

Aug 18

A nice friend just sent me a link to this article:

Addiction is a brain disease, experts declare
(Source: L.A. Times, August 16, 2011)

But wait: addiction is now ‘a brain disease‘?!

Well, be warned – here comes a therapist’s viewpoint on that! ūüėČ

The scientific community in the US and Europe is highly influenced (or corrupted?) by the money invested into neuronal and neurochemical research (especially by the pharma and the genetic research industry, but also the American government and the EU for various reasons).

As a result, there are only comparably little funds available for more research on utilizing psychotherapy or even neuroplasticity, because with those becoming more effective, these huge money-maker industries would lose cash and stock value.

That’s why a huge part of this particular scientific community is still seeing us as machines (just like in the 18th and 19th century!), which just need the correct surgery or pill in order to work ‘as intended’ (whatever that is..) again.

The simplified claim that the brain is ‘responsible’ for addiction is actually ridiculous and just possible if such a scientist is wearing blinders, completely blinding out all other research fields related to human behavior. If these theories were right, it would not be possible for patients to successfully stop taking drugs, gambling, over-eating etc. within just 2-3 months during a successful psychotherapy.

But it is.

It would be as if I would announce that I have found prove that ants are only able to crawl because they have legs. Yeah right, but there is a little bit more to ants than just legs.

And even though I would agree that our consciousness, our psyche is at least to a large extent -if not completely- a product of our brain, it would still be incorrect to blank out all the other means this ‘computer’ has to repair itself apart from pills or a scalpel.

May 19

One of the lesser known aspects of psychotherapy is the rule of confidentiality. This rule (which by the way is not a binding part of Thai law yet, but handled very strictly in most Western countries) basically says that everything a client tells in the context of an ongoing psychotherapy has to remain between the therapist and the client/patient. In my home country Austria, psychotherapists are not even allowed to inform married partners about the diagnosis or whether the spouse or wife has been attending a therapy session or not. Clients can release the therapist from this constraint, but only to a certain extent. In court, psychotherapists are not allowed to reveal details of the therapeutic conversations as well. Exceptions to the rule of confidentiality are usually only allowed in cases where there is imminent danger.

While this regulation might sound awkward to some, it makes perfect sense. it guarantees a safe place for patients where they can trustfully express their deepest feelings and weakest points without having to fear that anyone else will ever hear about them. In times where more and more slices of our ‘privacy’ are taken away from us by governments and electronic means, and where society has developed some very tight models of ‘politically correct’ thinking, it can be very important to be able to have at least one place where you can express your thoughts, concerns, or your most delicate problems, being sure that they will remain inside the 4 walls of the therapist’s practice. It has happened more than just a few times, for instance, where men told me about pedophile or violent fantasies or where women told about certain sex-related issues or problems trying to find a partner; only if such thoughts can be expressed and openly talked about without having to fear being looked down upon it is possible to put these very delicate issues into perspective and to develop strategies on how to deal with them better than before, or maybe even to resolve the situation by applying new ideas and approaches.

The rule of confidentiality alone is a good reason why someone seeing a psychotherapist or counselor doesn’t have to consider thenselves as ‘weak’ or ‘mental’. Having an atmosphere where one can openly talk about their problems with someone who will take a neutral position and just tries to support as effectively as possible can be reason enough. If you are not sure how your therapist or counselor handles the rule of confidentiality, just ask. It’s a sign of professionalism if you receive a straight answer on it.

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2011)

Jul 31

Psychiatrist, Psychologist, Counselor, Trainer or Psychotherapist?
The maze of mental health-related job titles.

Most of the people looking for advice, having personal problems or problems in their relationrships inevitably have to ask themselves: who is the right person to adress my issues? 100 years ago it was usually a priest or a medical doctor. Today, however, thanks to the great progress in specialization and research, it makes sense to contact the most competent partner.

