Archive for the 'mental health' Category

One Ounce That Does a Lot

The thyroid gland is about two inches long and about one inch wide. It sits at the base of the neck, straddling the windpipe. It weighs about an ounce. When your healthcare provider encircles your neck with her hands and asks you to swallow, she is checking the size of your thyroid.

The thyroid’s main job is to control metabolism by secreting hormones.  If you, an adult, have too much thyroid hormone (hyperthyroidism) you will lose weight. If you have too little (hypothyroidism), you will gain weight. But that’s not all. Thyroid hormones have a strong influence on the nervous system, which influences everything. In turn, a change in the nervous system affects the thyroid.  Together, the thyroid and the pituitary in your brain function like the heating/cooling system in your home. For example, if the temperature in your home falls below a preset minimum on your thermostat, the furnace will start and send heat around your house until the preset temperature is reached. Then, once again responding to the temperature on the thermostat, the furnace will stop sending heat. What does all this mean for the way you feel and behave?

If your thyroid gland isn’t functioning properly it will not respond to the pituitary. The level of thyroid hormone in your blood stream will remain the same or drop further.  You may feel tired or not mentally sharp. If this persists, you may feel depressed or moody. You may have difficulty sleeping, in spite of feeling tired and sleepy. Physically, you may begin gaining weight, no matter how little you eat or how much you exercise. Meanwhile, your pituitary is frantically sending out thyroid stimulating hormone (TSH).  If this goes on long enough – the pituitary in overdrive – it may result in enlargement of the pituitary. But most people never reach this stage.  They generally feel sick enough to consult a healthcare provider.

On the other hand, if your thyroid keeps sending out thyroid hormone no matter how little TSH there is in your blood, your symptoms will be different. Emotionally you may feel anxious for no reason or more anxious for the reasons you do have. There’s some evidence that prolonged stress increases your risk for hyperthyroidism. You may be irritable or have difficulty concentrating. You may have difficulty sleeping, just as with low thyroid.  Physically you will begin to lose weight, no matter how many carbs you pile on. You might notice your heart racing, often greater than 100 beats per minute. Your hands may tremble. Eventually your thyroid will enlarge and you will feel or see the enlargement at the base of your neck. But, once again, most people have consulted a healthcare provider before this occurs.

Bottom line? That little gland in your neck is powerful. It can cause both physical and emotional/mental symptoms. The mind and the body are connected. They are both part of us. It may be only one that is causing your symptoms. But always suspect both, not just one, when you aren’t feeling well.


Depression and the Holidays

A great deal has been written about the topic of depression during the holiday season. I’m not going to rehash that. Today’s blog is more of a personal reflection on my professional experiences with depression among the elderly and individuals needing long-term care.

In one of my positions as a psychologist, I “covered” skilled nursing facilities. That’s the newer term for nursing homes. Today’s skilled nursing facility (SNF) is unlike the nursing home or old people’s home of the past. A SNF has both “patients” in the traditional sense, that is, individuals who are recovering from a medical or surgical illness, and non-patients. The non-patients are long-term residents or clients: the younger physically disabled, the frail elderly, and the mentally disabled. Each SNF is somewhat like a small town without children. There are town officials (registered and licensed practical nurses), town employees (certified nursing assistants, dietary workers, physical, occupational and speech therapists), citizens in no official capacity (clients or patients), county or state officials (owners, physicians), and visiting dignitaries (medical and psychological specialty consultants). What makes the SNF unlike a real small town, however, is that only the citizens actually live in the town. Everyone else is an out-of-towner with lives separate from the townies.

Now for the holidays. The holidays are everywhere: TV, SNF décor, the conversations of the out-of-towners. There are more visiting dignitaries, the ones who come once a year and sing or dance or give out small gender neutral and politically correct gifts. All, absolutely all, of the dignitaries mean well. They want to bring cheer and happiness to the townies. But they, too, go home.

The townies? Well, they are left with their memories and thoughts. Remember that year that Santa left his footprints in the ashes? Oh. No one but me is left to remember. Remember sliding down that big hill behind the school? I remember the feeling. But my body can no longer feel the experience or any, for that matter. Remember – no, I’d rather not. My mom drank and my dad scowled. Remember. No, I can no longer remember. What are the holidays? Where is everyone?

Some townies get out of town to family from out of town. They bring back peace and, best of all, they bring back hope.

Hope – one of the criteria for happiness and a stalwart defense against depression.

So, my blog readers, I wish you hope in this crazy world. Please spare a thought in your busy days for those who have little or none of it.

