There has been a lot of buzz about the American Psychological Association’s recent Stress in America survey. Some question whether it really represents the state of the nation’s stress, others question whether or not we can really do anything about our stress, and some wonder if it even matters.

After all, everyone always has to deal with some stress, right?

Deborah Kotz of the Boston Globe’s Daily Dose questioned whether the APA’s survey results were accurate. She did her own (though admittedly unscientific) poll online.

Interestingly at the time I wrote this post, her results  mirrored those of the APA survey, and in fact, made the situation even more alarming. Her results indicated that 34.28 percent of Americans described themselves as extremely stressed, have gained weight and are having other health problems. And another 29.32 percent of Americans feel frazzled a lot and don’t believe they are dealing well with stress.

Her article has generated lots of comments by people frustrated at the lack of available services. The stigma they feel is attached to a diagnosis of mental illness and the cost of getting help. Others have pointed out the need for increased education about  stress and mental illness and the benefits to individuals and their families.

Here are some very important facts:

• People with serious mental illness have a 25-year shorter life span than those who do not. Three out of five of these people die of mostly preventable conditions, such as obesity and heart disease.
• Estimates are that 11 percent to 36 percent of primary care patients have a psychiatric disorder.
• One recent survey of mental health conditions in urban family medicine practices revealed that more than 40 percent of survey respondents met criteria for a mental health disorder. But, many come to the physicians’ offices with complaints of headaches and stomach issues such as irritable bowel. Too often patients are told to lose weight, take it easy or handed a prescription with no follow-up.

The American Academy of Family Physicians noted the following:

Psychiatric problems are a major health issue. In the United States, neuropsychiatric disorders have now surpassed other disorders such as cardiovascular diseases and malignant neoplasms as the number one cause of disability as expressed as disability-adjusted life years.

According to the most recent data available, mental health expenditures in the United States, expressed as a percentage of total health care expenditures, were more than 6 percent.

Most family practice physicians are not well trained to manage psychiatric issues. As a result, lots of unnecessary and very expensive medical tests are performed when psychotherapy might be what is needed.

So the answer is yes, stress matters! And yes, we need to learn to better manage our stress.

We need to learn about mental illness and make sure we provide and receive appropriate treatment. Financially, we can’t afford not to. The loss of life is so often unnecessary. There is no price to put on the life and unnecessary death of a loved one.

While I recognize that simply taking a bubble bath, as one person commented, will not solve the tremendous financial and family pressures that  people currently are facing, reducing our stress levels in areas where we have control–such as exercise, breathing techniques, massage, meditation and even bubble baths–can clear our minds so we are capable of making better choices and decisions and can be more resilient.

And remember: This is today. It does not mean things will be like this forever.

Photo by isabisa via Flickr

My mother-in-law is 97 years old. She was born in Italy and moved to the United States when she was 6. She has always been a homebody. She cooked, cleaned and took care of her family. And boy did she cook. Pasta was truly home made. Her fresh baked rolls, bracciolini, ravioli, squash blossoms and risotto were to die for! She rarely sat down. After her husband died, she moved in with her sister and ultimately became her older sister’s caretaker. This continued until she was in her late 80’s and her sister was in her early 90’s.

After she, herself, turned 90 she began to need  help for herself. She moved away from her home and friends and moved in with my sister-in-law who lives in another state. This took some adjustment (for both of them), of course. I think it is always a bit difficult to take two people who are used to running their homes in a certain way and ask them to change how they do things.  I recall my sister-in-law’s frustration when Mom would become upset she was using paper plates for a quick lunch. After all, she had lived through the Great Depression…paper plates were a waste of money.

As my mother-in-law has become more frail, she would tell us she was simply waiting for the grim reaper to come and take her. She became too tired to even read. Her hearing has failed and conversation was difficult, especially with multiple people in a room talking. We have talked about what she wants to happen when she dies. This was really important for all of us. We hoped that when her time came, she would simply die peacefully at home. But, unfortunately she had a mild stroke, fell and had to be hospitalized. She developed pneumonia, and although she survived all of that, she could no longer be cared for at home.

Within a week, she had left her home, spent hours in an emergency room, a few days in a hospital and then changed rooms three times in the nursing home before she was finally settled. There were days she didn’t know who we were or where she was.

The other day I brought her chicken soup and matzo balls. (Yes we have that whole Jewish/Italian thing in our family). When she was awake, her mind was clear. Maybe that is the hardest part. She knows what is happening. She knows where she is. She really wants to go home…not just back to my sister-in-law’s, but to her final home.  She is more than ready to go. She doesn’t like being helpless and just waiting for her life to end. I could see the sadness in her eyes. We held hands, watched some football and a cooking show together for a short while and I promised her jelly donuts the next time I come to see her. She smiled and told me I could go home as she was ready to go to sleep for the night. I know she wants to sleep forever. As humans, when we get to this point in life, we have to wait and wait. We don’t make our pets do this. We help them leave this world peacefully and with dignity.

Death is a hard topic to discuss. There is so much we don’t understand. But talking helps us prepare. What are your thoughts?

photo by LZ Creations

I can’t believe I am saying this. But, it is almost time for the kids to go back to school. While I don’t want to shorten anyone’s summer vacation, there are a few things that are important to consider in order to make the transition back to school a bit easier.