Psychiatrists and neurologists: they are trained medical doctors specializing in the diagnosis and predominantly pharmacological (drug) treatment of severe mental disorders such as personality disorders and psychosis (such as schizophrenia etc.) and neurological disorders (disorders of the nervous system).
Psychologists: are the experts on mental processes and structures. It’s clinical psychologists who usually specialize in diagnosis, counseling and training. Offering psychotherapy, however, requires additional qualifications in most countries.

Coaches, counselors, advisers: these titles are not protected, so a proliferation of vendors, mostly without any skills, or professionally based training exists. “Before use”, therefore, an opinion about the seriousness of the provider should be formed.
Psychotherapists: for their profession, the therapeutic treatment of mental disorders and psychological burden, they have to undergo several years of intense training. Psychotherapeutic applications include couples therapy and sex therapy. Psychotherapies usually involve sessions of about 50 minutes every 1-2 weeks.

For minor issues only recently beginning, counseling is usually sufficient. If these issues have lasted longer or occur again and again, it is recommended to visit a qualified psychotherapist and to follow through with the therapy for several months to achieve long-term improvement. With severe mental illness, consult a psychiatrist in order to get a correct diagnosis and medication support as complementary treatment – it is worldwide standard today to get supportive and stimulating psychotherapeutic treatment for psychiatric disorders as well. This approach however seems to only slowly gain footing in Thailand.

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2010)

Jul 28

counseling: who needs such a thing?‘ This is about the view some veteran personalities express when the issue comes to psychotherapy or counseling. psychotherapy still has a dubious image – people who need it would have to be losers or people who don’t have control over their lives.

But a look outside the box shows that in progressive and self-critical, competitive societies, approaches such as psychotherapy, coaching or counseling are well accepted aids in difficult situations of life. Celebrities talk openly about how they learned more about themselves in psychotherapy, and managers report about achieving new momentum through coaching on a regular basis for their challenging job.

To see the potential of counseling, one has to understand that a person’s ability to help and ‘advise’ herself is actually quite limited. Each of us has a very personal way to deal with problems: again and again we apply pretty much the same strategies – and even if they fail, most of us tend to just try harder, even at the risk of a disaster. counseling and therapy however primarily bring in neutral and unbiased feedback from a professional not stuck in the dilemma – often, he can also introduce new perspectives and establish new and creative ways of dealing with the challenge to ease overcoming the obstacles for a solution.
In this sense, seeking counseling, coaching or psychotherapy is a sign of foresight and intelligence: that someone considers himself and his life so valuable that he no longer accepts feeling unhappy or wastes time by just relying on his own ways of thinking.

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2010)

Jun 29

You’re psychotic!‘ That’s supposed to be the ‘polite’ form of the phrase ‘You’re insane!’, used by some when they can’t explain the actions of a person.

In deeply nature-bound cultures, people whose behavior strongly deviated from what was perceived as ‘normal’, were treated by magicians and shamans. In the West, however, they were locked up in so-called ‘insane asylums’ where they often received cruel treatment. Only in the 1930s, psychiatrist Karl Birnbaum introduced a first definition of the medical term ‘psychosis’: according to his theory, biological roots defined the form of the disease, while its severity, beginning and course would be strongly influenced by psychological factors, so new ways of treatment were experimented with.

The importance of the factors involved in psychiatric diseases was subjected to historical changes: while the ‘mentally ill’ were considered as uncurable before psychiatry became a medical science, after Birnbaum and Freud, psychotherapy had its heyday. Currently, we are again in a phase with an emphasis on physical (neurological) theories and treatments. Sometimes, treatment is so focused on pharmacological prescriptions that even patients feel that ‘something is missing’. The most successfull concepts in modern therapy therefore involve a multi-strategic approach of pharmacological, psychotherapeutic and social therapeutic aid.

People experiencing psychosis or psychotic episodes may report hallucinations or delusional beliefs, and exhibit personality changes and confusion. Depending on its severity, this may be accompanied by unusual or bizarre behavior, as well as difficulty with social interaction and impairment in carrying out every day activities due to feelings of anxiety, irritation, moodiness, and passive or indifferent behavior.