Your Brain And You

Brain injury. What does that call to mind? A devastating injury that leaves you paralyzed and speechless? How about blindness or a loss of the sense of smell? How about loss of the ability to recognize your loved ones or the inability to remember what happened an hour ago?


How about all of the above or none of the above?


That’s what a brain injury is – all, some, or none of the above. And, with between 10 and 20% of the approximately 1.8 million men and women serving in Iraq and Afghanistan sustaining brain injuries, that means between 180,000 and 360,000 young people may return to this country with injuries severe enough to prevent them from supporting themselves or, possibly, even caring for their basic needs.


To the above numbers you can add the civilians who sustain brain injuries as the result of accidents, sports, neurological disease, birth trauma or prematurity. Some of these individuals will need assistance – from family, from healthcare and from government. And they will need this assistance for years to come.


Brain injury can run the gamut from mild concussions that have only transitory effects (unless too many are sustained) to penetrating wounds that result in the actual result of brain tissue. Since the brain controls all physical and mental functions, it’s evident that
brain “injury” can have a variable presentation – the all or none above. Furthermore, the location of the injury is just as significant as the extent of the injury.


Brain injury, whether traumatic or disease related, is a growing problem. The military is aware of it LINK. Now the general public –  parents, coaches, adult children of elderly parents and schools – have to become aware of it.


Even if you are not your brain, your brain is your link to the world. Protect it.


March is National Brain Injury Awareness Month.


For more information on brain injury click:


National Institute of Neurological Disorders and Stroke

Brain Injury Association of America 

Thoughts On Business, The Economy And A Silver Lining

When most articles and items in the news seem designed to add to the individual’s and the nation’s stress, there it was, in print and on the Web, the silver lining. Well, OK, maybe the lining is a little tarnished. But, nevertheless, there is was: an acknowledgement that sometimes good can come from a truly bad situation.


The bad is obviously the recession (even the experts can’t decide either how deep it will go or how long it will last) Link


The silver lining (tarnished) is, well, the recession.


I’ve blogged a lot about stress (just put stress into the search box on the lower right side of this blog). Stress really is a subtle killer. One of the major contributors to America’s stress overload has been our focus on work and consumption. The Jones’ have a 54 inch TV in the living room! Well, the Smiths’ new “must have” (how I loathe that cliché!) is a bigger TV in the living room AND one in the bedroom. Just work extra hours! Who needs sleep? Why waste time on the kids or community or friends or exercise? De-stress with a beverage or comfort food or a smoke or a pill. But keep on working those extra hours for that bigger TV (or bigger house or second SUV or designer watch).


Did anyone ever stop to think just how nuts this is? Working extra hours to have something you don’t have the time to enjoy. When are you going to enjoy it? One week out of the year as you alternate between your cell phone and laptop and run from one “must see” tourist site to another?


Well, the recession may be a cure for all that.


It’s called furloughs or enforced fewer hours. Along with the reduction in pay comes more time for leisure (family, friends, community – remember?).


“Now she’s nuts,” you’re thinking. Along with a reduction in pay comes more stress – the mortgage, healthcare, oh, and food. Like one woman mentioned in the Times article, you might have to give up your only luxury – smoking!


I did say the silver lining was a bit tarnished. There would certainly be belt tightening. But as long as the reduced hours don’t eliminate benefits, the belt tightening may reduce stress.


  • Exercise: It costs nothing (well, maybe new sneakers) to walk or take up running. Now you have the time. Walk instead of ride.
  • Belt tightening: Use the library instead of buying books or DVDs.
  • Community: Matter of fact, volunteer at your library! Or the hospital or animal shelter.
  • Friends: Take that friend walking and talk about sports or fashion or celebrities or technology instead of going to a sporting event or shopping or a show or just e-mailing.
  • Family: Remember board games and cards? Does your child’s teacher know who you are? Another place to volunteer!


Well, you understand. I’m neither naive nor independently wealthy. I know how much things cost today and that a reduction in income REALLY hurts. But if the basics are covered, look at the new found time as a gift. Who knows? It may extend your life.

National Eating Disorders Awareness Week

According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM), “The Eating Disorders are characterized by severe disturbances in eating behavior.” DSM goes on to say that obesity is included as a general medical condition in the International Classification of Deceases (IC), but it has not been included in DSM because “… it has not been established that it is consistently associated with a psychological or behavioral syndrome.” If such factors are important in the etiology of a “particular” case of obesity, it should be noted as “Psychological Factors Affecting Medical Condition.”