1. Most kids have been staying up a lot later in the summer than they do during the school year. Start moving bedtimes back in ½ hour increments at least one week before school starts.
2. Since kids probably have also been sleeping later in the morning, start waking them up earlier as well.
3. Do a quick review of some reading and math from the previous school year.
4. Think Safety! Parenting expert Shannon Eis points out that many kids don’t know their street address or phone number. Be sure to review these with younger children.
5. If your child will be starting a new school, find out if you and your child can take a tour before classes begin.
6. If you have your list of needed school supplies, start shopping now. Many kids find picking out their new pencils, crayons and backpacks to be a lot of fun and something that gets them excited about going back to school.
7. Try to get back on a regular mealtime schedule. And make sure your kids are eating breakfast.
8. Talk with your children about after school schedules. Depending on the number of children you have, let them pick one or two after school activities. Keep in mind that kids who eat dinner with their family on a regular basis have a significantly lower rate of alcohol and drug abuse.
9. Make sure after school care and babysitters are secured.
10. And finally…if you believe your child was previously having school difficulties, either academic or behavioral, and nothing really was done to resolve the issues, consider going to school within the first week to try to get the ball rolling. Find out what services your school offers.  If not already in place, ask about a psychological evaluation, a 504 plan or an individual educational plan (IEP) if your child has been diagnosed with a condition such as ADHD or has other special needs that can affect his/her learning. School psychologists are overwhelmed with the numbers of children they have to evaluate. So, get started early to help make sure your child gets the appropriate support services.

photo by Lovebird Lady via Flickr

A major theme of the movie is related to the incredible stress and development of self destructive behaviors that are often found in the pursuit of perfectionism. In the film, Nina is dominated by her mother who seems to convey the message that Nina will only be safe if she remains close to her Mom. The outside world is dangerous. In her attempt to achieve perfection, Nina cuts and starves herself, purges when she does eat and becomes confused as to what is real and what is not.

 Her character is fictitious. But, the life she portrays illustrates many of the characteristics we see in a very serious mental illness called Borderline Personality Disorder (BPD). Individuals with BPD often become involved in intense and unstable relationships. These individuals tend to see everything in black or white, swinging rapidly between love and hate, feeling that something is all good or all bad. They often feel extremely empty inside and search frantically for ways to fill themselves and avoid feelings of abandonment. As a result, they frequently abuse drugs and /or alcohol and have a very high incidence of eating disorders. Most individuals diagnosed with BPD have learned that the world is unsafe. Yet they were not taught the skills on how to navigate through life.The very conflicted relationship seen between Nina and her mother in Black Swan is fairly typical of individuals who suffer from BPD. Individuals with BPD also tend to have a rather unstable self image. They frequently feel victimized and have difficulty taking responsibility for their behaviors. Other symptoms of BPD include:

·         Feelings of emptiness and boredom

·         Frequent displays of inappropriate anger

·         Impulsiveness with money, substance abuse, sexual relationships

·        Intolerance of being alone

·        Very high risk of suicide attempts and completion as well as other self destructive behaviors. 

  Treatment of BPD can be lengthy and quite difficult. However, a specific therapy called Dialectical Behavioral Therapy (DBT) developed by psychologist, Dr. Marsha Linehan, has proven to be highly successful in decreasing many of the self destructive behaviors. DBT utilizes numerous techniques to help individuals find a new way of dealing with very strong emotions, including cognitive therapy, mindfulness and relaxation techniques. Patients learn that although they may still have suicidal or other self-destructive thoughts, they do not have to act on them. They learn to employ other techniques to ride out the “storm” so to speak. Group treatment is often an extremely important part of DBT. Medications can help individuals cope with their feelings of depression and anxiety. But the major focus must be on changing the way the individual perceives and responds to events.

 It is this same Dr. Linehan, who very courageously this past week, told her own story to the New York Times about her struggles with severe mental illness. Her honest discussion of her lengthy hospitalizations and suicidal thoughts and attempts, gives hope to so many that mental illness does not have to keep one from living a good life.

photo  by Heiaken via Flickr

Maria and Arnold

Typically, divorce is a very contentious process, especially when there are children involved. If the couple can’t get along and solve problems during the marriage, it’s often even more difficult for them to get along and cooperate during a divorce. This is especially true when the typical divorce involves lawyers and clients fighting for “everything they can get.” In this style of divorce, there are no winners. Parents and children generally end up angry, hurt and emotionally bruised. Research shows that divorce can even affect physical health.

As a psychologist, I have seen the devastation that can occur when divorce becomes a battleground.

Fortunately there is another option: collaborative divorce, which is designed to help families divorce with a sense of dignity. Attorneys who do collaborative divorce are trained to focus on the overall well-being of the entire family.

The process uses a series of informal conferences attended by the attorneys, clients, a mental health professional (such as a psychologist), and a financial expert, when needed. An agenda is set prior to each meeting to limit the prospect of a “surprise” being raised. Clients work closely with their attorneys before the meetings so that they are familiar with the issues to be discussed and have an understanding of the law. All parties are able to review pertinent documentation prior to meetings and all negotiations are conducted openly with client participation.

The collaborative approach creates an atmosphere of open communication and cooperation that helps the couple in shaping a divorce agreement that fits the needs of their family. A psychologist or other mental health professional, a crucial part of the team, provides information on child development and family issues so that the parents can make good choices for and about their children. The team remains focused on a “win-win” solution.

Not all couples can use this process. In situations where there is abuse or domestic violence the couple may not be able to work together. However, for couples who truly love their children and can agree that they want to shape a plan that keeps the best interests of their kids at heart, I suggest that collaboration is the way to go.

Photo by DrJohnBullas (via flickr)