As patients are often intimidated about having to fight mental problems or might perceive their own situation in a distorted way, it is essential that friends or relatives do their best to help them get a proper diagnosis and therapy. If treatment starts early, the chances of stabilization and returning to a balanced and stable life increase significantly.

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2010)

Nov 29

Posttraumatic Stress Disorders (PTSD) was very much one of the centers of attention during the last years of psychological research. Posttraumatic stress disorders may develop when  people are exposed to life-threatening situations Рsuch as natural disasters, assassinations, sexual abuse or war events. It is estimated that up to 50% of all U.S. soldiers returning from war zones are affected by forms of post-traumatic stress disorder. But PTSD is difficult to treat and usually requires a lengthy therapy, even though various pharmacological approaches using the stress hormone cortisol, beta-blockers include Propranolo [1] and psychotherapy (the special trauma therapy methods based on hypnotherapy like EMDR, or combined approaches such as the one by Luise Reddemann) brought significant progress.

New hope now comes from a totally unexpected direction: in a study done together with graduate student E. Ganon-Elazar and published in the Journal of Neuroscience [2] it was shown that the activation of cannabinoid receptors in the basolateral nuclear complex of the amygdala (BLA) compensates the  effect of stress during conditioning. Many years ago, the pharmacist at the Jerusalem University, Rafael Meshulam, already published similar positive effects when he administered traumatized mice, now his results could be confirmed in trials with rats. Following a decision of the Supreme Court of Croatia in an appeal against a man who had fought in the war in Yugoslavia and was since then suffering from PTSD, war veterans suffering from post traumatic stress disorder may now even now grow marijuana for self-treatment. [3]

(Sources: [1] Andrea Naica-Loebell: “Die Pille f√ľr das Vergessen” in: telepolis Online-Magazin, 08/2005; [2] Ganon-Elazar, E. & Akirav, I. (2009), Cannabinoid receptor activation in the basolateral amygdala blocks the effects of stress on the conditioning and extinction of inhibitory avoidance. Journal of Neuroscience, 29(36):11078-11088; [3] Der Standard 04.06.2009; Image credit: Cannabisculture.com)

Aug 10

Antidepressants are now the best-selling drugs in the USA – and their consumption has doubled in the last 10 years.

This was established by a meta-analysis of studies from 1996 to 2005 among 50,000 children and adults and published in the Archives of General Psychiatry. Currently 10 percent of Americans – about 27 million people – are taking antidepressants, approximately twice as many as in 1996.

Only half of these people, however, are actually treated solely for depression, the rest are taking the drug because of back pain, fatigue, insomnia and other problems. So the increased consumption doesn’t necessarily mean that more people are depressed, but that the drugs are used to manage or facilitate everyday life, and probably also as mood enhancers.

This also fits the other findings, namely that the proportion of people who take antidepressants and who are undergoing psychotherapy at the same time dropped from 31 to 20 percent. Presumably many feel insecure about dealing with the reasons for their psychological problems or are uncertain about whether psychotherapy could really help – while the belief in the effectiveness of drugs is increasing. Also, ‘dropping a pill’ is simple and costs less money – at least in the short run, especially since many American insurance companies don’t pay for psychotherapy, and doctors prefer prescribing drugs over dealing with their patients thourougly as this saves valuable time for other patients waiting in the queues.

The study’s authors argue that an essential factor for these changes may represent the enormous dedication of funds for advertising: for advertisements aiming at end users (patients), 32 million USD were used in 1996, but already 122 million USD in 2005. Only 14% of the proceeds from sales had been reinvested in research and production by the industry – the rest goes to marketing and profit distributions 1.

Update:
A reader of this post has sent me a graphic his company, MedicalBillingAndCodingonline.org, has created and released under the Creative Commons License. I think it illustrates the major aspects of the current trends just great. Please click here or on the image at the right or download a large version of the graphcic from the author’s site.

(Sources: New England Jornal of Medicine in an interview by The Nation, 20090809; “National Patterns in Antidepressant Medication Treatment” by Mark Olfson & Steven C. Marcus in: Arch Gen Psychiatry 2009;66(8):848-85)

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