I’m left wondering what this means. What condition or conditions are they talking about? The DSM is used for psychological diagnosis (and, of course, for insurance reimbursement). So, does an obese person have to have a major mental disorder in order to have the obesity treated OR does the mental health practitioner have to diagnose a medical condition in order to begin a behavioral weight control program?


The above musing aside, Eating Disorders are real AND potentially life threatening. Eating disorders do not (at least yet) include disorders of over-eating with persistent weight gain. Eating disorders include:

  • Anorexia nervosa – a refusal to maintain a minimally normal body weight.
  • Bulimia nervosa – repeated episodes of binge eating followed by inappropriate compensatory behaviors (vomiting, purging, excessive exercise, fasting, misuse of medications).


Bulimia is more common than anorexia and, unlike individuals with anorexia, individuals with bulimia are often of normal weight. Both anorexia and bulimia are most prevalent in developed countries. Both disorders are more prevalent among girls/women than among boys/men. However, boys and men do develop both disorders. These are not just “women’s diseases.”


There is no one “cause” of eating disorders. There are multiple causes and one may weight more heavily than another in an individual case. The causes can be grouped into four loose categories:

  • Psychological factors
  • Interpersonal factors
  • Social factors
  • Familial factors

National Eating Disorders Association


Treatment for eating disorders involves psychological counseling and attention to medical and nutritional needs. It is crucial that treatment be coordinated with a team approach. Eating disorders affect not only weight. They affect the whole body, including the kidneys, heart, GI tract and teeth. Untreated eating disorders can have long term effects and are potentially fatal.


February 22 – 28 is National Eating Disorders Awareness week.


Or more information on eating disorders access:


Recession, Anxiety and Depression

It would be easy to find fault and a bit of glee when we hear of wealthy people suffering psychological distress as a result of loss of money and status. But the wealthy and formerly wealthy are no more protected from mental disorders than those who are less financially fortunate. Perhaps the distress is even worse if the fall follows years of working towards the top. It certainly makes sense if the climb started from a very low position. It may also be worse in those with a strong sense of social responsibility.


An article in Saturday’s New York Times started this rumination. The article can also be accessed online at LINK.


The article highlights a private psychiatric facility in New York. The facility is accustomed to high profile and wealthy clients. But there is mention that the symptoms of “recession psychosis” (an unofficial diagnosis not listed in the Diagnostic and Statistical Manual of Mental Disorders) can also be found among those not in the upper layers of society. The symptoms include severe anxiety and suicidal tendencies set off by the economy. In addition, there is often paranoia related to global or local news. This sometimes translates into a survival mentality, such as not eating in order to have enough money to buy food or buying guns in order to feel safe. Individuals who are still employed may have periods of manic behavior as they strive harder and harder to prove themselves worthy of keeping their jobs. Alcohol and drug abuse become more common as individuals try to either calm themselves or to increase their energy so they can work non-stop.


There is no easy cure for this “psychosis.” Of course, curing the economy is necessary. But since predictions for that occurrence are conservatively one or two years, people who find themselves unable to cope with their anxiety and depression need to have help now. Anxiety and depression are more easily handled, with psychotherapy and medication, before they become severe enough to make a hospital admission necessary.


Now is not the time to cut back on health benefits. Now is not the time to cut back on stress reducing tactics such as exercise or meditation.


Now is the time to gather support from family and friends and to remain connected to community.


And remember – seek help if you need it.

The Most Depressing Day of the Year

The third Monday in January has come and gone. According to a British psychologist, Cliff Arnall, that day is the most depressing day of the year. Dr. Arnall’s basis for this is a formula he developed that takes into account the weather, holiday debt, resolutions that have failed and a work-to-be-done/motivation-to-do-it ratio. His formula doesn’t even take into account current events (economy, war, healthcare).


Aren’t you glad it’s over and what a depressing thing to look forward to! Talk about a self-fulfilling prophecy.


So, what are you going to do about it? Another Briton, Sophie Howarth, has an idea. Get together with like-minded people and celebrate what is good in your life (yes there is!!). Take time (a very little time) to moan and groan then move on. Learn about ethical living, meaningful relationships and enjoyment.


Think about the good things every day. No good things? Oh, come on! Winter is 1/3 over. The price of gasoline has gone down. We’re beginning to disengage from one war. My amaryllis is blooming. I still have Internet.


So – take heart and think positively. Depression is self-reinforcing, but so is optimism. 

Mary Lou Bernardo, PhD, MSN


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